After the emergency department nurse has received a status report on the following clients who have been admitted with head injuries, which client should the nurse assess first?
A)A client whose cranial radiograph shows a linear skull fracture
B)A client who has an initial Glasgow Coma Scale score of 13
C)A client who lost consciousness for a few seconds after a fall
D)A client whose right pupil is 10 mm and unresponsive to light

Question

Quizplus · Accepted Answer

The dilated and nonresponsive pupil may indicate an intracerebral hemorrhage, brain herniation, and increased intracranial pressure. The other clients are not at immediate risk for complications such as herniation.

After the Emergency Department Nurse Has Received a Status Report