NSG 3280 EXAM 3 PATHOPHYSIOLOGY —
COMPLETE 150-QUESTION PRACTICE EXAM
Galen College of Nursing | 2026/2027 | Questions with
Answers & Rationales
SECTION 1: INCREASED INTRACRANIAL PRESSURE (ICP) & TRAUMATIC
BRAIN INJURY (Questions 1-35)
1. What assessment finding is the earliest indicator of increasing intracranial
pressure (ICP) in a client with acute brain injury?
A. Fixed dilated pupils
B. Change in level of consciousness
C. Cushing triad
D. Decerebrate posturing
Correct Answer: B
Rationale: A change in 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.
2. The normal range of ICP is:
A. 0-5 mm Hg
B. 0-15 mm Hg
,C. 15-30 mm Hg
D. 30-45 mm Hg
Correct Answer: B
*Rationale: Normal ICP ranges from 0-15 mm Hg. Sustained pressures above
20 mm Hg are considered elevated and require intervention.*
3. If all three compartments of the cranium remain fixed and one
compartment increases, what can happen?
A. Increased cerebral perfusion
B. Possible brain herniation
C. Decreased blood pressure
D. Spontaneous resolution
Correct Answer: B
Rationale: The Monro-Kellie doctrine states the cranial vault is a fixed
volume. If one component (brain tissue, CSF, or blood) increases, others
must decrease to compensate. When compensation fails, ICP rises and brain
herniation can occur.
4. A client with suspected increased ICP develops 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: B
Rationale: Headache, vomiting (often projectile), and blurred vision
,(papilledema) are early signs of increased ICP. Late signs include Cushing
triad and posturing.
5. A client's Glasgow Coma Scale (GCS) score is 8. How should the nurse
interpret this finding?
A. Mild TBI
B. Moderate TBI
C. Severe TBI
D. Normal neurologic function
Correct Answer: C
*Rationale: GCS classification: Mild TBI = 13-15, Moderate = 9-12, Severe = 8
or less. A score of 8 or less indicates severe TBI and often correlates with
coma.*
6. The three components of the cranium include:
A. Brain tissue, CSF, and blood
B. Brain tissue, water, and electrolytes
C. Neurons, glial cells, and meninges
D. Gray matter, white matter, and ventricles
Correct Answer: A
Rationale: The cranial vault contains three volume components: brain tissue
(80%), cerebrospinal fluid (10%), and blood (10%).
7. GCS is taken first ______ hours after a TBI.
A. 24
B. 48
, C. 72
D. 96
Correct Answer: B
Rationale: The Glasgow Coma Scale is typically assessed within the first 48
hours after traumatic brain injury to establish baseline and monitor for
deterioration.
8. If a patient has increased ICP, should you perform a lumbar puncture?
A. Yes, it is diagnostic and therapeutic
B. Yes, but only with ultrasound guidance
C. No, it could cause brain herniation
D. No, it is only contraindicated in meningitis
Correct Answer: C
Rationale: Lumbar puncture is contraindicated in the presence of increased
ICP because the sudden release of CSF pressure below the level of the
brainstem can cause downward herniation.
9. Primary injury in TBI refers to:
A. Progressive delayed cell death
B. Initial damage from the traumatic event that is not reversible
C. Cerebral edema occurring 24-48 hours after injury
D. Ischemic damage from hypotension
Correct Answer: B
Rationale: Primary injury is the initial mechanical damage occurring at the
moment of impact. It is immediate and not reversible.
COMPLETE 150-QUESTION PRACTICE EXAM
Galen College of Nursing | 2026/2027 | Questions with
Answers & Rationales
SECTION 1: INCREASED INTRACRANIAL PRESSURE (ICP) & TRAUMATIC
BRAIN INJURY (Questions 1-35)
1. What assessment finding is the earliest indicator of increasing intracranial
pressure (ICP) in a client with acute brain injury?
A. Fixed dilated pupils
B. Change in level of consciousness
C. Cushing triad
D. Decerebrate posturing
Correct Answer: B
Rationale: A change in 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.
2. The normal range of ICP is:
A. 0-5 mm Hg
B. 0-15 mm Hg
,C. 15-30 mm Hg
D. 30-45 mm Hg
Correct Answer: B
*Rationale: Normal ICP ranges from 0-15 mm Hg. Sustained pressures above
20 mm Hg are considered elevated and require intervention.*
3. If all three compartments of the cranium remain fixed and one
compartment increases, what can happen?
A. Increased cerebral perfusion
B. Possible brain herniation
C. Decreased blood pressure
D. Spontaneous resolution
Correct Answer: B
Rationale: The Monro-Kellie doctrine states the cranial vault is a fixed
volume. If one component (brain tissue, CSF, or blood) increases, others
must decrease to compensate. When compensation fails, ICP rises and brain
herniation can occur.
4. A client with suspected increased ICP develops 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: B
Rationale: Headache, vomiting (often projectile), and blurred vision
,(papilledema) are early signs of increased ICP. Late signs include Cushing
triad and posturing.
5. A client's Glasgow Coma Scale (GCS) score is 8. How should the nurse
interpret this finding?
A. Mild TBI
B. Moderate TBI
C. Severe TBI
D. Normal neurologic function
Correct Answer: C
*Rationale: GCS classification: Mild TBI = 13-15, Moderate = 9-12, Severe = 8
or less. A score of 8 or less indicates severe TBI and often correlates with
coma.*
6. The three components of the cranium include:
A. Brain tissue, CSF, and blood
B. Brain tissue, water, and electrolytes
C. Neurons, glial cells, and meninges
D. Gray matter, white matter, and ventricles
Correct Answer: A
Rationale: The cranial vault contains three volume components: brain tissue
(80%), cerebrospinal fluid (10%), and blood (10%).
7. GCS is taken first ______ hours after a TBI.
A. 24
B. 48
, C. 72
D. 96
Correct Answer: B
Rationale: The Glasgow Coma Scale is typically assessed within the first 48
hours after traumatic brain injury to establish baseline and monitor for
deterioration.
8. If a patient has increased ICP, should you perform a lumbar puncture?
A. Yes, it is diagnostic and therapeutic
B. Yes, but only with ultrasound guidance
C. No, it could cause brain herniation
D. No, it is only contraindicated in meningitis
Correct Answer: C
Rationale: Lumbar puncture is contraindicated in the presence of increased
ICP because the sudden release of CSF pressure below the level of the
brainstem can cause downward herniation.
9. Primary injury in TBI refers to:
A. Progressive delayed cell death
B. Initial damage from the traumatic event that is not reversible
C. Cerebral edema occurring 24-48 hours after injury
D. Ischemic damage from hypotension
Correct Answer: B
Rationale: Primary injury is the initial mechanical damage occurring at the
moment of impact. It is immediate and not reversible.
