Neuro CCRN- Critical Care Registered Nurse Study
Questions 2024/2025 Fully Solved 100%
A patient is admitted with subarachnoid hemorrhage. Which of the following is the
best reflection of fluid guidelines for this patient?
A.
This patient would be kept hypovolemic with pulmonary artery occlusive pressure
(PAOP) less than 8 mm Hg.
B.
This patient would be kept normovolemic with pulmonary artery occlusive pressure
(PAOP) between 8 and 12 mm Hg.
C.
This patient would be kept hypervolemic with pulmonary artery occlusive pressure
(PAOP) greater than 12 mm Hg.
D.
Fluid management is not a significant concern for this patient. - ANSWERC.
Keeping the patient hypervolemic aids in prevention and treatment of vasospasm, a
significant cause of morbidity in patients with subarachnoid hemorrhage.
Test Taking Tip
There are very few clinical situations in critical care in which fluid management is not
a significant concern, so eliminate option "Fluid management is not a significant
concern for this patient." Although you might be tempted to maintain euvolemia,
this patient needs more fluid than normal in the vessels to reduce spasm.
Which of the following is the most likely cause of anoxic encephalopathy?
A.
Shock
B.
Out-of-hospital cardiac arrest
C.
Intracranial cerebrovascular disease
D.
Extracranial cerebrovascular disease - ANSWERB.
,The most likely cause of anoxic encephalopathy is out-of-hospital cardiac arrest.
When blood flow is not promptly restored, cerebral hypoperfusion occurs and anoxic
encephalopathy results.
Teat Taking Tip
Because encephalopathy is a global effect, narrow the choices to options "Shock"
and "Out-of-hospital cardiac arrest." Next narrow to the most profound effect.
Cardiac arrest would have a more profound effect on brain perfusion than would
shock, so choose option "Out-of-hospital cardiac arrest."
A 72-year-old woman arrives at the emergency department after becoming
unresponsive while watching television with her husband. The nurse observes
paralysis of her right extremities, aphasia, and lethargy. Which of the following
would be a contraindication for fibrinolytic agents?
A.
Sluggish, dilated pupil
B.
Dysarthria
C.
Seizure
D.
Fibrinolytic treatment for a myocardial infarction - ANSWERC.
Seizure activity, particularly at the time of onset of symptoms, is suggestive of
intracranial hemorrhage.
A 23-year-old woman was admitted to the emergency department with status
epilepticus. Which of the following drugs would most likely be prescribed initially to
stop the seizures?
A.
Phenytoin
B.
Fosphenytoin
C.
Lorazepam
D.
Phenobarbital - ANSWERC.
,The initial goal of stopping the seizure is best accomplished through the use of a
benzodiazepine. The first choice is usually lorazepam, but diazepam may be given by
emergency medical services personnel because it does not require refrigeration and
it has a shorter half-life. Lorazepam crosses the blood-brain barrier more quickly
than phenytoin or phenobarbital. Phenytoin or fosphenytoin are used for status
epilepticus but generally after benzodiazepines. Phenobarbital typically is used only
after a benzodiazepine or phenytoin has failed to control status epilepticus.
Test Taking Tip
Because phenytoin and fosphenytoin are essentially the same drug, they both can't
be correct, so eliminate options "Phenytoin" and "Fosphenytoin." Next consider that
the benzodiazepine would achieve the treatment goal of stopping the seizure faster
than a barbiturate, so eliminate option "Phenobarbital" and choose option
"Lorazepam."
A 42-year-old patient was in a motor vehicle collision. Rescuers report that he had a
loss of reflexes and was bradycardiac and apneic for a brief period of time. He was
unconscious for about 4 hours and cannot remember what happened immediately
before and after the collision. This would be categorized as which of the following?
A.
Concussion
B.
Contusion
C.
Cortical contusion
D.
Acute subdural hematoma - ANSWERA.
A concussion is associated with focal neurologic deficit or alteration in level of
consciousness that clears within 6 to 12 hours or less. Retrograde or antegrade
amnesia is common.
