NRNP 6566 Week 8 Quiz V1 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 8 Quiz) | Walden University
1. A patient with a suspected stroke has an initial Glasgow Coma Scale (GCS) score of 7. What
is the priority intervention for this patient?
A. Stat CT scan of the head without contrast
B. Administration of intravenous Alteplase
C. Endotracheal intubation for airway protection
D. Lumbar puncture to rule out hemorrhage
Answer: C
Rationale: A Glasgow Coma Scale score of 8 or less indicates a significant impairment of
consciousness and the inability to maintain a patent airway. In the acute setting, securing
the airway via intubation is the immediate priority before diagnostic imaging or
pharmacological interventions. This prevents aspiration and ensures adequate oxygenation
to prevent secondary brain injury.
2. Which of the following blood pressure readings is the maximum allowed before initiating
intravenous fibrinolytic therapy in an acute ischemic stroke patient?
A. 180/105 mmHg
,B. 185/110 mmHg
C. 200/115 mmHg
D. 220/120 mmHg
Answer: B
Rationale: Clinical guidelines for acute ischemic stroke specify that blood pressure must
be maintained below 185/110 mmHg to safely administer thrombolytics. Exceeding these
limits significantly increases the risk of symptomatic intracranial hemorrhage following
treatment. Antihypertensive agents such as labetalol should be used to achieve these
targets if the patient is otherwise a candidate for therapy.
3. What are the three clinical manifestations known as Cushing’s Triad, indicating increased
intracranial pressure (ICP)?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension, and narrowed pulse pressure
C. Tachycardia, hypertension, and Cheyne-Stokes respirations
D. Bradycardia, systolic hypertension with widened pulse pressure, and irregular
respirations
Answer: D
Rationale: Cushing’s Triad is a late sign of increased intracranial pressure and impending
brain herniation. It consists of a slow heart rate, an increase in systolic blood pressure
,coupled with a widening pulse pressure, and abnormal respiratory patterns. Recognizing
these signs is critical for the acute care nurse practitioner to initiate emergent ICP-lowering
measures.
4. In the management of a patient with a traumatic brain injury (TBI), what is the calculated
Cerebral Perfusion Pressure (CPP) if the Mean Arterial Pressure (MAP) is 90 mmHg and the
ICP is 20 mmHg?
A. 110 mmHg
B. 80 mmHg
C. 60 mmHg
D. 70 mmHg
Answer: D
Rationale: Cerebral Perfusion Pressure is calculated by subtracting the Intracranial
Pressure from the Mean Arterial Pressure (CPP = MAP - ICP). For this patient, 90 minus 20
results in a CPP of 70 mmHg. Maintaining a CPP between 60 and 70 mmHg is generally the
target in TBI management to ensure adequate brain oxygenation.
5. A patient with a T6 spinal cord injury reports a sudden, severe headache and is found to
have a BP of 210/110 mmHg. What is the first action the provider should take?
A. Administer intravenous hydralazine
B. Perform a stat CT scan of the brain
C. Sit the patient upright and check for bladder distension
, D. Initiate a continuous infusion of nitroprusside
Answer: C
Rationale: Autonomic dysreflexia is a medical emergency occurring in patients with spinal
cord injuries at or above T6. The first step is to sit the patient upright to encourage
orthostatic lowering of blood pressure and then identify the noxious stimulus, which is
most commonly a full bladder or impacted bowel. Removing the trigger often resolves the
hypertensive crisis without the need for long-term medications.
6. Which medication is considered the first-line treatment for a patient in active status
epilepticus?
A. Phenytoin
B. Levetiracetam
C. Valproic acid
D. Lorazepam
Answer: D
Rationale: Benzodiazepines, such as lorazepam or diazepam, are the preferred first-line
agents to terminate active seizure activity quickly. They work by enhancing GABAergic
inhibition in the central nervous system. Following the stabilization of the seizure, long-
acting anticonvulsants like phenytoin are administered to prevent recurrence.
