Ch 44. Patients with Problems of the Peripheral Nervous System

The patient with Restless Leg Syndrome (RLS) has been prescribed Gabapentin. What does the nurse teach the patient about this medication? 1. Be careful while driving because it may cause drowsiness. 2. Gabapentin is an opioid that may cause respiratory depression. 3. Melatonin may be taken to treat insomnia caused by Gabapentin. 4. Gabapentin may cause iron and magnesium deficiencies.

1 Rationale Gabapentin is an antiepileptic drug. These drugs are usually taken at bedtime because they can cause daytime sleepiness. Opioids are prescribed for RLS as a last resort. Melatonin may be taken at bedtime for insomnia that is caused by RLS. Correcting iron and magnesium deficiencies can reduce RLS symptoms. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p. 926

GBS may also be referred to by what other names? **SATA** 1. acute idiopathic polyneuritis 2. acute inflammatory demyelinating polyneuropathy (AIDP) 3. acute motor axonal neuropathy (AMAN) 4. acute motor and sensory axonal neuropathy

1, 2, 3, 4

What drugs can precipitate or worsen myasthenia gravis (MG)? **SATA** 1. Antidysrhythmics 2. Beta-blocking agents 3. Anticholinesterases 4. Opioids 5. Corticosteroids

1, 2, 4 Rationale Antidysrthymics, beta-blocking agents, and opioids may precipitate or worsen myasthenia gravis (MG). Anticholinesterases and corticosteroids are used to manage MG. p. 922

What factors are suspected to be associated with the development of Guillain-Barré syndrome (GBS)? **SATA** 1. Infection with Campylobacter jejuni 2. Use of selective serotonin reuptake inhibitors (SSRIs) 3. Epstein-Barr viral infection 4. Infection with cytomegalovirus 5. Previous injury to the spinal cord (3 years or less) 6. Pregnancy

1, 3, 4 Rationale GBS is associated with bacterial infection, especially infection with Campylobacter jejuni. Influenza, Epstein-Barr, and cytomegalovirus viral infections have also been associated with GBS. There are other anecdotal and case reports from patients with surgery, trauma, and pregnancy who also developed GBS, but numbers are not sufficient to establish a causal relationship. There are also reports of some vaccines increasing the risk for GBS slightly, but epidemiologic evidence is weak. p. 914

A patient with an onset of Guillain-Barré syndrome is hospitalized in the critical care unit. What nursing interventions are needed for this patient?**SATA** 1. Check for adventitious breath sounds. 2. Auscultate the lungs every 8 hours. 3. Check for dyspnea and air hunger. 4. Assess respiratory rate, rhythm, and depth. 5. Check vital capacity every 6-8 hours. 6. Check for increased oxygen saturation.

1, 3, 4 Rationale In the initial phase of Guillain-Barré syndrome, the nurse should monitor the patient for signs of respiratory distress such as adventitious breath sounds, dyspnea, and air hunger. In addition, the respiratory rate, rhythm, and depth are monitored every 1-2 hours. In collaboration with the respiratory therapist, the lungs are auscultated at 4-hour intervals and vital capacity is checked every 2-4 hours. The nurse also monitors the patient for decreased oxygen saturation. p. 916

In caring for a patient with myasthenia gravis (MG), the nurse should keep which item by the bedside? 1. Tongue depressor 2. Ambu bag 3. Prefilled syringe of calcium gluconate 4. Automatic external defibrillator (AED)

2 Rationale Because of the respiratory complications associated with myasthenia gravis, the nurse should keep an Ambu bag by the bedside. Nurses should never place anything in the patient's mouth. The prefilled syringe of calcium is typically for the postoperative thyroidectomy patient at risk for removal of the parathyroid and calcium loss. The AED should always be available, but it does not need to be at the bedside since the majority of complications are due to respiratory depression. p. 919

The nurse is providing care for a patient who has a burning sensation in the legs at bedtime and constant leg movement. Which diagnosis does the nurse suspect on the basis of these initial data? 1. Bell's palsy 2. Restless leg syndrome 3. Peripheral nerve trauma 4. Eaton-Lambert syndrome

2 Rationale Clinical manifestations associated with restless leg syndrome include a burning or crawling-type sensation in the legs and constant leg movement. Bell's palsy involves the complete paralysis of facial muscles in the affected area. The patient cannot close his or her eyes, wrinkle the forehead, smile, whistle, or grimace. Peripheral nerve trauma may be caused by mechanical or vehicular accidents and sports. Eaton-Lambert syndrome is a type of myasthenia gravis. The characteristic symptoms of this disorder are ptosis, diplopia, and dysphagia. p. 925

