Neuro CCRN Study questions
A family member of a affected person inside the ICU, who these days skilled a TBI, asks the
nurse how long the affected person will ought to be on seizure medications because the
affected person has no longer had a seizure. Which of the subsequent would be the nurse's
satisfactory answer?
A. The patient will should be on seizure medicinal drugs for the rest of her life.
B. Ask the neurologist that question.
C. Typically, following trauma, seizure medicines are given for 7 days if no seizures
arise.
D. The neurologist will reevaluate her in the course of the three-month comply with-up
hospital go to. - ANS-C
The Brain Trauma Foundation's recommendation for antiepileptic prophylaxis is 7 days
following a TBI, if no seizure happens within the interval. This is the same recommendation
for supratentorial postcraniotomy sufferers. The use of prophylactic antiepileptic therapy
after ischemic strokes is not advocated however ICH strokes have a higher occurrence of
seizures and might require quick-term prophylaxis.
A myasthenia disaster can be a clinical emergency with a want for fast intervention. Which of
the following is taken into consideration the initial intervention of choice for a
hemodynamically volatile affected person in a myasthenia crisis?
A. IV immunoglobulin
B. IV steroids
C. Plasmaphoresis
D. Anticholinesterase inhibitors - ANS-A
Rapid treatment with IVIG or plasmaphoresis is similar in efficacy but in hemodynamically
unstable patients, plasmaphoresis is contraindicated. Rapid intervention with IVIG is the
most appropriate intervention. Concomitant management of ste- roids may be given however
steroids alone were found to exacerbate muscle weakness within 5 to ten days.
Anticholinesterase inhibitors are usually held at some stage in a myasthenia disaster due to
aggravation of secretions and can be restarted when the patient has stepped forward
clinically.
A patient has been inside the ICU for five days following a craniotomy for a tumor resection.
He has been on decadron, propofol, and fentanyl to manage an improved ICP and cerebral
edema. He is now growing metabolic acidosis and hyperkalemia. Which of the following will
be the most probable purpose?
A. Cushing's disease
B. Long-term neurological and cognitive dysfunction (LNCD)
C. Sepsis
D. Propofol infusion syndrome - ANS-D
Long-term or high-dose use of propofol has been observed to purpose propofol infusion
syndrome. Symptoms encompass metabolic acidosis, hyperkalemia, rhabdomyolysis, renal
failure, and myocardial failure. The use of exogenous steroids can bring about Cushing's
syndrome but does no longer typically present with metabolic acidosis or hyperkalemia.
Sepsis identifiers are tachycardia, fever, leukocytosis, and tachypnea. LNCD can be caused
, by the presence of delirium and use of sedation however is a problem experienced after the
ICU and does not gift with metabolic acidosis or hyperkalemia.
A affected person is admitted to the ICU with an ICH from persistent HTN. His BP is
presently 210/108 mmHg. The doctor has ordered BP parameters of 130-150 mmHg. Which
of the subsequent antihypertensives could much more likely exacerbate cerebral edema and
increase ICP?
A. Labetalo
lB. Nicardipine
C. Esmolol
D. Nipride - ANS-D
When preserving a lower BP to manipulate hemorrhagic strokes, the most generally used
antihypertensives are β-blockers and calcium channel blockers. Alpha-blockers, together
with Nipride, can reason giant vasodilation of the cerebral vessels, ensuing in an increase in
cerebral edema and ICP. Continuous infusion of antihypertensive agents could imply the
want to use shorter performing, greater titratable drugs which include nicardipine or esmolol.
Labetalol is generally used as an IV prn medication to lower BP in neurological patients.
A patient is identified with an ischemic stroke but is 4.Zero hours out from the initial onset of
stroke signs and symptoms. Which of the subsequent is a further exclusion if thinking about
the usage of the 4.5-hour window to manage IV tPA?
A. If taking oral anticoagulants, INR need to be < 2.5
B. Has a baseline NIH Stroke Scale < 20
C. History of both stroke and diabetes
D. Patient is younger than 50 years old - ANS-C
Based on some recent studies, some stroke centers extend the window of opportunity to
administer IV tPA in an ischemic stroke to 4.5 hours. There is additional exclusion criteria
used for the 3- to 4.5-hour time interval. These include: (a) history of both stroke and
diabetes, (b) patients receiving oral anticoagulation therapy regardless of INR, (c) patients
older than 80 years of age, and (d) baseline NIH Stroke Scale greater than 25.
A patient with a history of MG is admitted because of increased weakness. His vital capacity
and negative inspiratory force were evaluated by the respiratory therapist and impending
respiratory failure was predicted. He stated he had been feeling bad lately and had been
doubling his dose of pyridostigmine. Which of the following is the most likely cause for the
respiratory failure?
A. Cushing's syndrome
B. Steroid overdose
C. Myasthenia crisis
D. Cholinergic crisis - ANS-D
In an MG patient, both a myasthenia crisis and a cholinergic crisis can result in respiratory
weakness and failure. The hint in this question is that the patient was taking double his dose
of pyridostigmine, which is an anticholinesterase inhibitor. Cholinergic crisis is a result of
exaggerated cholinergic activity and is characterized by respiratory failure, bradycardia,
urinary retention, and increased oral secretions. Myasthenia crisis is typically a result of
failure to take medications or ineffectiveness of the medications.
A postcraniotomy patient develops respiratory failure and requires emergency intubation.
Rapid sequence intubation (RSI) is proposed for the intubation process. Which of the
following drugs would be the preferred induction drug in neurological patients?
