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Delirium related to being in the hospital is incorrect because although hospitalization can cause delirium in elderly patients, this explanation should not be assumed when there is a recent head injury. Intracranial bleeding must be ruled out first, as it is life-threatening and requires urgent intervention.

Diabetes is incorrect because there is no information provided indicating hypoglycemia or hyperglycemia, and diabetes would not be the most immediate concern related to confusion following a head injury. While glucose abnormalities can cause altered mental status, they are not the highest-priority concern in this scenario.

Scalp laceration is incorrect because scalp injuries can cause significant bleeding but do not typically cause changes in mental status. The presence of confusion after head trauma raises concern for deeper intracranial injury rather than a superficial wound.

The P2 wave is higher than P1 is incorrect because P2 reflects intracranial compliance, or the brain’s ability to accommodate changes in volume. When P2 becomes equal to or higher than P1, it indicates reduced compliance and rising intracranial pressure. This pattern is associated with conditions such as cerebral edema, intracranial bleeding, or mass lesions and represents an abnormal finding rather than a normal waveform.

P3 wave is higher than P1 is incorrect because P3, the dicrotic wave, corresponds to closure of the aortic valve during diastole and is normally the smallest component of the ICP waveform. An elevated P3 is not expected and suggests abnormal cerebrovascular dynamics or increased intracranial pressure.

P3 is higher than P2 is incorrect because under normal conditions P3 remains lower than P2. If P3 exceeds P2, the waveform is considered abnormal and may indicate disrupted cerebral blood flow or altered pressure transmission within the cranial vault.

Blood covering the whole gauze is incorrect because this suggests active bleeding only. It does not demonstrate separation of cerebrospinal fluid from blood and therefore does not indicate a cerebrospinal fluid leak.

There will be a greenish-colored fluid present on the gauze is incorrect because CSF is typically clear or straw-colored, not green. Green drainage is more suggestive of infection or purulent nasal discharge rather than a CSF leak.

There will be multiple circles of blood noted on the gauze is incorrect because multiple blood spots do not demonstrate the characteristic separation pattern seen with CSF. The halo sign specifically involves a central blood spot with a surrounding clear or yellow ring.

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.

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.

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.

Initiate barbiturate coma is incorrect because this is a last-resort therapy used for refractory intracranial hypertension that does not respond to first-line measures. It requires significant preparation, intubation, and continuous monitoring and is not the most immediate intervention.

Perform emergent CT scan is incorrect because diagnostic imaging should not delay life-saving treatment in a patient with critically elevated ICP and sudden neurological deterioration. ICP must be stabilized before transporting the patient for imaging.

Notify neurosurgeon for possible decompressive craniectomy is incorrect because although neurosurgical consultation is essential, decompressive craniectomy is not an immediate bedside intervention. Medical management to rapidly lower ICP must be initiated first.

Ibuprofen is incorrect because nonsteroidal anti-inflammatory drugs increase the risk of bleeding and do not reduce intracranial pressure. In a patient with an active intracranial hemorrhage, ibuprofen may worsen bleeding and is contraindicated.

IV heparin is incorrect because anticoagulants increase the risk of continued or worsening intracranial bleeding. Heparin would be avoided in a patient with a subdural hemorrhage unless there is a compelling and unrelated indication.

Warfarin is incorrect because it is an oral anticoagulant that significantly increases bleeding risk. In the setting of a subdural hemorrhage and increased ICP, warfarin would worsen hemorrhage and is contraindicated.

Dribbling of urine is incorrect because this symptom is associated with postrenal causes of acute kidney injury, such as bladder outlet obstruction or urethral stricture. Postrenal AKI occurs when urine cannot exit the urinary tract properly, leading to backpressure on the kidneys. Prerenal AKI, in contrast, is caused by reduced kidney perfusion, not obstruction.

Difficulty starting urine stream is incorrect because this symptom indicates a postrenal obstruction, such as benign prostatic hyperplasia or urethral stricture. In postrenal AKI, urine flow is blocked after it leaves the kidneys, causing backpressure and impaired renal function. This is different from prerenal AKI, where the problem originates before the kidneys due to reduced blood flow.

History of kidney stones is incorrect because kidney stones can lead to intermittent obstruction of urine flow, resulting in postrenal AKI. While kidney stones can compromise renal function if causing obstruction, they do not directly decrease renal perfusion and therefore are not a risk factor for prerenal AKI.

Induce diuresis is incorrect because while hypertonic saline can have some osmotic effects, its primary purpose in the context of IICP is not to produce urine output. Diuretics like mannitol are more commonly used for osmotic diuresis.

Correct hyponatremia is incorrect because although hypertonic saline will raise sodium levels, the main goal in a patient with IICP is not just correcting hyponatremia. Sodium correction is secondary to its effect on reducing brain swelling. Rapid correction of sodium carries its own risks, such as central pontine myelinolysis, so careful monitoring is required.

Increase blood pressure is incorrect because while hypertonic saline can increase intravascular volume slightly, its main therapeutic effect is on reducing brain swelling, not directly managing systemic blood pressure.

This is used more commonly than an AV fistula is incorrect because AV fistulas are preferred over AV grafts for long-term hemodialysis due to lower infection rates and longer patency. AV grafts are generally used when a patient’s vasculature is not suitable for a fistula.

This is a temporary access site is incorrect because AV grafts are considered semi-permanent access sites. Temporary access is typically established with a central venous catheter. Grafts are intended for repeated use over months to years, although they have a shorter lifespan than fistulas.

Patient cannot be discharged home with an AV graft is incorrect because patients with AV grafts can safely go home and perform regular daily activities. Proper education on infection prevention, graft care, and monitoring for complications is essential, but hospitalization is not required solely because of the graft.