NSG 3280 Pathophysiology for Nurses – Exam 3
Review (2026/2027 Update) Pathophysiology for
Nurses I | Review Questions and Answers | Grade
A | 100% Correct (Verified Solutions) Instant pdf
- Galen
:Intracranial Pressure & Neurological Emergencies
1. Which of the following best describes the compensatory mechanism of the
Monro-Kellie doctrine when an intracranial mass begins to expand?
A) Displacement of cerebrospinal fluid into the spinal canal and a decrease in cerebral
blood volume
B) Rapid increase in brain tissue volume to cushion the mass
C) Immediate dilation of cerebral arteries to enhance perfusion
D) Increased production of cerebrospinal fluid to buffer the pressure
Correct Answer: A
The Monro-Kellie doctrine states that the skull is a rigid container; when one component
(brain, blood, or CSF) increases in volume, another must decrease to maintain normal ICP.
Initial compensation occurs by shifting CSF into the spinal subarachnoid space and
reducing cerebral blood volume through vasoconstriction. The other options describe
responses that would increase intracranial volume and are not compensatory
mechanisms .
,2. A change in level of consciousness is the earliest and most sensitive indicator of
rising intracranial pressure because it reflects impairment of which cerebral
structure?
A) Cerebellar vermis
B) Reticular activating system
C) Hypothalamic thermoregulatory center
D) Pituitary stalk
Correct Answer: B
The reticular activating system (RAS) in the brainstem is responsible for maintaining
wakefulness and consciousness. Even slight increases in ICP can compress the RAS, leading
to drowsiness or confusion before other signs appear. The cerebellum, hypothalamus, and
pituitary are not the primary structures responsible for the earliest change in LOC .
3. A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 90
mm Hg and an ICP of 25 mm Hg. What is the cerebral perfusion pressure (CPP)?
A) 45 mm Hg
B) 115 mm Hg
C) 65 mm Hg
D) 90 mm Hg
Correct Answer: C
Cerebral perfusion pressure (CPP) is calculated as MAP minus ICP (90 − 25 = 65 mm Hg).
Normal CPP is 60−100 mm Hg. A CPP below 50 mm Hg indicates inadequate cerebral
blood flow. The other calculations are incorrect or represent components of the formula
rather than the result .
4. A nurse is assessing a patient with a severe closed head injury. Which set of vital
signs is most consistent with Cushing's triad?
A) Hypotension, tachycardia, and rapid shallow respirations
B) Bradycardia, hypotension, and Cheyne-Stokes respirations
C) Hypertension with narrowed pulse pressure, tachycardia, and hyperventilation
D) Hypertension with widened pulse pressure, bradycardia, and irregular respirations
,Correct Answer: D
Cushing's triad is a late sign of increased ICP and brainstem compression, characterized
by systolic hypertension with a widening pulse pressure, reflex bradycardia, and irregular
or depressed respirations. Hypotension, tachycardia, or narrowed pulse pressure are not
part of the classic triad .
5. Which type of intracranial hematoma results from a tear in the middle
meningeal artery and may present with a lucid interval?
A) Subdural hematoma
B) Intracerebral hematoma
C) Subarachnoid hematoma
D) Epidural hematoma
Correct Answer: D
An epidural hematoma typically arises from arterial bleeding, most often a tear of the
middle meningeal artery associated with a temporal bone fracture. Patients may
experience a brief lucid interval followed by rapid deterioration. Subdural hematomas
result from venous tearing, intracerebral from intraparenchymal vessels, and subarachnoid
from aneurysm rupture or trauma .
6. Which physiologic change is most likely to directly increase intracranial pressure
in a patient with a brain injury?
A) Hyperventilation leading to respiratory alkalosis
B) Cerebral vasodilation due to hypercapnia
C) Increased systemic vascular resistance from vasopressors
D) Decreased cerebral metabolic rate from sedation
Correct Answer: B
Hypercapnia causes cerebral vasodilation, which increases cerebral blood volume and
thereby raises ICP within the rigid skull. Hyperventilation causes vasoconstriction and
lowers ICP. Increased systemic vascular resistance does not directly dilate cerebral vessels,
and decreased metabolic rate tends to reduce ICP .
, 7. Secondary injury mechanisms of traumatic brain injury (TBI) include which of
the following? Select all that apply.
A) Ischemia
B) Hypoxia
C) Increased intracranial pressure
D) Neuroplasticity
Correct Answer: A, B, C
Secondary injury in TBI refers to the cascade of events that occur after the initial injury,
including ischemia (compromised blood flow), hypoxia, and increased intracranial
pressure. These processes worsen neuronal damage and contribute to poor outcomes.
Neuroplasticity is a recovery mechanism, not a secondary injury .
8. Part of brain tissue dies due to compromised blood flow, leading to increased
lactic acid. This describes which condition?
A) Stroke
B) Encephalitis
C) Brain abscess
D) Multiple sclerosis
Correct Answer: A
Stroke involves the death of brain tissue due to compromised blood flow (ischemia),
leading to anaerobic metabolism and increased lactic acid production. The other
conditions are not primarily caused by compromised blood flow .
9. A patient with a severe closed head injury is showing signs of increasing ICP.
Which finding would the nurse expect to see first?
