Intracranial pressure

Which problem can increase intracranial

pressure?

A. Hypoxia

B. Hypocapnia

C. Hypokalemia

D. Dehydration

A. Hypoxia

(Hypoxia leads to cerebral vasodilation, which can lead to

increased intracranial pressure (ICP). Hypocapnia (low PaCO2)

causes cerebral vasoconstriction, which decreases intracranial

volume and pressure. Dehydration, as may occur with mannitol,

would decrease intracranial volume and pressure)

A nurse is caring for a patient with a head injury. Which components make up the total intracranial volume according to the Monro-Kellie doctrine?

    ◦ A. Brain tissue, blood, and cerebrospinal fluid (CSF).

    ◦ B. Brain tissue, venous blood, and arterial blood.

    ◦ C. Neurons, glia, and CSF.

    ◦ D. Intracellular fluid, extracellular fluid, and blood.

    ◦ A. Brain tissue, blood, and cerebrospinal fluid (CSF).

Which of the following is the EARLIEST clinical indication of increasing ICP?

    ◦ A. Cushing’s triad.

    ◦ B. Change in Level of Consciousness (LOC).

    ◦ C. Decerebrate posturing.

    ◦ D. Projectile vomiting.

    ◦ B. Change in Level of Consciousness (LOC).

A patient’s blood pressure is 140/90 (MAP 107) and the ICP is 15 mmHg. Calculate the Cerebral Perfusion Pressure (CPP).

    ◦ A. 75 mmHg

    ◦ B. 92 mmHg

    ◦ C. 125 mmHg

    ◦ D. 107 mmHg

B. 92 mmHg

A nurse observes a patient with a head injury and notes a widening pulse pressure, bradycardia, and irregular respirations. What does the nurse suspect?

    ◦ A. Early stages of brain edema.

    ◦ B. Cushing’s triad, indicating a late sign of increased ICP.

    ◦ C. A normal compensatory response to pain.

    ◦ D. Improving neurological status.

    ◦ B. Cushing’s triad, indicating a late sign of increased ICP.

A patient with increased ICP is exhibiting "A waves" on their ICP monitor. What is the nurse's priority interpretation?

    ◦ A. This is a normal variation in the respiratory cycle.

    ◦ B. This indicates systemic arterial pressure variations.

    ◦ C. These are plateau waves indicating cerebral ischemia.

    ◦ D. The monitor needs to be recalibrated.

    ◦ C. These are plateau waves indicating cerebral ischemia.

Which PaCO2 level would the nurse anticipate the provider targeting to help reduce ICP through vasoconstriction?

    ◦ A. 45–50 mmHg

    ◦ B. 35–45 mmHg

    ◦ C. Less than 30 mmHg

    ◦ D. 50–60 mmHg

    ◦ C. Less than 30 mmHg

A nurse notes that a patient with a brain injury has begun to exhibit decerebrate posturing. How should the nurse describe this?

    ◦ A. Flexion of the arms and extension of the legs.

    ◦ B. Extreme extension of the upper and lower extremities.

    ◦ C. Flaccid paralysis of all limbs.

    ◦ D. Spontaneous rhythmic movements of the trunk.

    ◦ B. Extreme extension of the upper and lower extremities.

A patient has an ICP of 22 mmHg and a MAP of 50 mmHg. What is the nurse's primary concern?

    ◦ A. The CPP is 28 mmHg, which is incompatible with life.

    ◦ B. The patient is exhibiting a normal autoregulation response.

    ◦ C. The ICP is slightly elevated but the MAP is stable.

    ◦ D. The patient needs more sedation to lower the ICP.

    ◦ A. The CPP is 28 mmHg, which is incompatible with life.

(Rationale: CPP = MAP - ICP (50 - 22 = 28). A CPP < 30 mmHg results in ischemia and is incompatible with life.)

Which position is most appropriate for a patient with increased ICP?

    ◦ A. Prone with the head turned to the side.

    ◦ B. Trendelenburg position.

    ◦ C. Head of bed (HOB) elevated to 30–45 degrees with neutral head alignment.

    ◦ D. Flat/supine to ensure maximum blood flow to the brain.

c

The nurse is preparing to suction a patient with increased ICP. Which action is essential?

    ◦ A. Suction for at least 30 seconds to clear all secretions.

    ◦ B. Briefly hyperventilate the patient with 100% oxygen before suctioning.

    ◦ C. Suction every hour regardless of breath sounds.

    ◦ D. Turn the patient’s head to the side during suctioning.

B. Briefly hyperventilate the patient with 100% oxygen before suctioning.

What is the primary rationale for administering Mannitol (an osmotic diuretic) to a patient with ICP?

