A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided, and complains of headache. The patient has a pulse of 62 beats/min, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?
Obtain an order for a urinary catheter for urinary retention
Contact the anesthetist to request an order for ephedrine
Have the patient sit up to relieve the headache pain
Lower the head of the bead to a 10-15 degree head down position
The Correct Answer is D
A. While urinary retention is a common postoperative complication after spinal anesthesia, the priority in this scenario is the patient’s headache and hypotension, which may indicate post-dural puncture headache with potential spinal-induced hypotension. Catheterization may be necessary later but is not the first intervention.
B. Ephedrine is used to treat hypotension, but in this context, the headache associated with spinal anesthesia is typically relieved by positioning and supportive care. Immediate pharmacologic intervention may be required only if hypotension is severe or unresponsive.
C. Post-dural puncture headache is worse when the patient is upright because cerebrospinal fluid leaks increase intracranial tension. Sitting up would worsen the headache, not relieve it.
D. The patient’s headache and hypotension are consistent with post-dural puncture headache and spinal anesthesia–related sympathetic blockade. Lowering the head of the bed reduces gravitational stress on the CSF leak, helping relieve the headache, and improves venous return, which may help correct hypotension. This is an appropriate initial nursing action while monitoring vital signs and preparing for further interventions such as fluids, analgesics, or an anesthetist consult if symptoms persist.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Taking thyroid hormone with food, especially in the evening, can reduce absorptionbecause certain foods (like soy, high-fiber foods, and calcium-containing products) interfere with absorption. Evening dosing is generally not recommended.
B. Similar to the evening meal, taking the medication with lunch can decrease absorption and lead to subtherapeutic levels. Consistency with timing is important, and midday doses are not standard practice.
C. Thyroid replacement therapy (levothyroxine) is best absorbed when taken first thing in the morning, at least 30–60 minutes before breakfast, with a full glass of water. This timing ensures optimal absorption and mimics the body’s natural circadian rhythm for thyroid hormone levels. It also reduces interference from food, supplements, or other medications. Patients should be instructed to take it consistently at the same time each day.
D. Taking thyroid hormone at bedtime is generally avoided because absorption can be unpredictable, especially if the patient has eaten dinner or snacks beforehand. While some patients may take it at night if morning dosing is not feasible, the standard recommendation is morning dosing on an empty stomach.
Correct Answer is ["B","D","E"]
Explanation
A. Amide local anesthetics (e.g., lidocaine, bupivacaine, ropivacaine) have a very low risk of allergic reactions. True allergies are rare and usually related to preservatives rather than the amide molecule itself.
B. Ester local anesthetics (e.g., procaine, chloroprocaine, tetracaine) pose a higher risk of allergic reactionsbecause they are metabolized to para-aminobenzoic acid (PABA), which is a known allergen. Patients may develop urticaria, rash, or, rarely, anaphylaxis.
C. Lidocaine is an amide anesthetic, and allergic reactions are extremely rare. Most reported reactions are side effects or sensitivity to preservativesrather than true allergy to the drug.
D. Chloroprocaine is an ester-type local anesthetic, which carries a higher risk of allergic reactionscompared with amide anesthetics. Allergies are uncommon but possible due to PABA metabolites.
E. Cocaine is an ester-type local anestheticand is more likely to cause allergic reactionscompared with amides. Additionally, cocaine has sympathomimetic effectsthat can complicate its use, including cardiovascular stimulation.
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