The spouse of a patient admitted with severe head injury tells the nurse that she believes her husband is going to recover because he is continuing to make movements without stimulation. What should the nurse explain to the spouse?

Question

1. "With head injuries, the patient can continue to make movements, but these are reflexes that do not reflect brain function."
2. "Your husband will likely recover in time."
3. "As long as he has oxygen to the brain, he will recover."
4. "His movements indicate that his brain is dead."

Answer 1

Correct Answer: 1

One criterion of brain death is the lack of spontaneous movement; however, some spinal cord reflexes may be present. The nurse should not tell the spouse that the patient will recover in time or will recover as long as he has oxygen to the brain. The patient has a brain injury; his movements are likely spinal cord reflexes rather than spontaneous movements. Additional testing must be done before brain death is diagnosed.