Davis Combined Coordinating Care For Patients With Spinal Cord Disorders

Davis Combined Exam Questions & Answers Coordinating Care For Patients With Spinal Cord Disorders Chapter 37: Coordinating Care for Patients With Spinal Cord Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A patient asks what smoking cigarettes has to do with low back pain. How should the nurse respond to this patient? 1) “Smoking is a sedentary activ- ity.” 2) “Smoking is linked to nutritional disorders.” 3) “Nicotine in cigarettes interferes with nutrients that supply the disk spaces.” 4) “Nicotine hinders the mobility of the vertebral spaces and inter- feres with nerve function.” ``` 2. A patient with multiple sclerosis experiences exacerbations of new symptoms that last a few days and then disappear. Which type of multiple sclerosis is this patient most likely experiencing? 1) Relapsing-remitting 2) Primary progressive 3) Progressive relapsing 4) Secondary progressive 3. A patient is diagnosed with spinal stenosis. Which manifestation is caused by age- related loss of spinal muscle strength? 1) Fatigue 2) Constipation 3) Muscle spasm 4) Decreased stamina 4. A patient with low back pain asks why nerve conduction studies are prescribed. What explanation should the nurse provide to the patient relative to this diagnostic test? 1) “It measures damage to nerves.” 2) “It shows pressure on nerves from herniated disks.” 3) “It measures electrical impulses within muscle tissue.” 4) “It shows the structure of the vertebrae and joint outlines.” 5. A patient with low back pain asks what aspirin is supposed to do help with the pain. How should the nurse respond to this patient? 1) “It depresses the central nervous system.” 2) “It blocks sodium channels and stops the formation of nerve im- pulses.” 3) “It blocks enzymes and chemi- cals in the body to decrease pain and inflammation.” 4) “It blocks the production of sub- stances that trigger allergic and inflammatory reactions.” 6. The nurse is caring for a patient with unrelenting low back pain caused by a herni- ated disk. What instruction should the nurse provide to this patient to help with the pain? 1) Sit with the legs elevated 2) Reduce the intake of fluids 3) Limit activity until the pain sub- sides 4) Bend at the knees with a straight back 7. The nurse directs a patient with a herniated disk to notify the health-care provider immediately if the patient experiences which presentation? 1) New onset urinary incontinence 2) Sleepiness after taking pain med- ication 3) Difficulty with having a bowel movement 4) Transient pain with walking and changing position 8. A patient receives a definitive diagnosis of multiple sclerosis. What finding oc- curred to validate this diagnosis? 1) Onset of double vision 2) Loss of bowel and bladder control 3) Numbness and tingling of one limb 4) MRI changes in two separate lo- cations 9. A patient with multiple sclerosis is admitted for treatment of clinical manifesta- tions. What should the nurse expect to be prescribed for this patient? 1) Corticosteroids 2) Beta interferons 3) Muscle relaxants 4) Immunosuppressive agents 10. A patient with multiple sclerosis is developing speech difficulties. What should the nurse realize as being the reason for this new manifestation? 1) Depression 2) Medications 3) Nerve regeneration 4) Mental status changes 11. The nurse is caring for a patient with multiple sclerosis. What should the nurse do to increase venous return, prevent stiffness, and maintain muscle strength and en- durance? 1) Administer interferon 2) Administer corticosteroids 3) Turn and reposition every two hours 4) Encourage range-of-motion exer- cises 12. A patient is experiencing increasing flaccid upper arms while the lower extremities periodically cramp and contract. On which health problem should the nurse focus when assessing this patient? 1) Brain tumor 2) Spinal cord tumor 3) Multiple sclerosis 4) Amyotrophic lateral sclerosis (ALS) 13. A patient is admitted for diagnosis and treatment of ongoing spasticity and flaccid- ity of the extremities. Which diagnostic test should the nurse expect to be pre- scribed that will definitively determine this patient’s health problem? 1) MRI of the neck 2) CT scan of the head 3) A variety of tests will be ordered to help rule out other causes 4) Analysis of cerebrospinal fluid from a lumbar puncture 14. A client with amyotrophic lateral sclerosis is prescribed riluzole (Rilutek). What statement indicates additional teaching is required about the effects of this medi- cation? 1) “This will cure my disease.” 2) “This will help me stay awake.” 3) “This will stop my bladder spasms.” 4) “This will increase the progres- sion of my disease.” 