Chapter 39 (Nursing Skills Activity and Exercise)

Which actions are appropriate for the nurse to implement when a patient experiences orthostatic hypotension? Select all that apply. 1 Call for assistance. 2 Allow patient to sit down. 3 Take patient's blood pressure and pulse. 4 Continue to ambulate patient to build endurance. 5 If patient begins to faint, allow him or her to slide against the nurse's leg to the floor.

1,2,3,5 If the patient complains of dizziness and/or lightheadedness upon standing, call for assistance and allow the patient to sit back down. If the patient has a fainting episode (syncope), assume a wide base of support with one foot in front of the other, thus supporting the patient's body weight. Extend one leg and let the patient slide against it; gently lower the patient to the floor, protecting his or her head. Take the patient's blood pressure and pulse as soon as possible after the incident. Continuing to ambulate the patient in this condition is unsafe and can result in a fall or other injury; it will not help improve the patient's endurance. Study Tip: Practice helping your study partners to the floor while they take turns pretending they are experiencing orthostatic hypotension. Repeat the symptoms of orthostatic hypotension while you perform the practice. The student playing the nurse can ask, "What are you feeling?" and the student playing the patient can respond, "I'm so dizzy," or "My heart is racing," etc. Be dramatic—but safe—until you have rehearsed all the symptoms. Be sure to also pantomime the additional steps the nurse would take (calling for assistance, taking blood pressure and pulse).

The nurse is teaching a three-point gait to a patient whose left ankle is fractured. What is the most appropriate instruction given to the patient? 1 "Move both the crutches first then the left leg alternately." 2 "Move both crutches first and then the right leg alternately." 3 "Move the right leg and right crutch at the same time and then the left leg alternately." 4 "Move the left leg and left crutch at the same time and then the right leg alternately."

2 "Move both crutches first and then the right leg alternately." In a three-point gait, the patient bears weight on both crutches and the uninvolved leg alternately. Therefore, the most appropriate pattern for the patient will be to move both crutches first and then the right leg alternately. Moving both of the crutches and the left leg would cause weight bearing on the affected left leg. Moving the right leg and right crutch at the same time and then the left leg alternately would also cause weight bearing on the affected left leg. Moving the left leg and left crutch at the same time and then the right leg alternately will cause excessive strain on the affected left leg.

The nurse works at an occupational therapy clinic. A patient who is suffering from type 1 diabetes mellitus has recovered from a fractured tibia. The patient wishes to join a regular exercise program. What advice should the nurse give this patient? Select all that apply. 1 Perform high-intensity exercises. 2 Get a physical examination before starting the program. 3 Wear a medical alert bracelet. 4 Carry sugar packets or hard candy. 5 Monitor blood glucose levels before and after exercises

2 Get a physical examination before starting the program. 3 Wear a medical alert bracelet. 4 Carry sugar packets or hard candy. 5 Monitor blood glucose levels before and after exercises A physical examination before starting the exercise program helps to evaluate potential risks. Wearing a medical alert bracelet informs others about the patient's problem. It is easier for other people to help the patient in case of an emergency such as hypoglycemia. Sugar packets or hard candy help to treat hypoglycemia if it occurs. The blood sugar levels should be monitored before and after exercise to determine the fluctuations. The patient should not engage in high-intensity exercise. Low or moderate intensity exercises are preferred.

The primary health care provider asks the nurse to place a patient in the dorsal recumbent position for an assessment. What does the nurse do? 1 The nurse places the patient in a semi-sitting position. 2 The nurse places the patient in the lateral position. 3 The nurse places the patient in the supine position. 4 The nurse places the patient in the prone position.

2 The nurse places the patient in the lateral position. While assessing a patient in the recumbent position, the nurse places the patient in the lateral position, removing all positioning supports except one pillow. The patient should be placed in this position for assessment of the patient's body alignment. A semi-sitting position is a Fowler's position. The patient is placed on his or her back for the supine position. The patient is placed on his or her abdomen for the prone position.

