1
NUR 417
NUR 417 Final Exam Review | Care of
Adult II | Questions & Answers| Grade A |
100% Correct | (NEW 2025/ 2026)
1. A patient has a systemic BP of 120/60 mm Hg and an ICP of 24 mm
Hg. After calculating the patient's cerebral perfusion pressure (CPP),
how does the nurse interpret the results? A. High blood flow to the
brain
B. Normal intracranial pressure
C. Impaired blood flow to the brain
D. Adequate autoregulation of blood flow: C
Normal CPP is 60 to 100 mm Hg. The CPP is calculated with mean arterial
pressure
(MAP) minus ICP. MAP = SBP + 2 (DBP)/ 3: 120 mm Hg + 2 (60 mm Hg)/3
=
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80 mm Hg. MAP ICP: 80 mm Hg 24 mm Hg = 56 mm Hg CPP. The
decreased CPP indicates that there is impaired cerebral blood flow and
that autoregulation is impaired. Because the ICP is 24 mm Hg, treatment
is required.
A patient with suspected bacterial meningitis just had a lumbar
puncture in which cerebrospinal fluid was obtained for culture.
Which medication should the nurse give first?
A. Codeine
B. Phenytoin
C. Ceftriaxone
D. Acetaminophen: C
Bacterial meningitis is a medical emergency. When meningitis is
suspected, antibiotic therapy (e.g., ceftriaxone) is started immediately
after the collection of specimens for cultures and even before the diagnosis
is confirmed. Dexamethasone may be given before or with the first dose of
antibiotics. The nurse should collaborate with the health care provider to
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manage the headache (with codeine), fever (with acetaminophen), and
seizures (with phenytoin).
The nurse is caring for a patient admitted to the hospital with a
head injury who requires frequent neurologic assessment. Which
components are assessed using the Glasgow Coma Scale (GCS)?
(Select all that apply.)
A. Judgment
B. Eye opening
C. Abstract reasoning
D. Best motor response
E. Best verbal response
F. Cranial nerve function: B D E
The three dimensions of the GCS are eye opening, best verbal response,
and best motor response. Judgment, abstract reasoning, and cranial
nerve function are not components of the GCS.
What nursing intervention should be implemented for a patient
with increased intracranial pressure (ICP)?
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A. Monitor fluid and electrolyte status carefully.
B. Position the patient in a high Fowler's position.
C. Administer vasoconstrictors to maintain cerebral perfusion.
D. Maintain physical restraints to prevent episodes of agitation.: A
Fluid and electrolyte changes can have an adverse effect on ICP and
must be monitored vigilantly. The head of the patient's bed should be
kept at 30 degrees in most circumstances, and physical restraints are
not applied unless absolutely necessary. Vasoconstrictors are not
typically used in the treatment of ICP.
The nurse is caring for a patient admitted with a subdural hematoma
after a motor vehicle accident. What change in vital signs would the
nurse interpret as a manifestation of increased intracranial pressure
(ICP)?
A. Tachypnea
B. Bradycardia
C. Hypotension
D. Narrowing pulse pressure: B
NUR 417
NUR 417
NUR 417 Final Exam Review | Care of
Adult II | Questions & Answers| Grade A |
100% Correct | (NEW 2025/ 2026)
1. A patient has a systemic BP of 120/60 mm Hg and an ICP of 24 mm
Hg. After calculating the patient's cerebral perfusion pressure (CPP),
how does the nurse interpret the results? A. High blood flow to the
brain
B. Normal intracranial pressure
C. Impaired blood flow to the brain
D. Adequate autoregulation of blood flow: C
Normal CPP is 60 to 100 mm Hg. The CPP is calculated with mean arterial
pressure
(MAP) minus ICP. MAP = SBP + 2 (DBP)/ 3: 120 mm Hg + 2 (60 mm Hg)/3
=
NUR 417
, 2
NUR 417
80 mm Hg. MAP ICP: 80 mm Hg 24 mm Hg = 56 mm Hg CPP. The
decreased CPP indicates that there is impaired cerebral blood flow and
that autoregulation is impaired. Because the ICP is 24 mm Hg, treatment
is required.
A patient with suspected bacterial meningitis just had a lumbar
puncture in which cerebrospinal fluid was obtained for culture.
Which medication should the nurse give first?
A. Codeine
B. Phenytoin
C. Ceftriaxone
D. Acetaminophen: C
Bacterial meningitis is a medical emergency. When meningitis is
suspected, antibiotic therapy (e.g., ceftriaxone) is started immediately
after the collection of specimens for cultures and even before the diagnosis
is confirmed. Dexamethasone may be given before or with the first dose of
antibiotics. The nurse should collaborate with the health care provider to
NUR 417
, 3
NUR 417
manage the headache (with codeine), fever (with acetaminophen), and
seizures (with phenytoin).
The nurse is caring for a patient admitted to the hospital with a
head injury who requires frequent neurologic assessment. Which
components are assessed using the Glasgow Coma Scale (GCS)?
(Select all that apply.)
A. Judgment
B. Eye opening
C. Abstract reasoning
D. Best motor response
E. Best verbal response
F. Cranial nerve function: B D E
The three dimensions of the GCS are eye opening, best verbal response,
and best motor response. Judgment, abstract reasoning, and cranial
nerve function are not components of the GCS.
What nursing intervention should be implemented for a patient
with increased intracranial pressure (ICP)?
NUR 417
, 4
NUR 417
A. Monitor fluid and electrolyte status carefully.
B. Position the patient in a high Fowler's position.
C. Administer vasoconstrictors to maintain cerebral perfusion.
D. Maintain physical restraints to prevent episodes of agitation.: A
Fluid and electrolyte changes can have an adverse effect on ICP and
must be monitored vigilantly. The head of the patient's bed should be
kept at 30 degrees in most circumstances, and physical restraints are
not applied unless absolutely necessary. Vasoconstrictors are not
typically used in the treatment of ICP.
The nurse is caring for a patient admitted with a subdural hematoma
after a motor vehicle accident. What change in vital signs would the
nurse interpret as a manifestation of increased intracranial pressure
(ICP)?
A. Tachypnea
B. Bradycardia
C. Hypotension
D. Narrowing pulse pressure: B
NUR 417