A. Succinylcholine
B. Propofol
A family member of a affected person inside the ICU, who these days skilled a TBI, asks the
nurse how long the affected person will ought to be on seizure medications because the
affected person has no longer had a seizure. Which of the subsequent would be the nurse's
satisfactory answer?
A. The patient will should be on seizure medicinal drugs for the rest of her life.
B. Ask the neurologist that question.
C. Typically, following trauma, seizure medicines are given for 7 days if no seizures
arise.
D. The neurologist will reevaluate her in the course of the three-month comply with-up
hospital go to. - ANS-C
The Brain Trauma Foundation's recommendation for antiepileptic prophylaxis is 7 days
following a TBI, if no seizure happens within the interval. This is the same recommendation
for supratentorial postcraniotomy sufferers. The use of prophylactic antiepileptic therapy
after ischemic strokes is not advocated however ICH strokes have a higher occurrence of
seizures and might require quick-term prophylaxis.
A myasthenia disaster can be a clinical emergency with a want for fast intervention. Which of
the following is taken into consideration the initial intervention of choice for a
hemodynamically volatile affected person in a myasthenia crisis?
A. IV immunoglobulin
B. IV steroids
C. Plasmaphoresis
D. Anticholinesterase inhibitors - ANS-A
Rapid treatment with IVIG or plasmaphoresis is similar in efficacy but in hemodynamically
unstable patients, plasmaphoresis is contraindicated. Rapid intervention with IVIG is the
most appropriate intervention. Concomitant management of ste- roids may be given however
steroids alone were found to exacerbate muscle weakness within 5 to ten days.
Anticholinesterase inhibitors are usually held at some stage in a myasthenia disaster due to
aggravation of secretions and can be restarted when the patient has stepped forward
clinically.
A patient has been inside the ICU for five days following a craniotomy for a tumor resection.
He has been on decadron, propofol, and fentanyl to manage an improved ICP and cerebral
edema. He is now growing metabolic acidosis and hyperkalemia. Which of the following will
be the most probable purpose?
A. Cushing's disease
B. Long-term neurological and cognitive dysfunction (LNCD)
C. Sepsis
D. Propofol infusion syndrome - ANS-D
Long-term or high-dose use of propofol has been observed to purpose propofol infusion
syndrome. Symptoms encompass metabolic acidosis, hyperkalemia, rhabdomyolysis, renal
failure, and myocardial failure. The use of exogenous steroids can bring about Cushing's
syndrome but does no longer typically present with metabolic acidosis or hyperkalemia.
Sepsis identifiers are tachycardia, fever, leukocytosis, and tachypnea. LNCD can be caused
, by the presence of delirium and use of sedation however is a problem experienced after the
ICU and does not gift with metabolic acidosis or hyperkalemia.
A affected person is admitted to the ICU with an ICH from persistent HTN. His BP is
presently 210/108 mmHg. The doctor has ordered BP parameters of 130-150 mmHg. Which
of the subsequent antihypertensives could much more likely exacerbate cerebral edema and
increase ICP?
A. Labetalo
lB. Nicardipine
C. Esmolol
D. Nipride - ANS-D
When preserving a lower BP to manipulate hemorrhagic strokes, the most generally used
antihypertensives are β-blockers and calcium channel blockers. Alpha-blockers, together
with Nipride, can reason giant vasodilation of the cerebral vessels, ensuing in an increase in
cerebral edema and ICP. Continuous infusion of antihypertensive agents could imply the
want to use shorter performing, greater titratable drugs which include nicardipine or esmolol.
Labetalol is generally used as an IV prn medication to lower BP in neurological patients.
A patient is identified with an ischemic stroke but is 4.Zero hours out from the initial onset of
stroke signs and symptoms. Which of the subsequent is a further exclusion if thinking about
the usage of the 4.5-hour window to manage IV tPA?
A. If taking oral anticoagulants, INR need to be < 2.5
B. Has a baseline NIH Stroke Scale < 20
C. History of both stroke and diabetes
D. Patient is younger than 50 years old - ANS-C
Based on some recent studies, some stroke centers extend the window of opportunity to
administer IV tPA in an ischemic stroke to 4.5 hours. There is additional exclusion criteria
used for the 3- to 4.5-hour time interval. These include: (a) history of both stroke and
diabetes, (b) patients receiving oral anticoagulation therapy regardless of INR, (c) patients
older than 80 years of age, and (d) baseline NIH Stroke Scale greater than 25.
A patient with a history of MG is admitted because of increased weakness. His vital capacity
and negative inspiratory force were evaluated by the respiratory therapist and impending
respiratory failure was predicted. He stated he had been feeling bad lately and had been
doubling his dose of pyridostigmine. Which of the following is the most likely cause for the
respiratory failure?
A. Cushing's syndrome
B. Steroid overdose
C. Myasthenia crisis
D. Cholinergic crisis - ANS-D
In an MG patient, both a myasthenia crisis and a cholinergic crisis can result in respiratory
weakness and failure. The hint in this question is that the patient was taking double his dose
of pyridostigmine, which is an anticholinesterase inhibitor. Cholinergic crisis is a result of
exaggerated cholinergic activity and is characterized by respiratory failure, bradycardia,
urinary retention, and increased oral secretions. Myasthenia crisis is typically a result of
failure to take medications or ineffectiveness of the medications.
A postcraniotomy patient develops respiratory failure and requires emergency intubation.
Rapid sequence intubation (RSI) is proposed for the intubation process. Which of the
following drugs would be the preferred induction drug in neurological patients?
A. Succinylcholine
B. Propofol
