AQ: Head Injury and Brain Tumors

When preparing to administer a hypertonic saline infusion to a patient with an increased intracranial pressure (ICP), which parameters would the nurse monitor frequently? Select all that apply. 1 Blood glucose 2 Serum sodium 3 BP 4 Level of sedation 5 Gastrointestinal disturbances

Use hypertonic saline solutions to treat increased ICP. 2.3. Hypertonic saline infusions increase the intravascular fluid volume, which may alter the serum sodium levels and BP in the body. NOT 1 If administering corticosteroids to a patient, monitoring includes blood glucose levels. 4 Monitor sedation levels if administering barbiturates to the patient. 5 Monitor GI disturbances if administering corticosteroids to the patient.

For which treatment modality would the nurse prepare a patient whose MRI revealed the presence of a brain tumor? 1 Surgery 2 Chemotherapy 3 Radiation therapy 4 Biologic drug therapy

1 Surgical removal is the preferred treatment for brain tumors. NOT 2.4. The BBB, tumor cell heterogeneity, and tumor cell drug resistance limit the treatment of chemotherapy and biologic drug therapy. 3 Radiation therapy may be used as a follow-up measure after surgery.

To achieve the best outcome when providing care for a patient with an increased intracranial pressure (ICP) secondary to a mass lesion in the brain, which treatment information would the nurse provide the patient? 1 Surgery 2 Cimetidine 3 Craniectomy 4 Corticosteroids

1 Treatment of an increase in ICP because of a mass lesion such as a tumor or hematoma includes surgery. NOT 2 Cimetidine is an antihistamine preventing GI bleeding and ulcers associated with corticosteroids. 3 Craniectomy is a treatment utilized only in very aggressive situations. 4 Treatment of cerebral edema includes the use of corticosteroids.

Which observation would the nurse associate with a cerebrospinal fluid (CSF) leak when a patient with a suspected traumatic brain injury (TBI) develops a bloody nasal drainage? 1 A halo sign on the nasal-drip pad 2 Decreased BP and urinary output 3 A positive reading for glucose on a test-tape strip 4 Clear nasal drainage along with the bloody discharge

1 When drainage containing both CSF and blood is allowed to drip onto a white pad, within a few minutes the blood will coalesce (unite/join) into the center, and a yellowish ring of CSF will encircle the blood, giving a halo effect. NOT 3 The presence of glucose would be unreliable for determining the presence of CSF because blood also contains glucose. 2 Decreased BP and urinary output would not be indicative of a CSF leak.

Which interventions would the nurse implement to comfort the patient with a brain tumor who is experiencing disorientation and confusion due to perceptual problems? Select all that apply. 1 Create a routine. 2 Use reality orientation. 3 Provide increased stimuli. 4 Make the patient drive a vehicle. 5 Minimize environmental stimuli.

1.2.5. Creating a routine, using reality orientation, and minimizing environmental stimuli are appropriate actions to comfort the confused patient and to familiarize the confused patient with the environment. NOT 3.4. Providing increased stimuli and making the patient drive a vehicle are not advisable because they increase the risks for confusion.

For the patient admitted for surgical removal of a brain tumor, for which potential complications would the nurse integrate assessment interventions into a patient's plan of care? Select all that apply. 1 Vision loss 2 Cerebral edema 3 Pituitary dysfunction 4 Parathyroid dysfunction 5 Focal neurologic deficits 6 Diabetes mellitus

1.5. Brain tumors can manifest themselves in a wide variety of symptoms depending on location, including vision loss and focal neurologic deficits. 3 Tumors that put pressure on the pituitary can lead to dysfunction of the gland. 2 As the tumor grows, clinical manifestations of increased ICP and cerebral edema appear. NOT 4 The cerebral cortex or the pituitary gland do not regulate the parathyroid gland. 6 Trauma to the brain, or tumors of the thalamus and sellar tumors, may cause the development of DI, not DM.

For the intubated and mechanically ventilated patient, the development of which potential side effect of dexmedetomidine (Precedex) would the nurse anticipate monitoring? 1 Insomnia 2 BP changes 3 Hyperanxiety 4 Sedative effect

2 Dexmedetomidine is an α2-adrenergic agonist used for continuous IV sedation of intubated and mechanically ventilated patients. It activates the receptors in the brain and spinal cord and inhibits neuronal firing, which can cause both hypotension and HTN. NOT 1.2.3. Dexmedetomidine does not cause insomnia, hyperanxiety, or sedation. It is used in neurologic assessment because of its anxiolytic activities.

