COMPLEX HEALTH CHALLENGES II -
NEUROLOGICAL DISORDERS
Which change eventually exhausts compensatory mechanisms, leading to ischemia?
1. Progressive decreases in brain tissue volume
2. Rapid increases in neuronal compression
3. Progressive increases in brain tissue volume
4. Rapid decreases in neuronal compression - CORRECT ANSWER-3
Brain tissue volume compensates by distention of the dura or compression of the brain
tissue. Progressive increases in volume eventually exhaust compensatory mechanisms
and results in increased intracranial pressure (ICP), neuronal compression, and
ischemia.
Changes in which factor influence intracranial pressure (ICP) under normal
circumstances?
A. Blood pressure (BP)
B. Blood glucose levels
C. Hypovolemia
D. Electrolyte deficiencies - CORRECT ANSWER-A
Factors that influence intracranial pressure (ICP) under normal circumstances are
changes in blood pressure (BP), cardiac function, intra-abdominal and intrathoracic
pressure, body position, temperature, and blood gasses, particularly carbon dioxide
(CO2) levels. The degree to which these factors increase or decrease the ICP depends
on the ability of the brain to accommodate the changes.
Which stage on the pressure-volume curve is associated with high compliance in
autoregulation?
A. 1
B. 2
C. 3
D. 4 - CORRECT ANSWER-A
1
At stage 1 on the curve, there is high compliance. The brain is in total compensation,
with accommodation and autoregulation intact. An increase in volume (in brain tissue,
blood, or cerebral spinal fluid [CSF]) does not increase the intracranial pressure (ICP).
2
At stage 2, the compliance is lessening, and an increase in volume places the patient at
risk for increased intracranial pressure (ICP).
3
At stage 3, there is low compliance as compensatory mechanisms are becoming
exhausted. Any small addition of volume causes a great increase in intracranial
pressure (ICP). As compensatory mechanisms fail, there is a loss of autoregulation, and
,the patient may exhibit symptoms indicating increased ICP, such as headache, changes
in level of consciousness, or pupil responsiveness.
4
As the patient enters stage 4, the intracranial pressure (ICP) rises to lethal levels with
even slight increases in volume. Here the patient is at significant risk for hypoperfusion
and brain herniation and death. Herniation occurs as the brain tissue is forcibly shifted
from the compartment of greater pressure to a compartment of lesser pressure. In this
situation, intense pressure is placed on the brain stem, and if herniation continues,
brainstem death is imminent.
Which physiologic event leads to decreased oxygen and death of the brain cells?
A. Tissue edema
B. Excessive hydration
C. Decreased cerebral blood flow
D. Accumulation of carbon dioxide - CORRECT ANSWER-C
Decreased cerebral blood flow from compression of cerebral blood vessels leads to
decreased oxygen and brain tissue death.
Which statement describes the cause of interstitial cerebral edema?
A. Local disruption of the functional or morphological integrity of cell membranes
B. Changes in the endothelial lining of cerebral capillaries
C. Fluid and protein shift from the extracellular space directly into the cells, with
subsequent swelling
D. Periventricular diffusion of ventricular cerebral spinal fluid (CSF) in a patient with
uncontrolled hydrocephalus - CORRECT ANSWER-D
Interstitial cerebral edema is the result of periventricular diffusion of ventricular cerebral
spinal fluid (CSF) in a patient with uncontrolled hydrocephalus. It can also be caused by
enlargement of the extracellular space because of systemic water excess
(hyponatremia).
Which follow-up vital signs would indicate worsening intracranial pressure (ICP) for a
patient with a brain tumour and increased ICP with initial vital sins of: BP 128/88, HR
106, RR 22, and oxygen saturation 98%?
A. BP 116/82, HR 85, RR 20, oxygen saturation 97%
B. BP 172/98, HR 64, RR 24, oxygen saturation 99%
C. BP 98/76, HR 85, RR 12, oxygen saturation 90%
D. BP 135/86, HR 112, RR 10, oxygen saturation 89% - CORRECT ANSWER-B
BP 172/98, HR 64, RR 24, oxygen saturation 99% is characteristic of Cushing's triad,
elevated BP and decreased HR, indicating worsening intracranial pressure (ICP).
Which test is contraindicated if intracranial pressure (ICP) is increased?
