A nurse observes that decerebrate posturing is a comatose client's response to painful stimuli. Decerebrate posturing as a response to pain indicates:

Dysfunction in the cerebrum.

Dysfunction in the brain stem.

Dysfunction in the spinal column.

Dysfunction in the motor cortex.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Dysfunction in the cerebrum would likely result in different types of posturing, such as decorticate posturing, rather than decerebrate. The cerebrum is involved in controlling voluntary motor functions and damage here typically does not lead to decerebrate posturing.

Choice B rationale

Dysfunction in the brain stem results in decerebrate posturing, characterized by rigid extension of the arms and legs, downward pointing of the toes, and backward arching of the head. The brain stem is crucial for controlling basic life functions and its impairment leads to severe motor response issues.

Choice C rationale

Dysfunction in the spinal column typically does not lead to decerebrate posturing but may lead to different types of paralysis or movement issues depending on the location and severity of the damage.

Choice D rationale

Dysfunction in the motor cortex usually leads to abnormalities in voluntary movement, muscle tone, and coordination rather than decerebrate posturing which is more linked to brain stem issues.

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Correct Answer is D

Explanation

Choice A rationale

Infection is not directly related to weight loss, ill-fitting dentures, or limited fiber intake. The primary risks are more connected to gastrointestinal function rather than infections. While malnutrition can affect immune response, infection risk isn’t the primary concern here.

Choice B rationale

Deficient fluid volume is not a direct consequence of weight loss or dietary habits related to ill-fitting dentures. While fluid intake should be monitored, it is not the most immediate risk associated with these symptoms.

Choice C rationale

Excessive intake of convenience foods might contribute to poor nutritional status and unintended weight loss, but it is not the primary risk. The client's condition more directly influences gastrointestinal health rather than dietary habits.

Choice D rationale

Constipation is a significant risk due to limited intake of high-fiber foods. Fiber is crucial for promoting bowel movements and preventing constipation. Weight loss and ill-fitting dentures may further reduce the client's dietary fiber intake, increasing the likelihood of constipation

A. Swallowing. B. Smelling. C. Chewing. D. Tasting. E. Tasting.

Correct Answer is C

Explanation

Choice A rationale

Swallowing involves the glossopharyngeal and vagus nerves, not the trigeminal nerve. Thus, trigeminal neuralgia does not typically affect swallowing.

Choice B rationale

Smelling involves the olfactory nerve (cranial nerve I), not the trigeminal nerve (cranial nerve V). Therefore, trigeminal neuralgia does not affect the sense of smell.

Choice C rationale

Trigeminal neuralgia involves the trigeminal nerve, which is responsible for sensation in the face and motor functions such as biting and chewing. Therefore, chewing can be significantly affected.

Choice D rationale

Tasting involves the facial nerve (cranial nerve VII) and glossopharyngeal nerve (cranial nerve IX), not the trigeminal nerve. Thus, trigeminal neuralgia does not typically affect taste.

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A nurse observes that decerebrate posturing is a comatose client's response to painful stimuli. Decerebrate posturing as a response to pain indicates:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A nurse is caring for a client with a diagnosis of trigeminal neuralgia. Which activity is altered as a result of this diagnosis?

Correct Answer is C

Explanation

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