Chapter 24: Assessing Musculoskeletal System

Which joint movement is a nurse testing when asking a client to move an extremity towards the body? a) Adduction b) Abduction c) Extension d) Flexion

a) Adduction Adduction is the movement towards the midline of the body. Flexion is bending the extremity at the joint and decreasing the angle of the joint. Extension is straightening the extremity at the joint and increasing the angle of the joint. Abduction is moving away from the midline of the body.

Which of these medications should a nurse ask a client if they are taking when assessing the risk for osteoporosis? Select all that apply. a) Rescue inhaler for asthma b) Corticosteroids c) Estrogen replacement therapy d) Antihypertensives e) Thyroid replacement drugs

b) Corticosteroids, e) Thyroid replacement drugs Medications that may increase a client's risk for osteoporosis include corticosteroids, thyroid replacement drugs, seizure medications, and some drugs for gastrointestinal disorders. Antihypertensives & rescue inhalers for asthma do not cause bone loss. Estrogen replacement therapy is often indicated for females at risk for osteoarthritis when approaching menopause.

A nurse is working with a client who has cervical disc degenerative disease with resulting impaired range of motion and pain that radiates to the back. The nurse understands that joints between the vertebrae are which type of joint? a) Synovial b) Fibrous c) Cartilaginous d) Compact

c) Cartilaginous Fibrous joints (e.g., sutures between skull bones) are joined by fibrous connective tissue and are immovable. Cartilaginous joints (e.g., joints between vertebrae) are joined by cartilage. Synovial joints (e.g., shoulders, wrists, hips, knees, ankles) contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones. Compact is a type of bone, not a type of joint.

What range of motion is the nurse testing by asking a client to stoop to pick an object off the floor? a) Abduction b) Rotation c) Flexion d) Extension

c) Flexion Stooping is another term for bending. The client must be able to flex the thoracic and lumbar spines and flex the knees. Extension is straightening the extremity at the joint and increasing the angle of the joint. Abduction is moving away from the midline of the body. Rotation is turning the head to the right and then the left.

A client presents to the health care clinic with reports of onset of neck pain 3 days ago. The nurse recognizes that the most common cause of neck pain is what condition? a) Cervical strain b) Cervical disc degenerative disease c) Cervical spinal cord compression d) Compression fractures

a) Cervical strain The most common cause of neck pain is cervical strain. This can occur from sleeping in the wrong position, carrying a heavy load, or being in an automobile accident. Cervical disc degenerative disease is associated with impaired range of motion and pain that radiates to the back, shoulders, or arms. Cervical spinal cord compression causes neck pain with loss of sensation in the legs. Compression fractures of the neck may also cause loss of sensation in the legs if the spinal cord becomes compressed.

A client complains of chronic pain and fatigue. The nurse suspects fibromyalgia. What is a diagnosis of this condition based on? a) Client's symptoms b) X-rays c) Lab tests d) Range of motion tests

a) Client's symptoms Fibromyalgia, manifested by chronic pain and fatigue, affects about 5 million Americans. Diagnosis is made based on a person's symptoms as no there are no objective findings on X-rays or lab tests or range of motion tests. Persistent pain and fatigue interferes with the client's activities of daily living.

A nurse notices that a client has decreased range of motion with lateral bending of the cervical spine to the left side. What should the nurse do next in relation to this finding? a) Compare this finding to the range of motion to the right side b) Ask the client about previous injuries to the head and neck c) Notify the health care provider for further orders d) Finish with the assessment of the cervical spine before documenting

a) Compare this finding to the range of motion to the right side It is always important to compare both sides of the body for symmetry before making a judgment that data is abnormal. The nurse should then ask the client about previous injuries to the head and neck. All data must be properly documented in the client's record. If this finding is abnormal, the nurse should alert the health care provider for further orders

