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EDAPT: Nursing Care: Complex Intracranial
and Neurologic Alterations Questions and
Answers Latest Update
A client has a mean arterial pressure of 120 mmHg with an intracranial
pressure of 42 mmHg. What is the calculated cerebral perfusion pressure?
Ans: 78 mmHg
When intracranial pressure is significantly elevated, what symptoms might
the nurse expect? Select all that apply. Ans: Irregular breathing
Increased systolic blood pressure with decreased diastolic blood pressure.
Bradycardia
The nurse reports that the client is experiencing a reduced level of
consciousness. Which tool is used to measure and record the level of
consciousness? Ans: Glasgow coma scale (GCS)
For each category, click to specify the client history information that is
pertinent when seeing a client with altered intracranial regulation. Ans: Past
Medical History:
Dyslipidemia
Concussion
Bacterial Meningitis
Past surgical history:
© 2025 All rights reserved
, 2 | Page
Lumbar laminectomy
Family history:
Cerebral vascular disease
Social history:
Smoking history
Medications:
Aspirin 81 mg daily
Jesse (he/him/his) is admitted to the emergency department after a fall
from a second-story balcony. He states that he is unable to move both lower
extremities. His vital signs are stable, and he has had no urine output for the
past 6 hours. Suddenly, he starts to experience symptoms of cold clammy
skin from mid-chest down.
Which nursing action is most appropriate? Ans: Insert a straight catheter as
ordered.
Drag the causes of primary altered intracranial regulation problems into the
"primary issues" box, and secondary issues that can appear in the
"secondary issues" box. Ans: Primary:
Altered level of consciousness
Brain perfusion problems
Memory problems
Temperature control problems
Secondary:
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Skin breakdown
Reduced nutrition intake
Muscle atrophy
Drag the following nursing diagnoses to match the most appropriate
nursing actions. Ans: Decreased intracranial adaptive capacity
Elevate the head of the bed above 30 degrees.
Administer diuretics as prescribed.
Administer corticosteroids as prescribed.
Ineffective thermoregulation
Provide a cooling or warming blanket.
Pain
Administer pain medication as prescribed.
Use the transcutaneous electrical nerve stimulation (TENS) unit as
prescribed.
Reduced cardiac output
Administer fluids as prescribed.
Administer blood pressure-elevating medications.
Altered gas exchange
Administer oxygen as prescribed.
© 2025 All rights reserved
EDAPT: Nursing Care: Complex Intracranial
and Neurologic Alterations Questions and
Answers Latest Update
A client has a mean arterial pressure of 120 mmHg with an intracranial
pressure of 42 mmHg. What is the calculated cerebral perfusion pressure?
Ans: 78 mmHg
When intracranial pressure is significantly elevated, what symptoms might
the nurse expect? Select all that apply. Ans: Irregular breathing
Increased systolic blood pressure with decreased diastolic blood pressure.
Bradycardia
The nurse reports that the client is experiencing a reduced level of
consciousness. Which tool is used to measure and record the level of
consciousness? Ans: Glasgow coma scale (GCS)
For each category, click to specify the client history information that is
pertinent when seeing a client with altered intracranial regulation. Ans: Past
Medical History:
Dyslipidemia
Concussion
Bacterial Meningitis
Past surgical history:
© 2025 All rights reserved
, 2 | Page
Lumbar laminectomy
Family history:
Cerebral vascular disease
Social history:
Smoking history
Medications:
Aspirin 81 mg daily
Jesse (he/him/his) is admitted to the emergency department after a fall
from a second-story balcony. He states that he is unable to move both lower
extremities. His vital signs are stable, and he has had no urine output for the
past 6 hours. Suddenly, he starts to experience symptoms of cold clammy
skin from mid-chest down.
Which nursing action is most appropriate? Ans: Insert a straight catheter as
ordered.
Drag the causes of primary altered intracranial regulation problems into the
"primary issues" box, and secondary issues that can appear in the
"secondary issues" box. Ans: Primary:
Altered level of consciousness
Brain perfusion problems
Memory problems
Temperature control problems
Secondary:
© 2025 All rights reserved
, 3 | Page
Skin breakdown
Reduced nutrition intake
Muscle atrophy
Drag the following nursing diagnoses to match the most appropriate
nursing actions. Ans: Decreased intracranial adaptive capacity
Elevate the head of the bed above 30 degrees.
Administer diuretics as prescribed.
Administer corticosteroids as prescribed.
Ineffective thermoregulation
Provide a cooling or warming blanket.
Pain
Administer pain medication as prescribed.
Use the transcutaneous electrical nerve stimulation (TENS) unit as
prescribed.
Reduced cardiac output
Administer fluids as prescribed.
Administer blood pressure-elevating medications.
Altered gas exchange
Administer oxygen as prescribed.
© 2025 All rights reserved
