, Question 1
A patient with an external ventricular drain for a severe traumatic brain injury
has an ICP of 24 mmHg and a MAP of 78 mmHg. Which intervention should
the nurse anticipate first?
A. Administer mannitol 1 g/kg IV bolus
B. Elevate the head of the bed to 30 degrees
C. Perform a cerebrospinal fluid drainage of 5 mL
D. Hyperventilate the patient to a PaCO2 of 28 mmHg
Correct Answer: C - Perform a cerebrospinal fluid drainage of 5
mL
RATIONALE
The CPP is 54 mmHg (MAP - ICP), which is below the recommended
target of 60-70 mmHg, so CSF drainage directly reduces ICP and
improves CPP. Mannitol is second-line after CSF drainage and
requires adequate renal function and serum osmolality monitoring, and
hyperventilation is only a temporary bridge for herniation because it
risks ischemia.
Question 2
Which finding in a patient receiving mechanical ventilation for acute
respiratory distress syndrome indicates that lung-protective ventilation goals
are being met?
A. Tidal volume of 8 mL/kg predicted body weight and plateau pressure
of 32 cm H2O
B. Tidal volume of 6 mL/kg predicted body weight and plateau pressure
of 28 cm H2O
C. Tidal volume of 10 mL/kg predicted body weight and plateau pressure
of 30 cm H2O
D. Tidal volume of 6 mL/kg predicted body weight and plateau pressure
of 35 cm H2O
Page 2
,Correct Answer: B - Tidal volume of 6 mL/kg predicted body
weight and plateau pressure of 28 cm H2O
RATIONALE
Lung-protective ventilation targets 4-6 mL/kg predicted body weight
and plateau pressure 30 cm H2O to reduce ventilator-induced lung
injury. Option A uses a higher tidal volume, and options C and D
exceed the plateau pressure limit, increasing barotrauma risk.
Question 3
A patient with a cervical spinal cord injury at C5 suddenly develops
bradycardia, hypotension, and warm flushed skin. Which pathophysiologic
mechanism explains these findings?
A. Loss of sympathetic outflow causing unopposed vagal tone and
vasodilation
B. Excessive parasympathetic stimulation from vagus nerve injury
C. Increased systemic vascular resistance from catecholamine surge
D. Impaired venous return due to loss of skeletal muscle pump
Correct Answer: A - Loss of sympathetic outflow causing
unopposed vagal tone and vasodilation
RATIONALE
Neurogenic shock after high cervical injury results from disruption of
sympathetic pathways, leading to unopposed vagal tone (bradycardia)
and loss of vasoconstriction (hypotension, warm dry skin). Options B,
C, and D do not describe the classic triad of neurogenic shock.
Question 4
Which assessment finding is most concerning for impending herniation in a
patient with an acute ischemic stroke?
A. A unilateral dilated pupil with decreased level of consciousness
B. A new onset of mild headache relieved by acetaminophen
Page 3
, C. A blood pressure of 180/100 mmHg with no neurologic change
D. A transient episode of confusion that resolves within 10 minutes
Correct Answer: A - A unilateral dilated pupil with decreased
level of consciousness
RATIONALE
A unilateral fixed and dilated pupil with decreased LOC indicates
uncal herniation from rising ICP and requires immediate intervention.
The other findings are either expected, manageable, or transient and
do not indicate herniation.
Question 5
A patient with sepsis has a lactate of 4.2 mmol/L, MAP of 58 mmHg, and has
received 30 mL/kg of crystalloid. Which vasopressor is the first-line agent
according to the Surviving Sepsis Campaign?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
Correct Answer: B - Norepinephrine
RATIONALE
Norepinephrine is the first-line vasopressor for septic shock because it
effectively increases MAP with fewer arrhythmias than dopamine.
Vasopressin is added as a second agent, and phenylephrine is not
preferred due to potential reduction in cardiac output.
Question 6
Which medication should the nurse question for a patient admitted with status
epilepticus who has a history of myasthenia gravis?
