A nurse is caring for a client admitted with a skull fracture.

Which of the following assessment findings should be of greatest concern to the nurse?

Glasgow Coma Scale score changes from 14 to 9.

WBC count changes from 9,000 to 16,000/mm.

Pulse pressure changes from 30 to 20 mm Hg.

Bilateral pupil diameter changes from 4 to 2 mm.

Answer and Explanation

The Correct Answer is A

A decrease in the Glasgow Coma Scale (GCS) score indicates a decline in the client’s level of consciousness and neurological function.
This can be a sign of increased intracranial pressure or other complications related to the skull fracture.
Choice B is incorrect because an increase in WBC count may indicate an infection, but it is not as concerning as a decrease in GCS score.
Choice C is incorrect because a change in pulse pressure may indicate changes in cardiovascular function, but it is not as concerning as a decrease in GCS score.
Choice D is incorrect because a change in pupil diameter may indicate changes in neurological function, but it is not as concerning as a decrease in GCS score.

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Correct Answer is A

Explanation

Oral contraceptive use is a risk factor for the development of DVTs.
Choice B is incorrect because cirrhosis is not a known risk factor for DVTs.
Choice C is incorrect because hypertension is not a known risk factor for DVTs.
Choice D is incorrect because NSAID use is not a known risk factor for DVTs.

A. Headache. B. Bradycardia. C. Heat intolerance. D. Flushed skin color.

Correct Answer is A

Explanation

This statement indicates an understanding of the teaching because headache is a common symptom of anemia.

Choice B is incorrect because bradycardia (slow heart rate) is not a common symptom of anemia.
Instead, anemia can cause irregular heartbeats or a fast heartbeat.
Choice Dis incorrect because flushed skin color is not a common symptom of anemia.
Instead, anemia can cause pale or yellowish skin 1.
Choice Cis incorrect because heat intolerance is not a common symptom of anemia.

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A nurse is caring for a client admitted with a skull fracture. Which of the following assessment findings should be of greatest concern to the nurse?

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Naxlex Comprehensive Predictor Exams

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A nurse is caring for a client admitted with a skull fracture.

Which of the following assessment findings should be of greatest concern to the nurse?