PCC Chapter: 33. Activity and Exercise

A man has been admitted to the hospital unit with a medical diagnosis of chronic obstructive pulmonary disease (COPD). He is receiving supplemental oxygen at 2 L/min via nasal cannula. Which positioning technique will best assist him with his breathing? 1) Fowler's position 2) Sims' position 3) Lateral recumbent position 4) Lateral position

ANS: 1 Fowler's position is a semi-sitting position in which the head of the bed is elevated 45 to 60 degrees. This position promotes respiratory function by lowering the diaphragm and allowing the greatest chest expansion. Sim's position is a side-lying position where the patient is on his left side with left leg extended and right leg flexed. This position is commonly used for rectal examination. Lateral recumbent position is another term describing Sim's position. Lateral position simply means side lying. PTS:1DIF:EasyREF:p. 1146 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

The nurse is helping an 82-year-old patient to ambulate in the hallway. Suddenly she states, "I feel so light-headed and weak," as her knees begin to buckle. The nurse's best action at this time would be to: 1) Assist the patient to slide down his leg as he guides her to a seated or lying position. 2) Grab her under the arms and hold her up as he calls for assistance. 3) Immediately release the transfer device and place a wheelchair behind the patient to prevent a fall. 4) Instruct the patient to grab the rail in the hallway while he calls for assistance

ANS: 1 If a patient becomes weak or begins to fall when walking, do not attempt to hold the patient up. Instead, protect the patient as you guide her to a seated or lying position. Create a wide base of support, and project forward the hip closest to the patient. Assist the patient to slide down your leg as you call for help. Protect the patient's head as her body descends. PTS:1DIF:ModerateREF:p. 1152 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

A woman with a high-risk pregnancy with triplets is in preterm labor; she is on strict bedrest for 5 days. During this time she has not had a bowel movement, although normally, passes stool daily. She describes feeling bloated and uncomfortable. What information should the nurse give the patient when explaining constipation? 1) Immobility often causes constipation. 2) A stool softener daily will relieve the problem. 3) Use of a bedpan results in bloating and constipation. 4) A low-fiber diet will resolve the problem.

ANS: 1 Immobility slows peristalsis, which leads to constipation, gas, and difficulty evacuating stools from the rectum. Increasing fiber in the diet often prevents constipation. A stool softener may be ordered if other measures are unsuccessful. Some people do find use of a bedpan difficult. PTS:1DIF:EasyREF:p. 1137 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

An older patient with newly diagnosed osteoporosis asks the nurse to explain her health problem. Which of the following is the correct description of osteoporosis? 1) Loss of bone density that increases the risk of fracture 2) Degenerative joint disease that produces pain and decreased function 3) Chronic inflammatory joint disease that must be treated with steroids 4) Acute infection in the bone that must be treated with antibiotics

ANS: 1 Osteoporosis is a decrease in total bone density. The internal structure of the bone diminishes, and the bone collapses in on itself. Women experience a rapid decline in bone mass after menopause. Osteoarthritis is a degenerative joint disease. Osteomyelitis is a serious infection in the bone. PTS:1DIF:EasyREF:p. 1135 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

What would be the most appropriate goal for a frail, elderly patient with a nursing diagnosis of Risk for Injury after hip surgery? 1) Remain free from injury or falls throughout hospital stay. 2) Increase activity tolerance by discharge from hospital. 3) Demonstrate effective breathing when ambulating. 4) Increase mobility by discharge from hospital.

ANS: 1 Remaining free from injury or falls is a measurable goal, and it is directly related to the patient's nursing diagnosis, Risk for Injury. Increasing activity tolerance and mobility by the time of discharge is not specific and measurable. Additionally, these outcomes do not relate to Risk for Injury. A goal of effective breathing for a frail, elderly patient after hip surgery does not relate to Risk for Injury. PTS:1DIF:EasyREF:p. 1141 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application

The nurse is helping the patient to perform leg exercises after surgery to prevent thrombophlebitis. Which type of muscle is the patient using for these exercises? 1) Skeletal 2) Smooth 3) Cardiac 4) Slow-twitch fibers

ANS: 1 Skeletal muscle moves the bones with ligaments. Smooth muscle is found in the digestive tract and other hollow structures, such as the blood vessels and bladder. Cardiac muscle contracts spontaneously and is blood ejected out of the heart. Slow-twitch fibers are a subtype of skeletal muscle cell. Slow-twitch fibers (type I), or "red" muscle, have a rich blood supply and are rich in mitochondria (the powerhouse of the cell) to give the muscle more oxygen and energy to sustain aerobic activity. The fast-twitch fibers (type II skeletal muscle type) are known as "white" muscle. These fibers increase the speed of muscle contraction. PTS:1DIF:EasyREF:p. 1120 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

The nurse is instructing a patient about the need to replace fluid before, during, and after exercise in order to avoid dehydration. She should teach the patient to determine the amount of fluid to consume on the basis of: 1) Duration of exercise. 2) Environmental temperature. 3) Level of fitness. 4) Degree of thirst.

ANS: 1, 2 Lost fluids must be replaced to decrease the risk of dehydration, regardless of level of fitness. During intense exercise, the body can lose 2 liters of fluid for every hour of exercise. Elevated environmental temperatures also increase the amount of fluid lost through sweating. When athletes drink according to thirst, the risk that they will over-drink and so develop exercise-associated hyponatremia is minimized (Noakes, 2007). On the other hand, exercise can suppress thirst, making it an unreliable signal to replace fluids lost with exercise. PTS:1DIF:Easy REF:p. 1133; answer can be derived from the text KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

Which of the following body systems must interact to produce mobility and locomotion? Choose all that apply. 1) Digestive system 2) Muscles 3) Skeleton 4) Nervous system

ANS: 2, 3, 4 Activity and exercise require bodily movement (mobility) and locomotion (self-powered movement from one place to another). Mobility depends on the successful interaction among the skeleton, the muscles, and the nervous system. PTS:1DIF:EasyREF:p. 1119 KEY:Nursing process: N/A | Client need: PHSI | Cognitive level: Recall

A patient has started a fitness program. What program features illustrate that he has started a well-rounded program? 1) Flexibility 2) Isometric exercises 3) Resistance training 4) Aerobic conditioning

ANS: 1, 3, 4 Flexibility training helps warm up the muscles and prevents injury during exercise. Resistance training increases muscular strength and endurance. Aerobic conditioning affects fitness and body composition. Isometric exercise is an active form of physical activity using opposing resistance where the joints don't move and muscles don't lengthen. Isometrics are done in static positions, rather than moving through a range of motion. PTS:1DIF:ModerateREF:pp. 1129-1130 KEY: Nursing process: Evaluation | Client need: HPM | Cognitive level: Comprehension

Which of the following actions represent proper body mechanics for nurses providing care as well as teaching patients about safe body movements? Choose all that apply. 1) Stand with the body in alignment and erect posture. 2) Bend at the waist to lift heavy objects from the floor. 3) Use a wide base of support with your feet at shoulder width. 4) Keep objects close to your body when carrying them.

ANS: 1, 3, 4 Proper body mechanics involves good body alignment, erect posture, and a wide base of support. To prevent back injury resulting from reaching and straining muscles, carry objects close to the trunk. Bending at the waist to lift objects uses the back muscles and increases the risk of injury. Instead, squat to lower your center of gravity, and use your leg muscles for lifting. PTS:1DIF:ModerateREF:pp. 1121-1122 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

Which course of action taken by her patient with osteoporosis would allow the nurse to know that her teaching was effective? 1) Taking a calcium supplement every day and increasing her phosphorous intake 2) Participating in an aerobic barbell strength class at the gym three times a week 3) Using a wheelchair to reduce the risk of spontaneous fractures to her legs and feet 4) Seeking healthcare by scheduling a follow-up examination with bone density testing

ANS: 2 Active participation in a weight-bearing and weight-lifting program demonstrates not only understanding of the treatment of osteoporosis but commitment to an action plan to reduce bone loss that comes with osteoporosis. Calcium supplementation is also part of the treatment for osteoporosis. However, high phosphorous intake lowers calcium levels and would not be appropriate for a client with osteoporosis. Restricting weight-bearing activity to a wheelchair will actually lower bone density. Although follow-up care is appropriate for a client with osteoporosis, it does not indicate commitment to a daily treatment plan. PTS:1DIF:EasyREF:p. 1135 KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Analysis

