PrepU Chapter 33: Activity ML4

The nurse is preparing the client for the administration of an enema. The nurse will place the client into which position? prone Sims' supine Fowler's

Sims'

The client is ambulating in the room and walks around a bedside table. What is the best explanation for why the client does not bump into the table? The client is aware of spatial relationships to avoid the table. The brain is sending impulses to the muscles to avoid the table. The cerebellum is responding to impulses from the inner ear. The client's muscles are being stretched to walk around the table.

The client is aware of spatial relationships to avoid the table.

The client is an active, healthy 2-year-old child. His mother asks a nurse what she can expect developmentally from the boy over the next few years. What is the nurse's best response? The client will regress in fine and gross motor skill development. The client will continue to grow rapidly and will refine both gross and fine motor skills. The client will refine both gross and fine motor skills but longitudinal growth will slow. The client will continue to grow rapidly but gross and fine motor skill acquisition will slow.

The client will continue to grow rapidly and will refine both gross and fine motor skills.

The nurse observes an unlicensed assistive personnel (UAP) placing a client in the Fowler position. To prevent complications for the client, in which situation should the nurse intervene? Select all that apply. The knee gatch on the bed is engaged. There is a rolled towel beside the client's hips. There is a large pillow under the client's head. The client's forearms are supported on pillows. The client's foot is in the plantar flexion position.

The knee gatch on the bed is engaged. There is a large pillow under the client's head. The client's foot is in the plantar flexion position.

Using proper body mechanics, which motions would the nurse make to move an object? The nurse balances the head over the shoulders, leans forward, and relaxes the stomach muscles when moving an object. The nurse directly lifts an object rather than sliding, rolling, pushing, or pulling it, thus reducing the energy needed to lift the weight against the pull of gravity. The nurse uses the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling. The nurse uses the muscles of the back to help provide the power needed in strenuous activities.

The nurse uses the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling.

A client with a hip fracture is returning to the orthopedic unit, and the orders indicate that the client should be turned by logrolling. Which statement regarding logrolling is correct? Logrolling can be performed by one experienced nurse. Logrolling will maintain straight alignment when the client is sitting in a chair. It is acceptable to twist the client's head, but not the hips, while logrolling. Use a drawsheet or a friction-reducing sheet to facilitate smooth movement.

Use a drawsheet or a friction-reducing sheet to facilitate smooth movement.

The nurse teaches proper body mechanics for a group of unlicensed assistive personnel (UAP). Which statement by a class participant indicates the need for additional education? When I lift and carry a heavy box of supplies I will keep it at arm's length from my body. When lifting an object, I will keep my feet shoulder width apart. When I lift an object, I will get close to the object being lifted. When lifting an object, I will bend at the knees instead of the waist.

When I lift and carry a heavy box of supplies I will keep it at arm's length from my body.

Which type of mobility aid would be most appropriate for a client who has poor balance? axillary crutches a single-ended cane with a half-circle handle a single-ended cane with a straight handle a cane with four prongs on the end (quad cane)

a cane with four prongs on the end (quad cane)

The client is a clerical assistant for an inpatient hospital unit. He spends most of his day at a desk. What would the nurse advise the clerical assistant to do to minimize damage to his musculoskeletal system? Select all that apply. hold his breath only when lifting heavy objects adjust the height of the work area face in the direction of the activity he is performing use a wide stance and lift with the large leg muscles

adjust the height of the work area face in the direction of the activity he is performing use a wide stance and lift with the large leg muscles

The nurse and an unlicensed assistive personnel (UAP) are transferring a client from a bed onto a stretcher. Prior to the move, where should the nurse position the stretcher? alongside the bed 2 in (5 cm) lower alongside the bed at the same height alongside the bed 2 in (5 cm) higher alongside the bed 1 in (2.5 cm) either lower or higher

alongside the bed at the same height

A nurse is providing care to a client confined to bed. To promote independence while the client is moving in bed and provide the client assistance in moving up in bed, which device would be appropriate? foot board trochanter roll bed trapeze bed cradle

bed trapeze

The nurse is performing an assessment of an older adult client. What finding does the nurse document as a normal age-related change? unequal pupil size stumbling gait reports of pain in the lower back decrease in flexibility

decrease in flexibility

What is a benefit of regular exercise over time? increased risk for blood clots increased work of breathing decreased heart rate decreased venous return

decreased heart rate

A nurse is conducting an in-service education program for a group of staff nurses about ways to reduce the risk of client handling injuries. Which actions would the nurse include as contributing to this risk? Select all that apply. engaging in repetitive movements using assistive devices standing for long periods using uncoordinated lifts lifting when tired

engaging in repetitive movements using uncoordinated lifts lifting when tired

A nurse applies padded boots to maintain the foot in dorsiflexion to a client who is comatose. The nurse is protecting the client from: blood pressure changes. pooling of blood. decubitus ulcers. foot drop.

foot drop.

