EAQ M5 Chapter 30: Activity and Exercise (Activity and Exercise)

What should the nurse teach a diabetic patient about exercise?

*A. "Exercise leads to improved glucose control."* B. "You can perform medium- to high-intensity exercise." C. "The effect of exercise on blood glucose levels often lasts for 10 hours." D. "You can start an exercise routine on your own without any physical examination." Rationale: 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. Pg. 809

A nursing instructor asks a nursing student about the skeletal system. Which statement made by the student indicates a need for further teaching?

*A. "Fibrous joints are partially movable."* B. "Ligaments connect bones and cartilage." C. "Synovial joints are freely movable joints." D. "Cartilage is nonvascular, supporting connective tissue." Rationale: Fibrous joints are fixed joints that permit very little movement. Ligaments connect bones and cartilage. Synovial joints are freely movable joints. Cartilage is nonvascular, supporting connective tissue. Pg. 789

The nurse is teaching nursing students about how balance is maintained in the human body and its importance in performing activities of daily living (ADLs). Which statements made by the students indicates that they have understood the mechanism of balance in the human body?

*A. "The cerebellum coordinates all voluntary movements."* B. "The tympanic membrane helps to maintain balance." C. "The cerebrum coordinates highly skilled movements." D. "The inner ear coordinates all voluntary movements." Rationale: "The cerebellum coordinates all voluntary movements." "The tympanic membrane helps to maintain balance." "The cerebrum coordinates highly skilled movements." "The inner ear coordinates all voluntary movements." Pg. 791

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.

*A. Advise her to discuss her diet with a dietitian.* B. Advise her to undergo gastric banding. C. Advise her to undergo an intensive exercise training program. *D. Advise her to have realistic goals such as losing 4 pounds over 2 weeks.* E. Advise her to resign from her job immediately because it is the cause of her obesity. Rationale: A dietitian can help the patient plan a diet for weight reduction. The patient should be advised to set realistic goals for weight reduction. A reduction of 4 pounds over 2 weeks is acceptable. Gastric banding is the surgical procedure used for morbidly obese patients, if dietary measures and medications do not help them. Exercise is a healthy way to lose weight, but it should be gradual. A patient who has never exercised should not start with high-intensity exercises. The patient should start with a mild intensity exercise and gradually increase the intensity. Although her job is one of the reasons for her sedentary lifestyle and weight gain, it is not the only reason. Resigning from the job will not help the patient. Pg. 788

The nurse plans to provide education to the parents of school-age children. Which option does the nurse include to emphasize the results of children being less physically active outside of school?

*A. An increase in obesity* B. An increase in heart disease C. Higher computer literacy D. Improved school attendance and grades Rationale: It is increasingly clear that many children today are less active, resulting in an increase in childhood obesity. Strategies for physical activity incorporated early into a child's daily routine may provide a foundation for a lifetime commitment to exercise and physical fitness. Research shows that exercise plays a role in secondary prevention or recurrence of heart disease for adult patients already diagnosed with coronary heart disease. Pg. 793

Identify the type of joint that is circled in the image below.

*A. Fibrous joints* B. Synovial joints C. Ligaments D. Cartilaginous joints Rationale: Fibrous joints are joints that fit closely together and are fixed, permitting little or no movement. Synovial joints, or true joints, are freely movable and the most mobile, numerous, and anatomically complex body joints. Ligaments are white, shiny, flexible bands of fibrous tissue that bind joints and connect bones and cartilage. Cartilaginous joints have little movement but are elastic and use cartilage to unite separate bony surfaces. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Pg. 789

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.

*A. Instruct the patient to widen the base of support by separating the feet.* B. Instruct the patient to bring the knees closer together to maintain a broad base. *C. Instruct the patient to lower the center of gravity closer to the base of support.* D. Instruct the patient to keep the center of gravity away from the base of support. *E. Instruct the patient to maintain a vertical line from the center of gravity through the base of support.* Rationale: To maintain body balance, the patient must attain a posture that requires the least muscular work and places the least strain on muscles, ligaments, and bones. To do this, the patient must first separate the feet to a comfortable distance to widen the base of support. Then the patient must try to increase balance by bringing the center of gravity closer to the base of support. The body posture is adjusted such that the vertical line from the center of gravity falls through the base of support to attain body balance. The knees should not be kept closer, because this could decrease the width of the base of support and impair balance. Increasing the distance between the center of gravity and the base of support would also impair the balance of the patient. Knees should be kept wide. Keeping the center of gravity away from the base of support will result in a loss of balance while standing or walking. Test-Taking Tip: Focus on eliminating incorrect choices as you consider whether each choice is true or false. As you do that for this question, you will note that "Instruct the patient to bring the knees closer together to maintain a broad base" does not make sense; if the knees are closer together, then the base of support is narrower. Similarly, for "Instruct the patient to keep the center of gravity away from the base of support," how could a patient keep the center of gravity away from the base of support? Then reread the choices that did not seem incorrect. Do they still answer the question? Then you have the answers! Pg. 788

Which structure connects muscle to bone?

*A. Tendon* B. Cartilage C. Ligament D. Syndesmosis Rationale: Tendons are white, fibrous bands of tissue that connect muscle to bone at the origin or insertion of the muscle. Cartilage acts as a shock absorber between articulating bones, whereas ligaments are the structures that connect bones and cartilage. Syndesmosis is a fibrous joint between the tibia and fibula. Study Tip: Look at a drawing of the knee joint in an anatomy text and take note of the many ligaments that connect the femur to the tibia and fibula. Think about this picture to help you recall that ligaments connect bone to bone. Then you can differentiate ligaments from tendons. Tendons connect muscle to bone. Pg. 789

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?

*A. To the anterior* B. To the posterior C. To the left lateral side D. To the right lateral side Rationale: In pregnant women, changes in body posture and alignment occur due to weight gain and the growing fetus. The center of gravity of the body shifts to the anterior. Therefore, a pregnant woman leans backward and may report back pain. The center of gravity does not shift to the posterior or to any lateral sides; this might cause abnormal curvature of the spine. Pg. 793

A 70-year-old diabetic patient is advised to do aerobic exercises. Which activity should the patient perform?

*A. Walking* B. Yoga C. Active range of motion D. Resistance training Rationale: Walking is a type of aerobic exercise that would help to metabolize the excess sugar in the blood. Yoga is not a type of aerobic exercise. Active range of motion is one type of stretching and flexibility exercise. Resistance training is meant to increase the muscle strength and endurance. Pg. 809

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.

200 lb Rationale: If the patient weighs more than 200 lb, then friction reducing devices and at least three caregivers are needed to handle and position the patient. Pg. 793

A patient is fully dependent and the nurse is trying to determine if an assistive device should be used. How much of the patient's weight is the nurse required to lift in order to validate using an assistive device? Record your answer in pounds using a whole number.

35 lbs Rationale: During any patient-transferring task, if the nurse is required to lift more than 35 pounds of a patient's weight, then the patient should be considered to be fully dependent and assistive devices should be used. Pg. 793

What is the name for the white, glistening, and fibrous bands of tissue that connect muscle to bone?

A. Joints *B. Tendons* C. Cartilage D. Ligaments Rationale: Tendons are white, glistening, fibrous bands of tissue that connect muscles to bones. A joint is the connection between bones. Cartilage is nonvascular; it supports connective tissue that sustains weight and serves as a shock absorber between articulating bones. Ligaments are white, shiny, flexible bands of fibrous tissue that bind joints and connect bones with cartilage. Pg. 789

A nursing instructor asks a nursing student about skeletal muscles. Which statement if made by the student indicates the need for further teaching?

A. "Antigravity muscles stabilize joints." B. "Antagonistic muscles cause movement at a joint." C. "Muscle tone, or tonus, is the normal state of balanced muscle tension." *D. "The relaxation of skeletal muscles allows for walking and doing physical activities."* Rationale: The contraction of skeletal muscles allows people to walk, talk, run, breathe, and participate in physical activity. Antigravity muscles stabilize joints. Antagonistic muscles cause movement at a joint. Muscle tone, or tonus, is the normal state of balanced muscle tension. Pg. 789-790

Which group of patients is most at risk for severe injuries related to falls?

A. Adolescents *B. Older adults* C. Toddlers D. Young children Rationale: Some older adults walk more slowly and are less coordinated. They also take smaller steps, keeping their feet closer together, which decreases the base of support. Thus, body balance is unstable, and they are at greater risk for falls and injuries. Pg. 793

Which is a congenital defect?

A. Arthritis *B. Scoliosis* C. Osteoporosis D. Osteomalacia Rationale: Scoliosis is a structural curvature of the spine associated with vertebral rotation; it is a congenital defect. Arthritis is an inflammatory joint disease that causes systemic signs of inflammation and destruction of the synovial membrane and articular cartilage. Osteoporosis is an aging disorder that results in the reduction of bone density or mass. Osteomalacia is an uncommon metabolic disease characterized by inadequate and delayed mineralization, resulting in compact and spongy bones. Pg. 791

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?

A. Arthritis of the joint *B. Ligament tears in the joint* C. Contractures of the joint D. Fluid collection in the joint Rationale: While assessing the ROM of the patient, if increased mobility is noticed, it indicates that there is a possibility of ligament tears. Arthritis is an inflammation of the joint resulting in decreased mobility and stiffness. Contractures and fluid collection in the joint may decrease joint mobility and cause stiffness. Pg. 791, 803, 804

Why are older women more susceptible to fractures?

A. Due to firmness of the skeleton B. Due to elasticity of the skeletal system C. Due to flexibility of the skeletal system *D. Due to resorption and osteoporosis* Rationale: Older women are more susceptible to fractures due to bone loss (resorption) and osteoporosis. Firmness of the skeleton results from inorganic salts (such as calcium and phosphate) that are found in the bone matrix. Elasticity and flexibility of the skeletal system change with advancing age. However, among women, bone resorption and osteoporosis remain the most common factors that lead to fractures. Pg. 788

Which term is used to explain the relationship of one body part to another along a horizontal or vertical line?

A. Friction B. Body balance *C. Body alignment* D. Coordinated body movement Rationale: Body alignment refers to the relationship of one body part to another along a horizontal or vertical line. Friction is a force that opposes movement. Body balance is a technique in which a relatively low center of gravity is balanced over a wide, stable base of support and a vertical line falls from the center of gravity through the base of support. Coordinated body movement is a result of weight, center of gravity, and balance. 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 that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Pg. 788

How does exercise affect the pulmonary system?

A. Increased production of body heat B. Improved muscle tolerance to physical exercise C. Improved myocardial contraction, which strengthens the cardiac muscle *D. Increased respiratory rate and depth followed by a quicker return to the resting state* Rationale: The effect of exercise on the pulmonary system is an increased respiratory rate and depth followed by a quicker return to the resting state. The effect of exercise on the metabolic system includes an increased production of body heat. The effect of exercise on the musculoskeletal system includes improved muscle tolerance to physical exercise. The effect of exercise on the cardiovascular system includes improved myocardial contraction, which strengthens the cardiac muscle. Pg. 798

What event describes an impulse that is transmitted from the nervous system to the musculoskeletal system?

A. Isotonic contraction B. Voluntary movement C. Isometric contraction *D. Electrochemical activity* Rationale: The transmission of an impulse from the nervous system to the musculoskeletal system is an electrochemical activity that requires a neurotransmitter to transfer signals. Isotonic contractions are related to muscles and not related to the nervous system. The transmission of impulses from the nervous system to the musculoskeletal system are automatic, not voluntary, movements. Isometric contractions are related to muscles and not related to the nervous system. Pg. 790

Which is a principle of proper body mechanics when lifting or carrying objects?

A. Keep the knees in a locked position. B. Bend at the waist to maintain a center of gravity. *C. Maintain a wide base of support.* D. Hold objects away from the body for improved leverage. Rationale: Maintaining a wide base of support allows for proper body mechanics. Locking the knees or bending at the waist causes strain on the lower back. Holding objects close to the body helps use the center of gravity for leverage. Pg. 788

What action is the nurse least likely to perform while transferring a patient who is able to assist in the process?

A. Lifting B. Rolling C. Turning D. Pivoting Rationale: Lifting requires more work to transfer the patient. If the patient is able to assist, the nurse should not lift the patient. Rolling, turning, and pivoting require less work than lifting and can be performed by the nurse. Pg. 791

What is the normal state of balanced muscle tension?

A. Muscle tension B. Isotonic contraction C. Isometric contraction *D. Muscle tone/tonus* Rationale: Muscle tone, or tonus, is the normal state of balanced muscle tension. Muscle tension can be in various states. Muscle tone helps maintain functional positions such as sitting or standing, without excess muscle fatigue; this tone is maintained through the continual use of muscles. Isotonic (dynamic) contraction is a combination of concentric and eccentric muscle actions for active movement. Isometric (static) contraction causes an increase in muscle tension or muscle work but no shortening or active movement of the muscle. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Pg. 790

During preparation for practicing a mobility assessment, a student nurse encounters the term proprioception. Which phrase best explains the term proprioception?

A. Orientation to time, place, and person *B. Awareness of the position of the body and its parts* C. Perception of pressure over the palmar and plantar surfaces D. Perception of abnormal thermal sensation on the skin Rationale: Proprioception is defined as the awareness of the position of the body and its parts. Proprioceptors present in the nerve endings of muscles, joints, and tendons monitor proprioception. It is required by the body to maintain proper posture. There is no special term used for orientation. When pressure is applied over the palmar and plantar surfaces, a touch sensation is perceived. Study Tip: Proprioception can be thought of as position sense. Pg. 791

What nursing intervention should the nurse provide to a patient who has impaired gas exchange related to decreased cardiac output?

