Ch 24 Therapeutic Exercise

A nurse is caring for a 69-year-old client who is recovering from health problems. The physiotherapist has prescribed ambulatory exercise, for which the nurse needs to monitor and assist the client. Which of the following would the nurse assess most closely in order to determine if the activity is beyond the tolerance level of the client? A) Heart rate B) Oxygen saturation C) Body temperature D) Blood pressure

Ans: A Feedback: An increased heart rate in a client is an indication to the nurse that the activity is beyond the client's level of tolerance. The other vital signs are also important assessment parameters but heart rate is a priority assessment.

A nurse is observing the prescribed therapeutic activity for a middle-aged client who underwent a mastectomy to treat breast cancer. Which of the following active exercises or therapeutic activities should the client perform? A) Perform light exercise with the arm on the surgical side. B) Have the nurse perform passive ROM on the arm on the affected side. C) Perform weight-training with the arm on surgical side. D) Learn to perform activities of daily living with arm opposite the surgical side.

Ans: A Feedback: Clients who have undergone a mastectomy learn to exercise the arm on the surgical side by combing their hair, squeezing a soft ball, finger-climbing the vertical surface of a wall, and swinging a rope attached to a doorknob. Passive ROM would not significantly aid the client's recovery of normal function. Weight-training would pose a risk of injury and the client should aim to perform ADLs with the affected side rather than neglecting it.

A nurse is examining and documenting the physical condition of a client who is undergoing a prescribed stress electrocardiogram test at a health care facility. Which of the following observations should the nurse prioritize in an effort to ensure the test is performed safely? A) Client's breathing pattern B) Client's endurance level C) Client's running speed D) Client's muscle reflexes

Ans: A Feedback: During a stress electrocardiogram test, the nurse or the examiner notes the client's breathing pattern, heart rate and rhythm, blood pressure, and symptoms such as dizziness and chest pain. The client's endurance level, running speed, and muscle reflexes are part of the maximal activity performed by the client during the test but these variables do not directly indicate difficulty with completing the test or the presence of unintended health consequences.

A nurse is assessing the body mass index of a client during a comprehensive assessment. Which of the following variables could the nurse include in a determination of the client's body composition? A) Skin thickness B) Pulse rate C) Blood pressure D) Body temperature

Ans: A Feedback: Factors that determine body composition include anthropometric measurements such as height, weight, body mass index, skinfold thickness, and mid-arm muscle circumference. Body composition is the amount of body tissue that is lean versus the amount that is fat. Pulse rate, blood pressure, and temperature do not determine body composition, but rather a person's vital signs and physical status.

An obese client has been advised to begin a program of fitness exercise. In preparation for the program, the nurse has taught the client the concept of metabolic energy equivalents (METs). An understanding of METs allows the client to A) Compare the relative intensity of different forms of activity. B) Match glucose intake to energy needs while exercising. C) Understand the energy needs of the body cells and heart. D) Perform exercise at the time of day when it will have maximum benefit.

Ans: A Feedback: METs allow a comparison of the relative energy demands of different activities; activities assigned higher METs consume more energy and are more vigorous. METs do not directly address glucose needs, cellular metabolism, or the timing of exercise.

A nurse suggests that an elderly client perform his exercises in shallow water at a pool near his home. Which of the following is a benefit for older adults of performing exercise in water? A) Reduces stress to the joints B) Keeps the body cool C) Reduces blood pressure D) Keeps heart rate low

Ans: A Feedback: Performing exercises in the water reduces stress on the joints. Swimming or exercising in water puts less stress on joints and is beneficial for older adults. Exercising in the water may help to keep the body cool, which is not necessary in this case. There is no indication that performing exercises in the water reduces blood pressure. The heart rate is more likely to increase when performing physical activities or exercises, even if the client is performing them in the water.

A nurse is preparing to assist a client to perform exercises in order to prevent ankylosis. What type of exercise should the nurse assist the client with in this case? A) ROM exercises B) Continuous passive motion machine C) Active exercises D) Aerobic exercises

Ans: A Feedback: The nurse should assist the client to perform ROM exercises in order to prevent ankylosis. ROM exercises are therapeutic activities that move the joints. They are performed to assess joint flexibility before initiating an exercise program, maintain joint mobility and flexibility in inactive clients, prevent ankylosis (permanent loss of joint movement), stretch joints before performing more strenuous activities, and evaluate the client's response to a therapeutic exercise program. A continuous passive motion machine is an electrical device used as a supplement or substitute for manual ROM exercise. Active exercise is therapeutic activity that the client performs independently after proper instruction. Aerobic exercise is an isotonic exercise that promotes cardiorespiratory conditioning and increases lean muscle mass.

During discharge teaching with a client who has been treated for a hernia, the nurse has discussed the benefits of a regular regime of physical exercise. What benefits of regular exercise should the nurse cite? Select all that apply. A) Decreased low-density blood lipids B) Reduced blood pressure C) Reduced blood glucose levels D) Improved bowel function E) Increased urine concentration

Ans: A, B, C, D Feedback: There are multiple benefits of regular exercise, including cholesterol reduction, decreased blood pressure, reduced blood glucose, and regularity of bowel function. Increased urine concentration, however, is not a noted benefit of physical activity.