A) Decerebrate posturing
B) Unequal pupils
Review (2026/2027 Update) Pathophysiology for
Nurses I | Review Questions and Answers | Grade
A | 100% Correct (Verified Solutions) Instant pdf
- Galen
:Intracranial Pressure & Neurological Emergencies
1. Which of the following best describes the compensatory mechanism of the
Monro-Kellie doctrine when an intracranial mass begins to expand?
A) Displacement of cerebrospinal fluid into the spinal canal and a decrease in cerebral
blood volume
B) Rapid increase in brain tissue volume to cushion the mass
C) Immediate dilation of cerebral arteries to enhance perfusion
D) Increased production of cerebrospinal fluid to buffer the pressure
Correct Answer: A
The Monro-Kellie doctrine states that the skull is a rigid container; when one component
(brain, blood, or CSF) increases in volume, another must decrease to maintain normal ICP.
Initial compensation occurs by shifting CSF into the spinal subarachnoid space and
reducing cerebral blood volume through vasoconstriction. The other options describe
responses that would increase intracranial volume and are not compensatory
mechanisms .
,2. A change in level of consciousness is the earliest and most sensitive indicator of
rising intracranial pressure because it reflects impairment of which cerebral
structure?
A) Cerebellar vermis
B) Reticular activating system
C) Hypothalamic thermoregulatory center
D) Pituitary stalk
Correct Answer: B
The reticular activating system (RAS) in the brainstem is responsible for maintaining
wakefulness and consciousness. Even slight increases in ICP can compress the RAS, leading
to drowsiness or confusion before other signs appear. The cerebellum, hypothalamus, and
pituitary are not the primary structures responsible for the earliest change in LOC .
3. A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 90
mm Hg and an ICP of 25 mm Hg. What is the cerebral perfusion pressure (CPP)?
A) 45 mm Hg
B) 115 mm Hg
C) 65 mm Hg
D) 90 mm Hg
Correct Answer: C
Cerebral perfusion pressure (CPP) is calculated as MAP minus ICP (90 − 25 = 65 mm Hg).
Normal CPP is 60−100 mm Hg. A CPP below 50 mm Hg indicates inadequate cerebral
blood flow. The other calculations are incorrect or represent components of the formula
rather than the result .
4. A nurse is assessing a patient with a severe closed head injury. Which set of vital
signs is most consistent with Cushing's triad?
A) Hypotension, tachycardia, and rapid shallow respirations
B) Bradycardia, hypotension, and Cheyne-Stokes respirations
C) Hypertension with narrowed pulse pressure, tachycardia, and hyperventilation
D) Hypertension with widened pulse pressure, bradycardia, and irregular respirations
,Correct Answer: D
Cushing's triad is a late sign of increased ICP and brainstem compression, characterized
by systolic hypertension with a widening pulse pressure, reflex bradycardia, and irregular
or depressed respirations. Hypotension, tachycardia, or narrowed pulse pressure are not
part of the classic triad .
5. Which type of intracranial hematoma results from a tear in the middle
meningeal artery and may present with a lucid interval?
A) Subdural hematoma
B) Intracerebral hematoma
C) Subarachnoid hematoma
D) Epidural hematoma
Correct Answer: D
An epidural hematoma typically arises from arterial bleeding, most often a tear of the
middle meningeal artery associated with a temporal bone fracture. Patients may
experience a brief lucid interval followed by rapid deterioration. Subdural hematomas
result from venous tearing, intracerebral from intraparenchymal vessels, and subarachnoid
from aneurysm rupture or trauma .
6. Which physiologic change is most likely to directly increase intracranial pressure
in a patient with a brain injury?
A) Hyperventilation leading to respiratory alkalosis
B) Cerebral vasodilation due to hypercapnia
C) Increased systemic vascular resistance from vasopressors
D) Decreased cerebral metabolic rate from sedation
Correct Answer: B
Hypercapnia causes cerebral vasodilation, which increases cerebral blood volume and
thereby raises ICP within the rigid skull. Hyperventilation causes vasoconstriction and
lowers ICP. Increased systemic vascular resistance does not directly dilate cerebral vessels,
and decreased metabolic rate tends to reduce ICP .
, 7. Secondary injury mechanisms of traumatic brain injury (TBI) include which of
the following? Select all that apply.
A) Ischemia
B) Hypoxia
C) Increased intracranial pressure
D) Neuroplasticity
Correct Answer: A, B, C
Secondary injury in TBI refers to the cascade of events that occur after the initial injury,
including ischemia (compromised blood flow), hypoxia, and increased intracranial
pressure. These processes worsen neuronal damage and contribute to poor outcomes.
Neuroplasticity is a recovery mechanism, not a secondary injury .
8. Part of brain tissue dies due to compromised blood flow, leading to increased
lactic acid. This describes which condition?
A) Stroke
B) Encephalitis
C) Brain abscess
D) Multiple sclerosis
Correct Answer: A
Stroke involves the death of brain tissue due to compromised blood flow (ischemia),
leading to anaerobic metabolism and increased lactic acid production. The other
conditions are not primarily caused by compromised blood flow .
9. A patient with a severe closed head injury is showing signs of increasing ICP.
Which finding would the nurse expect to see first?
A) Decerebrate posturing
B) Unequal pupils
