TB Ch: 39 - Activity and Exercise

Question 1

A nurse observes a patient rising from a chair slowly by pushing on the chair arms. Which type of tension and contraction did the nurse observe?

a. Eccentric tension and isotonic contraction
b. Eccentric tension and isometric contraction
c. Concentric tension and isotonic contraction
d. Concentric tension and isometric contraction

Answer 1

ANS: A

This movement causes eccentric tension and isotonic contraction. Eccentric tension helps control the speed and direction of movement. For example, when using an overhead trapeze, the patient slowly lowers himself to the bed. The lowering is controlled when the antagonistic muscles lengthen. By pushing on the chair arms and rising eccentric tension and isotonic contraction occurred. In concentric tension, increased muscle contraction causes muscle shortening, resulting in movement such as when a patient uses an overhead trapeze to pull up in bed. Concentric and eccentric muscle actions are necessary for active movement and therefore are referred to as dynamic or isotonic contraction. Isometric contraction (static contraction) causes an increase in muscle tension or muscle work but no shortening or active movement of the muscle (e.g., instructing the patient to tighten and relax a muscle group, as in quadriceps set exercises or pelvic floor exercises).

Question 2

A nurse notices that a patient has a structural curvature of the spine associated with vertebral rotation. Which condition will the nurse most likely find documented in the patient’s medical record?

a. Scoliosis
b. Arthritis
c. Osteomalacia
d. Osteogenesis

Answer 2

ANS: A

Scoliosis is a structural curvature of the spine associated with vertebral rotation. Osteogenesis imperfecta is an inherited disorder that makes bones porous, short, bowed, and deformed. Osteomalacia is an uncommon metabolic disease characterized by inadequate and delayed mineralization, resulting in compact and spongy bone. Arthritis is an inflammatory joint disease characterized by inflammation or destruction of the synovial membrane and articular cartilage and by systemic signs of inflammation.

Question 3

A nurse is caring for a patient who has some immobility from noninflammatory joint degeneration. The nurse is teaching the patient about this process. Which information will the nurse include in the teaching session?

a. This will affect synovial fluid.
b. This will affect the body systemically.
c. This involves mostly non–weight-bearing joints.
d. This involves overgrowth of bone at the articular ends.

Answer 3

ANS: D

Joint degeneration, which can occur with inflammatory and noninflammatory disease, is marked by changes in articular cartilage combined with overgrowth of bone at the articular ends. Degenerative changes commonly affect weight-bearing joints. Synovial fluid is normal in noninflammatory diseases. Inflammatory joint disease (e.g., arthritis) is characterized by inflammation or destruction of the synovial membrane and articular cartilage and by systemic signs of inflammation.

Question 4

The nurse is providing care to a patient who is bedridden. The nurse raises the height of the bed. What is the rationale for the nurse’s action?

a. Narrows the nurse’s base of support.
b. Allows the nurse to bring feet closer together.
c. Prevents a shift in the nurse’s base of support.
d. Shifts the nurse’s center of gravity farther away from the base of support.

Answer 4

ANS: C

Raising the height of the bed when performing a procedure prevents bending too far at the waist and shifting the base of support. Balance is maintained by proper body alignment and posture through two simple techniques. First, widen the base of support by separating the feet to a comfortable distance. Second, increase balance by bringing the center of gravity closer to the base of support.

Question 5

A nurse is following the no-lift policy when working to prevent personal injury. Which type of personal back injury is the nurse most likely trying to prevent?

a. Thoracic
b. Cervical
c. Lumbar
d. Sacral

Answer 5

ANS: C

The most common back injury for nurses is strain on the lumbar muscle group, which includes the muscles around the lumbar vertebrae. While cervical, thoracic, and sacral can occur, lumbar is the most common.

Question 6

The nurse is caring for a patient in the emergency department with an injured shoulder. Which type of joint will the nurse assess?

a. Fibrous
b. Synovial
c. Synergistic
d. Cartilaginous

Answer 6

ANS: B

Synovial joints, or true joints, such as the hinge type at the elbow, are freely movable and the most mobile, numerous, and anatomically complex body joints. Fibrous joints fit closely together and are fixed, permitting little, if any, movement such as the syndesmosis between the tibia and the fibula. Synergistic is a type of muscle, not joint. Cartilaginous joints have little movement but are elastic and use cartilage to unite separate bony surfaces such as the synchondrosis that attaches the ribs to the costal cartilage.

