# A nurse is preparing a patient for a lumbar puncture. Which nursing intervention should be implemented first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541095  
> language: ko  
> subject: Adult Health

## 문제

A nurse is preparing a patient for a lumbar puncture. Which nursing intervention should be implemented first?

A 45-year-old patient is scheduled for a lumbar puncture to rule out meningitis. The patient appears anxious and asks multiple questions about the procedure.

## 보기

1. Obtain informed consent and verify patient understanding of the procedure **✔ 정답**
2. Position the patient in lateral recumbent position with knees flexed
3. Gather sterile equipment and prepare the procedural area
4. Administer prescribed pre-procedure sedation

**정답: 1**

## 해설

Obtaining informed consent is the priority before any invasive procedure like lumbar puncture, as it is a legal and ethical requirement. Other interventions (positioning, equipment prep, sedation) are important but follow consent.

## 심화 해설

Clinical Judgment
This question asks about the core of Prioritization and Patient Rights. Since a lumbar puncture is an invasive procedure, obtaining Informed Consent, a legal and ethical obligation, must precede all physical preparations. The situation where the patient is anxious and has many questions actually underscores the importance of the consent process. The nurse's role is to supplement the physician's explanation, verify the patient's understanding, and recognize that the procedure cannot begin without consent.

Memory Tip:
**C**onsent Comes **F**irst! Before any invasive procedure, **I**nformed **C**onsent is the top priority.

KR vs US:
In Korea, the physician is primarily responsible for explaining and signing the consent form, but in the US NCLEX, the nurse's responsibility for Verification of Understanding and confirming the consent form is completed is emphasized. The nurse acts as the final 'gatekeeper'.

## 임상 시나리오

Clinical Practice Guide
Before a lumbar puncture, the nurse prepares as follows: confirm NPO status (if required), measure baseline vital signs, check for allergies, and secure intravenous access. During the procedure, maintain sterile technique and monitor the patient's comfort and breathing (especially in the lateral decubitus position). After the procedure, to prevent post-LP headache, keep the patient in a flat position and encourage fluid intake.
Caution:
In SATA (Select All That Apply) questions, "obtaining consent" is always a priority option. "Positioning" or "preparing equipment" are tempting distractors, as they are implementation steps that occur after consent.

## 핵심 개념

- **Lumbar Puncture (요추천자)** — A diagnostic procedure in which a needle is inserted into the lumbar region (usually at the L3-L4 or L4-L5 interspace) to collect cerebrospinal fluid (CSF) or measure pressure.
- **Informed Consent (사전동의)** — A process in which a healthcare professional fully explains the purpose, risks, benefits, and alternatives of a procedure to a patient, after which the patient understands and voluntarily agrees. It is a legal requirement.
- **Meningitis (뇌수막염)** — Inflammation of the meninges surrounding the brain and spinal cord. Lumbar puncture is the primary test used to diagnose this.
- **Lateral Recumbent Position (측와위)** — Lying on your side with your knees bent toward your abdomen. This is the standard position to maximize the space between the vertebrae during a lumbar puncture.
- **Pre-procedure Sedation (전처치 진정)** — A sedative administered to reduce patient anxiety and promote comfort before a procedure. Benzodiazepines are commonly used.

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