When moving a client up in bed with the assistance of another caregiver, the nurse should: elevate the head of the bed. ask another nurse about the plan of care. have the client fold the arms across the chest. maintain a pillow under the client's head.

have the client fold the arms across the chest.

The nurse observes an older adult client walks walking with knees slightly flexed and body leaning. What does the nurse identify the client is demonstrating? should have an orthopedic consultation. is demonstrating a common gait for the older adult. requires crutches for mobility. requires a better walking shoe.

is demonstrating a common gait for the older adult.

As a part of his workout regimen, a 21-year-old college football player often engages in squats and lateral arm holds. These are examples of what type of exercise? anaerobic aerobic isometric isotonic

isometric

The nurse adjusts a client's bed to a comfortable working height in order to turn the client. What would be the nurse's next action? push the client to the edge of the bed to which the client will be turning pull the client to the edge of the bed to which the patient will be turning push the client to the opposite side of the bed move the client to edge of the bed opposite the side that client will be turning

move the client to edge of the bed opposite the side that client will be turning

The nurse is caring for a client who is on bed rest and was just turned to the left side. Which action should the nurse take next to decrease the risk of impaired skin integrity? pull the shoulder blade forward and out from under the client cover the client with the bed linens assess for pain place the call bell within reach

pull the shoulder blade forward and out from under the client

The nurse is caring for a client with incontinence who has been neglected in supine position at home for more than a week. Which priority nursing diagnosis will the nurse select? risk for disuse syndrome risk for impaired skin integrity impaired transfer ability impaired physical mobility

risk for impaired skin integrity

The nurse is performing a physical assessment on an adolescent. What assessment prioritiesare needed for this age group? scoliosis kyphosis increased need for calcium and vitamin D shifted center of gravity

scoliosis

The nurse is planning care for a client with a nursing diagnosis of Activity Intolerance. What assessment finding would cause the nurse the most concern? walking with a slow and uncoordinated movement shortness of breath after walking up five stairs joint stiffness after sitting for an hour a change in pulse from 80 to 84 after walking up 20 stairs

shortness of breath after walking up five stairs

The nurse wishes to keep a client from sliding down toward the foot of the bed. Into which position will the nurse place the client? supine slight Trendelenburg Sims' prone

slight Trendelenburg

The nurse has been educating the client about how to use a walker safely. The nurse knows that the education has been effective when the client: leans over the walker when walking. uses the sides of the walker to rise from a chair. places the walker far in front when walking. steps into the walker when walking.

steps into the walker when walking.

The pediatric nurse is caring for a newborn infant. In which position will the nurse place the infant to sleep? supine prone Sims' lateral

supine

The nurse is assisting a client with limited mobility to turn in bed. After successfully turning the client to the side, where would the nurse place an additional pillow? under the client's feet under the client's head in front of the client's abdomen supporting the client's back

supporting the client's back

The nurse is assessing the developmental level of children in a pediatric clinic. The nurse would be most concerned about which client? the 18-month-old child who is unable to stack blocks the 24-month-old child who is unable to walk unassisted the 3-month-old child who is unable to raise the head when prone the 6-month-old child who is unable to roll over

the 24-month-old child who is unable to walk unassisted

When assessing the physical activity of clients, the nurse would be most concerned about which client? the middle-aged computer programmer the older adult client who goes to the mall 3 times a week the Native American who hunts the young mother of a 2-year-old and 4-year-old

the middle-aged computer programmer

A client works in a warehouse and has been having low-back pain. Which statement would indicate the need for more education regarding safe lifting? "I try to rest between periods of lifting." "I stand with my feet apart so I have a better stance when I lift." "I bend with my knees when I pick up boxes." "I hold the boxes away from my body so I don't drop them on my feet."

"I hold the boxes away from my body so I don't drop them on my feet."

The nurse is teaching a client about good posture when lying down to go to sleep. Which teaching will the nurse include? "Sleep with your head tilted to one side to take pressure off your neck." "Keep knees and legs very straight." "Picture yourself with good posture standing; that is how good lying posture works." "Your feet should be at 45-degree angles from the legs."

