Nursing Assessment Chapter 21

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?

Impaired Physical Mobility

Mrs. Philips complains of numbness of her right hand. On examination, sensation of the volar aspect of the web of the thumb and index finger and pulp of the middle finger are normal. The pulp of the index finger has decreased sensation. Which of the following is affected?

Median nerve

The nurse is testing a client for carpal tunnel syndrome. The client flexes the wrists at an angle of 90° and holds the backs of the hands to each other for 60 seconds. The client tells the nurse that he is experiencing a burning pain as a result. Which test is the nurse performing on this patient?

Phalen's

A 38-year-old woman presents with multiple small joints that are symmetrically involved with pain, swelling, and stiffness. Which of the following is the most likely explanation?

Rheumatoid arthritis

The nurse is assessing an older adult with new onset dementia. The nurse is using the Morse Fall Scale; the client's score is 63. What does this tell the nurse?

That the client is at high risk for falling

After assessing the client for posture and body alignment, how would the nurse document head position in relation to the spine if alignment is normal with noticeable defect?

The head is midline and aligned with the spine

When providing teaching to clients in the community, a nurse is accurate in stating that the musculoskeletal system is most closely aligned with which other body system?

neurological system