Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
Guillain-Barré Syndrome (GBS) Quiz -
Chapter 38 Overview and Insights
1. A nurse is teaching about nursing actions for caring for patients with Guillain-Barré
syndrome (GBS). Which statement indicates effective learning?
▪ “Keep the patient in a single position.”
▪ “Do not offer any kind of diversions to the patient.”
▪ “Establish methods of communication and provide a method to call the nurse.”
o Rationale: The nurse may arrange for means of communication that the
patient with GBS can use to call the nurse.
▪ “Discuss the use of analgesics or nonopioids with a friend.”
2. when caring for a patient newly diagnosed with Guillain-Barré syndrome (GBS), which
intervention would the nurse anticipate?
▪ Corticosteroid administration
▪ Lumbar puncture
▪ Plasmapheresis
o Rationale: The American Academy of Neurology recommends
plasmapheresis for non-ambulatory adult patients with GBS who start
treatment within 4 weeks of onset of neuropathic symptoms.
▪ Emergency surgery
3. When caring for a patient experiencing ascending muscle weakness and reporting
recently being ill with COVID-19, which diagnostic test would the nurse anticipate being
ordered?
▪ CT scan
▪ Lumbar puncture
o Rationale: A lumbar puncture is performed to assist in the confirmation of a
diagnosis of GBS. Cerebrospinal fluid findings include elevated protein and
normal cell count.
▪ Electrocardiogram
▪ MRI
4. The patient and family are anxious and say to the nurse, “The doctor talked about his
condition and used the word paralyzed. What is going on?” How should the nurse reply?
Client Data
Nurses’ Notes Lumbar puncture performed at the bedside.
3/30/XX Patient tolerated the procedure with minimal
10:40 discomfort.
42-year-old man brought to the ED by Vital Signs
family. Recovering from influenza and 3/30/XX
developed pain and numbness of the 10:40
shoulders, back, buttocks, and upper Temp 100.3°F (37.9°C)
legs. Finding it difficult to move his HR 112 bpm
Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
, Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
toes. Onset of symptoms over the last RR 22 breaths/min
4 hours. “It feels like it is getting SpO2 96% on room air
worse.” Alert and oriented, no BP 147/89 mm Hg
difficulty with speech or breathing. 3/30/XX
Lungs clear, bowel sounds active. 11:05
Upon assessment, unable to move toes HR 106 bpm
or ankles. Appears anxious, RR 20 breaths/min
reassurance given. Asking “what is SpO2 95% on room air
wrong with me?” BP 130/84 mm Hg
3/30/XX Lab and Diagnostic Tests
11:00 3/30/XX
12:00
CSF with protein present with normal cell count
▪ “The condition he has can cause temporary paralysis. We’ll know more about
his illness progression each day and keep you informed.”
▪ “Paralysis is frightening, but I’m sure he’ll be fine.”
▪ “I’ll get the doctor to answer your questions.”
▪ “The treatments that we give you will eliminate the paralysis.”
5. When caring for a patient diagnosed with Guillain-Barré syndrome (GBS) who begins
showing signs of dyspnea with decreased oxygen saturation being noted, which nursing
intervention would be priority?
▪ Administer oxygen via nasal cannula
▪ Prepare patient for intubation
o Rationale: Patients diagnosed with GBS experience ascending muscle
weakness which can result in eventual diaphragm weakness and inadequate
oxygenation. The priority action by the nurse is to prepare the patient for and
assist with intubation.
▪ Administer intravenous corticosteroids
▪ Have the patient cough and deep breathe
6. Which pathophysiologic mechanism explains the development of Guillain-Barré
syndrome (GBS)?
▪ Receptor sites for acetylcholine are destroyed
▪ Autoimmune response that destroys nerve myelin
o Rationale: In GBS, the patient’s own immune system begins to destroy the
myelin that surrounds the peripheral nerves.
▪ Vascular compression causes facial pain
▪ Peripheral nerve cells are completely destroyed
7. The nurse is caring for a patient receiving plasmapheresis for treatment of Guillain-Barré
syndrome (GBS). Which complications should the nurse monitor for?