Which factors would the nurse evaluate before administering temozolomide (Temodar) as treatment for a patient's brain tumor? Select all that apply. 1 The medication temozolomide causes photosensitivity in cancer patients. 2 Evidence indicates that temozolomide is able to cross over the blood-brain barrier. 3 Myelosuppression occurs and requires an absolute neutrophil count before giving. 4 Other medication usually taken by brain tumor patients interact with temozolomide. 5 Temozolomide directly interferes with tumor growth by converting to a reactive agent.

2 Temozolomide can cross the BBB. 3 The drug is also known to cause myelosuppression; therefore, check absolute neutrophil counts and PLT counts before starting the therapy. 5 Temozolomide does not require metabolic activation to exert its effects and therefore can convert to an agent that directly interferes with tumor growth. NOT 1.4. It is not known to cause photosensitivity or interact with other drugs usually taken by brain tumor patients.

For the patient presenting with watery sanguineous nasal drainage after falling from a first-floor roof, which diagnostic method validates the nurse's suspicion of rhinorrhea? 1 Gram stain 2 The halo test 3 A Dextrostix 4 Slide smear for presence of leukocytes

2 The patient may be experiencing rhinorrhea, or leakage of CSF from the nose, which is also sanguineous (bloody). In the presence of blood, the halo test will be the most accurate for determining presence of CSF. NOT 1 A Gram stain is used to identify bacterial presence. 3 If blood is present, the Dextrostix (blood testing for glucose) will not be accurate because glucose is present in blood. 4 CSF is sterile in the body and, under normal circumstances, does not contain white cells (leukocytes) or bacteria.

While monitoring a patient's intracranial pressure (ICP) via an intracranial device in the neurologic intensive care unit, which aspect of care requires collaborative actions by the nurse? 1 Using aseptic technique for intracranial device care 2 Monitoring the intracranial device for greater than five days 3 Assessing the intracranial device insertion site routinely 4 Monitoring the cerebrospinal fluid (CSF) for a change in color

2 Use of the intracranial device for monitoring ICP should not occur for more than 5 days because it can lead to severe infection. NOT 1.3.4. Using aseptic technique, routinely assessing the insertion site, and monitoring the CSF for a change in drainage color prevent complications; therefore all are appropriate aspects of patient care that do not require follow-up by the nurse.

Which clinical manifestations would the nurse expect to identify when assessing a patient with a brain abscess within the occipital lobe? Select all that apply. 1 Visual field defects 2 Headache and fever 3 Nausea and vomiting 4 Psychomotor seizures 5 Visual impairment and hallucinations

2.3. An occipital abscess commonly presents with the clinical manifestations of HA and fever, as well as NV. 5 Visual impairment and hallucinations may accompany an occipital abscess. NOT 1.4. Abscesses of the TEMPORAL lobe present with visual field defects and psychomotor seizures.

To obtain an accurate brain tumor diagnosis, for which prescribed diagnostic procedures would the nurse anticipate preparing the patient? Select all that apply. 1 Lumbar puncture 2 Electron microscopy 3 Immunohistochemical stains 4 CT scan 5 Computer-guided stereotactic biopsy

2.3.5. Electron microscopy, immunohistochemical stains, and computer-guided stereotactic biopsy can help in the correct diagnosis of a brain tumor. NOT 4 CT scan helps to detect seizures. 1 Lumbar puncture does not detect the blood flow to tumor and involves additional risk.

Which primary goals would the nurse identify when planning the care of a patient with a brain tumor? Select all that apply. 1 Making the patient walk 2 Removing the tumor mass 3 Managing the patient's family 4 Identifying the tumor type and location 5 Managing increased intracranial pressure (ICP)

2.4.5. Removing tumor mass, identifying the tumor type and location, and managing the ICP are the primary goals of treatment of a patient with brain tumor. NOT 1.3. Assisting the patient with walking and managing the patient's family are not appropriate primary goals.

