NUR 376 Exam 4 V1 | NUR 376 Applied
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 4) | Concordia
1. A patient with a traumatic brain injury (TBI) presents with a rising systolic blood pressure,
widening pulse pressure, and bradycardia. Which pathophysiological phenomenon does the
nurse recognize?
A. Hypovolemic shock due to occult hemorrhage
B. Autonomic dysreflexia resulting from spinal shock
C. Cushing’s triad indicating increased intracranial pressure
D. Neurogenic shock from loss of sympathetic tone
Correct Answer: C
Cushing’s triad is a late sign of increased intracranial pressure (ICP) and indicates
impending brain herniation. The pathophysiology involves the brain’s attempt to maintain
cerebral perfusion pressure by increasing systemic blood pressure. This reflexive response
results in hypertension, bradycardia, and irregular respirations.
2. When evaluating a patient for a suspected ischemic stroke, which diagnostic finding is most
critical for determining the eligibility for tissue plasminogen activator (tPA) therapy?
A. An MRI showing a small area of infarction in the cerebellum
B. A non-contrast CT scan of the head showing no hemorrhage
,C. Elevated troponin levels suggesting concomitant myocardial infarction
D. Presence of a carotid bruit on physical examination
Correct Answer: B
A non-contrast CT scan is the first priority to rule out a hemorrhagic stroke before
administering fibrinolytic therapy. Administering tPA to a patient with a brain bleed would
be fatal. The scan must be interpreted quickly to ensure the patient falls within the
appropriate treatment window.
3. Which of the following conditions are considered common risk factors for the development
of a hemorrhagic stroke? (Select all that apply)
A. Chronic uncontrolled hypertension
B. Arteriovenous malformation (AVM)
C. Atrial fibrillation
D. Cocaine use
E. Anticoagulation therapy
F. Carotid artery stenosis
Correct Answer: A
Hypertension is the leading cause of intracerebral hemorrhage as it weakens the vessel
walls over time. Arteriovenous malformations and cocaine use provide structural and
hemodynamic triggers for vessel rupture. Anticoagulation therapy significantly increases
, the risk of bleeding into the brain parenchyma. Atrial fibrillation and carotid stenosis are
primarily risks for ischemic, not hemorrhagic, strokes.
4. A patient experiencing a tonic-clonic seizure is observed to have a period of muscle
contraction followed by rhythmic jerking. What is the primary pathophysiological mechanism
behind this event?
A. Sudden depletion of ATP in the synaptic cleft
B. Excessive, hypersynchronous discharge of cortical neurons
C. Delayed repolarization of the sinoatrial node
D. Failure of the blood-brain barrier to filter potassium
Correct Answer: B
Seizures occur when there is an imbalance between excitatory and inhibitory
neurotransmitters, leading to paroxysmal electrical discharges. The tonic phase involves
continuous muscle contraction, while the clonic phase represents alternating contraction
and relaxation. This electrical storm consumes high amounts of glucose and oxygen, often
leading to postictal exhaustion.
5. In the pathology of Multiple Sclerosis (MS), what is the direct consequence of the
autoimmune-mediated destruction of myelin sheaths in the central nervous system?
A. Slowed or blocked nerve impulse conduction
B. Inhibition of acetylcholine release at the neuromuscular junction
C. Degeneration of the lower motor neurons in the spinal cord
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 4) | Concordia
1. A patient with a traumatic brain injury (TBI) presents with a rising systolic blood pressure,
widening pulse pressure, and bradycardia. Which pathophysiological phenomenon does the
nurse recognize?
A. Hypovolemic shock due to occult hemorrhage
B. Autonomic dysreflexia resulting from spinal shock
C. Cushing’s triad indicating increased intracranial pressure
D. Neurogenic shock from loss of sympathetic tone
Correct Answer: C
Cushing’s triad is a late sign of increased intracranial pressure (ICP) and indicates
impending brain herniation. The pathophysiology involves the brain’s attempt to maintain
cerebral perfusion pressure by increasing systemic blood pressure. This reflexive response
results in hypertension, bradycardia, and irregular respirations.
2. When evaluating a patient for a suspected ischemic stroke, which diagnostic finding is most
critical for determining the eligibility for tissue plasminogen activator (tPA) therapy?
A. An MRI showing a small area of infarction in the cerebellum
B. A non-contrast CT scan of the head showing no hemorrhage
,C. Elevated troponin levels suggesting concomitant myocardial infarction
D. Presence of a carotid bruit on physical examination
Correct Answer: B
A non-contrast CT scan is the first priority to rule out a hemorrhagic stroke before
administering fibrinolytic therapy. Administering tPA to a patient with a brain bleed would
be fatal. The scan must be interpreted quickly to ensure the patient falls within the
appropriate treatment window.
3. Which of the following conditions are considered common risk factors for the development
of a hemorrhagic stroke? (Select all that apply)
A. Chronic uncontrolled hypertension
B. Arteriovenous malformation (AVM)
C. Atrial fibrillation
D. Cocaine use
E. Anticoagulation therapy
F. Carotid artery stenosis
Correct Answer: A
Hypertension is the leading cause of intracerebral hemorrhage as it weakens the vessel
walls over time. Arteriovenous malformations and cocaine use provide structural and
hemodynamic triggers for vessel rupture. Anticoagulation therapy significantly increases
, the risk of bleeding into the brain parenchyma. Atrial fibrillation and carotid stenosis are
primarily risks for ischemic, not hemorrhagic, strokes.
4. A patient experiencing a tonic-clonic seizure is observed to have a period of muscle
contraction followed by rhythmic jerking. What is the primary pathophysiological mechanism
behind this event?
A. Sudden depletion of ATP in the synaptic cleft
B. Excessive, hypersynchronous discharge of cortical neurons
C. Delayed repolarization of the sinoatrial node
D. Failure of the blood-brain barrier to filter potassium
Correct Answer: B
Seizures occur when there is an imbalance between excitatory and inhibitory
neurotransmitters, leading to paroxysmal electrical discharges. The tonic phase involves
continuous muscle contraction, while the clonic phase represents alternating contraction
and relaxation. This electrical storm consumes high amounts of glucose and oxygen, often
leading to postictal exhaustion.
5. In the pathology of Multiple Sclerosis (MS), what is the direct consequence of the
autoimmune-mediated destruction of myelin sheaths in the central nervous system?
A. Slowed or blocked nerve impulse conduction
B. Inhibition of acetylcholine release at the neuromuscular junction
C. Degeneration of the lower motor neurons in the spinal cord
