NR574 LATEST 2026 QUESTIONS AND SOLUTIONS
GUARANTEE A+
✔✔Calculate the GCS for Aasan.
Aasan, an elderly client, was brought to the emergency department by EMS following a
fall. There is a large laceration on his occiput with profuse bleeding. He opens his eyes
when you speak to him, but his responses are incompre- hensible. He responds to
localized painful stimuli. - ✔✔Aasan's GCS score is 10
✔✔Roy has a suspected head injury. Which of the following clinical findings increases
suspicion for a basilar skull fracture? - ✔✔Periorbital ecchymosis
✔✔GCS Eye Response Grading - ✔✔Eye Opening (4)
1 - No eye opening.2 - Eye opening to pain.3 - Eye opening to verbal command. 4 -
Eyes open spontaneously.
✔✔GCS verbal response grading - ✔✔Verbal response (5)
1 - No verbal response 2 - Incomprehensible sounds. 3 - Inappropriate words.4 -
Confused 5 - Orientated
✔✔GCS motor response grading - ✔✔Motor Response (6)
1 - No motor response.
2 - Extension to pain.
3 - Flexion to pain.
4 - Withdrawal from pain.
5 - Localizing pain.
6 - Obeys Commands.
✔✔diagnostic imaging for skull fracture - ✔✔CT scan of the head.
✔✔Normal ICP - ✔✔Normal adult intracranial pressure (ICP) is less than or equal to 15
millimeters mercury (mmHg)
✔✔what does ICP above 15mmHg mean? - ✔✔are consistent with intracranial
hypertension. Intracranial hypertension is a symptom of underlying pathology which
causes an imbalance between pressure and volume
✔✔cerebral perfusion pressure (CPP) - ✔✔maintain cerebral perfusion pressure(CPP),
or the pressure needed to ensure blood flow to the brain -A normal CPP is 60-100 mm
Hg
✔✔how to calculate CPP - ✔✔Remember this formula: CPP = MAP - ICP
✔✔a CPP <50 is associated with what? - ✔✔ischemia and neuronal death.
,✔✔brain death - ✔✔Brain death is defined as the complete, irreversible cessation of all
brain function as a result of catastrophic damage to the brain and the absence of brain
stem function
✔✔3 cardinal findings of brain death - ✔✔1.coma/unresponsiveness, 2.absence of
brainstem reflexes 3.apnea.
✔✔The World Brain Death Project -clinical diagnostic criteria for brain death- - ✔✔An
established neurological diagnosis that is capable of causing the irreversible loss of
brain function must be present.-All other conditions which can mimic brain death have
been excluded (intoxication, hypothermia, depressant drugs, shock, etc.).
-Both pupils must be fixed in a midsize or dilated position and not reactive to light.-No
evidence of arousal or awareness to maximal external stimulation (including noxious
visual, auditory, and tactile) exists.-No evidence of corneal, oculocephalic, and
oculovestibular reflexes.-No evidence of facial movement to noxious stimulation.-No
evidence of the gag reflex to bilateral pharyngeal stimulation.-No evidence of the cough
reflex to deep tracheal suctioning.-No evidence of brain-mediated motor responses in
the limbs to noxious stimuli.-No evidence of spontaneous respirations once one of the
apnea test targets (pH <7.30 or PaCO2 > 60 mm Hg) are achieved.
✔✔Omar is a 28-year-old male who was involved in a motor vehicle crash (MVC). He
sustained significant intracranial hemorrhage and has been de- clared brain dead by the
required standards. His wife states that he is moving and has been squeezing her hand.
What is the best response to Omar's wife? - ✔✔The movements you felt are not driven
by the brain. They are involuntary and do not represent life.
✔✔Roy is a 52-year-old male admitted to the ICU after a fall from a roof 6 hours ago.
He fell 8 feet from a ladder and landed on a concrete patio. He sustained several
broken ribs and a small subdural hematoma. Roy is minimally respon- sive and faint
bruising is noted under the eyes. Vital signs (VS) are as follows: blood pressure (BP)
202/110; heart rate (HR) 44; respiratory rate (RR) 12.What is the most likely underlying
cause of Roy's symptoms - ✔✔intracranial hypertension
✔✔Mechanism of Action: Anteroposterior - example - ✔✔pedestrian versus motor
vehicle
✔✔Mechanism of Action: lateral compression - example - ✔✔motor vehicle collision,
motorcycle, and direct crush injuries
✔✔Mechanism of Action: vertical sheer force - example - ✔✔fall or jump landing on a
straight leg
✔✔what is the difference between stable vs unstable pelvic fracture? - ✔✔pelvic ring
displacement:
, stable: do NOT involve the pelvic ring. minimally displaced fx.
unstable: In unstable fractures involving the pelvic ring, there is wide displacement with
the increased potential of damaging the underlying vessels and nerves.
