Multiple Sclerosis (MS) || acknowledged answers 100%.
The nurse is assessing a client suspected of having multiple sclerosis. Which manifestation
should the nurse expect to observe in the client? SATA
A) Spastic movements
B) Tachycardia
C) Lack of coordination
D) Decreased level of consciousness
E) Double Vision correct answers A, C, E
Rationale:
Double vision is consistent with multiple sclerosis; multiple sclerosis (MS) causes demyelination
and plaque formation in the central nervous system, including damage to the optic nerve. Spastic
movements are consistent with MS because it is an upper motor neuron disorder; these disorders
involve the central nervous system and cause spasticity. Lack of coordination is consistent with
multiple sclerosis; coordination and balance are controlled in the cerebellum, and damage to
nerve transmission in the cerebellum can cause loss of coordination and poor balance. Decreased
level of consciousness is not a manifestation that is directly related to multiple sclerosis.
Tachycardia, or rapid heart rate, is not a manifestation of multiple sclerosis.
A client has been diagnosed with relapsing-remitting multiple sclerosis. Which statement by the
nurse most accurately explains to the client the onset of symptoms with this type of MS?
A) "Symptoms will become progressively worse with periods of flare-ups."
B) "Symptoms will not develop for at least several years after diagnosis."
C) "Symptoms will flare up at times, with periods of partial or complete remission."
D) "Symptoms will develop slowly, but continuously with no periods of remission." correct
answers C)"Symptoms will flare up at times, with periods of partial or complete remission."
Rationale:
A client with relapsing-remitting MS will experience periods of flare-ups followed by periods of
partial or complete remission. Clients experience slow but continuous worsening of disease with
no remissions with primary-progressive MS. Clients experience progressive worsening of the
,disease with periods of flare-ups with progressive-relapsing MS. Symptoms of MS typically
develop immediately, not several years after diagnosis.
The nurse is preparing to teach about the manifestations of MS to a client newly diagnosed with
the disease. Which manifestation should the nurse include in this teaching?
A) Hypertension
B) Difficulty chewing
C) Fever
D) Frequent dry cough correct answers B) Difficulty chewing
Rationale:
A common manifestation of MS is difficulty chewing; it should be included in client teaching.
Frequent dry cough, fever, and hypertension are not manifestation of MS.
A client presents with double vision and increasing weakness in the lower extremities. Which
additional information should lead the nurse to expect that diagnostic testing for MS will be
ordered?
A) The client reports episodes of rapid heart rate during periods of weakness in the lower
extremities.
B) The client reports increasing manifestation over the past week.
C) The client reports previous episodes, each lasting 1 day, and then no problems for at least 1
month.
D) The client reports pain in the lower back for the past few days. correct answers C) The client
reports previous episodes, each lasting 1 day, and then no problems for at least 1 month.
Rationale:
MS can cause episodes lasting for more than 24 hours, and the episodes occur more than 1 month
apart. 1-week duration is too short to suspect multiple sclerosis; MS is diagnosed from
manifestations that last over a period of months; the client reports are not necessarily consistent
with multiple sclerosis. MS does not cause a rapid heart rate. The client could be describing a
cardiac disorder that is causing weakness from decreased cardiac output. Back pain for a few
days is more consistent with a back injury. The weakness in the legs could be from MS or from a
back injury
, The nurse is teaching a client diagnosed with MS about the factors that may precipitate a relapse.
Which factor should the nurse include? SATA
A) Increases in body temperature
B) Constipation
C) Stress
D) Acetaminophen use
E) Fatigue correct answers A, C, E
Rationale:
While there are no common triggers for relapses in MS, several factors such as stress, fatigue,
and increases in body temperature may influence a relapse. MS may cause constipation; it is not
a cause of a relapse. Acetaminophen may be used to reduce body temperature to prevent a
relapse; however, it does not cause a relapse in symptoms.
The nurse admits a client suspected of having MS. Which diagnostic test should the nurse expect
to be ordered? SATA
A) Lumbar puncture
B) ECG
C) Colonoscopy
D) Cystoscopy
E) MRI correct answers A, E
Rationale:
MRI and lumbar puncture are diagnostic tests that are useful in diagnosing MS. An MRI is used
to detect the presence of lesions in the central nervous system (CNS) that indicate demyelination.
A lumbar puncture is used to obtain cerebrospinal fluid (CSF), which is tested for the presence of
substances that indicate the presence of MS. Electrocardiography, colonoscopy, and cystoscopy
are not used to diagnose MS.
The nurse formulates the plan of care for a client diagnosed with MS. The client stays up late at
night, takes long hot showers, sleeps in a cool bedroom, loves fresh air all year round, and naps
after lunch. Which lifestyle changes should the nurse suggest for the client?
