Exam 10: Care of the Patient Experiencing an Intracranial Dysfunction

A patient with a head injury has a pO₂ of 88 and a pCO₂ of 58. The nurse realizes that which physiologic process will occur in this patient?

While a nasogastric tube is being inserted, a patient begins to cough and gag. What cranial nerves did the nurse inadvertently assess when inserting the nasogastric tube into the patient? Select all that apply.

The nurse prepares medications for a patient with status epilepticus. What should the nurse identify as the medication of choice for this patient?

When administering mannitol (Osmitrol) to a patient with increased intracranial pressure (ICP), what action should the nurse take?

A patient with a traumatic brain injury is showing signs of having pain. What would be the medication of choice for this patient?

The nurse, evaluating the tracing made from a patient's intracranial pressure monitor, notes the presence of many C waves. What does this finding indicate?

A patient recovering from otitis media develops meningitis. What should the nurse expect to assess in this patient? Select all that apply.

The nurse plans care for a patient with increased intracranial pressure. Which intervention would be appropriate for this patient?

The nurse is concerned that a patient's intracranial pressure monitor readings are incorrect. What should the nurse do to ensure that the monitor is measuring accurately? Select all that apply.

A patient is admitted with a fracture to the base of the skull. What might the nurse assess in this patient?

A patient with a head injury who is being mechanically ventilated needs to be suctioned. What should the nurse do to limit problems related to suctioning?

A patient with a skull fracture was admitted unconscious, became conscious, and has since moved into unconsciousness again. What should these assessment findings indicate to the nurse?

The nurse cares for a patient with status epilepticus. What should be the first goal of care for this patient?

What might a patient develop if intravenous phenytoin (Dilantin) is administered faster than 50 mg/minute?

The blood pressure of a patient with a traumatic brain injury increases from 130/60 to 170/65 mm Hg. How should the nurse respond to this change in blood pressure?

What action should the nurse take when administering hypertonic saline to a patient with increased intracranial pressure (ICP)? Select all that apply.

A patient with acute meningitis receives antibiotic therapy. The nurse notes that another medication is used as adjuvant therapy. Which medication is being used as an adjuvant for this patient?

The nurse teaches a patient recovering from a mild brain injury about manifestations to expect during the recovery process. What should the nurse instruct this patient to expect while recuperating from this injury? Select all that apply.

A patient has been receiving treatment for status epilepticus for the last 20 minutes. What should the nurse prepare to implement at this time? Select all that apply.

During an assessment, the nurse notes that the left pupil of a patient with a traumatic brain injury is larger than the right pupil. What action should the nurse take at this time?