When a patient's intracranial pressure (ICP) is being monitored with an intraventricular catheter, which information obtained by the nurse is most important to communicate to the health care provider?

Correct Answer: C

Rationale: The correct answer is C: Intracranial pressure 18 mm Hg. This is the most important information to communicate because changes in ICP can indicate increasing intracranial pressure, which can lead to serious complications such as brain herniation. Monitoring and promptly communicating any changes in ICP to the healthcare provider is crucial for timely intervention and prevention of further damage. Choice A: Oral temperature 102°F is important for assessing for signs of infection or inflammation, but it is not directly related to the intracranial pressure monitoring. Choice B: Apical pulse 102 beats/min is important for assessing cardiac function, but it is not directly related to intracranial pressure monitoring. Choice D: Mean arterial pressure 90 mm Hg is important for assessing perfusion to the brain, but it is not as directly relevant to intracranial pressure monitoring as the actual ICP reading itself.

Correct Answer: B

Rationale: The correct answer is B - Check the angle of the nail bed. Clubbing is characterized by an increased angle (>180 degrees) between the nail bed and the skin. This is best assessed by looking at the nail bed directly. Inspecting for white spots (A), assessing for swelling in the fingertips (C), and observing the color of the nail beds (D) are not specific or accurate indicators of clubbing. Checking the angle of the nail bed is the most direct and reliable method to assess for clubbing of the fingers.

Correct Answer: A

Rationale: The correct answer is A: Assess the range of motion of the joint. This is the next action because swelling and redness over a joint can indicate inflammation or injury, which may affect the joint's mobility. Assessing the range of motion will help determine the extent of the issue and guide further interventions. Applying heat (B) may worsen inflammation, documenting as normal (C) is inappropriate given the abnormal findings, and referring for further evaluation (D) can be considered after assessing the range of motion to provide more specific information to the healthcare provider.

Correct Answer: C

Rationale: The presence of an S3 heart sound typically indicates heart failure. This occurs due to rapid filling of the ventricles during early diastole, indicating volume overload. This sound is commonly heard in patients with heart failure, reflecting decreased cardiac function. In contrast, option A is incorrect as an S3 is not a normal finding in young adults. Option B, mitral valve stenosis, would present with an opening snap and a diastolic murmur, not an S3 sound. Option D, aortic regurgitation, is associated with a diastolic murmur and bounding pulses, not an S3 heart sound.

Correct Answer: D

Rationale: The correct answer is D: Increased total lung capacity. In COPD, there is typically air trapping due to decreased elasticity of the lungs and increased residual volume. This results in an increased total lung capacity as the lungs are hyperinflated. A: Decreased residual volume is incorrect because in COPD, there is air trapping leading to increased residual volume. B: Increased expiratory flow rates is incorrect because in COPD, there is airflow limitation causing decreased expiratory flow rates. C: Decreased functional residual capacity is incorrect because in COPD, there is air trapping leading to increased functional residual capacity.