(PrepU) Chapter 33: Activity
The nurse has been educating a client about health promotion and exercise. What statement made by the client demonstrates that the education has been successful?
"I will invite a friend to exercise with me." Exercising with a friend will add the support of a buddy. Joining a spa, health club, or exercise group is also recommended to provide support to exercise. Exercise sessions should be introduced gradually to prevent overexertion and injury to muscles. Clients should be encouraged to exercise for 30 to 45 minutes 3 or 4 times per week. Alternating types of exercise will help prevent boredom.
The nurse is teaching a client about good posture when lying down to go to sleep. Which teaching will the nurse include?
"Picture yourself with good posture standing; that is how good lying posture works." The best posture lying down will be the same as standing posture, except the client is horizontal. Knees should be slightly flexed; feet should be at a right angle from the legs; the head and neck muscles should be in a neutral position, centered between the shoulders. It is not correct to say to keep the knees and legs very straight, to position feet at a 45-degree angle from the legs, or to sleep with the head tilted to one side.
The nursing assistant is preparing to help the client make a lateral transfer from the bed to a stretcher. The client informs the nurse that the client is able to move onto the stretcher without the nurse's help. What is the nurse's best response?
"You are free to move onto the stretcher without assistance, but I will supervise for your safety." If the client is fully able to assist in the transfer, the nurse should allow the client to complete the movement independently, with supervision for safety. A physician order is not necessary for a transfer from a stretcher to a bed. The client can move independently and therefore does not need a friction-reducing device. A nurse should remain at the bedside to monitor the transfer.
A client has undergone foot surgery and will use crutches in the short term. Which teaching point should the nurse provide to the client?
"Your elbows will be slightly bent when you are using your crutches." When using crutches, the elbow should be slightly bent at about 30 degrees and the hands, not the armpits, should support the client's weight. Supervision of the client learning to use crutches should not be performed by unlicensed assistive personnel (UAP). The client should stop ambulating and sit down, if fatigued.
The nurse uses gait belts when assisting clients to ambulate. Which client would be a likely candidate for this assistive device?
A client who has leg strength and can cooperate with the movement The gait belt is used to help the client stand and provides stabilization during pivoting. Gait belts also allow the nurse to assist in ambulating clients who have leg strength, can cooperate, and require minimal assistance. A gait belt is not used on clients who have either an abdominal or thoracic incision. A gait belt would not be used on a client who is confined to bed rest.
The nursing student learns in Fundamentals that the primary purpose for using proper body mechanics is for which reason?
Acts to prevent injury to the client and/or nurse When nurses use their bodies to perform therapies, to assist clients with movement, or to move equipment, they benefit from the effective use of body mechanics to prevent injury to themselves and clients. The actions do not safeguard against legal action by the client but rather are in place to prevent injury.
The nurse moves a client's arm from an outstretched position to a position at the side of his body. What is the term used to describe this type of body movement?
Adduction Adduction is a lateral movement of a body part toward the midline of the body. An example of adduction is when a person's arm is moved from an outstretched position to a position alongside the body. Abduction is a lateral movement of a body part away from the midline of the body. An example of abduction is when a person's arm is moved away from the body. Circumduction is turning in a circular motion. This motion combines abduction, adduction, extension, and flexion. An example of this movement is the circling of the arm at the shoulder, as in bowling or a serve in tennis. Extension is the state of being in a straight line. An example of extension is when a person's cervical spine is extended, the head is held straight on the spinal column.
A client will be ambulating for the first time since his cardiac surgery. What should the nurse consider when assisting this client?
If an ambulating client whom a nurse is assisting begins to fall, the nurse should slide the client down his own body to the floor, carefully protecting the client's head. The nurse would use the gait belt to ease the client backward against his own body and gently ease the client to the floor while protecting the client's head. The client should not look at his feet, but rather out at eye level at his surroundings. The nurse should consult the plan of care for the client, but the nurse regularly ambulates a client without a physical therapist present. The evaluation of a client's muscle power to permit walking cannot be measured by the ability to lift the legs off the bed.
A nurse receives an order to apply graduated compression stockings for a client at risk for venous thromboembolism. How should the nurse apply the stockings?
