Question 1

Causes of metabolic coma include

Accepted Answer

A)  trauma. 
B)  ischemic stroke. 
C)  drug overdose. 
D)  intracerebral hemorrhage. 
A)  trauma. 
B)  ischemic stroke. 
C)  drug overdose. 
D)  intracerebral hemorrhage.

Question 2

A fast-acting, short-duration agent used for breakthrough seizures is

Accepted Answer

A)  lorazepam (Ativan). 
B)  phenytoin (Dilantin). 
C)  phenobarbital. 
D)  midazolam (Versed). 
A)  lorazepam (Ativan). 
B)  phenytoin (Dilantin). 
C)  phenobarbital. 
D)  midazolam (Versed).

Question 3

The osmotic diuretic that has been most effective in the reduction of increased ICP is

Accepted Answer

A)  mannitol. 
B)  furosemide (Lasix). 
C)  urea. 
D)  glycerol. 
A)  mannitol. 
B)  furosemide (Lasix). 
C)  urea. 
D)  glycerol.

Question 4

Nursing management of a patient with a clipped cerebral aneurysm receiving hypertensive hypervolemic hemodilution therapy includes

Accepted Answer

A)  administering osmotic diuretics and vasodilator agents. 
B)  providing the patient with a quiet environment. 
C)  maintaining the patient's systolic blood pressure at 150 to 160 mm Hg. 
D)  keeping the patient's central venous pressure at 5 to 8 mm Hg. 
A)  administering osmotic diuretics and vasodilator agents. 
B)  providing the patient with a quiet environment. 
C)  maintaining the patient's systolic blood pressure at 150 to 160 mm Hg. 
D)  keeping the patient's central venous pressure at 5 to 8 mm Hg.

Question 5

A patient has been experiencing drowsiness, confusion, and slight focal deficits for 3 days.The CT report findings are negative.The patient is being prepared for a lumbar puncture.The nurse anticipates that the CSF would appear

Accepted Answer

A)  cloudy. 
B)  bloody. 
C)  xanthochromic. 
D)  clear. 
A)  cloudy. 
B)  bloody. 
C)  xanthochromic. 
D)  clear.

Question 6

One of the pathologic consequences of an unruptured cerebral aneurysm is that it can

Accepted Answer

A)  shunt blood away from the surrounding tissues. 
B)  leak blood into the subarachnoid space. 
C)  damage the middle layer of the arterial wall. 
D)  place pressure on the surrounding tissues. 
A)  shunt blood away from the surrounding tissues. 
B)  leak blood into the subarachnoid space. 
C)  damage the middle layer of the arterial wall. 
D)  place pressure on the surrounding tissues.

Question 7

Which statement is true regarding the occurrence of SAHs?

Accepted Answer

A)  Greater occurrence in men than women younger than the age of 40 years old 
B)  Greater occurrence in men than women older than the age of 40 years old 
C)  90% of SAHs are caused by traumatic injury 
D)  Hemorrhage from SAHs have a better survival rate than hemorrhage from AVM 
A)  Greater occurrence in men than women younger than the age of 40 years old 
B)  Greater occurrence in men than women older than the age of 40 years old 
C)  90% of SAHs are caused by traumatic injury 
D)  Hemorrhage from SAHs have a better survival rate than hemorrhage from AVM

Question 8

Which nursing interventions will help prevent sharp spikes in ICP and surgical hemorrhage?

Accepted Answer

A)  Keep the head of the bed elevated 45 to 90 degrees. 
B)  Administer an antiemetic to prevent vomiting. 
C)  Provide fluid restriction. 
D)  Help with turn, cough, and deep breathe exercises. 
A)  Keep the head of the bed elevated 45 to 90 degrees. 
B)  Administer an antiemetic to prevent vomiting. 
C)  Provide fluid restriction. 
D)  Help with turn, cough, and deep breathe exercises.

Question 9

A patient who has experienced a right-sided stroke with hemiagnosia may experience

Accepted Answer

A)  reading the right side of the newspaper only. 
B)  denying ownership of the right side of the body. 
C)  being hyperresponsive when approached on the right side. 
D)  attempting to comb the hair with a toothbrush. 
A)  reading the right side of the newspaper only. 
B)  denying ownership of the right side of the body. 
C)  being hyperresponsive when approached on the right side. 
D)  attempting to comb the hair with a toothbrush.

Question 10

A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.Patient assessment includes T 98.7°F, P 98 beats/min and thready, R 8 breaths/min, and BP 168/100 mm Hg.The patient's initial treatment plan should involve

Accepted Answer

A)  placing her in the Trendelenburg position. 
B)  administering an antihypertensive agent. 
C)  initiating induced hypertensive therapy. 
D)  intubation to support airway and breathing. 
A)  placing her in the Trendelenburg position. 
B)  administering an antihypertensive agent. 
C)  initiating induced hypertensive therapy. 
D)  intubation to support airway and breathing.

Question 11

Emergency treatment of coma of unknown cause includes rapid intravenous administration of which three agents?

Accepted Answer

A)  Epinephrine, hydrocortisone, and Benadryl 
B)  Dopamine, 10% dextrose in distilled water, and calcium chloride 
C)  Mannitol, dexamethasone, and sodium bicarbonate 
D)  Thiamine, glucose, and opioid antagonist 
A)  Epinephrine, hydrocortisone, and Benadryl 
B)  Dopamine, 10% dextrose in distilled water, and calcium chloride 
C)  Mannitol, dexamethasone, and sodium bicarbonate 
D)  Thiamine, glucose, and opioid antagonist

Question 12

A patient's ICP is 34 mm Hg, and his cerebral perfusion pressure is 65 mm Hg.Which of the following is the most appropriate intervention?

Accepted Answer

A)  These are normal values, and no interventions are required. 
B)  Administer mannitol 1 to 2 g/kg IV. 
C)  Have the patient lie flat in bed. 
D)  Suction the patient to see if improving his airway will help his ICP. 
A)  These are normal values, and no interventions are required. 
B)  Administer mannitol 1 to 2 g/kg IV. 
C)  Have the patient lie flat in bed. 
D)  Suction the patient to see if improving his airway will help his ICP.

Question 13

The patient has sustained an ischemic stroke involving the left cerebral hemisphere.Which of the following neurologic abnormalities would you expect to see?

Accepted Answer

A)  Aphasia 
B)  Left visual field defect 
C)  Difficulty balancing his checkbook 
D)  Ataxic gait 
E)  Somnolence 
A)  Aphasia 
B)  Left visual field defect 
C)  Difficulty balancing his checkbook 
D)  Ataxic gait 
E)  Somnolence

Question 14

Downward displacement of the hemispheres, basal ganglia, and diencephalon through the tentorial notch is indicative of

Accepted Answer

A)  central herniation. 
B)  uncal herniation. 
C)  cingulate herniation. 
D)  infratentorial herniation. 
A)  central herniation. 
B)  uncal herniation. 
C)  cingulate herniation. 
D)  infratentorial herniation.

Question 15

A patient has been admitted with an ischemic stroke.The patient received recombinant tissue plasminogen activator (rtPA)in the emergency department.The nurse checks the medication administration record to make sure the patient does not have which medications for the next 24 hours?

Accepted Answer

A)  Aspirin 
B)  Sodium nitroprusside 
C)  Warfarin 
D)  Labetalol 
E)  Any antiplatelet drugs 
A)  Aspirin 
B)  Sodium nitroprusside 
C)  Warfarin 
D)  Labetalol 
E)  Any antiplatelet drugs

Question 16

Corneal epithelial breakdown in the coma patient is prevented by instillation of saline or methylcellulose lubricating eyedrops every

Accepted Answer

A)  2 hours. 
B)  4 hours. 
C)  8 hours. 
D)  12 hours. 
A)  2 hours. 
B)  4 hours. 
C)  8 hours. 
D)  12 hours.

