Activity and Exercise Terms and Review Questions

16. The nurse is caring for a client diagnosed with bilateral middle ear infections. Which of the following statements made by the nurse best reflects an understanding of the effects of this condition on the client's ability to move appropriately? 1. "He hasn't reported any nausea or vomiting." 2. "His ability to hear doesn't seem to be affected." 3. "I'll identify the client as a high falls' risk by noting it on his Kardex." 4. "I believe he is capable of using his call bell when he needs assistance."

"I'll identify the client as a high falls' risk by noting it on his Kardex."

17. An obese quadriplegic client has requested being transferred to a chair so he can be fed lunch sitting upright. Which of the following statements made by the ancillary personnel assigned the task reflects the best understanding of the implementation of this transfer? 1. "I'll reserve the mechanical lift for right before lunch." 2. "I'll certainly need someone to help me with this transfer." 3. "Eating in an upright position will certainly make lunch more enjoyable for him." 4. "Maybe he would enjoy being transferred into the dayroom to eat with the others."

"I'll reserve the mechanical lift for right before lunch."

20. Which of the following statements made by a woman recently diagnosed with osteoporosis indicates the greatest degree of readiness to begin a daily walking routine? 1. "The tests showed that I have osteoporosis and need to walk." 2. "I've walked around the local park three times, and that measures 1.75 miles." 3. "My sister has this problem, and she walks one mile a day around her neighborhood." 4. "I can join the spa and use the treadmill when the weather gets too cold to walk outside."

"I've walked around the local park three times, and that measures 1.75 miles."

14. A postmenopausal client is experiencing mild osteopenia and has been encouraged to walk 1 mile daily. Which of the following statements made by the client shows the best understanding of the positive effects of exercise on her condition? 1. "It makes me stronger and healthier." 2. "It helps make all my bones stronger." 3. "Walking increases the muscle mass in my legs." 4. "Regular walking improves my stamina and endurance."

"It helps make all my bones stronger."

21. Which of the following statements made by an older adult reflects the best understanding of the need to exercise no matter one's age? 1. "You are never too old to start exercising." 2. "My grandson and I walk together around the park 3 times a week." 3. "I got my granddaughter a subscription to a runner's magazine for her birthday." 4. "Kids today just don't seem to get the exercise we did when I was growing up."

"My grandson and I walk together around the park 3 times a week."

27. The nurse has delegated the task of ambulating a client who is experiencing activity intolerance. Which of the following statements made by the nurse best reflects an understanding of the nurse's role to properly instruct the ancillary personnel regarding this task? 1. "Stop the walking if the client complains of pain or weakness." 2. "Please be sure she has proper footwear on before starting out." 3. "Be sure to document the time spent and the distance she walked." 4. "Take her blood pressure and pulse both before and after walking."

"Stop the walking if the client complains of pain or weakness."

30. The nurse is discussing the benefits of regular walking with a group of senior citizens. Which of the following statements shows the best understanding of the positive impact of exercise on the older adult? 1. "Remember to warm up and cool down with stretching exercises." 2. "Find a walking partner that will accompany you on a regular basis." 3. "Be sure to hydrate yourself well before, during, and after your walk." 4. "Talk with your health care provider before starting a regular walking program."

"Talk with your health care provider before starting a regular walking program."

22. Which of the following nursing assessment questions will best determine the nature of an exercise-related injury? 1. "Do you experience the pain during or after your workout?" 2. "Tell me what is included in your typical workout routine." 3. "How long does it hurt after you have stopped exercising?" 4. "On a scale of 1 to 10, please rate your postexercise pain for me."

"Tell me what is included in your typical workout routine."

Mr. Rogers is able to walk but has a history of falls and reports feeling weak. He is 84 years old and lives alone. You are participating in his discharge planning. Which of the following pieces of equipment would be best to help Mr. Rogers in his home environment? 1. A walker 2. Crutches 3. A wheelchair 4. A mechanical lift device

1. A walker

Which statements apply to the proper use of a cane? (Select all that apply) 1. For maximum support when walking, the patient places the cane forward 15 to 25 cm, 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 are present at all times

1. For maximum support when walking, the patient places the cane forward 15 to 25 cm, keeping body weight on both legs. The weaker leg is moved forward to the cane so body weight is divided between the cane and the stronger leg 3. Canes provide less support than a walker and are less stable 4. The patient needs to learn that two points of support such as both feet or one foot and the cane are present at all times

Two nurses are standing on opposite sides of the bed to move a patient up in bed with a drawsheet. In relation to the patient, they stand even with the patient's 1. Hips 2. Chest 3. Knees 4. Shoulders

1. Hips

Which of the following methods of transfer from the bed to a chair is most appropriate for a patient who weighs 250 lbs and is able to minimally assist? 1. Mechanical lift 2. Sliding board 3. Drawsheet with two caregivers 4. Walker

1. Mechanical lift

1. When discussing the benefits of physical activity and exercise with a client, the nurse identifies which of the following as a positive outcome to the client? (Select all that apply.) 1. Stress management 2. Enhanced cardiac output 3. Improved bone integrity 4. Facilitation of weight control 5. Increased cognitive function 6. Increased musculoskeletal flexibility

1. Stress management 2. Enhanced cardiac output 3. Improved bone integrity 4. Facilitation of weight control 6. Increased musculoskeletal flexibility

A health care provider orders partial weight bearing on the left foot of a patient with a broken ankle and full weight bearing on the right foot. The crutch gait that the patient uses is the 1. Two point 2. Four point 3. Three point 4. Swing through

1. Two point

Which of the following would best motivate a patient to participate in an exercise program? 1. Given information on exercise 2. Being at the stage of readiness to change behavior 3. Diagnosed with a chronic disease such as diabetes 4. Ordered by the health care provider to begin an exercise program

2. Being at the stage of readiness to change behavior

A patient beings to fall during ambulation. Which of the following actions should you do first? 1. Call for assistance 2. Slide the patient down your body to the floor 3. Instruct the patient to sit in the nearest chair 4. Contact the health care provider and document the fall

2. Slide the patient down your body to the floor

32. A client who will be going home will need to use crutches for ambulation. Following teaching, the nurse notes that the client complains of pain under his arms. How much room should be between the crutch pad and client's axilla? 1. Axilla should lightly touch the crutch pad 2. 1 to 2 finger widths from the axilla 3. 3 to 4 finger widths from the axilla 4. 4 to 5 finger widths from the axilla

3 to 4 finger widths from the axilla

A nursing assistive personnel asks for assistance in transferring a 160 lb patient from the bed to a wheelchair. The patient is unable to assist. What is the nurse's best response? 1. As long as we use proper body mechanics, no one will get hurt 2. The patient only weighs 160 lbs. You don't need my assistance 3. Call the lift team for additional assistance 4. The two of us can easily lift the patient

3. Call the lift team for additional assistance

All of the following are necessary safety precautions when ambulating a patient except 1. Placing a transfer belt around patient's waist 2. Having patient wear well fitting rubber soled shoes or slippers 3. Having at least two people present to assist patient 4. Being sure that no pain medication was given for at least 3 hours before ambulation

4. Being sure that no pain medication was given for at least 3 hours before ambulation

A patient has a head injury and has been in a coma for several days. The best intervention to include in the care plan to prevent complications of immobility such as foot drop would be 1. Active range of motion 2. Isometric exercises 3. Turn every 4 hours 4. Passive range of motion

4. Passive range of motion

A nurse plans to provide education to the parents of school-aged children and includes which of the following result 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

A (An increase in obesity) (It is increasingly clear that children 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 lifetime commitment to exercise and physical fitness.)

