Exam-Head Injury

Question 1

What is the most common cause of traumatic brain injury (TBI)?
A. Gunshot wounds
B. Assaults
C. Falls
D. Recreational injuries

Answer 1

Answer: C. Falls
Rationale: Falls are the leading cause of TBIs, especially in older adults and young children.

Question 2

Which of the following is an early sign of increased intracranial pressure (ICP)?
A. Fixed pupils
B. Bradycardia
C. Confusion
D. Decerebrate posturing

Answer 2

Answer: C. Confusion
Rationale: Altered mental status or confusion is often the earliest sign of increased ICP.

Question 3

What is the Glasgow Coma Scale (GCS) score range for a severe brain injury?
A. 13–15
B. 10–12
C. 9–12
D. 3–8

Answer 3

Answer: D. 3–8
Rationale: A GCS score of 3–8 indicates severe TBI.

Question 4

What is the hallmark sign of a basilar skull fracture?
A. Vomiting
B. Battle sign
C. Blurred vision
D. Confusion

Answer 4

Answer: B. Battle sign
Rationale: Battle sign is bruising behind the ears and is a classic sign of basilar skull fracture.

Question 5

What is the priority nursing action for a patient with a GCS score of 7?
A. Begin IV fluids
B. Prepare for discharge
C. Intubate and protect airway
D. Administer pain medication

Answer 5

Answer: C. Intubate and protect airway
Rationale: A GCS score below 8 indicates the need for airway protection.

Question 6

What condition does the presence of rhinorrhea after head trauma most likely indicate?
A. Nasal fracture
B. CSF leak
C. Allergies
D. Sinus infection

Answer 6

Answer: B. CSF leak
Rationale: Clear nasal drainage after head trauma can indicate CSF leakage.

Question 7

Which test is used to determine if nasal fluid is CSF?
A. Urinalysis
B. Tes-Tape or Dextrostix
C. MRI
D. CT angiogram

Answer 7

Answer: B. Tes-Tape or Dextrostix
Rationale: These tests detect glucose in the fluid, suggesting the presence of CSF.

Question 8

Which condition is a neurologic emergency associated with arterial bleeding between the skull and dura mater?
A. Subdural hematoma
B. Epidural hematoma
C. Intracerebral hemorrhage
D. Aneurysm

Answer 8

Answer: B. Epidural hematoma
Rationale: Epidural hematomas often involve arterial bleeding and require rapid surgical intervention.

Question 9

What is the classic symptom pattern of an epidural hematoma?
A. Loss of consciousness → lucid interval → rapid decline
B. Headache → nausea → confusion
C. Vomiting → bradycardia → tremors
D. Dizziness → blurred vision → slurred speech

Answer 9

Answer: A. Loss of consciousness → lucid interval → rapid decline
Rationale: This classic pattern requires emergency intervention to prevent herniation.

Question 10

What is a hallmark symptom of a concussion?
A. Hemiplegia
B. Retrograde amnesia
C. Aphasia
D. Decerebrate posturing

Answer 10

Answer: B. Retrograde amnesia
Rationale: Patients with concussion may forget events before the injury.

Question 11

What finding is most concerning in a patient with head trauma?
A. Headache
B. Sleepiness
C. Unequal pupils
D. Nausea

Answer 11

Answer: C. Unequal pupils
Rationale: Pupillary asymmetry can indicate brain herniation due to increased ICP.

Question 12

What is a common complication of temporal skull fractures?
A. Seizures
B. CSF otorrhea
C. Dysphasia
D. Nasal bleeding

Answer 12

Answer: B. CSF otorrhea
Rationale: Temporal fractures often disrupt the middle meningeal artery and dura, causing CSF drainage from the ear.

Question 13

What does a “halo sign” indicate when assessing drainage from a head trauma patient?
A. Bleeding
B. Infection
C. CSF leak
D. Sinusitis

Answer 13

Answer: C. CSF leak
Rationale: A yellow ring surrounding blood on gauze suggests CSF is present.

Question 14

Which type of brain injury is characterized by widespread axonal damage?
A. Contusion
B. Subdural hematoma
C. Diffuse axonal injury (DAI)
D. Epidural hematoma

Answer 14

Answer: C. Diffuse axonal injury (DAI)
Rationale: DAI involves widespread damage to white matter tracts in the brain.

Question 15

Which medication is commonly used to prevent seizures after a head injury?
A. Acetaminophen
B. Phenytoin
C. Ibuprofen
D. Lorazepam

Answer 15

Answer: B. Phenytoin
Rationale: Phenytoin is often given to prevent post-traumatic seizures.

Question 16

What is the most accurate imaging study for detecting a skull fracture or hematoma in the acute setting?
A. MRI
B. X-ray
C. PET scan
D. CT scan

Answer 16

Answer: D. CT scan
Rationale: CT scans are fast and effective at detecting fractures and bleeding.

Question 17

A contusion typically occurs with what type of head injury?
A. Open wound
B. Penetrating trauma
C. Closed head injury
D. Scalp laceration

Answer 17

Answer: C. Closed head injury
Rationale: Contusions are bruises on the brain typically caused by closed trauma.

Question 18

What occurs in a coup-contrecoup injury?
A. One-sided swelling
B. Brain bruises on opposite sides
C. Rapid skull fracture
D. Only cerebellar injury

Answer 18

Answer: B. Brain bruises on opposite sides
Rationale: Coup-contrecoup injury causes damage at the point of impact and the opposite side due to rebound forces.

