NSG 233 Med Surg 3 Exam UPDATED
QUESTIONS AND CORRECT ANSWERS
What is the cardinal behavioral sign of a frontal lobe traumatic brain injury? - CORRECT
ANSWER Bizarre or irrational behavior.
What is the cardinal neurologic sign of a temporal lobe traumatic brain injury? - CORRECT
ANSWER Amnesia or disorientation.
Upon discharge, which s/s would you teach the patient to return to the emergency department if they
begin experiencing? - CORRECT ANSWER - decreased LOC.
- worsening headache.
- Dizziness.
- Seizures.
- Abnormal pupil response.
- vomiting.
- irritability.
- slurred speech.
- weakness or numbness of the extremities.
What are the three cardinal signs of brain death? - CORRECT ANSWER 1. coma.
2. absence of reflexes.
3. apnea.
What GCS score indicates a severe traumatic brain injury? - CORRECT ANSWER A score of
3-8.
What are the three signs of the Cushing's Triad and what do they indicate? - CORRECT
ANSWER 1. Bradycardia (decreased heart rate).
2. Widening pulse pressure (SBP is rising).
3. Irregular respirations.
,- Cushing's Triad indicates increased intracranial pressure.
What is a common electrolyte imbalance in patients who experience a TBI? - CORRECT
ANSWER Hyponatremia (low sodium).
Normal sodium levels are 135-145 mEq/L.
What are some nursing interventions for a TBI? - CORRECT ANSWER - Maintain a patent
airway.
- monitor neurologic function (neuro checks).
- monitor vitals (look for Cushing's triad).
- POSITION HOB AT 30 DEGREES WITH THE NECK IN A NEUTRAL POSITION TO PROTECT
C-SPINE.
- assess motor function.
- monitor for fluid and electrolyte imbalances, especially sodium.
- promote adequate nutrition.
- maintain thermoregulation.
- maintain skin integrity.
- early administration of anticonvulsants.
- maintain cerebral perfusion pressure.
What can hyponatremia cause? What precautions do we need to place our patient on because of this? -
CORRECT ANSWER Seizures!
Seizure precautions.
What should cerebral perfusion pressure be maintained at? - CORRECT ANSWER Above 50
mmHg.
What are three common symptoms for a patient coming out of a coma? - CORRECT
ANSWER 1. agitation.
2. restlessness.
, 3. incontinence.
May also experience lethargy and stupor.
What do unilaterally dilated and poorly responding pupils indicate? - CORRECT
ANSWER The development of a hematoma, with subsequent pressure on the third cranial nerve
due to shifting of the brain.
What is the medication Phenytoin (Dilantin) used for? - CORRECT ANSWER Used to control
seizures!
What is an important patient teaching point for a young woman who is taking Phenytoin? -
CORRECT ANSWER Oral contraceptives are less effective when taking this medication.
Therefore, you should use other forms of contraception in addition to oral contraceptives if you
choose to be sexually active.
What are the side effects of Phenytoin and what are some patient teaching points? - CORRECT
ANSWER S/E: nausea, vomiting, drowsiness, lethargy, and ataxia.
Pt teaching: maintain good oral hygiene to prevent gum disease! Also, use contraception, oral
contraceptives are less effective when taking Phenytoin.
What is Propofol and what is it used for? - CORRECT ANSWER It is an IV anesthetic
(sedative/hypnotic).
Used for induction and maintenance of general anesthesia. It provides smooth hypnosis in less than
one minute.
It blocks the perception of pain by producing amnesia, euphoria, and hypnosis. However, it does not
provide analgesia.
What are the two most common uses of Propofol for TBI patients? - CORRECT ANSWER 1.
used to sedate patients who are placed on mechanical ventilation.
2. suppresses laryngeal reflexes, making it a suitable choice when inserting supraglottic airway
devices.
QUESTIONS AND CORRECT ANSWERS
What is the cardinal behavioral sign of a frontal lobe traumatic brain injury? - CORRECT
ANSWER Bizarre or irrational behavior.
What is the cardinal neurologic sign of a temporal lobe traumatic brain injury? - CORRECT
ANSWER Amnesia or disorientation.
Upon discharge, which s/s would you teach the patient to return to the emergency department if they
begin experiencing? - CORRECT ANSWER - decreased LOC.
- worsening headache.
- Dizziness.
- Seizures.
- Abnormal pupil response.
- vomiting.
- irritability.
- slurred speech.
- weakness or numbness of the extremities.
What are the three cardinal signs of brain death? - CORRECT ANSWER 1. coma.
2. absence of reflexes.
3. apnea.
What GCS score indicates a severe traumatic brain injury? - CORRECT ANSWER A score of
3-8.
What are the three signs of the Cushing's Triad and what do they indicate? - CORRECT
ANSWER 1. Bradycardia (decreased heart rate).
2. Widening pulse pressure (SBP is rising).
3. Irregular respirations.
,- Cushing's Triad indicates increased intracranial pressure.
What is a common electrolyte imbalance in patients who experience a TBI? - CORRECT
ANSWER Hyponatremia (low sodium).
Normal sodium levels are 135-145 mEq/L.
What are some nursing interventions for a TBI? - CORRECT ANSWER - Maintain a patent
airway.
- monitor neurologic function (neuro checks).
- monitor vitals (look for Cushing's triad).
- POSITION HOB AT 30 DEGREES WITH THE NECK IN A NEUTRAL POSITION TO PROTECT
C-SPINE.
- assess motor function.
- monitor for fluid and electrolyte imbalances, especially sodium.
- promote adequate nutrition.
- maintain thermoregulation.
- maintain skin integrity.
- early administration of anticonvulsants.
- maintain cerebral perfusion pressure.
What can hyponatremia cause? What precautions do we need to place our patient on because of this? -
CORRECT ANSWER Seizures!
Seizure precautions.
What should cerebral perfusion pressure be maintained at? - CORRECT ANSWER Above 50
mmHg.
What are three common symptoms for a patient coming out of a coma? - CORRECT
ANSWER 1. agitation.
2. restlessness.
, 3. incontinence.
May also experience lethargy and stupor.
What do unilaterally dilated and poorly responding pupils indicate? - CORRECT
ANSWER The development of a hematoma, with subsequent pressure on the third cranial nerve
due to shifting of the brain.
What is the medication Phenytoin (Dilantin) used for? - CORRECT ANSWER Used to control
seizures!
What is an important patient teaching point for a young woman who is taking Phenytoin? -
CORRECT ANSWER Oral contraceptives are less effective when taking this medication.
Therefore, you should use other forms of contraception in addition to oral contraceptives if you
choose to be sexually active.
What are the side effects of Phenytoin and what are some patient teaching points? - CORRECT
ANSWER S/E: nausea, vomiting, drowsiness, lethargy, and ataxia.
Pt teaching: maintain good oral hygiene to prevent gum disease! Also, use contraception, oral
contraceptives are less effective when taking Phenytoin.
What is Propofol and what is it used for? - CORRECT ANSWER It is an IV anesthetic
(sedative/hypnotic).
Used for induction and maintenance of general anesthesia. It provides smooth hypnosis in less than
one minute.
It blocks the perception of pain by producing amnesia, euphoria, and hypnosis. However, it does not
provide analgesia.
What are the two most common uses of Propofol for TBI patients? - CORRECT ANSWER 1.
used to sedate patients who are placed on mechanical ventilation.
2. suppresses laryngeal reflexes, making it a suitable choice when inserting supraglottic airway
devices.
