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The nurse is caring for a client who was admitted 24 hours ago with a traumatic brain injury. Which medications would the nurse anticipate being prescribed to reduce cerebral edema and prevent a secondary brain injury? Select All That Apply

Morphine

Lactated Ringers

Selected Medications

Dexamethasone

Mannitol

Hypertonic saline

Furosemide

Answer and Explanation

Correct Answer : D,E,F,G

A. Morphine is typically used for pain relief, but it is not used to reduce cerebral edema.

B. Lactated Ringers is a balanced electrolyte solution, but it does not address the need for reducing cerebral edema.

D. Dexamethasone is a corticosteroid used to reduce inflammation and cerebral edema in cases of brain injury.

E. Mannitol is an osmotic diuretic used to reduce cerebral edema by drawing fluid out of the brain and into the bloodstream.

F. Hypertonic saline is used to increase serum osmolality, helping to pull water out of the brain and reduce edema.

G. Furosemide is a loop diuretic that can also help reduce cerebral edema by promoting diuresis.

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Correct Answer is A

Explanation

A. 0.9% normal saline IV at 100 mL/hr continuous: This order requires clarification. In acute heart failure, fluid management is crucial. A continuous IV infusion of normal saline could exacerbate fluid overload and worsen heart failure. Typically, IV fluids are given cautiously or restricted in heart failure cases.

B. Bumetanide (Bumex) 1 mg IV bolus every 12 hr: This is a loop diuretic, which is appropriate for managing fluid overload in heart failure.

C. Laboratory testing of serum potassium upon admission: This is appropriate, as diuretics like Bumex can lower potassium levels, so it is important to monitor electrolyte levels.

D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain: This is appropriate for pain management and to help with anxiety and breathing difficulties in acute heart failure.

A. Heart rate of 134 bpm B. Mild shortness of breath C. Three premature ventricular contractions in a row D. Blood pressure 152/88 mmHg

Correct Answer is C

Explanation

A. Heart rate of 134 bpm. A heart rate of 134 bpm is expected during a cardiac stress test, as the goal is to increase the heart rate to a target range to evaluate cardiac function under stress.

B. Mild shortness of breath. Mild shortness of breath is a common response to exercise and is not an indication to stop the test unless it becomes severe or is accompanied by other concerning symptoms like chest pain or cyanosis.

C. Three premature ventricular contractions in a row indicate a potential serious arrhythmia (ventricular tachycardia), which is a contraindication for continuing the stress test. This finding could place the client at risk for life-threatening cardiac events, such as ventricular fibrillation.

D. Blood pressure 152/88 mmHg. This is a slightly elevated but normal physiological response to exercise and does not warrant discontinuation of the test unless the blood pressure rises to dangerously high levels (e.g., >200/110 mmHg).

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The nurse is caring for a client who was admitted 24 hours ago with a traumatic brain injury. Which medications would the nurse anticipate being prescribed to reduce cerebral edema and prevent a secondary brain injury? Select All That Apply

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