A nurse is contributing to the plan of care for a client who had a craniotomy. Which of the following interventions should the nurse include in the plan?

Apply a warm cloth over the client's eyes.

Place the client in a supine position.

Maintain seizure precautions.

Obtain a prescription for an opioid medication for pain.

Answer and Explanation

The Correct Answer is C

a. Apply a warm cloth over the client's eyes: This intervention is not typically indicated for a client who had a craniotomy. It is important to monitor for signs of increased intracranial pressure, but a warm cloth over the eyes is not a standard intervention.

b. Place the client in a supine position: The position of the client after a craniotomy will depend on the surgeon's preference. It is important to follow specific postoperative positioning

instructions, which may or may not include supine positioning.

c. Maintain seizure precautions: Seizure precautions are crucial for clients who have had a craniotomy, as they are at an increased risk of seizures postoperatively.

d. Obtain a prescription for an opioid medication for pain: Pain management is important, but opioid medications may be carefully titrated due to the potential for respiratory depression and other side effects. It is not the primary intervention in the immediate postoperative period.

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Correct Answer is D

Explanation

a. "This test will inform your provider if you are anemic." Serum creatinine is not used to assess anemia. Anemia is often evaluated through tests like hemoglobin and hematocrit.

b. "This test will inform your provider if you have an infection." Serum creatinine is not a direct indicator of infection. It is primarily used to assess kidney function.

c. "This test will inform your provider if you have a thyroid disorder." Serum creatinine is not

used to evaluate thyroid function. Thyroid function is typically assessed through thyroid function tests.

d. "This test will inform your provider how your kidneys are functioning." This is the correct

response. Serum creatinine is a waste product that is filtered by the kidneys, and elevated levels may indicate impaired renal function.

A. Blood glucose 150 mg/dL B. Urine specific gravity 1.035 C. Weight loss of 3% of total body weight. D. Potassium 2.5 mEq/L

Correct Answer is D

Explanation

a. Blood glucose 150 mg/dL: While elevated blood glucose may be a concern, potassium levels are more critical in the context of acute gastroenteritis, which can lead to fluid and electrolyte

imbalances.

b. Urine specific gravity 1.035: Elevated urine specific gravity indicates concentrated urine and possible dehydration. However, the low potassium level takes precedence as it can lead to

serious cardiac complications.

c. Weight loss of 3% of total body weight: Weight loss is a concern, but the immediate risk of hypokalemia (low potassium) takes priority.

d. Potassium 2.5 mEq/L: This low potassium level is a critical finding that requires prompt attention, as it can lead to cardiac dysrhythmias and other serious complications.

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A nurse is contributing to the plan of care for a client who had a craniotomy. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

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