NUR 376 Exam 3 V3 | NUR 376 Applied
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 3) | Concordia
1. A nurse is caring for a patient who has sustained a traumatic brain injury and is displaying
Cushing’s triad. Which of the following sets of vital signs is most consistent with this finding?
A. Heart rate 110 bpm, Blood pressure 100/60 mmHg, Respiratory rate 28/min
B. Heart rate 45 bpm, Blood pressure 180/60 mmHg, Respiratory rate 10/min and
irregular
C. Heart rate 72 bpm, Blood pressure 120/80 mmHg, Respiratory rate 16/min
D. Heart rate 95 bpm, Blood pressure 140/95 mmHg, Respiratory rate 24/min
Correct Answer: B
Cushing’s triad is a late sign of increased intracranial pressure (ICP) indicating impending
brain herniation. It is characterized by bradycardia, widened pulse pressure (systolic
hypertension), and irregular respirations. This compensatory mechanism attempts to
maintain cerebral perfusion in the face of rising pressure within the cranial vault.
2. Which pathological process best describes the development of vasogenic edema in a
patient with a brain tumor?
A. Increased capillary permeability allowing fluid to leak into the extracellular space
B. Failure of the sodium-potassium pump leading to intracellular swelling
,C. Obstruction of cerebrospinal fluid flow through the ventricles
D. Rapid decrease in serum osmolality causing fluid to shift into brain cells
Correct Answer: A
Vasogenic edema occurs when the blood-brain barrier is disrupted, leading to increased
permeability of the capillary endothelium. This allows plasma proteins and fluid to leak
from the intravascular space into the extracellular fluid of the brain. It is common in
conditions such as tumors, abscesses, and trauma where the integrity of the barrier is
compromised.
3. A patient is admitted with a suspected ischemic stroke. Which underlying condition is most
frequently associated with the development of an embolic stroke?
A. Chronic hypertension
B. Type 2 diabetes mellitus
C. Atrial fibrillation
D. Systemic lupus erythematosus
Correct Answer: C
Atrial fibrillation is a primary risk factor for embolic strokes because the quivering of the
atria allows blood to pool and form thrombi, particularly in the left atrial appendage. These
clots can then travel through the systemic circulation and lodge in the cerebral arteries,
causing an infarction. Managing anticoagulation in these patients is a critical component of
secondary stroke prevention.
,4. During a seizure, a patient experiences a loss of consciousness followed by stiffening of the
body and then rhythmic jerking of the extremities. How should the nurse document this type
of seizure?
A. Myoclonic seizure
B. Absence seizure
C. Simple partial seizure
D. Generalized tonic-clonic seizure
Correct Answer: D
A generalized tonic-clonic seizure involves both the tonic phase (stiffening) and the clonic
phase (rhythmic jerking) and is associated with a loss of consciousness. The tonic phase
results from sudden intense muscle contractions, while the clonic phase is characterized by
alternating contraction and relaxation. Documentation of the duration and post-ictal state
is essential for neurological assessment.
5. A patient is suspected of having bacterial meningitis. Which clinical manifestations should
the nurse expect to assess? (Select all that apply)
A. Nuchal rigidity
B. Positive Brudzinski sign
C. Photophobia
D. Peripheral edema
, E. Projectile vomiting
Correct Answer: A,B,C,E
Bacterial meningitis presents with signs of meningeal irritation such as stiff neck (nuchal
rigidity), photophobia, and the Brudzinski sign, where hip/knee flexion occurs upon neck
flexion. Increased intracranial pressure from the infection can also cause projectile
vomiting and a high fever. Peripheral edema is not a standard finding in meningitis
pathophysiology. This question includes five options to reflect the Concordia examination
style for multiple response items.
6. Which statement regarding the pathophysiology of an epidural hematoma is correct?
A. It is usually arterial in origin, often involving the middle meningeal artery.
B. It typically results from a venous bleed between the dura and the arachnoid mater.
C. It presents as a slow, progressive decline in neurological function over weeks.
D. It is caused by the shearing of bridging veins during rapid deceleration.
Correct Answer: A
An epidural hematoma is characterized by bleeding between the skull and the dura mater,
most often due to an arterial tear. This lead to a rapid accumulation of blood and a classic
clinical presentation of a brief loss of consciousness followed by a lucid interval and then
rapid deterioration. This is a medical emergency requiring immediate surgical intervention
to relieve pressure.
