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Exhibits

Nurse reviews data.

For each joint, click to specify what type of range of motion was being assessed based on findings. Each category will have one response.

Joint

Type of range of motion

Shoulder - unable to move the arm away from the body

Flexion-a

Adduction-a

Abduction-a

Extension-a

Elbow - only able to straighten joint 20 degrees

Flexion-b

Adduction-b

Abduction-b

Extension-b

Wrist - able to bend wrist back

Flexion-c

Adduction-c

Abduction-c

Extension-c

Abduction-a

Abduction-b

Abduction-c

Adduction-a

Adduction-b

Adduction-c

Extension-a

Extension-b

Extension-c

Flexion-a

Flexion-b

Flexion-c

Answer and Explanation

The Correct Answer is ["A","H","I"]

Shoulder - unable to move the arm away from the body: Abduction
Rationale: Abduction refers to moving the arm away from the body. If the client is unable to perform this movement, it indicates a limitation in shoulder abduction.
Elbow - only able to straighten joint 20 degrees: Extension
Rationale: Extension involves straightening the joint. The client’s ability to only straighten the elbow 20 degrees suggests limited extension.
Wrist - able to bend wrist back: Extension
Rationale: Extension of the wrist refers to bending the wrist backward, away from the palm. If the client can perform this movement, it indicates functional wrist extension.

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Correct Answer is C

Explanation

A. A thickened and bulging tympanic membrane typically indicates a middle ear infection, such as otitis media, not an external ear infection, and would not be expected in this case based on the symptoms described.
B. A retracted and non-mobile tympanic membrane suggests Eustachian tube dysfunction or fluid in the middle ear, which does not correlate with the external ear symptoms of itching, pain, and discharge after swimming.
C. A red, edematous ear canal with no visualization of the tympanic membrane is indicative of otitis externa, commonly known as "swimmer's ear." This condition is characterized by inflammation of the external auditory canal, often following water exposure, which matches the client’s symptoms and history.
D. A translucent, pearly gray and mobile tympanic membrane is the appearance of a normal tympanic membrane, which would not be expected in a client with the described symptoms of pain, itching, and discharge associated with otitis externa.

A. Encourage fluid intake. B. Increase intake of red meat. C. Measure urine output. D. Splint the affected joint.

Correct Answer is A

Explanation

A. Encouraging fluid intake is important in managing elevated uric acid levels and conditions like gout. Increased fluid intake helps dilute the uric acid in the blood and promotes its excretion through the kidneys, which can help reduce the frequency of gout attacks.
B. Increasing the intake of red meat is not advisable, as red meat is high in purines, which can exacerbate gout by increasing uric acid levels. Clients with elevated uric acid should avoid purine-rich foods to prevent worsening their condition.
C. While measuring urine output can be useful in monitoring kidney function, it does not directly address the elevated uric acid levels or the acute gout symptoms the client is experiencing.
D. Splinting the affected joint may help with pain management by immobilizing the joint, but it is not a primary intervention for reducing uric acid levels or preventing further gout attacks. The focus should be on managing the underlying cause.

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Joint	Type of range of motion
Shoulder - unable to move the arm away from the body	Flexion-a Adduction-a Abduction-a Extension-a
Elbow - only able to straighten joint 20 degrees	Flexion-b Adduction-b Abduction-b Extension-b
Wrist - able to bend wrist back	Flexion-c Adduction-c Abduction-c Extension-c

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client presents with itching and pain in the left ear that started several days after beginning swim lessons. The nurse observes a discharge coming from the ear with a musty odor. How should the nurse expect the ear to appear when performing an otoscopic examination?

Correct Answer is C

Explanation

The nurse examines a client's right great toe. The joint is red, edematous, and very painful with limited range of motion. The client's serum uric acid levels are elevated. Which action should the nurse tell the client to make?

Correct Answer is A

Explanation

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Exhibits The nurse is assessing the client for bowel sounds. Which intervention(s) would be indicated to assess bowel sounds? Select all that apply.