Neuro Meds
A patient in status epilepticus is given a rapid IV medication that stops the seizure. The provider then orders a second medication to maintain seizure control. Name BOTH medications in correct order.
Lorazepam → then Phenytoin (or Levetiracetam)
A patient receives lorazepam IV for a seizure. Within minutes, the patient becomes very drowsy and respirations drop to 10. What is the priority nursing action?
Support airway and prepare for ventilation
A patient begins actively seizing in bed. The provider has already ordered lorazepam IV, but it has not been given yet. What is the nurse’s FIRST action?
Turn the patient on their side and protect the airway
A patient is given lorazepam IV, followed by phenytoin, after experiencing:
What is the diagnosis?
Tonic-clonic seizure
A patient receives lorazepam IV for a seizure. Shortly after, respirations drop to 10 and the patient is difficult to arouse. What is the red flag and action?
Respiratory depression → support airway immediately
A patient with increased ICP is receiving an osmotic diuretic. A few hours later, labs show rising serum osmolality and increasing creatinine. What medication is this, and what is the priority action?
Mannitol → HOLD and notify provider
A patient taking phenytoin presents with swollen, bleeding gums. What is the most appropriate nursing intervention?
Reinforce strict oral hygiene and regular dental care
A patient arrives to the ED with stroke symptoms and is a potential candidate for alteplase. What is the FIRST priority before administering the medication?
Obtain a CT scan
A patient receives alteplase after presenting with:
What condition is being treated?
Acute ischemic stroke
A patient receiving phenytoin IV develops hypotension and cardiac dysrhythmias during infusion. What is the red flag and action?
Cardiac instability → slow/stop infusion and monitor cardiac rhythm
A patient with acute ischemic stroke receives a thrombolytic. Thirty minutes later, the patient develops a sudden severe headache, vomiting, and decreased LOC. What medication was given, and what is the complication?
Alteplase (or Tenecteplase) → hemorrhagic transformation
A patient is receiving levetiracetam and begins showing increased irritability, agitation, and mood swings. What is the best nursing action?
Monitor and report behavioral changes to provider
A patient with increased ICP is restless and trying to sit up and bend their neck forward. The provider has ordered mannitol, but it has not yet been administered. What is the nurse’s FIRST action?
Reposition head midline and elevate HOB 30°
A patient with a head injury is receiving mannitol and becomes:
What condition is MOST likely occurring?
Increased intracranial pressure (ICP)
A patient on mannitol now has:
What is the red flag and action?
Renal failure → hold medication and notify provider
A patient with spinal cord injury develops hypotension and bradycardia. The provider orders two medications: one to increase heart rate and one to increase blood pressure. Name BOTH medications.
Atropine (↑ HR) + Norepinephrine (↑ BP)
A patient receiving mannitol for ICP has the following changes: decreasing urine output, rising creatinine, and increasing confusion. What is the priority action?
Hold the medication and notify the provider immediately
A patient with spinal cord injury develops hypotension and bradycardia. The provider orders norepinephrine and atropine. The medications are not yet available. What is the nurse’s FIRST action?
Initiate IV fluid bolus
A patient with spinal cord injury is prescribed atropine and norepinephrine after developing:
What condition is this?
Neurogenic shock
A patient receives alteplase and 1 hour later develops:
What is the red flag and action?
Intracranial hemorrhage → STOP infusion immediately and notify provider
A patient with TBI is receiving multiple medications:
The patient becomes bradycardic, hypotensive, and has decreasing urine output. Which medication is MOST likely contributing to the current deterioration?
Mannitol
A patient with ischemic stroke receives alteplase. Two hours later, the nurse notes:
What is happening, and what is the nurse’s FIRST action?
Suspected intracranial hemorrhage → STOP infusion and notify provider immediately
A patient with TBI is receiving mannitol and levetiracetam. The nurse notes:
What is the nurse’s FIRST action?
Assess airway and provide oxygen
A patient is receiving:
Suddenly develops:
What is the MOST likely diagnosis?
Hemorrhagic transformation (intracranial bleed after tPA)
A patient with spinal cord injury is receiving norepinephrine. The nurse notes:
What is the red flag and action?
Excessive vasoconstriction → assess perfusion and titrate medication