A client is experiencing decorticate posturing. Which assessment finding would the nurse expect to observe in this client?

Flexion and internal rotation of upper extremities

Flexion and external rotation of upper extremities

Extension and internal rotation of upper extremities

Extension and external rotation of upper extremities

Answer and Explanation

The Correct Answer is A

A.   This description accurately depicts decorticate posturing. The characteristic feature of decorticate posturing is the flexion of the upper extremities (arms) and the extension of the lower extremities (legs). The internal rotation of the legs is often observed in this posture. This pattern is seen in severe brain damage, particularly involving the corticospinal tract.
B.   External rotation of the arms is not characteristic of decorticate posturing. In decorticate posturing, the arms are flexed and positioned close to the body, with internal rotation being more typical. Therefore, this option does not accurately describe decorticate posturing.
C.   Extension of the arms is more characteristic of decerebrate posturing rather than decorticate posturing. Decerebrate posturing involves the extension of both the arms and legs. Internal rotation of the arms is not a typical feature of decerebrate posturing, so this choice does not describe decorticate posturing.
D.   Extension and external rotation of the arms describe decerebrate posturing rather than decorticate posturing. Decerebrate posturing is characterized by the extension of the arms and legs, not flexion. Therefore, this option does not describe decorticate posturing.

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Correct Answer is C

Explanation

A. This is the action of medications like anticholinergics, not lidocaine.
B. Lidocaine does have local anesthetic properties, but it's not used in this context to relieve pain. It's used for its anti-arrhythmic properties.
C. Lidocaine is a class IB anti-arrhythmic medication. It suppresses abnormal heart rhythms, making it a crucial drug in treating cardiac arrest.
D. This is the action of thrombolytic medications like tissue plasminogen activator (tPA), not lidocaine.

A. 8 B. 1 C. 3 D. 9

Correct Answer is D

Explanation

The client opens his eyes in response to voice, which scores 3 on the eye-opening part of the GCS.

Since the client does not understand questions, this would likely score 1 for verbal response, indicating incomprehensible sounds.

The motor response of bringing an arm up to a trapezius squeeze is localizing pain, which would score 5.

Therefore, the nurse would document the client's GCS score as E3V1M5, which totals to 9 out of a possible 15 points.

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A client is experiencing decorticate posturing. Which assessment finding would the nurse expect to observe in this client?

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Naxlex Comprehensive Predictor Exams

A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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