Fundamentals of Nursing-Chapter 39-Activity & Exercise

The nurse understands that older adult patients are at risk for osteoarthritis due to advanced age. Which questions would the nurse ask related to this risk? Select all that apply. 1 "Are you able to climb stairs comfortably?" 2 "Do you have pain in your knees or back when you walk?" 3 "Do you consume fruits daily? If so, which fruits?" 4 "Are you able to walk for 10 minutes without experiencing pain?" 5 "Do you void regularly? Is there any difficulty in defecation?"

1 "Are you able to climb stairs comfortably?" 2 "Do you have pain in your knees or back when you walk?" 4 "Are you able to walk for 10 minutes without experiencing pain?" Assessment questions for osteoarthritis include asking about mobility, endurance, and pain. Bowel and bladder elimination is not directly related to osteoarthritis. Eating fruit as part of the regular diet is not directly related to osteoarthritis.

What should the nurse teach a diabetic patient about exercise? 1 "Exercise leads to improved glucose control." 2 "You can perform medium- to high-intensity exercise." 3 "The effect of exercise on blood glucose levels often lasts for 10 hours." 4 "You can start an exercise routine on your own without any physical examination."

1 "Exercise leads to improved glucose control." 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.

A nursing instructor asks a nursing student about pathological factors that influence mobility and activity. What statements, if made by the student, indicate the need for further teaching? Select all that apply. 1 "Osteoporosis leads to an increase in bone density." 2 "Osteogenesis imperfecta affects the curvature of the spine." 3 "Arthritis is characterized by destruction of the synovial membrane." 4 "Scoliosis is a structural curvature of the spine associated with vertebral rotation." 5 "Osteomalacia is a metabolic disease characterized by early mineralization of the bone."

1 "Osteoporosis leads to an increase in bone density." 5 "Osteomalacia is a metabolic disease characterized by early mineralization of the bone." Osteoporosis is an aging disorder that leads to a decrease in bone density. Osteomalacia is a rare metabolic disease characterized by delayed mineralization of the bone. Osteogenesis imperfecta affects the curvature of the spine. Arthritis is characterized by destruction of the synovial membrane. Scoliosis is a structural curvature of the spine associated with vertebral rotation.

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? 1 "The cerebellum coordinates all voluntary movements." 2 "The tympanic membrane helps to maintain balance." 3 "The cerebrum coordinates highly skilled movements." 4 "The inner ear coordinates all voluntary movements."

1 "The cerebellum coordinates all voluntary movements." An adequate balance in the body is maintained by the nervous system, specifically through the cerebellum and inner ear. The cerebellum is the part of the brain that controls and coordinates all voluntary movements, particularly highly skilled movements. The inner ear helps in maintaining balance by allowing a person to change position suddenly without losing balance. The tympanic membrane helps in auditory function but has no role in maintaining balance. The cerebrum does not coordinate skilled movements. It is responsible for the regulation of voluntary movements and sensory perception. The inner ear does not control voluntary movements but helps in maintaining balance.

Which developmental factors related to activity and exercise should the nurse explain to the mother of a toddler? Select all that apply. 1 "Toddlers have slightly everted feet." 2 "Toddlers have a flexed thoracic spine." 3 "Toddlers have a sporadic and uneven growth." 4 "Toddlers lack anteroposterior curves of the adult." 5 "Toddlers have a slight swayback and a protruded abdomen."

1 "Toddlers have slightly everted feet." 5 "Toddlers have a slight swayback and a protruded abdomen." Toddlers have slightly everted feet. They also have swayback and a slightly protruded abdomen. Newborns have a flexed thoracic spine. Adolescents have sporadic and uneven growth. Infants lack the anteroposterior curves of the adult.

Which of the nursing assistant's statements about orthostatic hypotension indicates a need for further learning? 1 "Younger patients are prone to orthostatic hypotension." 2 "Diabetic patients are prone to orthostatic hypotension." 3 "Immobilized patients are prone to orthostatic hypotension." 4 "Patients on prolonged bed rest are prone to orthostatic hypotension."

1 "Younger patients are prone to orthostatic hypotension." Older, not younger, patients are prone to orthostatic hypotension. The other statements indicate understanding. Patients with chronic illnesses such as diabetes mellitus are prone to orthostatic hypotension. Patients who are immobilized or who are on prolonged bed rest are also prone to orthostatic hypotension.

What developmental and environmental factors significantly influence the activity and exercise regimen to be followed by a patient? Select all that apply. 1 Age 2 Ethnic origin 3 Work culture 4 Marital status 5 Number of children

1 Age 2 Ethnic origin 3 Work culture A patient's age, cultural and ethnic origin, and work culture may have developmental and environmental effects on a patient's activity and exercise habits. The number of children a patient has and the patient's marital status are not developmental and environmental factors that might influence a patient's exercise regimen.

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? 1 An increase in obesity 2 An increase in heart disease 3 Higher computer literacy 4 Improved school attendance and grades

1 An increase in obesity 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.

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

1 Both have handgrips. Both the double-adjustable crutch and the axillary crutch have a handgrip to support the body. A double-adjustable crutch, or forearm crutch, has a metal band that fits around the patient's forearm. An axillary crutch is more commonly used than a double-adjustable crutch. An axillary crutch has a padded curved surface at the top, which fits under the axilla while the double-adjustable crutch does not.

Exercise lowers blood glucose levels. For how long does the effect of exercise last on blood glucose levels? 1 For at least 24 hours 2 For at least 36 hours 3 For at least 48 hours 4 For at least 72 hours

1 For at least 24 hours It is important for the nurse to know the effects of exercise on glucose levels. Exercise lowers blood glucose levels and the effects of exercise on blood glucose levels often last for at least 24 hours. The lowered blood glucose levels do not last as long as 36, 48, or 72 hours. Therefore, the patient with high blood glucose should exercise on a daily basis.

The nurse is asked to assist an elderly patient with ambulation at 5:00 PM. At 5:00 PM, the nurse finds that the patient is distressed and is not oriented to time, place, or self. What is the most appropriate step that should be taken by the nurse? 1 Postpone the ambulation to another time. 2 Assist the patient in walking as scheduled. 3 Ask for help from another colleague to ambulate the patient. 4 Remove any obstacles on the floor before the ambulation.

1 Postpone the ambulation to another time. The patient is disoriented and may be at risk of falling if ambulated. Therefore, the nurse should postpone the patient's ambulation to another time when the patient is oriented and stable. This ensures the patient's safety. Assisting the disoriented patient as per the schedule may increase the risk of falling, even if help is received from a colleague and obstacles are removed from the floor.

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

2 "How far do you walk before the pain in your legs begins?" The nurse should use different questions, including open-ended and closed-ended ones, when assessing a patient. A patient who reports pain should be assessed for severity of the pain, and the most appropriate question to be asked would be, "How far do you walk before the pain in your legs begins?" If the patient is able to cover only a short distance, then it indicates that the patient's pain is severe. "Which activities trigger your pain?" and "What prevents you from exercising 30 minutes each day?" are questions that should be asked to gather information about the precipitating factors of pain. "Do you experience muscular or joint pain during or after exercise?" is a question that should be asked while assessing the extent to which the pain acts as a barrier to exercise.

Which statement made by the patient indicates the need for further teaching about the exercises to be done before initiating crutch walking? 1 "I should discontinue the exercise if I am not comfortable." 2 "I should contract my muscles for more than 30 seconds before relaxing them." 3 "I should start the exercise slowly and then increase repetitions as my physical condition improves." 4 "I should isometrically exercise muscle groups that are used for walking four times per day until I am ambulatory."

