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Question 10.05 pts

 

A client is admitted with a spinal cord injury at the seventh cervical vertebra secondary to a gunshot wound. Which nursing intervention is the priority for the client at this time?

Group of answer choices

Positioning the client to maximize ventilation potential

 

Taking vital signs every 2 hours

 

Inserting an indwelling urinary catheter

 

Monitoring the client’s nutritional status

 

 

Flag question: Question 2Question 20.05 pts

 

To prevent the leading cause of death for clients with spinal cord injury, collaboration with which component of the primary health care team is a nursing priority?

Group of answer choices

Nutritional therapy

 

Physical therapy

 

Respiratory therapy

 

Occupational therapy

 

 

Flag question: Question 3Question 30.05 pts

 

A family member of a client with a recent spinal cord injury asks the nurse, “Can you please tell me what the real prognosis for recovery is? I don’t feel like I’m getting a straight answer.” What would be the appropriate response for the nurse?

Group of answer choices

“Only time will tell, but hopefully the client will be able to care for yourself.”

 

“Every injury is different, and it is too soon to have any real answers right now.”

 

“The Health Insurance Portability and Accountability Act requires that I obtain the client’s permission first.”

 

“Please request a meeting with the primary health care provider. I can help set that up.”

 

 

Flag question: Question 4Question 40.05 pts

 

The nurse is collaborating with the rehabilitation therapist to improve mobility skills for a client with a complete high-level spinal cord injury. Which technique is appropriate for this client?

Group of answer choices

Use of a mechanical lift to get the client out of bed

 

Use of a sliding board (slider) to transfer from bed to a chair

 

Use of parallel bars to facilitate ambulation

 

Use of a walker to promote balance and prevent muscle atrophy

 

 

Flag question: Question 5Question 50.05 pts

 

Which nursing intervention is best for preventing complications of immobility when caring for a client with spinal cord injury?

Group of answer choices

pecial pressure-relief devices

 

Frequent ambulation

 

Encouraging nutrition

 

Regular turning and repositioning

 

 

Flag question: Question 6Question 60.05 pts

 

A client with severe muscle spasticity has been prescribed tizanidine. The nurse instructs the client about which adverse effect of tizanidine?

Group of answer choices

Drowsiness

 

Hypertension

 

Tachycardia

 

Hirsutism

 

 

Flag question: Question 7Question 70.05 pts

 

A client returns to the neurosurgical floor after undergoing a traditional anterior cervical diskectomy and fusion (ACDF). What is the nurse’s first action?

Group of answer choices

Check the client’s ability to void.

 

Administer pain medication.

 

Assist with ambulation.

 

Assess airway and breathing.

 

 

Flag question: Question 8Question 80.05 pts

 

The nurse is caring for a client with a spinal cord injury resulting from a diving accident, who has a halo fixator and an indwelling urinary catheter in place. The nurse notes that the blood pressure is elevated and that the client is reporting a severe headache. The nurse anticipates that the primary health care provider will prescribe which medication?

Group of answer choices

Nifedipine

 

Dopamine hydrochloride

 

Ziconotide

 

Methylprednisolone

 

 

Flag question: Question 9Question 90.05 pts

 

A client with a T6 spinal cord injury who is on the rehabilitation unit suddenly develops facial flushing and reports a severe headache. Blood pressure is elevated, and the heart rate is slow. Which action does the nurse take first?

Group of answer choices

Help the client sit up.

 

Check for fecal impaction.

 

Loosen the client’s clothing.

 

Insert a straight catheter.

 

 

Flag question: Question 10Question 100.05 pts

 

The nurse is caring for a client who sustained a complete cervical spinal cord injury and is at risk for autonomic dysreflexia. Which assessment findings would the nurse anticipate if this complication occurs? (Select all that apply.)

Group of answer choices

Goose bumps above and/or below the injury level

 

Sudden and severe hypertension

 

Severe throbbing headache

 

Profuse sweating above the injury level

 

Nasal congestion and blurred vision

 

Facial and skin flushing

 

 

SCIENCE
HEALTH SCIENCE
NURSING
GNRS 558

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