NR 341 Week 7 Exam Three Study Guide
(Chapters 19, 20, 6, 17, 13, 21, 18)
Chapter 19 & 20: Neurocritical Care & Neurological
Disorders
Question 1
A patient with a suspected epidural hematoma after a motor vehicle crash is being
monitored in the ICU. Which nursing action is the priority?
A. Administer pain medication as ordered
B. Perform hourly neurological checks
C. Obtain a CT scan immediately
D. Prepare for immediate surgery
Answer: B. Perform hourly neurological checks
Rationale: Hourly neuro checks are essential for early detection of deterioration in
epidural hematoma patients . Epidural hematomas can expand rapidly, leading to
herniation if not identified early. The nurse must monitor for changes in level of
consciousness, pupil reactivity, and motor function.
Question 2
,A patient with severe traumatic brain injury has a blood pressure of 150/50 mmHg
and an intracranial pressure (ICP) of 30 mmHg. What is the patient's Cerebral
Perfusion Pressure (CPP)?
A. 50 mmHg
B. 55 mmHg
C. 60 mmHg
D. 70 mmHg
Answer: B. 55 mmHg
Rationale: CPP = Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP). MAP = (SBP
+ 2DBP)/3 = (150 + 100)/3 = 83.3. CPP = 83.3 - 30 = 53.3 mmHg, approximately 55
mmHg . Normal CPP is 60-100 mmHg; values below 60 indicate inadequate cerebral
perfusion.
Question 3
Which assessment finding is the earliest indicator of increasing intracranial
pressure?
A. Bradycardia
B. Pupillary dilation
C. Decreased level of consciousness
D. Hypertension
Answer: C. Decreased level of consciousness
Rationale: Changes in level of consciousness occur first as cerebral perfusion becomes
compromised by rising intracranial pressure . This is the most sensitive indicator of
neurologic deterioration.
Question 4
Which assessment finding is most indicative of meningitis?
, A. Positive Babinski reflex
B. Nuchal rigidity
C. Facial droop
D. Intention tremor
Answer: B. Nuchal rigidity
Rationale: Neck stiffness is a classic sign of meningeal irritation caused by
inflammation . Nuchal rigidity, along with fever and altered mental status, forms the
classic triad of meningitis.
Question 5
A patient in status epilepticus is not responding to initial benzodiazepine therapy.
Which medication should the nurse anticipate administering to induce a coma?
A. Lorazepam
B. Diazepam
C. Valproic acid
D. Phenobarbital
Answer: D. Phenobarbital
Rationale: Phenobarbital is used when first-line benzodiazepines fail to control status
epilepticus . It induces a barbiturate coma to suppress seizure activity.
Question 6
What is the first-line medication for treatment of status epilepticus?
A. Phenytoin
B. Lorazepam (Ativan)
C. Phenobarbital
D. Valproic acid
Answer: B. Lorazepam (Ativan)
(Chapters 19, 20, 6, 17, 13, 21, 18)
Chapter 19 & 20: Neurocritical Care & Neurological
Disorders
Question 1
A patient with a suspected epidural hematoma after a motor vehicle crash is being
monitored in the ICU. Which nursing action is the priority?
A. Administer pain medication as ordered
B. Perform hourly neurological checks
C. Obtain a CT scan immediately
D. Prepare for immediate surgery
Answer: B. Perform hourly neurological checks
Rationale: Hourly neuro checks are essential for early detection of deterioration in
epidural hematoma patients . Epidural hematomas can expand rapidly, leading to
herniation if not identified early. The nurse must monitor for changes in level of
consciousness, pupil reactivity, and motor function.
Question 2
,A patient with severe traumatic brain injury has a blood pressure of 150/50 mmHg
and an intracranial pressure (ICP) of 30 mmHg. What is the patient's Cerebral
Perfusion Pressure (CPP)?
A. 50 mmHg
B. 55 mmHg
C. 60 mmHg
D. 70 mmHg
Answer: B. 55 mmHg
Rationale: CPP = Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP). MAP = (SBP
+ 2DBP)/3 = (150 + 100)/3 = 83.3. CPP = 83.3 - 30 = 53.3 mmHg, approximately 55
mmHg . Normal CPP is 60-100 mmHg; values below 60 indicate inadequate cerebral
perfusion.
Question 3
Which assessment finding is the earliest indicator of increasing intracranial
pressure?
A. Bradycardia
B. Pupillary dilation
C. Decreased level of consciousness
D. Hypertension
Answer: C. Decreased level of consciousness
Rationale: Changes in level of consciousness occur first as cerebral perfusion becomes
compromised by rising intracranial pressure . This is the most sensitive indicator of
neurologic deterioration.
Question 4
Which assessment finding is most indicative of meningitis?
, A. Positive Babinski reflex
B. Nuchal rigidity
C. Facial droop
D. Intention tremor
Answer: B. Nuchal rigidity
Rationale: Neck stiffness is a classic sign of meningeal irritation caused by
inflammation . Nuchal rigidity, along with fever and altered mental status, forms the
classic triad of meningitis.
Question 5
A patient in status epilepticus is not responding to initial benzodiazepine therapy.
Which medication should the nurse anticipate administering to induce a coma?
A. Lorazepam
B. Diazepam
C. Valproic acid
D. Phenobarbital
Answer: D. Phenobarbital
Rationale: Phenobarbital is used when first-line benzodiazepines fail to control status
epilepticus . It induces a barbiturate coma to suppress seizure activity.
Question 6
What is the first-line medication for treatment of status epilepticus?
A. Phenytoin
B. Lorazepam (Ativan)
C. Phenobarbital
D. Valproic acid
Answer: B. Lorazepam (Ativan)
