CNRN Neurosurgical Nursing and Postoperative Care 1 — Questions and Answers
Question 1: After a craniotomy, the nurse assesses the patient and finds clear fluid draining from the nose. To determine if this is CSF, the nurse should:
- Send fluid for glucose level only
- Test for beta-2 transferrin and check for a halo sign on filter paper (Correct answer)
- Perform a dipstick urinalysis on the fluid
- Observe the color and odor of the fluid
Correct answer: Test for beta-2 transferrin and check for a halo sign on filter paper
Beta-2 transferrin is the most specific test for CSF; the halo (ring) sign on filter paper — a clear ring around a bloody center — also suggests CSF.
Question 2: A patient who had a transsphenoidal hypophysectomy for pituitary adenoma develops polyuria (output 500 mL/hour) and hypernatremia. The nurse suspects:
- Syndrome of inappropriate ADH (SIADH)
- Diabetes insipidus (DI) (Correct answer)
- Cerebral salt-wasting syndrome
- Postoperative fluid mobilization
Correct answer: Diabetes insipidus (DI)
Diabetes insipidus after pituitary surgery results from ADH deficiency, causing large volumes of dilute urine and hypernatremia.
Question 3: Which medication is used to treat central diabetes insipidus after pituitary surgery?
- Fludrocortisone
- Desmopressin (DDAVP) (Correct answer)
- Furosemide
- Hydrocortisone
Correct answer: Desmopressin (DDAVP)
Desmopressin (DDAVP) is a synthetic analog of ADH used to treat central diabetes insipidus by reducing urine output.
Question 4: After lumbar spinal fusion surgery, the nurse assesses the surgical site and notes a bulge under the wound. The patient reports headache when upright that resolves when lying flat. The nurse suspects:
- Wound infection
- CSF leak with pseudomeningocele (Correct answer)
- Seroma formation
- Surgical hematoma
Correct answer: CSF leak with pseudomeningocele
A postural headache (worse upright, better supine) with a bulge under the wound after spinal surgery suggests a CSF leak and pseudomeningocele formation.
Question 5: A patient with a ventriculoperitoneal (VP) shunt develops fever, headache, and stiff neck. The priority nursing intervention is to:
- Pump the shunt reservoir to assess function
- Notify the neurosurgeon immediately for suspected shunt infection (Correct answer)
- Administer acetaminophen and reassess in 2 hours
- Perform a CT head immediately without notifying the surgeon
Correct answer: Notify the neurosurgeon immediately for suspected shunt infection
Fever, headache, and nuchal rigidity in a VP shunt patient suggests shunt infection/meningitis, a neurosurgical emergency requiring immediate notification.
Question 6: The nurse is monitoring a patient's external ventricular drain (EVD). The drain is set to drain at 10 cmHâ‚‚O. The nurse should position the drip chamber reference point at:
- The level of the patient's chin
- The level of the tragus of the ear (foramen of Monro) (Correct answer)
- The level of the patient's shoulder
- The level of the patient's mid-sternum
Correct answer: The level of the tragus of the ear (foramen of Monro)
The EVD reference point (zero level) is placed at the tragus of the ear, which corresponds to the level of the foramen of Monro for accurate ICP measurement.
CNRN Neurosurgical Nursing and Postoperative Care 1
After a craniotomy, the nurse assesses the patient and finds clear fluid draining from the nose.
To determine if this is CSF, the nurse should: