A nurse is providing care for a group of clients in the emergency department. Which of the following clients is at risk for developing neurogenic shock?

The client who has chronic kidney disease

The client experiencing an asthma attack

The client who has Guillain-Barré syndrome

The client who has a severe burn injury

Answer and Explanation

The Correct Answer is C

A.   This client is at risk for other complications such as electrolyte imbalances or heart failure, but not specifically neurogenic shock.
B.   This client is experiencing respiratory distress, which is a different type of shock (anaphylactic or septic shock might be considered, but not neurogenic).

C.   Guillain-Barré syndrome is an autoimmune disorder that affects the nervous system, often leading to paralysis. It can cause a rapid loss of muscle function, which can result in neurogenic shock due to loss of sympathetic nervous system tone.
D.   This client is at risk for hypovolemic shock due to fluid loss, not neurogenic shock.

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Correct Answer is D

Explanation

A. Jerking contractions of the head and neck is more indicative of seizures or other neurological conditions.
B. Pinpoint pupils can be associated with various conditions, including opioid overdose or pontine hemorrhage, but it's not specifically related to Babinski's sign.
C. Pronation of the arms is a general assessment finding, not specifically indicative of a neurological issue.
D. Dorsiflexion of the great toe is the classic response for Babinski's sign. It is an abnormal reflex indicating upper motor neuron damage.

A. Pupils round, 2mm and constricting to light B. Decreasing level of consciousness C. Temporal headache D. Glasgow coma score of 13

Correct Answer is B

Explanation

A. Pupils round, 2mm and constricting to light is a normal pupil response.
B. Decreasing level of consciousness is a critical sign of deteriorating neurological status and requires immediate medical intervention.
C. Temporal headache is a common symptom after head injury but it is not as urgent as a decreasing level of consciousness.
D. Glasgow coma score of 13 indicates a mild to moderate head injury, but it's a static measurement. A decreasing level of consciousness would indicate worsening condition.

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A nurse is providing care for a group of clients in the emergency department. Which of the following clients is at risk for developing neurogenic shock?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing the reflexes of a client who has an unrepaired femur fracture and has suddenly become stuporous. For which of the following findings should the nurse identify that the client exhibits Babinski's sign?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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