A nurse is assessing a client who has a suspected diagnosis of Guillain-Barre syndrome (GBS). Which of the following questions should the nurse ask the client?
Are you taking a multivitamin?
Have you had a recent influenza infection?
Have you traveled overseas recently?
Do you have a history of chronic alcohol abuse?
The Correct Answer is B
Choice A reason: Asking about multivitamin intake is not directly relevant to GBS, as the syndrome is not known to be caused by vitamin deficiencies or related to nutritional status.
Choice B reason: A recent influenza infection is relevant because GBS is often preceded by an infection, such as a respiratory or gastrointestinal viral infection. The immune system's response to this infection may mistakenly attack peripheral nerves, leading to GBS.
Choice C reason: While travel history is important in assessing exposure to infectious diseases, it is less specific than asking about recent infections. GBS can occur after exposure to certain viruses or bacteria, which can be contracted without overseas travel.
Choice D reason: Chronic alcohol abuse is a risk factor for various neurological conditions, but it is not a typical precursor to GBS. The syndrome is more commonly associated with immune responses to infections.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Urine specific gravity measures the kidney's ability to concentrate urine. A normal range is typically 1.005–1.030. A value of 1.020 indicates adequate hydration and suggests that the patient is responding well to IV fluid therapy.
Choice B reason: Serum sodium levels reflect electrolyte balance. The normal range is 135–145 mEq/L. A level of 165 mEq/L is significantly elevated, indicating hypernatremia, which could be a sign of inadequate hydration and not a positive response to treatment.
Choice C reason: Hematocrit represents the proportion of blood volume occupied by red blood cells. Normal ranges are 38.3–48.6% for men and 35.5–44.9% for women. A hematocrit of 48% is at the upper limit of normal and does not specifically indicate the effectiveness of dehydration treatment.
Choice D reason: Blood urea nitrogen (BUN) levels can indicate renal function and hydration status. The normal range is 7–20 mg/dL. A BUN of 12 mg/dL is within the normal range and does not specifically reflect the patient's response to IV fluids for dehydration.
Correct Answer is A
Explanation
Choice A reason: play a crucial role in transplant rejection. They can recognize and attack foreign tissues, including transplanted organs, leading to rejection. This immune response is a significant concern in transplant medicine, and managing T cell activity is essential for the success of organ transplants.
Choice B reason: While anaphylaxis is an acute allergic reaction, it is more commonly associated with the release of histamines and other mediators from mast cells and basophils. can contribute to the severity of the reaction, but they are not the primary cells involved in anaphylaxis.
Choice C reason: Bacterial phagocytosis is primarily the function of phagocytes like neutrophils and macrophages. do not directly engage in phagocytosis but can activate other immune cells that do.
Choice D reason: Hay fever, or allergic rhinitis, involves an immune response to airborne allergens, with contributing to the development of symptoms by helping to produce IgE antibodies. However, the immediate symptoms of hay fever are more directly related to mast cell activation rather than activity.
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