Ch 44 Activity & Exercise

A nurse educator is teaching a module on proper body mechanics during employee orientation. Which of the following statements by a newly nurse indicates a need for further teaching? A. My line of gravity should fall outside my base of support. B. The lower my center of gravity, the more stability I have. C. To broaden my base of support, I should spread my feet apart. D. When I lift an object, I should hold it as close to my body as possible.

A. My line of gravity should fall outside my base of support. (Not correct, line of gravity will fall with IN base of support )

Nurse is reviewing the effects of immobility on various body systems. List at least 2 effects on cardiovascular system.

Orthostatic hypotension Less fluid volume in the circulatory system Stasis of blood in the legs Diminished autonomic response Decreased cardiac output leading to poor cardiac effectiveness, which results in increased cardiac workload Increased oxygenation requirement Increased risk of thrombus development

Which statement from a client with one weak leg regarding use of crutches when using stairs indicates a need for increased teaching? "Going up, the strong leg goes first, then the weaker leg with both crutches." "Going down, the weaker leg goes first with both crutches, then the strong leg." "The weaker leg always goes first with both crutches." "A cane or single crutch may be used instead of both crutches if held on the weaker side."

Your Answer: "The weaker leg always goes first with both crutches." Rationale: Although the crutches (or cane) are always used along with the weaker leg, the weaker leg should go down the stairs first. The stronger leg can support the body as the weaker leg moves forward. All of the other statements are correct. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Evaluation.

A nurse educator is teaching basic principles of proper lifting technique to a group of newly hired nurses. Use the ATI Active Learning template to complete this item. Under the section Underlying Principles, list 4 key elements of proper lifting technique.

4 Principles of Lifting 1. Use the major muscle groups to prevent back strain and tighten the abdominal muscles to increase support to the back muscles. 2. Distribute the weight between the large muscles of the arms and legs to decrease the strain on any one muscle group and to avoid strain on the smaller muscles. 3. When lifting an object from the floor, flex the hip, knees & back. Get the object to thigh level, keeping the knees bent and the back straightened. Stand up while holding the object as close as possible to the body, bringing the load to the center of gravity to increase stability and decrease back strain. 4. Use assistive devices whenever possible, and seek assistance whenever it is needed.

A nurse is caring for a client who is on bed rest. Which of the following interventions should the nurse implement to maintain the patency of the client's airway? 1. Encourage isometric exercises. 2. Suction every 8 hours. 3. Give low-dose heparin 4. Promote incentive spirometer use.

4. Promote incentive spirometer use. -- helps keep the airways open and prevents atelectasis.

A nurse is caring for a client receiving enteral tube feedings due to dysphagia. Which of the following bed positions is appropriate for safe care of this client? A. Supine B. Semi-Fowler's C. Semi-Prone D. Trendelenburg

B. Semi-Fowler's -- The client lies supine with the head of the bed elevated approx. 30 degrees. This position is frequently used to prevent regurgitation and aspiration in clients who have difficulty swallowing. This is the safest position for the client receiving a tube feeding.

A nurse is instructing a client who is postoperative about the sequential compression device the provider prescribed. Which of the following client statements should indicate to the nurse that the client understands the teaching. A. This device will keep me from getting sores on my skin. B. This thing will keep the blood pumping through my leg. C. With this thing on my leg muscles wont get weak. D. This device is going to keep my joints in good shape.

B. This thing will keep the blood pumping through my leg. (promotes venous return in the deep veins of the legs and thus helps prevent thrombus formation.

A nurse is completing discharge teaching to a client who has COPD. The client verbalizes understanding of the orthopneic position when he states, "When I have difficulty breathing at night, I will A. lie on my back with my head and shoulders elevated on a pillow. B. lie flat on my stomach with my head to one side. C. sit on the side of my bed and rest my arms over pillows on top of my raised bedside table. D. lie on my side with my weight on my hips and shoulder with my arms flexed in front of me.

C. sit on the side of my bed and rest my arms over pillows on top of my raised bedside table. The client is describing the orthopneic position. This position allows for chest expansion and is especially beneficial to clients who have COPD.

A nurse is caring for a client who has been sitting in a chair for 3 hours. Which of the following problems is the client at risk for developing? 1. Stasis of secretions 2. Muscle atrophy 3. Pressure ulcer 4. Fecal impaction

Correct -- 3 - Pressure ulcer Incorrect 1. Stasis of secretions -Sitting in a chair will help prevent stasis of secretions 2. Muscle atrophy - is a complication for a client on prolonged bed rest, not just sitting in a chair. 4. Fecal impaction - complication for a client on prolonged bed rest not just sitting in a chair for brief time.

