M 11-3 Traumatic Brain Injury

Which types of sports are most likely to cause concussion and traumatic brain​ injury? A. High-impact B. Energetic C. Team D. Competitive

A. High-impact Rational: ​High-impact and extreme sports such as​ boxing, football,​ hockey, and skateboarding carry a higher risk of concussion and TBI. Team sports might be competitive and energetic without being high impact.

The parents of a 5-month-old infant come to the emergency department for treatment. The baby is listless and having seizures. The healthcare provider notices retinal hemorrhages. Which parent statement indicates that the infant may be a victim of shaken baby syndrome? A. "The baby would not stop crying, and I was getting frustrated." B. "I think something happened from the new prescription medicine." C. "When I went to bed last night, the baby was fine. I do not understand this." D. "We went to wake the baby up and noticed that he could not wake up."

A. "The baby would not stop crying, and I was getting frustrated." Rational: Shaken baby syndrome is the primary cause of traumatic brain injuries in infants. The infant presents with listlessness, seizures, and retinal hemorrhages. The parent admitting to getting frustrated because the baby would not stop crying is an indication that the parent lost their temper and shook the baby. The parent stating that the infant was like that when waking up, that the baby was fine the previous night, or that something happened as a result of the new prescription medication does not explain the symptoms the infant is experiencing.

Traumatic brain injury occurs when which of the following causes some degree of impairment to brain structure or​ function? A. External force B. Congenital disorder C. Infection D. Stress reaction

A. External force Rational: Traumatic brain injury occurs when an external force causes some degree of impairment to brain structure or function. The damage caused by this external force is referred to as the primary injury. Traumatic injury is not congenital and does not follow from infection or psychologic stress.

The nurse is caring for a soldier who experienced a traumatic brain injury (TBI) from a roadside bomb, resulting in auditory damage.Which intervention would be most appropriate for the nurse to incorporate in the plan of care? A. Facing the patient and speaking clearly B. Limiting available choices for decision making C. Providing frequent orientation to time and place D. Promoting independence with daily self-care

A. Facing the patient and speaking clearly Rational: The nurse should face the person and speak clearly for a patient that has experienced a traumatic brain injury with auditory deficits. Promoting independence with self-care would be appropriate for patients who have physical or cognitive deficits. Limiting choices would be appropriate for patients with poor judgment. The nurse would provide frequent orientation to time and place for a patient with cognitive deficits or memory problems.

A female patient who is unresponsive after sustaining injuries in a motor vehicle crash is brought to the emergency department. Laboratory results indicate that the patient is pregnant. Once the patient is stabilized, which intervention should the nurse perform next? A. Placing a fetal monitor on the patient B. Preparing for imminent miscarriage C. Administering anticonvulsant medications D. Administering oxygen via nasal cannula

A. Placing a fetal monitor on the patient Rational: Once the nurse determines that a patient with a traumatic brain injury (TBI) is pregnant, the next intervention the nurse should perform is to initiate fetal monitoring to determine the status of the fetus. The nurse would not assume that the patient will miscarry the baby, so the nurse would not prepare for this. The nurse would administer anticonvulsants if the patient were having a seizure. Oxygen would be administered if the patient were hypoxic.

An adolescent who wants to play baseball is seen at the clinic for a pre-sports physical. Which information should the nurse provide the adolescent that helps prevent traumatic brain injuries (TBIs)? A. Refrain from sliding into the base headfirst. B. Wear your helmet when you are a pitcher. C. Notify the coach if you are feeling overtired. D. Refrain from tackling other players on the field.

A. Refrain from sliding into the base headfirst. Rational: Children and adolescents who play baseball should be instructed to refrain from sliding into the base headfirst, because this could lead to aTBI. Baseball players usually do not wear helmets unless at bat. Tackling is a component of football, not baseball. Feeling overtired can be caused by a multitude of problems, including lack of sleep. This is not a sign of a concussion.

