Exam 3 EAQs

An older client is admitted to the hospital with the diagnosis of dementia of the Alzheimer type and depression. Which signs of depression does the nurse identify? Select all that apply. A. Loss of memory B. Increased appetite C. Neglect of personal hygiene D. "I don't know" answers to questions E. "I can't remember" answers to questions

B, C, D, E Neglect of personal hygiene is associated with depression because of low self-esteem. People who are depressed do not have physical or emotional energy; "I don't know" and "I can't remember" answers require little thought or decision-making. Clients with depression can either have decreased or increased appetite. Depression does not cause memory deficits.

The family members of a client with the diagnosis of cerebrovascular accident (CVA, also known as "brain attack") express concern that the client often becomes uncontrollably tearful during their visits. What should the nurse include in a response? A. Emotional lability is associated with brain trauma B. Their presence allows the client to express feelings C. The client is depressed about the loss of functional abilities D. Non-verbal expressions of feelings are more accurate than verbal ones

A. Emotional lability is associated with brain trauma Emotional lability is associated with brain trauma from ischemia or injury. The frontal lobe, hypothalamus, thalamus, and cortical limbic system are involved in expression of emotions. Emotional lability is not limited to interactions with family. Although the client may be depressed, the uncontrollable tearfulness is because of the disease process. Although nonverbal messages are often helpful in determining emotional response, these emotional outbursts may be unrelated to feelings

A client has left hemiplegia because of a cerebrovascular accident (CVA, "brain attack"). What can the nurse do to contribute to the client's rehabilitation? A. Begin active exercises B. Make a referral to the physical therapist C. Position the client to prevent contractures D. Avoid moving the affected extremities unless necessary

C. Position the client to prevent contractures To prevent contractures after a brain attack, the client should be positioned in functional alignment, and passive range-of-motion exercises should be performed. Active exercises are impossible with paralyzed limbs. The healthcare provider must request a consult with the physical therapist. Avoiding moving the affected extremities unless necessary will increase contractures and atrophy.

A client is receiving heparin sodium intravenously at 1500 units/hour. The concentration in the bag is 25,000 units/500 milliliters. The nurse determines that how many milliliters will infuse during the nurse's 8-hour shift? Record your answer using a whole number.

240 mL

An older adult experiencing delirium suffers from a leg fracture caused by a fall. Which interventions should the nurse follow to prevent future falls? Select all that apply. A. Minimizing medications B. Modifying the home environment C. Teaching clients about the safe use of the internet D. Manage foot and footwear problems E. Providing information about the effects of using alcohol

A, B, D The nursing interventions followed to prevent falls are minimizing medications, modifying the home environment and managing foot and footwear problems. Teaching clients about the safe use of Internet may be an effective intervention for preventing delirium. Providing information about the effects of using alcohol is not an intervention for older adults; this action is more beneficial for adolescents.

A nurse is preparing to discharge a client who is partially paralyzed following a stroke. What should the nurse teach the client's family about recognizing caregiver role strain? Select all that apply. A. The caregiver has disturbed sleep patterns B. The caregiver has reduced appetite and weight C. The caregiver is more concerned about personal appearance D. The caregivers engages in leisure activities as often as possible E. The caregiver is fearful about administering medications to the client

A, B, E A family should recognize that when the caregiver has disturbed sleep patterns, the caregiver is experiencing strain. Changes in appetite, weight, and sleep patterns are all indicative of caregiver role strain. A caregiver experiences strain while learning about new therapies and administering medications to the client. A caregiver experiencing role strain is not concerned about personal appearance and may withdraw from social groups. A caregiver also does not spend time in any leisure activities if overcome by strain.

What nursing action is essential when a client experiences hemianopsia as the result of a left ischemic stroke? A. Place objects within the visual field B. Teach passive ROM exercises C. Instill artificial teardrops into the affected eye D. Reduce time client is positioned on the left side

A. Place objects within the visual field A stroke in the left hemisphere will lead to a loss of the right visual field of each eye; objects should be placed within the client's view. Passive range-of-motion exercises, artificial teardrops, and reducing time client is positioned on the left side are not related to hemianopsia.

A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. A. Dementia B. Multiple losses C. Declines in health D. A milestone birthday E. An injury requiring hospitalization

B, C Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income. A decline in health, particularly when associated with a chronic illness, frequently precipitates depression in older adults. Dementia is a cognitive problem. Research does not correlate the onset of depression with a milestone birthday in older adults. A traumatic injury does not precipitate the onset of depression in the older adult as often as does a chronic illness.

A nursing student is listing the steps that need to be considered when preparing discharge planning for a client. Which steps listed by the nursing student are accurate? Select all that apply. A. "Plan the client's discharge at the time of leaving the hospital" B. "Teach the client the safe and effective use of medications and medical equipment" C. "Remember than discharge planning is a centralized, coordinated, and interdisciplinary process" D. "Coordinate with the PCP only when preparing discharge planning" E. "Develop a care plan that moves the client from the hospital to another level of healthcare"

B, C, E The nurse should teach the client the safe and effective use of medications and medical equipment before he or she leaves the health care facilities. The nurse should remember that discharge planning is a centralized, coordinated, interdisciplinary process that ensures that the client has a plan for continuing care after leaving a healthcare facility. The nurse should develop a care plan that moves the client from the hospital to another level of healthcare such as the client's home or a nursing home. The nurse should start discharge planning the moment a client is admitted to a healthcare facility. The nurse should coordinate with all members of the interdisciplinary healthcare team in order to identify and anticipate the client's need when preparing discharge planning.

A client manifests right-sided hemianopsia as a result of a brain attack (cerebrovascular accident, CVA). Which goal does the nurse include in the plan of care? A.Correct the client's misuse of equipment B. Instruct the client to scan surroundings C. Teach the client to look at the position of the left extremities D. Provide the client with tactile stimulation to the affected extremities

B. Instruct the client to scan surroundings The client has lost vision from the right visual field; scanning compensates for this loss. Correcting the client's misuse of equipment is used for clients with apraxia (inability to manipulate objects). Teaching the client to look at the position of the left extremities increases neglect of the affected side. Providing the client with tactile stimulation to the affected extremities is used for denial of the right side (unilateral neglect).

A client is admitted to the hospital with weakness in the right extremities, and speech that is slightly slurred. A diagnosis of brain attack (cerebrovascular accident, CVA) is suspected. During the first 24 hours after symptom onset, which action is priority? A. Assess the temperature B. Monitor bowel sounds C. Evaluate motor status D. Obtain a urinalysis

C. Evaluate motor status Evaluating the client's motor status will reveal whether there is a progression of symptoms. These data will assist the practitioner in determining a diagnosis. An elevation in temperature is not an early sign of an extension of a CVA. Monitoring bowel sounds is not the priority; motor ability takes precedence over peristalsis. Obtaining the client's urine for a urinalysis is not the priority assessment.

A client is diagnosed with a brain attack (cerebrovascular accident, CVA). The baseline vital signs are a pulse rate of 78 bpm and a blood pressure (BP) of 120/80 mm Hg. The nurse continues to monitor the vital signs and recognizes that which changes in vital signs indicate increased intracranial pressure (ICP)? A. Pulse 50, BP 140/60 B. Pulse 56, BP 130/110 C. Pulse 60, BP 129/96 D. Pulse 120, BP 80/60

A. Pulse 50, BP 140/60 Increasing intracranial pressure is evidenced by widening of pulse pressure and a decreased pulse rate. Pulse 56 bpm and BP 130/110 mm Hg, pulse 60 bpm and BP 126/96 mm Hg, and pulse 120 bpm and BP 80/60 mm Hg do not meet these criteria.

An older client experiences a cerebral vascular accident (CVA) and has right-sided hemiplegia and expressive aphasia. The client's children ask the nurse which functions will be impaired. Which abilities does the nurse explain will be affected? A. Stating wishes verbally B. Recognizing familiar objects C. Comprehending written words D. Understanding verbal communication

A. Stating wishes verbally Impaired ability to state wishes verbally is a characteristic of expressive aphasia from damage to Broca area in the dominant hemisphere of the brain. Not recognizing familiar objects is known as agnosia; it is not related to expressive aphasia. Not comprehending written words is known as alexia or dyslexia, a type of receptive aphasia. Not understanding verbal communication is related to receptive aphasia.

