Peripheral Neuropathy
The nurse is caring for a client who receives vitamin B12 injections to control her peripheral neuropathy. the client tells the nurse that she recently started experiencing increased tingling in her fingers and toes, and she asks the nurse what this means. How should the nurse reply? A) "The tingling suggests that you are due for another injection." B) "The tingling means that the injections are not producing their intended effect." C) "The tingling is a common side effect of B12 injections." D) "The tingling is most likely unrelated to your injections."
A) "The tingling suggests that you are due for another injection." Rationale: Vitamin B12 injections are given to reduce tingling related to peripheral neuropathy. A recent increase in tingling suggests that the medication has been working but the client is due for another injection soon.
The nurse is administering pain medication to a client with peripheral neuropathy related to Guillain-Barre syndrome. Which assessment should the nurse consider a priority? A) Respiratory status B) Renal function C) Bowel sounds D) Skin integrity of the feet
A) Respiratory status Rationale: A concern with peripheral neuropathy in a client with GBS treated for pain is adequate respiratory effort. Respiratory status should be monitored closely. Renal function, gastrointestinal movement, and skin integrity are also important, but are not priorities over respiratory status.
The nurse suspects that the client has peripheral neuropathy. Which aquestion should the nurse ask related to the client's occupation? SATA A) "Do you perform any repetitive tasks?" B) "Are you exposed to any toxins or chemicals?" C) "Do you sit much of the day?" D) "Does your employer cover physical therapy visits?" E) "Do you work evening or night shifts?"
A, B - Repetitive tasks - Toxin exposure Rationale: Repetitive tasks can lead to inflammation of a nerve and mononeuropathy. Toxin and chemical exposure increase risk of developing peripheral neuropathy. Sitting, working off shifts, and coverage of physical therapy are not associated with peripheral neuropathy.
A client with peripheral neuropathy asks the nurse why antiseizure medication is prescribed. Which response from the nurse is best? A) "I will contact the physician to see if it was a mistake." B) "You are having seizures in addition to your peripheral neuropathy." C) "This medication has proven to help with neuropathy pain." D) "This medication will also help you lose weight."
C) "This medication has proven to help with neuropathy pain." Rationale: Antiseizure medication has proven to treat pain well through an unknown mechanism, which may involve the blocking of pain receptors in the central nervous system. The medication does not affect appetite or weight loss. It is unlikely to be a mistake because it is a common prescriptive therapy with anti-inflammatories and antidepressants. The medication is given to treat pain in those with peripheral neuropathy, not seizure activity.
The nurse is providing teaching to a client at risk for acquired peripheral neuropathy. Which of the following activities should the nurse suggest the client modify or avoid to reduce the risk of this condition? A) Working as an automobile mechanic on the weekends B) Playing tennis every Saturday C) Drinking one six-pack of beer per day D) Typing on the computer for several hours a day
C) Drinking one six-pack of beer per day Rationale: The client has a daily alcohol intake of one six-pack of beer. Alcohol abuse is a risk factor for the development of acquired peripheral neuropathy, so the client should be discouraged from drinking. Typing on the computer for several hours each day might cause some localized nerve compression in the wrists but would not contribute to peripheral neuropathy. Working as an automobile mechanic and playing tennis would not cause peripheral neuropathy.