The nurse is caring for a patient whose calcium intake must increase because of high risk factors for osteoporosis. The nurse would recommend which of the following menus? A) Cream of broccoli soup with whole wheat crackers and tapioca for dessert B) Hamburger on soft roll with a side salad and an apple for dessert C) Low-fat turkey chili with sour cream and fresh pears for dessert D) Chicken salad on toast with tomato and lettuce and honey bun for dessert

A (Cream of broccoli soup with whole wheat crackers and tapioca for dessert) (The dairy and broccoli in the soup, the whole grain crackers, plus the tapioca are all great sources of calcium.)

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? A) Pulmonary rehabilitation provides a safe environment for monitoring your progress. B) You have to participate or you will be back in the hospital. C) Tell me more about your concerns with going to pulmonary rehabilitation. D) The staff at our pulmonary rehabilitation facility are professionals and will not cause you any harm.

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

A patient recovering from bilateral knee replacements is prescribed bilateral partial weight bearing. You reinforce crutch walking knowing that which of the following crutch gaits is most appropriate for this patient? A) Two-point gait B) Three-point gait C) Four-point gait D) Swing-through gait

A (Two-point gait) (The two-point gait requires at least partial weight bearing on each foot *see Fig. 38-12*. The patient moves a crutch at the same time as the opposing leg, so that the crutch movements are similar to arm motion during normal walking.)

Crutch Gait

A gait achieved by a person using crutches

18. During a musculoskeletal assessment of a 20-month-old toddler, the nurse expects to observe: 1. A swayback and outwardly turned feet 2. A spine that is flexed and lacking anteroposterior curves 3. Widened hips and fat deposits on the thighs and buttocks 4. A stance with moderately spaced foot placement and a slightly rounded abdomen

A swayback and outwardly turned feet

Mechanical Lift

A type of transfer for a patient with central nervous system damage

Before transferring a patient from the bed to a stretcher, which assessment data does the nurse need to gather? (Select all that apply.) A) Patient's weight B) Patient's level of cooperation C) Patient's ability to assist D) Presence of medical equipment E) 24-hour calorie intake

A, B, C, D (By assessing the patient thoroughly you make the correct decision concerning your ability to manage him or her safely, the need for additional personnel, the patient's ability or inability to assist you with the transfer, and the proper equipment to use for the transfer. The calorie intake for the past 24 hours does not affect safe transfer.)

Which action(s) are appropriate for the nurse to implement when a patient experiences orthostatic hypotension? (Select all that apply.) A) Call for assistance. B) Allow patient to sit down. C) Take patient's blood pressure and pulse. D) Continue to ambulate patient to build endurance. E) If patient begins to faint, allow him to slide against the nurse's leg to the floor.

A, B, C, E (If the patient has a fainting "syncope" episode or begins to fall, assume a wide base of support with one foot in front of the other, thus supporting the patient's body weight *see Fig. 38-5, A to C*. Extend one leg and let the patient slide against it; gently lower the patient to the floor, protecting his or her head. Take the patient's blood pressure and pulse as soon as possible after incident.)

Which of the following activities does the nurse delegate to nursing assistive personnel in regard to crutch walking? (Select all that apply.) A) Notify nurse if patient reports pain before, during, or after exercise. B) Notify nurse of patient complaints of increased fatigue, dizziness, light-headedness when obtaining vital signs before and/or after exercise. C) Notify nurse of vital sign values. D) Evaluate the patient's ability to use crutches properly. E) Prepare the patient for exercise by assisting in dressing and putting on shoes.

A, B, C, E (These are all correct as they are within the nursing assistive personnel activities *e.g., notifying the nurse or completing assigned activities*. Evaluation is within the scope of professional nursing practice and is not delegated.)

Select statements that apply to the proper use of a cane. (Select all that apply.) A) 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. B) A person's cane length is equal to the distance between the elbow and the floor. C) Canes provide less support than a walker and are less stable. D) The patient needs to learn that two points of support such as both feet or one foot and the cane need to be present at all times.

A, C, D (A person's cane length is equal to the distance between the greater trochanter and the floor. For maximum support when walking, the patient places the cane forward 15 to 25 cm *6 to 10 inches*, keeping body weight on both legs. The patient needs to learn that two points of support *i.e., both feet or one foot and the cane* are present at all times.)

The nurse is attempting to start an exercise program in a local community as a health promotion project. In explaining the purpose of the project, the nurse explains to community leaders that a. A sedentary lifestyle contributes to the development of health-related problems. b. The recommended frequency of workouts should be twice a day. c. An exercise prescription should incorporate aerobic exercise only. d. The purpose of weight training is to bulk up muscles.

ANS: A A sedentary lifestyle contributes to the development of health-related problems. A holistic approach is taken to develop overall fitness and includes warm-ups, aerobic exercise, resistance training, weight training, and so forth. The recommended frequency of aerobic exercise is 3 to 5 times per week or every other day for approximately 30 minutes. Cross-training is recommended for the patient who prefers to exercise every day. Some patients use weight training to bulk up their muscles. However, the purposes of weight training from a health perspective are to develop tone and strength and to simulate and maintain healthy bone

The nurse is preparing to reposition a patient. Before doing so, the nurse must a. Assess the weight to be lifted and the assistance needed. b. Attempt to manually lift the patient alone before asking for assistance. c. Attempt a manual lift only when lifting most or all of the patient's weight. d. Not use the agency lift team if a mechanical lift is available

ANS: A Before lifting, assess the weight to be lifted and determine the assistance needed and the resources available. Manual lifting is the last resort, and it is used when the task at hand does not involve lifting most or all of the patient's weight. Use safe patient handling equipment in conjunction with agency lift teams to reduce the risk of injury to the patient and members of the health care team.

Isotonic, isometric, and resistive isometric are three categories of exercise. They are classified according to the type of muscle contraction involved. Of the following exercises, which are considered isotonic? a. Bicycling, swimming, walking, jogging, dancing b. Tightening or tensing of muscles without moving body parts c. Push-ups, hip lifting, pushing feet against a footboard on the bed d. Quadriceps set exercises and contraction of the gluteal muscles

ANS: A Examples of isotonic exercises are walking, swimming, dance aerobics, jogging, bicycling, and moving arms and legs with light resistance. Isometric exercises involve tightening or tensing of muscles without moving body parts. Examples include quadriceps set exercises and contraction of the gluteal muscles. Examples of resistive isometric exercises are push-ups and hip lifting, as well as placing a footboard on the foot of the bed for patients to push against with their feet.

