A nurse is taking care of a client who has sustained a neurologic injury with increased intracranial pressure and decreased cerebral perfusion. Which of the following will keep cerebral perfusion pressure constant?

Regulation of constriction and dilation of blood vessels in the brain

Regulation of catecholamines circulating throughout the body

Regulation of the amount of carbon dioxide exhaled

Regulation of how much blood is pumped from the heart

Answer and Explanation

The Correct Answer is A

A.   The constriction and dilation of blood vessels in the brain helps maintain appropriate cerebral blood flow and cerebral perfusion pressure (CPP) despite fluctuations in blood pressure.
B.   Catecholamines regulate other systemic body functions, but they do not directly impact cerebral perfusion pressure.
C.   Carbon dioxide exhalation can affect blood flow, but the primary regulation of CPP is through blood vessel constriction and dilation.
D.   The amount of blood pumped from the heart can impact overall blood pressure but does not directly regulate cerebral perfusion pressure.

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Correct Answer is D

Explanation

A. A ventriculostomy involves inserting a catheter into the ventricles of the brain to monitor ICP, not a procedure for instilling drugs.
B. A ventriculostomy involves the insertion of a catheter to monitor ICP, not an internal transducer.
C. Cerebrospinal fluid (CSF) samples can be taken via ventriculostomy; the procedure does not prevent this.
D. A ventriculostomy measures the pressure within the brain’s ventricles to monitor intracranial
pressure, which is the correct understanding.

A. The client is unable to make vocal sound. B. The client is unconscious. C. The client opens his eyes when spoken to. D. The client can follow simple motor commands.

Correct Answer is C

Explanation

A. The client is unable to make vocal sound would be more consistent with a verbal response score of 1.
B. The client is unconscious is not correct, as a GCS score of 13 indicates they are not in a deep coma.
C. A GCS score of 3 for eye opening indicates that the patient responds to verbal stimuli (eye-opening to speech), a score of 5 for best verbal response indicates they can speak but not necessarily coherently, and a 5 for best motor response indicates purposeful movement, like following commands.
D. The client can follow simple motor commands would typically reflect a motor response score of 6, not

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A nurse is taking care of a client who has sustained a neurologic injury with increased intracranial pressure and decreased cerebral perfusion. Which of the following will keep cerebral perfusion pressure constant?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After receiving pre procedural instructions, which patient statement demonstrates an understanding of a scheduled ventriculostomy?

Correct Answer is D

Explanation

A nurse is receiving a transfer report for a client who has a head injury. The client has a Glasgow Coma Scale (GCS) score of 3 for eye opening, 5 for best verbal response, and 5 for best motor response. Which of the following is an appropriate conclusion based on this data?

Correct Answer is C

Explanation

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