Planning and goals for a patient with altered level of consciousness would include:
Maintenance of clear airway
Maintenance of skin integrity
Protection from injury
All of the above
The Correct Answer is D
Choice A: Maintenance of clear airway is a goal for a patient with altered level of consciousness, as it can prevent aspiration, hypoxia, and respiratory failure.
Choice B: Maintenance of skin integrity is a goal for a patient with altered level of consciousness, as it can prevent pressure ulcers, infection, and sepsis.
Choice C: Protection from injury is a goal for a patient with altered level of consciousness, as it can prevent falls, fractures, and trauma.
Choice D: All of the above is correct, as all of these goals are relevant for a patient with altered level of consciousness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A: Frequent vital sign monitoring including accurate blood sugars is not a direct intervention for maintaining an airway, but rather a general measure to monitor the patient's condition and prevent complications.
Choice B: Accurate intake and output records is not a direct intervention for maintaining an airway, but rather a general measure to monitor the patient's fluid and electrolyte balance and prevent dehydration or overhydration.
Choice C: Updating the patient's family on status is not a direct intervention for maintaining an airway, but rather a supportive measure to provide information and emotional support to the patient's family.
Choice D: Head of bed 30 degrees, suctioning, oral hygiene and monitoring of respiratory status is a correct intervention for maintaining an airway, as it can reduce the risk of aspiration, infection, and obstruction of the airway.
Correct Answer is A
Explanation
Choice A: Corticosteroids is correct, as they can reduce inflammation and swelling in the brain by suppressing the immune system and decreasing the permeability of blood vessels.
Choice B: Antibiotics is not correct, as they are used to treat bacterial infections, not cerebral edema.
Choice C: Tylenol is not correct, as it is a pain reliever and fever reducer, not an anti-inflammatory agent.
Choice D: All of the above is not correct, as only corticosteroids can be used to reduce cerebral edema.
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