Intracranial Emergencies and Intracranial Emergency Drugs

Every question here, with the answer

1. A client with increased intracranial pressure is receiving mannitol. Which positioning should the nurse maintain unless directed otherwise?

   1. Head of bed at 30 degrees with the neck in a neutral position.
   2. Trendelenburg position.
   3. Flat in bed with the head turned to the side.
   4. Head of bed at 30 degrees with the neck flexed forward.

   Answer: Head of bed at 30 degrees with the neck in a neutral position.

   Along with drugs, the nurse keeps the head of the bed at 30 degrees and the neck neutral to help stabilize and lower intracranial pressure. Lying flat, head-down positioning or a flexed or turned neck do not follow this guidance.

2. While preparing a mannitol infusion, the nurse sees crystals in the solution. What should the nurse do?

   1. Discard the solution.
   2. Shake the bag until the crystals disappear, then give it.
   3. Give it through a larger IV catheter.
   4. Give it slowly over a longer period.

   Answer: Discard the solution.

   Mannitol is inspected for particulate matter, discoloration or crystallization before and during administration, and the solution is discarded if any are present. The other options give a solution that should not be given.

3. A nurse is caring for a client at risk for cerebral edema. Which findings should the nurse report to the health care provider? Select all that apply.

   1. Pupils that do not react to light
   2. Increased urine output after mannitol
   3. Bradycardia
   4. Improved coordination
   5. New confusion

   Answer: Pupils that do not react to light, Bradycardia, New confusion

   Symptoms of cerebral edema and intracranial hypertension to report include headache, confusion, dizziness, convulsions, unconsciousness, bradycardia, and failure of the pupils to react to light. Increased urine output and improved coordination are listed as signs that pressure and edema are decreasing.

4. A client with idiopathic intracranial hypertension is prescribed acetazolamide. The client also takes high-dose aspirin. Which complication should the nurse watch for?

   1. Hypertensive crisis
   2. Metabolic acidosis
   3. Hyperkalemia
   4. Hypercalcemia

   Answer: Metabolic acidosis

   Concomitant high-dose aspirin and acetazolamide has been reported to cause anorexia, tachypnea, lethargy, metabolic acidosis and death. Acetazolamide is linked with hypokalemia rather than hyperkalemia, and the other options are not described for this combination.

5. Before giving an osmotic diuretic, the nurse reviews the client's history. Which conditions are contraindications? Select all that apply.

   1. Increased intraocular pressure
   2. Anuria due to renal disease
   3. Pulmonary edema
   4. Severe dehydration
   5. Cerebral edema

   Answer: Anuria due to renal disease, Pulmonary edema, Severe dehydration

   Osmotic diuretics are contraindicated in anuria due to renal disease, pulmonary edema, severe dehydration and progressive heart failure. Cerebral edema and increased intraocular pressure are indications for mannitol, not contraindications.

6. A client's intracranial pressure is being monitored with a catheter and transducer. At what level does the section say therapy to lower the pressure should begin?

   1. Greater than 7 mm Hg
   2. Greater than 15 mm Hg
   3. Only when the client loses consciousness
   4. Greater than 20 mm Hg to 25 mm Hg

   Answer: Greater than 20 mm Hg to 25 mm Hg

   Therapy to lower intracranial pressure should start when it is greater than 20 to 25 mm Hg. Normal pressure is 7 to 15 mm Hg, so those values do not call for treatment, and waiting for loss of consciousness delays care.