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Chapter 15 Question 1 A patient, admitted with the diagnosis of stroke, has left hemiparesis involving the face, arm, and leg. The nurse explains that this stroke most likely involves which artery? 1. Right vertebral 2. Left posterior communicating 3. Left middle cerebral 4. Right middle cerebral Question 2 A patient recovering from a frontal craniotomy is positioned with the head of the bed elevated 45 degrees at all times. What rationale would the nurse provide for this position? 1. The brain will compress the cerebral veins less in this position. 2. The ventricles of the brain will drain better in this position. 3. This position allows for less pain for the patient. 4. The cerebral spinal veins are valveless and drain by gravity. Question 3 The nurse is providing care for a patient who sustained a severe head injury. The nurse would intervene to prevent which occurrence that increases cerebral blood flow? 1. Oversedation 2. Hypothermia 3. Fever 4. Paralysis Question 4 The nurse is providing care for a patient who is at risk for developing an increase in intracranial pressure due to swelling of the brain. The nurse is aware that this increased brain size must be accompanied by which other change if intracranial pressure is to remain stable? 1. There will be an increase in the blood flow to the brain. 2. There is a decrease in the blood–brain barrier. 3. There must be a decrease in another of the intracranial compartments. 4. There will be an increase in the production of cerebrospinal fluid. Question 5 A nurse is monitoring the intracranial pressure of a patient with a closed-head injury. Which pressure would the nurse evaluate as requiring no additional intervention? 1. 12 mm Hg 2. 22 mm Hg 3. 25 mm Hg 4. 30 mm Hg Question 6 A nurse is providing care for a patient with increased intracranial pressure and is monitoring cerebral perfusion pressure. The nurse compares measurements to which critical normal value? 1. 50 mm Hg 2. 70 mm Hg 3. 120 mm Hg 4. 30 mm Hg Question 7 A patient with a head injury has a mean arterial pressure of 70 mm Hg and an intracranial pressure of 20 mm Hg. Which cerebral perfusion pressure would the nurse document for this patient? 1. 50 mm Hg 2. 90 mm Hg 3. 70/40 mm Hg 4. 40/70 mm Hg Question 8 A nurse is monitoring a patient who sustained a head injury. The nurse recognizes which finding as the earliest sign of change in neurologic status? 1. The patient cannot remember where he is. 2. The patient’s pupil size is increased. 3. The patient’s blood pressure has increased. 4. The patient exhibits decorticate posturing when stimulated. Question 9 A nurse is monitoring a patient’s Glasgow Coma Scale (GSC). At which point would the nurse document that the patient is comatose? 1. 11 2. 15 3. 7 4. 9 Question 10 The nurse, assessing a patient with a Glasgow Coma Score 4, finds the patient’s pupils to be pinpoint and nonreactive to light. The nurse takes into consideration that this finding can be due to which situations? 1. The patient was given atropine sulfate for bradycardia. 2. The patient has increased blood glucose. 3. The patient may have taken an opioid drug overdose. 4. The patient has sustained compression of the oculomotor nerve. 5. The patient has sustained damage to the pons.