Which pupil finding should the nurse report immediately in a patient being monitored after a head injury?
Correct answer: C. One newly dilated pupil that reacts poorly to light
- A. Equal pupils that constrict briskly to light
- B. Mild tearing when exposed to bright light
- C. One newly dilated pupil that reacts poorly to light
- D. Pupils that become smaller in dim light
Explanation
A new unilateral dilated and poorly reactive pupil may indicate compression of the third cranial nerve from increasing intracranial pressure. Equal, briskly reactive pupils are generally reassuring, whereas a sudden change requires urgent assessment.
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About Neurological Nursing
Covers nursing assessment and management of stroke, epilepsy, meningitis, raised intracranial pressure, head injury, spinal cord disorders, Parkinson disease and multiple sclerosis. Key areas include level of consciousness, pupil responses, motor and sensory findings, seizure precautions and distinguishing upper motor neuron from lower motor neuron signs.
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