N3630: Complex Health Challenges II -
Neurological Disorders Questions with
Guaranteed Pass Solutions 2026
Updated.
Which change eventually exhausts compensatory mechanisms, leading to ischemia?
1. Progressive decreases in brain tissue volume
2. Rapid increases in neuronal compression
3. Progressive increases in brain tissue volume
4. Rapid decreases in neuronal compression - Answer 3
Brain tissue volume compensates by distention of the dura or compression of the brain tissue.
Progressive increases in volume eventually exhaust compensatory mechanisms and results in
increased intracranial pressure (ICP), neuronal compression, and ischemia.
Changes in which factor influence intracranial pressure (ICP) under normal circumstances?
A. Blood pressure (BP)
B. Blood glucose levels
C. Hypovolemia
D. Electrolyte deficiencies - Answer A
Factors that influence intracranial pressure (ICP) under normal circumstances are changes in
blood pressure (BP), cardiac function, intra-abdominal and intrathoracic pressure, body
position, temperature, and blood gasses, particularly carbon dioxide (CO2) levels. The degree to
which these factors increase or decrease the ICP depends on the ability of the brain to
accommodate the changes.
Which stage on the pressure-volume curve is associated with high compliance in
autoregulation?
A. 1
B. 2
C. 3
D. 4 - Answer A
1
At stage 1 on the curve, there is high compliance. The brain is in total compensation, with
accommodation and autoregulation intact. An increase in volume (in brain tissue, blood, or
cerebral spinal fluid [CSF]) does not increase the intracranial pressure (ICP).
2
,At stage 2, the compliance is lessening, and an increase in volume places the patient at risk for
increased intracranial pressure (ICP).
3
At stage 3, there is low compliance as compensatory mechanisms are becoming exhausted. Any
small addition of volume causes a great increase in intracranial pressure (ICP). As compensatory
mechanisms fail, there is a loss of autoregulation, and the patient may exhibit symptoms
indicating increased ICP, such as headache, changes in level of consciousness, or pupil
responsiveness.
4
As the patient enters stage 4, the intracranial pressure (ICP) rises to lethal levels with even slight
increases in volume. Here the patient is at significant risk for hypoperfusion and brain
herniation and death. Herniation occurs as the brain tissue is forcibly shifted from the
compartment of greater pressure to a compartment of lesser pressure. In this situation, intense
pressure is placed on the brain stem, and if herniation continues, brainstem death is imminent.
Which physiologic event leads to decreased oxygen and death of the brain cells?
A. Tissue edema
B. Excessive hydration
C. Decreased cerebral blood flow
D. Accumulation of carbon dioxide - Answer C
Decreased cerebral blood flow from compression of cerebral blood vessels leads to decreased
oxygen and brain tissue death.
Which statement describes the cause of interstitial cerebral edema?
A. Local disruption of the functional or morphological integrity of cell membranes
B. Changes in the endothelial lining of cerebral capillaries
C. Fluid and protein shift from the extracellular space directly into the cells, with subsequent
swelling
D. Periventricular diffusion of ventricular cerebral spinal fluid (CSF) in a patient with
uncontrolled hydrocephalus - Answer D
Interstitial cerebral edema is the result of periventricular diffusion of ventricular cerebral spinal
fluid (CSF) in a patient with uncontrolled hydrocephalus. It can also be caused by enlargement
of the extracellular space because of systemic water excess (hyponatremia).
Which follow-up vital signs would indicate worsening intracranial pressure (ICP) for a patient
with a brain tumour and increased ICP with initial vital sins of: BP 128/88, HR 106, RR 22, and
oxygen saturation 98%?
A. BP 116/82, HR 85, RR 20, oxygen saturation 97%
,B. BP 172/98, HR 64, RR 24, oxygen saturation 99%
C. BP 98/76, HR 85, RR 12, oxygen saturation 90%
D. BP 135/86, HR 112, RR 10, oxygen saturation 89% - Answer B
BP 172/98, HR 64, RR 24, oxygen saturation 99% is characteristic of Cushing's triad, elevated BP
and decreased HR, indicating worsening intracranial pressure (ICP).
Which test is contraindicated if intracranial pressure (ICP) is increased?
A. Lumbar puncture
B. Cerebral angiography
C. PET scan
D. Brain tissue oxygenation measured via a Licox catheter - Answer A
Lumbar punctures are not performed if intracranial pressure (ICP) is increased because of
cerebral herniation from the sudden release of the pressure in the skull from the area above the
lumbar puncture
Which action would the nurse take when caring for a patient with a cerebrospinal fluid (CSF)
drainage system that begins to complain of headache and nausea?
A. Give oral mannitol
B. Administer an IV fluid bolus
C. Elevate head of patient's bed
D. Administer narcotic pain medicine - Answer C
Elevating the head of the bed allows for appropriate drainage of CSF and is helpful for the
patient with increased intracranial pressure (ICP).
Which device is used to measure cerebral oxygenation levels?
