NUR 265 Exam 3 |150 Questions and Answers Plus Rationales | Fall
2025/2026 Update | 100% Correct -Galen College of Nursing.
.
Question 1
A client is admitted to the emergency department after a direct blow to the head. A CT scan
reveals a skull fracture where bone fragments are driven into the brain tissue. The nurse
identifies this as which type of fracture?
A) Linear skull fracture
B) Comminuted skull fracture
C) Depressed skull fracture
D) Basilar skull fracture
E) Compound skull fracture
Correct Answer: C) Depressed skull fracture
Rationale: A depressed skull fracture is characterized by the inward depression of the bone,
with fragments potentially bruising or penetrating the underlying brain tissue. These
fractures are often palpable and visible on imaging and typically require surgical
intervention to elevate the bone fragments.
Question 2
A client presents with ecchymosis around both eyes ("raccoon eyes") and behind the ear (Battle's
sign) after a head injury. The nurse also notes a clear, thin fluid leaking from the client's nose.
These findings are most indicative of which type of skull fracture?
A) Depressed skull fracture
B) Linear skull fracture
C) Temporal bone fracture
D) Basilar skull fracture
E) Frontal bone fracture
Correct Answer: D) Basilar skull fracture
Rationale: Basilar skull fractures occur at the base of the skull. The classic manifestations
include periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), and
leakage of cerebrospinal fluid (CSF) from the ears (otorrhea) or nose (rhinorrhea) due to a
tear in the dura mater.
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Question 3
A client with a severe head injury begins to vomit without preceding nausea. The nurse
recognizes this as a cardinal sign of which complication?
A) Meningitis
B) Hypovolemic shock
C) Increased intracranial pressure (ICP)
D) Spinal shock
E) Seizure activity
Correct Answer: C) Increased intracranial pressure (ICP)
Rationale: Vomiting, especially projectile vomiting that is not preceded by nausea, is a
classic sign of increased ICP. It is caused by pressure on the vomiting center (the
chemoreceptor trigger zone) in the medulla of the brainstem.
Question 4
A client sustains a head injury resulting in a temporary loss of consciousness for approximately
three minutes, with no significant findings on a CT scan. This type of injury is best described as
a:
A) Contusion
B) Concussion
C) Diffuse axonal injury
D) Subdural hematoma
E) Epidural hematoma
Correct Answer: B) Concussion
Rationale: A concussion is a mild traumatic brain injury classified as a diffuse brain injury.
It is characterized by a brief loss of consciousness (typically 5 minutes or less) and
temporary neurological dysfunction but without any structural damage visible on standard
imaging like a CT scan.
Question 5
A client is admitted with a severe diffuse axonal injury (DAI). The nurse would anticipate which
of the following clinical presentations?
A) A brief period of unconsciousness followed by a lucid interval.
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B) Immediate and prolonged coma, abnormal posturing, and systemic hypertension.
C) Focal neurological deficits corresponding to a specific area of the brain.
D) Severe headache and nuchal rigidity.
E) Symptoms that develop gradually over several weeks.
Correct answer: B) Immediate and prolonged coma, abnormal posturing, and systemic
hypertension.
Rationale: Severe DAI is one of the most devastating forms of traumatic brain injury,
caused by widespread shearing of axons. The injury often involves the brainstem, leading
to an immediate and prolonged loss of consciousness (coma), abnormal posturing
(decorticate or decerebrate), and autonomic dysfunction, such as hypertension and fever.
Question 6
An epidural hematoma is most commonly caused by the tearing of which blood vessel?
A) The bridging veins
B) The internal carotid artery
C) The middle meningeal artery
D) The sagittal sinus
E) The vertebral artery
Correct Answer: C) The middle meningeal artery
Rationale: An epidural hematoma is a collection of blood between the dura mater and the
inner surface of the skull. It is most often caused by a fracture of the temporal bone, which
lacerates the middle meningeal artery, leading to a rapid, high-pressure arterial bleed.
