Page 1 Lewis Chapter 56 Acute Intracrainal Problems
A 19-year-old woman is hospitalized for a frontal skull A
fracture from a blunt force head injury. Clear fluid is Cerebrospinal fluid (CSF) rhinorrhea (clear or bloody drainage from the
draining from the patient's nose. What action by the nose) may occur with a frontal skull fracture. If CSF rhinorrhea occurs, the
nurse is most appropriate? nurse should inform the physician immediately. A loose collection pad may
be placed under the nose. The head of the bed may be raised to decrease
A. Apply a loose gauze pad under the patient's nose. the CSF pressure so that a tear can seal. The nurse should not place a
B. Place the patient in a modified Trendelenburg dressing or tube in the nasal cavity, and the patient should not sneeze or
position. blow the nose.
C. Ask the patient to gently blow the nose to clear the
drainage.
D. Gently insert a catheter in the nares and suction the
drainage.
Lewis Chapter 56 Acute Intracrainal Problems 1
,Page 2 Lewis Chapter 56 Acute Intracrainal Problems
A 32-year-old female patient is diagnosed with D
diabetes insipidus after transsphenoidal resection of a Laboratory findings in diabetes insipidus include an elevation in serum
pituitary adenoma. What should the nurse consider as osmolality and serum sodium and a decrease in urine specific gravity.
a sign of improvement? Normal serum osmolality is 275 to 295 mOsm/kg, normal serum sodium is
135 to 145 mEq/L, and normal specific gravity is 1.003 to 1.030. Elevated
A. Serum sodium of 120 mEq/L blood glucose levels occur with diabetes mellitus.
B. Urine specific gravity of 1.001
C. Fasting blood glucose of 80 mg/dL
D. Serum osmolality of 290 mOsm/kg
Lewis Chapter 56 Acute Intracrainal Problems 2
,Page 3 Lewis Chapter 56 Acute Intracrainal Problems
A 54-year old man is recovering from a skull fracture C.
with a subacute subdural hematoma. He has return of Residual mental and emotional changes of brain trauma with personality
motor control and orientation but appears apathetic changes are often the most incapacitating problems following head injury
and has reduced awareness of his environment. When and are common in patients who have been comatose longer than 6 hours.
planning discharge or the patient, the nurse explains Families must be prepared for changes in the patient's behavior to avoid
to the patient and the family that family-patient friction and maintain family functioning, and professional
assistance may be required. There is no indication he will be dependent on
a. continuous improvement in the patient's condition others for care, but he likely will not return to pre trauma status
should occur until he has returned to pre trauma
status
b. the patient's complete recovery may take years,
and the family should plan for his long term
dependent care
c. the patient is likely to have long term emotional and
mental changes that may require continued
professional help
d. role changes in family members will be necessary
because the patient will be dependent on his family
for care and support
Lewis Chapter 56 Acute Intracrainal Problems 3
, Page 4 Lewis Chapter 56 Acute Intracrainal Problems
A 68-year-old man with suspected bacterial C
meningitis has just had a lumbar puncture in which Bacterial meningitis is a medical emergency. When meningitis is suspected,
cerebrospinal fluid was obtained for culture. Which antibiotic therapy (e.g., ceftriaxone) is instituted immediately after the
medication should the nurse administer first? collection of specimens for cultures, and even before the diagnosis is
confirmed. Dexamethasone may also be prescribed before or with the first
A. Codeine dose of antibiotics. The nurse should collaborate with the health care
B. Phenytoin (Dilantin) provider to manage the headache (with codeine), fever (with
C. Ceftriaxone (Rocephin) acetaminophen), and seizures (with phenytoin).
D. Acetaminophen (Tylenol)
Lewis Chapter 56 Acute Intracrainal Problems 4
A 19-year-old woman is hospitalized for a frontal skull A
fracture from a blunt force head injury. Clear fluid is Cerebrospinal fluid (CSF) rhinorrhea (clear or bloody drainage from the
draining from the patient's nose. What action by the nose) may occur with a frontal skull fracture. If CSF rhinorrhea occurs, the
nurse is most appropriate? nurse should inform the physician immediately. A loose collection pad may
be placed under the nose. The head of the bed may be raised to decrease
A. Apply a loose gauze pad under the patient's nose. the CSF pressure so that a tear can seal. The nurse should not place a
B. Place the patient in a modified Trendelenburg dressing or tube in the nasal cavity, and the patient should not sneeze or
position. blow the nose.
C. Ask the patient to gently blow the nose to clear the
drainage.
D. Gently insert a catheter in the nares and suction the
drainage.
Lewis Chapter 56 Acute Intracrainal Problems 1
,Page 2 Lewis Chapter 56 Acute Intracrainal Problems
A 32-year-old female patient is diagnosed with D
diabetes insipidus after transsphenoidal resection of a Laboratory findings in diabetes insipidus include an elevation in serum
pituitary adenoma. What should the nurse consider as osmolality and serum sodium and a decrease in urine specific gravity.
a sign of improvement? Normal serum osmolality is 275 to 295 mOsm/kg, normal serum sodium is
135 to 145 mEq/L, and normal specific gravity is 1.003 to 1.030. Elevated
A. Serum sodium of 120 mEq/L blood glucose levels occur with diabetes mellitus.
B. Urine specific gravity of 1.001
C. Fasting blood glucose of 80 mg/dL
D. Serum osmolality of 290 mOsm/kg
Lewis Chapter 56 Acute Intracrainal Problems 2
,Page 3 Lewis Chapter 56 Acute Intracrainal Problems
A 54-year old man is recovering from a skull fracture C.
with a subacute subdural hematoma. He has return of Residual mental and emotional changes of brain trauma with personality
motor control and orientation but appears apathetic changes are often the most incapacitating problems following head injury
and has reduced awareness of his environment. When and are common in patients who have been comatose longer than 6 hours.
planning discharge or the patient, the nurse explains Families must be prepared for changes in the patient's behavior to avoid
to the patient and the family that family-patient friction and maintain family functioning, and professional
assistance may be required. There is no indication he will be dependent on
a. continuous improvement in the patient's condition others for care, but he likely will not return to pre trauma status
should occur until he has returned to pre trauma
status
b. the patient's complete recovery may take years,
and the family should plan for his long term
dependent care
c. the patient is likely to have long term emotional and
mental changes that may require continued
professional help
d. role changes in family members will be necessary
because the patient will be dependent on his family
for care and support
Lewis Chapter 56 Acute Intracrainal Problems 3
, Page 4 Lewis Chapter 56 Acute Intracrainal Problems
A 68-year-old man with suspected bacterial C
meningitis has just had a lumbar puncture in which Bacterial meningitis is a medical emergency. When meningitis is suspected,
cerebrospinal fluid was obtained for culture. Which antibiotic therapy (e.g., ceftriaxone) is instituted immediately after the
medication should the nurse administer first? collection of specimens for cultures, and even before the diagnosis is
confirmed. Dexamethasone may also be prescribed before or with the first
A. Codeine dose of antibiotics. The nurse should collaborate with the health care
B. Phenytoin (Dilantin) provider to manage the headache (with codeine), fever (with
C. Ceftriaxone (Rocephin) acetaminophen), and seizures (with phenytoin).
D. Acetaminophen (Tylenol)
Lewis Chapter 56 Acute Intracrainal Problems 4
