Back Pain

1. 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."

ANS: A Exercise can strengthen back muscles, reducing the incidence of low back pain. The other options will not prevent low back pain.

What should be included when providing discharge instructions to a patient recovering from an anterior cervical diskectomy and fusion (ACDF)? A. Do not drive. B. Restrict fluids. C. Lift only less than 10 lbs. D. Resume activities of daily living.

ANS: A 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.

6. A nurse assesses a client who is recovering from anterior cervical diskectomy and fusion. Which complication should alert the nurse to urgently communicate with the health care provider? a. Auscultated stridor b. Weak pedal pulses c. Difficulty swallowing d. Inability to shrug shoulders

ANS: A Postoperative swelling can narrow the trachea, cause a partial airway obstruction, and manifest as stridor. The client may also have trouble swallowing, but maintaining an airway takes priority. Weak pedal pulses and an inability to shrug the shoulders are not complications of this surgery.

Which intervention does the nurse include in education for the patient to prevent low back pain and injury? A. Stop smoking. B. Wear high-heeled shoes. C. Keep weight more than 20% above ideal. D. Avoid activity like swimming and walking.

ANS: A Smoking should be stopped to prevent low back pain and injury. Smoking causes vertebral disk degeneration and narrows the vessels that supply blood to the spine. High-heeled shoes are discouraged to promote proper body alignment. Weight should be within 10% of ideal body weight to reduce the impact of excess weight on the spine. Exercise is encouraged to prevent low back pain and injury, and swimming and walking are good activities to encourage.

8. A nurse plans care for a client with a halo fixator. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Tape a halo wrench to the client's vest. b. Assess the pin sites for signs of infection. c. Loosen the pins when sleeping. d. Decrease the client's oral fluid intake. e. Assess the chest and back for skin breakdown.

ANS: A, B, E A special halo wrench should be taped to the client's vest in case of a cardiopulmonary emergency. The nurse should assess the pin sites for signs of infection or loose pins and for complications from the halo. The nurse should also increase fluids and fiber to decrease bowel straining and assess the client's chest and back for skin breakdown from the halo vest.

What are reasons that a patient may develop spinal stenosis? Select all that apply. A. Trauma B. Arthritis C. Infection D. Herniated disk E. Slipped vertebra

ANS: A,B,C,D Spinal stenosis may be caused by trauma, arthritis, infection, and disk herniation. A slipped vertebra causes spondylolisthesis, not spinal stenosis.

Which factors contribute to back pain in the older adult? Select all that apply. A. Osteoporosis B. Spinal stenosis C. Blood dyscrasias D. Rheumatoid arthritis E. Intervertebral disk degeneration

ANS: A,B,C,E Osteoporosis, spinal stenosis, blood dyscrasias, and intervertebral disk degeneration all contribute to back pain in the older adult. Osteoporosis can lead to painful vertebral fractures. Spinal stenosis narrows the spinal canal, placing painful pressure on the nerves. Blood dyscrasias inhibit the work of healthy blood on the spine. Intervertebral disk degeneration allows for unsupported vertebrae bones to painfully grind against each other. Osteoarthritis, not rheumatoid arthritis, contributes to painful bone deformity of the spine.

Which assessment findings indicate that a patient has a problem with a cervical disk? Select all that apply. A. Arm tingling B. Pain when moving the neck C. Pain radiating down the arm D. Limited arm range of motion E. Pain radiating to the shoulder

ANS: A,B,C,E The typical history of a patient with a cervical disk problem includes tingling in the affected arm, pain when moving the neck, pain radiating down the arm, and pain radiating to the shoulder. Arm range of motion is not identified as being specific to a cervical disk problem.

Which activity instructions are indicated for a patient four to six weeks after back surgery? Select all that apply. A. Walk daily. B. Restrict driving. C. Limit lifting to 10 lb. D. Increase stair climbing. E. Avoid twisting at the waist.

ANS: A,B,E Instructions after back surgery include walking daily, restricting driving, and avoiding twisting and bending at the waist to protect the surgical site and promote patient safety. The patient would be instructed to limit stair climbing to protect impact on the surgical site, and lifting is limited to 5 lb or less to reduce strain.

What should the nurse emphasize when providing discharge instructions to a patient recovering from minimally invasive surgery for back pain? Select all that apply. A. Showering is permitted after 4 days. B. Resume normal activities after 3 weeks. C. Remove the Steri-Strips before showering. D. Expect clear fluid to seep from the incision. E. Remove the outer dressing before showering.

