Mobility, thermoregulation, diversity quiz
Osteomyelitis
inflammation of bone caused by infection
A client who had a brain attack (stroke) is admitted to the hospital with right-sided hemiplegia. For what reason does the nurse recognize the importance of identifying restrictions of mobility or neuromuscular abnormalities? -Shortening and eventual atrophy of the muscles will occur. -Hypertrophy of the muscles eventually will result from disuse. -Rigid extension can occur, making therapy painful and difficult. -Decreased movement on the affected side predisposes the client to infection
"Shortening and eventual atrophy of the muscles will occur" ......Shortening and eventual atrophy of muscles occur, resulting in contractures. Muscles will atrophy, not hypertrophy, from disuse. Flexion contractions, not extension rigidity, occur. Hemiplegia does not predispose to infection but to atrophy and contractures.
The nurse as a leader in the healthcare setting is studying how the communities and cultures that make up society relate to healthcare delivery. Which aspect of systems thinking theory of leadership is the nurse applying in this situation? -Thinking of the "Big Picture" -Balancing short-term and long-term objectives -Using measurable versus non-measurable data systems -Recognizing the dynamic, complex, and interdependent nature of systems
Recognizing dynamic, complex, and interdependent nature of systems --According to the systems thinking theory of leadership, the nurse as a leader should identify and understand the communities and cultures of a society and how they relate to healthcare delivery. When the nurse envisions the context of their work beyond the immediate tasks, it indicates thinking of the "Big Picture" principle of systems thinking theory. Balancing short-term and long-term objectives indicates that the nurse recognizes the long-term consequences of actions taken today on the organization or client care. Using measurable versus non-measurable data systems triggers the tendency to see only what is measured.
What points should a nurse keep in mind when caring for a client who belongs to a different culture? Select all that apply. -The nurse should be aware of his or her own cultural values and behavior patterns. -The nurse should focus on understanding the client's traditions, values, and beliefs. -The nurse should understand that unique cultural perceptions exist regarding health practices. -The nurse should know that every client strictly adheres to his or her cultural beliefs and traditions. -The nurse should know that a client's cultural background does not influence the nurse-client relationship.
-The nurse should be aware of his or her own cultural values and behavior patterns. -The nurse should focus on understanding the client's traditions, values, and beliefs. -The nurse should understand that unique cultural perceptions exist regarding health practices. .............Nurses should be aware of their own cultural values and behavior patterns. This awareness enables them to understand a client's values and beliefs. Nurses should focus on understanding the client's traditions, values, and beliefs and the manner in which these aspects influence his or her health, wellness, and illness. When educating clients about their health issues and treatment plans, nurses should understand that unique perceptions exist about the cause of an illness and its treatment. A nurse should never stereotype clients on the basis of their cultural background and assume that they strictly adhere to cultural traditions and practices. A nurse should understand that the cultural background of a client also influences the nurse-client relationship.
Which task must a nurse leader undertake to lead a healthcare culture? -Serving as a coach or a guide -Maintaining a good relationship with the team -Working to solve process problems with the team -Empowering staff to be continuous learners and risk takers
"Empowering staff to be continuous learners and risk takers" ...Nurse leaders should encourage and empower the staff to be continuous learners and risk takers in order to build a culture of curiosity and change. The nurse leader must serve as a coach or guide and should be able to maintain good relationship with the team. To lead processes, the nurse leader must work to solve process problems with the team and must make process changes as they emerge.
While measuring the rectal temperature, the nurse inserts the thermometer probe 2.5 to 3.5 cm into the anus in the direction of the umbilicus. What would be the rationale behind this? -Provide comfort to the client -Minimize trauma to rectal mucosa -Reduce transmission of microorganisms -Ensure adequate exposure to the blood vessels
"Ensure adequate exposure to the blood vessels" ...The nurse should place the thermometer probe into the anus in the direction of umbilicus to ensure adequate exposure to the blood vessels. Wiping the client's anal area with a soft tissue and helping the client get into the Sims' position provides comfort. Using a lubricant will help to minimize trauma to the rectal mucosa. The nurse should wash his or her hands before and after assessing the temperature to reduce the transmission of microorganisms.
