Chapter 60: Spinal Cord and Peripheral Nerve Problems

Chapter 60: Spinal Cord and Peripheral Nerve Problems

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse assessing a patient with newly diagnosed trigeminal neuralgia will ask the patient about

a.	visual problems caused by ptosis.
b.	triggers leading to facial discomfort.
c.	poor appetite caused by loss of taste.
d.	weakness on the affected side of the face.

 

 

ANS:  B

The major clinical manifestation of trigeminal neuralgia is severe facial pain triggered by cutaneous stimulation of the nerve. Ptosis, loss of taste, and facial weakness are not characteristics of trigeminal neuralgia.

 

DIF:    Cognitive Level: Apply (application)           REF:               1437

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

2. Which patient assessment will help the nurse identify potential complications of trigeminal neuralgia?

a.	Have the patient clench the jaws.
b.	Inspect the oral mucosa and teeth.
c.	Palpate the face to compare skin temperature bilaterally.
d.	Identify trigger zones by lightly touching the affected side.

 

 

ANS:  B

Oral hygiene is frequently neglected because of fear of triggering facial pain and may lead to gum disease, dental caries, or an abscess. Having the patient clench the facial muscles will not be useful because the sensory branches (rather than motor branches) of the nerve are affected by trigeminal neuralgia. Light touch and palpation may be triggers for pain and should be avoided.

 

DIF:    Cognitive Level: Apply (application)           REF:               1437

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

3. When evaluating outcomes of a glycerol rhizotomy for a patient with trigeminal neuralgia, the nurse will

a.	assess if the patient is doing daily facial exercises.
b.	question if the patient is using an eye shield at night.
c.	ask the patient about social activities with family and friends.
d.	remind the patient to chew on the unaffected side of the mouth.

 

 

ANS:  C

Because withdrawal from social activities is a common manifestation of trigeminal neuralgia, asking about social activities will help in evaluating if the patient’s symptoms have improved. Glycerol rhizotomy does not damage the corneal reflex or motor functions of the trigeminal nerve, so there is no need to use an eye shield, do facial exercises, or take precautions with chewing.

 

DIF:    Cognitive Level: Apply (application)           REF:               1438

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Physiological Integrity

 

4. Which action will the nurse include in the plan of care for a patient who is experiencing pain from trigeminal neuralgia?

a.	Assess fluid and dietary intake.
b.	Apply ice packs for 20 minutes.
c.	Teach facial relaxation techniques.
d.	Spend time talking with the patient.

 

 

ANS:  A

The patient with an acute episode of trigeminal neuralgia may be unwilling to eat or drink, so assessment of nutritional and hydration status is important. Because stimulation by touch is the precipitating factor for pain, relaxation of the facial muscles will not improve symptoms. Application of ice is likely to precipitate pain. The patient will not want to engage in conversation, which may precipitate attacks.

 

DIF:    Cognitive Level: Apply (application)           REF:               1438

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity

 

5. The nurse identifies a patient with type 1 diabetes and a history of herpes simplex infection as being at risk for Bell’s palsy. Which information should the nurse include in teaching the patient?

a.	“You may be able to prevent Bell’s palsy by doing facial exercises regularly.”
b.	“Prophylactic treatment of herpes with antiviral agents prevents Bell’s palsy.”
c.	“Medications to treat Bell’s palsy work only if started before paralysis onset.”
d.	“Call the doctor if you experience pain or develop herpes lesions near the ear.”

 

 

ANS:  D

Pain or herpes lesions near the ear may indicate the onset of Bell’s palsy, and rapid corticosteroid treatment may reduce the duration of Bell’s palsy symptoms. Antiviral therapy for herpes simplex does not reduce the risk for Bell’s palsy. Corticosteroid therapy will be most effective in reducing symptoms if started before paralysis is complete but will still be somewhat effective when started later. Facial exercises do not prevent Bell’s palsy.

 

DIF:    Cognitive Level: Apply (application)           REF:               1440

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Physiological Integrity