A traumatic brain injury on the brainstem can cause which of the following?

Emotional lability

Personality changes

Diabetes insipidus

Unstable vital signs

Answer and Explanation

The Correct Answer is D

A. Emotional lability (rapid mood swings) can occur with brain injuries, but it is more commonly associated with damage to the frontal lobe, not the brainstem.

B. Personality changes are also more likely to result from damage to the frontal lobe or other areas of the brain responsible for behavior and personality, not the brainstem.

C. Diabetes insipidus can result from brain injury, particularly damage to the hypothalamus or pituitary gland, but it is not a direct consequence of brainstem injury.

D. Unstable vital signs are a common result of damage to the brainstem, which is responsible for regulating autonomic functions such as heart rate, blood pressure, and respiration. Damage to the brainstem can lead to life-threatening instability in these vital functions.

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Correct Answer is D

Explanation

A. The client should not sit upright in a chair for prolonged periods (such as 4 hours at a time) immediately following spinal fusion, as this could place excessive strain on the surgical site. The client should be assisted to sit upright for short periods and be repositioned regularly.

B. Clear drainage on the spinal dressing could indicate cerebrospinal fluid leakage, which is a concern following spinal surgery. The nurse should expect minimal to no drainage, and if clear fluid is observed, it should be reported immediately.

C. Elevating the client's legs when lying on his side may not be necessary unless specifically ordered by the healthcare provider. In general, the client should maintain proper body alignment and avoid any positions that strain the surgical site.

D. Log rolling is a critical intervention for spinal fusion patients to prevent twisting of the spine. The nurse should assist the client in log rolling every 2 hours to maintain spinal alignment and prevent injury to the surgical site.

A. Have the client wear a cervical collar for the first 12 hr. B. Head of her bed elevated 30 degrees C. Logroll the client every 2 hr. D. Supine with her arms elevated on pillows

Correct Answer is C

Explanation

A. A cervical collar is not necessary for a lumbar laminectomy. A cervical collar is used for neck surgeries or spinal cord injuries involving the cervical spine, not for lumbar procedures.

B. The head of the bed elevated 30 degrees may be appropriate for certain conditions, but after a lumbar laminectomy, it is typically recommended to keep the head of the bed flat or slightly elevated to reduce pressure on the spine.

C. Logrolling the client every 2 hr is the correct action. After a lumbar laminectomy, the nurse should use the logroll technique to turn the patient to prevent strain on the spine and promote proper healing.

D. Supine with her arms elevated on pillows is not the best position. While elevation of the arms may be helpful for comfort, the focus should be on protecting the lumbar spine and ensuring proper positioning to prevent strain.

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A traumatic brain injury on the brainstem can cause which of the following?

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Naxlex Comprehensive Predictor Exams

A nurse is assisting with the plan of care for a client who is 1 day postoperative following spinal fusion. Which of the following interventions should the nurse include in the plan?

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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