The registered nurse is preparing to perform a physical assessment of a client with darker skin who is suspected to have jaundice. Which statement by the nurse indicates effective technique? -"I will examine the conjunctiva." -"I will examine the lips and tongue." -"I will examine the nail beds, palms, and soles." -"I will examine the sclera closest to the iris."
"I will examine the sclera closest to the iris." The most important assessment for clients who are suspected to have jaundice is examining the sclera closest to the iris. Assessments of the conjunctiva, lips, tongue, nail beds, palms, and soles are effective for a client who is suspected to have cyanosis.
A registered nurse is explaining the term "just culture" to the student nurse. Which explanation provided by the registered nurse is accurate? -"It refers to the agreement to keep promises." -"It refers to taking positive actions to help others." -"It refers to the ability to answer for one's actions." -"It refers to promoting open discussion whenever error occurs without fear of recrimination."
"It refers t promoting open discussion whenever error occurs without fear of recrimination" The term "just culture" refers to the promotion of open discussion whenever errors occur without fear of recrimination. Fidelity refers to the agreement to keep promises. Beneficence refers to taking positive actions to help others. Accountability refers to the ability to answer for one's actions.
The nurse is caring for a client whose forehead feels warm to the touch. The nurse uses a thermometer and obtains the client's temperature. What is the nurse doing? -Validation -Assessment -Interpretation -Documentation
"Validation" ....The nurse is validating the presence of fever in the client. Validation is the process of gathering more assessment data. It involves clarifying vague or unclear data. Assessment is the first step of the nursing process. It involves collecting information from the client and secondary sources. During interpretation, the nurse recognizes that further observations are needed to clarify information. Data documentation is the last part of a complete assessment. The nurse must document facts in a timely, thorough, and accurate manner to prevent information from getting lost.
1. Distraction & creative imagery during administration of medication, 11yo 2. Admin of analgesics only when pain intensifies, 9yo 3. Admin of opioids po(per oral)along with meals, 7yo 4. Administration of half of the adult does in case suppositories should not be done, 14yo
"Administration of half of the adult does in case suppositories should not be done, 14yo" .....When a child has acute pain, oral dosage forms of analgesics(tylenol, ibuprofen, NSAID asprin) should be given. These medications must be given before the pain intensifies, so the nursing intervention for client 2 needs correction. In pediatrics, distraction and creative imagery during the drug administration can help to distract the child from any pain or fear, so the nursing intervention for client 1 is appropriate. In pediatrics, opioids can cause certain changes like nausea and vomiting. Administering the medications with meals can help reduce the GI upset, so the nursing intervention for client 3 is appropriate. While administering suppositories to pediatric clients, care should be taken that an adult dose is halved, split, or divided to reduce the risk of overdose, so the nursing intervention for client 4 is appropriate.
The nurse is planning care for an immobilized client who has suffered a stroke. The client has right-sided hemiparesis (weakening of entire side of body). Which activity takes priority for this client? -Assess the client lung sounds every 8 hours. -Assist the client in performing range-of-motion (ROM) exercises every 1 to 2 hours. -Allow the client to sit upright in the chair for as long as tolerated. -Have the nursing assistant turn and reposition the client every 2 to 3 hours.
"Assist client in performing range of motion exercises every 1-2 hours" ...ROM exercises should be performed often to prevent muscle atrophy and contractures. Assessing the client's lung sounds every 8 hours is the minimum the nurse should assess lung sounds, and it is important, but it is not a priority in planning care for immobilization. The client should not be allowed to dangle in a chair for prolonged periods of time because of skin breakdown and venous return. The nursing assistant should be instructed to turn the client at least every 2 hours.
A nurse is caring for a group of clients with diverse cultural backgrounds. Which nursing theory does the nurse use as a guide? -Orem's theory -Leininger's theory -Henderson's theory -Betty Neuman's theory
"Leininger's theory" ...Leininger's theory guides the nurse to appropriately deal with clients from different cultural and ethnic groups. According to this theory, while caring for clients from different cultural backgrounds, the nurse should provide culturally specific nursing care. Dorothea Orem's self-care deficit theory focuses on the client's self-care needs. Henderson's theory involves working interdependently with other healthcare workers. Neuman's theory is based on stress and the client's reaction to the stressor.