2 "I should contract my muscles for more than 30 seconds before relaxing them." The exercise program for a patient with crutch walking requires isometric exercises of the biceps and triceps. In this exercise, the muscles should be contracted for no more than 10 seconds before relaxing them. Therefore, when the patient states that muscles should be contracted for more than 30 seconds, it indicates the need for further teaching. Isometric exercises should be discontinued if the patient experiences discomfort, fatigue, or pain. Isometric exercises should always be started slowly and then the repetitions should be increased as the physical condition is improved. The muscle groups, quadriceps, and gluteal muscles should be exercised during the isometric exercise.

A nursing instructor asks a nursing student about the principles of safe patient transferring and positioning. Which statement by the student indicates inadequate learning? Select all that apply. 1 "The lower the center of gravity, the greater the stability of the nurse." 2 "The narrower the base of the support, the greater the stability of the nurse." 3 "If I balance activity between my arms and legs this will reduce the risk of back injury." 4 "I should face the direction opposite to movement to prevent abnormal twisting of the spine." 5 "The equilibrium of an object is maintained as long as the line of gravity passes through its base of support."

2 "The narrower the base of the support, the greater the stability of the nurse." 4 "I should face the direction opposite to movement to prevent abnormal twisting of the spine." The wider the base of the support, the greater the stability of the nurse. Facing the direction of the movement prevents abnormal twisting of the spine. The lower the center of gravity, the greater the stability of the nurse. Dividing balanced activity between the arms and legs reduces the risk of a back injury. The equilibrium of an object is maintained as long as the line of gravity passes through its base of support.

The nurse measures the distance between the greater trochanter muscle of the patient and the floor and finds it to be 3 feet. How long should the patient's cane be? 1 2 ft 2 3 ft 3 4 ft 4 5 ft

2 3 ft The patient's cane length should be 3 ft, because a patient's cane length should be equal to the distance between the greater trochanter muscle and the floor. A 2-ft cane is too short, and a cane that is 4 ft or 5 ft is too long.

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? 1 Weight training 2 Kneading bread 3 Running upstairs 4 Running downstairs

2 Kneading bread 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.

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

2 Low blood sugar Exercise tends to decrease sugar levels and the patient is most likely to have low blood sugar or hypoglycemia. A patient with type 1 diabetes mellitus should perform low- to moderate-intensity exercises and carry a hard candy or sugar packets. The patient should also be informed to wear an alert bracelet. According to the scenario, the patient does not present with blood pressure-related problems, thus it is highly unlikely for hypotension or vasovagal syncope to be present in this patient. Hyperglycemia or high blood sugar would not cause a sudden collapse.

A patient on bed rest for several days attempts to walk with assistance. He becomes dizzy and nauseated. His pulse rate jumps from 85 beats/minute to 110 beats/minute. Of what are these most likely symptoms? 1 Rebound hypertension 2 Orthostatic hypotension 3 Dysfunctional proprioception 4 Central nervous system (CNS) rebound hypotension

2 Orthostatic hypotension Signs and symptoms of orthostatic hypotension include dizziness, light-headedness, nausea, tachycardia, pallor, and even fainting. Rebound hypertension is caused by abruptly discontinuing certain drugs such as beta-blockers. Dysfunctional proprioception is the patient's lack of awareness of the position of certain body parts. CNS rebound hypotension can by caused by cerebrospinal fluid leakage or certain drugs.

What is the physiological factor that influences a patient's activity tolerance? 1 Age 2 Pain 3 Depression 4 Motivation

2 Pain Pain is the physiological factor that influences a patient's activity tolerance, the response a patient has to the type and amount of exercise he or she is performing. Whereas age, depression, and motivation affect activity tolerance as well, age is considered a developmental factor, and depression and motivation are emotional factors.

Which option best motivates a patient to participate in an exercise program? 1 Giving a patient information on exercise 2 Providing information to the patient when the patient is ready to change behavior 3 Explaining the importance of exercise when a patient is diagnosed with a chronic disease such as diabetes 4 Following up with instructions after the health care provider tells a patient to begin an exercise program

2 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 provides continued follow-up support and assistance until the exercise program becomes a daily routine.