For which surgical techniques and procedures would the nurse prepare the patient scheduled for localizing brain tumors intraoperatively? Select all that apply. 1 X-ray 2 Ultrasound 3 Cortical mapping 4 Electroencephalogram (EEG) 5 Computer-guided stereotactic biopsy 6 Functional MRI

2.6.3.5. To localize brain tumors intraoperatively, providers utilize techniques like ultrasound, functional MRI, cortical mapping, and the computer-guided stereotactic biopsy. NOT 4 To rule out a seizure disorder, use the EEG. 1 X-rays show changes in the skull but may not show soft tissue changes due to brain tumor.

Which patient condition contraindicates testing the doll's-eye reflex when performing a neurologic assessment? 1 An unconscious patient 2 An uncooperative patient 3 A patient with cervical spine injury 4 A patient who has intracranial lesion

3 A doll's-eye reflex test is performed to determine the oculocephalic reflex. It increases the risk of brainstem injury with a cervical spine problem. NOT 2.1. A doll's-eye reflex test can be performed in an unconscious and uncooperative patient. 4 This test is used to determine the presence of intracranial lesions due to increased intracranial pressure.

Which clinical manifestation would the nurse associate with a patient reporting a headache, with disturbed consciousness, and whose imaging studies indicate cerebral edema in the white matter? 1 An intact blood-brain barrier is present. 2 A decreased oxygen supply to the brain exists. 3 An increase in the cerebral extracellular fluid volume occurred. 4 Something caused abnormal accumulations of cerebrospinal fluid in the brain.

3 Vasogenic cerebral edema mainly occurs in the white matter of the brain. In this type of cerebral edema, there is an increase in the permeability of the BBB, which causes increase in the extracellular fluid volume. NOT 2 Cerebral hypoxia or decreased oxygen supply is seen in cytotoxic cerebral edema. 1 An intact BBB is seen in cytotoxic cerebral edema. 4 Hydrocephalus or abnormal accumulation of CSF in the brain is seen in interstitial cerebral edema.

After sustaining a head injury, for which clinical manifestation would the nurse monitor potential development in a patient scheduled for a lumbar puncture? 1 Cerebral edema 2 Myelosuppression 3 Total body collapse 4 Cerebral herniation

4 A lumbar puncture involves removal of CSF from the lumbar region. This can raise the ICP, resulting in cerebral herniation. NOT 1 Cerebral edema is associated with radiation therapy. 2 Myelosuppression is associated with temozolomide drug therapy. 3 Total body collapse is associated with a ventricular shunt.

Glasgow Coma Scale (GCS): 3 categories, and best score to get, totally unresponsive score.

3: Eye-opening response, Best verbal response, and Best motor response Best Score: 15 Worst: 3 (totally unresponsive)

After 72 hours of intravenous (IV) fluid therapy for a patient who suffered a diffuse axonal traumatic brain injury (TBI), which rationale supports the nurse seeking an enteral feeding prescription? 1 Administration of free water is avoided in the setting of TBI. 2 Electrolytes and fluids can be managed more efficiently. 3 Enteral feedings assist with avoiding dehydration. 4 Malnutrition promotes continued cerebral edema.

4 A patient with diffuse axonal injury is unconscious and with increased ICP. This patient is in a hypermetabolic, hypercatabolic (excessive metabolic breakdown of complex substances (as protein) within the body) state that increases the need for fuel for healing. Malnutrition promotes continued cerebral edema, and early feeding may improve outcomes when begun within 3 days after injury. NOT 1 Neither IV fluids nor enteral nutrition is categorized as free water. 2 Electrolytes and fluid volume can be managed with both IV fluid and enteral nutrition administration. 3 Enteral feeding is not a treatment for dehydration; enteral nutrition can actually lead to dehydration due to the high concentration of solute in the feed.

When diagnosed with a brain tumor and acquired immunodeficiency syndrome (AIDS), which type of tumor growth would the nurse associate with this patient? 1 Metastatic tumor 2 Acoustic neuroma 3 Pituitary adenoma 4 Primary central nervous system lymphoma

4 AIDS affects lymphocyte production. Primary CNS lymphoma originates from lymphocytes and, therefore, is seen in patients with AIDS. NOT 1 Metastatic tumors are malignant types that originate in the lungs and breasts. 2 Acoustic neuroma is a low-grade malignancy that originates from cells that form myelin sheath. 3 Pituitary adenoma is usually benign and originates from the pituitary gland.

