1. Intracranial Regulation
Questions
Intracranial Regulation

2. 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?
Monitor the level of sedation and the respiratory rate.
Watch for a temperature elevation, indicating infection.
Gradually reduce the dose of medication.
Monitor for an allergic reaction to the medication.
A. Why?

3. 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?
Drug interaction
Developmental disabilities
Hemorrhagic stroke
Respiratory paralysis C.

4. 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?
Placing the child on his side, hyperextending his head, during the seizure.
Positioning the child on his back while holding him still until the seizure ends.
Loosening the child’s clothing to ensure a patent airway.
Protecting the child from harm during the seizure. D.

5. 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?
Multiple corrective surgeries to slowly remove diseased parts of his brain.
Physical, occupational, and speech therapy to maximize his potential.
Support for maintaining self-esteem because of his altered lifestyle.
Hyperventilation therapy to counteract the periods of decreased oxygenation. C.

6. 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?
PaC02 levels decrease, causing vasoconstriction.
Drainage of cerebrospinal fluid occurs.
Activity is controlled via a stimulator.
Hyperexcitability of the nerves is reduced. A.

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

8. 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?
HydroDiuril
Lasix
Mannitol
Aldactone C.
The osmotic diuretic mannitol is given to dehydrate the brain tissue and reduce cerebral edema. Aldactone, Laxis, and HydroDiuril are used to treat CHF and HTN.

9. 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?
Normal
High
Low
Compensating
C. 60 – 5 = 55 which is considered low. The normal CPP is mm/Hg. Patients with < 50 experience irreversible neurologic damage. A lower than normal CPP indicates that the cardiac output is insufficient to maintain adequate cerebral perfusion.

10. 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?
Change the patient’s position as indicated
Monitor serum electrolytes
Maintain NPO status
Monitor ABG’s
B. Postop fluid regimen depends on the type of neurosurgical procedure. The volume and composition of fluids are adjusted based on daily serum electrolyte values, along with I & O. Changing the patients position, maintaining an NPO status, and monitoring ABG’s DO NOT relate to the deficiency

11. 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?
IV Phenobarbitol
IV Valium
Oral Ativan
Oral Dilantin
B. Status epelepticus is prolonged seizure activity that occur without full recovery of consciousness between attacks. Medical management of it includes IV Valium and IV Ativan given slowly in a attempt to stop seizures immediately. Phenobarbitol and Dilantin are given later to maintain a seizure free state.

12. 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?
Cushing’s syndrome
Syndrome of inappropriate antidiuretic hormone
Adrenal crisis
Diabetes insipidus
D. DI is an abrupt onset of extreme polyuria that commonly occurs in patients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. SIADH is a result of increased secretion of ADH; the patient becomes fluid volume overloaded, urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypglycemia, hypovolemia, and hypotension.

13. 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?
It suggests onset of metabolic problems
It indicates paralysis on the right side of the body
It indicates paralysis of cranial nerve X
It indicates an injury at the midbrain level D.

14. Question 13
When caring for a patient with a neurologic impairment and his or her family, what are the mutual goals?
Achieve as high a level of function as possible
Enhance the quantity of life
Teach the family proper care of the patient
Provide community assistance
A. Highest level of function and quality of life. Not a goal to provide community assistance. The scenario does not indicate that the pt needs to be taken care of by the family.

15. Question 14
You have a patient with an altered level of consciousness. What would be your first action when assessing this patient?
Assessing the verbal response
Assessing if the patient follows commands
Assessing whether the patient will open their eyes
Assessing response to pain
A. Assessment of the patient with an altered LOC often starts with assessing the verbal response through determining the patient’s orientation to time, person, and place.

16. 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?
“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”
Loss of brainstem reflexes, including pupillary, corneal, gag, and swallowing reflexes is an ominous sign of approaching death.
All of the others are occurring as ICP continues to increase and condition worsens

17. 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?
Patient’s level of consciousness
Patient’s ultimate prognosis
Whether or not the patient’s brainstem is going to herniate
Patient’s underlying status D…

18. Question 17
A priority in postoperative management of a patient who has had intracranial surgery is what?
Reducing pain
Reducing periorbital edema
Monitoring ICP
Preserving seizures
C..ongoing management includes all, but monitoring and detecting for ICP takes priority.