Question 17

A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.While assisting the patient with her personal care, it is noted that she is unable to comb her hair with her left hand.The patient may have

Accepted Answer

A)  agnosia. 
B)  apraxia. 
C)  Broca aphasia. 
D)  Wernicke aphasia. 
A)  agnosia. 
B)  apraxia. 
C)  Broca aphasia. 
D)  Wernicke aphasia.

Question 18

Which assessment finding in a patient in coma 10 to 12 hours after cardiopulmonary arrest is indicative of unlikely survival?

Accepted Answer

A)  Decorticate posturing 
B)  Absent pupillary light reflexes 
C)  Decerebrate posturing 
D)  Central hyperventilation 
A)  Decorticate posturing 
B)  Absent pupillary light reflexes 
C)  Decerebrate posturing 
D)  Central hyperventilation

Question 19

A patient becomes flaccid with fixed and dilated pupils.The patient's ICP falls from 65 to 12 mm Hg.What should the nurse suspect is happening?

Accepted Answer

A)  The patient is having a seizure. 
B)  The patient's brain has herniated. 
C)  The patient's cerebral edema is resolving. 
D)  The patient is excessively dehydrated from the mannitol. 
A)  The patient is having a seizure. 
B)  The patient's brain has herniated. 
C)  The patient's cerebral edema is resolving. 
D)  The patient is excessively dehydrated from the mannitol.

Question 20

Which of the following statements regarding Guillain-Barré syndrome supports the admission to a critical care unit?

Accepted Answer

A)  The demyelination process of the peripheral nerves is irreversible. 
B)  The demyelination process is limited to the peripheral nervous system only. 
C)  The paralysis associated with the syndrome occurs in a descending pattern. 
D)  The most common cause of death is from respiratory arrest. 
A)  The demyelination process of the peripheral nerves is irreversible. 
B)  The demyelination process is limited to the peripheral nervous system only. 
C)  The paralysis associated with the syndrome occurs in a descending pattern. 
D)  The most common cause of death is from respiratory arrest.

Exam 18: Neurologic Disorders and Therapeutic Management

Causes of metabolic coma include

A fast-acting, short-duration agent used for breakthrough seizures is

The osmotic diuretic that has been most effective in the reduction of increased ICP is

Nursing management of a patient with a clipped cerebral aneurysm receiving hypertensive hypervolemic hemodilution therapy includes

A patient has been experiencing drowsiness, confusion, and slight focal deficits for 3 days.The CT report findings are negative.The patient is being prepared for a lumbar puncture.The nurse anticipates that the CSF would appear

One of the pathologic consequences of an unruptured cerebral aneurysm is that it can

Which statement is true regarding the occurrence of SAHs?

Which nursing interventions will help prevent sharp spikes in ICP and surgical hemorrhage?

A patient who has experienced a right-sided stroke with hemiagnosia may experience

Emergency treatment of coma of unknown cause includes rapid intravenous administration of which three agents?

A patient's ICP is 34 mm Hg, and his cerebral perfusion pressure is 65 mm Hg.Which of the following is the most appropriate intervention?

The patient has sustained an ischemic stroke involving the left cerebral hemisphere.Which of the following neurologic abnormalities would you expect to see?

Downward displacement of the hemispheres, basal ganglia, and diencephalon through the tentorial notch is indicative of

A patient has been admitted with an ischemic stroke.The patient received recombinant tissue plasminogen activator (rtPA)in the emergency department.The nurse checks the medication administration record to make sure the patient does not have which medications for the next 24 hours?

Corneal epithelial breakdown in the coma patient is prevented by instillation of saline or methylcellulose lubricating eyedrops every

Which assessment finding in a patient in coma 10 to 12 hours after cardiopulmonary arrest is indicative of unlikely survival?

A patient becomes flaccid with fixed and dilated pupils.The patient's ICP falls from 65 to 12 mm Hg.What should the nurse suspect is happening?

Which of the following statements regarding Guillain-Barré syndrome supports the admission to a critical care unit?

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

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