Traumatic Brain Injury (20 Questions)

1. M. Luc Tremblay, a 22-year-old hockey player, is brought to the ER after being checked into the boards. He lost consciousness for about 30 seconds on the ice but was alert and talking ("lucid interval") in the ambulance. Upon arrival, the nurse notes that M. Tremblay is becoming increasingly drowsy, and his left pupil is slightly larger than the right.

Question:
What is the nurse’s priority interpretation of this change in status? *
2. M. Bastien Leblanc, 17 years old, presents after being elbowed in the head during a soccer game. He was dazed for a minute, then walked off the pitch. On exam: GCS 15, no focal deficits, CT head negative. He complains of mild headache and nausea. The physician’s discharge orders are:
*“Observe for 24 h at home”
*“Return if headache worsens, vomiting, confusion, or seizures.”

Question:
Which instruction is most important for the nurse to emphasize at discharge? *
3. Mme Sophie Gagnon, 45 years old, was involved in a motor vehicle accident. She has a Glasgow Coma Scale (GCS) of 14. While assessing her face, the nurse notes bruising behind the ears (Battle’s sign) and around the eyes (Raccoon eyes). She also notices clear fluid dripping from the patient's nose.

Question:
Given these assessment findings, which nursing intervention is strictly contraindicated? *
4. Mme Karine Boucher, 65, fell at home two hours ago. CT head shows acute left subdural hematoma with midline shift. She is somnolent (GCS 10) and has right-sided weakness.

Orders:
*Head of bed at 30°;
*Mannitol 20% 0.5 g/kg IV STAT;
*Neuro vital signs q15 min;
*Neurosurgery consult for possible craniotomy.

During your assessment, she becomes more lethargic, GCS 8, pupils are unequal.

Question:
What is the nurse’s priority action? *
5. M. Pierre Roy, 68 years old, fell down a flight of stairs and has a subdural hematoma. He is being monitored in the ICU. Over the last hour, the nurse observes the following vital sign changes:
*BP: Increased from 130/70 to 180/60 mmHg (widening pulse pressure).
*HR: Decreased from 88 to 50 bpm (Bradycardia).
*RR: Irregular and slow (Cheyne-Stokes).

Question:
The nurse recognizes these vital signs as Cushing’s Triad. What does this indicate? *
6. M. Olivier Moreau, 40, was in an MVC and is intubated in ICU. He has an intraparenchymal ICP monitor in place.

Orders:
*Keep PaCO₂ 30–35 mmHg via ventilator settings;
*Sedate with Propofol infusion;
*Head midline, HOB 30°.

The nurse notes his head is turned to the left, and the right pupil is dilated.

Question:
Which action should the nurse take first? *
7. Mme Isabelle Dubé, 30 years old, sustained a severe TBI 3 days ago. The nurse notes that her urine output has suddenly increased to 400 mL/hr for the last 3 consecutive hours. The urine is very pale and clear. Her serum Sodium (Na+) is 155 mmol/L.

Question:
Which complication does the nurse suspect? *
8. Mme Élise Gagnon, 70, presents with raccoon eyes and clear fluid dripping from her nose after a fall. She is alert, complains of headache.

Orders:
*NPO;
*HOB 30°;
*No nasogastric tube or nasal suction;
*Beta-2 transferrin assay of nasal drainage.

She asks why she cannot blow her nose.

Question:
What is the nurse’s best explanation? *
9. M. Jean-Claude Fortin, 55 years old, is unconscious following a blow to the head. The nurse is performing a GCS assessment. When the nurse applies a central pain stimulus (sternal rub), M. Fortin extends his arms stiffly at his sides and points his toes.

