,NSG3280/NSG 3280 Exam 3 | Pathophysiology for
Nurses I | Galen College | Q & A | 2026/2027
Edition (PDF)
1. Which of the following best describes the Monroe-Kellie doctrine?
A) The brain can expand indefinitely to accommodate increasing pressure
B) The total volume within the skull is fixed, so an increase in one component requires a decrease in
another
C) Increased intracranial pressure always leads to immediate brain death
D) Cerebrospinal fluid production is independent of intracranial pressure
Correct Answer: The total volume within the skull is fixed, so an increase in one component requires a
decrease in another
Rationale: The Monroe-Kellie doctrine states that the skull is a rigid, closed box with a fixed total
volume. An increase in the volume of any one component (brain tissue, blood, or CSF) must be
compensated by a decrease in another to maintain normal ICP. The other options do not accurately
describe this principle.
2. What is the earliest and most sensitive indicator of increasing intracranial pressure (ICP) in a client
with an acute brain injury?
A) Fixed and dilated pupils
B) Cushing's triad (hypertension, bradycardia, irregular respirations)
C) A change in the level of consciousness
D) Decerebrate posturing
Correct Answer: A change in the level of consciousness
Rationale: A change in level of consciousness (LOC), such as confusion or lethargy, is typically the first
sign of rising ICP. This is because the reticular activating system and cerebral perfusion are affected
early. The other options are late, ominous signs indicating severe brain compression and impending
herniation.
,3. A patient is diagnosed with a subdural hematoma. Which of the following describes the location of
this type of bleed?
A) Between the skull and the dura mater
B) Between the dura mater and the arachnoid mater
C) Between the arachnoid mater and the pia mater
D) Within the brain parenchyma
Correct Answer: Between the dura mater and the arachnoid mater
Rationale: A subdural hematoma is a collection of blood in the subdural space, which is located between
the dura mater and the arachnoid mater. An epidural hematoma is between the skull and dura, a
subarachnoid hemorrhage is in the subarachnoid space, and an intracerebral hemorrhage is within the
brain tissue itself.
4. A researcher is studying the pathophysiology of Parkinson's disease. Which of the following
neurochemical deficits is central to this condition?
A) Decreased acetylcholine in the basal ganglia
B) Decreased dopamine in the basal ganglia
C) Increased serotonin in the brainstem
D) Decreased norepinephrine in the cerebellum
Correct Answer: Decreased dopamine in the basal ganglia
Rationale: Parkinson's disease is caused by the progressive loss of dopaminergic neurons in the
substantia nigra, leading to a deficiency of dopamine in the basal ganglia. This disrupts the balance
between dopamine and acetylcholine, causing the characteristic motor symptoms. The other options
describe different neurochemical changes.
5. What is the primary pathophysiological mechanism of a thrombotic stroke?
A) A blood clot that forms elsewhere in the body travels to the brain
B) A blood vessel in the brain ruptures, causing bleeding into the brain tissue
, C) A blood clot forms locally within a cerebral artery, often at the site of atherosclerosis
D) A temporary reduction in blood flow to the brain without infarction
Correct Answer: A blood clot forms locally within a cerebral artery, often at the site of atherosclerosis
Rationale: A thrombotic stroke occurs when a blood clot (thrombus) forms in a cerebral artery, typically
at the site of an atherosclerotic plaque, obstructing blood flow. An embolic stroke involves a clot from
another location, a hemorrhagic stroke involves a ruptured vessel, and a transient ischemic attack (TIA)
is a temporary episode.
6. A 65-year-old patient presents with sudden onset of right-sided weakness and difficulty speaking.
Which of the following is the most likely diagnosis?
A) Hemorrhagic stroke
B) Ischemic stroke
C) Transient ischemic attack
D) Seizure disorder
Correct Answer: Ischemic stroke
Rationale: The sudden onset of focal neurological deficits, such as unilateral weakness and aphasia, is
characteristic of an ischemic stroke. While a hemorrhagic stroke can present similarly, ischemic strokes
are more common. A TIA would have resolved within 24 hours, and a seizure typically involves altered
consciousness or involuntary movements.
7. According to the pathophysiology of Alzheimer's disease, which of the following are the two hallmark
neuropathological findings?
