3/29/25, 8:02 NRNP Finals 6560 |
AM
NRNP FINALS 6560 EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE
Terms in this set (235)
Dual impacting of the brain into the skull; coup injury occurs at the point of impact;
coup-contrecoup injury
contrecoup injury occurs on the opposite side of impact, as the brain rebounds.
Primary head injury
profuse bleeding - signs of hypovolemia
Scalp laceration: what, effect, management
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to nose/ ears
Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure precautions
Skull fracture: types, effect, management
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
1/23
,3/29/25, 8:02 NRNP Finals 6560 |
AM
Primary head injury
Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater than 2min
Brain injury: types, effect, management
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual changes
seizure precautions
Epidural hematoma: commonly temporal/ parietal region with skull fracture, causing
bleeding into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil
dilation CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if greater than 30cm
Hematoma - neuro: types, effect,
Subdural hematoma
management
most common type of intracranial bleed
Acute (hours): drowsy, agitated, confused, headache, pupil dilation,
CT scan (noncontrast)
surgery for 10mm thickness or 5mm midline shift or for worsening GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr holes/ crani
decreased level of
Cerebral edema/ ICP elevated/ herniation: consciousness Blown pupil
symptoms, management Cushing triad: HTN (widening pulse pressure), decreased resp rate,
bradycardia (means increased intracranial pressure)
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
GCS: 8 or below is comatose
Neuro exam components
Posturing:
decorticate = arms, legs in
decerebrate = arms, legs out
Hyponatremia: SIADH and cerebral salt wasting
Electrolyte imbalances in brain injury
Hypernatremia: DI (give mannitol)
2/23
, 3/29/25, 8:02 NRNP Finals 6560 |
AM
- Consult neurosurgery
- Limit secondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood
to improve tissue perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation
(PaCO2 25-30), during first 24hrs.
- sedation and analgesia: opioids to reduce ICP (Fentanyl) with propofol. Could give
Nimbex or Vec. to help oxygenate/ ventilate
Management of traumatic brain injury - steroids: avoid
- Give mannitol or hypertonic saline for herniation: bolus then gtt. monitor
serum osmolality, sodium, and bp.
- Seizure precautions: give phenytoin or keppra
- DVT prophylaxis: stockings, LMWH
- head injury means spine injury until proven otherwise
- hypothermia: can control ICP (89 - 91F)
- decompressive crani: ICP refractory to tx
- brain O2 monitoring ( jugular vein O2 sats)
For: GCS 3-8 with abnormal CT and comatose pt's with normal CT and older than
40, posturing, hypotension.
Normal value: 5-10 mmHg
ICP monitoring
Recommend initiating treatment if ICP > 20
mmHG. Can calculate CPP (CPP = MAP - ICP).
Should be 60
Must have all:
No spontaneous movement
Absence brain stem reflexes (fixed/ dilated pupils, no corneal reflexes, absent doll's
eyes, absent gag, absent vestibular response)
Absence breathing drive/ apnea
Brain death criteria
can't be declared brain dead when: hypothermia, drug intoxication, severe
electrolyte/ acid-base imbalance
EEG, CTA of brain, Cerebral angiography, transcranial doppler
- MVA, falls, acts of violence, sports, wounds
- Rapid acceleration/ deceleration causes hyperextension (fall, rear-end collision)
(central cord syndrome), hyperflexion (bilateral facet dislocation), vertical column
loading (compression and then shattering from falls/ dive lands on butt, at C1
from diving), whiplash
- Distraction injury: from hanging
Spinal cord trauma: cause and who
- penetrating trauma: from wound
- pathologic fractures (osteoporosis/ cancer)
mainly cervical spine. High mortality.
More common in men
more common in young than old
3/23
AM
NRNP FINALS 6560 EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE
Terms in this set (235)
Dual impacting of the brain into the skull; coup injury occurs at the point of impact;
coup-contrecoup injury
contrecoup injury occurs on the opposite side of impact, as the brain rebounds.