The nurse is providing care to a patient who is bedridden. To prevent fatigue, the nurse raises the height of the bed. The nurse understands that balance is maintained by raising the bed to a. Prevent a shift in the nurse's base of support. b. Narrow the base of support. c. Allow the nurse to bring his or her feet close together. d. Shift the center of gravity further away from the base of support

ANS: A Raising the height of the bed when performing a procedure prevents bending too far at the waist and causing a shift in the base of support. Balance is maintained by maintaining proper body alignment and posture through two simple techniques. First, widen the base of support by separating the feet to a comfortable distance. Second, increase balance by bringing the center of gravity closer to the base of support.

A structural curvature of the spine associated with vertebral rotation is known as a. Scoliosis. b. Osteogenesis. c. Osteomalacia. d. Arthritis

ANS: A Scoliosis is a structural curvature of the spine associated with vertebral rotation. Osteogenesis imperfecta is an inherited disorder that makes bones porous, short, bowed, and deformed. Osteomalacia is an uncommon metabolic disease characterized by inadequate and delayed mineralization, resulting in compact and spongy bone. Arthritis is an inflammatory joint disease characterized by inflammation or destruction of the synovial membrane and articular cartilage, and by systemic signs of inflammation

The patient weighs 450 lbs (204.5 kg) and complains of shortness of breath with any exertion. His health care provider has recommended that he begin an exercise program. He states that he can hardly get out of bed and just cannot do anything around the house. To focus on the cause of the patient's complaints, the nurse devises which of the following nursing diagnoses? a. Activity intolerance related to excessive weight b. Activity intolerance related to bed rest c. Impaired gas exchange related to shortness of breath d. Imbalanced nutrition: less than body requirements

ANS: A The diagnostic label directs nursing interventions. This requires the correct selection of related factors. For example, Activity intolerance related to excess weight gain requires very different interventions than if the related factor is prolonged bed rest. In this case, the intolerance is related to the patient's excessive weight. He is not on bed rest, although he claims that it is difficult for him to get out of bed. Shortness of breath is a symptom, not a cause, of Impaired gas exchange, making this nursing diagnosis ineffective. The patient certainly has an imbalance of nutrition, but it is more than body requirements

The patient is being admitted for elective knee surgery. While the nurse is admitting the patient, she will a. Begin to develop a discharge plan. b. Plan to wait until after the surgery to plan for discharge. c. Place a generalized discharge plan in the record for later use. d. Address immediate needs of the patient only and address other needs later

ANS: A The nurse needs to begin discharge planning when the patient enters the health care system. The nurse cannot wait until after surgery to begin to plan for discharge. In addition, the discharge plan is always individualized to the patient and directed at meeting the actual and/or potential needs of the patient

When assessing the activity tolerance of a patient, the nurse would evaluate which of the following? (Select all that apply.) a. Skeletal abnormalities b. Emotional factors c. Age d. Pregnancy status e. Race

ANS: A, B, C, D Factors influencing activity tolerance include physiological factors such as skeletal abnormalities, emotional factors such as anxiety/depression, developmental factors such as age and gender, and pregnancy status. Race is not a factor because people of all races are faced with similar factors that affect their activity tolerance.

Bones perform five functions in the body: support, protection, movement, mineral storage, and hematopoiesis. In the discussion of body mechanics, which are the most important? (Select all that apply.) a. Support b. Protection c. Movement d. Mineral storage e. Hematopoiesis

ANS: A, C Bones perform five functions in the body: support, protection, movement, mineral storage, and hematopoiesis. In the discussion of body mechanics, two of these functions—support and movement—are most important. In support, bones serve as the framework and contribute to the shape, alignment, and positioning of body parts. In movement, bones together with their joints constitute levers for muscle attachment. As muscles contract and shorten, they pull on bones, producing joint movement. Protection involves encasing the soft tissue organs in a protective cage. Mineral storage helps to strengthen bones but also helps regulate blood levels of certain nutrients. Hematopoiesis is the formation of blood cells

The patient is brought to the emergency department with possible injury to his shoulder. To help determine the degree of injury, the nurse should evaluate a. The patient's gait. b. The patient's range of motion. c. Fine motor coordination. d. Activity tolerance

ANS: B Assessing range of motion is one assessment technique used to determine the degree of damage or injury to a joint. Gait is the manner or style of walking. It may have little bearing on the shoulder damage. Assessing fine motor coordination would be beneficial in helping to assess the patient's ability to perform tasks but would not help in evaluating the shoulder. Activity tolerance refers to the type and amount of exercise or activity a person is able to perform. Damage to the shoulder would affect this, but this would not have a direct bearing on the amount of damage done to the shoulder.

The nurse is developing an exercise plan for someone diagnosed with congestive heart failure and exercise intolerance. In doing so, the nurse should a. Plan for 20 minutes of continuous aerobic activity and increase as tolerated. b. Perform 6-minute walks at the patient's pace at least 2 times a day. c. Instruct the patient that he should not take his beta blocker medication on exercise days. d. Encourage a high-calorie diet to plan for extra calorie expenditure

ANS: B For the diagnosis of exercise intolerance, the patient should begin by performing 6-minute walks at his own pace at least twice a day. The patient would not be able to tolerate 20 minutes of continuous aerobic activity. Patients should be instructed to take medications as ordered. Low-calorie, low-sodium, and high-protein diets are best for this type of patient

The nurse is ambulating a patient in the hall when she notices that he is beginning to fall. The nurse should a. Grab the patient and hold him tight to prevent the fall. b. Gently lower the patient to the floor. c. Jump back and let the patient fall naturally. d. Push the patient against the wall and guide him to the floor

ANS: B If the patient has a fainting episode or begins to fall, assume a wide base of support with one foot in front of the other, thus supporting the patient's body weight. Then extend one leg and let the patient slide against the leg, and gently lower the patient to the floor, protecting the patient's head. Grabbing the patient will shift the nurse's center of gravity and may lead to a back injury. Allowing the patient to fall could lead to head injury for the patient. Pushing the patient against the wall could also cause the patient to hit his head and cause injury.

The nurse is examining a patient who is admitted to the emergency department with severe elbow pain. Of the following situations, which would cause the nurse to suspect a ligament tear or joint fracture? a. Range of motion of the elbow is limited. b. Joint motion is greater than normal. c. The patient has arthritis. d. The elbow cannot be moved (frozen).

ANS: B Increased mobility (beyond normal) of a joint may indicate connective tissue disorders, ligament tears, or possible joint fractures. Limited range of motion often indicates inflammation such as arthritis, fluid in the joint, altered nerve supply, or contractures (frozen joints).

