150 multiple sclerosis

Question 1

A nurse is caring for a client with multiple sclerosis. Which mobility-related assessment finding is most expected in this client?
A. Continuous muscle rigidity
B. Intention tremors
C. Flaccid paralysis
D. Hyperactive reflexes with sustained clonus

Answer 1

B

Question 2

Which statement best describes the pathophysiology of multiple sclerosis?
A. MS causes degeneration of acetylcholine receptors at the neuromuscular junction.
B. MS leads to inflammation and demyelination of nerve fibers in the central nervous system.
C. MS is characterized by overstimulation of dopamine-producing neurons.
D. MS results from decreased blood flow to motor neurons in the spinal cord.

Answer 2

B

Question 3

Which factors may contribute to the etiology of multiple sclerosis?
Select all that apply:
A. Genetic predisposition
B. Prior viral infection
C. Deficiency of dopamine
D. Environmental exposures (e.g., low vitamin D)
E. Trauma to the spinal cord

Answer 3

A
B
D

Question 4

Which of the following are recognized risk factors for developing MS?
Select all that apply:
A. Female gender
B. Age 20 to 40 years
C. Smoking
D. High vitamin D levels
E. Family history of MS

Answer 4

A
B
C
E

Question 5

A client with MS presents with new symptoms. Which finding should the nurse report to the provider as a possible relapse?
A. Chronic fatigue that improves with rest
B. Improved coordination
C. New onset of blurred vision and muscle weakness
D. Stable mobility with occasional stiffness

Answer 5

C

Question 6

Which diagnostic tools and treatments are commonly used for managing MS?
Select all that apply:
A. MRI of the brain and spinal cord
B. Lumbar puncture for CSF analysis
C. Dopaminergic medications (e.g., levodopa)
D. Corticosteroid therapy during exacerbations
E. Disease-modifying therapies (e.g., interferon beta)

Answer 6

A
B
D
E

Question 7

Which nursing intervention is most appropriate when caring for an older adult with advanced MS?
A. Encourage daily high-impact exercise
B. Promote frequent bladder training and schedule toileting
C. Avoid use of assistive devices to foster independence
D. Restrict fluid intake to reduce bladder spasms

Answer 7

B

Question 8

A nurse is caring for an African American client newly diagnosed with MS. Which culturally competent interventions should the nurse implement?
Select all that apply:
A. Provide educational materials tailored to the client’s health literacy level
B. Assume the client will want to include family in all care decisions
C. Explore the client’s health beliefs and treatment preferences
D. Assess for any cultural stigmas associated with chronic illness
E. Use only standard Western medical terms when educating the client

Answer 8

A
C
D

Question 9

A nurse is planning care for a client with relapsing-remitting multiple sclerosis who is experiencing difficulty with gait and coordination. Which intervention should the nurse prioritize to promote mobility and prevent injury?

A. Encourage frequent bedrest during the day to reduce fatigue
B. Schedule physical therapy sessions during periods of exacerbation
C. Implement a walker with wheels and provide gait training
D. Apply heat packs to lower extremities to reduce spasticity

Answer 9

C

Question 10

Which mechanism best explains the neurological deficits seen in multiple sclerosis?

A. Axonal regeneration failure due to persistent dopamine imbalance
B. Immune-mediated destruction of peripheral myelin sheaths
C. Autoimmune attack on oligodendrocytes causing demyelination in the CNS
D. Decreased acetylcholine levels impairing neuromuscular transmission

Answer 10

C

Question 11

Which factors are believed to interact in the complex etiology of MS?
Select all that apply:

A. Altered gut microbiota and immune response
B. Genetic variants on the HLA-DRB1 gene
C. Long-term exposure to cold climates
D. Previous Epstein-Barr virus infection
E. High-saturated-fat diets during adolescence

Answer 11

A
B
D

Question 12

A nurse is educating a group of college students on MS prevention strategies. Which statement should the nurse include?

A. “You should increase your vitamin D intake, especially if you have darker skin or live in northern latitudes.”
B. “Wearing protective gear during sports can prevent MS.”
C. “Vaccination against viral infections will eliminate your risk.”
D. “Avoiding caffeine and alcohol are proven methods to reduce risk.”

Answer 12

A

Question 13

A nurse is assessing a client with suspected MS. Which of the following findings support the diagnosis?
Select all that apply:

A. Diplopia that worsens with fatigue
B. Hyperreflexia with positive Babinski sign
C. Asymmetric lower limb flaccidity
D. Numbness and tingling in one limb that resolves spontaneously
E. Rapid onset of generalized weakness and respiratory paralysis

Answer 13

A
B
D

Question 14

A client newly diagnosed with MS asks, “Why do I need an MRI if I already had a spinal tap?” What’s the best nursing response?

A. “The MRI can help confirm MS by showing changes in brain structure due to aging.”
B. “MRI helps monitor your liver function while you’re on medication.”
C. “The MRI identifies lesions in the brain and spinal cord that support the diagnosis.”
D. “Spinal taps are rarely accurate, so MRIs are preferred to make a diagnosis.”

Answer 14

C

Question 15

The nurse is caring for both a 28-year-old with early MS and a 70-year-old with advanced MS. Which nursing considerations should be applied to differentiate their care?
Select all that apply:

A. Address employment concerns and fertility planning in the younger adult
B. Emphasize fall prevention and home safety in the older adult
C. Avoid cognitive assessments in younger adults unless they report memory issues
D. Screen older adults more frequently for depression and isolation
E. Plan long-term care options for both clients regardless of age

Answer 15

A
B
D
E

Question 16

Which parts of the body does multiple sclerosis affect? (Select all)

A. Nerve endings
B. Brain
C. Spinal cord
D. Joints
E. Optic nerve

Answer 16

B
C
E

Question 17

Your pt was admitted with a new symptom, you treat them, the symptom goes away and they return to baseline. Which stage of MS can the nurse identify her pt is in?

