GRADE A+ ICP NCLEX style Questions and answers 2025
a, c, e. Blood adapts with increased venous outflow,
Which components are able to change to adapt to small increases decreased cerebral blood flow (CBF), and collapse of
in intracranial pressure (ICP) (select all that veins and dural sinuses. Brain tissue adapts with distention
apply)? of the dura, slight compression of tissue, or herniation.
a. Blood d. Scalp tissue Cerebrospinal fluid (CSF) adapts with increased absorption,
b. Skull bone e. Cerebrospinal fluid (CSF) decreased production, and displacement into the spinal
c. Brain tissue canal. Skull bone and scalp tissue do not adapt to changes
in intracranial pressure (ICP).
56 mm Hg
The cerebral perfusion pressure (CPP) is the pressure needed to
Mean arterial pressure (MAP) = diastolic blood pressure
ensure blood flow to the brain. Normal CPP is 60 to
(DBP) + 1
100 mm Hg. Calculate the CPP of a patient whose blood pressure
D3s(ystolic blood pressure [SBP] - DBP) =
(BP) is 106/52 mm Hg and ICP is 14 mm Hg.
52 + 18 = 70
mm Hg
Cerebral per
45 mm Hg
Calculate the CPP for the patient with an ICP of 34 mm Hg and a
MAP = DBP + 1
systemic BP of 108/64 mm Hg.
D3S(BP DBP) = 64 + 15 = 79
mm Hg
CPP = MAP ICP = 79 34 = 45
Which factors decrease cerebral blood flow (select all that apply)? c, e. Cerebral blood flow is decreased when the MAP
a. Increased ICP d. Arterial blood pH of 7.3 and the PaCO2
b. PaO2 of 45 mm Hg e. Decreased mean arterial pressure (MAP) are decreased. The other options increase
c. PaCO2 of 30 mm Hg cerebral blood flow.
b, e. Vasogenic cerebral edema, the most common type
of edema, occurs mainly in the white matter and is
What are causes of vasogenic cerebral edema (select all that characterized by leakage of macromolecules from the
apply)? capillaries into the surrounding extracellular space. This
a. Hydrocephalus results in an osmotic gradient that favors the flow of
b. Ingested toxins fluid from the intravascular to the extravascular space. A
c. Destructive lesions or trauma variety of insults, such as brain tumors, abscesses, and
d. Local disruption of cell membranes ingested toxins, may cause an increase in the permeability
e. Fluid flowing from intravascular to extravascular space of the blood-brain barrier and produce an increase in the
extracellular fluid volume. Hydrocephalus causes interstitial
cerebral edema.
Which events cause increased ICP (select all that apply)?
a, b, d. Increased ICP is caused by vasodilation and edema
a. Vasodilation d. Edema from initial brain insult
from the initial brain insult or necrotic tissue. Blood vessel
b. Necrotic tissue edema e. Brainstem compression and hernia-
compression and brainstem compression and herniation
tion
occur as a result of increased ICP.
c. Blood vessel compression
An early sign of increased ICP that the nurse should assess for is . c. One of the most sensitive signs of increased ICP is a
a. Cushing's triad. c. decreasing level of consciousness (LOC). decreasing level of consciousness (LOC). A decrease in
b. unexpected vomiting. d. dilated pupil with sluggish response to LOC will occur before changes in vital signs, ocular signs,
light. or projectile vomiting occur.
The nurse recognizes the presence of Cushing's triad in the c. Cushing's triad consists of three vital sign measures that
patient with which vital sign changes? reflect ICP and its effect on the medulla, hypothalamus,
a. Increased pulse, irregular respiration, increased BP pons, and thalamus. Because these structures are very deep,
b. Decreased pulse, increased respiration, decreased systolic BP Cushing's triad is usually a late sign of ICP. The signs
c. Decreased pulse, irregular respiration, widened pulse pressure include an increasing SBP with a widening pulse pressure,
d. Increased pulse, decreased respiration, widened pulse pres- a bradycardia with a full and bounding pulse, and irregular
sure respirations.
c. The dural structures that separate the two hemispheres
and the cerebral hemispheres from the cerebellum influence
Increased ICP in the left cerebral cortex caused by intracranial
the patterns of cerebral herniation. A cingulate herniation
bleeding causes displacement of brain tissue to the occurs where there is lateral displacement of brain tissue
right hemisphere beneath the falx cerebri. The nurse knows that beneath the falx cerebri. Uncal herniation occurs when there
this is referred to as what? is lateral and downward herniation. Tentorial herniation
a. Uncal herniation c. Cingulate herniation
occurs when the brain herniates down through the opening
b. Tentorial herniation d. Temporal lobe herniation
created by the brainstem. The temporal lobe can be involved
in central herniation
1/5
, GRADE A+ ICP NCLEX style Questions and answers 2025
Priority Decision: A patient has ICP monitoring with an intraven- a. An intraventricular catheter is a fluid-coupled system that
tricular catheter. What is a priority nursing can provide direct access for microorganisms to enter the
intervention for the patient? ventricles of the brain and aseptic technique is a very high
a. Aseptic technique to prevent infection c. Removal of CSF to nursing priority to decrease the risk for infection. Constant
maintain normal ICP monitoring of ICP waveforms is not usually necessary and
b. Constant monitoring of ICP waveforms d. Sampling CSF to removal of CSF for sampling or to maintain normal ICP is
determine abnormalities done only when specifically ordered.
