The nurse is preparing a teaching session about Guillain-Barre syndrome. Which statement should be included in the presentation?
The disorder is commonly fatal.
The progressive muscle weakness will begin in the lower extremities and move upward.
The disorder is caused by a fungal infection.
The disorder's most significant manifestations are muscle pain and stiffness.
The Correct Answer is B
Choice A reason: The disorder is commonly fatal, is not a true statement. Guillain-Barre syndrome is a rare and serious condition that affects the peripheral nervous system. It causes inflammation and damage to the nerve fibers, leading to muscle weakness, numbness, and paralysis. However, most people recover from Guillain-Barre syndrome, although some may have long-term complications or disabilities. The mortality rate is about 4% to 7%.
Choice B reason: The progressive muscle weakness will begin in the lower extremities and move upward, is a true statement. Guillain-Barre syndrome usually starts with tingling and weakness in the feet and legs, and then spreads to the arms and upper body. This pattern of weakness is called ascending paralysis, and it can affect the breathing, swallowing, and facial muscles. The weakness usually reaches its peak within two to four weeks, and then gradually improves over months or years.
Choice C reason: The disorder is caused by a fungal infection, is not a true statement. Guillain-Barre syndrome is not caused by a fungal infection, but by an abnormal immune response. The exact cause of Guillain-Barre syndrome is unknown, but it is often preceded by an infection, such as a respiratory or gastrointestinal infection, or a vaccination. The immune system mistakenly attacks the nerve fibers, causing inflammation and damage.
Choice D reason: The disorder's most significant manifestations are muscle pain and stiffness, is not a true statement. Guillain-Barre syndrome's most significant manifestations are muscle weakness and paralysis, not pain and stiffness. Muscle pain and stiffness may occur in some cases, but they are not the main symptoms or the most serious ones. The weakness and paralysis can affect the vital functions, such as breathing, blood pressure, and heart rate, and require intensive care and treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Diabetes mellitus Type 1 is a condition that affects the pancreas and the production of insulin, a hormone that regulates blood sugar levels. It does not directly cause anemia, but it can increase the risk of complications such as infections, ulcers, and nerve damage.
Choice B reason: Peripheral vascular disease is a condition that affects the blood vessels and the circulation of blood to the limbs. It does not directly cause anemia, but it can increase the risk of complications such as clots, wounds, and gangrene.
Choice C reason: Chronic kidney disease is a condition that affects the kidneys and their function of filtering waste and fluids from the blood. It can cause anemia by reducing the production of erythropoietin, a hormone that stimulates the bone marrow to make red blood cells.
Choice D reason: Hypertension is a condition that affects the blood pressure and the force of blood against the artery walls. It does not directly cause anemia, but it can increase the risk of complications such as stroke, heart attack, and kidney damage.
Correct Answer is B
Explanation
Choice A reason: "You need to bring your child to the emergency department immediately and have the stool tested for blood." is not an appropriate response by the nurse. Black stools can be a sign of gastrointestinal bleeding, which is a serious condition that requires immediate medical attention. However, in this case, the black stools are most likely caused by the iron supplement, which can change the color and consistency of the stool. Therefore, there is no need to panic or rush to the emergency department.
Choice B reason: "Greenish black stools are normal when oral iron supplements are being administered." is the most appropriate response by the nurse. It is a factual and reassuring statement that explains the reason for the stool color change and educates the mother about the expected side effect of the iron supplement. It also encourages the mother to continue the treatment for the child's anemia.
Choice C reason: "You should stop administering the daily iron supplement." is not an appropriate response by the nurse. It is a harmful and incorrect advice that contradicts the prescribed treatment for the child's anemia. Stopping the iron supplement can worsen the child's condition and lead to complications such as growth retardation, cognitive impairment, or heart failure.
Choice D reason: "Don't worry about it." is not an appropriate response by the nurse. It is a dismissive and vague statement that does not address the mother's concern or provide any information or education. It can also undermine the mother's trust and confidence in the nurse and the health care system.
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