Deck 39: Coordinating Care for Critically Ill Patients With Neurological Dysfunction

Question 1

A patient recovering from an ischemic stroke is prescribed verapamil (Calan). The nurse teaches the patient that this medication works by which action?
1)Increases urination
2)Slows the heart rate
3)Lowers blood lipids
4)Decreases blood pressure

Answer 1

4

Question 2

In assessing a patient with increased intracranial pressure, the nurse notes that the patient's left pupil is larger than the right pupil. The nurse correlates the larger left pupil to compression of which cranial nerve?
1)Left optic nerve
2)Left oculomotor nerve
3)Right optic nerve
4)Right oculomotor nerve

Answer 2

2

Question 3

A patient in a barbiturate coma for increased intracranial pressure (ICP) has audible gurgling through the endotracheal tube. What should the nurse do first before suctioning this patient?
1)Administer 100% oxygen.
2)Elevate the head of the bed.
3)Interrupt sedative administration.
4)Place the head in a neutral position.

Answer 3

1

Question 4

A patient with a cerebral vasospasm is receiving triple H therapy. What parameter should the nurse use to determine adequacy of hemodilution?
1)Hemoglobin level 30 g/dL
2)Blood pressure 154/80 mm Hg
3)Serum sodium level less than 160 mg/dL
4)Serum potassium level between 4.0 and 4.5 mEq/L

Question 5

A patient with neurogenic shock is demonstrating vagal stimulation. What should the nurse expect to be prescribed for this patient?
1)Atropine
2)Epinephrine
3)Phenylephrine
4)Norepinephrine

Question 6

The nurse is preparing a patient for insertion of an intraventricular catheter intracranial pressure (ICP) monitoring device. What is an advantage of this device?
1)Must be inserted in the operating room
2)Catheter tip located in the lateral ventricle
3)Less mechanical drift of the measurement over time
4)Lower rate of infection because of no fluid reservoir

Question 7

A patient with a traumatic brain injury is leaking clear fluid from the nose. What action should the nurse take?
1)Collecting the fluid with gauze
2)Applying pressure over the bridge of the nose
3)Suctioning the nares
4)Inserting a nasal plug in the nostril leaking the fluid

Question 8

A patient is admitted with a stroke/brain attack. The nurse correlates which predisposing factor in the patient's history places as placing this patient at greatest risk for embolic stroke?
1)Immobility as a result of back injury
2)Seizure history
3)Carotid plaque
4)Deep vein thrombus (DVT) in subclavian vein

Question 9

The nurse correlates which finding in a patient's history as the highest risk for a stroke?
1)Body mass index 24.8
2)Heart rate 90 bpm
3)Blood pressure 182/90 mm Hg
4)Pulse oximetry 90% on room air

Question 10

The nurse is monitoring a patient who is receiving triple H therapy for vasospasm secondary to a subarachnoid hemorrhage. Which finding requires the nurse to immediately contact the healthcare provider?
1)Blood pressure 100/60
2)Heart rate 88
3)Glasgow Coma Scale score 13
4)Complaints of a headache

Question 11

The nurse is caring for a patient in a barbiturate coma for increased intracranial pressure (ICP). What should the nurse assess to determine this patient's cerebral function?
1)Gag reflex
2)Glasgow Coma Scale
3)Pupillary size and reaction
4)Blood pressure and heart rate

Question 12

In monitoring a trauma patient for shock, the nurse differentiates neurogenic shock from hypovolemic shock by correlating which parameters to neurogenic shock?
1)Tachycardia with increased afterload
2)Tachycardia with decreased afterload
3)Bradycardia with decreased afterload
4)Bradycardia with increased afterload

Question 13

A patient with increased intracranial pressure (ICP) is sensitive to fluid-volume shifts. The nurse recognizes which approach as safest to reduce this patient's cerebral edema?
1)Mannitol 2.3% sodium chloride
3)0.9% normal saline
4)Packed red blood cells

Question 14

A patient who suffered a thrombotic stroke has residual left lower extremity motor deficit and dysphagia. The nurse identifies which of the following as the priority nursing diagnosis?
1)High Risk for Impaired Skin Integrity
2)High Risk for Aspiration
3)High Risk for Injury: Falls
4)High Risk for Impaired Verbal Communication

Question 15

The nurse monitors for which clinical manifestation in the patient with neurogenic shock?
1)Tachycardia
2)Hypertension
3)Warm dry skin
4)Rapid shallow respirations

