Which method would the nurse utilize to best facilitate communication when caring for a client with end stage amyotrophic lateral sclerosis (ALS)?

Speak slow and loud so that the client can understand speech

Encourage the client to write questions on a white erase board

Use pre-arranged eye signais because eye muscles remain intact

Have the client squeeze the nurse's hand when intubated and on the ventilator

Answer and Explanation

The Correct Answer is C

A. Speak slow and loud so that the client can understand speech:

While speaking slowly and clearly may help with communication in some patients with ALS, this approach is less effective as the disease progresses. As ALS advances, speech muscles become affected, and the client may be unable to speak at all, making this method inappropriate for end-stage ALS. Simply speaking louder does not address the communication needs of a client who can no longer use their voice.

B. Encourage the client to write questions on a white erase board:

While writing on a whiteboard may be an effective communication strategy in the early stages of ALS when the client still has adequate hand function, this becomes increasingly difficult as muscle weakness progresses. By the end-stage, clients may lose the ability to hold a pen or write legibly, making this method less viable as the disease advances. It is not the best option for clients with significant motor impairment.

C. Use pre-arranged eye signals because eye muscles remain intact: In clients with end-stage amyotrophic lateral sclerosis (ALS), muscle weakness and loss of voluntary control progressively affect motor functions, including the ability to speak, write, and move. However, the eye muscles are typically preserved until the later stages of the disease, allowing patients to communicate through eye movements. Pre-arranged eye signals, such as blinking for "yes" or "no" or using a system of eye movements to select letters or words, are effective ways to facilitate communication with clients who can no longer speak or write. This method respects the client's remaining abilities and allows for more effective communication, especially as the disease progresses to its final stages.

D. Have the client squeeze the nurse's hand when intubated and on the ventilator:

When a client is intubated and on a ventilator, their ability to squeeze the nurse's hand may be limited due to the sedation and ventilator settings, and they may not have sufficient motor control to respond consistently. Additionally, when intubated, respiratory effort is controlled by the ventilator, so relying on hand squeezing would not be an effective or reliable method of communication. Furthermore, ALS patients in the later stages may not have enough muscle control for this method to be practical.

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Correct Answer is C

Explanation

A) Assess for conjunctival bleeding
Conjunctival bleeding refers to blood in the white part of the eye (the conjunctiva), which is typically associated with trauma, infections, or certain blood disorders, but it is not a common cause of diplopia (double vision). Diplopia in multiple sclerosis (MS) is more often due to nerve damage affecting the eye muscles or the pathways controlling eye movement. Therefore, assessing for conjunctival bleeding is not a priority intervention for a client with diplopia related to MS.

B) Encourage the use of sunglasses when outside
While wearing sunglasses may help alleviate light sensitivity, which is a common symptom in individuals with MS, it is not the most appropriate intervention for treating diplopia itself. Diplopia is typically caused by issues with eye muscle control or coordination, often related to the central nervous system. Therefore, while sunglasses might provide comfort, they do not address the underlying cause of the double vision.

C) Alternate the use of an eye patch on each eye
Alternating the use of an eye patch on each eye is an effective intervention for managing diplopia, especially when the cause is related to misalignment or weakness of the eye muscles. The eye patch works by covering one eye at a time to prevent double vision. In MS, this technique can help reduce the visual disturbance and provide relief until further interventions (such as eye exercises or medications) can be considered. This approach is commonly used to manage diplopia caused by nerve involvement affecting ocular muscle function.

D) Apply cool compresses for pain relief
Cool compresses may provide relief for eye irritation or inflammation, but they are not typically used to treat diplopia. Diplopia in MS is more related to neuromuscular dysfunction or nerve damage, rather than acute inflammation or irritation of the eye. Therefore, while a cool compress may offer temporary relief for other symptoms, it is not a targeted solution for double vision in this context.

A. dextromethorphan 10 mg PO q 4 r B. cromolyn MDI 2 puffs daily C. guaifenesin 200 mg PO q 4 hr D. methylprednisone 30 mg IV BID

Correct Answer is C

Explanation

A. Dextromethorphan 10 mg PO q 4 hr: Dextromethorphan is a cough suppressant, and while it may be useful for controlling a dry, non-productive cough, it is not appropriate for ineffective airway clearance in pneumonia. In fact, suppressing the cough in pneumonia could prevent the patient from clearing mucus from the airways, exacerbating the problem. It is more appropriate for a client who has a dry cough without significant mucus production.

B. Cromolyn MDI 2 puffs daily: Cromolyn is a mast cell stabilizer used for the prevention of asthma and allergy symptoms, and it is not typically used for treating pneumonia or ineffective airway clearance. It works by preventing the release of inflammatory mediators in response to allergens, but it does not address the issue of clearing mucus in the airways during a bacterial infection like pneumonia.

C. Guaifenesin 200 mg PO q 4 hr: Guaifenesin is an expectorant that helps loosen and thin mucus in the airways, making it easier for the client to cough up and clear secretions. This is the most appropriate medication for addressing ineffective airway clearance in a client with pneumonia, as the goal is to facilitate the removal of mucus and improve respiratory function. Guaifenesin does not suppress the cough reflex but instead promotes productive coughing, which is essential for clearing the airways during a respiratory infection like pneumonia.

D. Methylprednisolone 30 mg IV BID: Methylprednisolone is a corticosteroid used to reduce inflammation and control severe allergic or inflammatory conditions. While corticosteroids may be used in certain cases of pneumonia (e.g., in cases of significant inflammation or an underlying condition like COPD), they are not the first-line treatment for ineffective airway clearance. The priority in this case is to promote mucus clearance, which is better addressed by guaifenesin.

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Which method would the nurse utilize to best facilitate communication when caring for a client with end stage amyotrophic lateral sclerosis (ALS)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client diagnosed with multiple sclerosis (MS) who is complaining of diplopia. Which intervention would be appropriate for the client with this problem?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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