Chapter 10: Exercise and Ambulation

Chapter 10: Exercise and Ambulation

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The patient has been admitted for hypertension. His blood pressure is normally in the 160/90 range. He has been on bed rest for the past few days, and the doctor has started him on a new blood pressure medication. The nurse is assisting the patient to move from the bed to the chair for breakfast, but when the patient tries to sit up on the side of the bed, he complains of being dizzy and nauseous. The nurse lays the patient down and takes his vital signs. His pulse is 124. His blood pressure is 130/80. This blood pressure is indicative of what?

ANS:  B

Orthostatic hypotension is a drop in blood pressure that occurs when the patient changes from a horizontal to a vertical position. It traditionally is defined as a drop in systolic or diastolic blood pressure of 20 or 10 mm Hg, respectively. Those at higher risk are immobilized patients, those undergoing prolonged bed rest, the older adult patient, those receiving antihypertensive medications, and those with chronic illness, such as diabetes mellitus or cardiovascular disease. Signs and symptoms of orthostatic hypotension include dizziness, light-headedness, nausea, tachycardia, pallor, and even fainting. Orthostatic hypertension would be an increase in blood pressure. Physiological changes associated with aging and prolonged bed rest may reduce the effectiveness of the baroreceptors. In these patients, moving to the dangling position may cause a gravity-induced drop in blood pressure; thus, it is recommended to raise the head of the bed and allow a few minutes before dangling.

DIF:    Cognitive Level: Analysis                REF:   Text reference: p. 236

OBJ:   Discuss indications for assisting with ambulation or using devices to assist with ambulation.

TOP:   Orthostatic Hypotension                  KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity

2. The patient is an elderly gentleman who has been on bed rest for the past several days. When getting the patient up, the nurse should:

ANS:  C

Physiological changes associated with aging and prolonged bed rest may influence the effectiveness of the baroreceptors. For these patients, moving to the dangling position may cause a gravity-induced drop in blood pressure; thus, it is recommended to raise the head of the bed and allow a few minutes before dangling. Interventions to minimize orthostatic hypotension include movement of the legs and feet in the dangling position to promote venous return via intermittent contraction and relaxation of the skeletal leg muscles, and asking the patient to take several deep breaths before and during dangling. Dangling a patient before standing is an intermediate step that allows assessment of the individual before changing positions to maintain safety and prevent injury to the patient.

DIF:    Cognitive Level: Application           REF:   Text reference: p. 236

OBJ:   Discuss indications for assisting with ambulation or using devices to assist with ambulation.

TOP:   Dangling        KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity

3. An appropriate technique for the nurse to use when performing range of motion (ROM) exercises is to:

ANS:  A

Each movement should be repeated five times during an exercise period. Be sure that ROM exercises are performed slowly and gently. When performing active-assisted or passive ROM exercises, support the joint by holding the distal portion of the extremity, or by using a cupped hand to support the joint. Discontinue exercise if the patient complains of discomfort, or if you note resistance or muscle spasm.

DIF:    Cognitive Level: Application           REF:   Text reference: p. 223

OBJ:   Demonstrate the following skills on selected patients: assisting with ambulation, assisting with ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric exercises, applying a CPM, and applying elastic stockings and SCD.

TOP:   Range of Motion                             KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity

4. A patient is admitted to the medical unit following a cerebrovascular accident (CVA). Evidence of left-sided hemiparesis is noted, and the nurse will be following up on ROM and other exercises performed in physical therapy. The nurse should correctly teach the patient and family members which of the following principles of ROM exercises?

ANS:  D

When performing active-assisted or passive ROM exercises, support the joint by holding the distal portion of the extremity, or by using a cupped hand to support the joint. The joint should be flexed to the point of resistance, not to the point of discomfort. Assess the patient’s level of comfort (on a scale of 0 to 10, with 10 being the worst pain) before performing exercises. Before beginning ROM exercises, determine whether the patient would benefit from pain medication. Joints should be moved slowly through the ROM. Quick movement could cause injury.

DIF:    Cognitive Level: Application           REF:   Text reference: p. 222

OBJ:   Demonstrate the following skills on selected patients: assisting with ambulation, assisting with ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric exercises, applying a CPM, and applying elastic stockings and SCD.

TOP:   Range of Motion                             KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity

5. A nurse should be concerned when observing a patient performing isometric exercises if the patient is:

ANS:  A

Patients doing isometric exercises should be taught to exhale while exerting effort. Many persons hold their breath (Valsalva maneuver), which increases intrathoracic pressure, causing a decrease in venous return to the heart. Each exercise prescription is individualized according to the patient’s needs and limitations. Gradual buildup of exercise repetitions improves both muscle strength and endurance. Hold the muscles tightly contracted for 5 to 15 seconds, and then relax completely for several seconds.

DIF:    Cognitive Level: Application           REF:   Text reference: p. 228

OBJ:   Demonstrate the following skills on selected patients: assisting with ambulation, assisting with ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric exercises, applying a CPM, and applying elastic stockings and SCD.

TOP:   Isometric Exercises                         KEY:  Nursing Process Step: Evaluation

MSC:  NCLEX: Physiological Integrity