Activity and Exercise

Question 1

An _ refers to a person’s routine of exercise, activity, leisure, and recreation. It includes (a) activities of daily living (ADLs) that require energy expenditure such as hygiene, dressing, cooking, shopping, eating, working, and home maintenance, and (b) the type, quality, and quantity of exercise, including sports.

Answer 1

activity-exercise pattern

Question 2

_, the ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living.

Answer 2

Mobility

Question 3

_ are the result of an intact musculoskeletal system, an intact nervous system, and intact inner ear structures responsible for equilibrium.

Answer 3

Normal movement and stability

Question 4

Four Basic Elements of Normal Movement

Answer 4

body alignment (posture),
joint mobility,
balance, and
coordinated movement.

Question 5

_ bring body parts into position in a manner that promotes optimal balance and maximal body function whether the client is standing, sitting, or lying down.

Answer 5

Proper body alignment and posture

Question 6

A person maintains balance as long as the _ (an imaginary vertical line drawn through the body’s center of gravity) passes through the _ (the point at which all of the body’s mass is centered) and the _ (the foundation on which the body rests).

Answer 6

line of gravity
center of gravity
base of support

Question 7

_ are the functional units of the musculoskeletal system.

Answer 7

Joints

Question 8

The _ of a joint is the maximum movement that is possible for that joint.

Answer 8

range of motion (ROM)

Question 9

The mechanisms involved in maintaining _ and _ are complex and involve informational inputs from the labyrinth (inner ear), from vision (vestibulo-ocular input), and from stretch receptors of muscles and tendons (vestibulospinal input).

Answer 9

balance
posture

Question 10

_ is the term used to describe awareness of posture, movement, and changes in equilibrium and the knowledge of position, weight, and resistance of objects in relation to the body.

Answer 10

Proprioception

Question 11

_, _, _ is the result of proper functioning of the cerebral cortex, cerebellum, and basal ganglia

Answer 11

Balanced, smooth, purposeful movement

Question 12

Decreasing the angle of the joint (e.g., bending the elbow)

Increasing the angle of the joint (e.g., straightening the arm at the elbow)

Further extension or straightening of a joint (e.g., bending the head backward)

Movement of the bone away from the midline of the body

Movement of the bone toward the midline of the body

Movement of the bone around its central axis

Movement of the distal part of the bone in a circle while the proximal end remains fixed

Turning the sole of the foot outward by moving the ankle joint

Turning the sole of the foot inward by moving the ankle joint

Moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body

Moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body

Answer 12

Flexion
Extension
Hyperextension
Abduction
Adduction
Rotation
Circumduction
Eversion
Inversion
Pronation
Supination

Question 13

FACTORS AFFECTING BODY ALIGNMENT AND ACTIVITY

Answer 13

Growth and Development
Nutrition
Personal Values & Attitudes
External Factors
Prescribed Limitations

Question 14

_ is a condition in which the bones become brittle and fragile due to calcium depletion.

Answer 14

Osteoporosis

Question 15

People participate in _ programs to decrease risk factors for chronic diseases and to increase their health and well-being.

Answer 15

exercise

Question 16

_ is another goal of exercise, and is defined as the ability of the body to perform work.

Answer 16

Functional strength

Question 17

_ is the type and amount of exercise or ADLs an individual is able to perform without experiencing adverse effects.

Answer 17

Activity tolerance

Question 18

Exercise involves the active contraction and relaxation of muscles. Exercises can be classified according to the type of muscle contraction (_, _, or ) and according to the source of energy ( or _).

Answer 18

isotonic, isometric, or isokinetic
aerobic or anaerobic

Question 19

_ are those in which the muscle shortens to produce muscle contraction and active movement.

Answer 19

Isotonic (dynamic) exercises

Question 20

Most physical conditioning exercises—running, walking, swimming, cycling, and other such activities—are _, as are ADLs and active ROM exercises (those initiated by the client).

Answer 20

isotonic

Question 21

_ are those in which muscle contraction occurs without moving the joint (muscle length does not change).