If the client was sitting up, have him or her lie down and elevate feet for 15 minutes before applying stockings. Be prepared to apply the stockings in the morning before the client is out of bed. Assist the client to a supine position. If the client has been sitting or walking, have him or her lie down with legs and feet well elevated for at least 15 minutes before applying the stockings. Powder the leg lightly unless client has a breathing problem, dry skin, or sensitivity to the powder. If the skin is dry, a lotion may be used. Powders and lotions are not recommended by some manufacturers; check the package material for manufacturer specifications.
The nurse is assisting a client from the bed into a wheelchair. What is a recommended guideline for this procedure?
Raise the head of the bed to a sitting position. When assisting a client from the bed into a wheelchair, the nurse would place the bed in the lowest position and raise the head of the bed to a sitting position. The nurse would make sure the bed brakes are locked and put the wheelchair next to the bed, locking the brakes of the chair.
The nurse is performing range-of-motion exercises on a client's arm. The nurse starts by lifting the arm forward to above the head of the client. Which action would the nurse perform next?
Return the arm to the starting position at the side of the body. The nurse would return the joint to a neutral position (i.e., its normal position of alignment) when finishing each exercise.
Two nurses are moving a client up in bed. What motion would the nurses use to counteract the client's weight?
Shift their weight back and forth, from back leg to front leg. The nurses would use a rocking motion to counteract the client's weight. The nurses would shift their weight back and forth, from back leg to front leg, count to three, and then move the client up toward the head of the bed. Rocking the client or turning the client from side to side is not used to move a client.
When working with a client who has a fractured wrist, the nurse applies what knowledge about the bones in the body?
Short bones contribute to movement. Short bones contribute to movement and are located in the wrist and ankle. The wrist is classified as a short bone. Long bones, such as the femur and humerus, are located in the upper and lower extremities and contribute to height and length. The flat bones are relatively thin and contribute to shape. The flat bones are found in the ribs and several of the skull bones and contribute to shape (structural contour).
The nurse is caring for a client with hemorrhoids. To facilitate a rectal examination, into which position will the nurse place the client?
Sims' Sims' position, a semiprone position, can be used for certain examinations of the rectum and vagina. The other positions do not allow adequate examination of this area.
A nurse is recommending aerobic exercise for a client who is overweight. Which exercise might the nurse suggest?
Swimming Swimming is an aerobic exercise, also known as a cardio exercise. The other options listed are anaerobic exercises.
When assessing correct body alignment when the client is standing, the nurse would document which abnormal findings? Select all that apply.
The arms are bent at the elbows. The knees are bent. Correct alignment permits optimal musculoskeletal balance and operation and promotes optimal physiologic function. With the client standing, the nurse would be concerned if the arms were bent at the elbows. The arms should hang comfortably at the sides. Also, the nurse would be concerned if the knees were bent. The knees should be in a slightly flexed position, not bent and not in the knee-locked position. It is a normal finding for the head to be held erect and in the midline position. It is also a normal finding for the feet to be at right angles to the lower legs. It is a normal finding for the chest to be held upward and forward.
The client is ambulating in the room and walks around a bedside table. What is the best explanation for why the client does not bump into the table?
The client is aware of spatial relationships to avoid the table. The client has awareness of spatial relationships (where objects are located in space). This ability comes from the visual or optic reflexes. The labyrinthine sense relates to the sensory organs in the inner ear and provides a sense of position, orientation, and movement. It does not contribute to where objects are in space. When the extensor muscles are stretched beyond a certain point, their stimulation causes a reflex contraction that aids a person to reestablish erect posture (e.g., when the knee buckles under, the reflex contraction aids the person to straighten the knee). This does not contribute to perception of where objects are in space.
The client is ambulating in the room and walks around a bedside table. What is the bestexplanation for why the client does not bump into the table?
The client is aware of spatial relationships to avoid the table. The client has awareness of spatial relationships (where objects are located in space). This ability comes from the visual or optic reflexes. The labyrinthine sense relates to the sensory organs in the inner ear and provides a sense of position, orientation, and movement. It does not contribute to where objects are in space. When the extensor muscles are stretched beyond a certain point, their stimulation causes a reflex contraction that aids a person to reestablish erect posture (e.g., when the knee buckles under, the reflex contraction aids the person to straighten the knee). This does not contribute to perception of where objects are in space.