A. Levetiracetam
B. Magnesium sulfate
Page 4
A patient with an external ventricular drain for a severe traumatic brain injury
has an ICP of 24 mmHg and a MAP of 78 mmHg. Which intervention should
the nurse anticipate first?
A. Administer mannitol 1 g/kg IV bolus
B. Elevate the head of the bed to 30 degrees
C. Perform a cerebrospinal fluid drainage of 5 mL
D. Hyperventilate the patient to a PaCO2 of 28 mmHg
Correct Answer: C - Perform a cerebrospinal fluid drainage of 5
mL
RATIONALE
The CPP is 54 mmHg (MAP - ICP), which is below the recommended
target of 60-70 mmHg, so CSF drainage directly reduces ICP and
improves CPP. Mannitol is second-line after CSF drainage and
requires adequate renal function and serum osmolality monitoring, and
hyperventilation is only a temporary bridge for herniation because it
risks ischemia.
Question 2
Which finding in a patient receiving mechanical ventilation for acute
respiratory distress syndrome indicates that lung-protective ventilation goals
are being met?
A. Tidal volume of 8 mL/kg predicted body weight and plateau pressure
of 32 cm H2O
B. Tidal volume of 6 mL/kg predicted body weight and plateau pressure
of 28 cm H2O
C. Tidal volume of 10 mL/kg predicted body weight and plateau pressure
of 30 cm H2O
D. Tidal volume of 6 mL/kg predicted body weight and plateau pressure
of 35 cm H2O
Page 2
,Correct Answer: B - Tidal volume of 6 mL/kg predicted body
weight and plateau pressure of 28 cm H2O
RATIONALE
Lung-protective ventilation targets 4-6 mL/kg predicted body weight
and plateau pressure 30 cm H2O to reduce ventilator-induced lung
injury. Option A uses a higher tidal volume, and options C and D
exceed the plateau pressure limit, increasing barotrauma risk.
Question 3
A patient with a cervical spinal cord injury at C5 suddenly develops
bradycardia, hypotension, and warm flushed skin. Which pathophysiologic
mechanism explains these findings?
A. Loss of sympathetic outflow causing unopposed vagal tone and
vasodilation
B. Excessive parasympathetic stimulation from vagus nerve injury
C. Increased systemic vascular resistance from catecholamine surge
D. Impaired venous return due to loss of skeletal muscle pump
Correct Answer: A - Loss of sympathetic outflow causing
unopposed vagal tone and vasodilation
RATIONALE
Neurogenic shock after high cervical injury results from disruption of
sympathetic pathways, leading to unopposed vagal tone (bradycardia)
and loss of vasoconstriction (hypotension, warm dry skin). Options B,
C, and D do not describe the classic triad of neurogenic shock.
Question 4
Which assessment finding is most concerning for impending herniation in a
patient with an acute ischemic stroke?
A. A unilateral dilated pupil with decreased level of consciousness
B. A new onset of mild headache relieved by acetaminophen
Page 3
, C. A blood pressure of 180/100 mmHg with no neurologic change
D. A transient episode of confusion that resolves within 10 minutes
Correct Answer: A - A unilateral dilated pupil with decreased
level of consciousness
RATIONALE
A unilateral fixed and dilated pupil with decreased LOC indicates
uncal herniation from rising ICP and requires immediate intervention.
The other findings are either expected, manageable, or transient and
do not indicate herniation.
Question 5
A patient with sepsis has a lactate of 4.2 mmol/L, MAP of 58 mmHg, and has
received 30 mL/kg of crystalloid. Which vasopressor is the first-line agent
according to the Surviving Sepsis Campaign?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
Correct Answer: B - Norepinephrine
RATIONALE
Norepinephrine is the first-line vasopressor for septic shock because it
effectively increases MAP with fewer arrhythmias than dopamine.
Vasopressin is added as a second agent, and phenylephrine is not
preferred due to potential reduction in cardiac output.
Question 6
Which medication should the nurse question for a patient admitted with status
epilepticus who has a history of myasthenia gravis?
A. Levetiracetam
B. Magnesium sulfate
Page 4