GCS Scoring Components:
Eye Opening (E – Max 4 points)
4: Spontaneous (eyes open on their own)
3: To verbal command (sound/speech)
2: To pain (pressure)
1: None

Best Verbal Response (V – Max 5 points)
5: Oriented (knows person, place, time)
4: Confused (disoriented, but conversing)
3: Inappropriate words (random words, crying)
2: Incomprehensible sounds (groans, moans)
1: None

Best Motor Response (M – Max 6 points)
6: Obeys commands (e.g., "lift your finger")
5: Localizes pain (moves toward painful stimulus)
4: Withdraws from pain (pulls away from stimulus)
3: Abnormal flexion (decorticate posturing to pain)
2: Abnormal extension (decerebrate posturing to pain)
1: None

Interpreting the Score
13-15: Mild Traumatic Brain Injury (mTBI)
9-12: Moderate Traumatic Brain Injury
≤8: Severe Traumatic Brain Injury (often suggests coma or need for intubation)

Question:
How should the nurse document the Motor component of the GCS? *
10. M. Nicolas Pelletier, 55, had a temporal bone fracture with epidural hematoma evacuated. He is in recovery with GCS 9. Suddenly he exhibits decerebrate posturing and his left pupil dilates.

Orders:
*Mannitol 20% 0.5 g/kg IV stat;
*Hypertonic saline 3% infusion;
*Prep for emergent CT and possible craniectomy.

Question:
What is the nurse’s immediate priority? *
11. Mme Valérie Morin, 29 years old, is being discharged home after a mild concussion (mTBI). She asks the nurse, "When can I go back to my job as an accountant?"

Question:
What is the best teaching regarding return to activity? *
12. M. Jacques Fortin, 45, underwent decompressive craniectomy for malignant edema. He’s on the ward with a protective helmet at bedside. He asks if he can lie on his right side tonight.

Question:
Which instruction should the nurse give? *
13. M. Guillaume Bouchard, 40 years old, is intubated in the ICU with increased Intracranial Pressure (ICP). The nurse is planning nursing care activities.

Question:
Which nursing intervention should be avoided or minimized to prevent spiking the ICP? *
14. Mme Céline Martel, 50, s/p severe TBI, is showing signs of increased ICP: Bradycardia 50 bpm, BP 180/100 mmHg, irregular respirations.

Question:
What nursing intervention will best reduce her ICP immediately? *
15. M. Marc-André Lefebvre, 19 years old, suffered a TBI from a fall. He is confused and restless. His serum Sodium (Na+) has dropped to 118 mmol/L, and his urine is concentrated. The physician diagnoses SIADH.

Question:
What is the nurse’s priority safety intervention? *
16. M. Simon Roy, 25, sustained a mild TBI 2 weeks ago. He continues to have headaches. The physician orders Acetaminophen 500 mg PO q6h PRN for pain and cautions no NSAIDs.

Question:
What is the nurse’s best patient teaching? *
17. Mme Claudette Poirier, 60 years old, fell 3 weeks ago and hit her head. She did not seek medical attention then. She is brought to the clinic today by her husband, who says, "She has been acting strange, forgetting things, and has a headache that won't go away."

Question:
What condition does the nurse suspect, which is common in the elderly on anticoagulants? *
18. Mme Véronique Simard, 60, s/p moderate TBI, is NPO pending swallow evaluation due to dysphagia.

Orders:
*“NPO until speech therapy swallow assessment.”
*“Maintain IV Normal Saline at 75 mL/hr.”

She repeatedly attempts to sip water.

Question:
What is the nurse’s immediate intervention? *
19. M. Robert Côté, 50 years old, has severe cerebral edema following a TBI. The physician orders Mannitol (Osmitrol) IV.

Question:
Which assessment finding indicates that the medication is having its intended therapeutic effect? *
20. M. Thierry Desjardins, 70, with severe TBI, has improved from GCS 8 to 12, is extubation-ready. He has spontaneous breathing trial tolerance, good cough, and gag reflex.

Orders include:
“Wean sedation;”
“Perform cuff leak test;”
“Extubate when criteria are met.”

Question:
Which finding best confirms readiness for safe extubation? *