NSG 430 Exam 3 Topic 9: (Latest 2026/2027 Update) Intracranial
Pressure, Head Trauma, Meningitis, Encephalitis, Spinal Cord Injury, ALS,
Guillain-Barré Syndrome | Q&A | Grade A | 100% Correct (Verified
Answers) – Nursing Program
Subject: Neurological Disorders – ICP Management, Head Trauma, Brain Tumors, Meningitis/Encephalitis, Spinal
Cord Injury, Autonomic Dysreflexia, Guillain-Barré Syndrome, ALS
Source: NSG 430 Exam 3 Topic 9 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
Total Questions: 130 (All processed – no omissions, no truncation)
1: What is a normal intracranial pressure (ICP)?
Correct Answer: 5 to 15 mm Hg
1. Normal ICP in adults is 5-15 mmHg supine.
2. Sustained ICP >20 mmHg requires intervention to prevent brain damage.
2: What factors influence intracranial pressure (ICP)?
Correct Answer: Arterial pressure, Venous pressure, Intraabdominal and intrathoracic pressure,
Posture, Temperature, Blood gases (CO2 levels)
1. Increased PaCO2 causes cerebral vasodilation, increasing ICP.
2. Fever increases cerebral metabolic rate and blood flow.
3: What is a normal cerebral perfusion pressure (CPP)?
Correct Answer: 60 to 100 mmHg
1. CPP = MAP - ICP; target is ≥60 mmHg for adequate brain perfusion.
2. CPP <50 mmHg causes ischemia; <30 mmHg incompatible with life.
4: What are decreased levels of cerebral blood flow associated with?
Correct Answer: Less than 50 = Ischemia and neuronal death; Less than 30 = incompatible with
life
1. CPP <50 causes ischemic penumbra; <30 causes irreversible neuronal death.
2. Maintain CPP >60 in brain-injured patients.
5: What are manifestations of increased ICP?
Correct Answer: Change in level of consciousness (ALOC) from flattening of affect to coma;
Cushing triad: Systolic hypertension with widened pulse pressure, bradycardia, irregular
respirations; Change in body temp
1. Cushing triad is a late sign of herniation.
2. ALOC is the earliest and most sensitive indicator of increased ICP.
,6: What may we see in cranial nerve 3 (oculomotor) with increased ICP?
Correct Answer: Fixed, dilated pupil, unilateral is considered neurological emergency (brain
herniation)
1. CN III compression causes ipsilateral fixed, dilated pupil.
2. Uncal herniation is a life-threatening emergency requiring immediate intervention.
7: What is central herniation?
Correct Answer: Sluggish but equal pupil response
1. Central herniation compresses brainstem symmetrically.
2. Pupils remain equal but become sluggish.
8: What is uncal herniation?
Correct Answer: Dilated unilateral pupil
1. Uncus herniates over tentorium, compressing CN III ipsilaterally.
2. Life-threatening emergency requiring hyperventilation and mannitol.
9: What is papilledema?
Correct Answer: Edematous optic disc on retinal exam
1. Caused by increased ICP transmitted through optic nerve sheath.
2. Indicates chronic or severe intracranial hypertension.
10: What is decorticate posturing (flexor)?
Correct Answer: Draws arms towards core
1. Decorticate: arms flexed, legs extended; indicates damage above red nucleus.
2. Less severe than decerebrate posturing.
11: What is decerebrate posturing (extensor)?
Correct Answer: Extend limbs away from body and maybe even arch; Indicates more serious
damage
1. Decerebrate: arms and legs extended, arching of back.
2. Indicates brainstem (midbrain) damage, worse prognosis.
12: What are clinical manifestations of increased ICP?
Correct Answer: Headache is continuous, but worse in the morning; Vomiting is projectile
1. Early morning headache from recumbent position increasing ICP overnight.
2. Projectile vomiting without nausea is characteristic.
13: What is a contraindication for increased pressure in the brain?
Correct Answer: Lumbar puncture
1. LP in presence of increased ICP can cause brain herniation.
2. CT scan before LP if mass lesion suspected.
, 14: What is the gold standard for monitoring ICP?
Correct Answer: Ventriculostomy, because it directly measures the pressure in the ventricles;
facilitates removal/sampling of CSF; allows for intracranial drug administration; Prevents infection
1. External ventricular drain (EVD) is gold standard.
2. Allows CSF drainage to lower ICP.
15: What is the nutritional therapy for patients with increased ICP?
