Ichs

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Sample questions from Ichs

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 67-year-old client with sudden right-sided weakness and vomiting has BP 214/116 mm Hg, HR 58/min, and a noncontrast head CT showing an acute intracerebral hemorrhage. Refer to the client's chart. Which action should the nurse take first?

   • A.Prepare the client for lumbar puncture
   • B.Lower the blood pressure rapidly to below 120/70 mm Hg without a prescription
   • C.Elevate the head of the bed to about 30 degrees and maintain the head midline
   • D.Administer oral fluids to prevent dehydration

   Rationale: The client has an acute hemorrhage and signs that may indicate rising intracranial pressure; head elevation and neutral alignment support venous drainage while avoiding neck compression. Oral fluids are unsafe with an acute neurologic deficit, and lumbar puncture is contraindicated with suspected increased intracranial pressure. Blood pressure reduction must be controlled and guided by prescribed targets, not performed precipitously.

2. 2.At change of shift in a neuro step-down unit, a 73-year-old client with an intracerebral hemorrhage is more difficult to arouse and has a newly unequal pupil. Which action should the nurse take?

   • A.Give the scheduled oral antihypertensive medication
   • B.Notify the rapid response team and provider immediately
   • C.Document the findings and reassess in 1 hour
   • D.Ask the assistive personnel to obtain a second set of pupils

   Rationale: Decreased level of consciousness and new anisocoria may signal expanding hemorrhage or herniation and require immediate escalation. Waiting delays treatment, and an oral medication is inappropriate before airway and neurologic status are evaluated. Assistive personnel cannot assess pupils or replace the nurse's urgent assessment.

3. 3.During a home visit, a 59-year-old client recovering from an intracerebral hemorrhage reports new left-hand clumsiness and a severe headache. BP is 188/102 mm Hg. Which actions should the nurse take? Select all that apply.

   • A.Drive the client to the hospital after completing the visit
   • B.Encourage the client to rest and call the clinic tomorrow
   • C.Record the time the new symptoms began
   • D.Keep the client from eating or drinking until swallowing status is assessed
   • E.Activate emergency medical services for urgent evaluation

   Rationale: New focal deficits and severe headache may indicate recurrent bleeding or another acute neurologic event, so emergency evaluation is needed. Oral intake should be withheld until swallowing safety is established, and symptom-onset time helps guide treatment decisions. Delaying care or transporting by private car can increase risk and delay emergency support.

4. 4.A provider prescribes IV nicardipine for a 64-year-old client with acute intracerebral hemorrhage and systolic BP 206 mm Hg. Which nursing action is most appropriate?

   • A.Hold the medication until the client develops chest pain
   • B.Give the medication as a rapid IV push to reduce pressure immediately
   • C.Stop neurologic assessments while the infusion is running
   • D.Use an infusion pump and monitor BP frequently while titrating to the prescribed target

   Answer and rationale are in the full material.

5. 5.In a neurocritical care unit, a 70-year-old client with an intracerebral hemorrhage has a Glasgow Coma Scale score of 8, a weak cough, and oxygen saturation of 91% on room air. Which prescription should the nurse anticipate as the priority?

   • A.Endotracheal intubation for airway protection
   • B.Oral antihypertensive medication
   • C.A bedside swallow evaluation before any airway intervention
   • D.Ambulation with two-person assistance

   Answer and rationale are in the full material.