Question 1

A patient with a traumatic brain injury being mechanically ventilated is prescribed propofol. What should the nurse identify as an advantage of using this medication? Select all that apply.

Accepted Answer

1. Propofol is a medication that decreases ICP.
2. Propofol does not reverse cerebral edema.
3. Propofol does not affect electrolyte levels.
4. Propofol allows less use of benzodiazepines.
5. One advantage of propofol is that the dose can be lowered, and within about 10 minutes an accurate neurological assessment can be obtained.

Question 2

What might a patient develop if intravenous phenytoin (Dilantin) is administered faster than 50 mg/minute?

Accepted Answer

1. A severe rash would not immediately occur.
2. Phenytoin is administered no faster than 25 to 50 mg/min, because faster administration may result in bradycardia, hypotension, heart block, and ventricular fibrillation.
3. Hematologic abnormalities would not occur immediately.
4. Bradycardia, heart block, and ventricular fibrillation can occur.

Question 3

A patient has been receiving treatment for status epilepticus for the last 20 minutes. What should the nurse prepare to implement at this time? Select all that apply.

Accepted Answer

1. If the seizure continues beyond 20 to 30 minutes, the patient should be intubated.
2. If the seizure continues beyond 20 to 30 minutes, the patient should have an indwelling urinary catheter inserted.
3. If the seizure continues beyond 20 to 30 minutes, the nurse should monitor the patient's body temperature.
4. If the seizure continues beyond 20 to 30 minutes, an electroencephalogram should be obtained.
5. An intravenous access line would have been placed earlier for the administration of intravenous medication.

Question 4

A patient demonstrates neurologic changes consistent with increasing intracranial pressure. For which primary cause of this pressure increase should the nurse assess at this time? Select all that apply.

Accepted Answer

1. Cerebral hemorrhage is a primary cause of increased intracranial pressure.
2. Ischemic stroke is a primary cause of increased intracranial pressure.
3. Airway obstruction is a secondary cause of increased intracranial pressure.
4. Hypotension is a secondary cause of increased intracranial pressure.
5. Electrolyte imbalances indicate metabolic disorders, which are secondary causes of increased intracranial pressure.

Question 5

During an assessment, the nurse notes that the left pupil of a patient with a traumatic brain injury is larger than the right pupil. What action should the nurse take at this time?

Accepted Answer

1. One pupil larger than the other is termed anisocoria and can indicate that ICP is higher than 20 mm Hg. Coughing should be avoided.
2. One pupil larger than the other is termed anisocoria and can indicate that ICP is higher than 20 mm Hg. The patient's head should be elevated.
3. One pupil larger than the other is termed anisocoria and can indicate that ICP is higher than 20 mm Hg. Raising the head of the bed will help reduce ICP.
4. One pupil larger than the other is termed anisocoria and can indicate that ICP is higher than 20 mm Hg. The Valsalva maneuver will increase ICP and should be avoided.

Question 6

What action should the nurse take when administering hypertonic saline to a patient with increased intracranial pressure (ICP)? Select all that apply.

Accepted Answer

1. Renal failure and pulmonary edema can occur from this fluid.
2. A solution greater than 2% should be administered through a central line.
3. Serum sodium levels should be frequently monitored during the administration of this fluid.
4. The patient's neurologic status and intracranial pressure level will improve within 15 minutes following the administration of this fluid.
5. Serum osmolarity should be measured at least every 12 hours and maintained at less than 320 mOsm/L.

Question 7

A patient with acute meningitis receives antibiotic therapy. The nurse notes that another medication is used as adjuvant therapy. Which medication is being used as an adjuvant for this patient?

Accepted Answer

1. Anticonvulsants are not used as adjuvant therapy for meningitis.
2. Steroids are currently recommended as adjunctive treatment of bacterial meningitis. Dexamethasone is believed to interrupt the neurotoxic effects resulting from the lysis of bacteria during the first days of antibiotic use. When steroids are given, they should be administered prior to or during the administration of antibiotics on the first 2 days of therapy.
3. Barbiturates are not used as adjuvant therapy for meningitis.
4. Pain medication is not used as adjuvant therapy for meningitis.

Question 8

A patient recovering from otitis media develops meningitis. What should the nurse expect to assess in this patient? Select all that apply.

Accepted Answer

1. Fever is a manifestation of meningitis.
2. A stiff neck or nuchal rigidity is a manifestation of meningitis.
3. A change in mental status is a manifestation of meningitis.
4. Photophobia is a manifestation of meningitis.
5. Palpitations are not manifestations of meningitis.

Question 9

A patient with a traumatic brain injury is diagnosed with an acute subdural hematoma. What should the nurse expect to assess in this patient? Select all that apply.

Accepted Answer

1. Loss of consciousness is a manifestation of acute subdural hematoma.
2. Hemiparesis is a manifestation of acute subdural hematoma.
3. Dysphagia is a manifestation of acute subdural hematoma.
4. Confusion is a manifestation of chronic subdural hematoma.
5. Headache is a manifestation of chronic subdural hematoma.

Question 10

The nurse cares for a patient with status epilepticus. What should be the first goal of care for this patient?

Accepted Answer

1. This is not the first priority for this patient.
2. This is not the first priority for this patient.
3. The first priority in status epilepticus is airway and oxygenation. For some patients, a nasopharyngeal airway is sufficient with provision of oxygen by nasal cannula. For other patients, endotracheal intubation is necessary.
4. This is not the first priority for this patient.

Question 11

The nurse identifies interventions to address the potential problem of increasing intracranial pressure for a victim of a house fire. For which secondary causes is the nurse planning care for this patient? Select all that apply.

Accepted Answer

1. Stroke is a common brain disorder that causes increased intracranial pressure.
2. Hypoxia is a secondary cause of increased intracranial pressure. Since the patient was in a house fire, this health problem could occur.
3. Hypercarbia is a secondary cause of increased intracranial pressure. Since the patient was in a house fire, this health problem could occur.
4. Hyperthermia is a secondary cause of increased intracranial pressure. Since the patient was in a house fire, this health problem could occur.
5. Spinal cord injury is not an identified cause for increased intracranial pressure.

Question 12

While a nasogastric tube is being inserted, a patient begins to cough and gag. What cranial nerves did the nurse inadvertently assess when inserting the nasogastric tube into the patient? Select all that apply.

Accepted Answer

1. This nerve is intact when the patient exhibits the cough and gag reflex.
2. This nerve is intact when the patient exhibits the cough and gag reflex.
3. This nerve is used to assess for the corneal reflex.
4. This nerve is used to assess for the corneal reflex.
5. This nerve is used to assess pupillary response.

Question 13

A patient with meningitis develops hypotension and tachycardia. What action should the nurse take? Select all that apply.

Accepted Answer

1. Waterhouse-Friderichsen syndrome is an adrenal hemorrhage that results in adrenal insufficiency, hypotension, and circulatory collapse. The health care provider should be notified.
2. Waterhouse-Friderichsen syndrome is an adrenal hemorrhage that results in adrenal insufficiency, hypotension, and circulatory collapse. A complete neurological assessment would not need to be completed at this time.
3. Waterhouse-Friderichsen syndrome is an adrenal hemorrhage that results in adrenal insufficiency, hypotension, and circulatory collapse. It is treated with supportive therapy.
4. The patient most likely will not need to be intubated.
5. Waterhouse-Friderichsen syndrome is an adrenal hemorrhage that results in adrenal insufficiency, hypotension, and circulatory collapse. It is treated with immediate replacement of adrenal corticosteroids.

Question 14

When administering mannitol (Osmitrol) to a patient with increased intracranial pressure (ICP), what action should the nurse take?

Accepted Answer

1. The reduction in intracranial pressure would begin almost immediately.
2. Mannitol can cause hypotension.
3. Hyponatremia and hypokalemia can occur with this medication.
4. Mannitol increases the osmolality of the blood with optimal osmolality between 300 and 320 mOsm. If repeated doses of mannitol are given, the nurse monitors the serum osmolality every 4 to 6 hours and ensures that it remains less than 320 mOsm.

Question 15

The nurse is concerned that a patient's intracranial pressure monitor readings are incorrect. What should the nurse do to ensure that the monitor is measuring accurately? Select all that apply.

Accepted Answer

1. One reason for inaccurate intracranial pressure readings would be an incorrect position of the stopcocks.
2. One reason for inaccurate intracranial pressure readings would be an incorrect position of the transducer.
3. One reason for inaccurate intracranial pressure readings would be air in the monitoring line.
4. One reason for inaccurate intracranial pressure readings would be the catheter being obstructed.
5. The condition of the dressing will not impact the accuracy of intracranial pressure readings.

Question 16

A patient diagnosed with a subdural hematoma has an intracranial pressure of 14 mm Hg. What body effect should the nurse expect if this pressure increases? Select all that apply.

Accepted Answer

1. According to the Munro Kelly hypothesis, intracranial pressure is kept between 5 to 15 mm Hg by a mechanism known as compliance. When the volume of one of the components increases, the body may respond by displacing cerebrospinal fluid into the lumbar cistern.
2. According to the Munro Kelly hypothesis, intracranial pressure is kept within a range between 5 to 15 mm Hg by a mechanism known as compliance. When the volume of one of the components increases, the body may respond by reabsorbing more cerebrospinal fluid.
3. According to the Munro Kelly hypothesis, intracranial pressure is kept within a range between 5 to 15 mm Hg by a mechanism known as compliance. When the volume of one of the components increases, the body may respond by compressing veins and shunting blood out of the venous sinuses.
4. Elevating the body temperature is not controlled by the compliance mechanism.
5. Increasing the carbon dioxide level is not controlled by the compliance mechanism.

Question 17

The nurse teaches a patient recovering from a mild brain injury about manifestations to expect during the recovery process. What should the nurse instruct this patient to expect while recuperating from this injury? Select all that apply.

Accepted Answer

1. Problems experienced by patients with mild brain injuries include headache.
2. Problems experienced by patients with mild brain injuries include dizziness.
3. Problems experienced by patients with mild brain injuries include fatigue.
4. Problems experienced by patients with mild brain injuries include memory loss.
5. Nausea is not a problem experienced by patients with mild brain injuries.

Question 18

The nurse prepares medications for a patient with status epilepticus. What should the nurse identify as the medication of choice for this patient?

Accepted Answer

1. A barbiturate is not the medication of choice for a patient experiencing status epilepticus.
2. A steroid is not the medication of choice for a patient experiencing status epilepticus.
3. An opioid is not the medication of choice for a patient experiencing status epilepticus.
4. The initial drug of choice is a benzodiazepine, usually lorazepam administered at the rate of 2 to 4 mg IV over 1 minute because it terminates seizures 60% to 80% of the time. The dose may be repeated after 5 to 10 minutes if the seizure has not stopped.

Quiz 10: Care of the Patient Experiencing an Intracranial Dysfunction