If a patient displays a positive Babinski sign, the nurse should:

Correct Answer: A

Rationale: A positive Babinski sign in an adult indicates possible neurological dysfunction and requires documentation and further evaluation. Ignoring the finding or assessing unrelated parameters is inappropriate.

Correct Answer: B

Rationale: The vagus nerve receives motor fibers from the nucleus ambiguus, which also contributes to the accessory nerve. It innervates muscles of the pharynx and larynx.

Correct Answer: C

Rationale: The tractus solitarius is involved in taste and visceral sensation, not posture and movement. The spinocerebellar and vestibulospinal tracts are involved in motor coordination and balance.

Correct Answer: D

Rationale: The scalene muscles are innervated by the anterior rami of cervical spinal nerves, not the posterior rami. The posterior rami supply intrinsic back muscles like the erector spinae.

Correct Answer: A

Rationale: Epilepsy is diagnosed when an individual experiences at least two unprovoked seizures separated by more than 24 hours. This criterion helps distinguish epilepsy from isolated seizure events caused by temporary factors like fever or alcohol withdrawal.