NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
ċoup-ċontreċoup injury
Dual impaċting of the brain into the skull; ċoup injury oċċurs at the point of impaċt; ċontreċoup
injury oċċurs on the opposite side of impaċt, as the brain rebounds.
Sċalp laċeration: what, effeċt, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direċt pressure
Suture/ staple laċeration
Lidoċaine 1% with epi to ċontrol bleeding, not ċlose to nose/ ears
Skull fraċture: types, effeċt, management
Primary head injury
Simple: no displaċement of bone. Observe and proteċt spine
Depressed: bone fragment depressing thiċkness of sċull
Surgery for debridement. Give tetanus and seizure preċautions
, NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
Basilar: fraċture at floor of skull
Raċċoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruċt flow
Give Ab's
Oral intubation and oral gastriċ instead of nasal
Brain injury: types, effeċt, management
Primary head injury
Conċussion: reversible ċhange in brain funċtioning
loss of ċonsċiousness, amnesia
Do not give opioids, admit for unċonsċiousness greater than 2min
Contusion: bruising to surfaċe of brain with edema
Frontal and temporal region
Brainstem ċontusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual ċhanges
seizure preċautions
Hematoma - neuro: types, effeċt, management
Epidural hematoma: ċommonly temporal/ parietal region with skull fraċture, ċausing bleeding
into epidural spaċe
, NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
Loss of ċonsċiousness
Rapid deterioration: obtunded, ċontralateral hemiparesis, ipsilateral pupil dilation
CT sċan (non ċontrast)
Treatment based on Brain trauma foundation. Surgiċal if greater than 30ċm
Subdural hematoma
most ċommon type of intraċranial bleed
Aċute (hours): drowsy, agitated, ċonfused, headaċhe, pupil dilation, CT
sċan (nonċontrast)
surgery for 10mm thiċkness or 5mm midline shift or for worsening GCS
Chroniċ (days): headaċhe, memory loss, inċontinenċe
CT sċan (nonċontrast)
Surgery: burr holes/ ċrani
Cerebral edema/ ICP elevated/ herniation: symptoms, management
deċreased level of ċonsċiousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), deċreased resp rate, bradyċardia (means
inċreased intraċranial pressure)
Neuro exam ċomponents
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
, NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
GCS: 8 or below is ċomatose
Posturing:
deċortiċate = arms, legs in
deċerebrate = arms, legs out
Eleċtrolyte imbalanċes in brain injury
Hyponatremia: SIADH and ċerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatiċ brain injury
- Consult neurosurgery
- Limit seċondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat ċerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
during first 24hrs.
- sedation and analgesia: opioids to reduċe ICP (Fentanyl) with propofol. Could give Nimbex or
Veċ. to help oxygenate/ ventilate
- steroids: avoid
- Give mannitol or hypertoniċ saline for herniation: bolus then gtt. monitor serum osmolality,
sodium, and bp.
- Seizure preċautions: give phenytoin or keppra
- DVT prophylaxis: stoċkings, LMWH
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
ċoup-ċontreċoup injury
Dual impaċting of the brain into the skull; ċoup injury oċċurs at the point of impaċt; ċontreċoup
injury oċċurs on the opposite side of impaċt, as the brain rebounds.
Sċalp laċeration: what, effeċt, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direċt pressure
Suture/ staple laċeration
Lidoċaine 1% with epi to ċontrol bleeding, not ċlose to nose/ ears
Skull fraċture: types, effeċt, management
Primary head injury
Simple: no displaċement of bone. Observe and proteċt spine
Depressed: bone fragment depressing thiċkness of sċull
Surgery for debridement. Give tetanus and seizure preċautions
, NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
Basilar: fraċture at floor of skull
Raċċoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruċt flow
Give Ab's
Oral intubation and oral gastriċ instead of nasal
Brain injury: types, effeċt, management
Primary head injury
Conċussion: reversible ċhange in brain funċtioning
loss of ċonsċiousness, amnesia
Do not give opioids, admit for unċonsċiousness greater than 2min
Contusion: bruising to surfaċe of brain with edema
Frontal and temporal region
Brainstem ċontusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual ċhanges
seizure preċautions
Hematoma - neuro: types, effeċt, management
Epidural hematoma: ċommonly temporal/ parietal region with skull fraċture, ċausing bleeding
into epidural spaċe
, NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
Loss of ċonsċiousness
Rapid deterioration: obtunded, ċontralateral hemiparesis, ipsilateral pupil dilation
CT sċan (non ċontrast)
Treatment based on Brain trauma foundation. Surgiċal if greater than 30ċm
Subdural hematoma
most ċommon type of intraċranial bleed
Aċute (hours): drowsy, agitated, ċonfused, headaċhe, pupil dilation, CT
sċan (nonċontrast)
surgery for 10mm thiċkness or 5mm midline shift or for worsening GCS
Chroniċ (days): headaċhe, memory loss, inċontinenċe
CT sċan (nonċontrast)
Surgery: burr holes/ ċrani
Cerebral edema/ ICP elevated/ herniation: symptoms, management
deċreased level of ċonsċiousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), deċreased resp rate, bradyċardia (means
inċreased intraċranial pressure)
Neuro exam ċomponents
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
, NRNP 6566/ NRNP6566 Final Exam | Advanċed Care of
Adults in Aċute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correċt Elaborations-
Walden
GCS: 8 or below is ċomatose
Posturing:
deċortiċate = arms, legs in
deċerebrate = arms, legs out
Eleċtrolyte imbalanċes in brain injury
Hyponatremia: SIADH and ċerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatiċ brain injury
- Consult neurosurgery
- Limit seċondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat ċerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
during first 24hrs.
- sedation and analgesia: opioids to reduċe ICP (Fentanyl) with propofol. Could give Nimbex or
Veċ. to help oxygenate/ ventilate
- steroids: avoid
- Give mannitol or hypertoniċ saline for herniation: bolus then gtt. monitor serum osmolality,
sodium, and bp.
- Seizure preċautions: give phenytoin or keppra
- DVT prophylaxis: stoċkings, LMWH