Question 7
A client is admitted after a fall and has an acute subdural hematoma. The nurse understands this
injury is caused by the tearing of:
A) An artery located on the surface of the brain.
B) The small dural sinuses.
C) The middle meningeal artery.
D) The bridging veins between the brain and the dura mater.
E) The arterioles within the brain tissue.
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Correct Answer: D) The bridging veins between the brain and the dura mater.
Rationale: A subdural hematoma is a collection of blood beneath the dura mater. It is
typically caused by the tearing of the bridging veins that drain blood from the surface of
the brain into the dural sinuses. Because it is a venous bleed, the onset of symptoms is
usually slower than with an arterial epidural hematoma.
Question 8
An older adult client with a history of alcoholism presents with gradual neurologic deterioration,
including drowsiness, inattentiveness, and personality changes over several weeks. Which type
of head injury should the nurse suspect?
A) Epidural hematoma
B) Acute subdural hematoma
C) Chronic subdural hematoma
D) Intracerebral hemorrhage
E) Concussion
Correct Answer: C) Chronic subdural hematoma
Rationale: Older adults and individuals with chronic alcoholism experience brain atrophy,
which stretches and weakens the bridging veins. Even a minor head injury can cause these
veins to tear, leading to a very slow, low-pressure bleed. The symptoms of a chronic
subdural hematoma are often insidious and develop over weeks to months.
Question 9
Following the surgical evacuation of a chronic subdural hematoma, why is the client often
positioned flat in bed?
A) To increase cerebral perfusion pressure.
B) To allow the brain to gradually re-expand and fill the cranial cavity.
C) To prevent a sudden drop in intracranial pressure.
D) To reduce the risk of postoperative seizures.
E) To promote drainage of cerebrospinal fluid.
Correct Answer: B) To allow the brain to gradually re-expand and fill the cranial cavity.
Rationale: After a large chronic subdural hematoma is evacuated, a significant space is left
between the brain and the dura. Placing the client flat allows the brain to slowly re-expand
2025/2026 Update | 100% Correct -Galen College of Nursing.
.
Question 1
A client is admitted to the emergency department after a direct blow to the head. A CT scan
reveals a skull fracture where bone fragments are driven into the brain tissue. The nurse
identifies this as which type of fracture?
A) Linear skull fracture
B) Comminuted skull fracture
C) Depressed skull fracture
D) Basilar skull fracture
E) Compound skull fracture
Correct Answer: C) Depressed skull fracture
Rationale: A depressed skull fracture is characterized by the inward depression of the bone,
with fragments potentially bruising or penetrating the underlying brain tissue. These
fractures are often palpable and visible on imaging and typically require surgical
intervention to elevate the bone fragments.
Question 2
A client presents with ecchymosis around both eyes ("raccoon eyes") and behind the ear (Battle's
sign) after a head injury. The nurse also notes a clear, thin fluid leaking from the client's nose.
These findings are most indicative of which type of skull fracture?
A) Depressed skull fracture
B) Linear skull fracture
C) Temporal bone fracture
D) Basilar skull fracture
E) Frontal bone fracture
Correct Answer: D) Basilar skull fracture
Rationale: Basilar skull fractures occur at the base of the skull. The classic manifestations
include periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), and
leakage of cerebrospinal fluid (CSF) from the ears (otorrhea) or nose (rhinorrhea) due to a
tear in the dura mater.
,[Type here]
Question 3
A client with a severe head injury begins to vomit without preceding nausea. The nurse
recognizes this as a cardinal sign of which complication?
A) Meningitis
B) Hypovolemic shock
C) Increased intracranial pressure (ICP)
D) Spinal shock
E) Seizure activity
Correct Answer: C) Increased intracranial pressure (ICP)
Rationale: Vomiting, especially projectile vomiting that is not preceded by nausea, is a
classic sign of increased ICP. It is caused by pressure on the vomiting center (the
chemoreceptor trigger zone) in the medulla of the brainstem.
