NRNP 6560 FINAL EXAM LATEST 2024 -
2025 130 + QUESTIONS AND VERIFIED
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Coup-contrecoup injury
Dual impacting of the brain into the skull; coup injury
occurs at the point of impact; contrecoup injury occurs
on the opposite side of impact, as the brain rebounds.
Scalp laceration: what, effect, management
Primary head injury
profuse bleeding - signs of hypovolemia
Apply direct pressure
Suture/ staple laceration
Lidocaine 1% with epi to control bleeding, not close to
nose/ ears
Page 1 of 139
,Skull fracture: types, effect, management
Primary head injury
Simple: no displacement of bone. Observe and protect
spine
Depressed: bone fragment depressing thickness of scull
Surgery for debridement. Give tetanus and seizure
precautions
Basilar: fracture at floor of skull
Raccoon eye - periorbital bruising
battle's sign: mastoid bruising
otorrhea/ rhinorrhea - halo sign: do not obstruct flow
Give Ab's
Oral intubation and oral gastric instead of nasal
Brain injury: types, effect, management
Primary head injury
Page 2 of 139
,Concussion: reversible change in brain functioning
loss of consciousness, amnesia
Do not give opioids, admit for unconsciousness greater
than 2min
Contusion: bruising to surface of brain with edema
Frontal and temporal region
Brainstem contusion: posturing, variable temp, variable
vital signs
N/V, dizziness, visual changes
seizure precautions
Hematoma - neuro: types, effect, management
Epidural hematoma: commonly temporal/ parietal region
with skull fracture, causing bleeding into epidural space
Loss of consciousness
Rapid deterioration: obtunded, contralateral hemiparesis,
ipsilateral pupil dilation
CT scan (non contrast)
Treatment based on Brain trauma foundation. Surgical if
greater than 30cm
Page 3 of 139
, Subdural hematoma
most common type of intracranial bleed
Acute (hours): drowsy, agitated, confused, headache,
pupil dilation,
CT scan (noncontrast)
surgery for 10mm thickness or 5mm midline shift or for
worsening GCS
Chronic (days): headache, memory loss, incontinence
CT scan (noncontrast)
Surgery: burr holes
Cerebral edema/ ICP elevated/ herniation: symptoms,
management
decreased level of consciousness
Blown pupil
Cushing triad: HTN (widening pulse pressure), decreased
resp rate, bradycardia (means increased intracranial
pressure)
Neuro exam components
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