The nurse is caring for a patient with a new traumatic brain injury and completes a neurologic assessment. The magnetic resonance imaging identifies an intracranial epidural hematoma. The nurse would immediately notify the provider of which assessment finding?

Choice A reason: There is total absence of dopamine at receptors in brain cells controlling motor movement, causing Parkinson symptoms to appear, is not the correct statement. Parkinson disease is not caused by a complete lack of dopamine, but by a gradual loss of dopamine-producing neurons in the substantia nigra, a part of the brain that regulates movement. The symptoms of Parkinson disease, such as tremor, rigidity, and bradykinesia, appear when about 80% of the dopamine neurons are lost.

Choice B reason: There is an excess of dopamine production and deficiency of acetylcholine production, is not the correct statement. Parkinson disease is not caused by an excess of dopamine, but by a deficiency of dopamine. Dopamine is a neurotransmitter that helps to control movement, balance, and coordination. Acetylcholine is another neurotransmitter that works in opposition to dopamine. When dopamine is low, acetylcholine becomes dominant and causes abnormal muscle movements.

Choice C reason: There is a decreased production of dopamine and excess of acetylcholine, is the correct statement. Parkinson disease is caused by a decreased production of dopamine and excess of acetylcholine. This creates an imbalance in the neurotransmitters that regulate movement, leading to the characteristic symptoms of Parkinson disease, such as tremor, rigidity, and bradykinesia.

Choice D reason: There is a deterioration of the myelin sheath of the basal ganglia and the person has tremors, is not the correct statement. Parkinson disease is not caused by a deterioration of the myelin sheath, but by a degeneration of the dopamine neurons. Myelin is a fatty substance that covers the axons of the nerve cells and helps to transmit electrical impulses. The basal ganglia are a group of structures in the brain that are involved in movement, learning, and emotion. Tremors are one of the symptoms of Parkinson disease, but they are not the only or the most specific one.

Choice A reason: Elevating the head of the bed 20 to 30 degrees is an appropriate intervention for a patient who had a craniotomy to relieve increased intracranial pressure. It helps to reduce the venous pressure and improve the cerebral perfusion.

Choice B reason: Maintaining bright lighting in the room to assess bleeding at the surgical site is not an appropriate intervention for a patient who had a craniotomy to relieve increased intracranial pressure. It can increase the sensory stimulation and aggravate the intracranial pressure. The nurse should use dim lighting and monitor the dressing and the drainage system for signs of bleeding.

Choice C reason: Stimulating the patient every half hour to assess changes in level of consciousness is not an appropriate intervention for a patient who had a craniotomy to relieve increased intracranial pressure. It can increase the cerebral metabolic demand and worsen the intracranial pressure. The nurse should assess the level of consciousness using the Glasgow Coma Scale and avoid unnecessary stimulation.

Choice D reason: Allowing the patient to change positions frequently to maintain comfort is not an appropriate intervention for a patient who had a craniotomy to relieve increased intracranial pressure. It can increase the intrathoracic pressure and affect the cerebral blood flow. The nurse should limit the patient's movement and avoid extreme flexion, extension, or rotation of the head and neck.