The nurse is caring for a patient receiving a spinal block. Which symptom would most concern the nurse?

Legs feeling heavy.

Hypotension.

Numbness below the injection site.

Nausea.

Answer and Explanation

The Correct Answer is B

Choice A reason: While legs feeling heavy can be a common sensation after a spinal block, it is not as concerning as other potential symptoms.

Choice B reason: Hypotension is a significant concern following a spinal block as it can indicate a high level of blockage affecting the autonomic nerves, which can lead to serious complications.

Choice C reason: Numbness below the injection site is expected after a spinal block and is not typically a cause for concern unless it is prolonged or accompanied by other symptoms.

Choice D reason: Nausea can occur but is less concerning than hypotension, which can have more immediate and severe consequences.

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Correct Answer is C

Explanation

Choice A reason: Using the incentive spirometer is important, but it is not specifically related to deep breathing and coughing exercises.

Choice B reason: Breathing deeply and coughing every 4 hours is part of postoperative care, but it does not indicate understanding of the technique to protect the incision.

Choice C reason: Splinting the incision with a pillow while coughing is a recommended technique to support the incision and reduce pain during coughing, indicating an understanding of the instructions.

Choice D reason: Lying flat is not recommended for deep breathing and coughing exercises as it can inhibit lung expansion and is not conducive to effective coughing.

A. Just before the nurse anticipates the behavior B. When the behavior is done C. When the staff or family complains about the behavior D. When the limit is set

Correct Answer is D

Explanation

Choice A reason: Setting consequences just before the behavior occurs does not provide clear expectations and boundaries for the patient.

Choice B reason: Setting consequences after the behavior is done may not effectively prevent the behavior and can lead to inconsistent enforcement.

Choice C reason: Waiting for complaints before setting consequences can lead to a reactive rather than proactive approach to care.

Choice D reason: Consequences should be clearly communicated when the limit is set to establish clear boundaries and expectations, which is essential in managing patients with personality disorders.

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The nurse is caring for a patient receiving a spinal block. Which symptom would most concern the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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