Which type of herniation would the nurse associate with imaging studies indicating the presence of lateral displacement of the patient's brain tissue beneath the falx cerebri? 1 Uncal herniation 2 Central herniation 3 Tentorial herniation 4 Cingulate herniation

4 Lateral displacement of brain tissue beneath the falx cerebri results in cingulate herniation. NOT 1 Lateral and downward herniation results in uncal herniation. 2.3. Forces caused by a mass lesion in the cerebrum cause downward movement of the brain, which results in central herniation or tentorial herniation.

Which action would the nurse implement when a patient's assessment reveals an increased intracranial pressure (ICP) and the patient has a lumbar puncture scheduled? 1 Prepare the patient and assist with the lumbar puncture. 2 Reschedule the lumbar puncture for the next business day. 3 Administer IV fluids before the lumbar puncture. 4 Cancel the lumbar puncture and contact the prescribing provider.

4 Lumbar puncture may cause cerebral herniation due to the sudden release of pressure in the skull from the area above the punctured site and is contraindicated in a patient with increased ICP, so cancel the procedure and contact the prescribing provider. NOT 2 Rescheduling the lumbar puncture for the next day may not reduce the risk of cerebral herniation. 1 Performing the lumbar puncture immediately may cause cerebral herniation. 3 Administering IV fluids does not reduce the risk of cerebral herniation.

When preparing to administer temozolomide (Temodar) to a patient with a brain tumor, which rationale supports the nurse's need to assess the patient's absolute neutrophil count to verify a count >1500/µL? 1 To reduce nausea and vomiting 2 To prevent metabolic inactivation 3 To prevent immune-related complications 4 To prevent drug interactions with corticosteroids

4 Temozolomide can cross the BBB and is used to treat brain tumors. It causes myelosuppression in patients with low levels of neutrophils. Therefore, the neutrophil count of the patient should be > or equal to 1500/µL before administering temozolomide to prevent immune-related complications. NOT 1 Administer temozolomide to patients with an empty stomach to prevent NV. 2 The medication does not require activation because it is a metabolically active drug. 4 This drug does not react with corticosteroids.

When assessing a patient's neurologic status upon arrival to the emergency room, which reliable indicator would the nurse utilize first? 1 Dim vision 2 Papilledema 3 Body temperature 4 Level of consciousness

4 The LOC is the most sensitive and reliable indicator of the patient's neurologic status (any condition that affects the brain, spinal cord or nervous system). NOT 1 Dim vision can occur due to dysfunction of CN. 2 Papilledema, which is an edematous optic disc seen on retinal examination, can be noted and is a nonspecific sign associated with persistent increases in ICP. 3 A change in body temperature may also occur because increased ICP affects the hypothalamus.

Which clinical manifestations would the nurse anticipate identifying in a patient who is comatose? Select all that apply. 1 Patient can cough and swallow. 2 Patient has bowel and bladder control. 3 Patient does not respond to painful stimuli. 4 Patient has incontinence of urine and feces. 5 Patient's corneal and pupillary reflexes are absent.

5 A coma is the deepest state of unconsciousness in which the corneal and pupillary reflexes are absent. 4.3. A comatose patient is also incontinent of urine and feces and does not respond to painful stimuli. NOT 1.2. The comatose patient is not able to cough and swallow and does not have any bowel and bladder control.

Which factors would the nurse consider when evaluating surgical therapy as treatment for the patient with a brain tumor? Select all that apply. 1 Complete removal of all types, sizes, and location of tumors can occur. 2 Partial removal of the ore invasive gliomas and medulloblastomas occurs. 3 Complete removal of more invasive gliomas and medulloblastomas occurs. 4 Complete removal of meningiomas and oligodendrogliomas can occur. 5 The outcome of surgical therapy depends on the type, size, and location of tumor.

5 The outcome of surgical therapy depends on the type, size, and location of the tumor. 2.4. Complete removal of meningiomas and oligodendrogliomas is usually achieved, and partial removal occurs with more invasive gliomas and medulloblastomas. NOT 1.3. Complete removal of all types, sizes, and locations of tumors cannot occur, and complete removal of more invasive gliomas and medulloblastomas cannot occur via surgical therapy.

