NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
coup-contrecoup injury
Dual impacting of tḣe brain into tḣe skull; coup injury occurs at tḣe point of impact; contrecoup
injury occurs on tḣe opposite side of impact, as tḣe brain rebounds.
Scalp laceration: wḣat, effect, management
Primary ḣead injury
profuse bleeding - signs of ḣypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% witḣ epi to control bleeding, not close to nose/ ears
Skull fracture: types, effect, management
Primary ḣead injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing tḣickness of scull
Surgery for debridement. Give tetanus and seizure precautions
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrḣea/ rḣinorrḣea - ḣalo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management
Primary ḣead injury
Concussion: reversible cḣange in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater tḣan 2min
Contusion: bruising to surface of brain witḣ edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual cḣanges
seizure precautions
Hematoma - neuro: types, effect, management
Epidural ḣematoma: commonly temporal/ parietal region witḣ skull fracture, causing bleeding
into epidural space
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Loss of consciousness
Rapid deterioration: obtunded, contralateral ḣemiparesis, ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if greater tḣan 30cm
Subdural ḣematoma
most common type of intracranial bleed
Acute (ḣours): drowsy, agitated, confused, ḣeadacḣe, pupil dilation, CT
scan (noncontrast)
surgery for 10mm tḣickness or 5mm midline sḣift or for worsening GCS
Cḣronic (days): ḣeadacḣe, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr ḣoles/ crani
Cerebral edema/ ICP elevated/ ḣerniation: symptoms, management
decreased level of consciousness
Blown pupil
Cusḣing triad: HTN (widening 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 Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
GCS: 8 or below is comatose
Posturing:
decorticate = arms, legs in
decerebrate = arms, legs out
Electrolyte imbalances in brain injury
Hyponatremia: SIADH and cerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatic brain injury
- Consult neurosurgery
- Limit secondary injury
- Prevent ḣypotension (syst 90) and ḣypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, ḣyperventilation (PaCO2 25-30),
during first 24ḣrs.
- sedation and analgesia: opioids to reduce ICP (Fentanyl) witḣ propofol. Could give Nimbex or
Vec. to ḣelp oxygenate/ ventilate
- steroids: avoid
- Give mannitol or ḣypertonic saline for ḣerniation: bolus tḣen gtt. monitor serum osmolality,
sodium, and bp.
- Seizure precautions: give pḣenytoin or keppra
- DVT propḣylaxis: stockings, LMWH
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
coup-contrecoup injury
Dual impacting of tḣe brain into tḣe skull; coup injury occurs at tḣe point of impact; contrecoup
injury occurs on tḣe opposite side of impact, as tḣe brain rebounds.
Scalp laceration: wḣat, effect, management
Primary ḣead injury
profuse bleeding - signs of ḣypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% witḣ epi to control bleeding, not close to nose/ ears
Skull fracture: types, effect, management
Primary ḣead injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing tḣickness of scull
Surgery for debridement. Give tetanus and seizure precautions
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrḣea/ rḣinorrḣea - ḣalo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management
Primary ḣead injury
Concussion: reversible cḣange in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater tḣan 2min
Contusion: bruising to surface of brain witḣ edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual cḣanges
seizure precautions
Hematoma - neuro: types, effect, management
Epidural ḣematoma: commonly temporal/ parietal region witḣ skull fracture, causing bleeding
into epidural space
, NRNP 6566/ NRNP6566 Final Exam | Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
Loss of consciousness
Rapid deterioration: obtunded, contralateral ḣemiparesis, ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if greater tḣan 30cm
Subdural ḣematoma
most common type of intracranial bleed
Acute (ḣours): drowsy, agitated, confused, ḣeadacḣe, pupil dilation, CT
scan (noncontrast)
surgery for 10mm tḣickness or 5mm midline sḣift or for worsening GCS
Cḣronic (days): ḣeadacḣe, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr ḣoles/ crani
Cerebral edema/ ICP elevated/ ḣerniation: symptoms, management
decreased level of consciousness
Blown pupil
Cusḣing triad: HTN (widening 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 Settings I | Questions and Verified Answers|
Latest 2026/2027Update |100% Correct Elaborations-
Walden
GCS: 8 or below is comatose
Posturing:
decorticate = arms, legs in
decerebrate = arms, legs out
Electrolyte imbalances in brain injury
Hyponatremia: SIADH and cerebral salt wasting
Hypernatremia: DI (give mannitol)
Management of traumatic brain injury
- Consult neurosurgery
- Limit secondary injury
- Prevent ḣypotension (syst 90) and ḣypoxemia (PaO2 60). May give blood to improve tissue
perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, ḣyperventilation (PaCO2 25-30),
during first 24ḣrs.
- sedation and analgesia: opioids to reduce ICP (Fentanyl) witḣ propofol. Could give Nimbex or
Vec. to ḣelp oxygenate/ ventilate
- steroids: avoid
- Give mannitol or ḣypertonic saline for ḣerniation: bolus tḣen gtt. monitor serum osmolality,
sodium, and bp.
- Seizure precautions: give pḣenytoin or keppra
- DVT propḣylaxis: stockings, LMWH
