NSG 233 Med Surg Exam 2: (Latest 2026/2027 Update) Neurological & Cardiac
Emergencies | Q&A | Grade A | 100% Correct (Verified Answers) – Nursing
Program
Subject: NSG 233 – Medical-Surgical Nursing / Emergency & Critical Care
Source: NSG 233 Med Surg Exam 2 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is a concussion?
Correct Answer: Temporary loss of neurological function with no structural damage to the brain.
Patient can safely return to activities once he feels better (symptom-free).
1. Concussion is a mild traumatic brain injury (mTBI) with transient symptoms.
2. No abnormality on standard neuroimaging.
3. Key is monitoring for worsening symptoms (vomiting, seizures, worsening headache, slurred
speech, confusion, weakness).
2. What should the nurse monitor for a patient who had a concussion?
Correct Answer: Monitor for worsening neurological symptoms: projectile vomiting, seizures,
worsening headache, irritability, slurred speech, confusion, weakness.
1. Red flags indicate possible intracranial hemorrhage or worsening cerebral edema.
2. Projectile vomiting suggests increased ICP.
3. Any worsening of symptoms requires immediate reevaluation.
3. What is the Monro-Kellie doctrine/hypothesis?
Correct Answer: The sum of volumes of brain tissue, cerebrospinal fluid (CSF), and intracranial blood
is constant. An increase in one must cause a decrease in one or both of the remaining two to maintain
normal intracranial pressure (ICP).
1. Normal ICP = 5-15 mm Hg; treatment considered if ICP >20 mm Hg.
2. Explains compensatory mechanisms and onset of increased ICP.
3. Failure of compensation leads to herniation.
4. What is the method of measuring intracranial pressure (ICP)?
Correct Answer: External ventricular drainage (EVD), also known as ventriculostomy — has two
functions: drain CSF and measure ICP.
1. EVD is gold standard for ICP monitoring and treatment (drains CSF to lower ICP).
2. Zero transducer at level of external auditory meatus.
3. Monitor for infection (ventriculitis).
, 5. What are the types of head injury?
Correct Answer: Open traumatic brain injury (skull fracture or penetration by object) and closed
traumatic brain injury (blunt trauma — more serious due to risk of increased ICP in closed vault).
1. Open injury may have lower ICP due to skull fracture releasing pressure.
2. Closed injury risk of mass effect and herniation.
3. Both can cause cerebral edema and secondary injury.
6. What is the nurse's management for a patient with traumatic brain injury (TBI) to prevent
complications?
Correct Answer: Administer stool softener, ensure ongoing nutritional support, anticipate
anticonvulsant, monitor for hyponatremia (cerebral edema → ADH dysregulation).
1. Stool softeners prevent constipation/straining (increases ICP).
2. Early enteral nutrition improves outcomes.
3. Seizure prophylaxis (phenytoin or levetiracetam) for 7 days.
7. What is the treatment for increased intracranial pressure (ICP)?
Correct Answer: Mannitol (osmotic diuretic) + 3% hypertonic saline. Never give to patient with
cerebral hemorrhage or anuria (output <30 mL/hr). Monitor for crystals; adjust infusion based on urine
output.
1. Mannitol draws water from brain tissue into intravascular space.
2. Dose 0.25-1 g/kg IV; monitor serum osmolality (<320 mOsm/L).
3. Hypertonic saline (3%) reduces cerebral edema without diuresis risk.
8. What are clinical manifestations of EARLY increased intracranial pressure?
Correct Answer: Change in level of consciousness is EARLIEST sign: irritability, restlessness,
decreased mental status, flattening of affect → drowsiness → seizures → coma → death. Cushing triad
(widened pulse pressure, hypertension, bradycardia); nuchal rigidity; temperature changes.
1. Decreasing LOC precedes vital sign changes.
2. Glasgow Coma Scale monitoring essential.
3. Cushing triad is LATE sign of herniation.
9. What is Cushing's triad in increased ICP?
Correct Answer: Profound hypertension and bradycardia with decreased or irregular respirations
(Cheyne-Stokes) due to brainstem compression. Do NOT confuse with neurogenic shock (hypotension
+ tachycardia).
