When caring for a client admitted with an acute ischemic cerebral vascular accident (CVA), the nurse knows that all the following are anticipated diagnostic tests except:

When caring for a client following a traumatic brain injury (TBI), the nurse knows that all the following are clinical manifestations of Cushing’s Triad except:  

The nurse is caring for a client admitted with an upper gastrointestinal (GI) bleed.  Based on bedside shift report, the nurse suspects the client is in hypovolemic shock.  The following assessment data supports the nurse’s concern for hypovolemic shock except:

The nurse is caring for a client who experienced a traumatic brain injury (TBI) and developed diabetes insipidus (DI) three days after the TBI.  The nurse knows that all the following statements are accurate about DI except:

The nurse is caring for a client in cardiogenic shock.  Determine if the below factors would be increased, decreased, normal, wide, or narrow in cardiogenic shock.  This is overall for cardiogenic shock and not stage specific.  ** You may use terms more than once and may also have terms that are unused. **

When caring for a client with a spinal cord injury (SCI), the nurse knows that which of the following is the most common cause of death?  

Determine the BSA burned using the Rule of 9s.   The client is burned on the anterior aspect of both legs, the genitals, the anterior abdomen, and the anterior aspect of the left arm.  [BLANK-1]

The nurse knows that a client with burns is at increased risk of shock primarily due to decreased circulating blood volume and therefore, decreased cardiac output.  

The nurse is caring for a spinal cord injury (SCI) client.  The nurse knows that the client should be evaluated for autonomic dysreflexia if which of the following clinical manifestations occurs?  (Select all that apply)

The suspected nurse injected ____________  into pediatic patients in the PICU which caused blood to seep from central catheter (PICC ) lines, needle pricks, and othe rinjection sites.