Nokea
The nurse is caring for a patient who has undergone supratentorial removal of a pituitary mass. What medication would the nurse expect to administer prophylactically to prevent seizures in this patient?
- A. Prednisone
- B. Dexamethasone
- C. Cafergot
- D. Phenytoin
Correct Answer: D
Rationale: Phenytoin is used prophylactically post-supratentorial surgery to prevent seizures. Prednisone and dexamethasone are steroids, and Cafergot treats migraines.
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The nurse is providing care for a patient who is unconscious. What nursing intervention takes highest priority?
- A. Maintaining accurate records of intake and output
- B. Maintaining a patent airway
- C. Inserting a nasogastric (NG) tube as ordered
- D. Providing appropriate pain control
Correct Answer: B
Rationale: Maintaining a patent airway is critical for an unconscious patient to ensure oxygenation and prevent aspiration. Other interventions, while important, are secondary to airway management.
The neurologic ICU nurse is admitting a patient following a craniotomy using the supratentorial approach. How should the nurse best position the patient?
- A. Position the patient supine.
- B. Maintain head of bed (HOB) elevated at 30 to 45 degrees.
- C. Position patient in prone position.
- D. Maintain bed in Trendelenberg position.
Correct Answer: B
Rationale: HOB elevation at 30-45 degrees reduces ICP in supratentorial craniotomy patients. Supine, prone, or Trendelenberg positions increase ICP risk.
While completing a health history on a patient who has recently experienced a seizure, the nurse would assess for what characteristic associated with the postictal state?
- A. Epileptic cry
- B. Confusion
- C. Urinary incontinence
- D. Body rigidity
Correct Answer: B
Rationale: Confusion is typical in the postictal state after a seizure. Epileptic cry, incontinence, and rigidity occur during the seizure, not afterward.
The nurse is participating in the care of a patient with increased ICP. What diagnostic test is contraindicated in this patients treatment?
- A. Computed tomography (CT) scan
- B. Lumbar puncture
- C. Magnetic resonance imaging (MRI)
- D. Venous Doppler studies
Correct Answer: B
Rationale: Lumbar puncture risks brain herniation in patients with increased ICP due to pressure changes. CT, MRI, and Doppler studies are safe and non-invasive.
A patient is postoperative day 1 following intracranial surgery. The nurses assessment reveals that the patients LOC is slightly decreased compared with the day of surgery. What is the nurses best response to this assessment finding?
- A. Recognize that this may represent the peak of post-surgical cerebral edema.
- B. Alert the surgeon to the possibility of an intracranial hemorrhage.
- C. Understand that the surgery may have been unsuccessful.
- D. Recognize the need to refer the patient to the palliative care team.
Correct Answer: A
Rationale: Cerebral edema peaks 24-36 hours post-surgery, often causing decreased LOC. Hemorrhage is not confirmed, surgery success is premature to judge, and palliative care is not indicated.