The nurse suspects that the patient has carpal tunnel syndrome and wants to perform the Phalen test. How should the nurse instruct the patient?

Hold hands back-to-back while flexing the wrists to 90 degrees for 60 seconds

Press the palms together for 2-3 seconds

Interlace the metacarpals for 2-3 seconds

Internally rotate the shoulders, pressing the hands into the back

Answer and Explanation

The Correct Answer is A

A. Hold hands back-to-back while flexing the wrists to 90 degrees for 60 seconds: This position increases pressure within the carpal tunnel and compresses the median nerve against the flexor retinaculum. The test is considered positive if the patient experiences numbness or tingling in the median nerve distribution. It is a specific diagnostic maneuver for entrapment.

B. Press the palms together for 2-3 seconds: This action does not provide the necessary mechanical compression of the median nerve required for a provocative neurological test. Brief palm pressing lacks the specific anatomical positioning needed to elicit symptoms of nerve compression. It is not a recognized maneuver for carpal tunnel.

C. Interlace the metacarpals for 2-3 seconds: Interlacing the fingers or metacarpals does not put the carpal tunnel under sufficient stress to reproduce neurological symptoms. This movement does not target the median nerve at the wrist joint. It is an irrelevant action for diagnosing upper extremity nerve entrapment syndromes.

D. Internally rotate the shoulders, pressing the hands into the back: This movement assesses the internal rotation of the glenohumeral joint and the integrity of the rotator cuff. It has no diagnostic value for conditions affecting the distal upper extremity or the median nerve. It is used for shoulder rather than wrist evaluations.

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Correct Answer is ["A","C"]

Explanation

A. Respiratory rate 29/minute: Tachypnea in a sickle cell patient may indicate acute chest syndrome or compensatory mechanisms for systemic hypoxia. Rapid breathing suggests pulmonary complications or significant physiological stress that requires immediate clinical evaluation. This rate is significantly above the normal adult range of 12 to 20 breaths per minute.

B. Blood pressure 118/68: This blood pressure reading is within the normal physiological range for an adult and indicates stable hemodynamics. It does not suggest hypovolemia or hypertensive crisis in the context of a sickle cell vaso-occlusive episode. Normal vascular pressure is a reassuring finding during a routine nursing assessment.

C. Pulse rate 112/minute: Tachycardia is a concerning sign that may reflect severe pain, dehydration, or anemic compensation to maintain cardiac output. It can also be an early indicator of infection or an impending sickle cell crisis. A heart rate exceeding 100 beats per minute necessitates further diagnostic investigation.

D. Temperature 37° Celsius: This represents a normal core body temperature, suggesting the absence of an acute febrile illness or systemic infection. Since infection is a frequent trigger for sickle cell crises, a localized or systemic normothermia is a stable finding. It does not currently indicate an inflammatory or infectious process.

A. "Do other people talk about you?" B. "Why don't you start going to church?" C. "Do you ever think about harming yourself?" D. "Can you spend more time with your children?"

Correct Answer is C

Explanation

A. "Do other people talk about you?": This question assesses for paranoia or ideas of reference, which are symptoms of psychosis rather than primary bereavement. While part of a mental status exam, it is not the immediate priority for a patient expressing profound sadness. It does not address the urgent safety risks associated with depression.

B. "Why don't you start going to church?": This is a non-therapeutic response that offers unsolicited advice and may impose the nurse's values on the patient. It fails to explore the patient's current emotional state or assess for clinical depression. It ignores the patient's expressed feelings of hopelessness and sadness.

C. "Do you ever think about harming yourself?": Assessing for suicidal ideation is the absolute priority for any patient expressing hopelessness. Safety is the foundation of psychiatric nursing, and direct questioning is the most effective way to identify self-harm risk. This intervention allows for the immediate implementation of suicide prevention protocols.

D. "Can you spend more time with your children?": While encouraging social support is beneficial, it is a secondary intervention that does not address the patient's immediate safety. This question assumes the patient has supportive family dynamics and ignores the depth of the hopelessness described. Safety assessment must always precede social or lifestyle recommendations.

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The nurse suspects that the patient has carpal tunnel syndrome and wants to perform the Phalen test. How should the nurse instruct the patient?

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