ANS: A,B,E Patients recovering from minimally invasive surgery for back pain may shower on the 4th day after surgery, may resume normal activities 3 weeks after surgery, and should remove the outer clear or gauze dressing before showering. The Steri-Strips should not be removed by the patient. These strips will either be removed by the surgeon or permitted to fall off on their own. Clear fluid seeping from the incision could indicate a meningeal tear and cerebrospinal fluid leak, which should be reported immediately to the surgeon.

In addition to trauma, which assessment findings are risk factors for back pain? Select all that apply. A. Obesity B. Anemia C. Smoking D. Hypertension E. Hyperkalemia F. Advanced age

ANS: A,C,F 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 nurse suspect is occurring with an older patient with chronic low back pain who is experiencing acute confusion and constipation? A. Stroke B. Side effects of opioids C. Increasing intracranial pressure D. Beginning stage of Alzheimer's disease

ANS: B Adverse drug effects of opioids include constipation and acute confusion. One-sided paralysis is associated with a stroke. A change in the level of consciousness and vital signs are associated with increasing intracranial pressure. Forgetfulness is associated with the beginning stages of Alzheimer's disease.

What is a priority of care for a patient recovering from minimally invasive surgery for back pain? A. Maintain bedrest. B. Follow the prescribed exercise program. C. Avoid oral analgesics to encourage healing. D. Wait for a home care nurse to change the dressing.

ANS: B 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

What is the symptom of a lateral herniation of the nucleus pulposus in an intervertebral disk of fifth and sixth cervical vertebrae? A. Pain in the leg B. Pain in the neck C. Pain in the abdomen D. Pain in the lower back

ANS: B 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.

22. 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 mental health disorder?" c. "Are you able to swallow medications?" d. "Do you smoke cigarettes or any illegal drugs?"

ANS: B Clients who have a mental health or behavioral health problem should not take ziconotide. The other questions do not identify a contraindication for this medication.

5. 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. "Wear your brace whenever you are out of bed." c. "You must remain in bed for 3 weeks after surgery." d. "You are prescribed medications to prevent rejection."

ANS: B Clients who undergo spinal fusion are fitted with a brace that they must wear throughout the healing process (usually 3 to 6 months) whenever they are out of bed. The client should not lift anything. The client does not need to remain in bed. Medications for rejection prevention are not necessary for this procedure.

What would be the appropriate nursing intervention for delusions occurring with ziconotide? A. Assuring the patient that the symptoms are normal B. Instructing the patient to stop taking the drug immediately C. Instructing the patient to decrease the dosage of the drug D. Asking the patient to begin taking haloperidol along with ziconotide

ANS: B Delusions are a symptom of psychosis and may worsen if taking ziconotide continues, so the nurse should instruct the patient to stop taking the drug immediately. Decreasing the dosage of the drug may not be enough to ease the symptoms of psychosis. Symptoms of psychosis are not normal. The patient should only start other medication at the discretion of the health care provider.

erniation of a disc occurs most commonly in which area of the spine? A. At the sacrum B. Between L4 and L5 C. Between C3 and C4 D. Between T6 and T7

ANS: B 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.

The nurse understands that which statement is true of back pain? A. Acute back pain continues for more than 12 weeks. B. Low back pain is the leading cause of work disability. C. The most common area for back pain is the thoracic spine. D. Subsequent episodes of back pain tend to decrease in severity.

ANS: B Low back pain is the leading cause of work disability and a significant burden of disease in the United States. Acute back pain lasts less than two weeks, while chronic back pain continues for 12 weeks or more. The most common areas for back pain are the cervical and lumbar spine where there is the most movement. Back pain can be recurrent with subsequent episodes generally increasing in severity.

9. An emergency department nurse cares for a client who experienced a spinal cord injury 1 hour ago. Which prescribed medication should the nurse prepare to administer? a. Intrathecal baclofen (Lioresal) b. Methylprednisolone (Medrol) c. Atropine sulfate d. Epinephrine (Adrenalin)

ANS: B Methylprednisolone (Medrol) should be given within 8 hours of the injury. Clients who receive this therapy usually show improvement in motor and sensory function. The other medications are inappropriate for this client.

Which area of the spinal column is most commonly affected by pain? A. Pelvic B. Cervical C. Thoracic D. Vertebral

ANS: B 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.