A client presents to the health care clinic with reports of a swollen, tender, reddened joint in the left big toe. The nurse recognizes this finding as an indication of what inflammatory process? a) Gouty arthritis b) Rheumatoid arthritis c) Verruca vulgaris (warts) d) Degenerative joint disease

a) Gouty arthritis Tender, painful, reddened, hot, and swollen metatarsophalangeal joint in the great (big) toe is seen in gouty arthritis. This is an inflammatory condition caused by an abnormal buildup of uric acid in the body that becomes deposited in the joints. Rheumatoid arthritis can occur in any joint but usually affects the hands first. Verruca vulgaris (warts) is a painful wart that occurs under a callus. Degenerative joint disease does not typically cause the joints to be reddened and hot because it is not an inflammatory process.

A nurse notices that a client's flexibility of the right elbow is less than the left elbow. What is an appropriate action by the nurse in regard to this finding? a) Measure movement with a goniometer b) Note that the dominant side is stronger c) Assess the client's hand grips d) Notify the health care provider

a) Measure movement with a goniometer If the nurse identifies a limitation in the range of motion for a joint, a goniometer should be used to measure the exact angle of movement present. The goniometer is placed at the joint and then moved to match the angle of the joint being assessed. It is not necessary to notify the health care provider until all information is collected. The hand grips test strength, not range of motion. The dominant side of the body is stronger but does not necessarily have greater range of motion.

A client presents to the health care clinic with a three (3) day history of fever, chills, neck pain and stiffness, and headache. The nurse observes an elevated temperature of 102.5° F and pain with rotation of the head side to side and decrease ability to flex the head forward. The nurse recognizes these findings as most likely the onset of what infectious process? a) Meningitis b) Bursitis c) Arthritis d) Spondylitis

a) Meningitis Impaired range of motion and neck pain associated with fever, chills, and a headache may be indicative of a serious infection such as meningitis. Arthritis is inflammation or infection within a joint. Spondylitis is an inflammation of the vertebra. Bursitis is an inflammation in the bursa (small sacs) of synovial fluid in the body.

A client receives physical therapy for carpal tunnel syndrome. Which action by the nurse is appropriate to assess the efficacy of the treatment? a) Place the backs of both hands against each other b) Flex the wrists 90 degrees upward c) Maintain flexed wrists for 90 seconds d) Bend the wrists down and back

a) Place the backs of both hands against each other The nurse should ask the client to place the backs of both hands against each other while flexing the wrist 90 degrees downwards for 60 seconds for the Phalen's test. If therapy for carpal tunnel syndrome has not been successful, the client may report tingling, numbness, and pain after holding the position for 60 seconds. The client need not flex the wrists 90 degrees upward for 90 seconds. The nurse asks the client to bend the wrists down and back to test the client's range of motion for the wrist.

A nurse is teaching a group of children about how to grow healthy bones and to prevent osteoporosis later in life. Which of the following should the nurse mention? Select all that apply. a) Playing outside in the sun for at least 20 minutes a day b) Wearing sunscreen when outdoors c) Drinking plenty of vitamin D-fortified milk d) Drinking 8 cups of water per day e) Eating a low-fat die

a) Playing outside in the sun for at least 20 minutes a day, c) Drinking plenty of vitamin D-fortified milk Exposure to sunlight, which is necessary for the manufacture of vitamin D in the body, is recommended to prevent deficiency in this nutrient and to thus help prevent osteoporosis. Likewise, intake of calcium and vitamin D by drinking fortified milk is also recommended. Wearing sunscreen when outdoors will help prevent sunburn but will not help prevent osteoporosis. Drinking plenty of water and eating a low-fat diet, while healthy, will also not help prevent osteoporosis.