An adult client and his nurse have collaboratively calculated the client's maximum heart rate for his age. The client has no major health problems but has very minimal experience with performing fitness exercise. The client's target heart rate during exercise should be no more than what approximate percentage of his maximum heart rate? A) 35% B) 50% C) 65% D) 80%

Ans: B Feedback: Beginners should not exceed 50% of maximum heart rate.

A nurse at a health care facility is assisting a client during a prescribed passive therapeutic exercise. Passive exercise is most suitable for which of the following clients? A) Clients who have undergone mastectomy surgery B) Clients who are paralyzed from a stroke or spinal injury C) Clients who have respiratory conditions D) Clients who have had prior cardiac-related symptoms

Ans: B Feedback: Passive exercise is most suitable for clients who are comatose or paralyzed from a stroke or spinal injury. Nurses perform exercises that maintain muscle tone and flexible joints. Active exercise is performed independently by clients who have undergone mastectomy surgery in order to exercise the arm on the surgical side. Isotonic exercise is the activity performed by clients to promote cardiorespiratory conditioning and increase lean muscle. Clients who have had prior cardiac-related symptoms, such as chest pain, or have major health risks use a stress electrocardiogram to assess their heart response to physical activity.

A nurse is caring for a client who recently underwent hip replacement surgery. Which of the following may benefit this client in order to restore muscle and joint functioning while not exceeding safe limits? A) Active exercises B) Continuous passive motion machine C) Isometric exercises D) Isotonic exercises

Ans: B Feedback: The nurse should suggest a continuous passive motion machine to the client who recently underwent hip surgery. A continuous passive motion machine is an electrical device used as a supplement or substitute for manual ROM exercises. Machine-assisted ROM sometimes is preferred during the rehabilitation of clients who have experienced burns or have had knee or hip replacement surgery, because the machine precisely controls the degree of joint movement and can increase it in specific increments throughout recovery. The other types of exercise do not include specific safety limits on the client's joint motion.

A nurse needs to administer the prescribed fitness test to a client who has had prior cardiac-related symptoms. Which of the following fitness test methods is likely the most suitable for the client? A) Cross-trainer fitness test B) Maximal fitness test C) Ambulatory electrocardiogram D) Stress electrocardiogram

Ans: C Feedback: An ambulatory electrocardiogram is used when the person has had prior cardiac-related symptoms, such as chest pain, or has major health risks that contraindicate a stress electrocardiogram. It is a less taxing version of a stress electrocardiogram. A stress electrocardiogram tests electrical conduction through the heart during maximal activity and is performed in an acute care facility or outpatient clinic. A cross-trainer fitness test is a normal fitness test done on a cross-trainer fitness machine. A maximal fitness test would tax the client to exhaustion and would be a safety risk.

A client is wearing a Holter monitor in order to undergo a prescribed ambulatory electrocardiogram. Which of the following precautions should the client take during an ambulatory electrocardiography test? A) Insulate all metal detectors. B) Avoid taking sponge baths. C) Avoid showering or swimming. D) Use an electric blanket rather than heavy cloth blankets.

Ans: C Feedback: During a prescribed ambulatory electrocardiography test, the client should not shower or swim; a sponge bath is permitted as long as the monitor does not get wet. The client also should avoid magnets, metal detectors, electric blankets, and high-voltage areas that may cause artifacts on the recordings that interfere with an accurate interpretation of the test results.

After being diagnosed with type 2 diabetes, a client has expressed her intention to ìturn over a new leafî and commit to a vigorous exercise regime. The nurse has emphasized the importance of having her fitness level assessed before beginning the exercise program. What is the main rationale for the nurse's advice? A) To provide a baseline against which to compare improvements B) To determine if the client's fitness matches norms for her age and gender C) To identify any risks for injury that might be posed by an exercise program D) To ensure that the client understands how to carry out the necessary exercises

Ans: C Feedback: Existing health problems can result in injury during exercise. Therefore, before a client begins an exercise program, assessment of his or her fitness level is necessary. This safety measure is more important than establishing baselines or teaching the correct techniques, though these may also be addressed.

A nurse at a health care facility is suggesting the use of isometric exercise to a client. What is the major purpose of isometric exercise? A) To prevent ankylosis B) To promote cardiorespiratory conditioning C) To increase lean muscle mass D) To maintain flexible joints

Ans: C Feedback: Isometric exercise consists of stationary exercises generally performed against a resistive force. Isometric exercises increase muscle mass, strength, and tone and define muscle groups. Although they improve blood circulation, they do not promote cardiorespiratory function. The nurse should suggest isotonic exercises in order to maintain cardiorespiratory conditioning and increase lean muscle mass. Passive exercises help to maintain flexible joints. Isometric exercise is not primarily intended to prevent ankylosis.