A client is admitted to a rehabilitation unit after a brain attack (cerebrovascular accident, CVA) with residual hemiparesis. To help achieve the goal of safe walking with a cane, what should the nurse teach the client to do? A. Shorten the stride to the unaffected extremity B. Advance the cane and the affected extremity simultaneously C. Lean the body toward the side with the can when ambulating D. Hold the cane on the same side as the affected extremity and increase the base of support

B. Advance the cane and the affected extremity simultaneously Advancing the cane and the affected extremity simultaneously supports stability. The body is supported partially on the affected limb and partially on the cane as the unaffected limb moves forward. Shortening the stride of the unaffected extremity will produce an awkward gait and instability; normal ambulation should be approximated. Leaning the body toward the cane when ambulating will change the center of gravity and cause instability. The cane is held on the unaffected, not the affected, side and advanced at the same time as the affected extremity to increase the base of support and provide stability.

An 84-year-old woman is admitted to the hospital with a diagnosis of dementia of the Alzheimer type. What does the nurse know about this disorder? A. Problem that first emerges in the third decade of life B. Nonorganic disorder that occurs in the later years of life C. Cognitive problem that is a slow and relentless deterioration of the mind D. Disorder that is easily diagnosed through laboratory and psychological tests

C. Cognitive problem that is a slow and relentless deterioration of the mind Dementia of the Alzheimer type accounts for 80% of dementias in older adults; it may be due to a neurotransmitter deficiency and is characterized by a steady decline in intellectual function, including memory deficits, disorientation, and decreased cognitive ability. More than 90% of people with dementia of the Alzheimer type are older than 50 years. It is an organic, not functional, disorder. Dementia of the Alzheimer type is difficult to diagnose and often is made when other causes of the dementia have been ruled out.

A client who had a cerebrovascular accident (CVA, "brain attack") is starting to eat lunch. Which client behavior indicates to the nurse that the client may be experiencing left hemianopsia? A. Asks to have the food moved to the left side of the tray B. Drops the coffee cup when trying to use the right hand C. Ignores the food on the left side of the tray when eating D. Reports not being able to use the right arm to help eat meals

C. Ignores the food on the left side of the tray when eating Clients with hemianopsia affecting the left field of vision cannot see whatever is in the left field of vision. Asking to have food moved to the left side of the tray may occur if the client has right hemianopsia and wishes to see better when eating. Dropping the coffee cup when trying to use the right hand may occur with right hemiparesis, not with hemianopsia. Reporting about not being able to use the right arm to help eat indicates hemiplegia, not hemianopsia.

A client who had a brain attack (cerebrovascular accident, CVA) has left-sided hemiparesis but is able to ambulate with assistance. When getting up from a lying position, the client reports feeling lightheaded and dizzy. The nurse explains that these clinical manifestations are a result of which condition? A. Inflamed peripheral nerves B. Loss of blood and blood volume C. Demyelination of peripheral nerves D. Blood pooling in the lower extremities

D. Blood pooling in the lower extremities Dilation of blood vessels causes dependent pooling when the client moves to an upright position, resulting in orthostatic (postural) hypotension. The client can limit feelings of lightheadedness and dizziness by moving gradually when changing positions. Inflammation of peripheral nerves is not the cause of the clinical manifestations. Inflamed peripheral nerves can cause neuropathies. Loss of blood and blood volume causes hypovolemia, leading to shock. Demyelination of peripheral nerves leads to multiple sclerosis.

Which health problem does the nurse identify from an older client's history that increases the client's risk factors for a cerebrovascular accident (CVA, also known as "brain attack")? A. Glaucoma B. Hypothyroidism C. Continuous nervousness D. Transient Ischemic Attacks (TIAs)

D. TIAs TIAs are temporary neurologic deficits related to cerebral hypoxia; about one third of the people who have TIAs will have a brain attack (CVA) within 2 to 5 years. Glaucoma, hypothyroidism, and continuous nervousness are not risk factors associated with a CVA.

A nurse is assessing an older adult with the diagnosis of dementia. Which manifestations are expected in this client? Select all that apply. A. Resistance to change B. Inability to recognize familiar objects C. Preoccupation with personal appearance D. Inability to concentrate on new activities or interests E. Tendency to dwell on the past and ignore the present

A, B, D, E Resistance to change is a clinical finding associated with dementia; these clients need structure and routines. An inability to recognize familiar objects (agnosia) is a typical cognitive dysfunction associated with dementia. A short attention span and little or no interest in new activities are typical of dementia. The past, rather than the threatening present, is where these clients feel comfortable. Clients with delirium, dementia, and other cognitive disorders rarely express any concern about personal appearance. The staff must meet most of these clients' personal needs.

