Prep U--Mobility
While performing a physical examination on a client, the nurse observes that the client has scoliosis based on which of the following?
Lateral deviation of the thoracic spine Explanation: Scoliosis is the lateral deviation of the thoracic spine. Concave curvature of the cervical spine, convex curvature of the thoracic spine, and concave curvature of the lumbar spine are the characteristics of a normal spinal alignment.
A nurse teaches a student nurse the importance of ambulating patients to prevent the effects of immobility on body systems. Which of the following is one of these effects?
Impaired circulation Explanation: Effects of immobility include impaired circulation, decreased muscle mass, increased cardiac workload, and decreased appetite.
The cardiac response to exercise is well-researched and documented. Which of the following is a cardiovascular response to regular exercise?
Increased efficiency of the heart Explanation: Regular exercise produces cardiovascular responses such as an increased efficiency of the heart, decreased heart rate and blood pressure, increased blood flow to all body parts, and increased circulation of fibrinolysin.
A nurse is caring for an inactive client and assisting the client in performing range-of-motion exercises. What care should the nurse take when performing range-of-motion exercises?
Move each joint until there is resistance but no pain Explanation: The nurse assisting the inactive client with range-of-motion exercises should assist in moving each joint until there is resistance but no pain so that each joint is exercised to its point of limitation. The nurse should not place any pillows and other positioning devices because they interfere with the exercises. The nurse should follow a systematic, repetitive pattern when performing the range-of-motion exercise to prevent overlooking any joint. The nurse must perform similar movements with each extremity to bilaterally exercise the joints.
A nurse is preparing to turn a 65-year-old hospitalized patient. Which of the following is a recommended guideline for performing this skill?
Position a friction-reducing sheet under the patient. Explanation: After placing the bed in a comfortable working position (usually elbow height of the caregiver), position a nurse on either side of the bed, position a friction-reducing sheet under the patient, and use the leg muscles to pull the patient to the side.
A physician has directed a nurse to assist a client to perform exercises in order to prevent ankylosis. What type of exercise should the nurse assist the client with in this case?
Range of motion exercises Explanation: The nurse should assist the client to perform range of motion exercises in order to prevent ankylosis. Range of motion (ROM) exercises are therapeutic activities that move the joints. They are performed to assess joint flexibility before initiating an exercise program, maintain joint mobility and flexibility in inactive clients, prevent ankylosis (permanent loss of joint movement), stretch joints before performing more strenuous activities, and evaluate the client's response to a therapeutic exercise program. A continuous passive motion machine is an electrical device used as a supplement or substitute for manual ROM exercise. Active exercise is therapeutic activity that the client performs independently after proper instruction. Aerobic exercise is an isotonic exercise that promotes cardiorespiratory conditioning and increases lean muscle mass.
A nurse is assisting a client at a health care facility to dangle before the client ambulates. The nurse places the client in Fowler's position for a few minutes. Which of the following is a possible reason for this action?
To maintain safety should the client become dizzy or faint Explanation: The nurse places the client in Fowler's position for a few minutes before dangling to maintain safety should the client feel dizzy or faint due to postural hypotension. The nurse lowers the height of the bed so that the client can use the floor for support. The nurse provides the client with a robe and slippers to maintain warmth and show respect for the client's modesty. The nurse helps the client pivot a quarter of a turn to swing the legs over the side and sit on the edge of the bed, which helps the client adjust to a sitting position.
A nurse is caring for a comatose patient. What can happen to the feet if they are unsupported in the dorsiflexed position?
plantar flexion and footdrop Explanation: The greatest danger to the feet occurs when they are unsupported in the dorsiflexed position. The toes drop downward and the feet are in plantar flexion. If maintained for an extended position, the patient may develop footdrop.
A group of nursing students are reviewing the aspects of motor function control by the nervous system. The students demonstrate understanding of this information when they identify which of the following as a function of the cerebellum?
Coordination of movement motor activities Explanation: The cerebellum coordinates motor activities of movement. The cerebral cortex initiates voluntary motor activity. The pyramidal tract transmits impulses to the spinal cord. The extrapyramidal tract inhibits and dampens impulses.
A college student fell and sprained his right ankle. The student health physician recommends the student use crutches to facilitate healing. Which of the following would the nurse teach the student?
The support of the body should be the hands and arms. Explanation: Teach the patient that the support of body weight should come primarily on the hands and arms when using the crutches, not in the axillary area, where pressure may damage nerves and cut off circulation.
