NSG 3130 Exam 3 2026/2027 | 200+ Practice Questions with Correct
Answers & Detailed Explanations
Question 1
A nurse is caring for a client who sustained a severe basal skull fracture.
Which clinical assessment finding should the nurse immediately report
to the physician as an indication of cerebrospinal fluid (CSF) leakage?
• A. Purulent, foul-smelling drainage from the external auditory
canal
• B. Clear or pink-tinged fluid draining from the nose that tests
positive for glucose
• C. Bilateral periorbital ecchymosis without visual disturbances
• D. Epistaxis secondary to dry nasal mucous membranes
Correct Answer: B. Clear or pink-tinged fluid draining from the nose
that tests positive for glucose
Detailed Rationale: CSF rhinorrhea or otorrhea occurs when a skull
fracture tears the dura mater. CSF contains high levels of glucose,
whereas normal nasal secretions do not. If blood is mixed with the fluid,
the "target sign" or "halo sign" (a yellowish ring surrounding a blood
stain on gauze) can help identify CSF leakage.
Question 2
A client is admitted to the emergency department following a motor
vehicle collision with a suspected spinal cord injury at the level of C4.
Which assessment finding requires the nurse's most immediate life-
saving intervention?
, • A. Absence of deep tendon reflexes in the lower extremities
• B. Spontaneous diaphragmatic paralysis and respiratory arrest
• C. Warm, flushed, dry extremities with hypotension
• D. Inability to move the lower fingers and thumb
Correct Answer: B. Spontaneous diaphragmatic paralysis and
respiratory arrest
Detailed Rationale: The phrenic nerve originates from spinal nerves C3
through C5, which innervates the diaphragm. A high cervical injury at or
above C4 results in paralysis of the diaphragm and immediate
respiratory arrest, making airway management and mechanical
ventilation the absolute highest priority.
Question 3
A client with increased intracranial pressure (ICP) is receiving
mechanical ventilation. Which arterial blood gas (ABG) target should
the nurse collaborate with the respiratory therapist to maintain?
• A. Mild hypercapnia (PaCO2 = 50--55 mmHg)
• B. Mild hypocapnia (PaCO2 = 30--35 mmHg)
• C. Severe metabolic alkalosis (pH = 7.55)
• D. Normal carbon dioxide levels (PaCO2 = 40 mmHg)
Correct Answer: B. Mild hypocapnia (PaCO2 = 30--35 mmHg)
Detailed Rationale: Carbon dioxide is a potent cerebral vasodilator.
Maintaining a mild hypocapnia (PaCO2 = 30--35 mmHg) via short-term
hyperventilation causes cerebral vasoconstriction, reducing cerebral
,blood volume and rapidly lowering intracranial pressure. Prolonged
hyperventilation is avoided to prevent cerebral ischemia.
Question 4
A nurse is caring for an unconscious client with a traumatic brain injury
and an intracranial pressure (ICP) monitor. The client's mean arterial
pressure (MAP) is 90 mmHgand the ICP is 20 mmHg. What is the
client's cerebral perfusion pressure (CPP), and is it within the normal
therapeutic range?
• A. CPP = 70 mmHg; Normal (Adequate)
• B. CPP = 110 mmHg; Abnormally high
• C. CPP = 50 mmHg; Abnormally low
• D. CPP = 70 mmHg; Abnormally low
Correct Answer: A. CPP = 70 mmHg; Normal (Adequate)
Detailed Rationale: Cerebral Perfusion Pressure is calculated as CPP =
MAP − ICP. With MAP = 90and ICP = 20, CPP = 90 − 20 =
70 mmHg. The normal therapeutic target for CPP is 60--100 mmHg,
making 70 mmHgan adequate perfusion pressure.
Question 5
A client is admitted to the neuro-intensive care unit following a stroke.
The nurse notes the client exhibits decorticate posturing when
stimulated. How should the nurse characterize this posturing?
• A. Extension of upper and lower extremities with plantar flexion
• B. Internal rotation and adduction of arms with flexion of elbows,
wrists, and fingers
, • C. Flaccid paralysis of all four extremities with absent reflexes
• D. Arching of the back with rigid hyperextension of the neck
Correct Answer: B. Internal rotation and adduction of arms with flexion
of elbows, wrists, and fingers
Detailed Rationale: Decorticate posturing (flexor response) involves stiff
extension of the legs, internal rotation of the arms, and flexion of the
elbows, wrists, and fingers. It indicates damage to the corticospinal
tract and cerebral hemispheres. Decerebrate posturing involves rigid
extension of all four limbs and indicates severe brainstem injury.
Question 6
A nurse is caring for a client with Parkinson's disease who is prescribed
levodopa-carbidopa. What is the primary therapeutic rationale for
combining carbidopa with levodopa?
• A. Carbidopa prevents the peripheral breakdown of levodopa,
allowing more drug to cross the blood-brain barrier into the brain.
• B. Carbidopa destroys dopamine receptors in the basal ganglia.
• C. Carbidopa acts as a powerful tranquilizer to prevent
dyskinesias.
• D. Carbidopa enhances renal excretion of dopamine metabolites.
Correct Answer: A. Carbidopa prevents the peripheral breakdown of
levodopa, allowing more drug to cross the blood-brain barrier into the
brain.
Detailed Rationale: Levodopa is converted to dopamine in peripheral
tissues by the enzyme dopa decarboxylase before reaching the brain.