Question 7

The nurse is caring for a patient with inner ear problems. Which goal is the priority?

a. Maintain balance.
b. Maintain proprioception.
c. Maintain muscle strength.
d. Maintain body alignment.

Answer 7

ANS: A

Within the inner ear are the semicircular canals, three fluid-filled structures that help maintain balance. Proprioception is the awareness of the position of the body and its parts, and proprioceptors are located on nerve endings, not the inner ear. Muscle strength is maintained with activity and exercise. Although body alignment is important, it is not maintained by the inner ear.

Question 8

A nurse is teaching a health promotion class about isotonic exercises. Which types of exercises will the nurse give as examples?

a. Swimming, jogging, and bicycling
b. Tightening or tensing of muscles without moving body parts
c. Quadriceps set exercises and contraction of the gluteal muscles
d. Push-ups, hip lifting, pushing feet against a footboard on the bed

Answer 8

ANS: A

Examples of isotonic exercises are walking, swimming, dance aerobics, jogging, bicycling, and moving arms and legs with light resistance. Isometric exercises involve tightening or tensing of muscles without moving body parts. Examples include quadriceps set exercises and contraction of the gluteal muscles. Examples of resistive isometric exercises are push-ups and hip lifting, as well as placing a footboard on the foot of the bed for patients to push against with their feet.

Question 9

An adolescent tells the nurse that a health professional said the fibrous tissue that connects bone and cartilage was strained in a sporting accident. On which structure will the nurse focus an assessment?

a. Tendon
b. Ligament
c. Synergistic muscle
d. Antagonistic muscle

Answer 9

ANS: B

Ligaments are white, shiny, and flexible bands of fibrous tissue that bind joints and connect bones and cartilage. Tendons are strong, flexible, and inelastic as they serve to connect muscle to bone. Muscles attach bone to bone. Synergistic muscles contract to accomplish the same movement. Antagonistic muscles cause movement at the joint.

Question 10

A nurse is developing an exercise plan for a middle-aged patient. In which order will the nurse instruct the patient to execute the plan, beginning with the first step?

1. Design the fitness program.
2. Assemble equipment.
3. Assess fitness level.
4. Monitor progress.
5. Get started.
   a. 5, 1, 3, 2, 4
   b. 1, 2, 3, 5, 4
   c. 2, 5, 3, 1, 4
   d. 3, 1, 2, 5, 4

Answer 10

ANS: D

Five steps to beginning an exercise program are Step 1: Assess fitness level; Step 2: Design the fitness program; Step 3: Assemble equipment; Step 4: Get started; and Step 5: Monitor progress.

Question 11

The nurse gives instructions to a nursing assistive personnel (NAP) regarding exercise for a patient. Which action by the NAP indicates a correct understanding of the directions?

a. Determines the patient’s ability to exercise
b. Teaches the patient how to do the exercises
c. Reports the patient got dizzy after exercising
d. Advises the patient to work through the pain

Answer 11

ANS: C

The NAP notifies the nurse if a patient reports increased fatigue, dizziness, or light-headedness when obtaining preexercise and/or postexercise vital signs. The nurse first must assess the patient’s ability and tolerance to exercise. The nurse also teaches patients and their families how to implement exercise programs. The NAP can prepare patients for exercise (e.g., putting on shoes and clothing, providing hygiene needs, and obtaining preexercise and postexercise vital signs). The NAP can help the patient exercise.

Question 12

The nurse is starting an exercise program in a local community as a health promotion project. Which information will the nurse include in the teaching session?

a. A cool-down period lasts about 5 to 10 minutes.
b. The purpose of weight training is to bulk up muscles.
c. Resistance training is appropriate for warm-up and cool-down periods.
d. Aerobic exercise should be done 3 to 5 times per week for about 20 minutes.

