# A nurse is caring for a client with multiple sclerosis who is experiencing an acute exacerbation. Which nursing intervention should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541181  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a client with multiple sclerosis who is experiencing an acute exacerbation. Which nursing intervention should be the priority?

## 보기

1. Encourage increased physical activity to prevent muscle atrophy
2. Administer prescribed corticosteroids as ordered **✔ 정답**
3. Provide high-protein diet supplements to increase energy
4. Implement aggressive range-of-motion exercises

**정답: 2**

## 해설

During an acute exacerbation of multiple sclerosis, the priority is to reduce inflammation with corticosteroids. Other options like increased activity or aggressive exercises may worsen symptoms during an exacerbation.

## 심화 해설

Understanding the Priority During an MS Exacerbation

An acute exacerbation of multiple sclerosis (MS) represents a period of new or worsening neurological symptoms caused by a focal inflammatory attack on the central nervous system myelin. The immediate therapeutic goal is to rapidly suppress this inflammation to limit axonal damage, shorten the duration of the relapse, and accelerate functional recovery. While rehabilitation and nutrition are vital components of long-term MS management, they are not the priority during the acute inflammatory phase.

The cornerstone of acute relapse management is high-dose intravenous corticosteroids, such as methylprednisolone. This intervention directly targets the underlying pathophysiology by reducing edema and inflammation at the lesion site, which is the most effective way to promote neurological recovery in the short term [1]. Delaying this treatment can prolong neurological deficits and may lead to incomplete recovery.

Why Other Interventions Are Not the Priority

Let's examine why the other options are less appropriate as the initial priority during an acute exacerbation:

-

**Encouraging increased physical activity and implementing aggressive range-of-motion exercises:** During an active inflammatory attack, the nervous system is in a state of acute stress. Aggressive physical activity can exacerbate fatigue, elevate core body temperature (potentially worsening conduction block in demyelinated nerves, known as Uhthoff's phenomenon), and does not address the underlying inflammation. Rest is a key component of acute management to conserve energy for neurological healing.

-

**Providing high-protein diet supplements:** While good nutrition supports overall health, a dietary supplement does not have a direct or rapid effect on the inflammatory cascade driving an acute MS relapse. This is a supportive, long-term wellness measure, not an acute pharmacological priority.

The Pathophysiology and Therapeutic Rationale

The rationale for prioritizing corticosteroids is deeply rooted in the immunopathology of an MS relapse. The acute inflammation involves a breakdown of the blood-brain barrier and an influx of autoreactive T-cells and other immune mediators. Corticosteroids work through multiple mechanisms, including inhibiting the expression of pro-inflammatory cytokines, reducing the activation of T-cells, and stabilizing the blood-brain barrier. This broad immunosuppressive effect directly counteracts the disease process.

It is also important to understand the role of humoral immunity in a subset of MS attacks. As highlighted in recent literature, some relapses are driven by autoantibodies and complement activation, a pattern known as immunopathological pattern II [1]. While the first-line treatment is still corticosteroids, this knowledge is crucial because it explains why some patients do not respond adequately. For these corticosteroid-refractory cases, a second-line escalation therapy like therapeutic plasma exchange (TPE) is considered. TPE works by mechanically removing pathogenic circulating autoantibodies and immune complexes from the plasma, thereby dampening the humorally driven inflammation [1]. This pathway underscores that the initial priority is always to administer the first-line anti-inflammatory agent (corticosteroids) and then to assess the response, escalating care if the patient's neurological deficits do not improve.

Therefore, administering prescribed corticosteroids is the independent, evidence-based nursing priority that directly intervenes in the pathological process of an acute MS exacerbation to preserve neurological function.

References (research sources)

- [1]Therapeutic Plasma Exchange in Corticosteroid-Refractory Multiple Sclerosis Relapses: Mechanisms, Efficacy, and Integration into Clinical Practice.Research articleMarrodan M, Ysrraelit MC, Correale J. (2025) · DOI: 10.3390/biomedicines13102399

## 임상 시나리오

Managing Acute MS ExacerbationPrioritizing Pharmacological Intervention Over Rehabilitation
The immediate priority during an acute exacerbation is to suppress the focal inflammatory attack on CNS myelin. Administering prescribed high-dose IV corticosteroids (e.g., methylprednisolone 1 g/day for 3–5 days) is the cornerstone treatment to reduce edema, shorten relapse duration, and accelerate functional recovery.

Rehabilitation efforts such as physical activity or aggressive range-of-motion exercises are contraindicated as the primary intervention during the acute phase. They can elevate core body temperature, potentially triggering Uhthoff's phenomenon and worsening conduction block in demyelinated nerves.

CautionDo not delay corticosteroid administration to focus on mobility or nutrition. Delaying treatment can prolong neurological deficits and lead to incomplete recovery. Aggressive physical therapy should be deferred until the acute inflammatory phase has subsided.

## 핵심 개념

- **Multiple Sclerosis Exacerbation** — A period of new or worsening neurological symptoms caused by a focal inflammatory attack on CNS myelin.
- **Corticosteroids** — High-dose IV medications like methylprednisolone used to rapidly reduce CNS inflammation and edema during an MS relapse.
- **Demyelination** — Damage to the protective myelin sheath surrounding nerve fibers in the central nervous system, impairing signal conduction.
- **Uhthoff's Phenomenon** — The temporary worsening of neurological symptoms in MS patients due to an increase in core body temperature.

## 같은 주제 문제

- [A nurse is assessing a 28-year-old male client who was recently diagnosed with multiple sc…](https://mymerci.kr/pages/nclex_q.php?qn_id=541178)
- [A nurse is assessing a 32-year-old male client newly diagnosed with multiple sclerosis (MS…](https://mymerci.kr/pages/nclex_q.php?qn_id=541179)
- [A nurse is assessing a 28-year-old female client who was recently diagnosed with multiple …](https://mymerci.kr/pages/nclex_q.php?qn_id=541180)
- [A nurse is caring for a client with multiple sclerosis who is experiencing an acute exacer…](https://mymerci.kr/pages/nclex_q.php?qn_id=541182)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._