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the nurse is planning care for a client with a T3 spinal cord injury. the nurse includes which intervention in the plan to prevent autonomic dysreflexia?

• assist the client to develop a daily bowel routine to prevent constipation

• have the client void before bed every night to assure no leakage of urine during the night

• have the client drink a full glass of water before going to bed to ensure hydration

• have you client eat a snack before bed to help with peristalsis

the nurse notes clear drainage from the nose of a patient with a frontal skull fracture and recognizes an intervention that is absolutely contraindicated for this patient is?

• performing nasopharyngeal suctioning

• assess for high fever and elevated WBC count

• if leakage of CSF persists in more than 24 hrs, perform lumbar puncture

• lay the client supine with the head and neck slightly elevated at less than 30 degree

a nurse is preparing a teaching plan for a client with migraine headaches who is receiving a beta blocker to help manage this disorder. which instruction would be appropriate to relay to the client

• "take this medication with high potassium foods like banana or avocado to help aid the absorption"

• "this medication should be taken with the combination of a calcium channel blocker to help ensure its effectiveness"

• "take this drug as ordered, even when feeling well, to prevent vascular changes associated with migraine headaches"

• "you can stop taking this drug once you are feeling better because that means the pressure from the blood has decreased in your veins"

the nurse is caring for a patient on the neuro unit who is in status epilepticus. what medication does the nurse know may be given to halt the seizures immediately

• IV diazepam (Valium)

• oral furosemide (Lasix)

• oral amlodipine (Norvasc)

• IV methypredinisolone (Solu Medrol)

the client is prescribed phenytoin (Dilantin) for treatment of seizure disorder. which precautions or instructions will be taught to this client?

• do not take warfarin while on this medication

• if this medication is given to slow, it will be not effective

• this medication should be given IV with combination of other drugs to help the effectiveness

• this medication is usually given as the last resort to helping with seizures

a patient diagnosed with MS has been admitted to your unit for an exaverbation. included in the admission order is baclofen (lioresal). what would you include as an expected outcome of this medication?

• decrease cerebrall ataxia in the upper extremities

• decrease fatigue in the patient during relapse periiods

• decreased muscle spasms in the lower extremities

• increased muscle tone in the lower extremities

within 4 hours after a cervical spinal cord injury, the client cannot perform motor movements, however maintains the sensation of deep touch. what is the nurse's interpretation of this finding?

• ss

• the spinal cord injury is anterior caused by hyperflexion injury

• the spinal cord injury

• ss

the patient seeks care for an increasing headache and N/V. when diagnostic testing for brain tumor is preformed, the client asks the nurse what will happen to him if he has a brain tumor. then nurse's response to the patient is based on knowledge that...

• brain tumors increase cerebral mass, resulting in increased intracranial pressure

• brain tumors decrease cerebral mass, resulting in increased intracranial pressure

• brain tumors increase cerebral mass, resulting decreased intracranial pressure

• brain tumors decrease cerebral mass, resulting in decreased intracranial pressure

for which side effect in the client with Parkinson's disease who has been taking a combination of caridopa-levodpa drug (Sinemet) for 3 years will the nurse monitor?

• nausea and vomiting

• ringing in the ear

• high blood pressure and low pulse

• abnormal movement

following recovery from a stroke, a 68 year old patient developed seizures with motor symptoms beginning in the right arm with progression to unconsciousness. the physician prescribed phenytoin (Dilantin) for controlled seizures. a statement by the patient that indicates understanding of self care related to this drug includes?

• as i start this drug i will need to monitor my blood pressure often

• as i start this drug i will need to have my blood taken frequently to check the level of the drug

• as i start this drug i will need to discontinue all my other drugs

• as i start this drug i will need to limit my potassium intake