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AHN 447 Exam 3- Questions & Solutions
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AHN 447 Exam 3- Questions & Solutions
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AHN 447 Exam 3- Questions & SolutionsWhat diagnostics are used to determine if a pt has a TBI? Correct Ans-CT scan= identifies the
extent and scope of injury, can identify the presence of an injury that requires surgical
intervention (ex: epidural hematoma, subdural hematoma)
MRI= detects subtle changes in brain tissue and shows more specific detail of the brain injury
Why might a pt with a TBI be treated with therapeutic hypothermia? Correct Ans-The
purpose of therapeutic hypothermia is to rapidly cool the pt to a core temperature of 89.6 F-
93.2 F for 24-48 hr after the primary injury.
The rational for therapuetic hypothermia is to reduce brain metabolism and prevent the
cascade of molecular and biochemical events that contribute to the secondary brain injury in
moderate-to-severe TBI.
Why do you want to avoid hyperventilation of the intubated pt who just sustained a
TBI? Correct Ans-Hyperventilation for the intubated pt during the first 24 hr after brain injury
is usually avoided b/c it may produce ischemia by causing cerebral VASOCONSTRICTION.
**CO2 IS A VERY POTENT VASODILATOR THAT CAN CONTRIBUTE TO INCREASES IN ICP!!!
How should you position the pt with a TBI? Correct Ans-Position the TBI pt to avoid extreme
flexion or extension of the neck and to maintain the head in the midline, neutral position.
Log roll him/her during turning to avoid extreme hip flexion and keep HOB elevated at least 30
degrees.
HOB elevation in pts with TBI is elevated 30-45 degrees to prevent aspiration. However, if
increasing head elevation significantly lowers systemic BP, the pt does NOT benefit from
drainage of venous blood or CSF out of the skull from this position.
,If hypotension accompanies an elevated backrest position, the pt may be harmed.
Avoid sudden vertical changes of the HOB in the older pt b/c the dura is tightly adhered to the
skull and may pull away from the brain, leading to subdural hematoma.
You receive an order from the MD to administer mannitol to the pt with a TBI. What do you
know as the nurse about this medication and why it is being prescribed? How do you administer
it? Correct Ans-Mannitol (Osmitrol), an osmotic diuretic, is often used to treat cerebral
edema by pulling water out of the extracellular space of the edematous brain tissue.
Mannitol is most effective when given in boluses rather than a continuous infusion.
Administer mannitol through a filter in the IV tubing or, if given by IV push, draw it up through a
filtered needle to eliminate microscopic crystals.
For a pt receiving either osmotic or loop diuretics, monitor for I&O, severe dehydration, and
indications of acute renal failure, weakness, edema, and changes in UOP.
Monitor serum electrolyte and osmolarity levels q 6 hr.
Insert an indwelling urinary catheter to maintain a strict measurement of output q hr.
Check the pt's serum and urine osmolarity daily.
Mannitol is used to obtain a serum osmolarity of 310-320 most/L, depending on HCP
preference.
,What drug is often given along side mannitol in TBI patients? Correct Ans-Furosemide (Lasix),
a loop diuretic, is often used as adjunctive therapy to reduce the incidence of rebound from
mannitol.
It also enhances the therapeutic action of mannitol, reduces edema and blood volume,
decreases sodium uptake by the brain, and decreased the production of CSF at the choroid
plexus.
What should you teach a pt and his/her caregiver prior to d/c with a mild TBI? Correct Ans-
Initial neurologic assessment occurs hourly until the pt returns to baseline.
For a headache, give Tylenol q 4 hr as needed.
Avoid giving the person sedatives, sleeping pills, or alcoholic beverages for at least 24 hours
after TBI unless the PHCP instructs otherwise.
Do NOT allow the person to engage in strenuous activity for at least 48 hours.
Teach the caregiver to be aware that balance disturbances cause safety concerns and that he or
she should provide for monitored or assisted movement.
IF any of these symptoms occur, take the person back to the ED immediately:
**severe HA, persistent or severe n/v, blurred vision, drainage from the ear or nose, increasing
weakness, slurred speech, progressive sleepiness, worsening HA, unequal pupil size
Keep follow-up appts with the HCP.
What should you teach the pt who recently sustained a mild TBI? Correct Ans-Teach the pt
who has sustained a MILD brain injury, sometimes referred to as a concussion, that symptoms
, that disturb sleep; affect enjoyment of daily activities, work performance, mood, memory, and
ability to learn new material; and cause changes in personality require follow-up care.
Provide the pt and family with education materials that will alert them to symptoms and
management options.
A good source of written info is available from the CDC.
List the difference in clinical manifestations for a cerebral vs brainstem tumor. Correct Ans-
Cerebral Tumor:
HA, seizure, vomiting, changes in vision, hemiparesis or hemiplegia, hypokinesia (decreased
motor ability), paresthesia, seizures, aphasia, changes in personality or behavior
Brainstem Tumor:
hearing loss, facial pain/weakness, dysphagia, nystagmus, hoarseness, ataxia, apnea,
bradycardia, hypotension
How should the RN care for a pt following a craniotomy? Correct Ans-Assess neurologic and
VS q 15-30 min for the first 4-6 hr after a craniotomy and then q hr.
If the pt is stable for 24 hr, the frequency of these checks may be decreased to every 2-4 hr.
Report immediately and document new neurologic deficits, such as decreased LOC, motor
weakness/paralysis, aphasia, decreased sensation, and sluggish pupil reaction to light.
Personality changes such as agitation, aggression, or passivity can also indicate worsening
neurologic status.
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