The nurse is assisting the neurologist with a lumbar puncture on a patient with possible meningitis. Which post-procedure teaching point is the highest priority for the patient?
Maintain a flat lying position for 14 hours following the procedure.
Muscular discomfort is expected after being in a curled position for a period of time.
Resume oral intake immediately after the procedure.
Mild pain is expected at the needle insertion site.
The Correct Answer is A
Choice A reason: Maintaining a flat lying position for 14 hours following the procedure is the highest priority teaching point for the patient who had a lumbar puncture. It helps to prevent cerebrospinal fluid leakage and post-lumbar puncture headache, which can be severe and debilitating.
Choice B reason: Muscular discomfort is expected after being in a curled position for a period of time, but it is not the highest priority teaching point for the patient who had a lumbar puncture. It is a common and mild side effect that can be relieved by analgesics, massage, or heat therapy.
Choice C reason: Resuming oral intake immediately after the procedure is not a priority teaching point for the patient who had a lumbar puncture. It is not contraindicated, but it is not essential either. The patient should drink plenty of fluids to replenish the cerebrospinal fluid and prevent dehydration.
Choice D reason: Mild pain is expected at the needle insertion site, but it is not the highest priority teaching point for the patient who had a lumbar puncture. It is a common and mild side effect that can be relieved by analgesics, ice packs, or dressing.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: "Try relaxation and warm moist compresses for your headaches and document your response." is not the best instruction by the nurse to gather additional data before the appointment. It is a suggestion for self-care and pain relief, but it does not provide any information about the cause, type, or severity of the headaches.
Choice B reason: "Keep a diary of your headaches, recording symptoms, timing, and headache triggers." is the best instruction by the nurse to gather additional data before the appointment. It is a useful tool for collecting objective and subjective data about the headaches, such as their frequency, duration, intensity, location, quality, associated symptoms, and precipitating factors. This can help the primary care practitioner to diagnose the type of headache, such as migraine, tension, or cluster, and prescribe the appropriate treatment.
Choice C reason: "Call and come in the next time you have a headache so you can be examined." is not the best instruction by the nurse to gather additional data before the appointment. It is a suggestion for urgent care, but it does not provide any information about the history, pattern, or characteristics of the headaches.
Choice D reason: "Keep track of how many headaches you have before you come in." is not the best instruction by the nurse to gather additional data before the appointment. It is a simple measure of the quantity of the headaches, but it does not provide any information about the quality, severity, or triggers of the headaches.
Correct Answer is C
Explanation
Choice A reason: Evening is not the best time to visit the patient with myasthenia gravis to help with bathing and exercising. Myasthenia gravis is a condition that causes muscle weakness and fatigue, which worsens as the day progresses. Therefore, the patient may have more difficulty performing these activities in the evening.
Choice B reason: Mid-afternoon is not the best time to visit the patient with myasthenia gravis to help with bathing and exercising. Myasthenia gravis causes muscle weakness and fatigue, which may be aggravated by the heat and humidity of the afternoon. Therefore, the patient may have more difficulty performing these activities in the mid-afternoon.
Choice C reason: Morning is the best time to visit the patient with myasthenia gravis to help with bathing and exercising. Myasthenia gravis causes muscle weakness and fatigue, which are less severe in the morning after a night of rest. Therefore, the patient may have more strength and energy to perform these activities in the morning.
Choice D reason: Before bedtime is not the best time to visit the patient with myasthenia gravis to help with bathing and exercising. Myasthenia gravis causes muscle weakness and fatigue, which are most severe at the end of the day. Therefore, the patient may have more difficulty performing these activities before bedtime.
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