Answer 21

Isometric (static or setting) exercises

Question 22

_ involve muscle contraction or tension against resistance.

Answer 22

Isokinetic (resistive) exercises

Question 23

_ is activity during which the amount of oxygen taken into the body is greater than that used to perform the activity.

Answer 23

Aerobic exercise

Question 24

Intensity of exercise can be measured in three ways:

Answer 24

1. Target heart rate
2. Talk test
3. Borg scale of perceived exertion

Question 25

_ involves activity in which the muscles cannot draw out enough oxygen from the bloodstream, and _ pathways are used to provide additional energy for a short time.

Answer 25

Anaerobic exercise

Question 26

Benefits of Exercise

Answer 26

MUSCULOSKELETAL SYSTEM
CARDIOVASCULAR SYSTEM
RESPIRATORY SYSTEM
GASTROINTESTINAL SYSTEM
METABOLIC/ENDOCRINE SYSTEM
URINARY SYSTEM
IMMUNE SYSTEM
PSYCHONEUROLOGIC SYSTEM
COGNITIVE FUNCTION
SPIRITUAL HEALTH

Question 27

The _, first described by Dr. Herbert Benson, is beneficial for counteracting some of the harmful effects of stress on the body and mind.

Answer 27

relaxation response (RR)

Question 28

The _ refers to holding the breath and straining against a closed glottis.

Answer 28

Valsalva maneuver

Question 29

_ is a common result of immobilization.

Answer 29

Orthostatic hypotension

Question 30

A _ is particularly dangerous if it breaks loose from the vein wall to enter the general circulation as an _ (an object that has moved from its place of origin, causing obstruction to circulation elsewhere).

Answer 30

thrombus (clot)
embolus

Question 31

_ (with too much muscle tone), or _ (without muscle tone).

Answer 31

spastic
flaccid

Question 32

_ (decrease in size)
_ (permanent shortening of the muscle)
_ (permanently immobile)

Answer 32

atrophy
contracture
ankylosed

Question 33

_ (a clot that is loosely attached to an inflamed vein wall)

Answer 33

thrombophlebitis

Question 34

_ (the maximum amount of air that can be exhaled after a maximum inhalation).
_ (the collapse of a lobe or of an entire lung)

Answer 34

vital capacity
atelectasis

Question 35

_ refers to the sum of all the physical and chemical processes by which living substance is formed and maintained and by which energy is made available for use by the body.

Answer 35

Metabolism

Question 36

The _ is the minimal energy expended for the maintenance of these processes, expressed in calories per hour per square meter of body surface.

Answer 36

basal metabolic rate

Question 37

protein synthesis () and
protein breakdown ()

Answer 37

anabolism
catabolism

Question 38

_ (accumulation of urine in the bladder)
_ (involuntary urination)
_ (backward flow)

Answer 38

urinary retention
urinary incontinence
urinary reflux

Question 39

_ (an exaggerated anterior/inward curvature of the lumbar spine)

Answer 39

lordosis

Question 40

The characteristic pattern of a person’s _ is assessed to determine the client’s mobility and risk for injury due to falling.

Answer 40

gait (walk)

Question 41

The nurse may also assess _ (the number of steps taken per minute), which often slows with age and disability.

Answer 41

pace

Question 42

_ (palpable or audible crackling or grating sensation produced by joint motion and frequently experienced in joints that have suffered repeated trauma over time).

Answer 42

Crepitation

Question 43

_ is the term used to describe the efficient, coordinated, and safe use of the body to move objects and carry out the ADLs.

Answer 43

Body mechanics

Question 44

It is important to remember that nurses should not lift more than _ without assistance from proper equipment and/or other individuals.

Answer 44

35 pounds

Question 45

_ is a technique in which the body is turned in a way that avoids twisting of the spine.

Answer 45

Pivoting

Question 46

_, or a _, is a bed position in which the head and trunk are raised 45° to 60° relative to the bed (visualize a 90° right angle to orient your thinking) and the knees may or may not be flexed.

