The nurse asks the client to "place one hand behind the back and touch the shoulder blade" in the position shown. The patient explains he cannot perform the movement. What MOST likely is causing the patient decreased range of motion (ROM) in this joint?

Pectoralis major tear

Arthritis

Rotator Cuff Tendinitis

Gout

Answer and Explanation

The Correct Answer is C

A) Pectoralis major tear: A tear of the pectoralis major muscle would likely cause pain and weakness, particularly in activities involving pushing or lifting. While it may affect shoulder movements, it is less likely to specifically impair the ability to reach behind the back and touch the shoulder blade compared to rotator cuff issues.
B) Arthritis: Arthritis, particularly osteoarthritis, can cause decreased range of motion and pain in the shoulder joint. However, the specific movement described—placing one hand behind the back to touch the shoulder blade—is most commonly affected by issues with the rotator cuff rather than arthritis alone.
C) Rotator Cuff Tendinitis: Rotator cuff tendinitis is a common cause of shoulder pain and decreased range of motion, particularly affecting movements that require lifting the arm or reaching behind the back. Tendinitis in the rotator cuff can lead to pain and difficulty performing the movement described due to inflammation and impingement of the tendons.
D) Gout: Gout is a type of arthritis caused by the accumulation of uric acid crystals in the joints, often affecting the big toe but can affect other joints. While it can cause joint pain and inflammation, it is less likely to specifically impair the shoulder movement described compared to rotator cuff tendinitis.

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Correct Answer is B

Explanation

A) Lateralization of the sound/vibration to both ears equally: The Weber test is used to assess unilateral hearing loss and would not show equal lateralization in the presence of unilateral sensorineural hearing loss. Equal lateralization would suggest normal hearing or symmetrical hearing loss, which is not the case here.
B) Lateralization of the sound/vibration to the left ear: In sensorineural hearing loss, sound is perceived to lateralize to the unaffected ear. Therefore, with right ear sensorineural hearing loss, the sound will lateralize to the left ear, indicating that the left ear has better hearing capability.
C) Bone conduction (BC) is greater than air conduction (AC): This finding is characteristic of conductive hearing loss, not sensorineural hearing loss. In sensorineural hearing loss, air conduction is typically greater than or equal to bone conduction, but the Weber test focuses on lateralization rather than BC versus AC.
D) Lateralization of the sound/vibration to the right ear: If the sound were to lateralize to the affected ear in sensorineural hearing loss, it would suggest that the affected ear is hearing better, which contradicts the nature of sensorineural hearing loss. The sound will actually lateralize to the better-hearing, unaffected ear.

A. Assist the client to a standing position. B. Focus a penlight on the client's chest. C. Use tangential lighting D. Use perpendicular lighting.

Correct Answer is C

Explanation

A. Assist the client to a standing position: While positioning can be important for various assessments, inspecting the apical impulse is best done with the client in a supine or left lateral position. Standing may not provide the best view or palpation for the apical impulse, which is usually assessed more accurately in a different position.

B. Focus a penlight on the client's chest: A penlight alone may not provide sufficient illumination for detailed inspection of the apical impulse. It is more important to use appropriate lighting techniques to ensure a clear view of the heart's movements.

C. Use tangential lighting: Tangential lighting is particularly useful for inspecting and palpating the apical impulse because it casts light across the surface, highlighting contours and movements. This type of lighting helps the nurse visualize the apical impulse more clearly by creating shadows that accentuate the impulse's presence and movements.

D. Use perpendicular lighting: Perpendicular lighting might not be as effective in highlighting the subtle movements of the apical impulse. Tangential lighting is preferred because it creates shadows and contrasts that make the apical impulse more visible and easier to assess.

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The nurse asks the client to "place one hand behind the back and touch the shoulder blade" in the position shown. The patient explains he cannot perform the movement. What MOST likely is causing the patient decreased range of motion (ROM) in this joint?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient came with a right ear sensorineural hearing loss. What should the nurse expect while performing the Weber test?

Correct Answer is B

Explanation

The nurse is planning to inspect a client's apical heart impulses. What should the nurse do to ensure an accurate assessment of this organ?

Correct Answer is C

Explanation

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