The nurse is assisting with planning care for a client who has a subarachnoid hemorrhage (SAH). Which of the following relates to a high mortality rate for a client who has an SAH?
Poor functional ability
Rebleeding of the injury
Decreased cerebrospinal fluid
Use of nimodipine
The Correct Answer is B
A. Poor functional ability: While poor functional ability may impact the overall prognosis and quality of life for a client with a subarachnoid hemorrhage (SAH), it is not directly associated with a high mortality rate. Functional ability can be improved with rehabilitation and supportive care.
B. Rebleeding of the injury: Rebleeding of the SAH is a significant risk factor associated with a high mortality rate. Rebleeding can lead to increased intracranial pressure, worsening neurological deficits, and even death. Preventing rebleeding is a critical aspect of managing SAH to improve outcomes.
C. Decreased cerebrospinal fluid: Decreased cerebrospinal fluid (CSF) may indicate conditions such as hydrocephalus, which can complicate the management of SAH. However, it is not directly associated with a high mortality rate compared to rebleeding.
D. Use of nimodipine: Nimodipine is a calcium channel blocker commonly used in the management of SAH to prevent cerebral vasospasm, which can lead to ischemia and worsen outcomes. While nimodipine plays a role in improving outcomes by preventing vasospasm, its use is not directly associated with mortality rates.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Isolated: This term refers to something that is separate or distinct. Confusion and agitation in a client are not typically isolated but can be part of a broader clinical picture.
B. Permanent: These manifestations are not typically permanent and can often be reversed with appropriate interventions.
C. Reversible: Confusion and agitation in a client are often reversible and can be due to various factors such as medications, infections, metabolic disturbances, or other medical conditions. Identifying and addressing the underlying cause can often restore the client to their baseline mental status.
D. Unique: While every individual's presentation may have unique aspects, confusion and agitation are not considered unique manifestations in the context of acute changes in mental status. They are common symptoms that can occur due to a variety of reasons and are not exclusive to any particular condition.
Correct Answer is B
Explanation
A. Lower extremities edematous with decreased pulses and cool to the touch While this finding suggests impaired circulation associated with peripheral artery disease, it does not indicate an immediate need for intervention. However, it requires timely assessment and intervention to prevent further complications.
B. Pain, pallor, and paresthesia in the foot This finding indicates critical limb ischemia, which is a severe complication of peripheral artery disease requiring immediate intervention. Pain, pallor (pale color), and paresthesia (abnormal sensations like tingling or numbness) suggest inadequate blood flow to the affected limb, putting the client at risk for tissue damage and limb loss if not promptly addressed.
C. Murmur auscultated at the left 5th midclavicular line, slight dyspnea, and lower extremity edema These findings are suggestive of cardiac issues such as heart failure rather than immediate complications of peripheral artery disease. While they require attention, they do not signify an urgent need for intervention specific to peripheral artery disease.
D. Presence of an open wound near the ankle with serous drainage and pruritus While an open wound warrants assessment and appropriate wound care, it does not indicate an immediate need for intervention unless there are signs of infection or severe tissue damage. In this scenario, the presentation of pain, pallor, and paresthesia indicates a more urgent need for intervention to prevent tissue necrosis and limb loss.
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