When caring for a patient with myasthenia gravis, the nurse notices the patient's eyelids are drooping. What term best describes this phenomenon? 1. Diplopia 2. Ptosis 3. Dysphagia 4. Thymoma

2 Rationale Drooping eyelids is also called ptosis. Diplopia is the term for double vision. Dysphagia refers to difficulty in chewing or swallowing. A thymoma is an encapsulated thymus gland tumor. p. 918

What other term is used to refer to Guillain-Barré syndrome? 1. Cranial polyneuritis 2. Eaton-Lambert syndrome 3. Polyradiculoneuropathy 4. Trigeminal neuralgia

3 Rationale Guillain-Barré syndrome is also called polyradiculoneuropathy because it is a polyneuropathy affecting peripheral nerves. Cranial polyneuritis is the term for Bell's palsy. Eaton-Lambert syndrome is a type of myasthenia gravis. Trigeminal neuralgia is a disease affecting the trigeminal nerve or cranial nerve V. p. 913

The nurse caring for a patient with Guillain-Barré syndrome is assessing the functions of the patient's cranial nerves. What cranial nerve deficit may be present if the patient is unable to shrug the shoulders? 1. Glossopharyngeal nerve 2. Vagus nerve 3. Accessory nerve 4. Hypoglossal nerve

3 Rationale If the patient is unable to shrug the shoulders, the accessory nerve may be damaged. If the patient has glossopharyngeal and vagus nerve deficits, the patient would be unable to cough, gag, or swallow. The patient may be unable to stick the tongue out straight if there is a deficit in the hypoglossal nerve. p. 914

Which phase of Guillain-Barré syndrome (GBS) coincides with axonal regeneration? 1. Acute phase 2. Plateau period 3. Recovery phase 4. Chronic phase

3 Rationale The recovery phase (gradually over 4 to 6 months, maybe up to 2 years) is thought to coincide with remyelination and axonal regeneration. The acute phase begins with onset of the first symptoms and ends when no further deterioration occurs. The plateau period follows the acute phase before remyelination and axonal regeneration occurs. Some patients do not completely recover and have permanent neurologic deficits, referred to as chronic GBS. 914

Which laboratory result is consistent with the diagnosis of Guillain-Barré syndrome (GBS)? 1. Positive rheumatoid factor 2. Decreased serum albumin 3. Increased protein in the cerebrospinal fluid 4. Decreased erythrocyte sedimentation rate

3. Rationale An increase in the cerebrospinal fluid protein level occurs in GBS due to the release of plasma proteins from inflammation and damage to nerve roots. This release does not affect serum protein levels, which remain normal. The rheumatoid factor is not elevated in this disease and the erythrocyte sedimentation rate could rise. p. 914

What is the priority nursing intervention for a patient with rapidly ascending Guillain-Barré Syndrome (GBS)? 1. Initiate plasmapheresis or IVIG 2. Obtain, order, and administer corticosteroids 3. Assess and document vital signs and fluid status 4. Maintain airway patency and adequate gas exchange

4 Rationale Inability to maintain an airway is a high risk and potentially fatal consequence of rapidly ascending GBS. The priority nursing intervention is to promote airway patency and adequate gas exchange. Plasmapheresis or IVIG are the primary treatment for GBS but the priority nursing intervention is to ensure a patent airway. Corticosteroids are not used unless medically indicated for associated diseases. Assessment and documentation of fluid status and vital signs is important but is not the priority intervention. p. 915

The patient presents with complaints of pain, numbness, and paresthesias for the past two days and now has sudden onset of lower extremity muscle weakness. The nurse expects the patient to be tested for which neurological disease? 1. Bell's palsy 2. Myasthenia Gravis 3. Trigeminal neuralgia 4. Guillain-Barré Syndrome

4 Rationale Pain, numbness, parasthesias, and sudden onset of muscle weakness are classic signs of Guillain-Barré Syndrome. Symptoms of Bell's palsy include facial paralysis; the face appears masklike and sags. Myasthenia gravis is characterized by diplopia and dysphagia. Trigeminal neuralgia is a chronic pain syndrome; this patient had symptoms that came on suddenly. p. 914

A patient with myasthenia gravis (MG) has been hospitalized after a myasthenic crisis. Once the patient is free from respiratory symptoms, which diet does the nurse anticipate the provider to order for this patient? 1. Clear liquid 2. Full liquid 3. Regular 4. Soft

4 Rationale Patients with MG have difficulty chewing and swallowing; the patient will do best with a soft diet. There is no need for a clear liquid diet to be ordered for this patient. Liquid diets increase the risk for aspiration. Regular diets are difficult for patients with MG to chew. p. 921