b. An inaccurate ICP reading can be caused by CSF
When using intraventricular ICP monitoring, what should the
leaks around the monitor device, obstruction of the
nurse be aware of to prevent inaccurate readings?
intraventricular catheter, kinks or bubbles in the tubing,
a. The P2 wave is higher than the P1 wave.
and incorrect height of the transducer or drainage system
b. CSF is leaking around the monitoring device.
relative to the patient's reference point. The P2 wave
c. The transducer of the ventriculostomy monitor is at the level of
being higher than the P1 wave indicates poor ventricular
the upper ear.
compliance. The transducer height should be at the tragus
d. The drain of the CSF drainage device was closed for 6 minutes
of the ear. The drain of the CSF drainage device should be
before taking the reading.
closed for 6 minutes preceding the reading.
b. The normal pressure of oxygen in brain tissue (PbtO2
)
The patient is being monitored long-term with a brain tissue oxy-
is 20 to 40 mm Hg. The normal jugular venous oxygen
genation catheter. What range for the pressure of
saturation (SjvO2
oxygen in brain tissue (PbtO2
) is 55% to 75% and indicates total venous
) will maintain cerebral oxygen supply and demand?
brain tissue extraction of oxygen; this is used for short-term
a. 55% to 75% c. 70 to 150 mm Hg
monitoring. The MAP of 70 to 150 mm Hg is needed for
b. 20 to 40 mm Hg d. 80 to 100 mm Hg
effective autoregulation of CBF. The normal range for PaO2
is 80 to 100 mm Hg.
c. Mannitol (Osmitrol) (25%) is an osmotic diuretic that
expands plasma and causes fluid to move from tissues into
the blood vessels. Hypertonic saline reduces brain swelling
Which drug treatment helps to decrease ICP by expanding plasma by moving water out of brain tissue. Oxygen administration
and the osmotic effect to move fluid? is done to maintain brain function. Pentobarbital
a. Oxygen administration c. Mannitol (Osmitrol) (25%) (Nembutal) and other barbiturates are used to reduce
b. Pentobarbital (Nembutal) d. Dexamethasone (Decadron) cerebral metabolism. The corticosteroid dexamethasone
(Decadron) is used to treat vasogenic edema to stabilize cell
membranes and improve neuronal function by improving
CBF and restoring autoregulation
d. A patient with increased ICP is in a hypermetabolic and
hypercatabolic state and needs adequate glucose to maintain
How are the metabolic and nutritional needs of the patient with fuel for the brain and other nutrients to meet metabolic needs.
increased ICP best met? Malnutrition promotes cerebral edema and if a patient cannot
a. Enteral feedings that are low in sodium take oral nutrition, other means of providing nutrition should
b. Simple glucose available in D5 be used, such as tube feedings or parenteral nutrition. Glucose
W IV solutions alone is not adequate to meet nutritional requirements and 5%
c. Fluid restriction that promotes a moderate dehydration dextrose solutions may increase cerebral edema by lowering
d. Balanced, essential nutrition in a form that the patient can serum osmolarity. Patients should remain in a normovolemic fluid
tolerate state with close monitoring of clinical factors such as
urine output, fluid intake, serum and urine osmolality, serum
electrolytes, and insensible losses.
Why is the Glasgow Coma Scale (GCS) used? a. The Glasgow Coma Scale (GCS) is used to quickly assess
a. To quickly assess the LOC the LOC with a standardized system. The three areas assessed
b. To assess the patient's ability to communicate are the patient's ability to speak, obey commands, and open
c. To assess the patient's ability to respond to commands eyes to verbal or painful stimulus. Although best motor
d. To assess the patient's coordination with motor responses response is an indicator, it is not used to assess coordination.
