NR 341 Exam Questions With Correct
Answers
What is the max GCS score? - answer15
What is the minimum GCS score? - answer3
What GCS score should you intubate? - answer8 and under
What are the limitations of the GCS? - answerage, drugs, and language
What is normal intracranial pressure (ICP)? -...
What GCS score should you intubate? - answer✔8 and under
What are the limitations of the GCS? - answer✔age, drugs, and language
What is normal intracranial pressure (ICP)? - answer✔5-15 mmHg
What are the signs and symptoms of increased ICP? - answer✔change in LOC, change in
speech, change in vital signs, seizures, headache, vomiting, eye changes, posture changes
What is the first sign of increased ICP? - answer✔changes in LOC
What is cushing's triad? - answer✔an effect of increased ICP of increased systolic BP,
decreased pulse, and cheyne-stokes respirations
What is Cheyne-Stokes respiration? - answer✔it is an abnormal rhythm of breathing with
alternation periods of hyperventilation and apnea
What is Kussmaul respiration? - answer✔deep, rapid breathing often induced by acidosis
What condition does Kussmaul respirations commonly occur with? - answer✔DKA
What posture changes occurs with increased ICP? - answer✔decerebrate, decorticate,or flaccid
What is decerebrate posturing? - answer✔Extensor response; problem with midbrain or pons
What is decorticate posturing? - answer✔Flexor response; problem with cervical spinal tract or
cerebral hemisphere
What are the eye changes that occur with increased ICP? - answer✔papilledema, pupillary
changes, impaired eye movement
What is a common cause of increased brain volume? - answer✔cerebral edema; can also be
caused by a tumor or meningitis
What causes increased cerebrospinal fluid? - answer✔hydrocephalus, blockage of normal flow,
obstruction of normal re-absorption, and excess production of CSF
What is cerebral perfusion pressure (CPP) dependent upon? - answer✔intracranial pressure
(ICP) and mean arterial pressure (MAP)
What is a normal cerebral perfusion pressure (CPP)? - answer✔50-70
What does a low cerebral perfusion pressure (CPP) result in? - answer✔loss of auto-regulation
and hypoxic insult to brain tissue
Nursing Mgmt. ICP: What is the maintenance goal of ICP? - answer✔ICP < 20 mmHg
Nursing Mgmt. ICP: What is the maintenance goal of CPP? - answer✔< 70 mmHg
Nursing Mgmt. ICP: Care should be ________ to allow rest. - answer✔spaced
Nursing Mgmt. ICP: Suctioning should be _______. - answer✔minimum/PRN
Nursing Mgmt. ICP: What should the HOB be at? - answer✔30-45 degrees (Semi-Fowler's);
keep neck in neutral position
Nursing Mgmt. ICP: Why should hyperthermia be avoided? - answer✔to help reduce metabolic
and oxygen demand
Nursing Mgmt. ICP: How should the patient be kept? - answer✔normovolemic
What is normovolemic? - answer✔normal blood volume
What electrolytes should be monitored with ICP mgmt.? - answer✔sodium --> seizures
What all should be monitored with ICP mgmt.? - answer✔ICP, electrolytes, ABG's vital signs,
daily weights, strict I&O, diabetes insipidus (DI), and SIADH
What tubes should be placed with increased ICP? - answer✔NG tube or orogastric tube
Which tube is preferred with patients who have facial fractures or skull fractures? -
answer✔orogastric tube
Nursing Mgmt. ICP: What forms of management should be given? - answer✔airway, pain and
anxiety (sedate)
Nursing Mgmt. ICP: How should the transducer be kept? - answer✔at level with the drain
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Brightstars. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.49. You're not tied to anything after your purchase.
