The nurse is caring for a client with a cerebral aneurysm. Why does the nurse limit the interaction of visitors or family members with the client who has an aneurysm?

The stimulation can increase intracranial pressure (ICP)

The interaction may cause the client to become violent

The client may become emotional and lose interest in the treatment

The interaction may cause migraine in the client

Answer and Explanation

The Correct Answer is A

Reasoning:

Choice A reason: Limiting visitor interaction reduces stimulation, which can increase intracranial pressure (ICP) in clients with cerebral aneurysms. Emotional or physical stress from interactions raises blood pressure, potentially increasing ICP and risking aneurysm rupture, making this a critical measure to maintain stability and prevent catastrophic bleeding.

Choice B reason: Interaction causing violence is not a typical concern in cerebral aneurysm management. Aneurysms may cause neurological symptoms, but violence is unrelated to visitor interactions. The primary risk is increased ICP from stimulation, not behavioral changes, making this an incorrect rationale for limiting visitors.

Choice C reason: Emotional distress from interactions may occur but is not the primary reason to limit visitors. The main concern in cerebral aneurysms is preventing ICP increases from stimulation, which could lead to rupture. Emotional impact on treatment adherence is secondary to this immediate physical risk.

Choice D reason: Migraines are not a direct consequence of visitor interactions in cerebral aneurysm cases. While headaches may occur, the primary concern is increased ICP from stimulation, which raises blood pressure and risks aneurysm rupture, not triggering migraines, which are unrelated to this context.

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Correct Answer is B

Explanation

Reasoning:

Choice A reason: Normal hematocrit is not typical in sickle cell anemia, a hemolytic disorder where red blood cells are destroyed prematurely due to abnormal hemoglobin (HbS). Chronic hemolysis reduces red blood cell mass, lowering hematocrit, making a normal value inconsistent with the disease’s pathophysiology.

Choice B reason: Low hematocrit is characteristic of sickle cell anemia due to chronic hemolysis. Sickled red blood cells have a shorter lifespan, reducing circulating red blood cells and hemoglobin, resulting in a decreased hematocrit. This reflects the anemia’s impact on oxygen-carrying capacity, a hallmark of the condition.

Choice C reason: High hematocrit is not associated with sickle cell anemia. Elevated hematocrit occurs in conditions like polycythemia, where red blood cell mass increases. Sickle cell anemia causes hemolysis, reducing red blood cells and hematocrit, making a high value inconsistent with the disease.

Choice D reason: A normal blood smear is not expected in sickle cell anemia. Blood smears show sickled red blood cells, anisocytosis, and poikilocytosis due to hemoglobin S polymerization. These abnormal findings contrast with a normal smear, which would not reflect the hemolytic and morphological changes of the disease.

A. Hair loss B. Serum glucose level C. Bone demineralization D. Menstrual flow

Correct Answer is B

Explanation

Reasoning:

Choice A reason: Hair loss may not significantly decline with successful Cushing’s syndrome treatment. Excess cortisol causes hirsutism or hair thinning due to androgen excess or protein catabolism. Treatment reduces cortisol, but hair changes may persist due to slow hair growth cycles or irreversible follicular damage.

Choice B reason: Successful treatment of Cushing’s syndrome lowers serum glucose levels. Excess cortisol induces insulin resistance and gluconeogenesis, causing hyperglycemia. Reducing cortisol through treatment (e.g., surgery or medication) restores insulin sensitivity and reduces glucose production, normalizing blood sugar levels, a key indicator of effective management.

Choice C reason: Bone demineralization may not decline quickly with treatment. Chronic cortisol excess inhibits osteoblast activity and calcium absorption, causing osteoporosis. While treatment halts further bone loss, reversal is slow due to the time required for bone remodeling, making this less immediate than glucose normalization.

Choice D reason: Menstrual flow may not immediately increase with treatment. Cortisol excess disrupts gonadotropin release, causing amenorrhea. Restoring normal cortisol levels may improve menstrual cycles, but hormonal recovery is gradual, and changes in flow are less immediate or reliable than glucose level declines as a treatment outcome.

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The nurse is caring for a client with a cerebral aneurysm. Why does the nurse limit the interaction of visitors or family members with the client who has an aneurysm?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with sickle cell anemia has a:

Correct Answer is B

Explanation

A client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in:

Correct Answer is B

Explanation

A client is brought to the ED by family after falling off the roof. The care team suspects an epidural hematoma, prompting the nurse to anticipate which priority intervention?

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be the best response by the nurse?

A client's electronic health record notes that the client has previously undergone treatment for secondary polycythemia. The nurse should assess for which factor?

A client is seen in the emergency department with severe pain related to a sickle cell crisis. What does the nurse understand is occurring with this client?

A nurse should perform which intervention for a client with Cushing's syndrome?

A nurse is caring for a client with Cushing’s syndrome. Which interventions would the nurse include in the client’s plan of care? (Select all that apply)

Which is a clinical manifestation of diabetes insipidus?

A client is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the client will experience?