Progressive Care Nursing Certification (PCCN) Practice Exam

What physical assessment sign is usually the second to change in unresponsive patients after pulse pressure?

1. Change in pupillary response

2. Blood glucose levels

3. Response of the cranial nerves

4. Heart rate

The correct answer is: Change in pupillary response

In unresponsive patients, the assessment of vital signs and neurological status is critical to determine the extent of impairment and possible underlying causes. The correct answer is the change in pupillary response, which typically follows changes in pulse pressure as an indicator of neurological function. When a patient becomes unresponsive, pulse pressure—defined as the difference between systolic and diastolic blood pressures—can be one of the first signs of altered hemodynamics and can indicate increased intracranial pressure or other serious issues. Following the changes in pulse pressure, alterations in pupillary response are often observed. As the brain becomes more impaired, the pupils may become sluggish, unequal, or non-reactive to light, reflecting deterioration in brainstem function. This sequence of assessment is essential; pupillary responses are governed by cranial nerves II and III, and changes can provide valuable insights into the level of consciousness and potential neurological deficits. Changes in blood glucose levels and heart rate are less directly correlated with changes in consciousness and may not provide immediate information about neurological function. Similarly, while the response of cranial nerves is important, pupillary response is a more direct and observable sign that typically fluctuates sooner in response to changes in neurological status.