Deck 46: Care of Patients With Problems of the Peripheral Nervous System

Question 1

A client who has myasthenia gravis is recovering after a thymectomy.Which complication does the nurse monitor for in this client?

A) Sudden onset of shortness of breath
B) Swelling of the lower extremities
C) Lower abdominal tenderness
D) Decreased urinary output

Answer 1

Sudden onset of shortness of breath

Question 2

The nurse is assessing a client who is experiencing a myasthenia crisis.Which diagnostic test does the nurse anticipate being ordered?

A) Babinski reflex test
B) Tensilon test
C) Cholinesterase challenge test
D) Caloric reflex test

Answer 2

Tensilon test

Question 3

The intensive care nurse is caring for a client who has Guillain-Barré syndrome.The nurse notes that the client's vital capacity has declined to 12 mL/kg,and the client is having difficulty clearing secretions.Which is the nurse's priority action?

A) Place the client in a high Fowler's position.
B) Prepare the client for elective intubation.
C) Administer oxygen via a nasal cannula.
D) Auscultate for breath sounds.

Answer 3

Prepare the client for elective intubation.

Question 4

A client who has myasthenia gravis is receiving atropine for a cholinergic crisis.Which intervention does the nurse implement for this client?

A) Suction the client to remove secretions.
B) Turn and reposition the client every 2 hours.
C) Measure urinary output every 30 minutes.
D) Administer prescribed anticholinergic drugs as needed.

Question 5

A client who has Guillain-Barré syndrome is scheduled for plasmapheresis.Before the procedure,which clinical manifestation does the nurse use to determine patency of the client's arteriovenous shunt?

A) Palpable distal pulses
B) A pink, warm extremity
C) The presence of a bruit
D) Shunt pressure higher than 25 mm Hg

Question 6

The nurse assesses a client who has myasthenia gravis.Which clinical manifestation does the nurse expect to observe in this client?

A) Inability to perform the six cardinal positions of gaze
B) Lateralization to the affected side during the Weber test
C) Absent deep tendon reflexes
D) Impaired stereognosis

Question 7

The nurse instructs a client who has myasthenia gravis to take prescribed medications on time and to eat meals 45 to 60 minutes after taking anticholinesterase drugs.The client asks why the timing of meals is so important.Which is the nurse's best response?

A) "This timing allows the drug to have maximum effect, so it is easier for you to chew, swallow, and not choke."
B) "This timing prevents your blood sugar level from dropping too low and causing you to be at risk for falling."
C) "These drugs are very irritating to your stomach and could cause ulcers if taken too long before meals."
D) "These drugs cause nausea and vomiting. By waiting a while after you take the medication, you are less likely to vomit."

Question 8

The nurse recognizes which pathophysiologic feature as a hallmark of Guillain-Barré syndrome?

A) Nerve impulses are not transmitted to skeletal muscle.
B) The immune system destroys the myelin sheath.
C) The distal nerves degenerate and retract.
D) Antibodies to acetylcholine receptor sites develop.

Question 9

A client with myasthenia gravis is preparing for discharge.Which instructions does the nurse include when educating the client's family members or caregiver?

A) Technique for therapeutic massage to the lower extremities
B) Administration of morphine sulfate via an IV pump
C) Instructions for preparing thin, puréed foods
D) Cardiopulmonary resuscitation (CPR)

Question 10

The nurse is assessing laboratory results for a client with myasthenia gravis (MG).Which results does the nurse correlate with this disease process?

A) Elevated serum calcium level
B) Decreased thyroid hormone level
C) Decreased complete blood count
D) Elevated acetylcholine receptor antibody levels

Question 11

The nurse assesses a client with Guillain-Barré syndrome during plasmapheresis.Which complication does the nurse monitor for during this procedure?

A) Tachycardia
B) Hypovolemia
C) Hyperkalemia
D) Hemorrhage

Question 12

The nurse teaches a client who has autonomic dysfunction about injury prevention.Which statement indicates that the client correctly understands the teaching?

A) "I will change positions slowly."
B) "I will avoid wearing cotton socks."
C) "I will use an electric razor."
D) "I will use a heating pad on my feet."

Question 13

The nurse reviews laboratory data for a client who has Guillain-Barré syndrome (GBS).Which result does the nurse correlate with this disease process?

A) Increased cerebrospinal fluid (CSF) protein level
B) Decreased serum protein electrophoresis results
C) Increased antinuclear antibodies
D) Decreased immune globulin G (IgG) levels

Question 14

A client suspected to have myasthenia gravis is scheduled for the Tensilon (edrophonium chloride)test.Which prescribed medication does the nurse prepare to administer if complications of this test occur?

A) Epinephrine
B) Atropine sulfate
C) Diphenhydramine
D) Neostigmine bromide

Question 15

The nurse is planning discharge teaching for a client who has peripheral neuropathy of the lower extremities.Which instruction does the nurse include in the teaching plan?