✔✔what is the most common reversible cause of death in clients with pelvic fractures. -
✔✔Hemorrhage-Mortality in the first 24 hours of pelvic fracture is almost always related
to uncontrolled bleeding and hemorrhage.
✔✔6 main treatment modalities with pelvic fracture - ✔✔1.stabilize the pelvis - bind the
pelvis! 2.mass transfusions - initial rescusitation
3.interventional radiology -embolize sm areas of bleeding4.ExLap - lg bleeding
stabilization5.orthopedic surgery - vertical shear fractures and open pelvic fractures will
require intervention 6.supportive care - DVT prophylaxis, pain management, rehab,
PT/OT
✔✔unstable pelvic fracture - pelvic stabilization - ✔✔-controls bleeding-Binding of the
pelvis using a pelvis binder or even a sheet can prevent hemorrhaging until the client
can be taken to the operating room or interventional radiology.ATLS (Primary Surgery
order)-Compress (push in) iliac wings only oncePerineal and genital exam during
"Exposure" component of primary survey Place Temporary Pelvic binder at level of
greater trochanters during logroll Stat Pelvic X ray
✔✔ExLap (exploratory laparoscopy) for unstable pelvic fractures - ✔✔Significant free
fluid in the abdomen/pelvis or shock from suspected intraperitoneal bleeding warrants
exploratory laparotomy to locate and control the bleeding.-may need vascular surgery
depending.
✔✔Patient presents to the ER with suspected unstable pelvic fx. Which diagnostic tool
will you use first - ✔✔FAST EXAM!The Focused Assessment with Sonography for
Trauma (FAST) assessing for free fluid in the abdomen and pelvis.A large amount of
fluid in the abdomen/pelvis is an indication for emergent explorato- ry laparotomy to
evaluate and control bleeding before the client undergoes extensive imaging.
✔✔diagnosis recommendation for a stable pelvic fx. - ✔✔basic Xray (yes its broken, no
its not) no concerns for vasculature compromise
✔✔the preferred imaging modality for clients with injuries due to high-energy trauma, as
multiple body systems are likely to be injured. - ✔✔CT Scan
✔✔When injury to the vascular system is suspected, what diagnostic imaging is best? -
✔✔CT angiography can be performed to better localize the bleed.
✔✔how to assess for pelvic stability - ✔✔-placing the hands on the iliac crests-push
firmly down and then rocking from side to side.-If the pelvis is mobile, an unstable
GUARANTEE A+
✔✔Calculate the GCS for Aasan.
Aasan, an elderly client, was brought to the emergency department by EMS following a
fall. There is a large laceration on his occiput with profuse bleeding. He opens his eyes
when you speak to him, but his responses are incompre- hensible. He responds to
localized painful stimuli. - ✔✔Aasan's GCS score is 10
✔✔Roy has a suspected head injury. Which of the following clinical findings increases
suspicion for a basilar skull fracture? - ✔✔Periorbital ecchymosis
✔✔GCS Eye Response Grading - ✔✔Eye Opening (4)
1 - No eye opening.2 - Eye opening to pain.3 - Eye opening to verbal command. 4 -
Eyes open spontaneously.
✔✔GCS verbal response grading - ✔✔Verbal response (5)
1 - No verbal response 2 - Incomprehensible sounds. 3 - Inappropriate words.4 -
Confused 5 - Orientated
✔✔GCS motor response grading - ✔✔Motor Response (6)
1 - No motor response.
2 - Extension to pain.
3 - Flexion to pain.
4 - Withdrawal from pain.
5 - Localizing pain.
6 - Obeys Commands.
✔✔diagnostic imaging for skull fracture - ✔✔CT scan of the head.
✔✔Normal ICP - ✔✔Normal adult intracranial pressure (ICP) is less than or equal to 15
millimeters mercury (mmHg)
✔✔what does ICP above 15mmHg mean? - ✔✔are consistent with intracranial
hypertension. Intracranial hypertension is a symptom of underlying pathology which
causes an imbalance between pressure and volume
✔✔cerebral perfusion pressure (CPP) - ✔✔maintain cerebral perfusion pressure(CPP),
or the pressure needed to ensure blood flow to the brain -A normal CPP is 60-100 mm
Hg
✔✔how to calculate CPP - ✔✔Remember this formula: CPP = MAP - ICP
✔✔a CPP <50 is associated with what? - ✔✔ischemia and neuronal death.
,✔✔brain death - ✔✔Brain death is defined as the complete, irreversible cessation of all
brain function as a result of catastrophic damage to the brain and the absence of brain
stem function
✔✔3 cardinal findings of brain death - ✔✔1.coma/unresponsiveness, 2.absence of
brainstem reflexes 3.apnea.
