# A patient admitted with Guillain-Barré syndrome and ascending paralysis has serial bedside spirometry. Forced vital capacity (FVC) drops from 32 mL/kg to 14 mL/kg over 4 hours and the patient reports increasing shortness of breath. Which is the priority nursing action?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374915&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: PA

## Question

A patient admitted with Guillain-Barré syndrome and ascending paralysis has serial bedside spirometry. Forced vital capacity (FVC) drops from 32 mL/kg to 14 mL/kg over 4 hours and the patient reports increasing shortness of breath. Which is the priority nursing action?

## Option

1. Continue routine monitoring and reassess FVC in 4 hours.
2. Notify the provider STAT and prepare for intubation; FVC less than 15 to 20 mL/kg in GBS signals impending respiratory failure and is a standard indication for elective intubation before crisis. **✔ Correct answer**
3. Encourage the patient to perform incentive spirometry every hour to strengthen the diaphragm.
4. Administer high-dose IV corticosteroids as the first-line treatment for GBS.

**Correct answer: 2**

## Explanation

In GBS, FVC < 15-20 mL/kg, negative inspiratory force less negative than -25 cm H2O, or rising bulbar/respiratory weakness signals impending respiratory failure. Standard practice is ELECTIVE intubation BEFORE crisis. Choice 1 misses the deteriorating trend. Choice 3 cannot strengthen demyelinated motor nerves. Choice 4 is wrong — corticosteroids are NOT effective in GBS; the disease-modifying treatments are plasmapheresis or IVIG.

## In-depth explanation

Two GBS NCLEX traps: (1) "give corticosteroids" — wrong, GBS treatment is plasmapheresis or IVIG; (2) "wait until FVC drops below 10 to intubate" — wrong, elective intubation at 15-20 mL/kg saves lives. The 20/30/40 rule (FVC < 20, NIF > -30, MIP < 40) signals respiratory deterioration.

## Clinical scenario

**Patient admitted with Guillain-Barré syndrome (GBS)** with rapidly ascending paralysis from feet to thighs. Bedside **FVC has fallen from 32 to 14 mL/kg over 4 hours**. The patient reports new shortness of breath. Code status full code.

## Key concepts

- **Guillain-Barré syndrome (GBS)** — Acute autoimmune demyelinating polyneuropathy with ascending paralysis; respiratory failure is the leading cause of mortality.
- **FVC monitoring in GBS** — Serial bedside spirometry; FVC < 15-20 mL/kg signals impending respiratory failure and indication for elective intubation.
- **GBS disease-modifying therapy** — Plasmapheresis or IVIG (intravenous immunoglobulin); corticosteroids are NOT effective.

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