TRAUMATIC LESIONS PNLE PRACTICE

1. Initial Priority

A client is rushed to the ER after a head-on collision. What is the nurse’s first action?
A. Assess airway and stabilize cervical spine
B. Perform a neurologic assessment
C. Check for CSF drainage
D. Obtain vital signs

Answer: A
Rationale: Airway and C-spine stabilization is always priority in trauma.
PNLE Trick: “Airway with spine = First.”

2. Basilar Skull Fracture

A client with basilar skull fracture has clear fluid leaking from the nose. Best action?
A. Suction the fluid immediately
B. Collect drainage on gauze pad to check halo sign
C. Insert NG tube for decompression
D. Pack nostrils with gauze

Answer: B
Rationale: Suspect CSF leak; test with halo sign/glucose. Never insert NG tube → risk of brain penetration.

3. Epidural Hematoma

A patient was briefly unconscious, then awake, then rapidly deteriorates. This indicates:
A. Subdural hematoma
B. Epidural hematoma
C. Concussion
D. Skull fracture

Answer: B
Rationale: Classic sign: lucid interval then rapid decline = epidural hematoma.

4. ICP Early Sign

Which finding is an early sign of ↑ ICP?
A. Bradycardia
B. Widening pulse pressure
C. Headache and vomiting
D. Cheyne-Stokes respiration

Answer: C
Rationale: Headache, vomiting, restlessness are early; Cushing’s triad is late.

5. Cushing’s Triad

The nurse notes BP 180/70, HR 50, irregular respirations. What does this indicate?
A. Hypovolemic shock
B. Cushing’s triad (late ↑ ICP)
C. Basilar fracture
D. Brain death

Answer: B

6. NG Tube Contraindication

Why should an NG tube not be inserted in basilar skull fracture?
A. Risk of aspiration
B. Tube may enter cranial cavity
C. Risk of infection only
D. It worsens ICP

Answer: B
Rationale: Basilar fracture → fractured cribiform plate → NG tube can penetrate brain.

7. Posturing

A TBI patient shows rigid extension and pronation of arms. This is:
A. Decorticate posturing
B. Decerebrate posturing
C. Flaccid paralysis
D. Normal response

Answer: B
Rationale: Decerebrate = extension, indicates brainstem involvement (worse prognosis).

8. CSF Leak Precaution

CSF is draining from the patient’s ear. Which action is correct?
A. Insert cotton tightly to stop flow
B. Place sterile gauze under ear to collect drainage
C. Apply firm pressure
D. Instill antibiotics

Answer: B
Rationale: Allow drainage, don’t block → prevents ↑ICP or infection.

9. Pain Management

Which analgesic should be avoided in TBI?
A. Morphine
B. Acetaminophen
C. Codeine
D. Opioids in high doses

Answer: D
Rationale: High-dose opioids depress respirations and mask neuro changes.

10. Seizure Precautions

A TBI patient is at risk for seizures. Which action is appropriate?
A. Pad side rails
B. Restrain client
C. Keep patient flat at all times
D. Provide tongue blade at bedside

Answer: A
Rationale: Pad rails, ensure airway; tongue blades never used.

11. GCS Assessment

A patient opens eyes to pain, makes incomprehensible sounds, withdraws from pain. What is GCS?
A. 10
B. 8
C. 6
D. 12

Answer: B
Rationale: Eye = 2, Verbal = 2, Motor = 4 → total = 8 (coma).

12. Concussion Teaching

A patient discharged after concussion should return to ER if:
A. Headache persists
B. Vomiting occurs repeatedly
C. Feels tired
D. Has mild dizziness

Answer: B
Rationale: Repeated vomiting = ↑ ICP, needs immediate eval.

13. ICP Nursing Action

Which action increases ICP?
A. Elevating HOB 30°
B. Maintaining neutral head position
C. Frequent suctioning for long periods
D. Avoiding hip flexion

Answer: C
Rationale: Suctioning increases ICP → limit to <10 sec.

14. Mannitol

What is the purpose of mannitol in head injury?
A. Decrease infection
B. Decrease intracranial pressure
C. Sedate patient
D. Prevent seizures

Answer: B
Rationale: Mannitol = osmotic diuretic, ↓ cerebral edema.

15. Pupil Changes

Unequal pupils in TBI patient indicate:
A. Normal aging
B. Herniation / ↑ ICP
C. Sleepiness
D. Drug intoxication

Answer: B
Rationale: Unequal pupils = ↑ ICP, cranial nerve compression.

16. Hyperventilation Use

Hyperventilation may be used temporarily in ↑ ICP because:
A. ↓ PaCO₂ causes cerebral vasoconstriction
B. ↑ O₂ to brain
C. ↓ Metabolic rate
D. Prevents seizures

Answer: A
Rationale: Lower CO₂ → vasoconstriction → ↓ ICP.

17. Halo Sign

Blood-stained drainage forms a yellow ring on gauze. This indicates:
A. Infection
B. CSF leak
C. Normal blood separation
D. Nothing significant

Answer: B

18. Restraints in TBI

A restless TBI patient tries to remove IV lines. Best action?
A. Apply bilateral wrist restraints
B. Use least restrictive measures like mittens or sitter
C. Restrain both arms and legs tightly
D. Sedate the patient heavily

Answer: B
Rationale: Use least restrictive first to prevent ↑ ICP.

19. Vomiting Pattern

Projectile vomiting without nausea in TBI means:
A. GI infection
B. ↑ Intracranial pressure
C. Food intolerance
D. Shock

Answer: B

20. Surgery Prep

The client with epidural hematoma is scheduled for craniotomy. Nursing priority pre-op?
A. Keep NPO
B. Start active ROM
C. Administer sedatives
D. Place in Trendelenburg

Answer: A
Rationale: Keep NPO for emergency surgery; Trendelenburg contraindicated.