Deck 18: Neurologic Disorders and Therapeutic Management

Question 1

Nursing management of a patient with a clipped cerebral aneurysm receiving hypertensive hypervolemic hemodilution therapy includes

A) administering osmotic diuretics and vasodilator agents.
B) providing the patient with a quiet environment.
C) maintaining the patient's systolic blood pressure at 150 to 160 mm Hg.
D) keeping the patient's central venous pressure at 5 to 8 mm Hg.

Answer 1

maintaining the patient's systolic blood pressure at 150 to 160 mm Hg.

Question 2

A patient who has experienced a right-sided stroke with hemiagnosia may experience

A) reading the right side of the newspaper only.
B) denying ownership of the right side of the body.
C) being hyperresponsive when approached on the right side.
D) attempting to comb the hair with a toothbrush.

Answer 2

denying ownership of the right side of the body.

Question 3

Corneal epithelial breakdown in the coma patient is prevented by instillation of saline or methylcellulose lubricating eyedrops every

A) 2 hours.
B) 4 hours.
C) 8 hours.
D) 12 hours.

Answer 3

2 hours.

Question 4

A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.Based on the type of stroke she experienced, which of the following signs and symptoms might she exhibit?

A) Right-sided hemiplegia and receptive aphasia
B) Left-sided hemiplegia and tactile agnosia
C) Decorticate posturing and unequal pupils
D) Unilateral neglect and dressing apraxia

Question 5

When an object is placed in the hand of a patient with neurologic impairment during assessment, the patient is unable to recognize the placement.This is termed tactile

A) homonymous hemianopsia.
B) aphasia
C) agnosia.
D) apraxia.

Question 6

Surgical placement of a ventriculoperitoneal shunt is used to treat

A) hyponatremia.
B) intracerebral hemorrhage.
C) spontaneous intracerebral hemorrhage.
D) hydrocephalus.

Question 7

Which statement is true regarding the occurrence of SAHs?

A) Greater occurrence in men than women younger than the age of 40 years old
B) Greater occurrence in men than women older than the age of 40 years old
C) 90% of SAHs are caused by traumatic injury
D) Hemorrhage from SAHs have a better survival rate than hemorrhage from AVM

Question 8

A patient presents with aphasia, decreased level of consciousness, and right-sided weakness.The patient has a history of heart disease, hyperlipidemia, and transient ischemic attacks.Based on the history, the nurse suspects that the patient has sustained which type of stroke?

A) Hemorrhagic stroke
B) Intracerebral hemorrhages
C) Subarachnoid hemorrhages
D) Ischemic stroke

Question 9

Appropriate therapy for ischemic stroke depends on rapid completion of which diagnostic study?

A) Magnetic resonance imaging
B) Noncontrast computed tomography
C) Contrast computed tomography
D) Lumbar puncture

Question 10

The stroke patient who has difficulty with speech has

A) expressive aphasia.
B) global aphasia
C) receptive aphasia.
D) apraxia.

Question 11

One of the pathologic consequences of an unruptured cerebral aneurysm is that it can

A) shunt blood away from the surrounding tissues.
B) leak blood into the subarachnoid space.
C) damage the middle layer of the arterial wall.
D) place pressure on the surrounding tissues.

Question 12

Causes of metabolic coma include

A) trauma.
B) ischemic stroke.
C) drug overdose.
D) intracerebral hemorrhage.

Question 13

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

A) Decorticate posturing
B) Absent pupillary light reflexes
C) Decerebrate posturing
D) Central hyperventilation

Question 14

Emergency treatment of coma of unknown cause includes rapid intravenous administration of which three agents?

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 15

Which of the following patients has the best prognosis based on the cause of coma?

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

Question 16

A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.Patient assessment includes T 98.7°F, P 98 beats/min and thready, R 8 breaths/min, and BP 168/100 mm Hg.The patient's initial treatment plan should involve

A) placing her in the Trendelenburg position.
B) administering an antihypertensive agent.
C) initiating induced hypertensive therapy.
D) intubation to support airway and breathing.

Question 17

Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA)is now recommended for the management of ischemic stroke if administration can be instituted within how many hours of onset of stroke symptoms?

A) 1
B) 4
C) 6
D) 10

Question 18

Which of the following statements regarding Guillain-Barré syndrome supports the admission to a critical care unit?

A) The demyelination process of the peripheral nerves is irreversible.
B) The demyelination process is limited to the peripheral nervous system only.
C) The paralysis associated with the syndrome occurs in a descending pattern.
D) The most common cause of death is from respiratory arrest.

Question 19

Which of the nursing diagnoses and interventions has the highest priority while treating a patient with GBS?

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 20

The incidence of rebleeding after a ruptured cerebral aneurysm is highest during which of the following time periods?

A) First 24 hours
B) 4 to 12 days
C) 3 to 4 weeks
D) 3 to 6 months

Question 21

Which of the following independent nursing measures can assist in reducing increased ICP?

A) Decreasing the ventilator rate
B) Decreasing noxious stimuli
C) Frequent orientation checks
D) Administration of loop diuretics

Question 22

One of the earliest and most important signs of increased ICP is

A) Cushing triad.
B) decerebrate posturing (abnormal extension).
C) a decrease in the level of consciousness.
D) an increase in pupillary size.

