CCRN - Review Neurological Critical Care Questions and Answers

Question 1

A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg and a mean arterial pressure (MAP) of 70 mmHg.
The nurse calculates the cerebral perfusion pressure (CPP) and recognizes the need for which immediate intervention?

Accepted Answer

Administering a prescribed vasopressor to increase MAP.

Answer

Administering an antihypertensive agent to lower MAP.

Answer

Increasing the head of the bed to 90 degrees.

Answer

Performing a deep suctioning of the endotracheal tube.

Question 2

A patient is admitted to the ICU following a ruptured cerebral aneurysm and subsequent subarachnoid hemorrhage (SAH). Which of the following physician's orders should the nurse anticipate to prevent cerebral vasospasm?

Accepted Answer

Administration of nimodipine 60 mg every 4 hours.

Answer

Intravenous mannitol every 6 hours.

Answer

Strict blood pressure control with a target SBP < 120 mmHg.

Answer

Initiation of therapeutic hypothermia.

Question 3

A critical care nurse is performing a neurological assessment on a patient with a large epidural hematoma. The nurse notes the development of a fixed and dilated pupil on the right side, bradycardia, and systolic hypertension. These findings are most indicative of which neurological emergency?

Accepted Answer

Uncal herniation with brainstem compression.

Answer

Central neurogenic hyperventilation.

Answer

Onset of a generalized tonic-clonic seizure.

Answer

Development of cerebral salt wasting.

Question 4

Which of the following is the first-line pharmacologic intervention for a patient who has been actively seizing for more than five minutes (status epilepticus)?

Accepted Answer

Lorazepam (Ativan) IV push.

Answer

Phenytoin (Dilantin) IV infusion.

Answer

Propofol (Diprivan) bolus and infusion.

Answer

Levetiracetam (Keppra) IV piggyback.

Question 5

A nurse is preparing to assist with an apnea test to determine brain death in a patient with a catastrophic brain injury. The nurse confirms that all prerequisites have been met. The test is considered positive, supporting a diagnosis of brain death, if what occurs?

Accepted Answer

The PaCO2 rises to ≥ 60 mmHg without respiratory effort.

Answer

The patient's heart rate increases by 20% from baseline.

Answer

The patient develops spontaneous respiratory effort.

Answer

The SpO2 drops below 85% for more than 30 seconds.

Question 6

A patient with an acute ischemic stroke is found to be outside the treatment window for thrombolysis. The neurologist has ordered permissive hypertension. The nurse understands the rationale for this order is to:

Accepted Answer

Improve blood flow to the ischemic penumbra.

Answer

Prevent hemorrhagic conversion of the stroke.

Answer

Reduce cerebral edema and lower intracranial pressure.

Answer

Prepare the patient for emergent craniotomy.