An 82-year-old patient is unsteady on her feet when walking about the room. She reports feeling a little sore but has no complaints of weakness. What is the appropriate piece of equipment to use when helping her ambulate? 1) Crutches 2) Transfer belt 3) Cane 4) Walker

ANS: 2 Crutches are commonly used when the patient has an injured lower extremity. A cane or walker is generally used for the patient with a lower extremity injury or weakness. The most appropriate equipment to use would be a transfer belt. A transfer belt allows the patient the greatest amount of independence while ensuring safety. PTS:1DIF:EasyREF:pp. 1149-1150 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

A patient is on strict bedrest for 5 days. During this time she has not had a bowel movement, although she normally passes stool daily. She describes feeling bloated and uncomfortable. A nursing diagnosis that would best address a patient who is on bedrest is Constipation related to: 1) Change in previous pattern. 2) Immobility. 3) Dietary intake. 4) Change in environment.

ANS: 2 Immobility slows peristalsis, which leads to constipation, gas, and difficulty evacuating stools from the rectum. Based on the scenario, this nursing diagnosis would specifically address the patient's condition. PTS:1DIF:Moderate REF:p. 1137; higher-order item with implied answer KEY: Nursing process: Diagnosis | Client need: PHSI | Cognitive level: Analysis

When caring for a patient with osteoporosis, which of the following is the most important action to take to minimize progression of the disease? 1) Take a calcium supplement twice a day. 2) Start a weight-bearing exercise program. 3) Avoid strenuous activity that puts stress on the bones. 4) Schedule regular healthcare checkups.

ANS: 2 Osteoporosis causes bones to become porous and weak. Starting a weight-bearing exercise program is the most important aid in promoting bone strength and decreasing the rate of bone loss. Calcium supplementation helps maintain bone density. PTS:1DIF:ModerateREF:p. 1135 KEY: Nursing process: Planning | Client need: PHSI | Cognitive level: Application

A nurse has been asked to design an exercise program with the goal of increasing a client's muscular strength and endurance. Which exercise program would specifically focus on meeting that goal? 1) Flexibility training 2) Resistance training 3) Aerobic conditioning 4) Anaerobic conditioning

ANS: 2 Resistance training involves movement against resistance, which increases muscular strength and endurance. Most commonly, resistance training refers to weight lifting and isotonic movement. When exercising for strength, the amount of resistance is increased with each exercise. When exercising for endurance, the number of repetitions is increased with each exercise. Flexibility training will not increase muscular strength. Aerobic and anaerobic conditioning may have some benefit on strength and endurance, but their primary focus is cardiovascular conditioning. PTS:1DIF:ModerateREF:p. 1129 KEY: Nursing process: Planning | Client need: HPM | Cognitive level: Analysis

A 15-year-old patient complains of left ankle pain after being tackled while playing football. He asks the nurse what tests he needs to have to determine if he has a strain or a fracture. How should the nurse reply? 1) "You don't need an x-ray; I can tell by the way your ankle looks and feels whether you have a strain or fracture." 2) "Sprains, strains, and fractures have similar symptoms at first; you will need an x-ray of the joint to be certain." 3) "We will need to get a venous Doppler study to make sure that there is not a fracture." 4) "First, we need to get an MRI to diagnose your injury as a fracture instead of strain or sprain."

ANS: 2 Signs and symptoms associated with a sprain, strain, or fracture are the same. An x-ray allows the medical provider to visually observe for any breaks in a bone. An x-ray is a more practical than an MRI to diagnose a fracture. A venous or arterial Doppler is used to detect blood flow.

Which of the following patients would you expect to be at risk for decreased activity? Choose all that apply. 1) Older adult who walks at the mall for physical activity 2) Someone living in a skilled nursing facility 3) Healthy adult who works as a computer programmer 4) Obese child who enjoys video games

ANS: 2, 3, 4 The person who lives in a skilled nursing facility might be sedentary because of advancing age and other age-associated medical problems that lead to inactivity. With obesity, movement becomes more difficult and strain on joints increases. A sedentary lifestyle, whether adult or child, contributes to obesity; activities, such as computer work and video games, are sedentary and require little physical activity. Physical activity doesn't have to be a structured fitness class but can also be walking, even walking in a mall or neighborhood, just as long as the intensity is moderately vigorous. PTS: 1 DIF: Moderate REF: p. 1119 KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Comprehension

What action is most important in limiting the nurse's risk of back injuries? 1) Use good body mechanics at all times. 2) Work with another nurse or an aide when lifting and turning patients. 3) Avoid manual lifting by using assistive devices as often as possible. 4) Develop a lift team at the clinical site.

ANS: 3 Back injuries are the leading cause of injury among nurses. Good body mechanics and teamwork limit the risk of injury. However, the American Nurses Association's (ANA) Handle with Care program advocates the regular use of assistive devices as well as avoiding manual lifting. PTS:1DIFgrinifficultREF:p. 1128 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

In order to achieve balance, body mass must be distributed around which point? 1) Center of body alignment 2) Center of balance 3) Center of gravity 4) Base of support

ANS: 3 Balance is achieved when the body is in alignment. To be balanced, a person's line of gravity must pass through his center of gravity, and the center of gravity must be close to his base of support. The center of gravity is the point around which mass is distributed. PTS:1DIF:EasyREF:p. 1121 KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Comprehension

A 16-year-old was hospitalized 3 weeks ago. He has been confined to bed throughout his hospital stay because of a crushed pelvis. His parents tell the nurse, "Our son is just staring off into space; he won't talk to us. We are worried because he has not even listened to his iPod, watched television, or played his video games for 2 days. That is so unlike him." What is the best response the nurse can make? 1) "I will inform his doctor and see if we can get your son started on an antidepressant medication." 2) "He is at a critical time in his life; teens are often moody, and being in the hospital with an injury will only make that worse." 3) "Your son had a major injury; and his immobility might be causing him to feel isolated and depressed." 4) "He is bored because he has been in the hospital for 3 weeks; I'll try to find something new for him to do."

ANS: 3 Being immobile, whether in the hospital or home, leads to isolation and mood changes. Patients who are in bed for long periods can suffer from psychological changes such as depression, anxiety, hostility, sleep disturbances, and changes in their ability to perform self-care activities. PTS:1DIF:ModerateREF:p. 1137 KEY: Nursing process: Diagnosis | Client need: PSI | Cognitive level: Analysis

The nurse planning the care for a frail, malnourished, immobile patient recognizes which of the following as the best treatment to protect the patient's integument? 1) Offering the patient six small meals a day 2) Assisting the patient to sit in a chair three times a day 3) Turning the patient at least every 2 hours 4) Administering fluid boluses as directed by the healthcare provider

ANS: 3 External pressure from lying or sitting in one position compresses capillaries and obstructs blood flow to the skin. Immobile patients confined to a bed should be turned at least every 2 hours to protect their skin and relieve pressure. PTS:1DIF:EasyREF:p. 1137 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Comprehension

A nurse is caring for a 25-year-old male quadriplegic patient. Which of the following treatments would the nurse perform to decrease the risk of joint contracture and promote joint mobility? 1) Active ROM 2) Turning the patient every 2 hours 3) Passive ROM 4) Administering glucosamine supplements

ANS: 3 Passive ROM involves moving the joints through their ROM when the patient is unable to do so for himself. Passive ROM promotes joint mobility. Active ROM would not be possible for a quadriplegic patient. Turning the patient every 2 hours prevents skin breakdown but does not promote mobility or prevent contracture. Glucosamine is a building block for the formation and repair of cartilage. However, there is inconclusive, scientific evidence regarding the benefit of this substance to improve joint function. PTS:1DIF:Moderate REF: pp. 1122, 1151; higher-order item, answer can be derived from text KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

Which of the following is true of synarthroses? Joints are: 1) Freely movable. 2) Capable of only limited movement. 3) Immovable. 4) Painful with movement.

ANS: 3 Synarthroses joints are immovable joints. The sutures between the cranial bones are considered synarthroses joints. Although these joints have some flexibility in youth to allow for growth, they gradually become rigid and immovable with age. There is no pain associated with synarthroses. PTS:1DIF:ModerateREF:p. 1120 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Recall

According to the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans, which of the following statements about the benefits of physical activity is correct? 1) The risks of physical activity outweigh the health benefits. 2) Physical activity in excess of recommendations for age is harmful. 3) Combining aerobic and muscle-strengthening activities promotes better health. 4) Lesser amounts of activity provide little to no health benefits.

ANS: 3 The combination of aerobic and bone- and muscle-strengthening physical activities leads to health benefits for people of all ethnic groups and ages. Physical activity is safe for almost everyone, and the health benefits of physical activity far outweigh the risks. Additional health benefits are provided by increasing to 300 minutes a week of moderate-intensity aerobic physical activity, or 150 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both. For all individuals, some activity is better than none. PTS:1DIF:EasyREF:p. 1130 KEY: Nursing process: Planning | Client need: HPM | Cognitive level: Comprehension

What is the correct method for turning an adult patient who recently sustained a spinal cord injury? 1) Ask the patient to assist with the turn by holding the side rails of the bed. 2) Place a draw sheet under the patient to assist with turning. 3) Request help from another nurse to perform the logrolling technique. 4) Use a mechanical lift for safe turning and protecting the nurse's back.

ANS: 3 The patient's spine should be maintained in straight alignment. Logrolling moves the patient's body as a unit and maintains the patient's spine in straight alignment. Holding on to the side rail or using a draw sheet or mechanical lift will not keep the spine in alignment. PTS: 1 DIF: Difficult REF: p. 1148 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

A nurse is assessing a 74-year-old male patient for an exercise program to be offered at the local hospital. During the evaluation, the nurse notes the following vital signs: P = 72, RR = 16, BP = 132/70. After 3 minutes of moderate-intensity running on the treadmill, the patient becomes short of breath and states, "I have to stop. I can't do this anymore." The nurse measures his vital signs again: P = 152, RR = 40, BP = 172/98. She instructs him to rest. Vital signs return to baseline after 15 minutes. The nurse should recognize his symptoms as associated with which of the following? 1) Anxiety 2) Orthostatic hypotension 3) Limited activity tolerance 4) Respiratory distress

ANS: 3 To assess for activity tolerance, assess and record vital signs before and after exercise. A rapid change from baseline vital signs or a slow return to baseline indicates limited activity tolerance. Anxiety might primarily exhibit signs of difficulty getting enough air and elevated heart rate and systolic blood pressure. Vitals would resolve when anxiety is reduced and not after exercise. Orthostatic hypotension is a temporary lowering of blood pressure when suddenly standing up. It is not a finding related to exercise. PTS:1DIF:ModerateREF:p. 1138 KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Analysis

A 32-year-old with a high spinal cord injury has been admitted to the hospital for antibiotic therapy to treat pneumonia. He lives independently and has developed strong upper-body strength to maximize his independence. Which transfer device should be used when transferring him from the bed to his wheelchair? 1) Mechanical lift 2) Transfer belt 3) Draw sheet 4) Transfer board

ANS: 4 A transfer board is used by patients with longstanding mobility problems; it offers them the greatest amount of independence while ensuring safety. Patients using a transfer board should have sufficient upper-body strength to perform the transfer safely. A mechanical lift could be used, but it does not promote independence. A transfer belt is used for clients who are able to stand. A draw sheet is useful for moving a patient in bed rather than from bed to wheelchair. PTS:1DIF:EasyREF:p. 1149 KEY: Nursing process: Evaluation | Client need: SECE | Cognitive level: Comprehension

A frail 78-year-old man is admitted to the hospital after a fall at home resulted in a left hip fracture. After surgery, he is to begin ambulating with a walker but must avoid weight-bearing on his left lower leg. What is the best intervention to help him use his walker? 1) Aerobic exercise with deep breathing 2) Quadriceps and gluteal repetitions 3) Isometric toning of lower legs 4) Arm resistance training

ANS: 4 Arm strength is necessary for ambulating with a walker and other assistive devices. Upper body resistance training increases muscles strength and tone, which will aid him in using the walker more easily. Toning the lower body through exercise of the quadriceps and gluteal muscles, although important for regaining strength in general after surgery, does not aid in using a walker. Aerobic exercise with deep breathing produces the greatest benefit to cardiovascular health but does little to improve the upper body strength needed for ambulating with an assistive device. PTS:1DIF:Moderate REF: pp. 1152-1156; synthesis of information required; not a direct response to the item KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

A healthy, 32-year-old man wants to start a fitness program to increase his muscle tone and muscle strength. What advice should the nurse offer him? "The United States Department of Health and Human Services recommends: 1) That exercising even once a week is beneficial." 2) 30 minutes or more of moderate-intensity physical activity three times a week." 3) 1 hour, three times a week of moderate-intensity physical activity." 4) 150 to 300 minutes or more of moderate-intensity physical activity per week

ANS: 4 Exercise involves physical activity and increases muscle tone and strength. The U.S. Department of Health and Human Services recommends 150 to 300 minutes or more of moderate- or vigorous-intensity physical activity per week. PTS:1DIF:ModerateREF:p. 1130 KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Comprehension

A patient fractured her right ulna 8 weeks ago and has just had her cast removed. The orthopedic surgeon prescribes isometric exercises for the right arm. Which of the following exercises comply with the surgeon's orders? 1) Place a 5-pound dumbbell in the right hand and squeeze; hold the squeeze position for 6 to 8 seconds, and repeat 5 to 10 times. 2) Grasping the right wrist with the left hand, move the right arm up, down, and side to side; hold each position for 6 to 8 seconds, and repeat 5 to 10 times. 3) Grasping the right wrist with the left hand, pull the right arm across the body; hold this position for 6 to 8 seconds, and repeat 5 to 10 times. 4) Press the right hand against a wall; hold this position for 6 to 8 seconds, and repeat 5 to 10 times.

ANS: 4 Isometric exercise involves muscle contraction without motion. Isometric exercises are useful for developing strength. This type of exercise is appropriate for the patient who has had an extremity confined to a cast because muscle atrophy occurs when the muscle is not used. Performing repetitions light weight increases strength but this would stress the healing fracture at this point in the rehabilitation. Pulling an arm across the body improves flexibility but does not benefit the ulna while healing. PTS:1DIFgrinifficultREF:p. 1128 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

When encouraging a fitness program for older adults, what must the nurse consider? 1) Older adults should engage in 75 to 150 minutes of moderate-intensity physical activity per week. 2) More than 150 minutes of moderate-intensity physical activity can be harmful to bones. 3) Structured fitness programs achieve greater health benefits for older adults. 4) Older adults at risk for falling should do activities that maintain or improve balance.

ANS: 4 Older adults should do exercises that maintain or improve balance if they are at risk of falling. Older adults should follow the adult guidelines, which are for 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in periods of at least 10 minutes, preferably spread throughout the week. If this is not possible because of limiting chronic conditions, older adults should be as physically active as their abilities allow. They should avoid inactivity. Structured calisthenics programs are no more beneficial for achieving health benefits than other forms of moderate- and vigorous-intensity physical activity. Structured fitness programs can become boring for some individuals. A varied routine often improves compliance and consistency of exercise. PTS: 1 DIF: Easy REF: pp. 1131-1132 KEY: Nursing process: Planning | Client need: HPM | Cognitive level: Application

Identify the most appropriate nursing diagnosis for promoting the safety of a frail, elderly patient after hip replacement surgery who also has a history of emphysema. 1) Impaired Mobility related to weakness 2) Ineffective Breathing Pattern related to disease process 3) Activity Intolerance related to injury 4) Risk for Injury related to medical condition

ANS: 4 The patient's medical condition places him at an increased Risk for Injury: He is at risk for falls and for further injury to his hip. The patient does have Impaired Mobility; however, his Impaired Mobility puts him at Risk for Injury. A diagnosis of Impaired Mobility would focus the outcomes on improving his mobility rather than protecting him from further injury. We have no data other than a diagnosis of emphysema to indicate that he is experiencing Ineffective Breathing Pattern. He is experiencing Activity Intolerance, but this is not his primary safety risk. A diagnosis of Activity Intolerance would focus the goals on increasing his endurance and conserving his energy. PTS:1DIF:ModerateREF:p. 1140 KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Synthesis