A nurse is caring for a client following a complete spinal cord transection injury. The client's family asks the nurse what the term paraplegia means. Which of the following responses should the nurse make?
His lower body and legs are extremely weak.
He is unable to move his lower body and legs.
He has temporarily lost motor and sensory functions below the waist.
He cannot move anything from the neck down.
The Correct Answer is B
A. Weakness in the lower body is not an accurate description of paraplegia. Paraplegia refers to the loss of function, not just weakness.
B. Paraplegia refers to the loss of motor and sensory function in the lower body, including the legs, due to a spinal cord injury, typically below the level of the injury. This is the most accurate response.
C. Temporary loss of motor and sensory functions is more characteristic of conditions like spinal shock, not paraplegia. Paraplegia refers to permanent impairment following spinal cord injury.
D. The description of loss of movement from the neck down is characteristic of quadriplegia (or tetraplegia), not paraplegia, which specifically involves the lower body.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The ECG finding of an irregularly irregular heart rate without P waves is characteristic of atrial fibrillation, which is expected in this client. This finding is not the priority in this situation.
B. Slurred speech is a potential sign of a stroke, which is a serious complication of atrial fibrillation due to the increased risk of thromboembolic events (e.g., stroke). This is the priority finding because it requires immediate intervention to assess and manage a possible stroke.
C. An aPTT of 70 seconds is slightly elevated, but it is within the therapeutic range for heparin therapy (usually 1.5 to 2.5 times the normal value). It does not warrant immediate action.
D. Cloudy and odorous urine could indicate a urinary tract infection or other issue, but it is not immediately life-threatening compared to the potential for a stroke in this client.
Correct Answer is A
Explanation
A. Providing a dark, quiet environment is an appropriate intervention for a client with a migraine headache. Migraines are often aggravated by bright lights and loud noises, so creating a calm, low-stimulation environment can help alleviate symptoms.
B. While caffeine can be a trigger for some individuals with migraines, it is not necessary to eliminate all caffeine. In fact, caffeine is sometimes included in medications for migraines to enhance their effectiveness.
C. Cognitive impairment is not a typical concern for migraines unless the headache is severe or prolonged. Monitoring for cognitive impairment would not be the primary action in this scenario.
D. Opioids are not recommended for the treatment of migraines due to their potential for abuse and side effects. NSAIDs, triptans, and other specific migraine treatments are preferred.
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