You are teaching an elderly female with osteoarthritis about her risk of herniating a disc. Which of the following statements made by the patient shows that she understands the teaching?
"Because I am old and have osteoarthritis, I am at risk for gradual herniation."
"If I think I have suffered a herniation, I should simply call my doctor and wait for an appointment."
"I am more likely to suffer a hernia in a thoracic disc."
"Smoking has nothing to do with potential for spine herniation."
You have a 45-year-old male patient in your office. He is an elementary school teacher, and he is concerned because he's been having a burning, tingling pain in his left "butt cheek" that radiates all the way down into his left foot, as well as leg weakness. The pain is especially bad when he's walking. He's been taking ibuprofen, but it isn't working.
Which of the following statements might you make to him?
"I highly suggest you go to the hospital. it sounds like you may have cauda equina syndrome."
"It sounds like you might have sciatica. I would tell your doctor so he can do some imaging."
"It sounds like you herniated a lumbar disc. I would advise you to go to the hospital because that can cause permanent paralysis."
"It sounds like you herniated a lumbar disc. This should heal on its own over time."
A 20-year-old female patient was in a car crash. She is in a lot of pain, but she is awake, alert, and responsive. During questioning, she complains to you that her lower back hurts worse than anything else. Concerned, you ask her if she felt her catheter go in, and she said that she doesn't feel anything in her genital region.
Which of the following actions do you do FIRST?
Report the signs and symptoms to the physician.
Order a CT scan for the patient.
Administer 4 mg of morphine in an IV injection.
Change the patient's position in bed
Cervical disc herniation does not result in symptoms in the lower body.
Your patient is about to undergo a myelogram, but she is nervous about the test because she's never heard of it before. Which of the following statements made by you, the nurse, is correct teaching?
"The doctor will inject you with a safe dye and take you down to X-ray."
"Your doctor will stick electrodes on your head and body to see the electrical activity of the muscles."
"Your doctor will stick needles into your muscles to measure speed and efficacy of nerve impulses."
"During this test, your muscles will be visualized at rest and during contraction."
Your student nurse is caring for a patient pre-op for a discectomy. The student nurse has no clue what this surgery is though. Select the statements that would be accurate teaching for your student.
"Your patient is going into surgery to have the part of the vertebra that covers the spinal canal removed."
"The point to this surgery is to enlarge the spinal canal and relieve pressure on the nerves."
"Your patient will be undergoing surgery to remove all or part of a herniated disc."
"A laminectomy or laminotomy may also be performed with the discectomy."
"The herniated disc will be removed and replaced with an artificial one."
Which of the following statements about a spinal fusion surgery is INCORRECT?
It is performed to join 2 or more vertebrae together.
Bone grafts, screws, and rods are used to join the vertebrae.
Fusing the spine prevents motion between the 2 vertebrae, which reduces pain.
Bone grafts are usually taken from a donor, meaning that rejection is the main nursing implication for this surgery.
An alternative to this surgery is placing an artificial disc.
Select the medications that may be used to treat neuropathic pain.
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Diazepam (Valium)
Baclofen (Lioresal)
Cyclobenzaprine (Ameix, Flexeril)
Select the medications that would be used to reduce muscle spasms.
Cyclobenzaprine (Amrix, Flexeril)
Which of the following statements is important and accurate teaching for a patient taking baclofen, cyclobenzaprine, or diazepam for muscle spasms?
"Take this drug as prescribed; if you don't, it could cause you to go into cardiac or respiratory arrest."
"It is safe for you to return to your job as a construction worker."
"You can still drink while taking this drug."
"This drug may cause mood changes."
Which of the following statements made by a patient shows that she understands the teaching given for gabapentin.
"I am still safe to drive to work."
"I should tell my husband to monitor me for mood changes."
"I can still drink, but I should probably be taken off of my Xanax."
"I will probably not experience side effects with this drug. Gabapentin is pretty safe."
Select the proper interventions to enact for a patient with a herniated disc in the lumbar region.
Teach the patient to avoid bending and twisting.
Teach the patient to flex the hips, place a pillow until his/her knees, and invest in a firm mattress.
Monitor for alterations in mobility and sensation.
Monitor vital signs for trends.
Discourage the patient from taking pain medications and encourage the patient to go to a physical therapist and a chiropractor instead.
Encourage the patient to maintain normal activities.
A teenage girl is upset because she has has just been diagnosed with moderate, idiopathic, nonstructural scoliosis. She wants to know more about her condition, and decides to ask you what it is.
Which of the following statements can you give this girl?
"Your case of scoliosis is nonstructural, meaning that the bones in your spinal column are deformed."
"Your case of scoliosis is idiopathic, which is relatively rare."
"Your case of scoliosis may be caused by abnormal force exerted on the spine by connective tissues or muscles."
"You were likely born like this."
A mother is wondering why her son's severe scoliosis needs to be treated because she "had scoliosis as a child and turned out fine." She seems to have the impression that his scoliosis will simply "clear up."
Select the complications you should inform this mother about.
If the curve worsens, her son could develop an asymmetric vertebral canal, which could cause pain later in life.
It may cause difficulty breathing, pneumonia, and other heart and lung problems.
It may cause paralysis.
He will face bullying from his classmates for having a strange walk.
He will face self-esteem problems from having a rip hump.
You are a middle school nurse. You have a kid visiting you because he "doesn't feel good". It's clear that he's lying to get out of class, but you do notice the typical "rib bump" and prominent shoulder blade common with scoliosis. You ask him if he's ever been diagnosed with scoliosis and he has no clue what you're talking about.
Which of the following actions might you take next?
Send the kid back to class.
Ask him to lean forward at the waist with his arms hanging down and use a scoliometer to measure the resulting hump.
Contact his parents and inform them that they should take him to the doctor's to get tested for scoliosis.
Contact his doctor's office and inform them that you've noticed abnormalities in his spine that may indicate scoliosis.
