Question 1- A 25 year old male is admitted to the ICU for observation with a closed head injury following a motorcycle accident. Upon arrival the patient has a GCS of 14. When assessing this patient, you notice ecchymosis over the mastoid bone. What other sign is consistent with this type of injury?
A. Ottohrea
B. Brudzinski's sign
C. Negative CT scan
D. Contralateral motor weakness
Question 2- Secondary brain injury is most commonly a result of
A. ischemia
B. coup - contracoup type injuries
C. transient loss of consciousness
D. diffuse axonal injury
Question 3- The earliest symptom indicating an increase in intracranial pressure is
A. an alteration in LOC
B. ipsilateral pupil dilation
C. a focal motor deficit
D. nausea and vomiting
Question 4- You are administering a Nicardipine drip for your patient. You have 25mg in 250ml of NS. Your pump is infusing at 50 ml/hr. How much Nicardipine is being delivered?
A. 0.5 mg/hr
B. 5 mg/hr
C. 0.1 mg/hr
D. 10 mg/hr
Question 5- The normal value for ICP is considered to be:
A. >15 mm Hg
B. 0 - 15 mm Hg
C. 60 - 80 cm H2O
D. < 50 cm H2O
Question 6- Given an ICP of 28 mmHg and an blood pressure of 136/74, the calculated cerebral perfusion pressure (CPP) would be:
A. 66 mmHg
B. 72 mmHg
C. 83 mmHg
D. 62 mmHg
Question 7- Which of the following is the MOST COMMON reason for a subarachnoid hemorrhage?
A. cerebral artery disease
B. cerebral aneurysm leak
C. chronic hypertension
D. blunt head trauma
Question 8- Your patient is 6 hours post admission following blunt head injury in which it was reported that he sustained a loss of consciousness for 10 minutes followed by a return of consciousness at which time he was oriented x3. When you assess him, he now arouses only to pain with groaning and grimacing. Which of the following injuries would you suspect?
A. basal skull fracture
B. epidural hematoma
C. concussion
D. subdural hematoma
Question 9- Which of the following is an example of compensation for cerebral swelling according to the Monroe-Kellie Hypothesis
A. Shifting of cerebral tissue to the opposite hemisphere
B. Reflexive hyperventilation to increase oxygenation
C. Redistribution of CSF to the spinal cord
D. Vasodilation of blood flow to the area of cerebral injury
Question 10- Hypotension will ultimately result in
A. decreased perfusion of cerebral tissue
B. increased cerebral blood flow
C. increased perfusion pressure across the blood-brain barrier
D. decreased CO2 production
Question 11- The neurosurgeon is setting up to insert an intraventricular monitoring catheter. You know that he will need to access it through the
A. cervical cistern
B. sub-arachnoid space
C. non-dominant lateral ventricle
D. Aqueduct of Sylvius
Question 12- Which of the following findings on your neurological exam denotes the most serious prognosis?
A. decerebrate posturing
B. GCS score of 14
C. hemiparesis
D. confused speech
Question 13- Which of the following medications is prescribed to decrease cerebral vasospasm?
A. Nimodipine (Nimotop)
B. Vecuronium (Norcuron)
C. Phenytoin (Dilantin)
D. Phenobarbital
Question 14- Your patient's ICP is being monitored and you note that the pressure has been in excess of 20 for the last 20 minutes. As an independent nursing action you would immediately
A. decrease the ventilator rate
B. lower the head of the bed so the patient is supine
C. decrease noxious stimuli
D. administermannitol as a precaution
Question 15- On your 2 hourneuro check, you note that one of your patient's pupils has dilated. You realize that this is an indication that
A. meningeal irritation is occurring from a subarachnoid hemorrhage
B. global brain ischemia has occurred from traumatic brain injury
C. the patient is retaining CO2 due to hyperventilation
D. herniation may be occurring with impingement on the ipsilateral 3rd cranial nerve
Question 16- The most important consideration in reducing secondary brain injury is by preventing
A. hyperkalemia and hypothermia
B. hypervolemia and hyperthermia
C. hypotension and hypoxia
D. hypertension and hypothermia
Question 17- You would most likely expect to provide seizure precautions for your patient with a(n)
A. concussion
B. sub-arachnoid hemorrhage
C. epidural bleed
D. basal skull fracture
Question 18- Nuchal rigidity occurs as a result of
A. hydrocephalus
B. meningeal irritation
C. ischemic stroke
D. herniation of the brain stem
Question 19- Bilaterally constricted pupils may be the result of (select all that apply):
A.opiate usage
B.pontine damage
C.cocaine overdose
D.anisocoria
E.ischemic brain damage
Question 20- Your patient has sustained a mild subdural hematoma and has been admitted to the Neuro ICU for observation. Neuro checks are ordered for every hour X 8. The rationale for this is to (pick all that apply):
A.trend for Glascow Coma Score
B.assure positive spinal reflexes
C.detect for signs of meningeal irritation
D.assess for CSF drainage
E.assess for signs and symptoms of increasing intracranial pressure
Question 21- When assessing your patient with traumatic brain injury, you would recognize Cushing's Triad when (select all that apply)?
A.you notice an increase in the pulse deficit
B.the GCS drops from 12 to 10
C.the pulse pressure widens
D.the heart rate drops from 82 to 56 bpm
E.the blood pressure drops to 90/60
Question 22- What are the 3 "H's" of Triple H Therapy (check all that apply)?
A.hypervolemia
B.hyperthermia??
C.hemodilution
D.hypertension??
E.hypoglycemia
Question 23- Which of the following medications might be utilized for a patient with increased intracranial pressure secondary to trauma (select all that apply)?
A.levetiracetam
B.mannitol
C.nimodipine
D.sodium bicarbonate
E.metoprolol
Question 24- Your patient is on a ventilator following acute head injury. The ICP is going above the physician's desired range and hyperventilation is to be initiated. You know that hyperventilation is (select all that apply):
A.a long-term therapy for potential cerebral edema
B.to beutilized only a temporizing measure to prevent impending herniation
C.contraindicated for all patients with a head injury
D.used to provide vasoconstriction of cerebral vasculature
E.useful in situations of cerebral vasospasm only
Question 25- Mrs. M has been admitted with an SAH. While reviewing her history you would expect to see which of the following prior symptoms? Select all that apply.
A.extended loss of consciousness
B.diffuse one-sided weakness
C.photophobia
D.abrupt onset of severe headache
E.nausea and vomiting
Question 26- A patient's ventriculostomy is showing an ICP of 32 mm Hg and his blood pressure is 134/62. (cerebral perfusion pressure is 54 mm Hg). Which of the following may be appropriate interventions? Select all that apply.
A.administer standing order for mannitol
B.Start vasopressor therapy with low dose Dopamine
C.drain CSF fluid per physician's orders
D.lay the patient flat in bed
E.Request ventilator settings to increase PEEP
Question 27- Which of the following are advantages of a ventriculostomy ICP monitoring system? Select all that apply.
A.ability to drain CSF
B.lower risk of infection
C.accurate readings of intracranial pressures
D.no penetration of the brain tissue is involved with placement
E.easy to use with minimal training required
Question 28- When assessing your patient as a potential organ donor, you know that definitive indications that your patient may be brain dead would be (Select all that apply).
A.there is no spontaneous breathing when taken off the ventilator
B.cardiac monitor is only showing a paced rhythm
C.a positive Babinski reflex
D.clinical evaluation shows absence of cranial nerve response
E. the EEG shows continuous seizure activity