A client is unable to perform abduction with the right arm and reports pain when attempting to do so. The nurse notices that the muscles surrounding the right shoulder are smaller than those on the left shoulder. The nurse recognizes this finding as the possibility of what condition? a) Rotator cuff tear b) Degenerative joint disease c) Tendinitis d) Fracture

a) Rotator cuff tear Painful and limited abduction accompanied by muscle weakness and atrophy are seen with rotator cuff tears. Rotator cuff tendinitis causes the client to report sharp catches of pain when bringing the hands overhead. A bone fracture presents with acute, severe pain, and often weakness of the entire extremity. Degenerative joint disease may cause limited range of motion for all of the shoulder movements and most likely occurs symmetrically.

A nurse inspects a flattened lumbar curvature in a client. Which of the following conditions should the nurse most suspect in this client? a) Unequal leg lengths b) Ankylosing spondylitis c) Lordosis d) Scoliosis

b) Ankylosing spondylitis A flattened lumbar curvature may be seen with a herniated lumbar disc or ankylosing spondylitis. Lateral curvature of the thoracic spine with an increase in the convexity on the curved side is seen in scoliosis. An exaggerated lumbar curve (lordosis) is often seen in pregnancy or obesity. Unequal heights of the hips suggest unequal leg lengths.

A nurse is caring for a client who is recovering from a stroke. The nurse assesses the muscle strength of the client's arm and finds that the joint exhibits active motion against gravity. Which of the following should the nurse document to classify muscle strength based on this finding? a) Severe weakness b) Average weakness c) Poor range of motion d) Slight weakness

b) Average weakness The nurse should document the finding as average weakness of the arm muscles. In passive range of motion (ROM), gravity is removed and the client performs ROM with assistance; in this case, the strength is classified as poor ROM. When the client is able to perform the active motion against some resistance, it is classified as slight weakness. If the client has only a slight flicker of contraction, muscle strength is classified as severe weakness.

To assess abduction of the shoulders and arms, a nurse should ask a client to do which of the following? a) Move the arms to the sides starting with the hands together overhead b) Bring both hands together overhead starting with the arms at the sides c) Move the arms forward starting with the arms at the sides d) Move the arms backward starting with the arms at the sides

b) Bring both hands together overhead starting with the arms at the sides To elicit abduction, the nurse should ask the client to bring both hands together overhead. Asking the client to move the arms forward elicits flexion, and asking the client to move the arms backward elicits extension. Asking the client to move the arms to the sides starting with the arms overhead elicits adduction.

A nurse performs inspection and palpation of a client's knee and detects swelling. What is the appropriate test the nurse should perform next to determine the cause of the swelling? a) Ballottement b) Bulge c) McMurray's d) Range of motion

b) Bulge If swelling is detected in the knee, the nurse should perform the bulge test to determine if the swelling is due to an accumulation of fluid or soft-tissue swelling. The bulge test will help to detect small amounts of fluid in the knee. Ballottement is a knee test used to assess for the presence of large amounts of fluid in the knee. McMurray's test is useful to confirm a meniscal tear. Pain or clicking during the test is indicative of a torn meniscus of the knee. Range of motion is not useful in determining the cause of swelling.

An African American client appears to have lumbar lordosis present upon examination of the thoracic and lumbar spine. What should the nurse do in relation to this finding? a) Report this to the health care provider for possible surgery b) Document this as a normal cultural variation c) Ask the client about previous injuries to the spinal area d) Check to see if the curve lengthens when the client bends forward

b) Document this as a normal cultural variation The nurse should document this as a normal finding. African Americans often have a large gluteal prominence, making the spine appear to have lumbar Lordosis. This finding is a normal variation and doe not need surgical intervention. Injuries to the spine cause paralysis or weakness not a change in the contour of the spine. All curves of the spine will lengthen and straighten when the client bends forward.

Upon examination of an elderly client, the nurse finds hard, painless nodules over the distal interphalangeal joints. What is the appropriate term the nurse should use to document this finding in the client's medical records? a) Painful corns b) Heberden's nodes c) Inflamed bursa d) Bouchard's nodes

b) Heberden's nodes The nurse should document the hard, painless nodules over the distal interphalangeal joints as Heberden's nodes. Inflamed bursa is an inappropriate term because bursae are not found in interphalangeal joints. Bouchard's nodes are seen over the proximal interphalangeal joints. Painful corns are thickenings of the skin that occur over bony prominences and at pressure points.

