The critical care nurse provides care for a client who is admitted for the treatment of head trauma and prescribed mannitol to reduce intracranial pressure (ICP). Which electrolyte is the priority for the nurse to monitor?
Potassium
Chloride
Magnesium
Sodium
The Correct Answer is D
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:
- 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.
- Chloride: Chloride may be altered as it accompanies sodium loss or retention, but it is not typically the primary concern in mannitol administration.
- 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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
An electroencephalogram (EEG) is a noninvasive procedure that evaluates electrical activity in the brain. Clients scheduled for a sleep-deprived EEG are often instructed to stay awake most of the night before the test to increase the chance of detecting abnormal brain wave activity. Sleep deprivation can help provoke seizures or abnormal discharges, improving diagnostic accuracy for epilepsy or other neurological conditions.
Rationale for Correct Answer:
B. “Try to stay awake most of the night prior to the procedure.”: Clients are often advised to reduce sleep before an EEG to enhance the sensitivity of the test, especially when evaluating seizure disorders. Sleep-deprived EEGs help uncover abnormalities that may not appear in a standard, well-rested recording.
Rationale for Incorrect Answers:
A. “Do not wash your hair the morning of the procedure.”: Clients should be instructed to wash their hair the night before or the morning of the test and avoid using conditioners, sprays, or gels. Clean, product-free hair improves electrode contact with the scalp.
C. “The procedure will take approximately 15 minutes.”: A standard EEG typically lasts 30 to 60 minutes, not 1E. Additional time may be needed for preparation or if extended monitoring is ordered.
D. “You will need to lie flat for 4 hours after the procedure.”: EEG is a noninvasive and painless procedure that does not require any recovery time or post-procedure positioning. Clients can resume normal activities immediately unless sedatives were used.
Key Takeaways:
• Sleep deprivation before EEG enhances detection of abnormal brain activity.
• Clients should wash hair prior to the EEG and avoid hair products.
• EEG is painless, noninvasive, and typically lasts longer than 15 minutes with no special recovery required.
Correct Answer is ["A","C","D","F"]
Explanation
The components that contribute to intracranial pressure (ICP) are described by the Monro-Kellie doctrine: brain tissue, cerebrospinal fluid (CSF), and blood. The dura mater, as part of the meningeal layers, also influences ICP dynamics.
Rationale for Correct Answers:
A. Brain: The brain tissue itself is one of the primary components of intracranial volume and contributes directly to ICP.
C. Cerebrospinal Fluid: CSF circulates within the ventricles and subarachnoid space and significantly influences ICP.
D. Blood: Cerebral blood volume impacts ICP through changes in arterial or venous flow.
F. Dura mater: The dura mater helps contain the intracranial contents and plays a structural role in pressure regulation.
Rationale for Incorrect Answers:
B. Neurons: While part of brain tissue, individual neurons are not discussed separately in ICP dynamics.
E. Periosteum: This membrane covers the outer surface of bone and is not involved in intracranial volume or pressure regulation.
Key Takeaways:
• Intracranial pressure is determined by the volume of brain tissue, blood, and CSF within the skull.
• The Monro-Kellie doctrine helps explain compensatory changes among these components.
• Structures outside the cranial cavity, such as the periosteum, do not impact ICP.
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