Peripheral Nervous System Disorders

Flashcards covering key vocabulary and concepts related to disorders of the peripheral nervous system for exam preparation.

NCLEX Scenario: Cranial Nerve Assessment

The LPN is assisting in the assessment of a client who recently suffered a head injury. The RN asks the LPN to check the client's facial symmetry and ability to smile and frown. Which cranial nerve (CN) is the LPN assessing?

A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN X (Vagus)
D. CN XI (Accessory)

Answer: B. CN VII (Facial) Rationale: The Facial nerve (CN VII) controls most of the muscles of facial expression, including smiling and frowning.

NCLEX Scenario: Peripheral Nervous System Location

A student nurse asks the LPN, "Which components make up the Peripheral Nervous System (PNS)?" The LPN should correctly identify the PNS as consisting of:

A. The brain and cranial nerves.
B. The spinal cord and spinal nerves.
C. The white matter of the cerebrum.
D. Cranial and spinal nerves located outside the brain and spinal cord.

Answer: D. Cranial and spinal nerves located outside the brain and spinal cord. Rationale: The PNS is defined as the nervous system structures external to the central nervous system (brain and spinal cord).

NCLEX Scenario: Sensory Changes

A client reports new onset of tingling and numbness in their feet. The LPN recognizes this finding as paresthesia and should prioritize which action?

A. Document the finding and wait for the next physical therapy session.
B. Encourage the client to walk around to improve circulation.
C. Report the change immediately to the Registered Nurse (RN).
D. Administer a PRN pain medication for neuropathy.

Answer: C. Report the change immediately to the Registered Nurse (RN). Rationale: New or escalating neurological symptoms, such as paresthesia, must be reported promptly to the RN or healthcare provider for further evaluation and diagnosis.

NCLEX Scenario: Brachial Plexus Injury

A client sustained an injury affecting the Brachial Plexus. Which function should the LPN expect to see impaired?

A. Sensation and movement in the lower leg.
B. Coordination of gait and balance.
C. Movement and sensation in the shoulder, arm, and hand.
D. Swallowing and speech articulation.

Answer: C. Movement and sensation in the shoulder, arm, and hand. Rationale: The Brachial Plexus is a network of nerves originating in the neck that supplies the motor and sensory function to the upper extremities.

NCLEX Scenario: Chronic Disease Management

When providing care for a client with a chronic peripheral nervous system disorder like ALS or MS, what is the primary focus of the LPN's holistic care interventions?

A. Rapidly reversing the disease progression.
B. Focusing solely on pharmacological management.
C. Promoting comfort, safety, and functional independence.
D. Preparing the client for surgical intervention.

Answer: C. Promoting comfort, safety, and functional independence. Rationale: For chronic, progressive neurological disorders, the core nursing goal is maintaining the highest possible quality of life by addressing symptoms and promoting safety and function.

NCLEX Scenario: Early Signs of Multiple Sclerosis (MS)

A 35-year-old client is being evaluated for possible Multiple Sclerosis. Which new symptom, if reported by the patient, is most characteristic of early MS?

A. Extreme rigidity and tremors at rest.
B. Persistent, debilitating, ascending muscle weakness.
C. Sudden, transient periods of visual blurring or diplopia.
D. Loss of tactile sensation below the knee.

Answer: C. Sudden, transient periods of visual blurring or diplopia. Rationale: Visual disturbances (optic neuritis, diplopia) and sensory changes are often among the earliest and most common symptoms of MS due to demyelination in the central nervous system.

NCLEX Scenario: MS and Heat Sensitivity

The LPN is teaching a client newly diagnosed with MS about managing exacerbations. The client should be taught to avoid which trigger that can worsen symptoms (Uhthoff's phenomenon)?

A. Excessive rest.
B. Exposure to extreme cold.
C. Prolonged hot baths or showers.
D. Eating high-fiber foods.

Answer: C. Prolonged hot baths or showers. Rationale: Increased body temperature (often caused by hot environments, fever, or intense exercise) further impedes nerve conduction in demyelinated fibers, temporarily worsening MS symptoms.

