NR 340 Week 3 EVOLVE
(Complete solutions and resources for the course exam)
Questions
1. 1.ID: 43154241
What is the therapeutic effect of head-of-the-bed elevation and neutral head and neck
alignment on increased intracranial pressure (ICP)?
o Lowering ICP by allowing for elevations in CO2 to dilate cerebral arteries
o Lowering ICP by facilitating venous drainage and decreasing venous
obstruction Correct
o Lowering ICP by maintaining an open airway
o Lowering ICP by reducing the risk of snoring
Head-of-the-bed elevation and a neutral head position that avoids hyperextension or
hyperflexion wfacilitate wjugular wvenous wdrainage, whelping wto wminimize wincreases win
wICP. wElevated wCO2 wcontributes wto wcerebral wvessel wvasodilation, wwhich wcan
wincrease wcerebral wblood wvolume wand wfurther welevate wICP. wMaintaining wan wopen
wairway walone wdoes wnot wminimize wincreases win wICP. wReducing wthe wrisk wof
wsnoring wby wmaintaining wan wopen wairway walone wdoes wnot wminimize wincreases win
wICP.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
2. 2.ID: w43154255
Under wnormal wcircumstances wthe wcerebral wvasculature wexhibits wpressure wand
wchemical wautoregulation. wWhat whappens wwhen wautoregulation wis wlost?
, o Central wvenous wengorgement woccurs.
o Cerebral wblood wflow wis wnot waffected.
o Hypertension wincreases wcerebral wblood wflow. wCorrect
o Shunting wof wcerebrospinal wfluid w(CSF) wis wblocked.
Autoregulation wis wthe wability wof wthe wcerebral wvessels wto wadjust wtheir wdiameter win
wresponse wto warterial wpressure wchanges wwithin wthe wbrain. wIf wmean warterial wblood
wpressure wrises, wcerebral wvessels wwill wconstrict wto wprevent wexcessive wdistention wof
wthe wcerebral warteries. wWhen wautoregulation wis wlost, wcerebral wvessels ware wno
wlonger wable wto wregulate wdiameter wand was wa wresult whypertension wincreases
wcerebral wperfusion wpressure. wCerebral wvessels wmay wbecome wengorged was wa wresult
wof wthe wloss wof wautoregulation. wCerebral wblood wflow wis waffected wwith wthe wloss wof
wautoregulation. wLoss wof wautoregulation wdoes wnot wblock wCSF wflow.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
3. 3.ID: w43154263
The wnurse wis wmonitoring wa wpatient’s wintracranial wpressure w(ICP). wWhile wthe
wnurse wis wproviding whygiene wmeasures, wshe wobserves wthat wthe wICP wreading wis
wsustained wat w18 wmm wHg. wWhat wis wthe wpriority wnursing waction?
o Cease wstimulating wthe wpatient. wCorrect
o Continue wwith whygiene wmeasures.
o Lower wthe whead wof wthe wbed wto w10 wdegrees.
o Open wthe wICP wmonitor wto wcontinuous wdrainage.
Sustained wincreases win wICP wshould wbe wavoided. wNursing wcare wactivities wshould wbe
wspaced wto wprevent wan wincrease win wICP. wActions wthat wcause wa wsustained
welevation win wICP wshould wbe wavoided wuntil wICP wreturns wto wbaseline wresting
wvalues. wElevating wthe whead wof wthe wbed wto w30 wdegrees wor wmore wcan whelp
wreduce wICP. wContinuous wdrainage wof wCSF wfluid wwill wresult win wherniation.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
4. 4.ID: w43154273
, Herniation wsyndromes wcan wbe wlife-threatening wsituations. wWhich wsyndrome wcauses wthe
wsupratentorial wcontents wto wshift wdownward wand wcompress wvital wcenters wof wthe
wbrainstem?
