NORCET 10 Prelims-2026: A patient after spinal anesthesia complains of headache. What should the nurse do?

NORCET 10 Prelims-2026

Medical & Surgical Nursing

Medium

Appeared in: NORCET 10 Prelims-2026

Explanation

The patient is likely experiencing a post-dural puncture headache (PDPH), a known complication of spinal anesthesia caused by cerebrospinal fluid (CSF) leakage.
Keeping the patient in a flat (supine) position is the primary intervention. This position minimizes the effect of gravity, which reduces pressure at the dural puncture site, slows the CSF leak, and alleviates the postural headache.
Administering intravenous (IV) or oral fluids promotes hydration, which helps the body to replenish the lost CSF volume more quickly.
This combined approach directly addresses the underlying pathophysiology of the headache.

Option B: Sitting the patient upright is contraindicated. This position increases the hydrostatic pressure gradient, which worsens the CSF leak and intensifies the headache due to increased downward traction on the brain.
Option C: Encouraging early ambulation involves an upright posture, which would exacerbate the postural headache caused by the CSF leak. Bed rest is the recommended activity level.
Option D: While a calm environment and diversional therapy are beneficial for patient comfort, they are only supportive measures. They do not address the physiological cause of the headache, which is the CSF volume depletion.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Management of Post-Dural Puncture Headache (PDPH) in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Recognizing a post-dural puncture headache is a critical nursing skill in postoperative and obstetric units. The key diagnostic feature is its postural nature—worsening on sitting/standing and improving on lying flat.
Initial nursing management with bed rest and hydration is effective in most cases and can prevent the need for more invasive procedures.
Nurses play a key role in patient education, explaining the reason for strict bed rest to ensure compliance and comfort.

How to Approach the Question

First, identify the key elements in the question: a patient has received spinal anesthesia and is now complaining of a headache.
Connect these elements to a known clinical complication. A headache following spinal anesthesia is the classic symptom of a post-dural puncture headache (PDPH).
Recall the underlying cause of PDPH: leakage of cerebrospinal fluid (CSF) through the puncture site in the dura.
Analyze how each option would affect this underlying cause. An upright position (sitting or ambulating) would worsen the leak due to gravity. Diversional therapy doesn't address the leak.
Select the option that directly counteracts the pathophysiology. Lying flat reduces the pressure gradient and slows the leak, while fluids help replenish the lost CSF volume. Therefore, this is the most appropriate initial action.

Concept Tested & Keywords

Concept Tested: Management of Post-Dural Puncture Headache (PDPH)
Stem keywords: spinal anesthesia, headache, nurse
Lead-in keywords: What should the nurse do
Clinical cues: The patient's complaint of headache following a spinal anesthesia procedure is a classic sign of a specific complication.

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