A client with MS experiences severe fatigue that interferes with activities of daily living (ADLs). Which medication might the provider prescribe?

Rationale:

A. Glargine is a long-acting, basal insulin with a peakless effect. It is not suitable for acute hyperglycemic emergencies, such as diabetic ketoacidosis (DKA), because it does not act quickly enough to reduce dangerously high blood glucose levels.

B. Lispro is a rapid-acting insulin, but intramuscular injection is not standard; it is administered subcutaneously. IM absorption can be unpredictable and may not provide reliable glucose lowering in emergencies.

C. NPH is an intermediate-acting insulin with delayed onset (1–2 hours) and a peak at 4–12 hours. It cannot rapidly lower blood glucose in an acute hyperglycemic crisis, making it inappropriate for emergency management.

D. Regular insulin given IV acts immediately and can be titrated continuously to rapidly reduce blood glucose in emergencies like DKA. IV administration allows close monitoring of glucose and potassium levels and is considered the standard of care for acute hyperglycemic crises in hospitalized patients.

Rationale:

A. While a high-fiber diet helps prevent constipation, it does not directly address bladder control issues. MS patients often experience neurogenic bladder dysfunction, which requires specific urinary management strategies rather than dietary modification.

B. Baclofen is a muscle relaxant used to treat spasticity, particularly in the limbs, but it does not improve bladder control. Using it for urinary symptoms would be ineffective.

C. Timed voiding (also called scheduled or prompted voiding) helps manage urinary incontinence and retention in MS by encouraging regular bladder emptying. This reduces the risk of urinary tract infections (UTIs), bladder overdistension, and incontinence, and promotes autonomy. It is a noninvasive, evidence-based nursing intervention for neurogenic bladder in MS.

D. Indwelling catheters are not routinely used due to the risk of infection, urethral trauma, and decreased bladder tone. Catheterization is reserved for acute urinary retention or severe complications, not as a first-line strategy for bladder management in MS.