LEWIS CHAPTER 61 - PERIPHERAL NERVE AND SPINAL CORD
PROBLEMS (PRE-TEST, BRIDGE NCLEX, NCLEX REVIEW, STUDY
QUESTIONS)
The nurse cares for a 63-year-old woman taking prednisone (Deltasone) and
acyclovir (Zovirax) for Bell's palsy. It is most important for the nurse to follow up
on which patient statement?
A. "I can take both medications with food or milk."
B. "I will take these medications for 2 to 3 months."
C. "I can take acetaminophen with the prescribed medications."
D. "Chances of a full recovery are good if I take the medications."
b
Prednisone and acyclovir will usually be prescribed for 10 days. Prednisone will be
tapered over the last 4 days of treatment. Oral prednisone and acyclovir may be taken
with food or milk to decrease gastrointestinal upset. Patients with Bell's palsy usually
begin recovery in 2 to 3 weeks, and most patients have complete recovery in 2 to 3
months. Patients have the best chance for full recovery if prednisone is initiated before
complete paralysis occurs. There are no serious drug interactions among prednisone,
acyclovir, and acetaminophen.
A 42-year-old man is admitted to the hospital with a diagnosis of Guillain-Barré
syndrome. The physician orders include IV Sandoglobulin. What is important for
the nurse to assess for before administration?
A. Elevated fasting blood glucose and serum albumin
B. Elevated activated partial thromboplastin time (aPTT)
C. Elevated serum creatinine and blood urea nitrogen (BUN)
D. Elevated aspartate aminotransferase and alanine aminotransferase
c
Patients receiving IV administration of high-dose immunoglobulin (Sandoglobulin) need
to be well hydrated and have adequate renal function. Elevated serum creatinine and
blood urea nitrogen indicate impaired renal function.
The nurse performs discharge teaching for a 34-year-old male patient with a T2
spinal cord injury resulting from a construction accident. Which statement, if
made by the patient to the nurse, indicates that teaching about recognition and
management of autonomic dysreflexia is successful?
A. "I will perform self-catheterization at least six times per day."
B. "A reflex erection may cause an unsafe drop in blood pressure."
C. "If I develop a severe headache, I will lie down for 15 to 20 minutes."
D. "I can avoid this problem by taking medications to prevent leg spasms."
a
Autonomic dysreflexia is usually caused by a distended bladder. Performing self-
, catheterization five or six times a day prevents bladder distention. Signs and symptoms
of autonomic dysreflexia include a severe headache. Patients should raise the head of
the bed to 45 to 90 degrees. This action helps to relieve hypertension (systolic pressure
up to 300 mm Hg) that occurs with autonomic dysreflexia.
A 19-year-old man is admitted to the emergency department with a C6 spinal cord
injury after a motorcycle crash. Which medication should the nurse anticipate
that she will administer first?
A. Enoxaparin (Lovenox)
B. Metoclopramide (Reglan)
C. IV immunoglobulin (Sandoglobulin)
D. Methylprednisolone sodium succinate (Solu-Medrol)
d
Methylprednisolone (MP) blocks lipid peroxidation by-products and improves blood flow
and reduces edema in the spinal cord. High-dose MP should be administered within 8
hours of injury. Enoxaparin is a low-molecular-weight heparin used to prevent deep vein
thrombosis. Metoclopramide is used to treat delayed gastric emptying. IV
immunoglobulin (Sandoglobulin) is used to treat Guillain-Barré syndrome.
A 22-year-old female with paraplegia after a spinal cord injury tells the home care
nurse that bowel incontinence occurs two or three times each day. Which action
by the nurse is most appropriate?
a. Take magnesium citrate (Citroma) every morning with breakfast.
b. Teach the patient to gradually increase intake of high-fiber foods.
c. Assess bowel movements for frequency, consistency, and volume.
d. Instruct the patient to avoid all caffeinated and carbonated beverages.
c
The nurse should establish baseline bowel function and explore the patient's current
knowledge of an appropriate bowel management program after spinal cord injury. To
prevent constipation, caffeine intake should be limited, but not eliminated. Oral saline
laxatives such as magnesium citrate are not indicated for long-term management of
bowel elimination. Instruction on high-fiber foods is indicated if the patient has a
knowledge deficit.
You suspect Bell's palsy in which patient?
A. Unilateral facial droop with contralateral extremity weakness
B. Sudden onset one-sided facial weakness with ear pain and vesicles
C. Sharp, knife-like facial pain when eating hot or cold foods
D. Inability to shrug the shoulders against resistance
B. Sudden onset one-sided facial weakness with ear pain and vesicles
Bell's palsy is an acute, peripheral facial paresis of unknown cause without systemic
effects. Facial droop is found in stroke. Sharp facial pain occurs with trigeminal
neuralgia. An inability to shrug the shoulders describes pathology of cranial nerve XI.
What should the patient with Bell's palsy be cautioned against?
