chapter 39, Fund of Nursing

A patient is learning crutch walking. Before starting to walk, the patient assumes a tripod position, extends the head and neck, straightens the vertebral column, extends the hips, and flexes the knees. What does the nurse tell the patient? Select all that apply. 1 "The axillae should bear some weight." 2 "The vertebral column is in a correct position." 3 "Keep the head and neck in an erect position." 4 "Keep the knees extended before advancing the limb." 5 "Keep the hips in an extended position while crutch walking."

2,3,5

Which is the correct gait when a patient is ascending stairs on crutches? 1. The affected leg is advanced between the crutches to the stairs in a modified two-point gait. 2. The unaffected leg is advanced between the crutches to the stairs in a modified three-point gait. 3. A swing-through gait 4. Both legs advance between the crutches to the stairs in a modified four-point gait.

2

Which measure should the nurse adopt to reposition a patient in bed? 1. When pulling a patient up in bed, the bed should be in anti-Trendelenburg's position. 2. For patients with stage III or IV pressure ulcers, care should be taken to avoid shearing force. 3. If the patient weighs less than 200 lb (91 kg), friction-reducing devices should be avoided. 4. If the caregiver needs to lift about 55 lb (25 kg) of a patient's weight, the patient is considered fully dependent.

2

Which statement if made by a nurse is correct? 1 "Permanent cartilage is ossified." 2 "Ligaments connect bones to cartilage." 3 "Cartilage is a vascular supporting connective tissue." 4 "The Achilles tendon is the thinnest tendon in the body."

2

While the nurse is talking to a patient, the patient faints and starts to fall. Arrange the steps the nurse takes in the appropriate order to protect the patient from head injury. 1. Extend one leg and let the patient slide down against the leg. 2. Assume a wide base of support. 3. Gently lower the patient to the floor, protecting the head. 4. Put one foot in front of the other to support the patient's body weight.

2,4,1,3

List examples of a "Resistive Isometric Exercise"

push-ups hip lifting

What is a example of a "Isometric Exercise"?

quadriceps exercises tightening the gluteal muscle

What is a "Resistive Isometric Exercise"?

the contracting of a muscle when pushing on a stationary object

What is "Isometric Exercises"?

tightening or tensing of a muscle without moving body parts

This type of exercise: -Enhance circulatory & respiratory function - increase muscle mass, tone, and strength

Isotonic excercise

What are examples of Isotonic Exercises:

Walking, jogging, swimming, dance aerobics, bicycling

What nursing intervention should the nurse provide to a patient who has impaired gas exchange related to decreased cardiac output? 1. Teach the patient how to restrict fluid intake 2. Administer oxygen at 2 L/min via the nasal cannula 3. Record activity of the patient in an exercise log daily along with the response 4. Ask the patient to perform a 2-to 3-mile brisk walk and isometric exercises three to four times a week

2

Which activity is least appropriate for an older adult patient's exercise program? 1. Stretching 2. High-intensity interval training 3. Agility training 4. Weight-bearing and other resistance exercises

2

Which environmental issue is a hindrance to activity and exercise? 1. Hormonal changes and increased osteoclastic activity with increasing age 2. Work sites reluctant in motivating employees for physical fitness regimens 3. A patient's decisions to change his or her behavior to include a daily exercise routine 4. A patient's knowledge, values, and beliefs about exercise in relation to health

2

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

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

How are the double adjustable-crutch and the axillary crutch similar? 1. Both have handgrips. 2. Both have metal bands. 3. Both are equally common in use. 4. Both have a curved surface at the top

1

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.mAsk for help from another colleague to ambulate the patient. 4. Remove any obstacles on the floor before the ambulation.

1

The nurse is caring for a pregnant patient. The nurse understands that the body posture and alignment in a pregnant patient may change. Where does the center of gravity of a pregnant woman shift? 1. To the anterior 2. To the posterior 3. To the left lateral side 4. To the right lateral side

1

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

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

Which is a congenital defect? 1. Arthritis 2. Scoliosis 3. Osteoporosis 4. Osteomalacia

2

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

Which is the correct gait when a patient is ascending stairs on crutches? 1. The affected leg is advanced between the crutches to the stairs in a modified two-point gait. 2. The unaffected leg is advanced between the crutches to the stairs in a modified three-point gait. 3. A swing-through gait 4. Both legs advance between the crutches to the stairs in a modified four-point gait

2

The nurse works at an occupational therapy clinic. A patient with type 1 diabetes mellitus has recovered from a fractured tibia and is advised to use a cane for walking. When teaching the patient about the use of canes, which information should the nurse include? Select all that apply. 1 . Canes are lightweight, easily movable devices made of wood or metal. 2 . Canes should be kept on the stronger side of the body. 3 . Canes should be of a length equal to the distance between the greater trochanter and the floor. 4 . Canes have a metal band and handgrip that are adjusted to fit the patient's height. 5 . Canes have a padded, curved surface at the top, which fits under the axilla.

1,2,3

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

1,2,3

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

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 shoes

1,2,3,5

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

A patient wants to know how exercise affects the body. What effects/changes does the nurse list? Select all that apply. 1. Increased joint mobility 2. Increased cardiac output 3. Increased resting heart rate 4. Increased respiratory rate followed by a slower return to resting state 5. Increased basal metabolic rate

1,2,5

Which actions should the nurse perform during the assessment phase when caring for a patient diagnosed with impaired physical mobility? Select all that apply. 1 Inspect the patient's body alignment, posture, and mobility 2 Reassess the patient for signs of improved activity and exercise tolerance 3 Observe the response of the patient's body systems to activity and exercise 4 Consult and collaborate with members of the health care team to increase activity 5 Ask for the patient's perception of activity and exercise status after interventions

1,3

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.

1,3,4

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.

1,3,4

The nurse is teaching a group of menopausal women about osteoporosis. What are some causes of osteoporosis? Select all that apply. 1. Lack of exercise 2. Brittle bones 3. Decreased estrogen levels 4. Increase in bone mass 5. Increased resorption of bone tissue

1,3,5

A patient with a body mass index (BMI) of 36 has a sedentary job. The patient states that she has never exercised. The patient has been advised to reduce weight. What actions should the nurse advise the patient to do to promote reduction of weight? Select all that apply. 1. Advise her to discuss her diet with a dietitian. 2. Advise her to undergo gastric banding. 3. Advise her to undergo an intensive exercise training program. 4. Advise her to have realistic goals such as losing 4 pounds over 2 weeks. 5. Advise her to resign from her job immediately because it is the cause of her obesity.

1,4

A patient is admitted to the hospital with osteoporosis and lower back pain. The patient loses balance when trying to stand and walk. The patient has a nursing diagnosis of body imbalance. What instructions does the nurse give the patient? Select all that apply. 1. Instruct the patient to widen the base of support by separating the feet. 2. Instruct the patient to bring the knees closer together to maintain a broad base. 3. Instruct the patient to lower the center of gravity closer to the base of support. 4. Instruct the patient to keep the center of gravity away from the base of support. 5. Instruct the patient to maintain a vertical line from the center of gravity through the base of support.

1.3.5

The nurse is attending to an older adult patient who has sustained a fall and has broken a femur. The nurse explains to the patient that as the body ages, the bones become weak due to osteoporosis and become more prone to fracture. Which statements are true about osteoporosis? Select all that apply. 1. The cause may be hormonal imbalances or insufficient intake of nutrients. 2. There is a structural curvature of the spine associated with vertebral rotation. 3. Osteoporosis is a disorder of aging and results in the reduction of bone density or mass. 4. There is inadequate and delayed mineralization, resulting in compact and spongy bone. 5. The bone remains biochemically normal but has difficulty maintaining integrity and support

1.3.5

A patient is admitted to the hospital with injury to the knee joint following a fall. The nurse notices an increased mobility of the joint while assessing the range of motion (ROM). What could be the reason for the increased mobility of the knee joint? 1. Arthritis of the joint 2. Ligament tears in the joint 3. Contractures of the joint 4. Fluid collection in the joint

2

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

A patient with a right knee replacement is prescribed no weight bearing on the right leg. You reinforce crutch walking knowing that which crutch gait is most appropriate for this patient? 1. A two-point gait 2. A three-point gait 3. A four-point gait

2

A patient with type 1 diabetes mellitus had normal blood glucose levels before going to the gym. While performing strenuous exercise at the gym, the patient suddenly collapsed. What is the most probable reason for this? 1. Low blood pressure 2. Low blood sugar 3. Vasovagal syncope 4. High blood sugar

2

The nurse is assessing a patient who reports joint pain during walking. Which is the most appropriate question to be asked by the nurse to assess the severity of pain in the patient? 1"Which activities trigger your pain?" 2"How far do you walk before the pain in your legs begins?" 3"What prevents you from exercising 30 minutes each day?" 4"Do you experience muscular or joint pain during or after exercise?"

