Á nurse is assessing a client who has a score of 6 on the Glasgow Coma Scale. The nurse should expect which of the following outcomes based on this score?
The client is alert and oriented.
Indicates stable neurologic status
The client needs total nursing care.
The client is in a deep coma.
The Correct Answer is C
A. A score of 6 indicates a severe impairment in consciousness, not alertness and orientation.
B. A score of 6 does not indicate a stable neurologic status but rather severe brain injury or impairment.
C. Because a score of 6 indicates the client is likely unresponsive or has very limited responses to stimuli, they cannot perform activities of daily living or protect their own airway. They require comprehensive, total nursing care.
D. While a GCS of 3 indicates deep coma, a score of 6 reflects severe impairment, though not necessarily a deep coma.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While antipsychotics may slightly increase stroke risk in older adults, the primary concern for dementia clients is often fall risk.
B. Many sedative and antipsychotic medications increase the risk of falls, especially in older adults, due to their sedating effects and impact on balance.
C. These medications do not typically cause an increase in blood pressure; they may actually lower it, contributing to dizziness and fall risk.
D. Infection risk is not directly increased by these medications, although fall injuries can complicate recovery and care.
Correct Answer is A
Explanation
A. Hypoxemia is an early sign of fat embolism syndrome due to the presence of fat globules in the pulmonary circulation.
B. Headache can be associated with hypoxemia but is not as specific or immediate as hypoxemia itself.
C. Petechiae, while a classic sign, usually appear later in the progression of fat embolism syndrome.
D. Precordial chest pain may occur but is not typically the first sign; hypoxemia is usually noted first.
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