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A nurse promotes the prevention of lower back pain by teaching clients at a community center. Which instruction should the nurse include in this education?
- A. Participate in an exercise program to strengthen muscles.
- B. Purchase a mattress that allows you to adjust the firmness.
- C. Wear flat instead of high-heeled shoes to work each day.
- D. Keep your weight within 20% of your ideal body weight.
Correct Answer: A
Rationale: Exercise can strengthen back muscles, reducing the incidence of low back pain. The other options will not prevent low back pain.
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A nurse prepares a client for prescribed magnetic resonance imaging (MRI). Which action should the nurse implement prior to the test?
- A. Screen for metal implants or devices.
- B. Implement nothing by mouth (NPO) status for 8 hours.
- C. Administer a sedative to reduce anxiety.
- D. Ensure the client has an empty bladder.
Correct Answer: A
Rationale: Screening for metal implants or devices is critical before an MRI to prevent harm due to magnetic fields. NPO status, sedation, and bladder emptying are not typically required unless specified.
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 teaches a client who is recovering from a spinal fusion. Which statement should the nurse include in this client's postoperative instructions?
- A. Only lift items that are 10 pounds or less.
- B. You must wear a brace throughout the healing process.
- C. You must remain in bed for 3 weeks after surgery.
- D. You are prescribed medications to prevent rejection.
Correct Answer: B
Rationale: Clients who undergo spinal fusion are fitted with a brace that they must wear throughout the healing process to stabilize the spine. The other options are incorrect: lifting restrictions may vary, bed rest for 3 weeks is not typically required, and rejection medications are not needed for spinal fusion.
A nurse is teaching a client with multiple sclerosis who is prescribed cyclophosphamide (Cytoxan) and methylprednisolone (Medrol). Which statement should the nurse include in this client's discharge teaching?
- A. Take warm baths to promote muscle relaxation.
- B. Avoid people with upper respiratory illnesses.
- C. Relying on a walker will weaken your gait.
- D. Take prescribed medication only when symptoms occur.
Correct Answer: B
Rationale: Clients taking cyclophosphamide and methylprednisolone are immunocompromised and should avoid people with upper respiratory illnesses to prevent infections. Warm baths may help but are not the priority, relying on a walker does not necessarily weaken gait, and medications should be taken as prescribed, not only when symptoms occur.
A nurse plans care for a client with lower back pain from a work-related injury. Which intervention should the nurse include in this work plan care?
- A. Encourage the client to stretch the back by reaching toward the toes.
- B. Massage the affected area with ice twice a day.
- C. Apply a heating pad for 20 minutes at least four times daily.
- D. Advise the client to avoid warm baths or showers.
Correct Answer: C
Rationale: Heat increases blood flow to the affected area and promotes healing of injured nerves. Stretching and ice will not promote healing, and there is no need to avoid warm baths or showers.