Questions INTRACRANIAL REGULATION Question 1 The physician has

Questions INTRACRANIAL REGULATION

Question 1 � The physician has ordered a rectal diazepam (Valium) for a 2 year old boy with status epilepticus. Which of the following instructions is essential for the nurse to teach the parents? a. Monitor the level of sedation and the respiratory rate. b. Watch for a temperature elevation, indicating infection. c. Gradually reduce the dose of medication. d. Monitor for an allergic reaction to the medication.

Question 2 � As a result of seizure activity, a CT scan was performed and showed that an 18 month old child has an intracranial arteriovenous malformation. The nurse would focus measures on prevention of which of the following? a. b. c. d. Drug interaction Developmental disabilities Hemorrhagic stroke Respiratory paralysis

Question 3 � A 4 year old boy has a febrile seizure during a well-child visit. Which of the following is the priority nursing intervention? a. Placing the child on his side, hyperextending his head, during the seizure. b. Positioning the child on his back while holding him still until the seizure ends. c. Loosening the child’s clothing to ensure a patent airway. d. Protecting the child from harm during the seizure.

Question 4 � The nurse is caring for a 8 year old boy who has a diagnosis of epilepsy with no sign of the seizure activity diminishing. Which of the following would be a priority for this child? a. Multiple corrective surgeries to slowly remove diseased parts of his brain. b. Physical, occupational, and speech therapy to maximize his potential. c. Support for maintaining self-esteem because of his altered lifestyle. d. Hyperventilation therapy to counteract the periods of decreased oxygenation.

Question 5 �A child with increased intracranial pressure is being treated with hyperventilation. The nurse understands that which of the following is the rationale for this treatment? a. Pa. C 02 levels decrease, causing vasoconstriction. b. Drainage of cerebrospinal fluid occurs. c. Activity is controlled via a stimulator. d. Hyperexcitability of the nerves is reduced.

Question 6 � Which of the following would lead the nurse to suspect that a child is beginning to develop ICP? a. Bradycardia b. Cheyne-Stokes respiration c. Fixed-dilated pupils d. Projectile vomiting

Question 7 �A patient is being admitted to the Neuro ICU following an acute head injury. The patient has cerebral edema. The nurse would expect to administer what priority medication to reduce the swelling? a. Hydro. Diuril b. Lasix c. Mannitol d. Aldactone

Question 8 � You have admitted a patient to the Neuro ICU with a brainstem herniation. The patient is now exhibiting an altered LOC. The nurse has determined that the patient’s MAP is 60 with an ICP reading of 5 mm/Hg. The nurse would be correct in determining the cerebral perfusion pressure (CPP) as which of the following values? a. b. c. d. Normal High Low Compensating

Question 9 � The nurse is caring for a postop craniotomy patient. When writing the plan of care, the patient has deficient fluid volume related to fluid restriction related to Mannitol use. What would be an appropriate intervention for this deficiency? a. Change the patient’s position as indicated b. Monitor serum electrolytes Maintain NPO status d. Monitor ABG’s c.

Question 10 � The nurse is caring for a patient on the neuro unit who is in status epilepticus. What medication does the nurse know may be given to halt the seizure immediately? a. IV Phenobarbitol b. IV Valium c. Oral Ativan d. Oral Dilantin

Question 11 � What should the nurse suspect when hourly assessments of urine ouput on a postcraniotomy patient exhibits a urine output from a catheter of 1500 ml for 2 consecutive hours? a. Cushing’s syndrome b. Syndrome of inappropriate antidiuretic hormone c. Adrenal crisis d. Diabetes insipidus

Question 12 � During the examination of an unconscious patient, the nurse notices that the patient’s pupils are fixed and dilated. What is the clinical significance of the nurse's findings? a. It suggests onset of metabolic problems b. It indicates paralysis on the right side of the body c. It indicates paralysis of cranial nerve X d. It indicates an injury at the midbrain level

Question 13 � When caring for a patient with a neurologic impairment and his or her family, what are the mutual goals? a. Achieve as high a level of function as possible b. Enhance the quantity of life c. Teach the family proper care of the patient d. Provide community assistance

Question 14 � You have a patient with an altered level of consciousness. What would be your first action when assessing this patient? a. Assessing the verbal response b. Assessing if the patient follows commands c. Assessing whether the patient will open their eyes d. Assessing response to pain

Question 15 � A patient is considered terminal after being involved in a MVA/MVC in which they received massive trauma to the head. As the patient’s ICP increases and condition worsens, the family asks you what indication of approaching or impending death will there be. What would be your best response? a. b. c. d. “there is change in the pattern of their respirations” “projectile vomiting and hemiplegia usually occur just before death” “posturing may develop as pressure on the brainstem increases” “loss of brainstem reflexes is a sign of approaching death”

