A home health nurse is developing a care plan for a child with hemiplegic cerebral palsy. What is the priority goal for the nurse to include in the care plan?

Improve the patient’s communication skills.

Foster self-care activities.

Provide respite services for the parents.

Enhance the patient’s mobility skills.

Answer and Explanation

The Correct Answer is D

Choice A rationale

While improving the patient’s communication skills is an important goal in the care of a child with hemiplegic cerebral palsy, it is not the priority goal. The priority should be based on the child’s most immediate needs and the potential for harm if those needs are not met.

Choice B rationale

Fostering self-care activities is another important goal in the care of a child with hemiplegic cerebral palsy. However, it is not the priority goal. The priority should be based on the child’s most immediate needs and the potential for harm if those needs are not met.

Choice C rationale

Providing respite services for the parents is an important aspect of care, but it is not the priority goal for the child’s care plan. The priority should be based on the child’s most immediate needs and the potential for harm if those needs are not met.

Choice D rationale

Enhancing the patient’s mobility skills is the priority goal for a child with hemiplegic cerebral palsy. Hemiplegic cerebral palsy affects one side of the body, impacting the child’s mobility.

Therefore, interventions should focus on improving mobility to enhance the child’s independence and quality of life.

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Correct Answer is A

Explanation

Choice A rationale

Hyperventilation is a potential treatment for brain herniation. Hyperventilation causes a decrease in carbon dioxide levels in the blood, leading to vasoconstriction of the cerebral blood vessels. This reduces cerebral blood flow and decreases intracranial pressure, which can help in the management of brain herniation.

Choice B rationale

Decreasing sedation is not typically a treatment for brain herniation. Sedation can be used in the management of increased intracranial pressure, but it is not a direct treatment for brain herniation.

Choice C rationale

Reducing the temperature in the room is not a direct treatment for brain herniation. While temperature control is important in the overall management of a patient with brain injury, it does not directly treat brain herniation.

Choice D rationale

Lowering blood pressure is not a direct treatment for brain herniation. While maintaining optimal blood pressure is important in the management of brain injury, aggressive lowering of blood pressure is not typically done as it could compromise cerebral perfusion.

A. Take the medication with an aspirin to enhance its effectiveness. B. Taking the maximum dose will provide stroke prevention. C. Sustained-release forms can be crushed for easier administration. D. Take the medication with food.

Correct Answer is D

Explanation

Choice A rationale

Taking ibuprofen with aspirin is not typically recommended without a doctor’s advice. Both are nonsteroidal anti-inflammatory drugs (NSAIDs), and taking them together increases the risk of side effects such as stomach bleeding.

Choice B rationale

Ibuprofen is not used for stroke prevention. Aspirin, not ibuprofen, is often used for this purpose because of its antiplatelet effect.

Choice C rationale

Crushing sustained-release forms of medication is generally not recommended because it can lead to a rapid release and absorption of the drug, which increases the risk of side effects.

Choice D rationale

Taking ibuprofen with food is often recommended to reduce the risk of stomach upset.

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A home health nurse is developing a care plan for a child with hemiplegic cerebral palsy. What is the priority goal for the nurse to include in the care plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is educating a group of nursing students about brain herniation.Which of the following interventions should the nurse include as a potential treatment for brain herniation?

Correct Answer is A

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Correct Answer is D

Explanation

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