NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update |100% Correct Elaborations-
Walden
coup-contrecoup injury
Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup
injury occurs on the opposite side of impact, as the brain rebounds.
Scalp laceration: what, effect, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to nose/ ears
Skull fracture: types, effect, management
Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure precautions
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update |100% Correct Elaborations-
Walden
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management
Primary head injury
Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater than 2min
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual changes
seizure precautions
Hematoma - neuro: types, effect, management
Epidural hematoma: commonly temporal/ parietal region with skull fracture, causing bleeding
into epidural space
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update |100% Correct Elaborations-
Walden
Lossd1ofd1consciousness
Rapidd1deterioration:d1obtunded,d1contralaterald1hemiparesis,d1ipsilaterald1pupild1di
lationd1CTd1scand1(nond1contrast)
Treatmentd1basedd1ond1Braind1traumad1foundation.d1Surgicald1ifd1greaterd1thand130cm
Subdurald1hematoma
mostd1commond1typed1ofd1intracraniald1bleed
Acuted1(hours):d1drowsy,d1agitated,d1confused,d1headache,d1pupild1dil
ation,d1CTd1scand1(noncontrast)
surgeryd1ford110mmd1thicknessd1ord15mmd1midlined1shiftd1ord1ford1worseningd
1GCSd1Chronicd1(days):d1headache,d1memoryd1loss,d1incontinence
CTd1scand1(noncontrast)d1S
urgery:d1burrd1holes/d1crani
Cerebrald1edema/d1ICPd1elevated/d1herniation:d1symptoms,d1manage
mentd1decreasedd1leveld1ofd1consciousness
Blownd1pupil
Cushingd1triad:d1HTNd1(wideningd1pulsed1pressure),d1decreasedd1respd1rate,d1bradycardiad1(me
ansd1increasedd1intracraniald1pressure)
Neurod1examd1components
AVPU:d1awake,d1responsed1tod1verbald1stimuli,d1painfuld1stimuli,d1unresponsive
, NRNPd16566/d1NRNP6566d1Finald1Examd1|d 1 Advancedd1Cared
1ofd1Adultsd1ind1Acuted1Settingsd1Id1|d1Questionsd1andd1Verifiedd1
Answers|d1Latestd12025/d12026d1Updated1|100%d1Correctd1Ela
borations-d1Walden
GCS:d18d1ord1belowd1isd1comatose
Posturing:
decorticated1=d1arms,d1legsd
1ind1decerebrated1=d1arms,d1
legsd1out
Electrolyted1imbalancesd1ind1braind1injuryd1Hypon
atremia:d1SIADHd1andd1cerebrald1saltd1wastingd1H
ypernatremia:d1DId1(gived1mannitol)
Managementd1ofd1traumaticd1braind1injury
- Consultd1neurosurgery
- Limitd1secondaryd1injury
- Preventd1hypotensiond1(systd190)d1andd1hypoxemiad1(PaO2d160).d1Mayd1gived1bloodd1tod1
improved1tissued1perfusion.
- Treatd1cerebrald1edema:d1elevated1bed,d1sedate,d1paralyse,d1mannitol,d1hyperventilationd1(PaC
O2d125-30),d1duringd1firstd124hrs.
- sedationd1andd1analgesia:d1opioidsd1tod1reduced1ICPd1(Fentanyl)d1withd1propofol.d1Couldd1gi
ved1Nimbexd1ord1Vec.d1tod1helpd1oxygenate/d1ventilate
- steroids:d1avoid
- Gived1mannitold1ord1hypertonicd1salined1ford1herniation:d1bolusd1thend1gtt.d1monitord1seru
md1osmolality,d1sodium,d1andd1bp.
- Seizured1precautions:d1gived1phenytoind1ord1keppra
- DVTd1prophylaxis:d1stockings,d1LMWH
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update |100% Correct Elaborations-
Walden
coup-contrecoup injury
Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup
injury occurs on the opposite side of impact, as the brain rebounds.
Scalp laceration: what, effect, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to nose/ ears
Skull fracture: types, effect, management
Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure precautions
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update |100% Correct Elaborations-
Walden
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management
Primary head injury
Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater than 2min
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual changes
seizure precautions
Hematoma - neuro: types, effect, management
Epidural hematoma: commonly temporal/ parietal region with skull fracture, causing bleeding
into epidural space
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update |100% Correct Elaborations-
Walden
Lossd1ofd1consciousness
Rapidd1deterioration:d1obtunded,d1contralaterald1hemiparesis,d1ipsilaterald1pupild1di
lationd1CTd1scand1(nond1contrast)
Treatmentd1basedd1ond1Braind1traumad1foundation.d1Surgicald1ifd1greaterd1thand130cm
Subdurald1hematoma
mostd1commond1typed1ofd1intracraniald1bleed
Acuted1(hours):d1drowsy,d1agitated,d1confused,d1headache,d1pupild1dil
ation,d1CTd1scand1(noncontrast)
surgeryd1ford110mmd1thicknessd1ord15mmd1midlined1shiftd1ord1ford1worseningd
1GCSd1Chronicd1(days):d1headache,d1memoryd1loss,d1incontinence
CTd1scand1(noncontrast)d1S
urgery:d1burrd1holes/d1crani
Cerebrald1edema/d1ICPd1elevated/d1herniation:d1symptoms,d1manage
mentd1decreasedd1leveld1ofd1consciousness
Blownd1pupil
Cushingd1triad:d1HTNd1(wideningd1pulsed1pressure),d1decreasedd1respd1rate,d1bradycardiad1(me
ansd1increasedd1intracraniald1pressure)
Neurod1examd1components
AVPU:d1awake,d1responsed1tod1verbald1stimuli,d1painfuld1stimuli,d1unresponsive
, NRNPd16566/d1NRNP6566d1Finald1Examd1|d 1 Advancedd1Cared
1ofd1Adultsd1ind1Acuted1Settingsd1Id1|d1Questionsd1andd1Verifiedd1
Answers|d1Latestd12025/d12026d1Updated1|100%d1Correctd1Ela
borations-d1Walden
GCS:d18d1ord1belowd1isd1comatose
Posturing:
decorticated1=d1arms,d1legsd
1ind1decerebrated1=d1arms,d1
legsd1out
Electrolyted1imbalancesd1ind1braind1injuryd1Hypon
atremia:d1SIADHd1andd1cerebrald1saltd1wastingd1H
ypernatremia:d1DId1(gived1mannitol)
Managementd1ofd1traumaticd1braind1injury
- Consultd1neurosurgery
- Limitd1secondaryd1injury
- Preventd1hypotensiond1(systd190)d1andd1hypoxemiad1(PaO2d160).d1Mayd1gived1bloodd1tod1
improved1tissued1perfusion.
- Treatd1cerebrald1edema:d1elevated1bed,d1sedate,d1paralyse,d1mannitol,d1hyperventilationd1(PaC
O2d125-30),d1duringd1firstd124hrs.
- sedationd1andd1analgesia:d1opioidsd1tod1reduced1ICPd1(Fentanyl)d1withd1propofol.d1Couldd1gi
ved1Nimbexd1ord1Vec.d1tod1helpd1oxygenate/d1ventilate
- steroids:d1avoid
- Gived1mannitold1ord1hypertonicd1salined1ford1herniation:d1bolusd1thend1gtt.d1monitord1seru
md1osmolality,d1sodium,d1andd1bp.
- Seizured1precautions:d1gived1phenytoind1ord1keppra
- DVTd1prophylaxis:d1stockings,d1LMWH
