# 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. Before discharge she asks how she can stay physically active. She says her energy is best from 07:00 to 10:00 and poorest after 15:00, and outdoor temperatures reach 33 °C by late morning. Which exercise plan is BEST for her?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630419  
> 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.

Before discharge she asks how she can stay physically active. She says her energy is best from 07:00 to 10:00 and poorest after 15:00, and outdoor temperatures reach 33 °C by late morning. Which exercise plan is BEST for her?

## 보기

1. Walk on an air-conditioned indoor track at 07:30 **✔ 정답**
2. Swim laps in a cool pool at 17:00, after work
3. Skip exercise on tired days and rest in bed instead
4. Jog outdoors at 11:30 during her lunch break

**정답: 1**

## 해설

A rise in body temperature temporarily worsens MS symptoms (Uhthoff phenomenon), and fatigue is managed by scheduling demanding activity for the times of best energy. Early-morning exercise in an air-conditioned space satisfies both rules. Regular exercise improves strength, fatigue, and mood, while bed rest worsens weakness and spasticity.

## 심화 해설

The best exercise plan
She asks how to stay active. Her energy is best from 07:00 to 10:00 and poorest after 15:00, and outdoor temperatures reach 33 °C by late morning. A rise in body temperature temporarily worsens MS symptoms (Uhthoff phenomenon), and fatigue is managed by scheduling demanding activity for the times of best energy. Walking on an air-conditioned indoor track at 07:30 satisfies both rules and is the best plan.

Two principles applied together
Heat sensitivity: demyelinated nerves conduct poorly when warm, so exercising in heat can bring on weakness, blurred vision, or fatigue until the body cools. Exercising in a cool environment, wearing light clothing, and using cooling strategies keep body temperature stable. Fatigue management: MS fatigue is common and often follows a daily pattern. Energy conservation means planning demanding activities for peak-energy periods and building in rest, not avoiding activity altogether. Regular exercise improves strength, fatigue, mood, and balance, while bed rest worsens weakness and spasticity.

| Plan | Heat | Energy timing | Verdict |
| --- | --- | --- | --- |
| Indoor air-conditioned walk at 07:30 | Cool | Best energy | Best |
| Cool pool swim at 17:00 | Cool | Poorest energy | Second-best |
| Bed rest on tired days | — | — | Worsens weakness and spasticity |
| Outdoor jog at 11:30 | 33 °C heat | Past best period | Worsens symptoms |

Why the other plans fall short
Swimming in a cool pool at 17:00 avoids overheating, but it falls in her period of poorest energy, when fatigue limits what she can do. Skipping exercise and resting in bed leads to deconditioning, weakness, and spasticity; activity is adjusted, not stopped. Jogging outdoors at 11:30 exposes her to late-morning heat that raises body temperature and temporarily worsens symptoms.

Teaching points
The nurse encourages a regular routine, gradual progression, hydration, cooling measures such as cool showers or cooling garments, and rest breaks. Symptoms that appear with heat usually resolve with cooling, but new symptoms that persist should be reported.

Exam takeaway
Key point For MS exercise questions, pick the option that avoids heat and matches the client's best-energy time. Bed rest is never the answer.

## 임상 시나리오

Exercise Planning in Multiple SclerosisAvoid heat, use peak energy
Rising body temperature temporarily worsens MS symptoms (Uhthoff phenomenon). Exercise is done in a cool environment, such as an air-conditioned indoor track.

Fatigue is managed by scheduling demanding activity for best-energy hours, here 07:00–10:00. Regular exercise improves strength, fatigue, and mood, while bed rest worsens weakness and spasticity.

CautionAvoid outdoor exercise in late-morning heat of 33 °C. Heat-related symptoms usually ease with cooling; persistent new symptoms are reported.

## 핵심 개념

- **Heat sensitivity** — Worsening of multiple sclerosis symptoms with rising body temperature.
- **Energy conservation** — Planning and pacing activities to match energy levels and reduce fatigue.
- **Spasticity** — Muscle stiffness and increased tone caused by damage to central nervous system pathways.
- **MS fatigue** — A common, often overwhelming tiredness in multiple sclerosis that frequently worsens later in the day.

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