A patient with an intracranial problem does not open his eyes to
any stimulus, has no verbal response except
moaning and muttering when stimulated, and flexes his arm in b. No opening of eyes = 1; incomprehensible words = 2;
response to painful stimuli. What should the nurse flexion withdrawal = 4. Total = 7
record as the patient's GCS score?
a. 6 c. 9
b. 7 d. 11
2/5
a, c, e. Blood adapts with increased venous outflow,
Which components are able to change to adapt to small increases decreased cerebral blood flow (CBF), and collapse of
in intracranial pressure (ICP) (select all that veins and dural sinuses. Brain tissue adapts with distention
apply)? of the dura, slight compression of tissue, or herniation.
a. Blood d. Scalp tissue Cerebrospinal fluid (CSF) adapts with increased absorption,
b. Skull bone e. Cerebrospinal fluid (CSF) decreased production, and displacement into the spinal
c. Brain tissue canal. Skull bone and scalp tissue do not adapt to changes
in intracranial pressure (ICP).
56 mm Hg
The cerebral perfusion pressure (CPP) is the pressure needed to
Mean arterial pressure (MAP) = diastolic blood pressure
ensure blood flow to the brain. Normal CPP is 60 to
(DBP) + 1
100 mm Hg. Calculate the CPP of a patient whose blood pressure
D3s(ystolic blood pressure [SBP] - DBP) =
(BP) is 106/52 mm Hg and ICP is 14 mm Hg.
52 + 18 = 70
mm Hg
Cerebral per
45 mm Hg
Calculate the CPP for the patient with an ICP of 34 mm Hg and a
MAP = DBP + 1
systemic BP of 108/64 mm Hg.
D3S(BP DBP) = 64 + 15 = 79
mm Hg
CPP = MAP ICP = 79 34 = 45
Which factors decrease cerebral blood flow (select all that apply)? c, e. Cerebral blood flow is decreased when the MAP
a. Increased ICP d. Arterial blood pH of 7.3 and the PaCO2
b. PaO2 of 45 mm Hg e. Decreased mean arterial pressure (MAP) are decreased. The other options increase
c. PaCO2 of 30 mm Hg cerebral blood flow.
b, e. Vasogenic cerebral edema, the most common type
of edema, occurs mainly in the white matter and is
What are causes of vasogenic cerebral edema (select all that characterized by leakage of macromolecules from the
apply)? capillaries into the surrounding extracellular space. This
a. Hydrocephalus results in an osmotic gradient that favors the flow of
b. Ingested toxins fluid from the intravascular to the extravascular space. A
c. Destructive lesions or trauma variety of insults, such as brain tumors, abscesses, and
d. Local disruption of cell membranes ingested toxins, may cause an increase in the permeability
e. Fluid flowing from intravascular to extravascular space of the blood-brain barrier and produce an increase in the
extracellular fluid volume. Hydrocephalus causes interstitial
cerebral edema.
Which events cause increased ICP (select all that apply)?
a, b, d. Increased ICP is caused by vasodilation and edema
a. Vasodilation d. Edema from initial brain insult
from the initial brain insult or necrotic tissue. Blood vessel
b. Necrotic tissue edema e. Brainstem compression and hernia-
compression and brainstem compression and herniation
tion
occur as a result of increased ICP.
c. Blood vessel compression
An early sign of increased ICP that the nurse should assess for is . c. One of the most sensitive signs of increased ICP is a
a. Cushing's triad. c. decreasing level of consciousness (LOC). decreasing level of consciousness (LOC). A decrease in
b. unexpected vomiting. d. dilated pupil with sluggish response to LOC will occur before changes in vital signs, ocular signs,
light. or projectile vomiting occur.
The nurse recognizes the presence of Cushing's triad in the c. Cushing's triad consists of three vital sign measures that
patient with which vital sign changes? reflect ICP and its effect on the medulla, hypothalamus,
a. Increased pulse, irregular respiration, increased BP pons, and thalamus. Because these structures are very deep,
b. Decreased pulse, increased respiration, decreased systolic BP Cushing's triad is usually a late sign of ICP. The signs
c. Decreased pulse, irregular respiration, widened pulse pressure include an increasing SBP with a widening pulse pressure,
d. Increased pulse, decreased respiration, widened pulse pres- a bradycardia with a full and bounding pulse, and irregular
sure respirations.
c. The dural structures that separate the two hemispheres
and the cerebral hemispheres from the cerebellum influence
Increased ICP in the left cerebral cortex caused by intracranial
the patterns of cerebral herniation. A cingulate herniation
bleeding causes displacement of brain tissue to the occurs where there is lateral displacement of brain tissue
right hemisphere beneath the falx cerebri. The nurse knows that beneath the falx cerebri. Uncal herniation occurs when there
this is referred to as what? is lateral and downward herniation. Tentorial herniation
a. Uncal herniation c. Cingulate herniation
occurs when the brain herniates down through the opening
b. Tentorial herniation d. Temporal lobe herniation
created by the brainstem. The temporal lobe can be involved
in central herniation
1/5
, GRADE A+ ICP NCLEX style Questions and answers 2025
Priority Decision: A patient has ICP monitoring with an intraven- a. An intraventricular catheter is a fluid-coupled system that
tricular catheter. What is a priority nursing can provide direct access for microorganisms to enter the
intervention for the patient? ventricles of the brain and aseptic technique is a very high
a. Aseptic technique to prevent infection c. Removal of CSF to nursing priority to decrease the risk for infection. Constant
maintain normal ICP monitoring of ICP waveforms is not usually necessary and
b. Constant monitoring of ICP waveforms d. Sampling CSF to removal of CSF for sampling or to maintain normal ICP is
determine abnormalities done only when specifically ordered.
