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NSG3850 EXAM 3 Actual Exam 2026/2027
Complete Questions and Verified Answers with
Detailed Rationales Pathophysiology for Nurses
II Grade A 100% Verified Solutions Pass
Guaranteed - A+ Graded
SECTION 1: NEUROLOGICAL PATHOPHYSIOLOGY (Questions 1-20)
Q1: A 72-year-old male with a history of atrial fibrillation presents with sudden onset of left-
sided hemiparesis, facial droop, and aphasia. CT scan shows no hemorrhage. Which
pathophysiological mechanism is MOST likely responsible for his condition?
A. Hypertensive rupture of lenticulostriate arteries
B. Embolus from the left atrium causing cerebral artery occlusion [CORRECT]
C. Spontaneous dissection of the internal carotid artery
D. Amyloid angiopathy causing lobar hemorrhage
Correct Answer: B
Rationale: Atrial fibrillation causes blood stasis in the left atrium, promoting thrombus
formation. Emboli can dislodge and travel to cerebral arteries, causing ischemic stroke. The
sudden onset of focal neurological deficits without hemorrhage on CT is characteristic of
embolic stroke. The other options describe hemorrhagic mechanisms or alternative causes not
supported by the atrial fibrillation history.
Q2: A patient presents with a severe headache described as "the worst headache of my life,"
nuchal rigidity, and photophobia. CT reveals blood in the subarachnoid space. Which
pathophysiological process is occurring?
A. Hypertensive rupture of microaneurysms in the putamen
B. Rupture of a saccular (berry) aneurysm at the circle of Willis [CORRECT]
C. Disruption of bridging veins due to trauma
D. Vasculitic inflammation of medium-sized arteries
Correct Answer: B
Rationale: Subarachnoid hemorrhage (SAH) classically presents with a thunderclap headache
and is most commonly caused by rupture of saccular aneurysms at arterial branch points in the
circle of Willis. The blood irritates meningeal sensory fibers causing nuchal rigidity and
,2
photophobia. Hypertensive hemorrhages typically affect deep brain structures, while bridging
vein disruption causes subdural hematoma.
Q3: A 68-year-old female with a history of hypertension suddenly develops severe headache,
vomiting, and decreased consciousness. CT shows a hematoma in the right basal ganglia. Which
vessel is MOST likely the source of bleeding?
A. Middle cerebral artery
B. Lenticulostriate arteries [CORRECT]
C. Anterior cerebral artery
D. Posterior communicating artery
Correct Answer: B
Rationale: Hypertensive intracerebral hemorrhage most commonly affects the basal ganglia,
particularly the putamen, due to rupture of small lenticulostriate arteries that branch directly from
the middle cerebral artery. Chronic hypertension causes lipohyalinosis and microaneurysm
formation in these small penetrating vessels, making them susceptible to rupture under pressure.
Q4: A 55-year-old male experiences transient right-sided weakness and aphasia that completely
resolves within 45 minutes. Which statement BEST describes the pathophysiology of this event?
A. Permanent neuronal infarction has occurred in the left hemisphere
B. Temporary ischemia without permanent tissue damage has occurred [CORRECT]
C. A small hemorrhage has been reabsorbed by cerebral microglia
D. Vasogenic edema has compressed neural tissue temporarily
Correct Answer: B
Rationale: A transient ischemic attack (TIA) is defined as a transient episode of neurological
dysfunction caused by focal brain ischemia without acute infarction. Symptoms resolve
completely, typically within minutes to hours, because blood flow is restored before irreversible
neuronal death occurs. Unlike stroke, TIAs leave no permanent imaging evidence of infarction.
Q5: During an ischemic stroke, which cellular mechanism contributes MOST significantly to
neuronal death in the ischemic core?
