Intracranial pressure icp - Study guides, Class notes & Summaries

ICP Nclex Questions, ICP NCLEX style Questions, ICP Nclex Questions The nurse notes that a patient with a head injury has a clear nasal drainage. The most appropriate nursing action for this finding is to a. obtain a specimen of the fluid and send for culture and sensitivity. b. take the patient's temperature to determine whether a fever is present. c. check the nasal drainage for glucose with a Dextrostik or Testape. d. have the patient to blow the nose and then check the nares fo...

ATI PN PEDIATRICS EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIONALES ALREADY GRADED A+ Priority finding to report for a brain tumor= - CORRECT ANSWER-Increased intracranial pressure (ICP) A nurse is caring for an adolescent who has sustained a closed head injury. Which of the following are clinical manifestations of increased intracranial pressure (ICP)? Select all. A. Report of headache B. Alteration in pupillary response C. Increased motor response D. Increased sleeping...

-decreased LOC(lethargy to coma) -restlessness, irritability, confusion -headache -projectile N&V -change in speech pattern/slurred speech -dilated nonreactive pupils or constructed nonreactive pupils -ataxia -seizure -abnormal posturing -Cushing's triad: severe HTN, widened pulse pressure, bradycardia Key sx of increased ICP - Symptoms of increased ICP -severe HTN, widened pulse pressure, bradycardia What is Cushing's triad - Most at risk during 1st 72 hours after stroke onset ...

The nurse is caring for a patient with increased intracranial pressure (ICP). Which action would be considered to be a collaborative intervention? a. Decreasing perfusion b. Administering an osmotic diuretic c. Assessing orientation d. Assessing for edema correct answer: ANS: B Which assessment finding would be the earliest and most sensitive indicator that there is an alteration in intracranial regulation? a. Change in level of consciousness b. Inability to focus visually c. Loss o...

The nurse is caring for the client with increased intracranial pressure. The nurse would note which trend in vital signs if the intracranial pressure is rising? 1. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure 2. Increasing temperature, decreasing pulse, decreasing respirations, decreasing blood pressure 3. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure 4. Decreasing temperature, increasing pulse, d...

1) A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances? 1. Vomiting continues 2. Intracranial pressure (ICP) is increased 3. The client needs mechanical ventilation 4. Blood is anticipated in the cerebralspinal fluid (CSF) 2 Sudden removal of CSF results in pressures lower in the lumba...

A client presents with a headache and complaining of vision difficulties. Which cranial nerve might be defective in this client? A) VIII (Vestibulocochlear) B) VII (Facial) C) XI (Accessory) D) III (Oculomotor) Answer: D A client presents to the ED with loss of consciousness. The RN evaluates the client using the Glasgow Coma Scale. The results are as follows: Eyes open to speech Abnormal flexion of extremities Use of inappropriate words What would the RN estimate this clie...

CRITICAL CARE FINAL EXAM PRACTICE QUESTIONS AND CORRECT ANSWERS 2023/2024 a,d,e,f - CORRECT ANSWER-A client with a primary brain tumor has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse will expect to see which clinical findings upon assessment? (Select all that apply). a. Nausea and vomiting b. Hyperthermia c. Bradycardia d. Increased weight e. Decreased serum sodium f. Decreased level of consciousness a,b - CORRECT ANSWER-A nurse is car...

Monitor heart. Complications of the heart. - Low potassium (Hypokalemia) Epinephrine, norepinephrine, cortisol. Increase heart rate and increase in blood pressure - Catecholamines - Flight or fight response Plasma protein. It keeps water along with it. Water escapes into interstitial cell space. Swelling. Fluid is in the wrong places. Fluid in the peritoneal cavity. - Function of Albumin - decrease albumin - ascites Sodium and water retention - Function of aldosterone extracellular, inters...

ECCO Caring for Patients with Neurologic Disorders: Part 1 Questions and Answers 100% Pass What vital sign assessments herald impending brainstem herniation? Increased SBP w/widening pulse pressure, changes in respirations, and bradycardia A patient is admitted after sustaining traumatic brain injury in a motorcycle crash. The patent's GCS score on admission is E 2, M 3, V 1T = 6T. Which of the following should the nurse perform to prepare the patient for ICP monitoring? Prior to placement of ...