▪ Hypertension
▪ Tachycardia
Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
Guillain-Barré Syndrome (GBS) Quiz -
Chapter 38 Overview and Insights
1. A nurse is teaching about nursing actions for caring for patients with Guillain-Barré
syndrome (GBS). Which statement indicates effective learning?
▪ “Keep the patient in a single position.”
▪ “Do not offer any kind of diversions to the patient.”
▪ “Establish methods of communication and provide a method to call the nurse.”
o Rationale: The nurse may arrange for means of communication that the
patient with GBS can use to call the nurse.
▪ “Discuss the use of analgesics or nonopioids with a friend.”
2. when caring for a patient newly diagnosed with Guillain-Barré syndrome (GBS), which
intervention would the nurse anticipate?
▪ Corticosteroid administration
▪ Lumbar puncture
▪ Plasmapheresis
o Rationale: The American Academy of Neurology recommends
plasmapheresis for non-ambulatory adult patients with GBS who start
treatment within 4 weeks of onset of neuropathic symptoms.
▪ Emergency surgery
3. When caring for a patient experiencing ascending muscle weakness and reporting
recently being ill with COVID-19, which diagnostic test would the nurse anticipate being
ordered?
▪ CT scan
▪ Lumbar puncture
o Rationale: A lumbar puncture is performed to assist in the confirmation of a
diagnosis of GBS. Cerebrospinal fluid findings include elevated protein and
normal cell count.
▪ Electrocardiogram
▪ MRI
4. The patient and family are anxious and say to the nurse, “The doctor talked about his
condition and used the word paralyzed. What is going on?” How should the nurse reply?
Client Data
Nurses’ Notes Lumbar puncture performed at the bedside.
3/30/XX Patient tolerated the procedure with minimal
10:40 discomfort.
42-year-old man brought to the ED by Vital Signs
family. Recovering from influenza and 3/30/XX
developed pain and numbness of the 10:40
shoulders, back, buttocks, and upper Temp 100.3°F (37.9°C)
legs. Finding it difficult to move his HR 112 bpm
Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
, Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
toes. Onset of symptoms over the last RR 22 breaths/min
4 hours. “It feels like it is getting SpO2 96% on room air
worse.” Alert and oriented, no BP 147/89 mm Hg
difficulty with speech or breathing. 3/30/XX
Lungs clear, bowel sounds active. 11:05
Upon assessment, unable to move toes HR 106 bpm
or ankles. Appears anxious, RR 20 breaths/min
reassurance given. Asking “what is SpO2 95% on room air
wrong with me?” BP 130/84 mm Hg
3/30/XX Lab and Diagnostic Tests
11:00 3/30/XX
12:00
CSF with protein present with normal cell count
▪ “The condition he has can cause temporary paralysis. We’ll know more about
his illness progression each day and keep you informed.”
▪ “Paralysis is frightening, but I’m sure he’ll be fine.”
▪ “I’ll get the doctor to answer your questions.”
▪ “The treatments that we give you will eliminate the paralysis.”
5. When caring for a patient diagnosed with Guillain-Barré syndrome (GBS) who begins
showing signs of dyspnea with decreased oxygen saturation being noted, which nursing
intervention would be priority?
▪ Administer oxygen via nasal cannula
▪ Prepare patient for intubation
o Rationale: Patients diagnosed with GBS experience ascending muscle
weakness which can result in eventual diaphragm weakness and inadequate
oxygenation. The priority action by the nurse is to prepare the patient for and
assist with intubation.
▪ Administer intravenous corticosteroids
▪ Have the patient cough and deep breathe
6. Which pathophysiologic mechanism explains the development of Guillain-Barré
syndrome (GBS)?
▪ Receptor sites for acetylcholine are destroyed
▪ Autoimmune response that destroys nerve myelin
o Rationale: In GBS, the patient’s own immune system begins to destroy the
myelin that surrounds the peripheral nerves.
▪ Vascular compression causes facial pain
▪ Peripheral nerve cells are completely destroyed
7. The nurse is caring for a patient receiving plasmapheresis for treatment of Guillain-Barré
syndrome (GBS). Which complications should the nurse monitor for?
▪ Hypertension
▪ Tachycardia
Guillain-Barré Syndrome (GBS) Quiz - Chapter 38 Overview and Insights