o Central wherniation wCorrect
o Cingulate wherniation
o Tonsillar wherniation
o Uncal wherniation
A wdownward wshift wof wthe wcerebral whemispheres, wbasal wganglia, wand wdiencephalon
wthrough wthe wtentorial wnotch wcauses wcentral wherniation, wwhich wcompresses wthe
wvital wcenters wof wthe wbrainstem. wThis wresults win wa wshift wof wone wcerebral
whemisphere wunder wthe wfalx wcerebri wto wthe wother wcerebral whemisphere. wCerebellar
wtonsils ware wdisplaced wthrough wthe wforamen wmagnum, wcausing wfatal wdamage wto
wthe wrespiratory wand wcardiac wcenters. wUncal wherniation wcompresses wthe wmidbrain,
wcausing wdysfunction wof wthe wipsilateral wthird wnerve, wresulting win wunilateral wpupil
wdilation.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
5. 5.ID: w43154282
In wa wpatient wwith wincreased wintracranial wpressure w(ICP), wwhich wof wthe wfollowing
wcranial wnerves wwould wbe wassessed wfor wconsensual wlight wresponse, welevation wof
wthe weyelids, wand weye wmovement?
o I, wIX, wX
o II, wV, wVII
o II, wVI, wX
o III, wIV, wVI wCorrect
Cranial wnerve wIII wis wresponsible wfor wthe wconsensual wlight wresponse, welevation wof
wthe weyelids, wand weye wmovements. wIn waddition, wcranial wnerves wIII, wIV, wand wVI
waffect wextraocular weye wmovements.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
, 6. 6.ID: w43154291
The wnurse wis wmanaging wthe wblood wpressure wof wa wpatient wwith wa wtraumatic wbrain
winjury. wWhen wplanning wthe wcare wof wthis wpatient, wwhich wstatement wbest
wrepresents wappropriate wblood wpressure wmanagement?
o Cerebral wperfusion wpressure w(CPP) wshould wbe wsustained wat wleast w70 wmm
wHg.
Correct
o Hypertension wgreater wthan w160 wmm wHg wis wnecessary wto wachieve
wadequate wperfusion.
o Nimodipine wreduces wblood wpressure wthrough wits weffect won wcerebral wvessels.
o Nitrates ware wthe wvasopressors wof wchoice wwith wincreased wICP.
To wachieve wadequate wcerebral wblood wflow, wcerebral wperfusion wpressure w(CPP w=
wMAP-ICP) wshould wbe wat wleast w70 wmm wHg. wWhile whypotension wmay wcompromise
wcerebral wblood wflow, win wthe wsetting wof wincreased wintracranial wpressure,
whypertension w(>160 wmm wHg) wcan wworsen wcerebral wedema wby wincreasing
wmicrovascular wpressure. wNimodipine wis wa wcalcium wchannel wblocker wthat wdoes
wnot waffect wcerebral wvasculature wand wis weffective win wproviding wquick, wtight
wcontrol wof wblood wpressure.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
7. 7.ID: w43154500
The wnurse wis wcaring wfor wa wpatient wwith wa wruptured wcerebral waneurysm. wDuring
winitial wassessment, wthe wnurse wnotes wthat wthe wcerebrospinal wfluid wdraining winto wa
wventriculostomy wsystem wis wblood wtinged. wWhat wis wthe wbest winterpretation wof wthis
wfinding wby wthe wnurse?
o Cerebral waneurysms wcommonly wrupture win wthe wsubarachnoid wspace. wCorrect
o This wassessment wfinding wis windicative wof wdeveloping wcerebral wmeningitis.
o Patient wmovement whas wresulted win wdislodgement wof wthe wcatheter.
o Normal wcerebral wspinal wfluid wcontains wa wsmall wamount wof wvisible wblood.
Cerebral waneurysms wcommonly wrupture win wthe wsubarachnoid wspace, wresulting win
wcerebral wspinal wfluid wthat wis wblood wtinged. wCerebral wspinal wfluid wis wcloudy win
wthe wpresence wof
(Complete solutions and resources for the course exam)
Questions
1. 1.ID: 43154241
What is the therapeutic effect of head-of-the-bed elevation and neutral head and neck
alignment on increased intracranial pressure (ICP)?
o Lowering ICP by allowing for elevations in CO2 to dilate cerebral arteries
o Lowering ICP by facilitating venous drainage and decreasing venous
obstruction Correct
o Lowering ICP by maintaining an open airway
o Lowering ICP by reducing the risk of snoring
Head-of-the-bed elevation and a neutral head position that avoids hyperextension or
hyperflexion wfacilitate wjugular wvenous wdrainage, whelping wto wminimize wincreases win
wICP. wElevated wCO2 wcontributes wto wcerebral wvessel wvasodilation, wwhich wcan
wincrease wcerebral wblood wvolume wand wfurther welevate wICP. wMaintaining wan wopen
wairway walone wdoes wnot wminimize wincreases win wICP. wReducing wthe wrisk wof
wsnoring wby wmaintaining wan wopen wairway walone wdoes wnot wminimize wincreases win
wICP.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
2. 2.ID: w43154255
Under wnormal wcircumstances wthe wcerebral wvasculature wexhibits wpressure wand
wchemical wautoregulation. wWhat whappens wwhen wautoregulation wis wlost?
, o Central wvenous wengorgement woccurs.
o Cerebral wblood wflow wis wnot waffected.
o Hypertension wincreases wcerebral wblood wflow. wCorrect
o Shunting wof wcerebrospinal wfluid w(CSF) wis wblocked.
Autoregulation wis wthe wability wof wthe wcerebral wvessels wto wadjust wtheir wdiameter win
wresponse wto warterial wpressure wchanges wwithin wthe wbrain. wIf wmean warterial wblood
wpressure wrises, wcerebral wvessels wwill wconstrict wto wprevent wexcessive wdistention wof
wthe wcerebral warteries. wWhen wautoregulation wis wlost, wcerebral wvessels ware wno
wlonger wable wto wregulate wdiameter wand was wa wresult whypertension wincreases
wcerebral wperfusion wpressure. wCerebral wvessels wmay wbecome wengorged was wa wresult
wof wthe wloss wof wautoregulation. wCerebral wblood wflow wis waffected wwith wthe wloss wof
wautoregulation. wLoss wof wautoregulation wdoes wnot wblock wCSF wflow.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
3. 3.ID: w43154263
The wnurse wis wmonitoring wa wpatient’s wintracranial wpressure w(ICP). wWhile wthe
wnurse wis wproviding whygiene wmeasures, wshe wobserves wthat wthe wICP wreading wis
wsustained wat w18 wmm wHg. wWhat wis wthe wpriority wnursing waction?
o Cease wstimulating wthe wpatient. wCorrect
o Continue wwith whygiene wmeasures.
o Lower wthe whead wof wthe wbed wto w10 wdegrees.
o Open wthe wICP wmonitor wto wcontinuous wdrainage.
Sustained wincreases win wICP wshould wbe wavoided. wNursing wcare wactivities wshould wbe
wspaced wto wprevent wan wincrease win wICP. wActions wthat wcause wa wsustained
welevation win wICP wshould wbe wavoided wuntil wICP wreturns wto wbaseline wresting
wvalues. wElevating wthe whead wof wthe wbed wto w30 wdegrees wor wmore wcan whelp
wreduce wICP. wContinuous wdrainage wof wCSF wfluid wwill wresult win wherniation.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
4. 4.ID: w43154273
, Herniation wsyndromes wcan wbe wlife-threatening wsituations. wWhich wsyndrome wcauses wthe
wsupratentorial wcontents wto wshift wdownward wand wcompress wvital wcenters wof wthe
wbrainstem?
