NSG 4100 Exam 4: Neurological and Medical-
Surgical Nursing Comprehensive Practice
Examination – 2026
HEAD INJURY AND INTRACRANIAL PRESSURE
Question 1
A patient is admitted to the emergency department following a motor vehicle accident with suspected
closed head injury. The nurse knows that normal intracranial pressure (ICP) ranges between:
A. 0-5 mmHg
B. 5-15 mmHg
C. 15-20 mmHg
D. 20-25 mmHg
ANSWER✨✔-: B
Rationale:
Option A (0-5 mmHg) is incorrect because this is too low; normal ICP does not typically fall below 5
mmHg in healthy adults.
Option B (5-15 mmHg) is CORRECT because normal intracranial pressure in adults ranges from 5-15
mmHg. Values above 20 mmHg are considered elevated and require intervention.
Option C (15-20 mmHg) is incorrect because while 15 is within normal range, 20 mmHg is considered the
upper limit and values at or above 20 mmHg indicate elevated ICP requiring treatment.
Option D (20-25 mmHg) is incorrect because this range represents elevated ICP that requires immediate
intervention. Treating ICP above 22 mmHg is recommended because values above this level are
associated with increased mortality.
Question 2
The nurse is caring for a patient with increased intracranial pressure (ICP). Which intervention should
the nurse implement to help reduce ICP?
A. Keep the head of bed flat
B. Elevate the head of bed to 30-45 degrees
C. Place the patient in Trendelenburg position
,D. Turn the patient every 4 hours
ANSWER✨✔-: B
Rationale:
Option A (Keep the head of bed flat) is incorrect because a flat position can increase ICP by impairing
venous drainage from the brain.
Option B (Elevate the head of bed to 30-45 degrees) is CORRECT because elevating the head of bed to
30-45 degrees promotes venous drainage from the brain, which helps reduce ICP. This is a standard
intervention for patients with elevated ICP.
Option C (Place the patient in Trendelenburg position) is incorrect because Trendelenburg position
(head down) would significantly increase ICP by promoting blood flow to the head and impairing venous
return.
Option D (Turn the patient every 4 hours) is incorrect because while turning is important for skin
integrity, turning every 4 hours is not frequent enough for ICP management, and excessive movement
can actually increase ICP.
Question 3
A patient with severe head injury has an ICP monitor in place. The nurse notes the ICP reading is 25
mmHg. What is the priority nursing action?
A. Document the finding and continue monitoring
B. Administer prescribed mannitol
C. Lower the head of the bed
D. Decrease the oxygen flow rate
ANSWER✨✔-: B
Rationale:
Option A (Document the finding and continue monitoring) is incorrect because an ICP of 25 mmHg is
elevated and requires immediate intervention, not just documentation.
Option B (Administer prescribed mannitol) is CORRECT because an ICP of 25 mmHg is above the normal
range (5-15 mmHg) and above the treatment threshold of 20-22 mmHg. Mannitol is an osmotic diuretic
commonly used to reduce ICP by drawing fluid out of brain tissue.
Option C (Lower the head of the bed) is incorrect because lowering the head of the bed would increase
ICP rather than decrease it. The head should be elevated to help reduce ICP.
Option D (Decrease the oxygen flow rate) is incorrect because decreasing oxygen could cause hypoxia,
which would increase ICP. Adequate oxygenation is essential for patients with elevated ICP.
Question 4
,The nurse is assessing a patient who sustained a head injury 24 hours ago. The nurse notes bruising
behind the patient's ear. This finding is documented as:
A. Raccoon eyes
B. Battle's sign
C. Cushing's triad
D. Kernig's sign
ANSWER✨✔-: B
Rationale:
Option A (Raccoon eyes) is incorrect because raccoon eyes refer to periorbital ecchymosis (bruising
around the eyes), not behind the ear.
Option B (Battle's sign) is CORRECT because Battle's sign is bruising or ecchymosis that appears behind
the ear over the mastoid process. It is a late sign of basilar skull fracture and indicates significant head
trauma.
Option C (Cushing's triad) is incorrect because Cushing's triad refers to the combination of hypertension,
bradycardia, and irregular respirations that occur with severely elevated ICP and brain herniation.
Option D (Kernig's sign) is incorrect because Kernig's sign is associated with meningitis and is
characterized by pain and resistance when attempting to extend the knee while the hip is flexed.
