GNRS 578 - Musculoskeletal

The nurse is assessing range of motion and notes a grating sound when examining the shoulder joint. The nurse would correctly document which of the following choices?

Crepitus of the shoulder joint Rationale: Crepitus is a grating sound caused by bone fragments in joints and is suggestive of degenerative disease, trauma, or inflammatory conditions. Limited motion would be documented by describing the inability of the joint to move in the normal ranges, and shoulder deformity and atrophy are not conclusive with this information.

The nurse is examining a client with a chief complaint of numbness and tingling in the hands. The nurse asks the client to bend the wrist downward and press the backs of the hands together. The client complains of numbness and tingling in the arms during the procedure. The nurse would suspect which of the following conditions in this situation?

Carpal tunnel syndrome Rationale: The test described is called Phalen's test and, when used on individuals with carpal tunnel syndrome, 80% experience pain, tingling, and numbness that radiates to the arm, shoulder, neck, or chest within 60 seconds. Another assessment for carpal tunnel syndrome is called Tinel's sign and is elicited by percussing lightly over the median nerve in each wrist. The test is positive if the client feels numbness, tingling, and pain along the median nerve. Crepitus is a grating sound caused by bone fragments in joints and is suggestive of degenerative disease, trauma, or inflammatory conditions. Dupuytren's contracture involves the inability to extend the fourth and fifth fingers, but is a painless, inherited disorder. Arthritis typically causes pain and limitations in movement but not numbness and tingling.

The nurse is performing range of motion of the cervical spine and asks the client to touch the chest with the chin. The nurse is assessing which of the following movements?

Flexion (acute angle) Rationale: Flexion causes a decrease in the angle from the chin to the chest, whereas hyperextension would cause an increase in this angle, such as looking up toward the ceiling. Attempting to touch each shoulder with the ear on that side would be lateral flexion, and turning the head to face each shoulder would be rotation.

The nurse is inspecting the spine of a client and notes the presence of an exaggerated lumbar curve. The nurse would correctly document which of the following choices?

Lordosis (think of "Game of Thrones" and egotistical lords with power) Rationale: Lordosis is an exaggerated lumbar curve and is often present in pregnancy, obesity, or other skeletal changes. The spine leans to the left or right in a list, and a line drawn from teh thoracic one vertebrae does not fall between the gluteal fold. This condition may occur with spasms in the paravertebral muscles or a herniated disc. Kyphosis is an exaggerated thoracic dorsal curve that causes asymmetry between the sides of the posterior thorax. A flattened lumbar curve is a concave curvature of the lumbar areas and occurs when lumbar muscles spasm.

The nurse is assessing muscle strength in a client and notes full range of motion against gravity with full resistance. The nurse would correctly document which of the following choices?

Normal Rationale: Full range of motion against gravity with full resistance is considered normal muscle strength, also rated a 5. A rating of good, or a 4, would be full range of motion against gravity with moderate resistance. A rating of fair, or a 3, would be full range of motion with gravity, and a rating of poor, or a 2, would be full range of motion without gravity, or passive motion.