Deck 23: Drugs for Multiple Sclerosis

Question 1

A patient is about to begin therapy with fingolimod [Gilenya] to treat multiple sclerosis. The nurse learns that the patient has not had chickenpox or the varicella zoster virus (VZV) vaccine. What will the nurse do?

A) Advise the patient to avoid individuals with chickenpox.
B) Give the VZV vaccine with the initial dose of fingolimod.
C) Give the VZV vaccine and tell the patient to begin using fingolimod in 1 month.
D) Obtain an order for a VZV antibody test.

Answer 1

Obtain an order for a VZV antibody test.

Question 2

A patient administers interferon beta-1a SQ [Rebif] 22 mcg/0.5 mL 3 times each week. The patient calls the nurse to report unrelieved itching and erythema at the injection site, despite the use of topical hydrocortisone for several weeks. What will the nurse tell this patient to do?

A) Apply ice to the injection site before and after the injection.
B) Ask the provider to reduce the dose of interferon beta to 8.8 mcg/0.2 mL.
C) Discuss using a prescription-strength hydrocortisone product with the provider.
D) Take oral diphenhydramine [Benadryl].

Answer 2

Take oral diphenhydramine [Benadryl].

Question 3

A patient who has recently begun taking interferon beta reports feeling depressed. Which action by the nurse is correct?

A) Notify the provider of these symptoms.
B) Reassure the patient that these symptoms will subside.
C) Request an order for an antidepressant medication.
D) Suggest counseling to discuss the effects of this chronic disease.

Answer 3

Notify the provider of these symptoms.

Question 4

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."

Question 5

A patient who stopped taking teriflunomide [Aubagio] 1 year prior tells the nurse that she has just found out she is pregnant. Which action by the nurse is correct?

A) Contact the provider to obtain an order for serum drug levels.
B) Reassure the patient that her fetus should be safe.
C) Suggest that she consider an abortion.
D) Tell her that she will not be able to nurse her baby when it is born.

Question 6

A patient has received an initial dose of glatiramer acetate [Copaxone] for relapsing-remitting multiple sclerosis. The nurse notes that the patient appears flushed and anxious and has urticaria. The patient reports palpitations, chest pain, and a feeling of laryngeal constriction. What will the nurse do?

A) Obtain an order for epinephrine to treat a hypersensitivity reaction.
B) Prepare to provide cardiorespiratory support.
C) Report a possible cardiotoxic episode to the provider.
D) Stay with the patient until this self-limiting episode passes.

Question 7

A patient has been diagnosed with multiple sclerosis (MS) for 10 years and has a history of 3 periods of neurologic dysfunction lasting several weeks separated by long periods of full recovery. In the past 6 months, the patient has had a prolonged period of neurologic dysfunction without remission. The nurse understands that the patient may have which MS subtype?

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

Question 8

Immunomodulator drugs have shown effectiveness for what?

A) Preventing the development of MS
B) Primary progressive MS
C) Progressive-relapsing MS
D) Relapsing-remitting MS
E) Secondary progressive MS

Question 9

A nurse provides teaching for a 25-year-old patient who will receive mitoxantrone [Novantrone] for worsening relapsing-remitting multiple sclerosis. Which statement by the patient indicates a need for further teaching?

A) "I may experience cardiac side effects several years after receiving this drug."
B) "I should report fever, chills, cough, and hoarseness immediately."
C) "I will need an infusion of this medication once weekly."
D) "I will need a liver function test and a pregnancy test before each dose."

Question 10

A patient has begun taking dimethyl fumarate [Tecfidera] to treat relapsing MS and calls the clinic to report flushing of the skin with itching and burning sensations. What will the nurse recommend to this patient?

A) "Take a non-enteric-coated aspirin 30 minutes before each dose."
B) "The provider will order an antihistamine to treat this symptom."
C) "Try taking the medication on an empty stomach."
D) "You should notify the provider immediately."

Question 11

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

Question 12

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

Question 13

Which drugs may be selected by the provider for initial treatment for a patient who is diagnosed with relapsing-remitting MS?

A) Dimethyl fumarate [Tecfidera] PO
B) Interferon beta-1a [Avonex] IM
C) Mitoxantrone [Novantrone] IV
D) Methotrexate [Rheumatrex] PO
E) Teriflunomide [Aubagio] PO