A nurse is assessing a client who has Guillain-Barre Syndrome, and notes that the client's breathing is shallow and the client is short of breath. The nurse understands that that the client's respiratory distress is caused by which of the following?
Degeneration of nerves in the brainstem and spinal cord.
Pleural effusion caused by immobility.
Demyelination of nerves that stimulate the respiratory muscles.
Bronchoconstriction and edema of the airways.
The Correct Answer is C
A. While GBS primarily affects peripheral nerves (nerves outside the brain and spinal cord), it does not typically cause direct degeneration of nerves in the brainstem and spinal cord. Therefore, this option is not correct in the context of respiratory distress in GBS.
B. Pleural effusion caused by immobility: Pleural effusion, an accumulation of fluid in the pleural cavity around the lungs, is not a typical complication of GBS. It is more commonly associated with conditions such as heart failure, pneumonia, or malignancy, rather than directly with GBS.
C. In Guillain-Barre Syndrome, demyelination of nerves affects the transmission of signals from the brain to the muscles, including those responsible for respiration. As a result, respiratory muscles may become weak or paralyzed, leading to shallow breathing and respiratory distress.
D. While respiratory distress can occur in some neurological conditions due to autonomic dysfunction or secondary complications, such as aspiration pneumonia, bronchoconstriction and airway edema are not typical manifestations of GBS itself.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. A vegetarian diet typically does not directly contribute to bronchoconstriction. In fact, a diet rich in fruits and vegetables may provide antioxidants and anti-inflammatory compounds that can be beneficial for respiratory health. Therefore, this option is less likely to be a cause of the client's bronchoconstriction.
B. Rosuvastatin (and other statins) are generally well-tolerated, but some individuals may experience respiratory side effects, including cough or shortness of breath. However, bronchoconstriction as a direct side effect of statins is uncommon and typically not a primary concern unless there is a rare hypersensitivity reaction.
C. Propranolol is a non-selective beta-blocker that can lead to bronchoconstriction, particularly in individuals with asthma or other respiratory conditions. Beta-blockers can block beta-2 receptors in the lungs, potentially causing constriction of the airways and worsening of respiratory symptoms.
D. Acetaminophen (paracetamol) is generally considered safe and does not typically cause bronchoconstriction. It is a non-steroidal anti-inflammatory drug (NSAID) that works differently from medications like beta-blockers, which directly affect the airways.
Correct Answer is C
Explanation
A. This statement refers to medications like statins (e.g., rosuvastatin, atorvastatin) which are used to lower cholesterol levels and reduce the risk of atherosclerosis progression. Docusate sodium does not treat hyperlipidemia or affect plaque formation directly.
B. This refers to anticoagulant medications (e.g., heparin, warfarin, direct oral anticoagulants) which are used to prevent clot formation and reduce the risk of thromboembolic events such as stroke. Docusate sodium does not have anticoagulant properties.
C. After a myocardial infarction (MI), especially in the early recovery phase, vagal stimulation can exacerbate bradycardia or contribute to dysrhythmias. Stool softeners like docusate sodium help prevent constipation, which can stimulate the vagus nerve during straining, potentially leading to vagally mediated dysrhythmias such as bradycardia or atrioventricular blocks.
D. Diuretics (e.g., furosemide, hydrochlorothiazide) are used to reduce fluid retention and lower blood pressure by increasing urine output. Docusate sodium does not remove excess sodium or affect blood pressure regulation.
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