nclex question...can someone please answer this question?

Virgo_RN · Dec 24, 2009, 02:29 PM

That is incorrect. I would use a different study guide, were I you.

* RN * · Dec 24, 2009, 05:59 PM

Well out of the choices, since the correct first thing to do is put in semi-fowlers position but since that is not a choice I would pick the tell patient to avoid coughing etc. It is the most correct answer out of the choices. Did the question specifically say "first response" or "initial action"? Sometimes the nclex questions say which would be the nurses "best response" or "most appropriate nursing action" - meaning it is not always the initial thing the nurse will do. My professor always says that sometimes the best answer is not one of the options, so it is important that we can identify the next best thing and weed out the wrong interventions. I have never heard of high fowlers with increased ICP - just semi fowlers and neck in neutral. I think wherever you got the question from is a good resource but it would certainly be better if it gave rationales. Sometimes saunders sucks in that the best answer is usually an option so you don't ever have to think about what the next best answer would be, seems like this might be a little more challenging.

morte · Dec 24, 2009, 08:12 PM

Originally Posted by princess007

i was doing some questions online and found this question the answer they show there i totally disagree with it.what do you guys think is the right answer? and if possible why you that is the right answer please..thanks soo much

A nursing assessment on a male patient indicates that he is showing evidence of increased intracranial pressure. The first nursing action is to

Answer=
A)Place him in high-Fowler`s position.

B) Place him on his side.

C) Have him cough and deep breathe.

http://www.free-ed.net/sweethaven/Me...01.asp?iNum=40 according to this, it would be B