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?
Hyperventilate the patient.
Decrease sedation.
Reduce the temperature in the room.
Lower blood pressure.
The Correct Answer is A
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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Vitamin K is not the antidote for heparin. It is used to reverse the effects of warfarin, which is a vitamin K antagonist.
Choice B rationale
Iron is not related to the reversal of heparin. It is a mineral that is crucial for many bodily functions, including the transport of oxygen in the blood.
Choice C rationale
Glucagon is a hormone that raises the level of glucose in the blood. It is not used as an antidote for heparin.
Choice D rationale
Protamine is the correct choice. Protamine sulfate is a drug that reverses the anticoagulant effects of heparin by binding to it and forming a stable complex, thereby neutralizing its anticoagulant activity.
Correct Answer is D
Explanation
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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