NSG3280/ NSG 3280 Exam 3 (2026/ 2027 Edition) Pathophysiology for Nurses I Review | Qs & As| Grade A| 100% Correct (Verified Solutions)- Galen

NSG3280/ NSG 3280 Exam 3 (2026/ 2027 Edition) Pathophysiology for Nurses I Review | Qs & As| Grade A| 100% Correct (Verified Solutions)- Galen Q. The brain needs which of the two to survive? ANSWER Oxygen & Glucose 3 multiple choice options Q. ______________________ is a secondary injury to ischemia that can result in free radicals, inflammation and more ischemia. ANSWER Reperfusion injury 3 multiple choice options Q. What neurotransmitter is responsible for most brain function and results in an influx of calcium? ANSWER Glutamate 3 multiple choice options Q. __________ often kills cells. ANSWER Free radicals 3 multiple choice options Q. Ischemia causes what to occur in the brain within minutes. ANSWER Necrosis 3 multiple choice options Q. The patient presents with headache, nausea, vomiting, blurry vision, and altered LOC the nurse would suspect ______________. ANSWER increased ICP. 3 multiple choice options Q. Reperfusion injuries result when oxygen returns to a new area of necrosis and binds to other stuff, making free radicals. ANSWER True 1 multiple choice option Q. Which of the following is NOT a concern with reperufsion injury? ANSWER Increased ICP 3 multiple choice options Q. _____________________ describes a phenomenon where when one intracranial component changes the others compensate? ANSWER Monro-Kellie doctorine 3 multiple choice options Q. What is the final stage of increased ICP? ANSWER Brain compression/herniation Q. What increases the risk of midline shift with increased ICP? ANSWER Unilateral swelling Q. What type of TBI happens when the brain shifts duiring acceleration-deceleration movement? ANSWER Polar injury (coup-contracoup) Q. Shaken baby syndrome is an example of ________ TBIs. ANSWER Diffuse injuries Q. Severing of ________________ can result in an irreversible comatose state. ANSWER Axon Q. _______________ hematoma happens between the skull and the dura. ANSWER Epidural Q. Ischemic stroke happens from occlusion by thrombus or embolism. ANSWER True 1 multiple choice option Q. The area of brain surrounding the ischemia that urgently needs to be treated to be spared is the _______________________. ANSWER Pneumbra Q. ______________ aphasia happens from damage to Broca's area. ANSWER Expressive 3 multiple choice options Q. __________________ occurs because of a lack of a capillary bed. ANSWER AVM Q. After how many minutes does a seizure become a medical emergency? ANSWER 5 Q. What is the name for the period before a seizure? ANSWER Prodrome 3 multiple choice options Q. During the ______________________ state patients may become agressive. ANSWER postichtal Q. Atonic seizures can be identified explicitly due to the loss of ______________________. ANSWER muscle tone Q. A seizure presenting with an aura are called: ANSWER tonic-clonic 3 multiple choice options Q. The disease results in a deficiency of dopamine: ANSWER Parkingson's Q. Inflammation of CN # _____ causes Bell's Palsy. ANSWER VII 3 multiple choice options Q. Which cranial nerve is responsible for pupillary response? ANSWER II 3 multiple choice options Q. Loss of consciousness is dependent on function of: ANSWER RAS Q. What position involves the arm and leg flexion with external rotation of the wrists which is a GCS score of 2. ANSWER Decerebrate 3 multiple choice options Q. The presentation of Doll's eyes response indicates brain stem damage. ANSWER True 1 multiple choice option Q. What type of hemorrhage happens between the outer arachnoid membrane and the pia mater? ANSWER Subarachnoid Q. tPA must be given within how many hours to be effective for ischemic stroke? ANSWER 3 3 multiple choice options Q. Where does the battle sign bruise present? ANSWER Under the ears 3 multiple choice options Q. A TIA resolves in ____________ hours. ANSWER 24 3 multiple choice options Q. What type of hearing loss happens when sound cannot reach the cochlea? ANSWER Conductive hearing loss Q. What part of the ear is responsible for transmitting sound energy from air to fluids? ANSWER Middle Ear 3 multiple choice options Q. Otosclerosis is a sensorineural hearing impairment. ANSWER False 1 multiple choice option Q. _____________________ occurs when the inner ear is unable to regulate normal systems including production, maintenance, and recycling ANSWER Meniere's Disease 1 multiple choice option Q. __________________ is a localized inflammatory disease of the endochondral bone and otic capsule. ANSWER Otosclerosis 3 multiple choice options In the eye, formation of the image occurs on the ________________. Retina 3 multiple choice options If the eye is elongated, the image will focus __________ the retina. in the front If the eye is shorter than normal, the image focuses behind the retina, this is called what? hyperopia What disease is also referred to as cross-eyed? strabismus 3 multiple choice options ________________ is caused by an increase in intraocular pressure. glaucoma 3 multiple choice options Dry macular degeneration is the most common type? True 1 multiple choice option Decreased sense of smell has been identified as an early indicator in ___________. Alzheimer's 3 multiple choice options Ligaments connect: bone to bone 3 multiple choice options Tendons connect: bone to muscle 3 multiple choice options What is a complete disruption of the ligament with instability? Grade 3 3 multiple choice options _______________ is a connective tissue of the body that envelopes muscles. Fasciae What type of fracture on a child would cause concerns about abuse? Spiral What type of fracture consists of more than one fracture line and more than two bone fragments? Comminuted 3 multiple choice options Nonunion occurs when a fracture has not healed after how many months? 6 3 multiple choice options What bone would be a high risk for fat embolism? Pelvis Scoliosis is curvature of the spine by ________________ degrees or more from the normal vertical line. 10 3 multiple choice options ________________ occurs when the rate of bone resorption is greater than bone remodling. Osteoporosis 3 multiple choice options This disease causes bone deformity most often in the sacrum/spine, femur, skull, and pelvis. Paget's Disease 3 multiple choice options This type of bone tumor is malignant and forms in the metaphyseal region of long bones. Osteosarcoma 3 multiple choice options Which one is a benign tumor? Osteochondroma 3 multiple choice options What is the most common form of muscular dystrophy? Duchenne 3 multiple choice options With Duchenne Muscular Dystrophy, how old do most patients live to be? Late 20's - early 30's 3 multiple choice options _____________ is a noninflammatory progressive loss of articular cartilage. Osteoarthritis 3 multiple choice options Heberden nodes are distal True 1 multiple choice option What is caused by borrelia burgdorferi. Lyme Disease 3 multiple choice options The excess of uric acid causes: gout 3 multiple choice options Charcot joint is also known as neuropathic osteoarthroplasty 3 multiple choice options The worst posturing position is: decerebrate 3 multiple choice options The most abundant leukocyte? neutrophils 3 multiple choice options This leukocyte is not active until it enters a tissue and converts into another form? monocyte 3 multiple choice options A cytotoxic kill T-cell of the adaptive immune stem is this type of cell. lymphocyte 3 multiple choice options primary injury initial damage to the brain that results from the traumatic event not reversible secondary injury an insult to the brain subsequent to the original traumatic event progressive with delayed cell death The more time that the injury effects the brain the more tissue that is affected/gone (Time is tissue) The three types of mechanisms of brain injury ischemia, hypoxia, increased ICP The three compartments of the cranium include: Brain tissue, CSF, and blood The normal range of ICP is 0-15mm Hg If one of the compartments in the cranium increases, what happen to the other two parts? they decrease If all three of the compartments of the cranium while one of the compartments is increased, what can happen? Possible brain herniation What could happen if there is a sudden decrease in CSF fluid? Brain herniation If the patient has increased ICP, should you do a lumbar puncture? Hell no delirious in an acutely disturbed state of mind resulting from illness or intoxication and characterized by restlessness, illusions, and incoherence of thought and speech. Obtunded Less than full alertness (altered level of consciousness), typically as a result of a medical condition or trauma. Falls asleep unless stimulated Stuporous Deep states of sleep: vigorous stimulation is required but pt cannot stay awake comatose Unable to be aroused, even with