Which signs are manifestations of the Cushing triad? Select all that apply.
Bradycardia.
Bradypnea.
Hypertension.
Tachycardia.
Correct Answer : A,B,C
Choice A rationale
Bradycardia (slow heart rate) is one of the key components of Cushing's triad, which indicates increased intracranial pressure and impending herniation.
Choice B rationale
Bradypnea (slow respiratory rate) is another manifestation of Cushing's triad and reflects brainstem compression.
Choice C rationale
Hypertension (high blood pressure) is the third component of Cushing's triad, resulting from the body's attempt to maintain cerebral perfusion.
Choice D rationale
Tachycardia (rapid heart rate) is not a sign of Cushing's triad and is not associated with increased intracranial pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Autolytic debridement is the natural process by which the body breaks down and removes dead tissue. Moisture-retentive dressings create an optimal environment for this process, facilitating wound healing.
Choice B rationale
Decreasing epidermal resurfacing is not a recognized benefit of moisture-retentive dressings. These dressings aim to promote healing, not inhibit epidermal growth.
Choice C rationale
While moisture-retentive dressings can help with the absorption of topical medications, this is not their main advantage. The primary benefit is creating a conducive environment for autolytic debridement.
Choice D rationale
Promoting the formation of a protective scab that traps excess exudate is not the main advantage of moisture-retentive dressings. In fact, these dressings help manage exudate and reduce the risk of infection without forming a scab.
Correct Answer is A
Explanation
Choice A rationale
Expressing satisfaction with the ability to perform Activities of Daily Living (ADLs) is a realistic and client-centered goal for managing osteoarthritis. It focuses on the client's quality of life and functional ability, which is essential in chronic conditions like OA.
Choice B rationale
Adhering to the prescribed plan of care is important for managing OA, but it is more of an ongoing process than a specific goal. The focus should be on the client's functional outcomes and overall well-being.
Choice C rationale
Osteoarthritis is a chronic condition that cannot be cured within six months. Recovery in the context of OA usually refers to managing symptoms and improving quality of life rather than a complete resolution of the disease.
Choice D rationale
Denying signs or symptoms of OA is unrealistic for a chronic condition. The goal should be managing symptoms effectively and maintaining functional ability rather than complete absence of symptoms.
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