Neuro ICU Exam Practice Questions (90) – ICP Monitoring, GCS, Traumatic Brain Injury Care | NURS 420 Neurocritical Care

This document contains 90 exam-style questions with verified answers designed to help students and healthcare professionals prepare for Neuro ICU examinations and neurocritical care assessments. The study material focuses on intracranial pressure (ICP) monitoring, cerebral perfusion pressure (CPP) management, traumatic brain injury (TBI), Glasgow Coma Scale (GCS) evaluation, neurological complications, and ICU pharmacologic management. The questions are presented in a structured question-and-answer format to reinforce critical care concepts commonly tested in nursing and neurocritical care training programs. The study guide begins with intracranial pressure (ICP) physiology and cerebral perfusion pressure calculations, which are essential in neurocritical care management. According to the document, cerebral perfusion pressure (CPP) is calculated using the formula CPP = MAP – ICP, and optimal cerebral perfusion requires a CPP of at least 60 mmHg. Normal intracranial pressure ranges from 0–15 mmHg, while pressures sustained above 15 mmHg for more than five minutes are considered elevated and require intervention (page 1). Another section explains the types of intracranial pressure monitoring devices used in neurocritical care units. Intraventricular catheters allow clinicians to both measure intracranial pressure and drain cerebrospinal fluid (CSF) to reduce pressure, but they carry a higher risk of infection and should generally not remain in place for more than seven days. In contrast, intraparenchymal sensors provide accurate ICP measurements and can often be inserted at the bedside, though they cannot drain CSF (page 2). The guide also reviews subarachnoid bolt monitoring systems, which allow ICP measurement but share limitations such as inability to drain cerebrospinal fluid and risk of infection. ICP monitoring devices must be properly leveled and zeroed at the foramen of Monro, approximately one inch above the patient’s ear, to ensure accurate readings (page 2). Another section focuses on clinical indicators of rising intracranial pressure, which include symptoms such as headache, visual disturbances, decreased level of consciousness, changes in pupil response (PERRLA), vomiting, photophobia, and decreased Glasgow Coma Scale scores. These neurological changes often signal worsening brain injury or cerebral edema and require immediate medical evaluation (page 3). The document also outlines criteria for initiating intracranial pressure monitoring. Patients with severe traumatic brain injury and a Glasgow Coma Scale (GCS) score between 3 and 8 are typically candidates for ICP monitoring. In contrast, a normal GCS score is 15, indicating full neurological function (page 3). A major portion of the study guide focuses on nursing interventions used to prevent increases in intracranial pressure. Recommended interventions include: Elevating the head of bed greater than 45 degrees Maintaining the head in a neutral midline position Spacing out nursing care activities to reduce stimulation Limiting suctioning to no more than two passes while pre-oxygenating Maintaining a quiet, calm environment with dim lighting Restricting visitors to reduce patient stimulation These strategies help minimize cerebral oxygen demand and reduce pressure fluctuations in the brain (page 3). The guide also discusses respiratory and hemodynamic targets for patients with elevated ICP. For example, patients with intracranial hypertension should maintain a PaCO₂ level between 30–35 mmHg, slightly lower than the normal range of 35–45 mmHg. Elevated carbon dioxide levels cause cerebral vasodilation, which can increase intracranial pressure. Additionally, maintaining a mean arterial pressure (MAP) between 70–90 mmHg helps preserve adequate cerebral perfusion (page 4). Another section reviews medications commonly used in neurocritical care. Osmotic diuretics such as mannitol help reduce intracranial pressure by drawing fluid out of brain tissue. Mannitol should be administered through filtered tubing, and warming the medication may help dissolve crystals before administration. Loop diuretics such as furosemide and bumetanide may also be used but require monitoring for tinnitus, hearing loss, and electrolyte imbalances (page 4). The document also explains sedation and critical care medications. Benzodiazepines may cause adverse effects such as slurred speech, weakness, and respiratory depression, while propofol can cause hypotension, bradycardia, elevated triglycerides, and rarely propofol infusion syndrome, which may include metabolic acidosis, hyperkalemia, hyperlipidemia, and rhabdomyolysis (page 5). Another section focuses on traumatic brain injury signs and skull fracture indicators. Classic signs of basilar skull fracture include Battle’s sign (bruising behind the ears), raccoon eyes (periorbital bruising), rhinorrhea (CSF leakage from the nose), and otorrhea (CSF leakage from the ears). The document also differentiates between epidural hematomas, which involve arterial bleeding and rapid symptom onset, and subdural hematomas, which involve slower venous bleeding that may present symptoms hours to days later (pages 5–6). The study guide concludes with a detailed review of the Glasgow Coma Scale scoring system, which evaluates neurological function based on eye opening, verbal response, and motor response. For example, spontaneous eye opening scores 4 points, while motor responses range from 6 points for purposeful movement to 1 point for no movement. These assessments help clinicians determine the severity of brain injury and guide treatment decisions in neurocritical care settings (pages 6–7). This study material may be relevant for courses such as: Neurocritical Care Nursing Critical Care Nursing Advanced Pathophysiology Traumatic Brain Injury Management Intensive Care Clinical Practice Students enrolled in the following programs may benefit from this document: Bachelor of Science in Nursing (BSN) Critical Care Nursing Programs Acute Care Nurse Practitioner Programs Emergency and Trauma Nursing Programs Advanced Practice Nursing Programs Example course codes commonly associated with these subjects include: NURS 420 – Neurocritical Care Nursing NURS 410 – Critical Care Nursing ACNP 520 – Advanced Neurocritical Care NURS 430 – Intensive Care Clinical Practice NURS 450 – Advanced Pathophysiology The concepts covered in this document align closely with major nursing and neurocritical care textbooks such as Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems and Critical Care Nursing: Diagnosis and Management by Urden, Stacy, and Lough. These textbooks provide the theoretical foundation for intracranial pressure management, traumatic brain injury treatment, neurological assessment, and critical care interventions reviewed in this exam preparation guide. Overall, this document functions as a focused Neuro ICU exam preparation resource, helping nursing students and healthcare professionals review key neurocritical care principles, neurological assessment techniques, and intensive care management strategies necessary for successful examination performance. 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