MEDICAL-SURGICAL ATI EXIT EXAM QUESTIONS WITH VERIFIED CORRECT ANSWERS

MEDICAL-SURGICAL ATI EXIT EXAM QUESTIONS WITH VERIFIED CORRECT ANSWERS nurse is caring for a client who is post procedure 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. Assist the client to a supine position. C. Administer an opioid medication. D. Encourage the client to increase fluid intake. 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) for ICP monitoring. The nurse should monitor the client for which of the following complications related to the ventriculostomy? A. Headache B. Infection