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NEWEST NEURO NR341 UPDATED ACTUAL EXAM 2025
UPDATED QUESTIONS AND CORRECT ANSWERS
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What is the max GCS score? - CORRECT ANSWER >>> 15 What is the minimum GCS score? - CORRECT ANSWER >>> 3 What GCS score should you intubate? - CORRECT ANSWER >>> 8 and under What are the limitations of the GCS? - CORRECT ANSWER >>> age, drugs, and language What is normal intracranial pressure (ICP)? - CORRECT ANSWER >>> 5 - 15 mmHg What are the signs and symptoms of increased ICP? - CORRECT ANSWER >>> change in LOC, change in speech, change in vital signs, seizures, headache, vomiting, eye changes, posture changes What is the first sign of increased ICP? - CORRECT ANSWER >>> changes in LOC What is cushing's triad? - CORRECT ANSWER >>> an effect of increased ICP of increased systolic BP, decreased pulse, and cheyne-stokes respirations What is Cheyne-Stokes respiration? - CORRECT ANSWER >>> it is an abnormal rhythm of breathing with alternation periods of hyperventilation and apnea
What is Kussmaul respiration? - CORRECT ANSWER >>> deep, rapid breathing often induced by acidosis What condition does Kussmaul respirations commonly occur with? **- CORRECT ANSWER
** DKA What posture changes occurs with increased ICP? - CORRECT ANSWER >>> decerebrate, decorticate,or flaccid What is decerebrate posturing? - CORRECT ANSWER >>> Extensor response; problem with midbrain or pons What is decorticate posturing? - CORRECT ANSWER >>> Flexor response; problem with cervical spinal tract or cerebral hemisphere What are the eye changes that occur with increased ICP? **- CORRECT ANSWER ** papilledema, pupillary changes, impaired eye movement What is a common cause of increased brain volume? - CORRECT ANSWER >>> cerebral edema; can also be caused by a tumor or meningitis What causes increased blood volume? - CORRECT ANSWER >>> loss of auto-regulation, decreased oxygenation, hypercapnia, increased metabolic demands, and obstruction of venous outflow What causes increased cerebrospinal fluid? - CORRECT ANSWER >>> hydrocephalus, blockage of normal flow, obstruction of normal re-absorption, and excess production of CSF
What electrolytes should be monitored with ICP mgmt.? - CORRECT ANSWER >>> sodium --> seizures What all should be monitored with ICP mgmt.? - CORRECT ANSWER >>> ICP, electrolytes, ABG's vital signs, daily weights, strict I&O, diabetes insipidus (DI), and SIADH What tubes should be placed with increased ICP? - CORRECT ANSWER >>> NG tube or orogastric tube Which tube is preferred with patients who have facial fractures or skull fractures? - CORRECT ANSWER >>> orogastric tube Nursing Mgmt. ICP: What forms of management should be given? **- CORRECT ANSWER
** airway, pain and anxiety (sedate) Nursing Mgmt. ICP: How should the transducer be kept? - CORRECT ANSWER >>> at level with the drain What is diabetes insipidus? - CORRECT ANSWER >>> a disorder caused by inadequate amounts of ADH which causes excessive water loss What are the signs and symptoms of diabetes insipidus? - CORRECT ANSWER >>> polyuria, low urine specific gravity, increased diuresis, increased sodium, decreased potassium What is the nursing management of diabetes insipidus? - CORRECT ANSWER >>> vasopressin What is SIADH? - CORRECT ANSWER >>> abnormal stimulation to the hypothalamic area of the brain, causing excessive secretion of antidiuretic hormone (Vasopressin)
What are the signs and symptoms of SIADH? - CORRECT ANSWER >>> oliguria, high urine specific gravity, fluid retention, decreased diuresis, decreased sodium, increased potassium What is the nursing management of SIADH? - CORRECT ANSWER >>> fluid restrictions administer potassium sodium restriction diuretics Demeclocycline drug use to suppress vasopressin What is the normal urine specific gravity? - CORRECT ANSWER >>> 1.000-1. Nursing Mgmt. ICP: What should be avoided with increased ICP? **- CORRECT ANSWER
** extreme hip flexion, valsalva maneuver, coughing, sneezing, hypoxemia, and sudden arousal from sleep What is the valsalva maneuver? - CORRECT ANSWER >>> Exhaling forcibly with the glottis
closed What is hypoxemia? - CORRECT ANSWER >>> low oxygen in the blood Nursing Mgmt. ICP: Why should extreme hip flexion be avoided? - CORRECT ANSWER >>> to protect the patient from injury Medical Mgmt. ICP: Adequate oxygenation - CORRECT ANSWER >>> goal PaO2, airway vigilance/watching, mechanical ventilation, adequate hematocrit Medical Mgmt. ICP: What is normal hematocrit levels? - CORRECT ANSWER >>> men: 42-54% women: 38-46%
Medical Mgmt. ICP: Loop Diuretics - CORRECT ANSWER >>> reduce brain tissue volume and decreased CSF formation Medical Mgmt. ICP: Fluid Administration - CORRECT ANSWER >>> optimize fluid administration with isotonic solutions, strict I&O, colloids or blood products to restore volume What is the goal of fluid administration? - CORRECT ANSWER >>> serum osmolality less than 320 mOsm/L Medical Mgmt. ICP: Blood Pressure - CORRECT ANSWER >>> avoid hypertension and avoid hypotension What is the goal MAP for for BP? - CORRECT ANSWER >>> 70 - 90 mmHg What is the goal CPP for BP? - CORRECT ANSWER >>> 70 mmHg Medical Mgmt. ICP: Why would you want to avoid hypertension? **- CORRECT ANSWER
