Sherpath Questions with CORRECT Answers (Verified Update)
Q1: Which patient would be most at risk for mortality related to traumatic brain injury (TBI)?
A. 16-year-old with an accidental gunshot injury to the face
B. 22-year-old who fell off a ladder
C. 41-year-old who was in a motor vehicle accident
D. 67-year-old who fell down a flight of steps
Answer: D. 67-year-old who fell down a flight of steps
Q2: Cerebral edema from a traumatic brain injury would produce which intracra- nial change?
A. Increased cerebral perfusion
B. Decreased intracranial pressure
C. Decreased permeability of the blood-brain barrier
D. Increased tissue hypoxia
Answer: D. Increased tissue hypoxia
Q3: Which condition is associated with secondary injury experienced after a traumatic brain
injury (TBI)?
A. Hypoxia
B. Contusion
C. Laceration
D. Hemorrhage
Answer: A. Hypoxia
Q4: How would the nurse interpret a patient's assessment findings that include a 4-minute loss of
consciousness (LOC) and a score of 15 on the Glasgow Coma Scale (GCS)?
A. No evidence of brain injury
B. Mild traumatic brain injury
C. Moderate traumatic brain injury
D. Severe traumatic brain injury
Answer: B. Mild traumatic brain injury
, Q5: Which clinical manifestation would the nurse expect in a patient with a concussion? Select all
that apply. One, some, or all responses may be correct.
A. Disorientation
B. Nausea
C. Dizziness
D. Retrograde amnesia
E. Irritability
Answer: A. Disorientation
B. Nausea
C. Dizziness
D. Retrograde amnesia
E. Irritability
Q6: When caring for a patient with an epidural hematoma, which assessment finding would
indicate the need for an immediate craniotomy?
A. Increased level of consciousness
B. Inadequate oxygenation
C. Increased respiratory rate
D. Midline shift on a CT scan
Answer: D. Midline shift on a CT scan
Q7: The nurse would maintain a systolic blood pressure (SBP) greater than 110 mm Hg in a
patient with traumatic brain injury (TBI) who is which age? Select all that apply. One, some,
or all responses may be correct.
A. 16 years old
B. 42 years old
C. 57 years old
D. 65 years old
E. 84 years old
Answer: A. 16 years old
B. 42 years old
E. 84 years old
Q8: Which intervention would the nurse include in the plan of care for a mechan- ically ventilated
patient with a traumatic brain injury (TBI)?
A. Cluster nursing interventions.
B. Limit suctioning to four passes per episode.
C. Maintain PaCO2 level at 45 mm Hg or higher.
D. Use cooling blankets to maintain temperature at 37.
Answer: D. Use cooling blankets to maintain temperature at 37.
Q1: Which patient would be most at risk for mortality related to traumatic brain injury (TBI)?
A. 16-year-old with an accidental gunshot injury to the face
B. 22-year-old who fell off a ladder
C. 41-year-old who was in a motor vehicle accident
D. 67-year-old who fell down a flight of steps
Answer: D. 67-year-old who fell down a flight of steps
Q2: Cerebral edema from a traumatic brain injury would produce which intracra- nial change?
A. Increased cerebral perfusion
B. Decreased intracranial pressure
C. Decreased permeability of the blood-brain barrier
D. Increased tissue hypoxia
Answer: D. Increased tissue hypoxia
Q3: Which condition is associated with secondary injury experienced after a traumatic brain
injury (TBI)?
A. Hypoxia
B. Contusion
C. Laceration
D. Hemorrhage
Answer: A. Hypoxia
Q4: How would the nurse interpret a patient's assessment findings that include a 4-minute loss of
consciousness (LOC) and a score of 15 on the Glasgow Coma Scale (GCS)?
A. No evidence of brain injury
B. Mild traumatic brain injury
C. Moderate traumatic brain injury
D. Severe traumatic brain injury
Answer: B. Mild traumatic brain injury
, Q5: Which clinical manifestation would the nurse expect in a patient with a concussion? Select all
that apply. One, some, or all responses may be correct.
A. Disorientation
B. Nausea
C. Dizziness
D. Retrograde amnesia
E. Irritability
Answer: A. Disorientation
B. Nausea
C. Dizziness
D. Retrograde amnesia
E. Irritability
Q6: When caring for a patient with an epidural hematoma, which assessment finding would
indicate the need for an immediate craniotomy?
A. Increased level of consciousness
B. Inadequate oxygenation
C. Increased respiratory rate
D. Midline shift on a CT scan
Answer: D. Midline shift on a CT scan
Q7: The nurse would maintain a systolic blood pressure (SBP) greater than 110 mm Hg in a
patient with traumatic brain injury (TBI) who is which age? Select all that apply. One, some,
or all responses may be correct.
A. 16 years old
B. 42 years old
C. 57 years old
D. 65 years old
E. 84 years old
Answer: A. 16 years old
B. 42 years old
E. 84 years old
Q8: Which intervention would the nurse include in the plan of care for a mechan- ically ventilated
patient with a traumatic brain injury (TBI)?
A. Cluster nursing interventions.
B. Limit suctioning to four passes per episode.
C. Maintain PaCO2 level at 45 mm Hg or higher.
D. Use cooling blankets to maintain temperature at 37.
Answer: D. Use cooling blankets to maintain temperature at 37.
