A 70year old client diagnosed with a hemorrhagic stroke was admitted 1 day ago. His

medical history includes hypertension, osteoarthritis, and type 2 diabetes. He has right sided

paralysis, garbled speech, and a weak cough reflex. This morning he is restless. Vital signs are Blood Pressure 160/80, pulse 110, respirations 24, oxygen saturation 90% Which of the following Interventions will the nurse take to avoid complications? Select all that apply

Select All that Apply)

A nurse is caring for a client who reports a throbbing headache after a lumbar puncture.  Which of the following actions is most likely to facilitate resolution of the headache? 

A nurse is caring for a client who has rightsided acoustic neuroma resulting in impairment of cranial nerves IX and X. Which of the following actions should the nurse take?

A nurse is caring for a client with a closed skull injury who has an intracranial pressure (ICP) reading consistently over 20 mmHg, According to the MonroeKellie Doctrine, If Intracranial pressure continues to Increase, what will occur? Select All that Apply.

A nurse working on a medical unit is caring for a client who is prescribed seizure precautions. Which of the following interventions should the nurse Include in the client's plan of care?

A nurse is caring for a client who is unconscious following a cerebral hemorrhage. Which of the following nursing interventions is of highest priority?

According to the ATI video case study, Cognition: Delirium and Dementia, which of the following is the best first action for the nurse to take when caring for a client with delirium?

After performing a neurological assessment, the student nurse shares the following findings with the primary nurse: Visual fields full to confrontation with Intact extraocular movements. No nystagmus, midline protrusion of tongue, and negative Romberg test. Which of the following will the primary nurse tell the student nurse to document?

A nurse is assessing a client who has a concussion from a sports injury. Which of the following manifestations should the nurse expect?

A client who suffered a stroke now has functional musculoskeletal deficits and is unable to perform ADLS independently. Which of the following Interventions are appropriate for this client?

You admit a client on day 1. After several days off, you are reassigned the same client. Click the tabs to review vital signs and nurse notes to review the client's progression.

Vital Signs Assessment Day 1:

Temperature 37.5° C (99.5° F) Blood pressure 198/96 mm Hg Heart rate 112/min

Respiratory rate 22/min

Oxygen saturation 96% on room air Day 7:

Temperature 38° C (100,4° F) Blood pressure 166/70 mm Hg Heart rate 68/min

Respiratory rate 20/min

Oxygen saturation 97% on room air

Question: For each client finding, click to specify if the finding could indicate Parkinson's disease, stroke, and/or multiple sclerosis. Each finding can support more than one disease process. Click the tabs at the top of the page for information about your client.