A physician has encouraged an obese client to join an aerobic exercise class to promote cardiorespiratory conditioning, reduce fat, and increase lean muscle mass. Which of the following fitness exercises is most suitable for the client? A) Passive ROM exercises B) Isometric exercise C) Isotonic exercise D) Submaximal exercise

Ans: C Feedback: Isotonic exercise is most suitable for an obese client, as it involves movement and work. The prime example is aerobic exercise, which involves moving all body parts at a moderate to slow speed without hindering the ability to breathe. To promote cardiorespiratory conditioning and increase lean muscle mass, a person should perform isotonic exercise at his or her target heart rate. Isometric exercise does not promote cardiorespiratory conditioning; in fact, strenuous isometric exercises elevate blood pressure temporarily. Passive ROM will not achieve the identified health goals. ìSubmaximalî is not a category of exercise.

A comatose client is being treated in the intensive care unit of a health care facility. What exercises should the nurse assist this client to perform in order to maintain the muscle tone and flexibility of the client's joints? A) Isotonic exercise B) Isometric exercise C) Passive exercise D) Active exercise

Ans: C Feedback: The nurse should assist the comatose client in performing passive exercise in order to maintain muscle tone and flexibility. Passive exercise is a therapeutic activity that the client performs with assistance and is provided when a client cannot move one or more parts of the body. An isotonic exercise is an activity that involves movement and work. Isometric exercise consists of stationary exercises generally performed against a resistive force. Active exercise is therapeutic activity that the client performs independently after proper instruction.

A nurse is conducting an admission assessment of a client who has presented to the hospital with complications of pregnancy. The nurse has asked the client to rate her perceived level of fitness. The nurse should be aware that fitness is defined as: A) Resistance to physical injury B) Ability to weight bear C) Objective evidence of cardiac output D) Capacity to exercise

Ans: D Feedback: Fitness means capacity to exercise. Weight-bearing and resistance to injury may be outcomes of fitness but they are not synonymous with it. Increased cardiac output facilitates fitness and is influenced by fitness but is not definitive of the term.

A nurse is calculating the maximum heart rate of a 20-year-old client who has undergone a prescribed fitness level test. What should this client's maximum heart rate be? A) 120 beats per minute B) 150 beats per minute C) 170 beats per minute D) 200 beats per minute

Ans: D Feedback: Maximum heart rate is calculated by subtracting a person's age from 220. Thus, a 20-year-old's maximum heart rate is 200 beats per minute (bpm), whereas a 50-year-old client's maximum heart rate is 170 bpm. The target heart rate is 60% to 90% of the maximum heart rate. Beginners should not exceed 60%, intermediates can exercise at 70% to 75%, and competitive athletes can tolerate 80% to 90% of their maximum heart rate.

A nurse is assisting a client in performing prescribed range-of-motion (ROM) exercises. What is the main reason that ROM exercises are performed? A) To maintain joint mobility and flexibility in active clients B) To stretch muscles before performing more strenuous activities C) To promote cardiorespiratory function and reduce body fat D) To test a client's ability to weight bear

Ans: D Feedback: ROM exercises are therapeutic activities that move the joints. They are performed to assess joint flexibility before initiating an exercise program, to maintain joint mobility and flexibility in inactive clients, to prevent ankylosis or permanent loss of joint movement, to stretch joints before performing more strenuous activities, and to evaluate the client's response to a therapeutic exercise program. Weight-bearing is not tested with ROM exercises.

A client has been ordered to undergo a step test. Which of the following arrangements is of greatest importance during a step test? A) Reduce the height of the step test machine platform. B) Make arrangements for a metronome and a stopwatch. C) Shorten the test time when the client's heart rate is rapid. D) Make provisions for possible cardiopulmonary resuscitation.

Ans: D Feedback: The most important arrangement that a nurse should make during a step test is to ask for the assistance of personnel certified in cardiopulmonary resuscitation and the use of an automatic cardiac defibrillator if there is an adverse cardiac event. The step test is used with caution; hence, test time is shortened if the client develops discomfort. The examiner uses a metronome and a stopwatch to keep track of the rate and the time, but this is not the most important arrangement. The height of the step test machine platform is prescribed as per the client.

A nurse is caring for a client at a health care facility who has been prescribed physical exercises by the physiotherapist. Which of the following beverages should the nurse encourage the client to avoid before or during physical activities? A) Mineral water B) Apple juice C) Pineapple juice D) Black tea

Ans: D Feedback: The nurse should eliminate tea from the diet of older adults before or during physical activities. Older adults need to eliminate their intake of caffeinated and alcoholic beverages before and during physical activity to avoid depleting fluid volume. Water is the preferred drink for fluid replacement, and thus the client is permitted to drink mineral water or juice.

A nurse is caring for client at a health care facility whose treatment includes therapeutic exercises. Which of the following nursing diagnoses is most likely for this client? A) Ineffective breathing pattern B) Perioperative-positioning injury C) Impaired social interaction D) Delayed surgical recovery

Ans: D Feedback: The nursing diagnosis of delayed surgical recovery should be treated with exercises. Some of the other nursing diagnoses that need to be treated with exercise are impaired physical mobility, disuse syndrome, unilateral neglect, and activity intolerance. The nursing diagnoses of ineffective breathing pattern, perioperative-positioning injury, or impaired social interaction do not require treatment with exercise.