Which information should the nurse provide the family of an 85-year-old patient to prevent traumatic brain injuries (TBIs)? A. Remove throw rugs and cords from pathways. B. Avoid inadequate administration of medication. C. Prevent improper use of home safety equipment. D. Ensure use of seat belts when in vehicles.

A. Remove throw rugs and cords from pathways. Rational: Older adults are at an increased risk for traumatic brain injuries (TBIs) due to sensory and perception changes. Therefore, the nurse would instruct the family to remove throw rugs and cords. Seat belt use affects all age groups. Improper use of home safety equipment is not a risk factor for TBIs. Overmedication, polypharmacy, leads to poor safety awareness in the older adult. Inadequate administration of medication is not an issue.

The nurse is caring for a patient admitted to a rehabilitation facility after sustaining a traumatic brain injury (TBI). The patient is withdrawn and refuses to leave the room. Which initial intervention would the nurse make to help the patient? A. Spending time with the patient in their room each day B. Assigning a roommate to the patient's room C. Arranging for the patient to attend a group activity D. Giving the patient books to read on their own

A. Spending time with the patient in their room each day Rational: The patient is having difficulty coping with changes that have occurred from the injury. The nurse's initial intervention would be to set aside time to spend with the patient in their room. Eventually, the nurse would progress to one-on-one activities out of the room, but not a group activity. Assigning a roommate may not help the patient who is depressed. The patient needs to progress through the depression at their own pace. Providing books to read further isolates the patient from the nurse and others.

A patient with a traumatic brain injury (TBI) is diagnosed as being brain dead. Which assessment finding supports this diagnosis? A. Extended neck and clenched jaw B. Absence of spontaneous respirations C. Awareness of environment but inability to communicate D. Complete unawareness of self

B. Absence of spontaneous respirations Rational: Brain death is the cessation and irreversibility of all brain functions, including the brainstem. Since the brainstem controls respirations, absence of respirations would be a nursing assessment finding in brain death. Complete unawareness of self describes a persistent vegetative state. An extended neck with clenched jaw describes decerebrate posturing. Awareness of the environment but inability to communicate describes locked-in syndrome.

A patient with a traumatic brain injury (TBI) is intubated and placed on mechanical ventilation. Which information should the nurse use to evaluate the effectiveness of this respiratory intervention? A. Glasgow Coma Scale score B. Arterial blood gas results C. Cranial nerve function D. Motor and sensory function

B. Arterial blood gas results Rational: A patient with an alteration in level of consciousness (LOC) may be unable to maintain an open airway and engage in spontaneous respirations. The patient may need endotracheal intubation or mechanical ventilation. Arterial blood gases are used to guide the effectiveness of ventilation. Glasgow Coma Scale score, cranial nerve function, and motor and sensory function are used to determine the effect of intracranial pressure on body functioning.

The nurse is working with the family of a patient who is on life support due to a severe traumatic brain injury (TBI). The healthcare provider informs the family that the patient has very little brain function and has little to no hope of survival. Which member of the healthcare team should the nurse include in the plan of care to meet the family's needs? A. Psychologist B. Chaplain C. Surgeon D. Psychiatrist

B. Chaplain Rational: The family is dealing with possible end-of-life issues with the patient. Therefore, the nurse would refer the patient's family to the hospital chaplain. A psychologist and psychiatrist would be beneficial for short- and long-term counseling later, but the immediate need is for a chaplain. The surgeon would be included in the plan of care if surgery were necessary for the treatment.

The nurse is caring for an adult patient who sustained multiple injuries in an all-terrain vehicle (ATV) accident. Which clinical finding warrants immediate healthcare provider notification? A. Reports of muscular pain in the arms B. Clear fluid from the patient's nose C. Bruising to the lower extremities D. Alert and oriented to place and situation

B. Clear fluid from the patient's nose Rational: Clear drainage from the nose or ears can indicate a cerebrospinal fluid leak. This warrants immediate healthcare provider notification, as this indicates a basilar skull fracture. Bruising and muscle pain are normal findings after sustaining an ATV accident and do not require notification. Alert and oriented to place and situation would be a normal finding.

Which of the following infant clients presenting with traumatic brain injury​ (TBI) is least likely the victim of child​ abuse? A. Infant with​ contusion, unknown cause B. Infant with diffuse axonal injury following involvement as passenger in a vehicle collision C. Infant with contusion sustained from fall from high chair D. Infant with diffuse axonal​ injury, unknown cause

B. Infant with diffuse axonal injury following involvement as passenger in a vehicle collision Rational: Assaults/child abuse are the leading cause of death for infants and children with TBI. Injury patterns will depend on the cause of injury. For​ example, an infant who suffers a TBI from shaken baby syndrome will exhibit diffuse axonal​ injury, whereas a toddler who suffers a fall may have a local contusion with edema from a​ coup-contrecoup injury. The fall from a high chair could have happened accidentally or have been caused to​ happen, and either a contusion or a diffuse axonal injury could be the result of abuse. A diffuse axonal injury following involvement in a vehicle​ collision, however, is most likely the result of the collision.

A patient experiences fractures of the left leg and a traumatic brain injury (TBI). Which assessment finding indicates increased intracranial pressure (IICP)? A. Nausea B. Irritability C. Hypotension D. Oliguria

B. Irritability Rational: Irritability may indicate that the patient is experiencing an increase in intracranial pressure, especially if associated with additional signs of bradycardia, increased systolic pressure, increased pulse pressure, vomiting, headache, lethargy, and change in mental status. Nausea does not accompany the vomiting associated with IICP. Hypotension and oliguria are not associated with IICP.

Which factor increases the risk of an older adult patient developing a traumatic brain injury (TBI)? A. Being a victim of violence B. Polypharmacy C. Motor vehicle crash D. Physical abuse

B. Polypharmacy Rational: Older adult patients are at higher risk for developing traumatic brain injuries (TBIs) due to polypharmacy, the use of multiple prescriptions and over-the-counter medications, and changes in sensory/perception with aging. Motor vehicle crashes affect younger people more than they do older adults. Physical abuse is one of the main causes of TBI in children under the age of 4. Violence affects adolescents related to gang activity.

The nurse is caring for a patient admitted to the hospital with brainstem damage resulting from a traumatic brain injury. Which assessment finding warrants immediate healthcare provider notification? A. Slurred speech B. Repetitive hiccupping C. Diarrhea D. Constipation

B. Repetitive hiccupping Rational: The brainstem is responsible for breathing, blood pressure, and pulse. Damage to the brainstem can lead to repetitive hiccupping, sneezing, or coughing. Therefore, this finding can indicate further damage and warrants immediate healthcare provider notification. Slurred speech can indicate cerebellar damage. Diarrhea and constipation are not related to brainstem damage.

Which patient should the nurse consider to be at highest risk for developing a traumatic brain injury (TBI)? A. A 14-year-old patient on the school tennis team B. A 26-year-old patient who uses a seat belt C. A 2-year-old child of an alcoholic parent D. A 50-year-old patient who is a maintenance worker

C. A 2-year-old child of an alcoholic parent Rational: The patient at highest risk for sustaining a TBI is the 2-year-old child who has an alcoholic parent. The parent may be abusive during alcoholic binges and cause a TBI to the child. The patient wearing a seat belt in the car has a lower risk for developing a TBI if a motor vehicle crash occurs. Tennis is not considered a contact sport and has a low incidence of TBI. Maintenance workers are not at risk for traumatic brain injuries.