Question 4
A client sustains a head injury resulting in a temporary loss of consciousness for approximately
three minutes, with no significant findings on a CT scan. This type of injury is best described as
a:
A) Contusion
B) Concussion
C) Diffuse axonal injury
D) Subdural hematoma
E) Epidural hematoma
Correct Answer: B) Concussion
Rationale: A concussion is a mild traumatic brain injury classified as a diffuse brain injury.
It is characterized by a brief loss of consciousness (typically 5 minutes or less) and
temporary neurological dysfunction but without any structural damage visible on standard
imaging like a CT scan.
Question 5
A client is admitted with a severe diffuse axonal injury (DAI). The nurse would anticipate which
of the following clinical presentations?
A) A brief period of unconsciousness followed by a lucid interval.
,[Type here]
B) Immediate and prolonged coma, abnormal posturing, and systemic hypertension.
C) Focal neurological deficits corresponding to a specific area of the brain.
D) Severe headache and nuchal rigidity.
E) Symptoms that develop gradually over several weeks.
Correct answer: B) Immediate and prolonged coma, abnormal posturing, and systemic
hypertension.
Rationale: Severe DAI is one of the most devastating forms of traumatic brain injury,
caused by widespread shearing of axons. The injury often involves the brainstem, leading
to an immediate and prolonged loss of consciousness (coma), abnormal posturing
(decorticate or decerebrate), and autonomic dysfunction, such as hypertension and fever.
Question 6
An epidural hematoma is most commonly caused by the tearing of which blood vessel?
A) The bridging veins
B) The internal carotid artery
C) The middle meningeal artery
D) The sagittal sinus
E) The vertebral artery
Correct Answer: C) The middle meningeal artery
Rationale: An epidural hematoma is a collection of blood between the dura mater and the
inner surface of the skull. It is most often caused by a fracture of the temporal bone, which
lacerates the middle meningeal artery, leading to a rapid, high-pressure arterial bleed.
Question 7
A client is admitted after a fall and has an acute subdural hematoma. The nurse understands this
injury is caused by the tearing of:
A) An artery located on the surface of the brain.
B) The small dural sinuses.
C) The middle meningeal artery.
D) The bridging veins between the brain and the dura mater.
E) The arterioles within the brain tissue.
, [Type here]
Correct Answer: D) The bridging veins between the brain and the dura mater.
Rationale: A subdural hematoma is a collection of blood beneath the dura mater. It is
typically caused by the tearing of the bridging veins that drain blood from the surface of
the brain into the dural sinuses. Because it is a venous bleed, the onset of symptoms is
usually slower than with an arterial epidural hematoma.
Question 8
An older adult client with a history of alcoholism presents with gradual neurologic deterioration,
including drowsiness, inattentiveness, and personality changes over several weeks. Which type
of head injury should the nurse suspect?
A) Epidural hematoma
B) Acute subdural hematoma
C) Chronic subdural hematoma
D) Intracerebral hemorrhage
E) Concussion
Correct Answer: C) Chronic subdural hematoma
Rationale: Older adults and individuals with chronic alcoholism experience brain atrophy,
which stretches and weakens the bridging veins. Even a minor head injury can cause these
veins to tear, leading to a very slow, low-pressure bleed. The symptoms of a chronic
subdural hematoma are often insidious and develop over weeks to months.
Question 9
Following the surgical evacuation of a chronic subdural hematoma, why is the client often
positioned flat in bed?
A) To increase cerebral perfusion pressure.
B) To allow the brain to gradually re-expand and fill the cranial cavity.
C) To prevent a sudden drop in intracranial pressure.
D) To reduce the risk of postoperative seizures.
E) To promote drainage of cerebrospinal fluid.
Correct Answer: B) To allow the brain to gradually re-expand and fill the cranial cavity.
Rationale: After a large chronic subdural hematoma is evacuated, a significant space is left
between the brain and the dura. Placing the client flat allows the brain to slowly re-expand
