A nurse is caring for a client who has sustained a neurologic injury with increased intracranial pressure and decreased cerebral perfusion.
Which of the following will maintain cerebral perfusion pressure constant?

Choice A rationale
Reducing the temperature in the room is not typically a treatment for brain herniation. While it’s important to maintain a comfortable environment for the patient, there’s no evidence to suggest that room temperature has a direct impact on the progression or treatment of brain herniation.
Choice B rationale

Hyperventilating the patient is a possible treatment for brain herniation. Hyperventilation causes vasoconstriction, which can decrease cerebral blood flow and intracranial pressure, potentially relieving the pressure caused by the herniation.
Choice C rationale
Lowering blood pressure is not typically a treatment for brain herniation. While maintaining a stable blood pressure is important in all patients, aggressively lowering blood pressure could potentially decrease cerebral perfusion and worsen the patient’s condition.
Choice D rationale
Decreasing sedation is not typically a treatment for brain herniation. In fact, sedatives might be used to reduce metabolic demands and control agitation in a patient with brain herniation.

Choice A rationale
Penetrating traumatic brain injuries can cause significant damage to the brain. The extent of this damage is often related to the size, route, and speed of the object entering the brain. A larger, faster object or one that follows a path through vital areas of the brain can cause more severe injury. This is because the object can disrupt normal brain tissue and function, leading to a range of potential effects, from temporary changes in brain function to long-term complications or even death.
Choice B rationale
While it is true that a penetrating injury can cause leakage of cerebrospinal fluid (CSF), this is not the primary source of damage in such injuries. CSF leakage can lead to complications such as meningitis, an infection of the protective membranes covering the brain and spinal cord.
However, the primary damage in penetrating brain injuries comes from the direct physical disruption of brain tissue by the object.
Choice C rationale
Coup and contrecoup injuries are terms used to describe injuries that occur at the site of impact (coup) and on the opposite side of the brain (contrecoup). These injuries are typically associated with blunt force trauma, not penetrating injuries. In a penetrating injury, the damage is localized to the path that the object has taken through the brain, rather than at the point of impact and its opposite side.

Choice D rationale
While a penetrating object can indeed shatter the skull and potentially cause an infection, the primary damage in penetrating brain injuries is caused by the direct injury to the brain tissue itself. Infections are a secondary complication that can occur if bacteria enter the brain through the wound.