NURC 424 EXAM #3 STUDY GUIDE TEST
BLUEPRINT AND KEY CONCEPTS
The majority of questions are multiple choice (you will need to select the “most correct”
or “best” answer [prioritize). However, there are some alternative format questions - if
you see one that says “select all that apply”, then you must select ALL of the correct
responses to answer that question correctly. In addition, there will also be fill-in-the-
blank questions for dosage calculation. Do not “label” the fill-in-the-blank questions –
they must be answered only with the correct number requested. When studying, try to
relate the information you have learned to patient situations (don’t just memorize facts…
put this knowledge into the context of nursing care). Remember that you cannot return
to a question after you have already answered it.
This examination has 75 questions, each worth 2.66 points, for a total of 200 points. You
will have 113 minutes to complete it.
Questions created based upon:
• Assigned reading
• All Assignments given
• PowerPoints
• Everything that is assigned
Dosage Calculation: 5 Questions
Neurological I
Chapter 61: 20 Questions
Acute Intracranial Problems
Intracranial Regulation
Increased Intracranial Pressure
Mechanisms of Increased Intracranial Pressure
- Intracranial pressure (ICP) is the pressure exerted by the total volume from brain
tissue, blood, and cerebrospinal fluid (CSF).
- Normal ICP: 5–15 mm Hg.
- Sustained ICP > 20 mm Hg is abnormal and must be treated.
Cerebral Edema
Vasogenic Cerebral Edema
- Most common type.
-
,- Results from the blood-brain barrier breakdown, allowing plasma to leak into the
extracellular space (e.g., tumors, abscesses).
,Cytotoxic Cerebral Edema
- Cellular injury leads to fluid shift into cells due to the failure of the sodium-potassium
pump (e.g., hypoxia, ischemia).
Interstitial Cerebral Edema
- Occurs with hydrocephalus.
- CSF leaks into the extracellular space of the brain tissue.
Clinical Manifestations
Change in LOC:
- Earliest and most sensitive sign; restlessness, confusion, decreasing levels
of consciousness.
Change in Vital Signs:
- Cushing’s Triad: increased systolic BP (widening pulse pressure), bradycardia, irregular
respirations.
Ocular Signs:
- Pupil changes (unilateral dilation, sluggish/no response to light).
Decrease in Motor Function:
- Hemiparesis, hemiplegia, posturing (decorticate or decerebrate).
Headache:
- Often continuous and worse in the morning.
Vomiting:
- Often projectile, without nausea.
Complications
- Inadequate cerebral perfusion
- Cerebral herniation
- Brainstem compression
- Death
Diagnostic Studies
- CT scan, MRI are preferred.
- No lumbar puncture if ↑ ICP is suspected due to the risk of herniation.
Monitoring ICP and Cerebral Oxygenation
Indications for Intracranial Pressure Monitoring:
- Indicated in severe traumatic brain injury, GCS ≤ 8 with abnormal CT/MRI.
Methods of Measuring ICP:
- Ventriculostomy (gold standard): Allows for therapeutic drainage of CSF.
, - Subarachnoid bolt, epidural catheter, fiberoptic catheter.
Cerebrospinal Fluid Drainage:
- Draining CSF via a ventriculostomy may help reduce ICP.
Cerebral Oxygenation Monitoring:
- Jugular venous bulb oximetry, PbtO₂ (brain tissue oxygenation).
Interprofessional Care
Management:
- Identify and treat the underlying cause.
- Support brain function and prevent secondary brain injury.
Drug Therapy:
- Mannitol (osmotic diuretic) to decrease ICP.
- Hypertonic saline.
- Corticosteroids (only for brain tumors).
- Antiseizure medications, antipyretics, sedatives, barbiturates.
Nutritional Therapy:
- Begin feeding within 3 days of injury.
- Full caloric replacement by day 7.
Nursing Management: Increased Intracranial Pressure
Nursing Assessment
- Glasgow Coma Scale (GCS) as per Table 61.5: Assesses eye opening, verbal, and motor
responses.
Glasgow Coma Scale
Appropriate Stimulus Response Score
Eyes Open
• Approach to bedside Spontaneous response. 4
• Verbal command
• Pain
Opening of eyes to 3
name or command.
Lack of opening of eyes 2
to previous stimuli but
opening to pain.
Lack of opening of eyes 1
to any stimulus.
