Question 1

What sites can be used for monitoring intracranial pressure (ICP)?

Accepted Answer

The five sites for monitoring intracranial pressure are (1)the intraventricular space,(2)the subarachnoid space,(3)the epidural space,(4)the subdural space,and (5)the parenchyma.

Question 2

The patient was admitted with a head injury and an intracranial pressure (ICP)monitoring device was placed.The nurse knows to notify the practitioner if what type of wave start to appear on the monitor?

Accepted Answer

A waves are the most clinically significant of the three types.They usually occur in an already elevated baseline intracranial pressure (ICP)(>20 mm Hg)and are characterized by sharp increases in ICP of 30 to 69 mm Hg,which plateau for 2 to 20 minutes and then return to baseline.B waves appear to reflect fluctuations in cerebral blood.C waves are small,rhythmic waves that occur every 4 to 8 minutes at normal levels of ICP.They are related to normal fluctuations in respiration and systemic arterial pressure.

Question 3

Which statements are correct regarding the assessment of motor function in the neurologically impaired patient?

Accepted Answer

The presence of a Babinski response in an adult is indicative of neurologic dysfunction,pushing or pulling against resistance tests muscle strength not tone,and deep tendon reflexes are not routinely checked by the critical care nurse during assessment.

Question 4

Indications for the use of electroencephalography (EEG)include

Accepted Answer

Indications for the use of electroencephalography include suspected seizure activity,cerebral infarct,metabolic encephalopathies,altered consciousness,infectious disease,some head injuries,and confirmation of brain death.

Question 5

A patient is being prepared for a neurologic work-up.The practitioner is getting ready to perform a lumbar puncture.What is the best position for the nurse to place the patient in for the procedure?

Accepted Answer

Patients undergoing a lumbar puncture are placed either in the lateral recumbent position,with the knees and head tightly tucked,or in the sitting position,leaning over a bedside table or some other support.

Question 6

According to the 2007 Brain Trauma Foundation guidelines,the recommended CPP range is:

Accepted Answer

The 2007 Brain Trauma Foundation guidelines now recommend a cerebral perfusion pressure (CPP)in the range of 50 to 70 mm Hg and consideration of cerebral autoregulation status when selecting a CPP target in a specific patient.

Question 7

The nurse and a new graduate nurse are caring for a comatose patient on continuous electroencephalography (cEEG)monitor.The new graduate says "This monitor is great.How come we don't use it on all the neuro patients?" What are the drawbacks to using this type of monitor?

Accepted Answer

The drawbacks to the use of continuous electroencephalography (cEEG)are that it is an expensive,labor-intensive program that requires expertise for interpretation,and is subject to artifacts from the intensive care unit environment.More research on cEEG is needed to determine its cost-saving potential and impact on outcome.

Question 8

A critical care patient is diagnosed with massive head trauma.The patient is receiving brain tissue oxygen pressure (PbtO₂)monitoring.The nurse recognized that the goal of this treatment is to maintain PbtO₂:

Accepted Answer

In a patient with head injury,the goal of treatment is to maintain the PbtO₂ greater than 20 mm Hg.Factors that decrease PbtO₂ include tissue hypoxia,hypocapnia,hypovolemia,decreased blood pressure,low hemoglobin levels,intracranial hypertension,and hyperthermia.Treatment is directed at the underlying cause.

Question 9

The patient's intracranial pressure (ICP)reading has gradually climbed from 15 to 23 mm Hg.The nurse's primary action is to:

Accepted Answer

Under normal physiologic conditions,mean intracranial pressure (ICP)is maintained below 15 mm Hg.An increase in ICP can decrease blood flow to the brain,causing brain damage.Persistent ICP elevation above 20 mm Hg remains the most significant factor associated with a fatal outcome.

Quiz 22: Neurologic Clinical Assessment and Diagnostic Procedures

What sites can be used for monitoring intracranial pressure (ICP) ?

The patient was admitted with a head injury and an intracranial pressure (ICP) monitoring device was placed.The nurse knows to notify the practitioner if what type of wave start to appear on the monitor?

Which statements are correct regarding the assessment of motor function in the neurologically impaired patient?

Indications for the use of electroencephalography (EEG) include

A patient is being prepared for a neurologic work-up.The practitioner is getting ready to perform a lumbar puncture.What is the best position for the nurse to place the patient in for the procedure?

According to the 2007 Brain Trauma Foundation guidelines,the recommended CPP range is:

The nurse and a new graduate nurse are caring for a comatose patient on continuous electroencephalography (cEEG) monitor.The new graduate says "This monitor is great.How come we don't use it on all the neuro patients?" What are the drawbacks to using this type of monitor?

A critical care patient is diagnosed with massive head trauma.The patient is receiving brain tissue oxygen pressure (PbtO₂) monitoring.The nurse recognized that the goal of this treatment is to maintain PbtO₂:

The patient's intracranial pressure (ICP) reading has gradually climbed from 15 to 23 mm Hg.The nurse's primary action is to: