NURSING PATHOPHYSIOLOGY EXAM #6C: ALTERATIONS IN NEUROLOGICAL
FUNCTION (2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT
ANSWERS
Advanced Pathophysiology Examination: Comprehensive Focus on Central & Peripheral Nervous
Systems | Core Domains: Cerebrovascular Disorders, TBI, Intracranial Hypertension,
Neurodegenerative Diseases, Seizure Disorders, CNS Infections, and Demyelinating Diseases |
Graduate-Level Nursing Focus | Case Study & Clinical Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 65-question assessment that includes complex, unfolding case
studies (e.g., stroke evolution, meningitis with increased ICP) to evaluate synthesis of concepts like
cellular vulnerability, vascular dynamics, and network dysfunction in explaining diverse neurological
presentations.
Answer Format
All correct answers must be presented in bold and green, followed by comprehensive rationales that
link the primary pathophysiological insult to the regional brain injury and the resulting constellation of
cognitive, motor, and sensory deficits presented in the case studies and questions.
Questions (65 Total)
1.
A patient involved in a high-speed motor vehicle collision is unconscious with decerebrate posturing.
What type of injury is most likely?
A. Concussion
B. Diffuse axonal injury (DAI)
C. Epidural hematoma
D. Subdural hematoma
DAI results from rotational acceleration-deceleration forces shearing white matter tracts. It causes
immediate unconsciousness and poor prognosis due to widespread disruption of neural networks.
2.
A patient with a brain tumor develops unilateral pupil dilation and contralateral hemiparesis.
,What herniation syndrome is occurring?
A. Central transtentorial
B. Uncal (transtentorial)
C. Cingulate
D. Tonsillar
Uncal herniation occurs when the uncus of the temporal lobe compresses the ipsilateral oculomotor
nerve (CN III), causing pupillary dilation, and the contralateral cerebral peduncle, causing hemiparesis
(Kernohan’s notch phenomenon).
3.
An elderly patient has progressive memory loss, disorientation, and difficulty with language. Autopsy
shows amyloid plaques and neurofibrillary tangles.
What is the diagnosis?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Huntington’s disease
D. Amyotrophic lateral sclerosis
Alzheimer’s involves extracellular amyloid-beta plaques and intracellular neurofibrillary tangles
(hyperphosphorylated tau), leading to synaptic loss, neuronal death, and progressive cognitive
decline—starting with memory impairment.
4.
A patient experiences a 5-minute generalized tonic-clonic seizure followed by postictal confusion.
What is the priority nursing action?
A. Restrain the patient
B. Place in recovery position and monitor airway
C. Administer IV glucose
, D. Perform EEG immediately
Postictal care focuses on airway protection. Place in side-lying (recovery) position to prevent
aspiration. Do not restrain during seizure. Glucose is given only if hypoglycemia is suspected.
5.
A college student presents with fever, headache, neck stiffness, and photophobia. CSF shows neutrophilia,
low glucose, and elevated protein.
What is the most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Encephalitis
D. Brain abscess
Bacterial meningitis causes neutrophil-predominant pleocytosis, hypoglycorrhachia (due to bacterial
glucose consumption), and elevated protein from blood-brain barrier disruption.
6.
A young woman reports blurred vision in one eye, followed weeks later by numbness and weakness in her
legs. MRI shows periventricular white matter lesions.
What condition is suspected?
A. Myasthenia gravis
B. Multiple sclerosis
C. Guillain-Barré syndrome
D. ALS
Multiple sclerosis is a T-cell-mediated autoimmune disorder targeting CNS myelin (oligodendrocytes),
causing demyelination, slowed conduction, and symptoms like optic neuritis, ataxia, and bladder
dysfunction.
7.
A patient presents with right-sided facial droop, left arm weakness, and aphasia.
FUNCTION (2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT
ANSWERS
Advanced Pathophysiology Examination: Comprehensive Focus on Central & Peripheral Nervous
Systems | Core Domains: Cerebrovascular Disorders, TBI, Intracranial Hypertension,
Neurodegenerative Diseases, Seizure Disorders, CNS Infections, and Demyelinating Diseases |
Graduate-Level Nursing Focus | Case Study & Clinical Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 65-question assessment that includes complex, unfolding case
studies (e.g., stroke evolution, meningitis with increased ICP) to evaluate synthesis of concepts like
cellular vulnerability, vascular dynamics, and network dysfunction in explaining diverse neurological
presentations.
Answer Format
All correct answers must be presented in bold and green, followed by comprehensive rationales that
link the primary pathophysiological insult to the regional brain injury and the resulting constellation of
cognitive, motor, and sensory deficits presented in the case studies and questions.
Questions (65 Total)
1.
A patient involved in a high-speed motor vehicle collision is unconscious with decerebrate posturing.
What type of injury is most likely?
A. Concussion
B. Diffuse axonal injury (DAI)
C. Epidural hematoma
D. Subdural hematoma
DAI results from rotational acceleration-deceleration forces shearing white matter tracts. It causes
immediate unconsciousness and poor prognosis due to widespread disruption of neural networks.
2.
A patient with a brain tumor develops unilateral pupil dilation and contralateral hemiparesis.
,What herniation syndrome is occurring?
A. Central transtentorial
B. Uncal (transtentorial)
C. Cingulate
D. Tonsillar
Uncal herniation occurs when the uncus of the temporal lobe compresses the ipsilateral oculomotor
nerve (CN III), causing pupillary dilation, and the contralateral cerebral peduncle, causing hemiparesis
(Kernohan’s notch phenomenon).
3.
An elderly patient has progressive memory loss, disorientation, and difficulty with language. Autopsy
shows amyloid plaques and neurofibrillary tangles.
What is the diagnosis?
A. Parkinson’s disease
B. Alzheimer’s disease
C. Huntington’s disease
D. Amyotrophic lateral sclerosis
Alzheimer’s involves extracellular amyloid-beta plaques and intracellular neurofibrillary tangles
(hyperphosphorylated tau), leading to synaptic loss, neuronal death, and progressive cognitive
decline—starting with memory impairment.
4.
A patient experiences a 5-minute generalized tonic-clonic seizure followed by postictal confusion.
What is the priority nursing action?
A. Restrain the patient
B. Place in recovery position and monitor airway
C. Administer IV glucose
, D. Perform EEG immediately
Postictal care focuses on airway protection. Place in side-lying (recovery) position to prevent
aspiration. Do not restrain during seizure. Glucose is given only if hypoglycemia is suspected.
5.
A college student presents with fever, headache, neck stiffness, and photophobia. CSF shows neutrophilia,
low glucose, and elevated protein.
What is the most likely diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Encephalitis
D. Brain abscess
Bacterial meningitis causes neutrophil-predominant pleocytosis, hypoglycorrhachia (due to bacterial
glucose consumption), and elevated protein from blood-brain barrier disruption.
6.
A young woman reports blurred vision in one eye, followed weeks later by numbness and weakness in her
legs. MRI shows periventricular white matter lesions.
What condition is suspected?
A. Myasthenia gravis
B. Multiple sclerosis
C. Guillain-Barré syndrome
D. ALS
Multiple sclerosis is a T-cell-mediated autoimmune disorder targeting CNS myelin (oligodendrocytes),
causing demyelination, slowed conduction, and symptoms like optic neuritis, ataxia, and bladder
dysfunction.
7.
A patient presents with right-sided facial droop, left arm weakness, and aphasia.