The nurse measures the distance between the greater trochanter muscle of the patient and the floor and finds it to be 3 feet. How long should the patient's cane be? 1- 2 ft 2- 3 ft 3- 4 ft 4- 5 ft

2- 3 ft The patient's cane length should be 3 ft, because a patient's cane length should be equal to the distance between the greater trochanter muscle and the floor. A 2-ft cane is too short, and a cane that is 4 ft or 5 ft is too long.

Which statements apply to the proper use of a cane as an assistive device? Select all that apply. 1 For maximum support when walking, the patient places the cane forward 15 to 25 cm (6 to 10 inches), keeping body weight on both legs. The weaker leg is moved forward to the cane so body weight is divided between the cane and the stronger leg. 2 A person's cane length is equal to the distance between the elbow and the floor. 3 Canes provide less support than a walker and are less stable. 4 The patient needs to learn that two points of support such as both feet or one foot and the cane need to be present at all times. 5 The straight-legged cane is the most common and provides the most support.

1 For maximum support when walking, the patient places the cane forward 15 to 25 cm (6 to 10 inches), keeping body weight on both legs. The weaker leg is moved forward to the cane so body weight is divided between the cane and the stronger leg. 3 Canes provide less support than a walker and are less stable. 4 The patient needs to learn that two points of support such as both feet or one foot and the cane need to be present at all times. A person's cane length is equal to the distance between the greater trochanter and the floor, not the elbow and the floor. For maximum support when walking, the patient places the cane forward 15 to 25 cm (6 to 10 inches), keeping body weight on both legs. Canes provide less support than a walker and are not as stable. The patient needs to learn that two points of support (i.e., both feet or one foot and the cane) are present at all times. The straight-legged cane is the most common, but the quad cane provides the most support and is used when there is partial or complete leg paralysis or some hemiplegia.

Which activities does the nurse delegate to nursing assistive personnel with regard to crutch walking? Select all that apply. 1 Notifying the nurse if the patient reports pain before, during, or after exercise 2 Notifying nurse of patient complaints of increased fatigue, dizziness, and/or light-headedness when obtaining and vital signs before and after exercise 3 Notifying the nurse of vital sign values 4 Evaluating the patient's ability to use crutches properly 5 Preparing the patient for exercise by assisting in dressing and putting on shoe

1 Notifying the nurse if the patient reports pain before, during, or after exercise 2 Notifying nurse of patient complaints of increased fatigue, dizziness, and/or light-headedness when obtaining and vital signs before and after exercise 3 Notifying the nurse of vital sign values 5 Preparing the patient for exercise by assisting in dressing and putting on shoe Four of these answers are correct, because they are within the nursing assistive personnel's scope of responsibilities except evaluating the patient's ability to properly use crutches. Evaluation is only within the scope of professional nursing practice and is not delegated.

The nurse is asked to assist an elderly patient with ambulation at 5:00 PM. At 5:00 PM, the nurse finds that the patient is distressed and is not oriented to time, place, or self. What is the most appropriate step that should be taken by the nurse? 1 Postpone the ambulation to another time. 2 Assist the patient in walking as scheduled. 3 Ask for help from another colleague to ambulate the patient. 4 Remove any obstacles on the floor before the ambulation

1 Postpone the ambulation to another time. The patient is disoriented and may be at risk of falling if ambulated. Therefore, the nurse should postpone the patient's ambulation to another time when the patient is oriented and stable. This ensures the patient's safety. Assisting the disoriented patient as per the schedule may increase the risk of falling, even if help is received from a colleague and obstacles are removed from the floor.

The nurse is caring for a patient who has a lack of coordination and weakness of both lower limbs. The patient is able to bear weight on both limbs but is unable to walk independently. Which gait does the nurse teach the patient? 1 A two-point gait 2 A four-point gait 3 A three-point gait 4 A three-point alternating gait

2 In a four-point gait, the patient bears his or her weight on both legs, which provides stability when walking. The patient then moves each leg alternately with each opposing crutch. The patient is able to bear weight but is unable to walk independently, thus the nurse should teach the four-point gait to the patient. This gait helps in maintaining stability while walking. Once the patient has mastered the four-point gait pattern, the patient should be taught the two-point gait, wherein the patient moves the crutch and opposing leg at the same time. In a three-point or three-point alternating gait, the patient bears the weight on both crutches first and then on the uninvolved leg alternately. This gait pattern is taught to those patients who lack function of one limb.

