Neurological Disorders Q 77 - Gyan Darpan : Learning Portal
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Monday, 18 April 2022

Neurological Disorders Q 77

During a routine physical examination to assess a male client’s deep tendon reflexes, the nurse should make sure to:
     A. Use the pointed end of the reflex hammer when striking the Achilles' tendon.
     B. Support the joint where the tendon is being tested.
     C. Tap the tendon slowly and softly.
     D. Hold the reflex hammer tightly.

Correct Answer: B. Support the joint where the tendon is being tested.

To prevent the attached muscle from contracting, the nurse should support the joint where the tendon is being tested. With clean hands on a fully relaxed joint, the tendon/target is struck with sufficient force to elicit the reflex while the clinician’s eyes are focused on the proximal muscle group, looking for contraction, rather than the distal appendage, looking for movement.

Option A: The nurse should use the flat, not pointed, end of the reflex hammer when striking the Achilles’ tendon. (The pointed end is used to strike over small areas, such as the thumb placed over the biceps tendon). A variety of tools are used to elicit a reflex which ranges from specialized to improvised, with specialized hammers being generally preferable. The most commonly used specialized reflex hammers are grouped into 3 types by the shape of the head: triangular/tomahawk shaped (Taylor), T-shaped (Tromner, Buck), or circular (Queen Square, Babinski).
Option C: Tapping the tendon slowly and softly wouldn’t provoke a deep tendon reflex response. The technique may vary slightly depending on what type of tool is used or what reflex is being tested, for instance, circular hammers can be “dropped” passively through an arc using gravity to strike the patellar tendon, but when striking the biceps tendon are generally swung like a drumstick.
Option D: The nurse should hold the reflex hammer loosely, not tightly, between the thumb and fingers so it can swing in an arc. If a patient is hyperreflexic, a clinician’s finger may be all that is needed because the forces needed are so slight. With any tool, a finger can be placed on the tendon to help guide the clinician’s blow to the correct location, to help feel the contraction, and to reduce discomfort for the patient by cushioning the blow. This is most commonly done when eliciting the biceps reflex.

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