Page 1 of 57
EXAM 2 : NR325 / NR 325 (LATEST
UPDATES STUDY BUNDLE PACKAGE WITH SOLUTIONS)
ADULT HEALTH II | QUESTIONS & ANSWERS | GRADE
A | 100% CORRECT (VERIFIED SOLUTIONS) -
CHAMBERLAIN
what are s/s of head injury? .....ANSWER.....leakage of CSF
Ecchymosis
Battle's sign/raccoon eyes
what is management of head injury? .....ANSWER.....ensure
patient airway*
priority
what is the Monro-Kellie doctrine? .....ANSWER.....If one
component increases, another must decrease to maintain ICP.
,Page 2 of 57
only applicable to closed skull patients*
what is normal ICP level? .....ANSWER.....5-15mmHg
>20mmHg needs treatment!!
What are key features of increased ICP?
.....ANSWER.....CUSHINGS TRIAD
lethargy to coma
change in speech
cranial nerve dysfunction
seizures
abnormal posturing
what is cushings triad? .....ANSWER.....elevated BP, Decreased
pulse, and decreased respirations.
,Page 3 of 57
KEY characteristic of increased ICP
how do we manage patients leaking CSF? .....ANSWER.....raise
head of bed
NO sneezing/blowing nose/bleeding
NO NG tube, nasotracheal suctioning
How do we place a patient with increased ICP?
.....ANSWER.....elevated HOB atleast 30 degrees
what is the treatmet for increased ICP? .....ANSWER.....maintain
AIRWAY*
Hyperventilate patient to "blow off" CO2 (CO2 dilates blood
vessels)
, Page 4 of 57
Raise HOB
Decrease metabolic demands by paralyzing and sedating
patient
Mannitol- only diuretic given for ICP *
corticosteroids
Pain management
Intracranial monitoring (in ventricle)
Craniotomies- removes portion of skull to allow for brain to swell.
Decompressive craniectomy
EXAM 2 : NR325 / NR 325 (LATEST
UPDATES STUDY BUNDLE PACKAGE WITH SOLUTIONS)
ADULT HEALTH II | QUESTIONS & ANSWERS | GRADE
A | 100% CORRECT (VERIFIED SOLUTIONS) -
CHAMBERLAIN
what are s/s of head injury? .....ANSWER.....leakage of CSF
Ecchymosis
Battle's sign/raccoon eyes
what is management of head injury? .....ANSWER.....ensure
patient airway*
priority
what is the Monro-Kellie doctrine? .....ANSWER.....If one
component increases, another must decrease to maintain ICP.
,Page 2 of 57
only applicable to closed skull patients*
what is normal ICP level? .....ANSWER.....5-15mmHg
>20mmHg needs treatment!!
What are key features of increased ICP?
.....ANSWER.....CUSHINGS TRIAD
lethargy to coma
change in speech
cranial nerve dysfunction
seizures
abnormal posturing
what is cushings triad? .....ANSWER.....elevated BP, Decreased
pulse, and decreased respirations.
,Page 3 of 57
KEY characteristic of increased ICP
how do we manage patients leaking CSF? .....ANSWER.....raise
head of bed
NO sneezing/blowing nose/bleeding
NO NG tube, nasotracheal suctioning
How do we place a patient with increased ICP?
.....ANSWER.....elevated HOB atleast 30 degrees
what is the treatmet for increased ICP? .....ANSWER.....maintain
AIRWAY*
Hyperventilate patient to "blow off" CO2 (CO2 dilates blood
vessels)
, Page 4 of 57
Raise HOB
Decrease metabolic demands by paralyzing and sedating
patient
Mannitol- only diuretic given for ICP *
corticosteroids
Pain management
Intracranial monitoring (in ventricle)
Craniotomies- removes portion of skull to allow for brain to swell.
Decompressive craniectomy