A patient on bed rest for several days attempts to walk with assistance. He becomes dizzy and nauseated. His pulse rate jumps from 85 beats/minute to 110 beats/minute. Of what are these most likely symptoms? 1 Rebound hypertension 2 Orthostatic hypotension 3 Dysfunctional proprioception 4 Central nervous system (CNS) rebound hypotension

2 Signs and symptoms of orthostatic hypotension include dizziness, light-headedness, nausea, tachycardia, pallor, and even fainting. Rebound hypertension is caused by abruptly discontinuing certain drugs such as beta blockers. Dysfunctional proprioception is the patient's lack of awareness of the position of certain body parts. CNS rebound hypotension can by caused by cerebrospinal fluid leakage or certain drugs. Study Tip: If you try to make a mnemonic for the signs and symptoms of orthostatic hypotension but can't come up with a final, all-inclusive mnemonic, that's OK! Just trying to make the mnemonic will help you rehearse the signs and symptoms, which will help your memory. One way to try is to imagine the disorder's term is the "across" part of a crossword puzzle. Then see how many signs and symptoms can be part of the "down" words that either begin with one of the disorder's letters, or intersect one of them. Try it!

What is the physiological factor that influences a patient's activity tolerance? 1 Age 2 Pain 3 Depression 4 Motivation

2 Pain Pain is the physiological factor that influences a patient's activity tolerance, the response a patient has to the type and amount of exercise he or she is performing. Whereas age, depression, and motivation affect activity tolerance as well, age is considered a developmental factor, and depression and motivation are emotional factors.

Which nursing intervention is appropriate for a patient who is diagnosed with decreased cardiac output related to decreased myocardial contractility? 1 Take steps to reduce the number of interruptions during sleep. 2 Administer oxygen to the patient at 2 L/min via the nasal cannula. 3 Provide the patient with a low-calorie, low-sodium, and high-protein diet. 4 Instruct the patient to take a brisk walk for 2 to 3 miles and perform isometric exercises three to four times a week

3 A patient who has decreased cardiac output related to decreased myocardial contractility should consume a low-calorie, low-sodium, and high-protein diet. A patient who has fatigue related to poor physical condition should have reduced sleep interruptions. The nurse should administer oxygen to the patient at 2 L/min via the nasal cannula in case of impaired gas exchange related to decreased cardiac output. A patient who has activity intolerance related to physical deconditioning should be instructed to take a brisk walk for 2 to 3 miles and perform isometric exercises three to four times a week. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple choice items. If you are uncertain about a question, eliminate the choices you believe are wrong, and then call on your knowledge, skills, and abilities to choose from the remaining responses.

The nurse is performing assessments to measure the cane size for a patient. Which measurement is appropriate in determining the correct size of the cane? 1 The length from the floor to the hip joint 2 The length from the floor to the iliac crest 3 The length from the floor to the greater trochanter 4 The length from the great toe to the lesser trochanter

3 The patient's cane length should be equal to the distance between the greater trochanter and the floor. This provides maximum support while walking. If the length of the cane were equal to the distance from the floor to the hip joint, the cane would be too long and might not support the patient's movements. If the cane length were equal to the distance from the floor to the iliac crest, it would result in a shorter cane. A cane length equal to the distance from the great toe to the lesser trochanter will also result in a shorter cane, which might make the patient unstable while walking.

What should the nurse teach a patient about safe axillary crutch walking? 1 "Buy an aluminum crutch that is slightly bent." 2 "Avoid using cloth towels to dry the crutch tips." 3 "Lean on the crutches to support your body weight." 4 "Use rubber crutch tips to increase surface friction."

