The nurse is caring for a client newly diagnosed with multiple sclerosis.
Which statement by the client indicates that additional instruction is needed?

Choice A rationale

A shuffling gait is a hallmark motor symptom resulting from the loss of dopaminergic neurons in the substantia nigra. This gait pattern is characterized by short, hesitant steps and a reduced lifting of the feet off the ground, often referred to as festination. This occurs because the basal ganglia can no longer effectively regulate the rhythm and amplitude of movement. It significantly increases the risk of tripping and falling, making gait assessment a priority for nursing safety interventions.

Choice B rationale

Bradykinesia refers to the generalized slowness of movement and is one of the cardinal features required for a clinical diagnosis. It affects all skeletal muscle groups, leading to difficulties in initiating movement and a reduction in spontaneous actions, such as blinking or swinging the arms while walking. This symptom is caused by the disruption of the motor pathways that coordinate complex voluntary movements. It often manifests as a mask like facial expression and significantly slows the performance of simple daily tasks.

Choice C rationale

Tremors at rest, often described as a pill rolling motion of the fingers, are a classic early sign of the disease. These rhythmic oscillations typically occur when the limb is supported and inactive, and they often diminish or disappear during purposeful voluntary movement or sleep. The tremor is a result of the imbalance between excitatory acetylcholine and inhibitory dopamine within the extrapyramidal system. While usually starting unilaterally, the tremor may eventually progress to involve both sides of the body.

Choice D rationale

Aphasia, which is the loss of the ability to understand or express speech due to brain damage, is not a standard feature of Parkinson disease. While patients may experience dysarthria, which is a physical difficulty in articulating words due to muscle weakness, or a soft, monotone voice known as hypophonia, the cognitive processing of language remains intact. Aphasia is more commonly associated with strokes or specific types of dementia that affect the language centers of the cerebral cortex, such as Broca's area.

Choice E rationale

Muscle rigidity is caused by increased muscle tone and a continuous resistance to passive movement in the joints. This can manifest as lead pipe rigidity, which is a constant resistance, or cogwheel rigidity, where the resistance is interrupted by small jerks. This stiffness is often painful and contributes to the characteristic stooped posture and decreased range of motion seen in affected individuals. It results from the sustained contraction of both agonist and antagonist muscles due to neurological dysfunction.

Choice A rationale

Administering oxygen is an important intervention during the postictal phase to ensure maternal and fetal oxygenation, but it cannot be performed effectively during the height of a generalized tonic-clonic seizure. The nurse must first ensure the patient is not alone and that additional medical assistance is on the way. Once the airway is protected and the seizure subsides, oxygen via a non-rebreather mask at 8 to 10 L/min is appropriate to correct any hypoxia.

Choice B rationale

Suctioning the mouth during an active seizure is contraindicated because it can cause oral trauma or stimulate the gag reflex, potentially leading to vomiting and aspiration. Suctioning equipment should be prepared and used immediately after the seizure ends to clear secretions or vomitus from the oropharynx. During the seizure, the nurse should turn the client to their side if possible to allow secretions to drain naturally from the mouth and maintain a patent airway.

Choice C rationale

Safety is the absolute priority during an eclamptic seizure. The nurse must remain with the client to prevent injury, such as falling out of bed, and must call for help to mobilize the rapid response team and obtain emergency medications like magnesium sulfate. The nurse should observe the seizure characteristics and timing while ensuring the environment is safe. Leaving the patient alone during a seizure increases the risk of airway obstruction, trauma, and unobserved status epilepticus.

Choice D rationale

Inserting an oral airway or any object into the mouth during an active seizure is strictly prohibited. It can lead to broken teeth, jaw injury, or complete airway obstruction if the object is pushed back into the throat. The masseter muscles are often tightly clenched during the tonic phase of a seizure. The nurse should never force anything between the teeth. Airway management focuses on positioning and postictal suctioning rather than mechanical insertion during the convulsive episode.