EXAM 3 - Brain Injury questions and
answers Newest RATED A+ 100% PASS
3 components of intracranial dynamics - Correct Answers 80% brain
II! II! II! II! II! II! II! II! II! II! II! II! II!
10% CSF (biggest component is glucose)
II! II! II! II! II! II!
10% blood II!
II! normal intracranial pressure - Correct Answers 5-15 mmHg
II! II! II! II! II! II! II! II! II! II! II!
II! The Monro-Kellie hypothesis explains the compensatory relationship among the structures in the skull
II! II! II! II! II! II! II! II! II! II! II! II!
II! that play a role with intracranial pressure. Which of the following are NOT compensatory mechanisms
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! performed by the body to decrease intracranial pressure naturally? Select all that apply: II! II! II! II! II! II! II! II! II! II! II! II!
A. Shifting cerebrospinal fluid to other areas of the brain and spinal cord
II! II! II! II! II! II! II! II! II! II! II! II!
B. Vasodilation of cerebral vessels
II! II! II! II!
C. Decreasing cerebrospinal fluid production
II! II! II! II!
D. Leaking proteins into the brain barrier - Correct Answers The answers are B and D. These are NOT
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
compensatory mechanisms, but actions that will actually increase intracranial pressure. Vasoconstriction
II! II! II! II! II! II! II! II! II! II! II!
(not dilation) decreases blood flow and helps lower ICP. Leaking of protein actually leads to more swelling
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
of the brain tissue. Remember water is attracted to protein (oncotic pressure).
II! II! II! II! II! II! II! II! II! II! II! II!
II! A patient is experiencing hyperventilation and has a PaCO2 level of 52. The patient has an ICP of 20
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! mmHg. As the nurse you know that the PaCO2 level will?
II! II! II! II! II! II! II! II! II! II!
A. cause vasoconstriction and decrease the ICP
II! II! II! II! II! II!
B. promote diuresis and decrease the ICP
II! II! II! II! II! II!
C. cause vasodilation and increase the ICP
II! II! II! II! II! II!
D. cause vasodilation and decrease the ICP - Correct Answers The answer is C. An elevated carbon
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
dioxide level in the blood will cause vasodilation (NOT constriction), which will increase ICP (normal ICP 5
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
to 15 mmHg). Therefore, many patients with severe ICP may need to be mechanical ventilated so PaCO2
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
levels can be lowered (30-35), which will lead to vasoconstriction and decrease ICP (with constriction
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
there is less blood volume and flow going to the brain and this helps decrease pressure)....remember
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
Monro-Kellie hypothesis.
II! II!
, II! What causes increased ICP? - Correct Answers head trauma, cerebral hemorrhage, hematoma,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! hydrocephalus, tumor, encephalitis etc. can all increase ICP. II! II! II! II! II! II! II!
II! A patient with increased ICP has the following vital signs: blood pressure 99/60, HR 65, Temperature
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! 101.6 'F, respirations 14, oxygen saturation of 95%. ICP reading is 21 mmHg. Based on these findings you
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! would?
A. Administered PRN dose of a vasopressor
II! II! II! II! II! II!
B. Administer 2 L of oxygen
II! II! II! II! II!
C. Remove extra blankets and give the patient a cool bath
II! II! II! II! II! II! II! II! II! II!
D. Perform suctioning - Correct Answers The answer is C. It is important to monitor the patient for
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
hyperthermia (a fever). A fever increases ICP and cerebral blood volume, and metabolic needs of the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patient. The nurse can administer antipyretics per MD order, remove extra blankets, decrease room
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
temperature, give a cool bath or use a cooling system. Remember it is important to prevent shivering (this
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
also increases metabolic needs and ICP).
II! II! II! II! II! II!
II! A patient has a ventriculostomy. Which finding would you immediately report to the doctor?
II! II! II! II! II! II! II! II! II! II! II! II! II!
A. Temperature 98.4 'F
II! II! II!
B. CPP 70 mmHg
II! II! II!
C. ICP 24 mmHg
II! II! II!
D. PaCO2 35 - Correct Answers The answer is C. A ventriculostomy is a catheter inserted in the area of
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
the lateral ventricle to assess ICP. It will help drain CSF during increase pressure readings and measure ICP.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
The nurse must monitor for ICP levels greater than 20 mmHg and report it to the doctor.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Which of the following is contraindicated in a patient with increased ICP?
II! II! II! II! II! II! II! II! II! II! II!
A. Lumbar puncture
II! II!
B. Midline position of the head
II! II! II! II! II!
C. Hyperosmotic diuretics
II! II!
