Care of Patients with Problems of the Central Nervous System: The Spinal Cord

What intervention is priority for a patient diagnosed with multiple sclerosis who is experiencing cognitive impairment?

Encourage the use of written lists The use of written lists can help reorient a patient. Monthly calendars are not recommended; daily calendars are. Teaching about antidepressants is not priority. Patients can use electronic devices for cues and reminders.

A patient has received preoperative teaching from the nurse for a microdiskectomy. Which statement by the patient indicates a correct understanding of the nurse's instruction?

"I can go home the day of the procedure." The patient who undergoes a microdiskectomy typically can return home the same day. The patient who undergoes a traditional open laminectomy typically can return home 48 hours after the procedure, will have a drain in place after the procedure, and will need to wear special stockings after the procedure.

The nurse is teaching a patient and her husband about sexuality issues after a spinal cord injury. Which comment by the patient indicates a correct understanding of the nurse's instruction?

"I may still be able to get pregnant." Many people with spinal cord injury go on to get pregnant and give birth to healthy children. Spinal cord injury is not a disorder that can be inherited.

The nurse teaches a patient about prevention of lower back pain and injuries. Which statement made by the patient indicates the need for further teaching?

"I will limit my intake of calcium and vitamin D supplements." The patient should take care to prevent lower back pain and injuries. Limiting the intake of calcium and vitamin D may worsen the pain. Smoking can lead to disk degeneration; therefore, the patient stating a desire to quit smoking is appropriate. Wearing high heel shoes does not support good posture and may worsen back pain. Maintaining a good posture while sitting, standing, and walking helps in managing lower back pain.

The family member of a patient diagnosed with multiple sclerosis expresses concern over the patient's inappropriate behavior. What statement by the nurse is most appropriate?

"It is a good idea to develop a cue to let them know they're being inappropriate." Developing a cue to let the patient know she is behaving inappropriately is indicated. Avoiding social situations is not indicated. This behavior may be a permanent part of the disease; however, telling the family that this will likely get worse is not supporting the family. There are no medications to improve the behavioral changes related to MS.

Weight control can help reduce chronic back pain. The nurse recommends weight loss as an intervention when the patient's weight exceeds ideal weight by what percentage?

10% Weight reduction can help reduce chronic back pain by decreasing the strain on vertebrae caused by excess weight. Weight reduction is recommended when the patient's weight exceeds the ideal by more than 10%.

A patient who is employed by a manufacturing plant is recovering from spinal fusion surgery at home. When should the patient expect to be able to return to work?

3 to 6 months The duration of home-based recovery depends on the nature of the job and the extent and type of surgery. A patient may not return to work for 3 to 6 months if the job is physically strenuous, such as working in a manufacturing plant. Two weeks after spinal fusion surgery is too soon to return to work. Most patients return to work after 6 weeks. Two months is not identified as a length of time for recovery and the ability to return to work after spinal fusion surgery.

During physical assessment, the nurse has the patient hold the leg straight while the nurse gently lifts the leg upward. If the patient responds with severe pain, which finding does the nurse suspect?

A vertebra is pressing on the sciatic nerve. If the sciatic nerve is compressed, significant pain occurs when the patient's leg is held straight and lifted upward. A fracture would cause pain but not of the sciatic nerve. Scoliosis is curvature of the spine and does not cause compression of the sciatic nerve. Spinal stenosis does not result in sciatic compression.

Which initial assessment is the first priority for a patient with a spinal cord injury?

Airway, breathing, and circulation The priority assessment for a patient with a spinal cord injury is assessing the patient's airway, breathing, and circulation. The airway may be compromised as well as the patient's breathing pattern. Assessing the level of consciousness, ability to recall event of the injury, and degree of numerologic injury are important, but are not the priority.

What action should the nurse take first to ensure personal safety when turning and repositioning a patient with a body mass index (BMI) of 40 who is recovering from a stroke?

Ask other health care professionals to assist The nurse will not be able to safely turn and reposition this patient alone. For safety, the nurse should first ask other health care professionals to assist. Raising the head of the bed will not facilitate turning and repositioning this patient. Lowering the height of the bed will place unnecessary stress on the nurse's lower back when turning and repositioning the patient. Washing hands and applying personal protective equipment would be completed immediately prior to turning and repositioning the patient.

Herniation of a disc occurs most commonly in which area of the spine?

Between L4 and L5 Herniated discs occur most often between the L4 and L5. They can occur at any place in the spine, but the fourth and fifth lumbar are the most common site.

Which assessment findings alert the nurse that a patient with a spinal cord injury is experiencing autonomic dysreflexia? Select all that apply.

Bradycardia Headache Hypertension Nasal stuffiness Patients experiencing autonomic dysreflexia present with bradycardia, headache, hypertension, and nasal stuffiness. They have flushing warm skin, not cold and clammy skin.

The nurse observes that the patient is unable to grasp a pen and form a fist when assessing motor function. Based on this assessment, what is the most likely level of spinal cord injury in the patient?

C8 The patient is unable to grasp an object or form a fist if there is a spinal cord injury C8. If the injury is at C4-5, the patient has problems in shrugging the shoulders upward against resistance. If injury is at C5-6, the patient has problems in pulling up the arms against resistance. If the injury is at C7, the patient has problems in straightening his or her flexed arms against resistance.

A patient diagnosed with multiple sclerosis has developed scotomas. What assessment finding is consistent with this finding?

Decreased peripheral vision Scotomas are changes in peripheral vision. Double vision is diplopia. Intention tremors are not scotomas. Involuntary eye movements are nystagmus.

A patient diagnosed with multiple sclerosis is having issues with her bowel and bladder. What complication does the nurse expect is causing the issues?

Demyelination of the spinal cord Patients with demyelination of the spinal cord often have issues with bowel and bladder. Cerebellar inhibition, disruption of the cranial nerves, and excitability of the white fiber tracks will not affect bowel and bladder.

What should be included when providing discharge instructions to a patient recovering from an anterior cervical diskectomy and fusion (ACDF)?