The nurse is planning teaching for a client diagnosed with diabetic neuropathy. What should the nurse include in this teaching? A) Set the water heater at 102F B0 Avoid hand and foot massages C) Use a mirror to inspect feet daily D) Increase medication for pain as necessary
C) Use a mirror to inspect feet daily Rationale: Using a mirror to inspect the feet daily is recommended because the client may not feel the formation of pressure points, blisters, or ulcers. Setting the water heater at 120°F is incorrect because it is too hot and the client may be scalded because of lack of sensation. Avoiding hand and foot massages is incorrect because this therapy will relax the client, increase the circulation, reduce the need for medication, and increase the psychologic benefits of touch, including the ability to be soothed, comforted, held, and loved. Increasing medication for pain as necessary is incorrect because it can further decrease touch sensation by clouding the sensorium and inducing lethargy, which requires additional supervision and monitoring to ensure safety
The nurse is caring for a client with diabetes who reports paresthesia in the toes and feet. Place the clinical events in order of development that may have contributed to this report: A) Neuropathy develops B) Peripheral nerves are damaged C) Diabetes causes internal tissue damage D) Blood is shunted away from small vessels to large vessels
C, D, B, A Rationale: Diabetes (or onset of trauma or chronic disease) causes internal tissue damage--> Blood is shunted from small vessels to large vessels--> Peripheral nerves are damaged--> Neuropathy develops
The nurse is creating a plan of care for the client with peripheral neuropathy. Which outcome should the nurse include? SATA A) The client will regain full sensation of numb areas B) The client will perform daily repetitive exercise movements C) The client will remain free of injury D) The client will experience effective pain control E) The client will verbalize concerns related to sensory loss
C, D, E Rationale: Goals of care for the client with peripheral neuropathy include remaining free of injury, controlling pain, and expressing concerns on this progressive disease. Full sensation is not always a realistic goal. Repetitive movements can contribute to the development of neuropathy.
The nurse is teaching a client about a tricyclic antidepressant that has been prescribed to treat pain associated with peripheral neuropathy. Which information should the nurse include? SATA A) "Take this medication in the morning." B) "Do not drink grapefruit juice while on this medication." C) "This medication may make you dizzy." D) "This medication may decrease your appetite." E) "It will take 4 weeks or more to reach therapeutic levels."
C, D, E Rationale: Tricyclic antidepressants may cause dizziness and loss of appetite and take 4 to 6 weeks to reach therapeutic levels. The medication should be taken at night because it causes drowsiness. Grapefruit should be avoided with antiseizure medications.
The nurse is teaching a client who has poorly controlled diabetes and peripheral neuropathy about self-care interventions. Which action is most important for this client? A) Weight loss B) Daily exercise C) Routine vision exams D) Care of the feet
D) Care of the feet Rationale: Care of the feet, which includes inspection, is important in relation to the development of peripheral neuropathy to prevent injury and infection. Exercise, weight management, and vision exams are important in the diabetic client, but care of the feet is of particular importance due to peripheral neuropathy.
*Possible Exam Question A client with peripheral neuropathy complains of leg aches and the inability to be comfortable. Which nursing diagnosis would be a priority for the client at this time? A) Anxiety B) Ineffective Peripheral Tissue Perfusion C) Ineffective Coping D) Chronic Pain
D) Chronic Pain Rationale: The client reports aching legs and an inability to be comfortable. The nursing diagnosis most appropriate for the client at this time would be Chronic Pain. Ineffective Peripheral Tissue Perfusion is the likely reason for the client's pain and discomfort, but the nurse's primary interventions for this client will relate to pain management, safety, and comfort, not to directly treating the cause of the pain. The client may have anxiety and be coping ineffectively, but the diagnosis of Chronic Pain is the priority.
Key Term: Peripheral Neuropathy
Peripheral neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased.
A client diagnosed iwth Charcot-Marie-Tooth disease asks the nurse about the cause of their peripheral neuropathy. Which response by the nurse is accurate? A) "You have inherited a disease that is degenerating your muscles." B) "An immunologic response to Campylobacter jejuni infection is causing your symptoms." C) "The cause of your peripheral neuropathy is unknown." D) "An elevated blood glucose level is damaging your blood vessels and nerves."
A) "You have inherited a disease that is degenerating your muscles." Rationale: Charcot-Marie-Tooth disease is an inherited disease causing peripheral neuropathy through the progressive degeneration of muscles. Idiopathic neuropathy occurs in30% of cases where the cause is unknown. Guillain-Barré syndrome(GBS) is often caused by an immunologic response to a Campylobacter jejuni infection.Diabetes-induced peripheral neuropathy is caused by damage from hyperglycemia.
An adolescent diagnosed with Charcot-Marie-Tooth disease asks the nurse how their ambulation will change with adulthood. Which is the best response from the nurse? A) "You will likely walk with a device such as a cane." B) "Physical therapy will allow you to walk normally." C) "You will be confined to a wheelchair." D) "You will not likely live to adulthood."