A home care nurse visits a client with Parkinson's disease. The nurse observes that the client has rhythmic, repetitive movements of the hands. The home care nurse documents this as which of the following?
Tremor Explanation: Tremors are rhythmic, repetitive movements that can occur at rest or when movement is initiated. A tremor usually interferes with fine motor control, but in Parkinson's disease it also can interfere with coordinated ambulation. Athetosis is movement characterized by slow, irregular, twisting motions. Dystonia is similar to athetosis but usually involves larger areas of the body. Ataxia is a general term used to describe impaired muscle coordination.
A nurse recommends a regular exercise program for a patient who has difficulty sleeping. The patient asks how this will help. How would the nurse respond?
"Improved sleep is one benefit of regular exercise." Explanation: Some of the most important benefits of regular exercise are psychological. Improved sleep is a benefit of regular exercise.
A patient is preparing to mobilize for the first time following the surgical removal of a bunion on her left foot. How should the nurse instruct the patient to ambulate with her crutches?
"Try to avoid putting too much pressure on your armpits with the tops of the crutches." Explanation: When using crutches, a patient should avoid pressure on the axillae in order to prevent skin breakdown. Elbows should be kept close to the sides and the crutches should come no closer than 12 inches from the feet. When rising from a chair, the patient should extend her left foot in order to prevent weight bearing.
When teaching range-of-motion exercises to a caregiver, a nurse moves the arm of the patient laterally to an upright position above the head, and then returns it to the original position. What term is used to describe this body movement?
Abduction Explanation: Abduction is lateral movement of a body part away from the midline of the body. Rotation occurs when a body part turns on its access toward or away from the midline of the body. Extension is the state of being in a straight line and flexion is the state of being bent.
A nurse is assisting a client to ambulate at the health care facility using a walking belt. How does the walking belt assist the client when ambulating?
Allows the nurse to support the client Explanation: A walking belt provides support if the client loses balance when ambulating and prevents injuries. When assisting a client to ambulate, the nurse walks alongside the client, holding the walking belt or the client's own belt and supporting the client's arm. A quadriceps setting would aid the client in extending the leg. The use of parallel bars as handrails helps the client to gain practice when ambulating. Exercising the quadriceps muscles enables the client to stand and support body weight.
Which of the following patients would be an appropriate candidate to move by using a powered stand-assist device?
An alert patient after knee replacement surgery who is being assisted to ambulate Explanation: Powered stand-assist devices can be used with patients with weight-bearing ability on at least one leg, who can follow directions, and who are cooperative. Patients who are unable to bear partial weight or full weight or who are uncooperative should be transferred using a full body sling lift.
A nurse is caring for a client whose fractured leg is in a cast. Which of the following ambulatory devices could the nurse suggest for the client to ambulate at the health care facility?
Axillary crutch Explanation: The nurse should suggest the use an axillary crutch for the client who has her fractured leg in a cast in order to aid the client to ambulate at the health care facility. Axillary crutches have a bar that fits beneath the axilla. Clients who need brief, temporary assistance with ambulation are likely to use axillary crutches. A cane is used for clients who have weakness in one side of the body. Clients who require considerable support and assistance with balance use a walker. Platform crutches are used by clients who cannot bear weight with their hands and wrists. Many clients with arthritis use them.
Which of the following ambulatory aids could a nurse suggest to assist a client who has weakness in one side of his body?
Cane Explanation: The nurse could suggest the use of a cane to a client who has weakness in one side of his body in order to aid ambulation. Canes are hand-held ambulatory devices made of wood or aluminum. A walker is used by clients who require considerable assistance with balance. Clients who need brief, temporary assistance with ambulation are likely to use axillary crutches. Forearm crutches generally are used by experienced clients who need permanent assistance with walking.
During an initial assessment, the nurse observes that the client has a festinating gait. The nurse bases this determination on which of the following?
Client walks on the toes as if being pushed Explanation: A festinating gait is typified by walking on the toes as if being pushed. A hemiplegic gait occurs when one leg is paralyzed or neurologically damaged, so the leg is dragged or swung around to propel it forward. A waddling gait is walking with feet wide apart in a duck-like fashion. The gait is called spastic when walking appears stiff and toes appear to catch and drag.
Which of the following clients would benefit the most from the use of a forearm crutch to assist in ambulation?
Client who needs permanent assistance when walking Explanation: A nurse should suggest the use of forearm crutches for clients who need permanent assistance when walking. Crutches are generally used in pairs and require a great deal of upper arm strength and balance; therefore, older adults or weak clients do not commonly use them. Clients who have weakness on one side of the body use a cane to ambulate. A walker is used by clients who require considerable assistance with balance; whereas, platform crutches are used by clients who cannot bear weight with their hands and wrists.