b. An inaccurate ICP reading can be caused by CSF
When using intraventricular ICP monitoring, what should the
leaks around the monitor device, obstruction of the
nurse be aware of to prevent inaccurate readings?
intraventricular catheter, kinks or bubbles in the tubing,
a. The P2 wave is higher than the P1 wave.
and incorrect height of the transducer or drainage system
b. CSF is leaking around the monitoring device.
relative to the patient's reference point. The P2 wave
c. The transducer of the ventriculostomy monitor is at the level of
being higher than the P1 wave indicates poor ventricular
the upper ear.
compliance. The transducer height should be at the tragus
d. The drain of the CSF drainage device was closed for 6 minutes
of the ear. The drain of the CSF drainage device should be
before taking the reading.
closed for 6 minutes preceding the reading.
b. The normal pressure of oxygen in brain tissue (PbtO2
)
The patient is being monitored long-term with a brain tissue oxy-
is 20 to 40 mm Hg. The normal jugular venous oxygen
genation catheter. What range for the pressure of
saturation (SjvO2
oxygen in brain tissue (PbtO2
) is 55% to 75% and indicates total venous
) will maintain cerebral oxygen supply and demand?
brain tissue extraction of oxygen; this is used for short-term
a. 55% to 75% c. 70 to 150 mm Hg
monitoring. The MAP of 70 to 150 mm Hg is needed for
b. 20 to 40 mm Hg d. 80 to 100 mm Hg
effective autoregulation of CBF. The normal range for PaO2
is 80 to 100 mm Hg.
c. Mannitol (Osmitrol) (25%) is an osmotic diuretic that
expands plasma and causes fluid to move from tissues into
the blood vessels. Hypertonic saline reduces brain swelling
Which drug treatment helps to decrease ICP by expanding plasma by moving water out of brain tissue. Oxygen administration
and the osmotic effect to move fluid? is done to maintain brain function. Pentobarbital
a. Oxygen administration c. Mannitol (Osmitrol) (25%) (Nembutal) and other barbiturates are used to reduce
b. Pentobarbital (Nembutal) d. Dexamethasone (Decadron) cerebral metabolism. The corticosteroid dexamethasone
(Decadron) is used to treat vasogenic edema to stabilize cell
membranes and improve neuronal function by improving
CBF and restoring autoregulation
d. A patient with increased ICP is in a hypermetabolic and
hypercatabolic state and needs adequate glucose to maintain
How are the metabolic and nutritional needs of the patient with fuel for the brain and other nutrients to meet metabolic needs.
increased ICP best met? Malnutrition promotes cerebral edema and if a patient cannot
a. Enteral feedings that are low in sodium take oral nutrition, other means of providing nutrition should
b. Simple glucose available in D5 be used, such as tube feedings or parenteral nutrition. Glucose
W IV solutions alone is not adequate to meet nutritional requirements and 5%
c. Fluid restriction that promotes a moderate dehydration dextrose solutions may increase cerebral edema by lowering
d. Balanced, essential nutrition in a form that the patient can serum osmolarity. Patients should remain in a normovolemic fluid
tolerate state with close monitoring of clinical factors such as
urine output, fluid intake, serum and urine osmolality, serum
electrolytes, and insensible losses.
Why is the Glasgow Coma Scale (GCS) used? a. The Glasgow Coma Scale (GCS) is used to quickly assess
a. To quickly assess the LOC the LOC with a standardized system. The three areas assessed
b. To assess the patient's ability to communicate are the patient's ability to speak, obey commands, and open
c. To assess the patient's ability to respond to commands eyes to verbal or painful stimulus. Although best motor
d. To assess the patient's coordination with motor responses response is an indicator, it is not used to assess coordination.
A patient with an intracranial problem does not open his eyes to
any stimulus, has no verbal response except
moaning and muttering when stimulated, and flexes his arm in b. No opening of eyes = 1; incomprehensible words = 2;
response to painful stimuli. What should the nurse flexion withdrawal = 4. Total = 7
record as the patient's GCS score?
a. 6 c. 9
b. 7 d. 11
2/5
