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A patient diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What should the nurse identify as an expected outcome of this treatment?
- A. Reduction in the appearance of new lesions on the MRI
- B. Decreased muscle spasms in the lower extremities
- C. Increased muscle strength in the upper extremities
- D. Decreased severity and duration of exacerbations
Correct Answer: B
Rationale: Baclofen reduces muscle spasms in MS by acting as a GABA agonist. It does not affect MRI lesions, upper extremity strength, or exacerbation duration.
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A patient is being admitted through the ED with suspected herpes simplex virus encephalitis. What nursing action best addresses the patient's complaints of headache?
- A. Initiating a patient-controlled analgesia (PCA) of morphine sulfate
- B. Administering hydromorphone (Dilaudid) IV as needed
- C. Dimming the lights and reducing stimulation
- D. Distracting the patient with activity
Correct Answer: C
Rationale: Dimming lights and reducing stimulation alleviate headache in herpes simplex virus encephalitis by minimizing sensory overload. Opioids may mask neurologic symptoms, and distraction is ineffective.
The nurse is creating a plan of care for a patient who has a recent diagnosis of MS. Which of the following should the nurse include in the patient's care plan?
- A. Encourage patient to void every hour.
- B. Order a low-residue diet.
- C. Provide total assistance with all ADLs.
- D. Instruct the patient on daily muscle stretching.
Correct Answer: D
Rationale: Daily muscle stretching helps manage spasticity in MS. Voiding every 30 minutes after drinking, high-fiber diets, and encouraging independence in ADLs are more appropriate.
A middle-aged woman has sought care from her primary care provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care?
- A. Cognitive declines
- B. Personality changes
- C. Contractures
- D. Difficulty in coordination
Correct Answer: D
Rationale: Difficulty in coordination, along with fatigue and weakness, is a common early symptom of MS prompting medical evaluation. Cognitive declines and contractures occur later, and personality changes are not typical.
A patient presents at the clinic complaining of pain and weakness in her hands. On assessment, the nurse notes diminished reflexes in the upper extremities bilaterally and bilateral loss of sensation. The nurse knows that these findings are indicative of what?
- A. Guillain-Barr?© syndrome
- B. Myasthenia gravis
- C. Trigeminal neuralgia
- D. Peripheral nerve disorder
Correct Answer: D
Rationale: Pain, weakness, diminished reflexes, and sensory loss in the extremities indicate a peripheral nerve disorder. Guillain-Barr?© involves ascending paralysis, myasthenia gravis affects voluntary muscles, and trigeminal neuralgia causes facial pain.
A patient with metastatic cancer has developed trigeminal neuralgia and is taking carbamazepine (Tegretol) for pain relief. What principle applies to the administration of this medication?
- A. Tegretol is not known to have serious adverse effects.
- B. The patient should be monitored for bone marrow depression.
- C. Side effects of the medication include renal dysfunction.
- D. The medication should be first taken in the maximum dosage form to be effective.
Correct Answer: B
Rationale: Carbamazepine can cause bone marrow depression, requiring monitoring. It has serious side effects like aplastic anemia, not renal dysfunction, and is started at a low dose, gradually increased.