UNIT XV - Mobility

Question 1

Define Mobility.

Answer 1

The ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living.

Question 2

What are the four basic elements of normal movement?

Answer 2

Body alignment (posture)
Joint mobility
Balance
Coordinated movement

Question 3

Describe Flexion

Answer 3

Decreasing the angle of the joint

e.g. bending the elbow

Question 4

Describe Extension

Answer 4

Increasing the angle of the joint

e.g. straightening the arm at the elbow

Question 5

Describe Hyperextension

Answer 5

Further extension or straightening of a joint.

e.g. bending the head backward

Question 6

What is a contracture?

Answer 6

When the muscle permanently shorten, and the joint becomes fixed in a flexed position.

Question 7

Describe Adbuction

Answer 7

Movement of the bone away from the midline of the body.

Question 8

Describe Adduction

Answer 8

Movement of the bone toward the midline of the body.

Question 9

ATI - Ambulation Module

A nurse is observing an assistive personnel (AP) who is using a mechanical lift with a hammock sling to transfer a patient from the bed to a chair. The nurse should intervene if the AP

A. places the sling under the patient from the shoulders to the knees.
B. leaves the bed in the lowest position throughout the procedure.
C. locks the hydraulic valve before attaching the sling to the lift.
D. raises the head of the bed to a sitting position just before transfer

Answer 9

B. leaves the bed in the lowest position throughout the procedure.

Question 10

ATI - Ambulation Module

A nurse is caring for a hospitalized patient who is performing active range-of-motion exercises. Which of the following body movements should indicate to the nurse the patient has full range of motion of the shoulder?

A. Adducting the arm so that it lies next to the patient’s side.
B. Flexing the should by raising the arm from a side position to a 180º angle.
C. Abducting the arm to a 90º angle from the side of the body.
D. Circumducting the shoulder in a 180º half circle.

Answer 10

B. Flexing the should by raising the arm from a side position to a 180º angle.

Question 11

ATI - Ambulation Module

As a nurse ambulates an unsteady patient, the patient becomes light-headed and begins to fall. Which of the following interventions by the nurse is appropriate in this situation?

A. Wrap both arms around the patient’s arms and shoulders.
B. Move both feet together went he patient begins to fall.
C. Protect the patient’s extremities while lowering him to the floor.
D. Extend one leg and allow the patient to slide down it.

Answer 11

D. Extend one leg and allow the patient to slide down it.

Question 12

ATI - Ambulation Module

A nurse is about to transfer to a chair a patient who has a weak left leg. Which of the following actions by the nurse demonstrates correct transfer technique?

A. Positioning the chair slightly behind the nurse so that the seat faces the patient’s bed.
B. Placing the patient’s left leg in front of her right leg just prior to the transfer.
C. Aligning the nurse’s knees with the patient’s knees just before the transfer.
D. Grasping the patient under the axilla to assist her to her feet.

Answer 12

C. Aligning the nurse’s knees with the patient’s knees just before the transfer.

Question 13

ATI - Ambulation Module

A nurse is performing a physical assessment on a patient and instructs the patient to stand with his feet together and arms at his sides. The purpose of positioning the patient in this manner is to test which of the following?

A. Balance
B. Muscle strength
C. Reflexes
D. Coordination

Answer 13

A. Balance

Question 14

ATI - Ambulation Module

A nurse in the emergency department is caring for a patient who has a knee injury. The patient will be discharged and will be using a pair of axillary crutches for the first time. Which of the following instructions should the nurse include when discharging this patient?

A. Lean on the crutches to support body weight when standing
B. Fully extend arms when holding onto the hand grips.
C. Hold the crutches on the unaffected side when preparing to sit in a chair.
D. Hold the crutches 9 to 12 inches in front of you and to the side of each foot.

Answer 14

C. Hold the crutches on the unaffected side when preparing to sit in a chair.

Question 15

ATI - Ambulation Module

A nurse stands facing a patient to demonstrate active range-of-motion exercises. Which of the following shouyld the nurse do when demonstrating hyperextension of the hip?

A. Move the leg behind the body.
B. Move the leg forward and up.
C. Move the leg medially toward the other leg.
D. Turn the foot and leg away from the other leg.

Answer 15

A. Move the leg behind the body.

Question 16

MyNursingLab - Submodule 2.10 Activity

The nurse encourages nursing staff to practice good body mechanics to:

A. Allow for greater weight lifting
B. Maximize muscle strength
C. Prevent injury
D. Increase endurance

Answer 16

C. Prevent injury

Question 17

MyNursingLab - Submodule 2.10 Activity

Which of the following demonstrates poor body mechanics?