Answer 12

ANS: A

The cool-down period follows the exercise routine and usually lasts about 5 to 10 minutes. The purposes of weight training from a health perspective are to develop tone and strength and to simulate and maintain healthy bone. Stretching and flexibility exercises are ideal for warm-up and cool-down periods. The recommended frequency of aerobic exercise is 3 to 5 times per week or every other day for approximately 30 minutes.

Question 13

The patient is eager to begin an exercise program with a 2-mile jog. The nurse instructs the patient to warm up. The patient does not want to waste time with a “warm-up.” Which information will the nurse share with the patient?

a. The warm-up in this case can be done after the 2-mile jog.
b. The warm-up prepares the body and decreases the potential for injury.
c. The warm-up allows the body to readjust gradually to baseline functioning.
d. The warm-up should be performed with high intensity to prepare for the coming challenge.

Answer 13

ANS: B

The warm-up activity prepares the body for activity and decreases the potential for injury and should not be omitted. It usually lasts about 5 to 10 minutes and may include stretching, calisthenics, and/or aerobic activity performed at a lower intensity. The warm-up is before the exercise, while the cool-down period is after the exercise. The cool-down, not the warm-up, allows the body to readjust gradually to baseline functioning and provides an opportunity to combine movement such as stretching with relaxation-enhancing mind-body awareness. The warm-up should not be a high-intensity workout.

Question 14

The nurse is caring for a patient who cannot bear weight but needs to be transferred from the bed to a chair. The nurse decides to use a transportable hydraulic lift. What will the nurse do?

a. Place a horseshoe-shaped base on the opposite side from the chair.
b. Remove straps before lowering the patient to the chair.
c. Hook longer straps to the bottom of the sling.
d. Attach short straps to the bottom of the sling.

Answer 14

ANS: C

The nurse should attach the hooks on the strap to the holes in the sling. Short straps hook to top holes of the sling; longer straps hook to the bottom of the sling. The horseshoe-shaped base goes under the side of the bed on the side with the chair. Position the patient and lower slowly into the chair in accordance with manufacturer guidelines to safely guide the patient into the back of the chair as the seat descends; then remove the straps and the mechanical/hydraulic lift.

Question 15

The nurse is preparing to move a patient to a wheelchair. Which action indicates the nurse is following recommendations for safe patient handling?

a. Mentally reviews the transfer steps before beginning
b. Uses own strength to transfer the patient
c. Focuses solely on body mechanics
d. Bases decisions on intuition

Answer 15

ANS: A

Safe patient handling includes mentally reviewing the transfer steps before beginning the procedure to ensure both the patient’s and your safety. Use the patient’s strength when lifting, transferring, or moving when possible. Body mechanics alone do not protect the nurse from injury to the musculoskeletal system when moving, lifting, or transferring patients. After completing the assessment, nurses use an algorithm to guide decisions about safe patient handling.

Question 16

A nurse is working in a facility that follows a comprehensive safe patient-handling program. Which finding will alert the nurse to intervene?

a. Mechanical lifts are in a locked closet.
b. Algorithms for patient handling are available.
c. Ergonomic assessment protocols are being followed.
d. A no-lift policy is in place with adherence by all staff.

Answer 16

ANS: A

The nurse will follow up when lifts are not kept in convenient locations. Comprehensive safe patient-handling programs include the following elements: an ergonomics assessment protocol for health care environments, patient assessment criteria, algorithms for patient handling and movement, special equipment kept in convenient locations to help transfer patients, back injury resource nurses, an “after-action review” that allows the health care team to apply knowledge about moving patients safely in different settings, and a no-lift policy.

Question 17

The patient is brought to the emergency department with possible injury to the left shoulder. Which area will the nurse assess to best determine joint mobility?

a. The patient’s gait
b. The patient’s range of motion
c. The patient’s ethnic influences
d. The patient’s fine-motor coordination

Answer 17

ANS: B

Assessing range of motion is one assessment technique used to determine the degree of joint mobility and injury to a joint. Gait is the manner or style of walking. It has little bearing on the shoulder damage. Assessing fine-motor coordination would be beneficial in helping to assess the patient’s ability to perform tasks such as feeding and dressing but would not help in evaluating the shoulder. Ethnic influences would not have a direct bearing on the amount of mobility in the joint.