4 "Use rubber crutch tips to increase surface friction." The nurse teaches the patient to use rubber crutch tips because they increase surface friction and help prevent slipping. Bent aluminum crutches should be avoided, because they alter body alignment. Cloth towels should be used to dry the crutch tips, because wetness decreases surface friction and increases risk of slipping. The patient should not lean on the crutches to support the body weight, because it causes pressure on the axillae.

Which of the nursing assistant's statements about orthostatic hypotension indicates a need for further learning? 1 "Younger patients are prone to orthostatic hypotension." 2 "Diabetic patients are prone to orthostatic hypotension." 3 "Immobilized patients are prone to orthostatic hypotension." 4 "Patients on prolonged bed rest are prone to orthostatic hypotension.

1 Older, not younger, patients are prone to orthostatic hypotension. The other statements indicate understanding. Patients with chronic illnesses such as diabetes mellitus are prone to orthostatic hypotension. Patients who are immobilized or who are on prolonged bed rest are also prone to orthostatic hypotension.

A patient is discharged after an exacerbation of chronic obstructive pulmonary disease (COPD). She states, "I'm afraid to go to pulmonary rehabilitation." What is your best response? 1 Pulmonary rehabilitation provides a safe environment for monitoring your progress. 2 You have to participate or you will be back in the hospital. 3 Why are you concerned about pulmonary rehabilitation? 4 The staff at our pulmonary rehabilitation facility are professionals and will not cause you any harm

1 Pulmonary rehabilitation is beneficial in helping patients reach an optimal level of functioning. Some patients are fearful of participating in exercise because of the potential for worsening dyspnea (difficulty breathing). Pulmonary rehabilitation provides a safe environment for monitoring the progress of patients.

What should the nurse teach a diabetic patient about exercise? 1 "Exercise leads to improved glucose control." 2 "You can perform medium- to high-intensity exercise." 3 "The effect of exercise on blood glucose levels often lasts for 10 hours." 4 "You can start an exercise routine on your own without any physical examination.

1 "Exercise leads to improved glucose control." The nurse should teach a diabetic patient that exercise leads to improved glucose control. Diabetic patients should perform low- to-medium intensity exercise. The effect of exercise on blood glucose lasts for 24 hours, not 10 hours. The nurse should instruct the patient to undergo a complete physical examination before starting any physical exercise routine.

At what point does the nurse begin the process of discharge planning for a patient? 1 When the patient starts taking medication 2 When the patient completes the treatment plan 3 When the patient enters the health care system 4 When the patient's definitive diagnosis is confirmed

3 Discharge planning begins when the patient enters the health care system. The nurse should start planning the care, patient education, home care services, and participation in community support groups if needed. Discharge planning is performed even before the patient starts taking medication, completes the treatment plan, or has a definitive diagnosis confirmed. This ensures that holistic care is provided to the patient.

What does the nurse teach a patient about a walker and its proper use? 1 "Hold the handgrips on the lower bars of the walker." 2 "A walker has four widely placed sturdy legs and two open sides." 3 "Each time you take a step, move the walker forward and take another step." 4 "Your elbows should be flexed at about 45 degrees when standing inside the walker.

3 "Each time you take a step, move the walker forward and take another step." While walking, each time the patient takes a step, the patient should move the walker forward and then take another step. The patient should hold the handgrips on the upper bars of the walker, not on the lower bars. A walker has four widely placed sturdy legs and one open side. The patient should flex the elbows at about 15 to 30, not 45, degrees when standing inside the walker.

A patient with a history of coronary heart disease and chronic obstructive pulmonary disease (COPD) has blood pressure of 180/98 mm Hg and a body mass index (BMI) of 28. The nurse is educating the patient on the benefits of exercise. Which point regarding exercise does the nurse keep in mind when educating the patient? 1 Exercise increases diastolic blood pressure in hypertensive patients. 2 Exercise aggravates systolic blood pressure in hypertensive patients. 3 Exercise helps in preventing recurrence of coronary heart disease. 4 Exercise can worsen chronic obstructive pulmonary disease.