A nurse is caring for a client who is post-operative. Which of the following nursing interventions reduce the risk of thrombus development.? (Select ALL that apply) 1. Instruct the client not to use the Valsalva maneuver. 2. Apply elastic stockings. 3. Review laboratory values for total protein level. 4. Place pillows under the client's knee's and lower extremities. 5. Assist the client to change position often.

Correct -->2. Apply elastic stockings.(promotes venous return and prevents thrombus formation) Correct --> 5. Assist the client to change position often. (prevents venous stasis) Wrong 1. Instruct the client not to use the Valsalva maneuver. (increases workload of heart, but it does not affect peripheral circulation) Wrong3. Review laboratory values for total protein level. (important for evaluating his ability to heal and prevent skin breakdown) Wrong4. Place pillows under the client's knee's and lower extremities. (further impairs circulation to lower extremities.)

Performance of activities of daily living (ADLs) and active range of motion (ROM) exercises can be accomplished simultaneously as illustrated by which of the following? Select all that apply. Elbow flexion with eating and bathing. Elbow extension with shaving and eating. Wrist hyperextension with writing. Thumb ROM with eating and writing. Hip flexion with walking.

Correct Answers: Elbow flexion with eating and bathing. Thumb ROM with eating and writing. Hip flexion with walking. Rationale: Eating and bathing will flex the elbow joint, and grasping and manipulating utensils to eat and write will take the thumb through its normal ROM. Walking flexes the hip. Shaving and eating require elbow flexion, not extension (option 2). Writing brings the fingers toward the inner aspect of the forearm, thus flexing the wrist joint (option 3). Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation.

To promote the safe use of a cane for a client who is recovering from a minor musculoskeletal injury of the lower left extremity, which of the following instructions should the nurse provide? (Select ALL that apply) 1 - Hold the cane on the right side. 2. Keep two points of support on the floor. 3. Place the cane 15 inches in front of the feet before advancing. 4. After advancing the cane, move the weaker leg forward. 5. Advance the stronger leg so that it aligns evenly with the cane.

Correct: 1 - Hold the cane on the right side. (hold cane on the uninjured side to provide support for injured leg) 2. Keep two points of support on the floor. (for stability) 4. After advancing the cane, move the weaker leg forward. (cane, weaker leg then stronger leg) Wrong: 3. Place the cane 15 inches in front of the feet before advancing. (s/b 6-10 inches) 5. Advance the stronger leg so that it aligns evenly with the cane. ( should advance the stronger leg past the cane)

A nurse manager is reviewing guidelines to prevent injury with staff nurses. Which of the following should the nurse manager include in the teaching? (Select ALL that apply) A. Request assistance when repositioning a client. B. Avoid twisting the spine or bending at the waist. C. Keep the knees slightly lower than the hips when sitting for long periods of time. D. Use smooth movements when lifting and moving clients. E. Take a break from repetitive movements every 2 - 3 hours to flex and stretch joints and muscles.

Correct: A. Request assistance when repositioning a client. B. Avoid twisting the spine or bending at the waist. D. Use smooth movements when lifting and moving clients. Incorrect: C. Keep the knees slightly lower than the hips when sitting for long periods of time. Should be knees HIGHER in order to decrease strain on the lower back. E. Take a break from repetitive movements every 2 - 3 hours to flex and stretch joints and muscles. Nurses should take a break every 15-20 min

A nurse is caring for a client who is sitting in a chair and asks to return to bed. Which of the following is the priority action for the nurse to take at this time? A. Obtain a walker for the client to use to transfer back to bed. B. Call for additional personnel to assist with the transfer C. Use a transfer belt and assist the client to bed. D. Assess the client's ability to help with the transfer.

D. Assess the client's ability to help with the transfer. The first action the nurse would take using the nursing process is to assess/collect data from the client. The nurse should assess the client's ability to help with the transfers (balance, muscle strength & endurance). Then the nurse can proceed with a safe transfer of the client.

Nurse is reviewing the effects of immobility on various body systems. List at least 2 effects on respiratory system.

Decreased respiratory movement resulting in decreased oxygenation and carbon dioxide exchange Stasis of secretions and decreased and weakened respiratory muscles, resulting in atelectasis and hypo-static pneumonia. Decreased cough response.

