Neuroscience Registered Nurse Certification Flashcards

A patient with ischemic stroke is being considered for IV alteplase. Which of the following is an absolute contraindication?

Answer: Blood pressure of 195/105 mmHg that does not respond to two antihypertensive doses

BP >185/110 mmHg that cannot be lowered and maintained is an absolute contraindication to IV tPA for acute ischemic stroke.

The nurse is caring for a patient with status epilepticus who has received two doses of lorazepam without seizure cessation. The next priority medication is:

Answer: Levetiracetam or fosphenytoin IV

After two benzodiazepine doses fail, second-line agents (fosphenytoin, levetiracetam, or valproate IV) are indicated per status epilepticus protocols.

Which clinical sign distinguishes central herniation from uncal herniation in a deteriorating patient?

Answer: Bilateral pinpoint pupils early in central herniation vs. ipsilateral blown pupil in uncal herniation

Central herniation causes early bilateral small pupils and gradual rostral-caudal deterioration, while uncal herniation classically presents with an ipsilateral dilated fixed pupil from CN III compression.

A patient with a C4 spinal cord injury develops a sudden headache (9/10), diaphoresis above the injury level, and hypertension of 210/118 mmHg. The nurse's first action is:

Answer: Sit the patient upright and search for a noxious stimulus below the injury level

Autonomic dysreflexia requires immediate upright positioning to use orthostatic hypotension as a rapid intervention while simultaneously identifying and removing the offending stimulus (most commonly a full bladder).

Which assessment finding indicates increasing intracranial pressure in a patient with a traumatic brain injury?

Answer: Widening pulse pressure with bradycardia

Cushing's triad (widening pulse pressure, bradycardia, and irregular respirations) signals critically elevated ICP and impending brainstem herniation.

A nurse is caring for a patient receiving hypertonic saline (3% NaCl) for cerebral edema. Which lab value requires the most immediate intervention?

Answer: Serum sodium of 162 mEq/L

Serum sodium >160 mEq/L during hypertonic saline therapy indicates hypernatremia beyond the intended therapeutic range and risks central pontine myelinolysis and renal injury.

A patient with myasthenia gravis crisis is admitted with dysphagia and respiratory distress. The nurse should prioritize:

Answer: Assessing respiratory function and preparing for possible intubation

In myasthenic crisis, airway and respiratory status are the immediate priority; intubation may be necessary before disease-specific treatment.