When documenting a musculoskeletal assessment, which of the following descriptions correctly indicates a muscle strength rating of 4/5?

Choice A reason: Painful urination, or dysuria, involves discomfort during voiding, often due to urinary tract infections or inflammation. It is not synonymous with nocturia, which specifically refers to frequent nighttime urination. Dysuria requires distinct clinical evaluation, including urinalysis, to identify causes like bacterial infection or urethral irritation, making this an incorrect description of the patient’s complaint.

Choice B reason: Nocturia is the medical term for frequent urination at night, disrupting sleep. In elderly patients, it may result from reduced bladder capacity, overactive bladder, or conditions like benign prostatic hyperplasia. This matches the patient’s complaint, as it directly addresses the symptom without implying unrelated issues like pain or incontinence, making it the accurate choice.

Choice C reason: Bladder incontinence involves involuntary urine leakage, distinct from nocturia, which is voluntary urination at night. Incontinence may stem from neurological disorders or weakened pelvic muscles but does not describe the patient’s symptom of frequent nighttime voiding. This choice is incorrect, as it misaligns with the clinical presentation described.

Choice D reason: An inability to void, or urinary retention, is the opposite of nocturia, where the patient voids frequently. Retention may result from obstructions like an enlarged prostate or neurological issues, requiring catheterization or imaging for diagnosis. This choice does not reflect the patient’s symptom of active, frequent urination at night.

Choice A reason: Cyanosis, indicating hypoxia, is not typical in alcohol use disorder with weight gain and abdominal tightness, which suggest liver issues like ascites causing jaundice. Assuming cyanosis risks misdiagnosis, delaying liver assessment or treatment, critical for managing complications like cirrhosis or portal hypertension in patients with chronic alcohol use.

Choice B reason: Erythema (redness) is unrelated to alcohol-related abdominal tightness and weight gain, which indicate liver dysfunction, often presenting with jaundice. Misdiagnosing erythema risks overlooking hepatic issues, delaying interventions like diuretics for ascites, essential for managing liver complications and improving outcomes in alcohol use disorder patients.

Choice C reason: Appearing normal is unlikely with alcohol use disorder causing weight gain and abdominal tightness, typically from ascites or liver damage, presenting as jaundice. Assuming normal risks missing serious liver pathology, delaying diagnosis and treatment, critical for preventing progression of cirrhosis or liver failure in affected patients.

Choice D reason: Jaundice, yellowing of skin, is likely in alcohol use disorder with abdominal tightness and weight gain, indicating liver dysfunction (e.g., cirrhosis or alcoholic hepatitis) causing ascites. Recognizing this guides urgent liver evaluation and treatments like abstinence or diuretics, critical for managing complications and improving survival in chronic alcohol users.