A nurse is caring for a patient in the intensive care unit who was admitted with severe head trauma and cerebral edema. The patient opens their eyes spontaneously, is oriented, and obeys commands.Which of the following findings indicate the patient is experiencing a decline in their condition?

Patient is confused

Patient mumbles inappropriate words

Eyes do not open to name

Answer and Explanation

The Correct Answer is A

Choice A rationale
A patient in the intensive care unit who was admitted with severe head trauma and cerebral edema, who opens their eyes spontaneously, is oriented, and obeys commands, would be experiencing a decline in their condition if they become confused. Confusion can be a sign of worsening brain function, indicating that the brain is not receiving enough oxygen or is being affected by a buildup of toxins. This could be due to increased intracranial pressure, decreased blood flow to the brain, or further injury to the brain tissue.
Choice B rationale

Mumbling inappropriate words can also be a sign of a decline in a patient’s condition. However, it is less specific than confusion. It could be due to a variety of factors, including medication side effects, sleep deprivation, or mental health issues.
Choice C rationale
If a patient’s eyes do not open to their name, it could indicate a significant decline in their condition. However, this is a more severe symptom than confusion and may not be the first sign of a decline.

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Correct Answer is C

Explanation

Choice A rationale
While improved rehabilitation outcomes and temporary behavior changes can occur after a neurological injury, they are not typically considered psychosocial changes. Psychosocial changes often involve alterations in the way individuals perceive, interact with, and navigate their social environments.
Choice B rationale
Improved mood stability and temper control are not typically associated with the aftermath of a neurological injury. In fact, individuals may experience mood swings, irritability, and difficulties with emotional regulation.
Choice C rationale
Changes to social cognition and challenges to inhibitory control are indeed possible psychosocial changes a client might have after sustaining a neurological injury. Social cognition involves understanding and interpreting social cues, which can be affected by brain injury.
Challenges to inhibitory control can lead to impulsive behavior and difficulties in social situations.
Choice D rationale
While a sense of purpose, improved motivation, and stable relationships can be part of a successful recovery process, they are not typically direct outcomes of a neurological injury. In

fact, relationships may be strained and motivation can be affected due to the physical and emotional challenges associated with such an injury.

A. Computerized Tomography Angiography (CTA) B. Transesophageal Echocardiogram (TEE) C. Complete Blood Count (CBC) D. Prothrombin Time (PT) .

Correct Answer is A

Explanation

Choice A rationale
A Computerized Tomography Angiography (CTA) scan is often used to diagnose a Transient Ischemic Attack (TIA). This imaging test can provide detailed images of blood vessels in the brain and neck, allowing healthcare providers to identify blockages or other abnormalities that could have caused the TIA12.
Choice B rationale
A Transesophageal Echocardiogram (TEE) is a type of echocardiogram that uses a probe passed down the esophagus to obtain detailed images of the heart. While it can be useful in diagnosing certain heart conditions, it is not typically the first-line diagnostic test for a TIA12.
Choice C rationale
A Complete Blood Count (CBC) is a blood test that measures different components of the blood, including red and white blood cells and platelets. While it can provide useful information about a person’s overall health, it is not typically used to diagnose a TIA12.
Choice D rationale
Prothrombin Time (PT) is a blood test that measures how long it takes for your blood to clot. While it can provide information about clotting disorders, it is not typically used to diagnose a

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A nurse is caring for a patient in the intensive care unit who was admitted with severe head trauma and cerebral edema. The patient opens their eyes spontaneously, is oriented, and obeys commands.Which of the following findings indicate the patient is experiencing a decline in their condition?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching to a group of nursing students about possible psychosocial changes a client might have after sustaining a neurological injury. Which of the following should the nurse mention?

Correct Answer is C

Explanation

A nurse is providing care for a patient in the emergency department who has been preliminarily diagnosed with a transient ischemic attack (TIA). Which diagnostic test should the nurse expect the healthcare provider to order?

Correct Answer is A

Explanation

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