Acute Care Nurse Practitioner Neurological Assessment and Management in the ICU 1 — Questions and Answers
Question 1: A patient's Glasgow Coma Scale is assessed as E2V3M4. What is the total GCS score?
- 7
- 9 (Correct answer)
- 11
- 13
Correct answer: 9
GCS = Eye (2) + Verbal (3) + Motor (4) = 9; scores ≤8 typically indicate the need for airway protection.
Question 2: Which finding on CT scan of the head indicates a subdural hematoma rather than an epidural hematoma?
- Biconvex (lens-shaped) hyperdense collection
- Crescent-shaped hyperdense collection crossing suture lines (Correct answer)
- Hypodense midline shift
- Bilateral symmetric hyperdensities
Correct answer: Crescent-shaped hyperdense collection crossing suture lines
Subdural hematomas appear crescent-shaped and can cross suture lines because they are contained by the dura, not periosteum.
Question 3: The ACNP is managing a patient with elevated ICP. What is the target range for cerebral perfusion pressure (CPP)?
- 40–50 mmHg
- 50–60 mmHg
- 60–70 mmHg (Correct answer)
- 80–90 mmHg
Correct answer: 60–70 mmHg
CPP = MAP − ICP; target CPP is 60–70 mmHg in TBI patients to ensure adequate cerebral perfusion without excessive vasodilation.
Question 4: Which intervention is MOST appropriate for acutely managing elevated ICP (>22 mmHg) in a TBI patient?
- Administer hypotonic saline
- Elevate head of bed to 30° and administer hypertonic saline or mannitol (Correct answer)
- Hyperventilate to PaCOâ‚‚ of 25 mmHg
- Administer furosemide IV
Correct answer: Elevate head of bed to 30° and administer hypertonic saline or mannitol
HOB 30° elevation and osmotic therapy (hypertonic saline or mannitol) are first-line interventions for elevated ICP management.
Question 5: Cushing's triad, indicating impending cerebral herniation, consists of which three findings?
- Hypotension, tachycardia, bradypnea
- Hypertension, bradycardia, irregular respirations (Correct answer)
- Hypertension, tachycardia, hyperpnea
- Hypotension, bradycardia, apnea
Correct answer: Hypertension, bradycardia, irregular respirations
Cushing's triad = hypertension + bradycardia + irregular respirations, representing the brain's last-ditch response to herniation.
Question 6: A patient with a subarachnoid hemorrhage (SAH) develops worsening neurological deficits on day 5. Which complication should the ACNP suspect?
- Re-bleeding
- Cerebral vasospasm (Correct answer)
- Hydrocephalus
- Meningitis
Correct answer: Cerebral vasospasm
Cerebral vasospasm typically occurs 4–14 days after SAH (peak days 7–10), causing delayed ischemic neurological deficits.
Acute Care Nurse Practitioner Neurological Assessment and Management in the ICU 1
A patient's Glasgow Coma Scale is assessed as E2V3M4.
What is the total GCS score?