RNSG 1430 Mobility questions with verified answers
. A client who was in a car accident and broke his femur has been immobilized for
5 days. When the nurse gets this client out of bed for the first time, a nursing
diagnosis related to the safety of this client will be:
A. Pain
B. Impaired skin integrity
C. Altered tissue perfusion
D. Risk for activity intolerance Ans✓✓✓ D
Risk for activity intolerance
Rationale-
Being on bed rest limit cardiac function, moving the client from a lying or supine
position to an upright position will require an immediate cardiac workload,
increase oxygen demand and will cause your patient to be short of breath and
exhibit an intolerance to activity. If you get your client up to fast, without allowing
time for positional changes to their cardiac system- the risk of falls increases.
. The nurse is caring for a client who has right-sided weakness. The nurse needs to
help the client walk. What should the nurse do while walking with the client?
A. Hold the client's left hand while walking
B. Hold the client's right hand while walking
C. Put a gait belt on the client and provide support on the left side
D. Put a gait belt on the client and provide support on the right side Ans✓✓✓ D
Put a gait belt on the client and provide support on the right side
Rationale:
With right-sided weakness this is the side that needs support during ambulation,
transfers, etc.
,6 P's Ans✓✓✓ Pain
Pressure increased in compartment
Paresthesia (numbness/tingling)
Pallor
Paralysis
Pulselessness
A client is admitted to the rehab unit following a Right total hip replacement
(THR). The client is 3 days post-op. Doctor order states: activity is weight bearing
as tolerated with assistance. Which nursing intervention should be implemented?
A. Assisting the client to get out of bed on the left side so the client can stand to
use the urinal
B. Assisting the client using a gait belt to the commode
C. Log rolling client on the right side to assist the client out of bed
D. Assisting the client to the bathroom, which has grab bars , an elevated toilet
seat, using a walker, and partial weight bearing of the right leg. Ans✓✓✓ D
Assisting the client to the bathroom, which has grab bars,elevated toilet seat,
using a walker, and partial weight bearing of the right leg.
Rationale: on the second day post-op your patient should be up and walking with
a walker and have doctor orders that stipulating weight bearing restrictions. An
elevated toilet seat is used to prevent hip flexion of >90 degrees when the client
sits.
A client is diagnosed with osteoarthritis (OA), tells a clinic nurse about the
inability to ambulate and staying on bed rest because of hip stiffness. In addition
to teaching the client measures to reduce joint stiffness, which referral for the
client should the nurse plan to discuss with the health care provider?
, A. Social worker
B. Occupational therapy
C. Arthritis Foundation
D. Physical Therapy Ans✓✓✓ D
Physical Therapist- rationale:
The P.T. can assist the client in adopting self-management strategies and teach
isometric, postural, and other exercises that prevent joint overuse.
ANTECEDENTS (What Must Occur for Mobility) Ans✓✓✓ Adequate Energy
Muscle Strength
Underlying Skeletal Stability
Joint Function
Neuromuscular Coordination
Age
Arthroplasty Ans✓✓✓ Reconstruction or replacement of a joint to relieve pain,
improve or maintain ROM, and correct deformity. (OA, RA, avascular necrosis,
congenital deformities or dislocations)
Attributes (cont) Ans✓✓✓ -Coordination-the ability to use different parts of the
body together smoothly and efficiently.
-Synchronized Efforts of Musculoskeletal and Nervous Systems occur because
receptors in the muscles send information to the brain regarding the position and
movement of a muscle or group of muscles.
attributes Ans✓✓✓ gross simple movements
. A client who was in a car accident and broke his femur has been immobilized for
5 days. When the nurse gets this client out of bed for the first time, a nursing
diagnosis related to the safety of this client will be:
A. Pain
B. Impaired skin integrity
C. Altered tissue perfusion
D. Risk for activity intolerance Ans✓✓✓ D
Risk for activity intolerance
Rationale-
Being on bed rest limit cardiac function, moving the client from a lying or supine
position to an upright position will require an immediate cardiac workload,
increase oxygen demand and will cause your patient to be short of breath and
exhibit an intolerance to activity. If you get your client up to fast, without allowing
time for positional changes to their cardiac system- the risk of falls increases.
. The nurse is caring for a client who has right-sided weakness. The nurse needs to
help the client walk. What should the nurse do while walking with the client?
A. Hold the client's left hand while walking
B. Hold the client's right hand while walking
C. Put a gait belt on the client and provide support on the left side
D. Put a gait belt on the client and provide support on the right side Ans✓✓✓ D
Put a gait belt on the client and provide support on the right side
Rationale:
With right-sided weakness this is the side that needs support during ambulation,
transfers, etc.
,6 P's Ans✓✓✓ Pain
Pressure increased in compartment
Paresthesia (numbness/tingling)
Pallor
Paralysis
Pulselessness
A client is admitted to the rehab unit following a Right total hip replacement
(THR). The client is 3 days post-op. Doctor order states: activity is weight bearing
as tolerated with assistance. Which nursing intervention should be implemented?
A. Assisting the client to get out of bed on the left side so the client can stand to
use the urinal
B. Assisting the client using a gait belt to the commode
C. Log rolling client on the right side to assist the client out of bed
D. Assisting the client to the bathroom, which has grab bars , an elevated toilet
seat, using a walker, and partial weight bearing of the right leg. Ans✓✓✓ D
Assisting the client to the bathroom, which has grab bars,elevated toilet seat,
using a walker, and partial weight bearing of the right leg.
Rationale: on the second day post-op your patient should be up and walking with
a walker and have doctor orders that stipulating weight bearing restrictions. An
elevated toilet seat is used to prevent hip flexion of >90 degrees when the client
sits.
A client is diagnosed with osteoarthritis (OA), tells a clinic nurse about the
inability to ambulate and staying on bed rest because of hip stiffness. In addition
to teaching the client measures to reduce joint stiffness, which referral for the
client should the nurse plan to discuss with the health care provider?
, A. Social worker
B. Occupational therapy
C. Arthritis Foundation
D. Physical Therapy Ans✓✓✓ D
Physical Therapist- rationale:
The P.T. can assist the client in adopting self-management strategies and teach
isometric, postural, and other exercises that prevent joint overuse.
ANTECEDENTS (What Must Occur for Mobility) Ans✓✓✓ Adequate Energy
Muscle Strength
Underlying Skeletal Stability
Joint Function
Neuromuscular Coordination
Age
Arthroplasty Ans✓✓✓ Reconstruction or replacement of a joint to relieve pain,
improve or maintain ROM, and correct deformity. (OA, RA, avascular necrosis,
congenital deformities or dislocations)
Attributes (cont) Ans✓✓✓ -Coordination-the ability to use different parts of the
body together smoothly and efficiently.
-Synchronized Efforts of Musculoskeletal and Nervous Systems occur because
receptors in the muscles send information to the brain regarding the position and
movement of a muscle or group of muscles.
attributes Ans✓✓✓ gross simple movements
