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WorksheetsIntracranial Regulation KA
Total questions: 14
Worksheet time: 7mins
Which assessment finding is most concerning in a client with increased intracranial pressure (ICP)?
Headache
Projectile vomiting
Unequal pupils
Irritability
A client with suspected increased ICP is placed in bed. Which position is best?
Flat supine
High Fowler’s at 90°
Semi-Fowler’s with head midline
Trendelenburg
Which vital sign pattern indicates Cushing’s triad from increased ICP?
Tachycardia, hypertension, tachypnea
Bradycardia, widened pulse pressure, irregular respirations
Hypertension, tachycardia, tachypnea
Hypotension, tachycardia, bradypnea
A nurse observes a client having a tonic-clonic seizure. What is the priority action?
Insert an oral airway
Restrain the client
Turn the client to the side
Place a tongue blade in the mouth
After a seizure, the client is drowsy and confused. What is this phase called?
Aura
Prodromal
Postictal
Interictal
Which medication is given IV for status epilepticus?
Phenytoin
Lorazepam
Carbamazepine
Gabapentin
A client with epilepsy reports stopping phenytoin abruptly. Why is this concerning?
It causes rebound hypertension
It increases seizure frequency
It causes weight gain
It leads to liver failure
Which lab test should be monitored for a client on phenytoin (Dilantin)?
Serum potassium
Serum phenytoin level
Serum calcium
Serum sodium
A client with seizure disorder is prescribed valproic acid. Which finding requires immediate reporting?
Hair loss
Nausea
Easy bruising
Tremors
Which client instruction is most important for a patient taking carbamazepine?
Avoid grapefruit juice.
Limit green leafy vegetables.
Take with dairy products only.
Avoid drinking milk.
Which seizure type is characterized by a brief staring episode and eye fluttering?
Tonic-clonic
Myoclonic
Absence
Atonic
A client has ICP monitoring via an intraventricular catheter. Which is the nurse’s priority?
Keep the transducer below the level of the ear
Monitor for signs of infection
Clamp the tubing to prevent drainage
Maintain the client flat in bed
Which early symptom suggests increased ICP?
Coma
Papilledema
Restlessness and decreased LOC
Cushing’s triad
A client has a seizure while ambulating in the hallway. What is the nurse’s first action?
Run to get help
Support the client to the floor
Insert a padded tongue blade
Hold the client tightly
