A nurse is responsible for six patients.
Which of the following patients are at risk for developing peripheral neuropathy (PN)? (Select all that apply.)

The patient admitted with diabetic ketoacidosis (DKA)

The patient admitted with sleep apnea

The patient admitted with a hypertensive crisis

The patient admitted for an exacerbation of Systemic Lupus Erythematosus (SLE)

The patient admitted with untreated tuberculosis

The patient admitted with cirrhosis secondary to chronic alcohol use

Answer and Explanation

Correct Answer : A,D,F

Choice A rationale
Patients with poorly controlled diabetes, such as those experiencing diabetic ketoacidosis (DKA), are at an increased risk of developing peripheral neuropathy. High blood sugar levels can damage peripheral nerves over time.
Choice B rationale
Sleep apnea is not typically associated with an increased risk of developing peripheral neuropathy.
Choice C rationale
While hypertension can lead to a variety of health complications, it is not typically associated with an increased risk of developing peripheral neuropathy.
Choice D rationale
Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect the nervous system, including the peripheral nerves, leading to peripheral neuropathy.
Choice E rationale

Untreated tuberculosis is not typically associated with an increased risk of developing peripheral neuropathy.
Choice F rationale
Chronic alcohol use can lead to nutritional deficiencies, particularly of the B vitamins, which are essential for nerve health. This can result in peripheral neuropathy.

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Correct Answer is A

Explanation

Choice A rationale
Nausea and vomiting are common symptoms associated with migraines. Asking about these symptoms can help confirm a diagnosis of a migraine.
Choice B rationale
Sensitivity to light, also known as photophobia, is a common symptom of migraines. However, the question “Are the lights in here bothering you?” is less specific to migraines as it could be indicative of several other conditions as well.
Choice C rationale
While confusion or clouded thinking can occur with migraines, it is not as common as other symptoms such as nausea, vomiting, and sensitivity to light.
Choice D rationale
Unusual smells, known as olfactory hallucinations, are not typically associated with migraines. They are more commonly associated with conditions such as epilepsy.
Choice E rationale
Weakness before the headache started or currently feeling weak now is not a typical symptom of migraines. It could be indicative of a more serious condition, such as a stroke.

A. Pulmonary embolus B. Bacterial translocation C. Deep vein thrombosis D. Myocardial infarction

Correct Answer is B

Explanation

Choice A rationale
Pulmonary embolus is a serious condition that can occur due to prolonged immobility, but it is not directly related to the timing of enteral nutrition in a client with increased intracranial pressure.

Choice B rationale
Bacterial translocation refers to the migration of bacteria from the gut to other areas of the body. Early enteral nutrition (within 24 to 48 hours) in critically ill patients can help maintain the integrity of the gut mucosa and prevent bacterial translocation. Therefore, starting enteral nutrition within this timeframe can help prevent bacterial translocation.
Choice C rationale
Deep vein thrombosis, like pulmonary embolus, is a risk due to immobility but is not directly related to the timing of enteral nutrition.
Choice D rationale
Myocardial infarction is a cardiac event that could be related to overall cardiovascular health, stress, or specific injury to the cardiac muscle. It is not directly prevented by the initiation of enteral nutrition.

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A nurse is responsible for six patients. Which of the following patients are at risk for developing peripheral neuropathy (PN)? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with a history of migraines comes to a clinic with a throbbing headache. What Questions should the nurse include in the assessment?

Correct Answer is A

Explanation

A nurse is planning care for a client who has increased intracranial pressure. The nurse should understand that enteral nutrition should begin within 24 to 48 hr to help prevent which of the following complications?

Correct Answer is B

Explanation

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A nurse is responsible for six patients.
Which of the following patients are at risk for developing peripheral neuropathy (PN)? (Select all that apply.)