A nurse is caring for a client who has multiple sclerosis and is experiencing progressive multifocal leukoencephalopathy (PML). Which of the following medications should the nurse recognize is associated with the development of PML?

Choice A Reason:

Decreased visual acuity is correct. Yes, decreased visual acuity, including issues such as poor depth perception, reduced peripheral vision, and difficulty with contrast sensitivity, can contribute to falls and head injuries in older adults.

Choice B Reason:

Motor vehicle crashes is incorrect. While motor vehicle crashes can cause head injuries in individuals of all ages, they are less common among older adults compared to younger age groups.

Choice C Reason:

Polypharmacy is correct. Yes, polypharmacy, which refers to the use of multiple medications concurrently, is a common risk factor for falls and head injuries in older adults. Certain medications, especially those with sedative or psychotropic effects, can increase the risk of falls and accidents.

Choice D Reason:

Weakness is correct. Yes, weakness, frailty, and decreased muscle strength are common age-related changes that can increase the risk of falls and subsequent head injuries in older adults.

Choice E Reason:

Chronic hypertension, particularly when poorly controlled, can contribute to an increased risk of falls in older adults through various mechanisms:Hypertension medications or the condition itself can lead to orthostatic hypotension. This can cause dizziness or lightheadedness, increasing the risk of falls.Chronic hypertension is a major risk factor for cerebrovascular disease, including strokes. These events can lead to neurological deficits such as weakness, numbness, or impaired balance, predisposing individuals to falls.

Choice F Reason:

Previous military experience is incorrect. While previous military experience may contribute to certain health conditions or injuries in older adults, it is not a common reason for head injuries specifically related to falls or accidents in this population.

Choice A Reason:

Memory loss is correct. Memory loss can occur in individuals with PML due to damage to the white matter of the brain caused by the JC virus infection. This damage can affect cognitive function, including memory.

Choice B Reason:

Clumsiness is correct. Clumsiness or lack of coordination is a common neurological symptom of PML. It can result from damage to areas of the brain responsible for motor function and coordination.

Choice C Reason:

Tardive dyskinesia is incorrect. Tardive dyskinesia is a movement disorder characterized by involuntary, repetitive movements, often involving the face, lips, tongue, and limbs. While tardive dyskinesia can occur as a side effect of certain medications, it is not typically associated with PML.

Choice D Reason:

Seizures is correct. Seizures can occur in individuals with PML due to the involvement of the brain's white matter by the JC virus infection. Seizures may present as sudden, uncontrolled movements, altered consciousness, or other neurological symptoms.

Choice E Reason:

Vision difficulty is correct. Vision difficulties, including blurred vision, visual field deficits, and other visual disturbances, are common manifestations of PML. Damage to the optic nerves or areas of the brain involved in visual processing can result in vision difficulties.