A client has a fever spike that is combined with normal temperature levels. The client's body temperature returns to a normal body temperature at least once a day. Which type of fever can be assessed in the client? -Sustained -Relapsing -Remittent -Intermittent
"intermittent" An intermittent fever is characterized by fever spikes interspersed with normal temperatures. In this type of fever, the body temperature returns to normal at least once in 24 hours. In the case of sustained fever, there is a constant body temperature greater than 38ºC. In relapsing fever, there is an occurrence of periods of febrile episodes with acceptable temperature values. In remittent fever, the body temperature increases and decreases without returning to normal body temperature levels.
The nurse plans to use the tympanic membrane method and an electronic infrared thermometer to measure a 2-year-old toddler's temperature. What steps should the nurse take? Select all that apply. -Pull the pinna up and back. -Pull the pinna backward, up, and out. -Refrain from applying pressure to the ejection button. -Obtain the temperature from patient's right ear if the nurse is right-handed. -Point the covered probe toward the midpoint between the eyebrow and sideburn
-Refrain from applying pressure to the ejection button. -Obtain the temperature from patient's right ear if the nurse is right-handed. -Point the covered probe toward the midpoint between the eyebrow and sideburn(bc child ear drum points forward, adult ear drum points backward) ........The nurse should be careful not to apply pressure to the ejection button. If the nurse is right-handed, the temperature is measured in the toddler's right ear. The nurse should point the covered probe toward the midpoint between the eyebrow and sideburn to measure body temperature in a child of 3 years or younger. The nurse should pull the pinna up and back in a child older than 3 years. When obtaining an adult's temperature, the nurse should pull the pinna backward, up, and out.
Which disorder of the foot is caused by continual pressure over bony prominences? -Corn -Plantar wart -Hammer toe -Hallux rigidus (big toe arthritis)
"corn" .....A corn is a foot disorder caused by continual pressure over bony prominences. A plantar wart is a foot disorder caused by a virus. Hammer toe is a foot disorder caused by flexion and deformity in the joints. Hallux rigidus (big toe arthritis) is caused by osteoarthritis.
While assessing a client's joint for mobility, the primary healthcare provider moved the client's first and fifth metacarpals anteriorly from the flattened palm. Which type of synovial joint movement is this termed? -Flexion -Extension -Abduction -Opposition
"opposition" .......Opposition is a synovial movement that involves moving the first and fifth metacarpals anteriorly from the flattened palm (cupping position). Flexion involves bending the joint as a result of muscle contractions that result in decreasing the angle between two bones. Extension involves the straightening of the joint that increases the angle between two bones. Abduction involves the movement of a part away from the midline of the body.
The nurse finds that the client's fever spikes and falls without a return to a normal level. Which pattern of fever is this a characteristic of? -Relapsing -Sustained -Remittent -Intermittent
"remittent" In a remittent pattern, fever spikes and falls without returning to normal temperature levels. Periods of febrile episodes coupled with periods of acceptable temperature values are called a relapsing pattern. A constant body temperature continuously above 38° C (100.4° F) with little fluctuation refers to a sustained pattern. In an intermittent pattern, fever spikes are interspersed with normal temperature levels.
A client with a femoral fracture associated with osteomyelitis is immobilized for 3 weeks. The nurse assesses for the development of renal calculi. What is the rationale for the nurse's assessment? -The client's dietary patterns have changed since admission. -The client has more difficulty urinating in a supine position. -Lack of weight-bearing activity promotes bone demineralization. -Fracture healing requires more calcium, which increases total calcium metabolism
"Lack of weight-bearing activity promotes bone demineralization" ......All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position because of an inability to assume the preferred anatomic position and the emotional effects of using a urinal, it usually does not predispose the client to developing renal calculi. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased.
The nurse uses which principles of body mechanics when caring for immobilized clients? -Bending at the waist to provide the power for lifting -Placing the feet apart to increase the stability of the body -Keeping the body straight when lifting to reduce pressure on the abdomen -Relaxing the abdominal muscles while using the extremities to prevent strain
"Placing feet apart to increase stability of body" ........Placing the feet apart creates a wider base of support and brings the center of gravity closer to the ground. This improves stability. Bending at the waist should be avoided because it strains the lower back muscles; the power of lifting should be supplied by the muscles of the thighs and buttocks. Pressure on the abdomen is prevented by tightening the abdominal and gluteal muscles to form an internal girdle; keeping the body straight does not reduce strain on the abdominal musculature. Relaxing the abdominal muscles with physical activity increases back strain.
