You are working in the ED and get call from the paramedics to tell you they are bringing in a patient. The paramedics tell you that the patient has a Glasgow coma scale (GCS) of 8. What should you expect when the patient arrives to the ED?
That the patient will be alert and oriented
The patient will be comatose
The patient will likely have a UTI
That the patient will be vomiting
The Correct Answer is B
A. That the patient will be alert and oriented is incorrect because a GCS of 8 indicates severe impairment of consciousness, not alertness. Patients who are alert and oriented typically have a GCS of 13–15.
B. The patient will be comatose is correct because a GCS score of 8 or less is generally considered coma or severe brain injury. This indicates significant neurological impairment, and the patient is likely unable to respond appropriately to verbal or painful stimuli. Immediate interventions often focus on airway protection, stabilization, and rapid neurological assessment.
C. The patient will likely have a UTI is incorrect because a urinary tract infection is not related to the GCS score. While a UTI can cause confusion in older adults, it does not directly correlate with a GCS of 8 in trauma or acute neurological events.
D. That the patient will be vomiting is incorrect because vomiting may occur in patients with elevated intracranial pressure or head trauma, but it is not a defining feature of a GCS of 8. The key concern is level of consciousness and neurological status.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Because patients are very specific in what they want is incorrect because patient preference does not drive the difficulty in medication selection for increased ICP. The challenge is clinical and related to accurate neurological assessment, not patient choice.
B. They can alter neurological state, masking true neurological changes is correct because sedatives, analgesics, and paralytics can suppress consciousness, motor responses, pupillary reactions, and reflexes. In patients with increased ICP, frequent and accurate neurological assessments are critical to detect deterioration. These medications can obscure important changes such as declining level of consciousness or new focal deficits, making it difficult to distinguish medication effects from worsening intracranial pathology.
C. Patients are usually allergic to many of these medications is incorrect because widespread allergies to sedatives, analgesics, and paralytics are uncommon and not the primary concern when managing increased ICP.
D. Many patients have comorbidities that make choice of agents difficult is incorrect because although comorbidities can influence medication selection, this is not the main reason these medications are challenging to use in patients with elevated ICP. The primary concern remains their impact on the ability to perform reliable neurological assessments.
Correct Answer is A
Explanation
A. Skull fracture is correct because bruising behind the ears (Battle’s sign) and around the eyes (raccoon eyes) are classic indicators of a basal skull fracture. These bruises result from bleeding from the fracture site tracking into surrounding soft tissues. Basal skull fractures carry significant risks, including cerebrospinal fluid (CSF) leak, intracranial hemorrhage, and cranial nerve injury, and require urgent assessment and monitoring.
B. Mastoiditis is incorrect because this is an infection of the mastoid bone, usually secondary to untreated middle ear infections. While bruising is near the mastoid area, mastoiditis does not cause Battle’s signafter trauma.
C. Subdural hematoma is incorrect because although head trauma can cause subdural hematomas, the presence of periorbital and postauricular bruising specifically indicates a skull fracture, not a hematoma itself. Subdural hematomas require imaging for diagnosis and may accompany a skull fracture but are not diagnosed by bruising patterns alone.
D. Concussion is incorrect because a concussion is a functional brain injury without structural damage. While it can occur with head trauma, raccoon eyes and Battle’s sign are not typical of concussion; they indicate structural skull damage.
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