    ◦ A. To increase blood pressure and improve perfusion.

    ◦ B. To reduce brain volume by drawing water across the blood-brain barrier.

    ◦ C. To provide sedation and reduce metabolic demand.

    ◦ D. To prevent the onset of seizures.

B. To reduce brain volume by drawing water across the blood-brain barrier.

A patient receiving Mannitol has a serum osmolality of 330 mOsm/kg. What is the nurse's priority action?

    ◦ A. Continue the medication as ordered.

    ◦ B. Assess the patient for signs of dehydration and report the finding.

    ◦ C. Increase the rate of IV fluids.

    ◦ D. Administer a dose of Furosemide.

    ◦ B. Assess the patient for signs of dehydration and report the finding.

The nurse is caring for a patient on a ventilator with increased ICP. Why should the nurse use PEEP (Positive End-Expiratory Pressure) cautiously?

    ◦ A. It can cause pneumonia.

    ◦ B. It may decrease venous return to the heart and increase ICP.

    ◦ C. It causes the patient to become agitated.

    ◦ D. It increases the risk of pneumothorax only.

    ◦ B. It may decrease venous return to the heart and increase ICP.

A patient with a head injury has a urine output of 250 mL/hr for two consecutive hours. Which condition does the nurse suspect?

    ◦ A. Acute Renal Failure.

    ◦ B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

    ◦ C. Diabetes Insipidus (DI).

    ◦ D. Normal response to IV fluids.

    ◦ C. Diabetes Insipidus (DI).

What is the goal of using high-dose barbiturates in an unresponsive patient with increased ICP?

    ◦ A. To prevent shivering during hypothermia.

    ◦ B. To reduce the brain's metabolic requirements.

    ◦ C. To maintain a patent airway.

    ◦ D. To increase the patient’s heart rate.

    ◦ B. To reduce the brain's metabolic requirements.

A nurse is clustering nursing care for a patient with increased ICP. Is this an appropriate action?

    ◦ A. Yes, it allows the patient longer periods of rest.

    ◦ B. No, nursing interventions should be spaced to prevent cumulative ICP increases.

    ◦ C. Yes, as long as the ICP remains below 30 mmHg.

    ◦ D. No, because the patient should be stimulated every 15 minutes.

   ◦ B. No, nursing interventions should be spaced to prevent cumulative ICP increases.

he nurse is administering stool softeners to a patient with increased ICP. What is the primary rationale?

    ◦ A. To prevent constipation caused by narcotics.

    ◦ B. To prevent the Valsalva maneuver, which increases ICP.

    ◦ C. To ensure the patient has three bowel movements a day.

    ◦ D. To decrease the patient’s overall fluid volum

    ◦ B. To prevent the Valsalva maneuver, which increases ICP.

A patient has an intraventricular catheter for ICP monitoring. What is the most significant risk associated with this device?

    ◦ A. Overdrainage of CSF causing a headache.

    ◦ B. Infection/Meningitis.

    ◦ C. Inaccurate readings due to patient movement.

    ◦ D. Damage to the ventricles during insertion.

B. Infection/Meningitis.

A patient is experiencing a generalized tonic-clonic seizure. What is the nurse's first priority?

    ◦ A. Insert a padded tongue blade into the patient's mouth.

    ◦ B. Restrain the patient’s limbs to prevent fractures.

    ◦ C. Ease the patient to the floor and protect the head.

    ◦ D. Administer IV Phenytoin immediately.

    ◦ C. Ease the patient to the floor and protect the head.

What should the nurse do immediately after a seizure has ended (postictal phase)?

    ◦ A. Give the patient water to drink.

    ◦ B. Place the patient in a side-lying position.

    ◦ C. Encourage the patient to walk to clear their head.

    ◦ D. Perform a sternal rub to wake them up.

    ◦ B. Place the patient in a side-lying position.

A patient has been in a continuous seizure for 10 minutes without regaining consciousness. How does the nurse classify this?

    ◦ A. Focal seizure.

    ◦ B. Tonic-clonic seizure.

    ◦ C. Status epilepticus.

    ◦ D. Postictal state.

    ◦ C. Status epilepticus.

Which medication is typically administered FIRST to halt a seizure in status epilepticus?

    ◦ A. Phenytoin

    ◦ B. Phenobarbital

    ◦ C. Diazepam or Lorazepam

    ◦ D. Valproate

    ◦ C. Diazepam or Lorazepam

A patient taking Phenytoin (Dilantin) for long-term seizure control should be educated on which side effect?

    ◦ A. Weight gain.

    ◦ B. Gingival hyperplasia.

    ◦ C. Insomnia.

    ◦ D. Hypertension.

