A nurse instructs a client taking glyburide about alcohol use. What statement by the client indicates the need for further teaching?

Rationale:

A. Baclofen is a centrally acting skeletal muscle relaxant that targets the GABA-B receptors in the spinal cord, inhibiting excitatory neurotransmission. By reducing the frequency and severity of muscle spasms, stiffness, and hypertonicity, it helps improve mobility, ADLs, and overall comfort in patients with MS. This demonstrates correct understanding of the therapeutic purpose of the medication.

B. Both baclofen and alcohol are CNS depressants, which can lead to additive effects such as excessive drowsiness, dizziness, hypotension, or impaired coordination, increasing the risk of falls or accidents. Avoiding alcohol ensures patient safety, especially during initiation or dose adjustments.

C. Stopping baclofen abruptly is dangerous. Sudden discontinuation can cause rebound spasticity, severe muscle rigidity, hallucinations, seizures, fever, and even life-threatening complications. Safe discontinuation requires a gradual tapering schedule under medical supervision. This statement indicates the patient does not understand the importance of safe medication management and the physiologic consequences of sudden withdrawal.

D. Drowsiness, fatigue, and generalized weakness are common CNS-related adverse effects of baclofen, particularly at the start of therapy or after dose increases. Educating patients about these effects helps them anticipate changes, avoid risky activities (e.g., driving or operating machinery), and adhere to the regimen while monitoring tolerance.

Rationale:

A. One of the hallmark early signs of MS is optic neuritis, which occurs when demyelination affects the optic nerve. This results in sudden or subacute vision loss in one eye, often accompanied by pain with eye movement. Visual symptoms may be transient or partially recover, but repeated episodes are common. Recognizing optic neuritis is important for early diagnosis and initiation of disease-modifying therapy.

B. MS commonly affects cranial nerves III, IV, and VI or their central pathways, leading to ocular motor dysfunction. This can cause: Diplopia (double vision) due to extraocular muscle weakness or impaired nerve conduction, Blurred vision from optic nerve involvement or demyelination in visual pathways, Nystagmus in some patients
These symptoms contribute to difficulty reading, driving, and performing fine visual tasks and often worsen with fatigue or heat (Uhthoff’s phenomenon).

C. Bradykinesia is a slowness of voluntary movement seen in Parkinson’s disease, not MS. While MS can cause motor weakness, spasticity, or coordination deficits, true bradykinesia is absent. Confusing the two may lead to misdiagnosis.

D. Fatigue is one of the most common and disabling symptoms of MS, affecting up to 80% of patients. It can be primary (from demyelination and CNS changes) or secondary (from sleep disturbance, depression, infection, or heat). Fatigue often: Worsens in the afternoon or after activity, Impairs ADLs, work performance, and quality of life and Requires energy conservation strategies, pacing, and sometimes pharmacologic management

E. Depression is common in MS due to a combination of: Neurochemical changes from CNS demyelination and psychological stress of living with a chronic, unpredictable disease
Depression can negatively impact adherence to medications, physical activity, and disease self-management. Screening and early treatment are essential.