vigorous painful stimuli; motor responses,such as withdrawal or posturing, may occur Decorticate posturing Contractures toward their core Decerebrate posturing posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe. dysconjugate gaze paralysis of gaze or lack of coordination between the movements of the two eyes ocular palsies One or more cranial nerves dysfunctional such that motor paralysis of the eye impairs movements in one or more directions Doll's eye reflex when you move the head, the eyes should move, then return to a central position; in some brain injuries, the eyes will be fixed centrally cold calorics test tests for brain stem function with cold water. Eyes should divert to side where cold water is being put on coup injury brain injury at the site of impact contracoup injury brain injury on the opposite side of impact GCS is taken first________ hours after a TBI 48 The primary injury after a TBI is a hematoma: epidural Subdural Subarachnoid WHICH CAN CAUSE INCREASE OF ICP Collection of blood between the dura and skull LOC can be normal and then rapidly decreases epidural hematoma Collection of blood between the dura and outer layer of arachnoid membrane: typically involves bridging veins Slower onset / prone to rebreeding Subdural hematoma Collection of blood between the arachnoid membrane and the Pia mater Meningeal irritation Subarachnoid hematoma CSF should have high amounts of glucose If there is a blockage of CSF to the brain, swelling could occur Stroke Sequelae Effects on body after the stroke Thrombolitic strokes comes from atherosclerosis / coagulopathies Embolitic stroke associated with cardiac dysfunction/ dysrhythmias (A-fib) Transient Ischemic Attack (TIA) Minor stroke; where neurological function is regained quickly with time fully resolves within 24 hours Hemorrhage within the brain parenchyma secondary to severe, chronic hypertension hemorrhagic stroke Loss of visual field on paralyzed side contributes to "neglect" Hemiattention Poor articulation and sparse vocabulary with simple sentences Brocas aphasia Impaired auditory comprehension, speech fluent but doesn't make sense Wernickes aphasia Lesion of an artery that results in dilation and ballooning of a segment of the vessel Cerebral aneurysm HTN, acute alcohol intoxication, and cocaine use are risk factors for aneurysms Severe headache, photophobia, nausea, vomiting, and stiff neck are s/s of aneurysm arterivenous malformation a tangle of abnormal blood vessels connecting arteries and veins without an intervening capillary bed Manifestations of acute brain ischemia (Chushings disease) is primarily due to __________ sympathetic nervous system activation Polar injuries in the brain often result in focal injury at both ends of the brain Secondary injury after head trauma refers to brain injury due to the body's response to tissue damage The stroke type with the highest morbidity rate is intracranial hemorrhage The most important preventative measure for hemorrhagic strokes is blood pressure control Cerebral aneurysms are more than likely the result of subarachnoid hemorrhages Vasogenic edema is usually secondary due to an increase of ___________ capillary pressure Intracellular edema is called _______. It results when the _________ because of cellular energy failure Decreased BP pH below 7.35 (acidosis) Cytotoxic edema tissues swell When there is an extreme increase of ICP, this can cause a ____________ reaction called ___________ sympathetic Cushing reflex An early sign of brain injury is _______ which then can turn to a late sign, which causes ________ Sluggish pupil dilation pupil dilation unequal size of pupils anisocoria Most hemorrhagic strokes occur in the ____________ or ___________ basal ganglia thalamus Patient with ______ hemispheric damage have issues receiving the relationship of two or more objects in spacial areas right Consists of poor articulation and sparse vocabulary Brocas Aphasia Characterized by impaired auditory comprehension and speech that is fluent but does not make sense Wernickes aphasia Risk factors for aneurysms Marfan Syndrome, Lupus, and bacterial endocarditis Basilar skull fracture is likely associated with CSF leaking in ears or nose encephalitis inflammation of the brain usually caused by a virus When prescribing therapy for an acute stoke, it is important to determine is it is a ischemic or hemorrhagic stroke A severe complication of elevated ICP is brain herniation The first indication of brain compression from increasing ICP may be sluggish pupil response to light The primary reason that prolonged seizure activity predisposed to ischemic brain damage is that the lack of airway maintenance can lead to hypoxia The dementia of Alzheimer disease is associated with structural changes in the brain, including deposition of amyloid plaques in the brain. Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis because demyelination is mediated by immune mechanisms. Upper extremity weakness in association with degeneration of CNS neurons is characteristic of amyotrophic lateral sclerosis. Ascending paralysis with no loss of sensation is characteristic of Guillain-Barré syndrome. Autonomic dysreflexia is characterized by hypertension and bradycardia What does the brain do to compensate for ICP? -Vasco constrict -Decrease CSF -Decrease size of cells myoclonic seizure sudden jerk of the body or extremities Automatisms are repetitive and purposeless movements often anxiety-driven like nail biting or fidgeting could be staring tonic(Stiffening)-clonic(Convulsions) seizure generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups status epilepticus A condition in which seizures recur every few minutes or last more than 30 minutes. substantia nigra An area of the midbrain that is involved in motor control and contains a large concentration of dopamine-producing neurons Lewy bodies Clumps of proteins observed in the surviving dopaminergic neurons of Parkinson's patients Bells palsy comes from a _________ infection viral hyperacusis excessively sensitive hearing Patients with epilepsy, the neurons in their brain have become ________ and _______ to changes abnormally hyperactive hypersensitive _______ and _______ may be the cause of these electrical abnormalities oxidative stress free radical damage trigeminal neuralgia characterized by severe lightning-like pain due to an inflammation of the fifth cranial nerve nerve demyelination is also common in trigeminal neuralgia cortical regions frontal lobe, parietal lobe, temporal lobe, occipital lobe subcortical region the region located within the brain, beneath the cortical surface brainstem is responsible for automatic survival functions migrane headache a headache characterized by sudden onset and severe throbbing pain on one side of the head diffuse axonal traumatic brain injury Diffuse axonal injury (DAI) results from widespread shearing and rotational forces that produce damage throughout the brain—to axons in the cerebral hemispheres, corpus callosum, and brain stem CTs or MRIs can detect them Cushing reflex Severe hypertension, widening pulse pressure, bradycardia When the basilar skull fractures, what is likely to Leak? CSF What are signs of increased ICP? Bradycardia Hypertension resp depression fixed and dilated pupils vomiting papilloedema Damage to the III cranial nerve would show diplopia, ptosis, and paresis of eye adduction and of upward and downward gaze Where are most aneurysms in the brain? Circle of willis Hypotension will predispose you to ______ Ischemia Severe hypertension may lead to__________ and ___________ edema Vascular damage brain edema Ischemia and hypoxia in the brain will result in __________ which then cells will not be able to produce ________ Cell death ATP/mitochondrial failure Ischemia can be a _______ or _______ brain injury Primary secondary Is bells palsy temporary? Yes Common issues with vision in patient with parkinsons includes _______ and _______ double vision and dry eyes Meniere's disease otosclerosis and hearing loss; conductive hearing loss Otitis media is usually linked with _________ infections respiratory Occurs when sound cannot reach cochlea due to earwax impact action or foreign body. Conduction hearing impairment Hearing mechanism is disturbed in inner ear in cochlea or vestibulocochlear nerve to brain usually due to trauma Sensoineural hearing impairment Spongelike bony lesions form around ossicles of middle ear Stapedial fixation Otosclerosis ; conductive hearing impairment Caused by drug toxicity from drugs like aminoglycoside antibiotics, salicylates, quinine, and cytotoxic antineoplastics ; sensorineural hearing impairment Ototoxicity Graduate onset of bilateral difficult hearing of high pitched and conversational tones Idiopathic Presbycusis; sensorineural hearing impairment Ocular misalignment Failure to focus