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?

Accepted Answer

D

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?

Accepted Answer

The left oculomotor nerve (cranial nerve III) controls pupil constriction. Compression of this nerve can lead to a dilated or non-responsive pupil on the affected side, which in this case is the left side.

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?

Accepted Answer

Administering 100% oxygen before suctioning is a standard practice to prevent hypoxia during the brief period when the airway is obstructed by the suction catheter.

Question 4

A patient with a cerebral vasospasm is receiving triple H therapy. What parameter should the nurse use to determine adequacy of hemodilution?

Accepted Answer

Hemodilution is part of triple H therapy (hypertension, hypervolemia, hemodilution) used to treat cerebral vasospasm. The goal is to reduce blood viscosity to improve cerebral blood flow. Adequacy of hemodilution is determined by monitoring hemoglobin levels, aiming for a lower level to ensure the blood is sufficiently diluted. However, the hemoglobin level of 30 g/dL mentioned in option A is incorrect as it is far too high and likely a typographical error. In clinical practice, a target hemoglobin level would be lower, typically around 30-35% hematocrit or a hemoglobin level of around 10 g/dL, to ensure adequate dilution without compromising oxygen-carrying capacity. The other options (B, C, D) are not direct indicators of hemodilution adequacy.

Question 5

A patient with neurogenic shock is demonstrating vagal stimulation. What should the nurse expect to be prescribed for this patient?

Accepted Answer

Atropine is used to treat bradycardia (slow heart rate) that can result from vagal stimulation, which is a common issue in neurogenic shock. It works by blocking the action of the vagus nerve on the heart, thereby increasing heart rate.

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?

Accepted Answer

The catheter tip being located in the lateral ventricle allows for direct measurement of intracranial pressure and also enables therapeutic cerebrospinal fluid drainage.

Question 7

A patient with a traumatic brain injury is leaking clear fluid from the nose. What action should the nurse take?

Accepted Answer

The clear fluid leaking from the nose could be cerebrospinal fluid (CSF), indicating a skull fracture. Collecting the fluid with gauze can help in testing it for CSF, which is important for diagnosis and further management. Applying pressure, suctioning, or inserting a plug could potentially worsen the injury or increase intracranial pressure.

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?

Accepted Answer

Carotid plaque can lead to embolic strokes by breaking off and traveling to the brain, causing a blockage in the blood supply.

Question 9

The nurse correlates which finding in a patient's history as the highest risk for a stroke?

Accepted Answer

High blood pressure (hypertension) is a major risk factor for stroke. A blood pressure reading of 182/90 mm Hg is significantly elevated, increasing the risk for both ischemic and hemorrhagic strokes.

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?

Accepted Answer

Triple H therapy involves hypertension, hypervolemia, and hemodilution to prevent vasospasm. A blood pressure of 100/60 may indicate inadequate hypertension, which could compromise cerebral perfusion, requiring immediate attention.

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?

Accepted Answer

The answer of The nurse is caring for a patient...

Question 12

In monitoring a trauma patient for shock, the nurse differentiates neurogenic shock from hypovolemic shock by correlating which parameters to neurogenic shock?

Accepted Answer

Neurogenic shock is characterized by bradycardia and decreased afterload due to the loss of sympathetic tone, leading to vasodilation.

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?

Accepted Answer

The answer of A patient with increased intracranial pressure (ICP)...

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?

Accepted Answer

The presence of dysphagia significantly increases the patient's risk for aspiration, which can lead to aspiration pneumonia, a potentially life-threatening condition. Therefore, addressing this risk is a priority in the nursing care plan.

Question 15

The nurse monitors for which clinical manifestation in the patient with neurogenic shock?

Accepted Answer

Neurogenic shock is characterized by the loss of sympathetic tone, leading to vasodilation. This results in warm, dry skin due to blood pooling in the extremities, unlike the cool, moist skin seen in other types of shock.

Question 16

Which is the best position for the nurse to place a patient with increased intracranial pressure (ICP) and decreased intracranial compliance?

Accepted Answer

Semi-Fowler's position with the neck in a neutral position is recommended for patients with increased intracranial pressure (ICP) and decreased intracranial compliance. This position facilitates venous drainage from the brain, potentially lowering ICP and improving cerebral perfusion.

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 14. Based on this data, the patient is most likely to have which procedure?

Accepted Answer

Aneurysm clipping is often preferred for wide-necked aneurysms and those with tortuous vascular anatomy, as it allows for direct access and secure closure of the aneurysm.

Question 18

The nurse correlates which clinical manifestation in the patient diagnosed with a basilar skull fracture?

Accepted Answer

Bruising around the ears, also known as Battle's sign, is a classic sign of a basilar skull fracture.

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?

Accepted Answer

A lower PaCO2 level (such as 32 mm Hg) helps reduce intracranial pressure by causing cerebral vasoconstriction, which decreases cerebral blood flow and subsequently reduces ICP.

Question 20

The nurse recognizes that which disease process places the patient at the greatest risk for neurogenic shock?

Accepted Answer

Cervical spine injury places the patient at the greatest risk for neurogenic shock due to potential disruption of the autonomic pathways, leading to a loss of sympathetic tone and unopposed parasympathetic activity.

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

A patient recovering from an ischemic stroke is prescribed verapamil (Calan) . The nurse teaches the patient that this medication works by which action?