PNR 408 FINAL EXAM QUESTIONS AND ANSWERS | PNR 408
FINAL STUDY GUIDE & PRACTICE TEST 2026/2027
The nurse is caring for a client with a suspected closed head injury who has bloody nasal drainage.
Which of the following observations should the nurse recognize as being a Cerebro-spinal fluid (CSF)
leak?
a) A halo sign on the nasal drip pad
b) Decreased blood pressure and urinary output
c)A positive reading for glucose on a test-tape strip
d)Clear nasal drainage along with the bloody discharge - ANS ✔✔A
When drainage containing both Cerebro-spinal fluid (CSF) and blood is allowed to drip onto a white pad,
within a few minutes the blood will coalesce into the centre, and a yellowish ring of CSF will encircle the
blood, giving a halo or ring effect. The presence of glucose would be unreliable for determining the
presence of CSF because blood also contains glucose.
The nurse is assessing a client for signs of meningeal irritation and observes for nuchal rigidity. Which of
the following findings indicates the presence of this sign of meningeal irritation?
a)Tonic spasms of the legs
b)Curling in a fetal position
c)Arching of the neck and back
d)Resistance to flexion of the neck - ANS ✔✔D
Nuchal rigidity is a clinical manifestation of meningitis. During assessment, the client will resist passive
flexion of the neck by the health care provider.
The nurse is caring for a client admitted with a subdural hematoma following a motor vehicle accident.
Which of the following changes in vital signs should the nurse interpret as a manifestation of increased
intracranial pressure?
a)Tachypnea
b)Bradycardia
c)Hypotension
d)Narrowing pulse pressure - ANS ✔✔B
Changes in vital signs indicative of increased intracranial pressure are known as Cushing's triad, which
consists of increasing systolic pressure with a widening pulse pressure, bradycardia with a full and
bounding pulse, and irregular respirations.
Which of the following nursing actions should be implemented in the care of a client who is experiencing
increased intracranial pressure (ICP)?
a)Monitor fluid and electrolyte status astutely.
, b)Position the client in a high Fowler's position.
c)Administer vasoconstrictors to maintain cerebral perfusion.
d)Maintain physical restraints to prevent episodes of agitation. - ANS ✔✔A
Fluid and electrolyte disturbances can have an adverse effect on intracranial pressure (ICP) and must be
monitored vigilantly. The head of the client's bed should be kept at 30 degrees in most circumstances,
and physical restraints are not applied unless absolutely necessary.
Magnetic resonance imaging (MRI) has revealed the presence of a brain tumour in a client. The nurse
would recognize the client's likely need for which of the following treatment modalities?
a)Surgery
b)Chemotherapy
c)Radiation therapy
d)Pharmacological treatment - ANS ✔✔A
Surgery is preferred if possible
The nurse is caring for a client admitted for evaluation and surgical removal of a brain tumour. The nurse
will plan interventions for this client based on knowledge that brain tumours can lead to which of the
following complications? (Select all that apply.)
a)Vision loss
b)Cerebral edema
c)Pituitary dysfunction
d)Parathyroid dysfunction
e)Focal neurological deficits - ANS ✔✔A, B, C, E
Brain tumours can manifest themselves in a wide variety of symptoms depending on location, including
vision loss and focal neurological deficits. Tumours that put pressure on the pituitary can lead to
dysfunction of the gland. As the tumour grows, clinical manifestations of increased intracranial pressure
(ICP) and cerebral edema can appear. The parathyroid gland is not regulated by the cerebral cortex or
the pituitary gland.
The nurse is providing care for a client who has been admitted to the hospital with a head injury and
who requires regular neurological vital signs. Which of the following assessments are components of the
Glasgow Coma Scale (GCS)? (Select all that apply.)
a)Judgement
b)Eye opening
c)Abstract reasoning
d)Best verbal response
e)Best motor response - ANS ✔✔B, D, E
The nurse is caring for a client who has been receiving scheduled doses of phenytoin and begins to
experience diplopia. Which of the following assessments should the nurse complete immediately?
a)An aura
FINAL STUDY GUIDE & PRACTICE TEST 2026/2027
The nurse is caring for a client with a suspected closed head injury who has bloody nasal drainage.
Which of the following observations should the nurse recognize as being a Cerebro-spinal fluid (CSF)
leak?
a) A halo sign on the nasal drip pad
b) Decreased blood pressure and urinary output
c)A positive reading for glucose on a test-tape strip
d)Clear nasal drainage along with the bloody discharge - ANS ✔✔A
When drainage containing both Cerebro-spinal fluid (CSF) and blood is allowed to drip onto a white pad,
within a few minutes the blood will coalesce into the centre, and a yellowish ring of CSF will encircle the
blood, giving a halo or ring effect. The presence of glucose would be unreliable for determining the
presence of CSF because blood also contains glucose.
The nurse is assessing a client for signs of meningeal irritation and observes for nuchal rigidity. Which of
the following findings indicates the presence of this sign of meningeal irritation?
a)Tonic spasms of the legs
b)Curling in a fetal position
c)Arching of the neck and back
d)Resistance to flexion of the neck - ANS ✔✔D
Nuchal rigidity is a clinical manifestation of meningitis. During assessment, the client will resist passive
flexion of the neck by the health care provider.
The nurse is caring for a client admitted with a subdural hematoma following a motor vehicle accident.
Which of the following changes in vital signs should the nurse interpret as a manifestation of increased
intracranial pressure?
a)Tachypnea
b)Bradycardia
c)Hypotension
d)Narrowing pulse pressure - ANS ✔✔B
Changes in vital signs indicative of increased intracranial pressure are known as Cushing's triad, which
consists of increasing systolic pressure with a widening pulse pressure, bradycardia with a full and
bounding pulse, and irregular respirations.
Which of the following nursing actions should be implemented in the care of a client who is experiencing
increased intracranial pressure (ICP)?
a)Monitor fluid and electrolyte status astutely.
, b)Position the client in a high Fowler's position.
c)Administer vasoconstrictors to maintain cerebral perfusion.
d)Maintain physical restraints to prevent episodes of agitation. - ANS ✔✔A
Fluid and electrolyte disturbances can have an adverse effect on intracranial pressure (ICP) and must be
monitored vigilantly. The head of the client's bed should be kept at 30 degrees in most circumstances,
and physical restraints are not applied unless absolutely necessary.
Magnetic resonance imaging (MRI) has revealed the presence of a brain tumour in a client. The nurse
would recognize the client's likely need for which of the following treatment modalities?
a)Surgery
b)Chemotherapy
c)Radiation therapy
d)Pharmacological treatment - ANS ✔✔A
Surgery is preferred if possible
The nurse is caring for a client admitted for evaluation and surgical removal of a brain tumour. The nurse
will plan interventions for this client based on knowledge that brain tumours can lead to which of the
following complications? (Select all that apply.)
a)Vision loss
b)Cerebral edema
c)Pituitary dysfunction
d)Parathyroid dysfunction
e)Focal neurological deficits - ANS ✔✔A, B, C, E
Brain tumours can manifest themselves in a wide variety of symptoms depending on location, including
vision loss and focal neurological deficits. Tumours that put pressure on the pituitary can lead to
dysfunction of the gland. As the tumour grows, clinical manifestations of increased intracranial pressure
(ICP) and cerebral edema can appear. The parathyroid gland is not regulated by the cerebral cortex or
the pituitary gland.
The nurse is providing care for a client who has been admitted to the hospital with a head injury and
who requires regular neurological vital signs. Which of the following assessments are components of the
Glasgow Coma Scale (GCS)? (Select all that apply.)
a)Judgement
b)Eye opening
c)Abstract reasoning
d)Best verbal response
e)Best motor response - ANS ✔✔B, D, E
The nurse is caring for a client who has been receiving scheduled doses of phenytoin and begins to
experience diplopia. Which of the following assessments should the nurse complete immediately?
a)An aura