A) "Cut all calluses and corns from your feet as soon as you notice them."
B) "Your balance will be steadier if you go barefoot while at home."
C) "Use a thermometer to check the temperature of bath water."
D) "Avoid using lotion on the feet and legs."

Question 16

The nurse is assessing a client with trigeminal neuralgia.Which clinical manifestation does the nurse expect to observe?

A) Excruciating pain
B) Decreased mobility
C) Controllable facial twitching
D) Increased talkativeness

Question 17

The nurse is caring for a client who has undergone peripheral nerve repair.Which priority assessment does the nurse perform postoperatively?

A) Evaluate extremity mobility.
B) Assess the skin surrounding the cast.
C) Test distal extremities for sensation.
D) Auscultate bowel sounds.

Question 18

The nurse is caring for a client who has myasthenia gravis.Which nursing intervention does the nurse implement to reduce muscle weakness in this client?

A) Administer a therapeutic massage.
B) Collaborate with the physical therapist.
C) Perform passive range-of-motion exercises.
D) Reposition the client every 2 hours.

Question 19

The nurse teaches a client with Guillain-Barré syndrome (GBS)about the recovery rate of this disorder.Which statement indicates that the client correctly understands the teaching?

A) "I need to see a lawyer because I do not expect to recover from this disease."
B) "I will have to take things slowly for several months after I leave the hospital."
C) "I expect to be able to return to work in construction soon after I get discharged."
D) "I wonder if my family will be able to manage my care now that I am paralyzed."

Question 20

The nurse assesses a client who has Guillain-Barré syndrome.Which clinical manifestation does the nurse expect to find in this client?

A) Ophthalmoplegia and diplopia
B) Progressive weakness without sensory involvement
C) Progressive, ascending weakness and paresthesia
D) Weakness of the face, jaw, and sternocleidomastoid muscles

Question 21

The nurse teaches a client who has Guillain-Barré syndrome (GBS)about pain management.Which statement indicates that the client correctly understands the teaching?

A) "I can use the button on the pump as often as I want to get more pain medication."
B) "Aspirin will provide the best relief from my pain associated with this disease."
C) "A combination of morphine and distraction helps bring me relief right now."
D) "I should not have any pain as a result of impaired motor and sensory neurons."

Question 22

The nurse is teaching a client who is receiving carbamazepine (Tegretol)for chronic trigeminal neuralgia.Which statement indicates that the client correctly understands the teaching?

A) "This drug will prevent seizures, which can occur because of trigeminal disease."
B) "I expect to have surgery soon, so I can stop taking this drug now."
C) "This medication is very successful in relieving pain. I am glad to be taking it."
D) "I will avoid drinking alcohol because it can add to the side effects of this medicine."

Question 23

A client has just undergone surgery for peripheral nerve trauma.Which interventions does the nurse include in the client's plan of care?

A) Immobilization of the affected area with a splint
B) Rotation of cold and heat therapy
C) Occupational therapy
D) Skin care, including hygiene and ointments
E) High-fat, low-protein diet

Question 24

The nurse is obtaining a health history for a 45-year-old woman with Guillain-Barré syndrome (GBS).Which statement by the client does the nurse correlate with the client's diagnosis?

A) "My neighbor also had Guillain-Barré syndrome."
B) "I had a viral infection about 2 weeks ago."
C) "I am an artist and work with oil paints."
D) "I have a history of a cardiac dysrhythmia."

Question 25

The nurse is preparing to send a cerebrospinal fluid sample to the laboratory.Which actions does the nurse implement during this procedure?

A) Use Standard Precautions.
B) Wear sterile gloves when handling the specimen.
C) Place the specimen on ice.
D) Send the specimen in a sealed bag displaying a biohazard symbol.
E) Confirm the specimen label with the client's identification band.

Question 26

The nurse is assessing a client who had a dissection of all branches of the right trigeminal nerve.When asked to wrinkle his forehead,the client wrinkles only the left side.Which is the nurse's best action?

A) Place the client in high Fowler's position.
B) Document the finding.
C) Assess the corneal reflex.
D) Notify the health care provider.

Question 27

The nurse is preparing a staff in-service program related to restless legs syndrome (RLS).Which potential risk factors of this syndrome does the nurse include?

A) Skin rashes
B) Polyneuropathies
C) Muscle atrophy
D) Diabetes mellitus type 2
E) Hypercalcemia

Question 28

A client with trigeminal neuralgia is about to undergo surgery for pain relief.The client asks,"How will this surgery relieve my pain?" How does the nurse respond?

A) "The surgeon will cut the connection between the cranial nerves."
B) "The surgeon will use an electrode to bypass the trigeminal nerve conduction."
C) "An incision is made into the nerve itself, and an anesthetic is applied to the area."
D) "A small artery compressing the nerve will be relocated."