BIOSC 0050-Chapter 63- Management of Patients With Neurologic Trauma

BIOSC 0050-Chapter 63- Management of Patients With Neurologic Trauma 1. After sustaining a fall at home, a patient is brought to the emergency room exhibiting altered level of consciousness. Following a skull x-ray, the patient is diagnosed with a basilar skull fracture. Which sign should alert the nurse to this type of fracture? A) Babinski's sign B) Kernig's sign C) Battle's sign D) Brudzinski's sign Ans: C Chapter: 63 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Patient Needs: A-1 Feedback: An area of ecchymosis (bruising) may be seen over the mastoid (Battle's sign) in a basilar skull fracture. A positive Kernig's sign and positive Brudzinski's sign indicate meningeal irritation. Babinski's sign (reflex) is indicative of central nervous system (CNS) disease in the corticospinal tract. 2. A patient brought to the trauma center by ambulance sustained a high cervical spinal cord injury 2 hours ago. The nurse knows that which of the following medications will be given to prevent further spinal cord damage? A) Furosemide (Lasix) B) Methylprednisolone (Solu-Medrol) C) Cyclobenzaprine (Flexeril) D) Hydralazine hydrochloride (Apresoline) Ans: B Chapter: 63 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Patient Needs: D-2 Feedback: The administration of high-dose corticosteroids, specifically methylprednisolone, has been found to improve motor and sensory outcomes at 6 weeks, 6 months, and 1 year if given within 8 hours of injury. Lasix, Flexeril, and Apresoline are used in the management of spinal cord injury but do not specifically prevent further spinal cord damage. 3. A nurse is performing pin site care to a patient in halo traction following a spinal cord injury. One of the traction pins becomes detached when the patient is turned. The nurse would be correct in implementing which of the following priority nursing actions? A) Complete the pin site care to decrease risk of infection. B) Notify the neurosurgeon of the occurrence. C) Stabilize the head in a lateral position. D) Reattach the pin to prevent further head trauma. Ans: B Chapter: 63 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Patient Needs: D-3 Feedback: If one of the pins becomes detached, the patient's head should be stabilized in neutral position by one person while another notifies the neurosurgeon. A torque screwdriver is used when the screws on the frame need tightening. Reattaching the pin would not be done as a nursing intervention due to risk of increased injury. Pin site care would not be a priority in this instance. Prevention of neurological injury is the priority. 4. The nurse observing a patient with autonomic dysreflexia would expect which of the following clinical manifestations? A) Tachycardia and hypotension B) Bradycardia and hypertension C) Tachycardia and hypertension D) Bradycardia and hypotension Ans: B Chapter: 63 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 6 Patient Needs: A-1 Feedback: Autonomic dysreflexia is characterized by a pounding headache, profuse sweating, nasal congestion, piloerection (goose bumps), bradycardia, and hypertension. It occurs in cord lesions above T6 after spinal shock has resolved. 5. The nurse is caring for a patient with increased intracranial pressure (ICP) caused by a traumatic brain injury. Which of the following clinical manifestations would indicate that the patient is experiencing increased brain compression causing brain stem damage? A) Hyperthermia B) Tachycardia C) Hypertension D) Bradypnea Ans: A Chapter: 63 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Patient Needs: A-1 Feedback: A rapid rise in body temperature is regarded as unfavorable. Hyperthermia increases the metabolic demands of the brain and may indicate brain stem damage. Other signs of increasing ICP include slowing of the heart rate (bradycardia), increasing systolic blood pressure, and widening pulse pressure. As brain compression increases, respirations become rapid, blood pressure may decrease, and the pulse slows further. 6. Based on the nurse's knowledge of the progression of an epidural hematoma, which priority intervention is prepared for? A) Insertion of an intracranial (IC) monitoring device B) Treatment with antihypertensives C) Emergency craniotomy D) Administration of anticoag