NEURO PRACTICE QUESTIONS/PATHOPHYSIOLOGY
QUESTIONS WITH DETAILED VERIFIED AND 100%
ACCURATE ANSWERS
A nurse assesses a client who has episodes of autonomic dysreflexia.
Which of the following conditions can cause autonomic dysreflexia?
Correct Answers Noxious stimuli
An 18-year-old client is admitted with a closed head injury sustained in
a MVA. His intracranial pressure (ICP) shows an upward trend. Which
intervention should the nurse perform first?An 18-year-old client is
admitted with a closed head injury sustained in a MVA. His intracranial
pressure (ICP) shows an upward trend. Which intervention should the
nurse perform first?
B. Administer 1 g Mannitol IV as ordered.
C. Increase the ventilator's respiratory rate to 20 breaths/minute.
D. Administer 100 mg of pentobarbital IV as ordered. Correct Answers
Correct Answer: A. Reposition the client to avoid neck flexion.
The nurse should first attempt nursing interventions, such as
repositioning the client to avoid neck flexion, which increases venous
return and lowers ICP. Elevate the head of the bed to greater than 30
degrees. Keep the neck midline to facilitate venous drainage from the
head. Nursing care must pay close attention to changes in neurologic
status, any change in vitals such as an increasingly erratic heart rate,
development of bradycardia, accurate and equal intake and output when
having diuresis, and maintenance of proper blood pressure.
Option B: Osmotic agents can be used to create an osmotic gradient
across blood thereby drawing fluid intravascularly and decreasing
cerebral edema. Mannitol was the primary agent used at doses of 0.25 to
1 g/kg body weight and is thought to exert its greatest benefit by
,decreasing blood viscosity and to a lesser extent by decreasing blood
volume. Side effects of mannitol use are eventual osmotic diuresis and
dehydration as well as renal injury if serum osmolality exceeds 320
mOsm.
Option C: Hypercarbia lowers serum pH and can increase cerebral blood
flow contributing to rising ICP, hence hyperventilation to lower pCO2
to around 30 mm Hg can be transiently used.
Option D: If nursing measures prove ineffective notify the physician,
who may prescribe pentobarbital. Pentobarbital is a drug within the
barbiturate class that works primarily on the central nervous system.
Common off-label uses are for control of intracranial pressure in
patients with severe brain injuries, cerebral ischemia, and those
receiving treatment for Reye syndrome.
A client with head trauma develops a urine output of 300 ml/hr, dry
skin, and dry mucous membranes. Which of the following nursing
interventions is the most appropriate to perform initially?
A. Evaluate urine specific gravity.
B. Anticipate treatment for renal failure.
C. Provide emollients to the skin to prevent breakdown.
D. Slow down the IV fluids and notify the physician. Correct Answers
Correct Answer: A. Evaluate urine specific gravity.
Urine output of 300 ml/hr may indicate diabetes insipidus, which is a
failure of the pituitary to produce the antidiuretic hormone. This may
occur with increased intracranial pressure and head trauma; the nurse
evaluates for low urine specific gravity, increased serum osmolarity, and
dehydration.
,Option B: There's no evidence that the client is experiencing renal
failure. The most common findings in patients with diabetes insipidus
are polydipsia, polyuria, and nocturia. Additional symptoms in patients
with diabetes insipidus may include weakness, lethargy, fatigue, and
myalgias.
Option C: Providing emollients to prevent skin breakdown is important,
but doesn't need to be performed immediately. Central diabetes
insipidus is diagnosed when there is evidence of plasma
hyperosmolality (greater than 300 mosm/l), urine hyperosmolarity (less
than 300 mosm/l or urine/plasma osmolality less than 1), with polyuria
(urinary volume greater than 4 mL/kg/hr to 5 mL/kg/hr for two
consecutive hours after surgery).
Option D: Slowing the rate of IV fluid would contribute to dehydration
when polyuria is present. In cases of nephrogenic diabetes insipidus,
water deprivation suboptimally increases urine osmolality. DDAVP
minimally increases urine osmolality in partial nephrogenic diabetes
insipidus, with no increase in urine osmolality in complete nephrogenic
diabetes insipidus.