The nurse is developing a plan of care for a patient diagnosed with activity intolerance. Of the following strategies, which has the best chance of maintaining patient compliance? a. Performing 20 minutes of aerobic exercise daily with 10 minute warm-up and cool-down periods b. Instructing the patient to use an exercise log to record day, time, duration, and responses to exercise activity c. Instructing the patient on the evils of not exercising, and getting her to take responsibility for her current health status d. Arranging for the patient to join a gym that she will have to pay, for so that she does not need to depend on insurance

ANS: B Keeping a log may increase adherence to an exercise prescription. Cross-training (combination of exercise activities) provides variety to combat boredom and increases the potential for total body conditioning as opposed to daily aerobic exercise. "Blaming" a patient for his or her health status is usually counterproductive. Instead, the nurse should instruct the patient about the physiological benefits of a regular exercise program. Developing a plan of exercise that the patient may perform at home may improve compliance

In planning a physical activity program for a patient, the nurse must understand that a. Isotonic exercises cause contraction without changing muscle length. b. The best program includes a combination of exercises. c. Isometric contraction involves the movement of body parts. d. Resistive isometric exercises can lead to bone wasting

ANS: B The best program of physical activity includes a combination of exercises that produce different physiological and psychological benefits. Isotonic exercises cause muscle contractions and changes in muscle length. Isometric exercises involve tightening or tensing of muscles without moving body parts. Resistive isometric exercises help promote muscle strength and provide sufficient stress against bone to promote osteoblastic activity

The patient is eager to begin his exercise program with a 2-mile jog. The nurse instructs the patient to warm up with stretching exercises. The patient states that he is ready and does not want to waste time with a "warm-up." The nurse explains that the warm-up a. Allows the body to readjust gradually to baseline functioning. b. Prepares the body and decreases the potential for injury. c. Should not involve stretching exercises because they can lead to injury. d. Should be performed with high intensity to prepare for the coming challenge

ANS: B The warm-up activity prepares the body for activity and decreases the potential for injury. It usually lasts about 5 to 10 minutes and may include stretching, calisthenics, and/or aerobic activity performed at a lower intensity. The cool-down period allows the body to readjust gradually to baseline functioning and provides an opportunity to combine movement such as stretching with relaxation-enhancing mind-body awareness.

The patient is admitted with a stroke. The outcome of this disorder is uncertain, but the patient is unable to move his right arm and leg. The nurse understands that a. Active range of motion is the only thing that will prevent contractors from forming. b. Passive range of motion must be instituted to help prevent contracture formation. c. Range-of-motion exercises should be started 2 days after the patient is stable. d. Range-of-motion exercises should be done on major joints only.

ANS: B When patients cannot participate in active range of motion, the nurse must institute passive range of motion to maintain joint mobility and prevent contractures. Passive range of motion can be substituted for active when needed. For the patient who does not have voluntary motor control, passive range-of-motion exercises are the exercises of choice. Unless contraindicated, the nursing care plan includes exercising each joint (not just major joints) through as nearly a full range of motion as possible. Initiate passive range-of-motion exercises as soon as the patient loses the ability to move the extremity or joint.

In developing a nursing care plan for increasing activity tolerance in a patient, the nurse should (Select all that apply.) a. Use generalized therapies because they work for everyone. b. Consult with members of the health care team. c. Avoid goals published by the American College of Sports Medicine. d. Involve the patient and the patient's family in designing an exercise plan. e. Consider the patient's ability to increase activity level.

ANS: B, D, E When planning care, the nurse should consult/collaborate with members of the health care team to increase activity, involve the patient and family in designing an activity and exercise plan (especially if family members are also providers of care), and consider the patient's ability to increase activity level. Therapies should be individualized to the patient's activity tolerance. Information from the American College of Sports Medicine serves as a standard that the nurse should use when applying activity and exercise goals

The coordinated efforts of the musculoskeletal and nervous system maintain balance, posture, and body alignment. Body alignment refers to a. A low center of gravity balanced over a wide base of support. b. The result of weight, center of gravity, and balance. c. The relationship of one body part to another. d. The force that occurs in a direction to oppose movement

ANS: C Body alignment refers to the relationship of one body part to another body part along a horizontal or vertical line. Body balance occurs when a relatively low center of gravity is balanced over a wide, stable base of support. Coordinated body movement is a result of weight, center of gravity, and balance. Friction is a force that occurs in a direction to oppose movement.

Many patients find it difficult to incorporate an exercise program into their daily lives because of time constraints. For these patients, it is beneficial to reinforce that many ADLs are used to accumulate the recommended 30 minutes or more per day of moderate-intensity physical activity. When instructing these patients, the nurse explains that a. Housework is not considered an aerobic exercise. b. To strengthen back muscles, the patient should bend using back muscles. c. Daily chores should begin with gentle stretches. d. The patient should stick to one chore until it is done before beginning a new one

ANS: C Daily chores should begin with gentle stretches. Housework is considered aerobic exercise. To make it more aerobic, work faster and scrub harder. Bend your legs rather than your back to prevent back injury. Alternate cleaning activities to prevent overworking the same muscle groups.

Approximately what percentage of all back pain is associated with manual lifting tasks? a. 10% b. 25% c. 50% d. 75%

ANS: C Half of all back pain is associated with manual lifting tasks

Unlike arthritis, joint degeneration a. Occurs only from noninflammatory disease. b. Occurs only from inflammatory disease. c. Involves overgrowth of bone at the articular ends. d. Affects mostly non-weight-bearing joints

ANS: C Joint degeneration, which can occur with inflammatory and noninflammatory disease, is marked by changes in articular cartilage combined with overgrowth of bone at the articular ends. Degenerative changes commonly affect weight-bearing joints.

In assisting the patient to exercise, the nurse should a. Expect that pain will occur with exercise of unused muscle groups. b. Set the pace for the exercise class. c. Force muscles or joints to go just beyond resistance. d. Stop the exercise if pain is experienced

ANS: D Assess for pain, shortness of breath, or a change in vital signs. If present, stop exercise. Let each patient exercise at his or her own pace. Assess for joint limitations, and do not force a muscle or a joint during exercise.

The nurse is preparing to position an immobile patient. Before doing so, the nurse must understand that a. Manual lifting is the easier method and should be tried first. b. Following body mechanics principles alone will prevent back injury. c. Body mechanics can be ignored when patient handling equipment is used. d. Body mechanics alone are not sufficient to prevent injuries

ANS: D Body mechanics alone are not sufficient to prevent musculoskeletal injuries when positioning or transferring patients. The use of patient-handling equipment in combination with proper body mechanics is more effective than either one in isolation. Body mechanics cannot be ignored even when patient handling equipment is being used. Manual lifting is the last resort, and it is only used when it does not involve lifting most or all of the patient's weight

The nurse is developing an exercise program for elderly patients living in a nursing home. To develop a beneficial health promotion program, the nurse needs to understand that when dealing with the elderly a. Exercise is of very little benefit because the patients are old. b. It is important to disregard their current interests in favor of exercise. c. No physical benefit can be gained without a formal exercise program. d. Adjustments to exercise programs may have to be made to prevent problems.

ANS: D Exercise is extremely beneficial for older adults, but adjustments to an exercise program may have to be made for those of advanced age to prevent problems. When developing an exercise program for any older adult, consider not only the person's current activity level, range of motion, muscle strength and tone, and response to physical activity, but also the person's interests, capacities, and limitations. Older adults who are unable to participate in a formal exercise program are able to achieve the benefits of improved joint mobility and enhanced circulation by simply stretching and exaggerating movements during performance of routine activities of daily living.

