C HAPTER 23: N EUROLOGIC D ISORDERS
AND T HERAPEUTIC M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. A patient has been experiencing drowsiness, confusion, and slight focal
deficits for several days. The initial noncontract computed tomography
(CT) findings are negative. The patient is being prepared for a lumbar
puncture. What appearance does the nurse anticipate that the cerebrospinal
fluid (CSF) would look?
a. Cloudy
b. Bloody
c. Yellow
d. Clear
ANS: B
If the initial computed tomography findings are nega tive, a lumbar
puncture is performed to obtain cerebrospinal fluid (CSF) for anal ysis.
CSF after subarachnoid hemorrhage (SAH) appears bloody and has a
red blood cell count greater than 1000 cells/mm3. If the lumbar
puncture is performed more than 5 days a fter the SAH, the CSF fluid is
xanthochromic (dark amber) because the blood products have broken
down. Cloudy CSF usuall y indicates some t ype of infectious process
such as bacterial meningitis, not SAH.
, PTS: 1 DIF: Cognitive Level: Understanding REF: p.
581 | Box 23-7 OBJ: Nursing Process Step: Diagnosis
TOP: Neurologic MSC: NC LEX: Physiologic Integrit y
2. Downward displacement of the hemispheres, basal ganglia, and
diencephalon through the tentorial notch is indicative of what type of
herniation?
a. Central
b. Uncal
c. Cingulate
d. Infratentorial
ANS: A
These effects are indicative of central herniation from an expanding
mass lesion of the midline, frontal, parietal, or occipital lobes. In uncal
herniation, a unilateral, expanding mass lesion, usuall y of the tem poral
lobe, increases intracranial pressure, causing lateral displacement of
the tip of the temporal lobe (uncus). Cingulate herniation occurs when
an expanding lesion of one hemisphere shifts laterall y and forces the
cingulate gyrus under the falx cerebri . The two infratentorial
herniation syndromes are upward transtentorial herniation and
downward cerebellar herniation.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
603 OBJ: Nursing Process Step: Diagnosis TOP:
Neurologic MSC: NC LEX: Physiologi c Integrit y
3. Which medical treatment should be considered LAST in treating
uncontrolled intracranial hypertension?
, a. Sedatives
b. Analgesics
c. Barbiturates
d. Oxygen
ANS: C
Barbiturate therapy is a treatment protocol developed for the
management of uncontrolled in tracranial hypertension that has not
responded to the conventional treatments previousl y described. The
two most commonl y used drugs in high -dose barbiturate therapy are
pentobarbital and thiopental. The goal with either of these drugs is a
reduction of intracranial pressure to 15 to 20 mm Hg while a mean
arterial pressure of 70 to 80 mm Hg is maintained.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
602 OBJ: Nursing Process Step: Intervention TOP:
Neurologic MSC: NC LEX: Physiologic Integrit y
4. Which medication is a fast -acting, short -duration agent used for
breakthrough seizures?
a. Lorazepam
b. Phenytoin
c. Phenobarbital
d. Midazolam
ANS: A
Lorazepam is a fast -acting, short-duration agent that may be indicated
for breakthrough seizures until therapeutic d rug levels can be reached.
, Phenytoin is the recommended medication for seizure prophylaxis.
Phenobarbital is a barbiturate whose action produces central nervous
s ystem depression and reduces the spread of an epileptic focus.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
601 OBJ: Nursing Process Step: Intervention TOP:
Neurologic MSC: NC LEX: Physiologic Integrit y
5. Which patient position is optimal to prevent elevated intracranial (ICP)
pressures?
a. The head of the bed elevated 30 to 40 degrees
b. Supine with the patient’s neck in a neutral alignment
c. Individualized head position to minimize ICP measurements
d. The head of the bed elevated with flexion of the hips
ANS: C
The recent trend is to individualize the head position to maximize
cerebral perfusion pressure and minimize intracranial pressure
measurements.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
596 | Box 23-20 OBJ: Nursing Process Step: Intervention
TOP: Neurologic MSC: NC LEX: Physiologic Integrit y
6. What is the target range for PaC O2 in the patient with intracranial
hypertension?
a. 25 to 30 mm Hg
b. 25 to 35 mm Hg
AND T HERAPEUTIC M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition
MULTIPLE CHOICE
1. A patient has been experiencing drowsiness, confusion, and slight focal
deficits for several days. The initial noncontract computed tomography
(CT) findings are negative. The patient is being prepared for a lumbar
puncture. What appearance does the nurse anticipate that the cerebrospinal
fluid (CSF) would look?
a. Cloudy
b. Bloody
c. Yellow
d. Clear
ANS: B
If the initial computed tomography findings are nega tive, a lumbar
puncture is performed to obtain cerebrospinal fluid (CSF) for anal ysis.
