Which three symptoms are characteristic of Cushing triad associated with increased ICP?
Bradycardia, hypertension, and widening pulse pressure
Widening pulse pressure, headache, and seizure
Hypertension, tachycardia, and headache
Hypotension, tachycardia, and narrowing pulse pressure
The Correct Answer is A
A. Bradycardia, hypertension, and widening pulse pressure
This combination of symptoms is characteristic of Cushing's triad. Bradycardia (slow heart rate), hypertension (elevated blood pressure), and widening pulse pressure (difference between systolic and diastolic blood pressure) are indicative of increased ICP, specifically resulting in the compression of brain structures that regulate vital functions.
B. Widening pulse pressure, headache, and seizure
While headache and seizure may occur in patients with increased ICP, widening pulse pressure alone is not sufficient to meet the criteria of Cushing's triad. The presence of bradycardia and hypertension, along with widening pulse pressure, is more indicative of Cushing's triad.
C. Hypertension, tachycardia, and headache
Hypertension and headache may occur in patients with increased ICP, but the absence of bradycardia and widening pulse pressure makes this option less characteristic of Cushing's triad.
D. Hypotension, tachycardia, and narrowing pulse pressure
Hypotension (low blood pressure) and narrowing pulse pressure are not typically associated with Cushing's triad. Tachycardia (rapid heart rate) may occur in response to increased ICP, but it is usually accompanied by bradycardia rather than hypotension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["15"]
Explanation
To calculate the dose of phenytoin suspension, the nurse should use the following formula:
Dose (mL) = Desired dose (mg) / Concentration (mg/mL) x Volume (mL)
Plugging in the values from the question, we get:
Dose (mL) = 75 mg / (25 mg/5 mL) x 5 mL
Dose (mL) = 15 mL
Therefore, the nurse should administer 15 mL of phenytoin suspension to the patient
Correct Answer is D
Explanation
A. Dizziness and problems with balance
While dizziness and problems with balance can occur more frequently in older adults due to age-related changes in the vestibular system and other factors, persistent or severe dizziness or balance issues should be evaluated further as they could indicate underlying neurological or medical conditions.
B. Slow papillary response to light
This finding may be considered abnormal, especially if it represents a significant change from the individual's baseline. While age-related changes in pupil function can occur, a slow or sluggish pupillary response to light may indicate dysfunction of the oculomotor nerve or other neurological issues and should be investigated further.
C. Jerky eye movements
Jerky eye movements, such as nystagmus, can be abnormal and may indicate dysfunction of the vestibular system or other neurological conditions. While some degree of nystagmus can occur with age, persistent or severe jerky eye movements should be evaluated further.
D. Absence of the Achilles tendon jerk
This finding may also be considered abnormal. The Achilles tendon reflex, tested using the deep tendon reflex (DTR) examination, can diminish with age but should not be completely absent in the absence of specific medical conditions affecting the reflex arc or spinal cord function.
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