A client has a history of progressive carotid and cerebral atherosclerosis and experiences transient ischemic attacks (TIAs). How does the nurse explain TIAs to the client? A. Temporary episodes of neurologic dysfunction B. Intermittent attacks caused by multiple small clots C. Ischemic attacks that result in progressive neurologic deterioration D. Exacerbations of neurologic dysfunction alternating with remissions

A. Temporary episodes of neurologic dysfunction Narrowing of arteries supplying the brain causes temporary neurologic deficits that last for a short period. Between attacks, neurologic functioning is normal. Emboli result in a brain attack (CVA); with a CVA the damage is usually permanent, not intermittent. Ischemic attacks that result in progressive neurologic deterioration occur with multiple small brain attacks; TIAs do not result in permanent damage. Exacerbations of neurologic dysfunction alternating with remission are not the description of a TIA; remissions and exacerbations occur with progressive degenerative neurologic disorders.

A nurse is assessing a client and attempting to distinguish between dementia and delirium. Which factors are unique to delirium? Select all that apply. A. Slurred speech B. Lability of mood C. Long-term memory loss D. Visual or tactile hallucinations E. Insidious deterioration of cognition F. A fluctuating level of consciousness

A, D, F Delirium, a transient cognitive disorder caused by global dysfunction in cerebral metabolism, results in sparse or rapid speech that may be slurred and incoherent. Visual or tactile hallucinations and illusions may occur with delirium because of altered cerebral function; hallucinations are not prominent with dementia. Clients with delirium fluctuate from hyperalert to difficult to arouse; they may lose orientation to time and place. Clients with dementia do not have a fluctuating level of consciousness, but they may be confused and disoriented. Clients with delirium are consistently irritable, anxious, and fearful; lability of mood is associated with dementia. Short-term memory loss is associated with both delirium and dementia; eventually long-term memory loss is associated with dementia. The onset of delirium is abrupt (hours to days) and has an organic basis; it is often precipitated by drugs such as anesthesia, analgesics, and antibiotics or by conditions such as infections, end-stage kidney disease, and substance abuse or withdrawal. The onset of dementia is slow and insidious (years).

A client with a disturbed state of mind is under observation. Which statement made by the nurse indicates that the client is suffering from dementia? Select all that apply. A. "The client is very depressed" B. "The client is not able to make decisions" C. "The client always tells about his/her failures" D. "The client is not able to perform purposeful work" E. "The client has a completely disturbed sleep/wake cycle"

B, D A client with dementia may not able to make decisions because it affects thinking ability. The client with dementia may suffer from apraxia in which the client is not able to perform purposeful work. In depression, the client will remain depressed but in dementia, the mood is affected superficially. A client with depression may tell about his/her failures, but in dementia, the client may or may not be able to recollect details of life. In dementia, the sleep/wake cycle of the client is a bit fragmented but in depression, it is completely disturbed.

A client experiences expressive aphasia as a result of a brain attack (cerebrovascular accident, CVA). The client's spouse asks whether the client's speech will ever return. What is the best response by the nurse? A. "It should return in several months" B. "You will have to ask the PCP" C. "It is hard to say how much improvement will occur" D. "Unfortunately your spouse will no longer be able to speak"

C. "It is hard to say how much improvement will occur" Recovery from aphasia is a continuous process; the amount of recovery cannot be predicted. The response "It should return in several months" gives false reassurance; it may take a year or longer or may never return. The response "You will have to ask the primary healthcare provider" abdicates the nurse's responsibility; the healthcare provider cannot predict return of function. Speech return is a continuous process; it may take a year or longer or may never return.

What is the priority nursing intervention for a client with stroke who is transitioned from ED to other settings? A. Monitoring VS B. Reassuring the client and family C. Assessing LOC D. Monitoring specific client manifestations of stroke

C. Assessing LOC Assessing the level of consciousness is the priority nursing action in the client with stroke and who is transitioned from ED to other settings. Monitoring the vital signs, reassuring the client and family, and monitoring specific client manifestations of stroke are ongoing nursing interventions.