✔✔The World Brain Death Project -clinical diagnostic criteria for brain death- - ✔✔An
established neurological diagnosis that is capable of causing the irreversible loss of
brain function must be present.-All other conditions which can mimic brain death have
been excluded (intoxication, hypothermia, depressant drugs, shock, etc.).
-Both pupils must be fixed in a midsize or dilated position and not reactive to light.-No
evidence of arousal or awareness to maximal external stimulation (including noxious
visual, auditory, and tactile) exists.-No evidence of corneal, oculocephalic, and
oculovestibular reflexes.-No evidence of facial movement to noxious stimulation.-No
evidence of the gag reflex to bilateral pharyngeal stimulation.-No evidence of the cough
reflex to deep tracheal suctioning.-No evidence of brain-mediated motor responses in
the limbs to noxious stimuli.-No evidence of spontaneous respirations once one of the
apnea test targets (pH <7.30 or PaCO2 > 60 mm Hg) are achieved.
✔✔Omar is a 28-year-old male who was involved in a motor vehicle crash (MVC). He
sustained significant intracranial hemorrhage and has been de- clared brain dead by the
required standards. His wife states that he is moving and has been squeezing her hand.
What is the best response to Omar's wife? - ✔✔The movements you felt are not driven
by the brain. They are involuntary and do not represent life.
✔✔Roy is a 52-year-old male admitted to the ICU after a fall from a roof 6 hours ago.
He fell 8 feet from a ladder and landed on a concrete patio. He sustained several
broken ribs and a small subdural hematoma. Roy is minimally respon- sive and faint
bruising is noted under the eyes. Vital signs (VS) are as follows: blood pressure (BP)
202/110; heart rate (HR) 44; respiratory rate (RR) 12.What is the most likely underlying
cause of Roy's symptoms - ✔✔intracranial hypertension
✔✔Mechanism of Action: Anteroposterior - example - ✔✔pedestrian versus motor
vehicle
✔✔Mechanism of Action: lateral compression - example - ✔✔motor vehicle collision,
motorcycle, and direct crush injuries
✔✔Mechanism of Action: vertical sheer force - example - ✔✔fall or jump landing on a
straight leg
✔✔what is the difference between stable vs unstable pelvic fracture? - ✔✔pelvic ring
displacement:
, stable: do NOT involve the pelvic ring. minimally displaced fx.
unstable: In unstable fractures involving the pelvic ring, there is wide displacement with
the increased potential of damaging the underlying vessels and nerves.
✔✔what is the most common reversible cause of death in clients with pelvic fractures. -
✔✔Hemorrhage-Mortality in the first 24 hours of pelvic fracture is almost always related
to uncontrolled bleeding and hemorrhage.
✔✔6 main treatment modalities with pelvic fracture - ✔✔1.stabilize the pelvis - bind the
pelvis! 2.mass transfusions - initial rescusitation
3.interventional radiology -embolize sm areas of bleeding4.ExLap - lg bleeding
stabilization5.orthopedic surgery - vertical shear fractures and open pelvic fractures will
require intervention 6.supportive care - DVT prophylaxis, pain management, rehab,
PT/OT
✔✔unstable pelvic fracture - pelvic stabilization - ✔✔-controls bleeding-Binding of the
pelvis using a pelvis binder or even a sheet can prevent hemorrhaging until the client
can be taken to the operating room or interventional radiology.ATLS (Primary Surgery
order)-Compress (push in) iliac wings only oncePerineal and genital exam during
"Exposure" component of primary survey Place Temporary Pelvic binder at level of
greater trochanters during logroll Stat Pelvic X ray
✔✔ExLap (exploratory laparoscopy) for unstable pelvic fractures - ✔✔Significant free
fluid in the abdomen/pelvis or shock from suspected intraperitoneal bleeding warrants
exploratory laparotomy to locate and control the bleeding.-may need vascular surgery
depending.
✔✔Patient presents to the ER with suspected unstable pelvic fx. Which diagnostic tool
will you use first - ✔✔FAST EXAM!The Focused Assessment with Sonography for
Trauma (FAST) assessing for free fluid in the abdomen and pelvis.A large amount of
fluid in the abdomen/pelvis is an indication for emergent explorato- ry laparotomy to
evaluate and control bleeding before the client undergoes extensive imaging.
✔✔diagnosis recommendation for a stable pelvic fx. - ✔✔basic Xray (yes its broken, no
its not) no concerns for vasculature compromise
✔✔the preferred imaging modality for clients with injuries due to high-energy trauma, as
multiple body systems are likely to be injured. - ✔✔CT Scan
✔✔When injury to the vascular system is suspected, what diagnostic imaging is best? -
✔✔CT angiography can be performed to better localize the bleed.
✔✔how to assess for pelvic stability - ✔✔-placing the hands on the iliac crests-push
firmly down and then rocking from side to side.-If the pelvis is mobile, an unstable
