# A client with a confirmed aneurysmal subarachnoid hemorrhage is admitted to the neuro ICU. Which interventions should the nurse anticipate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375079&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A client with a confirmed aneurysmal subarachnoid hemorrhage is admitted to the neuro ICU. Which interventions should the nurse anticipate? Select all that apply.

1

Maintain systolic BP under 160 mm Hg until aneurysm is secured, then permissive higher BP for vasospasm

2

Monitor for vasospasm (peak day 4-14) with neuro exams and transcranial Doppler

3

Use stool softeners to prevent Valsalva-induced rebleeding

4

Initiate triple-H therapy (hypertension, hypervolemia, hemodilution) prophylactically before vasospasm

5

Administer nimodipine 60 mg PO every 4 hours for 21 days

## Explanation

Aneurysmal SAH care: nimodipine 60 mg PO every 4 hours for 21 days reduces poor neurologic outcome from vasospasm (calcium channel blocker selective to cerebral vessels). BP is kept lower BEFORE the aneurysm is secured (under 160 systolic) to prevent rebleeding, then induced higher BP is used during vasospasm window if symptomatic. Vasospasm peaks days 4-14 and is monitored with serial neuro exams plus TCD. Stool softeners and other Valsalva prevention reduce rebleeding. Prophylactic triple-H is no longer recommended — induced euvolemia and BP augmentation only with symptomatic vasospasm.

## In-depth explanation

Hunt-Hess scale grades severity (1-5). Modern care: secure aneurysm in 24-48h with coiling/clipping, then nimodipine, vigilant for vasospasm.

## Clinical scenario

Hunt-Hess grade III. Day 1 post-coiling. BP 168/90, HR 78. Awake, mild aphasia.

## Key concepts

- **subarachnoid hemorrhage** — Bleeding into the subarachnoid space, classically from ruptured aneurysm.
- **nimodipine** — Cerebroselective calcium channel blocker; reduces poor outcome from vasospasm.
- **cerebral vasospasm** — Delayed arterial narrowing 4-14 days post-SAH causing ischemia.

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