The nurse is developing a plan of care for an MS client with constipation. Which interventions are appropriate? SELECT ALL THAT APPLY
Increase fluid intake
Use stool softeners or bulk-forming agents
Limit physical activity
Encourage high-fiber foods
Schedule regular bowel times
Correct Answer : A,B,D,E
Rationale:
A. Adequate hydration is crucial for softening stool and promoting bowel motility, especially in MS patients who may have neurogenic bowel or decreased mobility. Insufficient fluid intake can lead to hard, dry stools, worsening constipation and increasing the risk of complications like hemorrhoids or fecal impaction.
B. Medications such as docusate (stool softener) or psyllium (bulk-forming fiber) can help prevent straining and make bowel movements easier. In MS, nerve damage may reduce peristalsis and bowel coordination, so these agents support regularity and prevent complications associated with chronic constipation.
C. Physical activity stimulates the gastrointestinal tract and bowel motility. In MS patients, immobility already contributes to constipation due to slower colonic transit. Limiting activity would aggravate constipation. Gentle exercise, such as walking or stretching, should be encouraged to improve bowel function.
D. Fiber increases stool bulk and water retention, which helps stimulate peristalsis and improve regularity. Foods like whole grains, fruits, and vegetables are recommended. Low-fiber diets, common in some MS patients due to chewing/swallowing difficulties or diet restrictions, can worsen constipation.
E. Establishing a consistent routine, often after meals to take advantage of the gastrocolic reflex, encourages predictable bowel movements. This is especially important in MS clients with neurogenic bowel, who may have decreased sensory awareness of the need to defecate. Ignoring this can lead to infrequent, difficult, or incomplete bowel movements.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. NG tube placement is invasive and not routinely indicated for patients who can safely eat orally. It is only used if the patient cannot swallow safely or meet nutritional needs orally, not as a first-line aspiration prevention strategy. Unnecessary NG tubes can increase the risk of infection and discomfort.
B. Thickened liquids are easier to control in the mouth and reduce the risk of aspiration in patients with dysphagia, which is common in Parkinson’s disease due to impaired swallowing and delayed pharyngeal reflexes. Thickened liquids slow the flow of fluids, giving the patient more time to coordinate a safe swallow, and are considered a primary intervention for aspiration prevention.
C. Solid foods, particularly tough or dry meats, are difficult to chew and swallow for patients with Parkinson’s disease. Even with frequent chewing, these foods increase the risk of choking and aspiration. Modified diets with soft, moist foods are safer.
D. Thin liquids, such as water or juice, flow quickly and are harder to control during swallowing, which significantly increases the risk of aspiration in patients with dysphagia. Thin liquids should be avoided unless swallowing function is intact and closely monitored.
Correct Answer is A
Explanation
Rationale:
A. On-off syndrome is a common complication of long-term Levodopa-Carbidopa therapy in Parkinson’s disease. Clients experience sudden, unpredictable fluctuations between periods of good mobility (“on” periods) and severe motor impairment or immobility (“off” periods). This occurs due to pulsatile dopaminergic stimulation and the short half-life of Levodopa, which leads to inconsistent dopamine receptor activation in the basal ganglia. Recognition and management (e.g., adjusting dosing schedules, using controlled-release formulations, or adding adjunct medications) are key to improving functional mobility.
B. Withdrawal syndrome refers to symptoms that occur after abrupt discontinuation of a medication, such as sudden worsening of Parkinsonian symptoms or life-threatening complications with drugs like baclofen. In this case, the client is still taking Levodopa, so this is not a withdrawal effect.
C. Rebound tremor refers to a temporary increase in tremor after a medication wears off or is rapidly discontinued. While related to motor fluctuations, it is not synonymous with the full immobility episodes seen in on-off syndrome. Rebound tremor is a specific component of motor fluctuation, not the broader phenomenon described here.
D. Acute dystonia involves sustained, involuntary muscle contractions causing abnormal postures, often occurring shortly after starting or increasing certain medications (e.g., antipsychotics). The client’s sudden “off” periods of immobility are not dystonic postures but generalized motor blockade, making dystonia an inappropriate description.
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