D. Barbiturates medications - Correct Answers The answer is A. LPs are avoided in patients with ICP
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
because they can lead to possible brain herniation.
II! II! II! II! II! II! II! II!
II! You're collecting vital signs on a patient with ICP. The patient has a Glascoma Scale rating of 4. How will
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! you assess the patient's temperature?
II! II! II! II!
, A. Rectal II!
B. Oral II!
C. Axillary - Correct Answers The answer is A. This GCS rating demonstrates the patient is unconscious. If
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a patient is unconscious the nurse should take the patient's temperature either via the rectal, tympanic,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
or temporal method. Oral and axillary are not reliable.
II! II! II! II! II! II! II! II! II!
II! A patient who experienced a cerebral hemorrhage is at risk for developing increased ICP. Which sign and
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! symptom below is the EARLIEST indicator the patient is having this complication?
II! II! II! II! II! II! II! II! II! II! II!
A. Bradycardia II!
B. Decerebrate posturing
II! II!
C. Restlessness
II!
D. Unequal pupil size - Correct Answers The answer is C. Mental status changes are the earliest indicator
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a patient is experiencing increased ICP. All the other signs and symptoms listed happen later.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Select all the signs and symptoms that occur with increased ICP:
II! II! II! II! II! II! II! II! II! II!
A. Decorticate posturing
II! II!
B. TachycardiaII!
C. Decrease in pulse pressure
II! II! II! II!
D. Cheyne-stokes
II!
E. Hemiplegia
II!
F. Decerebrate posturing - Correct Answers The answers are A, D, E, and F. Option B is wrong because
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
bradycardia (not tachycardia) happens in the late stage along with an INCREASE (not decrease) in pulse
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
pressure.
II!
II! During the assessment of a patient with increased ICP, you note that the patient's arms are extended
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! straight out and toes pointed downward. You will document this as:
II! II! II! II! II! II! II! II! II! II!
A. Decorticate posturing
II! II!
B. Decerebrate posturing
II! II!
C. Flaccid posturing - Correct Answers B
II! II! II! II! II! II! II! II! II! II!
II! While positioning a patient in bed with increased ICP, it important to avoid?
II! II! II! II! II! II! II! II! II! II! II! II!
answers Newest RATED A+ 100% PASS
3 components of intracranial dynamics - Correct Answers 80% brain
II! II! II! II! II! II! II! II! II! II! II! II! II!
10% CSF (biggest component is glucose)
II! II! II! II! II! II!
10% blood II!
II! normal intracranial pressure - Correct Answers 5-15 mmHg
II! II! II! II! II! II! II! II! II! II! II!
II! The Monro-Kellie hypothesis explains the compensatory relationship among the structures in the skull
II! II! II! II! II! II! II! II! II! II! II! II!
II! that play a role with intracranial pressure. Which of the following are NOT compensatory mechanisms
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! performed by the body to decrease intracranial pressure naturally? Select all that apply: II! II! II! II! II! II! II! II! II! II! II! II!
A. Shifting cerebrospinal fluid to other areas of the brain and spinal cord
II! II! II! II! II! II! II! II! II! II! II! II!
B. Vasodilation of cerebral vessels
II! II! II! II!
C. Decreasing cerebrospinal fluid production
II! II! II! II!
D. Leaking proteins into the brain barrier - Correct Answers The answers are B and D. These are NOT
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
compensatory mechanisms, but actions that will actually increase intracranial pressure. Vasoconstriction
II! II! II! II! II! II! II! II! II! II! II!
(not dilation) decreases blood flow and helps lower ICP. Leaking of protein actually leads to more swelling
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
of the brain tissue. Remember water is attracted to protein (oncotic pressure).
II! II! II! II! II! II! II! II! II! II! II! II!
II! A patient is experiencing hyperventilation and has a PaCO2 level of 52. The patient has an ICP of 20
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! mmHg. As the nurse you know that the PaCO2 level will?
II! II! II! II! II! II! II! II! II! II!
A. cause vasoconstriction and decrease the ICP
II! II! II! II! II! II!
B. promote diuresis and decrease the ICP
II! II! II! II! II! II!
C. cause vasodilation and increase the ICP
II! II! II! II! II! II!
D. cause vasodilation and decrease the ICP - Correct Answers The answer is C. An elevated carbon
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
dioxide level in the blood will cause vasodilation (NOT constriction), which will increase ICP (normal ICP 5
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
to 15 mmHg). Therefore, many patients with severe ICP may need to be mechanical ventilated so PaCO2
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
levels can be lowered (30-35), which will lead to vasoconstriction and decrease ICP (with constriction
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
there is less blood volume and flow going to the brain and this helps decrease pressure)....remember
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
Monro-Kellie hypothesis.
