The nurse is caring for a patient who is about to have a lumbar puncture to obtain cerebrospinal fluid for lab analysis. The patient is anxious about damage to the spinal cord. What is the best response by the nurse?
"You may feel some slight tingling in your lower extremities."
"Paresthesia may occur because of the procedure, but it is only temporary."
"The needle is placed between the vertebrae, but below where the spinal cord ends."
"You should report any numbness during the procedure to the physician immediately."
The Correct Answer is C
A. Informing the patient about possible tingling is not as reassuring and does not directly address their concern about spinal cord damage.
B. While paresthesia can occur, focusing on temporary effects might not alleviate the patient’s primary concern about spinal cord injury.
C. Explaining that the needle is placed below where the spinal cord ends directly addresses the patient’s anxiety about potential damage, providing clarity and reassurance about the safety of the procedure.
D. While it is important for patients to report numbness, this response does not reassure them about the procedure's safety and may increase their anxiety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
A. An irregular border is a key characteristic of potentially cancerous skin lesions, particularly melanoma. Melanomas often have uneven, poorly defined edges.
B. Asymmetry is another sign of melanoma. If one half of a lesion does not match the other in shape or size, it should be evaluated by a healthcare professional.
C. Any lesion that has been increasing in size, particularly over a short period, is a concern and should be checked. Rapid growth can be a sign of malignancy.
D. A lesion with a diameter of less than 4 mm is generally less concerning, as most cancerous lesions are larger. However, the other factors (such as asymmetry and border irregularity) are more significant for diagnosis.
E. Ecchymosis (bruising) is not typically associated with cancerous skin lesions. Skin cancers like melanoma present as new or changing moles, not bruising.
Correct Answer is C
Explanation
A. Informing the patient about possible tingling is not as reassuring and does not directly address their concern about spinal cord damage.
B. While paresthesia can occur, focusing on temporary effects might not alleviate the patient’s primary concern about spinal cord injury.
C. Explaining that the needle is placed below where the spinal cord ends directly addresses the patient’s anxiety about potential damage, providing clarity and reassurance about the safety of the procedure.
D. While it is important for patients to report numbness, this response does not reassure them about the procedure's safety and may increase their anxiety.
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