Nokea
What is the term for range of motion (ROM) when it is performed by the patient?
- A. Assisted
- B. Passive
- C. Active
- D. Coordinated
Correct Answer: C
Rationale: ROM performed actively by the patient is designated as active ROM.
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What implementation might the nurse use to improve safety during a transfer?
- A. Weighing the patient first
- B. Using a transfer belt
- C. Putting shoes on the patient
- D. Supporting a flaccid arm
Correct Answer: B
Rationale: As a general rule, the nurse should use a transfer belt.
Acute ____ syndrome occurs in the extremities especially the legs where a sheath of inelastic fascia partitions blood vessel nerve and muscle tissue.
Correct Answer: compartment
Rationale: Acute compartment syndrome occurs in the extremities, especially the legs, where a sheath of inelastic fascia partitions blood vessel, nerve, and muscle tissue.
The nurse receives a patient from the recovery room following total hip replacement surgery. What will the nurse include when assessing neurovascular status on this patient?
- A. Pupils
- B. Pain
- C. Sensation
- D. Color
- E. Skin temperature
Correct Answer: B,C,D,E
Rationale: One of the responsibilities of the nurse is to frequently monitor the patient's neurovascular function, or circulation, movement, and sensation (CMS) assessment. The LPN/LVN checks for skin color, temperature, movement, sensation, pulses, capillary refill, and pain. Pupil assessment is part of a neurologic assessment.
The LPN/LVN assists a patient into the semi-Fowler's position per health care provider order. What would indicate that this patient is in the correct position?
- A. Patient is leaning over the bedside table
- B. Head of bed is at a 30-degree angle
- C. Knee is drawn toward the chest
- D. Arms are flexed toward the head
Correct Answer: B
Rationale: The semi-Fowler's position is when the head of the bed is raised approximately 30 degrees. Orthopneic position is when the patient is leaning over the bedside table. Sims position is when the knee is drawn toward the chest. Arms are not flexed toward the head in the semi-Fowler's position.
A nurse instructs an unlicensed assistive personnel about moving older adult patients in bed. When should the nurse intervene when observing the unlicensed assistive personnel perform a return demonstration?
- A. The unlicensed assistive personnel is using simple language.
- B. The unlicensed assistive personnel is avoiding jerky movements.
- C. The unlicensed assistive personnel is avoiding sudden movements.
- D. The unlicensed assistive personnel is pulling the patient across bed linens.
Correct Answer: D
Rationale: The skin of older adults is more fragile and susceptible to injury. When moving or transferring older adults, it is essential to avoid pulling them across bed linens because this may cause shearing or tearing of the skin. The nurse should explain each step in simple language and avoid jerky, sudden movements.