When caring for a patient with Guillain-Barré Syndrome, which of the following is the most critical assessment the nurse should prioritize?

Assessing respiratory function

Monitoring blood glucose levels

Checking for skin breakdown

Monitoring for signs of infection

Answer and Explanation

The Correct Answer is A

A.   Assessing respiratory function is critical as respiratory muscle involvement can lead to respiratory failure.
B.   Monitoring blood glucose levels is important but not the priority in this context.
C.   Checking for skin breakdown is important but secondary to respiratory assessment.
D.   Monitoring for signs of infection is necessary but less urgent than assessing respiratory status.

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Correct Answer is A

Explanation

A. Receiving medication to minimize episodes of breakthrough pain is a realistic and important goal for comfort.
B. Verbalizing an understanding of disease transmission may not be feasible at this stage.
C. Increasing attendance at community activities may not be practical for a client nearing end of life.
D. Experiencing weight gain may not be realistic given the client's condition.

A. Quaternary prevention B. Tertiary prevention C. Primary prevention D. Secondary prevention

Correct Answer is D

Explanation

A. Quaternary prevention focuses on preventing harm from unnecessary interventions; this does not apply.
B. Tertiary prevention relates to managing disease and its complications.
C. Primary prevention aims to prevent disease occurrence, which does not apply to testing.
D. Secondary prevention involves early detection of disease; free HIV testing fits this category to help prevent complications that follow due to immunosuppression.

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When caring for a patient with Guillain-Barré Syndrome, which of the following is the most critical assessment the nurse should prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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