A nurse is assessing a client who reports severe headache and a stiff neck. The nurse's assessment reveals positive Kernig's signs. Which of the following actions should the nurse perform first?
Administer Antibiotics
Decrease bright lights
Initiate IV access
Implement droplet precautions
The Correct Answer is D
A. Administering antibiotics is crucial but not the immediate first action.
B. Decreasing bright lights can help with comfort but is not the first priority.
C. Initiating IV access is important for medication administration but not the first action.
D. Implementing droplet precautions is the first action to prevent the spread of potentially contagious bacterial meningitis until the causative organism is identified.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
. Bounding peripheral pulses are not associated with diabetes insipidus.
B. Bradycardia is not a typical manifestation of diabetes insipidus.
C. Urine specific gravity 1.002 indicates very dilute urine, which is a hallmark of diabetes insipidus due to the kidneys' inability to concentrate urine.
D. Moist mucous membranes are not expected in diabetes insipidus; dehydration often leads to dry mucous membranes.
Correct Answer is B
Explanation
A. Limiting intake of potassium-rich foods is not recommended; clients with Cushing's disease often need to increase potassium intake due to hypokalemia.
B. Restricting sodium intake is important to help manage fluid retention and hypertension associated with Cushing's disease.
C. Increasing carbohydrate intake is not advisable as it can exacerbate hyperglycemia, a common issue in Cushing's disease.
D. Decreasing protein intake is not necessary; maintaining adequate protein intake is important for muscle mass and overall health.
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