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 8 Quiz) | Walden University
1. A patient with a suspected stroke has an initial Glasgow Coma Scale (GCS) score of 7. What
is the priority intervention for this patient?
A. Stat CT scan of the head without contrast
B. Administration of intravenous Alteplase
C. Endotracheal intubation for airway protection
D. Lumbar puncture to rule out hemorrhage
Answer: C
Rationale: A Glasgow Coma Scale score of 8 or less indicates a significant impairment of
consciousness and the inability to maintain a patent airway. In the acute setting, securing
the airway via intubation is the immediate priority before diagnostic imaging or
pharmacological interventions. This prevents aspiration and ensures adequate oxygenation
to prevent secondary brain injury.
2. Which of the following blood pressure readings is the maximum allowed before initiating
intravenous fibrinolytic therapy in an acute ischemic stroke patient?
A. 180/105 mmHg
,B. 185/110 mmHg
C. 200/115 mmHg
D. 220/120 mmHg
Answer: B
Rationale: Clinical guidelines for acute ischemic stroke specify that blood pressure must
be maintained below 185/110 mmHg to safely administer thrombolytics. Exceeding these
limits significantly increases the risk of symptomatic intracranial hemorrhage following
treatment. Antihypertensive agents such as labetalol should be used to achieve these
targets if the patient is otherwise a candidate for therapy.
3. What are the three clinical manifestations known as Cushing’s Triad, indicating increased
intracranial pressure (ICP)?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension, and narrowed pulse pressure
C. Tachycardia, hypertension, and Cheyne-Stokes respirations
D. Bradycardia, systolic hypertension with widened pulse pressure, and irregular
respirations
Answer: D
Rationale: Cushing’s Triad is a late sign of increased intracranial pressure and impending
brain herniation. It consists of a slow heart rate, an increase in systolic blood pressure
,coupled with a widening pulse pressure, and abnormal respiratory patterns. Recognizing
these signs is critical for the acute care nurse practitioner to initiate emergent ICP-lowering
measures.
4. In the management of a patient with a traumatic brain injury (TBI), what is the calculated
Cerebral Perfusion Pressure (CPP) if the Mean Arterial Pressure (MAP) is 90 mmHg and the
ICP is 20 mmHg?
A. 110 mmHg
B. 80 mmHg
C. 60 mmHg
D. 70 mmHg
Answer: D
Rationale: Cerebral Perfusion Pressure is calculated by subtracting the Intracranial
Pressure from the Mean Arterial Pressure (CPP = MAP - ICP). For this patient, 90 minus 20
results in a CPP of 70 mmHg. Maintaining a CPP between 60 and 70 mmHg is generally the
target in TBI management to ensure adequate brain oxygenation.
5. A patient with a T6 spinal cord injury reports a sudden, severe headache and is found to
have a BP of 210/110 mmHg. What is the first action the provider should take?
A. Administer intravenous hydralazine
B. Perform a stat CT scan of the brain
C. Sit the patient upright and check for bladder distension
, D. Initiate a continuous infusion of nitroprusside
Answer: C
Rationale: Autonomic dysreflexia is a medical emergency occurring in patients with spinal
cord injuries at or above T6. The first step is to sit the patient upright to encourage
orthostatic lowering of blood pressure and then identify the noxious stimulus, which is
most commonly a full bladder or impacted bowel. Removing the trigger often resolves the
hypertensive crisis without the need for long-term medications.
6. Which medication is considered the first-line treatment for a patient in active status
epilepticus?
A. Phenytoin
B. Levetiracetam
C. Valproic acid
D. Lorazepam
Answer: D
Rationale: Benzodiazepines, such as lorazepam or diazepam, are the preferred first-line
agents to terminate active seizure activity quickly. They work by enhancing GABAergic
inhibition in the central nervous system. Following the stabilization of the seizure, long-
acting anticonvulsants like phenytoin are administered to prevent recurrence.
