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NCLEX EXAM PREP 4 FINAL EXAM 150 / NCLEX EXAM PREP 4 FINAL EXAM 150QUESTION AND ANSWER WITH LATEST UPDATES 2023.

NCLEX EXAM PREP 4 FINAL EXAM 150 / NCLEX EXAM PREP 4 FINAL EXAM 150QUESTION AND ANSWER WITH LATEST UPDATES 2023.

NCLEX EXAM PREP 4 FINAL EXAM 150 / NCLEX EXAM PREP 4 FINAL EXAM 150QUESTION AND ANSWER WITH LATEST UPDATES 2023.
12. The nurse is caring for clients on the neurology unit. What would be the MOST appropriate action for the nurse to take after noting that a client suddenly developed a fixed and dilated pupil?

1. Reassess in five minutes.
2. Check the client’s visual acuity.
3. Lower the head of the client’s bed.
4. Contact the physician.

Strategy: Answers are a mix of assessments and implementations. Is this a situation that requires assessment or validation? No. Determine the
outcome of the implementations.
(1) assessment, situation does not require validation
(2) assessment, has symptoms of increased ICP
(3) implementation, would increase the intracranial pressure
(4) correct–implementation, fixed and dilated pupil represents a neurological emergency

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