Question 18

The nurse is evaluating care of a patient for crutches. Which finding indicates a successful outcome?

a. The top of the crutch is three to four finger widths from the armpit.
b. The elbows are slightly flexed at 30 to 35 degrees when the patient is standing.
c. The tip of the crutch is 4 to 6 inches anterior to the front of the patient’s shoes.
d. The position of the handgrips allows the axilla to support the patient’s body weight.

Answer 18

ANS: C

When crutches are fitted, the tip of the crutch is 4 to 6 inches anterior to the front of the patient’s shoes, and the length of the crutch is two to three finger widths from the axilla. Position the handgrips so the axillae are not supporting the patient’s body weight. Pressure on the axillae increases risk to underlying nerves, which sometimes results in partial paralysis of the arm. Determine correct position of the handgrips with the patient upright, supporting weight by the handgrips with the elbows slightly flexed at 20 to 25 degrees.

Question 19

The patient reports being tired and weak and lacks energy. Upon assessment, the nurse finds that patient has gained weight, and blood pressure and pulse are elevated after climbing stairs. Which nursing diagnosis will the nurse add to the care plan?

a. Fatigue
b. Ineffective coping
c. Activity intolerance
d. Decreased cardiac output

Answer 19

ANS: C

You consider nursing diagnoses of Activity intolerance or Fatigue in a patient who reports being tired and weak. Further review of assessed defining characteristics (e.g., abnormal heart rate and verbal report of weakness and the assessment findings occurring during the activity of climbing the stairs) leads to the definitive diagnosis (Activity intolerance). There is no data to support ineffective coping or decreased cardiac output.

Question 20

The patient weighs 450 lbs (204.5 kg) and reports shortness of breath with any exertion. The health care provider has recommended beginning an exercise program. The patient states that she can hardly get out of bed and just cannot do anything around the house. Which nursing diagnosis will the nurse add to the care plan?

a. Activity intolerance related to excessive weight
b. Impaired physical mobility related to bed rest
c. Imbalanced nutrition: less than body requirements
d. Impaired gas exchange related to shortness of breath

Answer 20

ANS: A

In this case, activity intolerance is related to the patient’s excessive weight. The patient is not on bed rest although claims that it is difficult to get out of bed, making this diagnosis inappropriate. Shortness of breath is a symptom, not a cause, of Impaired gas exchange, making this nursing diagnosis ineffective. The patient certainly has an imbalance of nutrition, but it is more than body requirements (obesity).

Question 21

A patient with diabetes mellitus is starting an exercise program. Which types of exercises will the nurse suggest?

a. Low intensity
b. Low to moderate intensity
c. Moderate to high intensity
d. High intensity

Answer 21

ANS: B

Instruct patients diagnosed with diabetes mellitus to perform low- to moderate-intensity exercises, carry a concentrated form of carbohydrates (sugar packets or hard candy), and wear a medical alert bracelet. Low intensity is not beneficial. Moderate to high and high intensity are not recommended for a beginner exercise program.

Question 22

A patient is admitted with a stroke. The outcome of this disorder is uncertain, but the patient is unable to move the right arm and leg. The nurse starts passive range-of-motion (ROM) exercises. Which finding indicates successful goal achievement?

a. Heart rate decreased.
b. Contractures developed.
c. Muscle strength improved.
d. Joint mobility maintained.

Answer 22

ANS: D

When patients cannot participate in active ROM, maintain joint mobility and prevent contractures by implementing passive ROM into the plan of care. Exercise and active ROM can improve muscle strength. ROM is not performed for the heart but for the joints.

