The nurse is caring for a client who sustained a head injury in a motor vehicle accident and is diagnosed with a subdural hematoma and increased intracranial pressure. Which nursing intervention is appropriate for this client?

Keeping the room brightly lit.

Encouraging coughing and deep breathing exercises.

Placing the client in a supine position.

Implementing seizure precautions.

Answer and Explanation

The Correct Answer is D

A. Keeping the room brightly lit can be overstimulating and may increase ICP; therefore, a calm, dimly lit environment is preferable.
B. Encouraging coughing and deep breathing exercises could increase ICP and should be avoided unless specifically indicated.
C. Placing the client in a supine position is not recommended for clients with increased ICP; they should typically be positioned with the head elevated to promote venous drainage.
D. Implementing seizure precautions is critical as head injuries can lead to seizures, and ensuring the client's safety is a priority.

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Correct Answer is ["A","B","D"]

Explanation

A. Hypertension can occur due to autonomic dysreflexia, especially in clients with cervical spinal cord injuries, as they may have exaggerated sympathetic responses.
B. A weakened gag reflex can result from cranial nerve involvement due to the cervical spinal cord injury, impacting the client's ability to protect their airway.
C. Absence of bowel sounds may indicate bowel immobility or dysfunction; however, it is not a direct complication of a cervical spinal cord injury.
D. Bradycardia is a common finding in cervical spinal cord injuries due to impaired sympathetic nervous system function, leading to decreased heart rate.
E. Tachycardia is less common in cervical injuries and is typically associated with lower injuries in the spinal cord.

A. Weight gain B. Tachycardia C. Weight loss D. Depression

Correct Answer is B

Explanation

A. Weight gain is not a symptom of hyperthyroidism; in fact, patients often experience weight loss.
B. Beta blockers are commonly used to manage symptoms of tachycardia and palpitations associated with hyperthyroidism, as they help to decrease heart rate and reduce anxiety.
C. Weight loss is a typical symptom of hyperthyroidism, and beta blockers do not address this issue directly.
D. Depression is not a primary indication for beta blocker use in hyperthyroidism; instead, they are more focused on managing the cardiovascular symptoms associated with the condition.

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The nurse is caring for a client who sustained a head injury in a motor vehicle accident and is diagnosed with a subdural hematoma and increased intracranial pressure. Which nursing intervention is appropriate for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

A nurse is caring for a client with hyperthyroidism. The nurse recognizes that beta blockers may be used for which of the following?

Correct Answer is B

Explanation

A nurse is in the emergency department (ED) and is caring for a client that has arrived by ambulance after a cervical spinal cord injury. Which assessment should be the priority for the nurse to perform at this time?

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