    ◦ B. Gingival hyperplasia.

What is a "provoked" seizure?

    ◦ A. A seizure caused by an unknown genetic factor.

    ◦ B. A seizure related to an acute, reversible condition like hyponatremia or hypoglycemia.

    ◦ C. A seizure that only occurs when the patient is stressed.

    ◦ D. A seizure that is intentionally induced for diagnostic testin

B. A seizure related to an acute, reversible condition like hyponatremia or hypoglycemia.

Which surgical intervention for epilepsy involves a device implanted under the clavicle that delivers electrical signals to the brain?

    ◦ A. Responsive neurostimulation system (RNS).

    ◦ B. Vagal nerve stimulator (VNS).

    ◦ C. Deep brain stimulation (DBS).

    ◦ D. Temporal lobectomy.

B. Vagal nerve stimulator (VNS).

(Rationale: A VNS is a device implanted under the clavicle connected to the vagus nerve to help control seizure activity)

A patient on long-term anticonvulsant therapy is at high risk for which of the following?

    ◦ A. Bone disease (osteoporosis).

    ◦ B. Increased muscle mass.

    ◦ C. Improved cognitive function.

    ◦ D. Reduced risk of infection.

    ◦ A. Bone disease (osteoporosis).

During a seizure, the nurse observes the patient's entire body becoming rigid, followed by alternating muscle relaxation and contraction. This is a:

    ◦ A. Tonic seizure.

    ◦ B. Clonic seizure.

    ◦ C. Generalized tonic–clonic seizure.

    ◦ D. Absence seizure.

    ◦ C. Generalized tonic–clonic seizure.

A patient with increased ICP is being monitored for temperature. Why is preventing an elevated temperature critical?

    ◦ A. Fever increases cerebral metabolism and ICP.

    ◦ B. Fever causes the patient to become lethargic.

    ◦ C. Elevated temperature causes cerebral vasoconstriction.

    ◦ D. It indicates the patient has an infection

    ◦ A. Fever increases cerebral metabolism and ICP.

The nurse is caring for a patient who just had a seizure. The patient is confused and wandering. What is the best action?

    ◦ A. Restrain the patient to the bed.

    ◦ B. Guide the patient gently to a bed or chair.

    ◦ C. Shout at the patient to sit down.

    ◦ D. Administer another dose of anti-epileptic medication.

    ◦ B. Guide the patient gently to a bed or chair.

Why should the nurse avoid extreme hip flexion in a patient with increased ICP?

    ◦ A. It causes skin breakdown.

    ◦ B. It increases intra-abdominal and intrathoracic pressure, which increases ICP.

    ◦ C. It is uncomfortable for the patient.

    ◦ D. It prevents the use of a catheter.

 ◦ B. It increases intra-abdominal and intrathoracic pressure, which increases ICP.

Which medication is associated with the toxic effect of "Aplastic Anemia"?

    ◦ A. Felbamate.

    ◦ B. Gabapentin.

    ◦ C. Levetiracetam.

    ◦ A. Felbamate.

The nurse is assessing a patient for "brain death." Which finding is consistent with this diagnosis?

    ◦ A. GCS of 3.

    ◦ B. Absence of brainstem reflexes.

    ◦ C. ICP of 20 mmHg.

    ◦ D. The patient is in a deep sleep.

    ◦ B. Absence of brainstem reflexes.

((Rationale: Loss of brainstem reflexes, along with profound coma and impaired respirations, are signs of brain death)

A patient presents to the emergency department (ED) with sudden right-sided weakness and a facial droop. What is the priority diagnostic test the nurse should ensure is initiated within 20 minutes of arrival?

A. Magnetic Resonance Imaging (MRI)

B. Noncontrast Computed Tomography (CT) scan

C. 12-lead Electrocardiogram (ECG)

D. Carotid Ultrasound

B. Noncontrast Computed Tomography (CT) scan

A patient is being evaluated for tissue plasminogen activator (t-PA) therapy. Which assessment finding would be a contraindication for this treatment?

A. Age 70 years

B. Symptom onset 2 hours ago

C. Blood pressure of 190/115 mm Hg

D. Platelet count of 150,000/mm³

C. Blood pressure of 190/115 mm Hg

((ationale: Eligibility criteria for t-PA require systolic blood pressure to be ≤185 mm Hg and diastolic ≤110 mm Hg. 190/115 mm Hg exceeds this threshold and must be lowered before administration.))

he nurse is caring for a patient with a left-hemispheric stroke. Which behavior should the nurse anticipate?

