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Exam & Evaluation (Subarachnoid Hemorrhage: Caring for the Patient)
 
Questions: Please respond to following statements.

1 The 6 month mortality rate for persons with SAH secondary to ruptured cerebral artery aneurysm is about:
  10%
  20%
  50%
  70%
2 The most common type of aneurysm is a:
  Fusiform aneurysm
  Berry aneursym
  Saccular aneurysm
3 SAH is more prevalent in:
  women
  men
4 Which of the following structures is responsible for the absorption of cerebrospinal fluid?
  Pia mater
  Basal cisterns
  Arachnoid villi
5 The brain's anterior and posterior circulations join at the:
  Circle of Willis
  Middle cerebral artery
  Subarachnoid space
6 Which of the following aneurysms is classified as a giant aneurysm?
  10 mm
  10-20 mm
  25-50 mm
  over 50 mm
7 All of the following may be symptoms of a minor aneurysmal bleed except:
  Hearing loss
  Photophobia
  Headache
  Neck pain
8 During which of the following activities would a SAH most likely occur?
  Driving
  Watching television
  Lifting and moving furniture
  Working at a computer
9 Which of the following are signs of increasing intracranial pressure?
  Tachycardia, hypertension, lessening pulse pressure
  Hypertension, bradycardia, widening pulse pressure
  Bradycardia, hypotension, widening pulse pressure
  Hypotension, tachycardia, lessening pulse pressure
10 An SAH patient with decerebrate posturing would be assigned to which classification on the Hunt and Hess scale?
  grade II
  grade III
  grade IV
  grade V
11 The drug nimodipine is given for 21 days after SAH to prevent:
  Rebleeding
  Vasospasms
  Hydrocephalus
  Electrolyte imbalance
12 Performing a Valsalva maneuver after an SAH is contraindicated because the maneuver:
  Lowers cerebral perfusion pressure
  Increases intracranial pressure
  Lowers systemic blood pressure
13 All of the following activities causes a Valsalva maneuver except:
  Coughing
  Straining at stool
  Keeping the head in extension
  Turning in bed with the mouth closed
14 Cerebral vasospasms is treated with:
  Hypertension
  Hypervolemia
  Calcium channel blocker
  Hemodilution
  All of above
15 A patient with an SAH who is a poor surgical candidate may benefit from:
  Serial lumbar punctures to lower intracranial pressure
  Osmotic diuretics
  Guglielmi Detachable Coil
16 Which of the following increases the potential for constipation and aneurysmal rebleeding?
  Immobility
  Codeine given for SAH headache
  Stool softeners
  1 and 2
17 A bowel program, including adequate hydration and stool softeners, should be implemented in the patient with SAH:
  Upon admission
  Within 24 to 48 hours of admission
  The first post-operative day after aneurysmal surgery
18 All of the following are important nursing measures for a patient on aneurysm precautions except:
  Head of bed at 30 degrees
  Side rails up and bed in lowest position
  Wrist and ankle restraints applied
  Padded side rails, tongue blade, and suction
19 Which of the following should alert the nurse to a change in neurological status?
  Increasing strength of hand grip on one side, apathy, decrease in pupillary reaction to light
  Decrease in pupillary reaction to light, development of slurred speech, one sided facial weakness
  Increase in alertness, slurred speech, unchanged pupillary reaction to light and accommodation
20 A lumbar puncture (LP) is dangerous in a person with increased intracranial pressure due to the possibility of brain herniation.
True     False
21 SAH rarely occurs without the patient complaining of a headache.
True     False
22 Aneurysm precautions are intended to prevent rapid increases in blood pressure that can precipitate rebleeding.
True     False
23 Signs and symptoms of aneurysmal rebleeding are subtle and gradual.
True     False
24 Hemodilution is part of hyperdynamic therapy.
True     False
25 Patients with aneurysm precautions are at high risk of deep vein thrombosis and potential pulmonary embolus.
True     False
26 Smoking is a risk factor for SAH.
True     False
27 Surgical clipping of cerebral aneurysms is usually done approximately one week after the initial hemorrhage.
True     False
28 The larger the hemorrhage, the more likely is vasospasm.
True     False
29 The word aneurysm comes from the Greek word "to widen."
True     False
30 It is rare for a cerebral aneurysm to occur in the very young or the very old.
True     False
31 Xanthochromia is a sign of SAH found in what body fluid? (three words)
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