100 Neuro NCLEX questionsAn 18-year-old client is admitted with a closed head injury sustained in a MVA. His intracranial pressure (ICP) shows an upward
... [Show More] trend. Which intervention should the nurse perform first?
1. Reposition the client to avoid neck flexion
2. Administer 1 g Mannitol IV as ordered
3. Increase the ventilator’s respiratory rate to 20 breaths/minute
4. Administer 100 mg of pentobarbital IV as ordered.
2. A client with a subarachnoid hemorrhage is prescribed a 1,000-mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?
1. Therapeutic drug levels should be maintained between 20 to 30 mg/ml. 2. Rapid Dilantin administration can cause cardiac arrhythmias.
3. Dilantin should be mixed in dextrose in water before administration.
4. Dilantin should be administered through an IV catheter in the client’s hand.
3. A client with head trauma develops a urine output of 300 ml/hr, dry skin, and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?
1. Evaluate urine specific gravity
2. Anticipate treatment for renal failure
3. Provide emollients to the skin to prevent breakdown
4. Slow down the IV fluids and notify the physician
4. When evaluating an ABG from a client with a subdural hematoma, the nurse notes the PaCO2 is 30 mm Hg. Which of the following responses best describes this result?
1. Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure (ICP).
2. Emergent; the client is poorly oxygenated.
3. Normal
4. Significant; the client has alveolar hypoventilation.
5. A client who had a transsphenoidal hypophysectomy should be watched carefully for hemorrhage, which may be shown by which of the following signs?
1. Bloody drainage from the ears 2. Frequent swallowing
3. Guaiac-positive stools
4. Hematuria
6. After a hypophysectomy, vasopressin is given IM for which of the following reasons?
1. To treat growth failure
2. To prevent syndrome of inappropriate antidiuretic hormone (SIADH)
3. To reduce cerebral edema and lower intracranial pressure
4. To replace antidiuretic hormone (ADH) normally secreted by the pituitary.
7. A client comes into the ER after hitting his head in an MVA. He’s alert and oriented. Which of the following nursing interventions should be done first? [Show Less]