MSN Exam for Guillain-Barré Syndrome

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1) Which patient should be assigned to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for 1 week?

  1. A 34-year-old patient newly diagnosed with multiple sclerosis (MS)
  2. A 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS)
  3. A 56-year-old patient with Guillain-Barre syndrome (GBS) in respiratory distress
  4. A 25-year-old patient admitted with CA level spinal cord injury (SCI)

2) A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?

  1. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.”
  2. “You’ll have to accept the fact that you’re permanently paralyzed. However, you won’t have any sensory loss.”
  3. “It must be hard to accept the permanency of your paralysis.”
  4. “You’ll first regain use of your legs and then your arms.”

3) A client with Guillain-Barré syndrome has been on a ventilator for three weeks, and can communicate only with eye blinks because of quadriplegia. The intensive care nursing staff sometimes have no time for this tedious communication process. The client’s family comes infrequently since they run a family-owned restaurant that does not close until visiting hours are over. How should the nurse respond to the family’s request for exemption from visiting hours?

  1. Arrange for a volunteer to stay with the client during the day to provide for socialization needs and to facilitate communication with staff.
  2. Explain to the family that consistency in enforcing rules is important to prevent complaints from the families of other clients.
  3. Suggest that the family visit in shifts during the normal visiting hours, since the client needs to sleep at night.
  4. Make an exception to visiting regulations because of the long-term nature of the client’s recovery and the need for family support.

4) A male client is hospitalized with Guillain-Barre Syndrome. Which assessment finding is the most significant?

  1. Even, unlabored respirations
  2. Soft, non distended abdomen
  3. Urine output of 50 ml/hr
  4. Warm skin

5) Female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has history of:

  1. Seizures or trauma to the brain
  2. Meningitis during the last 5 years
  3. Back injury or trauma to the spinal cord
  4. Respiratory or gastrointestinal infection during the previous month.

6) A female client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness?

  1. Giving client full control over care decisions and restricting visitors
  2. Providing positive feedback and encouraging active range of motion
  3. Providing information, giving positive feedback, and encouraging relaxation
  4. Providing intravaneously administered sedatives, reducing distractions and limiting visitors

7) A 40n year old male patient is complaining of chronic progressive and mental deterioration is admitted to the unit. The nurse recognizes that these characteristics indicate a disease that results in degeneration of the basal ganglia and cerebral cortex. The disease is called:

  1. multiple sclerosis
  2. myasthenia gravis
  3. Huntington’s disease
  4. Guillain-Barre syndrome

8) A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

  1. pH, 5.0; PaCO2 30 mm Hg
  2. pH, 7.40; PaCO2 35 mm Hg
  3. pH, 7.35; PaCO2 40 mm Hg
  4. pH, 7.25; PaCO2 50 mm Hg
Answers and Rationales
  1. B. A 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS) . The traveling is relatively new to neurologic nursing and should be assigned patients whose conditions are stable and not complex. The newly diagnosed patient will need to be transferred to the ICU. The patient with C4 SCI is at risk for respiratory arrest. All three of these patients should be assigned to nurses experienced in neurologic nursing care. Focus: Assignment
  2. A. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.” The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.
  3. D. Make an exception to visiting regulations because of the long-term nature of the client’s recovery and the need for family support.The need for family support is vital to prevent discouragement and depression. A volunteer will not take the place of family. The need for family support is vital to prevent discouragement and depression, even at the risk of offending the families of other patients. Loss of a breadwinner during the lengthy recovery process may add financial problems for the family. Guillain-Barré syndrome is characterized by the onset of ascending paralysis, which may include respiratory muscles. Persons with Guillain-Barré syndrome may remain ventilator-dependent for weeks, but have full consciousness. The prognosis for recovery from Guillain-Barré syndrome is good, but is very much dependent upon the level of supportive care during the acute stage.
  4. A. Even, unlabored respirations
  5. D. Respiratory or gastrointestinal infection during the previous month. Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery.
  6. C. Providing information, giving positive feedback, and encouraging relaxation. The client with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client’s condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.
  7. C. Huntington’s disease. Huntington’s disease is a hereditary disease in which degeneration of the basal ganglia and cerebral cortex causes chronic progressive chorea (muscle twitching) and mental deterioration, ending in dementia. Huntington’s disease usually strikes people ages 25 to 55.
  8. D. pH, 7.25; PaCO2 50 mm Hg. In respiratory acidosis, ABG analysis reveals an arterial pH below 7.35 and partial pressure of arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value of 30 mm Hg indicates respiratory alkalosis.