Question 1

Who must be notified immediately of physical or drug-induced restraints used for a patient?
A) The patient's family and physical therapist
B) The patient's occupational and physical therapists
C) The patient's case manager and nurses
D) The patient's attending physician

Accepted Answer

The attending physician must be notified as soon as possible if he or she did not order the restraint or seclusion.These orders are good for no longer than 4 hours for adults,2 hours for those ages 9-17,and 1 hour for children under age 9.The total time limit of an order is 24 hours,after which time a new order may be prescribed.

Question 2

Which areas of the side-lying patient are at greatest risk for pressure sores?
A) Sternum, iliac crests, patellae, and lateral ears
B) Lateral ears, lateral ribs, greater trochanters, and humeral epicondyles
C) Occipital tuberosity, transverse processes of vertebrae, sacrum, and heels
D) Forehead, spines of the scapulae, lesser trochanters, and fibular heads

Accepted Answer

The areas of greatest pressure when the patient is in a side-lying position are the lowermost lateral ear,lateral ribs,lateral acromion process,lateral head of the humerus,medial or lateral epicondyles of the humerus,greater trochanter of the femur,lateral condyle of the femur,malleolus of the fibula,medial condyle of the femur,and malleolus of the tibia if the uppermost lower extremity is positioned directly over the lowermost.

Question 3

Which position is most detrimental to a patient with a transfemoral amputation?
A) Prolonged trunk extension
B) Prolonged hip adduction
C) Prolonged hip extension
D) Prolonged hip flexion

Accepted Answer

For the patient with a transfemoral amputation,prolonged hip flexion (e.g.,from placement of a pillow under the residual limb of a supine patient)should be avoided.This position promotes the development of a contracture of the patient's hip flexor muscles.If those muscles become contracted,the patient is likely to experience difficulty using a prosthetic for ambulation.

Question 4

What activity is especially important for a patient with rheumatoid arthritis unless the joints are in a state of acute inflammation?
A) Resistance training for all joints
B) Forceful and frequent passive stretching of the involved joints
C) Prolonged immobilization
D) Gentle and frequent active or passive movement of the involved joints

Accepted Answer

Prolonged immobilization of the affected extremity joints should be avoided in a patient with rheumatoid arthritis,particularly joints maintained in flexion.Gentle,careful,and frequent active or passive movement of the involved joints should be performed several times per day unless the joints are in a state of acute inflammation.The uninvolved joints should be exercised actively.

Question 5

Following a total hip replacement,what device is often used for proper positioning?
A) An adduction pillow to prevent excessive hip adduction
B) A continuous passive motion machine
C) Lateral towel rolls to maintain hip adduction
D) A full-length leg cast

Accepted Answer

For the patient who has undergone a total hip replacement,the affected limb must be restricted from excessive hip adduction,rotation,and flexion.An adduction pillow can be used to prevent excessive adduction,and a wedge or rolled towel will assist in preventing excessive hip rotation.

Question 6

Which positions are most detrimental to a patient with a transtibial amputation?
A) Prolonged hip and knee extension
B) Prolonged hip and trunk extension
C) Prolonged hip and knee flexion
D) Prolonged hip adduction and knee extension

Accepted Answer

For the patient with a transtibial amputation,prolonged hip and knee flexion (as with placement of a pillow under the residual limb of a supine patient)should be avoided.This position promotes the development of a contracture of the patient's hip flexor and knee flexor muscles.If these muscles become contracted,the patient will experience difficulty using a prosthetic for ambulation.

Question 7

What information should a caregiver provide a patient before draping techniques are performed?
A) The planned treatment
B) The specific position in which the person is to be treated
C) The specific application of the linen items, gown, robe, or other clothing desired
D) All of the above

Accepted Answer

Before treatment,the caregiver should inform the patient that clothing may need to be removed and why such removal is necessary.The patient should be told how the body will be protected by linen or substitute garments.Additionally,the patient should be informed about the appropriate treatment position to maintain the usefulness of the draping.

