A patient with suspected meningitis is scheduled for a lumbar puncture. What action should the nurse take before the procedure?

Transfer the patient to radiology.

Enforce NPO status for 4 hours.

Help the patient to a lateral position.

Administer a sedative medication.

Answer and Explanation

The Correct Answer is C

A.   Transfer the patient to radiology: Lumbar punctures are typically performed at the bedside in the patient's room or in a procedure room, not in radiology.
B.   Enforce NPO status for 4 hours: NPO (nothing by mouth) status is not typically required before a lumbar puncture unless specifically ordered by the healthcare provider for a particular reason.
C.   Help the patient to a lateral position: Before a lumbar puncture, the patient should be placed in a lateral recumbent position (usually on their side with knees flexed towards the chest) to facilitate the procedure and minimize the risk of complications such as post-dural puncture headache.
D.   Administer a sedative medication: Sedative medications are not routinely administered before a lumbar puncture, as they can alter the patient's level of consciousness and interfere with neurological assessment during and after the procedure.

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Correct Answer is C

Explanation

A. "An MRI scan is not distorted by movement, so you do not have to lie still." This statement is incorrect. Movement during an MRI scan can distort images and affect the quality of the diagnostic information obtained. Patients are typically instructed to lie as still as possible during the procedure.

B. "The MRI contrast dye contains iodine and can cause your skin to itch." This statement is incorrect. MRI contrast agents do not contain iodine and are not associated with itching.
However, some patients may experience allergic reactions to MRI contrast agents, but this is not related to iodine.

C. "An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner." This statement is correct. MRI scanners produce loud noises during imaging, which can be bothersome to some patients. Patients are often provided with earplugs or headphones to help reduce the noise and make the experience more comfortable.

D. "An MRI scan is a short procedure and should take no longer than 30 minutes." This statement is incorrect. The duration of an MRI scan can vary depending on the type of imaging being performed and the specific protocol used. Some MRI scans may take longer than 30 minutes to complete.

A. Check the client's phenytoin (Dilantin) level. B. Get an order to decrease the rate of IV fluids. C. Ask the woman to describe how she's feeling. D. Offer the client clear liquids to prevent dehydration.

Correct Answer is C

Explanation

A. Check the client's phenytoin (Dilantin) level: Checking the phenytoin level would not be relevant in this situation as the client's presentation suggests a possible stroke, not related to phenytoin therapy.

B. Get an order to decrease the rate of IV fluids: While managing fluid balance is important, there is insufficient information to warrant decreasing IV fluids at this time. It's essential to assess the client's overall condition and consult with the healthcare provider before making changes to IV fluid administration.

C. Ask the woman to describe how she's feeling: Assessing the client's symptoms and response to treatment is crucial for monitoring her condition and guiding further interventions, especially in
the context of a possible stroke.

D. Offer the client clear liquids to prevent dehydration: While maintaining hydration is
important, offering clear liquids would not address the potential stroke or irregular respirations. Assessment and intervention related to the client's neurological status and respiratory function take precedence.

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A patient with suspected meningitis is scheduled for a lumbar puncture. What action should the nurse take before the procedure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is scheduled to have a magnetic resonance imaging (MRI) scan. The client asks the nurse what to expect during the procedure. Which of the following statements should the nurse make?

Correct Answer is C

Explanation

Correct Answer is C

Explanation

A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first?

A nurse is receiving a transfer report for a client who has a head injury. The client has a Glasgow Coma Scale (GCS) score of 3 for eye opening, 5 for best verbal response, and 5 for best motor response. Which of the following is an appropriate conclusion based on this data?

A patient with paraplegia resulting from a T9 spinal cord injury has a neurogenic reflexic bladder. Which action should the nurse include in the plan of care?

A nurse is creating a plan of care for a client who has a history of tonic-clonic seizure disorder. Which of the following interventions should the nurse include? (Select all that apply.)

When assessing the client with meningitis, the nurse looks for which manifestation as a frequent first sign of increased intracranial pressure?

A patient admitted with possible stroke has been aphasic for 3 hours and has a current blood pressure (BP) of 174/94 mm Hg. Which order by the health care provider should the nurse question?

Which information about a patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication?