NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
čoup-čontrečoup injury
Dual impačting of the brain into the skull; čoup injury oččurs at the point of impačt; čontrečoup
injury oččurs on the opposite side of impačt, as the brain rebounds.
Sčalp lačeration: what, effečt, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direčt pressure
Suture/ staple lačeration
Lidočaine 1% with epi to čontrol bleeding, not člose to nose/ ears
Skull fračture: types, effečt, management
Primary head injury
Simple: no displačement of bone. Observe and protečt spine
Depressed: bone fragment depressing thičkness of sčull
Surgery for debridement. Give tetanus and seizure prečautions
, NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
Basilar: fračture at floor of skull
Raččoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstručt flow
Give Ab's
Oral intubation and oral gastrič instead of nasal
Brain injury: types, effečt, management
Primary head injury
Cončussion: reversible čhange in brain funčtioning
loss of čonsčiousness, amnesia
Do not give opioids, admit for unčonsčiousness greater than 2min
Contusion: bruising to surfače of brain with edema
Frontal and temporal region
Brainstem čontusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual čhanges
seizure prečautions
Hematoma - neuro: types, effečt, management
Epidural hematoma: čommonly temporal/ parietal region with skull fračture, čausing bleeding
into epidural spače
, NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
Loss of čonsčiousness
Rapid deterioration: obtunded, čontralateral hemiparesis, ipsilateral pupil dilation
CT sčan (non čontrast)
Treatment based on Brain trauma foundation. Surgičal if greater than 30čm
Subdural hematoma
most čommon type of intračranial bleed
Ačute (hours): drowsy, agitated, čonfused, headačhe, pupil dilation, CT
sčan (nončontrast)
surgery for 10mm thičkness or 5mm midline shift or for worsening GCS
Chronič (days): headačhe, memory loss, inčontinenče
CT sčan (nončontrast)
Surgery: burr holes/ črani
Cerebral edema/ ICP elevated/ herniation: symptoms, management
dečreased level of čonsčiousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), dečreased resp rate, bradyčardia (means
inčreased intračranial pressure)
Neuro exam čomponents
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
, NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
GCS: 8 or below is čomatose
Posturing:
dečortičate = arms, legs in
dečerebrate = arms, legs out
Elečtrolyte imbalančes in brain injury
Hyponatremia: SIADH and čerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatič brain injury
- Consult neurosurgery
- Limit sečondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat čerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
during first 24hrs.
- sedation and analgesia: opioids to reduče ICP (Fentanyl) with propofol. Could give Nimbex or
Več. to help oxygenate/ ventilate
- steroids: avoid
- Give mannitol or hypertonič saline for herniation: bolus then gtt. monitor serum osmolality,
sodium, and bp.
- Seizure prečautions: give phenytoin or keppra
- DVT prophylaxis: stočkings, LMWH
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
čoup-čontrečoup injury
Dual impačting of the brain into the skull; čoup injury oččurs at the point of impačt; čontrečoup
injury oččurs on the opposite side of impačt, as the brain rebounds.
Sčalp lačeration: what, effečt, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direčt pressure
Suture/ staple lačeration
Lidočaine 1% with epi to čontrol bleeding, not člose to nose/ ears
Skull fračture: types, effečt, management
Primary head injury
Simple: no displačement of bone. Observe and protečt spine
Depressed: bone fragment depressing thičkness of sčull
Surgery for debridement. Give tetanus and seizure prečautions
, NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
Basilar: fračture at floor of skull
Raččoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstručt flow
Give Ab's
Oral intubation and oral gastrič instead of nasal
Brain injury: types, effečt, management
Primary head injury
Cončussion: reversible čhange in brain funčtioning
loss of čonsčiousness, amnesia
Do not give opioids, admit for unčonsčiousness greater than 2min
Contusion: bruising to surfače of brain with edema
Frontal and temporal region
Brainstem čontusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual čhanges
seizure prečautions
Hematoma - neuro: types, effečt, management
Epidural hematoma: čommonly temporal/ parietal region with skull fračture, čausing bleeding
into epidural spače
, NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
Loss of čonsčiousness
Rapid deterioration: obtunded, čontralateral hemiparesis, ipsilateral pupil dilation
CT sčan (non čontrast)
Treatment based on Brain trauma foundation. Surgičal if greater than 30čm
Subdural hematoma
most čommon type of intračranial bleed
Ačute (hours): drowsy, agitated, čonfused, headačhe, pupil dilation, CT
sčan (nončontrast)
surgery for 10mm thičkness or 5mm midline shift or for worsening GCS
Chronič (days): headačhe, memory loss, inčontinenče
CT sčan (nončontrast)
Surgery: burr holes/ črani
Cerebral edema/ ICP elevated/ herniation: symptoms, management
dečreased level of čonsčiousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), dečreased resp rate, bradyčardia (means
inčreased intračranial pressure)
Neuro exam čomponents
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
, NRNP 6566/ NRNP6566 Final Exam | Advančed Care of
Adults in Ačute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correčt Elaborations-
Walden
GCS: 8 or below is čomatose
Posturing:
dečortičate = arms, legs in
dečerebrate = arms, legs out
Elečtrolyte imbalančes in brain injury
Hyponatremia: SIADH and čerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatič brain injury
- Consult neurosurgery
- Limit sečondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat čerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
during first 24hrs.
- sedation and analgesia: opioids to reduče ICP (Fentanyl) with propofol. Could give Nimbex or
Več. to help oxygenate/ ventilate
- steroids: avoid
- Give mannitol or hypertonič saline for herniation: bolus then gtt. monitor serum osmolality,
sodium, and bp.
- Seizure prečautions: give phenytoin or keppra
- DVT prophylaxis: stočkings, LMWH