While performing passive range-of-motion exercises on the lower extremities of a patient with a spinal cord injury, the nurse assesses permanent flexion of the muscles. What term will the nurse use to document this finding related to the muscles?
Contractures Explanation: Contractures are permanent contraction of a muscle. Tonus is the term used to describe the state of slight contraction, the usual state of skeletal muscles. Atrophy is the decrease in muscle size from immobility. Ankylosis is a consolidation and immobilization of a joint.
A nurse is performing range-of-motion exercises for a comatose client. The nurse bends the client's arm to decrease the angle between two adjoining bones and then straightens it to increase the angle between two adjoining bones up to 180. Which of the following positions is involved in this movement?
Flexion and extension Explanation: Flexion and extension of the elbows involve bending the client's arm to decrease the angle between two adjoining bones and then straightening it to increase the angle between two adjoining bones up to 180. Abduction and adduction of the elbows involves moving the arm away and toward the midline. Plantar flexion and dorsiflexion involves bending the foot toward the sole of the foot and toward the dorsum or anterior side. Inversion and eversion involves turning the sole of the foot toward and away from the midline.
A nurse assists the client into the position shown in the accompanying image. What position is the client assuming?
Lateral oblique Explanation: In the lateral oblique position (a variation of the sidelying position), the client lies on the side with the top leg placed in 30 degrees of hip flexion and 35 degrees of knee flexion. The calf of the top leg is placed behind the midline of the body on a support such as a pillow. The back is supported, and the bottom leg is in neutral position. This position produces less pressure on the hip than a strictly lateral position and reduces the potential for skin breakdown.
When assisting a client with ambulation using an assistive device such as parallel bars or a walking belt, what should the nurse observe the client for?
Pallor, weakness, or dizziness Explanation: When assisting a client with ambulation using an assistive device such as parallel bars or a walking belt, the nurse should observe the client for pallor, weakness, or dizziness. Observing the client's walking gait would not be an appropriate action in this case. The nurse should preferably observe the walking gait of clients who ambulate with crutches, walkers, or canes. The nurse need not observe the upper arm strength of the client nor the tone and strength of the client's muscles. Upper arm strength and muscle tone and strength need to develop before the client begins to ambulate.
The nurse is preparing to put a patient's joints through the range of motion. What guideline will the nurse consider when performing the range of motion?
Return the joint to a neutral position when finishing each exercise. Explanation: Guidelines to follow when performing range of motion include returning the joint to a neutral position when finishing each exercise. The nurse should not perform range-of-motion exercises until the patient is fatigued because the exercises are not to exhaust or tax the individual. Avoid attempts to achieve full range of motion in older adults because these movements may be painful. All movements should be smooth and rhythmic.
A nurse is demonstrating the proper use of body mechanics to a group of nursing students. Which of the following would be most appropriate for the nurse to do?
Stand with legs wide apart Explanation: Proper body mechanics include having a wide base of support, facing the direction of the work or the direction of motion, keeping objects close to the body when lifting, and bending the knees and hips to change positions, keeping the knees relaxed and the trunk erect.
You are helping a patient walk in the hallway when the patient suddenly reaches for the handrail and states, "I feel so weak. I think I am going to pass out." Which of the following initial actions by are appropriate?
Support the patient's body against yours and gently slide the patient onto the floor. Explanation: Assessing for the potential causes of the weakness should occur after patient safety is assured.
A nurse is providing care for a patient who has been newly admitted to the long-term care facility. What is the primary criterion for the nurse's decision whether to use a mechanized assistive device for transferring the patient?
The patient's ability to assist Explanation: The nurse assesses several parameters when choosing whether to use a mechanized assistive device for a patient transfer. The most important consideration, however, is the patient's ability to safely assist with his or her transfer.
A client is beginning to ambulate with crutches after surgery on his right leg. He is allowed to bear weight only on his left leg. The nurse would work with the client to use which gait?
Three-point Explanation: Three-point gait is appropriate when the client bears weight on the foot and crutches by moving the weaker leg forward followed by the stronger leg. The swing-through gait is often used by clients with paraplegia, who move both crutches forward then swing the body beyond the crutches to propel themselves forward. The two-point gait requires at least partial weight bearing on each foot, as each crutch moves at the same time as the opposing leg. When the client can bear partial weight on both feet, the client uses a four-point gait.
A nurse is assisting a client in performing prescribed range of motion exercises. Why are range of motion exercises performed?
To assess joint flexibility before initiating an exercise program Explanation: Range of motion (ROM) exercises are therapeutic activities that move the joints. They are performed to assess joint flexibility before initiating an exercise program, to maintain joint mobility and flexibility in inactive clients, to prevent ankylosis or permanent loss of joint movement, to stretch joints before performing more strenuous activities, and to evaluate the client's response to a therapeutic exercise program.
A patient with severe osteoarthritis is having a surgical hip replacement. This is possible because of the type of joint found in the hip. What type is it?
ball-and-socket joint Explanation: The hip joint is a ball-and-socket joint, with the rounded head of one bone fitting into the cuplike cavity in the other. The head of the femur (the ball) is capable of being replaced.
While performing range-of-motion exercises on a patient, a nurse bends a patient's foot so that the toes are brought up, as though to point them at the knee. What is the term for this type of movement?
dorsiflexion Explanation: Dorsiflexion is backward bending of the hand or foot, for example, a person's foot is in dorsiflexion when the toes are brought up as though to point them at the knee. Inversion is the movement of the sole of the foot inward (occurs at the ankle). Rotation is turning on an axis; the turning of a body part on the axis provided by its joint. Eversion is the movement of the sole of the foot outward (occurs at the ankle).
A nurse is providing home care for an older woman with severe osteoporosis. What complication of this disease process must the nurse consider in the plan of care?
fractures Explanation: Osteoporosis is a condition occurring in older adults in which bone destruction exceeds bone formation. The resultant thin, porous bones fracture easily.
A nurse is assessing the muscles of an older adult. What will be assessed?
mass, tone, strength Explanation: Assessment of the muscles of an older adult includes bilateral mass, tone, and strength. Skin is assessed for temperature, turgor, and moisture. Joints are assessed for flexion and range of motion. Reflexes reflect neurologic integrity.
Laboratory results for a patient on prolonged bedrest include a high level of urinary calcium. What risk does this pose for the patient?
renal calculi (kidney stones) Explanation: Immobility predisposes the patient to renal calculi (kidney stones), which are a result of high levels of urinary calcium.
An immobile person has decreased movement of respiratory secretions. What condition is a greater risk as a result?
respiratory tract infection Explanation: When a person is immobile, the movement of secretions in the respiratory tract is decreased, causing secretions to pool and leading to respiratory congestion. These conditions predispose the person to respiratory tract infections.
Which of the following postural deformities might be assessed in a teenager?
scoliosis Explanation: Scoliosis, a lateral curvature of the spine, would most likely be assessed in a teenager. Kyphosis and osteoporosis are seen in older adults. Rickets is seen in children.
At what time would a nurse assess the gait of an ambulatory patient?
when the patient walks into the room Explanation: Begin the physical assessment of an ambulatory patient the moment the patient walks into the room, observing gait, posture, and voluntary or involuntary movements.
A nurse performing range-of-motion exercises on a bedfast patient moves the patient's chin down onto the chest and then back to an upright position. The nurse then tilts the head as far as possible to each shoulder. What therapeutic movement is the nurse achieving with this exercise? Select all that apply.
• Flexion • Extension Explanation: These movements provide for flexion, extension, and lateral flexion of the head and neck.
An 80-year-old patient experienced dysphagia (impaired swallowing) in the weeks following a recent stroke, but his care team wishes to now begin introducing minced and pureed food. How should the nurse best position the patient?
A high-Fowler's position optimizes cardiac function and respiratory function in addition to being the best position for eating. The patient's risk of aspiration would be extreme in a supine position. Low-Fowler's and semi-Fowler's are synonymous, and this position does not aid swallowing as much as a high-Fowler's position.
A nurse is caring for a client with arthritis, and isometric exercises have been recommended. How will isometric exercises help the client?
By improving muscle tone and strength Explanation: Isometric exercises are recommended to improve the muscle strength when preparing a client for ambulation. Isotonic exercises help the client to improve upper arm strength. Dangling helps to normalize a client's blood pressure, which may drop when the client rises from a reclining position. A tilt table is used to help the client bear weight on the feet.
A nurse is assessing the musculoskeletal system of a client during an initial visit to the clinic. The assessment reveals insufficient joint lubrication in the knees. The nurse documents this finding as which of the following?
