Chapter 38

Question 1

Activities usually performed in the course of a normal day in the patient’s life such as eating, dressing, bathing, brushing the teeth, or grooming.

Answer 1

activities of daily living (ADLs)

Question 2

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

Answer 2

activity tolerance

Question 3

Gait achieved by a person using crutches.

Answer 3

Crutch gait

Question 4

________ : A program of regular physical activity, has the potential to enhance all aspects of a patient’s biopsychosocial and spiritual model of health.

Answer 4

Exercise

Question 5

__________ are placed on the end of beds; patients push against them to move up in bed.

Answer 5

Footboards

Question 6

___________ Effects of rubbing or the resistance that a moving body meets from the surface on which it moves; a force that occurs in a direction to oppose movement.

Answer 6

Friction

Question 7

_______ is a coordinated process requiring equilibrium and balance/ the style or character of a person’s walk.

Answer 7

Gait

Question 8

An articulation, or ______ is the connection between bones.

Answer 8

Joint

Question 9

_____________ is the person’s ability to move about freely.

Answer 9

Mobility

Question 10

Using alignment, __________, and balance in a purposeful and coordinated effort during activity to prevent injury

Answer 10

Posture

Question 11

____________ is the Range of movement involving the muscles and joint from maximum extension to maximum flexion as measured in degrees of a circle.

Answer 11

Range of motion (ROM)

Question 12

___________ are white, glistening, fibrous bands of tissue that connect muscle to bone.

Answer 12

Tendons

Question 13

________________ is bodily movement produced by skeletal muscle contraction that increases energy expenditure

Answer 13

Physical Activity

Question 14

Water’s effect on the body ( 8 ) :

Answer 14

1. Moisten tissues (mouth, eyes, nose)
2. Protects body organs and tissues
3. Helps prevent constipation
4. Helps dissolve minerals/nutrients, making them accessible to body
5. Regulate body temperature
6. Lubricate joints
7. Lessens the burden on kidneys and liver by flushing out waste products.
8. Carries nutrients and oxygen to cell

Question 15

What restorative care device is used for:

• Four point alternating
• Three point alternating
• two point
• swing through

Answer 15

Crutches and crutch Gaits

Question 16

What restorative care device is used for:

• Single straight-legged
• Quad cane

Answer 16

Cane

Question 17

A nurse stretches out a patient’s leg and moves it in a circle. This is an example of what type of body movement? 
A. Abduction  
B. Flexion  
C. Circumduction  
D. Dorsiflexion

Answer 17

Answer: C. Circumduction

Rationale: Circumduction occurs when the distal part of the limb is moved to trace a circle while the proximal end of the bone remains fixed.

Question 18

A patient on bed rest for several days attempts to walk with assistance. He becomes dizzy and nauseated. His pulse rate jumps from 85 to 110 beats/min. These are most likely symptoms of which of the following?

1 Rebound hypertension

2 Orthostatic hypotension

3 Dysfunctional proprioception.

4 Central nervous system rebound hypotension

Answer 18

Answer: 2.
Signs and symptoms of orthostatic hypotension include dizziness, light-headedness, nausea, tachycardia, pallor, and even fainting.

Question 19

Which action(s) are appropriate for the nurse to implement when a patient experiences orthostatic hypotension?

1 Call for assistance.

2 Allow patient to sit down.

3 Take patient’s blood pressure and pulse.

4 Continue to ambulate patient to build endurance.

5 If patient begins to faint, allow him to slide against the nurse’s leg to the floor.

Answer 19

Answer: 1, 2, 3, 5.
If the patient has a fainting (syncope) episode or begins to fall, assume a wide base of support with one foot in front of the other, thus supporting the patient’s body weight (see Fig. 38-5, A to C). Extend one leg and let the patient slide against it; gently lower the patient to the floor, protecting his or her head. Take the patient’s blood pressure and pulse as soon as possible after incident.

Question 20

Which of the following best motivates a patient to participate in an exercise program?

1 Giving a patient information on exercise

2 Providing information to the patient when the patient is ready to change behavior

3 Explaining the importance of exercise when a patient is diagnosed with a chronic disease such as diabetes

4 Following up with instructions after the health care provider tells a patient to begin an exercise program

Answer 20

Answer: 2.
Patients are more open to developing an exercise program when they are at a stage of readiness to change their behavior. Once the patient is at the stage of readiness, collaborate with him or her to develop an exercise program that fits his or her needs and provide continued follow-up support and assistance until the exercise program becomes a daily routine.

Question 21

Which of the following is a principle of proper body mechanics when lifting or carrying objects?

1 Keep the knees in a locked position.

2 Bend at the waist to maintain a center of gravity.

3 Maintain a wide base of support.

4 Hold objects away from the body for improved leverage.

Answer 21

Answer: 3.
Maintaining a wide base of support allows for proper body mechanics. Locking the knees or bending at the waist causes strain on the lower back. Holding objects close to the body helps use the center of gravity for leverage.

Question 22

Which group of patients is at most risk for severe injuries related to falls?

1 Adolescents

2 Older adults

3 Toddlers

4 Young children

Answer 22

Answer: 2.
Some older adults walk more slowly and are less coordinated. They also take smaller steps, keeping their feet closer together, which decreases the base of support. Thus body balance is unstable, and they are at greater risk for falls and injuries

Question 23

A nurse plans to provide education to the parents of school-aged children and includes which of the following result of children being less physically active outside of school?

1 An increase in obesity

2 An increase in heart disease

3 Higher computer literacy

4 Improved school attendance and grades

Answer 23

Answer: 1.
It is increasingly clear that children are less active, resulting in an increase in childhood obesity. Strategies for physical activity incorporated early into a child’s daily routine may provide a foundation for lifetime commitment to exercise and physical fitness.