A. Keeping feet apart when moving a client up in bed
B. Holding a heavy object close to the center of the body
C. Keeping knees flexed when lifting an object
D. Bending at the waist when lifting a heavy object

Answer 17

D. Bending at the waist when lifting a heavy object

Question 18

MyNursingLab - Submodule 2.10 Activity

The LPN understands that when caring for clients he or she should exercise good body mechanics. The nurse recognizes which as good body mechanics?

A. Relaxing abdominal muscle when lifting.
B. Moving an object close to one’s body before lifting.
C. Using a narrow base of support.
D. Using a high center of gravity.

Answer 18

B. Moving an object close to one’s body before lifting.

Question 19

MyNursingLab - Submodule 2.10 Activity

The nurse observes the CNA while caring for a client. Which observation of body mechanics should the nurse correct?

A. Using the pelvis as the center of gravity.
B. Bending the knees.
C. Standing with feet close together.
D. Keeping the weight at waist level.

Answer 19

C. Standing with feet close together.

Question 20

MyNursingLab - Submodule 2.10 Activity

A client who is postop after a surgery for a fracture is experiencing pain. The nurse understands that the analgesic should be given:

A. After positioning
B. Before attempting to move the client
C. Just before transferring out of bed
D. Before breakfast

Answer 20

B. Before attempting to move the client

Question 21

MyNursingLab - Submodule 2.10 Activity

A client has weakness in both legs. The nurse instructs the client in the proper use of a walker by telling her to:

A. Lift the walker ahead and step into it
B. Push the walker forward and hop into it
C. Move the walker forward and then step into it
D. LIft up the walker while move the affected leg

Answer 21

C. Move the walker forward and then step into it

Question 22

MyNursingLab - Submodule 2.10 Activity

The nurse is preparing to assist the resident from the bed to the chair. The nurse correctly places his or her feet:

A. Alongside the chair
B. Slightly to the side and in front of the resident
C. Behind the resident
D. In between the resident’s feet

Answer 22

B. Slightly to the side and in front of the resident

Question 23

MyNursingLab - Submodule 2.10 Activity

The nurse instructs the CNA on active range-of-motion exercises. These exercises are:

A. Those that the client does unassisted
B. Those that the PT department performs with the client
C. The type that the nurse assists the client in performing
D. Performed only out of bed

Answer 23

A. Those that the client does unassisted

Question 24

MyNursingLab - Submodule 2.10 Activity

The nurse is correct when he or she tells the client needing a cane to:

A. Hold the cane on the weak side
B. Move the good leg forward, then move the cane and affected leg together
C. Move the cane forward, then the affected leg
D. Move the cane and the good leg together

Answer 24

B. Move the good leg forward, then move the cane and affected leg together

Question 25

MyNursingLab - Submodule 2.10 Activity The nurse can expect that, following knee replacement surgery, the client may have an order for which of the following equipment to help speed his recovery? A. CPRM (continuous passive range of motion) machine B. Nasogastric suction C. Foley catheter D. Nasal oxygen

Answer 25

A. CPRM (continuous passive range of motion) machine

Question 26

MyNursingLab - Submodule 2.10 Activity The nurse understands that when ambulating a client with hemiplegia the nurse should: A. Stand in back of the client in case he or she should fall B. Stand on the affected side and the hold the client's hand C. Stand on the affected side and support the client around the waist and upper arm D. Stand on the unaffected side and hold the client's arm

Answer 26

C. Stand on the affected side and support the client around the waist and upper arm

Question 27

MyNursingLab - Submodule 2.10 Activity The nurse helps the feeble client to maintain flexibility by performing: A. Isometric exercises B. Passive ROM exercises C. Resistance exercises D. Isotonic exercises

Answer 27

B. Passive ROM exercises

Question 28

MyNursingLab - Submodule 2.10 Activity The nurse understands that before dangling the client for the first time he or she should: A. Raise the head of the bed to a sitting position B. Offer the client a drink of water C. Place the bed at a comfortable work height D. LIft the person to a sitting position

Answer 28

A. Raise the head of the bed to a sitting position

Question 29

MyNursingLab - Submodule 2.10 Activity The nurse understands that the rationale for turning a client at least q2h is to: A. Permit assessment of skin B. Make sure skin is dry C. Provide massage to area D. Relieve pressure on body tissue.

Answer 29

D. Relieve pressure on body tissue.

Question 30

ATI Fundamentals Book - Chapter 40 A nurse is caring fora client who has been sitting in a chair for 3 hr. Which of the following is the client at risk for developing? A. Stasis of secretions B. Muscle atrophy C. Pressure ulcer D. Fecal impaction

Answer 30

C. Pressure ulcer

Question 31

ATI Fundamentals Book - Chapter 40 Which of the following nursing interventions should be implemented to maintain a patent airway in a client on bed rest? A. Perform isometric exercises B. Suction q8h C. Give low-dose heparin D. Teach to use an incentive spirometer while awake

Answer 31

D. Teach to use an incentive spirometer while awake

Question 32

ATI Fundamentals Book - Chapter 40 Which of the following nursing interventions reduce the risk of thrombus development? (Select all that apply.) A. Teach the client not use the Valsalva maneuver B. Apply elastic stockings C. Review laboratory values for total protein level D. Place pillows under the client's knees and lower extremities E. Assist the client to change position often.

Answer 32

B. Apply elastic stockings | E. Assist the client to change position often.

Question 33

ATI Fundamentals Book - Chapter 40 Which of the following clients would benefit from the application of cold? (Select all that apply) ``` A. A client who has a sprained ankle B. A client who has Raynaud's phenomenon C. A client who just had knee anthroplasty D. A client who has a toothache E. A client who has a nosebleed ```

Answer 33

C. A client who just had knee anthroplasty D. A client who has a toothache E. A client who has a nosebleed

Question 34

ATI Fundamentals Book - Chapter 40 Sequential compression devices are used to A. prevent pressure ulcers. B. promote venous return. C. prevent muscular atrophy. D. increase joint mobility

Answer 34

B. promote venous return.

Question 35

ATI Fundamentals Book - Chapter 40 Identify the order in which the following steps of elastic stocking application should be completed. __ Perform hand hygiene __ Smooth any creases or wrinkles __ Pull the remainder of the stocking over the client's heel and on up his leg __ Turn the stockings inside to the heel. __ Assess the condition of the client's skin and the circulation of his legs. __ Put the stocking on the client's foot __ Measure the client's calf and/or thigh circumference and length of the leg, and select the correct size stocking

Answer 35

1 Perform hand hygiene 7 Smooth any creases or wrinkles 4 Pull the remainder of the stocking over the client's heel and on up his leg 6 Turn the stockings inside to the heel. 2 Assess the condition of the client's skin and the circulation of his legs. 5 Put the stocking on the client's foot 3 Measure the client's calf and/or thigh circumference and length of the leg, and select the correct size stocking

Question 36

Berman Workbook - Chapter 31 How do nurses prevent the complications of immobility? A. Get clients out of bed q shift B. Identify clients at risk. C. Assess activity level D. Record baseline data

Answer 36

B. Identify clients at risk.

Question 37

Berman Workbook - Chapter 31 What is the term used to describe the efficient, coordinated, and safe use of the body to move objects and carry out the activities of daily living? A. Body mechanics B. Ambulating C. Mobility D. Repositioning

Answer 37

A. Body mechanics

Question 38

Berman Workbook - Chapter 31 How does a person enlarge the base of support? A. Bend the knees. B. Move the front foot forward. C. Keep the item close to the body D. Use the thigh muscles.

Answer 38

B. Move the front foot forward.

Question 39

Berman Workbook - Chapter 31 What is the position of choice for people who have difficulty breathing and for some people with heart problems? A. Supine B. Prone C. Trendelenburg's D. Fowler's

Answer 39

D. Fowler's

Question 40

Berman Workbook - Chapter 31 What position may not be recommended for people iwth problems of the cervical or lumbar spine? A. Supine B. Prone C. Side-lying D. Fowler's

Answer 40

B. Prone

Question 41

Berman Textbook - Chapter 31 To increase stability during client transfer, the nurse increases the base of support by performing which of the following? A. Leaning slightly backward B. Spacing the feet farther apart C. Tensing the abdominal muscles D. Bending the knees

Answer 41

B. Spacing the feet farther apart

Question 42

Berman Textbook - Chapter 31 The nurse promotes isotonic exercises such as walking in order to achieve which of the following? Select all that apply. A. Increase muscle tone and improve circulation B. Increase blood pressure C. Increase muscle mass and strength D. Decrease heart rate and cardiac output E. Maintain joint range of motion

Answer 42

A. Increase muscle tone and improve circulation C. Increase muscle mass and strength E. Maintain joint range of motion

Question 43

Berman Textbook - Chapter 31 Five minutes after the client's first postoperative exercise, the client's vital signs have not yet returned to baseline. An appropriate nursing diagnosis might be A. Activity Intolerance B. Risk for Activity Intolerance C. Impaired Physical Mobility D. Risk for Disuse Syndrome

Answer 43

A. Activity Intolerance

Question 44

Berman Textbook - Chapter 31 The client is ambulating for the first time after surgery. The client tells the nurse, "I feel faint." The best action by the nurse includes which of the following? A. Find another nurse to help. B. Return the client t her room as quickly as possible. C. Tell the client to take rapid, shallow breaths. D. Assist the client to nearby chair.

Answer 44

D. Assist the client to nearby chair.

Question 45

Berman Textbook - Chapter 31 The nurse is performing an assessment of an immobilized client. Which of the following assessments causes the nurse to take action? A. Heart rate 86 B. Reddened area on sacrum C. Non productive cough D. Urine output of 50 mL/hr

Answer 45

B. Reddened area on sacrum