** hypertension increases cerebral blood volume Medical Mgmt. ICP: What medication is used to decrease hypertension? **- CORRECT ANSWER ** Nicardipine Medical Mgmt. ICP: Why would you want to avoid hypotension? **- CORRECT ANSWER ** ischemia Medical Mgmt. ICP: What medication is used to increase hypotension? **- CORRECT ANSWER ** Vasopressors
Medical Mgmt. ICP: What temperature control mechanism is used to decrease metabolic demand and decrease the work of the brain? - CORRECT ANSWER >>> induced hypothermia Medical Mgmt. ICP: What is the goal temperature of induced hypothermia? - CORRECT ANSWER >>> 34 - 35 degrees Celcius Medical Mgmt. ICP: What are the drawbacks of induced hypothermia? **- CORRECT ANSWER
** bradycardia, shivering (can increase ICP), skin issues Medical Mgmt. ICP: What medications would be used for sedation? **- CORRECT ANSWER ** Benzodiazepines Propofol/Diprovan Analgesia (Fentanyl) Medical Mgmt. ICP: What should you monitor for when administering Propofol? - CORRECT ANSWER >>> Hypertension Medical Mgmt. ICP: What should you do for seizure precautions? **- CORRECT ANSWER ** Provide padding Remove unsafe objects from around pt Dilantin/Phenytoin Medical Mgmt. ICP: What should you monitor for when administering Dilantin/Phenytoin? What precaution should you use? - CORRECT ANSWER >>> hypertensive reaction; don't push fast Medical Mgmt. ICP: What is a neuromuscular blockade? - CORRECT ANSWER >>> use of paralytics
drug or EtOH (ethanol) withdrawal acute brain injury metabolic disturbances What is the physiological response for status epilepticus? **- CORRECT ANSWER
** hypertension, tachycardia, cardiac arrhythmias, hyperglycemia, hyperthermia, lactic acidosis, and possible irreversible neuronal destruction Status Epileptic: Collaborative Care - CORRECT ANSWER >>> stay and protect patient from injury airway and oxygenation management neurological assessment cardiac monitoring Status Epileptic: What medications are administered? **- CORRECT ANSWER ** benzodiazepines, anticonvulsants, barbiturates Status Epileptic: What medication is administered as a benzodiazepine? **- CORRECT ANSWER ** Lorazepam (Ativan) is first choice Status Epileptic: What medication is administered as a first line drug? **- CORRECT ANSWER ** benzodiazepine/Lorazepam Status Epileptic: What medication is administered as a anticonvulsant? **- CORRECT ANSWER ** Phenytoin
Phosphenytoin (Cerebyx)
Status Epileptic: What medication is administered if benzodiazepines and anticonvulsants are not effective? - CORRECT ANSWER >>> Barbiturates/ Phenobarbital Status Epilepticus: What is the goal of using barbiturates/Phenobarbital? **- CORRECT ANSWER
** to place the patient in an induced coma What is an acute stroke? - CORRECT ANSWER >>> sudden onset of focal neurological symptoms r/t changes in cerebral blood flow What is a stroke? - CORRECT ANSWER >>> damage to the brain from interruption of its blood supply Stroke: What is the recommended time from door to doctor? - CORRECT ANSWER >>> 10 minutes Stroke: What is the recommended time from doctor to access to a neurological expertise? - CORRECT ANSWER >>> 15 minutes Stroke: What is the recommended time from door to CT scan completion? - CORRECT ANSWER >>> 25 minutes Stroke: What is the recommended time from door to CT scan interpretation? - CORRECT ANSWER >>> 45 minutes Stroke: What is the recommended time from door to treatment? - CORRECT ANSWER >>> 60 minutes Stroke: What is the recommended time from admission to monitored bed? - CORRECT ANSWER >>> 3 hours
What is Kernig's sign? - CORRECT ANSWER >>> after flexing the hip and knee at 90 degree angles, pain and resistance are noted shows meningeal irritation What is Brudzinski's sign? - CORRECT ANSWER >>> after forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg showing meningeal irritation What steroid is the drug of choice for bacterial meningitis? **- CORRECT ANSWER
** Dexamethasone (Decadron), but Solumedrol can be used What form of precautions is a patient with bacterial meningitis placed on? - CORRECT ANSWER >>> droplet and seizure What can cause bacterial meningitis? - CORRECT ANSWER >>> N. meningitidis or H. influenzae What should be avoided with bacterial meningitis? - CORRECT ANSWER >>> any activities that can increase ICP such as:
- avoid valsalva maneuver
- prevent coughing
- avoid hypotension
- KEEP the HOB elevated What comfort measures are given to a patient with bacterial meningitis? **- CORRECT ANSWER
** maintenance of normal body temperature dim lights What is autonomic dysreflexia? - CORRECT ANSWER >>> results in vasodilation above the injury site and vasoconstriction below the injury site with spinal cord injuries at T6 or higher
What can trigger autonomic dysreflexia? - CORRECT ANSWER >>> restrictive clothing, wrinkled sheets, full bladder, UTI, pressure areas, or fecal impaction What signs/symptoms can be seen of vasodilation with autonomic dysreflexia? - CORRECT ANSWER >>> (above level of injury) increased BP, flushed face, headache, distended jugular veins, decreased HR, increased sweating What signs/symptoms can be seen of vasoconstriction with autonomic dysreflexia? - CORRECT ANSWER >>> (below level of injury) paleness, coolness, no sweating
