A client with acute confusion posthead injury is h

ATI LPN

ATI LPN Test Bank

A client with acute confusion post-head injury is having a lumbar puncture. What’s the most serious complication?

A. Meningitis B. Spinal cord trauma C. Dural tear D. Brainstem herniation

Correct Answer: D

Rationale: Brainstem herniation (D) is the gravest risk with ICP (text note).

The nurse cares for a client receiving mannitol 0.5 g/kg over 60 min. What indicates effectiveness?

A. Urine output 50 mL next hr B. O2 sat 89% on 3L C. BP 148/42 mm Hg D. WBC 6.4

Correct Answer: A

Rationale: Mannitol increases urine output (A) by reducing cerebral edema.

An infant (4.5 kg) is ordered penicillin 25,000 units/kg q8h. Amount per dose?

A. 72 B. 337,500 C. 14,062.50 D. 112,500

Correct Answer: D

Rationale: 25,000 × 4.5 = 112,500 units (D).

Which observation raises safety concerns for a client with tactile agnosia?

A. Gas range in kitchen B. Throw rugs in apartment C. Bathroom down hall D. Two stairs at entry

Correct Answer: A

Rationale: Gas range (A) poses burn risk due to sensory deficit.

Rationale for elevating HOB, neutral head, no sharp flexion in head injury?

A. Prevent aspiration B. Avoid obstructing venous return C. Prevent contractures D. Decrease CPP

Correct Answer: B

Rationale: Positioning (B) maintains venous drainage, reducing ICP.

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