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NUR 265 EXAM 3 — ORIGINAL PRACTICE
QUESTION BANK Advanced Application-Level
Questions | 2025/26 Study Update
NEUROLOGICAL EMERGENCIES
Q1: A patient with a severe traumatic brain injury has an ICP of 24 mmHg. The nurse notes a
new decrease in level of consciousness and unequal pupils. Which action should the nurse take
first?
A) Lower the head of the bed flat
B) Assess airway and oxygenation while immediately notifying the provider of suspected
neurologic deterioration
C) Administer oral fluids to maintain cerebral perfusion
D) Encourage the patient to cough to improve ventilation
Rationale: B is correct because increasing ICP accompanied by a declining neurologic status
and anisocoria can indicate worsening intracranial pathology or herniation. Immediate
assessment and stabilization of airway and oxygenation are priorities while urgent escalation
occurs. A is incorrect because a flat position can impair venous drainage and increase ICP. C is
inappropriate because oral fluids are unsafe in a patient with impaired consciousness. D is
incorrect because coughing and straining can further increase ICP.
Q2: A patient with a head injury develops bradycardia, widening pulse pressure, and irregular
respirations. Which interpretation is most appropriate?
A) The patient is experiencing hypovolemic shock
B) The patient is demonstrating signs associated with increased intracranial pressure
C) The patient is developing neurogenic bladder
D) The patient is experiencing an uncomplicated concussion
Rationale: B is correct because the combination of hypertension with widening pulse pressure,
bradycardia, and abnormal respirations is characteristic of Cushing’s response and suggests
significant intracranial hypertension. A is incorrect because hypovolemia typically produces
tachycardia and narrowing pulse pressure. C does not explain the cardiovascular and
respiratory findings. D is incorrect because these findings indicate potentially life-threatening
neurologic deterioration rather than an uncomplicated concussion.
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Q3: A patient with suspected spinal cord injury arrives after a motor-vehicle collision. Which
assessment finding requires the nurse's highest priority?
A) Severe back pain
B) Inability to move both legs
C) Loss of sensation below the waist
D) Increasing difficulty maintaining an open airway
Rationale: D is correct because airway compromise takes priority under the ABC framework.
Cervical spinal cord injury can impair respiratory muscles and airway protection. A, B, and C
are serious findings requiring immediate assessment, but they do not take precedence over an
actively threatened airway.
Q4: A patient with increased ICP is being positioned by the nurse. Which intervention is most
appropriate?
A) Flex the neck toward the chest
B) Place the patient in Trendelenburg position
C) Maintain the head in neutral alignment with the head of the bed elevated as prescribed
D) Routinely suction the patient every hour
Rationale: C is correct because neutral head alignment promotes venous drainage, while
appropriate head elevation can help reduce ICP. A can obstruct venous outflow. B can increase
intracranial venous pressure. D is incorrect because unnecessary suctioning can provoke
coughing and transiently increase ICP.
Q5: A patient with a traumatic brain injury suddenly develops a unilateral dilated pupil that is
poorly reactive to light. Which complication should the nurse suspect?
A) Improved cerebral perfusion
B) Intracranial mass effect with possible cerebral herniation
C) Hypoglycemia
D) Peripheral neuropathy
Rationale: B is correct because a new unilateral dilated, poorly reactive pupil can indicate
compression of cranial nerve III from expanding intracranial pressure or mass effect. A would
not cause this finding. C can cause altered consciousness but does not typically produce an
isolated fixed dilated pupil. D does not explain the acute pupillary change.
NUR 265 EXAM 3 — ORIGINAL PRACTICE
QUESTION BANK Advanced Application-Level
Questions | 2025/26 Study Update
NEUROLOGICAL EMERGENCIES
Q1: A patient with a severe traumatic brain injury has an ICP of 24 mmHg. The nurse notes a
new decrease in level of consciousness and unequal pupils. Which action should the nurse take
first?
A) Lower the head of the bed flat
B) Assess airway and oxygenation while immediately notifying the provider of suspected
neurologic deterioration
C) Administer oral fluids to maintain cerebral perfusion
D) Encourage the patient to cough to improve ventilation
Rationale: B is correct because increasing ICP accompanied by a declining neurologic status
and anisocoria can indicate worsening intracranial pathology or herniation. Immediate
assessment and stabilization of airway and oxygenation are priorities while urgent escalation
occurs. A is incorrect because a flat position can impair venous drainage and increase ICP. C is
inappropriate because oral fluids are unsafe in a patient with impaired consciousness. D is
incorrect because coughing and straining can further increase ICP.
Q2: A patient with a head injury develops bradycardia, widening pulse pressure, and irregular
respirations. Which interpretation is most appropriate?
A) The patient is experiencing hypovolemic shock
B) The patient is demonstrating signs associated with increased intracranial pressure
C) The patient is developing neurogenic bladder
D) The patient is experiencing an uncomplicated concussion
Rationale: B is correct because the combination of hypertension with widening pulse pressure,
bradycardia, and abnormal respirations is characteristic of Cushing’s response and suggests
significant intracranial hypertension. A is incorrect because hypovolemia typically produces
tachycardia and narrowing pulse pressure. C does not explain the cardiovascular and
respiratory findings. D is incorrect because these findings indicate potentially life-threatening
neurologic deterioration rather than an uncomplicated concussion.
, 2|Page
Q3: A patient with suspected spinal cord injury arrives after a motor-vehicle collision. Which
assessment finding requires the nurse's highest priority?
A) Severe back pain
B) Inability to move both legs
C) Loss of sensation below the waist
D) Increasing difficulty maintaining an open airway
Rationale: D is correct because airway compromise takes priority under the ABC framework.
Cervical spinal cord injury can impair respiratory muscles and airway protection. A, B, and C
are serious findings requiring immediate assessment, but they do not take precedence over an
actively threatened airway.
Q4: A patient with increased ICP is being positioned by the nurse. Which intervention is most
appropriate?
A) Flex the neck toward the chest
B) Place the patient in Trendelenburg position
C) Maintain the head in neutral alignment with the head of the bed elevated as prescribed
D) Routinely suction the patient every hour
Rationale: C is correct because neutral head alignment promotes venous drainage, while
appropriate head elevation can help reduce ICP. A can obstruct venous outflow. B can increase
intracranial venous pressure. D is incorrect because unnecessary suctioning can provoke
coughing and transiently increase ICP.
Q5: A patient with a traumatic brain injury suddenly develops a unilateral dilated pupil that is
poorly reactive to light. Which complication should the nurse suspect?
A) Improved cerebral perfusion
B) Intracranial mass effect with possible cerebral herniation
C) Hypoglycemia
D) Peripheral neuropathy
Rationale: B is correct because a new unilateral dilated, poorly reactive pupil can indicate
compression of cranial nerve III from expanding intracranial pressure or mass effect. A would
not cause this finding. C can cause altered consciousness but does not typically produce an
isolated fixed dilated pupil. D does not explain the acute pupillary change.
