Review Peripheral Nervous System Disorders: Peripheral neuropathy; Radiculopathy; Charcot-Marie-Tooth disease

Pathophysiology of the Nervous System > Pathophysiology

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Peripheral Nervous System Disorders: Peripheral neuropathy; Radiculopathy; Charcot-Marie-Tooth disease

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Question 1:

A nurse is caring for a client who has peripheral neuropathy due to diabetes mellitus. Which of the following interventions should the nurse include in the plan of care?

A. Inspect the client's feet daily for any injuries or infections B. Massage the client's legs and feet with lotion to improve circulation C. Encourage the client to wear tight-fitting shoes and socks to prevent friction D. Teach the client to soak their feet in warm water for 15 minutes twice a day

Answer and Explanation

Choice A:

This is a correct answer. Inspecting the client's feet daily for any injuries or infections is an important intervention for a client who has peripheral neuropathy due to diabetes mellitus. Peripheral neuropathy is a condition that affects the nerves in the extremities, causing numbness, tingling, pain, or weakness. Diabetes mellitus is a common cause of peripheral neuropathy, as high blood sugar levels can damage the nerves and blood vessels. The client may not feel any cuts, blisters, ulcers, or infections on their feet due to reduced sensation, which can lead to complications such as gangrene or amputation. Therefore, the nurse should inspect the client's feet daily and report any abnormalities to the provider.

Choice B:

This is an incorrect answer. Massaging the client's legs and feet with lotion to improve circulation is not an appropriate intervention for a client who has peripheral neuropathy due to diabetes mellitus. Massaging the client's legs and feet can cause further damage to the nerves or skin, especially if there are any injuries or infections present. Lotion can also increase the risk of infection by creating a moist environment for bacteria to grow. The nurse should avoid massaging the client's legs and feet and use other methods to improve circulation, such as elevating the legs, wearing compression stockings, or exercising regularly.

Choice C:

This is an incorrect answer. Encouraging the client to wear tight-fitting shoes and socks to prevent friction is not an appropriate intervention for a client who has peripheral neuropathy due to diabetes mellitus. Tight-fitting shoes and socks can impair blood flow and oxygen delivery to the feet, which can worsen peripheral neuropathy and increase the risk of tissue damage or necrosis. Tight-fitting shoes and socks can also cause pressure ulcers, blisters, or corns on the feet, which can become infected or difficult to heal. The nurse should encourage the client to wear loose-fitting shoes and socks that are comfortable and breathable.

Choice D:

This is an incorrect answer. Teaching the client to soak their feet in warm water for 15 minutes twice a day is not an appropriate intervention for a client who has peripheral neuropathy due to diabetes mellitus. Soaking the feet in warm water can cause burns or scalds on the skin, as the client may not be able to sense the temperature of the water due to reduced sensation. Soaking the feet in warm water can also increase the risk of infection by softening the skin and making it more prone to injury or breakdown. The nurse should teach the client to wash their feet with mild soap and water daily, dry them thoroughly, and check the water temperature with their elbow or thermometer before using it.

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Question 2:

A nurse is assessing a client who has radiculopathy due to a herniated intervertebral disc in the lumbar spine. Which of the following findings should the nurse expect? (Select all that apply.)

A. Low back pain that radiates down the leg B. Muscle weakness or atrophy in the affected leg C. Diminished or absent deep tendon reflexes in the affected leg D. Positive straight leg raise test on the affected side E. Loss of bladder or bowel control

Answer and Explanation

Choice A:

This is a correct answer. Low back pain that radiates down the leg is a common symptom of radiculopathy due to a herniated intervertebral disc in the lumbar spine. Radiculopathy is a condition that affects the nerve roots that exit from the spinal cord, causing pain, numbness, tingling, or weakness along their distribution. A herniated intervertebral disc is a common cause of radiculopathy, as it can compress or irritate the nerve roots in the spinal canal or intervertebral foramen. The pain may follow a dermatomal pattern depending on which nerve root is affected.

