NSG 430 Exam 3: (Latest 2026/2027 Update) Neurology, Renal
Disorders, Spinal Cord Injury, & Critical Care | Q&A | Grade A | 100%
Correct (Verified Answers)
Subject: Advanced Medical-Surgical / Neurology & Renal
Source: NSG 430 Exam 3 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What is meningitis?
Correct Answer: Inflammation of the meninges. Bacterial most often caused by
streptococcus pneumoniae (ear infection, sinus infection, head trauma, dental therapy, etc).
S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion followed by straighten of
leg causes pain), Brudzinski's sign (flexion of neck causes flexion of hips and knees), fever,
confusion, irritability, skin rashes. Diagnostics: CBC, CRP, blood cultures, lumbar puncture
(cloudy CSF abnormal, WBC and protein elevated, decreased glucose in bacterial
meningitis). Management: Droplet precautions at least 24 hours, supportive care for viral
infections, anti-seizure medications, seizure precautions, steroids, monitor/decrease ICP.
1. Kernig and Brudzinski signs indicate meningeal irritation.
2. LP shows low glucose, high protein, elevated WBC in bacterial meningitis.
3. Dexamethasone reduces inflammation and hearing loss risk.
2: What is a lumbar puncture and what are nursing considerations?
Correct Answer: Requires informed consent. Ask patient to empty bladder (must lay flat for
1 hour after). Positioning: Lateral recumbent preferred (can measure CSF pressure). Tripod
or orthopneic position if LR contraindicated (higher risk of disc herniation, cannot measure
CSF pressure). Strict sterile technique. Contraindicated in increased ICP if space-occupying
lesions. Post-op: Occlusive dressing (do not remove), monitor for bleeding or CSF leakage,
supine x 1 hour, push fluids to prevent headache, monitor I&O, alert provider immediately if
leakage (may use blood patch). Nursing considerations: Bedrest as ordered, monitor VS,
quiet and nonstimulating environment, antipyretics, antibiotics, analgesics, seizure
precautions, monitor for increased ICP, isolation precautions, elevate HOB 30 degrees and
avoid neck flexion and extreme hip flexion. Prevention: Vaccine, prophylactic abx for close
exposure. EBP recommends checking head CT before LP to rule out space occupying lesion.
1. Lateral recumbent allows measurement of opening pressure.
2. CSF leak requires blood patch to prevent headache and infection.
3. Head CT before LP prevents brain herniation if mass present.
, 3: What are brain tumors?
Correct Answer: Classified as benign or malignant and primary or secondary. Most
commonly secondary tumors in the brain. S/S: Headache (severe, especially upon
awakening), papilledema (swelling of optic disc), seizures, increased ICP, unequal pupil size,
bradycardia, HTN, N/V, hemiparesis, altered mentation. Diagnostics: Neurological exam,
EEG, LP, MRI, PET scan, biopsy. Treatment: Radiation, dexamethasone, chemo, dilantin (anti-
seizure), mannitol (osmotic diuretic), anticoagulants, surgery (gamma knife, craniotomy,
stereotactic). Complications: Increased ICP, herniation/ischemia, rupture/hemorrhage,
seizures, hydrocephalus, SIADH/DI/pituitary dysfunction, fluid/electrolyte imbalances. Care:
Frequent neuro checks, monitor VS, pain management, positioning (upright unless
contraindicated), decrease stimuli, prevent increased ICP, aspiration risk, seizure
precautions.
1. Dexamethasone reduces peritumoral edema.
2. Mannitol for acute ICP elevation.
3. Seizure prophylaxis with phenytoin or levetiracetam.
4: What are spinal cord tumors?
Correct Answer: Classified based on anatomic location. Intramedullary: within the cord.
Extramedullary: extradural, outside of the dural membrane. S/S: Pain, weakness, loss of
motor and sensory function. Treatment: related to type of tumor and location, usually
surgery and measures to relieve compression (dexamethasone with radiation). Nursing care:
Oral hygiene before meals (to stimulate appetite), plan meals for comfortable times, offer
preferred foods, daily weights, dietary supplements.
1. Intramedullary tumors more difficult to resect.
2. Dexamethasone reduces cord edema and preserves function.
3. Monitor for worsening neurologic deficits post-op.
5: What is encephalitis?
Correct Answer: Inflammation of the brain tissue itself (most often viral). May be caused by
herpes simplex. S/S: Severe headache, fever, confusion, nausea/vomiting, alterations in LOC,
bizarre behavior, S/S of increased ICP. Hx: Recent illness, herpes simplex, west nile, EEE,
warm climates. Dx: MRI/CT (may show small hemorrhagic lesions), lumbar puncture, CBC,
blood cultures, throat cultures, EEG, brain biopsy. Care: Isolation precautions (droplet),
supportive care, antibiotics if bacterial, pain/fever control, steroids, monitor and decreased
ICP, antivirals, maintain bedrest as ordered, nonstimulating environment, neuro assessments
every 2-4 hours, seizure precautions.
1. HSV encephalitis treated with acyclovir.
2. Temporal lobe involvement common in HSV.
3. EEG may show periodic lateralized epileptiform discharges.
6: What are head injuries and the difference between primary and secondary injury?
Correct Answer: Primary injury: caused by the initial trauma. Secondary injury: result of the
damage of the initial insult. Assume patients with head injuries also have spinal injuries until
ruled out.