A. Impulsivity and poor judgment

B. Lack of awareness of deficits

C. Slow, cautious behavior

D. Increased distractibility

C. Slow, cautious behavior

(Rationale: Patients with left-hemispheric strokes typically exhibit slow, cautious behavior and altered intellectual ability, whereas right-hemispheric stroke patients are often impulsive)

A patient has homonymous hemianopsia following an ischemic stroke. Which nursing intervention is most appropriate?

A. Approach the patient from the side of the visual deficit.

B. Place the call bell on the side of the visual deficit.

C. Encourage the patient to turn their head to scan the environment.

D. Keep the room dimly lit to prevent eye strain.

C. Encourage the patient to turn their head to scan the environment.

(Rationale: Homonymous hemianopsia is the loss of half of the visual field. Patients must be taught to scan their environment by turning their head toward the side of the deficit to ensure safety and compensate for the loss.)

During the "ischemic cascade," what is the primary reason the penumbra is considered salvageable tissue?

A. It is the area of dead neurons that cannot be revived.

B. It is an area of low cerebral blood flow where cells are threatened but not yet infarcted.

C. It is the area where the initial thrombus formed.

D. It is protected by the blood-brain barrier from calcium influx.

B. It is an area of low cerebral blood flow where cells are threatened but not yet infarcted.

(Rationale: The penumbra is an area of low cerebral blood flow surrounding the area of infarction. It can be revitalized with timely intervention, such as t-PA administration))

Following a carotid endarterectomy (CEA), the nurse notes the patient has a new onset of hoarseness and difficulty swallowing. What is the nurse's priority action?

A. Document the finding as a normal post-operative expectation.

B. Assess for cranial nerve dysfunction and notify the provider.

C. Offer the patient a glass of ice water to soothe the throat.

D. Encourage the patient to cough and deep breathe.

b

(Rationale: Difficulty swallowing and hoarseness may indicate cranial nerve injury, which is a complication of CEA. The nurse must focus on assessing nerves VII, IX, X, XI, and XII.)

A patient receiving an IV t-PA infusion develops a sudden, severe headache and a decrease in level of consciousness. What is the nurse's immediate priority?

A. Slow the rate of the t-PA infusion.

B. Prepare the patient for an emergent MRI.

C. Stop the t-PA infusion and notify the provider.

D. Administer a prescribed antihypertensive medication.

C. Stop the t-PA infusion and notify the provider.

Which diet would the nurse recommend for primary prevention of ischemic stroke in a high-risk patient?

A. High-protein, low-carbohydrate diet.

B. Mediterranean diet supplemented with nuts.

C. Clear liquid diet with high-glucose supplements.

D. Low-sodium, high-saturated fat diet.

B. Mediterranean diet supplemented with nuts.

A patient with atrial fibrillation is prescribed warfarin. The nurse knows this is to prevent which type of stroke?

A. Intracerebral hemorrhage

B. Small penetrating artery thrombotic stroke

C. Cardiogenic embolic stroke

D. Subarachnoid hemorrhage

C. Cardiogenic embolic stroke

In the hyperacute phase of ischemic stroke, why is maintaining a slightly elevated blood pressure often preferred (unless t-PA is used)?

A. To prevent cerebral edema.

B. To maintain cerebral perfusion to the penumbra.

C. To reduce the risk of a secondary hemorrhage.

D. To decrease the metabolic demand of the brain.

B. To maintain cerebral perfusion to the penumbra.

((Rationale: Adequate cerebral blood flow is essential for oxygenation; maintenance of cerebral hemodynamics to maintain cerebral perfusion is extremely important after a stroke))

A patient reports the "worst headache of my life" followed by a seizure. The nurse recognizes these as classic signs of which condition?

A. Ischemic stroke B. Hemorrhagic stroke C. TIA D. Myasthenic crisis

B. Hemorrhagic stroke

what is a calcium channel blocker prescribed to all patients with SAH to prevent vasospasm, a leading cause of morbidity

nimodipine

The nurse is administering nimodipine to a patient with a subarachnoid hemorrhage (SAH). What is the purpose of this medication?

A. To dissolve the existing clot.

B. To prevent cerebral vasospasm.

C. To lower the heart rate.

D. To treat hyponatremia.

B. To prevent cerebral vasospasm.

A patient with an aneurysm is being managed with "Triple-H" therapy. What are the components of this therapy?

A. Hyperthermia, hypertension, and hypovolemia.

B. Hypervolemia, induced arterial hypertension, and hemodilution.

C. Hypothermia, hypotension, and hydration.

D. Hyperventilation, hyperglycemia, and hematocrit control.

B. Hypervolemia, induced arterial hypertension, and hemodilution.

(Rationale: Triple-H therapy (hypervolemia, induced hypertension, and hemodilution) is used to minimize the effects of cerebral ischemia caused by vasospasm)

When is the risk of rebleeding highest for a patient with an unsecured ruptured cerebral aneurysm?