Question 23

A nurse is assessing a patient with activity intolerance for possible orthostatic hypotension. Which finding will help confirm orthostatic hypotension?

a. Blood pressure sitting 120/64; blood pressure 140/70 standing
b. Blood pressure sitting 126/64; blood pressure 120/58 standing
c. Blood pressure sitting 130/60; blood pressure 110/60 standing
d. Blood pressure sitting 140/60; blood pressure 130/54 standing

Answer 23

ANS: C

Orthostatic hypotension results in a drop of 20 mm Hg systolic or more in blood pressure when rising from sitting position (110/60). 120 to 140 means the blood pressure increased rather than dropped. 126 to 120 is only a six points’ difference. 140 to 130 is only a 10 points’ difference.

Question 24

The nurse is teaching a patient how to use a cane. Which information will the nurse include in the teaching session?

a. Place the cane at the top of the hip bone.
b. Place the cane on the stronger side of the body.
c. Place the cane in front of the body and then move the good leg.
d. Place the cane 10 to 15 inches in front of the body when walking.

Answer 24

ANS: B

Have the patient keep the cane on the stronger side of the body. A person’s cane length is equal to the distance between the greater trochanter and the floor. The cane should be moved first and then the weaker leg. 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 weaker leg is then moved forward to the cane, so body weight is divided between the cane and the stronger leg.

Question 25

A nurse is assisting the patient to perform isometric exercises. Which action will the nurse take?

a. Encourage wearing tight shoes.
b. Set the pace for the exercise session.
c. Stop the exercise if pain is experienced.
d. Force muscles or joints to go just beyond resistance.

Answer 25

ANS: C

Instruct the patient to stop the activity if pain, fatigue, or discomfort is experienced. Assess for pain, shortness of breath, or a change in vital signs; if present, stop the exercise. Let each patient move at his or her own pace. Assess for joint limitations, and do not force a muscle or a joint during exercise. Teach patient to wear comfortable shoes and clothing for exercise.

Question 26

The nurse is developing a plan of care for a patient diagnosed with activity intolerance. Which strategy will the nurse use to provide the best chance of maintaining patient compliance?

a. Performing 20 minutes of aerobic exercise 7 days a week with 10-minute warm-up and cool-down periods
b. Instructing the patient to use an exercise log to record day, time, duration, and responses to exercise activity
c. Stressing the harm of not exercising by getting the patient to take responsibility for current health status
d. Arranging for the patient to join a gym that takes self-pay rather than insurance

Answer 26

ANS: B

Keeping a log may increase adherence to an exercise prescription. Recommended frequency of aerobic exercise is 3 to 5 times per week or every other day for approximately 30 minutes. Focusing on the harm of not exercising is usually counterproductive. Instead, the nurse should instruct the patient about the physiological benefits of a regular exercise program. Developing a plan of exercise that the patient may perform at home may improve compliance.

Question 27

The nurse is preparing to transfer an uncooperative patient who does not have upper body strength. Which piece of equipment will be best for the nurses to obtain?

a. Drawsheet
b. Full body sling
c. Overhead trapeze
d. Friction-reducing slide sheet

Answer 27

ANS: B

Using a mechanical lift and full body sling to transfer an uncooperative patient who can bear partial weight or a patient who cannot bear weight and is either uncooperative or does not have upper body strength to move from bed to chair prevents musculoskeletal injuries to health care workers. The nurse should not attempt to move the patient with a drawsheet. The patient does not have upper body strength so an overhead trapeze is not appropriate. A friction-reducing slide sheet that minimizes shearing forces is not as effective as a full body sling.

Question 28

The nurse is teaching a patient how to sit with crutches. In which order will the nurse present the instructions starting with the first step?

1. Place both crutches in one hand.
2. Grasp arm of chair with free hand.
3. Completely lower self into chair.
4. Transfer weight to crutches and unaffected leg.
   a. 4, 1, 2, 3
   b. 1, 4, 2, 3
   c. 1, 2, 4, 3
   d. 4, 2, 1, 3

Answer 28

ANS: B

A patient is sitting in a chair with crutches. Both crutches are held in one hand. The patient then transfers weight to the crutches and the unaffected leg. Next, the patient grasps the arm of the chair with the free hand and begins to lower self into chair. Finally, the patient completely lowers self into chair.

