CHAPTER 14 MUSCULOSKELETAL, PN 111 INTEGUMENTARY
AND HEENT, PN 111 CH. 6, 7, 8, PN 111 CHAPTERS 1-4, PN 111
CH 16 AND 17, PN 111-CARDIAC AND GI, PN 111 RESPIRATORY
AND NEURO SYSTEMS, CRANIAL NERVES ALL QUESTIONS AND
VERIFIED CORRECT ANSWERS LATEST UPDATE
What is carpal tunnel syndrome?
-Caused by inflammation of the median nerve at
the wrist
-Causes numbness, tingling, and pain in thumb
index and first three fingers
How does the nurse assess for carpal tunnel syndrome?
By tapping on the medial nerve at the wrist and asking the patient if discomfort is felt
and where--Tinel test
By asking the patient to put the wrist together with the hands pointing to the ground and
ask if discomfort is felt and where-Phalen's Test/Manuever
How does the nurse test for muscle strength?
By asking the patient to hold out the arm or leg and the nurse applies pressure to the
arm or leg while the patient resists the pressure. Strength is graded on a scale of 0-5
What is gout?
,A hereditary disorder with increase in serum uric acid due to increased production, or
decreased excretion of uric acid and urate salts.
What are the manifestations of gout?
Somatic pain causing swelling, redness and tenderness in the joints, often the joint
at the base of the big toe. An attack of gout can occur suddenly
What is osteoarthritis?
Degenerative change in articular cartilage. Related to overuse of weight bearing joints.
Affects weight-bearing joints (vertebrae, hips, knees, and ankles); also hands and
fingers.
•R/t overuse of weight bearing joints
Joint involvement may be unilateral or bilateral.
What are the manifestations of osteoarthritis?
joint edema and aching pain
What is rheumatoid arthritis?
A chronic, autoimmune inflammatory disease of connective tissue.
What are the manifestations of rheumatoid arthritis?
Joint involvement is bilateral.
Symptoms are pain, edema, and stiffness of fingers, wrists, ankles, feet, knees., low-
grade fever and fatigue.
As disease continues, ulnar deviation, swan-neck deformity, and boutonnière deformity
may be observed.
Where is the temporomandibular joint located and how does the nurse assess it?
,The nurse will place two fingers in front of each ear and ask the patient to open and
close mouth and move mouth side to side. Joint should move freely and smoothly.
What are abnormal findings when assessing movement of a joint?
The joint should flex and extend freely without crepitus--rubbing/grating feeling
(depending on age of patient), subluxation--popping, erythema (redness, edema, heat) ,
or tenderness.
How does the nurse assess for eversion and inversion of a clients ankle/foot?
*To assess for eversion ask the patient to turn the foot outward with the small toe
facing up
*To assess for inversion ask the patient to turn the foot inward at the ankle with
the big toe facing up
How does the nurse instruct a patient to dorsiflex or plantarflex the foot?
•Dorsiflexion-flexing of the ankle and pointing of the toes toward the nose
•Plantar Flexion- when the foot is bent at the ankle away from the body
What is muscle atrophy?
Loss of muscle size and strength
What is scoliosis?
abnormal curvature of the spine
Which joints are able to move in a full circle?
Shoulder and hip joints
Where are the metatarsals located?
foot
Where are the metacarpals located?
, hand
What is jaundice
A yellowing of the skin and eyes
Where does the nurse assess for jaundice
sclera, soles of the hands and bottoms of the feet
What is petechiae?
pin point purplish or red discoloration of an area of the skin.
How does the nurse assess nevus (moles) or lesions for possible skin cancer
(melanoma)
By using the ABCDEF rule---F stands for Familiar
What are the four stages of a pressure ulcer?
◦Stage I = prolonged redness with unbroken skin
◦Stage II = partial-thickness skin loss appears as a superficial abrasion, blister, or
excoriation
◦Stage III = full-thickness skin loss with damage to subcutaneous tissue (may
note serosanguineous drainage)
◦Stage IV = full-thickness skin loss with invasion of deeper tissue into muscle
and/or bone; wound appears as an open ulceration with purulent drainage and
peripheral crusting
****Some are unstageable with tunnels and discoloration
What is impetigo?
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