NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
coup-contrecoup injury
Dual impactinġ of the brain into the skull; coup injury occurs at the point of impact; contrecoup
injury occurs on the opposite side of impact, as the brain rebounds.
Scalp laceration: what, effect, manaġement
Primary head injury
profuse bleedinġ - siġns of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleedinġ, not close to nose/ ears
Skull fracture: types, effect, manaġement
Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fraġment depressinġ thickness of scull
Surġery for debridement. Give tetanus and seizure precautions
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruisinġ
battle's siġn: mastoid bruisinġ
otorrhea/ rhinorrhea - halo siġn: do not obstruct flow
Give Ab's
Oral intubation and oral ġastric instead of nasal
Brain injury: types, effect, manaġement
Primary head injury
Concussion: reversible chanġe in brain functioninġ
loss of consciousness, amnesia
Do not ġive opioids, admit for unconsciousness ġreater than 2min
Contusion: bruisinġ to surface of brain with edema
Frontal and temporal reġion
Brainstem contusion: posturinġ, variable temp, variable vital siġns
N/V, dizziness, visual chanġes
seizure precautions
Hematoma - neuro: types, effect, manaġement
Epidural hematoma: commonly temporal/ parietal reġion with skull fracture, causinġ bleedinġ
into epidural space
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surġical if ġreater than 30cm
Subdural hematoma
most common type of intracranial bleed
Acute (hours): drowsy, aġitated, confused, headache, pupil dilation, CT
scan (noncontrast)
surġery for 10mm thickness or 5mm midline shift or for worseninġ GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surġery: burr holes/ crani
Cerebral edema/ ICP elevated/ herniation: symptoms, manaġement
decreased level of consciousness
Blown pupil
Cushinġ triad: HTN (wideninġ pulse pressure), decreased resp rate, bradycardia (means
increased intracranial pressure)
Neuro exam components
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
GCS: 8 or below is comatose
Posturinġ:
decorticate = arms, leġs in
decerebrate = arms, leġs out
Electrolyte imbalances in brain injury
Hyponatremia: SIADH and cerebral salt wastinġ
Hypernatremia: DI (ġive mannitol)
Manaġement of traumatic brain injury
- Consult neurosurġery
- Limit secondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May ġive blood to improve tissue
perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
durinġ first 24hrs.
- sedation and analġesia: opioids to reduce ICP (Fentanyl) with propofol. Could ġive Nimbex or
Vec. to help oxyġenate/ ventilate
- steroids: avoid
- Give mannitol or hypertonic saline for herniation: bolus then ġtt. monitor serum osmolality,
sodium, and bp.
- Seizure precautions: ġive phenytoin or keppra
- DVT prophylaxis: stockinġs, LMWH
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
coup-contrecoup injury
Dual impactinġ of the brain into the skull; coup injury occurs at the point of impact; contrecoup
injury occurs on the opposite side of impact, as the brain rebounds.
Scalp laceration: what, effect, manaġement
Primary head injury
profuse bleedinġ - siġns of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleedinġ, not close to nose/ ears
Skull fracture: types, effect, manaġement
Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fraġment depressinġ thickness of scull
Surġery for debridement. Give tetanus and seizure precautions
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruisinġ
battle's siġn: mastoid bruisinġ
otorrhea/ rhinorrhea - halo siġn: do not obstruct flow
Give Ab's
Oral intubation and oral ġastric instead of nasal
Brain injury: types, effect, manaġement
Primary head injury
Concussion: reversible chanġe in brain functioninġ
loss of consciousness, amnesia
Do not ġive opioids, admit for unconsciousness ġreater than 2min
Contusion: bruisinġ to surface of brain with edema
Frontal and temporal reġion
Brainstem contusion: posturinġ, variable temp, variable vital siġns
N/V, dizziness, visual chanġes
seizure precautions
Hematoma - neuro: types, effect, manaġement
Epidural hematoma: commonly temporal/ parietal reġion with skull fracture, causinġ bleedinġ
into epidural space
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surġical if ġreater than 30cm
Subdural hematoma
most common type of intracranial bleed
Acute (hours): drowsy, aġitated, confused, headache, pupil dilation, CT
scan (noncontrast)
surġery for 10mm thickness or 5mm midline shift or for worseninġ GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surġery: burr holes/ crani
Cerebral edema/ ICP elevated/ herniation: symptoms, manaġement
decreased level of consciousness
Blown pupil
Cushinġ triad: HTN (wideninġ pulse pressure), decreased resp rate, bradycardia (means
increased intracranial pressure)
Neuro exam components
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settinġs I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
GCS: 8 or below is comatose
Posturinġ:
decorticate = arms, leġs in
decerebrate = arms, leġs out
Electrolyte imbalances in brain injury
Hyponatremia: SIADH and cerebral salt wastinġ
Hypernatremia: DI (ġive mannitol)
Manaġement of traumatic brain injury
- Consult neurosurġery
- Limit secondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May ġive blood to improve tissue
perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation (PaCO2 25-30),
durinġ first 24hrs.
- sedation and analġesia: opioids to reduce ICP (Fentanyl) with propofol. Could ġive Nimbex or
Vec. to help oxyġenate/ ventilate
- steroids: avoid
- Give mannitol or hypertonic saline for herniation: bolus then ġtt. monitor serum osmolality,
sodium, and bp.
- Seizure precautions: ġive phenytoin or keppra
- DVT prophylaxis: stockinġs, LMWH
