NEWEST NSG 3280 Exam 3: Pathophysiology for Nurses (Galen
College of Nursing) QUESTIONS WITH VERIFIED ANSWERS 2026-
2027 GRADED A+
1. A patient with an acute brain injury is being monitored for increased intracranial
pressure (ICP). Which assessment finding is the earliest indicator of rising ICP?
A. Fixed and dilated pupils
B. Cushing's triad (hypertension, bradycardia, irregular breathing)
C. Change in level of consciousness (LOC)
D. Decerebrate posturing
Rationale: A change in LOC (drowsiness, confusion, restlessness) is the earliest and most
sensitive sign of rising ICP because cerebral perfusion and the reticular activating system
are affected early. Pupil changes and Cushing's triad are late signs indicating severe brain
compression .
2. A patient presents with hypertension, bradycardia, and irregular respirations
following a traumatic brain injury. This clinical triad is known as:
A. Kernig's sign
B. Brudzinski's sign
C. Cushing's triad
D. Battle's sign
Rationale: Cushing's triad (hypertension with widened pulse pressure, bradycardia, and
irregular respirations) is a late, life-threatening sign of increased ICP indicating brainstem
compression .
3. A patient with a head injury has a mean arterial pressure (MAP) of 90 mm Hg and
an ICP of 25 mm Hg. What is the cerebral perfusion pressure (CPP)?
A. 45 mm Hg
B. 55 mm Hg
C. 65 mm Hg
D. 115 mm Hg
, *Rationale: CPP = MAP – ICP. 90 – 25 = 65 mm Hg. Normal CPP is 60-100 mm Hg; a CPP
below 50 mm Hg indicates inadequate cerebral blood flow and risk of brain ischemia* .
4. According to the Monro-Kellie doctrine, which of the following compartments can
decrease in volume to compensate for an increase in another compartment within the
cranium?
A. Brain tissue only
B. Blood only
C. Cerebrospinal fluid (CSF) only
D. Both CSF and blood
Rationale: The Monro-Kellie doctrine states the skull is a fixed container. To maintain
normal ICP when one component increases (e.g., brain edema), compensation occurs
through displacement of CSF into the spinal canal and decreased cerebral blood volume .
5. A patient with a brain tumor has a dilated, fixed right pupil. Which cranial nerve is
likely being compressed?
A. Optic nerve (CN II)
B. Oculomotor nerve (CN III)
C. Trochlear nerve (CN IV)
D. Trigeminal nerve (CN V)
Rationale: The oculomotor nerve (CN III) is responsible for pupillary constriction. Increased
ICP can compress CN III against the tentorium, causing ipsilateral pupillary dilation and a
fixed pupil .
6. A patient is found with small, pinpoint pupils (1-2 mm) that are reactive to light.
This finding is most commonly associated with:
A. Uncal herniation
B. Pontine lesion or opioid use
C. Subarachnoid hemorrhage
D. Midbrain compression
Rationale: Pinpoint pupils (miosis) that are reactive are characteristic of a pontine lesion
(e.g., pontine hemorrhage) or opioid (narcotic) use. This occurs due to disruption of
sympathetic pathways or stimulation of parasympathetic pathways .
, 7. A patient with a traumatic brain injury has a Glasgow Coma Scale (GCS) score of 8.
This indicates:
A. Mild brain injury
B. Moderate brain injury
C. Severe brain injury
D. No brain injury
*Rationale: GCS scoring: 13-15 = Mild, 9-12 = Moderate, 8 or less = Severe. A score of 8
reflects significant neurologic impairment and often correlates with coma* .
8. A patient is brought to the ED after a motor vehicle crash. The initial trauma
caused damage at the site of impact and on the opposite side of the brain. This
pattern is known as:
A. Diffuse axonal injury
B. Coup-contrecoup injury
C. Ischemic stroke
D. Secondary edema
Rationale: Coup-contrecoup injury occurs when acceleration-deceleration forces cause
damage at two opposite poles of the brain. This is common in MVAs and motor vehicle
accidents .
9. Which statement best distinguishes a primary brain injury from a secondary brain
injury?
A. Primary injury is reversible, secondary is not
B. Primary injury results directly from the traumatic event; secondary injury is the
progressive damage that follows
C. Primary injury involves only the brainstem
D. Secondary injury occurs immediately at the time of trauma
Rationale: Primary injury is the initial, irreversible damage from the traumatic event (e.g.,
contusion, laceration). Secondary injury is the progressive, delayed cell death resulting from
inflammation, ischemia, and excitotoxicity following the initial trauma. Time is tissue .
10. A patient experiences a brief loss of consciousness after a fall, then becomes
alert and lucid, but rapidly deteriorates neurologically 30 minutes later. Which injury
should the nurse suspect?