A. Primary-progressive
B. Progressive-relapsing
C. Relapsing-remitting
D. Secondary-progressive

Answer 17

C

Question 18

Your pt was admitted with a new symptom, but complains of continuously worsening symptoms and hasn’t been able to get back to his baseline. Which stage of MS is this pt in?

A. Primary-progressive
B. Progressive-relapsing
C. Relapsing-remitting
D. Secondary-progressive

Answer 18

A

Question 19

Your pt has a hx of untreated relapsing-remitting MS, and is in therapy for dysphagia diagnosed 2 months ago, he has not improved since starting therapy.
-Which stage of MS might your pt be in?

A. Primary-progressive
B. Progressive-relapsing
C. Relapsing-remitting
D. Secondary-progressive

Answer 19

D

Question 20

A frequent flier comes to the ED, complaining of acute bowel incontinence. You notice in his chart that he has MS and in the past 3 visits, he also complained of acute BI.
-Which stage can you presume the pt is in?

A. Primary-progressive
B. Progressive-relapsing
C. Relapsing-remitting
D. Secondary-progressive

Answer 20

B

Question 21

Your monitoring your pt who has MS, who was admitted with a new symptom lasting 63 hours at shift change.
-What manifestation of MS is this?

A. Paroxysmal attacks
B. Relapse
C. Exacerbation
D. Pseudoexacerbation

Answer 21

C

Question 22

The nurse at shift change notifies you, pt 18’s acute symptom lasted 20 hours.
-What manifestation of MS is this?

A. Paroxysmal attacks
B. Relapse
C. Exacerbation
D. Pseudoexacerbation

Answer 22

A

Question 23

What can cause a relapse in MS? (select all)

A. Elevated WBC’s
B. Fever
C. Hyperglycemia
D. Hot weather
E. Mushrooms

Answer 23

A
B
D

Question 24

Your pt with MS tells you his symptoms get temporarily aggiated 4x a week, but he hasnt been able to identify a trigger.
What manifestation of MS is this?

A. Paroxysmal attacks
B. Relapse
C. Exacerbation
D. Pseudoexacerbation

Answer 24

D

Question 25

What lab do you need to monitor if a pt is taking a muscle relaxer? A. eGFR B. LFT's C. pTT D. Calcitonin

Answer 25

B

Question 26

Which Interferon medication does the nurse need baseline LFT's and to educate the pt on routinely monitoring his LFT level? A. Betaseron B. Plegridy C. Extavia D. Rebif

Answer 26

D

Question 27

Which non-interferon med should pt not take with: -HX of stroke, MI, and angina in the last 6 months A. Glatiramer B. Fingolimod C. Mitoxantrone D. Ocrelizumab

Answer 27

B

Question 28

Which non-interferon med requires the nurse to: Get an EKG before 1st dose, monitor 6 hours after 1st dose w/ HR, BP, repeat EKG A. Glatiramer B. Fingolimod C. Mitoxantrone D. Ocrelizumab

Answer 28

B

Question 29

What non-interferon causes: -Blue-green urine for 24hrs after -Cannot be used in pts with heart problems/liver disease? A. Glatiramer B. Fingolimod C. Mitoxantrone D. Ocrelizumab

Answer 29

C

Question 30

Which non-interferon does the nurse need to monitor the pt for 1hr after infusion for s/s of infusion reaction? A. Ocrelizumab B. Natalizumab C. Ofatumumab D. Teriflunomide

Answer 30

A

Question 31

Which med should the pt with the HBV infection not be prescribed? A. Ocrelizumab B. Natalizumab C. Ofatumumab D. Teriflunomide

Answer 31

C

Question 32

How long does the pt need to be free of symptoms to be in remission? A. 15 days B. 30 days C. 45 days D. 60 days

Answer 32

B

Question 33

What medication is used to treat an MS exacerbations? A. Baclofen B. Ocrelizumab C. Corticosteroids D. Vit. D

Answer 33

C

Question 34

What does the nurse need to ensure during her assessment with her pt with MS? (select all) A. Swallowing ability B. Checks for erectile dysfunction C. Gait & balance D. Hygiene E. Affect F. Speech

Answer 34

C D E F

Question 35

What 2 things cross the blood brain barrier and cause demyelination of the myelin sheath? A. Leukocytes B. Blastocytes C. Lymphocytes D. Macrophages

Answer 35

C D

Question 36

When oligodendrocytes repair the damaged myelin sheath, what happen to the pt? A. Flare up B. New symptom C. Remission D. Trigger

Answer 36

C

Question 37

Identify some primary symptoms that results from demyelination (select all) A. Balance disturbances B. Incontinence C. UTI's D. Depression E. Muscle atrophy F. Spasticity

Answer 37

A B D F

Question 38

Identify secondary symptoms resulting from prolonged primary symptoms (select all) A. Memory dysfunction B. Osteoporosis C. Bone fractures D. Partner strain E. Aspiration pneumonia F. Pressure injuries

Answer 38

B C E F

Question 39

Identify tertiary symptoms: (Select all) A. Hopelessness B. Muscle atrophy C. Social isolation D. License revoked E. Back & hip pain

Answer 39

A C D

Question 40

What type of response would infection and fevers elicit? A. Paroxysmal attacks B. Relapse C. Exacerbation D. Pseudoexacerbation

Answer 40

D