On a previous clinic visit a month ago, an overweight client reported shortness of breath with activity and constipation. The client was diagnosed as having osteoporosis and noted to have an elevated triglyceride level. The primary care provider prescribed an exercise program. The nurse is assessing for the effects of exercise. What are the expected outcomes for this client? Select all that apply.
The client reports no shortness of breath with activity. The client's weight is maintained or lessened. The client reports regular and formed bowel movements. Effects of an exercise program include improved work of breathing (no shortness of breath with activity), improved bowel elimination (regular and formed bowel movements), and weight controlled at the current weight, or ideally lessened. The client's blood triglyceride level should decrease with an effective exercise program. The client should experience increased joint mobility and less joint pain.
The client is an active, healthy 2-year-old child. His mother asks a nurse what she can expect developmentally from the boy over the next few years. What is the nurse's best response?
The client will continue to grow rapidly and will refine both gross and fine motor skills. The toddler years are a time of rapid longitudinal growth and rapid skill acquisition and refinement. Any regression in skill acquisition is indicative of a larger problem and must be evaluated.
Using proper body mechanics, which motions would the nurse make to move an object?
The nurse uses the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling. Use the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling. The internal girdle is made by contracting the gluteal muscles in the buttocks downward and the abdominal muscles upward. It is helped further by making a long midriff by stretching the muscles in the waist. The nurse would not relax the stomach muscles or use the muscles of the back when moving an object. The nurse would not lift an object when it can be safely slid, rolled, pushed, or pulled.
A client with a hip fracture is returning to the orthopedic unit, and the orders indicate that the client should be turned by logrolling. Which statement regarding logrolling is correct?
Use a drawsheet or a friction-reducing sheet to facilitate smooth movement. Logrolling requires the assistance of two or three nurses. Logrolling will maintain straight alignment when the client is being turned. The nurse should use a drawsheet or a friction-reducing sheet to facilitate smooth movement. The nurse should avoid twisting the client's head, spine, shoulders, knees, or hips while logrolling. A chair is not used with logrolling.
The nurse teaches proper body mechanics for a group of unlicensed assistive personnel (UAP). Which statement by a class participant indicates the need for additional education?
When I lift and carry a heavy box of supplies I will keep it at arm's length from my body. The nurse teaching a group of UAPs about proper body mechanics recognizes the need for additional education when a class participant states that, when lifting and carrying a heavy box of supplies, the UAP will keep it at an arm's length from body. This motion will result in injury and the UAP should be instructed to keep items close to the body. The UAPs should lift an object with feet shoulder width apart by bending at the knees instead of the waist and getting close to the object being lifted. These actions reflect the correct understanding of proper body mechanics.
Which type of mobility aid would be most appropriate for a client who has poor balance?
a cane with four prongs on the end (quad cane) Canes with three (tripod) or four prongs (quad cane) or legs to provide a wide base of support are recommended for clients with poor balance. Single-ended canes with half-circle handles are recommended for clients requiring minimal support and those who will be using stairs frequently. Single-ended canes with straight handles are recommended for clients with hand weakness because the handgrip is easier to hold but are not recommended for clients with poor balance. Axillary crutches are used to provide support for clients who have temporary restrictions on ambulation.
The client is a clerical assistant for an inpatient hospital unit. He spends most of his day at a desk. What would the nurse advise the clerical assistant to do to minimize damage to his musculoskeletal system? Select all that apply.
adjust the height of the work area face in the direction of the activity he is performing use a wide stance and lift with the large leg muscles Breath holding is a sign of muscle strain and an inefficient use of body mechanics.
When a client is lifted or held by a nurse, the additional weight becomes a part of the nurse's weight and should be:
balanced over the center of gravity. Maintaining balance involves keeping the spine in vertical alignment, the feet positioned for a broad base of balance, and the body weight close to the center of gravity.
