NSG 252 Exam 3 – Intracranial Regulation, Inflammation, Mobility, & Nursing Process Complete 200 Questions & Answers with Rationales | 2026/2027 Edition

NSG 252 Exam 3 – Intracranial Regulation,
Inflammation, Mobility, & Nursing Process
Complete 200 Questions & Answers with
Rationales | 2026/2027 Edition

SECTION A: INTRACRANIAL REGULATION (Questions 1-50)
1. A patient with increased intracranial pressure (ICP) exhibits a systolic
blood pressure of 170 mm Hg, pulse of 42 bpm, and irregular respirations.
What is this phenomenon called?
 A) Cushing's triad
 B) Cushing's reflex
 C) Autonomic dysreflexia
 D) Brain death criteria
Rationale: Cushing's reflex is the body's compensatory response to increased ICP,
characterized by hypertension, bradycardia, and irregular respirations (Cushing's
triad). This indicates impending brainstem herniation and requires immediate
intervention.


2. The nurse is caring for a patient with a traumatic brain injury. Which
assessment finding indicates worsening intracranial pressure?
 A) Pupils equal and reactive
 B) Decerebrate posturing
 C) Glasgow Coma Scale (GCS) of 14
 D) Oriented to person, place, and time

,Rationale: Decerebrate posturing (extension of arms and legs) indicates severe
brainstem dysfunction and increasing ICP. Decorticate posturing (flexion) is less
severe. A GCS of 14 indicates mild impairment, not worsening ICP.


3. What is the normal range for intracranial pressure (ICP) in a healthy
adult?
 A) 0-5 mm Hg
 B) 5-15 mm Hg
 C) 15-25 mm Hg
 D) 25-35 mm Hg
Rationale: Normal ICP is 5-15 mm Hg in a supine adult. Pressures above 20 mm
Hg are considered elevated and require intervention. Pressures above 40 mm Hg
are associated with severe neurologic compromise.


4. Which medication is MOST commonly administered to reduce cerebral
edema in a patient with increased ICP?
 A) Furosemide
 B) Mannitol (Osmitrol)
 C) Hydrochlorothiazide
 D) Spironolactone
Rationale: Mannitol is an osmotic diuretic that reduces cerebral edema by drawing
fluid from brain tissue into the vascular space. It is the first-line medication for
acute ICP reduction. Furosemide may be used as adjunct therapy.


5. The Monro-Kellie doctrine states that:
 A) Blood flow to the brain remains constant regardless of pressure

,  B) The total volume of intracranial contents (brain tissue, blood, CSF)
remains constant
 C) Brain tissue regenerates after injury
 D) ICP increases linearly with volume expansion
Rationale: The Monro-Kellie doctrine states that the skull is a rigid container with
fixed volume. An increase in any component (brain tissue, blood, CSF) requires a
compensatory decrease in another component to maintain stable ICP.


6. A patient with increased ICP is positioned with the head of the bed elevated
to 30 degrees. What is the primary rationale for this intervention?
 A) To prevent aspiration
 B) To promote lung expansion
 C) To promote venous drainage from the head
 D) To facilitate oral care
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage
from the cranial cavity, reducing intracranial blood volume and helping to lower
ICP. This position is standard for ICP management.


7. Which early sign of increased ICP should the nurse assess for FIRST?
 A) Papilledema
 B) Decreased level of consciousness (LOC)
 C) Fixed and dilated pupils
 D) Decerebrate posturing
Rationale: Decreased LOC is the earliest and most sensitive indicator of
increasing ICP. As pressure rises, cerebral perfusion decreases, affecting the
reticular activating system and causing drowsiness, confusion, and disorientation.

, 8. The nurse is assessing a patient's Glasgow Coma Scale. The patient opens eyes
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to pain, makes incomprehensible sounds, and withdraws from pain. What is the
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GCS score?
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 A) 6 k




 B) 7 k




 C) 8 k




 D) 9 k




Rationale: Eye opening to pain = 2, verbal response (incomprehensible sounds) = 2,
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motor response (withdrawal to pain) = 4. Total = 8. A GCS of 8 or less indicates severe
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brain injury and potential need for airway protection.
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9. Which nursing intervention is CONTRAINDICATED in a patient with
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increased ICP?
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 A) Maintaining head midline
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 B) Cluster nursing care
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 C) Maintaining normothermia
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 D) Suctioning for 30 seconds
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Rationale: Prolonged suctioning (over 15 seconds) can increase ICP due to
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hypoxia and stimulation. Suctioning should be brief (10-15 seconds) with pre-
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oxygenation. Clustering care is contraindicated as it causes multiple stimulation
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events that can spike ICP.
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10. What is the primary cause of secondary brain injury?
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 A) Initial trauma impact
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 B) Skull fracture
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 C) Cerebral hypoxia and ischemia
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 D) Subdural hematoma
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