Do not drive. Care of the patient after an ACDF includes instructing the patient not to drive. Fluids do not need to be restricted. The patient should be instructed to perform no lifting. No strenuous activities should be performed, which may include those as part of the patient's normal activities of daily living.

Which type of tumor may include meningiomas as an example?

Extramedullary Meningiomas are found within the spinal dura but outside the spinal parenchyma; therefore, they are known as extramedullary tumors. Epidural tumors occur between the vertebrae and spinal dura. Intramedullary tumors are found within the spinal parenchyma. Secondary tumors are cancerous whereas meningiomas are noncancerous tumors.

What symptoms should a patient taking teriflunomide be assessed for? Select all that apply.

Facial flushing Gastrointestinal (GI) disturbances Facial flushing and GI disturbances are major side effects of teriflunomide. Diplopia and dysarthria are symptoms of multiple sclerosis. Bradycardia, not tachycardia, is another common finding in patients taking teriflunomide.

Which type of spinal cord injury causes tearing of posterior ligaments and dislocation of vertebrae in the patient?

Hyperflexion Hyperflexion injury occurs when the head is accelerated forward forcefully and suddenly, causing tearing of the posterior ligaments and vertebral dislocation. Axial loading injury occurs due to compression, in which the vertebrae shatter, and the pieces damage the spinal cord. Hyperextension injury occurs when the head is suddenly accelerated and then decelerated. This causes tearing of the anterior longitudinal ligament and fractures the intervertebral disks. Penetrating trauma injury is classified by the speed of the object at the local site.

Which statement about multiple sclerosis (MS) is correct?

It occurs more frequently among whites than other races. MS affects people of all races but does tend to occur more frequently among whites. Women are affected twice as often as men. Though MS may occur in people over 50 years, it usually affects people between 20 and 40 years of age. There is a higher incidence in the colder climates of the Northeastern states, the Great Lakes, and Pacific Northwestern states, as well as Canada.

Which spinal surgical procedure uses the umbilical approach?

Laser-assisted laparoscopic lumbar diskectomy Laser-assisted laparoscopic lumbar diskectomy combines a laser with modified standard disk instruments inserted through the laparoscope using an umbilical, or belly button, incision. The diskectomy, laminectomy, and microdiscectomy use the spinal approach for the surgery.

A patient is admitted to the health care unit with acute spinal injuries. Which are the initial physical assessments that the nurse should perform? Select all that apply.

Level of consciousness Sensory and motor function Airway, breathing, and circulation pattern Assessment of the level of consciousness is evaluated in a patient with traumatic spinal injuries. Sensory and motor functions also need to be assessed when there is a spinal injury. Additionally, airway, breathing, and assessing the circulation are a major priority in a patient with spinal injuries. Mechanical ventilation with intubation may be required to prevent respiratory arrest. Circulation is assessed by monitoring the pulse, blood pressure, and perfusion. Blood glucose levels and volume of urine output are not the initial and physical assessments made in a patient who has spinal injuries.

A patient who has just undergone spinal surgery must be moved. How does the nurse plan to move this patient?

Log-rolling the patient Log-rolling the patient who has undergone spinal surgery is the best way to keep the spine in alignment. The patient who has undergone spinal surgery must remain straight. The Trendelenburg position is not indicated for the patient who has undergone spinal surgery, nor should the patient be lifted or encouraged to get up in a chair.

When providing teaching to a patient newly diagnosed with multiple sclerosis, the nurse informs the patient that the confirmation of the diagnosis is based on what findings?

Magnetic resonance imaging (MRI)

In the emergency department (ED), which is the nursing priority in assessing the patient with a spinal cord injury?

Patent airway Patients with injuries at or above T6 are at risk for respiratory complications. After assessment of cardiorespiratory status, the level of consciousness must be assessed using the Glasgow Coma Scale. In the ED, determining allergies or loss of sensation is not the first priority in assessing the patient with spinal cord injury.

The patient with a spinal cord injury at T2 is experiencing autonomic dysreflexia. Which intervention has the highest priority?

Placing the patient in a sitting position Autonomic dysreflexia is an excessive, uncontrolled sympathetic output characterized by severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing; it must be promptly treated to prevent a hypertensive stroke. Placing the patient in a sitting position creates the effect of orthostatic hypotension to relieve hypertensive pressure on the brain, and is the very first priority. Administering hydralazine, loosening tight clothing, and assessing urinary catheter tubing are important interventions and should also be performed, but they are not the first priority.

Which alternative therapy may lead to spasticity in patients with multiple sclerosis?

Positioning therapy Positioning therapy is ineffective in patients with multiple sclerosis because this therapy can lead to spasticity. Massage therapy helps relieve symptoms of spasticity. Reflexology and acupuncture are recommended to help decrease symptoms.

The nurse instructs a patient suffering from lower back pain to lie in a semi-Fowler's posture with a pillow under the knees. What type of non-surgical conservative pain management therapy is the nurse following?

Positioning therapy Williams position is a positioning therapy that is most comfortable and therapeutically effective for a patient with lower back pain due to a bulging or herniated disk. In this position, the patient lies in a semi-Fowler's position with a pillow under the knees to keep them flexed. In this position, the muscles of the lower back are relaxed and the pressure on the spinal nerve root is relieved. Semi-Fowler's posture with a pillow under the knees is not an aromatherapy, physical therapy, or weight loss therapy technique.

A patient signs a consent form for a bone graft to be used during back surgery. For which type of surgical procedure is this patient being prepared?

Spinal fusion A bone graft is performed if the patient has a spinal fusion. A bone graft is not a part of a microdiscectomy, microscopic diskectomy, or a percutaneous diskectomy.

Which condition in a patient involves complete but temporary loss of motor, sensory, reflex, and autonomic function?

Spinal shock Spinal shock occurs when the cord immediately responds to the injury. Patients with spinal shock have complete but temporary loss of motor, sensory, reflex, and autonomic function. Spinal cord tumor causes ischemia and infarction. Neurogenic shock causes hypoperfusion due to severe cord injury. Penetrating trauma causes local damage to the spinal cord.