Answer 46

Fowler’s position
semisitting position

Question 47

_ is when the head and trunk are raised 15 to 45 degrees.

Answer 47

Semi-Fowler’s position

Question 48

In _, the head and trunk are raised 60° to 90°, and most often means the client is sitting upright at a right angle to the bed.

Answer 48

high-Fowler’s position

Question 49

In the _, the client sits either in bed or on the side of the bed with an overbed table across the lap

Answer 49

orthopneic position

Question 50

In the _, the client’s head and shoulders are slightly elevated on a small pillow.

Answer 50

dorsal recumbent (back-lying) position

Question 51

_ or _ the head and shoulders are not elevated.

Answer 51

supine or dorsal position

Question 52

In the _, the client lies on the abdomen with the head turned to one side

Answer 52

prone position

Question 53

In the _, the client lies on one side of the body.

Answer 53

lateral (side-lying) position

Question 54

In _, the client assumes a posture halfway between the lateral and the prone positions.

Answer 54

Sims’ (semiprone) position

Question 55

_ are isotonic exercises in which the client moves each joint in the body through its complete range of movement, maximally stretching all muscle groups within each plane over the joint.

Answer 55

Active ROM exercises

Question 56

During _, another person moves each of the client’s joints through its complete range of movement, maximally stretching all muscle groups within each plane over each joint.

Answer 56

passive ROM exercises

Question 57

_ (the act of walking) is a function that most people take for granted. However, when clients are ill they are often confined to bed and are thus nonambulatory.

Answer 57

Ambulation

Question 58

_ is physical activity performed to improve health and maintain fitness.

Answer 58

Exercise

Question 59

To increase stability during client transfer, the nurse increases the base of support by performing which action?
1. Leaning slightly backward
2. Spacing the feet farther apart
3. Tensing the abdominal muscles
4. Bending the knees

Answer 59

1. Answer: 2. Rationale: A key word in the question is base, and the feet provide this foundation. Leaning backward actually decreases balance (option 1), and tensing abdominal muscles alone (option 3) or bending the knees (option 4) does not affect the base of support. Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 44-7.

Question 60

Isotonic exercises such as walking are intended to achieve which of the following? Select all that apply.
1. Increase muscle tone and improve circulation.
2. Increase blood pressure.
3. Increase muscle mass and strength.
4. Decrease heart rate and cardiac output.
5. Maintain joint range of motion.

Answer 60

2. Answer: 1, 3, and 5. Rationale: Isotonic exercise increases muscle tone, mass, and strength, maintains joint flexibility, and improves circulation. During isotonic exercise, both heart rate and cardiac output quicken to increase blood flow to all parts of the body (option 4). Little or no change in blood pressure occurs (option 2). Cognitive Level: Remembering. Client Need: Physiological Integrity. Nursing Process: Planning. Learning Outcome: 44-2.

Question 61

Five minutes after the client’s first postoperative exercise, the client’s vital signs have not yet returned to baseline. Which is an appropriate nursing diagnosis?
1. Activity Intolerance
2. Risk for Activity Intolerance
3. Impaired Physical Mobility
4. Risk for Disuse Syndrome

Answer 61

3. Answer: 1. Rationale: Vital signs that do not return to baseline 5 minutes after exercising indicate intolerance of exercise at that time. This is a real problem, not “at risk for,” as in option 2. There is no evidence that the client requires assistance (impaired mobility, option 3), or is immobile (disuse syndrome, option 4). Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Diagnosis. Learning Outcome: 44-6.

Question 62

Which statement from a client with one weak leg regarding use of crutches when using stairs indicates a need for increased teaching?
1. “Going up, the strong leg goes first, then the weaker leg with both crutches.”
2. “Going down, the weaker leg goes first with both crutches, then the strong leg.”
3. “The weaker leg always goes first with both crutches.”
4. “A cane or single crutch may be used instead of both crutches if held on the weaker side.”

Answer 62

4. Answer: 3. Rationale: Although the crutches (or cane) are always used along with the weaker leg, the weaker leg should go down the stairs first. The stronger leg can support the body as the weaker leg moves forward. All of the other statements are correct. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Evaluation. Learning Outcome: 44-9.