Crepitus Explanation: Crepitus indicates insufficient joint lubrication in the client. The nurse should listen for a crunching or grating sound, which can occur when bones rub against one another during movement because of inadequate protection or insufficient joint lubrication. Chorea refers to spontaneous, brief, involuntary muscle twitching of the limbs or facial muscles. Scoliosis refers to a lateral deviation of the thoracic spine. Swelling refers to an enlargement of the area, such as with fluid in the subcutaneous tissues.
You are caring for a patient who has been on bed rest. The primary care provider has just written a new order for the patient to sit in the chair three times a day. Which of the following actions will be most effective to transfer the patient safely into the chair?
Have the patient sit on the side of the bed for several minutes before moving to the chair. Explanation: Having the patient sit at the side of the bed minimizes the risk for blood pressure changes (orthostatic hypotension) that can occur with position change.
A nurse is fitting prophylactic braces to a client. Which of the following is the major function of prophylactic braces?
Prevent or reduce the severity of a joint injury Explanation: Prophylactic braces are used to prevent or reduce the severity of a joint injury. Braces are custom-made or custom-fitted devices designed to support weakened structures. Rehabilitative braces allow protected motion of an injured joint that has been treated operatively; whereas functional braces provide stability for an unstable joint. A spica cast encircles one or both legs, but when applied to a lower extremity, the cast is trimmed in the anal and genital areas to allow for the elimination of urine and stool.
You are caring for a patient who is on bed rest and was just turned to the left side. Which of the following actions should you take next to decrease the risk of impaired skin integrity?
Pull the shoulder blade forward and out from under the patient. Explanation: Positioning the shoulder blade in this manner removes pressure from the bony prominence.
When a patient independently moves all of the joints through their normal motions, it is referred to as active range of motion (AROM).
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A patient with a hip fracture is returning to the orthopedic unit, and the orders indicate that the patient should be turned by logrolling. What statement is correct regarding logrolling?
Use a drawsheet or a friction-reducing sheet to facilitate smooth movement. Explanation: Logrolling requires the assistance of two or three nurses. Logrolling will maintain straight alignment when the patient is being turned. The nurse should avoid twisting the patient's head, spine, shoulders, knees, or hips while logrolling. The nurse should use a drawsheet or a friction-reducing sheet to facilitate smooth movement.
What body system benefits the most from aerobic exercises?
cardiovascular Explanation: Aerobic exercises are sustained muscle movements that increase blood flow, heart rate, and metabolic demand for oxygen over time, promoting cardiovascular conditioning.
A nurse is assessing the vital signs of a patient who has exercised regularly for several years. What vital sign findings would be expected?
decreased pulse and blood pressure Explanation: Over time, with cardiovascular conditioning, regular exercise increases the efficiency of the heart and decreases heart rate and blood pressure.
A nurse is teaching an older adult about activity. What information would be included in the teaching plan?
the importance of regular exercise Explanation: Nurses should teach older adults the importance and benefits of regular exercise. In normal, healthy adults, exercise should strengthen muscles and bones and will not result in fractures.
Why is it important for the nurse to teach and role model proper body mechanics?
to promote health and prevent illness Explanation: The correct use of body mechanics is a part of health promotion and illness prevention. The nurse has a major responsibility to teach good body mechanics, both directly and indirectly by example.
A nurse is performing range-of-motion exercises for a client and moves the client's fingers apart and then back together. The nurse is performing which range of motion?
Adduction/abduction Explanation: Spreading the fingers apart and then brining them back together reflects adduction and abduction. Making a fist and then opening it back up reflects flexion and extension. Turning the ankle inward and then outward reflects inversion and eversion. Moving the foot toward the floor and then back up reflects plantarflexion and dorsiflexion.
A patient has chronic obstructive pulmonary disease and is unable to perform basic self-care activities or activities of daily living. Which of the following would be an appropriate nursing diagnosis?
Activity Intolerance Explanation: Activity Intolerance is any condition that interferes with the transport of oxygenated blood to tissue. Chronic obstructive pulmonary disease is one condition that meets these criteria.
You and an assistant are preparing to move a patient up in bed. Arrange the following steps in the correct order.
Adjust the head of the bed to a flat position. Remove all pillows from under the patient. Position the assistant on the side opposite you. Place a friction-reducing sheet under the patient. Ask the patient to bend legs and place the chin on the chest. Grasp the sheet and move the patient on the count of 3. Explanation: This is the correct order for a nurse and an assistant who are preparing to move a patient up in bed.
Three nurses are transferring a patient from a bed to a chair. Which of the following is a recommended guideline for handling patients safely during a transfer?