2

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

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

What group of muscles contract to accomplish the same movement? 1. Skeletal muscles 2. Synergistic muscles 3. Antigravity muscles 4. Antagonistic muscles

2

The nurse is assessing a patient whose right leg is injured and uses a modified three-point gait to climb upstairs. The patient stands at the bottom of the stairs and transfers body weight to the crutches. The patient then advances the right leg between the crutches to the stairs, and then shifts weight from the crutches to the left leg. Finally, the patient aligns both of the crutches on the stairs and repeats this sequence. According to the nurse, which step followed by the patient requires correction? 1. Standing at the bottom of the stairs and transferring body weight to the crutches 2. Advancing the right leg between the crutches to the stairs 3. Shifting the weight from the crutches to the left leg after advancing the right leg 4. Aligning both of the crutches on the stairs

2 While using the modified three-point gait when climbing up the stairs on crutches, the patient should first move the uninjured (left limb) to the stairs followed by the injured (right) limb. This is done so that the body weight is first transferred to the uninjured side. Advancing the right leg first and bearing weight on the limb during transfer would aggravate the injury.

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.

2,3,1,4

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

2,3,4,5

What type of diet does the nurse provide a patient who has decreased cardiac output related to a decrease in myocardial contractility? Select all that apply. 1 .Low-protein diet 2 . Low-sodium diet 3 .High-fat diet 4 .Low-calorie diet 5 . High-protein diet

2,4,5

A patient has a body mass index (BMI) of 36. Her work requires her to sit all day. The patient has been advised to lose weight. The patient follows an exercise program to lose weight. What are the benefits of a well-designed exercise program? Select all that apply. 1 . Increased cardiac output and decreased venous return 2 . Reduced bone loss and improved muscle tone 3 . Decreased gastric motility, and increased triglyceride breakdown 4 . Increased effort when breathing and improved alveolar ventilation 5 . Decreased fatigue and improved tolerance to stress

2,5

While assessing a patient with a head injury, the nurse suspects damage to the central nervous system (CNS). Why should the nurse assess the patient's voluntary movements? Select all that apply. 1. Damage to any part of the central nervous system (CNS) that regulates voluntary movement causes fractures. 2. Damage to any part of the central nervous system (CNS) that regulates voluntary movement causes impaired mobility. 3. Damage to any part of the central nervous system (CNS) that regulates voluntary movement causes joint degeneration. 4. Damage to any part of the central nervous system (CNS) that regulates voluntary movement causes articular disruption. 5. Damage to any part of the central nervous system (CNS) that regulates voluntary movement causes impaired body alignment.

2,5

What is the minimum patient weight that requires the use of friction reducing devices and at least three caregivers to handle and position the patient? Record your answer in pounds using a whole number.___________________________ lb

200

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

How does the nurse move his or her own body while transferring a patient to a bed? 1. The nurse relaxes the abdominal muscles. 2. The nurse twists the back and the pelvis slightly. 3. The nurse keeps the feet wide apart and bends at the knees. 4.The nurse avoids asking the patient to help as much as possible.

3

How is the body alignment and posture of a patient in a standing position different from the body alignment and posture of a patient in a sitting position? 1. The head is erect. 2.The spine is straight. 3. The arms hang at the sides. 4. The feet are flat on the floor.

3

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 trochante

3

The nurse is teaching a four-point alternating gait to a patient. If the patient has understood the teaching completely, what will be the pattern of the patient's gait? 1. The patient will advance both the left crutch and right foot at the same time. 2. The patient will advance both the right crutch and left foot at the same time. 3. The patient will move the right crutch forward first and then the left foot forward. 4.The patient will move the right leg forward first and then the right crutch forward.

3

The patient who has a severe left leg injury needs to avoid weight bearing on the affected leg. Which crutch gait is appropriate for the patient? 1. Two-point gait 2. Four-point gait 3. Three-point gait 4. Swing-through gait

3

What height of the bed is used to transfer and handle the patient safely? 1. Knee level 2. Hand level 3. Elbow level 4. Shoulder level

3

When caring for a patient who can assist with positioning, what should the nurse keep in mind? 1 If the center of gravity is higher, the nurse can have more stability. 2 If the base of support is narrower, the nurse can have more stability. 3 If the balancing activity is divided between the arms and legs, there is a reduced risk of back injury. 4 If the nurse's face is towards the direction opposite to movement, this positioning prevents abnormal twisting of the spine.