A. 3 to 14 days after the initial bleed.

B. During the first 2 to 12 hours after the initial hemorrhage.

C. 1 month after the event.

D. Only during physical exertion.

B. During the first 2 to 12 hours after the initial hemorrhage.

Which statement best describes an Arteriovenous Malformation (AVM)?

A. A dilation of the walls of a cerebral artery.

B. A tangle of arteries and veins that lacks a capillary bed.

C. A clot that has traveled from the heart to the brain.

D. Bleeding caused by the deposit of beta-amyloid protein.

B. A tangle of arteries and veins that lacks a capillary bed.

(Rationale: An AVM is caused by an abnormality in embryonic development leading to a tangle of vessels without a capillary bed, which can eventually rupture)

A patient with SAH has a serum sodium level of 128 mEq/L. The nurse recognizes this as:

A. A normal finding in stroke.

B. Hyponatremia, which may be associated with vasospasm.

C. Hypernatremia, requiring fluid restriction.

D. A side effect of Mannitol therapy.

B. Hyponatremia, which may be associated with vasospasm.

What is the goal of surgical "clipping" of an aneurysm?

A. To increase blood flow to the area of the aneurysm.

B. To divert blood flow away from the brain.

C. To isolate the aneurysm from its circulation.

D. To reinforce the vessel walls with beta-amyloid protein.

C. To isolate the aneurysm from its circulation.

Which intervention is part of "aneurysm precautions"?

A. Encouraging the patient to perform the Valsalva maneuver during bowel movements.

B. Providing a high-stimulation environment with bright lights.

C. Dimming the lights and maintaining a quiet, nonstressful environment. D. Keeping the HOB flat at all times.

C. Dimming the lights and maintaining a quiet, nonstressful environment.

What is the most common cause of primary intracerebral hemorrhage?

A. Ruptured AVM.

B. Cerebral amyloid angiopathy.

C. Uncontrolled hypertension.

D. Head trauma.

C. Uncontrolled hypertension.

Myasthenia Gravis is characterized by an autoimmune attack on which structure?

A. Peripheral nerve myelin.

B. Acetylcholine receptors at the myoneural junction.

C. Dopamine storage cells in the substantia nigra.

D. The Schwann cells.

B. Acetylcholine receptors at the myoneural junction.

(Rationale: MG is an autoimmune disease where antibodies attack acetylcholine receptor sites at the myoneural junction, impairing impulse transmission)

During a Tensilon (edrophonium) test, the nurse must have which medication available to treat potential side effects?

A. Pyridostigmine B. Atropine C. Epinephrine D. Protamine sulfate

B. Atropine

(Rationale: Edrophonium can cause bradycardia and asystole; therefore, atropine should be available to counteract these side effects)

What is the first-line therapy for providing symptomatic relief in MG?

A. Corticosteroids

B. Intravenous immunoglobulin (IVIG)

C. Pyridostigmine bromide

D. Thymectomy

C. Pyridostigmine bromide

A patient with MG is experiencing severe muscle weakness and respiratory distress. How can the nurse distinguish between a myasthenic crisis and a cholinergic crisis?

A. By the patient’s response to edrophonium (Tensilon).

B. By checking the patient's blood pressure.

C. By assessing the patient's pupils.

D. By measuring the patient’s heart rate.

A. By the patient’s response to edrophonium (Tensilon).

What is the goal of therapeutic plasma exchange (plasmapheresis) in MG?

A. To increase the production of acetylcholine.

B. To remove circulating antibodies from the plasma.

C. To replace lost electrolytes.

D. To stimulate the thymus gland.

B. To remove circulating antibodies from the plasma.

Why is a thymectomy performed for some patients with MG?

A. To increase the size of the thymus gland.

B. Because the thymus gland is often enlarged and involved in antibody production.

C. To increase dopamine levels.

D. To repair the myoneural junction directly.

B. Because the thymus gland is often enlarged and involved in antibody production.

What is the classic clinical presentation of GBS?

A. Descending paralysis starting in the face.

B. Sudden loss of consciousness and seizures.

C. Acute, rapid segmental demyelination producing ascending weakness.

D. Tremors and "pill-rolling" motions of the hands.

C. Acute, rapid segmental demyelination producing ascending weakness.

What is the most critical complication for the nurse to monitor in a patient with GBS?

