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 D

Explanation

Choice A rationale
This statement is incorrect. Nerves do not “go to sleep.”. Peripheral neuropathy in diabetes is caused by damage to the nerves as a result of high blood sugar levels over time.
Choice B rationale
This statement is incorrect. While nerve damage can occur due to various reasons, in the context of diabetes, it is primarily due to prolonged high blood sugar levels.
Choice C rationale
This statement is incorrect. Age and blood flow to the feet are not the primary causes of peripheral neuropathy in diabetes. The primary cause is prolonged high blood sugar levels.
Choice D rationale
This statement is correct. Prolonged high blood sugar levels in diabetes can cause damage to the peripheral nerves, leading to peripheral neuropathy.

A. A contrecoup injury is not viewed as a “true” injury, while a coup injury can have more severe consequences. B. Contrecoup injuries are generally less severe and heal more quickly over time. C. The coup injury is the primary point of injury, with the contrecoup injury occurring on the brain’s opposite side. D. The coup injury happens secondary to the contrecoup injury but does not impact the brain’s blood supply.

Correct Answer is C

Explanation

Choice A rationale
A contrecoup injury is indeed a “true” injury. It occurs on the side of the brain opposite to the point of impact and can have severe consequences, including brain damage. Therefore, this statement is incorrect.
Choice B rationale
The severity and healing time of contrecoup injuries can vary greatly depending on the force and location of the impact, as well as individual health factors. It’s not accurate to say that contrecoup injuries are generally less severe and heal more quickly over time.
Choice C rationale
This statement is correct. A coup injury refers to the brain damage that occurs directly under the point of impact, while a contrecoup injury occurs on the opposite side of the brain from

where the head is struck. These injuries can occur separately or together, but if the blow is strong enough, they usually appear together.
Choice D rationale
The sequence of coup and contrecoup injuries is not as this choice describes. The coup injury happens at the point of impact, and the contrecoup injury happens when the brain rebounds and hits the opposite side of the skull. Both types of injuries can impact the brain’s blood supply.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with uncontrolled diabetes mellitus reports experiencing numbness and tingling in their feet that disrupts their sleep.The nurse explains this as a nerve disorder known as peripheral neuropathy. Which statement by the client indicates they understand the cause of this condition?

Correct Answer is D

Explanation

A newly licensed nurse is learning about coup and contrecoup injuries. Which statement by the newly licensed nurse demonstrates a clear understanding of the topic?

Correct Answer is C

Explanation

A nurse is caring for a client who has sustained a neurologic injury with increased intracranial pressure and decreased cerebral perfusion. Which of the following will maintain cerebral perfusion pressure constant?

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?

A nurse is planning care for a client who has increased intracranial pressure. The nurse should understand that enteral nutrition should begin within 24 to 48 hr to help prevent which of the following complications?

A nurse is caring for a client who has increased intracranial pressure and has a worsening neurological condition. Which of the following cues should the nurse recognize as a worsening condition?

A nurse is responsible for six patients. Which of the following patients are at risk for developing peripheral neuropathy (PN)? (Select all that apply.)

The nurse is assisting with planning care for a client who has a subarachnoid hemorrhage (SAH). Which of the following relates to a high mortality rate for a client who has an SAH?

A nurse is caring for a patient experiencing acute pain following a knee injury. The nurse is educating the patient about pain management strategies to use at home.Which of the following non-pharmacological methods of pain relief should the nurse include in their teaching?

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?

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?