N4 - test - cerebral bleeding and ICP

http://www.nursingcenter.com/prodev/ce_article.asp?tid=502231
answers in comments

Some causes of cerebral bleeding:
aneurysm rupture
cerebral amyloid angiopathy
cerebral venous thrombosis
coagulopathies
eclampsia
illicit drug use
infection
neonatal germinal matrix or subependymal hemorrhage
sickle cell disease
sympathomimetic drug abuse
trauma
vasculitis.
Key symptoms:
altered level of consciousness, headache, nausea and vomiting, focal neurologic deficits, and seizures.
Neuro deficits by location:
Brain stem:
autonomic instability
ALOC
facial weakness
gaze paresis
miosis
ocular bobbing
Caudate nucleus:
Confusion
contralateral hemiparesis (opposite side)
Cerebellum:
lack of coordination
ALOC
gaze paresis
ipsilateral facial weakness (same side)
sensory loss
miosis.
Lobar region:
Aphasia
apraxia
contralateral hemiparesis
contrlateral sensory loss
contralateral conjugate gaze paresis
hemianopia (blindness in half of the visual field in one or both eyes)
Putamen:
same as lobar region
homonymous hemianopia (hemianopia in both eyes).
Thalamus:
aphasia
confusion
contralateral hemiparesis
contralteral sensory loss
contralateral conjugate gaze paresis
miosis.
Decrease ICP by:
elevating the head of the bed 30 degrees
preventing hyperextension of the head
making sure tracheostomy ties aren't too tight
limiting suctioning and hyperoxygenating the patient before suctioning
preventing seizures
administering sedatives and/or neuromuscular blockers as ordered to reduce restlessness

1.
Which of these patients is at the highest risk of developing an intracerebral hemorrhage?
a. a 24-year-old Asian female who's a vegetarian
b. a 47-year-old Caucasian female who's malnourished
c. a 66-year-old African-American male who's hypertensive

2.
Which of these manifestations should you expect to assess in a patient who has an intracerebral hemorrhage?
a. lethargy and headache
b. unrelenting eye pain with watery discharge
c. bleeding from the ear canal and irritability

3.
Constricted pupils, ocular bobbing, and facial weakness are signs of a cerebral bleed in which area?
a. putamen
b. caudate nucleus
c. brain stem

4.
Which of the following indicates a possible lobar region hemorrhage?
a. blindness in one-half of the visual field
b. ipsilateral facial weakness
c. contralateral hemiparesis

5.
Which of these diagnostic test results would determine the location of a cerebral bleed?
a. X-ray
b. biopsy
c. MRI

6.
Which of these laboratory tests will identify a patient's increased risk of bleeding?
a. complete blood count
b. prothrombin time
c. sedimentation rate

7.
If a patient has an intracerebral bleed, signs of increased intracranial pressure (ICP) include
a. bradycardia.
b. hypotension.
c. hypothermia.

8.
Stabilize the mean arterial pressure of a patient who has an intracerebral bleed between
a. 25 and 50 mm Hg.
b. 65 and 130 mm Hg.
c. 150 and 300 mm Hg.

9.
Which intravenous fluid is recommended for a patient with an intracerebral hemorrhage?
a. fresh frozen plasma
b. lactated Ringer's solution
c. 0.9% sodium chloride

10.
Which medication reduces blood pressure and ICP in a patient with an intracerebral hemorrhage?
a. labetalol
b. phenobarbital
c. dexamethasone

11.
An ICP of 18 mm Hg should be interpreted as
a. normal.
b. moderately elevated.
c. severely elevated.

12.
Which of these techniques calculates a patient's cerebral perfusion pressure?
a. Add the MAP to the average ICP.
b. Subtract the ICP from the MAP.
c. Multiply the MAP by the ICP.

13.
To reduce the ICP in a patient with a cerebral bleed,
a. keep the patient's neck hyperextended.
b. elevate the patient's head 30 degrees.
c. apply continuous pressure to the patient's occiput.

14.
Which of these factors suggests a poor prognosis for a patient with a cerebral bleed?
a. several superficial brain hemorrhages
b. late reduction in level of consciousness
c. cerebral perfusion pressure less than 25 mm Hg

15.
Which treatment is recommended for a patient who has an acute subdural hematoma?
a. surgical removal of the clot via craniotomy to prevent complications
b. hyperthermia to reduce the metabolic rate
c. antihypertensive medication to induce hypotension

16.
Which patient is at increased risk for developing a chronic subdural hematoma?
a. an adolescent who abuses drugs
b. a middle-aged adult who overeats
c. an elderly patient who abuses alcohol

17.
Which manifestation suggests a chronic subdural hematoma?
a. agitation and hyporeflexia
b. periorbital edema and paresthesias
c. cephalgia and confusion