College of Nursing) QUESTIONS WITH VERIFIED ANSWERS 2026-
2027 GRADED A+
1. A patient with an acute brain injury is being monitored for increased intracranial
pressure (ICP). Which assessment finding is the earliest indicator of rising ICP?
A. Fixed and dilated pupils
B. Cushing's triad (hypertension, bradycardia, irregular breathing)
C. Change in level of consciousness (LOC)
D. Decerebrate posturing
Rationale: A change in LOC (drowsiness, confusion, restlessness) is the earliest and most
sensitive sign of rising ICP because cerebral perfusion and the reticular activating system
are affected early. Pupil changes and Cushing's triad are late signs indicating severe brain
compression .
2. A patient presents with hypertension, bradycardia, and irregular respirations
following a traumatic brain injury. This clinical triad is known as:
A. Kernig's sign
B. Brudzinski's sign
C. Cushing's triad
D. Battle's sign
Rationale: Cushing's triad (hypertension with widened pulse pressure, bradycardia, and
irregular respirations) is a late, life-threatening sign of increased ICP indicating brainstem
compression .
3. A patient with a head injury has a mean arterial pressure (MAP) of 90 mm Hg and
an ICP of 25 mm Hg. What is the cerebral perfusion pressure (CPP)?
A. 45 mm Hg
B. 55 mm Hg
C. 65 mm Hg
D. 115 mm Hg
, *Rationale: CPP = MAP – ICP. 90 – 25 = 65 mm Hg. Normal CPP is 60-100 mm Hg; a CPP
below 50 mm Hg indicates inadequate cerebral blood flow and risk of brain ischemia* .
4. According to the Monro-Kellie doctrine, which of the following compartments can
decrease in volume to compensate for an increase in another compartment within the
cranium?
A. Brain tissue only
B. Blood only
C. Cerebrospinal fluid (CSF) only
D. Both CSF and blood
Rationale: The Monro-Kellie doctrine states the skull is a fixed container. To maintain
normal ICP when one component increases (e.g., brain edema), compensation occurs
through displacement of CSF into the spinal canal and decreased cerebral blood volume .
5. A patient with a brain tumor has a dilated, fixed right pupil. Which cranial nerve is
likely being compressed?
A. Optic nerve (CN II)
B. Oculomotor nerve (CN III)
C. Trochlear nerve (CN IV)
D. Trigeminal nerve (CN V)
Rationale: The oculomotor nerve (CN III) is responsible for pupillary constriction. Increased
ICP can compress CN III against the tentorium, causing ipsilateral pupillary dilation and a
fixed pupil .
6. A patient is found with small, pinpoint pupils (1-2 mm) that are reactive to light.
This finding is most commonly associated with:
A. Uncal herniation
B. Pontine lesion or opioid use
C. Subarachnoid hemorrhage
D. Midbrain compression
Rationale: Pinpoint pupils (miosis) that are reactive are characteristic of a pontine lesion
(e.g., pontine hemorrhage) or opioid (narcotic) use. This occurs due to disruption of
sympathetic pathways or stimulation of parasympathetic pathways .
, 7. A patient with a traumatic brain injury has a Glasgow Coma Scale (GCS) score of 8.
This indicates:
A. Mild brain injury
B. Moderate brain injury
C. Severe brain injury
D. No brain injury
*Rationale: GCS scoring: 13-15 = Mild, 9-12 = Moderate, 8 or less = Severe. A score of 8
reflects significant neurologic impairment and often correlates with coma* .
8. A patient is brought to the ED after a motor vehicle crash. The initial trauma
caused damage at the site of impact and on the opposite side of the brain. This
pattern is known as:
A. Diffuse axonal injury
B. Coup-contrecoup injury
C. Ischemic stroke
D. Secondary edema
Rationale: Coup-contrecoup injury occurs when acceleration-deceleration forces cause
damage at two opposite poles of the brain. This is common in MVAs and motor vehicle
accidents .
9. Which statement best distinguishes a primary brain injury from a secondary brain
injury?
A. Primary injury is reversible, secondary is not
B. Primary injury results directly from the traumatic event; secondary injury is the
progressive damage that follows
C. Primary injury involves only the brainstem
D. Secondary injury occurs immediately at the time of trauma
Rationale: Primary injury is the initial, irreversible damage from the traumatic event (e.g.,
contusion, laceration). Secondary injury is the progressive, delayed cell death resulting from
inflammation, ischemia, and excitotoxicity following the initial trauma. Time is tissue .
10. A patient experiences a brief loss of consciousness after a fall, then becomes
alert and lucid, but rapidly deteriorates neurologically 30 minutes later. Which injury
should the nurse suspect?