Focal neurologic deficit

A focal neurologic deficit is a problem with nerve, spinal cord, or brain function.

During the patient's initial assessment upon awakening after being comatose for seven hours, which clinical manifestations would the nurse anticipate identifying? Select all that apply. 1 Decreased apathy 2 Loss of concentration 3 Loss of social restraint 4 Increase in personal drive 5 Euphoria and mood swings

A patient with a head injury who has been comatose for more than 6 hours undergoes some personality changes. 2.3.5. The patient may lose concentration, social restraint, and experience euphoria and mood swings. NOT 1.4. Apathy may increase, and personal drive may decrease.

Which Glasgow Coma Scale (GCS) score would the nurse assign an unconscious patient who opens the eyes in response to pain but who does not respond to any other stimulus, moans to any verbal communication, and demonstrates flexion withdrawal? A 4 B 6 C 8 D 10

C The GCS is a quick, practical, and standardized system for assessing loss of consciousness. According to this scale, the patient's ability to open his or her eyes in response to only pain stimulus merits a score of 2. Expressing incomprehensible words such as moaning merits a score of 2; and for flexion withdrawal, a score of 4 is given. Therefore, 2 + 2 + 4 = 8 indicates the value for the GCS for this patient.

Which Glasgow Coma Scale (GCS) score would the nurse anticipate for a patient with a moderate type of head injury? A 3 B 5 C 10 D 14

C The GCS range for patients with a moderate type of head injury is 9 to 12. Therefore, for the patient with a moderate type of head injury, a score of 10 is suitable. NOT A.B. Patients with a severe type of head injury have a GCS score between 3 to 5. D Patients who has a minor type of head injury have a GCS score of 14.

Diffuse Axonal Injury (DAI)

Diffuse axonal injury is the shearing (tearing) of the brain's long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull.

Cortical mapping

Direct brain recording or stimulation to identify language, motor, and sensory areas of the cortex.

Dexmedetomidine (Precedex)

Drug that stimulates α2-receptors, characterized by its sedative, anxiolytic, and analgesic effects. It is used to treat surgical patients in intensive care.

Which pathophysiologic processes would the nurse suspect when a patient with a head injury develops a temperature of 103o F (39.4o C)? Select all that apply. 1 The patient's metabolic rate decreased. 2 An increased cerebral blood flow is occurring. 3 The patient's intracranial pressures have decreased. 4 The metabolic wastes are increasing due to the head injury. 5 A decreased blood flow decreased the amount of cerebral blood volume.

Hyperthermia occurs when there is an injury or inflammation in the hypothalamus. The body temp of 103° F (39.4° C) of a patient who has a head injury indicates an injury to the hypothalamus. 4 Injury to the hypothalamus can increase metabolic waste because of increased metabolism secondary to hyperthermia. Hyperthermia causes an increase in cerebral flow because of increased metabolic demands. 2 Hyperthermia associated with a head injury causes increased metabolism and increased ICP because of increased cerebral blood flow.

Which statements reflect understanding by the newly licensed registered nurse providing care for a patient with recent placement of a ventricular shunt? Select all that apply. 1 "I need to wear sterile gloves whenever I palpate the patient's incision site." 2 "I should be concerned if my patient begins to vomit or dry heave and has a headache." 3 "I will compare my current assessment findings with the patient's preoperative assessments." 4 "I informed the unlicensed assistive personnel (UAP) to reposition the patient quickly to prevent headaches." 5 "With placement of the ventricular shunt, I do not need to monitor the patient's intracranial pressures (ICPs) because they are now normal."

Rapid decompression of ICP can cause total body collapse, weakness, and headache by rapid position change. To prevent this, gradually move the patient into an upright position (4 = wrong). 1 Infection of shunts can occur, so the nurse should use sterile precautions when assessing incision sites. 3 To recognize changes in neurologic status, the nurse should compare postop findings with a baseline to quickly recognize complications or establish improvement from the surgical intervention. 2 HA, vomiting, change in LOC, restlessness, and visual disturbances are all indications of increased ICP from malfunction of the shunt. NOT 5 Although the ICPs may be normal with placement of the shunt, the patient is in the immediate postop period, and the shunt may malfunction. Continued monitoring for clinical manifestations of increased ICPs needs to occur.