Question 1

Appropriate therapy for ischemic stroke depends on rapid completion of which diagnostic study?

Accepted Answer

A)  Magnetic resonance imaging 
B)  Noncontrast computed tomography 
C)  Contrast computed tomography 
D)  Lumbar puncture 
A)  Magnetic resonance imaging 
B)  Noncontrast computed tomography 
C)  Contrast computed tomography 
D)  Lumbar puncture B

Question 2

The most common drug(s)used in high-dose barbiturate therapy are

Accepted Answer

A)  Dilantin and Cerebyx. 
B)  mannitol and nimodipine. 
C)  Dilantin and phenobarbital. 
D)  pentobarbital and thiopental. 
A)  Dilantin and Cerebyx. 
B)  mannitol and nimodipine. 
C)  Dilantin and phenobarbital. 
D)  pentobarbital and thiopental. D

Question 3

Which intervention should be considered LAST in treating uncontrolled intracranial hypertension?

Accepted Answer

A)  Sedatives 
B)  Analgesics 
C)  Barbiturates 
D)  Hyperventilation 
A)  Sedatives 
B)  Analgesics 
C)  Barbiturates 
D)  Hyperventilation C

Question 4

Which of the following patients has the best prognosis based on the cause of coma?

Accepted Answer

A)  A 36-year-old man with closed head injury 
B)  A 50-year-old woman with hepatic encephalopathy 
C)  A 46-year-old woman with subarachnoid hemorrhage 
D)  A 72-year-old man with hypertensive intracerebral hemorrhage 
A)  A 36-year-old man with closed head injury 
B)  A 50-year-old woman with hepatic encephalopathy 
C)  A 46-year-old woman with subarachnoid hemorrhage 
D)  A 72-year-old man with hypertensive intracerebral hemorrhage

Question 5

The incidence of rebleeding after a ruptured cerebral aneurysm is highest during which of the following time periods?

Accepted Answer

A)  First 24 hours 
B)  4 to 12 days 
C)  3 to 4 weeks 
D)  3 to 6 months 
A)  First 24 hours 
B)  4 to 12 days 
C)  3 to 4 weeks 
D)  3 to 6 months

Question 6

Which of the following independent nursing measures can assist in reducing increased ICP?

Accepted Answer

A)  Decreasing the ventilator rate 
B)  Decreasing noxious stimuli 
C)  Frequent orientation checks 
D)  Administration of loop diuretics 
A)  Decreasing the ventilator rate 
B)  Decreasing noxious stimuli 
C)  Frequent orientation checks 
D)  Administration of loop diuretics

Question 7

Which patient position is optimal to prevent elevated ICP pressures?

Accepted Answer

A)  The head of the bed elevated 30 to 40 degrees 
B)  Supine with the patient's neck in a neutral alignment 
C)  Individualized head position to maximize cerebral perfusion pressure and minimize ICP measurements 
D)  The head of the bed elevated with flexion of the hips 
A)  The head of the bed elevated 30 to 40 degrees 
B)  Supine with the patient's neck in a neutral alignment 
C)  Individualized head position to maximize cerebral perfusion pressure and minimize ICP measurements 
D)  The head of the bed elevated with flexion of the hips

Question 8

The target range for PaCO2 when using hyperventilation to lower ICP is

Accepted Answer

A)  25 to 30 mm Hg. 
B)  25 to 35 mm Hg. 
C)  35 to 40 mm Hg. 
D)  35 ± 2 mm Hg. 
A)  25 to 30 mm Hg. 
B)  25 to 35 mm Hg. 
C)  35 to 40 mm Hg. 
D)  35 ± 2 mm Hg.

Question 9

Which of the nursing diagnoses and interventions has the highest priority while treating a patient with GBS?

