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Journal of Neuroscience Nursing:
doi: 10.1097/JNN.0b013e3182642396
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Nursing Interventions and Assessments for Aneurysmal Subarachnoid Hemorrhage Patients: A Mixed Methods Study Involving Practicing Nurses

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GENERAL PURPOSE STATEMENT: To increase the ability of the registered nurse to recognize the importance of nursing interventions in caring for patients with aneurysmal subarachnoid hemorrhage (aSAH).

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

1. Describe the pathophysiology, symptomology, and recommended care of the patient with aSAH.

2. Discuss the research study’s findings in relation to managing the patient with aSAH.

1. What is the most common type of cerebral aneurysm causing aSAH?

a. dissecting

b. descending

c. fusiform

d. sacular

2. Aneurysms involved in aSAH generally form in the

a. cerebellum.

b. Circle of Willis.

c. medulla oblongata.

d. brain stem.

3. Which phrase best describes aSAH?

a. a cerebrovascular incident caused by hypotension and hypovolemia

b. the formation of an aneurysm in the subarachnoid space

c. a collection of cerebrospinal fluid in the subarachnoid space

d. a ruptured aneurysm and accumulation of blood in the subarachnoid space

4. The most notable symptom of an aSAH is a/an

a. explosive headache.

b. blurred vision.

c. conjunctival hemorrhage.

d. loss of consciousness.

5. The gold standard for diagnosis of aSAH is

a. CT scan.

b. PET scan.

c. cerebral angiography.

d. MRI.

6. The treatment of choice after an aSAH is

a. surgery to evacuate accumulated blood.

b. surgery to secure the aneurysm and prevent rebleeds.

c. angiographic occlusion of the artery feeding the aneurysm.

d. heparin therapy to prevent clot formation.

7. The prognosis for aSAH patients is poor with mortality rates as high as

a. 45%.

b. 55%.

c. 65%.

d. 75%.

8. Of patients who survive an aSAH, nearly 50% die from

a. a subsequent ruptured aneurysm.

b. a rebleed from the initial aneurysm.

c. complications of hypertension.

d. complications of vasospasm.

9. Identifying difficulties and concerns from the nurses’ perspective is crucial to

a. drive future nursing research and provide evidence needed for practice.

b. develop appropriate care plans for patients.

c. establish patient and family teaching programs.

d. increase the involvement of the family in the patient’s plan of care.

10. Trustworthiness of the qualitative data collected in this study was determined by analyzing all except

a. reliability.

b. confirmability.

c. objectivity.

d. credibility.

11. Two comorbidities shared by more than 50% of the aSAH patients cited during this study were

a. diabetes and hypertension.

b. smoking and hypertension.

c. obesity and smoking.

d. hyperlipidemia and heart disease.

12. On the checklist, which two interventions did all nurses state they were accountable for?

a. monitoring intake and output and seizure precautions

b. family education and limiting stimuli

c. neurologic evaluations and monitoring intracranial pressure

d. repositioning and monitoring patient temperature

13. Many nurses noted that induced hypertension resulted in

a. increased alertness.

b. seizure activity.

c. worsening headache.

d. focal neurologic deficits.

14. Because neurosurgeons are busy, the nurses noted

a. difficulty getting responses to questions about patient care.

b. the need to be more assertive in reaching out to the physician.

c. that nurses are the link between the neurosurgeon’s plan and the family’s expectations.

d. the expectation that they make more autonomous decisions.

15. To combat spikes in the patient’s intracranial pressure, the nurse positions the patient with

a. head elevated and knees flexed.

b. head and body remaining midline.

c. head and feet both elevated.

d. head and shoulders elevated.

16. Reduction of stimuli is an intervention to

a. give the patient a chance.

b. prevent injury.

c. maintain therapeutic milieu.

d. provide psychosocial care.

17. Vasospasm after an aSAH can result in

a. reduced cerebral blood flow and infarction.

b. increased pressure and formation of another aSAH.

c. increased blood flow and exacerbation of the bleed.

d. death in 40% of patients despite aggressive therapy.

18. The 2009 AANN guidelines indicate that the patient with vasospasm needs neurological exams

a. more frequently than hourly.

b. hourly.

c. every 2 hours.

d. as indicated by changes in condition.

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© 2012 American Association of Neuroscience Nurses