A) "You will likely walk with a device such as a cane." Rationale: The client with Charcot-Marie-Tooth disease will likely walk with a device such as a cane in adulthood. There is no indication that the adolescent will not grow into adulthood. Charcot-Marie-Tooth disease does not imply that the client will be wheelchair bound, but it is also not fully reversible with physical therapy.
The nurse identifies that a client diagnosed with diabetes is at risk of developing peripheral neuropathy. In which area of the body should the nurse expect the client to experience symptoms first? A) Bilateral feet B) Lower portion of the face C) Upper legs D) The right or left hand unilateraly
A) Bilateral feet Rationale: Peripheral neuropathy in the diabetic is a bilateral sensory disorder that starts in the lower extremities and moves upward. Bilaterally, toes and feet are affected first. The upper legs may be affected later in disease progression. The face is not usually affected by peripheral neuropathy in the diabetic. Bilaterally, hands may be affected later in disease progression.
A client has a new onset of numbness and tingling of the extremities. Which laboratory testing should the nurse anticipate to investigate the etiology of the peripheral neuropathy? SATA A) Metabolic panel B) Liver function tests C) Thyroid function tests D) Complete blood count (CBC) E) Serum thiamine
A, C, D, E Rationale: Serum thiamine, a metabolic panel, thyroid function tests, and a complete blood count are all expected diagnostic laboratory tests to investigate the etiology of peripheral neuropathy. Liver function testing is not a routine diagnostic tool for the investigation of peripheral neuropathy.
A client with motor nerve damage related to peripheral neuropathy asks the nurse why physical therapy is needed. Which is the best response from the nurse? A) "Physical therapy is not necessary if you promise to exercise regularly." B) "Physical therapy will help you maintain your ability to walk and prevent further decline." C) "Physical therapy will prevent you from needing surgery." D) "Physical therapy is covered by your health plan, so you should maximize your benefits."
B) "Physical therapy will help you maintain your ability to walk and prevent further decline." Rationale: The client with motor nerve damage related to peripheral neuropathy is at risk of injury from falls and further motor decline. Physical therapy will help the client maintain the ability to walk and prevent further decline. Physical therapy does not prevent surgery needed for compression-related causes of neuropathy. Regular exercise is needed but is not a substitute to physical therapy. Healthcare plan benefits are not the primary reason for physical therapy.
Which client's clinical manifestations are most consistent with Guillain-Barre syndrome? A) 13yo client feels weakness in the feet, ankles, and legs B) 5yo client feels leg pain and wants to be carried C) A 55yo client experiences a lack of hand strength D) A 23yo client with peripheral neuropathy has poor glycemic control
B) 5yo client feels leg pain and wants to be carried Rationale: Children younger than 6 years old with Guillain-Barré syndrome may present with a refusal to walk and pain in the legs. The 13-year-old client's feeling of weakness in the feet, ankles, and legs is likely an early manifestation of Charcot-Marie-Tooth syndrome, whereas the 55-year-old client's lack of hand strength is likely due to more advanced CMT syndrome. The 23-year-old client with poor glycemic control is likely due to diabetes, which is probably the cause of the client's peripheral neuropathy.
The nurse is caring for a client with ulnar nerve compression resulting in peripheral neuropathy of the right upper extremity. Which collaborative team member referral should the nurse identify as a priority for this client? A) A pharmacist B) A surgeon C) A physical therapist D) An endocrinologist
B) A surgeon Rationale: Peripheral neuropathy caused by compression requires surgical intervention, making the surgeon consult a priority for this client. The pharmacist and physical therapist may see the client to help with symptom management, but the surgeon is the priority consult for curative intervention. An endocrinologist would support treatment of the client with a metabolic issue, such as diabetes, to help reduce the impact of the disease on the nerves.