A. Teach the patient how to restrict fluid intake *B. Administer oxygen at 2 L/min via the nasal cannula* C. Record activity of the patient in an exercise log daily along with the response D. Ask the patient to perform a 2-to 3-mile brisk walk and isometric exercises three to four times a week Rationale: A patient should be administered oxygen at a rate of 2 L/min via the nasal cannula if the patient has impaired gas exchange related to decreased cardiac output. A patient who is diagnosed with decreased cardiac output related to decreased myocardial contractility should be taught how to restrict the intake of fluids. The nurse should record the activity of the patient in exercise log daily along with the response in case of activity intolerance related to physical deconditioning. The nurse should guide a patient who is diagnosed with activity intolerance related to physical deconditioning to take brisk walks and perform isometric exercise three to four times a week. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Pg. 800

What nursing intervention should the nurse provide to a patient who is diagnosed with activity intolerance related to physical deconditioning?

A. Teach the patient how to restrict fluids. B. Administer oxygen at a rate of 2 L/min via the nasal cannula. C. Schedule rest periods for the patient between nursing activities. *D. Guide the patient to take a 2- to 3-mile brisk walk and perform isometric exercises three to four times a week.* Rationale: The nurse should guide a patient who is diagnosed with activity intolerance related to physical deconditioning to take a brisk walk and perform isometric exercises three to four times a week. A patient who is diagnosed with decreased cardiac output related to decreased myocardial contractility should be taught how to restrict his or her fluid intake. A patient who has impaired gas exchange related to decreased cardiac output should be administered oxygen at a rate of 2 L/min via the nasal cannula. The nurse should schedule rest periods between nursing activities for a patient who is diagnosed with fatigue related to poor physical condition. Pg. 800

What nursing intervention should the nurse provide to a patient who is diagnosed with fatigue related to poor physical condition?

A. Teach the patient to restrict his or her fluid intake B. Administer oxygen at 2 L/min via the nasal cannula *C. Schedule rest periods for the patient between nursing activities* D. Ask the patient to perform a 2- to 3-mile brisk walk and perform isometric exercises three to four times a week Rationale: The nurse should schedule rest periods between nursing activities for a patient who is diagnosed with fatigue related to poor physical condition. A patient who is diagnosed with decreased cardiac output related to decreased myocardial contractility should be taught to restrict fluids. Oxygen is given at 2 L/min via the nasal cannula to a patient who has impaired gas exchange related to decreased cardiac output. The nurse should guide a patient who is diagnosed with an activity intolerance related to physical deconditioning to take brisk walks and perform isometric exercise three to four times a week. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Pg. 800

Which statement is true regarding exercise and activity?

A. There are four categories of exercise. B. Isotonic exercises cause muscle relaxation. C. Examples of resistive isometric exercise are walking and swimming. *D. Isometric exercises involve tensing muscles without moving body parts.* Rationale: Isometric exercises involve tightening or tensing muscles without moving body parts. There are three categories of exercise: isotonic, isometric, and resistive isometric. Isotonic exercises cause muscle contraction and changes in muscle length. Examples of resistive isometric exercises are push-ups and hip lifting. Pg. 788

An older adult who has recovered from a Colles fracture has been advised to do resistance-training exercises. Which activity should the nurse advise the patient to do?

A. Weight training *B. Kneading bread* C. Running upstairs D. Running downstairs Rationale: The Colles fracture is the fracture of the wrist, which is more common in older adult patients. Kneading bread is a type of resistance training, and helps to make the joint strong. Weight training is formal resistance training which may be inappropriate due to the history of fracture. Running upstairs or downstairs is an aerobic exercise and not meant for resistance training. Resistance training helps to increase muscle strength. Pg. 803

Which measure should the nurse adopt to reposition a patient in bed?

A. When pulling a patient up in bed, the bed should be in anti-Trendelenburg's position. *B. For patients with stage III or IV pressure ulcers, care should be taken to avoid shearing force.* C. If the patient weighs less than 200 lb (91 kg), friction-reducing devices should be avoided. D. If the caregiver needs to lift about 55 lb (25 kg) of a patient's weight, the patient is considered fully dependent. Rationale: For patients with stage III or IV pressure ulcers, care should be taken to avoid shearing forces. When pulling a patient up in bed, the bed should be flat or in a Trendelenburg's position. If the patient weighs less than 200 lb (91 kg), friction reducing devices and two to three caregivers are needed. If the caregiver needs to lift more than 35 lb (16 kg) of a patient's weight, then the patient is considered fully dependent and assistive devices should be used. Pg. 793