The ED nurse is caring for a client with a head injury and decerebrate posturing in response to painful stimuli. Which data would indicate the client’s condition is improving?

• A. The client has purposeful movement when the nurse rubs the sternum.
• B. The client extends the upper and lower extremities in response to painful stimuli.
• C. The client is flaccid when the nurse applies painful pressure to the sternum.
• D. The client has a Glasgow Coma Scale rating of 4 on a 1–15 scale.

Answer: (A)

Emergence of purposeful movement in response to a painful stimulus shows that the brain can initiate goal-directed motor activity, indicating improvement in neurological function. Decerebrate posturing reflects severe brainstem injury with rigid extension; finding purposeful movement suggests that the patient has regained some cortical or brainstem connectivity and arousal, which is a positive change in status.

Continuing extensor posturing (arms and legs extended) in response to pain still indicates a severe, non-improving motor pattern and sustained brain injury. Flaccidity in response to pain means a lack of motor tone and response, which does not demonstrate active recovery at this moment. A Glasgow Coma Scale score as low as 4 reflects profound coma and poor prognosis; improvement would be seen as an increase in the GCS score, not a static 4.