NUR 5461 Module 4 Quiz – Advanced Pathophysiology
(2026) William Paterson University | Concepts and Alterations of
the Neurological System 200 Practice Questions with Correct
Answers and Explanations.
SECTION 1: TRAUMATIC BRAIN INJURY (TBI) AND
INTRACRANIAL PRESSURE
Question 1
Age and the initial Glasgow Coma Scale (GCS) score are important diagnostic factors in
TBI. Which initial GCS score describes a severe TBI?
A) 13–15
B) 9–12
C) 3–8
D) 1–2
Correct Answer: C) 3–8
Explanation: On the Glasgow Coma Scale, scores of 3–8 indicate a severe traumatic brain
injury, 9–12 moderate, and 13–15 mild. A GCS ≤8 typically reflects coma and a high risk
of poor neurologic outcome. The GCS evaluates eye opening, verbal response, and motor
response, with lower scores indicating more severe impairment.
Question 2
A patient is hit in the temporal portion of his skull. Although initial loss of consciousness
occurs, the patient soon awakens and is conversant. Three hours later vomiting,
drowsiness, and confusion are noted. These symptoms most likely relate to which type
of brain injury?
A) Subdural hematoma
B) Intracerebral hemorrhage
,C) Contusion
D) Epidural hematoma
Correct Answer: D) Epidural hematoma
Explanation: Epidural hematomas, often from temporal bone fractures tearing the middle
meningeal artery, classically present with an initial loss of consciousness (due to
concussion), a "lucid interval" where the patient appears normal, followed by rapid
neurological deterioration (vomiting, drowsiness, confusion) as arterial blood accumulates
and compresses the brain. This is a neurosurgical emergency requiring immediate
evacuation.
Question 3
An older adult who abuses alcohol has fallen and is diagnosed with a hematoma that is
located under the skull but outside of the brain. Which type of hematoma fits this
description?
A) Epidural hematoma
B) Subdural hematoma
C) Intracerebral hematoma
D) Subarachnoid hematoma
Correct Answer: B) Subdural hematoma
Explanation: Subdural hematomas occur between the dura and arachnoid mater—under
the skull but outside the brain parenchyma. They are common in older adults and alcohol
users due to cerebral atrophy that stretches and weakens the bridging veins, making them
more susceptible to rupture even with minor falls.
Question 4
A person experiences a vertebral fracture in which the C1 vertebra is fractured into
several fragments. This type of fracture can be described as:
A) Compression
B) Burst
,C) Comminuted
D) Greenstick
Correct Answer: C) Comminuted
Explanation: A comminuted fracture involves the bone being broken into multiple
fragments (three or more). C1 (atlas) fractures with several bony pieces—such as a
Jefferson fracture—are classic examples of comminuted fractures and carry significant risk
for spinal cord compromise.
Question 5
Vomiting is a result of a central nervous system injury and is caused by which of the
following?
A) Stimulation of the medullary cough center
B) Involvement of the vestibular nuclei
C) Irritation of the spinal cord roots
D) Inhibition of the hypothalamus
Correct Answer: B) Involvement of the vestibular nuclei
Explanation: CNS injury can involve the vestibular nuclei, which connect to the vomiting
center in the medulla. This vestibular disturbance produces nausea and projectile vomiting
often seen with increased intracranial pressure or posterior fossa lesions. The vomiting is
often described as "projectile" and not preceded by nausea.
Question 6
A patient had a motor vehicle crash and suffered critical injuries to the brainstem. What
physiological responses would the healthcare professional expect to see?
A) Pulse and blood pressure changes
B) Hyperreflexia of all extremities
C) Isolated visual disturbances
D) Localized abdominal pain
Correct Answer: A) Pulse and blood pressure changes
, Explanation: The brainstem houses the medullary cardiovascular and respiratory centers
that regulate heart rate, blood pressure, and breathing. Critical brainstem injury disrupts
these centers, causing unstable vital signs including bradycardia, hypertension (Cushing's
reflex), and irregular respiratory patterns.
Question 7
What is the definition of perceptual dominance?
A) The strongest stimulus is ignored
B) Pain at one location may mask pain at another location
C) All pain signals are transmitted equally
D) No pain is perceived if the person is distracted
Correct Answer: B) Pain at one location may mask pain at another location
Explanation: Perceptual dominance describes how a more intense or prominent pain can
overshadow lesser pains, affecting how patients report symptoms and potentially
obscuring additional injuries. This has clinical significance in trauma patients where a
severe injury (e.g., femur fracture) may mask recognition of other painful conditions.
Question 8
Which statement is true regarding spinal shock?
A) It is permanent loss of all spinal function
B) It is characterized by complete loss of reflex function
C) It only affects sensory function
D) It involves only autonomic dysfunction
Correct Answer: B) It is characterized by complete loss of reflex function
Explanation: Spinal shock is a transient state after acute spinal cord injury marked by
flaccid paralysis, areflexia (complete loss of reflex function), and loss of autonomic function
below the level of the lesion. Reflexes may gradually return over days to weeks, unlike the
permanent deficits of the cord injury itself.
(2026) William Paterson University | Concepts and Alterations of
the Neurological System 200 Practice Questions with Correct
Answers and Explanations.
SECTION 1: TRAUMATIC BRAIN INJURY (TBI) AND
INTRACRANIAL PRESSURE
Question 1
Age and the initial Glasgow Coma Scale (GCS) score are important diagnostic factors in
TBI. Which initial GCS score describes a severe TBI?
A) 13–15
B) 9–12
C) 3–8
D) 1–2
Correct Answer: C) 3–8
Explanation: On the Glasgow Coma Scale, scores of 3–8 indicate a severe traumatic brain
injury, 9–12 moderate, and 13–15 mild. A GCS ≤8 typically reflects coma and a high risk
of poor neurologic outcome. The GCS evaluates eye opening, verbal response, and motor
response, with lower scores indicating more severe impairment.
Question 2
A patient is hit in the temporal portion of his skull. Although initial loss of consciousness
occurs, the patient soon awakens and is conversant. Three hours later vomiting,
drowsiness, and confusion are noted. These symptoms most likely relate to which type
of brain injury?
A) Subdural hematoma
B) Intracerebral hemorrhage
,C) Contusion
D) Epidural hematoma
Correct Answer: D) Epidural hematoma
Explanation: Epidural hematomas, often from temporal bone fractures tearing the middle
meningeal artery, classically present with an initial loss of consciousness (due to
concussion), a "lucid interval" where the patient appears normal, followed by rapid
neurological deterioration (vomiting, drowsiness, confusion) as arterial blood accumulates
and compresses the brain. This is a neurosurgical emergency requiring immediate
evacuation.
Question 3
An older adult who abuses alcohol has fallen and is diagnosed with a hematoma that is
located under the skull but outside of the brain. Which type of hematoma fits this
description?
A) Epidural hematoma
B) Subdural hematoma
C) Intracerebral hematoma
D) Subarachnoid hematoma
Correct Answer: B) Subdural hematoma
Explanation: Subdural hematomas occur between the dura and arachnoid mater—under
the skull but outside the brain parenchyma. They are common in older adults and alcohol
users due to cerebral atrophy that stretches and weakens the bridging veins, making them
more susceptible to rupture even with minor falls.
Question 4
A person experiences a vertebral fracture in which the C1 vertebra is fractured into
several fragments. This type of fracture can be described as:
A) Compression
B) Burst
,C) Comminuted
D) Greenstick
Correct Answer: C) Comminuted
Explanation: A comminuted fracture involves the bone being broken into multiple
fragments (three or more). C1 (atlas) fractures with several bony pieces—such as a
Jefferson fracture—are classic examples of comminuted fractures and carry significant risk
for spinal cord compromise.
Question 5
Vomiting is a result of a central nervous system injury and is caused by which of the
following?
A) Stimulation of the medullary cough center
B) Involvement of the vestibular nuclei
C) Irritation of the spinal cord roots
D) Inhibition of the hypothalamus
Correct Answer: B) Involvement of the vestibular nuclei
Explanation: CNS injury can involve the vestibular nuclei, which connect to the vomiting
center in the medulla. This vestibular disturbance produces nausea and projectile vomiting
often seen with increased intracranial pressure or posterior fossa lesions. The vomiting is
often described as "projectile" and not preceded by nausea.
Question 6
A patient had a motor vehicle crash and suffered critical injuries to the brainstem. What
physiological responses would the healthcare professional expect to see?
A) Pulse and blood pressure changes
B) Hyperreflexia of all extremities
C) Isolated visual disturbances
D) Localized abdominal pain
Correct Answer: A) Pulse and blood pressure changes
, Explanation: The brainstem houses the medullary cardiovascular and respiratory centers
that regulate heart rate, blood pressure, and breathing. Critical brainstem injury disrupts
these centers, causing unstable vital signs including bradycardia, hypertension (Cushing's
reflex), and irregular respiratory patterns.
Question 7
What is the definition of perceptual dominance?
A) The strongest stimulus is ignored
B) Pain at one location may mask pain at another location
C) All pain signals are transmitted equally
D) No pain is perceived if the person is distracted
Correct Answer: B) Pain at one location may mask pain at another location
Explanation: Perceptual dominance describes how a more intense or prominent pain can
overshadow lesser pains, affecting how patients report symptoms and potentially
obscuring additional injuries. This has clinical significance in trauma patients where a
severe injury (e.g., femur fracture) may mask recognition of other painful conditions.
Question 8
Which statement is true regarding spinal shock?
A) It is permanent loss of all spinal function
B) It is characterized by complete loss of reflex function
C) It only affects sensory function
D) It involves only autonomic dysfunction
Correct Answer: B) It is characterized by complete loss of reflex function
Explanation: Spinal shock is a transient state after acute spinal cord injury marked by
flaccid paralysis, areflexia (complete loss of reflex function), and loss of autonomic function
below the level of the lesion. Reflexes may gradually return over days to weeks, unlike the
permanent deficits of the cord injury itself.