NCLEX Scenario: Interferon Therapy Teaching

A client with MS is prescribed weekly Interferon beta-1a injections. Which instruction is essential for the LPN to reinforce regarding this medication?

A. Take the medication with a large meal to prevent GI upset.
B. Do not combine this drug with any over-the-counter pain relievers.
C. Report flu-like symptoms (fever, chills) as these are common side effects.
D. Stop the medication immediately if mood changes occur.

Answer: C. Report flu-like symptoms (fever, chills) as these are common side effects. Rationale: Interferons often cause transient flu-like symptoms. While common, the LPN should ensure the client knows to report them for management and differentiation from infection, but they are not usually an immediate cause to stop the drug.

NCLEX Scenario: Diplopia Management in MS

A client with MS reports severe double vision (diplopia). Which non-pharmacological nursing intervention should the LPN suggest to help the client ambulate safely?

A. Increasing the room temperature.
B. Covering one eye with an eye patch on an alternating basis.
C. Using a broad-spectrum antibiotic.
D. Limiting fluid intake.

Answer: B. Covering one eye with an eye patch on an alternating basis. Rationale: Covering one eye eliminates the second image, reducing diplopia. Alternating the eye patch prevents strain and eye muscle weakness in the covered eye.

NCLEX Scenario: Managing Fatigue in Chronic Illness

When assisting a client with Multiple Sclerosis who experiences severe fatigue, which nursing activity is most appropriate for the LPN to recommend?

A. Performing all necessary activities in the morning when energy is highest.
B. Limiting physical movement to conserve all energy reserves.
C. Planning household chores to occur during the hottest part of the day.
D. Prioritizing tasks and taking frequent, short rest breaks throughout the day.

Answer: D. Prioritizing tasks and taking frequent, short rest breaks throughout the day. Rationale: Pacing activities and incorporating rest breaks prevent reaching a point of extreme exhaustion, which is key to managing chronic fatigue in MS.

NCLEX Scenario: Urinary Urgency in MS

A client with MS complains of sudden, intense urinary urgency and occasional incontinence. What initial management strategy should the LPN reinforce?

A. Dramatically reducing daily fluid intake.
B. Relying entirely on indwelling catheterization.
C. Following a scheduled (timed) voiding routine.
D. Increasing caffeine and diuretic beverage consumption.

Answer: C. Following a scheduled (timed) voiding routine. Rationale: Timed voiding (bladder training) helps clients maintain control by emptying the bladder before urgency or incontinence occurs, which is a foundational non-pharmacological step.

NCLEX Scenario: Recognizing MS Exacerbation

Which observation made by the LPN indicates the client with MS may be experiencing an acute exacerbation?

A. The client reports mild baseline fatigue.
B. The client maintains stable neurological function.
C. New onset of severe spasticity and balance issues.
D. The client has no change in their vision over the past month.

Answer: C. New onset of severe spasticity and balance issues. Rationale: An exacerbation (flare-up) is characterized by new symptoms or a significant worsening of existing symptoms, reflecting new areas of demyelination and inflammation.

NCLEX Scenario: Initial Signs of Myasthenia Gravis (MG)

An elderly patient is admitted for weakness. Which finding would be most suggestive of early Myasthenia Gravis?

A. Weakness that decreases as the activity level increases.
B. Bilateral upper extremity pain.
C. Droopy eyelids (ptosis) that worsen late in the day.
D. Sudden, relentless muscle spasms.

Answer: C. Droopy eyelids (ptosis) that worsen late in the day. Rationale: MG is characterized by muscle weakness (often in the eye muscles first) that increases with activity and improves with rest, showing diurnal fluctuation.

NCLEX Scenario: Myasthenia Gravis (MG) Medication Timing

Administration of an anticholinesterase agent (e.g., pyridostigmine) for a client with MG should be precisely timed to ensure maximum effect during which vital activity?

A. Immediately before bedtime.
B. 30 to 60 minutes before meals.
C. When the client first wakes up.
D. Only when the client feels weak.

Answer: B. 30 to 60 minutes before meals. Rationale: Timing the medication to peak during mealtimes strengthens the muscles needed for chewing and swallowing (preventing aspiration and promoting nutrition).

