Acute Care Nurse Practitioner Neurological Assessment and Management in the ICU

Question 1

A patient's Glasgow Coma Scale is assessed as E2V3M4. What is the total GCS score?

Accepted Answer

9

Answer

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?

Accepted Answer

Crescent-shaped hyperdense collection crossing suture lines

Answer

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)?

Accepted Answer

60–70 mmHg

Answer

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?

Accepted Answer

Elevate head of bed to 30° and administer hypertonic saline or mannitol

Answer

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?

Accepted Answer

Hypertension, bradycardia, irregular respirations

Answer

Cushing's triad = hypertension + bradycardia + irregular respirations, representing the brain's last-ditch response to herniation.

Acute Care Nurse Practitioner Practice Test