Accepted Answer

A)  Imbalanced nutrition: less than body requirements related to lack of exogenous nutrients or increased metabolic demand 
B)  Acute pain related to transmission and perception of cutaneous, visceral, muscular, or ischemic impulses 
C)  Risk for aspiration 
D)  Ineffective breathing pattern related to musculoskeletal fatigue or neuromuscular impairment 
A)  Imbalanced nutrition: less than body requirements related to lack of exogenous nutrients or increased metabolic demand 
B)  Acute pain related to transmission and perception of cutaneous, visceral, muscular, or ischemic impulses 
C)  Risk for aspiration 
D)  Ineffective breathing pattern related to musculoskeletal fatigue or neuromuscular impairment

Question 10

When an object is placed in the hand of a patient with neurologic impairment during assessment, the patient is unable to recognize the placement.This is termed tactile

Accepted Answer

A)  homonymous hemianopsia. 
B)  aphasia 
C)  agnosia. 
D)  apraxia. 
A)  homonymous hemianopsia. 
B)  aphasia 
C)  agnosia. 
D)  apraxia.

Question 11

Which of the following is the most common complication after high-dose barbiturate therapy?

Accepted Answer

A)  Hypothermia 
B)  Hypotension 
C)  Myocardial depression 
D)  Decreased CVP 
A)  Hypothermia 
B)  Hypotension 
C)  Myocardial depression 
D)  Decreased CVP

Question 12

Nonencapsulated tumors tend to infiltrate brain tissue.These tumors can arise in any part of brain connective tissue and infiltrate primarily cerebral hemisphere tissue.These tumors grow rapidly and are difficult to excise completely.The tumors described are classified as

Accepted Answer

A)  angiomas. 
B)  pituitary adenomas. 
C)  meningiomas. 
D)  gliomas. 
A)  angiomas. 
B)  pituitary adenomas. 
C)  meningiomas. 
D)  gliomas.

Question 13

A patient is admitted to the critical care unit with an acute head injury after a motor vehicle accident.The patient has a Glasgow Coma Scale score of 6.The patient is intubated and ventilated, and a ventriculostomy is placed with physician orders to keep the ICP less than 15 mm Hg.The patient's ICP continues to rise despite aggressive intervention.Which of the following is an advantage of a ventriculostomy ICP monitoring system?

Accepted Answer

A)  Lower risk of infection 
B)  Ease of insertion 
C)  No penetration of brain 
D)  Access for cerebrospinal fluid drainage and sampling 
A)  Lower risk of infection 
B)  Ease of insertion 
C)  No penetration of brain 
D)  Access for cerebrospinal fluid drainage and sampling

Question 14

Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA)is now recommended for the management of ischemic stroke if administration can be instituted within how many hours of onset of stroke symptoms?

Accepted Answer

A)  1 
B)  4 
C)  6 
D)  10 
A)  1 
B)  4 
C)  6 
D)  10

Question 15

Surgical placement of a ventriculoperitoneal shunt is used to treat

Accepted Answer

A)  hyponatremia. 
B)  intracerebral hemorrhage. 
C)  spontaneous intracerebral hemorrhage. 
D)  hydrocephalus. 
A)  hyponatremia. 
B)  intracerebral hemorrhage. 
C)  spontaneous intracerebral hemorrhage. 
D)  hydrocephalus.

Question 16

A patient returns from surgery for removal of a pituitary tumor that has not extended into the intracranial vault.The nurse observes a large amount of clear drainage from the nose.The nurse expects the physician to order a glucose test of the drainage to confirm

Accepted Answer

A)  that infection has not occurred. 
B)  that a shift in osmolality has not occurred. 
C)  that the drainage is postoperative serous drainage. 
D)  that the drainage is CSF from a cerebrospinal leak. 
A)  that infection has not occurred. 
B)  that a shift in osmolality has not occurred. 
C)  that the drainage is postoperative serous drainage. 
D)  that the drainage is CSF from a cerebrospinal leak.

Question 17

Complications associated with craniotomy include

Accepted Answer

A)  diabetes mellitus. 
B)  fluid retention. 
C)  intracranial hypotension. 
D)  surgical hemorrhage. 
A)  diabetes mellitus. 
B)  fluid retention. 
C)  intracranial hypotension. 
D)  surgical hemorrhage.