NCLEX Scenario: Aspiration Prevention in MG

What is the priority nursing intervention when assisting a client with Myasthenia Gravis during a mealtime?

A. Providing a noisy environment to stimulate alertness.
B. Offering thin liquids to ease swallowing.
C. Encouraging verbal communication while eating.
D. Instructing the client to rest or sit quietly before the meal.

Answer: D. Instructing the client to rest or sit quietly before the meal. Rationale: Muscle fatigue worsens with activity. Resting before meals helps conserve energy for the work of chewing and swallowing, reducing aspiration risk.

NCLEX Scenario: Signs of Respiratory Compromise in MG

During routine data collection, the LPN notes a client with MG is slurring their speech and has a weak, ineffective cough. Which immediate action is prioritized?

A. Offering sips of water.
B. Contacting the dietary department to change the diet texture.
C. Elevating the head of the bed (HOB) and assessing oxygen saturation and respiratory rate.
D. Administering the client’s scheduled anticholinesterase drug immediately.

Answer: C. Elevating the head of the bed (HOB) and assessing oxygen saturation and respiratory rate. Rationale: Slurred speech and weak cough indicate bulbar muscle weakness, which can rapidly progress to respiratory distress (Myasthenic Crisis). Respiratory status is the top priority.

NCLEX Scenario: Cholinergic Crisis

A client receiving treatment for MG reports severe cramping, diarrhea, and increased salivation. The LPN recognizes these signs may indicate a Cholinergic Crisis. This crisis is caused by:

A. Too little acetylcholine (ACh) at the neuromuscular junction.
B. An overdose of anticholinesterase medication.
C. Viral infection requiring antibiotic intervention.
D. Progressive brain stem deterioration.

Answer: B. An overdose of anticholinesterase medication. Rationale: Cholinergic Crisis results from excessive ACh stimulation (too much medication), causing involuntary muscle responses including GI hypermotility and glandular secretions (SLUDGE symptoms: Salivation, Lacrimation, Urination, Defecation, GI Distress, Emesis).

NCLEX Scenario: Post-Thymectomy Care

A client recovering from a thymectomy (removal of the thymus gland, a treatment for MG) is transferred to the medical surgical unit. What is the most critical post-operative monitoring priority for the LPN to observe for in the first 24 hours?

A. Bowel sounds and appetite return.
B. Signs of infection at the suture site.
C. Chest tube patency and respiratory effort.
D. Peripheral edema and urinary output.

Answer: C. Chest tube patency and respiratory effort. Rationale: Thymectomy often involves entry into the thorax. Maintaining lung expansion and monitoring breathing are paramount, especially given the client's underlying muscle weakness (MG).

NCLEX Scenario: Myasthenic vs. Cholinergic Crisis Treatment

What medication is typically used as the antidote to reverse the effects in a confirmed Cholinergic Crisis?

A. IV Immunoglobulin (IVIg).
B. High-dose corticosteroids.
C. Atropine sulfate.
D. Edrophonium (Tensilon).

Answer: C. Atropine sulfate. Rationale: Atropine is an anticholinergic agent that blocks the excessive effects of acetylcholine, making it the appropriate antidote for Cholinergic Crisis.

NCLEX Scenario: Inadequate MG Medication Dosing

The LPN observes a client with Myasthenia Gravis who received their morning medication 3 hours ago but is now showing increased ptosis and difficulty drinking water. The LPN should document this finding and anticipate a potential need for:

A. Increased doses of immunosuppressants.
B. Evaluation for adjustment of the anticholinesterase medication time or dose.
C. Immediate respiratory therapy intervention.
D. A change in diet to NPO status.

Answer: B. Evaluation for adjustment of the anticholinesterase medication time or dose. Rationale: Worsening symptoms hours after dosing suggests the medication is wearing off or the current regimen is insufficient to manage the symptoms throughout the day.

NCLEX Scenario: Classic ALS Presentation

A nurse is reviewing the chart of a client recently diagnosed with Amyotrophic Lateral Sclerosis (ALS). The LPN expects to find documentation of which key feature?

