!QUIZ 4!

Question 1

The 3 essential volume components in the skull with the %’s?

Answer 1

Cerebral spinal fluid 10%, intravascular blood 12%, and brain tissue 38%

Question 2

When does the Monro-Kellie doctrine works?

Answer 2

Only if the skull is closed, so the body will compensate for only one of the essential volume components in the skull.

Question 3

What is normal ICP range?

Answer 3

5-15mmHg (greater than 20 is abnormal and can be life-threating)

Question 4

First stage of ICP?

Answer 4

Total compensation

Question 5

Stage two of ICP?

Answer 5

Decrease compensation at risk for increased ICP

Question 6

Stage three of ICP?

Answer 6

Failed compensation in clinical manifestations begin due to the increased ICP

Question 7

Stage four of ICP?

Answer 7

Herniation and death

Question 8

What is normal cerebral perfusion pressure?

Answer 8

60-100mmHg

Question 9

How to calculate cerebral perfusion pressure

Answer 9

MAP - ICP

Question 10

This is the most common cause of cerebral edema and occurs in the white matter and causes disruption of the blood brain barrier

Answer 10

Vasogenic

Question 10

Three types of cerebral edema

Answer 10

Vasogenic, cytotoxic, and interstitial

Question 11

What type of posturing is bad for a patient that has increased ICP?

Answer 11

Decorticate and decerebrate

Question 12

What is the gold standard diagnostic study for suspected increased ICP?

Answer 12

Preferably CT, but MRI can also be done

Question 12

What is the most severe complication of increased ICP?

Answer 12

Herniation

Question 13

List less common diagnostic studies to be done for suspected increased ICP

Answer 13

PET scan, cerebral angiography, transcranial doppler, evoke potential studies, and LICOX (measures ICP and brain tissue)

Question 14

What should never be done while a patient is herniating?

Answer 14

A lumbar puncture

Question 15

Question: Which component is NOT one of the three essential volume components of the skull as described in the Monro-Kellie doctrine?
A. Brain tissue
B. Cerebrospinal fluid
C. Blood
D. Lymphatic fluid

Answer 15

Answer: D. Lymphatic fluid
Rationale: The Monro-Kellie doctrine includes brain tissue, blood, and cerebrospinal fluid (CSF) — not lymphatic fluid.

Question 15

Question: Which condition results from increased secretion of ADH, leading to dilutional hyponatremia?
A. Diabetes mellitus
B. Diabetes insipidus
C. SIADH
D. Cerebral edema

Answer 15

Answer: C. SIADH
Rationale: SIADH causes fluid retention and hyponatremia due to excess ADH secretion.

Question 16

Question: Which posture indicates severe damage to the midbrain or brainstem?
A. Flaccid paralysis
B. Decorticate posturing
C. Opisthotonos
D. Decerebrate posturing

Answer 16

Answer: D. Decerebrate posturing
Rationale: Decerebrate posturing (rigid extension) indicates more severe damage compared to decorticate posturing (flexion).

Question 16

Question: What is the priority nursing action for a patient with a Glasgow Coma Scale (GCS) score of 8?
A. Insert an NG tube
B. Elevate the head of the bed to 90 degrees
C. Maintain a patent airway
D. Administer corticosteroids

Answer 16

Answer: C. Maintain a patent airway
Rationale: A GCS of 8 or less indicates coma; maintaining airway patency is the most critical intervention.

Question 17

Question: Which structure allows for CSF drainage in a patient with increased ICP using the gold standard method?
A. Ommaya reservoir
B. Central line
C. Jugular catheter
D. Ventriculostomy

Answer 17

Answer: D. Ventriculostomy
Rationale: A ventriculostomy is the gold standard for monitoring and draining CSF in patients with elevated ICP.

Question 18

Question: What is the most sensitive and reliable indicator of increased intracranial pressure?
A. Projectile vomiting
B. Pupil dilation
C. Change in level of consciousness
D. Bradycardia

Answer 18

Answer: C. Change in level of consciousness
Rationale: A change in LOC is typically the earliest and most sensitive indicator of increased ICP due to reduced cerebral perfusion.