1. Secondary injury causes more morbidity than primary injury.
2. Prevention of hypotension and hypoxia reduces secondary injury.
3. C-spine immobilization until cleared.
Disorders, Spinal Cord Injury, & Critical Care | Q&A | Grade A | 100%
Correct (Verified Answers)
Subject: Advanced Medical-Surgical / Neurology & Renal
Source: NSG 430 Exam 3 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What is meningitis?
Correct Answer: Inflammation of the meninges. Bacterial most often caused by
streptococcus pneumoniae (ear infection, sinus infection, head trauma, dental therapy, etc).
S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion followed by straighten of
leg causes pain), Brudzinski's sign (flexion of neck causes flexion of hips and knees), fever,
confusion, irritability, skin rashes. Diagnostics: CBC, CRP, blood cultures, lumbar puncture
(cloudy CSF abnormal, WBC and protein elevated, decreased glucose in bacterial
meningitis). Management: Droplet precautions at least 24 hours, supportive care for viral
infections, anti-seizure medications, seizure precautions, steroids, monitor/decrease ICP.
1. Kernig and Brudzinski signs indicate meningeal irritation.
2. LP shows low glucose, high protein, elevated WBC in bacterial meningitis.
3. Dexamethasone reduces inflammation and hearing loss risk.
2: What is a lumbar puncture and what are nursing considerations?
Correct Answer: Requires informed consent. Ask patient to empty bladder (must lay flat for
1 hour after). Positioning: Lateral recumbent preferred (can measure CSF pressure). Tripod
or orthopneic position if LR contraindicated (higher risk of disc herniation, cannot measure
CSF pressure). Strict sterile technique. Contraindicated in increased ICP if space-occupying
lesions. Post-op: Occlusive dressing (do not remove), monitor for bleeding or CSF leakage,
supine x 1 hour, push fluids to prevent headache, monitor I&O, alert provider immediately if
leakage (may use blood patch). Nursing considerations: Bedrest as ordered, monitor VS,
quiet and nonstimulating environment, antipyretics, antibiotics, analgesics, seizure
precautions, monitor for increased ICP, isolation precautions, elevate HOB 30 degrees and
avoid neck flexion and extreme hip flexion. Prevention: Vaccine, prophylactic abx for close
exposure. EBP recommends checking head CT before LP to rule out space occupying lesion.
1. Lateral recumbent allows measurement of opening pressure.
2. CSF leak requires blood patch to prevent headache and infection.
3. Head CT before LP prevents brain herniation if mass present.
, 3: What are brain tumors?
Correct Answer: Classified as benign or malignant and primary or secondary. Most
commonly secondary tumors in the brain. S/S: Headache (severe, especially upon
awakening), papilledema (swelling of optic disc), seizures, increased ICP, unequal pupil size,
bradycardia, HTN, N/V, hemiparesis, altered mentation. Diagnostics: Neurological exam,
EEG, LP, MRI, PET scan, biopsy. Treatment: Radiation, dexamethasone, chemo, dilantin (anti-
seizure), mannitol (osmotic diuretic), anticoagulants, surgery (gamma knife, craniotomy,
stereotactic). Complications: Increased ICP, herniation/ischemia, rupture/hemorrhage,
seizures, hydrocephalus, SIADH/DI/pituitary dysfunction, fluid/electrolyte imbalances. Care:
Frequent neuro checks, monitor VS, pain management, positioning (upright unless
contraindicated), decrease stimuli, prevent increased ICP, aspiration risk, seizure
precautions.
1. Dexamethasone reduces peritumoral edema.
2. Mannitol for acute ICP elevation.
3. Seizure prophylaxis with phenytoin or levetiracetam.
4: What are spinal cord tumors?
Correct Answer: Classified based on anatomic location. Intramedullary: within the cord.
Extramedullary: extradural, outside of the dural membrane. S/S: Pain, weakness, loss of
motor and sensory function. Treatment: related to type of tumor and location, usually
surgery and measures to relieve compression (dexamethasone with radiation). Nursing care:
Oral hygiene before meals (to stimulate appetite), plan meals for comfortable times, offer
preferred foods, daily weights, dietary supplements.
1. Intramedullary tumors more difficult to resect.
2. Dexamethasone reduces cord edema and preserves function.
3. Monitor for worsening neurologic deficits post-op.
5: What is encephalitis?
Correct Answer: Inflammation of the brain tissue itself (most often viral). May be caused by
herpes simplex. S/S: Severe headache, fever, confusion, nausea/vomiting, alterations in LOC,
bizarre behavior, S/S of increased ICP. Hx: Recent illness, herpes simplex, west nile, EEE,
warm climates. Dx: MRI/CT (may show small hemorrhagic lesions), lumbar puncture, CBC,
blood cultures, throat cultures, EEG, brain biopsy. Care: Isolation precautions (droplet),
supportive care, antibiotics if bacterial, pain/fever control, steroids, monitor and decreased
ICP, antivirals, maintain bedrest as ordered, nonstimulating environment, neuro assessments
every 2-4 hours, seizure precautions.
1. HSV encephalitis treated with acyclovir.
2. Temporal lobe involvement common in HSV.
3. EEG may show periodic lateralized epileptiform discharges.
6: What are head injuries and the difference between primary and secondary injury?
Correct Answer: Primary injury: caused by the initial trauma. Secondary injury: result of the
damage of the initial insult. Assume patients with head injuries also have spinal injuries until
ruled out.
1. Secondary injury causes more morbidity than primary injury.
2. Prevention of hypotension and hypoxia reduces secondary injury.
3. C-spine immobilization until cleared.