A. Sudden loss of all sensory perception.
B. Progressive deterioration of motor function with preserved cognition.
C. Autoimmune attacks leading to rapid ascending paralysis.
D. Intermittent periods of remission and exacerbation.

Answer: B. Progressive deterioration of motor function with preserved cognition. Rationale: ALS primarily affects the motor neurons, leading to muscle weakness and atrophy, while typically sparing intellectual, sensory, and autonomic function.

NCLEX Scenario: Priority Care in Advanced ALS

For a client in the advanced stages of ALS, what nursing diagnosis is usually considered the highest priority due to inevitable progression?

A. Risk for social isolation.
B. Impaired tissue perfusion.
C. Ineffective breathing pattern.
D. Deficient knowledge.

Answer: C. Ineffective breathing pattern. Rationale: Respiratory muscle failure is the main cause of death in ALS, making airway and breathing management the critical priority.

NCLEX Scenario: Communication in ALS

A client with ALS is experiencing difficulty formulating speech (dysarthria). Which adaptive strategy should the LPN reinforce?

A. Encouraging the client to speak only when absolutely necessary.
B. Teaching the client and family how to use a letter board or communication device.
C. Performing frequent oral suctioning.
D. Speaking loudly to encourage clear speech.

Answer: B. Teaching the client and family how to use a letter board or communication device. Rationale: As speech deteriorates, alternative communication methods must be established to maintain the client's ability to express needs since cognition remains intact.

NCLEX Scenario: Safety for Mobility in ALS

An LPN is assisting an ambulatory client with ALS. The client's muscle weakness is increasing, leading to a high fall risk. What safety measure should the LPN implement immediately?

A. Encourage independent, unsupervised ambulation to maintain strength.
B. Institute 'bed rest only' orders immediately.
C. Ensure a gait belt is used when assisting with transfers, and frequently check the home environment for clutter.
D. Apply bilateral wrist restraints while the client is sitting.

Answer: C. Ensure a gait belt is used when assisting with transfers, and frequently check the home environment for clutter. Rationale: Safety is the priority. Assisting transfers safely and modifying the environment are essential to prevent injury while maximizing mobility for as long as possible.

NCLEX Scenario: Respiratory Support in ALS

A client with ALS requires non-invasive positive pressure ventilation (NIPPV) at night. The client expresses feelings of fear and anxiety about using the machine. What is the most therapeutic LPN response?

A. "Don't worry, the machine will do all the work for you."
B. "It's natural to feel that way. We can try short periods of use now to get you comfortable."
C. "If you don't use it, your ALS will get worse faster."
D. "I will ask the doctor to prescribe a strong sedative so you sleep through it."

Answer: B. "It's natural to feel that way. We can try short periods of use now to get you comfortable." Rationale: Acknowledging feelings and offering gradual desensitization training promotes compliance and reduces anxiety surrounding a new, necessary device.

NCLEX Scenario: Family Coping in ALS

What teaching point regarding disease progression is essential for the LPN to stress when educating the family of an ALS patient?

A. Physical therapy will eventually restore lost muscle function.
B. The disease progression is highly variable, but it does not affect cognitive abilities.
C. Emotional changes are the major challenge in controlling ALS.
D. Medication can be used to stop the deterioration of motor neurons permanently.

Answer: B. The disease progression is highly variable, but it does not affect cognitive abilities. Rationale: Knowing that the client's mind remains intact is crucial for the family's approach to communication, support, and coping, focusing on maintaining dignity and recognizing the person remains themselves.

NCLEX Scenario: Hallmark Symptom of Guillain-Barré Syndrome (GBS)

Which clinical manifestation is the hallmark defining characteristic of Guillain-Barré Syndrome?

A. Progressive, symmetrical muscle weakness starting in the feet and moving upward.
B. Fluctuation of muscle weakness that improves with rest.
C. Cognitive decline associated with visual disturbances.
D. Spasticity and clonus in the lower extremities.

Answer: A. Progressive, symmetrical muscle weakness starting in the feet and moving upward. Rationale: GBS is classically defined by ascending paralysis, where the weakness starts distally and moves proximally.