A client weighs 250 pounds and needs to be transferred from the bed to a chair. Which instruction by the nurse to the unlicensed assistive personnel (UAP) is most appropriate? "Using proper body mechanics will prevent you from injuring yourself." "You are physically fit and at lesser risk for injury when transferring the client." "Use the mechanical lift and another person to transfer the client from the bed to the chair." "Use the back belt to avoid hurting your back."

Your Answer: "Use the mechanical lift and another person to transfer the client from the bed to the chair." Rationale: It is prudent for nurses to understand and use proper body mechanics at all times to decrease risk, while keeping in mind the importance of assistive devices and help from other staff. While it is generally accepted that proper body mechanics alone will not prevent injury, many work settings do not yet have "no manual lift" and "no solo lift" policies and resources in place. Cognitive Level: Analyzing. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation.

Five minutes after the client's first postoperative exercise, the client's vital signs have not yet returned to baseline. Which is an appropriate nursing diagnosis? Activity Intolerance. Risk for Activity Intolerance. Impaired Physical Mobility. Risk for Disuse Syndrome.

Your Answer: Activity Intolerance. Rationale: Vital signs that do not return to baseline 5 minutes after exercising indicate intolerance of exercise at that time. This is a real problem, not "at risk for," as in option 2. There is no evidence that the client requires assistance (impaired mobility, option 3), or is immobile (disuse syndrome, option 4). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Diagnosis.

The client is ambulating for the first time after surgery. The client tells the nurse, "I feel faint." Which is the best action by the nurse? Find another nurse for help. Return the client to her room as quickly as possible. Tell the client to take rapid, shallow breaths. Assist the client to a nearby chair.

Your Answer: Assist the client to a nearby chair. Rationale: Placing the client in a safe position is the best maneuver. Leaving the client creates unsafe conditions because the client may faint before being able to return to her room (options 1 and 2). Rapid, shallow breathing (hyperventilation) may increase the dizziness (option 3). Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation.

The nurse is performing an assessment of an immobilized client. Which assessment causes the nurse to take action? Heart rate 86 Reddened area on sacrum Nonproductive cough Urine output of 50 mL/hour

Your Answer: Reddened area on sacrum Rationale: The reddened area of the skin can lead to skin breakdown. The other options are within normal limits. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment.

To increase stability during client transfer, the nurse increases the base of support by performing which action? Leaning slightly backward. Spacing the feet farther apart. Tensing the abdominal muscles. Bending the knees.

Your Answer: Spacing the feet farther apart. Rationale: A key word in the question is base, and the feet provide this foundation. Leaning backward actually decreases balance (option 1), and tensing abdominal muscles alone (option 3) or bending the knees (option 4) does not affect the base of support. Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation.

When assessing a client's gait, which does the nurse look for and encourage? The spine rotates, initiating locomotion. Gaze is slightly downward. Toes strike the ground before the heel. Arm on the same side as the swing-through foot moves forward at the same time.

Your Answer: The spine rotates, initiating locomotion. Rationale: Normal gait involves a level gaze, an initial rotation beginning in the spine, heel strike with follow-through to the toes, and opposite arm and leg swinging forward. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment.

A nurse is teaching a client about active range-of-motion (ROM) exercises. The nurse then watches the client demonstrate these principles. The nurse would evaluate that teaching was successful when the client does which of the following? Exercises past the point of resistance. Performs each exercise one time. Performs each series of exercises once a day. Uses the same sequence during each exercise session.

Your Answer: Uses the same sequence during each exercise session. Rationale: When the client performs the movements systematically, using the same sequence during each session, the nurse can evaluate that the teaching was understood and is successful. When performing active ROM the client should exercise to the point of slight resistance, but never past that point of resistance in order to prevent further injury (option 1). The client should perform each exercise at least three times, not just once (option 2). The client should perform each series of exercises twice daily, not just once per day (option 3). Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Evaluation.

Isotonic exercises such as walking are intended to achieve which of the following? Select all that apply. Increase muscle tone and improve circulation. Increase blood pressure. Increase muscle mass and strength. Decrease heart rate and cardiac output. Maintain joint range of motion.

Your Answers: Increase muscle tone and improve circulation. Increase muscle mass and strength. Maintain joint range of motion. Rationale: Isotonic exercise increases muscle tone, mass, and strength, maintains joint flexibility, and improves circulation. During isotonic exercise, both heart rate and cardiac output quicken to increase blood flow to all parts of the body (option 4). Little or no change in blood pressure occurs (option 2). Cognitive Level: Remembering. Client Need: Physiological Integrity. Nursing Process: Planning.