You observe that a patient of head injury opens his eyes on painful stimuli but not on command; he localizes the site of the painful stimulus; and mutters incomprehensible sounds. His Glasgow Coma Scale Score is in the range of:

1. A

   5-6

2. B

   9-10

3. C

   12-13

4. D

   14-15

Appeared in: GMCH - 2016

Explanation

• The Glasgow Coma Scale (GCS) assesses a patient's level of consciousness through eye, verbal, and motor responses.
• The patient's eye response to painful stimuli scores 2 points.
• The verbal response of incomprehensible sounds scores 2 points.
• The motor response of localizing to a painful stimulus scores 5 points.
• The total GCS score is the sum of these components: 2 (Eye) + 2 (Verbal) + 5 (Motor) = 9.
• A total score of 9 falls into the 9-10 range, indicating a moderate head injury.

Why Other Options Were Wrong

• Option A: A score of 5-6 indicates a severe head injury. This patient's responses, particularly localizing pain (a higher-level motor response), result in a higher score.
• Option C: A score of 12-13 indicates a mild head injury. The patient's inability to speak coherently or open eyes to voice command shows a more significant impairment.
• Option D: A score of 14-15 represents a mild head injury or a fully conscious state. This patient has clear deficits in all three areas of the GCS.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Calculation and interpretation of the Glasgow Coma Scale (GCS) score in a head injury patient to guide bedside assessment, documentation, and the next nursing action.
• The GCS is a critical tool for nurses to objectively assess, document, and communicate a patient's neurological status, especially after a head injury.
• A declining GCS score is a major red flag indicating worsening neurological function (e.g., due to intracranial hemorrhage or swelling) and requires immediate notification of the physician for urgent intervention.
• What if? If the patient's motor response changed from 'localizes pain' (5) to 'abnormal flexion' (3), the GCS would drop to 7 (E2+V2+M3). This would reclassify the injury from moderate to severe, signaling a critical deterioration requiring urgent neuroimaging and intervention.

How to Approach the Question

• First, identify the three components of the GCS mentioned in the scenario: eye-opening, verbal response, and motor response.
• Second, assign the correct score to the eye response. 'Opens eyes on painful stimuli' is 2 points.
• Third, assign the score for the verbal response. 'Incomprehensible sounds' is 2 points.
• Fourth, assign the score for the motor response. 'Localizes the site of the painful stimulus' is 5 points.
• Finally, sum the scores from each component (2 + 2 + 5 = 9) and select the option that includes this total.

Concept Tested & Keywords

• Concept Tested: Calculation and interpretation of the Glasgow Coma Scale (GCS) score in a head injury patient.
• Stem keywords: head injury, Glasgow Coma Scale, opens his eyes on painful stimuli, localizes the site of the painful stimulus, incomprehensible sounds
• Lead-in keywords: in the range of

Question ID

QR6MqBHVHTh966l3GJiFBd

Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 196-198

E6 Nursing Fundamentals Taylor p. 412-414

E6 Medicine Harrison 22e Part 2 p. 1475-1477