Galen College NSG 3280 Exam 3 (pdf) | 2026/2027 | Pathophysiology
Q&A | Pathophysiology
1. A patient with a suspected brain injury has an intracranial pressure (ICP)
reading of 22 mm Hg. What is the nurse's priority interpretation of this
finding?
A) This is a normal ICP reading that requires no intervention.
B) This ICP is mildly elevated and requires continued monitoring.
C) This ICP is significantly elevated and requires immediate intervention.
D) This ICP indicates brain death.
Correct Answer: This ICP is significantly elevated and requires immediate
intervention.
Rationale: Normal ICP in an adult is 5-15 mm Hg. Sustained ICP above 20 mm
Hg is considered elevated and requires immediate intervention to prevent
brain herniation. Readings above 20 mm Hg are not normal and indicate a
critical situation.
2. The nurse is assessing a patient with a head injury. Which finding is the
earliest indicator of increasing intracranial pressure (ICP)?
A) Fixed dilated pupils
B) Change in level of consciousness
C) Cushing's triad
D) Decerebrate posturing
Correct Answer: Change in level of consciousness
Rationale: A change in level of consciousness (LOC) is typically the first sign
of rising ICP because cerebral perfusion and reticular activating system
,function are affected early. Late findings such as fixed pupils and posturing
suggest worsening brain compression.
3. The nurse is caring for a patient with suspected increased ICP. The patient
reports a headache, vomiting, and blurred vision. How should the nurse
interpret these findings?
A) They are late signs of brain herniation.
B) They are initial manifestations of increased ICP.
C) They indicate spinal cord injury.
D) They suggest seizure activity only.
Correct Answer: They are initial manifestations of increased ICP.
Rationale: Headache, vomiting, and blurred vision are identified as initial
manifestations of increased ICP. These symptoms result from increased
pressure on intracranial structures and should be reported immediately.
4. According to the Monro-Kellie doctrine, which three compartments are
housed within the cranium?
A) Dura mater, arachnoid mater, and pia mater
B) Brain tissue, cerebrospinal fluid (CSF), and blood
C) Neurons, glial cells, and synapses
D) Arteries, veins, and capillaries
Correct Answer: Brain tissue, cerebrospinal fluid (CSF), and blood
Rationale: The Monro-Kellie doctrine states that the cranium is a rigid, fixed
space containing three compartments: brain tissue, cerebrospinal fluid (CSF),
and blood. An increase in any one compartment must be compensated by a
decrease in another to maintain normal ICP.
,5. A patient with increased ICP has a sluggish pupil response. This finding
indicates pressure on which cranial nerve?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
Correct Answer: CN III (Oculomotor)
Rationale: A sluggish or non-reactive pupil response in a patient with
increased ICP indicates pressure on the oculomotor nerve (Cranial Nerve III).
This is a sign of uncal herniation and requires immediate intervention.
6. A patient with a brain injury is exhibiting Cushing's triad. Which set of
findings is consistent with this condition?
A) Hypotension, tachycardia, and tachypnea
B) Hypertension, bradycardia, and irregular respirations
C) Hypotension, bradycardia, and irregular respirations
D) Hypertension, tachycardia, and regular respirations
Correct Answer: Hypertension, bradycardia, and irregular respirations
Rationale: Cushing's triad is a late sign of significantly increased ICP and
consists of: (1) hypertension (widening pulse pressure), (2) bradycardia, and
(3) irregular respirations (often Cheyne-Stokes). This triad indicates
brainstem compression and is a medical emergency.
, 7. A patient is diagnosed with a subdural hematoma. The nurse understands
that this type of bleed is located:
A) Between the skull and the dura mater
B) Between the dura mater and the arachnoid mater
C) Between the arachnoid mater and the pia mater
D) Within the brain tissue itself
Correct Answer: Between the dura mater and the arachnoid mater
Rationale: A subdural hematoma is a collection of blood between the dura
mater and the arachnoid mater. It is often caused by tearing of the bridging
veins and can be acute or chronic.
8. A patient presents with a history of a fall and a lucid interval followed by a
rapid decline in consciousness. This clinical presentation is most consistent
with which type of head injury?
A) Epidural hematoma
B) Subdural hematoma
C) Subarachnoid hemorrhage
D) Diffuse axonal injury
Correct Answer: Epidural hematoma
Rationale: An epidural hematoma is characterized by a lucid interval
following the initial head injury, followed by a rapid decline in consciousness
as the arterial bleed expands. This is a classic presentation and requires
immediate surgical intervention.
9. The nurse is assessing a patient with a head injury using the Glasgow
Coma Scale (GCS). The patient opens their eyes to pain, makes
Q&A | Pathophysiology
1. A patient with a suspected brain injury has an intracranial pressure (ICP)
reading of 22 mm Hg. What is the nurse's priority interpretation of this
finding?
A) This is a normal ICP reading that requires no intervention.
B) This ICP is mildly elevated and requires continued monitoring.
C) This ICP is significantly elevated and requires immediate intervention.
D) This ICP indicates brain death.
Correct Answer: This ICP is significantly elevated and requires immediate
intervention.
Rationale: Normal ICP in an adult is 5-15 mm Hg. Sustained ICP above 20 mm
Hg is considered elevated and requires immediate intervention to prevent
brain herniation. Readings above 20 mm Hg are not normal and indicate a
critical situation.
2. The nurse is assessing a patient with a head injury. Which finding is the
earliest indicator of increasing intracranial pressure (ICP)?
A) Fixed dilated pupils
B) Change in level of consciousness
C) Cushing's triad
D) Decerebrate posturing
Correct Answer: Change in level of consciousness
Rationale: A change in level of consciousness (LOC) is typically the first sign
of rising ICP because cerebral perfusion and reticular activating system
,function are affected early. Late findings such as fixed pupils and posturing
suggest worsening brain compression.
3. The nurse is caring for a patient with suspected increased ICP. The patient
reports a headache, vomiting, and blurred vision. How should the nurse
interpret these findings?
A) They are late signs of brain herniation.
B) They are initial manifestations of increased ICP.
C) They indicate spinal cord injury.
D) They suggest seizure activity only.
Correct Answer: They are initial manifestations of increased ICP.
Rationale: Headache, vomiting, and blurred vision are identified as initial
manifestations of increased ICP. These symptoms result from increased
pressure on intracranial structures and should be reported immediately.
4. According to the Monro-Kellie doctrine, which three compartments are
housed within the cranium?
A) Dura mater, arachnoid mater, and pia mater
B) Brain tissue, cerebrospinal fluid (CSF), and blood
C) Neurons, glial cells, and synapses
D) Arteries, veins, and capillaries
Correct Answer: Brain tissue, cerebrospinal fluid (CSF), and blood
Rationale: The Monro-Kellie doctrine states that the cranium is a rigid, fixed
space containing three compartments: brain tissue, cerebrospinal fluid (CSF),
and blood. An increase in any one compartment must be compensated by a
decrease in another to maintain normal ICP.
,5. A patient with increased ICP has a sluggish pupil response. This finding
indicates pressure on which cranial nerve?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
Correct Answer: CN III (Oculomotor)
Rationale: A sluggish or non-reactive pupil response in a patient with
increased ICP indicates pressure on the oculomotor nerve (Cranial Nerve III).
This is a sign of uncal herniation and requires immediate intervention.
6. A patient with a brain injury is exhibiting Cushing's triad. Which set of
findings is consistent with this condition?
A) Hypotension, tachycardia, and tachypnea
B) Hypertension, bradycardia, and irregular respirations
C) Hypotension, bradycardia, and irregular respirations
D) Hypertension, tachycardia, and regular respirations
Correct Answer: Hypertension, bradycardia, and irregular respirations
Rationale: Cushing's triad is a late sign of significantly increased ICP and
consists of: (1) hypertension (widening pulse pressure), (2) bradycardia, and
(3) irregular respirations (often Cheyne-Stokes). This triad indicates
brainstem compression and is a medical emergency.
, 7. A patient is diagnosed with a subdural hematoma. The nurse understands
that this type of bleed is located:
A) Between the skull and the dura mater
B) Between the dura mater and the arachnoid mater
C) Between the arachnoid mater and the pia mater
D) Within the brain tissue itself
Correct Answer: Between the dura mater and the arachnoid mater
Rationale: A subdural hematoma is a collection of blood between the dura
mater and the arachnoid mater. It is often caused by tearing of the bridging
veins and can be acute or chronic.
8. A patient presents with a history of a fall and a lucid interval followed by a
rapid decline in consciousness. This clinical presentation is most consistent
with which type of head injury?
A) Epidural hematoma
B) Subdural hematoma
C) Subarachnoid hemorrhage
D) Diffuse axonal injury
Correct Answer: Epidural hematoma
Rationale: An epidural hematoma is characterized by a lucid interval
following the initial head injury, followed by a rapid decline in consciousness
as the arterial bleed expands. This is a classic presentation and requires
immediate surgical intervention.
9. The nurse is assessing a patient with a head injury using the Glasgow
Coma Scale (GCS). The patient opens their eyes to pain, makes
