Exam 35: Brain and Spinal Cord Injury

The nurse is teaching about the diagnostic tests for spinal cord injury to a group of staff nurses. Which statement made by an attending nurse indicates the need for further teaching?

The nurse in an extended care facility assesses a client diagnosed with a diffuse axonal brain injury. The client has been in a persistent coma for 6 months. The client's spouse states, "I just wish he would wake up so that we can resume our normal lives." Which factor does the nurse conclude is not understood by the spouse?

While assessing the motor strength in a client with a spinal cord injury, the nurse finds the movements of the client are active against gravity. Which score does the nurse record? 1.2

The nurse is assessing a client who presents to the emergency room with a spinal cord injury. Which finding in the client's reports causes the nurse to suspect central cord syndrome?

The nurse is assessing a client with a spinal cord injury. Manifestations include miosis (constricted pupil), anhidrosis (lack of sweat), and ptosis (drooping eyelid) on the affected side. Which additional information causes the nurse to identify Horner's syndrome?

The nurse is teaching a family member about providing home care for a client with a T1 spinal cord injury. The nurse stresses bowel and bladder management to avoid autonomic dysreflexia. Which additional care does the nurse reinforce to prevent the complication?

The computerized tomography (CT) scan of a client shows traumatic subarachnoid hemorrhage. Which are the causes for this condition? Select all that apply.

The nurse suspects cerebral edema in a client with a cerebral contusion. Which diagnostic test will confirm this?

A client experienced traumatic brain injury (TBI) participating in a contact sport. The health-care provider is focused on preventing increased intracranial pressure (ICP). Which intervention does the nurse expect the health-care provider to prescribe initially?

Laboratory reports for a client after an accident show a fracture in the temporal bone of the middle ear. Which type of fracture does the nurse suspect in this client?

Which statement made by the parent of a client with spinal cord injury causes the nurse to suspect an axial loading injury?

A client who sustained a rear-end motor vehicle collision is admitted to the emergency department. Which injury does the nurse expect to be present in the client?

The nurse is providing care for a young male client with a spinal cord injury. The client expresses concern about the ability to perform sexually. Which nerve does the nurse recognize as being responsible for sexual function?

The medical reports of a client who experienced an accident show injuries at the sixth thoracic vertebra. Which condition does the nurse suspect in the client?

Which factor can cause herniation of the brainstem?

While reviewing the clinical history of a client with brain injury, the nurse finds bruising of the mastoid process behind the ear of the affected side. Which fracture should the nurse suspect in the client?

Which manifestation does interruption of the dorsal spinal cord column cause in a client with spinal cord injury?

The nurse is reviewing subdural hematomas with a group of staff nurses. Which statement made by an attending staff nurse indicates understanding?

Which are symptoms of Horner's syndrome? Select all that apply.

The nurse is preparing to discharge an adolescent from the hospital after an injury from playing a contact sport. The client states, "I am really angry I cannot play for the rest of the season. I don't understand the reasoning." On which factual information is the nurse likely to focus?