CSF after subarachnoid hemorrhage (SAH) appears bloody and has a
red blood cell count greater than 1000 cells/mm3. If the lumbar
puncture is performed more than 5 days a fter the SAH, the CSF fluid is
xanthochromic (dark amber) because the blood products have broken
down. Cloudy CSF usuall y indicates some t ype of infectious process
such as bacterial meningitis, not SAH.
, PTS: 1 DIF: Cognitive Level: Understanding REF: p.
581 | Box 23-7 OBJ: Nursing Process Step: Diagnosis
TOP: Neurologic MSC: NC LEX: Physiologic Integrit y
2. Downward displacement of the hemispheres, basal ganglia, and
diencephalon through the tentorial notch is indicative of what type of
herniation?
a. Central
b. Uncal
c. Cingulate
d. Infratentorial
ANS: A
These effects are indicative of central herniation from an expanding
mass lesion of the midline, frontal, parietal, or occipital lobes. In uncal
herniation, a unilateral, expanding mass lesion, usuall y of the tem poral
lobe, increases intracranial pressure, causing lateral displacement of
the tip of the temporal lobe (uncus). Cingulate herniation occurs when
an expanding lesion of one hemisphere shifts laterall y and forces the
cingulate gyrus under the falx cerebri . The two infratentorial
herniation syndromes are upward transtentorial herniation and
downward cerebellar herniation.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
603 OBJ: Nursing Process Step: Diagnosis TOP:
Neurologic MSC: NC LEX: Physiologi c Integrit y
3. Which medical treatment should be considered LAST in treating
uncontrolled intracranial hypertension?
, a. Sedatives
b. Analgesics
c. Barbiturates
d. Oxygen
ANS: C
Barbiturate therapy is a treatment protocol developed for the
management of uncontrolled in tracranial hypertension that has not
responded to the conventional treatments previousl y described. The
two most commonl y used drugs in high -dose barbiturate therapy are
pentobarbital and thiopental. The goal with either of these drugs is a
reduction of intracranial pressure to 15 to 20 mm Hg while a mean
arterial pressure of 70 to 80 mm Hg is maintained.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
602 OBJ: Nursing Process Step: Intervention TOP:
Neurologic MSC: NC LEX: Physiologic Integrit y
4. Which medication is a fast -acting, short -duration agent used for
breakthrough seizures?
a. Lorazepam
b. Phenytoin
c. Phenobarbital
d. Midazolam
ANS: A
Lorazepam is a fast -acting, short-duration agent that may be indicated
for breakthrough seizures until therapeutic d rug levels can be reached.
, Phenytoin is the recommended medication for seizure prophylaxis.
Phenobarbital is a barbiturate whose action produces central nervous
s ystem depression and reduces the spread of an epileptic focus.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
601 OBJ: Nursing Process Step: Intervention TOP:
Neurologic MSC: NC LEX: Physiologic Integrit y
5. Which patient position is optimal to prevent elevated intracranial (ICP)
pressures?
a. The head of the bed elevated 30 to 40 degrees
b. Supine with the patient’s neck in a neutral alignment
c. Individualized head position to minimize ICP measurements
d. The head of the bed elevated with flexion of the hips
ANS: C
The recent trend is to individualize the head position to maximize
cerebral perfusion pressure and minimize intracranial pressure
measurements.
PTS: 1 DIF: Cognitive Level: Understanding REF: p.
596 | Box 23-20 OBJ: Nursing Process Step: Intervention
TOP: Neurologic MSC: NC LEX: Physiologic Integrit y
6. What is the target range for PaC O2 in the patient with intracranial
hypertension?
a. 25 to 30 mm Hg
b. 25 to 35 mm Hg