A. Accumulation of beta-amyloid protein
B. Excitotoxicity from glutamate release [CORRECT]
C. Demyelination of axonal sheaths
D. Autoimmune attack on acetylcholine receptors
, 3
Correct Answer: B
Rationale: Ischemia causes energy failure, leading to depolarization and massive release of the
excitatory neurotransmitter glutamate. Excessive glutamate stimulation of NMDA receptors
causes calcium influx, activating proteases, lipases, and free radical production, resulting in
neuronal death—termed excitotoxicity. This is the primary mechanism of neuronal death in the
ischemic core.
Q6: A patient with a large left hemisphere stroke develops progressive drowsiness, headache,
and pupillary dilation on the left. Which pathophysiological process is occurring?
A. Transtentorial (uncal) herniation [CORRECT]
B. Central herniation through the foramen magnum
C. Subfalcine herniation under the falx
D. Transcalvarial herniation through a skull defect
Correct Answer: A
Rationale: Progressive neurological deterioration with ipsilateral pupillary dilation
(Hutchinson's pupil) indicates uncal herniation, where the medial temporal lobe (uncus)
displaces medially and downward through the tentorial incisura, compressing the ipsilateral
oculomotor nerve (CN III) and posterior cerebral artery. This is a life-threatening complication of
increased intracranial pressure.
Q7: A 28-year-old female presents with episodes of staring spells lasting 10-15 seconds, during
which she is unresponsive but maintains posture. EEG shows 3 Hz spike-and-wave discharges.
Which pathophysiological process is occurring?
A. Focal seizure with impaired awareness originating in the temporal lobe
B. Generalized absence seizure involving thalamocortical circuits [CORRECT]
C. Focal aware seizure with motor manifestations
C. Status epilepticus with continuous seizure activity
Correct Answer: B
Rationale: Absence seizures are generalized seizures characterized by brief lapses of
consciousness without loss of posture, caused by abnormal rhythmic oscillations in
thalamocortical circuits. The classic 3 Hz spike-and-wave pattern on EEG and brief duration
(seconds) differentiate absence seizures from focal seizures or other generalized seizure types.
NSG3850 EXAM 3 Actual Exam 2026/2027
Complete Questions and Verified Answers with
Detailed Rationales Pathophysiology for Nurses
II Grade A 100% Verified Solutions Pass
Guaranteed - A+ Graded
SECTION 1: NEUROLOGICAL PATHOPHYSIOLOGY (Questions 1-20)
Q1: A 72-year-old male with a history of atrial fibrillation presents with sudden onset of left-
sided hemiparesis, facial droop, and aphasia. CT scan shows no hemorrhage. Which
pathophysiological mechanism is MOST likely responsible for his condition?
A. Hypertensive rupture of lenticulostriate arteries
B. Embolus from the left atrium causing cerebral artery occlusion [CORRECT]
C. Spontaneous dissection of the internal carotid artery
D. Amyloid angiopathy causing lobar hemorrhage
Correct Answer: B
Rationale: Atrial fibrillation causes blood stasis in the left atrium, promoting thrombus
formation. Emboli can dislodge and travel to cerebral arteries, causing ischemic stroke. The
sudden onset of focal neurological deficits without hemorrhage on CT is characteristic of
embolic stroke. The other options describe hemorrhagic mechanisms or alternative causes not
supported by the atrial fibrillation history.
Q2: A patient presents with a severe headache described as "the worst headache of my life,"
nuchal rigidity, and photophobia. CT reveals blood in the subarachnoid space. Which
pathophysiological process is occurring?
A. Hypertensive rupture of microaneurysms in the putamen
B. Rupture of a saccular (berry) aneurysm at the circle of Willis [CORRECT]
C. Disruption of bridging veins due to trauma
D. Vasculitic inflammation of medium-sized arteries
Correct Answer: B
Rationale: Subarachnoid hemorrhage (SAH) classically presents with a thunderclap headache
and is most commonly caused by rupture of saccular aneurysms at arterial branch points in the
circle of Willis. The blood irritates meningeal sensory fibers causing nuchal rigidity and
,2
photophobia. Hypertensive hemorrhages typically affect deep brain structures, while bridging
vein disruption causes subdural hematoma.
