# A nurse is preparing a client for a lumbar puncture. Which assessment finding would be most important for the nurse to report to the healthcare provider before the procedure? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541092 > language: ko > subject: Adult Health ## 문제 A nurse is preparing a client for a lumbar puncture. Which assessment finding would be most important for the nurse to report to the healthcare provider before the procedure? The nurse must identify critical assessment findings that could contraindicate a lumbar puncture procedure. ## 보기 1. Client reports a headache rated 6/10 on the pain scale 2. Client's blood pressure is 140/88 mmHg 3. Client has not voided in the past 4 hours 4. Client exhibits signs of increased intracranial pressure with papilledema **✔ 정답** **정답: 4** ## 해설 Signs of increased intracranial pressure with papilledema are an absolute contraindication due to risk of brain herniation. Other findings like headache or hypertension are less critical and do not typically contraindicate the procedure. ## 심화 해설 Understanding the Critical Contraindication Before a lumbar puncture (LP), the most critical assessment finding to report is evidence of significantly elevated intracranial pressure (ICP), such as papilledema. The primary, life-threatening risk of performing an LP in this context is cerebral herniation. This occurs because the procedure creates a pressure gradient by decompressing the spinal compartment. In a patient with increased ICP, this sudden drop in spinal pressure can force brain tissue downward through the foramen magnum, compressing the brainstem and leading to irreversible neurological damage or death [3]. Why the Other Options Are Not the Priority A headache, while uncomfortable, is a common indication for a diagnostic LP and is not a contraindication. A blood pressure of 140/88 mmHg is mildly elevated but does not represent a hypertensive emergency that would preclude the procedure. A client not voiding for 4 hours is a comfort and assessment finding to address, but it is not life-threatening and does not directly increase the procedural risk of LP. Pathophysiology and Clinical Reasoning The presence of papilledema, which is optic disc swelling caused by elevated ICP, serves as a crucial, non-invasive clinical sign of a potential mass effect or diffuse cerebral edema. While the foundational study by Gower et al. notes that papilledema is not a perfect predictor of complications, it remains a key part of the clinical assessment that correlates with anatomical criteria for herniation risk, such as a lateral shift of midline structures and obliteration of the basilar cisterns on CT scan [1]. The procedure creates a real risk of brain herniation, which is documented to occur in about 5% of patients with acute bacterial meningitis and is strongly associated with LP timing based on pathophysiologic principles [3]. Modern consensus reinforces that while LP is safe for most, identifying patients with central nervous system mass effect is paramount to avoid catastrophic complications [4]. Therefore, any clinical sign of increased ICP must be immediately communicated and investigated, typically with a CT scan, before the LP is performed [1, 2].References (research sources) - [1]Contraindications to lumbar puncture as defined by computed cranial tomography.Research articleDavid J. Gower, Alfred L. Baker, William O. Bell, Marshall R. Ball (1987) · DOI: 10.1136/jnnp.50.8.1071 - [3]Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: A ReviewResearch articleAri R. Joffe (2007) · DOI: 10.1177/0885066607299516 - [4]Lumbar Puncture in the 21st Century: an Imaging-Based Primer to Determine Procedural Safety.Research articleRigby MJ, Braksick SA, Hawkes MA. (2026) · DOI: 10.1016/j.mayocp.2026.06.016 ## 임상 시나리오 Lumbar Puncture Safety ScreeningIdentifying the Critical Contraindication Before a lumbar puncture, the most critical assessment is for signs of increased intracranial pressure (ICP), such as papilledema. The primary danger is cerebral herniation from the sudden pressure gradient created by spinal fluid removal. Papilledema is optic disc swelling that serves as a non-invasive marker for elevated ICP. While not a perfect predictor, its presence requires immediate reporting and likely neuroimaging before proceeding. CautionA headache or mildly elevated blood pressure (140/88 mmHg) are not contraindications. Do not delay reporting if papilledema or other focal neurological signs are present, as irreversible brainstem compression can occur. ## 핵심 개념 - **Papilledema** — Optic disc swelling caused by elevated intracranial pressure, a key clinical sign of potential mass effect or cerebral edema. - **Cerebral Herniation** — A life-threatening event where increased ICP forces brain tissue downward through the foramen magnum, compressing the brainstem. - **Lumbar Puncture** — A procedure involving needle insertion into the spinal canal to collect cerebrospinal fluid, typically for diagnostic purposes. - **Intracranial Pressure (ICP)** — The pressure inside the skull exerted by brain tissue, blood, and cerebrospinal fluid. - **Foramen Magnum** — The large opening at the base of the skull through which the brainstem connects to the spinal cord. ## 같은 주제 문제 - [A nurse is preparing a client for a lumbar puncture (LP) to rule out meningitis. 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