What is one of the earliest signs of increased intracranial pressure (ICP)?
Cushing triad.
Decreased level of consciousness (LOC).
Headache.
Coma.
The Correct Answer is B
Choice A rationale
Cushing triad is a late sign of increased ICP, characterized by bradycardia, hypertension, and irregular respirations, appearing after other symptoms like decreased LOC.
Choice B rationale
Decreased LOC is one of the earliest signs of increased ICP as it reflects the brain's response to pressure changes, alerting the need for immediate intervention.
Choice C rationale
Headache can be an early sign but is not as sensitive or specific as changes in LOC when assessing for increased ICP.
Choice D rationale
Coma is a late sign of significantly increased ICP, indicating severe brain dysfunction, often following initial symptoms like decreased LOC.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
The occipital lobe is responsible for processing visual information and does not play a significant role in spatial relationships.
Choice B rationale
The frontal lobe is involved in higher cognitive functions, decision-making, and voluntary movements, but it is not primarily responsible for spatial relationships.
Choice C rationale
The temporal lobe is involved in auditory processing, language comprehension, and memory formation. It is not primarily responsible for spatial relationships.
Choice D rationale
The parietal lobe is responsible for processing sensory information and plays a crucial role in spatial relationships, helping to understand and navigate the environment.
Correct Answer is B
Explanation
Choice A rationale
Scoliosis refers to a lateral curvature of the spine, not an exaggeration of the lumbar spine curve, which is characterized by lordosis.
Choice B rationale
Lordosis is an exaggerated inward curve of the lumbar spine, often referred to as swayback. This condition is identified by the nurse as the client presents with an exaggerated lumbar curve.
Choice C rationale
Kyphosis describes an excessive outward curvature of the thoracic spine, resulting in a hunched back, not the lumbar spine.
Choice D rationale
Dowager's hump is a term commonly associated with kyphosis, characterized by a pronounced curvature of the upper back, not the lumbar region.
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