CFRN Neurological Trauma Management 2

Question 1

A flight patient with severe TBI has a GCS of 6 and a BP of 90/60 mmHg. What is the primary hemodynamic goal during transport?

Accepted Answer

Maintain SBP ≥ 90 mmHg to prevent secondary brain injury

Answer

Hypotension (SBP < 90 mmHg) in TBI significantly worsens outcomes by reducing cerebral perfusion pressure and causing secondary brain injury.

Question 2

During air transport, a TBI patient develops Cushing's triad. Which combination correctly identifies this reflex?

Accepted Answer

Hypertension, bradycardia, and irregular respirations

Answer

Cushing's triad—hypertension, bradycardia, and irregular respirations—is a late sign of severely elevated ICP and impending herniation.

Question 3

A patient with a basilar skull fracture is exhibiting CSF rhinorrhea. What intervention is contraindicated?

Accepted Answer

Nasogastric tube insertion

Answer

Nasogastric tube insertion is contraindicated in basilar skull fracture due to risk of the tube entering the cranial vault through the fractured cribriform plate.

Question 4

Which pupillary finding is most consistent with uncal herniation in a TBI patient?

Accepted Answer

Unilateral fixed and dilated pupil ipsilateral to the lesion

Answer

Uncal herniation compresses CN III on the ipsilateral side, causing a fixed, dilated pupil on the same side as the expanding lesion.

Question 5

A patient with a spinal cord injury at C4 is being transported. What immediate respiratory concern should the flight nurse anticipate?

Accepted Answer

Loss of diaphragmatic function requiring ventilatory support

Answer

C4 and above injuries disrupt phrenic nerve function (C3-C5), eliminating diaphragm control and requiring immediate ventilatory support.

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Neurological Trauma Management 2