The nurse is caring for an older adult client with Guillain-Barre syndrome. For which factor is this client at increased risk compared to a middle-aged adult with GBS? A) Amount of medication required B) Death C) Cost D) Intensity of symptoms
B) Death Rationale: The older adult client with GBS is at increased risk of mortality, particularly if the client requires mechanical ventilation. Symptoms and treatment of a middle-aged adult with GBS is similar, with no difference in cost, intensity of symptoms, or medication requirements.
Which of the following statements regarding idiopathic neuropathy is true? A) idiopathic neuropathy is hereditary in nature B) Idiopathic neuropathy has no known cause C) Idiopathic neuropathy is caused by nutritional deficits D) Idiopathic neuropathy is caused by disease or illness
B) Idiopathic neuropathy has no known cause Rationale: Idiopathic neuropathies are from an unknown cause and account for up to 30% of neuropathies. These neuropathies are not hereditary and not caused by any identifiable factor such as nutrition or illness.
The nurse is planning care for an adolescent client recently diagnosed with Charcot-Marie-Tooth syndrome. Which intervention is the highest priority? A) Managing the client's chronic pain B) Reducing the client's risk for injury C) Addressing the client's perfusion problems D) Relaxing the client to reduce stress
B) Reducing the client's risk for injury Rationale: In the early stage of Charcot-Marie-Tooth syndrome, the disease may manifest in clumsiness due to foot drop and muscle weakness in the feet, ankles, and legs, so addressing risk for injury is the priority for this client. As the client ages, chronic pain will likely become a concern, but not likely at this stage in the disease. Addressing problems with perfusion would not be the priority here, and even if the client feels stress-induced anxiety because of the illness, that is not a priority over ensuring the safety of the client.
The nurse is planning to assess a client who reports increasing numbness and tingling in both lower legs. Which assessment technique should the nurse use to assess the client's perception of sensation? A) Deep tendon reflexes B) Vibration test C) Gait assessment D) Presence of peripheral pulses
B) Vibration test Rationale: The vibration test is used to test for sensation at the joints. Gait assessment helps to determine safety with ambulation. Deep tendon reflexes test nerve response. Peripheral pulses assess blood flow to the area.
The nurse is planning care for a client with peripheral neuropathy of the lower extremities. Which intervention should the nurse include? SATA A) Avoid massage of numb areas B) Review nutritional sources of vitamin B12 C) Reposition frequently to avoid prolonged pressure D) Discuss exercises to perform while in care and when back home E) Perform foot care
B, C, D, E Rationale: A client with peripheral neuropathy needs foot care to identify and prevent injury, vitamin B-12 to promote nerve health, repositioning to avoid pressure injury, and exercise. Massage should be performed to reduce pain and improve circulation.
The nurse is assessing a client with polyneuropathy. Which manifestation should the nurse expect to find? SATA A) Warm feet B) Numbness C) Aching pain D) Burning pain E) Shooting pain
B, C, D, E -Numbness - Aching pain - Shooting pain - Burning pain Rationale: The client with polyneuropathy is likely to experience numbness and pain described as aching, burning, or shooting. The client with polyneuropathy is most likely to feel cold feet.
The nurse is reviewing the medical history of a client with peripheral neuropathy. Which risk factor should the nurse expect to find? SATA A) Weekly B12 injections B) Daily alcohol use C) Insulin-dependent diabetes D) Height of 5ft 1in E) Cigarette smoking
B, C, E - Daily alcohol use - Insulin dependent diabetes - Cigarette smoking Rationale: Alcohol use, smoking, and diabetes are all risk factors associated with the development of peripheral neuropathy. A height of over 159 cm (5 ft 3 in.) is associated with increased risk of peripheral neuropathy. Supplementation of vitamin B-12 helps to prevent peripheral neuropathy.
The nurse is caring for a child having difficulty walking related to neuropathy associated with Guillain-Barre syndrome (GBS). Which treatment should the nurse anticipate for this child? A) Antiseizure medication B) Antidepressant medication C) IV immunoglobin D) Anti-inflammatory medication
C) IV immunoglobin Rationale: The treatment for GBS in children is IV immunoglobulin. Antiseizure, antidepressant, and anti-inflammatory medications are used for the treatment of peripheral neuropathy in adults.
