4 - 2 Multiple Sclerosis

Question 1

11. If patient reports bowel incontinence:
    A. Ignore due to embarrassment
    B. Bowel regimen: scheduled toileting, fiber, hydration
    C. Severe fluid restriction
    D. Encourage skipping meals

Answer 1

Neurogenic bowel responds to predictable routines.

Question 2

12. Prioritizing care during fatigue:
    A. Schedule ADLs during times of highest energy
    B. Do everything late at night
    C. Force activities during fatigue spikes
    D. Avoid planning

Answer 2

Maximize independence by timing tasks with best function.

Question 3

13. Diplopia worsening with fatigue:
    A. ~No interventions~
    B. Teach rest periods, alternate eye patching
    C. Increase bright-light exposure
    D. Ignore until next visit

Answer 3

Fatigue worsens vision → energy management important.

Question 4

14. For spastic bladder (urgency):
    A. Caffeine encouraged
    B. Limit bladder irritants; timed voiding
    C. Indefinite catheterization only
    D. Water restriction entirely

Answer 4

Irritant reduction improves continence (caffeine, carbonation).

Question 5

15. Teaching about exercise:
    A. High-impact only
    B. Low-impact strengthening + balance training; avoid overheating
    C. Avoid exercise completely
    D. Exercise only in hot environments

Answer 5

Moderate, cooled exercise improves mobility without exacerbating symptoms.

Question 6

16. Role of physical therapy:
    A. Worsens spasticity
    B. Maintain mobility, prevent deconditioning and contractures
    C. Used only in advanced stages
    D. Not needed with meds

Answer 6

PT improves muscle control, gait, function.

Question 7

17. Cognitive impairment support:
    A. No strategies available
    B. Use memory aids, structured routines, minimize distractions
    C. Encourage multitasking
    D. Discourage social contact

Answer 7

Compensation strategies support cognitive function.

Question 8

18. Sexual dysfunction care:
    A. Ignore topic
    B. Educate on positioning, timing, open partner communication, lubrication PRN
    C. Avoid intimacy permanently
    D. Pain meds only

Answer 8

Holistic care includes sexual wellness + comfort planning.

Question 9

19. Priority in infection risk:
    A. Avoid vaccinations
    B. Teach early infection recognition, hand hygiene, safe catheter care
    C. Allow UTIs to resolve on their own
    D. High-dose antibiotics routinely

Answer 9

Neurogenic bladder + immunosuppressants increase infection risk.

Question 10

20. What prevents pressure injuries in patients with immobility?
    A. Extended bedrest
    B. Frequent repositioning, pressure relief devices
    C. Avoid hygiene care
    D. No skin assessments needed

Answer 10

Skin integrity must be proactively protected.

Question 11

21. If medication causes worsening mood or suicidal thoughts:
    A. Ignore it
    B. Immediate mental health referral, evaluate med regimen
    C. Encourage stopping all communication
    D. Sedate patient

Answer 11

Psychosocial safety requires active monitoring.

Question 12

22. How does OT help?
    A. Provide only splints
    B. Assist with energy-conserving techniques, adaptive equipment for ADLs
    C. Avoid education
    D. No role in MS

Answer 12

OT focuses on function and independence.

Question 13

23. What should the nurse encourage during MS support group use?
    A. Avoid discussing reality
    B. Shared coping strategies, reduced isolation
    C. Competition between patients
    D. Avoid attendance

Answer 13

Peer support improves coping + mental health alignment.

Question 14

24. Key safety teaching for impaired sensation in feet:
    A. Walk barefoot
    B. Daily foot inspection; protective footwear
    C. Only cotton socks at night
    D. Ignore numbness

Answer 14

Prevent injuries from unnoticed trauma or burns.

Question 15

25. Priority education for vision loss episodes:
    A. Continue driving long distances
    B. Avoid dangerous activities during episodes and seek medical care
    C. No medical evaluation needed
    D. Wear sunglasses indoors always

Answer 15

Visual changes impair safety and require provider notification.

Question 16

1. A patient reports blurred vision and pain with eye movement. Most likely MS symptom:
   A. Optic neuritis
   B. Cataracts
   C. Diabetic retinopathy
   D. Glaucoma

Answer 16

Optic neuritis from optic nerve demyelination → visual loss, pain with movement.

Question 17

2. Lhermitte’s sign indicates:
   A. Cervical spinal cord demyelination causing electric shock sensation with neck flexion
   B. Peripheral nerve compression only
   C. Hip fracture
   D. Migraine aura

Answer 17

Dorsal column involvement → shock-like pain on neck flexion.