Question 19

What is the priority nursing assessment after a head injury?
A. Blood pressure
B. Glasgow Coma Scale
C. Reflexes
D. Bowel sounds

Answer 19

Answer: B. Glasgow Coma Scale
Rationale: GCS helps assess LOC and determine the severity of injury.

Question 20

What is the primary risk associated with chronic subdural hematomas in older adults?
A. Immediate death
B. Behavioral changes
C. Slow symptom progression
D. Unilateral blindness

Answer 20

Answer: C. Slow symptom progression
Rationale: Chronic subdural hematomas may develop over weeks and mimic dementia or TIA.

Question 21

What is a major complication of CSF leaks following skull fracture?
A. Aspiration
B. Pneumonia
C. Meningitis
D. Hypertension

Answer 21

Answer: C. Meningitis
Rationale: The open pathway between the CNS and environment increases infection risk.

Question 22

What intervention is contraindicated in a patient with a suspected skull fracture and CSF rhinorrhea?
A. Raising the HOB
B. Collecting drainage
C. Nasotracheal suctioning
D. Monitoring vital signs

Answer 22

Answer: C. Nasotracheal suctioning
Rationale: Suctioning can increase the risk of introducing infection or disrupting healing.

Question 22

When is surgical evacuation indicated in head trauma?
A. For all concussions
B. For large hematomas with increased ICP
C. For bruising
D. After 24 hours of observation

Answer 22

Answer: B. For large hematomas with increased ICP
Rationale: Rapid deterioration or large hematomas require surgery to prevent herniation.

Question 23

What is the best way to reduce ICP in the early post-injury phase?
A. Place patient flat
B. Encourage coughing
C. Keep head midline and elevated 30 degrees
D. Administer IV fluids rapidly

Answer 23

Answer: C. Keep head midline and elevated 30 degrees
Rationale: This position promotes venous return and reduces ICP.

Question 24

Which patient is at greatest risk for increased bleeding after a head injury? A. Diabetic patient B. Anticoagulant therapy patient C. Healthy athlete D. Child under 5

Answer 24

Answer: B. Anticoagulant therapy patient Rationale: Anticoagulants increase the risk of intracranial bleeding.

Question 25

What is a key feature of decerebrate posturing? A. Arms flexed, legs extended B. Arms and legs flaccid C. Arms extended and internally rotated D. One-sided weakness

Answer 25

Answer: C. Arms extended and internally rotated Rationale: Decerebrate posturing is a sign of severe brainstem injury.

Question 26

What is the primary nursing goal for a patient with head trauma? A. Maintain normothermia B. Prevent seizures C. Maintain cerebral perfusion and oxygenation D. Prevent infection

Answer 26

Answer: C. Maintain cerebral perfusion and oxygenation Rationale: Oxygen and blood flow to the brain are the most critical needs post-injury.

Question 27

What is the function of the dura mater? A. Cushion brain B. Produce CSF C. Outer protective membrane of the brain D. Absorb shock

Answer 27

Answer: C. Outer protective membrane of the brain Rationale: The dura mater is the tough, outermost layer of the meninges.

Question 28

What signs make up Cushing’s triad? A. Hypotension, bradycardia, tachypnea B. Hypertension, bradycardia, irregular respirations C. Tachycardia, fever, hyperpnea D. Confusion, ataxia, nystagmus

Answer 28

Answer: B. Hypertension, bradycardia, irregular respirations Rationale: Cushing’s triad indicates impending brain herniation due to increased ICP.

Question 29

When assessing a patient with a head injury, what does raccoon eyes indicate? A. Fatigue B. Frontal skull fracture C. Basilar skull fracture D. Periorbital cellulitis

Answer 29

Answer: C. Basilar skull fracture Rationale: Periorbital bruising is a classic sign of a basilar fracture.

Question 30

What should be avoided when managing a patient with a head injury? A. Monitoring pupils B. Hyperventilating patient C. Deep suctioning D. Elevating HOB

Answer 30

Answer: C. Deep suctioning Rationale: This can increase ICP and should be avoided unless absolutely necessary.

Question 31

What happens in decorticate posturing? A. Arms flexed toward chest, legs extended B. Arms extended, legs flexed C. Flaccid posture D. Twitching extremities

Answer 31

Answer: A. Arms flexed toward chest, legs extended Rationale: Decorticate posturing suggests damage to the cerebral hemispheres.

Question 32

Which lobes are most often affected in a coup-contrecoup injury? A. Occipital and cerebellar B. Parietal and insular C. Frontal and temporal D. Brainstem and spinal

Answer 32

Answer: C. Frontal and temporal Rationale: These lobes are most susceptible to bouncing forces in head trauma.

Question 33

What complication of head trauma can present weeks after injury with vague symptoms? A. Acute subdural hematoma B. Epidural hematoma C. Chronic subdural hematoma D. Brain abscess

Answer 33

Answer: C. Chronic subdural hematoma Rationale: These may present slowly and be mistaken for dementia or stroke in older adults.

Question 34

What does a GCS score of 15 indicate? A. Severe injury B. No response to stimuli C. Fully alert and oriented D. Moderate brain injury

Answer 34

Answer: C. Fully alert and oriented Rationale: A score of 15 is the highest possible and reflects normal LOC.