An older adult client is talking to the nurse about his Vietnam experiences and shares that he still has flashbacks. While assessing him the nurse notes that he is jumpy and exhibits startle reactions and poor concentration. With which mental health disorder does the nurse associate these symptoms? A. Delusions B. Hallucinations C. PTSD D. OCD

C. PTSD PTSD is a syndrome characterized by the development of symptoms after an extremely traumatic event. Symptoms include helplessness, flashbacks, intrusive thoughts, memories, images, emotional numbing, loss of interest, avoidance of any place that reminds the affected person of the traumatic event, poor concentration, irritability, startle reactions, jumpiness, and hypervigilance. Delusions are beliefs that guide one's interpretation of events and help make sense of disorder. Common delusions among older adults involve being poisoned, having their assets taken by their children, being held prisoner, and being deceived by a spouse or lover. Hallucinations are visual or auditory perceptions of nonexistent objects and sounds. Older adults with hearing and vision deficits may hear voices or see people who are not actually present. OCD is characterized by recurrent and persistent thoughts, impulses, and urges of ritualistic behaviors that improve the affected person's comfort level.

A nurse begins planning for the discharge of a client who had a brain attack (cerebrovascular accident, CVA) with residual hemiparesis and hemianopsia. Which information should the nurse include in the discharge teaching plan for this client? A. Necessity for bed rest at home B. Use of O2 therapy at home C. Significance of a safe environment D. Need for decreased protein in the diet

C. Significance of a safe environment Safety becomes a priority when the client has hemiparesis (paralysis on one side) and hemianopsia (abnormal visual field). Although a balance between activity and rest is important, the client does not have to maintain bed rest. Oxygen generally is not necessary. All the basic nutrients should be included in the diet; there is no reason to reduce protein intake.

What is the priority nursing care for a client with delirium? A. Providing a body massage B. Arranging for music therapy C. Teaching relaxation techniques D. Creating a calm and safe environment

D. Creating a calm and safe environment A client with delirium has cognitive impairment, so the priority nursing care is to create a calm and safe environment. Providing a body massage may provide physical comfort to the client but is not the priority nursing care. Arranging for music therapy may temporarily comfort the client but is not the priority nursing care. Teaching relaxation techniques is difficult for a client with delirium because the client is cognitively impaired.

A client who recently experienced a brain attack (cerebrovascular accident, CVA) and who has limited mobility reports constipation. What is most important for the nurse to determine when collecting information about the constipation? A. Presence of distention B. Extent of weight gain C. Amount of high-fiber food consumed D. Length of time this problem has existed

D. Length of time this problem has existed First, the nurse should establish when the client last defecated because the client may have perceived constipation. Abdominal distention may or may not be observed with constipation. Weight gain has no relationship to constipation. Although lack of bulk in the diet can lead to constipation, particularly in clients with limited activity or an inadequate fluid intake, the lack of bulk in the diet is not the most significant information to obtain at this time.

During a home visit to an older adult, the nurse observes a change in behavior and suspects delirium. The nurse assesses the client for one of several conditions that may have precipitated the delirium. Select all that apply. A. Infection B. Dementia C. Dehydration D. Urine retention E. Restricted mobility

A, C, D Infections, especially urinary tract infections in older clients, may cause delirium because they may become systemic. A memory aid for recalling the causes of delirium is DELIRIUMS: Drugs, Emotional factors, Low arterial oxygen level, Infections, Retention of urine or feces, Ictal or postictal state, Undernutrition, Metabolic conditions, and Subdural hematoma. Dehydration and fluid and electrolyte imbalances may lead to delirium because of the decrease in fluid and change in concentrations of electrolytes in the brain. Retention of urine may progress to a urinary tract infection that becomes systemic, which can cause delirium. Dementia is a chronic, irreversible cause of mental status changes. It must be differentiated from delirium, which is treatable. Restricted mobility is not related to delirium.

