The Nurse Is Caring for a Client Who Has a Systemic

question 35

Multiple Choice

The nurse is caring for a client who has a systemic BP of 108/51 mm Hg and an intracranial pressure (ICP) of 14 mm Hg. Which of the following actions should the nurse take first?

• A)Elevate the head of the client's bed to 60 degrees.
• B)Document the BP and ICP in the client's record.
• C)Report the BP and ICP to the health care provider.
• D)Continue to monitor the client's vital signs and ICP.

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Definitions:

Adapt to Environment

The process by which organisms adjust to changes in their surroundings to survive and reproduce.

Psychoanalysis

A therapeutic approach founded by Sigmund Freud, focusing on unconscious processes as they are manifested in a person's present behavior.

Unconscious Mind

A part of the mind that contains thoughts, memories, and desires not within the individual's conscious awareness but influencing behavior and emotions.

Structuralism

An early school of psychology that used introspection to explore the elemental structure of the human mind.