A patient asks the nurse, "What is paresthesia? Which response by the nurse is accurate? A) "Paresthesia is bad leg cramps that occur with abnormal potassium and calcium levels." B) "Paresthesia is a warning sign of impending paralysis." C) "Paresthesia is a numbness, tingling, or pricking sensation." D) "Paresthesia is caused by irregular heartbeats."
C) Paresthesia is a numbness, tingling, or pricking sensation Rationale: Paresthesia is an abnormal condition in which the person feels a sensation of burning, numbness, tingling, itching, or prickling. Paresthesia can also be described as a pins-and-needles or skin-crawling sensation. Paresthesia most often occurs in the extremities, such as the hands, feet, fingers, and toes, but it can occur in other parts of the body, too. Paresthesia is not related to paralysis, potassium or calcium levels, or an irregular heartbeat.
A client with a long history of type 2 DM complains of occassional coldness and numbness in both hands and both feet. These complaints are suggestive of which condition? A) Idiopathic peripheral neuropathy B) Mononeuropathy C) Polyneuropathy D) Hereditary peripheral neuropathy
C) Polyneuropathy Rationale: Polyneuropathies, the most common types of neuropathy associated with diabetes, are bilateral sensory disorders. The manifestations appear first in the toes and feet and progress upward. The fingers and hands also may be involved, but usually only in later stages of diabetes. Mononeuropathies are isolated and affect only single nerves; they are commonly associated with injury or trauma. An idiopathic peripheral neuropathy would have no known cause, but for this client diabetes would be a likely cause of neuropathy, and diabetes is not hereditary, so there is no reason to suspect hereditary peripheral neuropathy.
The nurse is provididng client teaching on Guillain-Barre syndrome. Which explanation for a client's false perception that socks are being worn is accurate? A) Confusion is a part of this disorder, so the client is simply confused as to whether socks are being worn. B) The medications used to treat this disorder cause the client to feel as if socks are being worn. C) This disorder causes a change in sensation that makes the client feel as if socks are being worn. D) Tactile hallucinations are part of this disorder, so the client is hallucinating that socks are present.
C) This disorder causes a change in sensation that makes the client feel as if socks are being worn. Rationale: Changes in sensation related to Guillain-Barré syndrome frequently cause a "stocking-glove" pattern—in which clients feel as if stockings and gloves are being worn when they are not—as well as pain in the hands, feet, and legs. Tactile hallucinations and confusion are not part of the disorder. Medications are not causing the client to feel as if socks are being worn.
Which statement regarding risk factors for peripheral neuropathy is accurate? A) Extremely short people are at the highest risk for developing peripheral neuropathy B) Height is a risk factor for women but not a proven risk factor for men C) Height is a risk factor for men but not a proven risk factor for women D) Risk for peripheral neuropathy is proportional to height for both men and women
D) Risk for peripheral neuropathy is proportional to height for both men and women Rationale: ) Height has been identified as a risk factor for the development of peripheral neuropathy, independent of gender or presence of diabetes mellitus. Men who are taller than 167 cm (5 ft 6 in.) and women who are taller than 159 cm (5 ft 3 in.) are at higher risk for developing peripheral neuropathy than individuals of shorter height, and they are at higher risk of amputation if they do develop peripheral neuropathy.
At which stage of pregnancy is Guillain-Barre syndrome most likely to cause neuropathy? A) First trimester B) Second trimester C) Postpartum period D) Third trimester
D) Third trimester Rationale: GBS is likely to affect the pregnant woman in the third trimester. The nurse should assess for peripheral loss of sensation in all stages of pregnancy, but the third trimester is the most likely time for GBS.
The nurse is conducting a health history for a patient who may have peripheral neuropathy. Which finding in the patient's history is considered a risk factor for this disorder? A) Glaucoma B) Early menopause C) Osteoporosis D) Vitamin B deficiency
D) Vitamin B deficiency Rationale: Vitamin B deficiency is a risk factor for developing peripheral neuropathy. Early menopause, osteoporosis, and glaucoma are not associated with the development of peripheral neuropathy.