Question 63

When assessing a client’s gait, which does the nurse look for and encourage?
1. The spine rotates, initiating locomotion.
2. Gaze is slightly downward.
3. Toes strike the ground before the heel.
4. Arm on the same side as the swing-through foot moves forward at the same time.

Answer 63

6. Answer: 1. Rationale: Normal gait involves a level gaze, an initial rotation beginning in the spine, heel strike with follow-through to the toes, and opposite arm and leg swinging forward. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 44-5.

Question 64

A nurse is teaching a client about active range-of-motion (ROM) exercises. The nurse then watches the client demonstrate these principles. The nurse would evaluate that teaching was successful when the client does which of the following?
1. Exercises past the point of resistance.
2. Performs each exercise one time.
3. Performs each series of exercises once a day.
4. Uses the same sequence during each exercise session.

Answer 64

5. Answer: 4. Rationale: When the client performs the movements systematically, using the same sequence during each session, the nurse can evaluate that the teaching was understood and is successful. When performing active ROM the client should exercise to the point of slight resistance, but never past that point of resistance in order to prevent further injury (option 1). The client should perform each exercise at least three times, not just once (option 2). The client should perform each series of exercises twice daily, not just once per day (option 3). Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Evaluation. Learning Outcome: 44-8.

Question 65

Performance of activities of daily living (ADLs) and active rangeof-motion (ROM) exercises can be accomplished simultaneously as illustrated by which of the following? Select all that apply.
1. Elbow flexion with eating and bathing
2. Elbow extension with shaving and eating
3. Wrist hyperextension with writing
4. Thumb ROM with eating and writing
5. Hip flexion with walking

Answer 65

7. Answer: 1, 4, and 5. Rationale: Eating and bathing will flex the elbow joint, and grasping and manipulating utensils to eat and write will take the thumb through its normal ROM. Walking flexes the hip. Shaving and eating require elbow flexion, not extension (option 2). Writing brings the fingers toward the inner aspect of the forearm, thus flexing the wrist joint (option 3). Cognitive Level: Applying. Client Need: Health Promotion and Maintenance. Nursing Process: Implementation. Learning Outcome: 44-1.

Question 66

A client weighs 250 pounds and needs to be transferred from the bed to a chair. Which instruction by the nurse to the unlicensed assistive personnel (UAP) is most appropriate?
1. “Using proper body mechanics will prevent you from injuring yourself.”
2. “You are physically fit and at lesser risk for injury when transferring the client.”
3. “Use the mechanical lift and another person to transfer the client from the bed to the chair.”
4. “Use the back belt to avoid hurting your back.”

Answer 66

8. Answer: 3. Rationale: It is prudent for nurses to understand and use proper body mechanics at all times to decrease risk, while keeping in mind the importance of assistive devices and help from other staff. While it is generally accepted that proper body mechanics alone will not prevent injury, many work settings do not yet have “no manual lift” and “no solo lift” policies and resources in place. Cognitive Level: Analyzing. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 44-7.

Question 67

The client is ambulating for the first time after surgery. The client tells the nurse, “I feel faint.” Which is the best action by the nurse?
1. Find another nurse for help.
2. Return the client to her room as quickly as possible.
3. Tell the client to take rapid, shallow breaths.
4. Assist the client to a nearby chair.

Answer 67

9. Answer: 4. Rationale: Placing the client in a safe position is the best maneuver. Leaving the client creates unsafe conditions because the client may faint before being able to return to her room (options 1 and 2). Rapid, shallow breathing (hyperventilation) may increase the dizziness (option 3). Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 44-10g.

Question 68

The nurse is performing an assessment of an immobilized client. Which assessment causes the nurse to take action?
1. Heart rate 86 beats/min
2. Reddened area on sacrum
3. Nonproductive cough
4. Urine output of 50 mL/h10.

Answer 68

Answer: 2. Rationale: The reddened area of the skin can lead to skin breakdown. The other options are within normal limits. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 44-3g.