The nurse notes fanning of the toes when the sole of the foot is ...

[Sufayan.ah]

The nurse notes fanning of the toes when the sole of the foot is stimulated during assessment of the plantar reflex. Which is appropriate for the nurse to use when documenting this finding in the medical record?
 
  1. Hyperreflexia.
  2. Babinski response.
  3. Brudzinski sign.
  4. Nuchal rigidity.

Question 2

While interviewing a client the nurse notes the client's eyes moving involuntarily. Which term will the nurse use to document this finding in the medical record?
 
  1. Nystagmus.
  2. Presbyopia.
  3. Anosmia.
  4. Polyneuritis.

[katara]

Answer to Question 1

Correct Answer: 2
The Babinski response is fanning of the toes with the great toe pointing downward when the sole of the foot is stimulated. This response is considered abnormal in adults. The findings described do not support hyperreflexia, which refers to a reflex that is abnormally strong. Brudzinski sign refers to flexion of the legs and thighs when the neck is flexed and is an assessment used to confirm meningitis. Nuchal rigidity refers to stiffness of the neck and is most often seen in meningitis.

Answer to Question 2

Correct Answer: 1
Nystagmus is an involuntary eye movement. Presbyopia is visual disturbances. Polyneuritis refers to nerve inflammation. Anosmia refers to the absence of smell.

[Sufayan.ah]

Thank you

[katara]

Happy to help you