*NURSING > EXAM PROCTORED > Saunder’s Neurological Study Guide Questions and Answers with Rationales (All)

Saunder’s Neurological Study Guide Questions and Answers with Rationales

Document Content and Description Below

1-The nurse is assessing the motor and sensory function of an unconscious client. The nurse should use which technique to test the client's peripheral response to pain? 1. Sternal rub 2. Nail bed p... ressure 3. Pressure on the orbital rim 4. Squeezing of the sternocleidomastoid muscle Rationale: Nail bed pressure tests a basic motor and sensory peripheral response. Cerebral responses to pain are tested using a sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle. 2-The nurse is caring for the client with increased intracranial pressure. The nurse would note which trend in vital signs if the intracranial pressure is rising? 1. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure 2. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure 3. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure 4. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure Rationale: A change in vital signs may be a late sign of increased intracranial pressure. Trends include increasing temperature and blood pressure and decreasing pulse and respirations. Respiratory irregularities also may occur. 3-A client recovering from a head injury is participating in care. The nurse determines that the client understands measures to prevent elevations in intracranial pressure if the nurse observes the client doing which activity? 1. Blowing the nose 2. Isometric exercises 3. Coughing vigorously 4. Exhaling during repositioning Rationale: Activities that increase intrathoracic and intraabdominal pressures cause an indirect elevation of the intracranial pressure. Some of these activities include isometric exercises, Valsalva's maneuver, coughing, sneezing, and blowing the nose. Exhaling during activities such as repositioning or pulling up in bed opens the glottis, which prevents intrathoracic pressure from rising. 4-A client has clear fluid leaking from the nose following a basilar skull fracture. Which finding would alert the nurse that cerebrospinal fluid is present? 1. Fluid is clear and tests negative for glucose. 2. Fluid is grossly bloody in appearance and has a pH of 6. [Show More]

Last updated: 1 year ago

Preview 1 out of 56 pages

Add to cart

Instant download

document-preview

Buy this document to get the full access instantly

Instant Download Access after purchase

Add to cart

Instant download

Reviews( 0 )

$12.00

Add to cart

Instant download

Can't find what you want? Try our AI powered Search

OR

REQUEST DOCUMENT
56
0

Document information


Connected school, study & course


About the document


Uploaded On

Apr 07, 2022

Number of pages

56

Written in

Seller


seller-icon
Georgemm

Member since 3 years

28 Documents Sold


Additional information

This document has been written for:

Uploaded

Apr 07, 2022

Downloads

 0

Views

 56

Document Keyword Tags

Recommended For You

Get more on EXAM PROCTORED »

$12.00
What is Browsegrades

In Browsegrades, a student can earn by offering help to other student. Students can help other students with materials by upploading their notes and earn money.

We are here to help

We're available through e-mail, Twitter, Facebook, and live chat.
 FAQ
 Questions? Leave a message!

Follow us on
 Twitter

Copyright © Browsegrades · High quality services·