NURSING 6005 CHAPTER 23: DRUGS FOR MULTIPLE SCLEROSIS Test Bank

NURSING 6005 CHAPTER 23: DRUGS FOR MULTIPLE SCLEROSIS Test Bank MULTIPLE CHOICE 1. A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching? a. “I may need to take additional drugs at times of acute relapse.” b. “I will need to take medication indefinitely.” c. “If medication is begun early, permanent remission can be achieved.” d. “Some symptoms may need to be managed with symptom-specific drugs.” ANS: C Drug therapy can reduce the frequency and severity of relapses, maintain quality of life, and prevent permanent damage to axons, but it does not produce permanent remission. Patients may need to take additional drugs during times of relapse and will need to take medications indefinitely. Some symptoms may be managed with symptom-specific drugs. DIF: Cognitive Level: Analysis REF: Overview of MS and Its Treatment | Drug Therapy Overview TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation 2. A 28-year-old woman is seen in the clinic after a single episode of blurred and double vision, weakness, and clumsiness lasting several days. The patient asks the nurse if she has multiple sclerosis. The nurse will tell this patient that the provider will: a. await a second clinical attack to confirm the diagnosis. b. consider her symptoms diagnostic of multiple sclerosis. c. order a magnetic resonance imaging (MRI) scan now and another when a second clinical attack occurs. d. have a definitive diagnosis based on an MRI scan ordered today. ANS: A This patient shows objective clinical evidence of clinical lesions and has had one attack. Diagnosis in this patient requires a second clinical attack or two MRI scans showing a new lesion over time. A single attack is not diagnostic. If an MRI scan is performed now, a second scan may be done at any time later to look for the development of new lesions; it is not necessary to do the second MRI scan at the time of another attack. An MRI scan done today may not be definitive, because it does not show dissemination over space or time. DIF: Cognitive Level: Application REF: Table 23-1: 2010 Revised McDonald Criteria for Diagnosis of MS TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 3. A patient has been diagnosed with primary progressive multiple sclerosis for 1 year and reports a recent brief period of being symptom free. The nurse will tell the patient that this indicates what? a. Hope for long-term remission b. Temporary improvement c. Development of relapsing-remitting MS d. Development of secondary progressive MS ANS: B Patients with primary progressive MS have symptoms that grow progressively more intense over time; patients may experience occasional plateaus or temporary improvement, but they do not have clear remissions. This episode does not represent hope for long-term remission or the development of a different subtype of MS. DIF: Cognitive Level: Application REF: MS Subtypes | Relapsing-Remitting MS | Secondary Progressive MS | Primary Progressive MS | Progressive-Relapsing MS TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 4. A patient is being treated with interferon beta-1a (Avonex) for relapsing-remitting MS. The patient calls the clinic to report headache, fever, chills, and muscle aches after administering a dose. What will the nurse recommend? a. Acetaminophen or ibuprofen b. Asking the provider to order a complete blood count (CBC) c. Coming to the clinic for evaluation for leukoencephalopathy d. Discontinuing the drug immediately ANS: A Patients treated with interferon beta can experience flulike reactions that diminish over time. Acetaminophen or ibuprofen may be used to treat symptoms. A CBC is not indicated. Leukoencephalopathy is a side effect of natalizumab, not interferon beta. It is not necessary to discontinue the drug. DIF: Cognitive Level: Application REF: Interferon Beta Preparations | Adverse Effects and Drug Interactions TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient with multiple sclerosis is to begin treatment with interferon beta. The patient comes to the clinic to have pretreatment laboratory tests. Which statement by the patient indicates a need for further teaching about these tests? a. “After the first year of treatment, I will need once yearly blood work.” b. “I will need to have lab tests done every 3 months for the first year.” c. “If my liver function tests are abnormal, I will need to stop using this drug.” d. “These lab tests will measure liver and bone marrow function.” ANS: A Patients treated with interferon beta require evaluation of bone marrow function with CBCs and of liver function with liver function tests (LFTs) at the beginning of therapy for baseline, every 3 months for a year, and then every 6 months thereafter. Abnormal LFTs warrant discontinuation of the drug. DIF: Cognitive Level: Application REF: Interferon Beta Preparations | Adverse Effects and Drug Interactions | Summary of Major Nursing Implications | Interferon Beta | Minimizing Adverse Effects TOP: Nursing Process: Planning