A. Deep vein thrombosis (DVT).

B. Respiratory failure.

C. Urinary retention.

D. Orthostatic hypotension.

B. Respiratory failure.

(Rationale: Upward progression of demyelination can affect the diaphragm and intercostal muscles, leading to respiratory failure, which is a medical emergency)

A patient with GBS experiences sudden tachycardia and labile blood pressure. The nurse understands this is due to:

A. Myoneural junction failure.

B. Autonomic dysfunction.

C. Anxiety regarding paralysis.

D. Rejection of IVIG therapy.

B. Autonomic dysfunction.

(Rationale: Vagus nerve demyelination results in autonomic dysfunction, manifested by instability of the cardiovascular system, including tachycardia and hypertension)

GBS is often preceded by which event in 60% to 70% of cases?

A. An antecedent event, most often a viral infection.

B. A head injury.

C. High-fat diet consumption.

D. Chronic use of antipsychotic medications.

A. An antecedent event, most often a viral infection.

(Rationale: Most cases of GBS are precipitated by an antecedent event, typically a viral infection, occurring 1 to 3 weeks before symptoms)

Which nursing intervention is essential to prevent complications of immobility in GBS?

A. Administering pyridostigmine.

B. Using sequential compression boots and anticoagulant agents.

C. Limiting fluid intake.

D. Keeping the patient in a supine position at all times.

B. Using sequential compression boots and anticoagulant agents.

How should the nurse assess for the risk of aspiration in a GBS patient?

A. Check for a positive Tensilon test.

B. Assess the gag reflex and the patient's ability to swallow.

C. Monitor for "pill-rolling" tremors.

D. Check for nuchal rigidity.

B. Assess the gag reflex and the patient's ability to swallow.

((Rationale: Bulbar muscle weakness related to cranial nerve demyelination can cause an inability to swallow or clear secretions, necessitating a gag reflex assessment)

What are the four cardinal manifestations of Parkinson’s Disease? A. Headache, seizure, vomiting, and aphasia.

B. Tremor, rigidity, bradykinesia/akinesia, and postural instability.

C. Weakness, ptosis, diplopia, and dysphagia.

D. Ascending paralysis, hyporeflexia, pain, and paresthesia.

B. Tremor, rigidity, bradykinesia/akinesia, and postural instability.

A patient taking levodopa/carbidopa for PD for several years develops rhythmic jerking movements of the hands and head bobbing. The nurse identifies this as:

A. An improvement in Parkinsonian tremors.

B. Dyskinesia, a common side effect of long-term levodopa therapy.

C. A sign that the medication dose needs to be increased.

D. A new onset of GBS.

B. Dyskinesia, a common side effect of long-term levodopa therapy.

Which nutritional intervention is appropriate for a patient with PD and dysphagia?

A. Provide thin liquids to make swallowing easier.

B. Encourage the patient to eat quickly to avoid fatigue.

C. Offer a semisolid diet with thick liquids and have the patient sit upright.

D. Instruct the patient to tilt their head back while swallowing.

. Offer a semisolid diet with thick liquids and have the patient sit upright.

To improve mobility and safety during ambulation, the nurse should teach the PD patient to:

A. Walk with their hands in their pockets.

B. Use a shuffling gait to maintain balance.

C. Practice walking to the sound of a ticking metronome or marching music.

D. Look at their feet while walking.

C. Practice walking to the sound of a ticking metronome or marching music.

PD is associated with the depletion of which neurotransmitter in the basal ganglia?

A. Acetylcholine

B. Dopamine

C. Serotonin

D. Gamma-aminobutyric acid (GABA)

dopamine

When utilizing hyperventilation therapy, what is the

physiologic rationale for maintaining PaCO2 between the

value of 25-35 mm/Hg?

A. The resultant vasodilation increases cerebral blood flow

but increases intracranial volume and pressure.

B. The resultant hypervolemia increases cerebral blood

flow but increases intracranial volume and pressure.

C. The resultant hypovolemia decreases intracranial

volume and pressure but may cause cerebral ischemia.

D. The resultant vasoconstriction decreases intracranial

volume and pressure but may cause cerebral ischemia.

D. The resultant vasoconstriction decreases intracranial

volume and pressure but may cause cerebral ischemia.

(Hyperventilation causes respiratory alkalosis which causes vasoconstriction

which decreases intracranial volume and pressure. However, if PaCO2 levels are

not carefully controlled, vasoconstriction potentially may cause cerebral

ischemia.)

A patient is admitted with an intracranial problem. He

develops a fever of 38.5° C (101.3 °F). Which of the

following is of greatest concern for this patient?

A. The effect of the febrile state on the immune system

B. The shift of the oxyhemoglobin dissociation curve

C. The impact of the febrile state on coagulation

D. The resultant increase in cerebral oxygen consumption

D. The resultant increase in cerebral oxygen consumption

A 23-year-old man has sustained a head injury. He is in the

neurosurgical intensive care unit after being resuscitated in the

emergency department. His current Glasgow Coma Scale score is 5.

