NURS 3366 EXAM 4 2026/2027 – PATHOPHYSIOLOGY STUDY GUIDE,
PRACTICE QUESTIONS, EXAM REVIEW & TEST PREP
What is cerebral perfusion pressure? - ANS ✔✔the pressure required to get oxygenated blood into the
brain to refuse the cells.
What happens if cerebral perfusion pressure is too high or too low? - ANS ✔✔It can lead to cerebral
edema and increase ICP (pressure within intracranial cavity)
Patho of too low/high CPR - ANS ✔✔ineffective perfusion -> ischemia to brain -> cellular hypoxia -> cell
injury/death -> loss of cell membrane integrity -> water and other cells are released -> results in cerebral
edema and increase ICP -> further loss of effective perfusion
ICP (intracranial pressure) - ANS ✔✔the totality of pressures in the brain - arterial & venous pressures +
CSF pressure + brain tissue
very sensitive to little increase in pressure in brain
A patient is exhibiting signs of increased intracranial pressure (IICP). The nurse understands that the
primary culprit causing IICP and the resulting imbalance between intracranial pressure (ICP) and cerebral
perfusion pressure (CPP) is:
A. Hypernatremia causing dehydration of brain cells
B. Cerebral edema secondary to ischemia
C. Excess cerebrospinal fluid production
D. Systemic hypertension leading to increased cardiac output - ANS ✔✔B. Cerebral edema secondary to
ischemia
The nurse is caring for a patient with a traumatic brain injury. The nurse understands that increased
intracranial pressure (ICP) can lead to decreased cerebral perfusion pressure (CPP). What is the best
explanation for this phenomenon?
A. Increased ICP reduces cerebrospinal fluid production, limiting oxygen delivery.
B. Elevated ICP compresses brain arteries, limiting oxygenated blood flow.
C. Decreased ICP causes vasoconstriction in the cerebral vessels.
D. High CPP causes blood to leak into brain tissue, increasing ICP. - ANS ✔✔B. Elevated ICP compresses
brain arteries, limiting oxygenated blood flow.
Rationale:Increased ICP causes compression of cerebral arteries, which reduces the flow of oxygenated
blood into the brain, leading to decreased CPP. This decrease in perfusion pressure can cause
malfunction of brain tissue. The body tries to balance ICP and CPP, but cerebral edema from trauma,
stroke, or infection can disrupt this balance and lead to diffuse or focal neurological dysfunction
A nurse is educating a patient about the warning signs of a brain attack. Which of the following
statements by the nurse indicates an appropriate understanding of the condition?
A. "A stroke, or CVA, is a slow loss of brain function that usually resolves on its own."
B. "A brain attack is another term for a seizure that affects the entire brain."
C. "A brain attack means there's been a sudden interruption of blood flow to the brain and requires
immediate treatment."
,D. "Brain attacks are only serious if they affect both sides of the brain." - ANS ✔✔C. "A brain attack
means there's been a sudden interruption of blood flow to the brain and requires immediate
treatment."
Which of the following best describes the pathophysiology of a thrombotic stroke?
A. A blood clot forms in the heart and travels to the brain, blocking a cerebral artery.
B. A weakened cerebral blood vessel ruptures, causing bleeding into brain tissue.
C. A clot or plaque forms in a cerebral artery, leading to local ischemia and tissue damage.
D. A temporary loss of blood flow to the brain causes symptoms that resolve within 24 hours. - ANS
✔✔C. A clot or plaque forms in a cerebral artery, leading to local ischemia and tissue damage.
Which of the following best describes the pathophysiology of an embolic stroke?
A. A clot forms in a cerebral artery, gradually narrowing the vessel until it becomes fully occluded.
B. A clot or plaque breaks off from a larger artery or the heart and travels to the brain, lodging in a
smaller artery and causing ischemia.
C. Bleeding from a ruptured cerebral vessel leads to increased intracranial pressure and decreased
perfusion.
D. Temporary blockage of cerebral blood flow causes symptoms that resolve in less than 24 hours. - ANS
✔✔Correct Answer:B. A clot or plaque breaks off from a larger artery or the heart and travels to the
brain, lodging in a smaller artery and causing ischemia
A patient presents to the emergency department reporting sudden right arm weakness and slurred
speech that resolved after 30 minutes. The nurse suspects a transient ischemic attack (TIA). Which of the
following is the most appropriate nursing explanation?
A. "This was a mild stroke that won't require further treatment."
B. "You likely had a seizure, but since it resolved quickly, there's no cause for concern."
C. "You experienced a temporary blockage of blood flow to the brain, and this event is a warning sign of
a possible future stroke."
D. "This episode was caused by a drop in blood pressure and is not related to brain function." - ANS
✔✔C. "You experienced a temporary blockage of blood flow to the brain, and this event is a warning sign
of a possible future stroke."
A nurse is caring for a patient diagnosed with a hemorrhagic stroke. Which of the following best
describes the underlying pathophysiology of this condition?
A. A clot forms within a cerebral artery, blocking blood flow to the brain.
B. Blood leaks directly onto brain tissue, triggering inflammation, cerebral edema, and increased
intracranial pressure.
C. A thrombus from a distant site embolizes and lodges in a cerebral vessel.
D. Temporary loss of blood flow causes brief neurologic symptoms that resolve within 24 hours. - ANS
✔✔B. Blood leaks directly onto brain tissue, triggering inflammation, cerebral edema, and increased
intracranial pressure.
A nurse assesses a patient with a right-sided brain lesion. Which sensorimotor finding should the nurse
expect?
A. Left-sided facial drooping and weakness
B. Right-sided weakness and sensory loss
C. Bilateral loss of sensation and movement
D. Normal sensorimotor function - ANS ✔✔A. Left-sided facial drooping and weakness
, A patient presents with weakness and decreased sensation in the left arm and leg. The nurse suspects a
focal brain lesion. Where is the most likely location of the lesion?
A. Left cerebral hemisphere
B. Right cerebral hemisphere
C. Brainstem at the level of the medulla
D. Spinal cord on the left side - ANS ✔✔B. Right cerebral hemisphere
A patient is brought to the emergency department after collapsing at home. Upon assessment, the nurse
notes the patient is unresponsive, has irregular breathing with periods of apnea, and a fluctuating heart
rate and blood pressure. Which of the following most likely explains these findings?
A. Increased cerebral perfusion pressure from a mild ischemic stroke
B. Occlusion of the middle cerebral artery affecting the frontal lobe
C. Vertebral-basilar artery occlusion leading to brain stem hypoxia
D. Partial blockage of the carotid artery causing localized edema - ANS ✔✔C. Vertebral-basilar artery
occlusion leading to brain stem hypoxia
A nurse is assessing a comatose patient who suffered a brain stem stroke. The patient exhibits a
breathing pattern characterized by cycles of deep, rapid respirations followed by periods of apnea. How
should the nurse document this finding?
A. Kussmaul respirations
B. Biot's respirations
C. Apneustic breathing
D. Cheyne-Stokes respirations - ANS ✔✔D. Cheyne-Stokes respirations
Rationale:Cheyne-Stokes respirations are characterized by a cyclical pattern of increasing then
decreasing depth and rate of breathing, followed by a period of apnea. It is often seen in comatose
patients with brain stem injury, especially those not on a ventilator.
A patient is alert and oriented ×4. He can smile on command, but only the left side of his face moves; the
right side droops. Based on this finding, which of the following is most likely?
A. Left hemisphere stroke with left-sided hemiparesis
B. Right hemisphere stroke with right-sided neglect
C. Right hemisphere stroke with left-sided hemiparesis
D. Left hemisphere stroke with aphasia - ANS ✔✔C. Right hemisphere stroke with left-sided hemiparesis
A comatose patient has fixed, dilated pupils that do not respond to light. Which of the following best
explains these findings?
A. Left hemispheric stroke involving cranial nerve VII
B. Right cerebellar infarct affecting coordination
C. Brain stem stroke involving cranial nerve III
D. Right hemispheric stroke causing spatial neglect - ANS ✔✔C. Brain stem stroke involving cranial nerve
III
A stroke patient is unaware that anything is wrong, denies their condition, and has some facial drooping.
Which of the following is most likely?