Correct Answer: Hypermetabolic and hypercatabolic state increase need for glucose; Early
feeding (meet caloric needs by at least 5 days after injury); Keep patient euvolemic
1. Brain injury increases metabolic demands.
2. Early enteral feeding improves outcomes.
16: When mannitol is given to ICP patients, what should we monitor?
Correct Answer: Monitor fluid and electrolyte status
1. Mannitol is an osmotic diuretic; monitor for dehydration and electrolyte imbalances.
2. Check serum osmolality; hold if >320 mOsm/L.
17: What do we monitor when a patient is taking hypertonic saline solutions?
Correct Answer: Monitor BP and serum sodium
1. Hypertonic saline increases serum sodium to reduce cerebral edema.
2. Monitor for hypernatremia and fluid overload.
18: What do we monitor when an ICP patient is taking corticosteroids (Decadron)?
Correct Answer: Monitor fluid intake, serum sodium, and glucose levels; Concurrent antacids,
H2 receptor blockers, and proton pump inhibitors
1. Corticosteroids cause hyperglycemia, fluid retention, and GI bleeding risk.
2. Used primarily for vasogenic edema from tumors, not traumatic brain injury.
19: What do we use to assess the level of consciousness for ICP?
Correct Answer: Glasgow Coma Scale; Cranial nerves; Motor strength (raise foot off bed,
pronator drift test, squeeze hands); Motor response (spontaneous or to pain); Vital signs
1. GCS is the standard for LOC assessment.
2. Deterioration of 2 or more points is significant.
20: What are some actions we can take to care for ICP patients' respiratory function?
Correct Answer: Maintain patent airway; Elevate HOB 30 degrees; Suction as needed (preferably
not because it may increase pressure); Prevent abdominal distention; Monitor ABGs; Maintain
effective ventilation
1. Avoid suctioning if possible; if needed, pre-oxygenate and limit to 10 seconds.
2. HOB 30° promotes venous drainage.
21: What are some actions we can take to care for ICP patients' pain and anxiety?
Correct Answer: Opioids; Propofol; Dexmedetomidine; Benzodiazepines; Nondepolarizing
neuromuscular blocking agent
1. Sedation reduces ICP by decreasing metabolic demand.
2. NMBAs used for refractory ICP elevation with sedation.
Pressure, Head Trauma, Meningitis, Encephalitis, Spinal Cord Injury, ALS,
Guillain-Barré Syndrome | Q&A | Grade A | 100% Correct (Verified
Answers) – Nursing Program
Subject: Neurological Disorders – ICP Management, Head Trauma, Brain Tumors, Meningitis/Encephalitis, Spinal
Cord Injury, Autonomic Dysreflexia, Guillain-Barré Syndrome, ALS
Source: NSG 430 Exam 3 Topic 9 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
Total Questions: 130 (All processed – no omissions, no truncation)
1: What is a normal intracranial pressure (ICP)?
Correct Answer: 5 to 15 mm Hg
1. Normal ICP in adults is 5-15 mmHg supine.
2. Sustained ICP >20 mmHg requires intervention to prevent brain damage.
2: What factors influence intracranial pressure (ICP)?
Correct Answer: Arterial pressure, Venous pressure, Intraabdominal and intrathoracic pressure,
Posture, Temperature, Blood gases (CO2 levels)
1. Increased PaCO2 causes cerebral vasodilation, increasing ICP.
2. Fever increases cerebral metabolic rate and blood flow.
3: What is a normal cerebral perfusion pressure (CPP)?
Correct Answer: 60 to 100 mmHg
1. CPP = MAP - ICP; target is ≥60 mmHg for adequate brain perfusion.
2. CPP <50 mmHg causes ischemia; <30 mmHg incompatible with life.
4: What are decreased levels of cerebral blood flow associated with?
Correct Answer: Less than 50 = Ischemia and neuronal death; Less than 30 = incompatible with
life
1. CPP <50 causes ischemic penumbra; <30 causes irreversible neuronal death.
2. Maintain CPP >60 in brain-injured patients.
5: What are manifestations of increased ICP?
Correct Answer: Change in level of consciousness (ALOC) from flattening of affect to coma;
Cushing triad: Systolic hypertension with widened pulse pressure, bradycardia, irregular
respirations; Change in body temp
1. Cushing triad is a late sign of herniation.
2. ALOC is the earliest and most sensitive indicator of increased ICP.
,6: What may we see in cranial nerve 3 (oculomotor) with increased ICP?
Correct Answer: Fixed, dilated pupil, unilateral is considered neurological emergency (brain
herniation)
1. CN III compression causes ipsilateral fixed, dilated pupil.
2. Uncal herniation is a life-threatening emergency requiring immediate intervention.
7: What is central herniation?
Correct Answer: Sluggish but equal pupil response
1. Central herniation compresses brainstem symmetrically.
2. Pupils remain equal but become sluggish.
8: What is uncal herniation?
Correct Answer: Dilated unilateral pupil
1. Uncus herniates over tentorium, compressing CN III ipsilaterally.
2. Life-threatening emergency requiring hyperventilation and mannitol.
9: What is papilledema?
Correct Answer: Edematous optic disc on retinal exam
1. Caused by increased ICP transmitted through optic nerve sheath.
2. Indicates chronic or severe intracranial hypertension.
10: What is decorticate posturing (flexor)?
Correct Answer: Draws arms towards core
1. Decorticate: arms flexed, legs extended; indicates damage above red nucleus.
2. Less severe than decerebrate posturing.
11: What is decerebrate posturing (extensor)?
Correct Answer: Extend limbs away from body and maybe even arch; Indicates more serious
damage
1. Decerebrate: arms and legs extended, arching of back.
2. Indicates brainstem (midbrain) damage, worse prognosis.
12: What are clinical manifestations of increased ICP?
Correct Answer: Headache is continuous, but worse in the morning; Vomiting is projectile
1. Early morning headache from recumbent position increasing ICP overnight.
2. Projectile vomiting without nausea is characteristic.
13: What is a contraindication for increased pressure in the brain?
Correct Answer: Lumbar puncture
1. LP in presence of increased ICP can cause brain herniation.
2. CT scan before LP if mass lesion suspected.
, 14: What is the gold standard for monitoring ICP?
Correct Answer: Ventriculostomy, because it directly measures the pressure in the ventricles;
facilitates removal/sampling of CSF; allows for intracranial drug administration; Prevents infection
1. External ventricular drain (EVD) is gold standard.
2. Allows CSF drainage to lower ICP.
15: What is the nutritional therapy for patients with increased ICP?
Correct Answer: Hypermetabolic and hypercatabolic state increase need for glucose; Early
feeding (meet caloric needs by at least 5 days after injury); Keep patient euvolemic
1. Brain injury increases metabolic demands.
2. Early enteral feeding improves outcomes.
16: When mannitol is given to ICP patients, what should we monitor?
Correct Answer: Monitor fluid and electrolyte status
1. Mannitol is an osmotic diuretic; monitor for dehydration and electrolyte imbalances.
2. Check serum osmolality; hold if >320 mOsm/L.
17: What do we monitor when a patient is taking hypertonic saline solutions?
Correct Answer: Monitor BP and serum sodium
1. Hypertonic saline increases serum sodium to reduce cerebral edema.
2. Monitor for hypernatremia and fluid overload.
18: What do we monitor when an ICP patient is taking corticosteroids (Decadron)?
Correct Answer: Monitor fluid intake, serum sodium, and glucose levels; Concurrent antacids,
H2 receptor blockers, and proton pump inhibitors
1. Corticosteroids cause hyperglycemia, fluid retention, and GI bleeding risk.
2. Used primarily for vasogenic edema from tumors, not traumatic brain injury.
19: What do we use to assess the level of consciousness for ICP?
Correct Answer: Glasgow Coma Scale; Cranial nerves; Motor strength (raise foot off bed,
pronator drift test, squeeze hands); Motor response (spontaneous or to pain); Vital signs
1. GCS is the standard for LOC assessment.
2. Deterioration of 2 or more points is significant.
20: What are some actions we can take to care for ICP patients' respiratory function?
Correct Answer: Maintain patent airway; Elevate HOB 30 degrees; Suction as needed (preferably
not because it may increase pressure); Prevent abdominal distention; Monitor ABGs; Maintain
effective ventilation
1. Avoid suctioning if possible; if needed, pre-oxygenate and limit to 10 seconds.
2. HOB 30° promotes venous drainage.
21: What are some actions we can take to care for ICP patients' pain and anxiety?
Correct Answer: Opioids; Propofol; Dexmedetomidine; Benzodiazepines; Nondepolarizing
neuromuscular blocking agent
1. Sedation reduces ICP by decreasing metabolic demand.
2. NMBAs used for refractory ICP elevation with sedation.
