When caring for a client with a cervical spinal cord injury, which intervention is the most important for the nurse to implement?

Assess the extremity reflexes.

Logroll to change positions.

Immobilize the head in anatomical alignment.

Obtain hourly neurological assessments.

Answer and Explanation

The Correct Answer is C

Choice A reason: Assessing the extremity reflexes is important for evaluating neurological function but is not the immediate priority.

Choice B reason: Logrolling to change positions is a technique used to maintain spinal alignment, but it is not the first intervention to ensure immediate safety.

Choice C reason:

The correct answer is c) because immobilizing the head in anatomical alignment is crucial to prevent further injury to the spinal cord. Proper immobilization helps stabilize the cervical spine and protects the spinal cord from additional damage.

Choice D reason: Obtaining hourly neurological assessments is important for monitoring the client's condition but comes after ensuring the cervical spine is properly immobilized.

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Correct Answer is D

Explanation

Choice A reason: Skull radiography is not typically used to diagnose bacterial meningitis.

Choice B reason: MRI can be useful in identifying complications of meningitis but is not the primary diagnostic tool.

Choice C reason: A CT scan may be done prior to a lumbar puncture if there is a concern for increased intracranial pressure, but it is not the primary diagnostic procedure.

Choice D reason:

The correct answer is d) because a lumbar puncture is the definitive diagnostic procedure for bacterial meningitis. It allows for the analysis of cerebrospinal fluid (CSF) to identify the presence of bacteria and other indicators of infection.

A. Sleep flat in a supine position. B. Observe pupil response of the right eye. C. Turn, cough, and deep breathe every 2 hours. D. Administer a stool softener.

Correct Answer is D

Explanation

Choice A reason: Sleeping flat in a supine position may increase intraocular pressure.

Choice B reason: Observing the pupil response of the right eye is not relevant to the left eye procedure.

Choice C reason: Turning, coughing, and deep breathing are important post-surgery but not specific to cataract extraction.

Choice D reason:

The correct answer is d) because administering a stool softener helps prevent straining during bowel movements, which can increase intraocular pressure.

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When caring for a client with a cervical spinal cord injury, which intervention is the most important for the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client admitted to the hospital with a tentative diagnosis of bacterial meningitis. Which diagnostic procedure should the nurse prepare the client for?

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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