Nursing Care of Patients With Peripheral Nervous System Disorders

"Time your medication so that its action is peaking during the time you need the most energy."

A mother of three young children who has a 3-year history of myasthenia gravis has had to stop helping in the children's classrooms in the morning because of fatigue. What should the nurse say to help the patient best cope with the problem? a. "You need to realize that you may not be able to do the things you used to do." b. "Time your medication so that its action is peaking during the time you need the most energy." c. "Getting plenty of sleep the night before you are scheduled to help will give you the stamina you need." d. "If you wait to take your medication after you finish helping in the classroom, you may find that your energy level is better."

"It may be an autoimmune reaction to a virus."

A patient diagnosed with Guillain-Barré syndrome (GBS) asks how the disease developed since the patient rarely has an illness. What nursing response is the most accurate? a. "No one knows what causes it." b. "It may be an autoimmune reaction to a virus." c. "It most often occurs as a result of a bacterial infection." d. "It is usually hereditary. Does anyone in your family have it?"

The manifestations can last up to 2 weeks

A patient in the plateau stage of Guillain-Barre syndrome is frustrated because there has not been any improvement in manifestations for 5 days. What should the nurse explain to the patient? a. The manifestations can last up to 2 weeks b. The manifestations can last up to 3 weeks c. The manifestations can last up to 6 months d. The manifestations can last up to 24 months

Myasthenia gravis (MG)

A patient is scheduled for a thymectomy. For which peripheral nervous system disorder should the nurse plan care for this patient? a. Multiple sclerosis (MS) b. Myasthenia gravis (MG) c. Guillain-Barré syndrome (GBS) d. Amyotrophic lateral sclerosis (ALS)

"It makes more neurotransmitter available so that your muscles can contract."

A patient who is prescribed neostigmine (Prostigmin) for newly diagnosed myasthenia gravis (MG) asks how the medication works. What should the nurse respond to the patient? a. "It is a muscle relaxant that prevents the cramping in your muscles." b. "It provides potassium to your muscles so that they will contract better." c. "It makes more neurotransmitter available so that your muscles can contract." d. "It reduces the inflammation in your nerves so that they transmit signals better.

Taste and chewing are affected.

A patient with Bell's palsy has lost 10 pounds since being diagnosed. Why should the nurse plan interventions to address the risk for nutrition problems? a. Appetite is diminished. b. Taste and chewing are affected. c. Nutrients are not absorbed efficiently. d. The patient may have difficulty preparing foods.

Inability to close the affected eye

A patient with Bell's palsy is experiencing symptoms. Which symptom should the nurse address first? a. Changes in taste b. Speech difficulty c. Drooping of one side of the face d. Inability to close the affected eye

Suction

A patient with amyotrophic lateral sclerosis has difficulty swallowing and copious pulmonary secretions. What equipment should the nurse ensure is at the bedside at all times? a. Tissues b. Suction c. Oxygen d. Tongue blade

C, D, F

A patient with multiple sclerosis has been prescribed baclofen (Lioresal) to relax muscles. What should be included in the nurse's teaching about this drug? (Select all that apply.) a. "Avoid crowds while on this medication." b. "Take a calcium supplement while on this medication." c. "Report any shortness of breath or other respiratory problems." d. "Do not drive or operate machinery until the effects of the drug on you are known." e. "Do not eat grapefruit, drink grapefruit juice, or consume other products containing grapefruit." f. "Try to prevent constipation by adequate fluid intake, eating fiber-rich foods, and using suppositories occasionally if necessary."

Observe for grimacing or agitation

A patient with multiple sclerosis is unable to verbally communicate needs. Which approach should the nurse use to assess this patient for pain? a. Observe for grimacing or agitation b. Ask the patient to press the call light if pain is present c. Schedule pain medication every 4 hours around the clock d. Offer pain medication every shift with routine medications

Provide soft foods at body temperature at mealtimes.

A patient with trigeminal neuralgia is admitted to the hospital for diagnostic testing and possible surgery. What intervention would be the most appropriate for this patient? a. Provide tissues for the patient to deal with drooling. b. Provide frequent mouth care with a firm toothbrush. c. Provide soft foods at body temperature at mealtimes. d. Provide a fan in the room to keep the room well ventilated.

A, B, C, D

After frequent examinations a patient is diagnosed with amyotrophic lateral sclerosis (ALS). Which test results should the nurse review as confirmation of this diagnosis? (Select all that apply.) a. Nerve biopsy b. Electroencephalogram c. Nerve conduction velocity d. Analysis of cerebrospinal fluid e. CT scan of the brain and spinal cord

"I have to take my Prostigmin exactly as prescribed without skipping a dose."

The nurse is assisting with discharging a patient with myasthenia gravis after hospitalization for severe respiratory distress. Which patient statement indicates that the nurse's discharge teaching has been effective? a. "If I develop muscle cramping, I can take quinine as needed." b. "I have to take my Prostigmin exactly as prescribed without skipping a dose." c. "I know I should take my Prostigmin as needed, whenever I feel short of breath." d. "I will take my anticholinergic medication to prevent developing respiratory distress again."

