Med surg ii exam med sur Study guides, Class notes & Summaries

Comprehensive exam 2020- Advanced Med Surg II RN Critical Alterations in Perfusion Assessment

A nurse is caring for a client who is postprocedure following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? (Select all that apply). A. Use the Glasgow Coma Scale when assessing the client. B. Assist the client to a supine position. C. Administer an opioid medication. D. Encourage the client to increase fluid intake. E. Instruct the client to perform deep breathing and coughing exercises. - answer B. ...

A nurse is caring for a client who is postprocedure following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? (Select all that apply). A. Use the Glasgow Coma Scale when assessing the client. B. Assist the client to a supine position. C. Administer an opioid medication. D. Encourage the client to increase fluid intake. E. Instruct the client to perform deep breathing and coughing exercises. Correct Answer - B. ...

Rationale: (B) The nurse should assist the client to a supine position, which can relieve a headache following a lumbar puncture (C) The nurse should administer an opioid medication for a client's report of headache pain. (D) The nurse should encourage increased fluid intake to maintain a positive fluid balance, which can relieve a headache following a lumbar puncture A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter (ventriculostomy...

1. A nurse is caring for a client who is postprocedure following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? (Select all that apply). A. Use the Glasgow Coma Scale when assessing the client. B. Assist the client to a supine position. C. Administer an opioid medication. D. Encourage the client to increase fluid intake. E. Instruct the client to perform deep breathing and coughing exercises.: B. Assist the cl...