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

2 The unaffected leg is advanced between the crutches to the stairs in a modified three-point gait. When ascending stairs on crutches, the patient usually uses a modified three-point gait.

A patient reports dizziness, light-headedness, and nausea. The nursing diagnosis is orthostatic hypotension. In which situation does the nurse take precautions to prevent orthostatic hypotension? 1 When changing the body from a vertical to a horizontal position 2 When changing the body from a horizontal to a vertical position 3 When changing the body from a supine to a prone position 4 When changing the body from a standing to a sitting position

2 When changing the body from a horizontal to a vertical position Orthostatic hypotension is defined as a drop in blood pressure that occurs when a patient shifts from a horizontal to a vertical position. When there is such a change in position, the blood moves from the central to the peripheral circulation. This causes a sudden drop in blood pressure. When a patient changes his or her position from vertical to horizontal, it does not cause a decrease in blood pressure. A change of body position from a supine to a prone position does not alter the blood pressure. A shift from a standing to a sitting position does not cause a drop in blood pressure.

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

2 Work sites reluctant in motivating employees for physical fitness regimens Activity and exercise promotion (or lack thereof) at work sites is an environmental factor that affects a patient's ability to exercise. Hormonal changes and increased osteoclastic activity with increasing age are developmental factors that affects activity and exercise. A patient's decision to change his or her behavior to include a daily exercise routine and the patient's knowledge, values, and beliefs about exercise in relation to health are behavioral factors that influence activity and exercise.

The nurse is measuring crutches for a patient and determining the height and placement of the handgrips. What should be the distance between the crutch pad and the patient's axilla? Record your answer using a whole number. _________ inches

2 Inches While determining the height and placement of the handgrips, the distance between the crutch pad and the patient's axilla should be approximately 2 inches.

Arrange the steps of a nurse following guidelines to initiate an exercise program in a patient in sequential order. 1. Monitor progress 2. Assess fitness level 3. Design the fitness program 4. Assemble equipment 5. Get started using the exercise routine

2,3,4,5,1 To initiate an exercise program, the nurse first needs to assess the patient's fitness level by seeking approval from the health care provider. The fitness program is then designed, taking fitness goals into consideration. All suitable equipment is then assembled and an exercise routine is started gradually. The progress is then monitored at 6 weeks and then every 3 to 6 months.

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

2,4,1,3 When the nurse finds that a patient is having a fainting episode and is about to fall, it is important to protect the patient from head injury. The first step by the nurse should be to assume a wide base of support by having one foot in front of the other to support the patient's body weight. The nurse should then extend one leg and let the patient slide down against this leg. The final step is to gently lower the patient to the floor, protecting the head.

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

3 If the balancing activity is divided between the arms and legs, there is a reduced risk of back injury. Dividing the balancing activity between the arms and legs reduces the risk of back injury. The lower the center of gravity, the greater the stability of the nurse. The wider the base of support, the greater the stability of the nurse. Facing the direction of movement prevents abnormal twisting of the spine.

Which nursing intervention is appropriate for a patient who is diagnosed with decreased cardiac output related to decreased myocardial contractility? 1 Take steps to reduce the number of interruptions during sleep. 2 Administer oxygen to the patient at 2 L/min via the nasal cannula. 3 Provide the patient with a low-calorie, low-sodium, and high-protein diet. 4 Instruct the patient to take a brisk walk for 2 to 3 miles and perform isometric exercises three to four times a week.

3 Provide the patient with a low-calorie, low-sodium, and high-protein diet. A patient who has decreased cardiac output related to decreased myocardial contractility should consume a low-calorie, low-sodium, and high-protein diet. A patient who has fatigue related to poor physical condition should have reduced sleep interruptions. The nurse should administer oxygen to the patient at 2 L/min via the nasal cannula in case of impaired gas exchange related to decreased cardiac output. A patient who has activity intolerance related to physical deconditioning should be instructed to take a brisk walk for 2 to 3 miles and perform isometric exercises three to four times a week.

