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Carpal Tunnel
Text Mode Text version of the exam
1) You deserve the nursing assistant performing all of these interventions for the patient with CTS. Which action
requires that you intervene immediately?
Arrange the patients lunch tray and cut the meat.
Provide warm water and assist the patient with a bath.
Replace the patients splint in hyperextension position.
Remind the patient not to lift very heavy objects.
2) You are providing nursing care for a patient with carpal tunnel syndrome (CTS) who is preparing for surgery.
Which intervention should you delegate to the nursing assistant?
Initiate placement of a splint for immobilization during the day.
Assess the patients wrist and hand for discoloration and brittle nails.
Assist the patient with daily self-care measures such as bathing and eating.
Test the patient for painful tingling in the four digits of the hand.
3) Of the following common problems of the upper extremities, which results from entrapment of the median nerve at
the wrist?
Carpal tunnel syndrome
Ganglion
Dupuytrens contracture
Impingement syndrome
4) The nurse is conducting a discharge teaching regarding the prevention of further problems to a client who
undergone surgery for carpal tunnel syndrome of the right hand. Which of the following instruction will the nurse
includes?
Learn to type using your left hand only.
Avoid typing in a long period of time.
Avoid carrying heavy things using the right hand.
Do manual stretching exercise during breaks.
5) As charge nurse you assign the nursing care of a patient who has just returned form open carpal tunnel release
surgery to an experienced LPN/LVN, who will perform under the supervision of an RN. Which of the following
instructions will you provide for the LPN/LVN? (Choose all that apply.)
Check the patients vital signs every 15 minutes in the first hour.
Check the dressing for drainage and tightness.
Elevate the patients hand above the heart.
The patient will no longer need pain medication.
Check the neurovascular status of the fingers every hour.
6) The patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What key point will you be
sure to teach the patient?
Pain and numbness will be experienced for several days to weeks.
Immediately after surgery, the patient will no longer need assistance.
After surgery, the dressing will be large with dots of drainage
After surgery, the pain and paresthesia will no longer be present.
7) A 45-yr-old auto mechanic comes to the physicians office because an exacerbation of his psoriasis is making it
difficult to work. He tells the nurse that his finger joints are stiff and sore in the morning. The nurse should respond
by:
Inquiring further about this problem because psoriatic arthritis can accompany psoriasis
vulgaris
Suggesting he take aspirin for relief because its probably early rheumatoid arthritis
Validating his complaint but assuming its an adverse effect of his vocation
Asking him if he has been diagnosed or treated for carpal tunnel syndrome
8) Mrs. Moore, 62-year-old, with diabetes is in the emergency department. She stepped on a sharp sea shells while
walking barefoot along the beach. Mrs. Moore did not notice that the object pierced the skin until later that evening.
What problem does the client most probably have?
Nephropathy
Macroangiopathy

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Carpal tunnel syndrome

Peripheral neuropathy
9) You are preparing the post-operative CTS patient for discharge. Which information is important to provide to this
patient?
The surgical procedure is a cure for CTS.
Hand movements will be restricted for 4 6 weeks after surgery.
Frequent pain medication dosages will no longer be necessary.
Notify the physician immediately for any pain or discomfort.
Answers and Rationales
C. Replace the patients splint in hyperextension position. When a patient with CTS
has a splint used for immobilization of the wrist, it is placed either in the neutral position or in slight
extension. The other interventions are correct and are within the scope of practice for a nursing
assistant. Nursing assistants may remind patients about elements of their care plans such as avoiding
heavy lifting. Focus: Delegation/supervision
C. Assist the patient with daily self-care measures such as bathing and
eating. Placing a splint for the first time is appropriate to the scope of practice for physical therapists.
Assessing and testing for paresthesia are not within the scope of practice for nursing assistants.
Assistance with activities of daily living is within the scope of practice for a nursing assistant. Focus:
Delegation/supervision
A. Carpal tunnel syndrome . Carpal tunnel syndrome is commonly due to repetitive hand
activities. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears
as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytrens contracture is a
slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the
shoulder and may progress to a rotator cuff tear.
D. Do manual stretching exercise during breaks. Manual stretching exercises will assist
in keeping the muscles and tendons supple and pliable, reducing the traumatic consequences of
repetitive activity.
A. Check the patients vital signs every 15 minutes in the first hour. , B. Check the
dressing for drainage and tightness. , C. Elevate the patients hand above the heart. , E.
Check the neurovascular status of the fingers every hour. Post-operatively, patients with OCTR
surgery have pain and numbness. Their discomfort may last for weeks to months. All of the other
directions are appropriate to the post-operative care for this patient. It is important or monitor for
drainage, tightness, and neurovascular changes. Raising the hand/wrist above the heart reduces the
swelling form surgery, and this is often done for several days. Focus: Assignment,
delegation/supervision
A. Pain and numbness will be experienced for several days to weeks. Post-operative
pain and numbness occur for a longer period of time with endoscopic carpal tunnel release than with
the open procedure. Patients often need assistance post-operatively, even after they are discharged.
The dressing from the endoscopic procedure is usually very small and there should not be a lot of
drainage. Focus: Prioritization
A. Inquiring further about this problem because psoriatic arthritis can accompany
psoriasis vulgaris . Anyone with psoriasis vulgaris who reports joint pain should be evaluated for
psoriaic arthritis. Approximately 15% to 20% of individuals with psoriasis will also develop psoriatic
arthritis, which can be painful and cause deformity. It would be incorrect to assume that his pain is
caused by early rheumatoid arthritis or his vocation without asking more questions or performing
diagnostic studies. Carpal tunnel syndrome causes sensory and motor changes in the fingers rather
than localized pain in the joints.
D. Peripheral neuropathy . Peripheral neuropathy refers to nerve damage of the hands
and feet. The client did not notice that the object pierced the skin.
B. Hand movements will be restricted for 4 6 weeks after surgery. Hand
movements, including heavy lifting, may be restricted for 4- 6 weeks after surgery. Patients experience
discomfort for weeks to months after surgery. The surgery is not always a cure. In some cases, CTS
may recur months to years after surgery. Focus: Prioritization