‼️FINAL ICP‼️ Flashcards
(31 cards)
What is the most sensitive and reliable indicator of increased intracranial pressure (ICP)?
A. Heart rate
B. Pupil size
C. Level of consciousness
D. Respiratory rate
Answer: C. Level of consciousness
Rationale: Changes in LOC are the earliest and most reliable signs of increased ICP because they reflect impaired cerebral blood flow and oxygenation.
Which vital sign change is part of Cushing’s triad?
A. Tachycardia
B. Narrow pulse pressure
C. Bradypnea
D. Hypertension
Answer: C. Bradypnea
Rationale: Cushing’s triad includes bradycardia, widened pulse pressure (systolic hypertension), and irregular respirations such as bradypnea—signs of brainstem compression.
Which intervention is appropriate for managing increased ICP?
A. Elevate the head of bed to 90 degrees
B. Keep the patient in Trendelenburg position
C. Maintain head midline and elevate HOB to 30 degrees
D. Hyperextend the neck
Answer: C. Maintain head midline and elevate HOB to 30 degrees
Rationale: This position promotes venous drainage and helps reduce ICP without compromising cerebral perfusion.
What is a sign of uncal herniation?
A. Bilateral dilated pupils
B. Unilateral dilated pupil
C. Constricted pupils
D. Equal and reactive pupils
Answer: B. Unilateral dilated pupil
Rationale: Uncal herniation compresses cranial nerve III, resulting in a fixed, dilated pupil on the same side as the lesion.
What medication is commonly used to reduce cerebral edema in increased ICP?
A. Furosemide
B. Mannitol
C. Acetaminophen
D. Dexamethasone
Answer: B. Mannitol
Rationale: Mannitol is an osmotic diuretic that pulls water from brain tissue into the vascular space, reducing cerebral edema.
What is the formula to calculate cerebral perfusion pressure (CPP)?
A. CPP = ICP - MAP
B. CPP = MAP + ICP
C. CPP = MAP - ICP
D. CPP = MAP / ICP
Answer: C. CPP = MAP - ICP
Rationale: CPP is calculated by subtracting ICP from MAP to assess adequate cerebral blood flow.
What does decerebrate posturing indicate?
A. Damage to the cerebral cortex
B. Disruption of motor fibers in the brainstem
C. Normal pain response
D. Recovery from ICP
Answer: B. Disruption of motor fibers in the brainstem
Rationale: Decerebrate posture reflects serious brainstem injury and indicates worsening neurologic status.
Which is an early sign of increased ICP?
A. Cushing’s triad
B. Fixed dilated pupils
C. Change in level of consciousness
D. Decerebrate posturing
Answer: C. Change in level of consciousness
Rationale: LOC is typically the first sign of increasing ICP and reflects impaired cerebral perfusion.
What is the normal range of ICP in adults?
A. 10–25 mmHg
B. 5–15 mmHg
C. 0–10 mmHg
D. 20–30 mmHg
Answer: B. 5–15 mmHg
Rationale: ICP greater than 20 mmHg is considered abnormal and requires intervention.
Which procedure is contraindicated in suspected increased ICP?
A. MRI
B. CT scan
C. Lumbar puncture
D. EEG
Answer: C. Lumbar puncture
Rationale: LP may cause brain herniation due to sudden decompression of pressure in the skull.
What pupil reaction is most concerning for brain herniation?
A. Reactive bilaterally
B. Constricted
C. Fixed and dilated
D. Sluggish but reactive
Answer: C. Fixed and dilated
Rationale: A fixed and dilated pupil suggests cranial nerve III compression and possible uncal herniation.
What causes the signs of Cushing’s triad?
A. Intracranial bleeding
B. Cerebral edema
C. Brainstem compression
D. Skull fracture
Answer: C. Brainstem compression
Rationale: Cushing’s triad results from pressure on the medulla and brainstem due to increasing ICP.
What is the primary goal in managing increased ICP?
A. Reduce MAP
B. Increase blood pressure
C. Maintain cerebral perfusion pressure
D. Lower body temperature
Answer: C. Maintain cerebral perfusion pressure
Rationale: Ensuring adequate CPP is essential to prevent brain ischemia and preserve function.
What medication is used to reduce ICP by drawing fluid from the brain into the bloodstream?
A. Mannitol
B. Dextrose 5%
C. 0.45% NS
D. Lactated Ringer’s
Answer: A. Mannitol
Rationale: Mannitol uses osmotic diuresis to reduce cerebral edema and lower ICP.
Which position is best for a patient with increased ICP?
A. Supine with head flat
B. Semi-Fowler’s with head midline
C. Side-lying with knees flexed
D. Trendelenburg
Answer: B. Semi-Fowler’s with head midline
Rationale: Head elevation at 30 degrees with midline alignment facilitates venous drainage from the brain.
What is the earliest sign of potential brain herniation?
A. Seizure
B. Change in LOC
C. Cushing’s triad
D. Vomiting
Answer: B. Change in LOC
Rationale: Changes in alertness or responsiveness usually occur before other herniation signs appear.
What electrolyte imbalance is associated with SIADH in increased ICP?
A. Hyperkalemia
B. Hypernatremia
C. Hyponatremia
D. Hypocalcemia
Answer: C. Hyponatremia
Rationale: SIADH leads to fluid retention and dilutional hyponatremia, worsening cerebral edema.
What kind of vomiting is a sign of increased ICP?
A. Nausea-induced vomiting
B. Post-prandial vomiting
C. Projectile vomiting
D. Vomiting with diarrhea
Answer: C. Projectile vomiting
Rationale: Projectile vomiting without warning is often related to pressure on the vomiting center in the medulla.
What does decorticate posturing indicate?
A. Brainstem herniation
B. Disruption of the spinal cord
C. Lesion in the cerebral cortex
D. Increased ICP recovery
Answer: C. Lesion in the cerebral cortex
Rationale: Decorticate posturing reflects damage to corticospinal tracts above the brainstem.
What is a late sign of increased ICP?
A. Headache
B. Nausea
C. Fixed dilated pupil
D. Irritability
Answer: C. Fixed dilated pupil
Rationale: A late and ominous sign indicating possible brain herniation.
What ICP level is considered dangerous and requires treatment?
A. 15 mmHg
B. 12 mmHg
C. 18 mmHg
D. 22 mmHg
Answer: D. 22 mmHg
Rationale: ICP >20 mmHg is abnormal and associated with increased risk of brain damage.
What vital signs reflect Cushing’s triad?
A. Hypotension, tachycardia, tachypnea
B. Wide pulse pressure, bradycardia, irregular respirations
C. Hypertension, tachycardia, normal respirations
D. Hypotension, bradycardia, shallow breathing
Answer: B. Hypertension, bradycardia, irregular respirations
Rationale: These signs indicate brainstem dysfunction from increased ICP.
Which of the following may increase ICP and should be minimized?
A. Low-stimulation environment
B. Hyperoxygenation
C. Frequent suctioning
D. Head-of-bed elevation
Answer: C. Frequent suctioning
Rationale: Suctioning can raise intrathoracic pressure and ICP; limit it to when absolutely necessary.
What is the gold standard for ICP monitoring?
A. EEG
B. Subdural catheter
C. Ventriculostomy
D. MRI
Answer: C. Ventriculostomy
Rationale: A ventriculostomy allows direct pressure measurement and therapeutic CSF drainage.