A. Licox catheter
B. Peripheral arterial line
C. Intraventricular catheter
D. Ventriculostomy catheter - Answer A
The Licox catheter is placed in the healthy white matter of the brain and provides continuous
monitoring of the pressure of oxygen in brain tissue (PbtO2).
Which step is first in the management of increased intracranial pressure (ICP)?
A. Support brain function by adequate oxygenation
B. Support the family and caregivers
C. Maintain dynamic equilibrium in cerebral responses
D. Maintain fluid balance - Answer A
, Ensuring adequate oxygenation to support brain function is the first step in the management of
increased cerebral spinal fluid (CSF). An endotracheal tube or tracheostomy may be necessary
to maintain adequate ventilation. Arterial blood gas (ABG) analysis guides the oxygen therapy.
The goal is to maintain the PaO2 at 100 mm Hg or greater. It may be necessary to maintain the
patient on a mechanical ventilator to ensure adequate oxygenation.
Which medication therapy is first-line treatment for elevated intracranial pressure (ICP)?
A. Hypertonic saline
B. Corticosteroids
C. Phenytoin
D. High-dose barbiturates - Answer A
Hypertonic saline is the first-line treatment for elevated cerebral spinal fluid (CSF). It reduces
swelling and improves cerebral blood flow (CBF), drawing water out of the brain tissue.
A patient presents with abnormal extension, does not open their eyes to stimulus, and does not
give a sound as reaction to pain. The patient exhibiting these signs would be given a score of
___________ using the Glasgow Coma Scale.
A. 2
B. 4
C. 5
D. 7 - Answer B
According to the Glasgow Coma Scale (GCS), abnormal extension receives a 2, lack of eye
opening receives a 1, and lack of sound to stimuli receives a 1, for a total of 4.
Which nursing assessment can indicate the presence of increased intracranial pressure (ICP)?
A. Capillary refill
B. Lung sounds
C. Pain assessment
D. Pupillary assessment - Answer D
Pupillary reaction is tested with a penlight. The normal reaction is brisk constriction when the
light is shone directly into the eye. A consensual response (a slight constriction in the opposite
pupil) should also be noted at the same time. A sluggish reaction can indicate early pressure on
CN III. A fixed pupil shows no response to light stimulus, which usually indicates increased
intracranial pressure (ICP).
Which provider order would the nurse anticipate when caring for a patient with increased
intracranial pressure (ICP) with nausea and vomiting?
A. IV protonix
B. PO antibiotics
Neurological Disorders Questions with
Guaranteed Pass Solutions 2026
Updated.
Which change eventually exhausts compensatory mechanisms, leading to ischemia?
1. Progressive decreases in brain tissue volume
2. Rapid increases in neuronal compression
3. Progressive increases in brain tissue volume
4. Rapid decreases in neuronal compression - Answer 3
Brain tissue volume compensates by distention of the dura or compression of the brain tissue.
Progressive increases in volume eventually exhaust compensatory mechanisms and results in
increased intracranial pressure (ICP), neuronal compression, and ischemia.
Changes in which factor influence intracranial pressure (ICP) under normal circumstances?
A. Blood pressure (BP)
B. Blood glucose levels
C. Hypovolemia
D. Electrolyte deficiencies - Answer A
Factors that influence intracranial pressure (ICP) under normal circumstances are changes in
blood pressure (BP), cardiac function, intra-abdominal and intrathoracic pressure, body
position, temperature, and blood gasses, particularly carbon dioxide (CO2) levels. The degree to
which these factors increase or decrease the ICP depends on the ability of the brain to
accommodate the changes.
Which stage on the pressure-volume curve is associated with high compliance in
autoregulation?
A. 1
B. 2
C. 3
D. 4 - Answer A
1
At stage 1 on the curve, there is high compliance. The brain is in total compensation, with
accommodation and autoregulation intact. An increase in volume (in brain tissue, blood, or
cerebral spinal fluid [CSF]) does not increase the intracranial pressure (ICP).
2
,At stage 2, the compliance is lessening, and an increase in volume places the patient at risk for
increased intracranial pressure (ICP).
3
At stage 3, there is low compliance as compensatory mechanisms are becoming exhausted. Any
small addition of volume causes a great increase in intracranial pressure (ICP). As compensatory
mechanisms fail, there is a loss of autoregulation, and the patient may exhibit symptoms
indicating increased ICP, such as headache, changes in level of consciousness, or pupil
responsiveness.
4
As the patient enters stage 4, the intracranial pressure (ICP) rises to lethal levels with even slight
increases in volume. Here the patient is at significant risk for hypoperfusion and brain
herniation and death. Herniation occurs as the brain tissue is forcibly shifted from the
compartment of greater pressure to a compartment of lesser pressure. In this situation, intense
pressure is placed on the brain stem, and if herniation continues, brainstem death is imminent.
Which physiologic event leads to decreased oxygen and death of the brain cells?
