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Exam (elaborations)

ATI SM 3.0: Mobility | with latest questions and answers 2023

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ATI SM 3.0: Mobility | with latest questions and answers 2023 A nurse in an emergency department is providing discharge teaching to a client who has a knee injury and will be using a pair of axillary crutches for the first time. Which of the following instructions should the nurse include? A. "Lean on the crutches to support your body weight when standing." B. "Fully extend your arms when holding onto the hand grips." C. "Hold the crutches on your unaffected side when preparing to sit in a chair." D. "Hold the crutches 9 inches in front of and to the side of each foot." - C. "Hold the crutches on your unaffected side when preparing to sit in a chair." Rationale: The crutches should be held on the unaffected side when preparing to sit in a chair. Incorrect rationale: - crutches should be fitted so the client's arms are flexed ~ 30° at elbows when holding onto hand grips. - crutches should be held 6 inches in front of & to side of each foot to assist w/ balance A nurse stands facing a client to demonstrate active range-of-motion exercises. Which of the following actions should the nurse take to demonstrate hyperextension of the hip? A. Move their leg behind their body. B. Move their leg forward and up. C. Move their leg medially toward their other leg. D. Turn their foot and leg away from their other leg. - A. Move their leg behind their body. Rationale: This movement demonstrates hyperextension of the hip. B. flexion C. adduction D. external rotation A nurse is caring for a client who has a prescription for knee-length antiembolic stockings. Which of the following actions should the nurse take? A. Place the stockings on the client after the client ambulates to the restroom. B. Ensure the client's toes are visible after placing the stockings on the client. C. After applying the stockings, place two fingers between the client's leg and stocking to check the fit. D. Measure the client's calf circumference and leg length from heel to knee. - D. Measure the client's calf circumference and leg length from heel to knee. Rationale: To ensure proper fit, the nurse should measure the widest part of the client's calf as well as the length of client's leg from heel to knee. Antiembolic stockings that are too large will not apply the pressure needed to prevent DVT. Antiembolic stockings that are too small could impair circulation in the client's legs. A nurse is assisting with the ambulation of a client who becomes light-headed and begins to fall. Which of the following actions should the nurse take?

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ATI SM 3.0: Mobility

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