Question 1

Which joint would the nurse pronate when performing range of motion on the hospitalized client?&#10;A)Neck&#10;B)Knee&#10;C)Elbow&#10;D)Finger&#10;

Accepted Answer

Pronation refers to the inward rotation of the forearm, which occurs at the elbow joint. Therefore, the nurse would pronate the client's elbow joint when performing range of motion exercises. None of the other joints listed involve pronation.

Question 2

The nurse is performing passive range of motion on the client and notes that the client's ankle is red,edematous,and painful to the touch.Which action by the nurse is the most appropriate?&#10;A)Perform range of motion very gently to the ankle.&#10;B)Perform normal range of motion to the ankle.&#10;C)Skip range of motion in this joint and move on to the next joints.&#10;D)Notify the health care provider before performing range of motion to this joint.&#10;

Accepted Answer

The redness, edema, and pain suggest possible inflammation or injury to the ankle joint. The nurse should notify the healthcare provider before performing any range of motion on the affected joint. This will ensure that the provider can assess the situation and make appropriate recommendations for treatment or further evaluation.

Question 3

The nurse caring for several clients could safely delegate which task to the unlicensed assistive personnel (UAP)?&#10;A)Initial application of the continuous positive motion (CPM)device to the postoperative client&#10;B)Assessment of client's tolerance for passive range of motion&#10;C)Documentation of joint improvement resulting from active range of motion&#10;D)Performance of passive range of motion to client experiencing a CVA 2 weeks ago&#10;

Accepted Answer

The performance of passive range of motion to a client experiencing a CVA 2 weeks ago can be safely delegated to the UAP as long as they have been trained and approved to perform this task. The other tasks require nursing judgment and assessment, which are outside the scope of practice for the UAP.

Question 4

The nurse educator is discussing the use of the continuous passive motion mechanical (CPM)device for hospitalized clients.Based on recent evidence,which clients may benefit from the use of CPM during hospitalization or the rehabilitation process?

A)Adult clients recovering from joint surgery
B)Older adult clients recovering after a stroke
C)Newborn clients receiving phototherapy
D)Adolescent clients receiving pharmacotherapy for acne
E)Clients in labor prior to delivery

Accepted Answer

Continuous passive motion (CPM) devices have been shown to be beneficial for clients recovering from joint surgery and older adult clients recovering after a stroke. The use of CPM devices for newborn clients receiving phototherapy, adolescent clients receiving pharmacotherapy for acne or clients in labor prior to delivery is not supported by recent evidence.

Question 5

The nurse assesses the client after being on the CPM for 2 hours.When documenting in the medical record for this client,which item does the nurse exclude from the documentation?&#10;A)Degree of flexion and extension&#10;B)Analgesia administered prior to starting the CPM&#10;C)Speed&#10;D)Duration of therapy and client tolerance&#10;

Accepted Answer

Analgesia administered prior to starting the CPM is not relevant to the assessment of the client's condition after being on the machine for two hours. The degree of flexion and extension, speed, duration of therapy and client tolerance would all be important information to document.

Question 6

Which joint will the nurse circumduct when performing range of motion on the hospitalized client?&#10;A)Neck&#10;B)Shoulder&#10;C)Foot&#10;D)Knee&#10;

Accepted Answer

Circumduction is a movement that involves the combination of flexion, extension, abduction, and adduction. The shoulder joint is the only joint listed that can perform circumduction.

Question 7

The nurse is delegating the performance of passive range of motion to the unlicensed assistive personnel (UAP).For which client would it not be appropriate to delegate this task to the UAP?&#10;A)Client who has been a quadriplegic for 3 years&#10;B)Unconscious client following excision of a brain tumor 2 days ago&#10;C)Client in rehabilitation center recovering from a CVA&#10;D)Client in a chronic vegetative state following a motor vehicle crash&#10;

Accepted Answer

Passive range of motion should not be delegated to UAP for an unconscious client because the client cannot communicate discomfort or pain during the procedure.

Question 8

The nurse observes the client performing range of motion exercises by using the strong arm to help the weaker arm move through the motions.When documenting this activity,which terms will the nurse use?

A)Active range of motion
B)Active-assistive range of motion
C)Passive range of motion
D)Continuous passive range of motion

Accepted Answer

The nurse observed the client using their strong arm to assist the weaker arm during range of motion exercises, which is referred to as active-assistive range of motion. Active range of motion is when the client is able to independently move their limb through the desired range of motion. Passive range of motion is when the nurse or therapist moves the client's limb without any assistance from the client. Continuous passive range of motion involves a machine that moves the client's limb through a specific range of motion.

Question 9

Which instrument does the nurse use to measure the arc or range of motion of a joint?&#10;A)Audiometer&#10;B)Goniometer&#10;C)Voltmeter&#10;D)Measuring tape and compass&#10;

Accepted Answer

A goniometer is the instrument used to measure the arc or range of motion of a joint.

Question 10

The nurse is applying the continuous passive motion (CPM)device to a postoperative client for the first time.Which flexion and extension settings are appropriate for this client?&#10;A)30&#176; flexion and 15&#176; extension&#10;B)15&#176; flexion and 40&#176; extension&#10;C)10&#176; flexion and 5&#176; extension&#10;D)20&#176; flexion and 20&#176; extension&#10;

Accepted Answer

The answer of The nurse is applying the continuous passive...

Question 11

The nurse identifies which anticipated outcomes of using a continuous passive motion mechanical device on the postoperative client?&#10;A)The client experiences decreased edema in the joint.&#10;B)The client does not accumulate blood in the joint.&#10;C)The client experiences decreased pain in the joint.&#10;D)The client has no or reduced scar tissue formation in the joint.&#10;E)The client is able to get out of bed quickly after surgery.&#10;

Accepted Answer

The answer of The nurse identifies which anticipated outcomes of...

Question 12

Which client would the nurse anticipate benefitting from continuous passive motion devices?&#10;A)The unconscious client&#10;B)The quadriplegic client&#10;C)The client who is confined to bed rest while in traction&#10;D)The postoperative client who had total knee replacement&#10;

Accepted Answer

The answer of Which client would the nurse anticipate benefitting...

Question 13

The nurse teaches the immobilized client range of motion to improve muscle strength,endurance,and to help maintain cardiorespiratory function.Which activity is not appropriate for the nurse to include in the teaching session?

A)Active range of motion
B)Passive range of motion
C)Active-assistive range of motion
D)Active or active-assistive range of motion

Accepted Answer

The answer of The nurse teaches the immobilized client range...

Deck 13: Maintaining Joint Mobility