Question 1

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

Question 2

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 3

Which diuretic is the most effective in the reduction of increased intracranial pressure (ICP)?

Accepted Answer

A)  Mannitol 
B)  Furosemide 
C)  Urea 
D)  Glycerol 
A)  Mannitol 
B)  Furosemide 
C)  Urea 
D)  Glycerol

Question 4

Which independent nursing measures can assist in reducing increased intracranial pressure (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 5

The nurse is caring for a patient who is had trans-sphenoidal surgery for removal of a pituitary tumor.The nurse observes a large amount of clear drainage from the nose.The provider requests the drainage be tested for the presence of glucose.Why did the physician order this test?

Accepted Answer

A)  To assess for an infection 
B)  To check for a shift in osmolality 
C)  To check for occult blood 
D)  To assess for a cerebrospinal fluid leak 
A)  To assess for an infection 
B)  To check for a shift in osmolality 
C)  To check for occult blood 
D)  To assess for a cerebrospinal fluid leak

Question 6

A right-handed patient has been admitted with an intracerebral hemorrhage.A computed tomography (CT)of the patient's head reveals a large left parietal area bleed.Patient assessment includes temperature (T),98.7° F; pulse (P),98 beats/min and thready; respirations (R),8 breaths/min; and blood pressure (BP),168/100 mm Hg.Initial management of the patient includes which intervention?

Accepted Answer

A)  Placing the patient in the Trendelenburg position 
B)  Administering an antihypertensive agent 
C)  Initiating induced hypertensive therapy 
D)  Intubating and ventilating the patient 
A)  Placing the patient in the Trendelenburg position 
B)  Administering an antihypertensive agent 
C)  Initiating induced hypertensive therapy 
D)  Intubating and ventilating the patient

Question 7

A patient is admitted with an acute head injury after a motor vehicle accident.The patient is intubated and ventilated,and a ventriculostomy is placed.In addition to monitoring of intracranial pressure,what treatment can be provided with the ventriculostomy?

Accepted Answer

A)  Instillation of mannitol 
B)  Drainage of subdural hematoma 
C)  Brain tissue sampling 
D)  Cerebrospinal fluid drainage 
A)  Instillation of mannitol 
B)  Drainage of subdural hematoma 
C)  Brain tissue sampling 
D)  Cerebrospinal fluid drainage

Question 8

What is one of the earliest signs of increased intracranial pressure (ICP)?

Accepted Answer

A)  Cushing triad 
B)  Decerebrate posturing (abnormal extension) 
C)  Change in level of consciousness 
D)  Increase in pupillary size 
A)  Cushing triad 
B)  Decerebrate posturing (abnormal extension) 
C)  Change in level of consciousness 
D)  Increase in pupillary size

Question 9

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 10

The extrusion of cerebral tissue through the cranium is what type of herniation?

Accepted Answer

A)  Transcalvarial 
B)  Uncal 
C)  Cingulate 
D)  Transtentorial 
A)  Transcalvarial 
B)  Uncal 
C)  Cingulate 
D)  Transtentorial

Question 11

What is one cause of metabolic coma?

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 12

Which nursing diagnosis has the highest priority in the nursing management plan for a patient with Guillain-Barré syndrome?

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 13

What are the most common medications used in high-dose barbiturate therapy?

Accepted Answer

A)  Phenytoin and fosphenytoin 
B)  Mannitol and nimodipine 
C)  Lidocaine and phenobarbital 
D)  Pentobarbital and thiopental 
A)  Phenytoin and fosphenytoin 
B)  Mannitol and nimodipine 
C)  Lidocaine and phenobarbital 
D)  Pentobarbital and thiopental

Question 14

A patient has been admitted post craniotomy for a brain tumor.The nursing management plan should include monitoring the patient for what complication?

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 15

A patient has been experiencing drowsiness,confusion,and slight focal deficits for several days.The initial noncontract computed tomography (CT)findings are negative.The patient is being prepared for a lumbar puncture.What appearance does the nurse anticipate that the cerebrospinal fluid (CSF)would look?

Accepted Answer

A)  Cloudy 
B)  Bloody 
C)  Xanthochromic 
D)  Clear 
A)  Cloudy 
B)  Bloody 
C)  Xanthochromic 
D)  Clear

Question 16

Which nursing intervention will help prevent spikes in intracranial pressure in the post-neurosurgical patient?

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 17

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 18

A patient's ICP is 34 mm Hg,and his cerebral perfusion pressure is 65 mm Hg.Given that the practitioner has left appropriate orders,which action should the nurse take next?

Accepted Answer

A)  No action is required. 
B)  Administer mannitol 1 to 2 g/kg IV. 
C)  Place the patient supine and flat in bed. 
D)  Suction the patient. 
A)  No action is required. 
B)  Administer mannitol 1 to 2 g/kg IV. 
C)  Place the patient supine and flat in bed. 
D)  Suction the patient.

Question 19

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 20

Which patient 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

Exam 23: Neurologic Disorders and Therapeutic Management

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

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?

Which diuretic is the most effective in the reduction of increased intracranial pressure (ICP)?

Which independent nursing measures can assist in reducing increased intracranial pressure (ICP)?

The nurse is caring for a patient who is had trans-sphenoidal surgery for removal of a pituitary tumor.The nurse observes a large amount of clear drainage from the nose.The provider requests the drainage be tested for the presence of glucose.Why did the physician order this test?

A patient is admitted with an acute head injury after a motor vehicle accident.The patient is intubated and ventilated,and a ventriculostomy is placed.In addition to monitoring of intracranial pressure,what treatment can be provided with the ventriculostomy?

What is one of the earliest signs of increased intracranial pressure (ICP)?

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

The extrusion of cerebral tissue through the cranium is what type of herniation?

What is one cause of metabolic coma?

Which nursing diagnosis has the highest priority in the nursing management plan for a patient with Guillain-Barré syndrome?

What are the most common medications used in high-dose barbiturate therapy?

A patient has been admitted post craniotomy for a brain tumor.The nursing management plan should include monitoring the patient for what complication?

Which nursing intervention will help prevent spikes in intracranial pressure in the post-neurosurgical patient?

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.Given that the practitioner has left appropriate orders,which action should the nurse take next?

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

Which patient has the best prognosis based on the cause of coma?

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