Chapter 61: Management of Patients With Neurologic Dysfunction

Chapter 61: Management of Patients With Neurologic Dysfunction

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

 

 

 

 

1. A patient is being admitted to the Neuro ICU following an acute head injury. The patient has cerebral edema. The nurse would expect to administer what priority medications to reduce cerebral edema?
2. A) Hydrochlorothiazide (HydroDIURIL)
3. B) Lasix (Furosemide)
4. C) Mannitol (Osmitrol)
5. D) Spirolactone (Aldactone)

 

Ans:  C

Chapter:  61

Client Needs:  D-2

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  1867, Increased Intracranial Pressure

 

Feedback:  The osmotic diuretic mannitol is given to dehydrate the brain tissue and reduce cerebral edema. This drug acts by reduces the volume of brain and extracellular fluid. Spirolactone, Lasix, and Hydrochorothiazide are used in the treatment of CHF and hypertension.

 

 

 

 

2. When caring for an unconscious patient what nursing intervention takes highest priority?
3. A) Inserting an indwelling urinary catheter
4. B) Maintaining a patent airway
5. C) Putting a nasogastric (NG) tube in place
6. D) Administering an enema daily

 

Ans:  B

Chapter:  61

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  1869, Increased Intracranial Pressure

 

Feedback:  Maintaining a patent airway always takes top priority. An indwelling urinary catheter and NG tube can be inserted after airway patency has been established. Enemas should be avoided because of the danger of increasing intracranial pressure.

 

 

 

 

3. You have admitted a patient to the Neurolog Intensive Care Unit with a brainstem herniation. The patient is now exhibiting an altered level of consciousness. The nurse has determined that the patient’s mean arterial pressure (MAP) is 60 with an intracranial pressure (ICP) reading of 5 mm Hg. The nurse would be correct in determining the cerebral perfusion pressure (CPP) as which of the following values?
4. A) Normal
5. B) High
6. C) Low
7. D) Compensating

 

Ans:  C

Chapter:  61

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  1865, Increased Intracranial Pressure

 

Feedback:  The cerebral perfusion pressure (CPP) is 55 mm Hg, which is considered low. The normal CPP is 70 to 100 mm Hg. Patients with a CPP of less than 50 mm Hg experience irreversible neurologic damage. A lower than normal CPP indicates that the cardiac output is insufficient to maintain adequate cerebral perfusion.

 

 

 

 

4. The nurse is caring for a postop craniotomy patient. When writing the plan of care, the patient has a diagnosis of Deficient fluid volume related to fluid restriction related to osmotic diuretic use. What would be an appropriate intervention for this diagnosis?
5. A) Change the patient’s position as indicated
6. B) Monitor serum electrolytes
7. C) Maintain NPO status
8. D) Monitor arterial blood gas values

 

Ans:  B

Chapter:  61

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  1878, Supratentorial and Infratentorial Approaches

 

Feedback:  The postoperative fluid regimen depends on the type of neurosurgical procedure and is determined on an individual basis. The volume and composition of fluids are adjusted based on daily serum electrolyte values, along with fluid intake and output. Fluids may have to be restricted in patients with cerebral edema. Changing the patient’s position, maintaining an NPO status, and monitoring ABG values do not relate to the nursing diagnosis of Risk for imbalanced fluid volume.

 

 

 

 

5. A patient with a seizure disorder is presenting having a generalized seizure. An appropriate nursing intervention during the seizure would include what?
6. A) Restrain the patient to prevent injury.
7. B) Open the patient’s jaws to insert an oral airway.
8. C) Place patient in high Fowler’s position.
9. D) Loosen the patient’s restrictive clothing.

 

Ans:  D

Chapter:  61

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  9

Page and Header:  1883, The Epilepsies

 

Feedback:  An appropriate nursing intervention would include loosening any restrictive clothing on the patient. No attempt should be made to restrain the patient during the seizure because muscular contractions are strong and restraint can produce injury. Do not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken teeth and injury to the lips and tongue may result from such an action. If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus.