CNRN Neurovascular Disorders and Stroke Nursing 2 — Questions and Answers
Question 1: Vasospasm after subarachnoid hemorrhage peaks at which time frame following the initial bleed?
- Days 1–3
- Days 4–14 (peak days 7–10) (Correct answer)
- Days 15–21
- More than 3 weeks
Correct answer: Days 4–14 (peak days 7–10)
Cerebral vasospasm after SAH typically occurs between days 4–14, with the highest incidence around days 7–10.
Question 2: Which medication regimen is standard to reduce vasospasm-related ischemia after subarachnoid hemorrhage?
- Nimodipine 60 mg orally every 4 hours for 21 days (Correct answer)
- Nifedipine 10 mg orally three times daily
- Verapamil IV infusion for 14 days
- Amlodipine 5 mg daily for 30 days
Correct answer: Nimodipine 60 mg orally every 4 hours for 21 days
Nimodipine 60 mg orally every 4 hours for 21 days is the evidence-based standard to reduce vasospasm-related cerebral ischemia after SAH.
Question 3: A patient with SAH develops delayed cerebral ischemia. The nurse implements 'Triple-H therapy.' This refers to:
- Hypertension, hemodilution, hyperventilation
- Hypertension, hypervolemia, hemodilution (Correct answer)
- Hypotension, hypervolemia, hyperoxia
- Hyperventilation, hemodilution, hypothermia
Correct answer: Hypertension, hypervolemia, hemodilution
Triple-H therapy (hypertension, hypervolemia, hemodilution) aims to increase cerebral perfusion in vasospasm-related delayed ischemia.
Question 4: A patient presents with sudden onset of diplopia, dysphagia, ataxia, and ipsilateral facial numbness with contralateral body numbness. The nurse recognizes this as:
- Middle cerebral artery syndrome
- Anterior cerebral artery syndrome
- Wallenberg (lateral medullary) syndrome (Correct answer)
- Weber syndrome
Correct answer: Wallenberg (lateral medullary) syndrome
Wallenberg syndrome (lateral medullary infarction) presents with ipsilateral facial sensory loss, contralateral body sensory loss, dysphagia, hoarseness, and ataxia.
Question 5: Which stroke scale is used at the bedside by nurses to quantify stroke severity and guide acute treatment decisions?
- Barthel Index
- Modified Rankin Scale (mRS)
- NIH Stroke Scale (NIHSS) (Correct answer)
- Hunt and Hess Scale
Correct answer: NIH Stroke Scale (NIHSS)
The NIH Stroke Scale (NIHSS) is the standardized bedside tool used to quantify acute stroke severity across 15 neurological domains.
Question 6: A patient develops worsening headache, confusion, and right-sided weakness 24 hours after a craniotomy for AVM resection. The most likely complication is:
- Normal post-operative pain
- Normal perfusion pressure breakthrough bleeding (Correct answer)
- Meningitis
- Hyponatremia
Correct answer: Normal perfusion pressure breakthrough bleeding
Normal perfusion pressure breakthrough (NPPB) hemorrhage occurs when chronically hypoperfused vessels cannot autoregulate after AVM removal.
CNRN Neurovascular Disorders and Stroke Nursing 2
Vasospasm after subarachnoid hemorrhage peaks at which time frame following the initial bleed?