If patient is in pain, administer analgesics in advance. Explanation: If the patient is in pain, administer the prescribed analgesic sufficiently in advance of the transfer to allow the patient to participate in the move comfortably. Patients should be encouraged to assist in their own transfers. During any patient transferring task, if any caregiver is required to lift more than 35 pounds of a patient's weight, then the patient should be considered to be fully dependent and assistive devices should be used for the transfer. Handling aids should be used whenever possible to help reduce the risk of injury to the nurse and patient.
physician has directed a nurse to assist a client to perform exercises in order to prevent ankylosis. What type of exercise should the nurse assist the client with in this case?
Range of motion exercises Explanation: The nurse should assist the client to perform range of motion exercises in order to prevent ankylosis. Range of motion (ROM) exercises are therapeutic activities that move the joints. They are performed to assess joint flexibility before initiating an exercise program, maintain joint mobility and flexibility in inactive clients, prevent ankylosis (permanent loss of joint movement), stretch joints before performing more strenuous activities, and evaluate the client's response to a therapeutic exercise program. A continuous passive motion machine is an electrical device used as a supplement or substitute for manual ROM exercise. Active exercise is therapeutic activity that the client performs independently after proper instruction. Aerobic exercise is an isotonic exercise that promotes cardiorespiratory conditioning and increases lean muscle mass.
A nurse is working with a female client with osteoporosis on an exercise program. The nurse instructs the client to increase her tolerance gradually. The nurse determines that the teaching was effective when the client states which of the following?
The client's statement about stopping if pain occurs is correct. Initially, clients should plan on a realistic goal, such as beginning with 3 days a week and working up to an average of 3 to 5 days a week. Weight-bearing exercises are beneficial for those with osteoporosis. Strength training is helpful in increasing range of motion, strength, and balance, especially in older adults.
A nurse at a health care facility is suggesting the use of isometric exercise to a client. What is the purpose of isometric exercise?
To improve blood circulation Explanation: Isometric exercise improves blood circulation. Isometric exercise consists of stationary exercises generally performed against a resistive force. Isometric exercises increase muscle mass, strength, and tone and define muscle groups. Although they improve blood circulation, they do not promote cardiorespiratory function. In fact, strenuous isometric exercises elevate blood pressure temporarily. The nurse should suggest isometric exercises in order to maintain cardiorespiratory conditioning and increase lean muscle mass. Passive exercises help to maintain flexible joints.
A nurse is caring for a client who is on complete bed rest while recovering from hip surgery 12 hours ago. When the client is able to start walking, which ambulation aid will most likely be recommended for use?
Walker Explanation: The nurse could suggest the use of a walker for the client who is recovering from hip surgery and has been recommended complete bed rest. Clients who require considerable support and assistance with balance use a walker, the most stable form of ambulatory aid. A cane is used by clients who have weakness on one side of the body. Clients who need brief, temporary assistance with ambulation are likely to use axillary crutches. Forearm crutches generally are used by experienced clients who need permanent assistance with walking.
A 60-year-old client who uses a walker to aid ambulation is being discharged from the health care facility. Which of the following changes should be made to the homes of older adults to increase safety? Select all that apply.
• Replace scatter rugs with secure mats. • Ensure that there are no electric cords in the passageway. • Add railings and grab bars to the bathrooms and entrance. Explanation: When an older client who uses a walker to aid ambulation is being discharged from the health care facility, a home safety evaluation is recommended. The nurse should suggest that the home be made safe by removing scatter rugs or replacing them with a secure mat, ensuring that no electric cords are in the passageways and railings or grab bars should be added to bathrooms and outside entrances. The nurse should ensure that the lighting is adequate and not too bright. The room need not be painted to promote well-being.
When explaining the benefits of isotonic exercises to promote cardiorespiratory conditioning and increase lean muscle mass, which of the following exercises should the nurse tell the client to perform?
Aerobic exercise Explanation: The nurse should ask the client to perform aerobic exercises, which involve rhythmically moving all parts of the body at a moderate to slow speed without hindering the ability to breathe. Body building, weight lifting, and push-ups are isometric exercises, which improve blood circulation but do not promote cardiorespiratory function. In fact, strenuous isometric exercises temporarily elevate blood pressure.
A nurse is following a plan of care for passive range-of-motion (ROM) exercises. What specifics will be included on the plan?
Do ROM exercises two times a day, each exercise two to five times. Explanation: Do not move joints to the point of pain. Passive ROM exercises should be done twice a day, with each exercise carried out two to five times.