A client presents to the health care clinic with reports of pain in the hands and right wrist. Additional history reveals that the client is a factory worker who spends all day performing the same repetitive task. The nurse performs Phalen's test and Tinel's test with positive results. The hand grips are unequal, with the right weaker than the left. What nursing diagnosis can the nurse confirm from this data? a) Activity Intolerance b) Impaired Physical Mobility c) Disturbed Body Image d) Risk for Trauma

b) Impaired Physical Mobility This client is likely experiencing carpal tunnel syndrome because of the repetitive hand movements that inflame the median nerve as it passes through the wrist. Impaired Physical Mobility related to decreased muscle strength as evidenced by a weak right hand grip meets the major criteria to confirm this nursing diagnosis. Risk for Trauma cannot be confirmed because the client already has carpal tunnel syndrome so he is not at risk. Disturbed Body Image and Activity Intolerance do not meet any major defining characteristics to confirm these nursing diagnoses.

Which finding in an elderly client requires additional assessment by a nurse when inspecting the musculoskeletal system? a) An exaggerated thoracic curve (kyphosis) b) Inability to button the jacket due to swollen finger joints c) Slow and steady gait with a wide base of support d) Symmetrical atrophy of the biceps muscles

b) Inability to button the jacket due to swollen finger joints With aging, the joints and muscles lose their flexibility and bones loose their density. Therefore, the elderly client is at risk for joint stiffening, muscle atrophy, and fractures. Swelling of the joints may indicate an inflammatory process is occurring and this needs to be further assessed by the nurse. When muscle loss is symmetrical it is generally due to the normal aging process. A slow and steady gait assists the elderly client to maintain balance. Kyphosis is a normal finding in the elderly client.

A nurse is working with an older client who has osteoporosis. The nurse understands that osteoporosis is more common in older people for which of the following reasons? Select all that apply. a) Increased incidence of arthritis b) Increased bone resorption c) Decreased calcium absorption d) Decreased intake of vitamin K e) Increased sun exposure f) Decreased osteoblast production

b) Increased bone resorption, c) Decreased calcium absorption, f) Decreased osteoblast production Osteoporosis is more common as a person ages because that is a time when bone resorption increases, calcium absorption decreases, and production of osteoblasts decreases as well. Arthritis is not a risk factor for osteoporosis. It is not established that decreased intake of vitamin K or increased sun exposure are associated with advancing age, and even if it were, these are not risk factors associated with osteoporosis.

A nurse obtains an order to measure a client's leg length. How should a nurse correctly implement this order? a) Place the tape on the iliac crest and measure down to the heel b) Measure from the anterior superior iliac spine to the medial malleolus c) Ask the client to stand up straight and measure from the iliac crest to the floor d) Assess from the umbilicus to the knee then from the knee to the hee

b) Measure from the anterior superior iliac spine to the medial malleolus To correctly measure leg length, ask the client to lie with legs extended. With a tape measure, measure the distance between the anterior superior iliac spine and the medial malleolus, crossing the tape on the medial side of the knee.

Which action by a nurse is a correct method for performing the Tinel's test to determine the presence of carpel tunnel syndrome? a) Palpate the hollow area on the back of the wrist. b) Percuss lightly on the inner aspect of the wrist. c) Perform wrist movements against resistance. d) Ask the client to bend the wrist down and back

b) Percuss lightly on the inner aspect of the wrist. The nurse should tap at the inner aspect of the wrist to percuss the median nerve because the median nerve is located at the inner aspect of the wrist where it enters the carpal canal. Palpation of the hollow area on the back of the wrist is done to examine the anatomic snuffbox. Asking the client to bend the wrist down and back and performing wrist movements against resistance are done to assess range of motion and muscle strength.