The nurse is working with the patient in developing an exercise plan. The patient tells the nurse that she just will not participate in a formal exercise program. The nurse then suggests that exercise activities can be incorporated into activities of daily living. The patient seems to be agreeable to that concept. Of the following activities, which would be considered a moderate-intensity activity? a. Doing laundry b. Making the bed c. Ironing d. Folding clothes

ANS: D Low-intensity ADLs include doing the laundry, making the bed, ironing, and washing dishes. Moderate-intensity ADLs include sweeping the kitchen or sidewalk, washing windows, folding clothes, and vacuuming.

An active lifestyle is important for maintaining and promoting health. In developing an exercise program, the nurse understands that a. Physical exercise is contraindicated for patients with chronic illnesses. b. Regular physical activity is beneficial only for the body part that is exercised. c. Physical exercise has no effect on psychological well-being. d. Physical activity enhances functioning of all body systems.

ANS: D Regular physical activity and exercise enhance the functioning of all body systems, including cardiopulmonary functioning, musculoskeletal fitness, weight control and maintenance, and psychological well-being. It is also essential in treatment for chronic illness.

The patient has been in bed for several days and needs to be ambulated. Before ambulation, the nurse a. Removes the gait belt to allow for unrestricted movement. b. Has the patient get up from bed before he has a chance to get dizzy. c. Has the patient look down to watch his feet to prevent tripping. d. Dangles the patient on the side of the bed.

ANS: D Some patients experience orthostatic hypotension—a drop in blood pressure that occurs when the patient changes from a horizontal to a vertical position. Assist the patient to a position of sitting at the side of the bed, and dangle for 1 to 2 minutes before standing. The nurse needs to provide support at the waist so that the patient's center of gravity remains midline. This is achieved with the use of a gait belt. A gait belt encircles the patient's waist and may have handles attached for the nurse to hold while the patient ambulates. The patient should maintain as normal a walking posture as possible with the head erect.

Which of the following exercise activities would most likely provide the opportunity for mind-body awareness? a. Warm-up activity b. Resistance training c. Aerobic exercise d. Cool-down activity

ANS: D The cool-down period allows the body to readjust gradually to baseline functioning and provides an opportunity to combine movement such as stretching with relaxation-enhancing mind-body awareness. The warm-up activity prepares the body and decreases the potential for injury. Aerobic exercise includes running, bicycling, jumping rope, and so forth, and is the main portion of exercise activity; it precedes the cool-down period. Resistance training increases muscle strength and endurance and is associated with improved performance of daily activities but not with enhancing mind-body awareness.

The patient has been bedridden for several months owing to severe congestive heart disease. In determining a plan of care for this patient that will address his activity level, the nurse formulates which of the following nursing diagnoses? a. Fatigue related to poor physical condition b. Impaired gas exchange related to decreased cardiac output c. Decreased cardiac output related to decreased myocardial contractility d. Activity intolerance related to physical deconditioning

ANS: D When activity and exercise are problems for a patient, nursing diagnoses often focus on the individual's ability to move. The diagnostic label directs nursing interventions. In this case, physical deconditioning must be addressed relative to activity level, perhaps leading to 6-minute walks twice a day. Physical deconditioning is the cause of fatigue as well, so it would take priority over that diagnosis. Decreased cardiac output and myocardial contractility are serious concerns that must be addressed before activity intolerance to keep the patient safe and to help determine the level of exercise that the patient can tolerate, but reconditioning of the patient's body will help improve contractility and cardiac output

Orthostatic Hypotension

Abnormally low blood pressure occurring when a person stands up

6. The client needs to use crutches at home, and will have to manage going up and down a short flight of stairs. The nurse evaluates the use of an appropriate technique if the client: 1. Uses a banister or wall for support when descending 2. Uses one crutch for support while going up and down 3. Advances the crutches first to ascend the stairs 4. Advances the affected leg after moving the crutches to descend the stairs

Advances the affected leg after moving the crutches to descend the stairs

Footdrop

An abnormal neuromuscular condition of the lower leg and foot, characterized by an inability to dorsiflex the foot

The patient at greatest risk for developing multiple adverse effects of immobility is a: A) 1-year-old child with a hernia repair. B) 80-year-old woman who has suffered a hemorrhagic cerebrovascular accident (CVA). C) 51-year-old woman following a thyroidectomy. D) 38-year-old woman undergoing a hysterectomy.

B (80-year-old woman who has suffered a hemorrhagic cerebrovascular accident *CVA*.) (The older the patient and the greater the period of immobility, which can be significant following a hemorrhagic stroke, the greater is the number of systems that can be affected by the immobility.)

Which is the correct gait when a patient is ascending stairs on crutches? A) A modified two-point gait. The affected leg is advanced between the crutches to the stairs. B) A modified three-point gait. The unaffected leg is advanced between the crutches to the stairs. C) A swing-through gait. D) A modified four-point gait. Both legs advance between the crutches to the stairs.

B (A modified three-point gait. The unaffected leg is advanced between the crutches to the stairs.) (When ascending stairs on crutches, the patient usually uses a modified three-point gait *see Fig. 38-13*)

Which is an outcome for a patient diagnosed with osteoporosis? A) Maintain serum level of calcium. B) Maintain independence with activities of daily living (ADLs). C) Reduce supplemental sources of vitamin D. D) Reverse bone loss through dietary manipulation.

B (Maintain independence with activities of daily living *ADLs*) (The main goal is to maintain independence in ADLs once osteoporosis is diagnosed. It is best to identify individuals at risk and work toward preventing the disease.)

Which group of patients is at most risk for severe injuries related to falls? A) Adolescents B) Older adults C) Toddlers D) Young children

B (Older Adults) (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)

A patient on bed rest for several days attempts to walk with assistance. He becomes dizzy and nauseated. His pulse rate jumps from 85 to 110 beats/min. These are most likely symptoms of which of the following? A) Rebound hypertension B) Orthostatic hypotension C) Dysfunctional proprioception. D) Central nervous system rebound hypotension

B (Orthostatic hypotension) (Signs and symptoms of orthostatic hypotension include dizziness, light-headedness, nausea, tachycardia, pallor, and even fainting.)

Which of the following best motivates a patient to participate in an exercise program? A) Giving a patient information on exercise B) Providing information to the patient when the patient is ready to change behavior C) Explaining the importance of exercise when a patient is diagnosed with a chronic disease such as diabetes D) Following up with instructions after the health care provider tells a patient to begin an exercise program

B (Providing information to the patient when the patient is ready to change behavior) (Patients are more open to developing an exercise program when they are at a stage of readiness to change their behavior. Once the patient is at the stage of readiness, collaborate with him or her to develop an exercise program that fits his or her needs and provide continued follow-up support and assistance until the exercise program becomes a daily routine.)

A patient of any age can develop a contracture of a joint when: A) The adductors muscles are weakened as a result of immobility. B) The muscle fibers become shortened because of disuse. C) The calcium-to-phosphorus ratio becomes disrupted. D) There is a deficiency in vitamin D.

B (The muscle fibers become shortened because of disuse.) (The adductor muscles are stronger than the abductor muscles; when patients are immobile and the joint is not exercised through their ROM, the adductor muscle fibers shorten, resulting in the contracture of that joint, which is usually permanent.)

