Galen NSG 3280 Exam 3 | Pathophysiology for
Nurses I (2026) Actual Q&A PDF
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: Displacement of cerebrospinal fluid into the spinal canal and a
decrease in cerebral blood volume
Rationale: 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.
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: Reticular activating system
,Rationale: 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.
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: 65 mm Hg
Rationale: 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.
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: Hypertension with widened pulse pressure, bradycardia, and
irregular respirations
,Rationale: 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.
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 hemorrhage
D) Epidural hematoma
Correct Answer: Epidural hematoma
Rationale: Epidural hematoma occurs when blood accumulates between the dura
mater and the skull, most commonly from a tear in the middle meningeal artery. A
classic feature is a brief loss of consciousness followed by a lucid interval before
rapid deterioration.
6. A patient is admitted with a suspected ischemic stroke. Which modifiable risk
factor should the nurse prioritize when teaching this patient about secondary
prevention?
A) Family history of stroke
B) Age greater than 65 years
C) Hypertension
D) Male gender
Correct Answer: Hypertension
, Rationale: Hypertension is the most significant modifiable risk factor for ischemic
stroke. Controlling blood pressure through medication, diet, and lifestyle changes
substantially reduces the risk of recurrent stroke. Family history, age, and gender are
non‑modifiable.
7. Which clinical manifestation is most characteristic of a left‑sided hemispheric
stroke?
A) Left‑sided neglect
B) Aphasia
C) Spatial‑perceptual deficits
D) Impulsive behavior
Correct Answer: Aphasia
Rationale: The left hemisphere is typically dominant for language functions. A
left‑sided stroke commonly produces aphasia (expressive, receptive, or global).
Right‑sided strokes are more often associated with neglect and spatial‑perceptual
deficits.
8. A patient with a hemorrhagic stroke has a blood pressure of 190/110 mm Hg.
Which pathophysiologic mechanism explains the rationale for cautious blood
pressure management in this patient?
A) Rapid blood pressure reduction increases the risk of rebleeding
B) Hypertension worsens cerebral edema in the ischemic penumbra
C) Cerebral autoregulation is impaired, and excessive reduction can cause ischemia
D) Elevated blood pressure is protective against vasospasm
Correct Answer: Cerebral autoregulation is impaired, and excessive reduction can
cause ischemia
Nurses I (2026) Actual Q&A PDF
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: Displacement of cerebrospinal fluid into the spinal canal and a
decrease in cerebral blood volume
Rationale: 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.
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: Reticular activating system
,Rationale: 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.
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: 65 mm Hg
Rationale: 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.
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: Hypertension with widened pulse pressure, bradycardia, and
irregular respirations
,Rationale: 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.
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 hemorrhage
D) Epidural hematoma
Correct Answer: Epidural hematoma
Rationale: Epidural hematoma occurs when blood accumulates between the dura
mater and the skull, most commonly from a tear in the middle meningeal artery. A
classic feature is a brief loss of consciousness followed by a lucid interval before
rapid deterioration.
6. A patient is admitted with a suspected ischemic stroke. Which modifiable risk
factor should the nurse prioritize when teaching this patient about secondary
prevention?
A) Family history of stroke
B) Age greater than 65 years
C) Hypertension
D) Male gender
Correct Answer: Hypertension
, Rationale: Hypertension is the most significant modifiable risk factor for ischemic
stroke. Controlling blood pressure through medication, diet, and lifestyle changes
substantially reduces the risk of recurrent stroke. Family history, age, and gender are
non‑modifiable.
7. Which clinical manifestation is most characteristic of a left‑sided hemispheric
stroke?
A) Left‑sided neglect
B) Aphasia
C) Spatial‑perceptual deficits
D) Impulsive behavior
Correct Answer: Aphasia
Rationale: The left hemisphere is typically dominant for language functions. A
left‑sided stroke commonly produces aphasia (expressive, receptive, or global).
Right‑sided strokes are more often associated with neglect and spatial‑perceptual
deficits.
8. A patient with a hemorrhagic stroke has a blood pressure of 190/110 mm Hg.
Which pathophysiologic mechanism explains the rationale for cautious blood
pressure management in this patient?
A) Rapid blood pressure reduction increases the risk of rebleeding
B) Hypertension worsens cerebral edema in the ischemic penumbra
C) Cerebral autoregulation is impaired, and excessive reduction can cause ischemia
D) Elevated blood pressure is protective against vasospasm
Correct Answer: Cerebral autoregulation is impaired, and excessive reduction can
cause ischemia