Question 24

A nursing assistive personnel asks for help to transfer a patient who is 125 pounds (56.8kg) from the bed to a wheelchair. The patient is unable to assist. What is the nurse’s best response?

1 “As long as we use proper body mechanics, no one will get hurt.”

2 “The patient only weighs 125lb. You don’t need my assistance.”

3 “Call the lift-team for additional assistance.”

4 “The two of us can easily lift the patient.”

Answer 24

Answer: 3.
Body mechanics alone are not sufficient to prevent musculoskeletal injuries when positioning or transferring patients (see Table 38-1). Teaching the use of patient-handling equipment or the use of a lift-team in combination with proper body mechanics is more effective.

Question 25

You are transferring a patient who weighs 320lb (145.5kg) from his bed to a chair. The patient has an order for partial weight bearing as a result of bilateral reconstructive knee surgery. Which of the following is the best technique for transfer?

1 Use a transfer board.

2 Obtain a stand assist device.

3 Implement a three-person carry.

4 Use the ceiling-mounted lift.

Answer 25

Answer: 4.

The use of patient-handling equipment helps prevent injury to health care workers and patients.

Question 26

Which is the correct gait when a patient is ascending stairs on crutches?

1 A modified two-point gait. The affected leg is advanced between the crutches to the stairs.

2 A modified three-point gait. The unaffected leg is advanced between the crutches to the stairs.

3 A swing-through gait.

4 A modified four-point gait. Both legs advance between the crutches to the stairs.

Answer 26

Answer: 2.

When ascending stairs on crutches, the patient usually uses a modified three-point gait

Question 27

A patient recovering from bilateral knee replacements is prescribed bilateral partial weight bearing. You reinforce crutch walking knowing that which of the following crutch gaits is most appropriate for this patient?

1 Two-point gait

2 Three-point gait

3 Four-point gait

4 Swing-through gait

Answer 27

Answer: 1.
The two-point gait requires at least partial weight bearing on each foot (see Fig. 38-12). The patient moves a crutch at the same time as the opposing leg, so that the crutch movements are similar to arm motion during normal walking.

Question 28

A patient with a right knee replacement is prescribed no weight bearing on the right leg. You reinforce crutch walking knowing that which of the following crutch gaits is most appropriate for this patient?

1 Two-point gait

2 Three-point gait

3 Four-point gait

4 Swing-through gait

Answer 28

Answer: 2.
Three-point alternating, or three-point, gait requires the patient to bear all of the weight on one foot. In a three-point gait, the patient bears weight on both crutches and then on the uninvolved leg, repeating the sequence

Question 29

A patient on week-long bed rest is now performing isometric exercises. Which nursing diagnosis best addresses the safety of this patient?

1 Disturbed thought processes

2 Impaired skin integrity

3 Disturbed body image

4 Risk for activity intolerance

Answer 29

Answer: 4.
The nursing diagnosis, risk for activity intolerance, best relates to patient safety because of the potential for orthostatic hypotension associated with prolonged bed rest.

Question 30

Which of the following activities does the nurse delegate to nursing assistive personnel in regard to crutch walking? (Select all that apply.)

1 Notify nurse if patient reports pain before, during, or after exercise.

2 Notify nurse of patient complaints of increased fatigue, dizziness, light-headedness when obtaining vital signs before and/or after exercise.

3 Notify nurse of vital sign values.

4 Evaluate the patient’s ability to use crutches properly.

5 Prepare the patient for exercise by assisting in dressing and putting on shoes.

Answer 30

Answer: 1, 2, 3, 5.
Answers 1, 2, 3, and 5 are all correct as they are within the nursing assistive personnel activities (e.g., notifying the nurse or completing assigned activities). Evaluation is within the scope of professional nursing practice and is not delegated.

Question 31

Select statements that apply to the proper use of a cane. (Select all that apply.)

1 For maximum support when walking, the patient places the cane forward 15 to 25cm (6 to 10 inches), keeping body weight on both legs. The weaker leg is moved forward to the cane so body weight is divided between the cane and the stronger leg.

2 A person’s cane length is equal to the distance between the elbow and the floor.

3 Canes provide less support than a walker and are less stable.

4 The patient needs to learn that two points of support such as both feet or one foot and the cane need to be present at all times.

Answer 31

Answer: 1, 3, 4.
A person’s cane length is equal to the distance between the greater trochanter and the floor. For maximum support when walking, the patient places the cane forward 15 to 25 cm (6 to 10 inches), keeping body weight on both legs. The patient needs to learn that two points of support (i.e., both feet or one foot and the cane) are present at all times.

Question 32

A patient is discharged after an exacerbation of chronic obstructive pulmonary disease (COPD). She states, “I’m afraid to go to pulmonary rehabilitation.” What is your best response?

1 Pulmonary rehabilitation provides a safe environment for monitoring your progress.

2 You have to participate or you will be back in the hospital.

3 Tell me more about your concerns with going to pulmonary rehabilitation.

4 The staff at our pulmonary rehabilitation facility are professionals and will not cause you any harm.

Answer 32

Answer: 1.
Pulmonary rehabilitation is beneficial in helping patients reach an optimal level of functioning. Some patients are fearful of participating in exercise because of the potential of worsening dyspnea (difficulty breathing). Pulmonary rehabilitation provides a safe environment for monitoring the progress of patients.

Question 33

4 components of mobility are:

Answer 33

Exercise, activity tolerance, gait, and body alignment

Question 34

Not forcing a muscle or a joint during exercise, considering current activity level, ROM, muscle strength, personal interests, muscle strength and tone including assessing for a patient’s physiological and psychological learning are all setting what?

Answer 34

limitations