Untestable U
Best Verbal Response
• Verbal questioning Appropriate orientation, 5
with maximum arousal conversant. Correct
identification of self,
BLUEPRINT AND KEY CONCEPTS
The majority of questions are multiple choice (you will need to select the “most correct”
or “best” answer [prioritize). However, there are some alternative format questions - if
you see one that says “select all that apply”, then you must select ALL of the correct
responses to answer that question correctly. In addition, there will also be fill-in-the-
blank questions for dosage calculation. Do not “label” the fill-in-the-blank questions –
they must be answered only with the correct number requested. When studying, try to
relate the information you have learned to patient situations (don’t just memorize facts…
put this knowledge into the context of nursing care). Remember that you cannot return
to a question after you have already answered it.
This examination has 75 questions, each worth 2.66 points, for a total of 200 points. You
will have 113 minutes to complete it.
Questions created based upon:
• Assigned reading
• All Assignments given
• PowerPoints
• Everything that is assigned
Dosage Calculation: 5 Questions
Neurological I
Chapter 61: 20 Questions
Acute Intracranial Problems
Intracranial Regulation
Increased Intracranial Pressure
Mechanisms of Increased Intracranial Pressure
- Intracranial pressure (ICP) is the pressure exerted by the total volume from brain
tissue, blood, and cerebrospinal fluid (CSF).
- Normal ICP: 5–15 mm Hg.
- Sustained ICP > 20 mm Hg is abnormal and must be treated.
Cerebral Edema
Vasogenic Cerebral Edema
- Most common type.
-
,- Results from the blood-brain barrier breakdown, allowing plasma to leak into the
extracellular space (e.g., tumors, abscesses).
,Cytotoxic Cerebral Edema
- Cellular injury leads to fluid shift into cells due to the failure of the sodium-potassium
pump (e.g., hypoxia, ischemia).
Interstitial Cerebral Edema
- Occurs with hydrocephalus.
- CSF leaks into the extracellular space of the brain tissue.
Clinical Manifestations
Change in LOC:
- Earliest and most sensitive sign; restlessness, confusion, decreasing levels
of consciousness.
Change in Vital Signs:
- Cushing’s Triad: increased systolic BP (widening pulse pressure), bradycardia, irregular
respirations.
Ocular Signs:
- Pupil changes (unilateral dilation, sluggish/no response to light).
Decrease in Motor Function:
- Hemiparesis, hemiplegia, posturing (decorticate or decerebrate).
Headache:
- Often continuous and worse in the morning.
Vomiting:
- Often projectile, without nausea.
Complications
- Inadequate cerebral perfusion
- Cerebral herniation
- Brainstem compression
- Death
Diagnostic Studies
- CT scan, MRI are preferred.
- No lumbar puncture if ↑ ICP is suspected due to the risk of herniation.
Monitoring ICP and Cerebral Oxygenation
Indications for Intracranial Pressure Monitoring:
- Indicated in severe traumatic brain injury, GCS ≤ 8 with abnormal CT/MRI.
Methods of Measuring ICP:
- Ventriculostomy (gold standard): Allows for therapeutic drainage of CSF.
, - Subarachnoid bolt, epidural catheter, fiberoptic catheter.
Cerebrospinal Fluid Drainage:
- Draining CSF via a ventriculostomy may help reduce ICP.
Cerebral Oxygenation Monitoring:
- Jugular venous bulb oximetry, PbtO₂ (brain tissue oxygenation).
Interprofessional Care
Management:
- Identify and treat the underlying cause.
- Support brain function and prevent secondary brain injury.
Drug Therapy:
- Mannitol (osmotic diuretic) to decrease ICP.
- Hypertonic saline.
- Corticosteroids (only for brain tumors).
- Antiseizure medications, antipyretics, sedatives, barbiturates.
Nutritional Therapy:
- Begin feeding within 3 days of injury.
- Full caloric replacement by day 7.
Nursing Management: Increased Intracranial Pressure
Nursing Assessment
- Glasgow Coma Scale (GCS) as per Table 61.5: Assesses eye opening, verbal, and motor
responses.
Glasgow Coma Scale
Appropriate Stimulus Response Score
Eyes Open
• Approach to bedside Spontaneous response. 4
• Verbal command
• Pain
Opening of eyes to 3
name or command.
Lack of opening of eyes 2
to previous stimuli but
opening to pain.
Lack of opening of eyes 1
to any stimulus.
Untestable U
Best Verbal Response
• Verbal questioning Appropriate orientation, 5
with maximum arousal conversant. Correct
identification of self,
