Question 1

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."

Accepted Answer

The most common side effect of dimethyl fumarate is flushing,which decreases over time. Patients should be counseled to take a non-enteric-coated aspirin 30 minutes prior to the dose and to take the medication with food. Antihistamines are not indicated. It is not a serious symptom and the provider does not need to be notified.

Question 2

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.

Accepted Answer

Interferon beta may promote or exacerbate depression and some patients may experience suicidal ideation or may attempt suicide. The provider should be notified so that the patient may be monitored and a reduction of dose may be required. Reassuring the patient is not correct because the symptoms may worsen. Patients experiencing depression should be referred to a psychiatrist for treatment. The depression is caused by the drug and should not be considered a normal effect of the disease.

Question 3

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

Accepted Answer

Secondary progressive MS occurs when a patient with relapsing-remitting MS develops steadily worsening dysfunction with or without plateaus or acute exacerbations,or minor remissions. Within 10 to 20 years of onset,about 50% of patients with MS will develop this type. Primary progressive MS occurs when symptoms grow progressively more intense from the onset. Progressive-relapsing MS is similar to primary progressive MS,but with acute exacerbations imposed on the steadily worsening symptoms. Relapsing-remitting MS is the most common initial presentation,which is characterized by recurrent,clearly defined episodes of symptoms with periods of remission with relapse occurring approximately twice every 3 years.

Question 4

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.

Accepted Answer

Women taking teriflunomide should be tested prior to beginning the drug to rule out pregnancy and should be counseled to use a reliable form of birth control while taking it since the drug is listed as pregnancy category X and can cause serious birth defects. The drug can stay in the system for up to 2 years. Women who become pregnant should be evaluated to determine serum drug levels and bile acid sequestrants or activated charcoal may be given to enhance drug elimination. The nurse cannot assure her that her fetus is safe and should not counsel abortion.

Question 5

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 6

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

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 7

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

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 8

Which drugs may be selected by the provider for initial treatment for a patient who is diagnosed with relapsing-remitting MS? (Select all that apply.)
A) Dimethyl fumarate [Tecfidera] PO
B) Interferon beta 1a [Avonex] IM
C) Mitoxantrone [Novantrone] IV
D) Methotrexate [Rheumatrex] PO
E) Teriflunomide [Aubagio] PO

Accepted Answer

All patients with relapsing-remitting MS,regardless of age,frequency of attacks,or disability,should receive one of the immunomodulators,such as dimethyl fumarate,interferon beta 1a,or teriflunomide. Mitoxantrone is an immunosuppressant and may be added if the immunomodulator fails. Methotrexate is an immunosuppressant and is used experimentally to treat primary progressive MS.

Question 9

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."

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 10

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."

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 11

Immunomodulator drugs have shown effectiveness for what? (Select all that apply.)
A) Preventing the development of MS
B) Primary progressive MS
C) Progressive-relapsing MS
D) Relapsing-remitting MS
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 12

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 13

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 14

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."

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.

Quiz 23: Drugs for Multiple Sclerosis

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

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 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 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 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?

Which drugs may be selected by the provider for initial treatment for a patient who is diagnosed with relapsing-remitting MS? (Select all that apply.)

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 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?

Immunomodulator drugs have shown effectiveness for what? (Select all that apply.)

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 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?