Q3: A 68-year-old female with a history of hypertension suddenly develops severe headache,
vomiting, and decreased consciousness. CT shows a hematoma in the right basal ganglia. Which
vessel is MOST likely the source of bleeding?
A. Middle cerebral artery
B. Lenticulostriate arteries [CORRECT]
C. Anterior cerebral artery
D. Posterior communicating artery
Correct Answer: B
Rationale: Hypertensive intracerebral hemorrhage most commonly affects the basal ganglia,
particularly the putamen, due to rupture of small lenticulostriate arteries that branch directly from
the middle cerebral artery. Chronic hypertension causes lipohyalinosis and microaneurysm
formation in these small penetrating vessels, making them susceptible to rupture under pressure.
Q4: A 55-year-old male experiences transient right-sided weakness and aphasia that completely
resolves within 45 minutes. Which statement BEST describes the pathophysiology of this event?
A. Permanent neuronal infarction has occurred in the left hemisphere
B. Temporary ischemia without permanent tissue damage has occurred [CORRECT]
C. A small hemorrhage has been reabsorbed by cerebral microglia
D. Vasogenic edema has compressed neural tissue temporarily
Correct Answer: B
Rationale: A transient ischemic attack (TIA) is defined as a transient episode of neurological
dysfunction caused by focal brain ischemia without acute infarction. Symptoms resolve
completely, typically within minutes to hours, because blood flow is restored before irreversible
neuronal death occurs. Unlike stroke, TIAs leave no permanent imaging evidence of infarction.
Q5: During an ischemic stroke, which cellular mechanism contributes MOST significantly to
neuronal death in the ischemic core?
A. Accumulation of beta-amyloid protein
B. Excitotoxicity from glutamate release [CORRECT]
C. Demyelination of axonal sheaths
D. Autoimmune attack on acetylcholine receptors
, 3
Correct Answer: B
Rationale: Ischemia causes energy failure, leading to depolarization and massive release of the
excitatory neurotransmitter glutamate. Excessive glutamate stimulation of NMDA receptors
causes calcium influx, activating proteases, lipases, and free radical production, resulting in
neuronal death—termed excitotoxicity. This is the primary mechanism of neuronal death in the
ischemic core.
Q6: A patient with a large left hemisphere stroke develops progressive drowsiness, headache,
and pupillary dilation on the left. Which pathophysiological process is occurring?
A. Transtentorial (uncal) herniation [CORRECT]
B. Central herniation through the foramen magnum
C. Subfalcine herniation under the falx
D. Transcalvarial herniation through a skull defect
Correct Answer: A
Rationale: Progressive neurological deterioration with ipsilateral pupillary dilation
(Hutchinson's pupil) indicates uncal herniation, where the medial temporal lobe (uncus)
displaces medially and downward through the tentorial incisura, compressing the ipsilateral
oculomotor nerve (CN III) and posterior cerebral artery. This is a life-threatening complication of
increased intracranial pressure.
Q7: A 28-year-old female presents with episodes of staring spells lasting 10-15 seconds, during
which she is unresponsive but maintains posture. EEG shows 3 Hz spike-and-wave discharges.
Which pathophysiological process is occurring?
A. Focal seizure with impaired awareness originating in the temporal lobe
B. Generalized absence seizure involving thalamocortical circuits [CORRECT]
C. Focal aware seizure with motor manifestations
C. Status epilepticus with continuous seizure activity
Correct Answer: B
Rationale: Absence seizures are generalized seizures characterized by brief lapses of
consciousness without loss of posture, caused by abnormal rhythmic oscillations in
thalamocortical circuits. The classic 3 Hz spike-and-wave pattern on EEG and brief duration
(seconds) differentiate absence seizures from focal seizures or other generalized seizure types.
