Exam (elaborations)
week 3 VATI remediation
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week 3 VATI remediation
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The nurse is caring for a client post-craniotomy to treat a brain tumor. Whatpostoperative nursing actions should the nurse initiate?
The nurse should administer medications as ordered regarding risks and
complications of seizures, increased intracranial pressure and monitor neurologic
status. The medications used include manitol and dexamethasone, and phenytoin
or diazepam for the seizures. The nurse should additionally initiate a consult to
Occupation, speech, and physical therapy as needed. Social services should also be
offer for assistance in case management, family and rehab.
A hospitalized client with a sealed radioactive implant asks the nurse, “can my
family visit me?” What education should the nurse provide regarding visitors?
The clients family runs risk of lead contamination and poisoning so, the nurse
should assure the client that they may receive visitors but under limitations and
instruction. The client and visitors should understand that they can only visit x 30
minutes, they should refrain at 6 feet from source, and they cannot visit if they are
under 16 years old, pregnant or trying to conceive.
A client with Alzheimer’s Disease is being discharged home. What teaching
should the nurse provide to the client and the caregiver regarding home safety
measures?
The nurse should educate the client and caregiver to ensure safety at home by
doing the following:
- remove scatter rugs
- install door locks and alarms
- provide good lighting and hand rails on stairs
- mark steps with colored tape
- place mattresses on floor
- remove clutter from halls
- place shower chair in the tub
- keep cleaning supplies in locked cupboards
- enrolls in safe return home program www.aiz.org
- participate in exercise program to maintain mobility
The nurse is assessing a client with a left-sided stroke. What clinical
manifestations can the nurse anticipate?
The left cerebral hemisphere is respoinsible for language, math skills and
analytical thinking- these may be clinically shown affected by :
- expressive or receptive aphasia
- agnosia (cannot recognize familiar objects)
- alexia ( reading difficulty)
- aragphia (writing difficulty)
- right extremity weakness or paralysis
- slow cautious behavior
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