Chapter 71: Management of Clients with Peripheral Nervous System Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 71: Management of Clients with Peripheral Nervous System Disorders

MULTIPLE CHOICE

1. The client hospitalized for severe lumbar disk pain asks the nurse to equip his bed with a trapeze. In response to this request, the nurse should

a.

apply the trapeze mount to the bed.

b.

call the physician for an order for the trapeze.

c.

delay applying the trapeze mount until the client is more comfortable.

d.

explain that a trapeze is contraindicated because it promotes twisting.

ANS: D

Trapezes promote the twisting of the spine and are contraindicated for people with lumbar disk disease.

DIF: Comprehension/Understanding REF: p. 1877 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

2. On the second postoperative day following herniated disk surgery, the client says, My legs are numb. I thought surgery was going to fix my problems. The nurses best response to explain the continued pain is

a.

Because of the surgery, there is some swelling, which should subside.

b.

This pain is from the anesthesia and will subside by this afternoon.

c.

This pain is positional and will subside if you roll over on your side.

d.

You are probably moving around too much. I will raise the knee gatch.

ANS: A

Following spinal surgery, the nurse should question the client about pain and paresthesias. New paresthesias are probably related to swelling from the surgery, but the surgeon should be notified about their development. If progressive weakness or paralysis of the lower extremities, loss of sphincter control, anal numbness, or urinary retention occurs, emergency surgical decompression may be required.

DIF: Application/Applying REF: p. 1877 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

3. The spouse of a client who suffers from chronic back pain is exasperated by the clients crankiness and sarcastic way of talking. The nurse should base a response to the spouse based on the knowledge that

a.

chronic pain can lead to depression and personality changes.

b.

clients with back pain often become addicted to narcotics.

c.

often spouses are not supportive and this frustrates the clients.

d.

when clients are non-compliant with treatment plans, they often act out.

ANS: A

Research shows that clients with chronic back pain are often frustrated because there is no cut-and-dried approach to this condition, as opposed to other conditions where treatment plans are well-known. Living in chronic pain combined with no clear diagnosis and no cure in sight often leads to depression and personality changes.

DIF: Comprehension/Understanding REF: p. 1875 OBJ: Intervention

MSC: Psychological Integrity Psychosocial Adaptation-Psychopathology

4. In performing a neurologic evaluation of a client who had lumbar surgery 36 hours ago, it is important that the nurse assess

a.

ability to move shoulders.

b.

leg movement.

c.

level of consciousness.

d.

reflex response.

ANS: B

Assess neurologic function by asking the client to move his or her legs and then comparing the results with those of the baseline evaluation.

DIF: Application/Applying REF: p. 1877 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

5. On the first postoperative day, a client who had a cervical surgery requests the bedpan often, but cannot void. Based on these observations, the nurse should

a.

assess for bladder distention.

b.

assess for manifestations of urinary tract infection.

c.

document this outcome as normal.

d.

increase fluid intake.

ANS: A

Cervical surgery may affect the parasympathetic chain, causing urinary retention.

DIF: Analysis/Analyzing REF: p. 1882 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

6. Before the administration of the first dose of carbamazepine (Tegretol) to a client with trigeminal neuralgia, the nurse should

a.

assess the clients deep tendon reflexes.

b.

check the clients blood pressure.

c.

determine if the client abuses alcohol.

d.

remind the client to remain in bed for 20 minutes after receiving the drug.

ANS: C

Liver impairment may result from administration of both carbamazepine and phenytoin. Liver enzymes must be monitored before and during therapy. These medications should be used cautiously in clients with a history of alcohol abuse.

DIF: Application/Applying REF: p. 1885 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

7. A client with Bells palsy tells the nurse that s/he is very depressed about having the disease. The most informative response from the nurse would be

a.

Bells palsy can be treated successfully with medication.

b.

I understand how you feel; it is difficult to live with a chronic disease.

c.

Surgery has been very successful in improving the problem.

d.

The symptoms are likely to disappear or get better within a few weeks.

ANS: D

Most clients recover from Bells palsy within a few weeks without residual manifestations. Medications can be used if needed and include analgesics, corticosteroids, and acyclovir. Giving the client information helps the client to feel more in control and assists in coping.

DIF: Application/Applying REF: p. 1886 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

8. The nurse conducting an admission interview for a client with a herniated lumbar disk would be certain to ask the client about a history of

a.

abdominal trauma.

b.

developmental problems of the spine.

c.

history of meningitis.

d.

previous back injury.