In assessing a client's temporomandibular joint (TMJ), the nurse asks the client to move the jaw forward. This movement is known as which of the following? a) Retraction b) Protraction c) Supination d) Pronation

b) Protraction Protraction is moving forward. Retraction is moving backward. Pronation is turning or facing downward. Supination is turning or facing upward. Pronation and supination are not possible at the TMJ.

A nurse performs a nudge test to assess the gait of a client with Parkinson's disease. Which action by the nurse demonstrates the correct technique for performing this test? The nurse should stand: a) in front of the client and nudge the sternum b) at the back of the client and nudge the sternum c) at the back of the client and nudge the back d) in front of the client and nudge the back

b) at the back of the client and nudge the sternum To perform the nudge test, the nurse should stand at the back of the client and nudge his sternum. The nurse should put her arms around the client to prevent a fall. Falling backward easily is seen with cervical spondylosis and Parkinson's disease. Standing in front of the client and nudging his sternum, standing at the back of the client and nudging his back, and standing in front of the client and nudging his back are inaccurate methods for performing the nudge test.

What is an appropriate question by the nurse to ask a client about the presence of temporomandibular joint dysfunction? a) "Can you fully clench your teeth and feel the muscles in your jaw tense?" b) "Please stick out your tongue sand move it from side to side" c) "Have you noticed a popping or grating sound when you chew?" d) "Do you notice any swelling around the teeth or gums?"

c) "Have you noticed a popping or grating sound when you chew?" The temporomandibular joint (TMJ) provides the stability of the jaw to open and close. Often the joint can become swollen, causing pain and decrease in range of motion of the jaw. Decreased muscle strength and range of motion, along with a popping, clicking, or grating sound may be noted with TMJ dysfunction. Swelling around the teeth and gums is seen with gingivitis. Clenching the teeth test the integrity of cranial nerve V (trigeminal nerve). Asking the client to stick out the tongue and move it from side to side tests cranial nerve XII (hypoglossal nerve).

Which nutrient deficiency should a nurse recognize as placing a client at risk for osteoporosis? a) Protein b) Vitamin C c) Calcium d) Vitamin D

c) Calcium A calcium deficiency increases the risk osteoporosis. This causes the bones to become softer in nature because the rate at which bone is destroyed is occurring at a faster rate than new bone is made. Protein functions in muscle tone and growth. Vitamin C promotes healing of tissues and bones. Vitamin D deficiency causes osteomalacia, softening of the bones due to defective bone mineralization. Osteomalacia in children is known as rickets.

A nurse inspects a child's legs with the child standing and notices that the knees turn inward. How should this finding be documented in the medical record? a) Genu varum b) Bowed legs c) Genu valgum d) Ballottement

c) Genu valgum The inward turning of the knees is called knock knees or genu valgum. Genu varum is the outward turning or the knees or bowed legs. Ballottement is a knee test used to assess for the presence of large amounts of fluid in the knee.

Which characteristics should a nurse assess during inspection of the musculoskeletal system? Select all that apply a) Contour b) Pain c) Masses d) Color e) Passive motion f) Swelling

c) Masses, d) Color, a) Contour, f) Swelling Inspection is the technique of observation. The nurse should inspect the client's joints for shape, color, symmetry, masses, deformities, or muscle atrophy. Bilateral joint findings should be compared for any differences between sides of the body. Pain is rated by subjective data only. Passive range of motion requires the examiner to assist the client to move a joint through the motions.

