front 1 A client has had a traumatic brain injury and is mechanically ventilated. Which technique does the nurse use to prevent increasing intracranial pressure (ICP)?
| back 1 B. Maintaining neutral head position |
front 2 A client is considering treatments for a malignant brain tumor. Which statement by the client indicates a need for further instruction by the nurse?
| back 2 C. “I can go home the day of my craniotomy.” |
front 3 A client hospitalized for hypertension presses the call light and reports “feeling funny.” When the nurse gets to the room, the client is slurring words and has right-sided weakness. What does the nurse do first?
| back 3 A. Assesses airway, breathing, and circulation |
front 4 The nurse is evaluating the collaborative care of a client with traumatic brain injury (TBI). What is the most important goal for this client?
| back 4 A. Achieving the highest level of functioning |
front 5 The nurse is monitoring a postoperative craniotomy client with increased intracranial pressure (ICP). Which pharmacologic agent does the nurse expect to be requested to maintain the ICP within a specified range?
| back 5 C. Mannitol (Osmitrol) |
front 6 A client with a traumatic brain injury from a motor vehicle crash is monitored for signs/symptoms of increased intracranial pressure (ICP). Which sign/symptoms does the nurse monitor for?
| back 6 A. Changes in breathing pattern |
front 7 The nurse is assessing a client with a traumatic brain injury after a skateboarding accident. Which sign/symptom is the nurse most concerned about?
| back 7 B. Asymmetric pupils |
front 8 A client presents to the Emergency Department from an assisted living facility after a ground level fall with a head strike. The client has a Glasgow Coma Score (GCS) of 12, which is decreased for this client, and has projectile vomiting. What is the priority intervention for this client?
| back 8 C. Positioning the client to prevent aspiration |
front 9 An alert and oriented person is admitted to the emergency department with a GCS of 10, indicating a moderate brain injury. Which assessment finding will the nurse report immediately to the health care provider?
| back 9 D. New difficulty in responsiveness or sudden drowsiness |
front 10 A client returns from the postanesthesia care unit (PACU) after a craniotomy for removal of a left parietal lobe tumor. How will the nurse position the client after surgery?
| back 10 C. Elevate the client's head to at least 30 degrees to promote cerebral venous drainage. |