ANS: D

More than half of people with clinical manifestations of a herniated disk give a history of a previous back injury.

DIF: Application/Applying REF: p. 1873 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. A clients medical record notes a forward slipping of the L5 vertebra. The nurse expects that the diagnosis at the end of the report will state

a.

back strain.

b.

disk herniation.

c.

lordosis.

d.

spondylolisthesis.

ANS: D

Spondylolisthesis is the forward slipping of one vertebra. It commonly occurs at L5-S1, where L5 slips forward.

DIF: Comprehension/Understanding REF: p. 1873 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. The nurse should assess a client who has had unrelieved trigeminal neuralgia for the past 6 months for

a.

alcohol consumption.

b.

suicidal ideation.

c.

vocational rehabilitation.

d.

weight gain.

ANS: B

Unrelieved pain from trigeminal neuralgia is so intense that clients often consider suicide. Because of the pain, they do not eat and neglect oral hygiene.

DIF: Application/Applying REF: p. 1885 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Mental Health Concepts

11. The nurse would assist the client with low back pain resulting from herniated lumbar disk into the position of

a.

either to the right or left side with knees straight.

b.

prone with a very small pillow under the head.

c.

side-lying with knees flexed.

d.

supine with head elevated 90 degrees.

ANS: C

The pain is exacerbated by straining (coughing, sneezing, defecation, bending, lifting, and straight-leg raising) and is relieved by side-lying with the knees flexed.

DIF: Application/Applying REF: p. 1874 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Non-Pharmacological Comfort Interventions

12. When the client who had a cervical spinal fusion this morning complains of a sudden radicular pain, the nurse is

a.

alerted because this indicates possible infection.

b.

concerned because this indicates possible meningitis.

c.

distressed because of the possible need to repeat the surgery.

d.

relieved because this indicates a reduction in edema.

ANS: A

Pain around the spinal nerves could indicate the bone graft has moved out of place and the surgery will have to be repeated.

DIF: Analysis/Analyzing REF: p. 1881 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

13. A client with acute disk herniation began using ice for analgesia along with medication therapy. The nurse explains that the client will be switched to heat therapy after

a.

24 hours.

b.

48 hours.

c.

72 hours.

d.

96 hours.

ANS: B

Ice may be used to reduce pain with acute disk herniation for the first 48 hours. After that time, heat usually is a better analgesic.

DIF: Comprehension REF: pp. 1874-1875

OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Non-Pharmacological Comfort Interventions

14. The nurse would recommend that the habit that should be modified to reduce the incidence of back pain is

a.

eating a high-fiber diet.

b.

mild exercise three times a week.

c.

sitting for long periods, rather than standing.

d.

using leg muscles when lifting.

ANS: C

Prolonged sitting strains the back; the client should get up and move around to break up long periods of being seated.

DIF: Application/Applying REF: p. 1875 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

15. The nurse explains that the client diagnosed with a spinal tumor will receive

a.

radiation and/or chemotherapy.

b.

radiation therapy and/or immunotherapy.

c.

surgery and/or chemotherapy.

d.

surgery and/or radiation therapy.

ANS: D

Interventions for spinal tumors are surgery, radiation therapy, or both. Surgery should be done emergently if there is evidence of cord compression or nerve root compression. The course of the disease is usually progressive.

DIF: Knowledge/Remembering REF: pp. 1883-1884

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

16. The nurse would question a client with suspected trigeminal neuralgia about facial pain that is

a.

characterized by intermittent episodes of severe pain with gradual onset.

b.

characterized by intermittent episodes of severe pain with sudden onset.

c.

constant and aching or burning in nature.

d.

constant, severe, and sharp in nature.

ANS: B

Trigeminal neuralgia is characterized by intermittent episodes of intense pain of sudden onset.

DIF: Application/Applying REF: p. 1885 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. The nurse would instruct a client who has undergone microvascular decompression surgery of the trigeminal nerve to

a.

chew on the affected side of the mouth.

b.

eat foods that are very warm or very cold for better taste.

c.

resume a full diet immediately.

d.

use a water jet device instead of a toothbrush.

ANS: D

If facial anesthesia is present after surgery, clients must learn to test the temperature of food before putting it into their mouth. They should chew on the unaffected side and inspect mucous membranes for irritation. Assess for aspiration and advance the diet slowly. Teach the client to use a water jet device instead of a toothbrush for dental hygiene.