A nurse manager works on a unit where the nursing staff members are uncomfortable taking care of clients from cultures that are different from their own. How should the nurse manager address this situation? -Assign articles about various cultures so that they can become more knowledgeable. -Relocate the nurses to units where they will not have to care for clients from a variety of cultures. -Rotate the nurses' assignments so they have an equal opportunity to care for clients from other cultures. -Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work.
"Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work." ...A workshop provides an opportunity to discuss cultural diversity; this should include identification of one's own feelings. Also, it provides an opportunity for participants to ask questions. Although articles provide information, they do not promote a discussion about the topic. Relocation is not feasible or desirable; clients from other cultures are found in all settings. Rotating the nurses' assignments probably will increase tension on the unit.
What does a public health nurse expect to encounter when working with families raised in a culture of poverty? -Willingness to delay gratification -Optimism about improving their lifestyle -Shame because of their inadequacy as parents -Powerlessness relative to changing their situation
"Powerlessness relative to changing their situations" ...Powerlessness is a characteristic feeling among people in the culture of poverty, which tends to erode their hope for change. People in the culture of poverty usually require immediate gratification because they do not have enough faith in the future to delay gratification. Pessimism, not optimism, about changing a lifestyle is more common in these families. There is not sufficient evidence to indicate that poor people feel shame for their situation or that they are inadequate parents.
A client sustains a fractured right femur after an automobile accident and is admitted to the hospital's emergency department. Which assessment is the priority? -Turn the client to the side-lying position. -Take the client's pedal pulse in the affected extremity. -Instruct the client to wiggle the toes of the right foot. -Ask the client if numbness or tingling is present in the right foot
"Take the client's pedal pulse in the affected extremity" ......Monitoring a pedal pulse will assess circulation to the foot. Palpate the pulse distal to the injury. Turning the client to the side-lying position is contraindicated if a fracture of the femur is suspected; moving this client can cause further trauma. The inability to wiggle the toes indicates neurologic, not circulatory, impairment. The presence of numbness or tingling indicates that paresthesia is present, indicating neurologic damage. Circulation is the priority in this situation.
*What does grade 3 indicate according to the muscle-strength scale? -Active movement against gravity and some resistance -Active movement of body part with elimination of gravity -Active movement against full resistance without evident fatigue -Active movement against gravity only and not against resistance
"active movement against gravity only and not against resistance" ........According to the muscle-strength scale, a score of 3 indicates active movement against gravity only and not against resistance. A score of 4 indicates active movement against gravity and some resistance. A score of 2 indicates active movement of a body part with elimination of gravity. A score of 5 indicates active movement against full resistance without evident fatigue.
A nurse is caring for a client whose mobility is restricted to a wheelchair following a motor vehicle accident. The client has been prescribed physiotherapy as a part of rehabilitation care. What interventions should the nurse consider when the client is discharged from the healthcare facility? Select all that apply. -Focus firmly on the challenges faced by the client -Refrain from including children in the support system -Assist the family in identifying community support systems -Encourage the primary caregiver to set a routine time for respite -Consider the primary caregiver's experience in the discharge plan
"assist the family in identifying community support systems" "encourage the primary caregiver to set a routine time for respite" "consider primary caregiver's experience in the discharge plan" .....The nurse should assist the family in identifying support within the community. The family may need assistance with meals, physiotherapy exercises, and care for younger children. The nurse should encourage the primary caregiver to set a routine time for respite. The nurse should consider the primary caregiver's experience and abilities with nursing care while planning client discharge. The nurse should not only focus on the weaknesses and challenges faced by the client, but also the client's strengths. Children should be included in the support system, and the client and family should spend time sharing their stories with each other.
*Which ethnic group has a greater incidence of osteoporosis due to musculoskeletal differences? -Irish Americans -African Americans Chinese Americans -Egyptian Americans
"chinese americans" .......Chinese Americans have an increased incidence of osteoporosis because they have shorter and smaller bones with lower bone density. Irish Americans have taller and broader bones than other Euro-Americans. African Americans have a decreased incidence of osteoporosis. Egyptian Americans are shorter in stature than Euro-Americans and African Americans.