A patient with multiple sclerosis and receiving drug therapy develops severe disability. A cerebrospinal fluid examination and magnetic resonance images (MRI) indicate progressive multifocal leukoencephalopathy (PML). What should be the immediate nursing intervention?

Terminating natalizumab intravenous administration Natalizumab is a monoclonal antibody given as intravenous infusion under careful supervision. The major risk factor associated with this drug therapy is progressive multifocal leukoencephalopathy (PML). Terminating the drug administration is the best course of action. Co-administering mitoxantrone or fingolimod will not stabilize the patient. Natalizumab cannot be orally administered.

The registered nurse teaches the student nurse about the clinical manifestations of the spinal tumors in the cervical region. Which clinical manifestation is least likely to occur in a patient with spinal tumors?

Urinary incontinence The clinical manifestations of spinal tumors include the sensory or motor dysfunction of the organs located in that area. Loss of bladder control or urinary incontinence is the clinical manifestations of the spinal tumors located in the lumbosacral region. Cervical tumor manifestations include respiratory distress, diaphragm paralysis, and occipital headaches, which are the sensory and motor dysfunction of the organs located in that region.

What statement by the patient diagnosed with multiple sclerosis indicates a need for further teaching?

"If my muscles are feeling tired I will take a hot bath." Taking a hot bath is contraindicated in patients with multiple sclerosis; extreme heat will exacerbate the multiple sclerosis. Use of stress relief techniques is indicated. The patient should avoid people with infections. If the patient has diplopia, alternating an eyepatch from side to side is appropriate.

The nurse is providing instructions to a patient with a spinal cord injury about caring for the halo device. The nurse plans to include which instructions?

"Keep straws available for drinking fluids." Keeping straws available makes it easier to drink fluids because the device makes it difficult to bring a cup or a glass to the mouth. Driving should be avoided because vision is impaired with the device. The head should be supported with a small pillow when sleeping to prevent unnecessary pressure and discomfort. Swimming should be avoided to prevent the risk for infection.

A patient diagnosed with multiple sclerosis is examining the use of complementary therapies. What statement by the patient indicates a need for further teaching?

"Massage and acupuncture may allow me to not use medications anymore." Using massage, acupuncture, or other complementary therapies will not replace medications for patients with multiple sclerosis. Complementary therapies are meant for symptomatic treatment. Aromatherapy and meditation may help manage stress. Reflexology and yoga may help with balance and weakness. Massage and acupuncture may help the patient move better.

The nurse is teaching a patient newly diagnosed with multiple sclerosis (MS). Which statement by the patient indicates a correct understanding of the pathophysiology of the disease?

"Parts of my nervous system have plaques." MS is characterized by an inflammatory response that results in diffuse random or patchy areas of plaque in the white matter of the central nervous system. The patient with MS has no decrease in life expectancy. Frequent times of remission are common in patients with MS. There is no known cause for MS.

What question should the nurse ask to determine the cause of a patient's acute back pain?

"What were you doing when the pain started?" Because acute back pain usually results from injury or trauma (such as during a fall, vehicular crash, or lifting a heavy object), the nurse should ask the patient what he or she was doing when the pain started. Arthritis is associated with spinal stenosis. Asking about daily medications will not help determine the cause for the patient's acute back pain. Asking about daily physical exercise may help determine the patient's fitness level, but will not necessarily help determine the cause for the acute back pain.

A registered nurse is supervising the student nurse who is providing emergency care to a patient experiencing autonomic dysreflexia. Which action of the student nurse indicates the need for further teaching?

Administering beta blocker in the patient with recurrent dysreflexia Autonomic dysreflexia is potentially a life-threatening condition considered a medical emergency and is most often diagnosed in a patient with spinal cord injury. A patient suffering from recurrent autonomic dysreflexia should be administered alpha blocker, prophylactically. The patient should be placed in a safe position and priority given to the patient being seated. The urinary retention in the patient is checked, and if indicated, it is catheterized. Blood pressure is monitored in the patient with autonomic dysreflexia, every 10 to 15 minutes.

What treatment can be used to relieve diplopia in a patient diagnosed with multiple sclerosis?

Alternate an eyepatch from eye to eye every few hours.\ Alternating an eyepatch from eye to eye every few hours can relieve diplopia. Corrective lenses help with visual acuity. Rest does not affect diplopia. Scanning techniques are used for issues with preferable vision.

Which area of the spinal column is most commonly affected by pain?

Cervical The cervical area of the spinal column is most commonly affected by pain because of being the most flexible. The pelvis is not an area of the spinal column. The thoracic region of the spinal column is not identified as being the most flexible or the most commonly affected by pain. Vertebral is not a specific area of the spinal column; rather, the vertebrae are the bones of the spinal column.

In addition to frequent repositioning, the nurse anticipates a consultation request for which special pressure relief device to help prevent pressure ulcers in the patient with a spinal cord injury?

Chair pad In addition to regular turning and repositioning, special pressure-relief devices such as chair pads may be used in the wheelchair to prevent pressure ulcers in the patient with spinal cord injury. TED hose help prevent thrombus, not pressure ulcers. A trapeze helps the patient reposition him- or herself; it is not a pressure-relief device. A water bottle is not indicated for the patient with spinal cord injury.

The nurse is performing a postoperative assessment on a patient after open back diskectomy. The nurse becomes concerned that the wound drainage contains cerebrospinal fluid when it appears as what color?

Clear Following open back surgery, a postoperative assessment finding of clear drainage on the dressing may indicate cerebrospinal fluid leakage, and must be reported immediately to the surgeon.

The nurse is caring for an older adult patient with chronic low back pain who has been prescribed an opioid. For which adverse effects of the drug does the nurse monitor the patient? Select all that apply.

