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KL is a 34-year-old male admitted to the hospital (large trauma center) after suffering a traumatic brain injury (TBI) secondary to a serious motor vehicle accident. He was in excellent health prior to the accident. HT: 6'2" WT: 190 pounds (86 kg) What is the best means of determining KL's caloric needs while in the hospital?
- A. Mifflin-St Jeor equation
- B. Harris-Benedict equation
- C. WHO standards
- D. Indirect calorimetry
Correct Answer: D
Rationale: Indirect calorimetry is the gold standard for determining caloric needs in critically ill patients, including those with traumatic brain injury (TBI). It measures oxygen consumption and carbon dioxide production to provide an accurate assessment of energy expenditure.
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An 18 year-old college freshman presents to the emergency room for evaluation of fever, headache, and neck stiffness. On physical examination, the patient is resting quietly and has a flushed face. His vital signs are as follows: temperature, 104 F; pulse, 110 bpm; and BP, 105/70. He has no rashes. During the physical examination, you flex the patient's neck and his hips and knees flex in response, indicating a meningeal irritation. The name of this positive sign is:
- A. Kernig's sign
- B. Brudzinski sign
- C. Babinski's sign
- D. Lachman's sign
Correct Answer: B
Rationale: Brudzinski's sign is a physical finding associated with meningeal irritation. When the neck is flexed, it causes involuntary flexion of the hips and knees. This sign, along with Kernig's sign, is used to diagnose meningitis. Babinski's sign and Lachman's sign are unrelated to meningeal irritation.
To assess the Glasgow Coma Scale (GCS), the nurse needs to evaluate:
- A. Eye opening, verbal response, and motor response.
- B. Heart rate, blood pressure, and temperature.
- C. Pupil size, reaction to light, and accommodation.
- D. Skin turgor, moisture, and temperature.
Correct Answer: A
Rationale: The Glasgow Coma Scale (GCS) assesses a patient's level of consciousness based on eye opening, verbal response, and motor response. It is a standardized tool used in neurological assessments.
Which statement concerning the areas of the brain is true?
- A. The cerebellum is the center for speech and emotions.
- B. The hypothalamus controls body temperature and regulates sleep.
- C. The basal ganglia are responsible for controlling voluntary movements.
- D. Motor pathways of the spinal cord and brainstem synapse in the thalamus.
Correct Answer: B
Rationale: The correct answer is B. The hypothalamus controls body temperature and regulates sleep. The hypothalamus is a part of the brain responsible for maintaining homeostasis, including regulating body temperature and controlling sleep patterns. It acts as a thermostat for the body, adjusting temperature through various mechanisms. Additionally, it plays a crucial role in the sleep-wake cycle by influencing the production of sleep-inducing hormones.
Choices A, C, and D are incorrect:
A: The cerebellum is not the center for speech and emotions; it is primarily involved in coordination and movement control.
C: The basal ganglia are responsible for coordinating motor movements and are not directly involved in voluntary movements.
D: Motor pathways of the spinal cord and brainstem do not synapse in the thalamus; they synapse in the brainstem and spinal cord itself.
Which of the following might indicate a problem with the patient's sensory system?
- A. Inability to feel light touch or pain in specific areas.
- B. Normal sensation throughout the body.
- C. Clear and accurate perception of temperature.
- D. Absence of tingling or numbness.
Correct Answer: A
Rationale: Inability to feel light touch or pain suggests sensory system dysfunction. Normal sensation, accurate temperature perception, and absence of tingling are expected findings.
In providing care for the patient, what is most important for the nurse to do?
- A. Teach the family members how to care adequately for the patient's needs.
- B. Encourage the patient to maintain social interactions to prevent social isolation.
- C. Promote the use of assistive devices so the patient can participate in self-care activities.
- D. Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy.
Correct Answer: C
Rationale: Promoting independence through assistive devices is key to maintaining quality of life