The nurse caring for a client who has sustained a head trauma closely monitors respirations because:
A)
the client will be lethargic and forget to breathe.
B)
the trauma may cause the client to be disoriented.
C)
breathing is controlled by the respiratory center in the brain.
D)
the client will be unable to cough and clear secretions.
C
Explanation:
A)
The brain injury may have impacted chemoreceptors in the respiratory center of the brain, which controls breathing. Options B and D may be true but do not explain why respirations are monitored. Breathing is a function of the autonomic nervous system; absence would indicate a neurologic impairment.
Application
Implementation
Physiological Integrity: Reduction of Risk Potential
B)
The brain injury may have impacted chemoreceptors in the respiratory center of the brain, which controls breathing. Options B and D may be true but do not explain why respirations are monitored. Breathing is a function of the autonomic nervous system; absence would indicate a neurologic impairment.
Application
Implementation
Physiological Integrity: Reduction of Risk Potential
C)
The brain injury may have impacted chemoreceptors in the respiratory center of the brain, which controls breathing. Options B and D may be true but do not explain why respirations are monitored. Breathing is a function of the autonomic nervous system; absence would indicate a neurologic impairment.
Application
Implementation
Physiological Integrity: Reduction of Risk Potential
D)
The brain injury may have impacted chemoreceptors in the respiratory center of the brain, which controls breathing. Options B and D may be true but do not explain why respirations are monitored. Breathing is a function of the autonomic nervous system; absence would indicate a neurologic impairment.
Application
Implementation
Physiological Integrity: Reduction of Risk Potential
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