A. Left hemispheric stroke with right facial droop and aphasia
B. Brain stem stroke with bilateral flaccidity and dilated pupils
C. Right hemispheric stroke with left facial droop and spatial neglect
PRACTICE QUESTIONS, EXAM REVIEW & TEST PREP
What is cerebral perfusion pressure? - ANS ✔✔the pressure required to get oxygenated blood into the
brain to refuse the cells.
What happens if cerebral perfusion pressure is too high or too low? - ANS ✔✔It can lead to cerebral
edema and increase ICP (pressure within intracranial cavity)
Patho of too low/high CPR - ANS ✔✔ineffective perfusion -> ischemia to brain -> cellular hypoxia -> cell
injury/death -> loss of cell membrane integrity -> water and other cells are released -> results in cerebral
edema and increase ICP -> further loss of effective perfusion
ICP (intracranial pressure) - ANS ✔✔the totality of pressures in the brain - arterial & venous pressures +
CSF pressure + brain tissue
very sensitive to little increase in pressure in brain
A patient is exhibiting signs of increased intracranial pressure (IICP). The nurse understands that the
primary culprit causing IICP and the resulting imbalance between intracranial pressure (ICP) and cerebral
perfusion pressure (CPP) is:
A. Hypernatremia causing dehydration of brain cells
B. Cerebral edema secondary to ischemia
C. Excess cerebrospinal fluid production
D. Systemic hypertension leading to increased cardiac output - ANS ✔✔B. Cerebral edema secondary to
ischemia
The nurse is caring for a patient with a traumatic brain injury. The nurse understands that increased
intracranial pressure (ICP) can lead to decreased cerebral perfusion pressure (CPP). What is the best
explanation for this phenomenon?
A. Increased ICP reduces cerebrospinal fluid production, limiting oxygen delivery.
B. Elevated ICP compresses brain arteries, limiting oxygenated blood flow.
C. Decreased ICP causes vasoconstriction in the cerebral vessels.
D. High CPP causes blood to leak into brain tissue, increasing ICP. - ANS ✔✔B. Elevated ICP compresses
brain arteries, limiting oxygenated blood flow.
Rationale:Increased ICP causes compression of cerebral arteries, which reduces the flow of oxygenated
blood into the brain, leading to decreased CPP. This decrease in perfusion pressure can cause
malfunction of brain tissue. The body tries to balance ICP and CPP, but cerebral edema from trauma,
stroke, or infection can disrupt this balance and lead to diffuse or focal neurological dysfunction
A nurse is educating a patient about the warning signs of a brain attack. Which of the following
statements by the nurse indicates an appropriate understanding of the condition?
A. "A stroke, or CVA, is a slow loss of brain function that usually resolves on its own."
B. "A brain attack is another term for a seizure that affects the entire brain."
C. "A brain attack means there's been a sudden interruption of blood flow to the brain and requires
immediate treatment."
,D. "Brain attacks are only serious if they affect both sides of the brain." - ANS ✔✔C. "A brain attack
means there's been a sudden interruption of blood flow to the brain and requires immediate
treatment."
Which of the following best describes the pathophysiology of a thrombotic stroke?
A. A blood clot forms in the heart and travels to the brain, blocking a cerebral artery.
B. A weakened cerebral blood vessel ruptures, causing bleeding into brain tissue.
C. A clot or plaque forms in a cerebral artery, leading to local ischemia and tissue damage.
D. A temporary loss of blood flow to the brain causes symptoms that resolve within 24 hours. - ANS
✔✔C. A clot or plaque forms in a cerebral artery, leading to local ischemia and tissue damage.
Which of the following best describes the pathophysiology of an embolic stroke?
A. A clot forms in a cerebral artery, gradually narrowing the vessel until it becomes fully occluded.
B. A clot or plaque breaks off from a larger artery or the heart and travels to the brain, lodging in a
smaller artery and causing ischemia.
C. Bleeding from a ruptured cerebral vessel leads to increased intracranial pressure and decreased
perfusion.
D. Temporary blockage of cerebral blood flow causes symptoms that resolve in less than 24 hours. - ANS
✔✔Correct Answer:B. A clot or plaque breaks off from a larger artery or the heart and travels to the
brain, lodging in a smaller artery and causing ischemia
A patient presents to the emergency department reporting sudden right arm weakness and slurred
speech that resolved after 30 minutes. The nurse suspects a transient ischemic attack (TIA). Which of the
following is the most appropriate nursing explanation?
