The nurse is assessing a client's skeletal muscle movements and strength. Which action should the nurse instruct the client to perform to evaluate prime-mover muscle groups?
Flex and hold as opposing force is applied.
Perform sets of passive range of motion.
Hold arms straight forward with eyes closed.
Stand on each foot without assistance.
The Correct Answer is A
Rationale:
A. Flex and hold as opposing force is applied: This technique evaluates the strength of prime-mover muscle groups by having the client actively flex against resistance. It allows the nurse to assess muscle function, endurance, and the ability to maintain strength against an external force.
B. Perform sets of passive range of motion: Passive range of motion exercises assess joint flexibility and mobility but do not evaluate the client's active muscle strength since the movements are performed by the examiner rather than the client.
C. Hold arms straight forward with eyes closed: This action is part of a neurological assessment, specifically testing for proprioception and balance (Romberg test), not a direct evaluation of muscle group strength.
D. Stand on each foot without assistance: Standing on one foot assesses balance and coordination more than muscle strength. It involves neuromuscular control but does not directly isolate or test specific prime-mover muscle groups under resistance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["40"]
Explanation
Number of packs smoked per day: 2
Number of years the client has smoked at this rate: 20 years
- Calculate the pack-years
Pack-years = (Number of packs smoked per day) x (Number of years smoked)
= 2 packs/day x 20 years
= 40
Correct Answer is A
Explanation
Rationale:
A. Inspect the external ear canals: Muffled hearing, especially if unilateral, may be due to cerumen impaction, swelling, or other obstructions in the external auditory canal. Visual inspection is a quick, non-invasive first step that can help identify mechanical causes of hearing difficulty before pursuing more complex diagnostic tests.
B. Ask client if he has tinnitus: Tinnitus refers to ringing or buzzing in the ears and is often associated with sensorineural hearing loss rather than conductive hearing loss, which is more likely when hearing is muffled. While relevant for a full hearing evaluation, it does not address the immediate symptom of muffled hearing.
C. Determine ability to maintain balance with eyes closed: Balance issues are more related to inner ear dysfunction, particularly involving the vestibular system. Since the client's primary complaint is muffled hearing and not dizziness or balance problems, this assessment is not the most appropriate first step.
D. Differentiate ability to hear high and low pitched sounds: Differentiating pitch perception helps assess for specific types of sensorineural hearing loss. However, before conducting specialized auditory discrimination tests, it is more appropriate to first check for any external, easily correctable issues such as blockage or infection.
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