Question 18

Question: What drug is commonly used as an osmotic diuretic to reduce intracranial pressure?
A. Furosemide
B. Dexamethasone
C. Mannitol
D. Hydrochlorothiazide

Answer 18

Answer: C. Mannitol
Rationale: Mannitol draws water out of brain tissue and into the vasculature, lowering ICP through osmotic diuresis.

Question 19

Question: Cushing’s triad includes all the following EXCEPT:
A. Bradycardia
B. Widened pulse pressure
C. Hypotension
D. Irregular respirations

Answer 19

Answer: C. Hypotension
Rationale: Cushing’s triad consists of bradycardia, widened pulse pressure, and irregular respirations — not hypotension.

Question 20

Question: What is the normal range for cerebral perfusion pressure (CPP)? A. 50 to 90 mm Hg B. 30 to 70 mm Hg C. 60 to 100 mm Hg D. 70 to 110 mm Hg

Answer 20

Answer: C. 60 to 100 mm Hg Rationale: CPP values under 50 mm Hg may cause ischemia, while values under 30 mm Hg are incompatible with life.

Question 21

Question: Which cranial nerve is most commonly compressed with increased ICP leading to pupil dilation? A. Cranial Nerve II (Optic) B. Cranial Nerve III (Oculomotor) C. Cranial Nerve VII (Facial) D. Cranial Nerve V (Trigeminal)

Answer 21

Answer: B. Cranial Nerve III (Oculomotor) Rationale: Compression of CN III leads to a fixed, dilated pupil on the affected side and is a sign of brain herniation.

Question 22

Question: What is a hallmark early symptom of vasogenic cerebral edema? A. Coma B. Vomiting C. Headache D. Fixed pupils

Answer 22

Answer: C. Headache Rationale: Headache is often the first symptom of vasogenic cerebral edema due to the pressure on pain-sensitive intracranial structures.

Question 23

Question: Which type of cerebral edema results from direct cellular injury and hypoxia? A. Vasogenic edema B. Interstitial edema C. Cytotoxic edema D. Hydrostatic edema

Answer 23

Answer: C. Cytotoxic edema Rationale: Cytotoxic edema results from the breakdown of cell membranes due to hypoxia or trauma, causing fluid to shift into cells.

Question 24

Question: What finding suggests a patient is experiencing brain herniation? A. Hyperactive reflexes B. Fixed and dilated pupils C. Nystagmus D. Slurred speech

Answer 24

D. Slurred speech Answer: B. Fixed and dilated pupils Rationale: Fixed, unilateral, dilated pupils are a neurological emergency and may indicate herniation due to increased ICP.

Question 25

Question: What diagnostic procedure is contraindicated in a patient with suspected increased ICP? A. CT scan B. Lumbar puncture C. MRI D. EEG

Answer 25

Answer: B. Lumbar puncture Rationale: A lumbar puncture is contraindicated because it may cause brain herniation from sudden pressure release.

Question 26

Question: What is the recommended head-of-bed position to reduce ICP while maintaining CPP? A. Flat B. 15 degrees C. 30 degrees D. 90 degrees

Answer 26

Answer: C. 30 degrees Rationale: Elevating the head of the bed to 30 degrees helps promote venous drainage and reduce ICP without significantly lowering CPP.

Question 26

Question: What is the expected cerebrospinal fluid (CSF) output in an adult per hour? A. 5–10 mL/hr B. 20–30 mL/hr C. 40–60 mL/hr D. 50–100 mL/hr

Answer 26

Answer: B. 20–30 mL/hr Rationale: Normal CSF production in adults is approximately 20–30 mL per hour, with a total volume of about 150 mL.

Question 27

Question: What is the desired PaO₂ level in a patient with increased ICP? A. 60 mm Hg B. 70 mm Hg C. 80 mm Hg D. 100 mm Hg or greater

Answer 27

Answer: D. 100 mm Hg or greater Rationale: Adequate oxygenation (PaO₂ ≥ 100 mm Hg) is essential to prevent secondary brain injury in patients with increased ICP.