A patient with a right knee replacement is prescribed no weight bearing on the right leg. You reinforce crutch walking knowing that which of the following crutch gaits is most appropriate for this patient? A) Two-point gait B) Three-point gait C) Four-point gait D) Swing-through gait

B (Three-point gait) (Three-point alternating, or three-point, gait requires the patient to bear all of the weight on one foot. In a three-point gait, the patient bears weight on both crutches and then on the uninvolved leg, repeating the sequence *see Fig. 38-12, B*)

An older adult has limited mobility as a result of a surgical repair of a fracture hip. During assessment you note that the patient cannot tolerate lying flat. Which of the following assessment data support a possible pulmonary problem related to impaired mobility? (Select all that apply.) A) B/P = 128/84 B) Respirations 26 per minute on room air C) HR 114 D) Crackles heard on auscultation E) Pain reported as 3 on scale of 0 to 10 after medication

B, C (Patients with reduced mobility are at risk for retained pulmonary secretions, and this risk increases in postoperative patients. As a result of retained secretions, the respiratory rate increases. The heart rate also increases because the heart is trying to improve oxygen levels. These symptoms are of concern for older adults because, if left untreated, further complications such as heart failure can occur.)

A home care nurse is preparing the home for a patient who is discharged to home following a left-sided stroke. The patient is cooperative and can ambulate with a quad-cane. Which of the following must be corrected or removed for the patient's safety? (Select all that apply.) A) The rubber mat in the walk-in shower B) The three-legged stool on wheels in the kitchen C) The braided throw rugs in the entry hallway and between the bedroom and bathroom D) The night-lights in the hallways, bedroom, and bathroom E) The cordless phone next to the patient's bed

B, C (Stools on wheels and braided throw rugs are hazards that put the patient at risk for falls. By planning ahead and collaborating, the home care nurse can provide a safe home environment for the patient after discharge.)

Immobilized patients are at risk for impaired skin integrity. Which of the following interventions would reduce this risk? (Select all that apply.) A) Repositioning patient every 1 to 2 hours while awake B) Using an objective, valid scale to assess patient's risk for pressure ulcer development C) Using a device to relieve pressure when patient is seated in chair D) Teaching patient how to shift weight at regular intervals while sitting in a chair E) A good rule is: the higher the risk for skin breakdown, the shorter the interval between position changes

B, C, D, E (Patients must be repositioned around the clock, not just when they are awake. An objective assessment scale allows the nurse to assess for pressure ulcer risk over time. Once the risk is identified, the assessment tool guides the nurse in selecting appropriate pressure-relief devices. Showing the patient how to reduce his or her risk by shifting pressure is also important. Frequent and meaningful position changes that are in concert with the patient's condition and risk factors are necessary to reduce pressure ulcer developments.)

Side Rails

Bars positioned along the sides of the length of the bed or stretcher to reduce the patient's risk of falling

33. When planning care for a client with newly diagnosed hypertension, the nurse knows that which form of exercise would be most beneficial in lowering both systolic and diastolic blood pressure? 1. Lifting weights 2. Running 3. Bicycling 4. Competitive swimming

Bicycling

34. In teaching a newly diagnosed 17-year-old client with type 1 diabetes, the nurse knows that the exercise is an important component in care. Which of the following activities would be most appropriate for the previously sedentary client? 1. Kick-boxing class 2. Football 3. Bicycling 4. Soccer

Bicycling

A nursing assistive personnel asks for help to transfer a patient who is 125 pounds (56.8 kg) from the bed to a wheelchair. The patient is unable to assist. What is the nurse's best response? A) "As long as we use proper body mechanics, no one will get hurt." B) "The patient only weighs 125 lb. You don't need my assistance." C) "Call the lift-team for additional assistance." D) "The two of us can easily lift the patient."

C ("Call the lift-team for additional assistance.") (Body mechanics alone are not sufficient to prevent musculoskeletal injuries when positioning or transferring patients *see Table 38-1*. Teaching the use of patient-handling equipment or the use of a lift-team in combination with proper body mechanics is more effective.)

A patient has her call bell on and looks frightened when you enter the room. She has been on bed rest for 3 days following a fractured femur. She says, "It hurts when I try to breathe, and I can't catch my breath." Your first action is to: A) Call the health care provider to report this change in condition. B) Give the patient a paper bag to breathe into to decrease her anxiety. C) Assess her vital signs, perform a respiratory assessment, and be prepared to start oxygen. D) Explain that this is normal after such trauma and administer the ordered pain medication.

C (Assess her vital signs, perform a respiratory assessment, and be prepared to start oxygen.) (These are signs of possible pulmonary emboli, which can be life threatening. You must assess your patient, be prepared to start oxygen, and have someone call the surgeon while you stay with the patient to continue to monitor her status.)

Which of the following 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.

C (Maintain a wide base of support.) (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.)

Which of the following indicates that additional assistance is needed to transfer the patient from the bed to the stretcher? A) The patient is 5 feet 6 inches and weighs 120 lbs. B) The patient speaks and understands English. C) The patient received an injection of morphine 30 minutes ago for pain. D) You feel comfortable handling a patient of his size and with his level of cooperation.

C (The patient received an injection of morphine 30 minutes ago for pain.) (The morphine injection would change the patient's ability to safely follow directions and participate in the transfer; therefore additional help would be needed to safely transfer the patient from the bed to the stretcher.)

36. A client with coronary heart disease has been meeting with a cardiac rehabilitation nurse for the past 5 weeks. The nurse has provided the client with interventions to increase the client's activity level. The client states that they don't know if the exercise program is helping. The nurse can assess the effectiveness of the interventions by: 1. Comparing baseline vital signs with current vital signs 2. Weighing the client 3. Asking the client if he feels that he has met his goals 4. Telling the client that the exercise will only help if the client has a positive attitude

Comparing baseline vital signs with current vital signs

Active Range of Motion Exercises

Completion of exercise to the joint by the patient while doing activities of daily living or during joint assessment

Joint

Connections between bones, classified according to structure and degree of mobility

Body Mechanics

Coordinated efforts of the musculoskeletal and nervous systems to maintain proper balance, posture, and body alignment

A patient with left-sided weakness asks his nurse, "Why are you walking on my left side? I can hold on to you better with my right hand." What would be your best therapeutic response? A) "Walking on your left side lets me use my right hand to hold on to your arm. In case you start to fall, I can still hold you." B) "Would you like me to walk on your right side so you feel more secure?" C) "Either side is appropriate, but I prefer the left side. If you like, I can have another nurse walk with you who will hold you on the right side." D) "By walking on your left side I can support you and help keep you from injury if you should start to fall. By holding your waist I would protect your shoulder if you should start to fall or faint.

D ("By walking on your left side I can support you and help keep you from injury if you should start to fall. By holding your waist I would protect your shoulder if you should start to fall or faint.) (Walking on the affected *weak side* side and holding the patient around the waist or using a gait belt gives you better control if the patient starts to fall. If you were holding the patient's arm as he was falling, you might dislocate his shoulder.)