Question 16

Which is the best position for the nurse to place a patient with increased intracranial pressure (ICP) and decreased intracranial compliance?
1)Flat
2)Prone
3)Side-lying with the neck flexed
4)Semi-Fowler's with the neck in a neutral position

Question 17

The nurse is caring for a patient admitted for treatment of a subarachnoid hemorrhage caused by a cerebral aneurysm who has a wide neck and tortuous vascular anatomy. The patient is hemodynamically stable with Glasgow Coma Scale of 1
1)Aneurysm coiling
2)Aneurysm clipping
3)Reinforcing aneurysm wall
4) Based on this data, the patient is most likely to have which procedure?
4)Evacuation of the hematoma

Question 18

The nurse correlates which clinical manifestation in the patient diagnosed with a basilar skull fracture?
1)Hyperthermia
2)Episodic tachycardia
3)Bruising around the ears
4)Rapid deterioration to comatose

Question 19

In monitoring a patient with increased intracranial pressure (ICP) who is mechanically ventilated, the nurse correlates which arterial blood gas value to effective management of the increased ICP?
1)pH 7.32
2)PaCO₂ 32 mm Hg
3)PaO₂ 85 mm Hg
4)HCO₃^- 22 mEq/L

Question 20

The nurse recognizes that which disease process places the patient at the greatest risk for neurogenic shock?
1)Cerebral artery aneurysm
2)Cervical spine injury
3)Left embolic stroke
4)Epidural hematoma

Question 21

A patient with an ischemic stroke is being considered for recombinant tissue plasminogen activator (rt-PA). The nurse recognizes which factors as contraindications to this treatment? Select all that apply.
1)Age 83 years
2)Symptoms present for 45 minutes
3)Computed tomography (CT) scan demonstrates area of ischemia 4.10-year history of type 2 diabetes mellitus
5)Takes warfarin sodium for atrial fibrillation

Question 22

A patient is demonstrating signs of increasing intracranial pressure (ICP). Which nursing actions are indicated to decrease ICP? Select all that apply.
1)Placing the head in a neutral position
2)Turning into a left side-lying position
3)Raising the head of the bed 60 degrees
4)Elevating the foot of the bed 45 degrees
5)Placing supine with a pillow under the head

Question 23

The nurse monitors for which clinical manifestations in the patient experiencing an ischemic stroke of the basilar artery? Select all that apply.
1)Ataxia
2)Nausea
3)Dysphasia
4)Inability to swallow
5)Difficulty with speech

Question 24

A patient with neurogenic shock has a sustained heart rate of 38 beats per minute. Based on this observation, for what should the nurse prepare the patient?
1)Intravenous fluids
2)Pacemaker insertion
3)Cardiac catheterization
4)Arterial blood gas analysis

Question 25

A patient is being discharged after treatment for an ischemic stroke. Which medications does the nurse correlate with this management of this neurological disorder? Select all that apply.
1)Antibiotics
2)Anticoagulants
3)Antihypertensives
4)Antiplatelet therapy
5)Lipid-lowering agent

Question 26

A patient has an intracranial pressure measurement of 22 mm Hg and blood pressure of 174/88 mm Hg. What is the patient's cerebral perfusion pressure?

Question 27

The nurse is caring for a patient with hypotension caused by neurogenic shock. What action should the nurse take to reduce the risk of developing orthostatic hypotension?
1)Raising the head of the bed slowly
2)Elevating the foot of the bed 30 degrees
3)Placing in the supine position with the head flat
4)Keeping the head of the bed elevated at 60 degrees

Question 28

The nurse provides care to a patient who is prescribed a continuous infusion of propofol (Diprivan) at 20 mcg/kg/min. The patient's current weight is 110 lbs. (50 kg). The patient receives ____________________ mcg/min.

Question 29

Which questions does the nurse ask when conducting an expanded assessment to determine patient orientation? Select all that apply.
1)"What is your name?"
2)"What state are you in right now?"
3)"What is today's date?"
4)"What are names of your children?"
5)"What kind of place are we in right now?"

Question 30

The nurse contacts the healthcare provider with data collected from a patient admitted for a stroke. Which information indicates the patient may be experiencing central herniation? Select all that apply.
1)Posturing
2)Bradycardia
3)Positive Babinski reflex
4)Unilateral dilated pupil
5)Increased systolic blood pressure