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

3 The arms hang at the sides. In a standing position, the arms of the patient hang comfortably at the sides. In a sitting position, the forearms of the patient are supported on the armrest, in the lap, or on a table in front of the chair. In both the positions, the head is erect, the spine is straight, and the feet are flat on the floor.

The nurse is performing assessments to measure the cane size for a patient. Which measurement is appropriate in determining the correct size of the cane? 1 The length from the floor to the hip joint 2 The length from the floor to the iliac crest 3 The length from the floor to the greater trochanter 4 The length from the great toe to the lesser trochanter

3 The length from the floor to the greater trochanter The patient's cane length should be equal to the distance between the greater trochanter and the floor. This provides maximum support while walking. If the length of the cane were equal to the distance from the floor to the hip joint, the cane would be too long and might not support the patient's movements. If the cane length were equal to the distance from the floor to the iliac crest, it would result in a shorter cane. A cane length equal to the distance from the great toe to the lesser trochanter will also result in a shorter cane, which might make the patient unstable while walking.

Before discharge of a bedridden patient to home, the nurse taught the patient's caregiver about repositioning the patient every 2 hours to prevent development of pressure ulcers. Four days after discharge, the patient developed skin breakdown at the sacral region with redness and edema. What does the nurse say in order to evaluate the caregiver's understanding of the repositioning techniques taught during discharge? 1 "I suspect the patient is developing pressure ulcers." 2 "You have been careless in not following my instructions." 3 "I shall refer the patient to the primary health care provider for an antibiotic prescription." 4 "Have you been repositioning the patient every 2 hours?"

4 "Have you been repositioning the patient every 2 hours?" When evaluating the nursing interventions, the nurse should compare the actual outcomes with the expected outcomes. If the expected outcomes are not met, the nurse should try to explore the reason behind it and make changes in the teaching strategy. Therefore, the most important step would be to ask for the reason behind the development of pressure ulcers, and if the caregiver had been following the repositioning regimen. Stating that the patient may have developed pressure ulcers may not help in evaluating the nursing intervention. When talking to the patient, the nurse should avoid judgments or use demeaning words such as "careless." Referring the patient to a primary health care provider would be helpful in obtaining a prescription for antibiotics but would not help in evaluating the nursing interventions.

A nursing instructor asks a nursing student about skeletal muscles. Which statement if made by the student indicates the need for further teaching? 1 "Antigravity muscles stabilize joints." 2 "Antagonistic muscles cause movement at a joint." 3 "Muscle tone, or tonus, is the normal state of balanced muscle tension." 4 "The relaxation of skeletal muscles allows for walking and doing physical activities."

4 "The relaxation of skeletal muscles allows for walking and doing physical activities." 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.

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

4 Administer oxygen at 2 L/min via a nasal cannula. A respiratory rate of 30 breaths/minute and an oxygen saturation of 83% are indicative of decreased gas exchange. This is a critical finding related to breathing (remember the ABCs: Airway-Breathing-Circulation). In this case, oxygen should be administered at the rate of 2 L/min via a nasal cannula. This is done to improve oxygen saturation. Following this intervention, the provider should immediately be notified, but the patient's compromised respiratory status must be addressed first. Assessing the blood pressure and blood glucose will not address the respiratory compromise. Administering 25% dextrose via an IV catheter helps to reverse hypoglycemia but has no effect on respiratory compromise.

Why are older women more susceptible to fractures? 1 Due to firmness of the skeleton 2 Due to elasticity of the skeletal system 3 Due to flexibility of the skeletal system 4 Due to resorption and osteoporosis

4 Due to resorption and osteoporosis 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.

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

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