A) Lewy bodies and neurofibrillary tangles
B) Amyloid plaques and neurofibrillary tangles
C) Demyelination and gliosis
D) Dopamine depletion and Lewy bodies
Correct Answer: Amyloid plaques and neurofibrillary tangles
Nurses I | Galen College | Q & A | 2026/2027
Edition (PDF)
1. Which of the following best describes the Monroe-Kellie doctrine?
A) The brain can expand indefinitely to accommodate increasing pressure
B) The total volume within the skull is fixed, so an increase in one component requires a decrease in
another
C) Increased intracranial pressure always leads to immediate brain death
D) Cerebrospinal fluid production is independent of intracranial pressure
Correct Answer: The total volume within the skull is fixed, so an increase in one component requires a
decrease in another
Rationale: The Monroe-Kellie doctrine states that the skull is a rigid, closed box with a fixed total
volume. An increase in the volume of any one component (brain tissue, blood, or CSF) must be
compensated by a decrease in another to maintain normal ICP. The other options do not accurately
describe this principle.
2. What is the earliest and most sensitive indicator of increasing intracranial pressure (ICP) in a client
with an acute brain injury?
A) Fixed and dilated pupils
B) Cushing's triad (hypertension, bradycardia, irregular respirations)
C) A change in the level of consciousness
D) Decerebrate posturing
Correct Answer: A change in the level of consciousness
Rationale: A change in level of consciousness (LOC), such as confusion or lethargy, is typically the first
sign of rising ICP. This is because the reticular activating system and cerebral perfusion are affected
early. The other options are late, ominous signs indicating severe brain compression and impending
herniation.
,3. A patient is diagnosed with a subdural hematoma. Which of the following describes the location of
this type of bleed?
A) Between the skull and the dura mater
B) Between the dura mater and the arachnoid mater
C) Between the arachnoid mater and the pia mater
D) Within the brain parenchyma
Correct Answer: Between the dura mater and the arachnoid mater
Rationale: A subdural hematoma is a collection of blood in the subdural space, which is located between
the dura mater and the arachnoid mater. An epidural hematoma is between the skull and dura, a
subarachnoid hemorrhage is in the subarachnoid space, and an intracerebral hemorrhage is within the
brain tissue itself.
4. A researcher is studying the pathophysiology of Parkinson's disease. Which of the following
neurochemical deficits is central to this condition?
A) Decreased acetylcholine in the basal ganglia
B) Decreased dopamine in the basal ganglia
C) Increased serotonin in the brainstem
D) Decreased norepinephrine in the cerebellum
Correct Answer: Decreased dopamine in the basal ganglia
Rationale: Parkinson's disease is caused by the progressive loss of dopaminergic neurons in the
substantia nigra, leading to a deficiency of dopamine in the basal ganglia. This disrupts the balance
between dopamine and acetylcholine, causing the characteristic motor symptoms. The other options
describe different neurochemical changes.
5. What is the primary pathophysiological mechanism of a thrombotic stroke?
A) A blood clot that forms elsewhere in the body travels to the brain
B) A blood vessel in the brain ruptures, causing bleeding into the brain tissue
, C) A blood clot forms locally within a cerebral artery, often at the site of atherosclerosis
D) A temporary reduction in blood flow to the brain without infarction
Correct Answer: A blood clot forms locally within a cerebral artery, often at the site of atherosclerosis
Rationale: A thrombotic stroke occurs when a blood clot (thrombus) forms in a cerebral artery, typically
at the site of an atherosclerotic plaque, obstructing blood flow. An embolic stroke involves a clot from
another location, a hemorrhagic stroke involves a ruptured vessel, and a transient ischemic attack (TIA)
is a temporary episode.
6. A 65-year-old patient presents with sudden onset of right-sided weakness and difficulty speaking.
Which of the following is the most likely diagnosis?
A) Hemorrhagic stroke
B) Ischemic stroke
C) Transient ischemic attack
D) Seizure disorder
Correct Answer: Ischemic stroke
Rationale: The sudden onset of focal neurological deficits, such as unilateral weakness and aphasia, is
characteristic of an ischemic stroke. While a hemorrhagic stroke can present similarly, ischemic strokes
are more common. A TIA would have resolved within 24 hours, and a seizure typically involves altered
consciousness or involuntary movements.
7. According to the pathophysiology of Alzheimer's disease, which of the following are the two hallmark
neuropathological findings?
A) Lewy bodies and neurofibrillary tangles
B) Amyloid plaques and neurofibrillary tangles
C) Demyelination and gliosis
D) Dopamine depletion and Lewy bodies
Correct Answer: Amyloid plaques and neurofibrillary tangles
