A nurse is discussing discharge instructions to a client with a lumbar herniated disk and is prescribed a conservative treatment. The nurse provides instructions based on this treatment plan and suggests which of the following.
Reducing body weight.
Avoiding painful positions.
Attending physical and chiropractic therapy as prescribed.
Taking nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed.
Taking corticosteroids as prescribed.
Correct Answer : A,B,C,D
A. Reducing body weight can relieve pressure on the lumbar spine, which can help decrease pain and improve function.
B. Avoiding painful positions helps prevent exacerbation of symptoms and protects the affected area.
C. Physical therapy is an important part of conservative treatment to strengthen supporting muscles, improve flexibility, and promote recovery. Chiropractic therapy may be recommended but should be guided by a physician's recommendation.
D. NSAIDs are commonly prescribed to manage inflammation and relieve pain associated with lumbar herniated disks.
E. Corticosteroids may be prescribed in some cases but are generally not part of initial conservative management unless inflammation is severe and not managed by NSAIDs.
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Correct Answer is C
Explanation
A. A short-term, low-dose steroid use (one week) has minimal risk for adrenal suppression.
B. Three weeks of steroids increases risk, but daily use presents a higher risk.
C. Prolonged daily steroid use, especially in an older adult, poses the greatest risk for adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis.
D. Intermittent steroid use is less likely to cause adrenal insufficiency compared to daily long-term use.
Correct Answer is ["A","C","D"]
Explanation
A. Calcium binders are used to help decrease the amount of calcium absorbed from the gastrointestinal tract, thus lowering calcium levels in the blood.
B. Vitamin D supplements would actually increase calcium levels by enhancing intestinal absorption, so this option is not appropriate in hypercalcemia.
C. Administering fluids helps to dilute serum calcium levels and promote renal excretion of calcium, making it a priority treatment.
D. Furosemide (Lasix) can help promote diuresis, thereby increasing the excretion of calcium through the urine, which is beneficial in managing hypercalcemia.
E. Oral phosphates may be used in some cases to manage hypercalcemia, but they are not a first-line treatment and their administration should be carefully considered in conjunction with other treatments.