II! II!
, II! What causes increased ICP? - Correct Answers head trauma, cerebral hemorrhage, hematoma,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! hydrocephalus, tumor, encephalitis etc. can all increase ICP. II! II! II! II! II! II! II!
II! A patient with increased ICP has the following vital signs: blood pressure 99/60, HR 65, Temperature
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! 101.6 'F, respirations 14, oxygen saturation of 95%. ICP reading is 21 mmHg. Based on these findings you
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! would?
A. Administered PRN dose of a vasopressor
II! II! II! II! II! II!
B. Administer 2 L of oxygen
II! II! II! II! II!
C. Remove extra blankets and give the patient a cool bath
II! II! II! II! II! II! II! II! II! II!
D. Perform suctioning - Correct Answers The answer is C. It is important to monitor the patient for
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
hyperthermia (a fever). A fever increases ICP and cerebral blood volume, and metabolic needs of the
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
patient. The nurse can administer antipyretics per MD order, remove extra blankets, decrease room
II! II! II! II! II! II! II! II! II! II! II! II! II! II!
temperature, give a cool bath or use a cooling system. Remember it is important to prevent shivering (this
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
also increases metabolic needs and ICP).
II! II! II! II! II! II!
II! A patient has a ventriculostomy. Which finding would you immediately report to the doctor?
II! II! II! II! II! II! II! II! II! II! II! II! II!
A. Temperature 98.4 'F
II! II! II!
B. CPP 70 mmHg
II! II! II!
C. ICP 24 mmHg
II! II! II!
D. PaCO2 35 - Correct Answers The answer is C. A ventriculostomy is a catheter inserted in the area of
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
the lateral ventricle to assess ICP. It will help drain CSF during increase pressure readings and measure ICP.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
The nurse must monitor for ICP levels greater than 20 mmHg and report it to the doctor.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Which of the following is contraindicated in a patient with increased ICP?
II! II! II! II! II! II! II! II! II! II! II!
A. Lumbar puncture
II! II!
B. Midline position of the head
II! II! II! II! II!
C. Hyperosmotic diuretics
II! II!
D. Barbiturates medications - Correct Answers The answer is A. LPs are avoided in patients with ICP
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
because they can lead to possible brain herniation.
II! II! II! II! II! II! II! II!
II! You're collecting vital signs on a patient with ICP. The patient has a Glascoma Scale rating of 4. How will
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! you assess the patient's temperature?
II! II! II! II!
, A. Rectal II!
B. Oral II!
C. Axillary - Correct Answers The answer is A. This GCS rating demonstrates the patient is unconscious. If
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a patient is unconscious the nurse should take the patient's temperature either via the rectal, tympanic,
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
or temporal method. Oral and axillary are not reliable.
II! II! II! II! II! II! II! II! II!
II! A patient who experienced a cerebral hemorrhage is at risk for developing increased ICP. Which sign and
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! symptom below is the EARLIEST indicator the patient is having this complication?
II! II! II! II! II! II! II! II! II! II! II!
A. Bradycardia II!
B. Decerebrate posturing
II! II!
C. Restlessness
II!
D. Unequal pupil size - Correct Answers The answer is C. Mental status changes are the earliest indicator
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
a patient is experiencing increased ICP. All the other signs and symptoms listed happen later.
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! Select all the signs and symptoms that occur with increased ICP:
II! II! II! II! II! II! II! II! II! II!
A. Decorticate posturing
II! II!
B. TachycardiaII!
C. Decrease in pulse pressure
II! II! II! II!
D. Cheyne-stokes
II!
E. Hemiplegia
II!
F. Decerebrate posturing - Correct Answers The answers are A, D, E, and F. Option B is wrong because
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
bradycardia (not tachycardia) happens in the late stage along with an INCREASE (not decrease) in pulse
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
pressure.
II!
II! During the assessment of a patient with increased ICP, you note that the patient's arms are extended
II! II! II! II! II! II! II! II! II! II! II! II! II! II! II! II!
II! straight out and toes pointed downward. You will document this as:
II! II! II! II! II! II! II! II! II! II!
A. Decorticate posturing
II! II!
B. Decerebrate posturing
II! II!
C. Flaccid posturing - Correct Answers B
II! II! II! II! II! II! II! II! II! II!
II! While positioning a patient in bed with increased ICP, it important to avoid?
II! II! II! II! II! II! II! II! II! II! II! II!