The home healthcare nurse visits an elderly couple living independently. The wife cares for the husband who has dementia. Which interventions should the nurse implement for them? Select all that apply. A. Assess the wife for caregiver burden B. Arrange hospice care for the husband C. Make healthcare decisions for the couple D. Assess the husband for signs of physical abuse E. ID social support within the community

A, D, E An older caregiver should be assessed for caregiver burden. Anxiety, depression, relationship tension, or health changes are indicators of caregiver burden. The nurse should assess the client for any unexplained bruises or skin trauma; these are signs of physical abuse. These findings must be reported to the state protective agencies. The nurse should also help the couple identify social support within the community. Terminally ill clients who need pain management require hospice care. The nurse need not arrange hospice care for a client with dementia. The nurse should not make healthcare decisions for the client. The client and spouse should be consulted in all healthcare decisions.

Four days after the client's total hip arthroplasty, the nurse is preparing to transfer the client to a rehabilitation center. Before admission the client took warfarin sodium daily for a history of pulmonary embolus. While hospitalized, the client received subcutaneous heparin two times a day. The nurse does not see any anticoagulant therapy listed on the client's transfer prescriptions. What should the nurse do? A. Contact the HCP to determine which anticoagulant therapy should be prescribed for this client B. Arrange for a supply of heparin for the client to take to the rehab center C. Explain to the client that anticoagulant therapy will no longer be needed D. Instruct the client to talk about anticoagulant needs with the healthcare provider at the rehabilitation center

A. Contact the HCP to determine which anticoagulant therapy should be prescribed for this client Failure to clarify this omission can be life threatening because of the potential for an embolus. Waiting until the client is in the new facility to discuss the administration of an anticoagulant may jeopardize the client's status. Because anticoagulant therapy was not included in the transfer prescriptions, the nurse cannot legally supply the client with medications to take to the rehabilitation center. It is unclear what the anticoagulant needs are for this client; it is unsafe to tell the client that anticoagulants are no longer required. It is the nurse's, not the client's, responsibility to discuss this situation with the healthcare provider.

Bed rest is prescribed after a client's cerebrovascular accident (CVA, "brain attack") results in right hemiplegia. Which exercises should the nurse incorporate into the client's plan of care 24 hours after the brain attack? A. Passive ROM B. Active ROM C. Light weight-lifting exercises of the right side D. Isotonic exercises that will capitalize on returning muscle function

A. Passive ROM Passive range-of-motion exercises prevent the development of deformities (e.g., contractures) and do not require any energy expenditure by the client. Instituting range-of-motion exercises is an independent nursing function. The client will be unable to perform active exercises and weight-lifting. Isotonic exercises are active movement, which the client is unable to do.

The primary objective of nursing intervention for clients with dementia, delirium, and other cognitive disorders is to maintain what? A. Safety within the environment B. Psychological faculties C. Participation in educational activities D. Face-to-face contact with other clients

A. Safety within the environment Clients with cognitive disorders need an environment that will keep them safe, because their own abilities to interpret and respond appropriately are diminished. People with dementia, delirium, and other cognitive disorders usually have a declining level of function in all areas. Maintaining psychological function is often not possible. People with dementia, delirium, and other cognitive disorders have a limited ability to participate in educational activities and may also have a limited ability to interact socially with other clients.

A client with a history of hypertension is admitted to the hospital immediately after a brain attack (cerebrovascular accident, CVA). The client is unconscious, and the vital signs are temperature 98° F (36.7° C), pulse 78 beats per minute, respiration 16 breaths per minute, and blood pressure 120/80 mm Hg. Which nursing concern is a priority for this client? A. Injury B. Constipation C. Respiratory distress D. Decreased fluid volume

C. Respiratory distress The risk for an obstructed airway is the priority when a client is unconscious; reduced oxygen intake may lead to serious complications. Although protecting the client from injury is important, it is not as life threatening as an obstructed airway. Although important, constipation is not as life threatening as an obstructed airway. Although maintaining fluid balance is important, it is not as critical as maintaining a patent airway.

The nurse is caring for a client two days after the client had a brain attack (cerebrovascular accident, CVA). To prevent the development of plantar flexion, which action should the nurse take? A. Place a pillow under the thighs B. Elevate the knee gatch of the bed C. Encourage active range of motion D. Maintain the feet at right angles to the legs

D. Maintain the feet at right angles to the legs Maintaining the feet at right angles to the legs produces dorsiflexion of the feet and prevents the tendons from shortening, preventing footdrop. Placing a pillow under the thighs and elevating the knee gatch of the bed will not prevent plantar flexion; it can promote hip and knee flexion contractures. The client will not have the ability or strength to perform range-of-motion exercises unassisted at this time.