NCLEX Scenario: Priority Assessment in GBS - Ascending Paralysis

A client admitted with GBS is moving from the feet to the knees. The LPN should be most vigilant for signs of complication related to the involvement of the nerves supplying the:

A. Face and neck.
B. Hands and arms.
C. Eyes and ears.
D. Diaphragm and intercostal muscles.

Answer: D. Diaphragm and intercostal muscles. Rationale: As paralysis moves upward, the respiratory muscles are eventually affected, leading to respiratory failure—the most life-threatening complication.

NCLEX Scenario: Complication of Immobility in GBS

Because GBS often requires prolonged immobility, the LPN must monitor for which severe complication of stasis?

A. Hyperkalemia.
B. Deep Vein Thrombosis (DVT).
C. Hypoglycemia.
D. Increased mental status.

Answer: B. Deep Vein Thrombosis (DVT). Rationale: Immobility slows venous return, significantly increasing the risk of forming blood clots (DVT), necessitating prophylactic measures.

NCLEX Scenario: Monitoring Respiratory Decline in GBS

When caring for a hospitalized client in the acute phase of GBS, what key piece of objective data collected by the LPN requires immediate reporting to the RN?

A. Respiratory rate of 18 breaths/min.
B. Heart rate fluctuations between 65 and 90 beats/min.
C. Oxygen saturation dropping from 96% to 92% on room air.
D. Reports of mild pain in the legs.

Answer: C. Oxygen saturation dropping from 96% to 92% on room air. Rationale: A significant drop in oxygen saturation is an objective sign of worsening gas exchange and impending respiratory failure, demanding urgent intervention.

NCLEX Scenario: Skin Care in Immobile GBS Patient

To prevent pressure ulcers in a client who is paralyzed and on continuous mechanical ventilation due to GBS, the LPN should prioritize which intervention?

A. Massaging all bony prominences vigorously.
B. Limiting fluid intake to decrease incontinence.
C. Repositioning the client every two hours and ensuring proper pad placement.
D. Applying lotion to skin that is red or showing breakdown.

Answer: C. Repositioning the client every two hours and ensuring proper pad placement. Rationale: Frequent turning is the most effective way to relieve pressure and prevent skin breakdown in severely immobile clients.

NCLEX Scenario: Autonomic Dysfunction in GBS

During the plateau phase of GBS, the client is at risk for autonomic nervous system dysfunction. The LPN should closely monitor for signs of:

A. Stable blood pressure and heart rate.
B. Significant blood pressure fluctuations or cardiac dysrhythmias.
C. Increased urination and regular bowel movements.
D. Steady neurological improvement.

Answer: B. Significant blood pressure fluctuations or cardiac dysrhythmias. Rationale: Autonomic dysfunction in GBS can cause severe instability in involuntary bodily functions, leading to labile blood pressure (orthostatic hypotension or hypertension) and heart rate variations.

NCLEX Scenario: GBS Progression Education

A client newly diagnosed with GBS tearfully asks, "Will I stay paralyzed forever?" What is the most appropriate LPN response regarding the client's prognosis?

A. "Yes, once the nerves are damaged, function never returns."
B. "GBS often involves gradual recovery over weeks to months, although fatigue may persist."
C. "You should see full recovery within 48 hours."
D. "It is impossible to predict recovery since GBS is a fatal condition."

Answer: B. "GBS often involves gradual recovery over weeks to months, although fatigue may persist." Rationale: While GBS is frightening, it is generally considered a recoverable disorder. Providing accurate hope regarding the typical pattern of recovery is essential emotional support.

NCLEX Scenario: Bell Palsy Affected Nerve

Bell Palsy is characterized by sudden, temporary unilateral weakness or paralysis of the face. This condition involves inflammation of which specific cranial nerve?

A. CN V (Trigeminal).
B. CN II (Optic).
C. CN VII (Facial).
D. CN IX (Glossopharyngeal).

Answer: C. CN VII (Facial). Rationale: Bell Palsy is idiopathic peripheral facial paralysis caused by acute inflammation of the Facial nerve (CN VII).