15. A victim of a motor vehicle crash is diagnosed with a neck whiplash. Which mani- festation should the nurse expect to assess in this patient? 1) Bladder dysfunction 2) Loss of proprioception 3) Ipsilateral loss of motor function 4) Pain below the level of the injury 16. The nurse is reviewing orders written for a patient with a new spinal cord injury. Which order should the nurse question before completing? 1) Place on air mattress 2) Insert a nasogastric tube and at- tach to low suction 3) Insert indwelling urinary catheter; strict intake and output 4) Dexamethasone (Decadron) 10 mg IVP now and repeat in 4 hours 17. The latest blood pressure reading for a patient with a spinal cord injury is 210/140 mm Hg. What action should the nurse take first? 1) Palpate for bladder distention 2) Assess for a bowel impaction 3) Re-measure the blood pressure 4) Raise the head of the bed 45 de- grees 18. The nurse notes crusting of secretions around the pins of a patient with a Halo de- vice. What action should be taken at this time? 1) Wrap the pins with gauze soaked with normal saline 2) Gently pick the crusting off of the pins with a dry gauze pad 3) Apply gauze soaked with hydro- gen peroxide around the pins 4) Syringe 1/2 strength hydrogen peroxide and sterile water to the crusted areas 19. A patient has a new onset of back pain radiating down the left leg. For which health problem should the nurse expect this patient to be evaluated? 1) Meningitis 2) Spinal cord tumor 3) Multiple sclerosis 4) Amyotrophic lateral sclerosis 20. A patient is suspected as having a spinal cord tumor. Which diagnostic test should the nurse expect to be prescribed to definitively diagnose this patient’s problem? 1) MRI 2) Myelogram 3) Cerebral angiogram 4) Nerve conduction studies 21. A patient has a 4 cm spinal cord tumor located at T10. Which therapeutic treat- ment should the nurse anticipate will be ordered for this patient? 1) Surgery 2) Radiation 3) Chemotherapy 4) Stereotactic radiosurgery 22. The nurse is reviewing orders written for a patient returning from surgery to re- move a spinal cord tumor. Which order should the nurse implement immediately? 1) Install a bed cradle 2) Apply heel protection 3) Dexamethasone (Decadron) 10 mg IVP now and every 8 hours x 2 doses 4) Monitor bowel sounds; notify if unable to obtain or faint in any abdominal quadrant Multiple Response Identify one or more choices that best complete the statement or answer the question. 23. The nurse is concerned that a patient is at risk for a lumbar disk herniation. What assessment information is causing the nurse to have this concern? Select all that apply. 1) Fell off of a ladder 2) Body mass index 32.3 3) Smokes 1 pack of cigarettes per day 4) Works in an automotive factory 5) Lifts 50 lb. sack of cement at work 24. A patient with low back pain asks what nonmedical treatments can be used to help with the discomfort. Which complementary and alternative therapies should the nurse recommend to this patient? Select all that apply. 1) Yoga 2) Qi gong 3) Acupuncture 4) Massage therapy 5) Chiropractic treatments 25. The nurse notes that a patient with low back pain is experiencing radiculopathy. What should the nurse expect when assessing this patient? Select all that apply. 1) Pain 2) Edema 3) Weakness 4) Numbness 5) Inability to control motor move- ment 26. A patient with a herniated disk is prescribed conservative treatment. For which an- ticipated treatments should the nurse prepare to instruct this patient? Select all that apply. 1) Reducing body weight 2) Avoiding painful positions 3) Engaging in aerobic activities 4) Performing planned exercises 5) Taking pain medication as pre- scribed 27. The nurse is assessing a patient with multiple sclerosis. What should the nurse ex- pect to assess in this patient? Select all that apply. 1) Anxiety 2) Dizziness 3) Double vision 4) Unsteady gait 5) Electric shocks with head move- ment 28. A patient with amyotrophic lateral sclerosis (ALS) is being prepared for discharge. What teaching would be essential for the family to receive prior to taking the pa- tient home? Select all that apply. 1) Skin care 2) Aspiration precautions 3) Recognizing exacerbations 4) Lower extremity circulation 5) Reporting changes in continence Chapter 37: Coordinating Care for Patients With Spinal Cord Disorders Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: 37, Coordinating Care for Patients With Spinal Cord Dis- orders Chapter learning objective: Describing the epidemiology of spinal cord disorders Chapter page reference: 771 Heading: Low Back Pain > Epidemiology Integrated Processes: Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Mobility; Promoting Health Difficulty: Easy Feedback 1 There is no evidence to link smoking with a sedentary life- style. 