A. Cornea dryness
B. Driving while experiencing diplopia
PROBLEMS (PRE-TEST, BRIDGE NCLEX, NCLEX REVIEW, STUDY
QUESTIONS)
The nurse cares for a 63-year-old woman taking prednisone (Deltasone) and
acyclovir (Zovirax) for Bell's palsy. It is most important for the nurse to follow up
on which patient statement?
A. "I can take both medications with food or milk."
B. "I will take these medications for 2 to 3 months."
C. "I can take acetaminophen with the prescribed medications."
D. "Chances of a full recovery are good if I take the medications."
b
Prednisone and acyclovir will usually be prescribed for 10 days. Prednisone will be
tapered over the last 4 days of treatment. Oral prednisone and acyclovir may be taken
with food or milk to decrease gastrointestinal upset. Patients with Bell's palsy usually
begin recovery in 2 to 3 weeks, and most patients have complete recovery in 2 to 3
months. Patients have the best chance for full recovery if prednisone is initiated before
complete paralysis occurs. There are no serious drug interactions among prednisone,
acyclovir, and acetaminophen.
A 42-year-old man is admitted to the hospital with a diagnosis of Guillain-Barré
syndrome. The physician orders include IV Sandoglobulin. What is important for
the nurse to assess for before administration?
A. Elevated fasting blood glucose and serum albumin
B. Elevated activated partial thromboplastin time (aPTT)
C. Elevated serum creatinine and blood urea nitrogen (BUN)
D. Elevated aspartate aminotransferase and alanine aminotransferase
c
Patients receiving IV administration of high-dose immunoglobulin (Sandoglobulin) need
to be well hydrated and have adequate renal function. Elevated serum creatinine and
blood urea nitrogen indicate impaired renal function.
The nurse performs discharge teaching for a 34-year-old male patient with a T2
spinal cord injury resulting from a construction accident. Which statement, if
made by the patient to the nurse, indicates that teaching about recognition and
management of autonomic dysreflexia is successful?
A. "I will perform self-catheterization at least six times per day."
B. "A reflex erection may cause an unsafe drop in blood pressure."
C. "If I develop a severe headache, I will lie down for 15 to 20 minutes."
D. "I can avoid this problem by taking medications to prevent leg spasms."
a
Autonomic dysreflexia is usually caused by a distended bladder. Performing self-
, catheterization five or six times a day prevents bladder distention. Signs and symptoms
of autonomic dysreflexia include a severe headache. Patients should raise the head of
the bed to 45 to 90 degrees. This action helps to relieve hypertension (systolic pressure
up to 300 mm Hg) that occurs with autonomic dysreflexia.
A 19-year-old man is admitted to the emergency department with a C6 spinal cord
injury after a motorcycle crash. Which medication should the nurse anticipate
that she will administer first?
A. Enoxaparin (Lovenox)
B. Metoclopramide (Reglan)
C. IV immunoglobulin (Sandoglobulin)
D. Methylprednisolone sodium succinate (Solu-Medrol)
d
Methylprednisolone (MP) blocks lipid peroxidation by-products and improves blood flow
and reduces edema in the spinal cord. High-dose MP should be administered within 8
hours of injury. Enoxaparin is a low-molecular-weight heparin used to prevent deep vein
thrombosis. Metoclopramide is used to treat delayed gastric emptying. IV
immunoglobulin (Sandoglobulin) is used to treat Guillain-Barré syndrome.
A 22-year-old female with paraplegia after a spinal cord injury tells the home care
nurse that bowel incontinence occurs two or three times each day. Which action
by the nurse is most appropriate?
a. Take magnesium citrate (Citroma) every morning with breakfast.
b. Teach the patient to gradually increase intake of high-fiber foods.
c. Assess bowel movements for frequency, consistency, and volume.
d. Instruct the patient to avoid all caffeinated and carbonated beverages.
c
The nurse should establish baseline bowel function and explore the patient's current
knowledge of an appropriate bowel management program after spinal cord injury. To
prevent constipation, caffeine intake should be limited, but not eliminated. Oral saline
laxatives such as magnesium citrate are not indicated for long-term management of
bowel elimination. Instruction on high-fiber foods is indicated if the patient has a
knowledge deficit.
You suspect Bell's palsy in which patient?
A. Unilateral facial droop with contralateral extremity weakness
B. Sudden onset one-sided facial weakness with ear pain and vesicles
C. Sharp, knife-like facial pain when eating hot or cold foods
D. Inability to shrug the shoulders against resistance
B. Sudden onset one-sided facial weakness with ear pain and vesicles
Bell's palsy is an acute, peripheral facial paresis of unknown cause without systemic
effects. Facial droop is found in stroke. Sharp facial pain occurs with trigeminal
neuralgia. An inability to shrug the shoulders describes pathology of cranial nerve XI.
What should the patient with Bell's palsy be cautioned against?
A. Cornea dryness
B. Driving while experiencing diplopia