Question 28

Question: What electrolyte imbalance is associated with diabetes insipidus secondary to increased ICP? A. Hyponatremia B. Hypokalemia C. Hypernatremia D. Hypocalcemia

Answer 28

Answer: C. Hypernatremia Rationale: Diabetes insipidus causes increased urine output, leading to dehydration and hypernatremia if not treated promptly.

Question 29

Question: Which intervention helps reduce the risk of increased ICP during suctioning? A. Suction for 20 seconds continuously B. Administer atropine before suctioning C. Pre-oxygenate with 100% O₂ before and after suctioning D. Avoid suctioning in unconscious patients

Answer 29

Answer: C. Pre-oxygenate with 100% O₂ before and after suctioning Rationale: Pre-oxygenation helps prevent hypoxia, which could elevate ICP during the suctioning procedure.

Question 30

Question: Which drug is used to reduce ICP by drawing fluid out of swollen brain cells into the bloodstream? A. Propofol B. Hypertonic saline C. Dexamethasone D. Midazolam

Answer 30

Answer: B. Hypertonic saline Rationale: Hypertonic saline reduces cerebral edema by creating an osmotic gradient, shifting fluid out of cells into vessels.

Question 31

Question: What is the primary risk of corticosteroid therapy in patients with brain tumors? A. Hypervolemia B. Hypoglycemia C. Hyperglycemia and GI bleeding D. SIADH

Answer 31

Answer: C. Hyperglycemia and GI bleeding Rationale: Corticosteroids like dexamethasone can lead to elevated blood sugar and increase the risk of gastric ulcers and bleeding.

Question 32

Question: Why are benzodiazepines typically avoided in patients with increased ICP? A. They cause hypertension B. They elevate intracranial pressure C. They have a long half-life and hypotensive effects D. They are not sedating

Answer 32

Answer: C. They have a long half-life and hypotensive effects Rationale: Benzodiazepines may mask neurologic changes and decrease CPP due to lowered blood pressure.

Question 33

Question: What is the ideal reference point for leveling a ventriculostomy transducer? A. Outer canthus of the eye B. Sternal notch C. Tragus of the ear D. Top of the head

Answer 33

Answer: C. Tragus of the ear Rationale: The transducer is leveled at the tragus of the ear to align with the foramen of Monro for accurate ICP readings.

Question 34

Question: Which of the following respiratory patterns is associated with severely increased ICP? A. Cheyne-Stokes respirations B. Eupnea C. Kussmaul respirations D. Biot’s respirations

Answer 34

Answer: A. Cheyne-Stokes respirations Rationale: Cheyne-Stokes breathing may indicate brainstem dysfunction and is commonly seen in increased ICP.

Question 35

Question: What nursing action is most appropriate to prevent abdominal distention that could increase ICP? A. Use of incentive spirometry B. Insert a nasogastric tube unless contraindicated C. Give antiemetics PRN D. Elevate the foot of the bed

Answer 35

Answer: B. Insert a nasogastric tube unless contraindicated Rationale: An NG tube prevents abdominal distention and reduces risk of vomiting or aspiration, especially in unconscious patients.

Question 36

Question: What is the rationale for avoiding extreme hip flexion in patients with increased ICP? A. It increases CSF production B. It impairs arterial circulation C. It raises intraabdominal pressure and ICP D. It restricts venous access

Answer 36

Answer: C. It raises intraabdominal pressure and ICP Rationale: Hip flexion can increase intraabdominal and thoracic pressure, which impairs venous return from the brain, raising ICP.

Question 37

Question: What condition is suggested by decreased urine output and dilutional hyponatremia in a patient with brain injury? A. Diabetes insipidus B. Renal failure C. SIADH D. Dehydration

Answer 37

Answer: C. SIADH Rationale: SIADH leads to fluid retention, reduced urine output, and hyponatremia, commonly triggered by brain injuries.