Possible interventions for the most clinically significant intracranial pressure (ICP)
waves include any of the following except:
A.
administration of mannitol.
B.
repositioning of the patient.
C.
initiation of hyperventilation therapy.
, D.
drainage of cerebrospinal fluid (CSF) via an intraventricular catheter. - ANSWERB.
When patients have elevation in ICP, it is important not to do anything that might
increase the ICP further. Mannitol administration and CSF drainage are methods that
are often used to reduce acute increases in ICP. Hyperventilation therapy might be
used to cause cerebral vasoconstriction in a time of crisis but should not be used
routinely. Repositioning the patient may increase the ICP. Avoid anything that may
increase ICP, especially in times of crisis.
Test Taking Tip
"Administration of mannitol," "initiation of hyperventilation therapy," and "drainage
of cerebrospinal fluid (CSF) via an intraventricular catheter" all cause the loss of
volume from the head. Mannitol decreases cerebral edema, hyperventilation causes
cerebral vessel constriction and decrease in blood volume in the head, and CSF
drainage reduces the volume of CSF in the head. Repositioning the patient may
increase ICP. Also note that repositioning the patient is a general statement versus
the other more specific options. Choose "repositioning of the patient" as an
intervention that should not be initiated.
Which of the following best describes the pathophysiology of vasogenic cerebral
edema?
A.
An increase in intracellular fluid caused by failure of the sodium-potassium pump
B.
An increase in extracellular fluid caused by breakdown of the blood-brain barrier
C.
An increase in intravascular fluid which increases hydrostatic pressure
D.
An increase in cerebrospinal fluid (CSF) production which increases CSF volume -
ANSWERB.
Vasogenic cerebral edema is an increase in extracellular fluid caused by a breakdown
of the blood-brain barrier with the resultant increase in vascular permeability. This
cerebral edema begins locally and becomes more generalized. Common causes are
trauma (including surgical trauma), tumors, hemorrhage, and abscesses.
Test Taking Tip
Remember that cyto means cell, and cytotoxic is an increase in intracellular fluid,
whereas vasogenic is an increase in extracellular fluid.Boc
Questions 2024/2025 Fully Solved 100%
A patient is admitted with subarachnoid hemorrhage. Which of the following is the
best reflection of fluid guidelines for this patient?
A.
This patient would be kept hypovolemic with pulmonary artery occlusive pressure
(PAOP) less than 8 mm Hg.
B.
This patient would be kept normovolemic with pulmonary artery occlusive pressure
(PAOP) between 8 and 12 mm Hg.
C.
This patient would be kept hypervolemic with pulmonary artery occlusive pressure
(PAOP) greater than 12 mm Hg.
D.
Fluid management is not a significant concern for this patient. - ANSWERC.
Keeping the patient hypervolemic aids in prevention and treatment of vasospasm, a
significant cause of morbidity in patients with subarachnoid hemorrhage.
Test Taking Tip
There are very few clinical situations in critical care in which fluid management is not
a significant concern, so eliminate option "Fluid management is not a significant
concern for this patient." Although you might be tempted to maintain euvolemia,
this patient needs more fluid than normal in the vessels to reduce spasm.
Which of the following is the most likely cause of anoxic encephalopathy?
A.
Shock
B.
Out-of-hospital cardiac arrest
C.
Intracranial cerebrovascular disease
D.
Extracranial cerebrovascular disease - ANSWERB.
,The most likely cause of anoxic encephalopathy is out-of-hospital cardiac arrest.
When blood flow is not promptly restored, cerebral hypoperfusion occurs and anoxic
encephalopathy results.
Teat Taking Tip
Because encephalopathy is a global effect, narrow the choices to options "Shock"
and "Out-of-hospital cardiac arrest." Next narrow to the most profound effect.
Cardiac arrest would have a more profound effect on brain perfusion than would
shock, so choose option "Out-of-hospital cardiac arrest."
A 72-year-old woman arrives at the emergency department after becoming
unresponsive while watching television with her husband. The nurse observes
paralysis of her right extremities, aphasia, and lethargy. Which of the following
would be a contraindication for fibrinolytic agents?
