The nurse is caring for a patient diagnosed with a brain injury to the cerebellum. Which nursing intervention is priority?

Clarify misinformation and reorient when confused

Turn patient every 2 hours

Ensure bed alarm is on when leaving the patient's room

Vary schedule to prevent memorization and boredom

Answer and Explanation

The Correct Answer is C

A. Reorienting confused patients is important but is not directly related to cerebellar injury.

B. While turning every 2 hours is important to prevent pressure injuries, it does not address the specific fall risk associated with cerebellar damage.

C. The cerebellum is responsible for balance and coordination, so injuries in this area increase the risk of falls. Ensuring the bed alarm is on provides immediate alerts if the patient attempts to get out of bed, helping to prevent falls.

D. Varying the schedule to prevent boredom is not a priority in the care of patients with cerebellar injury.

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Correct Answer is A

Explanation

A. Neurogenic shock occurs in spinal cord injuries above T6 and is characterized by hypotension, bradycardia, and loss of sympathetic tone below the level of injury. This condition results from disruption of autonomic pathways.

B. Brain herniation typically involves increased intracranial pressure and different neurological symptoms.

C. Spinal shock involves temporary loss of reflexes and sensation but does not specifically cause bradycardia or hypotension.

D. Autonomic dysreflexia involves sudden high blood pressure and is usually triggered by noxious stimuli, occurring after the acute phase of SCI.

A. Nitroprusside B. Furosemide C. 3% Normal Saline D. Norepinephrine

Correct Answer is C

Explanation

A. Nitroprusside is a vasodilator and is not used for managing ICP; it can increase intracranial pressure if not carefully monitored.

B. Furosemide is a diuretic but is less effective for ICP reduction compared to hypertonic saline or mannitol.

C. Hypertonic saline (3% Normal Saline) is used to reduce intracranial pressure by drawing fluid out of the brain tissue and into the bloodstream, which can help prevent cerebral edema.

D. Norepinephrine is a vasopressor and is not used specifically to manage intracranial pressure.

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The nurse is caring for a patient diagnosed with a brain injury to the cerebellum. Which nursing intervention is priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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