Choice B:

This is a correct answer. Muscle weakness or atrophy in the affected leg is another common symptom of radiculopathy due to a herniated intervertebral disc in the lumbar spine. Muscle weakness or atrophy may result from reduced nerve stimulation or innervation to the muscles in the leg, which can affect their function and appearance. The muscle weakness or atrophy may follow a myotomal pattern depending on which nerve root is affected.

Choice C:

This is a correct answer. Diminished or absent deep tendon reflexes in the affected leg is another common symptom of radiculopathy due to a herniated intervertebral disc in the lumbar spine. Deep tendon reflexes are involuntary responses that are elicited by tapping on specific tendons with a reflex hammer, such as the patellar or Achilles tendon. Diminished or absent deep tendon reflexes may indicate damage or dysfunction of the nerve roots that mediate the reflex arc. The diminished or absent deep tendon reflexes may follow a segmental pattern depending on which nerve root is affected.

Choice D:

This is a correct answer. Positive straight leg raise test on the affected side is another common symptom of radiculopathy due to a herniated intervertebral disc in the lumbar spine. The straight leg raise test is a physical examination maneuver that involves raising the client's leg while keeping it straight and flexing the foot. A positive test is indicated by pain in the low back or leg that is reproduced or worsened by the maneuver, which suggests nerve root compression or irritation by the herniated disc.

Choice E:

This is an incorrect answer. Loss of bladder or bowel control is not a common symptom of radiculopathy due to a herniated intervertebral disc in the lumbar spine. Loss of bladder or bowel control may indicate cauda equina syndrome, which is a rare but serious condition that involves compression of the nerve roots at the end of the spinal cord, causing severe low back pain, saddle anesthesia, sexual dysfunction, and urinary or fecal incontinence. Cauda equina syndrome requires immediate medical attention and surgical decompression to prevent permanent nerve damage or paralysis.

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Question 3:

A nurse is caring for a client who has Charcot-Marie-Tooth disease (CMT). Which of the following statements by the client indicates a need for further teaching?

A. "I will wear braces or splints to support my feet and ankles." B. "I will avoid strenuous exercise and heavy lifting." C. "I will take vitamin B12 supplements to prevent nerve damage." D. "I will inspect my feet daily for any injuries or infections."

Answer and Explanation

Choice A:

This is an incorrect answer. The client does not need further teaching if they say they will wear braces or splints to support their feet and ankles. Braces or splints are helpful devices for clients who have CMT, which is a hereditary disorder that affects the peripheral nerves and causes muscle weakness, atrophy, and deformity in the feet, legs, hands, and arms. Braces or splints can improve mobility, stability, and alignment of the affected limbs.

Choice B:

This is an incorrect answer. The client does not need further teaching if they say they will avoid strenuous exercise and heavy lifting. These activities can worsen the symptoms and progression of CMT, as they can cause fatigue, injury, or overuse of the weakened muscles and nerves. The client should engage in moderate exercise and physical therapy that are tailored to their abilities and needs.

Choice C:

This is a correct answer. The client needs further teaching if they say they will take vitamin B12 supplements to prevent nerve damage. Vitamin B12 deficiency can cause peripheral neuropathy, which is a condition that affects the peripheral nerves and causes numbness, tingling, pain, or weakness in the extremities. However, vitamin B12 supplements do not prevent or treat CMT, which is a genetic disorder that affects the structure and function of the peripheral nerves.

Choice D:

This is an incorrect answer. The client does not need further teaching if they say they will inspect their feet daily for any injuries or infections. This is an important self-care measure for clients who have CMT, as they may have reduced sensation, circulation, or healing in their feet due to nerve damage. The client should inspect their feet daily and report any abnormalities to their provider.

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Question 4:

A nurse is performing a physical examination on a client who has radiculopathy due to cervical spine degeneration. Which of the following tests should the nurse use to assess the client's condition?

A. Spurling's test B. Romberg's test C. Tinel's sign D. Phalen's test

Answer and Explanation

Choice A:

This is a correct answer. Spurling's test is a physical examination maneuver that involves extending, rotating, and laterally flexing the client's neck to the affected side and applying downward pressure on the head. A positive test is indicated by pain or paresthesia radiating from the neck to the shoulder or arm on the same side, which suggests nerve root compression or irritation by cervical spine degeneration.

