To preserve cerebral perfusion of a patient with an elevated intracranial pressure (ICP), which cerebral perfusion pressure (CPP) would the nurse maintain when suctioning the patient?

80 mm Hg

20 mm Hg

40 mm Hg

60 mm HG

Answer and Explanation

The Correct Answer is A

A.   Cerebral perfusion pressure (CPP) is crucial for maintaining adequate blood flow to the brain. A CPP of 80 mm Hg is typically considered the lower limit for preserving cerebral perfusion, particularly in patients with elevated ICP.
B.   20 mm Hg is too low and would indicate inadequate perfusion, which could result in brain ischemia.
C.   40 mm Hg is too low for optimal cerebral perfusion in critically ill patients with elevated ICP.
D.   60 mm Hg is also too low for optimal cerebral perfusion in critically ill patients with elevated ICP.

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Correct Answer is C

Explanation

A. The oculocephalic reflex test should cause the eyes to move in the opposite direction to the head turn, indicating intact brainstem function.
B. Movement of the eyes in an upward direction upon neck flexion indicates an abnormal response, suggesting a lesion.
C. A lesion could result in abnormal eye movement, as the eyes should move opposite to head movement.
D. Eye movement in the downward direction during neck extension is not a normal response and suggests a brainstem issue.

A. Managing sedation B. Monitoring volume status C. Completing hourly endotracheal suctioning D. Ensuring proper ventriculostomy transducer levels E. Elevating the head of the bed 30°

Correct Answer is ["A","B","D","E"]

Explanation

A. Managing sedation helps prevent agitation and decreases metabolic demands, which can exacerbate ICP.
B. Monitoring volume status is essential to prevent fluid imbalances that can worsen ICP.
C. Completing hourly endotracheal suctioning is not appropriate for this patient. Excessive suctioning can cause increased ICP and should be done cautiously.
D. Ensuring proper ventriculostomy transducer levels is critical for accurate measurement of ICP.
E. Elevating the head of the bed 30° helps improve venous drainage and reduces ICP.

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To preserve cerebral perfusion of a patient with an elevated intracranial pressure (ICP), which cerebral perfusion pressure (CPP) would the nurse maintain when suctioning the patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After performing an assessment of the oculocephalic reflex, the nurse suspects that the patient has an intracranial lesion. Which patient behavior supports the nurse's assessment findings?

Correct Answer is C

Explanation

A nurse is caring for a client who has increased intracranial pressure. Which of the following interventions should the nurse plan to include in the plan of care? (Select All that Apply.)

Correct Answer is ["A","B","D","E"]

Explanation

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