o Central wherniation wCorrect
o Cingulate wherniation
o Tonsillar wherniation
o Uncal wherniation
A wdownward wshift wof wthe wcerebral whemispheres, wbasal wganglia, wand wdiencephalon
wthrough wthe wtentorial wnotch wcauses wcentral wherniation, wwhich wcompresses wthe
wvital wcenters wof wthe wbrainstem. wThis wresults win wa wshift wof wone wcerebral
whemisphere wunder wthe wfalx wcerebri wto wthe wother wcerebral whemisphere. wCerebellar
wtonsils ware wdisplaced wthrough wthe wforamen wmagnum, wcausing wfatal wdamage wto
wthe wrespiratory wand wcardiac wcenters. wUncal wherniation wcompresses wthe wmidbrain,
wcausing wdysfunction wof wthe wipsilateral wthird wnerve, wresulting win wunilateral wpupil
wdilation.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
5. 5.ID: w43154282
In wa wpatient wwith wincreased wintracranial wpressure w(ICP), wwhich wof wthe wfollowing
wcranial wnerves wwould wbe wassessed wfor wconsensual wlight wresponse, welevation wof
wthe weyelids, wand weye wmovement?
o I, wIX, wX
o II, wV, wVII
o II, wVI, wX
o III, wIV, wVI wCorrect
Cranial wnerve wIII wis wresponsible wfor wthe wconsensual wlight wresponse, welevation wof
wthe weyelids, wand weye wmovements. wIn waddition, wcranial wnerves wIII, wIV, wand wVI
waffect wextraocular weye wmovements.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
, 6. 6.ID: w43154291
The wnurse wis wmanaging wthe wblood wpressure wof wa wpatient wwith wa wtraumatic wbrain
winjury. wWhen wplanning wthe wcare wof wthis wpatient, wwhich wstatement wbest
wrepresents wappropriate wblood wpressure wmanagement?
o Cerebral wperfusion wpressure w(CPP) wshould wbe wsustained wat wleast w70 wmm
wHg.
Correct
o Hypertension wgreater wthan w160 wmm wHg wis wnecessary wto wachieve
wadequate wperfusion.
o Nimodipine wreduces wblood wpressure wthrough wits weffect won wcerebral wvessels.
o Nitrates ware wthe wvasopressors wof wchoice wwith wincreased wICP.
To wachieve wadequate wcerebral wblood wflow, wcerebral wperfusion wpressure w(CPP w=
wMAP-ICP) wshould wbe wat wleast w70 wmm wHg. wWhile whypotension wmay wcompromise
wcerebral wblood wflow, win wthe wsetting wof wincreased wintracranial wpressure,
whypertension w(>160 wmm wHg) wcan wworsen wcerebral wedema wby wincreasing
wmicrovascular wpressure. wNimodipine wis wa wcalcium wchannel wblocker wthat wdoes
wnot waffect wcerebral wvasculature wand wis weffective win wproviding wquick, wtight
wcontrol wof wblood wpressure.
Awarded w0.0 wpoints wout wof w1.0 wpossible wpoints.
7. 7.ID: w43154500
The wnurse wis wcaring wfor wa wpatient wwith wa wruptured wcerebral waneurysm. wDuring
winitial wassessment, wthe wnurse wnotes wthat wthe wcerebrospinal wfluid wdraining winto wa
wventriculostomy wsystem wis wblood wtinged. wWhat wis wthe wbest winterpretation wof wthis
wfinding wby wthe wnurse?
o Cerebral waneurysms wcommonly wrupture win wthe wsubarachnoid wspace. wCorrect
o This wassessment wfinding wis windicative wof wdeveloping wcerebral wmeningitis.
o Patient wmovement whas wresulted win wdislodgement wof wthe wcatheter.
o Normal wcerebral wspinal wfluid wcontains wa wsmall wamount wof wvisible wblood.
Cerebral waneurysms wcommonly wrupture win wthe wsubarachnoid wspace, wresulting win
wcerebral wspinal wfluid wthat wis wblood wtinged. wCerebral wspinal wfluid wis wcloudy win
wthe wpresence wof