Question 5
Which sign would alert the nurse to possible brain herniation in a patient with increased intracranial
pressure?
A. Pupils that are equal and reactive
B. Abnormal pupil response
C. Normal gag reflex
D. Stable vital signs
ANSWER✨✔-: B
Rationale:
Option A (Pupils that are equal and reactive) is incorrect because equal and reactive pupils are normal
findings and do not indicate brain herniation.
Option B (Abnormal pupil response) is CORRECT because abnormal pupil response, such as dilated
pupils, unequal pupils (anisocoria), or pupils that are non-reactive to light, is a classic sign of brain
herniation. This occurs due to compression of the oculomotor nerve (CN III).
, Option C (Normal gag reflex) is incorrect because a normal gag reflex is not indicative of brain
herniation. In fact, loss of the gag reflex would be more concerning.
Option D (Stable vital signs) is incorrect because stable vital signs are normal. Brain herniation typically
causes Cushing's triad: hypertension, bradycardia, and irregular respirations.
Question 6
The nurse is caring for a patient with a closed head injury. Which sports-related mechanism is most
likely to cause this type of injury?
A. Penetrating trauma from a projectile
B. Direct blow causing the brain to move within the skull
C. Open skull fracture with brain tissue exposure
D. Surgical intervention
ANSWER✨✔-: B
Rationale:
Option A (Penetrating trauma from a projectile) is incorrect because penetrating trauma causes an open
head injury, not a closed head injury.
Option B (Direct blow causing the brain to move within the skull) is CORRECT because closed head injury
occurs when there is no penetration of the skull, but the brain moves within the skull due to
acceleration-deceleration forces or direct impact, as commonly seen in sports injuries and car crashes.
Option C (Open skull fracture with brain tissue exposure) is incorrect because this describes an open
head injury, not a closed head injury.
Option D (Surgical intervention) is incorrect because surgical intervention is a treatment, not a
mechanism of injury.
Question 7
A patient with head injury is showing signs of increased ICP. The nurse anticipates that the healthcare
provider will order HOB (head of bed) elevation to what degree to reduce pressure?
A. 0-15 degrees
B. 30-45 degrees
C. 60-90 degrees
D. Flat position
ANSWER✨✔-: B
Rationale:
Surgical Nursing Comprehensive Practice
Examination – 2026
HEAD INJURY AND INTRACRANIAL PRESSURE
Question 1
A patient is admitted to the emergency department following a motor vehicle accident with suspected
closed head injury. The nurse knows that normal intracranial pressure (ICP) ranges between:
A. 0-5 mmHg
B. 5-15 mmHg
C. 15-20 mmHg
D. 20-25 mmHg
ANSWER✨✔-: B
Rationale:
Option A (0-5 mmHg) is incorrect because this is too low; normal ICP does not typically fall below 5
mmHg in healthy adults.
Option B (5-15 mmHg) is CORRECT because normal intracranial pressure in adults ranges from 5-15
mmHg. Values above 20 mmHg are considered elevated and require intervention.
Option C (15-20 mmHg) is incorrect because while 15 is within normal range, 20 mmHg is considered the
upper limit and values at or above 20 mmHg indicate elevated ICP requiring treatment.
Option D (20-25 mmHg) is incorrect because this range represents elevated ICP that requires immediate
intervention. Treating ICP above 22 mmHg is recommended because values above this level are
associated with increased mortality.
Question 2
The nurse is caring for a patient with increased intracranial pressure (ICP). Which intervention should
the nurse implement to help reduce ICP?
A. Keep the head of bed flat
B. Elevate the head of bed to 30-45 degrees
C. Place the patient in Trendelenburg position
,D. Turn the patient every 4 hours
ANSWER✨✔-: B
Rationale:
Option A (Keep the head of bed flat) is incorrect because a flat position can increase ICP by impairing
venous drainage from the brain.
Option B (Elevate the head of bed to 30-45 degrees) is CORRECT because elevating the head of bed to
30-45 degrees promotes venous drainage from the brain, which helps reduce ICP. This is a standard
intervention for patients with elevated ICP.
Option C (Place the patient in Trendelenburg position) is incorrect because Trendelenburg position
(head down) would significantly increase ICP by promoting blood flow to the head and impairing venous
return.
Option D (Turn the patient every 4 hours) is incorrect because while turning is important for skin
integrity, turning every 4 hours is not frequent enough for ICP management, and excessive movement
can actually increase ICP.