Constipation Drowsiness Acute confusion Older adult patients taking opioids are monitored for side effects that include constipation, drowsiness, and acute confusion. The drug does not cause urinary retention. Low serum sodium is a side effect antiepileptic drugs used to treat neuropathic pain, not tricyclic antidepressants.

Which medications are used for the acute exacerbation of multiple sclerosis? Select all that apply.

Corticosteroid Interferon-beta-1b Corticosteroid and interferon-beta-1b are used to treat the acute exacerbation of multiple sclerosis. Ibuprofen is not indicated for exacerbations of MS. Natalizumab is a monoclonal antibody that binds to white blood cells to prevent further damage to the myelin. Teriflunomide is an immunomodulator.

What medications are given in combination with immunosuppressive therapy to stabilize the disease process and decrease inflammation in patients diagnosed with multiple sclerosis? Select all that apply.

Cyclophosphamide Methylprednisolone Adrenocorticotropic hormone (ACTH) Cyclophosphamide, methylprednisolone, and adrenocorticotropic hormone (ACTH) are used in combination with immunosuppressive therapy to decrease inflammation and stabilize the disease process. Mitoxantrone is a chemotherapy drug that is used to reduce neurologic disability. Glatiramer acetate is a synthetic protein.

What laboratory findings are consistent with a diagnosis of multiple sclerosis? Select all that apply.

Elevated protein in the cerebrospinal fluid Immunoglobulins in the cerebrospinal fluid A collection of findings such as elevated proteins and immunoglobulins in the cerebrospinal fluid are consistent with a diagnosis of multiple sclerosis. Positive protein in the urine is not significant for multiple sclerosis. An elevated albumin level or a decreased white blood cell count in the peripheral blood sample are not indicative of multiple sclerosis.

The nurse assesses a patient with a spinal cord injury. To assess motor function in the L2-L4 vertebrae, the nurse applies resistance and asks the patient to perform which motion?

Elevation of the legs To assess L2-L4, the nurse should apply resistance and ask the patient to elevate the legs from the bed. Dorsiflexion of the feet is done to assess L5. Flexion of the feet is performed to assess S1. There is no indicated use for asking the patient to flex the knees against resistance.

What assessment findings does a nurse anticipate when caring for a patient with an acute exacerbation of multiple sclerosis? Select all that apply.

Fatigue Muscle spasms The patient with an acute exacerbation of multiple sclerosis will experience fatigue and muscle spasms. Hypertension is not a sign of an acute exacerbation. Loss of vision is not a sign of multiple sclerosis. Positive Babinski's reflex would be expected.

What is a priority of care for a patient recovering from minimally invasive surgery for back pain?

Follow the prescribed exercise program. After minimally invasive surgery, the patient should be instructed to follow the prescribed exercise program, which begins immediately after discharge. Bedrest is not prescribed after this surgery. Oral analgesics are needed while nerve tissue heals over the next few weeks. The patient will have a Band-Aid, Steri-Strips, or a clear or gauze dressing over the incision. A home care nurse is not required to change these dressings.

The nurse is conducting a physical assessment for visual acuity, visual fields, and pupils in a patient diagnosed with multiple sclerosis. Which clinical finding is not a complication of multiple sclerosis?

Glaucoma Glaucoma is an ocular disorder associated with increased fluid pressure in the eye. This condition is not caused by a neurological dysfunction and is not related to multiple sclerosis. Diplopia or double vision is caused by cranial nerve disorders and neuromuscular junction; this condition is associated with multiple sclerosis. Scotomas are changes in the peripheral vision; this condition is caused by optic nerve damage due to demyelinating diseases such as multiple sclerosis. Nystagmus or rapid eye movements is caused by central nervous system disorders; this is a typical clinical finding associated with multiple sclerosis.

A patient is taking ziconotide for severe chronic back pain. The nurse instructs the patient to stop taking the drug and call the provider immediately if which side effect occurs?

Hallucinations and delusions If symptoms such as hallucinations and delusions occur with ziconotide, the patient must stop the drug immediately and contact the health care provider. Ziconotide should not be given to patients with severe mental health/behavioral health problems because it can cause psychosis. Numbness and tingling of extremities does not occur with this drug. Many drugs cause nausea and vomiting, but these symptoms would not require the patient to stop the drug and call the provider. Blurred vision is not associated with ziconotide.

What are methods of decreasing fatigue in a patient with multiple sclerosis?

Keeping frequently used items easily accessible or a patient with multiple sclerosis who is experiencing fatigue, any items used on a daily basis should be kept close and accessible. Aerobic exercise is good. Activities should be spaced apart, not grouped together. Use of CNS stimulants is indicated for patients with fatigue related to MS.

Which assessment findings alert the nurse that a patient with a spinal cord injury is developing neurogenic shock? Select all that apply.

Hypotension Warm, dry skin The patient experiencing neurogenic shock exhibits severe hypotension and warm, dry skin. The patient would display bradycardia, not tachycardia. Pupillary dilation, projectile vomiting, and facial flushing are not symptoms of neurogenic shock.

Which drug does the nurse expect to administer as part of the treatment plan for a patient with relapsing multiple sclerosis (MS)?

Immunomodulator Immunomodulators such as interferon-beta, synthetic proteins like glatiramer acetate, and monoclonal antibodies such as natalizumab are among the current drug therapies recommended for early and continuous treatment of relapsing types of MS. Penicillin-based antibiotics are used in the treatment of bacterial infections. Calcium channel blockers are commonly used in patients with hypertension and other cardiovascular issues. Antispasmodics are used to suppress muscle spasms.

What pain management modality is commonly used on patients with failed back surgery syndrome?

Implantable spinal cord stimulators In failed back surgery syndrome, patients suffer from chronic lower back pain even after repeated surgical procedures. The best pain management modality for patients with failed back surgery syndrome is implantable spinal cord stimulators. Iontophoresis, phonophoresis, and thermotherapy are used for acute lower back pain management.

Which assessment finding indicates the patient may have damage to the sacral spinal nerves?

