Answers Spring 2023-2024 Complete Guide A+
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,1.A nurse is caring for a client who experienced a traumatic head injury and has
an intraventricular catheter (Ventriculostomy) for ICP monitoring. The nurse
should monitor the client for which of the following complications related to the
ventriculostomy?:
a. Headache
b. Infection
c. Aphasia
d. Hypertension
(Correct Answer) - ✅ b. Infection Monitor for infection and use strict asepsis to avoid
life-threatening meningitis.
2.A nurse is providing education to a client who is to undergo an EEG the next
day. Which of the following info should the nurse include in the teaching?
a. "Do not wash your hair the morning of the procedure."
b. "Try and stay awake most of the night prior to the procedure."
c. "The procedure will take approximately 15 mins."
d. "You will need to lie flat for 4 hours after the procedure."
(Correct Answer) - ✅ b. "Try and stay awake most of the night prior to the procedure."
Tell the client to remain awake to provide cranial stress and increase the possibility of
abnormal electrical activity
3.A nurse is caring for a client who is postprocedural following a lumbar puncture
and reports a throbbing headache when sitting upright. Which of the following
actions should the nurse take? SATA.
a. Use the GCS scale to assess the client
b. Assist the client into a supine position
c. Administer an opioid analgesic
d. Encourage the client to increase PO fluid intake e. Instruct the client to perform
coughing and deep breathing
(Correct Answer) - ✅ B, D
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, 4.A nurse is caring for a client who has continuous bladder irrigation following a
transurethral resection of the prostate (TURP). Which of the following findings
should the nurse report to the provider?
a Output equal to the instilled irrigate
b. Client reports bladder spasms
c. Viscous urinary output with clots
d. Reports of strong urge to urinate
(Correct Answer) - ✅ c. Viscous urinary output with clots Urine that is bright red with
clots is an indication of arterial bleeding.
5.A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the
following findings should the nurse expect?
a. Flattened T waves
b. Prolonged QT intervals
c. Shortened QT intervals
d Widened QRS complexes
(Correct Answer) - ✅ b. Prolonged QT intervals Manifestations of hypocalcemia include
tingling, numbness, tetany, seizures, prolonged QT intervals, and laryngospasm.
6.A nurse is preparing a client who has a brain tumor for a CT scan. Which of the
following factors affects the manner in which the nurse will prepare the client for
the scan?
a. No food or fluids consumed for 4 hours
b. Difficulty recalling recent events
c. Development of hives while eating shrimp
d. Paresthesia in both hands
(Correct Answer) - ✅ c. Development of hives while eating shrimp Shellfish allergy is
contraindication of use of contrast media during a CT scan.
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