Which action by a nurse is a correct method for performing Tinel's test to determine the presence of carpel tunnel syndrome? a) Perform wrist movements against resistance b) Palpate the hollow area on the back of the wrist c) Percuss lightly on the inner aspect of the wrist d) Ask the client to bend the wrist down and back

c) Percuss lightly on the inner aspect of the wrist The nurse should tap at the inner aspect of the wrist to percuss the median nerve because the median nerve is located at the inner aspect of the wrist where it enters the carpal canal. Palpation of the hollow area on the back of the wrist is done to examine the anatomic snuffbox. Asking the client to bend the wrist down and back and performing wrist movements against resistance are done to assess range of motion and muscle strength.

The nurse is working with a client who has leukemia, which affects the red marrow of the bones. The nurse understands that which of the following is characteristic of red marrow? a) Is composed mostly of fat b) Is hard and dense and makes up the shaft and outer layers c) Produces red blood cells d) Covers the bones and contains osteoblasts and blood vessels

c) Produces red blood cells Bones contain red marrow that produces blood cells and yellow marrow composed mostly of fat. The periosteum covers the bones and contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues. Composed of osseous tissue, bones can be divided into two types: compact bone, which is hard and dense and makes up the shaft and outer layers; and spongy bone, which contains numerous spaces and makes up the ends and centers of the bones.

A nurse is inspecting a client's gait. Which of the following would indicate an abnormal finding? a) Posture is erect b) Arms swing in opposition c) Toes point out d) Weight is evenly distributed

c) Toes point out Abnormal findings in gait include the following: uneven weight bearing is evident; client cannot stand on heels or toes; toes point in or out; client limps, shuffles, propels forward, or has wide-based gait. Posture being erect, arms swinging in opposition, and weight being evenly distributed are all normal findings.

A nurse is testing the range of motion of a client's wrist for supination. Which movement will this involve? a) Turning the palm of the hand downward b) Moving the tips of the fingers toward the forearm c) Turning the palm of the hand upward d) Moving the tips of the fingers away from the forearm

c) Turning the palm of the hand upward Supination involves turning or facing upward, in this case turning the palm upward. Pronation involves turning or facing downward, in this case turning the palm downward. Flexion involves bending the extremity at the joint and decreasing the angle of the joint, in this case moving the tips of the fingers toward the forearm. Extension involves straightening the extremity at the joint and increasing the angle of the joint, in this case moving the tips of the fingers away from the forearm.

To assess abduction of the shoulders and arms, a nurse should ask a client to: a) bring both hands in front of the body b) move the arms to the sides c) bring both hands together overhead d) move the arms forward

c) bring both hands together overhead To elicit abduction, the nurse should ask the client to bring both hands together overhead. Asking the client to move the arms forward elicits flexion, and asking the client to move the arms backward elicits extension. Asking the client to bring both hands in front of the body elicits adduction. The client's arm is at the sides when at rest.

A client is brought to the health care facility with a sudden loss of movement on the right side of the body. Upon assessment, the nurse finds that the client has a slight flicker of contraction in the muscles on the right side. What should the nurse document as the muscle strength rating a) 4 b) 3 c) 2 d) 1

d) 1 The nurse should rate the muscle strength as 1. Muscle rating 4 is given when the client is able to perform active motion against some resistance. When the client is able to perform active movements against gravity, the muscle strength is graded as 3. If the client is able to perform passive ROM, the muscle strength is rated as 2.

A client visits the health care facility with reports of lumbar back pain that radiates down the back. The nurse performs the straight leg test to determine the origin of the pain. Which techniques should the nurse use to perform this test? a) Instruct the client to touch the chin to the chest b) Instruct the client to bend forward and touch the toes c) Palpate the spinous processes and the paravertebral muscles d) Ask the client to raise the leg to the point of pain and then dorsiflex the foot

d) Ask the client to raise the leg to the point of pain and then dorsiflex the foot To perform the straight leg test, the nurse should ask the client to raise the client's leg to the point of pain and then dorsiflex the foot to check for a herniated nucleus pulposus. Asking the client to bend forward and touch the toes facilitates assessment of range of motion of the lumbar spine. Asking the client to touch the chin to the chest evaluates range of motion of the cervical spine. The spinous processes and the paravertebral muscles on both sides of the spine are palpated for tenderness and pain and are not a part of the straight leg test.