Ptosis is temporarily improved.

The nurse is assisting with the administration of a Tensilon test. What response to the test causes the nurse to suspect that the patient has myasthenia gravis? a. Dyspnea develops b. Muscle cramps develop c. Muscles become very weak. d. Ptosis is temporarily improved.

Demyelination and destruction of nerve fibers

The nurse is caring for a patient experiencing an acute exacerbation of multiple sclerosis (MS). Which pathophysiological change should the nurse recognize as causing the manifestations of MS? a. Myelin buildup in the central nervous system b. Demyelination and destruction of nerve fibers c. Gamma aminobutyric acid (GABA) deficiency d. Reduced acetylcholine receptors with impaired nerve impulse transmission

A, E

The nurse is caring for a patient who is being tested for possible myasthenia gravis (MG). Which early symptoms of myasthenia gravis should the nurse document in the medical record? (Select all that apply.) a. Ptosis b. Nausea c. Tremor d. Confusion e. Weakness f. Numbness of the extremities

E,F

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). Which assessment findings should the nurse anticipate? (Select all that apply.) a. Hemiparesis b. Bradykinesia c. Pill-rolling tremor d. Ascending paralysis e. Progressive weakness f. Decreased coordination of extremities

Urinary tract infection

The nurse is caring for a patient with an exacerbation of multiple sclerosis (MS). What should the nurse include when teaching the patient about risk factors for exacerbation? a. Vegetarian diet b. Exposure to sun c. Sedentary lifestyle d. Urinary tract infection

Pyridostigmine (Mestinon)

The nurse is caring for a patient with an exacerbation of multiple sclerosis. Which medication should the nurse anticipate administering to this patient? a. Thyrotropin b. Pyridostigmine (Mestinon) c. Diphenhydramine (Benadryl) d. Adrenocorticotropic hormone (ACTH)

A, B

The nurse is caring for a patient with post-polio syndrome. What should the nurse explain to the patient in preparation for discharge? (Select all that apply.) a. Engage in moderate exercise. b. Ensure an adequate amount of rest each day. c. Schedule periods of intense physical activity. d. Spend several hours each day in direct sunlight. e. Reduce the intake of high protein high fat foods.

A, B, F

The nurse is explaining the difference between Bell's palsy and trigeminal neuralgia to a nursing assistant. What should the nurse include as characteristics of Bell's palsy? (Select all that apply.) a. Drooling b. Facial droop c. Sudden onset d. Airflow sensitivity e. Sensitivity to temperature f. Loss of taste over anterior part of tongue

Use lukewarm water and cotton balls.

The nurse is helping a patient with trigeminal neuralgia with bathing. Which action should the nurse take when washing the patient's face? a. Use hot water and antibacterial soap. b. Use lukewarm water and cotton balls. c. Use cold water to reduce inflammation. d. Use a washcloth to stimulate circulation.

Complete blood count, platelets, and clotting studies

The nurse is preparing a patient with myasthenia gravis to undergo plasmapheresis. Which laboratory tests should the nurse verify and place on the medical record before the procedure? a. Urine analysis, urine protein, BUN, and creatinine b. Complete blood count, platelets, and clotting studies c. Creatinine phosphokinase, blood type, and electrolytes d. Electrolytes, blood urea nitrogen (BUN), creatinine, and albumin

Arterial blood gases (ABGs)

The nurse is providing care to a patient with Guillain-Barré syndrome. Which laboratory result should the nurse evaluate first? a. Electrolytes b. Blood urea nitrogen (BUN) c. Arterial blood gases (ABGs) d. Hemoglobin (Hgb) and hematocrit (Hct)

Request an order for ointment and a patch.

The nurse is providing eye care to a patient with Bell's palsy. Which nursing action is most appropriate to help protect the affected eye? a. Keep the room lights dim at all times. b. Check for pupil response twice a day. c. Request an order for ointment and a patch. d. Apply a warm moist compress to the eye three times a day.

Pain related to inflammation of cranial nerve V

The nurse is reviewing nursing diagnoses identified for a patient with trigeminal neuralgia. Which nursing diagnosis should the nurse identify as a priority for this patient? a. Ineffective coping b. Self-care deficit: hygiene c. Pain related to inflammation of cranial nerve V d. Imbalanced nutrition: less than body requirements

A, B, C, E, F

The nurse is teaching a patient with myasthenia gravis how to recognize a cholinergic crisis. What manifestations should the nurse include in this teaching? (Select all that apply.) a. Diarrhea b. Salivation c. Vomiting d. Difficulty speaking e. Abdominal cramping f. Increased bronchial secretions

B, C, D, E

The nursing diagnosis Ineffective Airway Clearance has been identified for a patient with multiple sclerosis. Which interventions should the nurse include in this patient's plan of care? (Select all that apply.) a. Measure intake and output b. Elevate the head of the bed c. Evaluate gag reflex every shift d. Monitor oxygen saturation twice a shift e. Encourage deep breathing and coughing every 2 hours