DIF: Application/Applying REF: p. 1886 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Personal Hygiene

18. The nurse points out the physical therapy modality that would be avoided in the treatment for a client with Bells palsy is

a.

cold packs.

b.

facial nerve stimulation with faradic current.

c.

gentle massage.

d.

moist heat.

ANS: A

Palliative measures include physiotherapy, moist heat, gentle massage, and stimulation of the facial nerve with faradic current.

DIF: Knowledge/Remembering REF: p. 1886 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

19. Important discharge instructions for the client with a cervical disk problem being discharged with a cervical collar include

a.

ambulate carefully to avoid falls.

b.

perform active range-of-motion exercises four times daily.

c.

release the Velcro strap every 2 hours while awake.

d.

wash the collar with mild soap and water daily.

ANS: A

Safety awareness is important to prevent falls in the client who is wearing a cervical collar because s/he cannot look down at the feet. This vision limitation is a safety concern. The other three options are not recommended for this client.

DIF: Analysis/Analyzing REF: p. 1881 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

20. The nurse instructs a group of secretaries that which activities could prevent carpal tunnel syndrome?

a.

Getting up and walking every hour

b.

Routine use of nonsteroidal anti-inflammatory medication

c.

Splinting and elevation of the hand

d.

Worksite evaluation and modifications

ANS: D

Carpal tunnel syndrome is a cumulative trauma disorder frequently caused by back-and-forth motion of the wrist with the wrist remaining in constant flexion. This leads to entrapment of the median nerve. It is common among secretaries, musicians, computer operators, homemakers, factory workers, and others who have this repetitive hand motion. Workplace analysis and modification with re-design of work space can prevent it, or keep it from recurring after it has been treated.

DIF: Comprehension/Understanding REF: p. 1889 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Disease Prevention

21. A client has returned to the nursing unit after having a cervical fusion from the anterior approach. What piece of equipment does the nurse ensure is at the bedside?

a.

A patient-controlled analgesia (PCA) pump

b.

Emergency tracheostomy set

c.

Humidified oxygen

d.

Suction setup and rigid suction catheter

ANS: B

A complication of the anterior approach is respiratory paralysis caused by spinal cord edema and swelling and shifting of the trachea. An emergency tracheostomy kit is kept at the bedside to treat this emergent development.

DIF: Application/Applying REF: p. 1881 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

22. The nurse outlines that the usual remedy to achieve wrist rest for a client with carpal tunnel syndrome is

a.

applying a wrist splint.

b.

encouraging use of analgesics.

c.

supporting the hand on a pillow.

d.

using a special adaptor on a keyboard.

ANS: A

Initially the wrist is splinted in a neutral position to prevent mechanical irritation of the nerve.

DIF: Comprehension/Understanding REF: pp. 1887-1888

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

23. The point the nurse should stress in giving home instructions to the client regarding home care following carpal tunnel release surgery is

a.

flex and extend the fingers every 4 hours while awake.

b.

notify the physician if part of the hand becomes cold or tingly.

c.

restrict lifting for 2 weeks.

d.

wear a splint for 24 to 48 hours.

ANS: B

Notify the physician if you notice the hand or fingers becoming pale, tingly, or cold. Flex and extend the fingers hourly during waking hours. Restrict lifting for 2 months. Wear a splint for 7 to 14 days after surgery or until the sutures are removed.

DIF: Application/Applying REF: p. 1888 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

24. The nurse explains that the assessment of the salivary nicotine levels before a spinal fusion surgery is done to reduce the risk of

a.

cardiac dysrhythmias.

b.

nonunion.

c.

sudden hypertension.

d.

vasospasm.

ANS: B

Use of nicotine can cause nonunion of the fusion.

DIF: Comprehension/Understanding REF: p. 1877 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

MULTIPLE RESPONSE

1. To promote back health, nursing personnel are instructed in good body mechanics, which include (Select all that apply)

a.

avoid twisting the body when lifting.

b.

hold objects away from the body when lifting in case they are dropped.

c.

keep heavy objects close to the body when lifting.

d.

participate in exercises to strengthen abdominal and back muscles.

ANS: A, C, D

Good body mechanics include standing with a wide gait, sizing up the load before lifting, pushing (not pulling), avoid twisting the body when lifting, holding objects close to the body when lifting, and having enough help. Muscle tone from exercise increases strength and will help diminish lifting injuries. Do not hold objects away from the body when lifting as this adds to the stress load on the spine.

DIF: Comprehension/Understanding REF: p. 1875 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Ergonomic Principles

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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