An older adult is admitted to the hospital following a closed head injury from a fall that resulted in a 5-minute period of unconsciousness. Which priority nursing assessment indicates neurological deterioration in the patient?

Choice A reason: "You need to bring your child to the emergency department immediately and have the stool tested for blood." is not an appropriate response by the nurse. Black stools can be a sign of gastrointestinal bleeding, which is a serious condition that requires immediate medical attention. However, in this case, the black stools are most likely caused by the iron supplement, which can change the color and consistency of the stool. Therefore, there is no need to panic or rush to the emergency department.

Choice B reason: "Greenish black stools are normal when oral iron supplements are being administered." is the most appropriate response by the nurse. It is a factual and reassuring statement that explains the reason for the stool color change and educates the mother about the expected side effect of the iron supplement. It also encourages the mother to continue the treatment for the child's anemia.

Choice C reason: "You should stop administering the daily iron supplement." is not an appropriate response by the nurse. It is a harmful and incorrect advice that contradicts the prescribed treatment for the child's anemia. Stopping the iron supplement can worsen the child's condition and lead to complications such as growth retardation, cognitive impairment, or heart failure.

Choice D reason: "Don't worry about it." is not an appropriate response by the nurse. It is a dismissive and vague statement that does not address the mother's concern or provide any information or education. It can also undermine the mother's trust and confidence in the nurse and the health care system.

Choice A reason: This is incorrect. Generalized muscle weakness and severe muscle spasms are not late manifestations of amyotrophic lateral sclerosis, but rather early or intermediate symptoms. Amyotrophic lateral sclerosis is a progressive neurodegenerative disorder that affects the motor neurons that control voluntary muscles. The disease causes muscle weakness, stiffness, twitching, and cramps.

Choice B reason: This is incorrect. Mental confusion and aggressive behaviors are not common manifestations of amyotrophic lateral sclerosis, but rather signs of dementia or other psychiatric disorders. Amyotrophic lateral sclerosis does not usually affect the cognitive or emotional functions of the brain, except in some rare cases.

Choice C reason: This is incorrect. Dysarthria and decreased clarity of spoken words are not late manifestations of amyotrophic lateral sclerosis, but rather intermediate or advanced symptoms. Dysarthria is a speech disorder that results from the weakness or paralysis of the muscles involved in speech production. It causes slurred, slow, or distorted speech.

Choice D reason: This is correct. Impairment of respiratory muscles and cognition remains intact are common late manifestations of amyotrophic lateral sclerosis. As the disease progresses, the respiratory muscles become weak and unable to support breathing. This can lead to respiratory failure and death. However, the cognition of the patient usually remains intact until the end, as the disease does not affect the higher functions of the brain.