A. Tissue edema
B. Excessive hydration
C. Decreased cerebral blood flow
D. Accumulation of carbon dioxide - Answer C
Decreased cerebral blood flow from compression of cerebral blood vessels leads to decreased
oxygen and brain tissue death.
Which statement describes the cause of interstitial cerebral edema?
A. Local disruption of the functional or morphological integrity of cell membranes
B. Changes in the endothelial lining of cerebral capillaries
C. Fluid and protein shift from the extracellular space directly into the cells, with subsequent
swelling
D. Periventricular diffusion of ventricular cerebral spinal fluid (CSF) in a patient with
uncontrolled hydrocephalus - Answer D
Interstitial cerebral edema is the result of periventricular diffusion of ventricular cerebral spinal
fluid (CSF) in a patient with uncontrolled hydrocephalus. It can also be caused by enlargement
of the extracellular space because of systemic water excess (hyponatremia).
Which follow-up vital signs would indicate worsening intracranial pressure (ICP) for a patient
with a brain tumour and increased ICP with initial vital sins of: BP 128/88, HR 106, RR 22, and
oxygen saturation 98%?
A. BP 116/82, HR 85, RR 20, oxygen saturation 97%
,B. BP 172/98, HR 64, RR 24, oxygen saturation 99%
C. BP 98/76, HR 85, RR 12, oxygen saturation 90%
D. BP 135/86, HR 112, RR 10, oxygen saturation 89% - Answer B
BP 172/98, HR 64, RR 24, oxygen saturation 99% is characteristic of Cushing's triad, elevated BP
and decreased HR, indicating worsening intracranial pressure (ICP).
Which test is contraindicated if intracranial pressure (ICP) is increased?
A. Lumbar puncture
B. Cerebral angiography
C. PET scan
D. Brain tissue oxygenation measured via a Licox catheter - Answer A
Lumbar punctures are not performed if intracranial pressure (ICP) is increased because of
cerebral herniation from the sudden release of the pressure in the skull from the area above the
lumbar puncture
Which action would the nurse take when caring for a patient with a cerebrospinal fluid (CSF)
drainage system that begins to complain of headache and nausea?
A. Give oral mannitol
B. Administer an IV fluid bolus
C. Elevate head of patient's bed
D. Administer narcotic pain medicine - Answer C
Elevating the head of the bed allows for appropriate drainage of CSF and is helpful for the
patient with increased intracranial pressure (ICP).
Which device is used to measure cerebral oxygenation levels?
A. Licox catheter
B. Peripheral arterial line
C. Intraventricular catheter
D. Ventriculostomy catheter - Answer A
The Licox catheter is placed in the healthy white matter of the brain and provides continuous
monitoring of the pressure of oxygen in brain tissue (PbtO2).
Which step is first in the management of increased intracranial pressure (ICP)?
A. Support brain function by adequate oxygenation
B. Support the family and caregivers
C. Maintain dynamic equilibrium in cerebral responses
D. Maintain fluid balance - Answer A
, Ensuring adequate oxygenation to support brain function is the first step in the management of
increased cerebral spinal fluid (CSF). An endotracheal tube or tracheostomy may be necessary
to maintain adequate ventilation. Arterial blood gas (ABG) analysis guides the oxygen therapy.
The goal is to maintain the PaO2 at 100 mm Hg or greater. It may be necessary to maintain the
patient on a mechanical ventilator to ensure adequate oxygenation.
Which medication therapy is first-line treatment for elevated intracranial pressure (ICP)?
A. Hypertonic saline
B. Corticosteroids
C. Phenytoin
D. High-dose barbiturates - Answer A
Hypertonic saline is the first-line treatment for elevated cerebral spinal fluid (CSF). It reduces
swelling and improves cerebral blood flow (CBF), drawing water out of the brain tissue.
A patient presents with abnormal extension, does not open their eyes to stimulus, and does not
give a sound as reaction to pain. The patient exhibiting these signs would be given a score of
___________ using the Glasgow Coma Scale.
A. 2
B. 4
C. 5
D. 7 - Answer B
According to the Glasgow Coma Scale (GCS), abnormal extension receives a 2, lack of eye
opening receives a 1, and lack of sound to stimuli receives a 1, for a total of 4.
Which nursing assessment can indicate the presence of increased intracranial pressure (ICP)?
A. Capillary refill
B. Lung sounds
C. Pain assessment
D. Pupillary assessment - Answer D
Pupillary reaction is tested with a penlight. The normal reaction is brisk constriction when the
light is shone directly into the eye. A consensual response (a slight constriction in the opposite
pupil) should also be noted at the same time. A sluggish reaction can indicate early pressure on
CN III. A fixed pupil shows no response to light stimulus, which usually indicates increased
intracranial pressure (ICP).
Which provider order would the nurse anticipate when caring for a patient with increased
intracranial pressure (ICP) with nausea and vomiting?
A. IV protonix
B. PO antibiotics