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 3) | Concordia
1. A nurse is caring for a patient who has sustained a traumatic brain injury and is displaying
Cushing’s triad. Which of the following sets of vital signs is most consistent with this finding?
A. Heart rate 110 bpm, Blood pressure 100/60 mmHg, Respiratory rate 28/min
B. Heart rate 45 bpm, Blood pressure 180/60 mmHg, Respiratory rate 10/min and
irregular
C. Heart rate 72 bpm, Blood pressure 120/80 mmHg, Respiratory rate 16/min
D. Heart rate 95 bpm, Blood pressure 140/95 mmHg, Respiratory rate 24/min
Correct Answer: B
Cushing’s triad is a late sign of increased intracranial pressure (ICP) indicating impending
brain herniation. It is characterized by bradycardia, widened pulse pressure (systolic
hypertension), and irregular respirations. This compensatory mechanism attempts to
maintain cerebral perfusion in the face of rising pressure within the cranial vault.
2. Which pathological process best describes the development of vasogenic edema in a
patient with a brain tumor?
A. Increased capillary permeability allowing fluid to leak into the extracellular space
B. Failure of the sodium-potassium pump leading to intracellular swelling
,C. Obstruction of cerebrospinal fluid flow through the ventricles
D. Rapid decrease in serum osmolality causing fluid to shift into brain cells
Correct Answer: A
Vasogenic edema occurs when the blood-brain barrier is disrupted, leading to increased
permeability of the capillary endothelium. This allows plasma proteins and fluid to leak
from the intravascular space into the extracellular fluid of the brain. It is common in
conditions such as tumors, abscesses, and trauma where the integrity of the barrier is
compromised.
3. A patient is admitted with a suspected ischemic stroke. Which underlying condition is most
frequently associated with the development of an embolic stroke?
A. Chronic hypertension
B. Type 2 diabetes mellitus
C. Atrial fibrillation
D. Systemic lupus erythematosus
Correct Answer: C
Atrial fibrillation is a primary risk factor for embolic strokes because the quivering of the
atria allows blood to pool and form thrombi, particularly in the left atrial appendage. These
clots can then travel through the systemic circulation and lodge in the cerebral arteries,
causing an infarction. Managing anticoagulation in these patients is a critical component of
secondary stroke prevention.
,4. During a seizure, a patient experiences a loss of consciousness followed by stiffening of the
body and then rhythmic jerking of the extremities. How should the nurse document this type
of seizure?
A. Myoclonic seizure
B. Absence seizure
C. Simple partial seizure
D. Generalized tonic-clonic seizure
Correct Answer: D
A generalized tonic-clonic seizure involves both the tonic phase (stiffening) and the clonic
phase (rhythmic jerking) and is associated with a loss of consciousness. The tonic phase
results from sudden intense muscle contractions, while the clonic phase is characterized by
alternating contraction and relaxation. Documentation of the duration and post-ictal state
is essential for neurological assessment.
5. A patient is suspected of having bacterial meningitis. Which clinical manifestations should
the nurse expect to assess? (Select all that apply)
A. Nuchal rigidity
B. Positive Brudzinski sign
C. Photophobia
D. Peripheral edema
, E. Projectile vomiting
Correct Answer: A,B,C,E
Bacterial meningitis presents with signs of meningeal irritation such as stiff neck (nuchal
rigidity), photophobia, and the Brudzinski sign, where hip/knee flexion occurs upon neck
flexion. Increased intracranial pressure from the infection can also cause projectile
vomiting and a high fever. Peripheral edema is not a standard finding in meningitis
pathophysiology. This question includes five options to reflect the Concordia examination
style for multiple response items.
6. Which statement regarding the pathophysiology of an epidural hematoma is correct?
A. It is usually arterial in origin, often involving the middle meningeal artery.
B. It typically results from a venous bleed between the dura and the arachnoid mater.
C. It presents as a slow, progressive decline in neurological function over weeks.
D. It is caused by the shearing of bridging veins during rapid deceleration.
Correct Answer: A
An epidural hematoma is characterized by bleeding between the skull and the dura mater,
most often due to an arterial tear. This lead to a rapid accumulation of blood and a classic
clinical presentation of a brief loss of consciousness followed by a lucid interval and then
rapid deterioration. This is a medical emergency requiring immediate surgical intervention
to relieve pressure.
