Chapter 36- Traumatic Brain Injury My Nursing Test Banks

 

1.

A patient who was in a motor vehicle accident struck her forehead on the windshield of her car after crashing into the back of another car. Given this mechanism of injury, which regions of the brain are most likely to be injured? Select all that apply.

A)

Frontal lobes

B)

Parietal lobes

C)

Occipital lobes

D)

Temporal lobes

E)

Diencephalon

F)

Medulla oblongata

2.

A patient was involved in a fight in which he was struck in the back of the head with a blunt object. Scalp laceration is immediately evident. The nurse suspects cerebral edema and ischemia. On CT scan, it appears that he has contusions and a fractured skull. On neurological assessment, the nurse finds evidence of concussion, as the patient demonstrates short-term memory impairment. Of these findings, which are secondary brain injuries? Select all that apply.

A)

Scalp laceration

B)

Cerebral edema

C)

Ischemia

D)

Contusions

E)

Fractured skull

F)

Concussion

3.

Following cerebral angiography, a patient is found to have carotid artery dissection. What critical complication associated with this injury should the nurse be most concerned about because it could lead to stroke?

A)

Concussion

B)

Hemorrhage

C)

Diffuse axonal injury

D)

Coma

4.

A patient with traumatic brain injury is experiencing cerebral edema, which has led to severely elevated intracranial pressure. He has increased pulse pressure, decreased heart rate, and an irregular respiratory pattern. He has lost consciousness and demonstrates bilateral pupillary dilation. The nurse recognizes that these symptoms point to which condition?

A)

Central herniation syndrome

B)

Uncal herniation syndrome

C)

Cerebrovascular injury

D)

Diffuse axonal injury

5.

A patient with traumatic brain injury is being assessed. This patient demonstrates gross defects in visual acuity on reading a Snellen eye chart. Which cranial nerve is most likely damaged?

A)

Cranial nerve I

B)

Cranial nerve II

C)

Cranial nerve III

D)

Cranial nerve IV

6.

A comatose patient with a traumatic brain injury is being tested for cranial nerve damage. The nurse passes a wisp of cotton over the lower conjunctiva of each eye. The patients lower eyelid in each eye twitches when the cotton makes contact with the cornea. The nurse recognizes that this result indicates which of the following?

A)

The trigeminal nerve is functioning properly but the facial nerve is not

B)

The facial nerve is functioning properly but the trigeminal nerve is not

C)

Neither the trigeminal nerve nor the facial nerve is functioning properly

D)

Both the trigeminal and the facial nerves are functioning properly

7.

A patient with traumatic brain injury is found to have bilateral lesions deep in the cerebral hemispheres. What respiratory pattern should the nurse most expect to find in this patient?

A)

Alternating hyperpneic and apneic phases (Cheyne-Stokes breathing)

B)

Sustained, regular, rapid, and deep hyperventilation (neurogenic hyperventilation)

C)

Long pause at full inspiration or full expiration (apneustic breathing)

D)

Gasping breaths with irregular pauses (cluster breathing)

8.

A patient is suspected of having injury to his carotid artery following trauma to his neck after engaging in a fight during a hockey game. Which diagnostic test would be most effective in investigating this injury?

A)

Computed tomography (CT)

B)

Magnetic resonance imaging (MRI)

C)

Electroencephalogram (EEG)

D)

Cerebral angiography

9.

An inexperienced nurse who is new to the ICU is examining the eyes of a comatose patient with traumatic brain injury who is on a ventilator. In doing so, she turns the patients head sharply to one side. After she is finished, she leaves the patients head turned to the side. A more experienced nurse sees this and cautions the new nurse not to turn the patients head so sharply or leave it in that position. What is the best rationale for the more experienced nurses admonition?

A)

Compression of the jugular vein leading to increased intracranial pressure

B)

Lack of a patent airway

C)

Lack of dignity for the patient

D)

Cramping of neck muscles

10.

A nurse is caring for a patient with a traumatic brain injury who is paralyzed. The nurse must decide how best to meet the nutritional needs of this patient. What intervention is best to support the nutritional needs of the patient?

A)

Replace 140% of the patients resting energy expenditure via parenteral nutrition.

