An older adult client with a recent history of a cerebrovascular accident (CVA) presents with right hemiparesis. The nurse tests the deep tendon reflexes on the right side and elicits a brisk 4+ response. Which interpretation of this finding is accurate?

Rationale: A. Flaccid paralysis: Flaccid paralysis is characterized by limp, weak muscles and absent or greatly diminished reflexes. A brisk 4+ reflex does not align with flaccid paralysis, which is typically seen in acute lower motor neuron injuries or immediately after a CVA before spasticity develops. B. Hyperactive response consistent with an upper motor neuron disorder: A brisk 4+ deep tendon reflex indicates hyperreflexia, which is characteristic of upper motor neuron disorders, such as those resulting from a cerebrovascular accident (stroke). Loss of inhibitory control from the brain leads to exaggerated reflexes on the affected side. C. A normal reflex response: A normal reflex response would be graded as 2+ on the reflex scale. A 4+ response is considered markedly hyperactive, not normal, and suggests pathology related to central nervous system injury. D. Absent or sluggish response consistent with a lower motor neuron lesion: Lower motor neuron lesions typically cause absent (0) or diminished (1+) reflexes. A 4+ reflex response is not compatible with lower motor neuron damage, but rather with upper motor neuron dysfunction.