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A nurse assesses the health history of a client who is prescribed ziconotide (Prialt) for chronic back pain. Which assessment question should the nurse ask?
- A. Are you taking a nonsteroidal anti-inflammatory drug?
- B. Do you have a history of psychiatric disorders?
- C. Do you have difficulty swallowing medications?
- D. Do you smoke cigarettes or any illegal drugs?
Correct Answer: B
Rationale: Ziconotide can cause psychiatric side effects, so assessing for a history of psychiatric disorders is crucial. The other questions are less relevant to ziconotide's safety profile.
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A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod (Gilenya). For which adverse effect should the nurse monitor?
- A. Peripheral edema
- B. Black and tarry stools
- C. Bradycardia
- D. Nausea and vomiting
Correct Answer: C
Rationale: Fingolimod (Gilenya) can cause bradycardia, especially within the first 6 hours after administration. Peripheral edema, black and tarry stools, and nausea and vomiting are not typical adverse effects of this medication.
A nurse teaches a client with a lower motor neuron lesion who wants to achieve bladder control. Which statement should the nurse include in this client's teaching?
- A. Stroke the inner aspect of your thigh to initiate voiding.
- B. Implement digital anal stimulation when your bladder is full.
- C. Tighten your abdominal muscles to stimulate urine flow.
- D. Use a catheter to empty your bladder completely.
Correct Answer: C
Rationale: In clients with lower motor neuron injuries, performing a Valsalva maneuver by tightening abdominal muscles can stimulate urine flow. The other options are not effective for achieving bladder control in this context.
A nurse assesses a client with paraplegia from a spinal cord injury and notes reddened areas over the client's hips and sacrum. Which actions should the nurse take? (Select all that apply.)
- A. Perform range-of-motion (ROM) exercises for the hip joint.
- B. Reposition the client off of the reddened areas.
- C. Get the client out of bed and into a chair once a day.
- D. Obtain a low-air-loss mattress to minimize pressure.
- E. Apply a barrier cream to the reddened areas.
Correct Answer: B,D
Rationale: Repositioning and using a low-air-loss mattress relieve pressure on reddened areas. Rubbing, barrier creams, ROM exercises, and sitting in a chair do not address pressure relief effectively.
A nurse assesses a client who is recovering from a lumbar laminectomy. Which complications should alert the nurse to urgently communicate with the health care provider? (Select all that apply.)
- A. Surgical discomfort.
- B. Redness and itching at the incision site.
- C. Incisional bulging.
- D. Clear drainage on the dressing.
- E. Sudden and severe headache.
Correct Answer: C,D,E
Rationale: Incisional bulging, clear drainage (possible CSF leak), and severe headache are emergencies post-laminectomy. Surgical discomfort and redness/itching are normal and not urgent.
A nurse assesses a client with a spinal cord injury at level T5. The client's blood pressure is 184/95 mm Hg, and the client presents with a flushed face and blurred vision. Which action should the nurse take first?
- A. Administer oxygen via a nasal cannula.
- B. Place the client in a supine position.
- C. Palpate the bladder for distention.
- D. Administer a prescribed beta blocker.
Correct Answer: C
Rationale: The client is manifesting symptoms of autonomic dysreflexia, likely due to bladder distention. Palpating the bladder to check for distention is the first step to identify and address the cause. The other actions are not appropriate as initial responses.