Which condition contraindicates ziconotide therapy? A. Seizures B. Schizophrenia C. Gastroenteritis D. Respiratory depression

ANS: B Ziconotide is contraindicated in patients with severe mental or behavioral health problems such as schizophrenia because the drug may cause or exacerbate psychosis. Seizures, gastroenteritis, and respiratory depression do not contraindicate the use of ziconotide

Which diagnostic tests are indicated for a patient experiencing severe numbness and tingling of the right hand and fingers? Select all that apply. A. Hand x-ray B. Myelogram C. Nerve conduction studies D. Computed tomography (CT) scan of the neck E. Magnetic resonance imaging (MRI) of the neck

ANS: B,C,D,E To determine the exact cause of the numbness and tingling, diagnostic tests may be used. These tests may include a myelogram to evaluate nerve root lesions, nerve conduction studies to help differentiate cervical radiculopathy from other peripheral nerve problems, CT scan of the neck to determine spinal nerves and disks, and an MRI to determine the condition of the nerves and disks. Hand x-rays show general arthritis changes and bony alignment.

The nurse is caring for a postoperative patient who underwent spinal fusion surgery. The nurse observes that the patient's respiratory rate is 28 breaths per minute, and the patient is anxious and confused. The PaO 2 value is 60 mm Hg. The nurse suspects what condition? A. Infection B. Paralytic ileus C. Fat embolism D. Urinary retention

ANS: C A fat embolism is a postoperative complication especially after spinal fusion. A fat particle may dislodge from the bone marrow and move inside the circulation, which may block the blood flow in blood vessels with smaller lumens. Fat emboli may manifest as dyspnea, low PaO 2 value, anxiety, and deteriorating mental status. An infection is a postoperative complication and manifests as fever, pain, and swelling. A paralytic ileus is absence of bowel sounds, and it manifests as abdominal distension, nausea, and vomiting. Urinary retention can be assessed by determining the urinary output.

Which cervical disk space is most often affected by spinal nerve root compression? A. C1-2 B. C3-4 C. C5-6 D. C7-8

ANS: C Cervical disk herniation leading to spinal nerve root compression most often occurs between the fifth and sixth cervical vertebrae (C5-6). C1-2, C3-4, and C7-8 are not identified as the disk spaces most often affected by cervical disk herniation.

2. A nurse plans care for a client with lower back pain from a work-related injury. Which intervention should the nurse include in this client's plan of 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.

ANS: C 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.

4. A nurse assesses clients at a community center. Which client is at greatest risk for lower 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 45-year-old male with osteoarthritis d. A 53-year-old female who uses a walker

ANS: C Osteoarthritis causes changes to support structures, increasing the client's risk for low back pain. The other clients are not at high risk.

7. 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. Initiate 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.

ANS: C The client is manifesting symptoms of autonomic dysreflexia. Common causes include bladder distention, tight clothing, increased room temperature, and fecal impaction. If persistent, the client could experience neurologic injury. Precipitating conditions should be eliminated and the physician notified. The other actions would not be appropriate.

Which concern does the nurse anticipate to be of the most importance to a patient who has lower back pain? A. Numbness B. Constipation C. Continuous pain D. Urinary incontinence

ANS: C The primary concern of the patient with lower back pain is the presence of continuous pain that impacts mobility and all activity including sleep and rest. Numbness may occur if the cause of the lower back pain involves the ability of the nerve to conduct sensation. Constipation and continence changes may occur if spinal nerve intervention to the bowel and bladder are impacted.

5. 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

ANS: C, D, E Bulging at the incision site or clear fluid on the dressing after a laminectomy strongly suggests a cerebrospinal fluid leak, which constitutes an emergency. Loss of cerebral spinal fluid may cause a sudden and severe headache, which is also an emergency situation. Pain, redness, and itching at the site are normal.

3. A nurse assesses a client who is recovering from a diskectomy 6 hours ago. Which assessment finding should the nurse address first? a. Sleepy but arouses to voice b. Dry and cracked oral mucosa c. Pain present in lower back d. Bladder palpated above pubis

ANS: D A distended bladder may indicate damage to the sacral spinal nerves. The other findings require the nurse to provide care but are not the priority or a complication of the procedure.

Which assessment finding suggests to the nurse that a patient is experiencing sciatic nerve compression? A. Urinary incontinence B. Frequent diarrhea-like bowel movements C. Inability to bear weight on the affected leg D. Severe pain when the patient's leg is held straight and lifted upward

ANS: D If the sciatic nerve is compressed, severe pain occurs when the patient's leg is held straight and lifted upward. Diarrhea and urinary incontinence are not signs of nerve compression. The affected leg may be weak, but the patient should be able to bear weight.