Which older adult would be at increased risk for intracranial hemorrhage after sustaining a fall? A. A patient with a prior history of Alzheimer-type dementia B. A patient with a history of Parkinson disease C. A patient taking anticoagulant medication for atrial fibrillation D. A patient with osteoporosis who sustained a hip fracture

C. A patient taking anticoagulant medication for atrial fibrillation Rational: The older adult is at higher risk for falls and traumatic brain injuries (TBIs) due to sensory or perceptual deficits. The patient that is at highest risk for an intracranial hemorrhage is the person taking anticoagulants, because this increases the risk for bleeding. A history of TBIs as a child or young adult can increase the risk for dementia later in life. Osteoporosis is not a risk factor for intracranial hemorrhage; it is caused by loss of calcium in the bones. Parkinson disease can lead to an increased risk for falls, but it does not lead directly to intracranial hemorrhage.

Which clinical manifestation is associated with a mild​ concussion? A. Bleeding in the brain B. Prolonged unconsciousness C. Acute headache D. Difficulty breathing

C. Acute headache Rational: Acute headache is a clinical manifestation of a mild concussion or traumatic brain injury. Bleeding in the​ brain, difficulty​ breathing, and prolonged unconsciousness are all clinical manifestations of moderate to severe traumatic brain injury.

Which class of medication should the nurse expect to administer to a patient with seizures related to a traumatic brain injury (TBI)? A. H2-receptor antagonist B. Stool softener C. Antiseizure D. Vasoactive medication

C. Antiseizure Rational: The patient experiencing seizures due to TBI would benefit from an anticonvulsant. H2-receptor antagonists decrease gastric acid production in patients with TBIs. Stool softeners prevent straining with bowel movements, which can increase intracranial pressure. Vasoactive medications are used to keep the patient hemodynamically stable.

The nurse includes the assistance of the social worker when planning care for a patient who has physical limitations resulting from a traumatic brain injury (TBI). Which intervention would the social worker provide? A. A home exercise program B. Home health therapy visits C. Home modifications D. Home medication monitoring

C. Home modifications Rational: The social worker would be able to provide the patient and the family with resources for home modifications that are needed to meet physical needs. The physical and occupational therapists would develop a home exercise program. Home medication monitoring would be provided by a skilled nurse.

A client is classified as Grade 4 for risk of cerebral vasospasm because of intracerebral clotting and absence of blood in the basal cisterns. Which diagnostic test is most useful to assess intracerebral hemorrhage and grade cerebral​ vasospasms? A. Ct scan B. Cerebrospinal fluid (CSF) analysis C. Transcranial Doppler D. MRI

C. Transcranial Doppler Rational: Transcranial Doppler may be indicated for intracerebral hemorrhage and is especially useful with grading cerebral vasospasms that may accompany a subarachnoid hemorrhage. A CT scan is vital to the diagnosis of traumatic brain injury​ (TBI) because it can detect the presence and location of skull​ fractures, contusions,​ hematomas, hemorrhage, and other brain damage. MRI scans are beneficial for providing more detailed brain​ images, including axonal​ injury, once the client is stabilized. Any clear fluid that leaks from the​ client's nose or ears should be assessed for CSF​ (glucose will be​ present) because this may be indicative of a basilar skull fracture.

The nurse is teaching a group of adolescents on how to decrease the risk of traumatic brain injuries (TBIs). Which information is most appropriate to provide to this age group? A. Refraining from participating in all sports B. Decreasing the amount of alcohol ingested C. Wearing a helmet when skateboarding D. Keeping pathways clear and free of cords

C. Wearing a helmet when skateboarding Rational: Adolescents are risk takers. At their developmental age level, they believe that they are invincible and that nothing can hurt them. Therefore, they tend to ride bikes and skateboards as well as participate in contact sports without the use of helmets. The nurse should instruct the adolescent on the importance of safety headgear. Adolescents should be eliminating alcohol and drug consumption, not just decreasing it. The nurse would not instruct the adolescent to refrain from participating in all sports. Appropriate safety precautions minimize the risk of TBIs. Removing cords from pathways minimizes falls in the older adult population.