A nurse is providing care to a client confined to bed. To promote independence while the client is moving in bed and provide the client assistance in moving up in bed, which device would be appropriate?
bed trapeze A trapeze bar is a handgrip suspended from a frame near the head of the bed. A client can grasp the bar with one or both hands and raise the trunk from the bed. The trapeze makes moving and turning considerably easier for many clients and facilitates transfers into and out of bed. A foot board helps reduce the risk of foot drop. A bed cradle is usually a metal frame that supports the bed linens away from the client while providing privacy and warmth. Trochanter rolls are used to support the hips and legs so that the femurs do not rotate outward.
A 45-year-old man is interested in starting an exercise program. The nurse informs him that exercise does not:
decrease appetite. Exercise generally leads to an increased appetite.
A client who has an immobilizer on the arm reports shortness of breath following ambulation to the bathroom. The nurse notes the client's pulse increased from 82 to 124 beats/min, respirations increased from 16 to 24 breaths/min, and blood pressure is 90/50 mmHg. The nurse makes the nursing diagnosis of Activity Intolerance. What are the client's defining characteristics for this diagnosis? Select all that apply.
client reports of shortness of breath increase in pulse rate increase in respiratory rate decrease in blood pressure Defining characteristics for the nursing diagnosis Activity Intolerance include the client's report of shortness of breath with activity, increased pulse rate, increased respiratory rate, and decrease in blood pressure. Limited range of motion is a defining characteristic for the nursing diagnosis Impaired Physical Mobility.
What is a benefit of regular exercise over time?
decreased heart rate Regular physical activity over time results in cardiovascular conditioning and therefore decreased heart rate. Regular exercise increases circulating fibrinolysin that serves to break up small clots, thus decreasing the risk for blood clots. Over time, regular exercise leads to improved pulmonary function, including decreased work of breathing. Venous return is improved when contracting muscles compress superficial veins and push blood back to the heart against gravity.
The nurse is caring for an 84-year-old client. While assessing the client, the nurse notes that the client has an unsteady gait and weak muscle strength and tires easily with physical exertion. How will the nurse document this finding?
disuse syndrome Disuse syndrome is the appropriate documentation of this client finding. Energy is the capacity to do work. Alignment is the part of an object in proper relationship to others. Functional position is the position in which an activity is properly and normally performed. Therefore low energy, poor alignment, and functional position are not how the nurse would document this finding.
A nurse applies padded boots to maintain the foot in dorsiflexion to a client who is comatose. The nurse is protecting the client from:
foot drop. A footboard or boots should be applied to maintain dorsiflexion and tendon flexibility. Foot drop is a contracture in which the foot is fixed in plantar flexion.
When moving a client up in bed with the assistance of another caregiver, the nurse should:
have the client fold the arms across the chest. Positioning the arms across the chest improves assistance, reduces friction, and prevents hyperextension of the neck. Before attempting to move a client up in bed, the nurse should review the medical record and the nursing plan of care. This validates the correct client and correct procedure, identification of limitation, and ability. Reviewing the medical record and plan of care also identifies use of an algorithm to prevent injury and assists in determining the best plan for client movement. The head of the bed should be flat or as low as the client can tolerate; this will help to decrease the gravitational pull of the upper body. If tolerated, a slight Trendelenburg position aids in movement. Pillows should be removed from under the client's head; this facilitates movement.
The nurse is positioning a client with limited mobility who is lying down to go to sleep. Which positioning technique is most appropriate?
horizontal position with knees slightly flexed and head centered between the shoulders The best posture lying down will be the same as that for standing posture, except the client is horizontal. Knees should be slightly flexed; feet should be at a right angle from the legs; the head and neck muscles should be in a neutral position, centered between the shoulders.
When turning a client in bed, what muscle groups would the nurse use to pull the client to the opposite side of the bed?
leg The nurse would tighten gluteal and abdominal muscles, flex the knees, and use the leg muscles to do the pulling. This saves strain on the nurse's lower back. The arms and chest are part of the accessory muscle groups used in pulling a client.