3 Exercise helps in preventing recurrence of coronary heart disease. Physical activity and exercise improve the cardiac function of an individual. Thus, exercise helps in secondary prevention or recurrence of coronary heart disease. It is proven that exercise can improve the health of patients with hypertension and chronic pulmonary disorders by decreasing the diastolic blood pressure as well as systolic blood pressure. Patients with COPD should be supported and encouraged to increase activity and exercise in a safe environment. The progress of patients with COPD should be monitored in pulmonary rehabilitation.

Before discharge of a bedridden patient to home, the nurse taught the patient's caregiver about repositioning the patient every 2 hours to prevent development of pressure ulcers. Four days after discharge, the patient developed skin breakdown at the sacral region with redness and edema. What does the nurse say in order to evaluate the caregiver's understanding of the repositioning techniques taught during discharge? 1 "I suspect the patient is developing pressure ulcers." 2 "You have been careless in not following my instructions." 3 "I shall refer the patient to the primary health care provider for an antibiotic prescription." 4 "Have you been repositioning the patient every 2 hours?

4 "Have you been repositioning the patient every 2 hours? When evaluating the nursing interventions, the nurse should compare the actual outcomes with the expected outcomes. If the expected outcomes are not met, the nurse should try to explore the reason behind it and make changes in the teaching strategy. Therefore, the most important step would be to ask for the reason behind the development of pressure ulcers, and if the caregiver had been following the repositioning regimen. Stating that the patient may have developed pressure ulcers may not help in evaluating the nursing intervention. When talking to the patient, the nurse should avoid judgments or use demeaning words such as "careless." Referring the patient to a primary health care provider would be helpful in obtaining a prescription for antibiotics but would not help in evaluating the nursing interventions.

The nurse is attending to an older adult patient. The nurse understands that the patient is at risk of osteoarthritis due to advanced age. What questions should the nurse ask the patient to assess the osteoarthritis? Select all that apply. 1 "Do you feel pain in the legs when climbing stairs?" 2 "Do you have pain in your knee or back when you walk?" 3 "Do you consume fruits daily? If yes, which fruits?" 4 "Are you able to go for morning walks even with the pain and discomfort?" 5 "Do you void regularly? Is there any difficulty in defecation?"

1,2,4 Assessment questions for osteoarthritis include asking about mobility, endurance, and pain. Bowel and bladder elimination is not directly related to osteoarthritis. Eating fruit in the diet is not directly related to osteoarthritis.

What are the signs and symptoms of orthostatic hypotension? Select all that apply. 1 Pallor 2 Fainting 3 Diarrhea 4 Dizziness 5 Bradycardia

1,2,4 Pallor, fainting, and dizziness are the signs and symptoms of orthostatic hypotension. Diarrhea and bradycardia may indicate other disorders.

The nurse works at an occupational therapy clinic. A patient with type 1 diabetes mellitus recovered from a fractured tibia and is advised to use a cane for walking. The nurse teaches the patient how to use the cane when walking. Arrange the steps of walking with a cane in the correct order. 1. The weaker leg is moved forward to the cane. 2. The stronger leg is advanced past the cane. 3. Have the patient keep the cane on the stronger side of the body. 4. The patient places the cane forward 15 to 25 cm, keeping body weight on both legs.

1. Have the patient keep the cane on the stronger side of the body. 2. The patient places the cane forward 15 to 25 cm, keeping body weight on both legs. 4. The weaker leg is moved forward to the cane 3. The stronger leg is advanced past the cane. The patient keeps the cane on the stronger side of the body. The patient then places the cane forward 15 to 25 cm, keeping body weight on both legs. This provides maximum support to the body. The weaker leg is then moved forward to the cane so that the bodyweight is divided between the cane and the stronger leg. The stronger leg is then advanced past the cane so that the weaker leg and the body weight are supported by the cane. (Cane, weak, strong))

A patient recovering from bilateral knee replacements is prescribed bilateral partial weight bearing. To reinforce crutch walking, which gait is most appropriate for this patient? 1 A two-point gait 2 A three-point gait 3 A four-point gait 4 A swing-through gait

1 A two-point gait The two-point gait requires at least partial weight bearing on each foot. The patient moves a crutch at the same time as the opposing leg, so that the crutch movements are similar to arm motion during normal walking. All the weight must be on one foot for the three-point gait, so this would not be appropriate for a patient with bilateral knee replacements. The four-point gait requires weight bearing on both legs. The swing-through gait is most appropriate for patients with paraplegia.

