Which term would the nurse use to document a patient who is comatose from a head injury and display flexion of the arms, wrists, and fingers, as well as adduction of the upper extremities?
Decorticate posturing
Epileptic
Stroke
Decerebrate posturing
The Correct Answer is A
A. Decorticate posturing indicates severe brain injury, characterized by flexion of the arms and adduction of the upper extremities.
B. Epileptic is not a term used to describe posturing related to head injury.
C. Stroke does not describe posturing.
D. Decerebrate posturing is characterized by extension and pronation of the arms, not flexion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Increased intracranial pressure (ICP) typically causes hypertension (increased blood pressure) rather than hypotension.
B. A decreased level of consciousness is one of the hallmark signs of increased ICP, as pressure on the brainstem affects consciousness.
C. Tachypnea may occur with ICP, but it is less specific compared to decreased consciousness.
D. This can occur with brain injury but is not as directly indicative of ICP as decreased consciousness.
Correct Answer is A
Explanation
A. Decorticate posturing indicates severe brain injury, characterized by flexion of the arms and adduction of the upper extremities.
B. Epileptic is not a term used to describe posturing related to head injury.
C. Stroke does not describe posturing.
D. Decerebrate posturing is characterized by extension and pronation of the arms, not flexion.
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