A.
Sluggish, dilated pupil
B.
Dysarthria
C.
Seizure
D.
Fibrinolytic treatment for a myocardial infarction - ANSWERC.
Seizure activity, particularly at the time of onset of symptoms, is suggestive of
intracranial hemorrhage.
A 23-year-old woman was admitted to the emergency department with status
epilepticus. Which of the following drugs would most likely be prescribed initially to
stop the seizures?
A.
Phenytoin
B.
Fosphenytoin
C.
Lorazepam
D.
Phenobarbital - ANSWERC.
,The initial goal of stopping the seizure is best accomplished through the use of a
benzodiazepine. The first choice is usually lorazepam, but diazepam may be given by
emergency medical services personnel because it does not require refrigeration and
it has a shorter half-life. Lorazepam crosses the blood-brain barrier more quickly
than phenytoin or phenobarbital. Phenytoin or fosphenytoin are used for status
epilepticus but generally after benzodiazepines. Phenobarbital typically is used only
after a benzodiazepine or phenytoin has failed to control status epilepticus.
Test Taking Tip
Because phenytoin and fosphenytoin are essentially the same drug, they both can't
be correct, so eliminate options "Phenytoin" and "Fosphenytoin." Next consider that
the benzodiazepine would achieve the treatment goal of stopping the seizure faster
than a barbiturate, so eliminate option "Phenobarbital" and choose option
"Lorazepam."
A 42-year-old patient was in a motor vehicle collision. Rescuers report that he had a
loss of reflexes and was bradycardiac and apneic for a brief period of time. He was
unconscious for about 4 hours and cannot remember what happened immediately
before and after the collision. This would be categorized as which of the following?
A.
Concussion
B.
Contusion
C.
Cortical contusion
D.
Acute subdural hematoma - ANSWERA.
A concussion is associated with focal neurologic deficit or alteration in level of
consciousness that clears within 6 to 12 hours or less. Retrograde or antegrade
amnesia is common.
Possible interventions for the most clinically significant intracranial pressure (ICP)
waves include any of the following except:
A.
administration of mannitol.
B.
repositioning of the patient.
C.
initiation of hyperventilation therapy.
, D.
drainage of cerebrospinal fluid (CSF) via an intraventricular catheter. - ANSWERB.
When patients have elevation in ICP, it is important not to do anything that might
increase the ICP further. Mannitol administration and CSF drainage are methods that
are often used to reduce acute increases in ICP. Hyperventilation therapy might be
used to cause cerebral vasoconstriction in a time of crisis but should not be used
routinely. Repositioning the patient may increase the ICP. Avoid anything that may
increase ICP, especially in times of crisis.
Test Taking Tip
"Administration of mannitol," "initiation of hyperventilation therapy," and "drainage
of cerebrospinal fluid (CSF) via an intraventricular catheter" all cause the loss of
volume from the head. Mannitol decreases cerebral edema, hyperventilation causes
cerebral vessel constriction and decrease in blood volume in the head, and CSF
drainage reduces the volume of CSF in the head. Repositioning the patient may
increase ICP. Also note that repositioning the patient is a general statement versus
the other more specific options. Choose "repositioning of the patient" as an
intervention that should not be initiated.
Which of the following best describes the pathophysiology of vasogenic cerebral
edema?
A.
An increase in intracellular fluid caused by failure of the sodium-potassium pump
B.
An increase in extracellular fluid caused by breakdown of the blood-brain barrier
C.
An increase in intravascular fluid which increases hydrostatic pressure
D.
An increase in cerebrospinal fluid (CSF) production which increases CSF volume -
ANSWERB.
Vasogenic cerebral edema is an increase in extracellular fluid caused by a breakdown
of the blood-brain barrier with the resultant increase in vascular permeability. This
cerebral edema begins locally and becomes more generalized. Common causes are
trauma (including surgical trauma), tumors, hemorrhage, and abscesses.
Test Taking Tip
Remember that cyto means cell, and cytotoxic is an increase in intracellular fluid,
whereas vasogenic is an increase in extracellular fluid.Boc