Answers & Detailed Explanations
Question 1
A nurse is caring for a client who sustained a severe basal skull fracture.
Which clinical assessment finding should the nurse immediately report
to the physician as an indication of cerebrospinal fluid (CSF) leakage?
• A. Purulent, foul-smelling drainage from the external auditory
canal
• B. Clear or pink-tinged fluid draining from the nose that tests
positive for glucose
• C. Bilateral periorbital ecchymosis without visual disturbances
• D. Epistaxis secondary to dry nasal mucous membranes
Correct Answer: B. Clear or pink-tinged fluid draining from the nose
that tests positive for glucose
Detailed Rationale: CSF rhinorrhea or otorrhea occurs when a skull
fracture tears the dura mater. CSF contains high levels of glucose,
whereas normal nasal secretions do not. If blood is mixed with the fluid,
the "target sign" or "halo sign" (a yellowish ring surrounding a blood
stain on gauze) can help identify CSF leakage.
Question 2
A client is admitted to the emergency department following a motor
vehicle collision with a suspected spinal cord injury at the level of C4.
Which assessment finding requires the nurse's most immediate life-
saving intervention?
, • A. Absence of deep tendon reflexes in the lower extremities
• B. Spontaneous diaphragmatic paralysis and respiratory arrest
• C. Warm, flushed, dry extremities with hypotension
• D. Inability to move the lower fingers and thumb
Correct Answer: B. Spontaneous diaphragmatic paralysis and
respiratory arrest
Detailed Rationale: The phrenic nerve originates from spinal nerves C3
through C5, which innervates the diaphragm. A high cervical injury at or
above C4 results in paralysis of the diaphragm and immediate
respiratory arrest, making airway management and mechanical
ventilation the absolute highest priority.
Question 3
A client with increased intracranial pressure (ICP) is receiving
mechanical ventilation. Which arterial blood gas (ABG) target should
the nurse collaborate with the respiratory therapist to maintain?
• A. Mild hypercapnia (PaCO2 = 50--55 mmHg)
• B. Mild hypocapnia (PaCO2 = 30--35 mmHg)
• C. Severe metabolic alkalosis (pH = 7.55)
• D. Normal carbon dioxide levels (PaCO2 = 40 mmHg)
Correct Answer: B. Mild hypocapnia (PaCO2 = 30--35 mmHg)
Detailed Rationale: Carbon dioxide is a potent cerebral vasodilator.
Maintaining a mild hypocapnia (PaCO2 = 30--35 mmHg) via short-term
hyperventilation causes cerebral vasoconstriction, reducing cerebral
,blood volume and rapidly lowering intracranial pressure. Prolonged
hyperventilation is avoided to prevent cerebral ischemia.
Question 4
A nurse is caring for an unconscious client with a traumatic brain injury
and an intracranial pressure (ICP) monitor. The client's mean arterial
pressure (MAP) is 90 mmHgand the ICP is 20 mmHg. What is the
client's cerebral perfusion pressure (CPP), and is it within the normal
therapeutic range?
• A. CPP = 70 mmHg; Normal (Adequate)
• B. CPP = 110 mmHg; Abnormally high
• C. CPP = 50 mmHg; Abnormally low
• D. CPP = 70 mmHg; Abnormally low
Correct Answer: A. CPP = 70 mmHg; Normal (Adequate)
Detailed Rationale: Cerebral Perfusion Pressure is calculated as CPP =
MAP − ICP. With MAP = 90and ICP = 20, CPP = 90 − 20 =
70 mmHg. The normal therapeutic target for CPP is 60--100 mmHg,
making 70 mmHgan adequate perfusion pressure.
Question 5
A client is admitted to the neuro-intensive care unit following a stroke.
The nurse notes the client exhibits decorticate posturing when
stimulated. How should the nurse characterize this posturing?
• A. Extension of upper and lower extremities with plantar flexion
• B. Internal rotation and adduction of arms with flexion of elbows,
wrists, and fingers
, • C. Flaccid paralysis of all four extremities with absent reflexes
• D. Arching of the back with rigid hyperextension of the neck
Correct Answer: B. Internal rotation and adduction of arms with flexion
of elbows, wrists, and fingers
Detailed Rationale: Decorticate posturing (flexor response) involves stiff
extension of the legs, internal rotation of the arms, and flexion of the
elbows, wrists, and fingers. It indicates damage to the corticospinal
tract and cerebral hemispheres. Decerebrate posturing involves rigid
extension of all four limbs and indicates severe brainstem injury.
Question 6
A nurse is caring for a client with Parkinson's disease who is prescribed
levodopa-carbidopa. What is the primary therapeutic rationale for
combining carbidopa with levodopa?
• A. Carbidopa prevents the peripheral breakdown of levodopa,
allowing more drug to cross the blood-brain barrier into the brain.
• B. Carbidopa destroys dopamine receptors in the basal ganglia.
• C. Carbidopa acts as a powerful tranquilizer to prevent
dyskinesias.
• D. Carbidopa enhances renal excretion of dopamine metabolites.
Correct Answer: A. Carbidopa prevents the peripheral breakdown of
levodopa, allowing more drug to cross the blood-brain barrier into the
brain.
Detailed Rationale: Levodopa is converted to dopamine in peripheral
tissues by the enzyme dopa decarboxylase before reaching the brain.