Vital signs are blood pressure 120/64 mm Hg, heart rate 92

beats/min, and respiratory rate 28 breaths/min. He is on a ventilator.

An intraventricular catheter has been inserted, and his intracranial

pressure (ICP) is 30 mm Hg. To maintain adequate cerebral perfusion

pressure in this patient, the mean arterial pressure must be at least:

A. 60 mm Hg

B. 80 mm Hg

C. 100 mm Hg

D. 150 mm Hg

C. 100 mm Hg

((Let’s do the math backwards!!! The goal in this patient would be to

maintain a cerebral perfusion pressure (CPP) of at least 70 mm Hg.

CPP = MAP – ICP, so a MAP of 100 mm Hg would be required to

maintain a CPP of 70 mm Hg in a patient with an ICP of 30 mm Hg.

Answer D is incorrect because the question asked “MAP must be at

least?”)

A patient has had an ischemic stroke and is

currently dysphagic. What measure would increase

his risk of aspiration when he is eating?

A. Having him sit upright

B. Giving him primarily liquids until he can swallow

C. Placing foods on the unaffected side of his

mouth

D. Keeping distractions at a minimum during

mealtimes

B. Giving him primarily liquids until he can swallow

(Swallowing liquids is difficult for patients with dysphagia.

Semiliquid and soft foods are better tolerated. Place the patient

upright (A), place foods on the unaffected side of the mouth (C),

and avoid distractions during mealtime )

A 64-year-old man is admitted for suspicion of

stroke. To assess for muscle weakness, the nurse

asks the patient to hold his arms out in front of him.

One arm drifts slightly downward. This assessment

finding is referred to as:

A. hemiparalysis.

B. hemianesthesia.

C. pronator drift.

D. agnosia.

C. pronator drift.

what would prevent the

patient from even raising the limb (

hemiparalysis

A 76-year-old woman is following a right cerebral

hemisphere brain attack or hemorrhage. Assessment

would reveal which of the following?

A. Dilated left pupil and paresis on the left side.

B. Dilated left pupil and paresis on the right side.

C. Dilated right pupil and paresis on the right side.

D. Dilated right pupil and paresis on the left side.

D. Dilated right pupil and paresis on the left side.

(Because the hemorrhage/ischemia was on the

right, the right (ipsilateral) pupil would dilate and

be nonreactive and there would be motor changes

on the left (contralateral). Remember ipsilateral

pupil dilation and contralateral motor changes.)

what side would these symptoms show brain damage on ?

Paralyzed right side:

hemiplegia

• Impaired

speech/Language

aphasias

• Impaired right/left

discrimination

• SLow performance,

cautious

• Aware of deficits 

depression, anxiety

• Impaired comprehension

related to Language &

math (think… L is closer in

the alphabet to M

left brain

what side brain damage woul this be on

]Paralyzed left side:

hemiplegia

• Left-sided neglect

• Spatial-perceptual deficits

(think… R is closer in the

alphabet to S & P)

• Tends to deny or

minimize problems

• Rapid performance, short

attention span

• Impulsive / impaired

judgment / impaired time

concepts  safety

problems!

right

A 72-year-old woman arrives at the emergency

department after exhibiting “odd” behavior while watching

television with her husband. The nurse observes paralysis

of her right extremities, aphasia, and lethargy. From onset

of symptoms to administration of fibrinolytics, the time

frame is generally no longer than:

3 hours

A 68-year-old man is admitted via the emergency

department with expressive aphasia and drooping of the

left side of his face. He also has left-sided hemiparalysis.

His family reports that his symptoms started about 2 hours

ago. The decision is made to use tissue plasminogen

activator (t-PA). Which of the following is the most serious

complication of t-PA for stroke?

A. Surface bleeding from puncture points

B. Hematuria

C. Intracranial bleeding

D. Cardiac tamponade

C. Intracranial bleeding

patient initially complained of dizziness, right-

sided weakness, and diplopia. These symptoms

subsided within 4 hours. The patient likely has

A. had a transient ischemic attack (TIA).

B. had a dysrhythmia.

C. had a completed stroke.

D. probably developed a brain tumor.

A. had a transient ischemic attack (TIA).

(The clinical manifestations are of cerebral

hypoperfusion. Because S&S disappeared in less than 24

hours, makes this a TIA rather than a completed stroke

(D). A dysrhythmia (B) may cause dizziness but not the

other S&S (signs and symptoms). There is no evidence to

suggest a brain tumor has developed (D).))

Which of the following descriptions about intracranial

pressure (ICP) monitoring systems is incorrect?

