C HAPTER 17: N EUROLOGIC D ISORDERS AND
T HERAPEUTIC M ANAGEMENT
Urden: Priorities in Cr itical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. A patient has been admitted with an intracerebral hemorrhage. A CT of
the patient’s head reveals a large left p arietal area bleed. Patient
assessment includes T —98.7°F, P—98 beats/min and thready, R —8
breaths/min, and BP —168/100 mm Hg. Initial management of the patient
includes which intervention?
a. Placing the patient in the Trendelenburg position
b. Administering an antihypertensive agent
c. Initiating hemodynamic augmentation therapy
d. Intubating and ventilating the patient
ANS: D
Intracerebral hemorrhage is a medical emergency. Initial management
requires attention to airway, breathing, and circulation. Intubation is
usuall y necessary. Blood pressure management must be based on
individual factors. Reduction in blood pressure is usuall y necessary to
decrease ongoing bleeding, but lowering blood pressure too much or
too rapidl y may compromise cerebral perfusion pressure, e speciall y in
a patient with elevated intracranial pressure. National guidelines
recommend keeping the mean arterial blood pressure below 130 mm Hg
in patients with a history of hypertension by moderate blood pressure
reduction to a mean arterial pressure b elow 110 mm Hg. Vasopressor
, therapy after fluid replenishment is recommended if systolic blood
pressure falls below 90 mm Hg.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Implementation TOP: Neurologic
Disorders and Therapeutic Management MSC: NC LEX:
Physiological Integrity: Reduction of Risk Potential
2. A right-handed patient has been admitted with an intracerebral
hemorrhage. A CT of the patient’s head reveals a large left parietal area
bleed. Based on the type of stroke, which signs and signs might the
patient exhibit?
a. Right-sided hemiplegia and receptive aphasia
b. Left-sided hemiplegia and tactile agnosia
c. Decorticate posturing and unequal pupils
d. Unilateral neglect and dressing apraxia
ANS: A
Damage to the dominant hemisphere p roduces problems with speech
and language and abstract and anal ytical skills.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Assessment TOP: Neurologic Disorders and
Therapeutic Management MSC: NC LEX:
Physiological Integrity: Phys iological Adaptation
3. A patient has been experiencing drowsiness, confusion, and slight focal
deficits for several days. The initial noncontract CT findings are
, negative. The patient is being prepared for a lumbar puncture. Which
CSF appearance finding sho uld the nurse expect?
a. Cloudy
b. Bloody
c. Xanthochromic
d. Clear
ANS: B
If the initial computed tomography findings are negative, a lumbar
puncture is performed to obtain cerebrospinal fluid (CSF) for anal ysis.
CSF after subarachnoid hemorrhage (SAH) appears blo ody and has a
red blood cell count greater than 1000 cells/mm3. If the lumbar
puncture is performed more than 5 days after the SAH, the CSF fluid is
xanthochromic (dark amber) because the blood products have broken
down. Cloudy CSF usuall y indicates some t ype of infectious process
such as bacterial meningitis, not SAH.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Diagnosis TOP: Neurologic Disorders and
Therapeutic Management MSC: NC LEX:
Physiological Integrity: Physiological Adap tation
4. A patient has just been admitted with head trauma. While awaiting the
results of the CT scan, the patient becomes comatose, develops fixed
and dilated pupils, and flaccid to noxious stimuli. The nurse knows that
these signs are indicative of which t ype of herniation?
a. Central
b. Uncal
c. Cingulate
d. Infratentorial
T HERAPEUTIC M ANAGEMENT
Urden: Priorities in Cr itical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. A patient has been admitted with an intracerebral hemorrhage. A CT of
the patient’s head reveals a large left p arietal area bleed. Patient
assessment includes T —98.7°F, P—98 beats/min and thready, R —8
breaths/min, and BP —168/100 mm Hg. Initial management of the patient
includes which intervention?
a. Placing the patient in the Trendelenburg position
b. Administering an antihypertensive agent
c. Initiating hemodynamic augmentation therapy
d. Intubating and ventilating the patient
ANS: D
Intracerebral hemorrhage is a medical emergency. Initial management
requires attention to airway, breathing, and circulation. Intubation is
usuall y necessary. Blood pressure management must be based on
individual factors. Reduction in blood pressure is usuall y necessary to
decrease ongoing bleeding, but lowering blood pressure too much or
too rapidl y may compromise cerebral perfusion pressure, e speciall y in
a patient with elevated intracranial pressure. National guidelines
recommend keeping the mean arterial blood pressure below 130 mm Hg
in patients with a history of hypertension by moderate blood pressure
reduction to a mean arterial pressure b elow 110 mm Hg. Vasopressor
, therapy after fluid replenishment is recommended if systolic blood
pressure falls below 90 mm Hg.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Implementation TOP: Neurologic
Disorders and Therapeutic Management MSC: NC LEX:
Physiological Integrity: Reduction of Risk Potential
2. A right-handed patient has been admitted with an intracerebral
hemorrhage. A CT of the patient’s head reveals a large left parietal area
bleed. Based on the type of stroke, which signs and signs might the
patient exhibit?
a. Right-sided hemiplegia and receptive aphasia
b. Left-sided hemiplegia and tactile agnosia
c. Decorticate posturing and unequal pupils
d. Unilateral neglect and dressing apraxia
ANS: A
Damage to the dominant hemisphere p roduces problems with speech
and language and abstract and anal ytical skills.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Assessment TOP: Neurologic Disorders and
Therapeutic Management MSC: NC LEX:
Physiological Integrity: Phys iological Adaptation
3. A patient has been experiencing drowsiness, confusion, and slight focal
deficits for several days. The initial noncontract CT findings are
, negative. The patient is being prepared for a lumbar puncture. Which
CSF appearance finding sho uld the nurse expect?
a. Cloudy
b. Bloody
c. Xanthochromic
d. Clear
ANS: B
If the initial computed tomography findings are negative, a lumbar
puncture is performed to obtain cerebrospinal fluid (CSF) for anal ysis.
CSF after subarachnoid hemorrhage (SAH) appears blo ody and has a
red blood cell count greater than 1000 cells/mm3. If the lumbar
puncture is performed more than 5 days after the SAH, the CSF fluid is
xanthochromic (dark amber) because the blood products have broken
down. Cloudy CSF usuall y indicates some t ype of infectious process
such as bacterial meningitis, not SAH.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Diagnosis TOP: Neurologic Disorders and
Therapeutic Management MSC: NC LEX:
Physiological Integrity: Physiological Adap tation
4. A patient has just been admitted with head trauma. While awaiting the
results of the CT scan, the patient becomes comatose, develops fixed
and dilated pupils, and flaccid to noxious stimuli. The nurse knows that
these signs are indicative of which t ype of herniation?
a. Central
b. Uncal
c. Cingulate
d. Infratentorial