Question 8

Which positions of the involved lower extremity are most detrimental to a patient with hemiplegia?
A) Prolonged hip extension and internal rotation, and ankle dorsiflexion
B) Prolonged hip flexion and internal rotation, and knee extension
C) Prolonged hip flexion and external rotation, and ankle plantarflexion
D) Prolonged hip extension and external rotation, and ankle dorsiflexion

Accepted Answer

When a patient's lower extremity is involved,prolonged hip and knee flexion,hip external rotation,and ankle plantarflexion and inversion should be avoided.These positions are those most likely to lead to soft tissue contractures caused by muscle spasticity,reduced function of the opposing muscle,and lack of active motion.

Question 9

Which areas of a supine patient are at greatest risk for pressure sores?
A) Occipital tuberosity, spines of the scapula, sacrum, and heels
B) Acromions, lateral epicondyles, anterior iliac crests, and metatarsal heads
C) Posterior iliac crests, mandibular condyles, patellae, and medial malleoli
D) Inferior angles of the scapula, tibial tubercle, and transverse processes of the vertebrae

Accepted Answer

The areas of greatest pressure when the patient is supine are the occipital tuberosity,spine and inferior angle of the scapula,spinous processes of the vertebrae,olecranon process,posterior iliac crests,sacrum,and posterior calcaneus.Other possible pressure areas,depending on how the patient is positioned,are the medial epicondyle of the humerus,head of the fibula,greater trochanter of the hip,and lateral malleolus if excessive external rotation of the hip occurs.

Question 10

Which positions of the involved upper extremity are most detrimental to a patient with hemiplegia?
A) Prolonged shoulder adduction and internal rotation, and elbow flexion
B) Prolonged shoulder abduction and internal rotation, and elbow extension
C) Prolonged shoulder adduction and external rotation, and elbow flexion
D) Prolonged shoulder abduction and external rotation, and elbow extension

Accepted Answer

When the patient's upper extremity is involved,the following should be avoided: prolonged shoulder adduction and internal rotation; elbow flexion; forearm supination or pronation; wrist,finger,or thumb flexion; and finger and thumb adduction.These positions,although possibly ones of comfort,are the most likely to lead to soft tissue contractures caused by muscle spasticity,reduced function of the opposing muscles,and lack of active motion.

Question 11

In general,how frequently should a dependent patient's positioned be changed?
A) At least every 2 hours
B) At least every 4 hours
C) Twice per day
D) Once per day

Accepted Answer

Frequent changes in the dependent patient's position,at least every 2 hours,are necessary to prevent contractures and relieve pressure to the skin,subcutaneous tissue,and the circulatory,neural,respiratory,and lymphatic systems,as well as other structures.

Question 12

Which area of pillow placement is most likely to contribute to a contracture of the hamstring muscles in the prone patient?
A) Anterior to the thighs
B) Anterior to the abdomen
C) Posterior to the knees
D) Anterior to the ankles

Accepted Answer

The use of a pillow under the anterior portion of the patient's ankles will relieve stress on the hamstring muscles and feet and will allow the pelvis and lower back to relax.However,a pillow placed anterior to the ankles will cause knee flexion and may contribute to a contracture of the hamstring muscles.To avoid the development of a contracture,this position should not be maintained for a prolonged period.

Question 13

Which areas are especially prone to pressure sores in a patient who is wheelchair dependent?
A) The mandible and knees
B) Acromions and dorsal surfaces of the feet
C) Ischial tuberosities and olecranon processes
D) Tibial tubercles and the occiput

Accepted Answer

Wheelchair-bound patients who sit for long periods of time need appropriate seating surfaces that safely reduce pressure while providing adequate support and stability.Areas at particularly high risk to the seated person include ischial tuberosities,olecranon processes,the back of the knees if resting against the seat,and the heels and feet.

Question 14

Concerning burned or grafted burn areas,what should be avoided?
A) Positions of comfort
B) Positions of mild stress or tension to the wound or graft
C) Frequent position changes
D) Active motion of the involved joints

Accepted Answer

It is important to avoid prolonged positioning of the joints that have been affected by the burn or graft used to repair the wound.It is particularly important to avoid positions of comfort.A position of comfort for the patient with a burn is the position that does not produce stress or tension to the wound or graft.Moreover,the patient should be encouraged to perform gentle,careful,and frequent movement of the involved joints and should exercise the uninvolved joints.

