# Situation: A 24-year-old man is transferred to the neurosurgical ward 2 days after a motorcycle crash. Computed tomography (CT) showed a small frontal contusion and a basilar skull fracture, with no hematoma needing surgery. His cervical spine has been cleared. He is drowsy but easily roused and slightly confused. On day 5 he is to be discharged to his sister's care. Which statement by his sister shows correct understanding of the home instructions?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630423  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 24-year-old man is transferred to the neurosurgical ward 2 days after a motorcycle crash. Computed tomography (CT) showed a small frontal contusion and a basilar skull fracture, with no hematoma needing surgery. His cervical spine has been cleared. He is drowsy but easily roused and slightly confused.

On day 5 he is to be discharged to his sister's care. Which statement by his sister shows correct understanding of the home instructions?

## 보기

1. "I will give him a sleeping pill so he rests well tonight."
2. "I will bring him back if he vomits often or is hard to wake." **✔ 정답**
3. "A glass of beer in the evening will help him relax at home."
4. "He can ride his motorcycle to work once the headache is gone."

**정답: 2**

## 해설

Repeated vomiting, increasing drowsiness or difficulty waking, worsening headache, confusion, unequal pupils, weakness, seizure, or clear fluid from the nose or ears need immediate return to the hospital. Sedatives and alcohol are avoided because they hide or worsen changes in consciousness. Return to strenuous or risky activity follows medical clearance, not just the end of a headache.

## 심화 해설

The statement that shows understanding
He is being discharged to his sister's care after a head injury. Repeated vomiting, increasing drowsiness or difficulty waking, worsening headache, confusion, unequal pupils, weakness, seizure, or clear fluid from the nose or ears need immediate return to the hospital. The sister who says she will bring him back if he vomits often or is hard to wake has understood the most important home instruction.

Why these warning signs matter
After a head injury, delayed complications can develop over hours to days, including expanding hematoma, worsening brain swelling, and, after a basilar skull fracture, CSF leak or meningitis. These processes raise intracranial pressure or affect brain function. Repeated vomiting and a declining level of consciousness are among the earliest and most important signs. A family caregiver who recognizes them and returns promptly can prevent serious harm. Teaching is directed at the caregiver because the client himself may not notice his own decline.

| Statement | Correct? | Reason |
| --- | --- | --- |
| Give him a sleeping pill | No | Sedatives mask a declining level of consciousness |
| Bring him back if he vomits often or is hard to wake | Yes | Key warning signs of deterioration |
| A glass of beer helps him relax | No | Alcohol clouds consciousness and hides deterioration |
| Ride the motorcycle once headache is gone | No | Return to risky activity needs medical clearance |

Why the other statements need correction
Sedatives and alcohol are avoided because they hide or worsen changes in consciousness. A sleeping pill can make it impossible to tell whether drowsiness is from the drug or from brain deterioration. Beer has the same effect and can also impair judgment and balance. Riding a motorcycle once the headache is gone ignores the need for medical clearance; return to strenuous or risky activity follows the provider's advice, not just the end of a headache, because thinking, reaction time, and balance may still be impaired and a second injury could be serious.

Discharge teaching
The nurse gives written and verbal instructions, ensures that a responsible adult stays with him, explains which pain relievers are allowed, and encourages rest with gradual return to activity. The caregiver is told to seek emergency care for any warning sign without waiting for the next appointment.

Exam takeaway
Key point After head injury, teach caregivers to return for repeated vomiting, difficulty waking, worsening headache, confusion, unequal pupils, weakness, seizure, or clear nasal or ear fluid, and to avoid sedatives and alcohol.

## 임상 시나리오

Head Injury Discharge TeachingWhat the caregiver must watch for
Return immediately for repeated vomiting, increasing drowsiness or difficulty waking, worsening headache, confusion, unequal pupils, weakness, seizure, or clear fluid from the nose or ears.

Sedatives and alcohol are avoided because they hide changes in consciousness. Return to strenuous or risky activity, such as riding a motorcycle, requires medical clearance.

CautionA responsible adult should stay with the client. Do not wait for a scheduled visit if a warning sign appears.

## 핵심 개념

- **Delayed hematoma** — A collection of blood in or around the brain that enlarges hours to days after injury.
- **Level of consciousness** — A person's degree of alertness and responsiveness, a key sign after head injury.
- **Medical clearance** — A provider's approval to resume specific activities after injury.
- **Caregiver teaching** — Education given to a family member who will monitor and care for the client at home.

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