CNRN Traumatic Brain Injury and Spinal Cord Injury 1 — Questions and Answers
Question 1: Which classification of traumatic brain injury (TBI) is defined by a GCS score of 13–15?
- Severe TBI
- Moderate TBI
- Mild TBI (Correct answer)
- Critical TBI
Correct answer: Mild TBI
Mild TBI is defined by a GCS of 13–15, moderate TBI by GCS 9–12, and severe TBI by GCS 8 or below.
Question 2: A patient with a basilar skull fracture may exhibit which classic clinical sign involving discoloration around the eyes?
- Cullen's sign
- Battle's sign
- Raccoon eyes (periorbital ecchymosis) (Correct answer)
- Kernig's sign
Correct answer: Raccoon eyes (periorbital ecchymosis)
Raccoon eyes (bilateral periorbital ecchymosis) indicate a basilar skull fracture involving the anterior cranial fossa.
Question 3: Which type of intracranial hematoma is caused by arterial bleeding, typically from rupture of the middle meningeal artery, and presents with a lucid interval?
- Subdural hematoma
- Subarachnoid hemorrhage
- Epidural hematoma (Correct answer)
- Intracerebral hematoma
Correct answer: Epidural hematoma
Epidural hematoma results from arterial (middle meningeal artery) bleeding, often showing a classic lucid interval before rapid neurological deterioration.
Question 4: For severe TBI management, the Brain Trauma Foundation recommends maintaining ICP below:
- 10 mmHg
- 15 mmHg
- 22 mmHg (Correct answer)
- 30 mmHg
Correct answer: 22 mmHg
The Brain Trauma Foundation guidelines recommend treating ICP when it exceeds 22 mmHg to reduce mortality in severe TBI.
Question 5: The nurse is caring for a patient with severe TBI receiving hypertonic saline for ICP management. The MOST important parameter to monitor is:
- Blood glucose
- Serum sodium and osmolality (Correct answer)
- Liver function tests
- Serum potassium
Correct answer: Serum sodium and osmolality
Hypertonic saline can cause hypernatremia and hyperosmolality; serum sodium and osmolality must be monitored to prevent complications.
Question 6: Which clinical finding differentiates neurogenic shock from spinal shock after acute spinal cord injury?
- Presence of flaccid paralysis
- Hypotension with bradycardia (neurogenic) vs. flaccid areflexia below injury (spinal shock) (Correct answer)
- Absence of reflexes below the injury level
- Loss of bowel and bladder function
Correct answer: Hypotension with bradycardia (neurogenic) vs. flaccid areflexia below injury (spinal shock)
Neurogenic shock refers to hemodynamic instability (hypotension and bradycardia) from loss of sympathetic tone, while spinal shock is the physiologic state of flaccid areflexia below the injury level.
CNRN Traumatic Brain Injury and Spinal Cord Injury 1
Which classification of traumatic brain injury (TBI) is defined by a GCS score of 13–15?