Week 11: Concept of Functional Ability

Dorsiflexion, plantar flexion, eversion, and inversion

A nurse performs full range-of-motion exercises on a clients extremities. When putting an ankle through range-of-motion exercises, what must the nurse perform?

Effectiveness of respiratory exchange and ability to swallow

A client is suspected to having myasthenia gravis. What are the most significant initial nursing assessments that should be performed?

Space activities throughout the day.

A client newly diagnosed with myasthenia gravis is concerns about fluctuations in physical condition and generalized weakness. When caring for this client it is most important for the nurse to plan which intervention?

They combat the extrapyramidal side effects of the neuroleptic drug.

A nurse is administering medications to clients on a psychiatric unit. What does the nurse identify as the reason that so many psychiatric clients are given the drug benztropine or trihexyphenidyl in conjunction with the phenothiazine-derivative neuroleptic medications?

Maintaining safety

A 10-year-old child in whom autism was diagnosed at the age of 3 years attends a school for developmentally disabled children and lives with parents. The child has frequent episodes of self-biting and head-banging and needs help with feeding and toileting. What is the priority nursing goal for this child?

Fluctuating weakness of muscles innervated by the cranial nerves

A client diagnosed with myasthenia gravis. Which response does the nurse expect the client to demonstrate?

Dysphagia

A client with a parotid tumor and enlarged lymph nodes in the neck is undergoing radiation therapy on an outpatient basis. Which condition will the nurse most closely assess the client for during the return visit to the radiology department?

Inhale completely and then blow out as hard and as fast as possible through the mouthpiece.

A client with asthma is being taught how to use peak flow meter to monitor how well the asthma is being controlled. What should the nurse instruct the client to do?

Aspirations

A client with myasthenia gravis experiences dysphagia. What is the priority risk associated with dysphagia that must be considered when planning nursing care?

Providing frequent rest periods

A client with myasthenia gravis experiences generalized weakness. What is most important when planning this clients nursing care?

Blocks the action of cholinesterase

A client with myasthenia gravis has been receiving neostigmine and asks about its action. What information about its action should the nurse consider when formulating a response?

Make arrangements immediately for further medical evaluation by the client's primary health care provider

A client with parkinsonism is taking an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complains of some numbness in the left hand. What is the nursed priority intervention?

Self-administer the eye medications using appropriate technique

A debilitated older client with glaucoma who places great value on independence is being prepared for discharge from the hospital. To promote indolence, what should the nurse encourage the client to do?

"The client will maintain present muscle strength"

A healthcare provider prescribes a diagnostic workup for a client who may have myasthenia gravis. What is the initial nursing objective for the client during the diagnostic phase?

"The thirst reflex diminishes with age, and therefore the recognition of the need for fluid is decreased."

An 80-year-old client is admitted to the hospital because of complications associated with severe dehydration. The clients daughter asks the nurse how her mother could have become dehydrated, because she is alert and able to care for herself. The nurses best response is?

Having the client breathe into a paper bag

Besides providing reassurance, what should nursing interventions for a client who is hyperventilating be focused on?

Pelvis

In which part of the clients body is the amphiarthroidial joint located?

"When I exercise I will reduce the number of repetitions when I have pain"

The nurse is providing discharge teaching to a 30-year-old client who was hospitalized for exacerbation of rheumatoid arthritis. Which statement by the client indicates correct understanding of the treatment plan?

Active movement against gravity only and not against restistance

What does grade 3 indicate according to the muscle strength scale?

Reduced need for sleep

What does the nurse explain happens during the transition from infanthood to toddlerhood?

-Holding a rattle -Picking up objects -Holding a baby bottle

Which actions demonstrate fine motor skills? Select all that apply.

Chinese Americans

Which ethnic group has a greater incidence of osteoporosis due to musculoskeletal differences?

Sacroiliac joint

Which joint in the clients body is an example of gliding joint?

Neutral positioning of the foot with the use of a splint

Which nursing intervention prevents footdrop in a client with osteomyelitis?

-Slowed movement -Cartilage degeneration -Increased bone prominence

Which physiologic changes of the musculoskeletal system are related to aging?

Copying squares

Which skill does the nurse explain to parent is normally exhibited by a preschooler?

Ligaments

Which structure connects he clients tibia to the femur at the knee joint?

Pronation

Which synovial joint movement is involved in turning the clients palm downward?

Abduction

Which term should the nurse use to describe synovial joint movement that moves away from the midline of the body?

Restore function and/or appearance

A nurse understand that the primary purpose for a client to undergo reconstructive surgery is to do what?

Teaching the client to use head movements to scan the left field of vision

A client is admitted with a brain attack (cerebrovascular accident, CVA) with left sided paralysis. The client leans to the left when placed in a sitting position and fails to respond to stimuli in the left visual field. What should the clients plan of care include?

Raise the head of the bed

A nurse enters the room of a client with myasthenia gravis and identifies that the client is experiencing increased dysphagia. What should the nurse do?

2 years

A nurse is assessing a child with suspected autism. At what age does the nurse determine that the signs of autism initially may be evident?