"Picture yourself with good posture standing; that is how good lying posture works."

The nurse is assisting an older adult client with dementia in getting dressed after morning care. Which statement would be most beneficial to the client? "Put your pants on and zip the zipper." "Don't put on your shoes yet." "Put on your shirt." "Put your arm in this sleeve."

"Put your arm in this sleeve."

A client is to do quadriceps drills as an isometric exercise after surgery. The nurse provides which information about this exercise? Select all that apply. "The muscle you are tightening is the one on the front of the thigh." "Don't fully relax the muscle between episode of tightening." "Repeat this exercise until your muscle is tired." "Do these exercises once in the morning and once in the evening." "Do not hold your breath while tightening the muscles"

"The muscle you are tightening is the one on the front of the thigh." "Do not hold your breath while tightening the muscles"

The 55-year-old client who is newly diagnosed with osteoarthritis of the hips asks the nurse why it hurts when walking. What is the nurse's best response? "Osteoarthritis is painful and very common as you age." "You have lost the padding in your joints and the friction causes pain." "If you recently fell, you might have a fractured hip." "Because you lose muscle tone with age, it hurts to walk."

"You have lost the padding in your joints and the friction causes pain."

A client has undergone foot surgery and will use crutches in the short term. Which teaching point should the nurse provide to the client? "When your crutches fit right, most of your body weight will be supported by your armpits." "If you feel tired while walking with your crutches, rest your weight on your armpits for a moment and then continue slowly." "We'll have the nursing assistant watch you while you walk around the unit the first time." "Your elbows will be slightly bent when you are using your crutches."

"Your elbows will be slightly bent when you are using your crutches."

The nurse uses gait belts when assisting clients to ambulate. Which client would be a likely candidate for this assistive device? A client who has leg strength and can cooperate with the movement A client with a thoracic incision A client who has an abdominal incision A client who is confined to bed rest

A client who has leg strength and can cooperate with the movement

The occupational nurse is teaching employees about maintaining good posture. Which teaching will the nurse include? (Select all that apply.) Maintain the hips at an even level. Bend the knees slightly to avoid straining joints. Push the buttocks out and hold the abdomen up to properly align the spine. Keep the shoulders even and centered above the hips. Alternate placing weight on one foot versus the other.

Bend the knees slightly to avoid straining joints. Maintain the hips at an even level. Keep the shoulders even and centered above the hips.

A client is lying on her back with her arms at her side and knees supported with a pillow. What nursing documentation is most appropriate for this client? Client is in lateral oblique position with arms in functional position and pillow support under the knees. Client is in supine position with arms in functional position and pillow support under the knees. Client is in prone position with arms in functional position and pillow support under the knees. Client is in Sims' position with arms in functional position and pillow support under the knees.

Client is in supine position with arms in functional position and pillow support under the knees.

A nurse is promoting exercise and activities for an older adult client. Which teaching point would be appropriate for this client? Encourage the client to warm up before beginning exercises and to cool down after exercising. Instruct the client to continue exercise even if feeling weak, to build up stamina. Teach the client to force joints to meet their natural limit and beyond prior to modifying exercises. Encourage the client to quickly increase the repetitions for arm and leg exercises.

Encourage the client to warm up before beginning exercises and to cool down after exercising.

The nurse manager is assessing the unit for proper work ergonomics. Which finding will require immediate intervention by the nurse manager? Chairs have firm back support and allow the feet to touch the floor. Equipment is positioned to the side, 50 degrees away. Work is being carried out under sources of non-glare lighting. A small dolly is used to transport heavy items.

Equipment is positioned to the side, 50 degrees away.

A client who has been lying prone reports shortness of breath and a sensation of choking. Into which position will the nurse place the client? prone supine Sims' Fowler's

Fowler's

A nurse receives an order to apply graduated compression stockings for a client at risk for venous thromboembolism. How should the nurse apply the stockings? Avoid the use of powders on the legs before applying stockings. If the client was sitting up, have him or her lie down and elevate feet for 15 minutes before applying stockings. Apply the stockings after the client has been sitting up for an hour. Apply the stockings at night when the client is going to bed.

