CNRN Neurosurgical Nursing and Postoperative Care 2 — Questions and Answers
Question 1: A patient undergoes clipping of an intracranial aneurysm. The most serious immediate postoperative complication the CNRN nurse monitors for is:
- Wound infection
- Cerebral vasospasm and delayed cerebral ischemia (Correct answer)
- Urinary retention
- Pneumonia
Correct answer: Cerebral vasospasm and delayed cerebral ischemia
Cerebral vasospasm causing delayed cerebral ischemia is the most serious postoperative complication after aneurysm clipping, occurring days 4–14.
Question 2: The nurse is monitoring a patient post-craniotomy and notes the Jackson-Pratt drain output is 300 mL of bright red blood over 1 hour. The priority action is to:
- Document and reassess in 30 minutes
- Empty the drain bulb and continue monitoring
- Immediately notify the neurosurgeon (Correct answer)
- Apply a pressure dressing over the drain site
Correct answer: Immediately notify the neurosurgeon
Sudden large-volume bright red blood output from a post-craniotomy drain indicates active hemorrhage requiring immediate neurosurgical notification.
Question 3: A patient with normal pressure hydrocephalus (NPH) classically presents with which triad of symptoms?
- Headache, papilledema, diplopia
- Gait disturbance, urinary incontinence, and dementia (Hakim's triad) (Correct answer)
- Seizures, focal weakness, and confusion
- Rigidity, tremor, and bradykinesia
Correct answer: Gait disturbance, urinary incontinence, and dementia (Hakim's triad)
Normal pressure hydrocephalus presents with Hakim's triad: gait apraxia (magnetic gait), urinary incontinence, and cognitive decline (dementia).
Question 4: After a patient returns from carotid endarterectomy (CEA), which neurological assessment finding requires immediate notification of the surgeon?
- Mild throat soreness
- New facial droop or arm weakness on the operative side (Correct answer)
- Mild headache
- Hoarse voice
Correct answer: New facial droop or arm weakness on the operative side
New focal neurological deficits after CEA suggest stroke from thromboembolism or carotid occlusion, requiring immediate surgical reassessment.
Question 5: Which post-operative position is recommended after infratentorial (posterior fossa) craniotomy to minimize cerebellar and brainstem edema?
- Flat with no pillow
- Head of bed elevated 30–45 degrees, head midline (Correct answer)
- Lateral decubitus position
- Trendelenburg position
Correct answer: Head of bed elevated 30–45 degrees, head midline
Head elevation at 30–45 degrees with midline head positioning promotes venous drainage and reduces posterior fossa edema after infratentorial craniotomy.
Question 6: The nurse caring for a patient post-endoscopic third ventriculostomy (ETV) monitors closely for which early sign of procedure failure?
- Hypertension and tachycardia
- Worsening headache, nausea, and decreased level of consciousness (Correct answer)
- Incisional pain
- Mild fever within 24 hours
Correct answer: Worsening headache, nausea, and decreased level of consciousness
Worsening headache, nausea, and declining LOC after ETV suggest closure of the ventriculostomy with return of hydrocephalus.
CNRN Neurosurgical Nursing and Postoperative Care 2
A patient undergoes clipping of an intracranial aneurysm.
The most serious immediate postoperative complication the CNRN nurse monitors for is: