ESTUDYR
NSG 3280 EXAM 3 2025 MULTICHOICE ANSWERED
EXAM QUESTIONS WITH DETAILED RATIONALES
Primary brain injury refers to:
A. Reversible swelling after trauma
B. Secondary ischemia from hypoxia
C. Initial irreversible damage to the brain resulting from the traumatic event
D. Infection following trauma
Rationale: Primary injury is the direct, immediate damage at the moment of trauma.
Secondary brain injury is:
A. The initial impact injury
B. Insult to the brain subsequent to the original event causing progressive delayed cell death
C. Always reversible swelling
D. Viral encephalitis only
Rationale: Secondary injury evolves after the initial trauma (ischemia, edema, inflammation).
“Time is tissue” means:
A. Brain injury effects decrease over time
B. Only old tissue is damaged
C. The longer treatment is delayed, the more brain tissue is lost
D. Time heals tissue automatically
Rationale: Delays in treating brain injury increase irreversible tissue loss.
Primary mechanisms of brain injury include:
A. Infection, tumor, stroke
B. Ischemia, hypoxia, and increased intracranial pressure (ICP)
C. Autoimmunity only
D. Degeneration only
Rationale: These are main pathophysiologic processes causing brain cell death after trauma.
Three compartments of the cranium are:
A. Skull, scalp, dura
B. Brain tissue, cerebrospinal fluid (CSF), and blood
C. Atrium, ventricle, sinus
D. Meninges layers only
Rationale: Monro-Kellie components: brain, CSF, blood.
,ESTUDYR
Normal intracranial pressure (ICP) range is approximately:
A. 20–30 mm Hg
B. 0–15 mm Hg
C. 30–50 mm Hg
D. 50–70 mm Hg
Rationale: Normal ICP is low; sustained elevation above ~20 mm Hg is concerning.
If one intracranial compartment increases, the others typically:
A. Increase as well
B. Decrease to compensate
C. Remain unchanged
D. Cause instant herniation
Rationale: Compensatory mechanisms displace CSF or blood to maintain ICP.
If all three compartments increase simultaneously, what may occur?
A. Improved perfusion
B. Decreased ICP
C. Brain herniation
D. Skull expansion
Rationale: When compensatory capacity is exceeded, herniation can result.
A sudden decrease in CSF volume can lead to:
A. Seizures only
B. Hypertension
C. Brain herniation (due to pressure shifts)
D. Increased CSF production
Rationale: Rapid CSF loss can cause brain displacement and herniation.
In a patient with increased ICP, should you perform a lumbar puncture?
A. No—do not perform lumbar puncture
B. Yes—immediately
C. Only after mannitol
D. Only if CT shows no mass
Rationale: LP can precipitate herniation when ICP is elevated.
“Delirious” best describes:
A. Deep sleep from which patient cannot be aroused
B. Acutely disturbed state of mind with restlessness, illusions, incoherence
C. Chronic dementia only
,ESTUDYR
D. Minor confusion only
Rationale: Delirium is an acute fluctuating disturbance in attention and cognition.
“Obtunded” indicates:
A. Hyperalertness
B. Less than full alertness; falls asleep unless stimulated
C. Coma with no response
D. Normal awake state
Rationale: Obtundation is moderate reduction in arousal and responsiveness.
“Stuporous” means:
A. Fully alert
B. Deep sleep requiring vigorous stimulation; may not remain awake
C. Restless and agitated
D. Mild confusion only
Rationale: Stupor indicates severe depression of consciousness.
“Comatose” describes:
A. Mild sleepiness
B. Arousal with minimal stimuli
C. Unarousable state, no purposeful responses to even painful stimuli
D. Easily rousable with voice
Rationale: Coma is profound loss of consciousness.
Decorticate posturing is characterized by:
A. Limbs extended and rotated outward
B. Flexion of arms toward the core (arms flexed, legs extended)
C. No motor response
D. Random twitching only
Rationale: Decorticate indicates severe cortical/spinal damage with flexor posturing.
Decerebrate posturing is:
A. Less severe than decorticate
B. Extension posturing with neck extension and rigid extension of limbs—worse sign
C. Localized tremor only
D. Only in spinal injury
Rationale: Decerebrate posture indicates brainstem dysfunction and worse prognosis.
Dysconjugate gaze means:
A. Normal coordinated eye movement
B. Paralysis or lack of coordination between the two eyes
, ESTUDYR
C. Pupil asymmetry only
D. Blink reflex absent
Rationale: Dysconjugate gaze shows cranial nerve or brainstem lesion affecting coordinated
eye movement.
Ocular palsies refer to:
A. Loss of pupillary reflex only
B. Dysfunction of one or more cranial nerves causing impaired eye movements
C. Photosensitivity only
D. Retinal detachment
Rationale: Ocular motor neuropathies produce palsies of eye movement.
The Doll’s-eye reflex tests:
A. Pupillary light reaction only
B. Brainstem integrity—eyes move with head rotation if brainstem intact
C. Corneal reflex only
D. Motor strength
Rationale: Presence of doll’s-eye indicates intact brainstem vestibulo-ocular reflex.
Cold caloric testing assesses:
A. Hearing acuity
B. Brainstem function by irrigating ear with cold water—eyes deviate toward irrigated side if
intact
C. Cerebellar function only
D. Smell sense
Rationale: Caloric testing evaluates vestibulo-ocular reflex and brainstem function.
A coup injury is:
A. Injury opposite to impact
B. Brain injury at the site of impact
C. Diffuse axonal shearing only
D. Infection after trauma
Rationale: Coup refers to direct impact injury at contact site.
A contrecoup injury occurs:
A. At the site of impact only
B. On opposite side of impact due to brain movement within skull
C. Only in penetrating trauma
D. As chronic ischemia
Rationale: Contrecoup results from rebound injury opposite the impact.
NSG 3280 EXAM 3 2025 MULTICHOICE ANSWERED
EXAM QUESTIONS WITH DETAILED RATIONALES
Primary brain injury refers to:
A. Reversible swelling after trauma
B. Secondary ischemia from hypoxia
C. Initial irreversible damage to the brain resulting from the traumatic event
D. Infection following trauma
Rationale: Primary injury is the direct, immediate damage at the moment of trauma.
Secondary brain injury is:
A. The initial impact injury
B. Insult to the brain subsequent to the original event causing progressive delayed cell death
C. Always reversible swelling
D. Viral encephalitis only
Rationale: Secondary injury evolves after the initial trauma (ischemia, edema, inflammation).
“Time is tissue” means:
A. Brain injury effects decrease over time
B. Only old tissue is damaged
C. The longer treatment is delayed, the more brain tissue is lost
D. Time heals tissue automatically
Rationale: Delays in treating brain injury increase irreversible tissue loss.
Primary mechanisms of brain injury include:
A. Infection, tumor, stroke
B. Ischemia, hypoxia, and increased intracranial pressure (ICP)
C. Autoimmunity only
D. Degeneration only
Rationale: These are main pathophysiologic processes causing brain cell death after trauma.
Three compartments of the cranium are:
A. Skull, scalp, dura
B. Brain tissue, cerebrospinal fluid (CSF), and blood
C. Atrium, ventricle, sinus
D. Meninges layers only
Rationale: Monro-Kellie components: brain, CSF, blood.
,ESTUDYR
Normal intracranial pressure (ICP) range is approximately:
A. 20–30 mm Hg
B. 0–15 mm Hg
C. 30–50 mm Hg
D. 50–70 mm Hg
Rationale: Normal ICP is low; sustained elevation above ~20 mm Hg is concerning.
If one intracranial compartment increases, the others typically:
A. Increase as well
B. Decrease to compensate
C. Remain unchanged
D. Cause instant herniation
Rationale: Compensatory mechanisms displace CSF or blood to maintain ICP.
If all three compartments increase simultaneously, what may occur?
A. Improved perfusion
B. Decreased ICP
C. Brain herniation
D. Skull expansion
Rationale: When compensatory capacity is exceeded, herniation can result.
A sudden decrease in CSF volume can lead to:
A. Seizures only
B. Hypertension
C. Brain herniation (due to pressure shifts)
D. Increased CSF production
Rationale: Rapid CSF loss can cause brain displacement and herniation.
In a patient with increased ICP, should you perform a lumbar puncture?
A. No—do not perform lumbar puncture
B. Yes—immediately
C. Only after mannitol
D. Only if CT shows no mass
Rationale: LP can precipitate herniation when ICP is elevated.
“Delirious” best describes:
A. Deep sleep from which patient cannot be aroused
B. Acutely disturbed state of mind with restlessness, illusions, incoherence
C. Chronic dementia only
,ESTUDYR
D. Minor confusion only
Rationale: Delirium is an acute fluctuating disturbance in attention and cognition.
“Obtunded” indicates:
A. Hyperalertness
B. Less than full alertness; falls asleep unless stimulated
C. Coma with no response
D. Normal awake state
Rationale: Obtundation is moderate reduction in arousal and responsiveness.
“Stuporous” means:
A. Fully alert
B. Deep sleep requiring vigorous stimulation; may not remain awake
C. Restless and agitated
D. Mild confusion only
Rationale: Stupor indicates severe depression of consciousness.
“Comatose” describes:
A. Mild sleepiness
B. Arousal with minimal stimuli
C. Unarousable state, no purposeful responses to even painful stimuli
D. Easily rousable with voice
Rationale: Coma is profound loss of consciousness.
Decorticate posturing is characterized by:
A. Limbs extended and rotated outward
B. Flexion of arms toward the core (arms flexed, legs extended)
C. No motor response
D. Random twitching only
Rationale: Decorticate indicates severe cortical/spinal damage with flexor posturing.
Decerebrate posturing is:
A. Less severe than decorticate
B. Extension posturing with neck extension and rigid extension of limbs—worse sign
C. Localized tremor only
D. Only in spinal injury
Rationale: Decerebrate posture indicates brainstem dysfunction and worse prognosis.
Dysconjugate gaze means:
A. Normal coordinated eye movement
B. Paralysis or lack of coordination between the two eyes
, ESTUDYR
C. Pupil asymmetry only
D. Blink reflex absent
Rationale: Dysconjugate gaze shows cranial nerve or brainstem lesion affecting coordinated
eye movement.
Ocular palsies refer to:
A. Loss of pupillary reflex only
B. Dysfunction of one or more cranial nerves causing impaired eye movements
C. Photosensitivity only
D. Retinal detachment
Rationale: Ocular motor neuropathies produce palsies of eye movement.
The Doll’s-eye reflex tests:
A. Pupillary light reaction only
B. Brainstem integrity—eyes move with head rotation if brainstem intact
C. Corneal reflex only
D. Motor strength
Rationale: Presence of doll’s-eye indicates intact brainstem vestibulo-ocular reflex.
Cold caloric testing assesses:
A. Hearing acuity
B. Brainstem function by irrigating ear with cold water—eyes deviate toward irrigated side if
intact
C. Cerebellar function only
D. Smell sense
Rationale: Caloric testing evaluates vestibulo-ocular reflex and brainstem function.
A coup injury is:
A. Injury opposite to impact
B. Brain injury at the site of impact
C. Diffuse axonal shearing only
D. Infection after trauma
Rationale: Coup refers to direct impact injury at contact site.
A contrecoup injury occurs:
A. At the site of impact only
B. On opposite side of impact due to brain movement within skull
C. Only in penetrating trauma
D. As chronic ischemia
Rationale: Contrecoup results from rebound injury opposite the impact.
