CCRN Neurological Critical Care 3 — Questions and Answers
Question 1: A patient with an aneurysmal subarachnoid hemorrhage is at highest risk for cerebral vasospasm during which time frame?
- Days 4 to 14 after the bleed (Correct answer)
- Within the first 6 hours
- Days 21 to 30 after the bleed
- Only after surgical clipping
Correct answer: Days 4 to 14 after the bleed
Vasospasm peaks between days 4 and 14 following aneurysmal subarachnoid hemorrhage.
Question 2: Which medication is given to reduce the risk of poor outcomes from cerebral vasospasm after subarachnoid hemorrhage?
- Nimodipine (Correct answer)
- Labetalol
- Mannitol
- Phenytoin
Correct answer: Nimodipine
Nimodipine, a calcium channel blocker, improves neurologic outcomes after SAH-related vasospasm.
Question 3: The Hunt and Hess scale is used to grade the severity of which condition?
- Subarachnoid hemorrhage (Correct answer)
- Ischemic stroke
- Spinal cord injury
- Status epilepticus
Correct answer: Subarachnoid hemorrhage
The Hunt and Hess scale grades the clinical severity of subarachnoid hemorrhage.
Question 4: A patient with SAH develops hyponatremia, hypovolemia, and high urine sodium with signs of dehydration. Which diagnosis is most consistent?
- Cerebral salt wasting (Correct answer)
- SIADH
- Diabetes insipidus
- Acute kidney injury
Correct answer: Cerebral salt wasting
Cerebral salt wasting causes hyponatremia with volume depletion and renal sodium loss.
Question 5: Which intervention is contraindicated for a patient with a sudden severe headache described as 'the worst headache of my life' before the aneurysm is secured?
- Activities that increase intrathoracic pressure such as straining (Correct answer)
- Maintaining a quiet, dark environment
- Keeping systolic blood pressure controlled
- Bed rest with limited stimulation
Correct answer: Activities that increase intrathoracic pressure such as straining
Straining raises intracranial and arterial pressure, risking aneurysm rebleeding before it is secured.
Question 6: Triple-H therapy historically used for cerebral vasospasm includes hypertension, hemodilution, and which third component?
- Hypervolemia (Correct answer)
- Hypothermia
- Hyperventilation
- Hyperglycemia
Correct answer: Hypervolemia
Triple-H therapy combines hypertension, hemodilution, and hypervolemia to improve cerebral perfusion.
Question 7: What is the gold standard diagnostic test to identify the source of an aneurysmal subarachnoid hemorrhage?
- Cerebral angiography (Correct answer)
- Lumbar puncture
- Skull radiograph
- Electroencephalogram
Correct answer: Cerebral angiography
Cerebral angiography is the gold standard for locating the aneurysm responsible for SAH.
CCRN Neurological Critical Care 3
A patient with an aneurysmal subarachnoid hemorrhage is at highest risk for cerebral vasospasm during which time frame?