The healthcare provider ordered a computerized tomography (CT) scan for a patient admitted with a possible traumatic brain injury (TBI). The family wants to know about the purpose of this test. Which response by the nurse is accurate? A. "A CT scan is used to determine the presence of tumors or abnormal growths that caused the problem." B. "A CT scan will help determine the presence of hearing or language difficulties related to the injury." C. "A CT scan is a diagnostic test that the healthcare provider will prescribe for all patients." D. "A CT scan will determine the presence and location of any fractures of the skull or bleeding in the brain."

D. "A CT scan will determine the presence and location of any fractures of the skull or bleeding in the brain." Rational: The patient possibly sustained a traumatic brain injury (TBI), and a CT scan will show any areas of bleeding inside or outside of the skull, any fractures, or other brain damage. The healthcare provider will not arbitrarily prescribe a CT scan for all patients admitted to the hospital, as this is an expensive test and is not necessary for everyone. Hearing and language difficulties are determined by audiologists and speech therapists. Tumors and growths can be detected by a CT scan; however, this patient is being evaluated for a TBI, not a malignancy.

The nurse is working with a veteran who experienced a traumatic brain injury (TBI) related to combat. The patient has made progress and is medically stable but needs further extensive physical and occupational therapy. From which type of facility would the patient get the most benefit? A. Home health service B. A nursing home C. An outpatient center D. A rehabilitation center

D. A rehabilitation center Rational: This patient who needs further physical and occupational inpatient care would benefit most from a rehabilitation center. A nursing home would not provide therapy for the patient. An outpatient center would not provide extensive therapy. Home health services may be beneficial when the patient is discharged from the rehabilitation facility.

The school nurse is teaching a group of adolescent students regarding the incidence of traumatic brain injuries (TBI). Which sport should the nurse include in the presentation as an example that causes a high incidence of concussions and TBIs? A. Bicycling B. Swimming C. Jogging D. Hockey

D. Hockey Rational: Sports such as hockey, football, and boxing have a high rate of concussions and TBIs due to head trauma. Swimming, bicycling, and jogging have low rates due to lack of direct head contact.

Which statement about cerebral edema or ischemia is​ true? A. It often causes a skull fracture B. It is an example of a lacerating injury C. It is an example of a penetrating injury D. It is often secondary to a traumatic brain injury

D. It is often secondary to a traumatic brain injury Rational: Secondary injuries can be caused by intracranial damage or systemic insults to the brain. Some examples of secondary injuries include cerebral​ ischemia, cerebral​ edema, increased intracranial pressure​ (IICP), infection,​ hypoxia, hypotension,​ fever, and hyponatremia. Cerebral edema or ischemia might follow skull fracture but would not cause​ it, and neither is an example of a lacerating or penetrating injury.

The nurse is developing a plan of care for the family of a war veteran who sustained a moderate traumatic brain injury (TBI). The patient is experiencing verbal and language impairment. Which intervention would be most appropriate for the nurse to include? A. Providing information about hearing aids B. Orienting the patient to person, place, and time C. Administering medications as prescribed D. Providing a dry erase board and a marker

D. Providing a dry erase board and a marker Rational: The patient is experiencing difficulty with speech and language; therefore, the nurse would provide a dry erase board and marker to help the patient communicate. The patient who is confused would need to be reoriented to person, place, and time. The nurse would not administer medications to correct speech and language deficits. Medications may be used to treat seizures or manage pain. The patient does not have a hearing problem, so a hearing aid would not be needed.

The nurse is teaching a child and their parents about postconcussion instructions prior to discharge. Which information should the nurse include in the teaching? A. Allowing continuous sleep for the first 12 hours B. Taking ibuprofen as directed on the bottle C. Instructing that drowsiness is normal for the first few days D. Refraining from sports for at least 7-10 days

D. Refraining from sports for at least 7-10 days Rational: The nurse would instruct the patient and family to refrain from sporting activities for a minimum of 7-10 days after a concussion. This prevents second injury syndrome (SIS). Ibuprofen and other nonsteroidal anti-inflammatory drugs are contraindicated, as they can cause intracranial hemorrhage. The child should not be allowed to sleep continuously for the first 12 hours. The family should wake the child every 2-3 hours to determine changes in manner or actions. Increased drowsiness is understandable for the first day, but chronic sleepiness needs to be reported.

