TBI Quiz: Can You Catch Rising ICP?

1. Which nursing intervention should be avoided in TBI patients with elevated ICP?

Head-of-bed elevation to 30 degrees

Vigorous suctioning and neck flexion

Quiet environment and minimal stimulation

Midline head positioning

2. A patient with moderate TBI is confused and has a GCS of 12. What is the appropriate monitoring level?

Discharge home with head injury precautions

Intensive care unit with continuous monitoring

Regular hospital floor with hourly assessments

Observation unit with discharge in 24 hours

3. What is the target cerebral perfusion pressure (CPP) to maintain adequate brain perfusion in TBI?

40-50 mmHg

50-60 mmHg

60-70 mmHg

70-80 mmHg

4. A TBI patient's ICP waveform shows persistent high-amplitude waves. What does this indicate?

Normal compensatory response

Loss of intracranial compliance; risk of herniation

Artifact requiring recalibration

Adequate cerebral perfusion pressure

5. Which factor MOST increases ICP in a TBI patient?

Fever and hypercapnia

Normothermia and hypocapnia

Sedation and analgesia

Quiet environment and rest

6. What is the significance of a 'blown pupil' (unilateral dilation) in TBI assessment?

Minor finding requiring observation only

Sign of uncal herniation; medical emergency

Indicates mild concussion

Normal variation in pupil size

7. A patient post-TBI develops diabetes insipidus. What is the likely cause?

Pituitary gland injury

Hyperglycemia from stress

Acute kidney injury

Sepsis from infection

8. Which imaging modality is most commonly used initially to assess acute TBI?

MRI brain

CT head without contrast

PET scan

Skull X-ray

9. What does a negative fluid responsiveness to mannitol indicate in a TBI patient?

ICP is controlled

Possible brain herniation or severe damage

Need for higher doses

Patient is improving

10. A patient with TBI has a CT scan showing a small epidural hematoma. What is the expected clinical course?

Gradual neurological decline over hours

Immediate loss of consciousness

Potential for rapid deterioration if untreated

Stable condition indefinitely

11. A patient with traumatic brain injury has a Glasgow Coma Scale (GCS) score of 8. What is the primary nursing priority?

Establish airway and prepare for intubation

Administer pain medication

Elevate the head of the bed 45 degrees

Perform a full neurological assessment

12. An ICP monitoring device shows a sustained pressure above 20 mmHg. What should the nurse do first?

Notify the provider and implement ICP reduction measures

Document and recheck in one hour

Increase sedation only

Position patient supine

13. Which type of head injury involves bleeding between the dura and arachnoid membrane?

Epidural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Intracerebral hemorrhage

14. A patient with TBI becomes agitated and combative. What is the best initial nursing action?

Restrain the patient immediately

Assess for hypoxia and full bladder

Administer sedation without assessment

Call security to control behavior

15. Which assessment finding indicates Cushing's triad and severely elevated ICP?

Tachycardia, hypertension, tachypnea

Bradycardia, hypertension, irregular respirations

Hypotension, bradypnea, hypothermia

Tachycardia, hypotension, fever

16. A patient with severe TBI is placed on mechanical ventilation. What target PaCO2 level helps reduce ICP?

30-35 mmHg

35-45 mmHg

45-55 mmHg

55-65 mmHg

17. Which medication is commonly used to osmotically reduce ICP in TBI patients?

Propofol

Mannitol

Dobutamine

Furosemide

18. A patient develops dilated pupils and decreased motor response after head trauma. These signs suggest which complication?

Epidural hematoma

Uncal herniation

Subarachnoid hemorrhage

Diffuse axonal injury

19. What is the recommended head-of-bed position to reduce ICP in TBI patients?

Flat or 0 degrees

30 degrees

45 degrees

60 degrees

20. Which of the following is an early sign of increased intracranial pressure (ICP)?

Hypotension and bradycardia

Headache and restlessness

Hypothermia and muscle rigidity

Tachycardia and facial flushing