The nurse is caring for a young patient with a closed head injury who has an intracranial pressure of 35 (normal <20) and serum osmolality of 330 mOsm/kg. The nurse would anticipate which action?

Correct Answer: B

Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure (ICP) by drawing fluid out of the brain tissue. However, it should be used cautiously in patients with elevated serum osmolality, as it can exacerbate hyperosmolality and lead to renal failure or other complications. In this case, the patient's serum osmolality is already high (330 mOsm/kg), so mannitol should be withheld, and other measures to reduce ICP, such as elevating the head of the bed, maintaining proper oxygenation, and avoiding hypercapnia, should be prioritized. Sodium nitroprusside (C) is used for hypertension, not ICP, and taking no action (D) is inappropriate given the elevated ICP.

Correct Answer: A

Rationale: Myelosuppression, a common side effect of chemotherapy, leads to a decrease in white blood cells, red blood cells, and platelets. A drop in white blood cells, particularly neutrophils, increases the risk of infection. Monitoring for a change in temperature is critical because fever is often the first sign of infection in neutropenic patients. Early detection allows for prompt intervention, such as administering antibiotics, to prevent life-threatening complications. While gastrointestinal function, cardiac compromise, and changes in taste are important to assess, they are not as immediately life-threatening as an undetected infection in a myelosuppressed patient.

Correct Answer: D

Rationale: When monitoring a patient on Clopidogrel therapy, it is important to monitor for signs of thrombotic thrombolytic purpura (TTP), bleeding during therapy, and changes in blood counts. Clopidogrel is an antiplatelet medication that works by preventing platelets from sticking together and forming clots. Monitoring for signs of TTP is necessary as clopidogrel has been associated with an increased risk of TTP in some patients. Additionally, monitoring for bleeding is crucial as clopidogrel, like other antiplatelet medications, can increase the risk of bleeding complications. Monitoring a complete blood count (CBC) with differential and platelet count allows healthcare providers to assess the patient's blood cell levels and ensure that the medication is not causing any adverse effects on blood counts. Therefore, monitoring all of the above parameters is essential to ensure the safety and efficacy of clopidogrel therapy.

Correct Answer: B

Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure (ICP) by drawing fluid out of the brain tissue. However, it should be used cautiously in patients with elevated serum osmolality, as it can exacerbate hyperosmolality and lead to renal failure or other complications. In this case, the patient's serum osmolality is already high (330 mOsm/kg), so mannitol should be withheld, and other measures to reduce ICP, such as elevating the head of the bed, maintaining proper oxygenation, and avoiding hypercapnia, should be prioritized. Sodium nitroprusside (C) is used for hypertension, not ICP, and taking no action (D) is inappropriate given the elevated ICP.

Correct Answer: D

Rationale: In the scenario described, the patient presents with acute decompensated heart failure (HF) with dyspnea at rest, indicating severe symptoms. Nesiritide, a recombinant B-type natriuretic peptide, is commonly used in the management of acute decompensated HF to improve symptoms of dyspnea and congestion. It acts as a vasodilator and promotes natriuresis and diuresis, helping to alleviate the symptoms of heart failure exacerbation. While other medications like Carvedilol (Coreg) and Lisinopril (Prinivil) are commonly used in chronic HF management, in this acute scenario with severe symptoms, Nesiritide would be the appropriate medication to anticipate for administration in the ICU setting. Atropine is not indicated for acute decompensated heart failure.