A client presents with a mild concussion following a fall. Which nursing diagnosis is least likely to be made for this​ client? A. Acute pain B. Nausea C. Acute confusion D. Risk for post-trauma syndrome

D. Risk for post-trauma syndrome Rational: A client with a mild concussion following a fall might present with acute​ pain, acute​ confusion, and​ nausea, but a diagnosis of Risk for​ Post-Trauma Syndrome would be much more likely for a client with a moderate to severe traumatic brain injury.

The nurse is working with a patient who sustained a traumatic brain injury (TBI) from a motor vehicle crash and will be discharged in a wheelchair. The patient reports three or four stairs to enter the house. Which member of the healthcare team would the nurse consult to help the patient find assistance for home modifications? A. Occupational therapist B. Physical therapist C. Psychologist D. Social worker

D. Social worker Rational: The nurse would consult the social worker who can provide information regarding community resources for home modifications. The physical therapist provides gait training and lower extremity muscle strengthening. The psychologist helps the patient sort out feelings and cope with grief and losses from the injury. The occupational therapist works with the patient to learn adaptive ways to perform daily care and upper body strength and conditioning.

The nurse is developing a plan of care for a patient who sustained a traumatic brain injury (TBI). The nurse develops a goal of performing morning care with minimal assistance. Which intervention should the nurse implement to facilitate the patient meeting this goal? A. The nurse performing 75% of the bath and morning care B. The patient requiring help with getting dressed and bathing C. The patient being independent only with oral and facial care D. Taking a shower with assistance in washing their back

D. Taking a shower with assistance in washing their back Rational: The patient who is able to perform all of their own self-care, with the exception of washing the back, indicates that only minimal assistance is needed and the goal is met. Performing 25% of their own self-care indicates that the nurse is performing 75% of care, and this is not minimal assistance. A patient needing help with dressing and bathing or only being independent with oral and facial care indicates that the goal is not met.

The school nurse is teaching a group of adolescent athletes about reducing the risk for sustaining traumatic brain injuries​ (TBI). To provide​ client-centered education to this​ population, which information is most appropriate for the school nurse to include in the teaching​ session? A. ​"Wearing seat belts can protect against injuries in motor vehicle​ collisions." B. "A fall from even a low height can cause traumatic brain​ injury." C. ​"A traumatic brain injury can occur to anyone from a wide range of​ causes." D. ​"If you are injured in a game or​ practice, don't play through the​ pain."

D. ​"If you are injured in a game or​ practice, don't play through the​ pain." Rational: Adolescents often downplay their injuries or do not report them for fear of looking weak or being unable to participate in sports and other activities. This greatly increases their risk of being injured again and developing second impact​ syndrome, which can be fatal. Nurses play a vital role in helping prevent both​ first-time and repeated TBIs by providing appropriate client teaching. Although the other statements are​ true, they​ don't specifically address the prevention challenges for TBIs that adolescents present.

A nurse is planning a teaching exercise on prevention of traumatic brain injury and identifying examples of people with a higher risk of TBI. Which of the following people is not in a​ higher-risk group for a​ TBI? A. A 13-year-old adolescent B. A​ 77-year-old retiree C. A​ 44-year-old office worker D. A​ 2-year-old child

Rational: The office worker is not in a professional occupation involving a high risk of physical impact and so would not be in a​ higher-risk group for TBI. Because TBI is often the result of an​ accident, every individual is at risk for TBI.​ However, some individuals have a higher risk than others.​ Children, especially children under the age of​ 4, are at increased risk for TBI due to falls or abuse. Adolescents and young adults are at increased risk for TBI due to interpersonal violence and sports. Older adults are at increased risk for TBI due to​ falls, which are usually related to sensory perception changes or medication side effects.