Exam 63: Nursing Management Peripheral Nerve and Spinal Cord Problems

After a young adult client has returned home following rehabilitation for a spinal cord injury, the home care nurse notes that the partner is performing many of the activities that the client had been managing during rehabilitation. Which of the followingactions by the nurse is most appropriate at this time?

The nurse is caring for a client who has Guillain-Barré syndrome. Which of the following assessment data obtained by the nurse will require the most immediate action?

The nurse is caring for a client who has an incomplete right spinal cord lesion at the level of T7, resulting in Brown-Séquard syndrome. Which of the following nursing actions should be included in the plan of care?

Which of the following actions should the nurse include in the plan of care when caring for a client who is experiencing trigeminal neuralgia?

The nurse is caring for a client with a T2 spinal cord injury who tells the nurse, "I feel awful today. My head is throbbing, and I feel sick to my stomach." Which of the following actions should the nurse take first?

Which of the following nursing interventions is appropriate for a client with a spinal cord injury who is in the anger phase of adjustment?

A client arrives at an urgent care centre with a deep puncture wound after stepping on a nail that was lying on the ground. The client reports having had a tetanus booster 7 years ago. Which of the following actions should the nurse anticipate?

The nurse is caring for a client with a C3 injury who is demonstrating diaphragmatic respirations. Which of the following findings should the nurse expect to assess?

The nurse is caring for a client who has halo traction. Which of the following weight amounts should the nurse anticipate will be used with the traction when it is first applied?

The nurse is caring for a client with paraplegia resulting from a T10 spinal cord injury who has a neurogenic reflex bladder. Which of the following actions should the nurse include in the plan of care?

Which of the following nursing actions should the home health nurse include in the plan of care for a client with paraplegia in order to prevent autonomic dysreflexia?

In which order will the nurse perform the following actions when caring for a client with possible C₆ spinal cord trauma who is admitted to the emergency department? A)Infuse normal saline at 150 mL/hour. B)Monitor cardiac rhythm and blood pressure. C)Administer O₂ using a non-rebreather mask. D)Transfer the client to radiology for spinal computed tomography (CT). E)Immobilize the client's head, neck, and spine.

The nurse is caring for a client who has numbness and weakness of both feet and who is hospitalized with Guillain-Barré syndrome. Which of the following information should the nurse include in the client's plan of care?

The nurse is caring for a client with a T1 spinal cord injury in the intensive care unit. Which of the following information should the nurse include in the teaching plan for the client and family?

The nurse is caring for a client who had a C8 spinal cord injury 10 days ago and has a weak cough effort and loose-sounding secretions. Which of the following actions should the nurse implement initially?

The nurse is developing a rehabilitation plan for a client with a C6 spinal cord injury. Which of the following goals should the nurse include for this client?

The nurse is admitting a client with a spinal cord injury. Which of the following collaborative and nursing actions should the nurse do immediately? (Select all that apply.)

The nurse is caring for a client with Bell's palsy who refuses to eat while others are present because of embarrassment about drooling. Which of the following responses is best for the nurse to do?

The nurse is caring for a client who sustained a spinal cord injury a week ago and becomes angry, telling the nurse "I want to be transferred to a hospital where the nurses know what they are doing!" Which of the following actions by the nurse is best?

The nurse is caring for a client who has onset Guillain-Barré syndrome. During this phase of the client's illness, which of the following parameters is the most important for the nurse to assess?