The nurse is caring for the patient experiencing Guillain-Barre Syndrome (GBS). It is most important for the nurse to monitor the patient for which complication?
Urinary retention
Hypertension
Hyperglycemia
Respiratory failure
The Correct Answer is D
A. Urinary retention can occur in Guillain-Barre Syndrome due to autonomic dysfunction, but it is not the most life-threatening complication.
B. Hypertension may be seen as part of autonomic instability in GBS, but it is usually not the primary concern.
C. Hyperglycemia is not a typical complication of GBS itself, unless related to treatments like IV corticosteroids (which are not first-line therapy for GBS) or comorbid conditions.
D. Guillain-Barre Syndrome causes progressive ascending paralysis, which can eventually involve the respiratory muscles. Monitoring for respiratory failure is critical, as it can develop rapidly and requires immediate intervention, such as mechanical ventilation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["10"]
Explanation
Step 1: Identify what’s given
- Infusion rate = 8 mg/hour
- One bag = 80 mg in 200 mL
- We want to know how many hours the 80 mg will last at 8 mg/hour.
Step 2: Calculate time
Total dose in the bag ÷ infusion rate:
80 mg ÷ 8 mg/hour = 10 hours
Final Answer: 10 hours
Correct Answer is C
Explanation
A. Atorvastatin at bedtime to reduce my cholesterol levels.: is a statin used to lower cholesterol levels and reduce the risk of further cardiovascular events. It is commonly recommended to take statins in the evening because cholesterol synthesis occurs mostly at night. The client is following proper instructions here.
B. Metoprolol to decrease my heart's need for oxygen.: Metoprolol is a beta-blocker that reduces the heart's demand for oxygen by lowering the heart rate, blood pressure, and the force of contraction. This helps in reducing the risk of further complications after a myocardial infarction (MI).
C. Sublingual nitroglycerin each day to prevent chest pain.: This indicates the need for further education. Sublingual nitroglycerin is typically used as needed for acute chest pain or angina and should not be taken regularly each day for prevention. For long-term prevention, other medications like beta-blockers or calcium channel blockers are usually prescribed, not sublingual nitroglycerin. Taking nitroglycerin every day without chest pain could cause unnecessary side effects, such as hypotension or tolerance to the medication.
D. Clopidogrel to prevent clots from forming.: Clopidogrel is an antiplatelet medication that helps to prevent blood clots from forming by inhibiting platelet aggregation. It is often prescribed following a myocardial infarction to reduce the risk of further clot formation and to improve cardiovascular outcomes.
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