A patient presents to the Emergency Department (ED) reporting right facial weakness. The nurse understands that a patient suffering from Bell's Palsy will exhibit which assessment findings related to the cranial nerve involvement?

painful areas on the affected side following 3 branches of the nerve

decreased visual acuity when tested with Snellen Chart

unilateral upper and lower facial weaknesses including forehead

facial dropping, with arm and leg weakness on the affected side

Answer and Explanation

The Correct Answer is C

A) Painful areas on the affected side following 3 branches of the nerve:
This is not typically a feature of Bell's Palsy. Bell's Palsy is primarily a motor dysfunction of the facial nerve (cranial nerve VII), leading to facial weakness. The pain associated with Bell's Palsy, if present, is usually mild and localized to the jaw, behind the ear, or along the jawline rather than along all three branches of the trigeminal nerve (cranial nerve V), which controls sensation in the face. Therefore, this choice is not consistent with the typical presentation of Bell's Palsy.

B) Decreased visual acuity when tested with Snellen Chart:
Decreased visual acuity is not a primary feature of Bell's Palsy. This condition specifically affects facial nerve function, which controls the muscles of facial expression, including those responsible for closing the eyes tightly. However, Bell's Palsy does not typically result in visual changes such as decreased visual acuity or problems with vision itself. Decreased vision would be more indicative of an issue with the optic nerve (cranial nerve II) or other eye-related conditions.

C) Unilateral upper and lower facial weakness including forehead:
This is the hallmark sign of Bell's Palsy. The facial nerve (cranial nerve VII) controls the muscles of the face, and when it becomes affected by Bell's Palsy, both the upper and lower parts of the face on one side can be weak or paralyzed. Importantly, Bell's Palsy causes inability to wrinkle the forehead, which distinguishes it from stroke, where the forehead is typically spared because the upper part of the facial muscles receives bilateral input from the brain. Thus, both upper and lower facial weakness, including inability to raise the eyebrow (forehead), is characteristic of Bell's Palsy.

D) Facial dropping, with arm and leg weakness on the affected side:
Facial drooping is a common symptom of Bell's Palsy, but arm and leg weakness is not associated with it. Arm and leg weakness on the same side would be more suggestive of a stroke affecting the cerebrovascular system, rather than a peripheral nerve issue like Bell's Palsy. Bell's Palsy is confined to facial nerve dysfunction and does not cause weakness in the limbs.

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Correct Answer is D

Explanation

A) Hypoglycemic event often develops:
Phenytoin is an anticonvulsant, and while it can affect glucose metabolism, hypoglycemia is not a typical consequence of abruptly stopping the drug. This is not a primary concern when discontinuing phenytoin therapy. Hypoglycemia is more commonly associated with medications like insulin or sulfonylureas, not anticonvulsants like phenytoin.

B) Physical dependency on the drug develops over time:
Phenytoin does not cause physical dependence in the way that some other substances (e.g., alcohol, opioids) can. While the body can become used to a medication over time, and withdrawal symptoms can occur, the risk of physical dependence is not the main reason why phenytoin should not be stopped suddenly.

C) A heart block is likely to develop:
Phenytoin is known to have effects on cardiac conduction, and it can cause heart rhythm disturbances like bradycardia or a prolonged PR interval, especially with toxicity. However, the risk of a heart block developing due to abrupt discontinuation of phenytoin is not the primary concern.

D) Status epilepticus may develop:
The most serious risk of suddenly stopping phenytoin, or any anticonvulsant, is the potential for status epilepticus. Status epilepticus is a medical emergency where seizures occur continuously without recovery in between, which can be life-threatening. Abruptly discontinuing phenytoin can lead to a rebound increase in seizure activity, which can result in status epilepticus.

A. begins training to prepare to run a marathon next year B. refuses to attend church and states that ‘’his faith has failed him’’ C. promises God to give up smoking if allowed to live until their children are married D. gathers the family together in order to discuss what their last wishes are

Correct Answer is B

Explanation

A) Begins training to prepare to run a marathon next year:
This response is not characteristic of the stage of anger. Instead, this behavior suggests denial or possibly bargaining, as the client may be attempting to maintain a sense of normalcy or even hope in the face of a terminal illness like Amyotrophic Lateral Sclerosis (ALS).

B) Refuses to attend church and states that "his faith has failed him":
This statement reflects the anger stage of Kubler-Ross’s five stages of grief. During the anger stage, individuals often experience intense feelings of frustration, helplessness, and resentment about their situation. They may direct these emotions towards others, including higher powers or themselves. In this case, the client is expressing anger by blaming his circumstances and feeling abandoned by his faith, a common reaction when facing an irreversible condition like ALS.

C) Promises God to give up smoking if allowed to live until their children are married:
This behavior represents the bargaining stage of grief, not anger. In the bargaining phase, individuals may attempt to negotiate with a higher power or themselves, making promises or deals in exchange for a prolongation of life or a desired outcome. The client is trying to strike a "deal" by making promises for future behavior in exchange for a specific wish, reflecting bargaining rather than anger.

D) Gathers the family together in order to discuss what their last wishes are:
This scenario aligns more with the acceptance stage of grief. In the acceptance stage, individuals come to terms with their diagnosis and begin to make plans for the end of their life. The act of discussing last wishes indicates that the client is accepting the reality of their condition and preparing for what is to come.

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A patient presents to the Emergency Department (ED) reporting right facial weakness. The nurse understands that a patient suffering from Bell's Palsy will exhibit which assessment findings related to the cranial nerve involvement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client newly diagnosed with a seizure disorder about phenytoin sodium therapy. What information should the nurse stress regarding the client stopping the drug suddenly? The drug should not be stopped abruptly because:

Correct Answer is D

Explanation

A client is diagnosed with Amyotrophic Lateral Sclerosis (ALS). Which situation represents Kubler-Ross grief stage of anger? The client:

Correct Answer is B

Explanation

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