A nurse is preparing to administer an IV osmotic diuretic to a client with increased intracranial pressure (ICP). Which of the following should the nurse identify as the purpose of the medication?
To lower intracranial pressure by increasing urinary output.
To reduce cerebral blood flow.
To prevent the formation of cerebral edema.
To decrease brain oxygen consumption.
The Correct Answer is A
A. The primary purpose of administering an osmotic diuretic, such as mannitol, is to lower ICP by promoting diuresis, which results in increased urinary output and decreases fluid volume in the brain.
B. Osmotic diuretics do not specifically reduce cerebral blood flow; rather, they work by reducing fluid volume and thus intracranial pressure.
C. While osmotic diuretics can help manage edema, their primary role is not solely to prevent the formation of cerebral edema but to actively reduce existing pressure.
D. Osmotic diuretics do not directly decrease brain oxygen consumption; their main function is to create an osmotic gradient that pulls fluid from the brain to reduce ICP.
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Correct Answer is D
Explanation
A. Keeping the room brightly lit can be overstimulating and may increase ICP; therefore, a calm, dimly lit environment is preferable.
B. Encouraging coughing and deep breathing exercises could increase ICP and should be avoided unless specifically indicated.
C. Placing the client in a supine position is not recommended for clients with increased ICP; they should typically be positioned with the head elevated to promote venous drainage.
D. Implementing seizure precautions is critical as head injuries can lead to seizures, and ensuring the client's safety is a priority.
Correct Answer is C
Explanation
A. Diplopia is a concerning symptom but does not indicate immediate deterioration in neurological status like a change in GCS does.
B. Ataxia is also significant but is less acute than a drop in GCS score.
C. A change in the Glasgow Coma Scale score from 13 to 11 indicates a worsening level of consciousness and necessitates immediate reporting, as it may suggest increased intracranial pressure or other complications.
D. A decrease in heart rate from 76 to 69 bpm is not significant enough in the context of TBI to warrant immediate reporting, as it remains within a normal range.