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RNSG 2432 – ICP EXAM QUESTIONS WITH COMPLETE SOLUTIONS
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RNSG 2432 – ICP EXAM QUESTIONS WITH COMPLETE SOLUTIONS
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RNSG 2432 – ICP EXAM QUESTIONS WITHCOMPLETE SOLUTIONS
A 26 year-old patient was admitted to the ICU yesterday s/p TBI
from an MVC. He is currently intubated and on mechanical
ventilation. He has not been responding to stimuli, and his pupils
have been equal and reactive with q1 hour Neuro Checks. Upon
your hourly assessment, you note a decreasing systolic blood
pressure, tachycardia, and his right pupil to be fixed and dilated.
What is your primary concern here? Immediate TX? Correct
Answer Herniation, burr holes, Intervene surgery
A patient who is regaining consciousness after a craniotomy
becomes restless and attempts to pull out her IV line. Which
nursing intervention protects the client without increasing her
ICP?
A. Place her in a jacket restraint
B. Wrap her hands in soft "mitten" restraints
C. Tuck her arms and hands under the draw sheet
D. Apply a wrist restraint to each arm Correct Answer B
Describe and differentiate the different types of herniation
syndromes.
1) cingulate herniation
2) tentorial (central) herniation
3) uncal (lateral) herniation Correct Answer 1) (shift to side):
when there is a lateral displacement of brain tissue BENEATH
the falx cerebri, It is seen on X-rays as shift to the brain; (non
life-threatening)
, 2) when a mass lesion in the cerebrum forces the brain to
herniate DOWNWARD through the opening created by the
brainstem. Death occurs from compression of brainstem
compressing vital centers (life-threatening)
3) when there is a LATERAL & DOWNWARD herniation
- causes decreased level of consciousness (RAS compression) &
death (Life-threatening -- no shit!)
Describe cerebral blood flow (CBF) and how auto regulation
affects cerebral circulation. Correct Answer Normally,
autoregulation maintains an adequate CBF & perfusion pressure
(CPP) by adjusting the diameter of the cerebral blood vessels
-- It is critical to remember that CPP may NOT reflect perfusion
pressure in all parts of the brain. There may be local areas of
swelling and compression limiting regional perfusion pressure.
- THUS, a higher CPP may be needed for these pts to prevent
localized tissue damage. (ex: A pt who had a stroke, may require
a higher BP, increasing MAP and CPP, in order to increase
perfusion to the brain and prevent further tissue damage)
Describe normal compensatory auto regulation in relation to
intracranial pressure (ICP) and relate the Monro-Kelle doctrine
to increased ICP. Correct Answer Monro-Kelle : states that the
3 components (brain, CSF, blood vessel) must remain at a
relatively constant volume within the closed skull structure
- If the volume of any of the 3 components increases & the
volume from another component is replaced, the total
intracranial volume will not change.
*This is ONLY applicable in situations in which the skull is
closed!*
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