When evaluating an ABG from a client with a subdural hematoma, the
nurse notes the PaCO2 is 30 mm Hg. Which of the following responses
best describes this result?
A. Appropriate; lowering carbon dioxide (CO2) reduces intracranial
pressure (ICP).
B. Emergent; the client is poorly oxygenated.
C. Normal
D. Significant; the client has alveolar hypoventilation. Correct Answers
Correct
, Correct Answer: A. Appropriate; lowering carbon dioxide (CO2)
reduces intracranial pressure (ICP).
A normal PaCO2 value is 35 to 45 mm Hg. CO2 has vasodilating
properties; therefore, lowering PaCO2 through hyperventilation will
lower ICP caused by dilated cerebral vessels. A subdural hematoma
forms because of an accumulation of blood under the dura mater, one of
the protective layers to the brain tissue under the calvarium.
Option B: Oxygenation is evaluated through PaO2 and oxygen
saturation. The clinician must begin immediate medical management.
These measures include sedation, neuromuscular blockade when
appropriate, moderate hyperventilation to a Pc02 (32 to 36), adequate
oxygenation to maintain Sp02 greater than 95%, head elevation, and
avoidance of hyperthermia.
Option C: Often, the bleeding is undetected initially, discovered as a
chronic subdural hematoma. When there is a sufficient accumulation of
blood to occupy a large intracranial space, the brain midline shifts
toward the opposite side, encroaching on the brain structures against the
inner surface of the calvarium after decreasing the volume of the lateral
third and fourth ventricles. As the intracranial space becomes limited,
the volumetric forces push the uncal portion of the temporal lobe toward
the foramen magnum causing herniation of the brain.
Option D: Alveolar hypoventilation would be reflected in an increased
PaCO2. The infusion of hypertonic saline or mannitol serves to decrease
intracranial pressure by promoting osmotic changes in the brain and
transiently affecting the rheological properties of the cerebral blood
flow, respectively.
A client comes into the ER after hitting his head in an MVA. He's alert
and oriented. Which of the following nursing interventions should be
done first?
QUESTIONS WITH DETAILED VERIFIED AND 100%
ACCURATE ANSWERS
A nurse assesses a client who has episodes of autonomic dysreflexia.
Which of the following conditions can cause autonomic dysreflexia?
Correct Answers Noxious stimuli
An 18-year-old client is admitted with a closed head injury sustained in
a MVA. His intracranial pressure (ICP) shows an upward trend. Which
intervention should the nurse perform first?An 18-year-old client is
admitted with a closed head injury sustained in a MVA. His intracranial
pressure (ICP) shows an upward trend. Which intervention should the
nurse perform first?
B. Administer 1 g Mannitol IV as ordered.
C. Increase the ventilator's respiratory rate to 20 breaths/minute.
D. Administer 100 mg of pentobarbital IV as ordered. Correct Answers
Correct Answer: A. Reposition the client to avoid neck flexion.
The nurse should first attempt nursing interventions, such as
repositioning the client to avoid neck flexion, which increases venous
return and lowers ICP. Elevate the head of the bed to greater than 30
degrees. Keep the neck midline to facilitate venous drainage from the
head. Nursing care must pay close attention to changes in neurologic
status, any change in vitals such as an increasingly erratic heart rate,
development of bradycardia, accurate and equal intake and output when
having diuresis, and maintenance of proper blood pressure.
Option B: Osmotic agents can be used to create an osmotic gradient
across blood thereby drawing fluid intravascularly and decreasing
cerebral edema. Mannitol was the primary agent used at doses of 0.25 to
1 g/kg body weight and is thought to exert its greatest benefit by
,decreasing blood viscosity and to a lesser extent by decreasing blood
volume. Side effects of mannitol use are eventual osmotic diuresis and
dehydration as well as renal injury if serum osmolality exceeds 320
mOsm.
Option C: Hypercarbia lowers serum pH and can increase cerebral blood
flow contributing to rising ICP, hence hyperventilation to lower pCO2
to around 30 mm Hg can be transiently used.
Option D: If nursing measures prove ineffective notify the physician,
who may prescribe pentobarbital. Pentobarbital is a drug within the
barbiturate class that works primarily on the central nervous system.
Common off-label uses are for control of intracranial pressure in
patients with severe brain injuries, cerebral ischemia, and those
receiving treatment for Reye syndrome.
A client with head trauma develops a urine output of 300 ml/hr, dry
skin, and dry mucous membranes. Which of the following nursing
interventions is the most appropriate to perform initially?
A. Evaluate urine specific gravity.
B. Anticipate treatment for renal failure.
C. Provide emollients to the skin to prevent breakdown.
D. Slow down the IV fluids and notify the physician. Correct Answers
Correct Answer: A. Evaluate urine specific gravity.
Urine output of 300 ml/hr may indicate diabetes insipidus, which is a
failure of the pituitary to produce the antidiuretic hormone. This may
occur with increased intracranial pressure and head trauma; the nurse
evaluates for low urine specific gravity, increased serum osmolarity, and
dehydration.
,Option B: There's no evidence that the client is experiencing renal
failure. The most common findings in patients with diabetes insipidus
are polydipsia, polyuria, and nocturia. Additional symptoms in patients
with diabetes insipidus may include weakness, lethargy, fatigue, and
myalgias.
Option C: Providing emollients to prevent skin breakdown is important,
but doesn't need to be performed immediately. Central diabetes
insipidus is diagnosed when there is evidence of plasma
hyperosmolality (greater than 300 mosm/l), urine hyperosmolarity (less
than 300 mosm/l or urine/plasma osmolality less than 1), with polyuria
(urinary volume greater than 4 mL/kg/hr to 5 mL/kg/hr for two
consecutive hours after surgery).
Option D: Slowing the rate of IV fluid would contribute to dehydration
when polyuria is present. In cases of nephrogenic diabetes insipidus,
water deprivation suboptimally increases urine osmolality. DDAVP
minimally increases urine osmolality in partial nephrogenic diabetes
insipidus, with no increase in urine osmolality in complete nephrogenic
diabetes insipidus.
When evaluating an ABG from a client with a subdural hematoma, the
nurse notes the PaCO2 is 30 mm Hg. Which of the following responses
best describes this result?
A. Appropriate; lowering carbon dioxide (CO2) reduces intracranial
pressure (ICP).
B. Emergent; the client is poorly oxygenated.
C. Normal
D. Significant; the client has alveolar hypoventilation. Correct Answers
Correct
, Correct Answer: A. Appropriate; lowering carbon dioxide (CO2)
reduces intracranial pressure (ICP).
A normal PaCO2 value is 35 to 45 mm Hg. CO2 has vasodilating
properties; therefore, lowering PaCO2 through hyperventilation will
lower ICP caused by dilated cerebral vessels. A subdural hematoma
forms because of an accumulation of blood under the dura mater, one of
the protective layers to the brain tissue under the calvarium.
Option B: Oxygenation is evaluated through PaO2 and oxygen
saturation. The clinician must begin immediate medical management.
These measures include sedation, neuromuscular blockade when
appropriate, moderate hyperventilation to a Pc02 (32 to 36), adequate
oxygenation to maintain Sp02 greater than 95%, head elevation, and
avoidance of hyperthermia.
Option C: Often, the bleeding is undetected initially, discovered as a
chronic subdural hematoma. When there is a sufficient accumulation of
blood to occupy a large intracranial space, the brain midline shifts
toward the opposite side, encroaching on the brain structures against the
inner surface of the calvarium after decreasing the volume of the lateral
third and fourth ventricles. As the intracranial space becomes limited,
the volumetric forces push the uncal portion of the temporal lobe toward
the foramen magnum causing herniation of the brain.
Option D: Alveolar hypoventilation would be reflected in an increased
PaCO2. The infusion of hypertonic saline or mannitol serves to decrease
intracranial pressure by promoting osmotic changes in the brain and
transiently affecting the rheological properties of the cerebral blood
flow, respectively.
A client comes into the ER after hitting his head in an MVA. He's alert
and oriented. Which of the following nursing interventions should be
done first?