The oxygen saturation value of an African client measured through a pulse oximeter is 93%. What does the nurse infer from this reading? -The client has a normal SpO2 value. -The oximeter is unable to detect desaturation levels. -The client has an abnormal SpO2 value. -The oximeter may not work with clients experiencing impaired blood flow
"client has normal Sp02 value" ..........Normal pulse oximeter values lie between 95% and 100%. Clients with darker skin normally have slightly lower SpO2 values because of the deeper coloration of the nail bed. A pulse oximeter is indeed able to detect desaturation levels regardless of skin tone. Usually, oximeter values vary with ethnicities because of skin coloration. If a client is having any degree of impaired peripheral blood flow, the oximeter should be placed on the forehead for accurate results.
A client's leg is placed in Buck extension to immobilize a fracture until surgery can be performed. When planning caring for this client, the nurse considers that Buck extension is which type of traction? -Skeletal traction -Cutaneous traction -Halter transfixation -Balanced suspension
"cutaneous traction" .....example of traction applied directly to the skin (cutaneous) by tape or by a foam boot. Skeletal traction is applied directly to the bony skeleton. There is no such intervention as halter transfixation. A halter (strap) may be used with cervical or pelvic traction. Balanced suspension traction keeps the affected extremity elevated off the bed.
*Which synovial joint movement is described as turning the sole outward away from the midline of the body? -Pronation -Eversion -Adduction -Supination
"enversion" ......Eversion is a synovial joint movement that describes turning the sole outward away from the midline of the body. Pronation is a synovial joint movement that describes turning the palm downward. Adduction is a synovial joint movement that describes movement toward midline of the body. Supination is a synovial joint movement that describes turning the palm upward.
What does the professional nurse consider to be the center of decision-making when providing client care? -Ethics of care -Nursing skills -Analytical skills -Research based practice
"ethics of care" A professional nurse always follows the ethics of care and considers caring to be the center of decision-making. The nurse must know what behavior is ethically appropriate while caring for a client. A nurse's effectiveness in performing tasks is important to client care; however, client satisfaction comes from the effective dimension of care. Because ethics of care are unique to each client, the nurse should not base decision-making only on analytical skills. The nurse should not provide client care based only on intellectual principles or research knowledge. Caring is the most important factor because it considers client preferences and values.
Since giving birth 6 months ago, a new mother has breast-fed her infant. The woman becomes hysterical after learning that her husband has been seriously injured in an automobile accident. Culturally this woman believes that emotional stress while breast-feeding can "sour the milk," and she indicates that she must wean her infant immediately. What should the nurse do? -Instruct the mother about formula feeding. -Explain to the mother that these beliefs are wrong. -Provide the mother with books indicating that the milk does not sour. -Encourage the mother to take an antianxiety drug while continuing breast-feeding.
"instruct mother about formula feeding" .....The nurse should teach the mother how to formula feed, because cultural beliefs are deeply ingrained and it is unlikely at this time that the nurse will change the client's mind. Explaining to the mother that these beliefs are wrong is a judgmental response that does not take into consideration the client's beliefs or feelings. It is not therapeutic to contradict the client, especially when the alternative to breast-feeding will not harm the mother or infant. Providing the mother with books indicating that the milk does not sour is a judgmental response that does not recognize the client's beliefs or feelings. This is not therapeutic. Antianxiety medications are contraindicated in breast-feeding women.
A client who has been immobilized for an extended period of time questions why the tilt table is being used. What is the nurse's best explanation of the tilt table's function? "It prevents hypertension." "It encourages increased activity." "It maintains circulation to the skin." "It prevents loss of calcium from long bones."
"maintains circulation to the skin" ...Calcium leaves the long bones during periods of prolonged bed rest. The tilt table places the client in an upright position, which provides for weight bearing. The tilt table is used to prevent orthostatic hypotension by gradually allowing an individual who has been immobilized to adjust to an upright position. The client is carefully strapped to the table so that mobility actually is impaired to ensure safety. Although the pressure on bony prominences is altered, the use of the tilt table is not frequent enough to prevent the development of pressure ulcers.
What statements about culturally congruent care by the student nurse are correct? Select all that apply. -"It is the main goal of transcultural nursing." -"It is provided through cultural competence." -"It is provided in accordance with set criteria." -"It is bound to the professional health care system." -"It depends on the patterns and needs of an individual."