Inability to void An inability to void may indicate damage to the sacral spinal nerves, which control the detrusor muscle of the bladder. Abdominal distention may occur due to the effects of anesthesia, but does not indicate sacral nerve damage. A positive Babinski's sign is indicative of nerve damage other than the sacral spinal nerve. Paresthesia of the fingers is not associated with damage to the spinal nerves.

What does the nurse prioritize when caring for a patient diagnosed with multiple sclerosis who is experiencing hypalgesia?

Injury risk A patient with multiple sclerosis who has hypalgesia has decreased sensitivity to pain, which increases the risk of injury. Pain is not as high a priority as injury risk. Reduced capacity for self-care is important but not priority. Likewise, lack of tolerance for activity is important but not priority.

Which statement about autonomic dysreflexia is accurate?

It can be caused due to a distended bladder. Autonomic dysreflexia refers to an excessive, uncontrolled sympathetic output that is caused due to a noxious stimulus. This stimulus often arises from a distended bladder. It is seen in upper spinal cord injuries (SCI) above the level of T6. Orthostatic hypotension may occur due to interruption of the sympathetic innervations caused by SCI. Autonomic dysreflexia involves excessive sympathetic output, and therefore causes severe hypertension. It also causes bradycardia, which is a decrease in heart rate.

Which central nervous system condition is managed by phonophoresis?

Lower back pain Phonophoresis technique is the use of ultrasound to enhance the delivery of topical drugs subcutaneously. This technique is mainly used to deliver analgesic and anti-inflammatory drugs into the body; therefore, it is used to manage conditions such as lower back pain. Spinal cord injury, spinal cord tumors, and multiple sclerosis are not managed by phonophoresis.

A patient reports pain when moving the neck. What diagnostic test is used to provide images of the muscles in the neck?

Magnetic resonance imaging (MRI) MRI provides images of spinal tissue, bones, spinal cord, nerves, ligaments, disks, and musculature. Plain x-rays show changes in the bone, such as changes in the joints and in the positioning and alignment of bones. CT shows the bones, nerves, disks, and ligaments. Myelogram or postmyelogram CT is used for evaluating lesions of the nerve root and any other mass lesion or infection that is within or invading the thecal sac.

What is the priority when caring for a patient recovering from an anterior cervical diskectomy and fusion (ACDF)?

Maintaining an airway The priority for care in the immediate postoperative period after an ACDF is maintaining an airway. Controlling pain can be addressed after an adequate airway is ensured. Monitoring urine output and ensuring adequate blood pressure control can be addressed if necessary after an adequate airway is ensured.

In caring for a patient in the early postoperative period after anterior cervical diskectomy and fusion (ACDF), which nursing intervention is the priority?

Maintaining an open airway The priority for care in the immediate postoperative period after an ACDF is maintaining an airway and ensuring the patient has no problems breathing. Maintaining cervical alignment, intravenous pain management, and strict intake and output are important nursing interventions, but are not the priority.

Which finding should be reported to the surgeon for a patient with a spinal cord stimulator implanted in the epidural space?

New onset of leg weakness For patients who have a spinal cord stimulator implanted in the epidural space, early changes in movement and muscle strength such as leg weakness should be reported immediately to the surgeon. Constipation is not an adverse effect of a spinal cord stimulator. A change in appetite can have many causes and is not associated with the use of a spinal cord simulator. A reduction in nerve pain would be an expected response when using a spinal cord stimulator.

The diagnostic results for a patient who reports severe chronic lower back pain shows that the vertebral disk is not pressing into the spinal cord. Which surgical treatment should the nurse expect to be performed to manage the patient's chronic pain?

Minimally invasive surgery Minimal invasive surgeries are performed through tiny incisions with minimal loss of blood, muscle injury, and decreased postoperative pain. This treatment is best suited for treating chronic lower back pain only if the vertebral disk is not pressed into the spinal cord. Microdiskectomy, percutaneous endoscopic diskectomy, and laser-assisted laparoscopic lumbar diskectomy are performed when the vertebral disk is pressing against the spinal cord.

What chemotherapy drug has been shown to effectively reduce neurologic disability in patients with multiple sclerosis?

Mitoxantrone Mitoxantrone is a chemotherapy drug that has been shown to be effective in reducing neurologic disability. Fingolimod was the first oral immunomodulator. Cyclosporine and methotrexate are immunosuppressants.

A patient with multiple sclerosis will begin therapy with fingolimod. Which instruction does the nurse give the patient about this drug?

Monitor pulse daily The patient should be taught to monitor the pulse daily as the medication can cause bradycardia, especially within the first 6 hours of taking it. The drug does not cause elevated blood sugar, so monitoring of blood sugar is not required. The drug does not cause vertigo or flushing.

A halo fixator with a jacket is used to immobilize the spine of a patient following a vertebral fracture. What nursing assessment monitors for neurogenic shock?

Monitor the patient every hour for severe hypotension. Neurogenic shock occur due to decreased circulating blood volume following a spinal cord injury. The patient must be monitored at least hourly for severe hypotension to assess for neurogenic shock. The patient's breath sounds should be assessed every 2 to 4 hours to note if the airway is patent and ventilation is adequate. The patient should be monitored for severe bradycardia at least hourly to monitor for neurogenic shock. Inserting a finger between the jacket and the patient's skin ensures that the jacket is not causing pressure.

A patient had a surgery for a lumbosacral spinal tumor. Which is a postoperative and priority nursing intervention for the patient?

Monitoring the vital signs and neurological status every 1 or 2 hours Postoperative nursing care of a patient with a spinal cord tumor focuses on careful monitoring of the vital signs and neurological status every 1 or 2 hours until the patient is stable, and then every 4 hours. Chemotherapy in patient with spinal cord tumors is very limited. The nurse is not supposed to advise chemotherapy for the patient. Radiation therapy is limited in spinal tumors. The spinal cord cannot tolerate high doses of radiation which may lead to spinal damage. The nurse is not authorized to advise radiation therapy; a radiation oncologist would do that. Respiratory management care is done in a patient who has undergone surgery for cervical tumors.

