what is the best nursing intervention for a client with limited mobility who cannot move independently

ATI RN

Multi Dimensional Care | Final Exam

1. What is the best nursing intervention for a client with limited mobility who cannot move independently?

A. Passive range of motion
B. Pillows for positioning
C. Active range of motion
D. Continuous passive motion

Correct answer: A

Rationale: The best nursing intervention for a client with limited mobility who cannot move independently is passive range of motion. Passive range of motion exercises help maintain joint flexibility, prevent contractures, and improve circulation in immobile clients. Choice B, pillows for positioning, may provide comfort but does not address the need for joint movement. Choice C, active range of motion, requires the client's active participation, which is not feasible for someone with limited mobility. Choice D, continuous passive motion, is more commonly used in rehabilitation settings for specific joints and is not typically the primary intervention for overall limited mobility.

2. The nurse is preparing communication for a provider. The client is experiencing acute pain greater than the severity of the fracture. Distal to the injury, he is experiencing a 'pins and needles' sensation. The pulse is weak and thready but is bounding on all unaffected extremities. What emergent condition does the nurse suspect?

A. Ischial tuberosity
B. Compartment syndrome
C. Broken arm syndrome
D. Pulmonary embolism

Correct answer: B

Rationale:

3. Unlicensed assistive personnel (UAP) is assisting a client in traction. Which of these actions requires immediate intervention?

A. The unlicensed assistive personnel carefully lower the traction weights to hang freely
B. The unlicensed assistive personnel provides small pillows to cushion the unaffected extremities
C. The UAP carefully empties the indwelling catheter bag
D. The UAP shows the client how to use the call light

Correct answer: A

Rationale: The correct answer is A because traction weights should hang freely to maintain their effectiveness. Choice B is incorrect because providing pillows to cushion unaffected extremities is appropriate. Choice C is also incorrect as emptying the catheter bag is a routine nursing task. Choice D is incorrect as teaching the client to use the call light promotes client safety.

4. A client has sustained an open fracture. What nursing intervention will best prevent osteomyelitis in this client?

A. Delegate all client personal care to specific unlicensed assistive personnel
B. Place the client in contact precautions
C. Proper hand hygiene
D. Administer pain medication

Correct answer: C

Rationale: Proper hand hygiene is crucial in preventing infections such as osteomyelitis in clients with open fractures. Keeping the hands clean helps reduce the risk of introducing harmful pathogens to the wound site. Delegating all client personal care to specific unlicensed assistive personnel (Choice A) is not appropriate as direct involvement in wound care is essential in preventing infections. Placing the client in contact precautions (Choice B) is not directly related to preventing osteomyelitis in this context. Administering pain medication (Choice D) is important for managing the client's pain but does not directly address the prevention of osteomyelitis.