Question 16 � The nursing instructor is teaching her students about monitoring a patient with increased ICP. What is a trend of ICP measurements over time an important indication of? a. Patient’s level of consciousness b. Patient’s ultimate prognosis c. Whether or not the patient’s brainstem is going to herniate d. Patient’s underlying status

Question 17 �A priority in postoperative management of a patient who has had intracranial surgery is what? a. Reducing pain b. Reducing periorbital edema c. Monitoring ICP d. Preserving seizures

Question 18 �A patient with a newly diagnosed seizure disorder is to be discharged home in the morning. You are preparing patient/family teaching and know that a priority to the teach the family is what? a. Place the patient in a side-lying position b. Pad the bed rails c. Keep a bite block nearby at all times d. Withhold medication after a seizure

Question 19 � When caring for a patient who had a hemorrhagic stroke, close monitoring of vital signs and neurologic changes are imperative. What is the earliest sign of deterioration in a patient with a hemorrhagic stroke? a. b. c. d. Headache Alterations in level of consciousness Tonic-clonic seizures Shortness of breath

Question 20 �A patient who just suffered a hemorrhagic stroke is brought to the ED by ambulance. What would the nurse’s primary assessment focus on? a. Cardiac and respiratory status b. Seizure activity c. Urinary output d. Fluid and electrolyte balance

Question 21 � The patient has been diagnosed with aphasia after suffering a stroke. What can the nurse do to make the patient’s atmosphere more conducive to communication? a. Help the patient compose a list of daily tasks b. Have the patient speak to loved ones on the phone daily c. Help the patient complete his or her sentences d. Speak in a louder voice to the patient

Question 22 � The nurse is caring for a patient with increased ICP caused by a traumatic brain injury. Which of the following clinical manifestations would indicate the patient is experiencing increased brain compression causing brainstem damage? a. Hyperthermia b. Tachycardia Hypertension d. bradypnea c.

Question 23 � A patient is bought to the ED by her family after falling off the roof. A family tells the nurse that when the patient fell she was “knocked out” but came to and seemed ok. Now, the patient is complaining of severe headache and not feeling well. The nurse suspects an epidural hematoma. Based on the knowledge of the progression of this type of hematoma, the nurse prepares for which priority intervention? a. b. c. d. Insertion of ICP monitor device Treatment with antihypertensives Emergency craniotomy Administration of anticoagulant therapy

Question 24 � The paramedics have brought an intubated patient to the ED following a head injury due to acceleraton-deceleration MVA. ICP is suspected. An appropriate nursing intervention would include what? a. Keep the HOB flat at all times b. Teach the patient to perform the Valsalva maneuver c. Administer antipyretics on a prn basis d. Perform endotracheal suctioning every hour

Question 25 � An elderly female is found on the floor of her home. She had apparently fallen and hit her head on the bathtub. She has a decreased LOC on admission to the neuro unit. What is the best rationale for the following physician orders: elevate HOB, keep head in neutral alignment with no neck flexion or head rotation, and avoid sharp hip flexion. a. b. c. d. To decrease cerebral arterial pressure To avoid impending venous outlflow To prevent flexion contractures To prevent aspiration of stomach contents

Question 26 (bonus) � The ED is notified that a six year old is in transit with a suspected brain injury after being involved in a pedestrian/MVA. The child is unresponsive at this time. Vital signs are within normal limits. What will therapy used on this child be directed towards? a. b. c. d. Maintaining the child’s airway Decreasing the ICP Assessing for secondary brain injury Preserving brain homeostasis

Question 27 � An 82 year old male is admitted for observation after a fall. What is this patient at increased risk for? a. Hematoma b. Skull fracture c. Embolus d. Stroke

Question 28 � A 77 year old patient had a thromboembolic right stroke; his left arm is swollen. Which of the following conditions may cause swelling after a stroke? a. Elbow contracture secondary to spasticity b. Loss of muscle contraction decreasing venous return c. DVT due to immobility of the ipsilateral (same) side d. Hypoalbuminemia due to protein escape from the inflamed glomerulus

Question 29 � The parents of a child in a coma with a serious head injury ask the nurse if the child is going to be all right. Which of the following responses by the nurse would be the most appropriate? a. “children usually don’t do very well after head injuries like this” b. “children usually recover rapidly from head injuries” c. “it’s hard to tell this early, but we’ll keep you informed of the progress” d. “that’s something you will have to talk to the doctor about”

Question 30 � During the first 24 hours after thrombolytic treatment for an ischemic stroke, the primary goal is to control the clients? a. Pulse b. Respirations c. Blood Pressure d. Temperature