A. "This was a mild stroke that won't require further treatment."
B. "You likely had a seizure, but since it resolved quickly, there's no cause for concern."
C. "You experienced a temporary blockage of blood flow to the brain, and this event is a warning sign of
a possible future stroke."
D. "This episode was caused by a drop in blood pressure and is not related to brain function." - ANS
✔✔C. "You experienced a temporary blockage of blood flow to the brain, and this event is a warning sign
of a possible future stroke."
A nurse is caring for a patient diagnosed with a hemorrhagic stroke. Which of the following best
describes the underlying pathophysiology of this condition?
A. A clot forms within a cerebral artery, blocking blood flow to the brain.
B. Blood leaks directly onto brain tissue, triggering inflammation, cerebral edema, and increased
intracranial pressure.
C. A thrombus from a distant site embolizes and lodges in a cerebral vessel.
D. Temporary loss of blood flow causes brief neurologic symptoms that resolve within 24 hours. - ANS
✔✔B. Blood leaks directly onto brain tissue, triggering inflammation, cerebral edema, and increased
intracranial pressure.
A nurse assesses a patient with a right-sided brain lesion. Which sensorimotor finding should the nurse
expect?
A. Left-sided facial drooping and weakness
B. Right-sided weakness and sensory loss
C. Bilateral loss of sensation and movement
D. Normal sensorimotor function - ANS ✔✔A. Left-sided facial drooping and weakness
, A patient presents with weakness and decreased sensation in the left arm and leg. The nurse suspects a
focal brain lesion. Where is the most likely location of the lesion?
A. Left cerebral hemisphere
B. Right cerebral hemisphere
C. Brainstem at the level of the medulla
D. Spinal cord on the left side - ANS ✔✔B. Right cerebral hemisphere
A patient is brought to the emergency department after collapsing at home. Upon assessment, the nurse
notes the patient is unresponsive, has irregular breathing with periods of apnea, and a fluctuating heart
rate and blood pressure. Which of the following most likely explains these findings?
A. Increased cerebral perfusion pressure from a mild ischemic stroke
B. Occlusion of the middle cerebral artery affecting the frontal lobe
C. Vertebral-basilar artery occlusion leading to brain stem hypoxia
D. Partial blockage of the carotid artery causing localized edema - ANS ✔✔C. Vertebral-basilar artery
occlusion leading to brain stem hypoxia
A nurse is assessing a comatose patient who suffered a brain stem stroke. The patient exhibits a
breathing pattern characterized by cycles of deep, rapid respirations followed by periods of apnea. How
should the nurse document this finding?
A. Kussmaul respirations
B. Biot's respirations
C. Apneustic breathing
D. Cheyne-Stokes respirations - ANS ✔✔D. Cheyne-Stokes respirations
Rationale:Cheyne-Stokes respirations are characterized by a cyclical pattern of increasing then
decreasing depth and rate of breathing, followed by a period of apnea. It is often seen in comatose
patients with brain stem injury, especially those not on a ventilator.
A patient is alert and oriented ×4. He can smile on command, but only the left side of his face moves; the
right side droops. Based on this finding, which of the following is most likely?
A. Left hemisphere stroke with left-sided hemiparesis
B. Right hemisphere stroke with right-sided neglect
C. Right hemisphere stroke with left-sided hemiparesis
D. Left hemisphere stroke with aphasia - ANS ✔✔C. Right hemisphere stroke with left-sided hemiparesis
A comatose patient has fixed, dilated pupils that do not respond to light. Which of the following best
explains these findings?
A. Left hemispheric stroke involving cranial nerve VII
B. Right cerebellar infarct affecting coordination
C. Brain stem stroke involving cranial nerve III
D. Right hemispheric stroke causing spatial neglect - ANS ✔✔C. Brain stem stroke involving cranial nerve
III
A stroke patient is unaware that anything is wrong, denies their condition, and has some facial drooping.
Which of the following is most likely?
A. Left hemispheric stroke with right facial droop and aphasia
B. Brain stem stroke with bilateral flaccidity and dilated pupils
C. Right hemispheric stroke with left facial droop and spatial neglect