Which disease is characterized by remissions and exacerbations of symptoms causing neurological disability?

Multiple sclerosis Multiple sclerosis is an inflammatory disease of the brain and spinal cord that can cause neurological disabilities. This disease is characterized by remission and exacerbation of symptoms causing neurological disability. Spinal shock can occur after a spinal injury; it may not have remissions. Spinal cord tumors are not associated with remissions and exacerbations. Amyotrophic lateral sclerosis (ALS) is a lower and upper motor neuron disease; ALS is not characterized by a remission and exacerbation of symptoms.

A patient is being discharged with paraplegia secondary to a motor vehicle crash and expresses concern over the ability to cope in the home setting after the injury. Which is the best resource for the nurse to provide for the patient?

National Spinal Cord Injury Association The National Spinal Cord Injury Association will inform the patient of support groups in the area and will assist in answering questions regarding adjustment in the home setting. The hospital library is not typically consumer-oriented; most information available there is targeted to health care professionals. The Internet is not the best resource simply because of the unlimited volume of information available and its questionable quality. The health care provider's office typically does not provide information about spinal cord injury support groups.

Which complications occur most commonly after conventional diskectomy, laminectomy, or spinal fusion? Select all that apply.

Nerve injury Dural tears The most common major complications of diskectomy, laminectomy, or spinal fusion are nerve injury and dural tears. Wound infection may occur, but is not related just to this type of surgery. Paralysis could occur, but is not common and is unlikely. Bowel perforation could occur with any abdominal surgery, but is not common to these surgeries. Encephalitis is not caused by surgery of any kind.

The nurse is caring for a patient with a spinal cord injury resulting from a diving accident who has a halo fixator and an indwelling urinary catheter in place. The nurse notes that the blood pressure is elevated and that the patient is reporting a severe headache. The nurse anticipates that the health care provider will request which medication?

Nifedipine This patient is experiencing autonomic dysreflexia, which is a neurologic medical emergency that causes severe hypertension and bradycardia; nifedipine is given to treat the elevated blood pressure. Dopamine hydrochloride is an inotropic agent used to treat severe hypotension. Methylprednisolone is a glucocorticoid and is not indicated because it may further increase blood pressure. Ziconotide is an N-type calcium channel blocker that is used to treat severe chronic back pain and failed back surgery syndrome (FBSS) and is also used for patients with cancer, AIDS, and unremitting pain from other nervous system disorders.

A patient admitted to the intensive care unit earlier that day after sustaining a cervical spinal cord injury in a motor vehicle crash is intubated and is receiving mechanical ventilation. The nurse notes a heart rate of 56 beats/min; blood pressure of 88/60 mm Hg; and warm, dry skin. Which action does the nurse perform next?

Notify the provider of these findings immediately. Neurogenic shock is a potentially life-threatening complication of spinal cord injury in patients with injuries above T6 and is characterized by bradycardia; hypotension; and warm, dry skin. The nurse should notify the provider immediately so that fluids can be restored to the circulating blood volume. Bradycardia is related to shock and not hypoxia, so increasing oxygen or suctioning are not indicated.

The nurse is monitoring a patient for major complications following lumbar spinal surgery. What assessments does the nurse make to monitor for fat embolism syndrome (FES)? Select all that apply.

Observe for chest pain, dyspnea, anxiety, and mental status changes Note petechiae around the neck, upper chest, and conjunctiva To assess for FES following lumbar spinal surgery, it is important to observe for chest pain, dyspnea, anxiety, and change in mental status of the patient. Petechiae around the neck, upper chest, buccal mucosa, and conjunctiva may also indicate FES. The presence of clear fluid on or around the dressing may indicate leakage of cerebrospinal fluid. Hypotension and tachycardia may indicate a fluid volume deficit. Abdominal distention, nausea, or vomiting would be present with a paralytic ileus rather than FES. Pain or swelling around the wound site or the legs may indicate an infection.`

What teaching is priority for a patient taking dalfampridine?

Observing for seizure activity Dalfampridine has been shown to improve the ability of patients with multiple sclerosis to walk; however, it has a high incidence of seizures. There's no indication to check the pulse while on this medication. It does not carry the risk of bleeding. Dalfampridine does not increase the risk of visual disturbances.

What change in the musculoskeletal support structures is a contributing factor for lower back pain?

Osteoarthritis Lower back pain may be caused by many factors, which include changes in support structures, vertebral support and malalignment, intervertebral disk degeneration, and decreased blood supply to spinal cord due to arteriosclerosis. An example of change in the support structures is osteoarthritis. Scoliosis and lordosis are the examples of changes in vertebral support and malalignment. Intervertebral disk degeneration causes lower back pain but is not classified as changes in support structure.

What is the most common manifestation of a spinal cord tumor?

Pain at rest The most common problem in patients with a spinal cord tumor is non-mechanical back pain. Leg weakness, bowel incontinence, and hand grasp strength would depend upon the location of the spinal cord tumor.

What is the symptom of a lateral herniation of the nucleus pulposus in an intervertebral disk of fifth and sixth cervical vertebrae?

Pain in the neck Bulging or herniation of the nucleus pulposus laterally in an intervertebral disk of fifth and sixth cervical vertebrae causes spinal nerve root compression. Spinal nerve root compression results in motor and sensory nerve manifestations in the neck, upper back, and down the affected arm. Pain in the leg, abdomen, and lower back are caused by herniation of intervertebral disks of the cervical vertebrae.

What assessment finding is associated with a lower thoracic spinal cord injury?

Paraplegia Paraplegia is paralysis of the lower extremities that is seen in lower thoracic injuries. Tetraplegia is paralysis of all four extremities and is associated with cervical cord and upper thoracic injuries. Hemiplegia is paralysis of one side of the body and is associated with stroke. Quadriplegia is the same as tetraplegia, which is paralysis of all four extremities. Quadriplegia is associated with cervical cord and upper thoracic injuries.

