Patient Data
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 |
Wrist - able to bend wrist back toward forearm |
Abduction Flexion Extension Adduction |
Shoulder - unable to move the arm away from the body |
Extension Adduction Flexion Abduction |
Flexion
Adduction
Abduction
Extension
The Correct Answer is ["A","C"]
WRIST - ABLE TO BEND WRIST BACK TOWARD FOREARM:
Abduction
Abduction refers to the movement of a body part away from the body's midline. This movement is typically used for fingers, arms, or legs, but not for the wrist. Therefore, this choice is incorrect for the wrist's range of motion.
Flexion
Flexion refers to the bending of a joint that reduces the angle between two body parts. For the wrist, flexion would involve bending the wrist forward, toward the palm of the hand. Since the patient is able to bend the wrist backward (toward the forearm), this is not the correct choice.
Extension
Extension refers to straightening a joint, which increases the angle between the body parts. For the wrist, extension is the movement where the hand moves away from the palm (backward toward the forearm). This is the correct choice because the patient is able to bend the wrist back toward the forearm, which is extension.
Adduction
Adduction refers to the movement of a body part toward the body's midline. This is not relevant to the wrist, so it is an incorrect option.
SHOULDER - UNABLE TO MOVE THE ARM AWAY FROM THE BODY:
Extension
Extension refers to the movement that straightens a joint, increasing the angle between two parts of the body. For the shoulder, this would involve moving the arm behind the body, and it's not the movement of the arm away from the body, so this is not the correct choice.
Adduction
Adduction refers to moving a body part toward the midline of the body. For the shoulder, this would involve moving the arm closer to the body. This does not correspond to the action of moving the arm away from the body, so this is not the correct choice either.
Flexion
Flexion refers to the bending of a joint that decreases the angle between two body parts. For the shoulder, this would involve raising the arm forward, not moving it away from the body. This is not the correct choice for the described movement.
Abduction
Abduction refers to the movement of a body part away from the midline of the body. In this case, the shoulder movement of moving the arm away from the body is abduction. Since the client is unable to move the arm away from the body (i.e., is experiencing weakness or limited ROM), the shoulder’s range of motion has a restriction in abduction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Facial asymmetry may indicate neurological issues, but it does not directly assess the stuporous state.
B. A stuporous state is characterized by a reduced level of consciousness, and the nurse should assess
the client’s response to stimuli to confirm the report of stupor.
C. A positive Romberg sign indicates a balance issue, but it is not directly related to confirming a stuporous state.
D. While pupillary response is important, it does not provide sufficient information to confirm a stuporous state without assessing responsiveness to stimuli.
Correct Answer is ["B","C","D","E"]
Explanation
A. Documenting the roaring and crackles is important to note any abnormal findings. However, this does not directly mitigate artifacts, which may interfere with the accuracy of the sounds heard through auscultation.
B. Wetting the chest hair is a useful technique to reduce the sound interference caused by chest hair rubbing against the stethoscope. This helps eliminate some of the unwanted sounds and improves the clarity of auscultation.
C. Ensuring the room is warm and the stethoscope is warmed before use is important because cold stethoscopes can cause discomfort to the client and may lead to muscle tensing, making it harder to hear clear heart and lung sounds.
D. Reaching under the gown ensures that no clothing creates friction on the stethoscope, which can produce unwanted sounds during auscultation. This helps in obtaining clear and accurate heart or lung sounds.
E. A quiet environment is crucial for auscultation, as background noise can obscure important sounds. Ensuring that the room is free from distractions and noise will significantly improve the quality of auscultation.
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