A nurse is caring for a client post-lumbar puncture who reports a throbbing headache when sitting upright for meals. Which of the following are appropriate actions by the nurse? Select all that apply

Mannitol is an osmotic diuretic commonly used in clients with increased intracranial pressure (ICP) to reduce cerebral edema by drawing fluid from the brain into the vascular system. However, this diuresis can cause significant fluid and electrolyte imbalances, particularly affecting sodium levels. Hypernatremia or hyponatremia may develop depending on the patient's fluid status, so sodium must be closely monitored to prevent neurological deterioration or worsening cerebral edema.

Rationale for Correct Answer:
D. Sodium: Mannitol causes osmotic diuresis, which may result in hypernatremia if excessive water loss occurs or hyponatremia if free water replacement is inadequate. Either imbalance can worsen neurologic status, making sodium the most critical electrolyte to monitor in these patients.

Rationale for Incorrect Answers:

1. Potassium: Although mannitol can cause some renal electrolyte losses, potassium disturbances are less common and less urgent than sodium changes in the context of mannitol therapy.
2. Chloride: Chloride may be altered as it accompanies sodium loss or retention, but it is not typically the primary concern in mannitol administration.
3. Magnesium: Magnesium levels can be affected by diuretics, but neurologic implications of sodium imbalance take priority in clients with increased ICP.

Key Takeaways:
• Sodium is the priority electrolyte to monitor when administering mannitol due to the risk of diuresis-induced imbalances.
• Both hypernatremia and hyponatremia can worsen neurologic status and must be addressed promptly.
• While other electrolytes are also monitored, sodium directly affects cerebral fluid balance and ICP.

A cerebral angiogram is a diagnostic imaging procedure that uses iodinated contrast dye and fluoroscopy to visualize cerebral blood flow. Prior to the procedure, the nurse must assess for conditions that could pose a risk or require modification of care, such as pregnancy, bleeding risk from anticoagulants, or allergies to contrast agents. Some client-reported statements, especially those related to contrast dye sensitivity and anticoagulation, require immediate provider notification.

Rationale for Correct Answers:

A. “I think I may be pregnant.”: Exposure to radiation and contrast dye during a cerebral angiogram may pose potential harm to a developing fetus. This possibility should be investigated and reported before proceeding.

B. “I take Coumadin.”: Warfarin is an anticoagulant that increases the client’s risk for bleeding during the procedure. The provider must evaluate coagulation status and possibly pause or adjust therapy.

D. “I am allergic to shrimp.”: Although a seafood allergy does not automatically mean an iodine allergy, a history of shrimp allergy may be associated with contrast dye sensitivity. The provider should assess further and consider premedication to prevent a hypersensitivity reaction.

Rationale for Incorrect Answers:
C. “I take antihypertensive medication.”: Antihypertensive medications are generally safe and may even be beneficial for clients undergoing angiography. There is no need to stop these medications unless directed by the provider.
E. “I am allergic to latex.”: Latex allergy is important to document, but it is not a specific concern related to angiography with contrast dye. Latex-free equipment is widely available, and this allergy does not require cancellation or modification of the procedure itself.

Key Takeaways:
• Always report possible pregnancy, use of anticoagulants, and contrast dye allergy risks before cerebral angiography.
• Latex allergy, while relevant, does not pose a direct risk during contrast administration.
• Routine medications like antihypertensives are generally not contraindicated unless otherwise instructed.