If the client was sitting up, have him or her lie down and elevate feet for 15 minutes before applying stockings

The nurse is caring for a client with rectal bleeding. The nurse will place the client into which position to facilitate rectal examination? supine prone Fowler's Sims'

Sims'

The nurse is performing an assessment of a client's joint mobility. What documentation should the nurse provide related to this assessment if joint function is considered normal? Select all that apply. Able to lift head from pillow Walks 20 feet No swelling, heat, tenderness, pain, nodules, or crepitation Full range of motion with each joint No masses, deformities, or muscle atrophy

No swelling, heat, tenderness, pain, nodules, or crepitation Full range of motion with each joint No masses, deformities, or muscle atrophy

The nurse is assisting a client from the bed into a wheelchair. What is a recommended guideline for this procedure? Raise the head of the bed to a sitting position. Make sure the bed brakes are unlocked. Place the bed in the highest position. Put the chair at the foot of the bed.

Raise the head of the bed to a sitting position.

Two nurses are moving a client up in bed. What motion would the nurses use to counteract the client's weight? Shift their weight back and forth, from back leg to front leg. Shift their weight back and forth from the legs to the back muscles. Rock the client back and forth to raise the client up in bed. Turn the client from side to side while pushing upward.

Shift their weight back and forth, from back leg to front leg.

When working with a client who has a fractured wrist, the nurse applies what knowledge about the bones in the body? Flat bones are found in the spinal column. Long bones are relatively thin and contribute to shape. Short bones contribute to movement. The wrist is classified as an irregular bone.

Short bones contribute to movement.

The nurse is caring for a client with hemorrhoids. To facilitate a rectal examination, into which position will the nurse place the client? Fowler's prone Sims' supine

Sims'

A nurse is conducting a home assessment of a 90-year-old client with a history of several minor strokes that have left the client with a hemiplegic gait. The nurse is particularly concerned about falls. Which activities would help to prevent falls for this client? Select all that apply. installing hardwood floors moving the bedroom to the ground floor removing clutter from the floor placing nightlights in the bathroom and hallways

moving the bedroom to the ground floor removing clutter from the floor placing nightlights in the bathroom and hallways

After positioning a client to move from the bed into a wheelchair, how would the nurse stand when helping the client sit up on the side of the bed? near the client's hip, with legs together to the dominant side of the client, with legs together and one foot near the head of the bed near the client's hip, with legs shoulder width apart and one foot near the head of the bed to the nondominant side of the client, with legs together and one foot near the head of the bed.

near the client's hip, with legs shoulder width apart and one foot near the head of the bed

A nurse is working with a client who has a history of lung disease and arthritis to develop an exercise program. The nurse instructs the client to take which action before beginning the program? pick an activity the client enjoys to promote adherence understand that the activity will have positive benefits. choose a specific single-exercise activity obtain a pre-exercise medical examination for clearance

obtain a pre-exercise medical examination for clearance

The nurse would like to promote ventilation in a client with chronic obstructive pulmonary disease by elevating the client's arms. What intervention should the nurse implement? instruct the client to place arms on the side rails place a trochanter roll under the arms elevate the head of the bed place a small pillow under each arm

place a small pillow under each arm

A 74-year-old client has kyphosis and is reporting discomfort of the cervical vertebrate. Which nursing intervention is most appropriate? placing a small towel under the neck contacting the primary care physician administering a muscle relaxer positioning the client on the stomach

placing a small towel under the neck

The nurse is delegating inactive client positioning to a UAP. What directions will the nurse include? providing skin care before repositioning helping the client change positions every 4 hours using a sheet to drag and lift the client placing the client in good alignment with joints slightly flexed

placing the client in good alignment with joints slightly flexed

The nurse is assessing a client who is bedridden. For which condition would the nurse consider this client to be at risk? increase in the movement of secretions in the respiratory tract predisposition to renal calculi increase in circulating fibrinolysin increased metabolic rate

predisposition to renal calculi

The nurse is caring for a client who has a lower-body injury and who is able to partially assist with transfers. The nurse should: manually roll the client to the side of the bed. use a pull sheet whenever moving the client. teach the client to pull up with the headboard. provide the client with an overhead trapeze.

provide the client with an overhead trapeze.

The nurse is providing health teaching for a client who flies often for business. Which risk factor associated with flying will the nurse emphasize? skeletal contractures thrombus formation pooling of secretions oliguria

thrombus formation

The nurse is caring for a 76-year-old client who has an unsteady gait. Which method is most appropriate to assist in transferring? roller sheet transfer boards mechanical lift transfer belt

transfer belt

The nurse is working to increase functional ability with a client. Which assistive technique should be included in the plan of care? pull sheets log rolling trapeze bar trochanter rolls

trapeze bar

A client with limited mobility has outward rotation of the bony protrusions at the head of the femur. Which assistive device would the nurse include in the plan of care? roller sheets trochanter rolls foot splints foot boards

trochanter rolls