Chapter 63: Nursing Management: Peripheral Nerve and Spinal Cord Problems
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is assessing a client with newly diagnosed trigeminal neuralgia. Which of the
following parameters should the nurse assess?
a. Triggers that lead to facial pain
b. Visual problems caused by ptosis
c. Poor appetite caused by a loss of taste
d. Weakness on the affected side of the face
ANS: A
The major clinical manifestation of trigeminal neuralgia is severe facial pain that is
triggered by cutaneous stimulation of the nerve. Ptosis, loss of taste, and facial weakness
are not characteristics of trigeminal neuralgia.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. Which of the following actions should the nurse take when assessing a client with
trigeminal neuralgia?
a. Examine the mouth and teeth thoroughly.
b. Have the client clench and relax the jaw and eyes.
c. Identify trigger zones by lightly touching the affected side.
d. Gently palpate the face to compare skin temperature bilaterally.
ANS: A
Oral hygiene is frequently neglected because of fear of triggering facial pain. Having the
client clench the facial muscles will not be useful because the sensory branches of the
nerve are affected by trigeminal neuralgia. Light touch and palpation may be triggers for
pain and should be avoided.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse is caring for a client with trigeminal neuralgia who has had a glycerol rhizotomy.
Which of the following interventions should the nurse implement?
a. Ask whether the client is using an eye shield at night.
b. Determine whether the client is doing daily facial exercises.
c. Question the client about social activities with family and friends.
d. Remind the client to chew food on the unaffected side of the mouth.
ANS: C
Because withdrawal from social activities is a common manifestation of trigeminal
neuralgia, asking about social activities will help in evaluating whether the client’s
symptoms have improved. Glycerol rhizotomy does not damage the corneal reflex or
motor functions of the trigeminal nerve, so there is no need to use an eye shield, do facial
exercises, or take precautions with chewing.
, DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
4. Which of the following actions should the nurse include in the plan of care when caring
for a client who is experiencing trigeminal neuralgia?
a. Teach facial and jaw relaxation techniques.
b. Assess intake and output and dietary intake.
c. Apply ice packs for no more than 20 minutes.
d. Spend time at the bedside talking with the client.
ANS: B
The client with an acute episode of trigeminal neuralgia may be unwilling to eat or drink,
so assessment of nutritional and hydration status is important. Because stimulation by
touch is the precipitating factor for pain, relaxation of the facial muscles will not improve
symptoms. Application of ice is likely to precipitate pain. The client will not want to
engage in conversation, which may precipitate attacks.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
5. The nurse is teaching a client who is at risk for Bell’s palsy because of previous herpes
simplex infection. Which of the following information should the nurse include?
a. “Call the doctor if pain or herpes lesions occur near the ear.”
b. “Treatment of herpes with antiviral agents prevents Bell’s palsy.”
c. “You may be able to prevent Bell’s palsy by doing facial exercises regularly.”
d. “Medications to treat Bell’s palsy work only if started before paralysis onset.”
ANS: A
Pain or herpes lesions near the ear may indicate the onset of Bell’s palsy and rapid
corticosteroid treatment may reduce the duration of Bell’s palsy symptoms. Antiviral
therapy for herpes simplex does not reduce the risk for Bell’s palsy. Corticosteroid therapy
will be most effective in reducing symptoms if started before paralysis is complete but will
still be somewhat effective when started later. Facial exercises do not prevent Bell’s palsy.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. 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?
a. Respect the client’s desire and arrange for privacy at mealtimes.
b. Teach the client to chew food on the unaffected side of the mouth.
c. Offer the client liquid nutritional supplements at frequent intervals.
d. Discuss the client’s concerns with visitors who arrive at mealtimes.
ANS: A
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is assessing a client with newly diagnosed trigeminal neuralgia. Which of the
following parameters should the nurse assess?
a. Triggers that lead to facial pain
b. Visual problems caused by ptosis
c. Poor appetite caused by a loss of taste
d. Weakness on the affected side of the face
ANS: A
The major clinical manifestation of trigeminal neuralgia is severe facial pain that is
triggered by cutaneous stimulation of the nerve. Ptosis, loss of taste, and facial weakness
are not characteristics of trigeminal neuralgia.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. Which of the following actions should the nurse take when assessing a client with
trigeminal neuralgia?
a. Examine the mouth and teeth thoroughly.
b. Have the client clench and relax the jaw and eyes.
c. Identify trigger zones by lightly touching the affected side.
d. Gently palpate the face to compare skin temperature bilaterally.
ANS: A
Oral hygiene is frequently neglected because of fear of triggering facial pain. Having the
client clench the facial muscles will not be useful because the sensory branches of the
nerve are affected by trigeminal neuralgia. Light touch and palpation may be triggers for
pain and should be avoided.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse is caring for a client with trigeminal neuralgia who has had a glycerol rhizotomy.
Which of the following interventions should the nurse implement?
a. Ask whether the client is using an eye shield at night.
b. Determine whether the client is doing daily facial exercises.
c. Question the client about social activities with family and friends.
d. Remind the client to chew food on the unaffected side of the mouth.
ANS: C
Because withdrawal from social activities is a common manifestation of trigeminal
neuralgia, asking about social activities will help in evaluating whether the client’s
symptoms have improved. Glycerol rhizotomy does not damage the corneal reflex or
motor functions of the trigeminal nerve, so there is no need to use an eye shield, do facial
exercises, or take precautions with chewing.
, DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
4. Which of the following actions should the nurse include in the plan of care when caring
for a client who is experiencing trigeminal neuralgia?
a. Teach facial and jaw relaxation techniques.
b. Assess intake and output and dietary intake.
c. Apply ice packs for no more than 20 minutes.
d. Spend time at the bedside talking with the client.
ANS: B
The client with an acute episode of trigeminal neuralgia may be unwilling to eat or drink,
so assessment of nutritional and hydration status is important. Because stimulation by
touch is the precipitating factor for pain, relaxation of the facial muscles will not improve
symptoms. Application of ice is likely to precipitate pain. The client will not want to
engage in conversation, which may precipitate attacks.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
5. The nurse is teaching a client who is at risk for Bell’s palsy because of previous herpes
simplex infection. Which of the following information should the nurse include?
a. “Call the doctor if pain or herpes lesions occur near the ear.”
b. “Treatment of herpes with antiviral agents prevents Bell’s palsy.”
c. “You may be able to prevent Bell’s palsy by doing facial exercises regularly.”
d. “Medications to treat Bell’s palsy work only if started before paralysis onset.”
ANS: A
Pain or herpes lesions near the ear may indicate the onset of Bell’s palsy and rapid
corticosteroid treatment may reduce the duration of Bell’s palsy symptoms. Antiviral
therapy for herpes simplex does not reduce the risk for Bell’s palsy. Corticosteroid therapy
will be most effective in reducing symptoms if started before paralysis is complete but will
still be somewhat effective when started later. Facial exercises do not prevent Bell’s palsy.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. 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?
a. Respect the client’s desire and arrange for privacy at mealtimes.
b. Teach the client to chew food on the unaffected side of the mouth.
c. Offer the client liquid nutritional supplements at frequent intervals.
d. Discuss the client’s concerns with visitors who arrive at mealtimes.
ANS: A