Question 3
A patient with severe head injury has an ICP monitor in place. The nurse notes the ICP reading is 25
mmHg. What is the priority nursing action?
A. Document the finding and continue monitoring
B. Administer prescribed mannitol
C. Lower the head of the bed
D. Decrease the oxygen flow rate
ANSWER✨✔-: B
Rationale:
Option A (Document the finding and continue monitoring) is incorrect because an ICP of 25 mmHg is
elevated and requires immediate intervention, not just documentation.
Option B (Administer prescribed mannitol) is CORRECT because an ICP of 25 mmHg is above the normal
range (5-15 mmHg) and above the treatment threshold of 20-22 mmHg. Mannitol is an osmotic diuretic
commonly used to reduce ICP by drawing fluid out of brain tissue.
Option C (Lower the head of the bed) is incorrect because lowering the head of the bed would increase
ICP rather than decrease it. The head should be elevated to help reduce ICP.
Option D (Decrease the oxygen flow rate) is incorrect because decreasing oxygen could cause hypoxia,
which would increase ICP. Adequate oxygenation is essential for patients with elevated ICP.
Question 4
,The nurse is assessing a patient who sustained a head injury 24 hours ago. The nurse notes bruising
behind the patient's ear. This finding is documented as:
A. Raccoon eyes
B. Battle's sign
C. Cushing's triad
D. Kernig's sign
ANSWER✨✔-: B
Rationale:
Option A (Raccoon eyes) is incorrect because raccoon eyes refer to periorbital ecchymosis (bruising
around the eyes), not behind the ear.
Option B (Battle's sign) is CORRECT because Battle's sign is bruising or ecchymosis that appears behind
the ear over the mastoid process. It is a late sign of basilar skull fracture and indicates significant head
trauma.
Option C (Cushing's triad) is incorrect because Cushing's triad refers to the combination of hypertension,
bradycardia, and irregular respirations that occur with severely elevated ICP and brain herniation.
Option D (Kernig's sign) is incorrect because Kernig's sign is associated with meningitis and is
characterized by pain and resistance when attempting to extend the knee while the hip is flexed.
Question 5
Which sign would alert the nurse to possible brain herniation in a patient with increased intracranial
pressure?
A. Pupils that are equal and reactive
B. Abnormal pupil response
C. Normal gag reflex
D. Stable vital signs
ANSWER✨✔-: B
Rationale:
Option A (Pupils that are equal and reactive) is incorrect because equal and reactive pupils are normal
findings and do not indicate brain herniation.
Option B (Abnormal pupil response) is CORRECT because abnormal pupil response, such as dilated
pupils, unequal pupils (anisocoria), or pupils that are non-reactive to light, is a classic sign of brain
herniation. This occurs due to compression of the oculomotor nerve (CN III).
, Option C (Normal gag reflex) is incorrect because a normal gag reflex is not indicative of brain
herniation. In fact, loss of the gag reflex would be more concerning.
Option D (Stable vital signs) is incorrect because stable vital signs are normal. Brain herniation typically
causes Cushing's triad: hypertension, bradycardia, and irregular respirations.
Question 6
The nurse is caring for a patient with a closed head injury. Which sports-related mechanism is most
likely to cause this type of injury?
A. Penetrating trauma from a projectile
B. Direct blow causing the brain to move within the skull
C. Open skull fracture with brain tissue exposure
D. Surgical intervention
ANSWER✨✔-: B
Rationale:
Option A (Penetrating trauma from a projectile) is incorrect because penetrating trauma causes an open
head injury, not a closed head injury.
Option B (Direct blow causing the brain to move within the skull) is CORRECT because closed head injury
occurs when there is no penetration of the skull, but the brain moves within the skull due to
acceleration-deceleration forces or direct impact, as commonly seen in sports injuries and car crashes.
Option C (Open skull fracture with brain tissue exposure) is incorrect because this describes an open
head injury, not a closed head injury.
Option D (Surgical intervention) is incorrect because surgical intervention is a treatment, not a
mechanism of injury.
Question 7
A patient with head injury is showing signs of increased ICP. The nurse anticipates that the healthcare
provider will order HOB (head of bed) elevation to what degree to reduce pressure?
A. 0-15 degrees
B. 30-45 degrees
C. 60-90 degrees
D. Flat position
ANSWER✨✔-: B
Rationale:
