# Situation: A 29-year-old woman with relapsing-remitting multiple sclerosis (MS) is admitted to the medical ward with new weakness and numbness of both legs for 3 days. She lives in a hot, humid area and works in an office. On day 2, before the second dose, her temperature is 38.3 °C, she reports burning on urination, and her leg weakness is worse than yesterday. Which conclusion should guide the nurse?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630418  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 29-year-old woman with relapsing-remitting multiple sclerosis (MS) is admitted to the medical ward with new weakness and numbness of both legs for 3 days. She lives in a hot, humid area and works in an office.

On day 2, before the second dose, her temperature is 38.3 °C, she reports burning on urination, and her leg weakness is worse than yesterday. Which conclusion should guide the nurse?

## 보기

1. The first dose has not yet worked; give the second dose on time
2. Fever is a steroid effect; give paracetamol and continue the course
3. Infection may be worsening her; check with the physician first **✔ 정답**
4. The relapse is spreading; give the dose now to limit new damage

**정답: 3**

## 해설

Fever and urinary symptoms suggest a urinary tract infection, a common cause of pseudo-relapse, because fever further slows conduction in demyelinated nerves. High-dose steroids suppress immunity, so the nurse checks with the physician before giving the dose when an active infection is present. Treating the infection and the fever may reverse the worsening.

## 심화 해설

The conclusion that should guide the nurse
On day 2, before the second dose, she has a temperature of 38.3 °C, burning on urination, and worse leg weakness than the day before. Fever and urinary symptoms suggest a urinary tract infection, a common cause of pseudo-relapse, because fever further slows conduction in demyelinated nerves. High-dose steroids suppress immunity, so the nurse checks with the physician before giving the dose when an active infection is present.

Understanding pseudo-relapse
In MS, demyelinated nerve fibers conduct impulses poorly and are very sensitive to temperature. A rise in body temperature, whether from fever, hot weather, or exercise, further reduces conduction and can make existing symptoms temporarily worse. This is not new inflammatory damage but a pseudo-relapse. Treating the infection and the fever may reverse the worsening, whereas giving more immunosuppression without addressing the infection can allow it to progress, sometimes to urosepsis. Urinary infections are common in MS because of bladder dysfunction and incomplete emptying.

| Feature | True relapse | Pseudo-relapse |
| --- | --- | --- |
| Cause | New inflammatory demyelination | Fever, infection, heat, stress |
| Fever or infection | Usually absent | Often present |
| Course | Lasts at least 24 hours | Resolves when trigger is treated |
| Action | Steroids may be used | Treat the trigger; review steroid dosing |

Why the other conclusions are wrong
Saying the first dose has not yet worked ignores the new fever and urinary symptoms, which point to infection and must be reported before another immunosuppressive dose. Calling fever a steroid effect is incorrect; methylprednisolone does not cause fever and more often masks it, so a new fever is significant. Concluding that the relapse is spreading misreads the picture, because worsening that arrives together with fever and dysuria suggests infection rather than spreading inflammation.

Nursing actions
The nurse holds the dose pending the physician's review, reports the fever and urinary symptoms, anticipates urinalysis and urine culture, encourages fluids, and uses cooling measures and paracetamol (acetaminophen) for fever as ordered. Neurologic status is reassessed as the fever settles.

Exam takeaway
Watch out In MS, worsening symptoms with fever suggest pseudo-relapse from infection. Find and treat the trigger, and question further immunosuppression while infection is active.

## 임상 시나리오

Pseudo-Relapse in Multiple SclerosisFever, dysuria, and worsening weakness
Fever of 38.3 °C and burning on urination suggest a urinary tract infection. Fever further slows conduction in demyelinated nerves, causing a pseudo-relapse with worsening weakness.

High-dose steroids suppress immunity, so the nurse checks with the physician before giving the next dose. Treating the infection and fever may reverse the worsening.

CautionMethylprednisolone does not cause fever and may mask it. A new fever during steroid therapy is always reported.

## 핵심 개념

- **Pseudo-relapse** — Temporary worsening of multiple sclerosis symptoms caused by fever, infection, or heat rather than new demyelination.
- **Urinary tract infection** — Infection of the bladder or urinary tract, common in MS because of bladder dysfunction.
- **Immunosuppression** — Reduction of immune defenses, as caused by high-dose corticosteroids.
- **Neurogenic bladder** — Bladder dysfunction caused by nerve damage, leading to retention or urgency.

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