A nurse is teaching a community group about ways to minimize the risk of developing osteoporosis. Which of the following statements made by a woman in the audience reflects a need for further education? A) "I usually go swimming with my family at the YMCA 3 times a week." B) "I need to ask my doctor if I should have a bone mineral density check this year." C) "If I don't drink milk at dinner, I'll eat broccoli or cabbage to get the calcium that I need in my diet." D) "I'll check the label of my multivitamin. If it has calcium, I can save money by not taking another pill. "

D ("I'll check the label of my multivitamin. If it has calcium, I can save money by not taking another pill.") (Just because a multivitamin has calcium in it does not mean that the woman is receiving enough to meet her needs. She must know her requirement and make the decision based on that rather than on the value for calcium on the label.)

A patient had a left-sided cerebrovascular accident 3 days ago and is receiving 5000 units of heparin subcutaneously every 12 hours to prevent thrombophlebitis. The patient is receiving enteral feedings through a small-bore nasogastric (NG) tube because of dysphagia. Which of the following symptoms requires the nurse to call the health care provider immediately? A) Pale yellow urine B) Unilateral neglect C) Slight movement noted on the R side D) Coffee ground-like aspirate from the feeding tube

D (Coffee ground-like aspirate from the feeding tube) (When patients are receiving medications such as heparin or enoxaparin *Lovenox*, you must assess for signs of bleeding. These include overt signs such as bleeding from their gums or covert signs, which can be detected by testing their stool or observing their aspirate from NG tubes for coffee ground-like matter. These are signs of bleeding in the gastrointestinal tract.)

The nurse puts elastic stockings on a patient following major abdominal surgery. The nurse teaches the patient that the stockings are used after a surgical procedure to: A) Prevent varicose veins. B) Prevent muscular atrophy. C) Ensure joint mobility and prevent contractures. D) Promote venous return to the heart.

D (Promote venous return to the heart.) (Elastic stockings maintain external pressure on the lower extremities and assist in promoting venous return to the heart. This increase in venous return helps reduce the stasis of blood and in turn reduces the risk for deep vein thrombosis *DVT* formation in the lower extremities.)

An older adult who was in a car accident and fractured his femur has been immobilized for 5 days. Which nursing diagnosis is related to patient safety when the nurse assists this patient out of bed for the first time? A) Chronic pain B) Impaired skin integrity C) Risk for ineffective cerebral tissue perfusion D) Risk for activity intolerance

D (Risk for activity intolerance) (Patients on bed rest are at risk for activity intolerance, which increases patients' risk for falling.)

A patient on week-long bed rest is now performing isometric exercises. Which nursing diagnosis best addresses the safety of this patient? A) Disturbed thought processes B) Impaired skin integrity C) Disturbed body image D) Risk for activity intolerance

D (Risk for activity intolerance) (The nursing diagnosis, risk for activity intolerance, best relates to patient safety because of the potential for orthostatic hypotension associated with prolonged bed rest.)

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 as a result of bilateral reconstructive knee surgery. Which of the following is the best technique for transfer? A) Use a transfer board. B) Obtain a stand assist device. C) Implement a three-person carry. D) Use the ceiling-mounted lift.

D (Use the ceiling-mounted lift.) (The use of patient-handling equipment helps prevent injury to health care workers and patients.)

13. Which of the following nursing interventions is likely to have the most impact on reducing friction when positioning an immobile client? 1. Involving at least two personnel in the actual transfer 2. Lubricating all body parts that are in contact with the bed 3. Dressing the bed with a lift sheet to be use during the transfer 4. Thoroughly explaining the process to the client before the move

Dressing the bed with a lift sheet to be use during the transfer

25. The nurse has determined that a client reporting general fatigue is experiencing activity intolerance. Which of the following assessment findings, observed after the client ambulates to the bathroom, best confirms this nursing diagnosis? 1. Dyspnea 2. Diaphoresis 3. Hypotension 4. Mental confusion

Dyspnea

Friction

Effects of rubbing or the resistance that a moving body meets from the surface on which it moves

40. A client with cancer expresses interest in increasing his activity level. The nurse begins by assessing baseline data regarding the client's current activity patterns. The nurse uses professional standards to develop a plan of care for this client. Professional standards are important because they: 1. Are developed by government agencies 2. Establish scientifically proven guidelines 3. Shift responsibility for the plan of care from the nurse 4. Are required by all healthcare organizations

Establish scientifically proven guidelines

11. Following an assessment of the client, the nurse identifies the nursing diagnosis activity intolerance related to increased weight gain and inactivity. An outcome identified by the nurse should be: 1. Resting heart rate will be 90 to 100 beats/minute 2. Blood pressure will be maintained between 140/80 and 160/90 mm Hg 3. Exercise will be performed 3 to 4 times over the next 2 weeks 4. Achievement of a rating of 3 for activity endurance

Exercise will be performed 3 to 4 times over the next 2 weeks

8. A client is admitted to the medical unit following a CVA (stroke). There is evidence of left-sided hemiparesis and the nurse will be following up on range-of-motion and other exercises performed in physical therapy. The nurse correctly teaches the client and family members which one of the following principles of range-of-motion exercises? 1. Flex the joint to the point of discomfort. 2. Work from proximal to distal joints. 3. Move the joints quickly. 4. Provide support for distal joints.

Flex the joint to the point of discomfort.

9. Nurses need to implement appropriate body mechanics in order to prevent injury to themselves and their clients. Which principle of body mechanics should the nurse incorporate into client care? 1. Flex the knees and keep the feet wide apart. 2. Assume a position far enough away from the client. 3. Twist the body in the direction of movement. 4. Use the strong back muscles for lifting or moving.

Flex the knees and keep the feet wide apart.

Dorsiflexion

Flexion toward the back

15. A client who is confined to a wheelchair is encouraged to engage in resistive isometric exercises to increase muscle strength and decrease the development of pressure ulcers. Which of the following is the most appropriate example of such an exercise for this client? 1. Hip lifting 2. Gluteal contraction 3. Foot pressure off-loading 4. Bicep-tricep compression

Hip lifting

19. The nurse recognizes that the older adult's tendency to take smaller steps with feet kept closer together will most likely: 1. Increase the client's risk of injury resulting from falls 2. Result in less stress on the client's knees, hips, and ankles 3. Decrease the amount of energy the client expends on movement 4. Allow for mobility in spite of the effects of aging on the client's joints

Increase the client's risk of injury resulting from falls

31. A client who is immobilized in bed due to skeletal traction tells the nurse that they miss their exercise regimen that they had started prior to the accident that resulted in their hospitalization. The nurse knows that which of the following is a good form of exercise that this client can still perform while immobilized? 1. Isotonic exercise 2. Isometric contraction 3. Resistive isometric exercise 4. Aerobic exercise

Isometric contraction

Activity Tolerance

Kind or amount of exercise or work a person is able to perform

7. While ambulating in the hallway of a hospital, the client complains of extreme dizziness. The nurse, alert to a syncopal episode, should first: 1. Support the client and walk quickly back to the room 2. Lean the client against the wall until the episode passes 3. Lower the client gently to the floor 4. Go for help