What should the nurse do first for a patient recovering from spinal fusion surgery who develops shortness of breath and chest pain?

Prepare for an arterial blood gas sample. Manifestations of a fat embolism include acute shortness of breath and chest pain. The nurse should prepare for an arterial blood gas sample to assess arterial oxygen level. Turning and repositioning and assessing the surgical site are not indicated for shortness of breath and chest pain. Administering the prescribed analgesic would depend upon the patient's pain level.

The patient reports progressive fatigue, muscle weakness, and diplopia that has worsened during the past six months. The MRI reveals the presence of plaques on the brain and spinal cord. What diagnosis does the nurse anticipate?

Primary progressive multiple sclerosis Primary progressive multiple sclerosis involves a steady, gradual neurologic deterioration with plaques on the brain and spinal cord. The symptoms of progressive fatigue, muscle weakness, and diplopia are not consistent with relapsing-remitting, secondary progressive, or progressive-relapsing multiple sclerosis.

Which type of multiple sclerosis (MS) involves steady and gradual neurological deterioration without temporary diminution of the symptoms?

Primary progressive multiple sclerosis (PPMS) Primary progressive multiple sclerosis involves steady and gradual neurological dysfunction without the remittance of the symptoms. Relapsing-remitting multiple sclerosis involves the development and resolution of symptoms within the span of a few weeks to a few months. After the resolution of symptoms, the patient returns to the baseline. Progressive relapsing multiple sclerosis involves frequent relapses with partial recovery without the patient returning to the baseline. Secondary progressive multiple sclerosis begins with a relapsing remitting course that later becomes steadily progressive.

A patient with bladder dysfunction has presented with five urinary tract infections in the last three months. The patient is using straight catheterization at home. What intervention should the nurse prepare to provide teaching on?

Prophylactic antibiotics The patient has already developed infections, so prophylactic antibiotics may decrease the incidence of infections. Bladder training is not indicated. Bladder pacemaker is not indicated for the reduction of infection. An indwelling urinary catheter will increase the risk of infection, not reduce it.

What treatments can provide relief from tremors in a patient with multiple sclerosis? Select all that apply.

Propranolol Thalamotomy Propranolol and thalamotomy can be used to provide relief from tremors in patients with multiple sclerosis. Carbamazepine is used to treat paresthesia. Cyclophosphamide is immunosuppressant therapy. Amantadine hydrochloride is used to treat fatigue.

A patient who has undergone an anterior cervical diskectomy with fusion is experiencing difficulty swallowing a soft diet. The patient is breathing normally and is wearing a large neck brace. What is the nurse's best action?

Reassure the patient that this is usually a temporary postoperative effect Patients often have temporary dysphagia after cervical diskectomy with fusion so the nurse should reassure the patient that this will probably abate over time. It does not indicate loosening of the screws or graft. It is not necessary to notify the Rapid Response Team since the patient is breathing normally. The brace should not be removed until the provider orders it.

A patient diagnosed with multiple sclerosis reports fatigue and loss of interest in sexual activity. The patient expresses depression and frustration with the change in sexual desire. What intervention is most appropriate?

Refer the patient to licensed therapist It is important to refer the patient to a licensed therapist to deal with a sexual dysfunction and depression. Discussing methods of conserving energy is important but not the priority. Offering information on treatments for sexual dysfunction should be done but is not the priority. Reviewing side effects of medications may be done but is not the priority.

Which major risk factor is associated with cervical spinal cord injury?

Respiratory distress The major risk factor associated with cervical spinal cord injury is respiratory compromise. The cervical spinal nerves innervate the phrenic nerve, controlling the diaphragm. Injury to the nerve causes the breathing disturbances. Migraine, dementia, and cardiac arrest are not the major risk factors associated with cervical spinal cord injury.

To prevent the leading cause of death for patients with spinal cord injury, collaboration with which component of the health care team is a nursing priority?

Respiratory therapy A patient with a cervical spinal cord injury is at risk for breathing problems resulting from an interruption of spinal innervation to the respiratory muscles. In collaboration with the respiratory therapist, the nurse should perform a complete respiratory assessment, including pulse oximetry for arterial oxygen saturation every 8-12 hours to prevent respiratory complications such as pneumonia, pulmonary emboli, and atelectasis. Collaboration with nutritional therapy, occupational therapy, and physical therapy does not help prevent the leading cause of death in patients with spinal cord injury.

What recommendations should the nurse give to a patient diagnosed with multiple sclerosis who is trying to manage fatigue? Select all that apply.

Rest periods Amantadine Aerobic exercise Rest periods, amantadine, and aerobic exercise are recommended to decrease fatigue in patients diagnosed with multiple sclerosis. Mitoxantrone is used for patients with worsening disease to reduce disability; it does not affect fatigue. Grouping activities will not conserve energy or manage fatigue.

A patient diagnosed with relapsing-remitting multiple sclerosis is being seen at the practitioner's office. The patient reports that symptoms have become steadily progressive with no return to baseline. What form of multiple sclerosis is the patient experiencing?

Secondary progressive multiple sclerosis Secondary progressive multiple sclerosis (MS) begins with relapsing-remitting MS and later becomes steadily progressive. Primary progressive MS does not begin with relapsing-remitting MS. Progressive-relapsing MS is characterized by frequent relapses and the patient does not return to baseline. Steady progression of symptoms with no return to baseline is not indicative of an exacerbation of relapsing-remitting multiple sclerosis.

Which position should be used to reduce the pain of a bulging disk?

Semi-Fowler's The Williams position or the semi-Fowler's position with a pillow under the knees reduces the pain of a bulging disk. The Sims, prone, and supine positions are not identified as helpful to reduce the pain of a bulging disk.

Which position accurately describes the Williams' position?

Semi-Fowler's with a pillow under the knees to keep them flexed The Williams' position, typically used for patients with low back pain from a bulging or herniated disk, is described as lying in semi-Fowler's position with a pillow under the knees to keep them flexed.

