PCCN Neurological Exam with Questions and Answers

PCCN Neurological Exam with Questions and Answers The most sensitive indicator of changes in intracranial pressure in the unresponsive patient is: a. A change in pulse pressure b. A change in pupillary response c. Blood glucose levels d. Response of the cranial nerves ANSWER a. A change in pulse pressure In patient who are unresponsive, the second physical assessment sign to change is the pulse pressure: the systolic pressure raises, the diastolic drops and the patient's heart rate slows. The triad of changes associated with increasing intracranial pressure occurs in this order: Change in mental status, widening of pulse pressure and slowing of the heart rate, followed by pupillary changes. If hyperventilation is used to control increased intracranial pressure, it should be directed at achieving which of the following goals? a. CO2 between 32 mmHg and 35 mmHg b. Increasing the PO2 to 200 mmHg c. Maintaining a respiratory rate of 30 breaths per minute d. Lowering the serum pH ANSWER a. CO2 between 32 mmHg and 35 mmHg Decreasing the CO2 to just below normal will cause the arterial blood vessels to remain normal. High CO2 dilates the vessels and a severe drop in CO2 can cause vasospasm with lowered blood flow.