Primary head injury
profuse bleeding - signs of hypovolemia
Scalp laceration: what, effect, management
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to nose/ ears
Primary head injury
Simple: no displacement of bone. Observe and protect spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure precautions
Skull fracture: types, effect, management
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
1/23
,3/29/25, 8:02 NRNP Finals 6560 |
AM
Primary head injury
Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater than 2min
Brain injury: types, effect, management
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable vital signs
N/V, dizziness, visual changes
seizure precautions
Epidural hematoma: commonly temporal/ parietal region with skull fracture, causing
bleeding into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis, ipsilateral pupil
dilation CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if greater than 30cm
Hematoma - neuro: types, effect,
Subdural hematoma
management
most common type of intracranial bleed
Acute (hours): drowsy, agitated, confused, headache, pupil dilation,
CT scan (noncontrast)
surgery for 10mm thickness or 5mm midline shift or for worsening GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr holes/ crani
decreased level of
Cerebral edema/ ICP elevated/ herniation: consciousness Blown pupil
symptoms, management Cushing triad: HTN (widening pulse pressure), decreased resp rate,
bradycardia (means increased intracranial pressure)
AVPU: awake, response to verbal stimuli, painful stimuli, unresponsive
GCS: 8 or below is comatose
Neuro exam components
Posturing:
decorticate = arms, legs in
decerebrate = arms, legs out
Hyponatremia: SIADH and cerebral salt wasting
Electrolyte imbalances in brain injury
Hypernatremia: DI (give mannitol)
2/23
, 3/29/25, 8:02 NRNP Finals 6560 |
AM
- Consult neurosurgery
- Limit secondary injury
- Prevent hypotension (syst 90) and hypoxemia (PaO2 60). May give blood
to improve tissue perfusion.
- Treat cerebral edema: elevate bed, sedate, paralyse, mannitol, hyperventilation
(PaCO2 25-30), during first 24hrs.
- sedation and analgesia: opioids to reduce ICP (Fentanyl) with propofol. Could give
Nimbex or Vec. to help oxygenate/ ventilate
Management of traumatic brain injury - steroids: avoid
- Give mannitol or hypertonic saline for herniation: bolus then gtt. monitor
serum osmolality, sodium, and bp.
- Seizure precautions: give phenytoin or keppra
- DVT prophylaxis: stockings, LMWH
- head injury means spine injury until proven otherwise
- hypothermia: can control ICP (89 - 91F)
- decompressive crani: ICP refractory to tx
- brain O2 monitoring ( jugular vein O2 sats)
For: GCS 3-8 with abnormal CT and comatose pt's with normal CT and older than
40, posturing, hypotension.
Normal value: 5-10 mmHg
ICP monitoring
Recommend initiating treatment if ICP > 20
mmHG. Can calculate CPP (CPP = MAP - ICP).
Should be 60
Must have all:
No spontaneous movement
Absence brain stem reflexes (fixed/ dilated pupils, no corneal reflexes, absent doll's
eyes, absent gag, absent vestibular response)
Absence breathing drive/ apnea
Brain death criteria
can't be declared brain dead when: hypothermia, drug intoxication, severe
electrolyte/ acid-base imbalance
EEG, CTA of brain, Cerebral angiography, transcranial doppler
- MVA, falls, acts of violence, sports, wounds
- Rapid acceleration/ deceleration causes hyperextension (fall, rear-end collision)
(central cord syndrome), hyperflexion (bilateral facet dislocation), vertical column
loading (compression and then shattering from falls/ dive lands on butt, at C1
from diving), whiplash
- Distraction injury: from hanging
Spinal cord trauma: cause and who
- penetrating trauma: from wound
- pathologic fractures (osteoporosis/ cancer)
mainly cervical spine. High mortality.
More common in men
more common in young than old
3/23
