NSG 3130 — Fundamentals II
Chapter 28: Activity, Immobility, and Safe Movement
Clinical Judgment Practice Test — 28 Questions
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
CHAPTER 28: ACTIVITY, IMMOBILITY, AND SAFE MOVEMENT — Questions 1–28
Q1. A nurse is explaining to a student why a patient with cerebellar disease has difficulty maintaining balance despite normal muscle
strength. Which structures are most directly responsible for equilibrium and balance?
Nervous system control of balance
A. The cerebellum and inner ear, which together maintain balance during movement
B. The skeletal muscles alone, independent of any input from the nervous system
C. The cardiopulmonary system, which supplies oxygen directly to the balance centers
D. The bones of the lower extremities, which bear the body's weight during standing
Q2. A patient has a stroke affecting the right side of the brain. Which finding would the nurse expect based on the neurologic
principle of contralateral motor control?
Contralateral motor control
A. Weakness or paralysis on the right side of the body
B. Weakness or paralysis on the left side of the body
C. Weakness affecting just the lower extremities bilaterally
D. No motor effects, since the right side of the brain does not control movement
Q3. A nurse notes that a patient on prolonged bed rest has developed permanent plantar flexion of the foot that limits the ability to
stand with the foot flat on the ground. What is this finding called, and what is the most effective preventive measure?
Musculoskeletal effects of immobility
A. Disuse osteoporosis, prevented by increasing dietary calcium intake alone
B. A pathologic fracture, prevented by strict bed rest to avoid further injury
C. Footdrop, prevented by using an ankle-foot orthotic, footboard, or high-top shoes
D. Atrophy, prevented by applying heat packs to the affected extremity
Q4. [PRIORITY] A nurse is caring for a patient who has been on strict bed rest for several days following surgery. Understanding
the rate at which immobility affects muscle strength, what should the nurse prioritize?
Rate of muscle strength decline
A. Delaying any activity until the patient specifically requests to get out of bed
B. Assuming muscle strength will not be significantly affected until several weeks of bed rest have passed
C. Focusing exclusively on wound healing while deprioritizing any mobility interventions
D. Encouraging early ambulation and activity as soon as safely possible, since muscle strength declines rapidly with bed
rest
Q5. A nurse is assisting a patient to get out of bed for the first time after several days of bed rest. What is the rationale for having the
patient dangle at the side of the bed before standing?
Dangling before first ambulation
A. Immobility can alter proprioception and equilibrium, so dangling helps prevent injury before standing
B. Dangling is done purely for the patient's comfort and has no relationship to fall prevention
C. Dangling is needed just for patients who report feeling energetic and ready to walk
D. Dangling should be skipped for efficiency if the patient was ambulatory before the current illness
, Q6. A nurse checks a patient's blood pressure and pulse when the patient moves from lying to standing for the first time after a period
of bed rest. Which finding meets the criteria for orthostatic hypotension?
Orthostatic hypotension criteria
A. A drop in systolic blood pressure of 5 mm Hg upon standing
B. A drop in systolic blood pressure of 20 mm Hg upon standing
C. An increase in heart rate of 5 beats per minute upon standing
D. A rise in diastolic blood pressure of 10 mm Hg upon standing
Q7. [EXCEPT] A new nurse describes several methods for assessing a patient for deep vein thrombosis (DVT). All of the following
are appropriate, current practices EXCEPT:
DVT assessment misconceptions
A. Assessing for warmth, redness, swelling, or pain in an extremity and considering an ultrasound if present
B. Completing a thorough peripheral vascular assessment, including pulses and capillary refill
C. Using the Homans' sign (calf pain with knee flexion and foot dorsiflexion) as a reliable diagnostic method for DVT
D. Monitoring for edema and determining whether it is pitting or nonpitting
Q8. A nurse is assessing a patient on prolonged bed rest for skin breakdown. What is the underlying mechanism of pressure injury
development, and which areas are at greatest risk?
Pressure injury risk
A. Excess moisture alone causing skin breakdown, with risk concentrated just in skin folds
B. Allergic reaction to bed linens, with risk concentrated on the anterior trunk
C. Nutritional deficiency alone, with risk equally distributed across the entire body surface
D. Prolonged ischemia from pressure over bony prominences, with risk greatest at the buttocks, coccyx, heels, and hips
Q9. A nurse assesses a patient on bed rest and notes decreased bowel sounds on auscultation in all four quadrants along with
infrequent bowel movements. What is the most likely explanation for this finding, and what should the nurse monitor?