Age related Cross eyed Strabismus Poor visual acuity in absence of organic causes Lazy eye Amblyopia Deposits of cellular debris on retina Dry Macular degeneration Fluid accumulation behind retina Wet macular degeneration Spontaneous secondary to trauma floating spots and loss of vision Retinal detachment Weakness of eye vessels decreased flow of O2 blurred or disturbed vision Diabetic neuropathy Blocks outflow of aqueous humor brow pain headache Angle closure Idiopathic slow increase of IOP Gradual loss of vision halos over-production of aqueous humor Open-angle The prolonged exposure to loud noises. Could be occupational Permanent threshold shift If a patient has menieres disease and they preform a glycerol dehydration test, what will that do? It will temporarily improve hearing Main manifestations of menieres disease: Tinnitus Sensorineural hearing loss Vertigo Nystagmus Inert Soft Tissue Injuries tissue possesses no ability to contract or relax joint, ligament, bursae, fasciae, dura mater, nerve roots Contractile Soft Tissue Injuries structures involved in the contraction of muscle; injury to: muscle tendon bony insertion (enthesis) Joint Capsule Injuries injury causes increase in vascularity and development of fibrous tissue leads to a thick capsule Can cause "frozen joint" Internal joint derangement Tears of menisci or ligaments will result in instability of joint Cause restrictions of the joint and may lead to soft-tissue dysfunction in the form of weakness, loss of motion, or pain piece of joint that got torn off will become dislodged into somewhere not good Injuries to Fasciae and Bursae • Fasciae are connective tissues of the body arranged in sheaths that envelop muscles. - Trauma leads to edema and possible scarring. - Restriction in fascia movement causes joint restriction. • Bursae are pockets of connective tissue lined with synovium in locations between muscles or between muscle or tendon and bone. - If inflamed called bursitis; very painful Neropathic pain Pain resulting from damage to peripheral nerves or central nervous system numbness or tingling can be caused by acute trauma injury to tendon tendonitis infection repetitive motion blunt trauma An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities. can lead to compartment syndrome; the bleeding doesn't have anywhere to go, causing an increase of pressure in surrounding areas, constricting capillaries, muscles getting lack of oxygen Blood will coagulate/calcify in compartment area transverse fracture occurs straight across the bone spiral fracture a fracture in which the bone has been twisted apart longitudinal fracture a fracture that runs parallel to the long axis of the bone oblique fracture occurs at an angle across the bone 45 degree angle comminuted fracture fracture in which the bone is splintered or crushed impacted fracture broken bone ends are forced into each other greenstick fracture bending and incomplete break of a bone; most often seen in children stress fracture a small crack in the bone that often develops from chronic, excessive impact avulsion fracture fragment of bone chipped away from the main bone Some complication of fractures includes: Delayed healing, osteonecrosis, osteomyelitis, compartment syndrome, fat embolism syndrome, DVT, PE, neuromuscular injury Dislocation displacement of a bone from its joint subluxation partial dislocation nonstructural scoliosis resolves when the patient bends to the affected side poor posture inflammation structural scoliosis fixed deformity that does not correct with bending congenital scoliosis condition of birth with a lateral curvature of the spine Osteomyelitis pyogenic infection of the bone (pus) usually due to blood stream infection (CLABSI or IV) but can also be caused by trauma Spinal Tuberculosis (Pott's Disease) Lymphohematogenous or contiguous spread from primary lung lesion localized back pain immunosuppressed people immigrants afet 1991 Osteoporosis (metabolic bone disease) decreased bone density post menopausal women nutritional deficiencies anticonvulsants can cause bone density issues DM I Smoking alcohol consumption corticosteroids thyroid supplements Pagets disease excessive bone formation and breakdown weak and less structurally compact stiff joints Osteomalacia/rickets bones become softer because of a vitamin D deficiency bowing of bones muscles weakened nutritional deficiency Nonmalignant bone tumors osteochondroma (forms in growth plate/ cartilage areas) chondroma (cartilage forming) Osteoid osteoma (cortex of tibia or femur) Giant cell tumor (benign but aggressive) malignant bone tumors Osteosarcoma ( Chondrosarcoma (cartilage) (femur, increase in bone length) Ewing's sarcoma (medullary canals of bone) (fever, anemia, leukocytosis, increased ESR) Multiple myeloma (Bone marrow, neoplastic proliferation of plasma cells, anemia) Onset of Muscular Dystrophy 5-30 years old Types of muscular dystrophy Duchennes, Beckers, Facioscapulohumeral, myotonia Learning disabilities can coincide with muscular dystrophy -X-linked trait (only affects males) - muscle cells deficient in dystrophin (protein that allows fluid into muscle cells) - Calf muscles enlarged due to infiltration of fat cells and degeneration of muscle fibers - frequent falling by 5-6 years old - 12-14 years old will be confined to wheel chair -Heart failure and pulmonary infections Duchenne Muscular Dystrophy Genetic as well but milder •Slower muscle degeneration •Calf hypertrophy with milder pain, loss ofstrength, inability to ambulate •Patient requires a wheelchair by 30 y/o Beckers muscle dystrophy • Inherited - autosomal dominant • Affects muscles of shoulder girdle and face • Occurs in 20s • Facial muscles affected first • Sensorineural hearing loss • Retinal vascular abnormalities • Later - shoulder, scapula, upper arms are involved • Progresses slowly and can involve distal muscles ofall extremities Facioscapulohumeral Muscular Dystrophy • Inherited - autosomal dominant • Progressive muscle weakness and myotonia (cannotrelax muscle) • Delayed muscle relaxation after stimulation • Distal limb weakness with muscle wasting• Complications • Cardiac conduction defects • Cataracts • Endocrine dysfunction • Testicular atrophy • Sleep apnea Myotonic dystrophy Osteoarthritis Loss of cartilage in joint which causes the bones to rub on each other, causing inflammation, deformity, and pain. Treated with joint replacements Secondary joint dysfunction Psoriatic arthritis Enteropathic arthritis Neuropathic arthritis Gout Peripheral joint involvement • Onycholysis of nails (raised thickening with ridging) • Sacroiliac and spinal involvement • Fusiform swelling of digits (dactylitis) • Skin changes – red lesions with silvery scaling familial tendency • Inflammatory markers positive (ESR(inflammatory marker), CRP(another inflammatory marker)) • RF and Anti CCP labs negative (rheumatoid arthritislabs) • X-ray Psoriatic arthritis -Articular manifestations of ulcerative colitis and Crohn's disease -Painful nodules under skin / leg ulcers -Visual disturbances -Peripheral arthritis -Spondylitis - spine inflammation -Involvement of muscles and bone -Pain: ankles, knees,sacroiliac Enteropathic arthritis -Can be a complication of peripheral nerve injury / DM /pernicious anemia /MS / syringomyelia (fluid filled cyst in spinal cord) -Loss of proprioception (body awareness) and pain responses -Painful, swollen deformed joints Unstable joints Neuropathic arthritis Deposits of urate salts found inarticular /periarticular /subQ tissue • Hyperuricemia and urate crystal-induced arthritis (stimulated by aninflammatory response) • Body is unable to oxidize uric acid and excrete it by kidneys • Production exceeds rate of excretion Gout Ewings sarcoma is more common in males Which fracture results in a "shattering effect" comminuted Arterial blood collection between the dura mater and arachnoid membrane subdural hematoma Sudden onset of eye pain and impaired vision loss closed angle glaucoma Which is the most dangerous form of hematoma? Subarachnoid Hearing loss related to ahminoglycosides is known as Sensorineural hearing loss (ototoxicity) The late sign of compartment syndrome is pulselessness Characterized by short term lucidity immediately after the injury epidural bleeding Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to Cerebral vasospasm The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that the lack of airway maintenance can lead to hypoxia. The dementia of Alzheimer disease is associated with structural changes in the brain, including deposition of amyloid plaques in the brain Opacification = cataracts In older women, osteoporosis is thought to be primarily due to estrogen deficiency Muscular dystrophy includes a number of muscle disorders that are genetically transmitted inadequate renal excretion of uric acid Gouty arthritis