A nurse is assessing a client who has suffered a traumatic brain injury. When the nurse applies a stimuli to the client, which of the following responses by the client indicates that the client has suffered an extensive cervical spine injury?

Choice A Reason: This is incorrect because inability to recognize any words may indicate a problem with the auditory cortex, which is the part of the brain that processes sound, not the inner ear. The inner ear consists of the cochlea, which converts sound waves into nerve impulses, and the vestibular system, which helps with balance and orientation.

Choice B Reason: This is correct because loss of balance is a common symptom of an inner ear infection. An inner ear infection can cause inflammation and fluid buildup in the vestibular system, which can disrupt the sense of equilibrium and cause vertigo, dizziness, or nausea.

Choice C Reason: This is incorrect because twitching of the cheek may indicate a problem with the facial nerve, which controls the muscles of facial expression, not the inner ear. The facial nerve runs close to the inner ear, but it is not part of it.

Choice D Reason: This is incorrect because lack of air sound may indicate a problem with the outer or middle ear, which transmit sound waves to the inner ear, not the inner ear itself. The outer ear consists of the pinna and the ear canal, and the middle ear consists of the eardrum and the ossicles.

Choice A Reason: Increasing protein from red meat is not part of client education, as it can worsen the condition and increase the risk of complications. Red meat is high in fat and low in fiber, which can cause constipation and increase the pressure in the colon. Diverticulosis is a condition where small pouches or sacs form in the wall of the colon due to weak spots or increased pressure.

Choice B Reason: Decreasing fluid intake is not part of client education, as it can worsen the condition and increase the risk of complications. Fluid intake should be increased to prevent dehydration and promote bowel movements. Diverticulosis can cause abdominal pain, bloating, cramping, and changes in bowel habits.

Choice C Reason: Incorporating soft foods that are pureed in consistency is not part of client education, as it can worsen the condition and increase the risk of complications. Soft foods are low in fiber and can cause constipation and increase the pressure in the colon. Diverticulosis can lead to diverticulitis, which is inflammation or infection of the pouches or sacs.

Choice D Reason: This is the correct choice. Increasing dietary fiber is part of client education, as it can improve the condition and prevent complications. Fiber helps soften the stool and reduce the pressure in the colon. Diverticulosis can be managed by eating a high-fiber diet, drinking plenty of fluids, exercising regularly, and avoiding straining or holding stools.