Deck 35: Brain and Spinal Cord Injury

Question 1

Which manifestation does the nurse expect to find on assessment of a client with a skull fracture in the frontal fossa?
1)Whiplash
2)Battle's sign
3)Thunderclap headache
4)Periorbital ecchymosis

Answer 1

4

Question 2

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?
1)Fractures of L1 and L2
2)Injury at T1 and above
3)Damage to the ascending and descending neural tracts
4)Disruption of blood flow to the anterior two-thirds of the spinal cord

Answer 2

2

Question 3

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?
1)Penetrating injury
2)Rotational injury
3)Hyperextension injury
4)Hyperflexion injury

Answer 3

3

Question 4

Which manifestation does interruption of the dorsal spinal cord column cause in a client with spinal cord injury?
1)Ipsilateral paralysis
2)Loss of proprioception
3)Positive Babinski sign
4)Loss of pain and temperature sensation

Question 5

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?
1)Concussion
2)Neurogenic shock
3)Diffuse axonal injury
4)Conus medullaris syndrome

Question 6

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?
1)"Myelography demonstrates intrinsic spinal cord pathology."
2)"X-rays show injury or malalignment of bones."
3)"Subtle fractures and soft tissue injury are more evident with computerized topography (CT) scans."
4)"Magnetic resonance imaging (MRI) provides detailed pictures of the spinal cord, intervertebral discs, and cerebrospinal fluid (CSF) spaces."

Question 7

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?
1)Reinjury increases the chance of long-term problems
2)Prescribed medications will interfere with ability to play
3)The health-care provider always decides on the side of caution
4)The brain masks symptoms of injury to avoid pain and dysfunction

Question 8

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?
1)Basilar skull fracture
2)Linear fracture
3)Depressed fracture
4)Temporal bone fracture

Question 9

Which factor can cause herniation of the brainstem?
1)Cerebral vasospasm
2)Rupture of a cerebral artery
3)Compression of the optic nerve
4)Oculomotor nerve dysfunction

Question 10

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?
1)Linear fracture
2)Basilar skull fracture
3)Depressed fracture
4)Frontal fossa fracture

Question 11

The registered nurse is teaching about Brown-Séquard syndrome to a group of student nurses. Which statement made by the student nurse indicates effective learning?
1)"Brown-Séquard syndrome causes incontinence."
2)"Brown-Séquard syndrome results in disrupted aortic blood flow."
3)"Brown-Séquard syndrome is characterized by swelling of the neuronal axons."
4)"Brown-Séquard syndrome is associated with penetrating injuries that lead to the hemisection of the spinal cord."

Question 12

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?
1)Placing a catheter in the ventricles
2)Lowering blood pressure
3)Infusing hypertonic IV solution
4)Decompressing with a craniotomy

Question 13

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?
1)Clients with this injury do not awake from a coma.
2)Extensive brain surgery is needed to fully recover.
3)Most who regain consciousness are severely impaired.
4)Rehabilitation with physical therapy is essential.

Question 14

The nurse is reviewing subdural hematomas with a group of staff nurses. Which statement made by an attending staff nurse indicates understanding?
1)"Subdural hematomas cause bleeding in the space below the skull bone and above the dura mater."
2)"Subdural hematomas cause bleeding in the space below the dura mater and above the arachnoid membrane."
3)"Subdural hematomas cause cerebral aneurysms in the terminal portion of the internal carotid artery."
4)"Subdural hematomas cause tearing of the cerebral and meningeal vessels within the subarachnoid space of the brain."

Question 15

Which statement made by the parent of a client with spinal cord injury causes the nurse to suspect an axial loading injury?
1)"My child was injured in a fireworks accident yesterday."
2)"My child was injured while diving in the swimming pool."
3)"My child was injured when he fell from the first floor of our house."
4)"My child was injured during an accident while driving at a fast speed."

Question 16

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?
1)Hemisection of the spinal cord
2)Acute intervertebral disc herniation
3)Hyperextension of the cervical spine
4)Fractures at L1 and L2

Question 17

The health-care provider prescribes myelography for a client who sustained a spinal cord injury. Which is the rationale for this diagnostic test?
1)To provide a detailed picture of the intervertebral discs
2)To provide information on the integrity of the carotid arteries
3)To look for obstructed cerebrospinal fluid (CSF) flow around the spinal cord
4)To show malalignment of the bones that may aggravate injury to the spinal cord

Question 18

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?
1)Cervical nerve
2)Lumbar nerve
3)Thoracic nerve
4)Sacral nerve

Question 19

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
2)3
3)4
4)5

Question 20

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?
1)Positioning that avoids poor body alignment
2)Providing massage to keep the leg muscles relaxed
3)Performing passive body exercise every day
4)Preventing the development of pressure ulcers

Question 21

The nurse suspects cerebral edema in a client with a cerebral contusion. Which diagnostic test will confirm this?
1)Skull x-ray
2)Cerebral angiography
3)Magnetic resonance imaging (MRI)
4)Computerized tomography (CT) scan

Question 22

The computerized tomography (CT) scan of a client shows traumatic subarachnoid hemorrhage. Which are the causes for this condition? Select all that apply.
1)Trauma to the carotid artery
2)Stretching of the vertebral artery
3)Rupture of the middle meningeal artery
4)Rotational-acceleration injury of the brain
5)Defects in the muscle layers of the artery wall

Question 23

The nurse is reviewing neurogenic shock with staff nurses. Which statement made by an attending nurse indicates the need for additional review? Select all that apply.
1)"Neurogenic shock reduces the systemic blood pressure."
2)"Neurogenic shock results in peripheral vasodilation."
3)"Neurogenic shock causes flaccid muscles and paralysis."
4)"Loss of the anal reflex is the hallmark sign of neurogenic shock."
5)"Neurogenic shock is a lack of sympathetic outflow from the T1-L2 region."

Question 24

Which are symptoms of Horner's syndrome? Select all that apply.
1)Constipation
2)Incontinence
3)Lack of sweat
4)Drooping eyelid
5)Constricted pupil