A. Lumbar puncture
B. Cerebral angiography
C. PET scan
D. Brain tissue oxygenation measured via a Licox catheter - CORRECT ANSWER-A
, Lumbar punctures are not performed if intracranial pressure (ICP) is increased because
of cerebral herniation from the sudden release of the pressure in the skull from the area
above the lumbar puncture
Which action would the nurse take when caring for a patient with a cerebrospinal fluid
(CSF) drainage system that begins to complain of headache and nausea?
A. Give oral mannitol
B. Administer an IV fluid bolus
C. Elevate head of patient's bed
D. Administer narcotic pain medicine - CORRECT ANSWER-C
Elevating the head of the bed allows for appropriate drainage of CSF and is helpful for
the patient with increased intracranial pressure (ICP).
Which device is used to measure cerebral oxygenation levels?
A. Licox catheter
B. Peripheral arterial line
C. Intraventricular catheter
D. Ventriculostomy catheter - CORRECT ANSWER-A
The Licox catheter is placed in the healthy white matter of the brain and provides
continuous monitoring of the pressure of oxygen in brain tissue (PbtO2).
Which step is first in the management of increased intracranial pressure (ICP)?
A. Support brain function by adequate oxygenation
B. Support the family and caregivers
C. Maintain dynamic equilibrium in cerebral responses
D. Maintain fluid balance - CORRECT ANSWER-A
Ensuring adequate oxygenation to support brain function is the first step in the
management of increased cerebral spinal fluid (CSF). An endotracheal tube or
tracheostomy may be necessary to maintain adequate ventilation. Arterial blood gas
(ABG) analysis guides the oxygen therapy. The goal is to maintain the PaO2 at 100 mm
Hg or greater. It may be necessary to maintain the patient on a mechanical ventilator to
ensure adequate oxygenation.
Which medication therapy is first-line treatment for elevated intracranial pressure (ICP)?
A. Hypertonic saline
B. Corticosteroids
C. Phenytoin
D. High-dose barbiturates - CORRECT ANSWER-A
Hypertonic saline is the first-line treatment for elevated cerebral spinal fluid (CSF). It
reduces swelling and improves cerebral blood flow (CBF), drawing water out of the
brain tissue.
A patient presents with abnormal extension, does not open their eyes to stimulus, and
does not give a sound as reaction to pain. The patient exhibiting these signs would be
given a score of ___________ using the Glasgow Coma Scale.
A. 2
NEUROLOGICAL DISORDERS
Which change eventually exhausts compensatory mechanisms, leading to ischemia?
1. Progressive decreases in brain tissue volume
2. Rapid increases in neuronal compression
3. Progressive increases in brain tissue volume
4. Rapid decreases in neuronal compression - CORRECT ANSWER-3
Brain tissue volume compensates by distention of the dura or compression of the brain
tissue. Progressive increases in volume eventually exhaust compensatory mechanisms
and results in increased intracranial pressure (ICP), neuronal compression, and
ischemia.
Changes in which factor influence intracranial pressure (ICP) under normal
circumstances?
A. Blood pressure (BP)
B. Blood glucose levels
C. Hypovolemia
D. Electrolyte deficiencies - CORRECT ANSWER-A
Factors that influence intracranial pressure (ICP) under normal circumstances are
changes in blood pressure (BP), cardiac function, intra-abdominal and intrathoracic
pressure, body position, temperature, and blood gasses, particularly carbon dioxide
(CO2) levels. The degree to which these factors increase or decrease the ICP depends
on the ability of the brain to accommodate the changes.
Which stage on the pressure-volume curve is associated with high compliance in
autoregulation?
A. 1
B. 2
C. 3
D. 4 - CORRECT ANSWER-A
1
At stage 1 on the curve, there is high compliance. The brain is in total compensation,
with accommodation and autoregulation intact. An increase in volume (in brain tissue,
blood, or cerebral spinal fluid [CSF]) does not increase the intracranial pressure (ICP).
2
At stage 2, the compliance is lessening, and an increase in volume places the patient at
risk for increased intracranial pressure (ICP).
3
At stage 3, there is low compliance as compensatory mechanisms are becoming
exhausted. Any small addition of volume causes a great increase in intracranial
pressure (ICP). As compensatory mechanisms fail, there is a loss of autoregulation, and
,the patient may exhibit symptoms indicating increased ICP, such as headache, changes
in level of consciousness, or pupil responsiveness.
