A client is admitted with a closed head injury sustained in a motor vehicle accident.
The nurse notes that the client's intracranial pressure (ICP) shows an upward trend. Which action should the nurse prioritize?
Administer 100 mg of pentobarbital IV as ordered.
Administer 1 g Mannitol IV as ordered.
Increase the ventilator respiratory rate to 20 breaths/minute.
Reposition the client to avoid neck flexion.
The Correct Answer is B
Managing increased intracranial pressure requires applying knowledge of osmotic therapy, cerebral perfusion, and neurological positioning. Nurses must prioritize interventions that rapidly reduce cerebral edema while maintaining physiological stability and preventing herniation in patients with traumatic brain injuries or intracranial hypertension.
Choice A rationale
Pentobarbital is a barbiturate used for medically induced comas to reduce cerebral metabolic demand. While effective for refractory intracranial hypertension, it is typically a secondary or tertiary intervention rather than the immediate priority for an upward trend in pressure.
Choice B rationale
Mannitol is an osmotic diuretic that creates an osmotic gradient, pulling fluid from the cerebral interstitial space into the vascular compartment. This rapidly reduces brain volume and intracranial pressure, making it the first-line pharmacological priority for acute elevations.
Choice C rationale
Hyperventilation decreases PaCO2, causing cerebral vasoconstriction and reduced blood volume. However, excessive hyperventilation can cause cerebral ischemia. Increasing the rate to 20 should only be done under specific medical direction and is not the primary nursing priority here.
Choice D rationale
Proper positioning, such as head of bed elevation and avoiding neck flexion, facilitates venous drainage from the brain. While important, it is a supportive measure and less effective than osmotic diuretics for treating an acute, upward trend.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
Post-myocardial infarction discharge teaching focuses on secondary prevention and cardiac rehabilitation. Knowledge of cardiovascular physiology, lifestyle modification, and pharmacology is necessary to ensure the client understands how to reduce cardiac workload and prevent further coronary artery occlusion or heart failure.
Choice A rationale
Reporting chest pain is critical as it indicates potential myocardial ischemia. Early intervention can prevent further muscle damage. Clients must understand that any recurrence of angina requires immediate medical evaluation to assess coronary artery patency and perfusion.
Choice B rationale
Gradual activity increase is a hallmark of cardiac rehabilitation. It allows the heart muscle to adapt to increased demands without causing excessive strain or rupture. Controlled exercise improves cardiovascular efficiency and lowers the resting heart rate over time.
Choice C rationale
Polyunsaturated fats help lower low density lipoprotein cholesterol, reducing the risk of further atherosclerosis. A heart healthy diet limits saturated fats and trans fats, which are known to contribute to plaque formation within the coronary arteries.
Choice D rationale
Heavy weightlifting or isometric exercises can significantly increase systemic vascular resistance and blood pressure. This places excessive afterload on the healing myocardium. Clients are usually advised to avoid heavy lifting or straining during the initial recovery phase.
Choice E rationale
Adherence to medications such as beta blockers, antiplatelets, and statins is vital for long term survival. These drugs reduce blood pressure, prevent clot formation, and stabilize plaques, directly impacting the prevention of a secondary cardiac event.
Correct Answer is C
Explanation
Evaluating pulmonary embolism in patients with renal impairment requires knowledge of contrast-induced nephropathy risks. One must apply understanding of different imaging modalities to select a test that provides diagnostic clarity without using nephrotoxic agents that would worsen kidney failure.
Choice A rationale
Pulmonary angiography is an invasive procedure requiring a large bolus of iodinated contrast. In a client with chronic kidney disease and recent nephropathy, this would likely cause further irreversible damage to the remaining renal function.
Choice B rationale
D-dimer is a screening tool with high sensitivity but low specificity. While it does not require contrast, it cannot definitively diagnose a PE. It is used to rule out PE in low-risk patients rather than confirm.
Choice C rationale
A ventilation-perfusion scan uses radioactive isotopes rather than iodinated contrast. It is the preferred diagnostic test for patients with renal failure because it avoids the risk of contrast-induced nephropathy while effectively assessing for V/Q mismatch.
Choice D rationale
A chest X-ray is useful for ruling out other causes of respiratory distress like pneumonia or pneumothorax, but it is not sensitive or specific enough to diagnose a pulmonary embolism. Most PE patients have normal X-rays..
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