When Assessing an Adult After a Fall, the Nurse Notes

question 34

Multiple Choice

When assessing an adult after a fall, the nurse notes a dilated pupil on the right and a hematoma in the right temporal area. The nurse realizes that this likely means that

• A) the process affecting the pupil is occurring locally on the right side (ipsilateral pupil dilation).
• B) the process affecting the pupil is occurring on the opposite side and is unrelated to the right temporal hematoma.
• C) the process affecting the right pupil is temporary and soon both pupils will be equal in size.
• D) the process causing the right pupil to dilate is a result of a metabolic process.

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