A nurse performs a nudge test to assess the gait of a client with Parkinson's disease. Which action by the nurse demonstrates the correct technique for performing this test? The nurse should stand: a) In front of the client and nudge the sternum b) In front of the client and nudge the back c) At the back of the client and nudge the back d) At the back of the client and nudge the sternum

d) At the back of the client and nudge the sternum To perform the nudge test, the nurse should stand at the back of the client and nudge his sternum. The nurse should put arms around the client to prevent a fall. Falling backward easily is seen with cervical spondylosis and Parkinson's disease. Standing in front of the client and nudging his sternum, standing at the back of the client and nudging his back, and standing in front of the client and nudging his back are inaccurate methods for performing the nudge test.

Which movement should the nurse instruct the client to perform to assess range of motion for the knee? a) Rotation b) Abduction c) Circumduction d) Flexion

d) Flexion The nurse should instruct the client to perform flexion to assess the range of motion for the client's knee. Circumduction, rotation, and abduction movements are not possible in the knees. Circumduction is the circular motion of the joint. Rotation involves turning the head to the right shoulder then back to midline and then turning the head to the left shoulder then back to midline. Abduction refers to moving away from the midline of the body. The knees are capable of performing only flexion and extension.

A client expresses to the nurse that he has a "giving in" or "locking" sensation in the knee. Which test should the nurse perform to elicit related findings of a possible tear in the meniscus of the client's knee? a) Bulge b) Phalen's c) Ballottement d) McMurray's

d) McMurray's The nurse should perform McMurray's test to confirm meniscal tear. Pain or clicking during the test is indicative of a torn meniscus of the knee. The ballottement test and the bulge test are done to detect the presence of fluid in the knee joint. Phalen's test is done to test for carpal tunnel syndrome.

What finding should a nurse expect when performing Phalen's test on a client with suspected carpal tunnel syndrome? a) A change in the color of the fingers from red to white (pale) b) Stiffness in the hands and fingers after holding and releasing a tight fist c) Inability to perform active range of motion with the involved wrist d) Reports of tingling, numbness, and pain in the involved wrist

d) Reports of tingling, numbness, and pain in the involved wrist Phalen's test is performed by asking the client to place the backs of both hands against each other while flexing the wrists 90 degrees downward. The client holds this position for 60 seconds. A positive test would be the report of tingling, numbness, and pain in the involved wrist by the client. Inability to perform active range of motion with the involved wrist and stiffness in the hands and fingers after holding and releasing a tight fist may be seen in clients with arthritis in the joints. A change in color of the fingers from red to white (pale) is seen in clients with Raynaud's disease

A nurse tells a client that the next step in the musculoskeletal assessment is to perform range of motion of the thoracic and lumbar spine. The nurse should demonstrate which movements for the client to facilitate the examination? Select all that apply. a) Extension b) Circumduction c) Rotation d) Lateral bending e) Flexion

e) Flexion, d) Lateral bending, c) Rotation To assess the range of motion of the thoracic and lumbar spine, the client should be shown the muscle movements of flexion, lateral bending (right and left), rotation (twisting the shoulders one way then the other), and bending backwards (hyperextension). Circumduction is moving is a circular motion.

A nurse is instructing a client with gouty arthritis on foods to avoid that trigger this condition. Which of the following should the nurse mention? Select all that apply. a) Alcohol b) Orange juice c) Coffee d) Whole milk e) Liver f) Sardines

e) Liver, f) Sardines A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis. The other foods listed are not associated with triggering gouty arthritis. Excessive consumption of alcohol or caffeine can increase the risk of osteoporosis. Adequate protein in the diet promotes muscle tone and bone growth; vitamin C promotes healing of tissues and bones. A calcium deficiency increases the risk of osteoporosis