Author Question: A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action ... (Read 36 times)

Jramos095 · **on:** Jun 27, 2018

A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action at this time?

A) Monitor for a decrease in spasticity.
B) Observe for signs of meningeal irritation.
C) Assess motor function.
D) Observe for mental confusion or hallucinations.

Question 2

A 6-year-old boy with cerebral palsy has been admitted to the hospital for tests. His condition is stable. The boy's mother remains with her son, but she is obviously exhausted and stressed. How should the nurse respond?

A) Would you like me to bring you a blanket and pillow?
B) You are doing such a wonderful job with your son.
C) He's in good hands; consider going home and getting some sleep.
D) Are you planning to spend the night or to go home?

aidanmbrowne · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

B
Response:
Following myelography, the nurse should carefully observe for signs of meningeal irritation because of what is involved in this procedure. The other actions are appropriate following an intrathecal test dose of baclofen.

Answer to Question 2

C
Response:
Providing daily intense care can be demanding and tiring. When a child with CP is admitted to the hospital, this may serve as a time of respite for the family and primary caregivers. The nurse should remind the mother that her son is in good hands and urge her to go home. Asking her whether she is planning to stay might make the mother feel obligated to stay. Asking if she wants a blanket or pillow does not encourage the mother to leave the hospital. Telling the mother she is doing a good job is nice but does not encourage her to take a break.