Question 18

The stroke patient who has difficulty with speech has

Accepted Answer

A)  expressive aphasia. 
B)  global aphasia 
C)  receptive aphasia. 
D)  apraxia. 
A)  expressive aphasia. 
B)  global aphasia 
C)  receptive aphasia. 
D)  apraxia.

Question 19

Which of the following medications is prescribed to decrease cerebral vasospasm?

Accepted Answer

A)  Phenytoin (Dilantin) 
B)  Phenobarbital 
C)  Nimodipine (Nimotop) 
D)  Vecuronium (Norcuron) 
A)  Phenytoin (Dilantin) 
B)  Phenobarbital 
C)  Nimodipine (Nimotop) 
D)  Vecuronium (Norcuron)

Question 20

After neurosurgery, the patient is at the greatest risk of developing

Accepted Answer

A)  injury from falls. 
B)  infection. 
C)  seizures. 
D)  corneal abrasions. 
A)  injury from falls. 
B)  infection. 
C)  seizures. 
D)  corneal abrasions.

Exam 18: Neurologic Disorders and Therapeutic Management

Appropriate therapy for ischemic stroke depends on rapid completion of which diagnostic study?

The most common drug(s)used in high-dose barbiturate therapy are

Which intervention should be considered LAST in treating uncontrolled intracranial hypertension?

Which of the following patients has the best prognosis based on the cause of coma?

The incidence of rebleeding after a ruptured cerebral aneurysm is highest during which of the following time periods?

Which of the following independent nursing measures can assist in reducing increased ICP?

Which patient position is optimal to prevent elevated ICP pressures?

The target range for PaCO2 when using hyperventilation to lower ICP is

Which of the nursing diagnoses and interventions has the highest priority while treating a patient with GBS?

When an object is placed in the hand of a patient with neurologic impairment during assessment, the patient is unable to recognize the placement.This is termed tactile

Which of the following is the most common complication after high-dose barbiturate therapy?

Nonencapsulated tumors tend to infiltrate brain tissue.These tumors can arise in any part of brain connective tissue and infiltrate primarily cerebral hemisphere tissue.These tumors grow rapidly and are difficult to excise completely.The tumors described are classified as

Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA)is now recommended for the management of ischemic stroke if administration can be instituted within how many hours of onset of stroke symptoms?

Surgical placement of a ventriculoperitoneal shunt is used to treat

A patient returns from surgery for removal of a pituitary tumor that has not extended into the intracranial vault.The nurse observes a large amount of clear drainage from the nose.The nurse expects the physician to order a glucose test of the drainage to confirm

Complications associated with craniotomy include

The stroke patient who has difficulty with speech has

Which of the following medications is prescribed to decrease cerebral vasospasm?

After neurosurgery, the patient is at the greatest risk of developing

Caring for the Critically Ill Patient

Ethical and Legal Issues

Patient and Family Education

Psychosocial and Spiritual Alterations and Management

Sleep Alterations

Nutritional Alterations

Gerontological Alterations

Pain and Pain Management

Sedation, Agitation and Delirium Management

End of Life Care

Cardiovascular Clinical Assessment and Diagnostic Procedures

Cardiovascular Disorders

Cardiovascular Therapeutic Management

Pulmonary Clinical Assessment and Diagnostic Procedures

Pulmonary Disorders

Pulmonary Therapeutic Management

Neurologic Clinical Assessment and Diagnostic Procedures

Kidney Clinical Assessment and Diagnostic Procedures

Kidney Disorders and Therapeutic Management

Gastrointestinal Clinical Assessment and Diagnostic Procedures

Gastrointestinal Disorders and Therapeutic Management

Endocrine Clinical Assessment and Diagnostic Procedures

Endocrine Disorders and Therapeutic Management

Trauma

Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

Hematologic Disorders and Oncologic Emergencies

Filters

The target range for PaCO₂ when using hyperventilation to lower ICP is