A nurse is instructing coworkers about how to minimize lower back pain and avoid repeated episodes of back pain.
Which of the following strategies should the nurse include? (Select all that apply.)
Apply cold packs frequently.
Avoid prolonged sitting.
Sleep on a soft mattress.
Ask for help when moving clients.
Do partial sit-ups with the knees bent.
Correct Answer : B,D,E
Choice A rationale
Applying cold packs, or cryotherapy, is primarily indicated for acute soft tissue injuries to induce vasoconstriction, thereby decreasing local blood flow, metabolism, and inflammation, which reduces pain and swelling. For chronic or recurring lower back pain prevention, heat is often more effective, as it promotes vasodilation, increasing blood flow to relax muscles and reduce stiffness, making cold less suitable as a frequent preventative strategy.
Choice B rationale
Prolonged static postures, like sitting, increase intradiscal pressure and muscle tension in the lumbar region, leading to muscle fatigue and reduced blood flow to the supporting structures, which exacerbates back pain. Regular movement and changing positions is crucial to maintain flexibility, promote circulation, and distribute mechanical stress across different structures, minimizing sustained strain on the spinal ligaments and discs.
Choice C rationale
Sleeping on a mattress that is too soft fails to provide adequate support for the spine's natural curvature (lumbar lordosis), allowing the trunk to sink, which can lead to spinal misalignment and increased strain on the back muscles and ligaments. A medium-firm mattress is generally recommended to maintain proper spinal alignment during sleep, which reduces mechanical stress and prevents morning stiffness and pain.
Choice D rationale
Asking for help when moving clients ensures the nurse can use proper body mechanics, which involves keeping the load close to the body, maintaining a wide base of support, and lifting with the legs, not the back. This principle minimizes the mechanical stress and sheer forces applied to the intervertebral discs and paraspinal muscles, significantly lowering the risk of acute muscle strains or chronic cumulative trauma to the lumbar spine.
Choice E rationale
Partial sit-ups with the knees bent strengthen the abdominal and oblique muscles, which are key components of the body's core musculature. A strong core acts as a stabilizer for the lumbar spine, increasing intra-abdominal pressure to support the vertebral column and reducing the load and mechanical strain on the lower back structures during movement and daily activities, thereby preventing injury recurrence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Asking the child to turn to the side and remain relaxed is insufficient as it does not optimally expose or accentuate the characteristic anatomical deformities of scoliosis, which include lateral spinal curvature and vertebral rotation. A relaxed, upright posture may conceal mild curvature, thus making a reliable assessment of spinal symmetry and trunk rotation difficult or inconclusive for screening purposes.
Choice B rationale
These neck movements assess the range of motion of the cervical spine (neck flexion and extension), which is unrelated to the primary screening for idiopathic scoliosis, a condition characterized by a structural lateral curve and rotation predominantly in the thoracic and lumbar spine. This instruction would not provide the necessary positional change to observe the trunk asymmetry.
Choice C rationale
Lying prone on the examination table takes the gravitational load off the spine and alters the relationship of the trunk to gravity, making the observation of subtle curvatures or the characteristic rib hump extremely difficult. This position is unsuitable as a screening method, which relies on an upright, forward-bending posture to best reveal the rotational deformity inherent to structural scoliosis.
Choice D rationale
The instruction to "Bend forward from the waist with your head and arms downward" describes the Adam's forward bend test, the gold standard screening method for scoliosis. This position causes the rotational component of the scoliotic curve to become most prominent, revealing a rib or flank hump (asymmetry) due to the underlying vertebral rotation, which is crucial for early detection.
Correct Answer is C
Explanation
Choice A rationale
Aspirin (acetylsalicylic acid) at a low daily dose of 81 mg is typically used for its antiplatelet effects (irreversible inhibition of COX-1 in platelets) to prevent cardiovascular events. This dose has minimal analgesic or anti-inflammatory effects. Therefore, monitoring a pain rating of 6 or more is not a primary concern for this specific prophylactic indication.
Choice B rationale
Encouraging increased intake of green leafy vegetables, which are rich in Vitamin K, is relevant for clients on warfarin (Coumadin), as Vitamin K can counteract its effect. Aspirin, however, works on platelet aggregation and is not affected by dietary Vitamin K levels. This advice is irrelevant to the pharmacodynamics of aspirin.
Choice C rationale
Aspirin is a non-steroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal irritation and bleeding, a side effect that is dose-dependent but still possible with low-dose therapy. Black, tarry stools (melena) are an indication of upper gastrointestinal bleeding due to the degradation of hemoglobin to hematin. The nurse must monitor for this serious adverse effect.
Choice D rationale
Aspirin, especially at higher doses, can impair renal function by inhibiting prostaglandin synthesis, which is essential for maintaining renal blood flow. This effect typically leads to an increase (not a sudden drop) in blood urea nitrogen (BUN) (normal range 8-20 mg/dL) and creatinine (normal range 0.6-1.2 mg/dL) levels due to decreased glomerular filtration.
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