Question 23

After neurosurgery, the patient is at the greatest risk of developing

A) injury from falls.
B) infection.
C) seizures.
D) corneal abrasions.

Question 24

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

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

Question 25

The target range for PaCO₂ when using hyperventilation to lower ICP is

A) 25 to 30 mm Hg.
B) 25 to 35 mm Hg.
C) 35 to 40 mm Hg.
D) 35 ± 2 mm Hg.

Question 26

A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.While assisting the patient with her personal care, it is noted that she is unable to comb her hair with her left hand.The patient may have

A) agnosia.
B) apraxia.
C) Broca aphasia.
D) Wernicke aphasia.

Question 27

A fast-acting, short-duration agent used for breakthrough seizures is

A) lorazepam (Ativan).
B) phenytoin (Dilantin).
C) phenobarbital.
D) midazolam (Versed).

Question 28

A patient returns from surgery for removal of a pituitary tumor that has not extended into the intracranial vault.The nurse observes a large amount of clear drainage from the nose.The nurse expects the physician to order a glucose test of the drainage to confirm

A) that infection has not occurred.
B) that a shift in osmolality has not occurred.
C) that the drainage is postoperative serous drainage.
D) that the drainage is CSF from a cerebrospinal leak.

Question 29

The osmotic diuretic that has been most effective in the reduction of increased ICP is

A) mannitol.
B) furosemide (Lasix).
C) urea.
D) glycerol.

Question 30

Which patient position is optimal to prevent elevated ICP pressures?

A) The head of the bed elevated 30 to 40 degrees
B) Supine with the patient's neck in a neutral alignment
C) Individualized head position to maximize cerebral perfusion pressure and minimize ICP measurements
D) The head of the bed elevated with flexion of the hips

Question 31

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

A) Sedatives
B) Analgesics
C) Barbiturates
D) Hyperventilation

Question 32

Which of the following is the most common complication after high-dose barbiturate therapy?

A) Hypothermia
B) Hypotension
C) Myocardial depression
D) Decreased CVP

Question 33

A patient is admitted to the critical care unit with an acute head injury after a motor vehicle accident.The patient has a Glasgow Coma Scale score of 6.The patient is intubated and ventilated, and a ventriculostomy is placed with physician orders to keep the ICP less than 15 mm Hg.The patient's ICP continues to rise despite aggressive intervention.Which of the following is an advantage of a ventriculostomy ICP monitoring system?

A) Lower risk of infection
B) Ease of insertion
C) No penetration of brain
D) Access for cerebrospinal fluid drainage and sampling

Question 34

The most common drug(s)used in high-dose barbiturate therapy are

A) Dilantin and Cerebyx.
B) mannitol and nimodipine.
C) Dilantin and phenobarbital.
D) pentobarbital and thiopental.

Question 35

A patient's ICP is 34 mm Hg, and his cerebral perfusion pressure is 65 mm Hg.Which of the following is the most appropriate intervention?

A) These are normal values, and no interventions are required.
B) Administer mannitol 1 to 2 g/kg IV.
C) Have the patient lie flat in bed.
D) Suction the patient to see if improving his airway will help his ICP.

Question 36

Which nursing interventions will help prevent sharp spikes in ICP and surgical hemorrhage?

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 37

A patient has been experiencing drowsiness, confusion, and slight focal deficits for 3 days.The CT report findings are negative.The patient is being prepared for a lumbar puncture.The nurse anticipates that the CSF would appear

A) cloudy.
B) bloody.
C) xanthochromic.
D) clear.

Question 38

Which of the following medications is prescribed to decrease cerebral vasospasm?

A) Phenytoin (Dilantin)
B) Phenobarbital
C) Nimodipine (Nimotop)
D) Vecuronium (Norcuron)

Question 39

A patient becomes flaccid with fixed and dilated pupils.The patient's ICP falls from 65 to 12 mm Hg.What should the nurse suspect is happening?

A) The patient is having a seizure.
B) The patient's brain has herniated.
C) The patient's cerebral edema is resolving.
D) The patient is excessively dehydrated from the mannitol.

Question 40

Downward displacement of the hemispheres, basal ganglia, and diencephalon through the tentorial notch is indicative of

A) central herniation.
B) uncal herniation.
C) cingulate herniation.
D) infratentorial herniation.

Question 41

Nonencapsulated tumors tend to infiltrate brain tissue.These tumors can arise in any part of brain connective tissue and infiltrate primarily cerebral hemisphere tissue.These tumors grow rapidly and are difficult to excise completely.The tumors described are classified as

A) angiomas.
B) pituitary adenomas.
C) meningiomas.
D) gliomas.

Question 42

Complications associated with craniotomy include

A) diabetes mellitus.
B) fluid retention.
C) intracranial hypotension.
D) surgical hemorrhage.

Question 43

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

A) Aphasia
B) Left visual field defect
C) Difficulty balancing his checkbook
D) Ataxic gait
E) Somnolence

Question 44

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?

A) Aspirin
B) Sodium nitroprusside
C) Warfarin
D) Labetalol
E) Any antiplatelet drugs