A nurse is monitoring a client who has a leaking cerebral aneurysm. Which of the following manifestations should indicate to the nurse that the client is experiencing an increase in intracranial pressure (ICP)? (Select all that apply.)

Choice A reason : Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) which can be detrimental to patients with congestive heart failure (CHF). NSAIDs can lead to sodium and fluid retention, exacerbating CHF symptoms and potentially leading to a worsening of the condition⁶⁷. Therefore, it is not recommended for managing discomfort in CHF patients.

Choice B reason : Slowing down if feeling tired after exercising is a prudent measure for anyone, especially for CHF patients. It indicates the patient is listening to their body and respecting its limits, which is essential in managing CHF. Overexertion can strain an already compromised heart, so moderation and careful monitoring of physical activity are key¹².

Choice C reason : The recommended daily sodium intake for heart failure patients is generally less than 2,000 mg¹⁶¹⁷¹⁸. A limit of 4 grams per day is significantly higher than the recommended amount and could lead to fluid retention and worsening of heart failure symptoms. Therefore, this statement does not reflect effective teaching.

Choice D reason : Diuretics are often prescribed to CHF patients to manage fluid retention. However, taking diuretics before sleep can lead to nocturia, disrupting sleep due to the need to urinate at night. It is generally recommended to take diuretics earlier in the day, with the last dose no later than 4 p.m., to minimize nighttime disruptions¹³¹⁴. Drinking fluids during the day without restriction can also contribute to fluid overload, which is counterproductive in CHF management.

Choice A reason : Individuals with OCD often engage in compulsive behaviors, such as picking up after others, to make their environment feel more controlled or tolerable. This behavior is a response to the anxiety produced by their obsessions, which in this case, could be related to cleanliness or order¹. By controlling their immediate environment, they may feel a temporary relief from their anxiety, even though this relief is often short-lived and the compulsion becomes a repetitive cycle².

Choice B reason : Changing tasks is not typically the goal of compulsive behaviors in OCD. These behaviors are usually very specific and are performed to manage the anxiety associated with particular obsessions. While the individual might switch from one compulsive behavior to another, it is not done with the intention of task variation but rather as a response to shifting obsessive thoughts¹.

Choice C reason : Compulsive behaviors in OCD are not aimed at increasing social interaction. In fact, these behaviors can often interfere with social activities and relationships, as they can be time-consuming and may make the individual feel embarrassed or ashamed, leading to social isolation².

Choice D reason : Compulsive behaviors can sometimes be a way for individuals with OCD to exert control over other behaviors or thoughts. However, the primary function of these behaviors is to manage the anxiety associated with obsessions, not necessarily to control other unrelated behaviors¹.