Chapter 66 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 66  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. A patient is being admitted to the neurologic ICU following an acute head injury that has resulted in cerebral edema. When planning this patient’s care, the nurse would expect to administer what priority medication?

  1. A)  Hydrochlorothiazide (HydroDIURIL)
  2. B)  Furosemide (Lasix)
  3. C)  Mannitol (Osmitrol)
  4. D)  Spirolactone (Aldactone)

Ans: C

Feedback:

The osmotic diuretic mannitol is given to dehydrate the brain tissue and reduce cerebral edema. This drug acts by reducing the volume of brain and extracellular fluid. Spirolactone, furosemide, and hydrochlorothiazide are diuretics that are not typically used in the treatment of increased ICP resulting from cerebral edema.

2. The nurse is providing care for a patient who is unconscious. What nursing intervention takes highest priority?

  1. A)  Maintaining accurate records of intake and output
  2. B)  Maintaining a patent airway
  3. C)  Inserting a nasogastric (NG) tube as ordered
  4. D)  Providing appropriate pain control

Ans: B

Feedback:

Maintaining a patent airway always takes top priority, even though each of the other listed actions is necessary and appropriate.

3. The nurse is caring for a patient in the ICU who has a brain stem herniation and who is exhibiting an altered level of consciousness. Monitoring reveals that the patient’s mean arterial pressure (MAP) is 60 mm Hg with an intracranial pressure (ICP) reading of 5 mm Hg. What is the nurse’s most appropriate action?

  1. A)  Position the patient in the high Fowler’s position as tolerated.
  2. B)  Administer osmotic diuretics as ordered.
  3. C)  Participate in interventions to increase cerebral perfusion pressure.
  4. D)  Prepare the patient for craniotomy.

Ans: C

Feedback:

The cerebral perfusion pressure (CPP) is 55 mm Hg, which is considered low. The normal CPP is 70 to 100 mm Hg. Patients with a CPP of less than 50 mm Hg experience irreversible neurologic damage. As a result, interventions are necessary. A craniotomy is not directly indicated. Diuretics and increased height of bed would exacerbate the patient’s condition.

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4. The nurse is caring for a patient who is postoperative following a craniotomy. When writing the plan of care, the nurse identifies a diagnosis of “deficient fluid volume related to fluid restriction and osmotic diuretic use.” What would be an appropriate intervention for this diagnosis?

  1. A)  Change the patient’s position as indicated.
  2. B)  Monitor serum electrolytes.
  3. C)  Maintain NPO status.
  4. D)  Monitor arterial blood gas (ABG) values.

Ans: B

Feedback:

The postoperative fluid regimen depends on the type of neurosurgical procedure and is determined on an individual basis. The volume and composition of fluids are adjusted based on daily serum electrolyte values, along with fluid intake and output. Fluids may have to be restricted in patients with cerebral edema. Changing the patient’s position, maintaining an NPO status, and monitoring ABG values do not relate to the nursing diagnosis of deficient fluid volume.

5. A patient with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate?

  1. A)  Restrain the patient to prevent injury.
  2. B)  Open the patient’s jaws to insert an oral airway.
  3. C)  Place patient in high Fowler’s position.
  4. D)  Loosen the patient’s restrictive clothing.

Ans: D

Feedback:

An appropriate nursing intervention would include loosening any restrictive clothing on the patient. No attempt should be made to restrain the patient during the seizure because muscular contractions are strong and restraint can produce injury. Do not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken teeth and injury to the lips and tongue may result from such an action. If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus.

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