Managing patients with severe traumatic brain injury

doi: 10.1097/01.NURSE.0000444642.83033.46
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INSTRUCTIONS Managing patients with severe traumatic brain injury


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Managing patients with severe traumatic brain injury

GENERAL PURPOSE: To provide an overview of TBI and its implications for patient care. LEARNING OBJECTIVES: After reading this article and taking the test, you should be able to: 1. Identify the causes of TBI. 2. Choose appropriate nursing interventions for patients with severe TBI.

1. Which is an example of a diffuse brain injury?

a. contusion

b. laceration

c. hematoma

d. concussion

2. Which group has the highest rate of TBI hospitalization and death?

a. children age 4 years and younger

b. adults age ≥ 75

c. women ages 30 to 40

d. adults ages 20 to 24

3. Which GCS score indicates moderate TBI?

a. 3 to 5

b. 6 to 8

c. 9 to 12

d. 13 to 15

4. The mechanism of injury associated with coup-contracoup injuries is

a. acceleration-deceleration.

b. rotational.

c. angular acceleration.

d. DAI.

5. Which statement about DAI is true?

a. It's readily demonstrated on noncontrast CT scan.

b. Severe DAI often occurs in the brain stem.

c. DAI is a common secondary injury.

d. DAI results from penetrating head injuries.

6. What's the primary tenet of the Monro-Kellie hypothesis?

a. The brain accounts for 60% of the skull's contents.

b. Decreased ICP leads to neurologic deterioration.

c. Cerebral edema causes brain herniation.

d. A rigid container (the skull) can't expand.

7. Which of the following is correct about secondary brain injury?

a. It's associated with lower mortality than primary injury.

b. It's often related to hypoxia and hypoperfusion.

c. It can be prevented by keeping BP at hypotensive levels.

d. It's more easily treated than primary injury.

8. In the ED, care for a patient with severe TBI begins with

a. transporting the patient to a trauma center.

b. protecting the patient's airway and maintaining oxygenation.

c. establishing peripheral venous access.

d. initiating cardiac monitoring.

9. Which statement about ICP monitoring in adults with TBI is accurate?

a. The ICP target is often 30 mm Hg.

b. Monitoring should be initiated in any patient with a GCS score < 12.

c. The ICP target is < 20 mm Hg.

d. Lab specimens should be collected after ICP catheter placement.

10. Which statement is correct about CPP?

a. It's an estimate of the adequacy of cerebral circulation.

b. It's measured directly using a ventricular catheter.

c. It's normally 50 mm Hg or less.

d. It represents the volume of CSF.

11. Which of the following raises ICP?

a. avoiding extreme hip flexion

b. maintaining the cervical spine in neutral position

c. elevating the head of the bed

d. lateral neck flexion

12. Mannitol helps manage TBI by

a. increasing brain volume.

b. drawing water from the intravascular space to the brain parenchyma.

c. decreasing cerebral edema.

d. increasing ICP.

13. Which of the following is correct about propofol?

a. It prevents hypotension.

b. It's a slow-acting analgesic.

c. It permits intermittent neurologic assessment.

d. It has a long half-life.

14. Which medication is contraindicated in patients with an egg allergy?

a. dexmedetomidine

b. propofol

c. fentanyl

d. mannitol

15. Which drug is a relatively selective alpha2-adrenergic agonist?

a. midazolam

b. dexmedetomidine

c. propofol

d. fentanyl

16. The goal of decompressive craniectomy is to

a. prevent brain herniation.

b. reverse brain damage.

c. prevent the brain from expanding.

d. increase ICP.

17. Which statement is true about postdecompressive craniectomy care?

a. Cerebral blood flow isn't likely to change postoperatively.

b. Advanced neuromonitoring devices are always placed intraoperatively.

c. PaCO2 is maintained between 35 and 45 mm Hg.

d. Therapeutic hypothermia is a standard of care.

18. Which factor is associated with fewer infections and lower overall complications?

a. decreased metabolic demands

b. sympathetic storming

c. early enteral feeding

d. abnormal posturing

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