NR 341 Neuro questions with correct answers
What is the max GCS score? Correct Answer-15
What is the minimum GCS score? Correct Answer-3
What GCS score should you intubate? Correct Answer-8 and under
What are the limitations of the GCS? Correct Answer-age, drugs, and
language
What is normal intracranial pressure (ICP)? Correct Answer-5-15
mmHg
What are the signs and symptoms of increased ICP? Correct Answer-
change in LOC, change in speech, change in vital signs, seizures,
headache, vomiting, eye changes, posture changes
What is the first sign of increased ICP? Correct Answer-changes in LOC
What is cushing's triad? Correct Answer-an effect of increased ICP of
increased systolic BP, decreased pulse, and cheyne-stokes respirations
What is Cheyne-Stokes respiration? Correct Answer-it is an abnormal
rhythm of breathing with alternation periods of hyperventilation and
apnea
,What is Kussmaul respiration? Correct Answer-deep, rapid breathing
often induced by acidosis
What condition does Kussmaul respirations commonly occur with?
Correct Answer-DKA
What posture changes occurs with increased ICP? Correct Answer-
decerebrate, decorticate,or flaccid
What is decerebrate posturing? Correct Answer-Extensor response;
problem with midbrain or pons
What is decorticate posturing? Correct Answer-Flexor response;
problem with cervical spinal tract or cerebral hemisphere
What are the eye changes that occur with increased ICP? Correct
Answer-papilledema, pupillary changes, impaired eye movement
What is a common cause of increased brain volume? Correct Answer-
cerebral edema; can also be caused by a tumor or meningitis
What causes increased blood volume? Correct Answer-loss of auto-
regulation, decreased oxygenation, hypercapnia, increased metabolic
demands, and obstruction of venous outflow
, What causes increased cerebrospinal fluid? Correct Answer-
hydrocephalus, blockage of normal flow, obstruction of normal re-
absorption, and excess production of CSF
What is cerebral perfusion pressure (CPP) dependent upon? Correct
Answer-intracranial pressure (ICP) and mean arterial pressure (MAP)
What is a normal cerebral perfusion pressure (CPP)? Correct Answer-
50-70
What does a low cerebral perfusion pressure (CPP) result in? Correct
Answer-loss of auto-regulation and hypoxic insult to brain tissue
Nursing Mgmt. ICP: What is the maintenance goal of ICP? Correct
Answer-ICP < 20 mmHg
Nursing Mgmt. ICP: What is the maintenance goal of CPP? Correct
Answer-< 70 mmHg
Nursing Mgmt. ICP: Care should be ________ to allow rest. Correct
Answer-spaced
Nursing Mgmt. ICP: Suctioning should be _______. Correct Answer-
minimum/PRN
What is the max GCS score? Correct Answer-15
What is the minimum GCS score? Correct Answer-3
What GCS score should you intubate? Correct Answer-8 and under
What are the limitations of the GCS? Correct Answer-age, drugs, and
language
What is normal intracranial pressure (ICP)? Correct Answer-5-15
mmHg
What are the signs and symptoms of increased ICP? Correct Answer-
change in LOC, change in speech, change in vital signs, seizures,
headache, vomiting, eye changes, posture changes
What is the first sign of increased ICP? Correct Answer-changes in LOC
What is cushing's triad? Correct Answer-an effect of increased ICP of
increased systolic BP, decreased pulse, and cheyne-stokes respirations
What is Cheyne-Stokes respiration? Correct Answer-it is an abnormal
rhythm of breathing with alternation periods of hyperventilation and
apnea
,What is Kussmaul respiration? Correct Answer-deep, rapid breathing
often induced by acidosis
What condition does Kussmaul respirations commonly occur with?
Correct Answer-DKA
What posture changes occurs with increased ICP? Correct Answer-
decerebrate, decorticate,or flaccid
What is decerebrate posturing? Correct Answer-Extensor response;
problem with midbrain or pons
What is decorticate posturing? Correct Answer-Flexor response;
problem with cervical spinal tract or cerebral hemisphere
What are the eye changes that occur with increased ICP? Correct
Answer-papilledema, pupillary changes, impaired eye movement
What is a common cause of increased brain volume? Correct Answer-
cerebral edema; can also be caused by a tumor or meningitis
What causes increased blood volume? Correct Answer-loss of auto-
regulation, decreased oxygenation, hypercapnia, increased metabolic
demands, and obstruction of venous outflow
, What causes increased cerebrospinal fluid? Correct Answer-
hydrocephalus, blockage of normal flow, obstruction of normal re-
absorption, and excess production of CSF
What is cerebral perfusion pressure (CPP) dependent upon? Correct
Answer-intracranial pressure (ICP) and mean arterial pressure (MAP)
What is a normal cerebral perfusion pressure (CPP)? Correct Answer-
50-70
What does a low cerebral perfusion pressure (CPP) result in? Correct
Answer-loss of auto-regulation and hypoxic insult to brain tissue
Nursing Mgmt. ICP: What is the maintenance goal of ICP? Correct
Answer-ICP < 20 mmHg
Nursing Mgmt. ICP: What is the maintenance goal of CPP? Correct
Answer-< 70 mmHg
Nursing Mgmt. ICP: Care should be ________ to allow rest. Correct
Answer-spaced
Nursing Mgmt. ICP: Suctioning should be _______. Correct Answer-
minimum/PRN