Question 38

Question: Which of the following describes decorticate posturing? A. Extension and outward rotation of all limbs B. Arms extended, legs stiff and straight C. Arms flexed inward on the chest, legs extended D. Flaccid muscle tone throughout

Answer 38

Answer: C. Arms flexed inward on the chest, legs extended Rationale: Decorticate posturing reflects damage to the cerebral hemispheres, causing internal flexion of the upper limbs.

Question 39

Question: What type of herniation occurs when brain tissue is pushed downward through the foramen magnum? A. Uncal herniation B. Central herniation C. Cingulate herniation D. Tentorial herniation

Answer 39

Answer: B. Central herniation Rationale: Central herniation involves downward displacement of brain structures through the foramen magnum, often compressing the brainstem.

Question 40

Question: What Glasgow Coma Scale (GCS) score is indicative of coma? A. 13–15 B. 10–12 C. 9–11 D. 8 or less

Answer 40

Answer: D. 8 or less Rationale: A GCS score of 8 or less reflects severe brain injury and coma, warranting immediate airway management and monitoring.

Question 41

Question: Which waveform component becomes elevated in poor ventricular compliance? A. P1 B. P2 C. P3 D. D wave

Answer 41

Answer: B. P2 Rationale: When P2 rises above P1 on the ICP waveform, it suggests reduced ventricular compliance and possible increased ICP.

Question 42

Question: Which type of edema is typically associated with hydrocephalus? A. Cytotoxic B. Vasogenic C. Interstitial D. Osmotic

Answer 42

Answer: C. Interstitial Rationale: Interstitial edema is caused by hydrocephalus, in which excess CSF increases fluid in the extracellular brain space.

Question 43

Question: What clinical sign would most likely prompt the nurse to suspect increasing ICP in a conscious patient? A. Sudden decrease in blood pressure B. Flattened affect and restlessness C. Increased grip strength D. Warm, flushed skin

Answer 43

Answer: B. Flattened affect and restlessness Rationale: Subtle changes in LOC, such as decreased attention and personality changes, may indicate rising ICP.

Question 44

Question: What is the rationale for keeping a patient in a quiet, calm environment with increased ICP? A. To prevent delirium B. To reduce stimulation that can raise ICP C. To improve patient satisfaction D. To support respiratory efforts

Answer 44

Answer: B. To reduce stimulation that can raise ICP Rationale: Noise and stimulation can elevate blood pressure and cerebral metabolism, increasing ICP.

Question 45

Question: What is the purpose of administering histamine receptor blockers or PPIs in patients on corticosteroids? A. To reduce allergic reactions B. To prevent hyperglycemia C. To prevent GI bleeding and ulcers D. To increase drug absorption

Answer 45

Answer: C. To prevent GI bleeding and ulcers Rationale: Corticosteroids increase the risk of gastric irritation and bleeding; PPIs or H₂ blockers help prevent these complications.

Question 46

Question: What neurological test involves rapidly turning the patient’s head and watching for opposite eye movement? A. Caloric stimulation B. Glasgow motor score C. Oculocephalic reflex ("doll’s eyes") D. Corneal reflex

Answer 46

Answer: C. Oculocephalic reflex ("doll’s eyes") Rationale: The oculocephalic reflex is used to assess brainstem function; absence of this reflex may indicate severe brain injury.

Question 47

Question: Why should hand-squeezing not be used to assess motor response in comatose patients? A. It’s painful B. It’s unreliable due to reflexes C. It only tests cranial nerves D. It elevates ICP

Answer 47

Answer: B. It’s unreliable due to reflexes Rationale: Hand-squeezing can be a reflexive action and may mislead the nurse about actual voluntary motor function.

Question 48

Question: Which of the following is a serious complication of prolonged ICP monitoring? A. Stroke B. Brain tumor C. Infection D. Hypertension

Answer 48

Answer: C. Infection Rationale: Infection is a major risk with invasive ICP monitoring, especially if monitoring continues beyond 5 days.