A nurse receives a report on a client with a basilar skull fracture. What findings should the nurse expect with this client?
Bruising over the mastoid process
Pooling of blood and edema around the eyes
Ability to recall how the injury occurred
Chvostek’s sign
The Correct Answer is A
Choice A rationale
Bruising over the mastoid process, also known as Battle’s sign, is a classic clinical sign of a basilar skull fracture.
Choice B rationale
Pooling of blood and edema around the eyes, or ‘raccoon eyes’, is another sign of a basilar skull fracture.
Choice C rationale
The ability to recall how the injury occurred is not directly related to the presence of a basilar skull fracture. Memory loss or confusion could be symptoms of a traumatic brain injury, but they are not specific to a basilar skull fracture.
Choice D rationale
Chvostek’s sign is a clinical sign of hypocalcemia, not a basilar skull fracture
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale
Pupillary dilation can be a sign of increased intracranial pressure, which could be a result of a traumatic brain injury following a motor vehicle accident. It’s important to assess for this symptom as it may indicate a serious condition that requires immediate medical attention.
Choice B rationale
Persistent headache is a common symptom following a head injury and can be a sign of a concussion or more serious brain injury. It’s crucial to monitor for this symptom as it can provide important information about the patient’s condition.
Choice C rationale
Presence of hand tremors is not typically associated with a head injury from a motor vehicle accident. While tremors can be a symptom of various neurological conditions, they are not commonly seen immediately after a traumatic head injury.
Choice D rationale
Difficulty waking can be a sign of a serious head injury. It could indicate a concussion or other type of traumatic brain injury. This symptom should be closely monitored as it may require immediate medical intervention.
Choice E rationale
Foot drop is not typically a symptom observed immediately after a motor vehicle accident. It’s more commonly associated with peripheral nerve conditions or stroke, rather than a head injury.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale
Decreased visual acuity can increase the risk of falls, which are a common cause of head injuries in older adults. Impaired vision can affect balance and coordination, making it more difficult for an individual to navigate their environment safely.
Choice B rationale
While motor vehicle crashes can certainly lead to head injuries, they are not one of the most common causes of head injuries in older adults. Falls are actually the leading cause of head injuries in this population.
Choice C rationale
Polypharmacy, or the use of multiple medications by a patient, is common in older adults and can increase the risk of falls and, consequently, head injuries. Certain medications can cause side effects such as dizziness or confusion, which can lead to falls.
Choice D rationale
Weakness, particularly in the lower body, can increase the risk of falls and subsequent head injuries in older adults. Lower body weakness can affect an individual’s balance and mobility, making falls more likely.
Choice E rationale
Chronic hypertension can lead to a variety of health complications, including an increased risk of falls and head injuries. Hypertension can cause dizziness and balance problems, which can increase the risk of falls.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.