19. 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?
Place the patient in a side-lying position
Pad the bed rails
Keep a bite block nearby at all times
Withhold medication after a seizure
A. To prevent complications to facilitate drainage of oral secretions and maintain patent airway. Most patients at home do not have bed rails; a bite block is no longer used, and you do not withhold medication from a seizure patient.

20. 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?
Headache
Alterations in level of consciousness
Tonic-clonic seizures
Shortness of breath
B..alteration in LOC is the earliest sign, such as mild drowsiness, slight slurring of speech, and sluggish pupillary reaction.

21. 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?
Cardiac and respiratory status
Seizure activity
Urinary output
Fluid and electrolyte balance
A. Acute care begins with managing ABC’s…neuro assessments come next, and fluid and electrolyte balance must be controled carefully with the goal of adequate hydration to promote perfusion.

22. 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?
Help the patient compose a list of daily tasks
Have the patient speak to loved ones on the phone daily
Help the patient complete his or her sentences
Speak in a louder voice to the patient
A. Aphasia impairs the patient’s ability to understand what is being said and to express himself or herself. An aphasic person may become depressed because of the inability to talk with others, so inability to talk on the phone or answer a question or exclusion from conversion causes anger, frustration, and fear.

23. 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?
Hyperthermia
Tachycardia
Hypertension
bradypnea
A. Signs of increasing ICP include slowing of HR, respirations become rapid, blood pressure may decrease, and the pulse slows further. A rapid rise in body temperature is regarded as unfavorable and may indicate brainstem damage.

24. 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?
Insertion of ICP monitor device
Treatment with antihypertensives
Emergency craniotomy
Administration of anticoagulant therapy
C. ICP device may be placed during surgery to monitor for ICP once clot is removed.

25. 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?
Keep the HOB flat at all times
Teach the patient to perform the Valsalva maneuver
Administer antipyretics on a prn basis
Perform endotracheal suctioning every hour
C..It is imp to manage temperature elevations in a patient with suspected increased ICP. A hyperthermic state causes increased ICP.
The HOB should be elevated 30 degrees. Suctioning should be done on a limited basis due to increasing pressure in the cranium. The valsalva maneuver should be avoided…this also causes increased ICP.

26. 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.
To decrease cerebral arterial pressure
To avoid impending venous outlflow
To prevent flexion contractures
To prevent aspiration of stomach contents
Any activity or position that impedes venous outflow from the head may contribute to increased volume inside the skull and possibly increase ICP.
Cerebral arterial pressure will be affected by the balance between oxygen and carbon dioxide. Flexion contractures aren’t a priority at this time. Stomach contents could still be aspirated in this position.

27. 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 the therapy used on this child be directed towards?
Maintaining the child’s airway
Decreasing the ICP
Assessing for secondary brain injury
Preserving brain homeostasis
D…all therapy is directed at preserving brain homestasis and preventing secondary brain injury, which is the injury that occurs after the original traumatic event (ICP or hemmor following a blow to the head). The scenario does not indicate the child has increased ICP or a secondary brain injury at this point. Maintaining the child’s airway is part of preserving brain homeostasis.

28. Question 27
An 82 year old male is admitted for observation after a fall. What is this patient at increased risk for?
Hematoma
Skull fracture
Embolus
Stroke
A. Two major factors place older adults at increased risk for hematomas…first, the dura becomes more adherent to the skull with increasing age…second, many older adults take aspirin or anticoagulants as part of routine mgt of chronic conditions.

29. 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?
Elbow contracture secondary to spasticity
Loss of muscle contraction decreasing venous return
DVT due to immobility of the ipsilateral (same) side
Hypoalbuminemia due to protein escape from the inflamed glomerulus
In clients with hemiplegia or hemiparesis, loss of muscle contraction decreases venous return and may cause swelling of the affected extremity.
Contractures, or bony calcifications may occur with stroke, but do not appear with swelling. DVT may develop in clients with a stroke but is more like to occur in the lower extremities. Stroke is not linked to protein loss.

30. 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?
“children usually don’t do very well after head injuries like this”
“children usually recover rapidly from head injuries”
“it’s hard to tell this early, but we’ll keep you informed of the progress”
“that’s something you will have to talk to the doctor about” C

31. Question 30
During the first 24 hours after thrombolytic treatment for an ischemic stroke, the primary goal is to control the clients?
Pulse
Respirations
Blood Pressure
Temperature
C. Control of the bp is critical during the first 24 hours after tx because of intracerebral hemorrhage is the major adverse affect of therapy.