-"It is the main goal of transcultural nursing." -"It is provided through cultural competence." -"It depends on the patterns and needs of an individual." Culturally congruent care is tailored to the needs of people themselves, not delivered in accordance with predetermined criteria. This care may be different from the values and meanings of the professional health care system. The main goal of transcultural nursing is to provide culturally congruent care. Cultural competence is applied to ensure the delivery of this care. Culturally congruent care is provided in accordance with people's life patterns, values, and beliefs.
What should a nurse ask to understand the social organization of an individual? Select all that apply. -The nurse should ask about the preferences of caregivers. -The nurse should ask about the ways for taking care of the family. -The nurse should ask about the effects of the illness upon the individual. -The nurse should ask about the individual's expectations from the family. -The nurse should ask about the person who is responsible for making family decisions.
-The nurse should ask about the individual's expectations from the family. -The nurse should ask about the person who is responsible for making family decisions. ........To understand an individual's social organization, the nurse should ask about what the individual expects from the family (e.g., the mother or father). The nurse should also ask about the person who makes family decisions. Asking which caregivers the individual prefers elicits the individual's caring beliefs. How the client takes care of the family during illness tells the nurse about caring beliefs and practices. Asking about the influence of the illness on the individual yields insight about biocultural ecology and health risks.
A nurse plans to take the temperature of a 4-year-old child with a diagnosis of leukemia who has a fever. Which thermometers with the most accurate results can the nurse use safely for this child? Select all that apply. -Digital, rectal -Electronic, oral -Infrared, tympanic -Sensor, ear-based -Chemical dot, axilla
-infared, tympanic -chemical dot, axilla .....The infrared thermometer can be used on the tympanic membrane; it is safe to use for a child with leukemia. The chemical dot or liquid crystal skin contact thermometer is a flexible, one-use, disposable thermometer. It can be used to take oral or axillary temperatures and is safe for use in a child with leukemia. Rectal temperature taking is contraindicated in children with leukemia because it may result in trauma to the rectal mucosa. Also, the use of a rectal probe may be perceived as an intrusive procedure by a 4-year-old. Most digital thermometers can be used to take oral, axillary, or rectal temperatures. An oral temperature with an electronic thermometer is not safe or accurate for a 4-year-old; it is considered safe for a child who is at least 5 years old. The ear-based sensor thermometer is used in ambulatory settings; its reliability is a matter of some controversy.
The nurse is providing care to a client from another culture who is involved in a motor vehicle accident. Which is the priority nursing action to provide culturally sensitive care for this client? -Reviewing information from the client's culture - Notifying the medical interpreter that translation is needed - Requesting that a male nurse provide care due to the documented culture -Asking the client and family if there is any special care related to their culture
Asking the client and family if there is any special care related to their culture. --The priority nursing action when providing care to a client who is from a different culture is to ask the client and family if there is any special care related to the cultural background. It is appropriate for the nurse to review information related to the client's culture, but it is not certain that this information would apply to this specific client. There is no indication that the client does not speak English; therefore, it is not necessary to notify the medical interpreter. There is no indication that the client's culture necessitates care from one gender or the other.
The nurse is assessing four clients with musculoskeletal injuries. Which client is advised to have thermotherapy? Client A Foot Drop Client B Contractures Client C Muscle spasms Client D Muscle atrophy
Client C ....Muscle spasms are caused by involuntary muscle contractions after fractures. Thermotherapy reduces muscle spasm. Therefore client C with muscle spasms is instructed to undergo this treatment. Client A with a foot drop is advised to keep the foot in a neutral position. Client B with contractures is advised to change positions frequently. Client D with muscle atrophy is advised to practice an isometric muscle-strengthening exercise regimen.
*According to the common scale for grading muscle strength, what rating will be given to a client who can complete range of motion with some resistance? 1 2 3 4
rating 4 .....According to the common scale for grading muscle strength, a client who can complete range of motion with some resistance is given the rating 4. Rating 1 is given to a client with no joint motion and slight evidence of muscle contractility. Rating 2 is given to a client who can complete range of motion with gravity eliminated. Rating 3 is given to a client who can complete range of motion against gravity.