When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should

A. Stress. Stress is a common trigger for both tension-type headaches and cluster headaches. Tension headaches are often caused by muscle tension and stress, while stress-related physiological changes, such as vasodilation and increased sympathetic activity, can contribute to cluster headaches.
B. Smoking. Smoking is a known trigger for cluster headaches but is not commonly associated with tension-type headaches. Nicotine can cause vasoconstriction, leading to rebound vasodilation that contributes to cluster headache episodes. However, it is not a significant factor in tension-type headaches, which are more related to muscle tension and stress.
C. Depression. Depression is more strongly linked to chronic tension-type headaches, but it is not a major trigger for cluster headaches. Cluster headaches are primarily associated with trigeminal autonomic dysfunction rather than mood disorders.
D. Poor posture. Poor posture is a contributing factor for tension-type headaches due to muscle strain in the neck and shoulders, but it is not a common trigger for cluster headaches, which are linked to hypothalamic activation and vascular changes.

A: "Assess for the presence of chest pain." While chest pain is an important symptom to evaluate in many patients, it is not specifically related to multiple sclerosis (MS). MS primarily affects the central nervous system and may not directly cause chest pain, making this assessment less relevant in the context of suspected MS.
B: "Inspect the skin for rashes or discoloration." Although skin changes can occur in various conditions, they are not characteristic of MS. MS primarily involves neurological symptoms, so inspecting the skin may not provide significant information regarding the patient's condition.
C: "Ask the patient about any increase in libido." Changes in libido are not typically associated with MS. Patients may experience various symptoms, including fatigue and mobility issues, but libido changes are not a primary concern or common symptom linked to the disease.
D: "Inquire about urinary tract problems." This is a relevant assessment for a patient with possible MS. Urinary dysfunction is common in individuals with MS due to neurological damage affecting bladder control. Patients may experience urgency, frequency, or incontinence, making it essential to assess urinary tract issues during the health history and physical examination. Addressing these concerns can help guide appropriate management strategies.