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Chapter 18 Question 1 A patient comes into the emergency department with complaints of headache, lethargy, and vomiting. He reports being hit in the head by a batted baseball during a company picnic “about 6 weeks ago.” The nurse would ask additional assessment questions regarding which condition? 1. Acute subdural hematoma 2. Subacute subdural hematoma 3. Epidural hematoma 4. Chronic subdural hematoma Question 2 The nurse is caring for a patient recovering from surgery to evacuate an epidural hematoma. Which assessment finding would warrant immediate collaboration with the surgeon? 1. Urine output has dropped from 100 mL each hour to 60 mL per hour. 2. The patient’s hand grasps are weak bilaterally. 3. Fine crackles can be auscultated in the lung bases bilaterally. 4. The pupil on the side of the injury has become fixed and dilated. Question 3 The family of a patient with a concussion is concerned that the patient continues to complain of and demonstrate ongoing neurological deficits even though the injury occurred 6 weeks ago. What information should the nurse provide? 1. Symptoms of the concussion will continue for most of the patient’s life. 2. The concussion might be healed; however, the patient will not recover from the symptoms. 3. Symptoms of the concussion will come and go depending upon the patient’s health status. 4. Symptoms of a concussion can last 3 months or more. Question 4 A patient diagnosed with mild diffuse axonal injury is being admitted to the intensive care unit. The nurse would anticipate which assessment findings? 1. The accident causing this injury occurred several weeks ago. 2. There are symptoms that are similar to those demonstrated by a patient who sustained a concussion. 3. There is dilation of the pupils for several hours post injury. 4. There is presence of coma that may last for an extended period of time. Question 5 A patient with a moderate diffuse head injury is demonstrating a variety of neurological symptoms. What is the priority when caring for this patient? 1. Electrolyte replacements 2. Maintain adequate fluid volume. 3. Supporting nutritional needs 4. Maintain stable cerebral perfusion pressure. Question 6 A patient is admitted with a traumatic brain injury. The nurse would anticipate participating in interventions toward which immediate goal? 1. Reducing cerebral swelling 2. Confining inflammation to one area 3. Supporting absorption of debris from neuronal death 4. Limiting ischemic tissue injury Question 7 A patient with traumatic brain injury has had placement of an intraventricular catheter (IVC). The nurse participates in level two interventions to reduce intracranial pressure (ICP) through which uses of this catheter? 1. Assessing of color of the cerebral spinal fluid 2. Assessing of the amount of cerebral spinal fluid 3. Instillation of hyperosmolar therapy via the catheter 4. Draining CSF 5. Directly monitoring the ICP Question 8 A patient with traumatic brain injury continues to have increased intracranial pressure despite conventional therapeutic interventions. The nurse would anticipate which level four intervention? 1. High-dose barbiturate therapy 2. High-volume intravenous fluids 3. Hyperbaric oxygen therapy 4. Hyperosmolar therapy Question 9 A patient diagnosed with a traumatic brain injury is receiving mannitol. The nurse would evaluate which findings as indicating this therapy is having its desired effects? 1. ICP is increasing 2. Serum sodium is 148 mEq/L 3. Serum osmolality is 300 mOsm 4. Osmotic gap is 12 Question 10 A patient being treated for increased intracranial pressure from a traumatic brain injury demonstrates an increase in pressure with minimal care activity. What instruction should the nurse provide the nursing student assisting with care for this patient? 1. “We will let this patient rest between his bath and changing his linens.” 2. “We are going to bath this patient, get his linens changed, suction him, and do all of our other care early this morning, so he can get a long rest this afternoon.” 3. “Be certain that we don’t raise this patient’s head above 10 degrees during his bath.” 4. “You have to learn to suction patients with traumatic brain injury very quickly, taking no more than 30 seconds.”