Neuro CCRN Study questions Latest Update 2024-2025 Actual Exam Questions and 100% Verified Correct Answers Guaranteed
A family member of a patient in the ICU, who recently experienced a TBI, asks the nurse how long the patient will have to be on seizure medications as the patient has not had a seizure. Which of the following would be the nurse's best answer?
- The patient will have to be on seizure medications for the rest of her life.
- Ask the neurologist that question.
- Typically, following trauma, seizure medications are given for 7 days if no seizures
- The neurologist will reevaluate her during the 3-month follow-up clinic visit. -
occur.
CORRECT ANSWER: C
The Brain Trauma Foundation's recommendation for antiepileptic prophylaxis is 7 days following a TBI, if no seizure occurs in the interval. This is the same recommendation for supratentorial postcraniotomy patients. The use of prophylactic antiepileptic therapy after ischemic strokes is not recommended but ICH strokes have a higher incidence of seizures and may require short-term prophylaxis.
A myasthenia crisis can be a clinical emergency with a need for rapid intervention.Which of the following is considered the initial intervention of choice for a hemodynamically unstable patient in a myasthenia crisis?
- IV immunoglobulin
- IV steroids
- Plasmaphoresis
D. Anticholinesterase inhibitors - CORRECT ANSWER: A
Rapid treatment with IVIG or plasmaphoresis is comparable in efficacy but in hemodynamically unstable patients, plasmaphoresis is contraindicated. Rapid intervention with IVIG is the most appropriate intervention. Concomitant administration of ste- roids may be given but steroids alone have been found to exacerbate muscle weakness within 5 to 10 days. Anticholinesterase inhibitors are typically held during a myasthenia crisis due to aggravation of secretions and can be restarted when the patient has improved clinically.
A patient has been in the ICU for 5 days following a craniotomy for a tumor resection.He has been on decadron, propofol, and fentanyl to manage an elevated ICP and cerebral edema. He is now developing metabolic acidosis and hyperkalemia. Which of the following would be the most likely cause?
- Cushing's disease
- Long-term neurological and cognitive dysfunction (LNCD)
- Sepsis
D. Propofol infusion syndrome - CORRECT ANSWER: D
Long-term or high-dose use of propofol has been found to cause propofol infusion syndrome. Symptoms include metabolic acidosis, hyperkalemia, rhabdomyolysis, renal 1 / 2
failure, and myocardial failure. The use of exogenous steroids can result in Cushing's syndrome but does not typically present with metabolic acidosis or hyperkalemia.Sepsis identifiers are tachycardia, fever, leukocytosis, and tachypnea. LNCD may be caused by the presence of delirium and use of sedation but is a complication experienced after the ICU and does not present with metabolic acidosis or hyperkalemia.
A patient is admitted to the ICU with an ICH from chronic HTN. His BP is currently 210/108 mmHg. The physician has ordered BP parameters of 130-150 mmHg. Which of the following antihypertensives would more likely exacerbate cerebral edema and increase ICP?
- Labetalo
- Esmolol
lB. Nicardipine
D. Nipride - CORRECT ANSWER: D
When maintaining a lower BP to manage hemorrhagic strokes, the most commonly used antihypertensives are β-blockers and calcium channel blockers. Alpha-blockers, such as Nipride, can cause significant vasodilation of the cerebral vessels, resulting in an increase in cerebral edema and ICP. Continuous infusion of antihypertensive agents would indicate the need to use shorter acting, more titratable drugs such as nicardipine or esmolol. Labetalol is commonly used as an IV prn medication to lower BP in neurological patients.
A patient is diagnosed with an ischemic stroke but is 4.0 hours out from the initial onset of stroke symptoms. Which of the following is an additional exclusion if considering using the 4.5-hour window to administer IV tPA?
- If taking oral anticoagulants, INR must be < 2.5
- Has a baseline NIH Stroke Scale < 20
- History of both stroke and diabetes
D. Patient is younger than 50 years old - CORRECT ANSWER: C
Based on some recent studies, some stroke centers extend the window of opportunity to administer IV tPA in an ischemic stroke to 4.5 hours. There is additional exclusion criteria used for the 3- to 4.5-hour time interval. These include: (a) history of both stroke and diabetes, (b) patients receiving oral anticoagulation therapy regardless of INR, (c) patients older than 80 years of age, and (d) baseline NIH Stroke Scale greater than 25.
A patient with a history of MG is admitted because of increased weakness. His vital capacity and negative inspiratory force were evaluated by the respiratory therapist and impending respiratory failure was predicted. He stated he had been feeling bad lately and had been doubling his dose of pyridostigmine. Which of the following is the most likely cause for the respiratory failure?
- Cushing's syndrome
- Steroid overdose
- Myasthenia crisis
D. Cholinergic crisis - CORRECT ANSWER: D
- / 2