NCLEX Scenario: Eye Protection in Bell Palsy

The most serious risk associated with the facial paralysis of Bell Palsy is the inability to close the eyelid (lagophthalmos). Which action must the LPN emphasize for the client to perform during the day?

A. Chewing food only on the unaffected side.
B. Covering the eye with a dry cloth.
C. Frequently applying moisturizing eye drops (artificial tears).
D. Avoiding all facial movements.

Answer: C. Frequently applying moisturizing eye drops (artificial tears). Rationale: Due to the lack of tear film spreading and blinking protection, the cornea is highly vulnerable to dryness and abrasion, requiring frequent lubrication.

NCLEX Scenario: Teaching Self-Care for Bell Palsy

When instructing a client with Bell Palsy about managing the affected side of the face, the LPN should encourage which practice?

A. Vigorous facial exercises to regain muscle tone quickly.
B. Applying a warm, moist heat to the affected side.
C. Eating only soft, pureed foods until resolution.
D. Applying ice packs to control inflammation.

Answer: B. Applying a warm, moist heat to the affected side. Rationale: Heat application can help decrease muscle soreness and improve circulation to the affected facial muscles.

NCLEX Scenario: Acute Treatment for Bell Palsy

Which class of medication is typically prescribed immediately upon diagnosis of Bell Palsy to reduce swelling and improve recovery time?

A. Opiate analgesics.
B. High-dose corticosteroids (e.g., Prednisone).
C. Anticholinesterase inhibitors.
D. Monoclonal antibodies.

Answer: B. High-dose corticosteroids (e.g., Prednisone). Rationale: Bell Palsy is linked to nerve inflammation, so corticosteroids are used early in the course of the disorder to reduce swelling and nerve compression.

NCLEX Scenario: Cerebrospinal Fluid (CSF) Analysis in MS

A client undergoing diagnosis for persistent neurological symptoms has a lumbar puncture. The LPN recognizes that the presence of which substance in the Cerebrospinal Fluid (CSF) is characteristic of Multiple Sclerosis?

A. High glucose levels.
B. Oligoclonal bands (OCBs).
C. Elevated erythrocyte count.
D. Extremely high protein.

Answer: B. Oligoclonal bands (OCBs). Rationale: Oligoclonal bands represent local production of immunoglobulins within the CNS, a key and characteristic finding in the CSF of MS patients.

NCLEX Scenario: MRI Safety

To prepare a client suspected of having MS for a head MRI, the LPN assists with screening for contraindications. Which finding, if present, would prevent the test from proceeding?

A. History of asthma.
B. Client is pregnant.
C. Presence of a cardiac pacemaker or metallic fragments.
D. Current use of Interferon therapy.

Answer: C. Presence of a cardiac pacemaker or metallic fragments. Rationale: MRI uses strong magnetic fields. Any implanted metal device, especially pacemakers, cochlear implants, or aneurysm clips, is a strict contraindication.

NCLEX Scenario: LPN Role in Evaluating Therapeutic Effectiveness

A client with Myasthenia Gravis is taking anticholinesterase agents. How should the LPN best evaluate the effectiveness of this medication regimen?

A. By checking the client's temperature every few hours.
B. By observing improved muscle strength, reduced ptosis, and easier swallowing.
C. By monitoring for new onset of sensory symptoms (numbness).
D. By collecting blood pressure readings three times daily.

Answer: B. By observing improved muscle strength, reduced ptosis, and easier swallowing. Rationale: Anticholinesterase drugs treat muscle weakness; therefore, therapeutic effectiveness is measured by observing functional improvement in target muscle groups.

NCLEX Scenario: Ethics and Autonomy

A client with a progressive neurological disorder wishes to remain at home as long as possible, despite increasing care needs. The LPN's role in this situation is primarily to:

A. Discourage the client until the disease stabilizes.
B. Respect the client's decision and help coordinate necessary home health services and adaptations.
C. Insist the client move to an assisted living facility for safety.
D. Focus only on direct bedside medical tasks.

Answer: B. Respect the client's decision and help coordinate necessary home health services and adaptations. Rationale: Nursing care principles prioritize client autonomy and support the client's wishes for quality of life, adjusting the care plan to meet those goals safely.