Lower the client gently to the floor

10. The nurse is presenting a teaching session on exercise for a group of corporate executives. An appropriate recommendation is that 1. Continuous activity is required in order for the exercise to be worthwhile 2. 3000 to 4000 calories may be easily expended each week 3. Lower-intensity activities need to be done more often for value 4. Only formal exercise activities are counted in a regular plan

Lower-intensity activities need to be done more often for value

Gait

Manner or style of walking, including rhythm, cadence and speed

Trapeze Bar

Metal triangular shaped bar that can be suspended dover a patient's bed from an overhanging frame

Center of Gravity

Midpoint or center of the weight of a body or object

Extension

Movement by certain joints that increases the angle between two adjoining bones

Abduction

Movement of a limb away from the body

Adduction

Movement of a limb toward the body

39. The nurse is working with a nursing assistive personnel to provide care for a group of clients. The nurse can delegate which of the following activities to the nursing assistive personnel? 1. Assess for medical limitations before beginning the exercise activity. 2. Teach the clients breathing skills to help reduce their anxiety. 3. Obtain preexercise and postexercise vital signs. 4. Document the client's progress.

Obtain preexercise and postexercise vital signs.

26. A client with a nursing diagnosis of activity intolerance has developed reddened areas on both heels and his coccyx. Which of the following nursing interventions will most likely have the greatest impact on this diagnosis? 1. Ambulating him to the bathroom before returning to bed 2. Encouraging him to change position every 2 hours while in bed 3. Including active range-of-motion exercises in both AM and PM care 4. Planning a rest period after AM care but before walking to the dining room for lunch

Planning a rest period after AM care but before walking to the dining room for lunch

Hyperextension

Position of maximal extension of a joint

Posture

Position of the body in relation to the surrounding space

Supine

Position of the patient in which the patient is resting on his or her back

Prone

Position of the patient lying face down

1. A client has been prescribed bed rest for a prolonged time. To specifically promote the use of resistive isometric exercise for the client, the nurse will initiate: 1. Quadriceps setting 2. Gluteal muscle contraction 3. Moving the arms and legs in circles 4. Pushing against a footboard

Pushing against a footboard

2. The nurse is assessing the body alignment of an alert and mobile client. The first action that the nurse should take is to: 1. Observe gait 2. Put the client at ease 3. Determine activity tolerance 4. Determine range of joint motion

Put the client at ease

Range of Motion

Range of movement o f a joint, from maximum extension to maximum flexion, as measure in degrees of a circle

Passive Range of Motion Exercises

Range of movement through which a joint is moved with assistance

12. The primary purpose for placing an immobile client's arms across his or her chest when preparing to transfer the client up in the bed is to: 1. Increase the stability of the client's body 2. Protect the client's arms from being hurt during the transfer 3. Produce a more compact form that facilitates the transfer 4. Reduce the amount of body surface area that is in contact with the bed.

Reduce the amount of body surface area that is in contact with the bed.

38. One of the most debilitating health hazards among nurses is musculoskeletal injuries. In order to eliminate these injuries, the American Nurses Association is advocating which of the following? 1. Mandate that physical therapists do all patient transfers. 2. Require minimum staffing levels in health care organizations. 3. Request the use of assistive equipment and devices. 4. Require a minimum number of staff to be involved in all patient transfers.

Request the use of assistive equipment and devices.

Trochanter Rolls

Rolled towel support placed against the hips and upper leg to prevent external rotation of the legs

Hand Rolls

Rolls of cloth that keep the thumb slightly adducted and in opposition to the fingers

Foot Boot

Soft, foot shaped devices designed to reduce the risk of foot drop by maintaining the foot in dorsiflexion

Hand Wrist Splints

Splints individually molded for the patient to maintain proper alignment of the thumb, slight adduction of the wrist and slight dorsiflexion

3. An average-size male client has right-sided hemiparesis. The nurse helps this client to walk by: 1. Standing at his left side and holding his arm 2. Standing at his left side and holding one arm around his waist 3. Standing at his right side and holding his arm 4. Standing at his right side and holding one arm around his waist

Standing at his right side and holding one arm around his waist

28. A client is discussing an exercise program that includes running 1.5 miles 3 times a week. Which of the following suggestions made by the nurse is most likely to result in minimizing the client's risk for injury? 1. Stretching before and after running 2. Alternating running paths every week 3. Hydrating well with sports drinks during and after running 4. Wearing running shoes that have been professionally fitted

Stretching before and after running

Proprioception

The body's ability to sense its position and movement in space

35. A newly diagnosed client with type 2 diabetes expresses concern that he will not be able to maintain his active lifestyle, which includes bicycling. The nurse instructs the client about risks and precautions regarding exercise including which of the following? 1. To avoid leisurely bicycling day trips 2. To avoid strenuous bicycling for long periods of time 3. It is better for them to exercise for 1 to 2 hours once a week than for 20 minutes 3 days per week 4. As long as he is not participating in strenuous exercise, there is no need to include warm-up or cool-down exercises

To avoid strenuous bicycling for long periods of time

Plantar Flexion

Toe down motion of the foot at the ankle

41. When moving a client who is unable to assist, what is the most important principle for the nurse to remember to avoid injury? 1. Face opposite of the direction of movement. 2. Keep your feet close together. 3. The higher the center of gravity, the greater the stability of the nurse. 4. Try to avoid lifting the patient if possible.

Try to avoid lifting the patient if possible.

4. The nurse is working with a client who has left-sided weakness. After instruction, the nurse observes the client ambulate in order to evaluate the use of the cane. Which action indicates that the client knows how to use the cane properly? 1. The client keeps the cane on the left side. 2. Two points of support are kept on the floor at all times. 3. There is a slight lean to the right when the client is walking. 4. After advancing the cane, the client moves the right leg forward.

Two points of support are kept on the floor at all times.

5. A client with a fractured left femur has been using crutches for the past 4 weeks. The physician tells the client to begin putting a little weight on the left foot when walking. Which of the following gaits should the client be taught to use? 1. Two-point 2. Three-point 3. Four-point 4. Swing-through

Two-point

37. Passive range-of-motion exercises are most important for which of the following clients? 1. Pediatric client with a broken femur 2. Diabetic client with a total knee replacement 3. Unconscious client in ICU 4. Elderly client with a bowel obstruction

Unconscious client in ICU

29. The first rule of safety when managing client transfers is: 1. Flex your knees and plant your feet far apart 2. Keep your back aligned with your neck, pelvis, and feet 3. Use lift teams or mechanical lifts when the transfer requires it 4. Always use the large muscles of the arms and legs, not the small muscles of the back

Use lift teams or mechanical lifts when the transfer requires it

23. The nurse encourages a non-insulin-dependent diabetic client to engage in a regular exercise program primarily because to do so will most likely improve the client's: 1. Gastric motility, thus affecting glucose digestion 2. Respiratory recovery time, thus decreasing breath load 3. Average cardiac output, thus decreasing resting heart rate 4. Use of glucose and fatty acids, thus decreasing blood glucose level

Use of glucose and fatty acids, thus decreasing blood glucose level