Question 18

3. Which symptom strongly suggests cerebellar involvement in MS?
   A. Rigid posture only
   B. Ataxia, intention tremor, dysarthria
   C. Severe abdominal pain
   D. Photophobia alone

Answer 18

Cerebellar lesions → unsteady gait, tremors, scanning speech.

Question 19

4. Which bladder pattern is typical?
   A. Normal storage and emptying
   B. Urgency + frequency + incontinence with retention risk
   C. Complete renal shutdown
   D. Polyuria only

Answer 19

CNS control loss → neurogenic bladder dysfunction.

Question 20

5. MS sensory change:
   A. No sensory symptoms
   B. Numbness, tingling, burning pain in limbs
   C. Complete anesthesia always
   D. Only facial numbness

Answer 20

Sensory paresthesias are common early MS symptoms.

Question 21

6. Gait abnormalities in MS often result from:
   A. Flat arches only
   B. Spasticity, weakness, proprioception loss
   C. Bone spurs in knees
   D. Pure emotional withdrawal

Answer 21

Mobility decline results from multiple CNS deficits.

Question 22

7. A patient drops objects and has hand clumsiness. Cause:
   A. Shoulder instability
   B. Motor + sensory pathway demyelination
   C. ACL tear
   D. Carpal tunnel syndrome only

Answer 22

UMN + proprioceptive issues impair fine motor control.

Question 23

8. What is a hallmark of relapsing-remitting MS?
   A. Constant progression without recovery
   B. Episodes of neurologic deficits followed by partial recovery
   C. Only one relapse ever
   D. Immediate full remission permanently

Answer 23

RRMS: relapses with incomplete/complete remissions.

Question 24

9. Diagnosis of MS is supported by:
   A. Joint X-ray erosion
   B. MRI showing dissemination in space and time
   C. Bone scan only
   D. Liver ultrasound

Answer 24

MRI shows multiple lesions separated anatomic/time-wise.

Question 25

10. CSF result supporting MS: A. Neutrophil dominance B. Oligoclonal IgG bands C. Very low protein only D. Positive rheumatoid factor

Answer 25

Intrathecal IgG production implies CNS immune activation.

Question 26

11. Early sign: A. Severe bone pain B. Vision changes, numbness, fatigue C. Renal failure D. Joint deformity

Answer 26

Fatigue + sensory + visual symptoms appear early.

Question 27

12. Uhtoff’s phenomenon: A. Improvement with heat B. Worsening neurologic symptoms with heat exposure C. Cold intolerance only D. Hypertension only

Answer 27

Heat worsens demyelinated conduction.

Question 28

13. Babinski reflex in MS: A. Normal plantar flexion B. Upgoing toe suggests UMN lesion C. Absent only in infants D. Downgoing always

Answer 28

UMN signs → positive Babinski.

Question 29

14. Which finding differentiates MS from fibromyalgia? A. Fatigue B. Normal reflexes C. Objective neurologic deficits (e.g., weakness, Babinski) D. Headache

Answer 29

MS has objective motor + sensory deficits.

Question 30

15. Diplopia is caused by: A. Cataract only B. Ocular nerve pathway demyelination causing misalignment C. Too much blinking D. Retinal detachment only

Answer 30

Extraocular muscle control relies on CNS pathways.

Question 31

16. Positive Romberg test suggests: A. Only PNS issue B. Proprioception deficit from spinal cord lesions C. Stroke only D. Normal balance

Answer 31

Dorsal column damage causes ataxia with eyes closed.

Question 32

17. Symptom that often worsens as day progresses: A. Reflexes B. Fatigue and weakness C. Hair growth D. Blood glucose stability

Answer 32

Conduction fatigability causes late-day worsening.

Question 33

18. Common speech issue: A. Aphonia from vocal cord rupture B. Dysarthria (slow, slurred speech) from cerebellar lesions C. Rapid fluent speech D. No speech effect

Answer 33

Cerebellar lesions → slurred or scanning speech.

Question 34

19. MRI hallmark: A. Lesions only in gray matter B. White matter plaques in periventricular/optic/spinal regions C. Lesions only in PNS D. Tumors only

Answer 34

Periventricular plaques are characteristic.

Question 35

20. Why does temperature regulation worsen? A. MS targets sweat glands B. ANS pathway damage disrupts autonomic control C. Kidney disease only D. Improved conduction with heat

Answer 35

ANS involvement → heat intolerance.

Question 36

21. What indicates disease progression? A. Stable symptoms for years B. Worsening mobility + spasticity despite therapy C. Only better sleep patterns D. Isolated headaches

Answer 36

Progressive disability → decreasing neurologic reserve.

Question 37

22. Varied symptom pattern due to: A. Same lesion site in all patients B. Lesions in different CNS regions → different deficits C. Only peripheral damage D. No differences among patients

Answer 37

Lesion location dictates symptoms.

