Author Question: A client with increased intracranial pressure (ICP) is being repositioned by the nurse with the help ... (Read 222 times)

V@ndy87 · **on:** Jul 22, 2018

A client with increased intracranial pressure (ICP) is being repositioned by the nurse with the help of the family members present. Of the following, which interventions are appropriate for the nurse to teach the family? (Select all that apply.

) 1. Clients with ICP should remain in a stationary position.
2. The family should use slow, gentle movements when repositioning the client.
3. The client should be returned to supine position.
4. The client should be repositioned every hour.
5. The head of the bed should be elevated.

Question 2

A client wants to visit family in Asia but has a fear of flying. An intervention strategy planned to help this individual face the fear is to teach:

1. Physical exercise.
2. Meditation.
3. Goal-oriented contracting.
4. Negative thought challenging.

otokexnaru · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

2. The family should use slow, gentle movements when repositioning the client.
5. The head of the bed should be elevated.

Rationale:
Clients with ICP should be repositioned slowly and with gentle movements, because rapid changes can cause the pressure to increase. The head of the bed should be elevated. The degree depends on the reaction of the client to the position; 30 degrees is usually appropriate, but this can vary by the client. Clients with ICP must not remain stationary, but position changes should be done less frequently than for other clients because turning, skin care, and passive ROM exercises can elicit posturing, which also causes increased ICP.

Answer to Question 2

4. Negative thought challenging.

Rationale:
Negative thought challenging is a cognitive behavioral technique that helps clients to think differently about their fears. Meditation helps with relaxation. Goal-oriented contracting increases a sense of control. Physical exercise does not directly deal with cognition.