Chapter 40: Concepts of Care for Patients
with Problems of the Central Nervous
System: The Spinal Cord
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a client with a spinal cord injury. With which interprofessional
health team member would the nurse collaborate to assist the client with activities of
daily living?
a. Social worker
b. Physical therapist
c. Occupational therapist
d. Case manager
ANS: C
The occupational therapist instructs the patient in the correct use of all adaptive
equipment. In collaboration with the therapist, the nurse instructs family members or
the caregiver about transfer skills, feeding, bathing, dressing, positioning, and skin
care. The other team members are consulted to assist the client with other issues.
DIF: Understanding TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Spinal cord injury, Interprofessional collaboration
MSC: Client Needs Category: Safe and Effective Care Environment:
Management of Care
,2. After teaching a client with a high thoracic spinal cord injury, the nurse assesses the
client’s understanding. Which statement by the client indicates a correct
understanding of how to prevent respiratory problems at home?
a. “I’ll use my incentive spirometer every 2 hours while I’m awake.”
b. “I’ll drink thinned fluids to prevent choking.”
c. “I’ll take cough medicine to prevent excessive coughing.”
d. “I’ll position myself on my right side so I don’t aspirate.”
ANS: A
The client with a cervical or high thoracic spinal cord injury typically has weak
intercostal muscles and is at higher risk for developing atelectasis and stasis
pneumonia. Using an incentive spirometer every 2 hours helps the client expand the
lungs more fully and helps prevent atelectasis and other respiratory problems. Clients
should drink fluids that they can tolerate; usually thick fluids are easier to tolerate.
The client would be encouraged to cough and clear secretions, and placed in high-
Fowler position to prevent aspiration.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Spinal cord injury, Prevention of Complications MSC:
Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3. A client continues to have persistent low back pain even after using a number of
nonpharmacologic pain management strategies. Which prescribed drug would the
nurse anticipate that the client might need to manage the pain?
a. Oxycontin
b. Gabapentin
c. Lorazepam
d. Tramadol
ANS: D
When nonpharmacologic strategies, including physical therapy, are not effective in
managing pain, current standards recommend a mild opioid such as tramadol or
, serotonin-norepinephrine reuptake inhibitor. Strong opioids such as oxycontin and
benzodiazepines such as lorazepam are not considered best practice.
DIF: Remembering TOP: Integrated Process: Caring KEY: Low back
pain, Pain management MSC: Client Needs Category: Physiological
Integrity: Basic Care and Comfort
4. A client is scheduled for a percutaneous endoscopic lumbar discectomy. Which
statement by the client indicates a need for further teaching?
a. “I should have a lot less pain after surgery.”
b. “I’ll be in the hospital for 2 to 3 days.”
c. “I should not have any major surgical complications.”
d. “I could possibly get an infection after surgery.”
ANS: B
Percutaneous endoscopic discectomy is a minimally invasive surgical procedure that
requires a shorter hospital stay (23 hours or less) when compared to open traditional
surgery. The risk for surgical complications is very low and clients experience less far
pain from this procedure. However, due to interrupting skin integrity, infection may
occur at the surgical site.
DIF: Understanding TOP: Integrated Process: Nursing Process: Evaluation
KEY: Low back pain, Perioperative care MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
5. A nurse assesses clients at a community center. Which client is at greatest risk for low
back pain?
a. A 24-year-old female who is 25 weeks pregnant.
b. A 36-year-old male who uses ergonomic techniques.
c. A 53-year-old female who uses a walker.
d. A 65-year-old female with osteoarthritis.
with Problems of the Central Nervous
System: The Spinal Cord
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a client with a spinal cord injury. With which interprofessional
health team member would the nurse collaborate to assist the client with activities of
daily living?
a. Social worker
b. Physical therapist
c. Occupational therapist
d. Case manager
ANS: C
The occupational therapist instructs the patient in the correct use of all adaptive
equipment. In collaboration with the therapist, the nurse instructs family members or
the caregiver about transfer skills, feeding, bathing, dressing, positioning, and skin
care. The other team members are consulted to assist the client with other issues.
DIF: Understanding TOP: Integrated Process: Nursing Process: Planning and
Implementation KEY: Spinal cord injury, Interprofessional collaboration
MSC: Client Needs Category: Safe and Effective Care Environment:
Management of Care
,2. After teaching a client with a high thoracic spinal cord injury, the nurse assesses the
client’s understanding. Which statement by the client indicates a correct
understanding of how to prevent respiratory problems at home?
a. “I’ll use my incentive spirometer every 2 hours while I’m awake.”
b. “I’ll drink thinned fluids to prevent choking.”
c. “I’ll take cough medicine to prevent excessive coughing.”
d. “I’ll position myself on my right side so I don’t aspirate.”
ANS: A
The client with a cervical or high thoracic spinal cord injury typically has weak
intercostal muscles and is at higher risk for developing atelectasis and stasis
pneumonia. Using an incentive spirometer every 2 hours helps the client expand the
lungs more fully and helps prevent atelectasis and other respiratory problems. Clients
should drink fluids that they can tolerate; usually thick fluids are easier to tolerate.
The client would be encouraged to cough and clear secretions, and placed in high-
Fowler position to prevent aspiration.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Spinal cord injury, Prevention of Complications MSC:
Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3. A client continues to have persistent low back pain even after using a number of
nonpharmacologic pain management strategies. Which prescribed drug would the
nurse anticipate that the client might need to manage the pain?
a. Oxycontin
b. Gabapentin
c. Lorazepam
d. Tramadol
ANS: D
When nonpharmacologic strategies, including physical therapy, are not effective in
managing pain, current standards recommend a mild opioid such as tramadol or
, serotonin-norepinephrine reuptake inhibitor. Strong opioids such as oxycontin and
benzodiazepines such as lorazepam are not considered best practice.
DIF: Remembering TOP: Integrated Process: Caring KEY: Low back
pain, Pain management MSC: Client Needs Category: Physiological
Integrity: Basic Care and Comfort
4. A client is scheduled for a percutaneous endoscopic lumbar discectomy. Which
statement by the client indicates a need for further teaching?
a. “I should have a lot less pain after surgery.”
b. “I’ll be in the hospital for 2 to 3 days.”
c. “I should not have any major surgical complications.”
d. “I could possibly get an infection after surgery.”
ANS: B
Percutaneous endoscopic discectomy is a minimally invasive surgical procedure that
requires a shorter hospital stay (23 hours or less) when compared to open traditional
surgery. The risk for surgical complications is very low and clients experience less far
pain from this procedure. However, due to interrupting skin integrity, infection may
occur at the surgical site.
DIF: Understanding TOP: Integrated Process: Nursing Process: Evaluation
KEY: Low back pain, Perioperative care MSC: Client Needs
Category: Physiological Integrity: Physiological Adaptation
5. A nurse assesses clients at a community center. Which client is at greatest risk for low
back pain?
a. A 24-year-old female who is 25 weeks pregnant.
b. A 36-year-old male who uses ergonomic techniques.
c. A 53-year-old female who uses a walker.
d. A 65-year-old female with osteoarthritis.