What pain management modality is commonly used on patients with failed back surgery syndrome? A. Iontophoresis B. Phonophoresis C. Thermotherapy D. Implantable spinal cord stimulators

ANS: D 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 spinal surgical procedure uses the umbilical approach? A. Diskectomy B. Laminectomy C. Microdiskectomy D. Laser-assisted laparoscopic lumbar diskectomy

ANS: D 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 reports pain when moving the neck. What diagnostic test is used to provide images of the muscles in the neck? A. Plain x-rays B. Computed tomography (CT) C. Myelogram or postmyelogram CT D. Magnetic resonance imaging (MRI)

ANS: D 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.

Which pharmacological treatment does the nurse anticipate being prescribed first for the treatment of new onset back pain? A. Opioids B. Antibiotics C. N-type calcium channel blockers (NCCBs) D. Nonsteroidal antiinflammatory drugs (NSAIDs)

ANS: D NSAIDs are the first pharmacological treatment prescribed to treat the pain and inflammation of the back. Opioids are introduced if NSAIDs are not effective. Antibiotics are used for infection and not indicated for back pain. NCCBs are used for severe, chronic back pain.

A patient who has undergone an anterior cervical diskectomy and fusion is in the postoperative care unit and reports dysphagia and hoarseness in the voice. Which nursing intervention should be performed after assessing the patient? A. Apply an ice compress to the incision site B. Teach the patient to only talk when necessary C. Consult with speech therapy for a communication board D. Explain that the symptoms may last for a few days to several months

ANS: D Postoperative complications after anterior cervical diskectomy and fusion include hoarseness due to laryngeal injury and temporary dysphagia. The nurse should explain that the symptoms are temporary and may last for few days to several months. Applying an ice compress to the incision site and teaching the patient to speak only when necessary does not help with resolving dysphagia and hoarseness. A communication board is not needed as the patient can still verbalize needs.

Which statement accurately describes the Williams position? A. Lying prone with the head of the bed flat B. Sitting in a reclining wheelchair with the knee-gatch raised C. Lying supine with the head flat and the feet elevated 30 degrees D. Semi-Fowler's with a pillow under the knees to keep them flexed

ANS: D The Williams position, typically used for patients with low back pain from a bulging or herniated disk, is described as lying in a semi-Fowler's position with a pillow under the knees to keep them flexed. The other statements do not reflect the Williams position accurately

Which position should be used to reduce the pain of a bulging disk? A. Sims B. Prone C. Supine D. Semi-Fowler's

ANS: D 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.

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? A. 2 weeks B. 6 weeks C. 2 months D. 3 to 6 months

ANS: D 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.

Which action does the nurse take first for a patient following back surgery who has a suspected cerebrospinal leak? A. Notify the surgeon. B. Remove the dressing. C. Administer analgesics. D. Place the patient in a flat-lying position.

ANS: D The first action by the nurse would be to place the patient in a flat-lying position to slow the leakage of fluid. After laying the patient down, the nurse can then notify the surgeon. The dressing would have clear fluid, be bulging, or have a halo on or around it, but there is no need to remove it. Administration of analgesics would be done for the patient experiencing pain.

8. An emergency room nurse initiates care for a client with a cervical spinal cord injury who arrives via emergency medical services. Which action should the nurse take first? a. Assess level of consciousness. b. Obtain vital signs. c. Administer oxygen therapy. d. Evaluate respiratory status.

ANS: D The first priority for a client with a spinal cord injury is assessment of respiratory status and airway patency. Clients with cervical spine injuries are particularly prone to respiratory compromise and may even require intubation. The other assessments should be performed after airway and breathing are assessed.

Which intervention is the priority for the nurse to perform for a patient following anterior cervical discectomy and fusion? A. Manage pain. B. Evaluate the ability to swallow. C. Check the incision site for bleeding. D. Assess airway, breathing, and circulation.

ANS: D The priority for the nurse is to assess airway, breathing, and circulation for a patient following anterior cervical discectomy and fusion to ensure the airway and cardiovascular system are stable. Managing pain, evaluating the ability to swallow, and checking the incision site for bleeding are all best practices in patient care after this surgery, but airway, breathing, and circulation must first be assessed and deemed stable.

The nurse would recommend weight loss as an intervention for a patient with chronic back pain when the patient's weight exceeds ideal weight by what percentage? A. 3% B. 5% C. 7% D. 10%

ANS: D 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%.

The nurse instructs a patient experiencing 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? A. Aromatherapy (wtaf) B. Physical therapy C. Weight loss therapy D. Positioning therapy

ANS: D 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.