MSNCB Neurological Nursing 4 — Questions and Answers
Question 1: Which finding on CT scan would CONTRAINDICATE administration of tPA for acute stroke?
- Absence of hemorrhage
- Small area of hypodensity in basal ganglia
- Large hyperdense area indicating intracranial hemorrhage (Correct answer)
- Subtle loss of gray-white matter differentiation
Correct answer: Large hyperdense area indicating intracranial hemorrhage
Intracranial hemorrhage on CT is an absolute contraindication to tPA because the thrombolytic would worsen the bleeding.
Question 2: A nurse is caring for a patient with bacterial meningitis. Which precaution is required until 24 hours after antibiotics are initiated?
- Contact precautions
- Airborne precautions
- Droplet precautions (Correct answer)
- Reverse isolation
Correct answer: Droplet precautions
Droplet precautions are required for bacterial meningitis (especially Neisseria meningitidis) until 24 hours of effective antibiotic therapy have been completed.
Question 3: Which ICP waveform component, when elevated above the other components, indicates decreased intracranial compliance?
- P1 (percussion wave)
- P2 (tidal wave) (Correct answer)
- P3 (dicrotic wave)
- A-wave (plateau wave)
Correct answer: P2 (tidal wave)
When P2 exceeds P1, it indicates decreased intracranial compliance, meaning the brain has less ability to accommodate changes in volume.
Question 4: A patient receiving phenytoin (Dilantin) for seizure control should be monitored for which serious adverse effect?
- Nephrotoxicity
- Cardiac dysrhythmias during rapid IV infusion (Correct answer)
- Pulmonary fibrosis
- Hepatic encephalopathy
Correct answer: Cardiac dysrhythmias during rapid IV infusion
Rapid IV infusion of phenytoin can cause severe hypotension and cardiac dysrhythmias; it must be administered no faster than 50 mg/min.
Question 5: A patient with Alzheimer's disease becomes agitated and tries to climb out of bed at night. The BEST nursing intervention is to:
- Apply wrist restraints to prevent falls
- Administer a PRN benzodiazepine immediately
- Reorient the patient, reduce environmental stimuli, and ensure safety (Correct answer)
- Increase lighting in the room and turn on the television
Correct answer: Reorient the patient, reduce environmental stimuli, and ensure safety
Non-pharmacological interventions including reorientation, calm reassurance, and a safe low-stimulation environment are the first-line approach for sundowning.
Question 6: A patient with a brain tumor develops new onset of seizures. The nurse understands that seizures in this population are most often caused by:
- Elevated ICP causing global cerebral ischemia
- Cortical irritation from the tumor or surrounding edema (Correct answer)
- Metabolic imbalances from tumor-related cachexia
- Medication side effects from chemotherapy agents
Correct answer: Cortical irritation from the tumor or surrounding edema
Brain tumors cause seizures primarily through cortical irritation from the tumor mass itself or the peritumoral edema surrounding it.
Question 7: Which medication is used to reduce cerebral edema in patients with brain tumors?
- Furosemide
- Dexamethasone (Correct answer)
- Mannitol infusion
- Hypertonic saline bolus
Correct answer: Dexamethasone
Dexamethasone (a corticosteroid) is the first-line treatment for vasogenic cerebral edema surrounding brain tumors.
MSNCB Neurological Nursing 4
Which finding on CT scan would CONTRAINDICATE administration of tPA for acute stroke?