A nurse is collecting data from a client who has increased intracranial pressure and is informed by the charge nurse that the client demonstrates decorticate posturing. Which of the following findings should the nurse expect to observe?
Extension of the extremities
External rotation of the lower extremities
Pronation of the hands
Plantar flexion of the legs
The Correct Answer is D
a. Decorticate posturing is marked by the flexion of the arms, with the hands clenched into fists and the legs extended and internally rotated.
b. External rotation of the lower extremities is not a characteristic of decorticate posturing. In decorticate posture, legs are held out straight.
c. Pronation of the hands is characteristic of decerebrate posturing, where the arms are extended and pronated.
d. In decorticate posturing, the lower extremities typically exhibit plantar flexion. Additionally, the upper extremities show flexion of the arms, wrists, and fingers with adduction of the arms.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The nurse should instruct the client to elevate the affected ankle to the level of the heart. Elevation helps to reduce swelling and pain by promoting venous return and decreasing blood flow to the injured area. This is an important part of the RICE (Rest, Ice, Compression, Elevation) method for treating sprains and strains.
a. The elastic compression dressing should not be applied so tight that it causes numbness in the toes and ankle.
b. The client should avoid placing weight on the affected leg when walking until advised by a healthcare provider.
d. Heat should not be applied during the first 24 hours after a sprain as it can increase swelling and inflammation.
Correct Answer is C
Explanation
The nurse should anticipate that the provider will initially prescribe acetaminophen to the client who has a new diagnosis of osteoarthritis. Acetaminophen (Tylenol, others) has been shown to help some people with osteoarthritis who have mild to moderate pain². It is often used as a first-line treatment for osteoarthritis pain.
a. Hyaluronic acid is not typically the first medication prescribed for osteoarthritis.
b. Ibuprofen may be prescribed for osteoarthritis but is not typically the first medication prescribed.
d. Celecoxib may be prescribed for osteoarthritis but is not typically the first medication prescribed.
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