Question 1

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

Acetaminophen or ibuprofen

Accepted Answer

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.

Question 2

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?&#10;A) Hope for long-term remission&#10;B) Temporary improvement&#10;C) Development of relapsing-remitting MS&#10;D) Development of secondary progressive MS

Accepted Answer

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.

Question 3

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."

"After the first year of treatment, I will need once yearly blood work."

Accepted Answer

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.

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."

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Accepted Answer

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.

Question 5

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.

Accepted Answer

About 10% of patients taking glatiramer acetate experience a self-limited postinjection reaction characterized by flushing, palpitations, severe chest pain, anxiety, laryngeal constriction, and urticaria; the episode usually lasts 15 to 20 minutes. No treatment is required, but the nurse should stay with the patient to help alleviate anxiety associated with this reaction. Epinephrine is not indicated. Cardiorespiratory support is not necessary. This does not represent a cardiotoxic reaction.

Question 6

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."

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Accepted Answer

Mitoxantrone is given as an infusion once every 3 months. Cardiac side effects may become apparent during treatment or up to years after discontinuation of the drug. Fever, chills, cough, and hoarseness are signs of infection and should be reported immediately. LFTs and a pregnancy test should be done before each infusion.

Question 7

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.

Accepted Answer

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.

Question 8

Immunomodulator drugs have shown effectiveness for what? (Select all that apply.)&#10;A) Preventing the development of MS&#10;B) Primary progressive MS&#10;C) Progressive-relapsing MS&#10;D) Relapsing-remitting MS&#10;E) Secondary progressive MS

Accepted Answer

Immunomodulators can be used in progressive-relapsing MS, relapsing-remitting MS, and secondary progressive MS but not to prevent MS from developing or to treat primary progressive MS.

Question 9

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.

Accepted Answer

Patients who have not had chickenpox or the VZV vaccine should be tested for VZV antibodies before receiving fingolimod. It is not correct to advise patients to avoid people with chickenpox, because this disease is endemic. Patients who do not have VZV antibodies should receive the VZV vaccine 1 month before beginning the fingolimod. The VZV vaccine should be given only to those who do not have VZV antibodies.

Question 10

A patient administers interferon beta-1a SQ (Rebif) 22 mcg/0.5 mL three 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).

Accepted Answer

Oral diphenhydramine can help reduce itching and erythema. Ice is used to control pain and should be used before the injection; warm, moist compresses are used after the injection. Reducing the dose of interferon will not reduce the local reaction. Continuous use of topical steroids is not recommended because of the risk of skin damage.

Question 11

A nurse provides teaching to a patient who is about to receive a first dose of fingolimod (Gilenya). Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I may experience a rapid heart rate and palpitations with the first dose.&#34;&#10;B) &#34;I should report nausea, vomiting, poor appetite, and dark urine.&#34;&#10;C) &#34;I will need an ophthalmologic examination before beginning treatment.&#34;&#10;D) &#34;I will need to remain in an observation unit for 6 hours after the first dose.&#34;

Accepted Answer

The answer of A nurse provides teaching to a patient...

Deck 23: Drugs for Multiple Sclerosis