A client is concerned about developing carpal tunnel syndrome. Which screening technique should the nurse perform to provide the client with useful information?

Ask the client about progressive contractures of the 4th and 5th fingers.

Compress the ulnar and radial arteries, then observe for flushing in the hand when ulnar pressure is released.

Compare the client's hands bilaterally for pain, pallor, pulses, paralysis, and paresthesia.

Instruct the client to place the backs of the hands together and flex both wrists.

Answer and Explanation

The Correct Answer is D

A.   Contractures of the 4th and 5th fingers are more indicative of ulnar nerve involvement, not median nerve compression. Carpal tunnel syndrome primarily affects the thumb, index finger, middle finger, and part of the ring finger. Thus, asking about contractures of the 4th and 5th fingers would not provide useful information about carpal tunnel syndrome.
B.   This technique is used to assess the patency of the radial and ulnar arteries, commonly referred to as the Allen test. It is used to evaluate blood flow in the hand, particularly before performing procedures that may impact arterial circulation. This test is not specific to carpal tunnel syndrome and does not provide useful information about median nerve compression.
C.   While comparing the hands bilaterally for various signs can be useful in assessing general hand function and circulation, this method does not specifically target the symptoms or diagnostic tests associated with carpal tunnel syndrome. It provides a broad overview but is not specific enough to confirm CTS.
D.   This technique is known as the Phalen’s test, which is specifically used to assess for carpal tunnel
syndrome. During the Phalen’s test, the client is asked to flex their wrists and hold the position for about 60 seconds. If the client experiences tingling, numbness, or pain in the median nerve distribution (thumb, index, middle finger, and part of the ring finger), it suggests carpal tunnel syndrome.

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Correct Answer is A

Explanation

A. The numeric pain intensity scale is a direct and effective method to assess the level of pain a patient is experiencing. If a client is splinting their chest, it’s essential to evaluate their pain level to determine the severity and guide appropriate pain management strategies. This is likely the most relevant and immediate follow-up assessment in this scenario.
B. An apical-radial pulse deficit measures the difference between the apical pulse (heart rate auscultated at the apex of the heart) and the radial pulse (heart rate palpated at the wrist). This assessment is used to detect conditions such as atrial fibrillation or other arrhythmias and is not directly related to the client’s chest splinting. Therefore, it is not the most relevant follow-up assessment in this context.
C. The anteroposterior (AP) chest diameter assessment is used to evaluate conditions such as barrel chest, which can be associated with chronic respiratory conditions. While this measurement can be important for assessing chronic respiratory issues, it is not directly related to the immediate concern of chest splinting, which is more likely associated with acute pain or discomfort.
D. Measuring body temperature is important for assessing the presence of fever or infection, but it does not directly address the client’s immediate complaint of chest pain or discomfort. While an elevated temperature might be relevant if an infection is suspected, it is not the most direct or immediate follow- up assessment for the observed behavior of splinting the chest.

A. Circulation impaired. B. Paresthesia reported. C. Reports feeling "on fire." D. Inflammation present.

Correct Answer is B

Explanation

A. This term suggests a problem with blood flow, which could potentially cause symptoms such as numbness or tingling. However, it does not specifically address the sensation of burning. Using this term might lead to an incorrect or incomplete assessment of the client's condition.
B. Paresthesia is a term used to describe abnormal sensations in the skin, such as burning, tingling, or prickling. The client's report of a burning sensation in the hands and legs aligns well with the definition of paresthesia. Documenting it as "paresthesia reported" accurately reflects the nature of the symptoms and is a medically precise way to describe the abnormal sensory experience.
C. This documentation uses colloquial language ("on fire") to describe the client's symptoms. While it conveys the intensity of the sensation, it is not a standardized medical term and may not be as clear or useful for clinical documentation.
D. Inflammation refers to the body's response to injury or infection, which often involves redness, swelling, heat, and pain. The term "inflammation" does not specifically describe the sensation of burning reported by the client.

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A client is concerned about developing carpal tunnel syndrome. Which screening technique should the nurse perform to provide the client with useful information?

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