A nurse is planning care for a client who has multiple sclerosis and is receiving methylprednisolone. Which of the following adverse effects should the nurse anticipate? (Select all that apply.)

Choice A Reason:

Primary progressive multiple sclerosis (PPMS) is false. This subtype of MS is characterized by a gradual worsening of symptoms from the onset of the disease, without distinct relapses or remissions. It typically leads to a progressive accumulation of disability over time, without periods of remission. The pattern described by the client, with alternating periods of active symptoms and symptom-free periods, does not align with the continuous progression seen in PPMS.

Choice B Reason:

Relapsing-remitting multiple sclerosis (RRMS) is true. RRMS is characterized by distinct relapses, during which new symptoms may appear or existing symptoms may worsen, followed by periods of partial or complete recovery (remissions), during which the symptoms improve or may even disappear entirely. This pattern matches the description provided by the client, indicating RRMS as the likely subtype.

Choice C Reason:

Clinically isolating syndrome (CIS) is false. CIS refers to a single episode of neurological symptoms caused by inflammation or demyelination in the central nervous system, which may or may not progress to MS. However, CIS does not involve the characteristic pattern of relapses and remissions seen in RRMS.

Choice D Reason:

Secondary progressive multiple sclerosis (SPMS) is false. SPMS is characterized by a gradual worsening of symptoms and disability over time, following an initial period of relapsing-remitting disease. It may or may not involve distinct relapses and remissions, depending on the individual's disease course. While SPMS can involve periods of symptom exacerbation, it typically lacks the clear pattern of relapses followed by remissions seen in RRMS.

Choice A Reason:

Paresthesia is appropriate. Paresthesia, or abnormal sensations such as tingling, numbness, or burning, is a common neurological symptom in individuals with multiple sclerosis. It results from damage to the nerves or disruption of nerve signals in the central nervous system.

Choice B Reason:

Nausea and vomiting is inappropriate. While nausea and vomiting can occur in individuals with multiple sclerosis, they are not considered hallmark symptoms of the disease. These symptoms may be associated with other factors such as medications, autonomic dysfunction, or complications such as urinary tract infections.

Choice C Reason:

Dysphagia is appropriate. Dysphagia, or difficulty swallowing, is a common symptom in individuals with multiple sclerosis, particularly as the disease progresses. It can result from damage to the nerves that control swallowing muscles or from impaired coordination of swallowing reflexes.

Choice D Reason:

Spasticity is appropriate. Spasticity, or muscle stiffness and involuntary muscle contractions, is a common symptom in individuals with multiple sclerosis. It occurs due to damage to the nerve fibers that control muscle movement and can lead to difficulty with movement, walking, and muscle control.

Choice E Reason:

Vertigo is appropriate. Vertigo, or the sensation of spinning or dizziness, can occur in individuals with multiple sclerosis, particularly if lesions develop in areas of the brain involved in balance and coordination.