Question 15

Why is patient draping important?
A) To provide for the modesty of the patient
B) To maintain appropriate body temperature
C) To provide access to areas to be treated while protecting other areas
D) All of the above

Accepted Answer

The primary reasons to appropriately drape or clothe a patient are to expose or free an area to be treated; provide for modesty; maintain a comfortable body temperature; and protect the skin and clothing from becoming soiled or damaged.

Question 16

What is a potential adverse effect of the placement of a small bolster behind the knees of a supine patient?
A) Quadriceps and hip extensor contractures
B) Erector spinae and ankle dorsiflexor contractures
C) Iliopsoas and hamstring contractures
D) Hip adductor and extensor contractures

Accepted Answer

A small pillow or bolster can be placed behind the knees to relieve lumbar lordosis and promote comfort in the supine patient.However,this position should not be maintained for a prolonged period because the item behind the knees will encourage hip and knee flexion and may contribute to lower extremity contractures of the iliopsoas (hip flexor)and hamstring (knee flexor)muscles.

Question 17

Following a total knee replacement,in what position is it important to keep the affected extremity at rest?
A) Knee flexion
B) Knee extension
C) Hip flexion
D) Hip extension

Accepted Answer

For the patient who has had a total knee replacement,it is important to keep the affected knee in extension.This is not a comfortable position for the patient initially,but it will enhance future restoration of motion.

Question 18

Which exercises would help a patient bound to a wheelchair alleviate pressure on the ischial tuberosities?
A) Biceps curls and knee extensions
B) Wheelchair push-ups and weight shifts
C) Ankle pumps and neck curls
D) Trunk extension isometrics

Accepted Answer

Patients who have good upper body strength should be taught to do wheelchair push-ups to alleviate pressure on the ischial tuberosities.Leaning side to side to alleviate ischial tuberosity pressure is another option if the patient is unable to perform push-ups from the arm supports.

Question 19

If a supine patient has a flaccid upper extremity,how should the hand be positioned?
A) Below the heart
B) Above the elbow
C) Near the side of the body
D) Palm up

Accepted Answer

If a patient has a flaccid upper extremity,the hand should be placed higher than the elbow to prevent dependent edema.

Question 20

Which areas of a prone patient are at greatest risk for pressure sores?
A) Occipital tuberosity, sternum, sacrum, and heels
B) Dorsum of the feet, spines of the scapulae, patellae, and spinous processes of the vertebrae
C) Acromion processes, forehead, crests of the tibias, and dorsum of the feet
D) Ears, greater trochanters, ischial tuberosities, and heels

Accepted Answer

The areas of greatest pressure when the patient is prone are the forehead or lateral ear,tip of the acromion process,anterior head of the humerus,sternum,antero-superior iliac spine,patella,crest of the tibia,and dorsum of the foot.

Quiz 5: Positioning and Draping

Who must be notified immediately of physical or drug-induced restraints used for a patient?

Which areas of the side-lying patient are at greatest risk for pressure sores?

Which position is most detrimental to a patient with a transfemoral amputation?

What activity is especially important for a patient with rheumatoid arthritis unless the joints are in a state of acute inflammation?

Following a total hip replacement,what device is often used for proper positioning?

Which positions are most detrimental to a patient with a transtibial amputation?

What information should a caregiver provide a patient before draping techniques are performed?

Which positions of the involved lower extremity are most detrimental to a patient with hemiplegia?

Which areas of a supine patient are at greatest risk for pressure sores?

Which positions of the involved upper extremity are most detrimental to a patient with hemiplegia?

In general,how frequently should a dependent patient's positioned be changed?

Which area of pillow placement is most likely to contribute to a contracture of the hamstring muscles in the prone patient?

Which areas are especially prone to pressure sores in a patient who is wheelchair dependent?

Concerning burned or grafted burn areas,what should be avoided?

Why is patient draping important?

What is a potential adverse effect of the placement of a small bolster behind the knees of a supine patient?

Following a total knee replacement,in what position is it important to keep the affected extremity at rest?

Which exercises would help a patient bound to a wheelchair alleviate pressure on the ischial tuberosities?

If a supine patient has a flaccid upper extremity,how should the hand be positioned?

Which areas of a prone patient are at greatest risk for pressure sores?