Lumbar Puncture
A nurse is teaching a school-age child who is to undergo a bone marrow aspiration. Which of the following statements should the nurse make?
"I will place a pressure dressing over the area following the procedure." Applying a pressure dressing over the area following the procedure helps prevent bleeding from the site.
A client is scheduled for a lumbar puncture to rule out bacterial meningitis. She tells the nurse that she is fearful of becoming paralyzed from the needle placement in her spinal column. Which of the following responses should the nurse offer?
"The needle is inserted below the third lumbar vertebrae, which is well below the point at which the spinal cord ends." This therapeutic response provides information that specifically addresses the client's concerns and helps decrease anxiety and fears.
The nurse should apply EMLA cream to the puncture site at least
1 hour prior to the lumbar puncture to decrease the adolescent's pain during the procedure
A nurse is reviewing the laboratory results of a lumbar puncture (LP) for a client who has manifestations of bacterial meningitis. Which of the following findings should the nurse expect?
Elevated protein An LP is a diagnostic test in which cerebrospinal fluid is extracted for examination. Manifestations of bacterial meningitis include increased protein in the cerebrospinal fluid.
A routine chest X-ray can be delayed.
If the client was experiencing respiratory difficulty, then the chest X-ray would be a higher priority.
Bone marrow aspiration will not affect the brain or its fluids.
Lumbar punctures are likely to cause headaches.
A nurse is caring for an adolescent following a lumbar puncture. Which of the following actions should the nurse take?
Place the adolescent in a supine position The nurse should place the adolescent in a supine position for 30 minutes to 1 hour following a lumbar puncture to decrease the risk of a post-dural puncture headache.
A nurse is preparing a client for a lumbar puncture. The client has signed the consent form but tells the nurse that she does not remember what the doctor will do during the procedure. Which of the following actions should the nurse take?
Remind the client that the doctor will insert a needle to get a sample of fluid from her spine. A signed consent form indicates that the provider informed the client about the procedure and that at the time the client understood what to expect. If the client states she does not remember what to expect, the nurse should clarify any details the provider previously gave the client. However, if the client expresses a further lack of understanding or states that the provider did not inform her, the nurse should either notify the charge nurse or call the provider directly.
A nurse is assisting a provider during a femoral venipuncture on a toddler. The nurse should place the child in which of the following positions?
Supine The client should be placed in the supine position, with the legs in a frog position.
A nurse is caring for several clients who require diagnostic testing and is delegating tasks to an assistive personnel (AP). Which of the following tasks should the nurse direct the AP to perform first?
Take an arterial blood gas specimen to the laboratory Arterial blood gas specimens are placed on ice and must be transported to the laboratory immediately to prevent degradation of the sample. Since this task needs to be done within a specified timeframe, it is the first task the AP should perform.
The nurse should assist the provider in applying an adhesive bandage to the puncture site following the procedure.
The nurse should avoid the application of heat because it promotes blood flow to the site, which increases the client's risk for bleeding.
The signed consent form indicates that the provider explained the procedure to the client previously.
The nurse should have confirmed this when witnessing the consent.
D-dimer measures coagulation activity and is used to evaluate blood clotting.
The presence of D-dimer in the cerebrospinal fluid is not a manifestation of bacterial meningitis.
The flexed sitting position may be used during
a lumbar puncture
Manifestations of bacterial meningitis include
decreased glucose in the cerebrospinal fluid
Although the nurse should provide this information, "Explain how the assistant will position the client for the procedure"
does not clarify what the provider will do once the client is in position and directs the focus away from what the client wants to know
RBCs present in the cerebrospinal fluid can be an indication of bleeding
however, the presence of WBCs in the cerebrospinal fluid indicates bacterial meningitis
The side-lying position
may be used during a lumbar puncture
"Tell the client that someone will explain the procedure when it is time to begin" is
nontherapeutic, rejects the client's concern, and fails to identify the need for the nurse to take further action
A semi-recumbent position is used when
performing a gavage feeding. The client's head and chest should be elevated.
The nurse should encourage the adolescent to consume fluids following a lumbar puncture to promote
replacement of cerebrospinal fluid
"Let's not focus on the negative. Let's focus on getting better" is a nontherapeutic response because
the nurse is changing the subject, which blocks further communication about the client's concerns
"Your doctor is very skilled at this procedure. Everything will be all right." is a nontherapeutic response because
the nurse is providing false reassurance to the client
"Why are you feeling so anxious about this procedure?" is a nontherapeutic response because
the nurse is requesting an explanation. Clients can interpret "why" questions as accusations.
The child should be in the prone position because
the provider will obtain the specimen from the iliac crest
The child should not receive an antibiotic prior to a bone marrow biopsy because
the use of an antibiotic might skew the test results
While a client who has just had a lumbar puncture will need to force fluids to help prevent a post-lumbar puncture headache
this is not the first task the AP should perform
