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NSG 4100 (AHIII) EXAM 4 NEWEST 2025 ACTUAL
EXAM TEST BANK| COMPLETE 180 REAL EXAM
QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) ALREADY
GRADED A+|| BRAND NEW!!
The nurse is caring for a pt w a brain tumor. What drug would the nurse expect to be ordered to reduce the edema surrounding the tumor?
- solumedrol
- dextromethorphan
- dexamethasone
- furosemide - Correct Answer - C
The nurse is caring for a pt who sustained a moderate head injury following a bicycle accident. The nurses most recent assessment reveals that the pt's respiratory effort has increased. What is the nurses most appropriate response?
- inform the care team and assess for further signs of possible increased
- administer bronchodilators and monitor the pt's LOC
- increase the pt's bed height and reassess in 30 mins
- administer a bolus of normal line as ordered - Correct Answer - A
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ICP
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pg. 2 A pt has a poor prognosis after being involved in a motor vehicle accident resulting in a head injury. As the pt's ICP increases and condition worsens, the nurse knows to assess for indications of approaching death. These indications include which of the following?
- hemiplegia
- dry mucous membranes
- signs of internal bleeding
- loss of brain stem reflexes - Correct Answer - D
When caring for a pt w increased ICP the nurse knows the importance of monitoring for possible secondary complications, including syndrome of inappropriate antidiuretic hormone (SIADH). What nursing interventions would the nurse most likely initiate if the pt developed
SIADH?
- fluid restriction
- transfusion of platelets
- transfusion of fresh frozen plasma (FFP)
- electrolyte restriction - Correct Answer - A
A pt is recovering from an intracranial surgery performed approximately 24 hrs ago and is complaining of a headache that the pt rates at 8 on a 10-point pain scale. What nursing action is most appropriate?
- administer morphine sulfate as ordered
- reposition the pt in a prone position
- apply a hot pack to the pt's scalp
- implement distraction techniques - Correct Answer - A 2 / 4
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pg. 3 A nurse is caring for a critically ill pt w autonomic dysreflexia. What clinical manifestations would the nurse expect in this pt?
- respiratory distress & projectile vomiting
- bradycardia & HTN
- tachycardia & agitation
- third-spacing & hyperthermia - Correct Answer - B
The nurse is caring for a pt w increased ICP caused by a traumatic brain injury. Which of the following clinical manifestations would suggest that the pt may be experiencing increased brain compression causing brains temp damage?
- hyperthermia
- tachycardia
- HTN
- bradypnea - Correct Answer - A
A pt is brought to the ED by her family after falling off the roof. A family member tells the nurse that when the pt fell, she was knocked out, but came back and seemed okay. Now she is c/o a severe HA and not feeling well. The care team suspects an epidural hematoma, prompting the nurse to prepare for which priority intervention?
- insertion of an intracranial monitoring device
- treatment w antihypertensives
- emergency craniotomy
- administration of anticoagulant therapy - Correct Answer - C 3 / 4
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pg. 4 A pt w a cerebral aneurysm exhibits s/s of an increase in ICP. What nursing intervention would be the most appropriate for this pt?
- ROM exercises to prevent contractors
- encouraging independence w ADLs to promote recovery
- early initiation of physical therapy
- absolute bed rest in a quiet, non stimulating environment - Correct
Answer - D
A pt has been admitted to the ICU after being recently diagnosed w an aneurysm and the pt's admission orders include specific aneurysm precautions. What nursing action will the nurse incorporate into the pt's plan of care?
- elevate the HOB to 45 degrees
- maintain the pt on complete bed rest
- administer enemas when the pt is constipated
- avoid use of thigh-high elastic compression stockings - Correct
Answer - B
A pt diagnosed w a cerebral aneurysm reports a severe HA to the nurse.What action is a priority for the nurse?
- sit w the pt for a few minutes
- administer an analgesic
- inform the nurse-manager
- call the physician immediately - Correct Answer - D
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