B)

Meet metabolic demands of the patient within 8 to 10 days of the injury.

C)

Collaborate with a nutrition support team to meet the patients nutritional needs.

D)

Maintain the patients blood sugar level at 300 mg/dL.

11.

A patient has experienced a traumatic brain injury. During initial assessment, the nurse determines that the mechanism of injury was accelerationdeceleration. What is the best rationale for this nursing assessment?

A)

Helps to predict nature of internal injuries

B)

Satisfied the nurses curiosity

C)

Required on admission form

D)

May be part of legal evidence

12.

A patient with a traumatic brain injury is at high risk for a secondary brain injury. What is the best nursing explanation of a secondary brain injury?

A)

Result of a repeated assault incident

B)

From a penetrating gunshot wound

C)

Trauma inflicted by another person

D)

Cerebral edema and ischemia

13.

The patient has a depressed skull fracture resulting in a tear of the dura mater. What nursing intervention is most directed at preventing a significant complication of this particular injury?

A)

Elevating the head of the bed to 15 degrees

B)

Giving supplemental oxygen by mask

C)

Ensuring compliance with hand hygiene protocols

D)

Obtaining consent for surgical repair of fracture

14.

A patient with a skull fracture has a positive halo sign. What does this sign indicate?

A)

Fracture of the anterior fossa

B)

Presence of a basilar skull fracture

C)

Impingement of cranial nerves

D)

Cerebrospinal fluid leak

15.

A patient with a suspected skull fracture is observed to have raccoon eyes, or bilateral periorbital bruising. What other symptom does the nurse expect?

A)

Positive Battles sign

B)

Cerebrospinal fluid rhinorrhea

C)

Cerebrospinal fluid otorrhea

D)

Maxillarycranial separation

16.

About 6 weeks after a concussion injury, the patient is complaining of headaches, decreased attention span, and short-term memory impairment. The patient expresses extreme frustration and anxiety. What is the best nursing intervention?

A)

Obtain an order for a repeat computed tomography (CT) scan

B)

Admit the patient for a complete neurologic evaluation

C)

Provide emotional support and explanations

D)

Refer to psychiatry for evaluation and treatment

17.

The patient has an acute subdural hematoma from an acute head injury. What is the most typical symptom that the nurse would expect during the first 2 days after the injury?

A)

Decreasing level of consciousness

B)

Labile blood pressure

C)

Cardiac dysrhythmias

D)

Impingement of cranial nerve 8

18.

The nurse is evaluating the cognitive function of a patient with impaired neurologic functioning after an acute brain injury. What is the best nursing approach for evaluation of orientation to person, place, and time?

A)

Ask exactly the same questions each time.

B)

Ask if the patient knows where he is.

C)

Vary the questions slightly each time.

D)

Ask the family to corroborate information.

19.

The nurse is assessing a patients level of arousal. Since the patient is unresponsive to verbal and touch stimulation, the nurse decides to try a central pain stimulus. What technique would the nurse be least likely to use?

A)

Squeeze the trapezius muscle.

B)

Apply pressure over the supraorbital notch.

C)

Apply pressure to closed eyelids.

D)

Perform a sternal rub.

20.

A patient with a traumatic brain injury is given IV phenytoin to prevent seizures. Three days after the drug is started, the patient develops a red, vesicular rash on her trunk. What is the most appropriate collaborative intervention?

A)

Administer an antihistamine.

B)

Discontinue phenytoin.

C)

Evaluate for contact dermatitis.

D)

Place in contact isolation.

21.

A patient with a neurologic deficit following traumatic brain injury is making very slow progress toward normal. The family expresses distress and worry about financial and other matters to the nurse. What is the nurses best response?

A)

Referral for nursing home placement

B)

Questions about insurance status

C)

Referral to psychiatry for evaluation

D)

Referral to multidisciplinary rehabilitation team

Answer Key

1.

A, C

2.

B, C

3.

B

4.

A

5.

B

6.

D

7.

A

8.

D

9.

A

10.

C

11.

A

12.

D

13.

C

14.

D

15.

B

16.

C

17.

A

18.

C

19.

C

20.

B

21.

D

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