2 There is no evidence to link smoking with nutritional disor- ders. 3 Nicotine in cigarettes is thought to interfere with vital nutrients being absorbed by the interver- tebral disks. 4 There is no evidence to link nico- tine to vertebral space mobility and nerve function. PTS: 1 CON:Mobility | Promoting Health 2. ANS: 1 Chapter number and title: 37, Coordinating Care for Patients With Spinal Cord Dis- orders Chapter learning objective: Describing the epidemiology of spinal cord disorders Chapter page reference: 777 Heading: Multiple Sclerosis > Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Mobility Difficulty: Moderate Feedback 1 In relapsing-remitting multiple sclerosis, relapses or exacerba- tions occur during which new symptoms appear and old ones worsen or reappear; these re- lapses can last days or months. 2 Primary progressive multiple sclerosis has gradual progression with no remissions. 3 Progressive relapsing multiple sclerosis has a gradual worsening of symptoms from onset, and the relapses may or may not have recovery. 4 Secondary progressive multiple sclerosis is when the patient ini- tially had relapsing-remitting but it gradually becomes worse. PTS: 1 CON:Mobility 3. ANS: 3 Chapter number and title: 37, Coordinating Care for Patients With Spinal Cord Dis- orders Chapter learning objective: Correlating clinical manifestations to the pathophysio- logical processes of: Low back pain Chapter page reference: 772 Heading: Low Back Pain > Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity/Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Mobility Difficulty: Moderate Feedback 1 Fatigue could occur because of needing to be sedentary to pre- vent the onset of pain. 2 Constipation could occur because of decreased mobility. 3 Muscle spasm is the sudden, in- voluntary contraction of a single muscle or muscle group. Most back muscle spasms are due to inflammation and soreness be- cause of sudden movement or bending, but they can also result from age-related loss of spinal muscle strength as muscles spasm to protect the worn areas of the spine. 4 Decreased stamina is possible if pain decreases activity and the patient becomes more sedentary. PTS: 1 CON:Mobility 4. ANS: 1 Chapter number and title: 37, Coordinating Care for Patients With Spinal Cord Dis- orders Chapter learning objective: Describing the diagnostic results used to confirm spinal cord disorders Chapter page reference: 773 Heading: Low Back Pain > Medical Management > Diagnosis Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity/Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Mobility Difficulty: Moderate Feedback 1 Nerve conduction studies (NCS) measure the electrical nerve im- pulse that indicates damage to the nerve. 2 A myelogram shows pressure on the spinal cord or nerves from herniated disks. 3 Electromyography (EMG) mea- sures the electrical impulse within muscle tissue. 4 X-rays show the structure of the vertebrae and joint outlines. PTS: 1 CON:Mobility 5. ANS: 3 Chapter number and title: 37, Coordinating Care for Patients With Spinal Cord Dis- orders Chapter learning objective: Developing a comprehensive plan of nursing care for patients with disorders of the spinal cord Chapter page reference: 773 Heading: Low Back Pain > Nursing Management > Actions Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Mobility; Comfort; Medication Difficulty: Moderate Feedback 1 Muscle relaxants depress the central nervous system. 2 Tricyclic antidepressants block the sodium channels and de- crease formation of ectopic neu- ronal pacemakers. 3 NSAIDs block enzymes and prostaglandins throughout the body, thereby decreasing pain and inflammation. 4 Corticosteroids block the produc- tion of substances that trigger al- lergic and inflammatory reac- tions. PTS: 1 CON:Mobility | Comfort | Medication 6. ANS: 4 Chapter number and title: 37, Coordinating Care for Patients With Spinal Cord Dis- orders Chapter learning objective: Designing a plan of care that includes pharmacological, dietary, and lifestyle considerations for patients with disorders of the spine Chapter page reference: 777 Heading: Herniated Nucleus Pulposus > Nursing Management > Teaching Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Mobility; Promoting Health; Medication; Comfort Difficulty: Moderate Feedback 1 Sitting with the legs elevated puts pressure on the lower spine. 2 Reducing the intake of fluids can cause constipation, which wors- ens back pain. 3 Activity should be performed as prescribed to build core muscle