A Nurse Is Caring for a 10-Year-Old Child with a Brain

question 11

Multiple Choice

A nurse is caring for a 10-year-old child with a brain injury.On assessing the child,the nurse finds the following data: opens eyes only to pain,mutters inappropriate words,has abnormal extension to stimulation.Which action by the nurse takes priority?

• A) Alert the operating room for emergent surgery.
• B) Document the findings; reassess in 15 minutes.
• C) Notify the provider; prepare for intubation.
• D) Raise the head of the child's bed to 45°.

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Definitions:

Tibial Tuberosity

A large protrusion on the anterior part of the tibia, where the patellar ligament attaches.

Femur

The longest and strongest bone in the human body, extending from the hip to the knee.

Patellar Surface

The patellar surface is the area on the distal end of the femur where the patella (kneecap) articulates or makes contact.

Tibia

A large bone located in the lower leg, also known as the shinbone, which bears much of the body's weight.