The nurse adjusts a client's bed to a comfortable working height in order to turn the client. What would be the nurse's next action
move the client to edge of the bed opposite the side that client will be turning When turning a client in bed, the nurse would use a friction-reducing sheet to pull the client to the edge of the bed that is opposite the side the client will be turning. Pushing the client to the opposite side of the bed is not good for back safety. Consult a Safe Patient Handling algorithm to determine whether assistive devices or additional nurses are needed, depending on the individual client.
After positioning a client to move from the bed into a wheelchair, how would the nurse stand when helping the client sit up on the side of the bed?
near the client's hip, with legs shoulder width apart and one foot near the head of the bed When assisting the client from the bed into a wheelchair, the nurse would take position near the client's hip, with legs shoulder width apart and one foot near the head of the bed. This ensures that the nurse's center of gravity is placed near the client's greatest weight to assist the client to a sitting position safely. The dominant or nondominant side is not relevant when moving a client with equal strength but would be helpful with a client who has had a stroke.
A nurse is preparing to turn a client who is unable to mobilize independently. Which action best ensures the safety of both the client and the nurse?
positioning a friction-reducing sheet under the client to facilitate movement After placing the bed in a comfortable working position (usually elbow height of the caregiver), position a nurse on either side of the bed, place a friction-reducing sheet under the client, and use the leg muscles to pull the client to the side.
The nurse is assessing a client who is bedridden. For which condition would the nurse consider this client to be at risk?
predisposition to renal calculi In a bedridden client, the kidneys and ureters are level, and urine remains in the renal pelvis for a longer period of time before gravity causes it to move into the ureters and bladder. Urinary stasis favors the growth of bacteria that, when present in sufficient quantities, may cause urinary tract infections. Poor perineal hygiene, incontinence, decreased fluid intake, or an indwelling urinary catheter can increase the risk for urinary tract infection in an immobile client. Immobility also predisposes the client to renal calculi, or kidney stones, which are a consequence of high levels of urinary calcium; urinary retention and incontinence resulting from decreased bladder muscle tone; the formation of alkaline urine, which facilitates growth of urinary bacteria; and decreased urine volume. The client would be at risk for decreased movement of secretion in the respiratory tract, due to lack of lung expansion. The client would suffer from decreased metabolic rate due to being bedridden. The client would not have an increase in circulating fibrinolysin.
An older adult client is scheduled to receive passive range-of-motion (ROM) exercises. The family is present to learn how to do the exercises for the client at home. What interventions would the nurse include? Select all that apply.
provide slow and gentle movements while supporting the extremity perform the exercise to the point of resistance In performing passive ROM exercises and teaching the family, the nurse will provide slow and gentle movements while supporting the extremity and will perform the exercise until the point of resistance is met. The nurse does not ask the UAP to teach the family, because the UAP may not teach. If the client reports sudden sharp pain in the leg during ROM exercises, the procedure is stopped and an assessment is completed. ROM exercises should be performed twice a day.
The nurse is caring for a client who is on bed rest and was just turned to the left side. Which action should the nurse take next to decrease the risk of impaired skin integrity
pull the shoulder blade forward and out from under the client Positioning the shoulder blade in this manner removes pressure from the bony prominence and thus helps decrease the risk of impaired skin integrity. The other actions should also be performed but do not decrease the risk of impaired skin integrity.
A nurse is conducting a home assessment of a 90-year-old client with a history of several minor strokes that have left the client with a hemiplegic gait. The nurse is particularly concerned about falls. Which activities would help to prevent falls for this client? Select all that apply.
removing clutter from the floor placing nightlights in the bathroom and hallways moving the bedroom to the ground floor Removing clutter from the floor, placing nightlights in the bathroom and hallways, and moving the bedroom to the ground floor will reduce the risk of falling and encourage the client to increase his mobility. Installing hardwood floors may induce falls due to the smooth surface; wall-to-wall carpeting would provide traction.
The nurse is caring for a client with incontinence who has been neglected in supine position at home for more than a week. Which priority nursing diagnosis will the nurse select?
risk for impaired skin integrity Although the client may have or be at risk for any of these nursing diagnoses, risk for impaired skin integrity is the priority, as the client has incontinence and has been left in a supine position, which could facilitate skin breakdown. Therefore the other nursing diagnoses are not the priority.
