A nurse is caring for a patient following surgery under a spinal anesthetic.
What interventions can the nurse implement to prevent a spinal headache?
Ambulate the patient.
Have the patient sit in a chair.
Limit fluids.
Keep the patient lying flat.
The Correct Answer is D
Choice A rationale
Early ambulation is generally encouraged after most surgical procedures to prevent complications such as deep vein thrombosis or pneumonia. However, in the specific context of a patient who has received spinal anesthesia, upright movement and walking can actually exacerbate the leakage of cerebrospinal fluid from the dural puncture site. This increase in leakage leads to decreased intracranial pressure, which is the primary physiological trigger for a debilitating spinal headache.
Choice B rationale
Having the patient sit in a chair involves an upright posture that increases the hydrostatic pressure of the cerebrospinal fluid at the site of the dural puncture. This pressure promotes the continued exit of fluid into the epidural space. Because the headache is caused by low spinal fluid volume, gravity-dependent positions like sitting will worsen the symptoms or prevent the puncture from sealing properly, thereby failing to prevent the development of a post-dural puncture headache.
Choice C rationale
Limiting fluids is contraindicated in the prevention of spinal headaches. Adequate hydration is essential because it supports the body's natural production of cerebrospinal fluid. Increasing fluid intake helps to compensate for the fluid lost through the dural puncture, potentially restoring intracranial pressure more quickly. Restricting fluids would likely leave the patient more susceptible to the physiological changes that result in the characteristic throbbing pain associated with a spinal headache after anesthesia.
Choice D rationale
Keeping the patient lying flat is a standard nursing intervention to prevent spinal headaches. This horizontal position reduces the pressure exerted by the cerebrospinal fluid on the dural puncture site, which minimizes further leakage into the epidural space. By maintaining a flat position, usually for several hours post-procedure, the nurse allows the puncture site to begin healing while keeping intracranial pressure stable, effectively reducing the risk of a spinal headache developing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["300"]
Explanation
Step 1 is 0600 - 0330 = 2 hours and 30 minutes.
Step 2 is 2.5 hours × 120 mL ÷ hour = 300 mL. The final calculated answer is 300 mL.
Correct Answer is A
Explanation
Choice A rationale
Insulin glargine is classified as a long-acting basal insulin analogue designed to provide a steady level of insulin for an extended period. It typically has an onset of 1.1 hours, no pronounced peak, and a duration of action that lasts between 18 to 24 hours. This pharmacological profile mimics the continuous basal secretion of insulin by a healthy pancreas, which is essential for maintaining stable blood glucose levels between meals and during sleep.
Choice B rationale
A duration of 14 hours is generally associated with intermediate-acting insulins like NPH, which typically act for 12 to 18 hours, rather than long-acting glargine. Insulin glargine is specifically engineered with a low solubility at a neutral pH, allowing it to form micro-precipitates in the subcutaneous tissue that release slowly over a full day. A 14-hour window would result in a significant gap in basal coverage for a patient requiring 24-hour glycemic control.
Choice C rationale
A duration of 3 to 6 hours is characteristic of rapid-acting insulins such as lispro, aspart, or glulisine, which are used primarily to manage postprandial glucose spikes. These insulins have a quick onset of 15 minutes and peak within 1 to 2 hours. Using these as a reference for insulin glargine would be incorrect because glargine is meant for long-term stabilization rather than immediate mealtime coverage, and its action is significantly more prolonged.
Choice D rationale
A duration of 6 to 10 hours is most representative of short-acting regular insulin, which has a total duration of action typically spanning 5 to 7 or 8 hours. Regular insulin is used for bolus coverage during meals or in emergency intravenous scenarios. Glargine’s unique chemical structure ensures a much longer presence in the systemic circulation to maintain a flat, peakless effect, making the 6 to 10-hour timeframe inaccurate for this specific medication.
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