1. Cushing's triad indicates impending herniation.
2. Widened pulse pressure (systolic rise, diastolic stable).
3. Immediate intervention needed.
Emergencies | Q&A | Grade A | 100% Correct (Verified Answers) – Nursing
Program
Subject: NSG 233 – Medical-Surgical Nursing / Emergency & Critical Care
Source: NSG 233 Med Surg Exam 2 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is a concussion?
Correct Answer: Temporary loss of neurological function with no structural damage to the brain.
Patient can safely return to activities once he feels better (symptom-free).
1. Concussion is a mild traumatic brain injury (mTBI) with transient symptoms.
2. No abnormality on standard neuroimaging.
3. Key is monitoring for worsening symptoms (vomiting, seizures, worsening headache, slurred
speech, confusion, weakness).
2. What should the nurse monitor for a patient who had a concussion?
Correct Answer: Monitor for worsening neurological symptoms: projectile vomiting, seizures,
worsening headache, irritability, slurred speech, confusion, weakness.
1. Red flags indicate possible intracranial hemorrhage or worsening cerebral edema.
2. Projectile vomiting suggests increased ICP.
3. Any worsening of symptoms requires immediate reevaluation.
3. What is the Monro-Kellie doctrine/hypothesis?
Correct Answer: The sum of volumes of brain tissue, cerebrospinal fluid (CSF), and intracranial blood
is constant. An increase in one must cause a decrease in one or both of the remaining two to maintain
normal intracranial pressure (ICP).
1. Normal ICP = 5-15 mm Hg; treatment considered if ICP >20 mm Hg.
2. Explains compensatory mechanisms and onset of increased ICP.
3. Failure of compensation leads to herniation.
4. What is the method of measuring intracranial pressure (ICP)?
Correct Answer: External ventricular drainage (EVD), also known as ventriculostomy — has two
functions: drain CSF and measure ICP.
1. EVD is gold standard for ICP monitoring and treatment (drains CSF to lower ICP).
2. Zero transducer at level of external auditory meatus.
3. Monitor for infection (ventriculitis).
, 5. What are the types of head injury?
Correct Answer: Open traumatic brain injury (skull fracture or penetration by object) and closed
traumatic brain injury (blunt trauma — more serious due to risk of increased ICP in closed vault).
1. Open injury may have lower ICP due to skull fracture releasing pressure.
2. Closed injury risk of mass effect and herniation.
3. Both can cause cerebral edema and secondary injury.
6. What is the nurse's management for a patient with traumatic brain injury (TBI) to prevent
complications?
Correct Answer: Administer stool softener, ensure ongoing nutritional support, anticipate
anticonvulsant, monitor for hyponatremia (cerebral edema → ADH dysregulation).
1. Stool softeners prevent constipation/straining (increases ICP).
2. Early enteral nutrition improves outcomes.
3. Seizure prophylaxis (phenytoin or levetiracetam) for 7 days.
7. What is the treatment for increased intracranial pressure (ICP)?
Correct Answer: Mannitol (osmotic diuretic) + 3% hypertonic saline. Never give to patient with
cerebral hemorrhage or anuria (output <30 mL/hr). Monitor for crystals; adjust infusion based on urine
output.
1. Mannitol draws water from brain tissue into intravascular space.
2. Dose 0.25-1 g/kg IV; monitor serum osmolality (<320 mOsm/L).
3. Hypertonic saline (3%) reduces cerebral edema without diuresis risk.
8. What are clinical manifestations of EARLY increased intracranial pressure?
Correct Answer: Change in level of consciousness is EARLIEST sign: irritability, restlessness,
decreased mental status, flattening of affect → drowsiness → seizures → coma → death. Cushing triad
(widened pulse pressure, hypertension, bradycardia); nuchal rigidity; temperature changes.
1. Decreasing LOC precedes vital sign changes.
2. Glasgow Coma Scale monitoring essential.
3. Cushing triad is LATE sign of herniation.
9. What is Cushing's triad in increased ICP?
Correct Answer: Profound hypertension and bradycardia with decreased or irregular respirations
(Cheyne-Stokes) due to brainstem compression. Do NOT confuse with neurogenic shock (hypotension
+ tachycardia).
1. Cushing's triad indicates impending herniation.
2. Widened pulse pressure (systolic rise, diastolic stable).
3. Immediate intervention needed.