The nurse has been educating the client about how to use a walker safely. The nurse knows that the education has been effective when the client:
steps into the walker when walking. A walker is mechanical aid that enhances the client's balance and ability to bear weight. Education is usually done by physical medicine or physical therapy, but the nurse should continue to assess the client's ability to use the walker properly. The client should step into the walker when walking rather than walking behind it. When the client is rising from a seated position, the arms of the chair, not the walker, should be used for support. The client should be cautioned to avoid pushing the walker out too far in front. Also, the client should avoid leaning over the walker but should instead stay upright while moving.
The pediatric nurse is caring for a newborn infant. In which position will the nurse place the infant to sleep?
supine Supine position is recommended as a way to reduce the incidence of sudden infant death syndrome (SIDS) among newborns. The other positions are inappropriate for placing an infant to sleep.
The pediatric nurse is caring for a 3-week-old infant. In which position will the nurse place the infant to sleep?
supine Supine position is recommended as a way to reduce the incidence of sudden infant death syndrome (SIDS) among newborns. The other positions are incorrect.
The nurse is assisting a client with limited mobility to turn in bed. After successfully turning the client to the side, where would the nurse place an additional pillow?
supporting the client's back The nurse would place the pillow under the client's back to provide support and help maintain the proper position. A pillow can also be placed between the knees. More than one pillow under the client's head is not necessary. Placing a pillow in front of the client's abdomen would be helpful for a client who has undergone abdominal surgery. Placing a pillow under the client's feet is not helpful for the side lying position.
The nurse is assessing the developmental level of children in a pediatric clinic. The nurse would be most concerned about which client?
the 24-month-old child who is unable to walk unassisted At 15 months of age, most toddlers can walk unassisted; there would be concern for a 24-month-old child who could not. At 3 months of age, an infant may be able to raise the head, but this is not expected at this age. Rolling over is usually accomplished between 6 and 9 months of age, so it would not be expected for all 6-month-old infants. Stacking blocks is accomplished by most 3-year-olds, but doing so at 18 months is considered early.
When assessing the physical activity of clients, the nurse would be most concerned about which client?
the middle-aged computer programmer Although further assessments should be done to avoid making assumptions and imposing stereotypes, there are many variables that may contribute to a sedentary lifestyle, such as occupations. A computer programmer has a job that is inactive. The nurse would be concerned about this client and would need to do further assessments to determine activity, frequency, and intensity that occur outside of work. The mother of small children would be involved in housecleaning and chasing after the children. Walking is a commonly prescribed exercise, and going to the mall provides a safe environment where walking would be possible. A Native American who hunts is engaging in culturally related physical activity.
The nurse is providing health teaching for a client who flies often for business. Which risk factor associated with flying will the nurse emphasize?
thrombus formation Prolonged sitting can increase a client's risk for thrombus formation. The nurse will emphasize this and teach stretching exercises. Skeletal contractures, pooling of secretions, and oliguria are not risk factors associated with flying (prolonged sitting).
The nurse is caring for a 76-year-old client who has an unsteady gait. Which method is most appropriate to assist in transferring?
transfer belt A transfer belt is designed for clients who can bear weight and help with the transfer but are unsteady. The other options are inappropriate for this client.
The nurse is caring for a 76-year-old client who has an unsteady gait. Which method is mostappropriate to assist in transferring?
transfer belt A transfer belt is designed for clients who can bear weight and help with the transfer but are unsteady. The other options are inappropriate for this client.
The nurse is working to increase functional ability with a client. Which assistive technique should be included in the plan of care?
trapeze bar Promoting client independence with movement and activity is an important intervention for clients with musculoskeletal problems. Unlike log rolling and pull sheets, which are nurse-initiated methods, the overhead trapeze is used by the client.
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:
tremor 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 client with limited mobility has outward rotation of the bony protrusions at the head of the femur. Which assistive device would the nurse include in the plan of care?
trochanter rolls Trochanter rolls prevent the legs from turning outward. The trochanters are the bony protrusions at the heads of the femurs, near the hip. Placing positioning devices at the trochanters helps prevent the legs from rotating outward. Other devices are inappropriate for this client.