A. Intermittent flush devices are not used.

B. Heparin is not added to the solution used to prime the

tubing.

C. Only preservative-free saline is used to prime the

tubing.

D. The transducer is leveled to the phlebostatic axis.

D. The transducer is leveled to the phlebostatic axis.

( Intermittent flush devices ensure a continuous flush of ~5 mL/hr. This is undesirable in monitoring intracranial

pressure because even small volumes may cause significant increases in

intracranial pressure in some patients (A). Heparin (B) is not added because it may cause intracranial hemorrhage, and cerebrospinal fluid does not clot. Only preservative-free saline is used to prime the tubing due to the potential of meningeal irritation from preservatives (C))

What is triple-H therapy?

Hypertension, hypervolemia, hemodilution

what involves increasing IV fluids or

administering a volume expander (albumin) to

increase blood volume

hypervolemia

what is (controlled) to force arterial

blood flow through the narrowed (vasospastic)

artery. May use a drug such as phenylephrine

(vasoconstrictor)

hypertension

what involves making the blood thin

and watery so that it flows more easily through

narrowed arteries.

hemodilution

A 42-year-old woman is admitted with "the worst

headache I've ever had." CT reveals an aneurysm in the

circle of Willis. Vasospasm may be treated with which of

the following?

A. Fluid administration

B. Loop diuretics

C. Fibrinolytic agent

D. Osmotic diuretics

A. Fluid administration

(Administering fluids helps create a hypervolemic state, forcing blood through the vasospastic vessels, decreasing potential cerebral ischemia and infarction. Remember that the vessels are made of smooth muscle. When you get a muscle cramp, the treatment is to stretch the muscle to relieve the cramp or spasm.

The same is true of the smooth muscle in the vessels. Volume will stretch the muscle)

what two drugs would contribute to a hypovolemic state and may potentiate vasospasm.

mannitol and furosemide

A patient admitted with a subarachnoid

hemorrhage from an aneurysm has a sudden rise in

blood pressure. This change is of concern due to

the potential for

A. a cerebral artery occlusion

B. hydrocephalus

C. cerebral artery spasm

D. cerebral artery rebleeding

D. cerebral artery rebleeding

A patient is diagnosed with a brain contusion. Provide the best statement when giving information to

the family about the diagnosis. There is….

a bruise on the brain

Which of the following are common reasons for

patients with Guillain-Barre Syndrome

to be admitted to the critical care unit?

A. Urinary tract sepsis and heart failure

B. Urinary tract sepsis and acute respiratory failure

C. Aspiration and acute respiratory failure

D. Heart failure and aspiration

C. Aspiration and acute respiratory failure

A nurse is caring for a client who who has had a stroke involving the right hemisphere. Which of the following

alterations in function should the nurse expect?

A. Difficulty reading

B. Inability to recognize his family members

C. Right hemiparesis

D. Aphasia

B. Inability to recognize his family members

A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for

which of the following findings?

A. Poor impulse control

B. Unable to discriminate words and letters

C. Deficits in the right visual field

D. Motor retardation

A. Poor impulse control

A nurse is caring for a client who had a stroke involving the left cerebral hemisphere. The nurse should monitor for

which of the following findings?

A. Impaired sense of humor

B. Loss of depth perception

C. Poor judgment

D. Intellectual impairment

D. Intellectual impairment

A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after

stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of

198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the

following neurologic disorders should the nurse suspect?

A. Transient ischemic attack (TIA)

B. Hemorrhagic stroke

C. Thrombotic stroke

D. Embolic stroke

B. Hemorrhagic stroke

(Sudden onsets of symptoms )

manifestations of ICP include ?

bradycardia and HTN, vomiting and widened pulse

A nurse is monitoring a client who had a cerebral aneurysm rupture. Which of the following findings should the

nurse identify as a manifestation of increased intracranial pressure?

A. Hypotension

B. Tachycardia

C. Irritability

D. Tinnitus

C. Irritability

A nurse is caring for a client who has global aphasia. Which of the following actions should the nurse take?

A. Speak to the client about one idea at a time.

B. Ask the client to multi-task.

C. Limit questions to yes and no answers.

D. Focus on a single form of communication

A. Speak to the client about one idea at a time.

A nurse is caring for a client who has atrial fibrillation and is receiving heparin. Which of the following findings is

the nurse’s priority?

A. The client's ECG tracing shows irregular heart rate without P waves.

B. The client has an aPTT of 80 seconds.

C. The client experiences sudden weakness of one arm and leg.

D. The client's urine output is cloudy and odorous.

C. The client experiences sudden weakness of one arm and leg.

(greatest risk for stroke )