GI effects of immobility
A. Hypomotility of the GI tract from inactivity, requiring monitoring of fiber and fluid intake
B. A normal expected finding requiring no further monitoring or intervention
C. An allergic reaction to the patient's current medications requiring immediate discontinuation
D. A sign of impending renal failure unrelated to gastrointestinal function
Q10. A nurse is caring for a patient on bed rest and recognizes an increased risk for urinary tract infection and renal calculi. What is
the physiologic explanation for this increased risk?
GU effects of immobility
A. Increased fluid intake causing dilution of urine and subsequent infection risk
B. Urinary stasis from the dependent bladder position, combined with calcium excretion from bone resorption
C. Overactivity of the bladder muscle from excessive movement during bed rest
D. A direct effect of dietary protein restriction unrelated to positioning or bone changes
Q11. A patient who has been immobile for an extended period reports feeling lonely and anxious and appears to have limited
interaction with the environment. What is the most likely explanation for this presentation?
Psychosocial effects of immobility
A. A normal, expected reaction unrelated to the patient's immobility that requires no further assessment
B. A side effect exclusively caused by the patient's prescribed pain medication
C. Sensory deprivation and isolation resulting from limited ability to ambulate and interact with others
D. An unrelated preexisting personality trait that immobility has not influenced
Q12. A nurse understands that immobility can lead to a negative nitrogen balance in a patient with insufficient dietary protein. What
is the underlying mechanism, and what should the nurse monitor?
Nutrition and immobility
A. Increased basal metabolic rate leads to excess protein synthesis, so the nurse should monitor for weight gain just
B. Immobility has no effect on metabolism or nitrogen balance, so no specific monitoring is needed
C. Increased physical activity during bed rest leads to excessive protein breakdown unrelated to metabolic rate
D. Decreased basal metabolic rate leads to catabolism of muscle protein, so monitor nutrition and serum albumin
Chapter 28: Activity, Immobility, and Safe Movement
Clinical Judgment Practice Test — 28 Questions
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
CHAPTER 28: ACTIVITY, IMMOBILITY, AND SAFE MOVEMENT — Questions 1–28
Q1. A nurse is explaining to a student why a patient with cerebellar disease has difficulty maintaining balance despite normal muscle
strength. Which structures are most directly responsible for equilibrium and balance?
Nervous system control of balance
A. The cerebellum and inner ear, which together maintain balance during movement
B. The skeletal muscles alone, independent of any input from the nervous system
C. The cardiopulmonary system, which supplies oxygen directly to the balance centers
D. The bones of the lower extremities, which bear the body's weight during standing
Q2. A patient has a stroke affecting the right side of the brain. Which finding would the nurse expect based on the neurologic
principle of contralateral motor control?
Contralateral motor control
A. Weakness or paralysis on the right side of the body
B. Weakness or paralysis on the left side of the body
C. Weakness affecting just the lower extremities bilaterally
D. No motor effects, since the right side of the brain does not control movement
Q3. A nurse notes that a patient on prolonged bed rest has developed permanent plantar flexion of the foot that limits the ability to
stand with the foot flat on the ground. What is this finding called, and what is the most effective preventive measure?
Musculoskeletal effects of immobility
A. Disuse osteoporosis, prevented by increasing dietary calcium intake alone
B. A pathologic fracture, prevented by strict bed rest to avoid further injury
C. Footdrop, prevented by using an ankle-foot orthotic, footboard, or high-top shoes
D. Atrophy, prevented by applying heat packs to the affected extremity
Q4. [PRIORITY] A nurse is caring for a patient who has been on strict bed rest for several days following surgery. Understanding
the rate at which immobility affects muscle strength, what should the nurse prioritize?
Rate of muscle strength decline
A. Delaying any activity until the patient specifically requests to get out of bed
B. Assuming muscle strength will not be significantly affected until several weeks of bed rest have passed
C. Focusing exclusively on wound healing while deprioritizing any mobility interventions
D. Encouraging early ambulation and activity as soon as safely possible, since muscle strength declines rapidly with bed
rest
Q5. A nurse is assisting a patient to get out of bed for the first time after several days of bed rest. What is the rationale for having the
patient dangle at the side of the bed before standing?