3

Which nursing intervention is appropriate for a patient who is diagnosed with decreased cardiac output related to decreased myocardial contractility? 1nTake 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

Which statement is true about the different forms of exercise? 1. Isotonic exercises promote osteoclastic activity. 2. Push-ups and hip lifting are examples of isotonic exercises. 3. A patient who is immobilized can perform isometric exercises. 4. Resistive isometric exercises involve tensing muscles without moving body parts.

3

Which term is used to explain the relationship of one body part to another along a horizontal or vertical line? 1. Friction 2. Body balance 3. Body alignment 4. Coordinated body movement

3

A patient has paraplegia and wears weight-supporting braces. Which crutch gait pattern should the patient be trained to use during ambulation? 1. A two-point gait 2. A four-point gait 3. A three-point gait 4.A swing-through gait

4

A patient reports sweating and shortness of breath while walking. On examination, the patient's respiratory rate is found to be 30 breaths/minute and the oxygen saturation of blood (SpO2) is 83%. What is the most appropriate intervention? 1.Assess the blood pressure. 2.Assess the blood glucose levels. 3.Administer 25% dextrose via an intravenous (IV) catheter. 4.Administer oxygen at 2 L/min via the nasal cannula.

4

A patient with paraplegia wants to sit in a chair. The patient's right side is stronger than the left. What does the patient do when trying to sit? 1. Hold one crutch in each hand and bear body weight on the crutches. 2. Hold one crutch in each hand and bear body weight on both the legs and the crutches. 3.Hold both crutches in the left hand and bear body weight on the left side and the crutches. 4. Hold both crutches in the right hand and bear body weight on the right side and the crutches.

4

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

The nurse is assessing joint movements in a patient. What happens during the process of flexion at the elbow joint? 1. Triceps brachii acts as an antagonistic muscle and contracts. 2. Biceps brachii acts as a synergistic muscle and relaxes. 3. Triceps brachii acts as a synergistic muscle and contracts. 4. Biceps brachii acts as a synergistic muscle and contracts.

4

What is the normal state of balanced muscle tension? 1. Muscle tension 2. Isotonic contraction 3. Isometric contraction 4. Muscle tone/tonus

4

Which statement is true regarding exercise and activity? 1. There are four categories of exercise. 2. Isotonic exercises cause muscle relaxation. 3. Examples of resistive isometric exercise are walking and swimming. 4. Isometric exercises involve tensing muscles without moving body parts.

4

You are transferring a patient who weighs 320 lb (145.5 kg) from his bed to a chair. The patient has an order for partial weight bearing because of bilateral reconstructive knee surgery. Which is the best technique for transfer? 1. Use a transfer board. 2. Obtain a stand assist device. 3. Implement a three-person carry. 4. Use the ceiling-mounted lift.

4

How is the isotonic form of exercise different from the isometric form? 1. Isotonic exercises promote osteoblastic activity. 2. Isotonic exercises enhance circulatory functioning. 3. Isotonic exercises increase muscle mass, tone, and strength. 4. Isotonic exercises cause muscle contraction and changes in muscle length.

4 Isotonic exercises cause muscle contraction and changes in muscle length, whereas isometric exercise involves tightening or tensing muscles without moving the body parts. Both isotonic and isometric forms of exercise promote osteoblastic activity. Both forms of exercise enhance circulatory functioning. Both forms of exercise increase muscle mass, tone, and strength.

A patient with a body mass index (BMI) of 36 has a sedentary job. She has been advised to reduce her weight through exercise. To begin an exercise program, she needs to go through five steps. Arrange the steps in the appropriate order. 1. Assemble equipment. 2. Get started. 3.Design the fitness program. 4. Monitor progress. 5. Assess fitness level

5,3,1,2,4

What form of exercise combats promotes Osteoblastic activity & Osteoporosis? a. Isometric b. Restive Isometric c. Isotonic d. Isoressessive

C

What patient would benefit from Isometric Exercises: a. boy with a common cold b. a pregnant women c. a bedridden patient d. a ampute

C

What is a "Isotonic Exercise"?

a exercise that causes change in muscle length , and muscle contraction