Choice B:

This is an incorrect answer. Romberg's test is a physical examination maneuver that involves asking the client to stand with their feet together and eyes closed for 20 seconds while observing for balance and sway. A positive test is indicated by loss of balance or increased sway, which suggests cerebellar dysfunction or proprioceptive impairment.

Choice C:

This is an incorrect answer. Tinel's sign is a physical examination maneuver that involves tapping over the median nerve at the wrist or the ulnar nerve at the elbow. A positive sign is indicated by tingling or pain in the distribution of the nerve, which suggests nerve entrapment or injury.

Choice D:

This is an incorrect answer. Phalen's test is a physical examination maneuver that involves asking the client to hold their wrists in full flexion for 60 seconds while pressing the dorsal surfaces of their hands together. A positive test is indicated by numbness, tingling, or pain in the median nerve distribution of the hand, which suggests carpal tunnel syndrome.

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Question 5:

A nurse is providing education to a client who has peripheral neuropathy due to chemotherapy. Which of the following information should the nurse include in the teaching? (Select all that apply.)

A. The symptoms of peripheral neuropathy may improve after stopping chemotherapy B. The risk of peripheral neuropathy can be reduced by taking antioxidants C. The treatment of peripheral neuropathy may include medications such as gabapentin or duloxetine D. The prevention of peripheral neuropathy includes avoiding alcohol and smoking E. The complications of peripheral neuropathy may include falls or injuries

Answer and Explanation

Choice A:

This is a correct answer. The nurse should inform the client that the symptoms of peripheral neuropathy may improve after stopping chemotherapy, as chemotherapy is a common cause of peripheral neuropathy. Chemotherapy can damage the peripheral nerves and cause numbness, tingling, pain, or weakness in the extremities. The symptoms may be reversible or permanent depending on the type, dose, and duration of chemotherapy and the individual's response.

Choice B:

This is an incorrect answer. The nurse should not tell the client that the risk of peripheral neuropathy can be reduced by taking antioxidants, as there is no evidence to support this claim. Antioxidants are substances that protect the cells from oxidative stress and free radical damage, which may contribute to various diseases and aging. However, antioxidants have not been proven to prevent or treat peripheral neuropathy, and some antioxidants may interact with chemotherapy or other medications.

Choice C:

This is a correct answer. The nurse should inform the client that the treatment of peripheral neuropathy may include medications such as gabapentin or duloxetine, which are commonly used to manage neuropathic pain. Gabapentin is an anticonvulsant that modulates calcium channels and reduces nerve excitability. Duloxetine is an antidepressant that inhibits the reuptake of serotonin and norepinephrine and enhances pain inhibition. The nurse should also educate the client about the possible side effects and interactions of these medications.

Choice D:

This is a correct answer. The nurse should inform the client that the prevention of peripheral neuropathy includes avoiding alcohol and smoking, which are common risk factors for peripheral neuropathy. Alcohol and smoking can damage the peripheral nerves and blood vessels, impairing blood flow and oxygen delivery to the extremities. The nurse should advise the client to limit or quit alcohol and smoking and seek help if needed.

Choice E:

This is a correct answer. The nurse should inform the client that the complications of peripheral neuropathy may include falls or injuries, which can affect their safety and quality of life. Peripheral neuropathy can impair sensation, balance, coordination, and reflexes in the extremities, increasing the risk of falls or injuries. The nurse should teach the client strategies to prevent falls or injuries, such as wearing proper footwear, using assistive devices, removing hazards from the environment, and inspecting their feet daily for any wounds or infections.

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Peripheral Nervous System Disorders: Peripheral neuropathy; Radiculopathy; Charcot-Marie-Tooth disease Share this Share This Link Share on social media Facebook Messager WhatsApp Share URL Copy Close

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Peripheral Nervous System Disorders: Peripheral neuropathy; Radiculopathy; Charcot-Marie-Tooth disease

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