Exercise lowers blood glucose levels. For how long does the effect of exercise last on blood glucose levels? 1 For at least 24 hours 2 For at least 36 hours 3 For at least 48 hours 4 For at least 72 hours

1 For at least 24 hours It is important for the nurse to know the effects of exercise on glucose levels. Exercise lowers blood glucose levels and the effects of exercise on blood glucose levels often last for at least 24 hours. The lowered blood glucose levels do not last as long as 36, 48, or 72 hours. Therefore, the patient with high blood glucose should exercise on a daily basis.

What are the possible effects of exercise in a healthy individual? Select all that apply. 1 Reduced bone loss 2 Decreased work of breathing 3 Decreased resting heart rate 4 Increased blood pressure 5 Decreased gastric motility

1 Reduced bone loss 2 Decreased work of breathing 3 Decreased resting heart rate Exercise affects various body systems in a healthy individual. Some of the effects include reduced bone loss due to mineralization, decreased work of breathing due to better lung expansion, and decreased resting heart rate due to improved cardiac output. Blood pressure usually decreases due to relaxation of the vessel wall, and gastric motility increases, which helps to prevent constipation.

The nurse is assessing the body alignment and posture of a patient. Which are the indicators of an optimal standing posture? Select all that apply. 1 The knees are in a straight line between the hips and ankles. 2 The head is flexed anteriorly and in midline. 3 The feet are flat on the floor and slightly apart. 4 The spine is straight with normal curvatures. 5 The abdominal muscles are relaxed.

1 The knees are in a straight line between the hips and ankles. 3 The feet are flat on the floor and slightly apart. 4 The spine is straight with normal curvatures. When assessing a patient's standing posture, the nurse must ensure that the knees are in a straight line between the hips and ankles and slightly flexed. This position of the knees is required so that the weight-bearing forces are evenly distributed on the surfaces of the joints. The feet should be flat on the floor, pointed directly forward, and slightly apart to maintain a wide base of support. This is required to maintain balance of the body over the limbs. The spine must be straight with normal curvatures. Abnormalities in spinal curvature could cause the weight-bearing forces to damage the vertebrae. The head should be erect in both standing and sitting positions. The abdominal muscles must not be relaxed but should be well tucked. The abdominals form an important part of the core muscles that support the vertebral column.

Chronologically arrange the steps a nurse should take to prepare for and react to a syncopal episode. 1. Bend the knees to lower the body as the patient slides to the floor. 2. Stand with feet apart with one foot in front of the other. 3. Extend one leg of the patient and let the patient slide against the leg. 4. Gently lower the patient to the floor protecting the patient's head.

1. Stand with feet apart with one foot in front of the other. 2. Extend one leg of the patient and let the patient slide against the leg. 3. Gently lower the patient to the floor protecting the patient's head. 4. Bend the knees to lower the body as the patient slides to the floor First, the nurse stands with his or her feet apart with one foot in front of the other. This provides a wide base of support and helps in supporting the patient's body weight. Then, the nurse extends one leg of the patient and lets the patient slide against the leg. Next, the patient is gently lowered to the floor while protecting the patient's head. Finally, the knees are bent to lower the body as the patient slides to the floor.

The nurse and an occupational therapist are devising a treatment plan for a patient with low activity tolerance. The patient is able to do mild-intensity activities of daily living (ADLs) easily but has difficulty in doing moderate-intensity ADLs. Which activity is the patient encouraged to do to improve functional capacity? 1 Doing laundry 2 Folding clothes 3 Making the bed 4 Washing dishes

2 Patients who are not able to exercise can perform activities of daily living (ADLs) to accumulate half an hour of exercise. Moderate-intensity ADLs include folding clothes, washing windows, sweeping the kitchen or sidewalk, and vacuuming. Doing laundry, making the bed, and washing dishes are all lower-intensity ADLs.