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The Nurse Is Assessing a Client That Experienced a Head

Question 25

Multiple Choice

The nurse is assessing a client that experienced a head injury using the Glasgow Coma Scale. Which findings reflect the motor response portion of the scale? Select all that apply.


A) No response with eyes to commands.
B) Abnormal flexion to pain.
C) Pupil response sluggish.
D) Abnormal extension to pain.
E) Pupils fixed and dilated.

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