Free Certified Neuroscience Registered Nurse Questions and Answers — Questions and Answers
Question 1: A patient with status epilepticus has been taken into the hospital. Right now, the patient is postictal. Which of the following nursing factors is most crucial when managing the patient?
- Maintain an airway. (Correct answer)
- Obtain an electrocardiogram.
- Insert a central line.
- Prepare the patient for a lumbar puncture.
Correct answer: Maintain an airway.
During the postictal phase following a seizure, patients are often drowsy, confused, and may have depressed respiratory drive or a relaxed tongue, which can obstruct the airway. Maintaining a patent airway is paramount to ensure adequate oxygenation and prevent aspiration, making it the most critical immediate nursing intervention to prevent further complications.
Question 2: An external ventricular drain is present in a patient. Between 25 and 30 mm Hg is the intracranial pressure (ICP) range. Which of the following traits or symptoms is not a match for these ICPs?
- Irregular respirations.
- Tachycardia. (Correct answer)
- Fixed pupils.
- Bradycardia.
Correct answer: Tachycardia.
Significantly elevated intracranial pressure (ICP) typically triggers Cushing's triad, which includes bradycardia (slow heart rate), widening pulse pressure, and irregular respirations. Tachycardia, or a fast heart rate, is generally not a direct sign of high ICP; instead, bradycardia is the expected cardiovascular response as the body attempts to maintain cerebral perfusion.
Question 3: ICP is 30 mm Hg in a patient with an external ventricular drain (EVD). When the drain is opened, the output is extremely slow. What comes after that?
- Continue to monitor the ICP.
- Flush the drain distally.
- Call the attending/resident. (Correct answer)
- Flush the drain proximally.
Correct answer: Call the attending/resident.
An ICP of 30 mmHg is significantly elevated and requires immediate attention. If the external ventricular drain (EVD) is open but output is extremely slow, it suggests a potential malfunction, obstruction, or inadequate drainage, which can lead to further neurological compromise. This situation warrants immediate medical evaluation and intervention from the attending physician or resident.
Question 4: After a stroke, a patient will be given aspirin (Ecotrin) and ticagrelor (Brilinta) to take home. Which of the following side effects of these drugs ought to be explained to the family?
- Nystagmus.
- Tardive dyskinesia.
- Ataxia.
- Bleeding (Correct answer)
Correct answer: Bleeding
Both aspirin and ticagrelor are antiplatelet medications prescribed to prevent blood clots after a stroke. Their primary mechanism of action involves inhibiting platelet aggregation, which significantly increases the risk of bleeding. Patients and their families must be educated about potential signs of bleeding, such as easy bruising, nosebleeds, or blood in urine or stools, to ensure prompt recognition and management.
Question 5: Lethargy, anorexia, vomiting, and a high-grade fever appear in an inmate with a history of HIV. The patient shows a positive Brudzinski sign during physical examination. In order to confirm the diagnosis, which of the following tests would not be used?
- CT scan of the abdomen and pelvis. (Correct answer)
- Erythrocyte sedimentation rate.
- Lumbar Puncture
- Blood cultures
Correct answer: CT scan of the abdomen and pelvis.
The patient's symptoms (lethargy, high fever, positive Brudzinski sign) strongly suggest meningitis, especially given their history of HIV. Tests like lumbar puncture (for CSF analysis), blood cultures, and erythrocyte sedimentation rate (ESR) are directly relevant to diagnosing meningitis and systemic infection. A CT scan of the abdomen and pelvis is unrelated to a neurological infection and would not be used to confirm this diagnosis.
Question 6: The ICP of a patient with an EVD has been steadily rising. Which drugs should the nurse anticipate administering to this patient?
- Hydrochlorothiazide (Microzide).
- Mannitol (Osmitrol). (Correct answer)
- Hydralazine.
- Furosemide (Lasix).
Correct answer: Mannitol (Osmitrol).
Mannitol is an osmotic diuretic commonly administered to rapidly reduce elevated intracranial pressure (ICP). It works by drawing fluid from the brain tissue into the vascular space, thereby decreasing cerebral edema and subsequently lowering ICP. This makes it the appropriate drug to anticipate for a patient with steadily rising ICP.
Question 7: After receiving a trigeminal neuralgia diagnosis and treatment, a patient is leaving the hospital. Which of the following recommendations for the patient should not be made by the nurse?
- Chewing gum may help symptoms. (Correct answer)
- Drinking room temperature drinks may help prevent pain.
- Shaving may precipitate pain.
- Eating soft foods may prevent symptoms.
Correct answer: Chewing gum may help symptoms.
Trigeminal neuralgia is characterized by severe facial pain triggered by light touch, chewing, talking, or even a breeze. Chewing gum involves repetitive jaw movement and stimulation of facial muscles, which is a common trigger for pain in patients with trigeminal neuralgia. Therefore, recommending chewing gum would likely exacerbate symptoms rather than provide relief.
Free Certified Neuroscience Registered Nurse Questions and Answers
A patient with status epilepticus has been taken into the hospital.
Right now, the patient is postictal.
Which of the following nursing factors is most crucial when managing the patient?