A nurse is gathering neurological data on a patient with a neurological injury and observes signs indicative of Cushing’s Triad.
The nurse understands that Cushing’s Triad is a nervous system response that could prevent which of the following conditions?

Brainstem ischemia

Tachycardia

Agonal breathing

Chest pain

Answer and Explanation

The Correct Answer is A

Choice A rationale
Cushing’s Triad, which includes bradycardia (low heart rate), irregular respiration, and widened pulse pressure, is a nervous system response that could prevent brainstem ischemia. Brainstem ischemia is a condition where there is insufficient blood flow to the brainstem, which can lead to cell death.
Choice B rationale

While tachycardia (high heart rate) is a serious condition, it is not typically prevented by Cushing’s Triad.
Choice C rationale
Agonal breathing, which is characterized by gasping, labored breathing, particularly when lying flat, is not typically prevented by Cushing’s Triad.
Choice D rationale
Chest pain is not typically prevented by Cushing’s Triad. Cushing’s Triad is a response to increased intracranial pressure, not a cardiac condition.

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Correct Answer is C

Explanation

Choice A rationale
Smoking is a risk factor for many health conditions, including headaches. However, it is not a common precipitating factor in both tension-type and cluster headaches.
Choice B rationale
Depression can be associated with both tension-type and cluster headaches, but it is not a common precipitating factor for these types of headaches.

Choice C rationale
Stress is a common precipitating factor for both tension-type and cluster headaches. Both types of headaches can be triggered by psychological factors like stress.
Choice D rationale
Poor posture can contribute to tension-type headaches by causing muscle tension in the neck and shoulders. However, it is not a common precipitating factor for cluster headaches.

A. Monitoring volume status B. Ensuring proper ventriculostomy transducer levels C. Managing sedation D. Elevating the head of the bed 15 degrees

Correct Answer is D

Explanation

Choice A rationale
Monitoring volume status is important in managing increased ICP, but it is not a direct intervention to reduce ICP78.
Choice B rationale

Ensuring proper ventriculostomy transducer levels is important in monitoring ICP, but it is not a direct intervention to reduce ICP78.
Choice C rationale
Managing sedation can help control agitation and excessive muscular activity, which can potentially increase ICP. However, it is not a direct intervention to reduce ICP78.
Choice D rationale
Elevating the head of the bed 15 degrees can help promote venous drainage, enhance cerebral perfusion, and reduce ICP78.

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A nurse is gathering neurological data on a patient with a neurological injury and observes signs indicative of Cushing’s Triad. The nurse understands that Cushing’s Triad is a nervous system response that could prevent which of the following conditions?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has headaches. Which of the following precipitating factors is common in both tension-type headaches and cluster headaches?

Correct Answer is C

Explanation

A nurse is caring for a client who has increased intracranial pressure. Which of the following interventions should the nurse plan to include in the plan of care?

Correct Answer is D

Explanation

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A nurse is gathering neurological data on a patient with a neurological injury and observes signs indicative of Cushing’s Triad.
The nurse understands that Cushing’s Triad is a nervous system response that could prevent which of the following conditions?