In assessing a patient with back pain, the nurse uses a paper clip bilaterally on each limb. What is the nurse assessing?

Sensation Both extremities may be checked for sensation by using a pin or paper clip and a cotton ball for comparison of light and deep touch. The patient may feel sensation in both limbs but may experience a stronger sensation on the unaffected side. Gait is assessed by having the patient walk. Mobility is assessed by determining the patient's level of self-care. Strength is measured by having the patient perform bilateral grips.

The nurse obtains a cotton swab and paper clip before entering a patient's room. What is this nurse planning to focus on when assessing the patient?

Skin sensation Sensory perception is assessed by using a cotton ball and a paper clip to compare light and deep touch. Movement is used to determine muscle tone and progressive motor loss. A straight leg raise is used to assess sciatic nerve compression.

In addition to trauma, which assessment findings are risk factors for back pain? Select all that apply.

Smoking Obesity Advanced age Smoking has been linked to disc degeneration due to vasoconstriction of vessels that supply the spine. Obesity places increased stress on back muscles and can cause back pain. Older adults are also at risk due to spinal stenosis. Hypertension, anemia, and hyperkalemia have not been linked to the development of back pain.

What should the patient recovering from an anterior cervical diskectomy and fusion (ACDF) expect to wear after he or she is permitted to remove the hard collar?

Soft cervical collar After the initial brace is removed, the patient should expect to wear a soft collar for several weeks, or longer if needed. A back brace would be appropriate for a lumbar spinal fusion. A woolen scarf is not required to be worn after an ACDF. Wearing nothing around the neck is not an option for this patient.

What specialist should the patient experiencing dysarthria be referred to?

Speech-language pathologist Patients having difficulty with speech (dysarthria) should be referred to a speech-language pathologist (SLP). There's no indication to refer the patient to physical therapist, occupational therapist, or urologist.

A patient's medical record notes a narrowing of the spinal canal and nerve roots. The patient experiences back pain and numbness in the feet. Which disorder does the nurse suspect the patient is most likely experiencing?

Spinal stenosis Spinal stenosis is a narrowing of the spinal canal or nerve root. HNP is a bulging disc. Spondylolisthesis occurs when one vertebrae slips forward on the one below it. Scoliosis is a curvature of the spine.

The nurse performing an assessment on a patient 6 hours postoperative for diskectomy notices the presence of clear drainage from the incision site. The nurse suspects the drainage may be cerebrospinal fluid (CSF) and evaluates the patient for which accompanying sign/symptom?

Sudden headache Sudden and intense headache occurs when there is leakage of CSF. Nausea and vomiting are not directly related to CSF drainage and could be due to the effects of anesthesia. Change in level of consciousness and decerebrate posturing are critical signs associated with head injury and increased intracranial pressure, not the drainage of CSF.

A patient is placed in a halo device to stabilize a cervical fracture. Which nursing action is a priority for this patient's safety?

Taping the wrench to the vest To ensure the patient's safety, a special wrench is needed to loosen the vest in emergencies such as cardiopulmonary arrest. The wrench should be taped to the vest for consistent accessibility and ease of use. The device should never be used to turn the patient. The screws should not be adjusted by holding the device in place. A sharp object such as a pencil should never be used to relieve itching because this could promote skin damage and infection.

The nurse is caring for a patient postoperatively after an anterior cervical diskectomy and fusion. Which assessment finding is of greatest concern to the nurse?

The patient is reporting difficulty swallowing secretions. Difficulty swallowing may indicate swelling in the neck and the potential for compromise of the patient's airway. Experiencing neck pain and numbness and tingling bilaterally down the arms are expected findings after this surgery. Serosanguineous fluid oozing onto the neck dressing is also a normal finding after this surgery.

Which statement about spinal cord tumors is correct?

These patients are managed primarily by surgery. Spinal cord tumors are managed primarily by surgery to remove as much of the tumor as possible. Spastic paralysis is more common, although flaccid paralysis may occur at times. A positive Babinski's sign is a key thoracic manifestation. In this condition, patients often lose control over their urinary bladder before losing bowel control.

Which statement about spinal cord injuries is correct?

They occur mostly in young males. Almost 80% of spinal cord injuries (SCIs) occur in young males and the majority of them are Euro-Americans. Falls are likely the cause of SCIs in older adults; however, most SCIs are caused by trauma from motor vehicle crashes. Cervical SCIs are more common than thoracic and lumbosacral cord injuries.

What are reasons that a patient may develop spinal stenosis? Select all that apply.

Trauma Arthritis Infection Herniated disk Spinal stenosis may be caused by trauma, arthritis, infection, and disk herniation. A slipped vertebra causes spondylolisthesis, not spinal stenosis.

Which site in patients does the nurse recognize as being responsible for the development of epidural tumors?

Vertebral bone Epidural or extradural tumors occur between the vertebrae and spinal dura. The site of development of this tumor is the surrounding vertebral bone and causes their destruction. Intradural tumors are located within the dura and originate from the spinal tissue such as spinal roots, pia-arachnoid, and spinal ligament.

Which functional changes should be assessed while taking the medical history of a patient with multiple sclerosis? Select all that apply.

Vision Mobility Sensory perception Vision, mobility, and sensory perception changes should be assessed while taking the medical history of a patient suspected with multiple sclerosis. All of these changes are the early indicators of multiple sclerosis. Temperature and behavioral changes would be assessed later on.

Which observation indicates that a patient is experiencing sciatic pain?

Walking with a limp Walking with a limp indicates possible sciatic nerve involvement. Inability to bend at the waist, walking with a stiff flexed posture, and holding the hand over the lower back are all behaviors consistent with back pain; however, they don't necessarily indicate sciatic nerve involvement.

What lab value should be assessed in patients taking oral immunomodulating drugs?

White blood cells White blood cells should be checked in patients taking immunomodulating drugs because they can cause a drop in the white blood cells, thereby predisposing the patient to infection. Hemoglobin, platelets, and potassium do not need to be monitored while a patient is on this medication.