Dangling before first ambulation
A. Immobility can alter proprioception and equilibrium, so dangling helps prevent injury before standing
B. Dangling is done purely for the patient's comfort and has no relationship to fall prevention
C. Dangling is needed just for patients who report feeling energetic and ready to walk
D. Dangling should be skipped for efficiency if the patient was ambulatory before the current illness
, Q6. A nurse checks a patient's blood pressure and pulse when the patient moves from lying to standing for the first time after a period
of bed rest. Which finding meets the criteria for orthostatic hypotension?
Orthostatic hypotension criteria
A. A drop in systolic blood pressure of 5 mm Hg upon standing
B. A drop in systolic blood pressure of 20 mm Hg upon standing
C. An increase in heart rate of 5 beats per minute upon standing
D. A rise in diastolic blood pressure of 10 mm Hg upon standing
Q7. [EXCEPT] A new nurse describes several methods for assessing a patient for deep vein thrombosis (DVT). All of the following
are appropriate, current practices EXCEPT:
DVT assessment misconceptions
A. Assessing for warmth, redness, swelling, or pain in an extremity and considering an ultrasound if present
B. Completing a thorough peripheral vascular assessment, including pulses and capillary refill
C. Using the Homans' sign (calf pain with knee flexion and foot dorsiflexion) as a reliable diagnostic method for DVT
D. Monitoring for edema and determining whether it is pitting or nonpitting
Q8. A nurse is assessing a patient on prolonged bed rest for skin breakdown. What is the underlying mechanism of pressure injury
development, and which areas are at greatest risk?
Pressure injury risk
A. Excess moisture alone causing skin breakdown, with risk concentrated just in skin folds
B. Allergic reaction to bed linens, with risk concentrated on the anterior trunk
C. Nutritional deficiency alone, with risk equally distributed across the entire body surface
D. Prolonged ischemia from pressure over bony prominences, with risk greatest at the buttocks, coccyx, heels, and hips
Q9. A nurse assesses a patient on bed rest and notes decreased bowel sounds on auscultation in all four quadrants along with
infrequent bowel movements. What is the most likely explanation for this finding, and what should the nurse monitor?
GI effects of immobility
A. Hypomotility of the GI tract from inactivity, requiring monitoring of fiber and fluid intake
B. A normal expected finding requiring no further monitoring or intervention
C. An allergic reaction to the patient's current medications requiring immediate discontinuation
D. A sign of impending renal failure unrelated to gastrointestinal function
Q10. A nurse is caring for a patient on bed rest and recognizes an increased risk for urinary tract infection and renal calculi. What is
the physiologic explanation for this increased risk?
GU effects of immobility
A. Increased fluid intake causing dilution of urine and subsequent infection risk
B. Urinary stasis from the dependent bladder position, combined with calcium excretion from bone resorption
C. Overactivity of the bladder muscle from excessive movement during bed rest
D. A direct effect of dietary protein restriction unrelated to positioning or bone changes
Q11. A patient who has been immobile for an extended period reports feeling lonely and anxious and appears to have limited
interaction with the environment. What is the most likely explanation for this presentation?
Psychosocial effects of immobility
A. A normal, expected reaction unrelated to the patient's immobility that requires no further assessment
B. A side effect exclusively caused by the patient's prescribed pain medication
C. Sensory deprivation and isolation resulting from limited ability to ambulate and interact with others
D. An unrelated preexisting personality trait that immobility has not influenced
Q12. A nurse understands that immobility can lead to a negative nitrogen balance in a patient with insufficient dietary protein. What
is the underlying mechanism, and what should the nurse monitor?
Nutrition and immobility
A. Increased basal metabolic rate leads to excess protein synthesis, so the nurse should monitor for weight gain just
B. Immobility has no effect on metabolism or nitrogen balance, so no specific monitoring is needed
C. Increased physical activity during bed rest leads to excessive protein breakdown unrelated to metabolic rate
D. Decreased basal metabolic rate leads to catabolism of muscle protein, so monitor nutrition and serum albumin
