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A patient diagnosed with Guillain-Barré syndrome has a burning, tickling feeling and asks what causes that feeling. What is the best response?
- A. The myelin cover of the nerve endings is absent.
- B. You are lying too long on the affected side.
- C. This is in response to the medication.
- D. This is secondary to dysphagia.
Correct Answer: A
Rationale: Loss of myelin leads to abnormal sensations such as burning or tingling.
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A previously healthy 26-year-old male is brought to the emergency department due to muscle weakness. He reports mild weakness in his legs that has progressively worsened over a few days to the point that he can barely move his legs. He has some numbness in his legs and his arms feel weak. He has recently recovered from a respiratory infection. 1/5 muscle strength is noted throughout the lower extremities, as well as absent patellar and ankle reflexes. 3 to 4-/5 muscle strength is appreciated throughout his upper extremities. A lumbar puncture is performed, which shows the following: Cell count: 4 cells/mm3, Glucose: 67 mg/dL, Protein: 187 mg/dL Gram stain: no organisms Spirometry is performed, which shows a forced vital capacity of 0.85 L. Which of the following is the best next step in management?
- A. Intravenous (IV) immunoglobulin
- B. Intubation
- C. IV corticosteroids
- D. Immunomodulating agent
Correct Answer: B
Rationale: The patient's presentation of rapidly progressive weakness, areflexia, and elevated cerebrospinal fluid protein with normal cell count (albuminocytologic dissociation) is classic for Guillain-Barre syndrome (GBS). The forced vital capacity of 0.85 L indicates respiratory failure, necessitating immediate intubation to protect the airway and provide mechanical ventilation. Intravenous immunoglobulin and plasma exchange are treatments for GBS but are secondary to securing the airway in this critically ill patient.
A patient says, I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day. Which response by the nurse fosters cognitive restructuring?
- A. You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking.
- B. Let's see whether any other explanations for your vomiting are possible.
- C. You seem so worried. Let's talk about how you're feeling.
- D. We should talk about something else.
Correct Answer: B
Rationale: The correct answer is B because it encourages the patient to consider alternative explanations for their symptoms, which is key in cognitive restructuring. By exploring other possible reasons for the vomiting, the patient is guided to challenge their automatic assumption of having a brain tumor. This approach helps the patient to reevaluate their thoughts and beliefs in a more rational manner.
Choices A, C, and D are incorrect:
A: This response dismisses the patient's concerns without addressing the underlying irrational belief. It does not promote cognitive restructuring.
C: While acknowledging the patient's emotions is important, this response does not actively challenge the patient's irrational belief or encourage critical thinking.
D: Changing the subject does not address the patient's cognitive distortions and does not facilitate cognitive restructuring.
What does an abnormal finding in the assessment of the patient's motor function suggest?
- A. Possible neurological impairment or muscle weakness.
- B. Normal muscle strength and coordination.
- C. Absence of neurological symptoms.
- D. Stable and symmetrical muscle function.
Correct Answer: A
Rationale: Abnormal motor function findings, such as weakness or asymmetry, suggest possible neurological impairment. Normal strength, coordination, and stable function are expected findings.
Which statement describes osteosarcoma?
- A. High rate of local recurrence
- B. Very malignant and metastasizes early
- C. Arises in cancellous ends of long bones
- D. Develops in the medullary cavity of long bones
Correct Answer: B
Rationale: Osteosarcoma is highly malignant and metastasizes early.
Which patient should the nurse assess first after change-of-shift report?
- A. A 42-year-old patient with carpal tunnel syndrome complaining of pain.
- B. A 64-year-old patient with osteoporosis who is waiting for discharge.
- C. A 28-year-old patient with fracture complaining that the cast is tight.
- D. A 56-year-old patient with left leg amputation complaining of phantom pain.
Correct Answer: C
Rationale: A tight cast can lead to compartment syndrome, which is a medical emergency.