A) Eliminating the post-lunch nap.
The nurse is assessing a client suspected of having multiple sclerosis. Which manifestation
should the nurse expect to observe in the client? SATA
A) Spastic movements
B) Tachycardia
C) Lack of coordination
D) Decreased level of consciousness
E) Double Vision correct answers A, C, E
Rationale:
Double vision is consistent with multiple sclerosis; multiple sclerosis (MS) causes demyelination
and plaque formation in the central nervous system, including damage to the optic nerve. Spastic
movements are consistent with MS because it is an upper motor neuron disorder; these disorders
involve the central nervous system and cause spasticity. Lack of coordination is consistent with
multiple sclerosis; coordination and balance are controlled in the cerebellum, and damage to
nerve transmission in the cerebellum can cause loss of coordination and poor balance. Decreased
level of consciousness is not a manifestation that is directly related to multiple sclerosis.
Tachycardia, or rapid heart rate, is not a manifestation of multiple sclerosis.
A client has been diagnosed with relapsing-remitting multiple sclerosis. Which statement by the
nurse most accurately explains to the client the onset of symptoms with this type of MS?
A) "Symptoms will become progressively worse with periods of flare-ups."
B) "Symptoms will not develop for at least several years after diagnosis."
C) "Symptoms will flare up at times, with periods of partial or complete remission."
D) "Symptoms will develop slowly, but continuously with no periods of remission." correct
answers C)"Symptoms will flare up at times, with periods of partial or complete remission."
Rationale:
A client with relapsing-remitting MS will experience periods of flare-ups followed by periods of
partial or complete remission. Clients experience slow but continuous worsening of disease with
no remissions with primary-progressive MS. Clients experience progressive worsening of the
,disease with periods of flare-ups with progressive-relapsing MS. Symptoms of MS typically
develop immediately, not several years after diagnosis.
The nurse is preparing to teach about the manifestations of MS to a client newly diagnosed with
the disease. Which manifestation should the nurse include in this teaching?
A) Hypertension
B) Difficulty chewing
C) Fever
D) Frequent dry cough correct answers B) Difficulty chewing
Rationale:
A common manifestation of MS is difficulty chewing; it should be included in client teaching.
Frequent dry cough, fever, and hypertension are not manifestation of MS.
A client presents with double vision and increasing weakness in the lower extremities. Which
additional information should lead the nurse to expect that diagnostic testing for MS will be
ordered?
A) The client reports episodes of rapid heart rate during periods of weakness in the lower
extremities.
B) The client reports increasing manifestation over the past week.
C) The client reports previous episodes, each lasting 1 day, and then no problems for at least 1
month.
D) The client reports pain in the lower back for the past few days. correct answers C) The client
reports previous episodes, each lasting 1 day, and then no problems for at least 1 month.
Rationale:
MS can cause episodes lasting for more than 24 hours, and the episodes occur more than 1 month
apart. 1-week duration is too short to suspect multiple sclerosis; MS is diagnosed from
manifestations that last over a period of months; the client reports are not necessarily consistent
with multiple sclerosis. MS does not cause a rapid heart rate. The client could be describing a
cardiac disorder that is causing weakness from decreased cardiac output. Back pain for a few
days is more consistent with a back injury. The weakness in the legs could be from MS or from a
back injury
, The nurse is teaching a client diagnosed with MS about the factors that may precipitate a relapse.
Which factor should the nurse include? SATA
A) Increases in body temperature
B) Constipation
C) Stress
D) Acetaminophen use
E) Fatigue correct answers A, C, E
Rationale:
While there are no common triggers for relapses in MS, several factors such as stress, fatigue,
and increases in body temperature may influence a relapse. MS may cause constipation; it is not
a cause of a relapse. Acetaminophen may be used to reduce body temperature to prevent a
relapse; however, it does not cause a relapse in symptoms.
The nurse admits a client suspected of having MS. Which diagnostic test should the nurse expect
to be ordered? SATA
A) Lumbar puncture
B) ECG
C) Colonoscopy
D) Cystoscopy
E) MRI correct answers A, E
Rationale:
MRI and lumbar puncture are diagnostic tests that are useful in diagnosing MS. An MRI is used
to detect the presence of lesions in the central nervous system (CNS) that indicate demyelination.
A lumbar puncture is used to obtain cerebrospinal fluid (CSF), which is tested for the presence of
substances that indicate the presence of MS. Electrocardiography, colonoscopy, and cystoscopy
are not used to diagnose MS.
The nurse formulates the plan of care for a client diagnosed with MS. The client stays up late at
night, takes long hot showers, sleeps in a cool bedroom, loves fresh air all year round, and naps
after lunch. Which lifestyle changes should the nurse suggest for the client?
A) Eliminating the post-lunch nap.
