When assessing a patient with altered level of consciousness, which of the following would the nurse assess first?

Choice A: Object penetrates the brain or trauma is so severe that the scalp and skull are opened is correct because it is the definition of an open traumatic brain injury. An open traumatic brain injury occurs when a foreign object such as a bullet, knife, or bone fragment enters the brain or when a blunt force trauma such as a fall, collision, or assault causes a fracture or laceration of the skull. This can damage the brain tissue, blood vessels, and nerves and cause bleeding, swelling, or infection.

Choice B: Stress is incorrect because it is not a type of traumatic brain injury. Stress is a psychological or emotional response to a challenging or threatening situation. It can affect the brain function and health, but it does not cause physical damage to the brain tissue.

Choice C: Acceleration/deceleration injury occurs when the head accelerates and then rapidly decelerates, damaging brain tissue is incorrect because it is not an open traumatic brain injury. It is a type of closed traumatic brain injury, which occurs when the head moves violently without breaking the skull. This can cause the brain to hit against the inner wall of the skull or twist within the skull, resulting in bruising, tearing, or shearing of the brain tissue.

Choice D: All of the above are incorrect because only choice a) describes an open traumatic brain injury. Choices b) and c) are not related to an open traumatic brain injury and do not match its characteristics. The nurse should know the different types and causes of traumatic brain injury and their implications for assessment and care.

Choice A: When patient no longer has numbness in extremities is incorrect because it is not a reliable indicator of cervical spine injury or recovery. Numbness in extremities can be caused by various factors such as nerve compression, inflammation, or medication. It can also persist or recur after the cervical collar is removed. The nurse should assess the patient's neurological status but should not remove the cervical collar based on this symptom alone.

Choice B: When patient states they have no pain in the neck is incorrect because it is also not a reliable indicator of cervical spine injury or recovery. Pain in the neck can be subjective, variable, or masked by other factors such as analgesics, shock, or distraction. It can also be absent or delayed after the cervical collar is removed. The nurse should assess the patient's pain level but should not remove the cervical collar based on this symptom alone.

Choice C: When doctor has cleared patient following a cervical X-ray is correct because it is the safest and most accurate way to determine if the patient has a cervical spine injury or not. A cervical X-ray can show any fractures, dislocations, or other abnormalities in the cervical vertebrae that may require immobilization or surgery. The nurse should follow the doctor's orders and remove the cervical collar only after the doctor has confirmed that there is no risk of further damage to the spinal cord or nerves.

Choice D: All of the above are incorrect because only choice c) is sufficient and necessary to remove the cervical collar from a head injury patient. Choices a) and b) are not valid criteria and may expose the patient to potential harm or complications. The nurse should use evidence-based practice and follow the protocols for head injury management and care.