4
As the patient enters stage 4, the intracranial pressure (ICP) rises to lethal levels with
even slight increases in volume. Here the patient is at significant risk for hypoperfusion
and brain herniation and death. Herniation occurs as the brain tissue is forcibly shifted
from the compartment of greater pressure to a compartment of lesser pressure. In this
situation, intense pressure is placed on the brain stem, and if herniation continues,
brainstem death is imminent.
Which physiologic event leads to decreased oxygen and death of the brain cells?
A. Tissue edema
B. Excessive hydration
C. Decreased cerebral blood flow
D. Accumulation of carbon dioxide - CORRECT ANSWER-C
Decreased cerebral blood flow from compression of cerebral blood vessels leads to
decreased oxygen and brain tissue death.
Which statement describes the cause of interstitial cerebral edema?
A. Local disruption of the functional or morphological integrity of cell membranes
B. Changes in the endothelial lining of cerebral capillaries
C. Fluid and protein shift from the extracellular space directly into the cells, with
subsequent swelling
D. Periventricular diffusion of ventricular cerebral spinal fluid (CSF) in a patient with
uncontrolled hydrocephalus - CORRECT ANSWER-D
Interstitial cerebral edema is the result of periventricular diffusion of ventricular cerebral
spinal fluid (CSF) in a patient with uncontrolled hydrocephalus. It can also be caused by
enlargement of the extracellular space because of systemic water excess
(hyponatremia).
Which follow-up vital signs would indicate worsening intracranial pressure (ICP) for a
patient with a brain tumour and increased ICP with initial vital sins of: BP 128/88, HR
106, RR 22, and oxygen saturation 98%?
A. BP 116/82, HR 85, RR 20, oxygen saturation 97%
B. BP 172/98, HR 64, RR 24, oxygen saturation 99%
C. BP 98/76, HR 85, RR 12, oxygen saturation 90%
D. BP 135/86, HR 112, RR 10, oxygen saturation 89% - CORRECT ANSWER-B
BP 172/98, HR 64, RR 24, oxygen saturation 99% is characteristic of Cushing's triad,
elevated BP and decreased HR, indicating worsening intracranial pressure (ICP).
Which test is contraindicated if intracranial pressure (ICP) is increased?
A. Lumbar puncture
B. Cerebral angiography
C. PET scan
D. Brain tissue oxygenation measured via a Licox catheter - CORRECT ANSWER-A
, Lumbar punctures are not performed if intracranial pressure (ICP) is increased because
of cerebral herniation from the sudden release of the pressure in the skull from the area
above the lumbar puncture
Which action would the nurse take when caring for a patient with a cerebrospinal fluid
(CSF) drainage system that begins to complain of headache and nausea?
A. Give oral mannitol
B. Administer an IV fluid bolus
C. Elevate head of patient's bed
D. Administer narcotic pain medicine - CORRECT ANSWER-C
Elevating the head of the bed allows for appropriate drainage of CSF and is helpful for
the patient with increased intracranial pressure (ICP).
Which device is used to measure cerebral oxygenation levels?
A. Licox catheter
B. Peripheral arterial line
C. Intraventricular catheter
D. Ventriculostomy catheter - CORRECT ANSWER-A
The Licox catheter is placed in the healthy white matter of the brain and provides
continuous monitoring of the pressure of oxygen in brain tissue (PbtO2).
Which step is first in the management of increased intracranial pressure (ICP)?
A. Support brain function by adequate oxygenation
B. Support the family and caregivers
C. Maintain dynamic equilibrium in cerebral responses
D. Maintain fluid balance - CORRECT ANSWER-A
Ensuring adequate oxygenation to support brain function is the first step in the
management of increased cerebral spinal fluid (CSF). An endotracheal tube or
tracheostomy may be necessary to maintain adequate ventilation. Arterial blood gas
(ABG) analysis guides the oxygen therapy. The goal is to maintain the PaO2 at 100 mm
Hg or greater. It may be necessary to maintain the patient on a mechanical ventilator to
ensure adequate oxygenation.
Which medication therapy is first-line treatment for elevated intracranial pressure (ICP)?
A. Hypertonic saline
B. Corticosteroids
C. Phenytoin
D. High-dose barbiturates - CORRECT ANSWER-A
Hypertonic saline is the first-line treatment for elevated cerebral spinal fluid (CSF). It
reduces swelling and improves cerebral blood flow (CBF), drawing water out of the
brain tissue.
A patient presents with abnormal extension, does not open their eyes to stimulus, and
does not give a sound as reaction to pain. The patient exhibiting these signs would be
given a score of ___________ using the Glasgow Coma Scale.
A. 2