Question 38

23. Sexual dysfunction cause: A. Emotional overreaction only B. Neurologic pathways for arousal and sensation disrupted C. Kidney failure only D. Solely psychological refusal

Answer 38

CNS lesions affect arousal, sensation, response.

Question 39

24. Diagnostic test to rule out similar disorders like neuropathy: A. EMG/NCS B. Kidney biopsy C. Chest X-ray D. Colonoscopy

Answer 39

Electrodiagnostic testing helps exclude PNS disorders.

Question 40

25. When should emergency care be sought? A. Full remission B. Sudden severe neurologic decline (e.g., inability to walk, acute dysphagia) C. Mild fatigue only D. Numb toe for 5 min

Answer 40

Sudden worsening may require urgent treatment to limit disability.

Question 41

1. First-line treatment for acute MS exacerbation causing significant neurologic decline: A. High-dose corticosteroids (e.g., IV methylprednisolone) B. IV antibiotics C. NSAIDs only D. Daily opioids

Answer 41

Steroids reduce acute CNS inflammation and speed relapse recovery.

Question 42

2. Primary purpose of disease-modifying therapies (DMTs) like interferon-beta: A. Cure MS completely B. Reduce relapse frequency and slow progression C. Treat only spasticity D. Provide immediate pain relief

Answer 42

DMTs alter immune activity → fewer new lesions and slower disability progression.

Question 43

3. Teaching for interferon-beta therapy: A. No side effects expected B. Monitor for flu-like reactions and injection-site issues; report depression C. Permanent cure after one dose D. Skip doses during stress

Answer 43

Side effects include flu-like symptoms; adherence crucial.

Question 44

4. Purpose of glatiramer acetate: A. Treat UTIs only B. Modify immune response → reduce relapses C. Cure blindness D. Reverse all plaques

Answer 44

Helps shift immune response to reduce CNS attack.

Question 45

5. Nursing action before natalizumab (Tysabri): A. No screening needed B. Monitor for PML risk (JC virus testing) and educate on neuro changes to report C. Give with steroids always D. Stop all vaccines forever

Answer 45

Natalizumab can cause progressive multifocal leukoencephalopathy → early detection critical.

Question 46

6. Fingolimod teaching: A. Causes no cardiac effects B. First-dose cardiac monitoring may be needed due to bradycardia risk C. Not a DMT D. Mostly affects kidneys

Answer 46

Early doses may slow heart rate → monitor.

Question 47

7. Baclofen use in MS: A. Increases strength only B. Treats spasticity by reducing muscle tone C. Cures MS D. Causes permanent paralysis

Answer 47

Spasticity relief improves mobility and comfort.

Question 48

8. Medication for neuropathic pain in MS: A. Gabapentin or pregabalin B. Acetaminophen only C. No medication works D. Multivitamins only

Answer 48

Anticonvulsants reduce nerve pain from demyelination.

Question 49

9. Oxybutynin may be used for: A. Constipation B. Overactive bladder symptoms like urgency/frequency C. Improving gait D. Increasing heart rate

Answer 49

Anticholinergics help spastic bladder control.

Question 50

10. Best therapy for severe fatigue: A. High-dose opioids B. Amantadine or modafinil as ordered + nonpharmacologic fatigue management C. Immediate bedrest only D. Caffeine exclusively

Answer 50

Stimulants or antiviral amantadine may help; pacing remains essential.

Question 51

11. Why avoid excessive heat during therapy sessions? A. Heat improves conduction B. Heat worsens symptoms due to conduction block in demyelinated nerves C. It cures MS D. No effect at all

Answer 51

Heat ↑ symptom severity (Uhthoff’s).

Question 52

12. Benefit of plasma exchange (plasmapheresis): A. First-line for mild symptoms B. Used in severe steroid-refractory relapses to remove harmful antibodies C. Permanent cure D. Strengthens myelin

Answer 52

Helps when relapses do not respond to steroids.

Question 53

13. Dalfampridine (Ampyra) purpose: A. Improves walking speed by enhancing conduction in demyelinated nerves B. Controls seizures only C. Treats depression D. Induces sleep

Answer 53

Potassium channel blocker improves signal transmission.

Question 54

14. Why screen before live vaccines when on immunosuppressants? A. To increase side effects B. Immunosuppression increases risk of infection from live vaccines C. To skip all vaccines permanently D. Vaccines worsen spasticity

Answer 54

Safety concern: reduced defense → vaccine-controlled organism could replicate.

Question 55

15. Treatment goal of MS care overall: A. Total cure by one medication B. Prevent relapses, manage symptoms, maintain function & quality of life C. Focus only on MRI results D. Discontinue all activity

Answer 55

Realistic: slow disease + preserve independence.