Question 29

The nurse is caring for a group of patients. Which patient will the nurse see first?

a. A patient with chronic obstructive pulmonary disease doing stretching exercises
b. A patient with diabetes mellitus carrying hard candy while doing exercises
c. A patient with a heart attack doing isometric exercises
d. A patient with hypertension doing Tai Chi exercises

Answer 29

ANS: C

The nurse must see the myocardial infarction patient first to stop this type of exercise. It is important to understand the energy expenditure (increased respiratory rate and increased work on the heart) associated with isometric exercises because the exercises are sometimes contraindicated in certain patients’ illnesses (e.g., myocardial infarction or chronic obstructive pulmonary disease). All the rest are appropriate. Stretching exercises are beneficial for patients with chronic obstructive pulmonary disease. Also instruct patients to perform low- to moderate-intensity exercises, carry a concentrated form of carbohydrates (sugar packets or hard candy), and wear a medical alert bracelet. The effect of a Tai Chi exercise program has demonstrated a significant reduction in systolic and diastolic blood pressures.

Question 30

A nurse is preparing to move a patient who is able to assist. Which principles will the nurse consider when planning for safe patient handling? (Select all that apply.)

a. Keep the body’s center of gravity high.
b. Face the direction of the movement.
c. Keep the base of support narrow.
d. Use the under-axilla technique.
e. Use proper body mechanics.
f. Use arms and legs.

Answer 30

ANS: B, E, F

When a patient is able to assist, remember the following principles: The wider the base of support, the greater the stability of the nurse; the lower the center of gravity, the greater the stability of the nurse; facing the direction of movement prevents abnormal twisting of the spine. The use of assistive equipment and continued use of proper body mechanics significantly reduces the risk of musculoskeletal injuries. Use arms and legs (not back) because the leg muscles are stronger, larger muscles capable of greater work without injury. The under-axilla technique is physically stressful for nurses and uncomfortable for patients.

Question 31

A nurse is assessing activity tolerance of a patient. Which areas will the nurse assess? (Select all that apply.)

a. Skeletal abnormalities
b. Emotional factors
c. Pregnancy status
d. Race
e. Age

Answer 31

ANS: A, B, C, E

Physiological, emotional, and developmental factors (age) influence the patient’s activity tolerance. Factors influencing activity tolerance include physiological factors such as skeletal abnormalities, emotional factors such as anxiety/depression, developmental factors such as age and gender, and pregnancy status. Race is not a factor because people of all races are faced with similar factors that affect their activity tolerance.

Question 32

A nurse is working in a facility that uses no-lift policies. Which benefits will the nurse observe in the facility? (Select all that apply.)

a. Reduced number of work-related injuries
b. Increased musculoskeletal accidents
c. Reduced safety of patients
d. Improved health of nurses
e. Increased indirect costs

Answer 32

ANS: A, D

Implementing evidence-based interventions and programs (e.g., lift teams) reduces the number of work-related injuries, which improves the health of the nurse and reduces indirect costs to the health care facility (e.g., workers’ compensation and replacing injured workers). Knowing the movements and functions of muscles in maintaining posture and movement and implementing evidence-based knowledge about safe patient handling are essential to protecting the safety of both the patient and the nurse.

Question 33

A nurse writes the following outcomes for a patient who has chronic obstructive pulmonary disease to improve activity level: Diastolic blood pressure will remain below 70 mm Hg with systolic below 130 mm Hg. Resting heart rate will range between 65 and 75. The last goal is that the patient will exercise 3 times a week. Which evaluative findings indicate successful goal achievement? (Select all that apply.)

a. Resting heart rate 70
b. Blood pressure 126/64
c. Blood pressure 140/90
d. Reports doing stretching and flexibility exercises 2 times this week
e. Reports doing resistive training 1 time and aerobics 2 times this week

Answer 33

ANS: A, B, E

Compare actual outcomes with expected outcomes to determine the patient’s health status and progression. Heart rate of 70 is between 65 and 75. Blood pressure 126/64 meets the goal. Did resistive training 1 time and aerobics 2 times equals exercising 3 times a week. Did stretching and flexibility exercises 2 times is below the 3 times a week. Blood pressure 140/90 is too high and does not meet the goal.