Mobility in Context Principles of Patient

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Chapter 8: Transferring Dependent Patients

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Which of the following is most strongly related to injuries sustained when assisting patients?
A. The age and weight of the person completing the transfer
B. The diagnosis of the patient being transferred
C. The number of repetitions of the task completed by the person
D. Unexpected changes in the patient’s position during the transfer
____ 2. Which of the following maneuvers is considered to be the most physically stressful to the caregiver?
A. Transferring a patient from bathtub to chair
B. Transferring a patient from bed to chair
C. Transferring a patient from chair to bed
D. Transferring a patient from chair to toilet
____ 3. Which of the following patient situations is the best indication for a zero-lift transfer?
A. The patient requires a level 3 transfer that does not involve a teaching component.
B. The patient requires level 0 transfer assistance and has lower-extremity weight-bearing
restrictions.
C. The patient requires level 1 transfer assistance because of occasional loss of balance.
D. The patient requires level 1 transfer assistance and weighs more than 250 lbs.
____ 4. You are a therapist working in home health care. Your patient is a 23-year-old man who recently sustained a
spinal cord injury resulting in complete paralysis below the level of his upper chest. His family is having
significant difficulty transferring him between the bed and the chair. Which of the following should you
primarily consider when making recommendations to his family about transfer methods?
A. The age of the persons assisting the patient with the transfer
B. The amount of help the patient requires for the transfer
C. The height of the surfaces involved in the transfers
D. The number of steps leading into the house
____ 5. Your patient is a 47-year-old man with good upper-body strength and poor lower-extremity strength. He
weighs 385 lbs. and has just had surgery to repair a fractured left ankle. He also has a groin wound that
requires wound care. He is currently nonweight-bearing on the left lower extremity and needs to get out of the
bed for wound care. Which of the following is the most appropriate response regarding this patient’s transfer?
A. Borrow a lift that is rated for 400 lbs. from the acute care unit and complete the transfer by
yourself.
B. Defer the transfer because you do not have the appropriate equipment and do the wound
care with the patient remaining in the bed.
C. Use the lift you have in your department that has a weight limit of 350 lbs. and get an aide
to help you.
D. Obtain the assistance of two or three other people and assist the patient in performing a
lateral transfer using a bariatric transfer board.
____ 6. Your patient is an 88-year-old man who underwent left total hip arthroplasty (using a posterior approach) 3
weeks ago because of severe joint degeneration. After his surgery he developed pneumonia. He is recovering
and does not have weight-bearing restrictions, but he continues to demonstrate generalized weakness. You are
going to transfer him from the bed to a bedside chair using a total body lift. Which of the following is the best
method for positioning the lift sling underneath him?
 A. Ask the patient to use both legs to bridge the hips with assistance as necessary while you
slide the sling under him.
B. Ask the patient to lean forward into long-sitting and then place the sling behind his back.
C. Ask the patient to roll onto his left side, place the sling under his hips, and have him roll
back into supine.
D. Ask the patient to roll onto his right side, place the sling under his hips, and have him roll
back into supine.
____ 7. You have transferred a patient out of bed using a total body lift with a sling. You have positioned the patient
in a bedside chair and plan to return in 1 hr to assist the patient back into bed. Which of the following choices
is the best way to manage the sling upon the completion of this transfer?
A. Leave the sling under the patient, making sure to eliminate any wrinkles in the sling.
B. Place a sheet between the patient and the sling so you can keep the patient dry.
C. Place a sheet in the chair so you can use it to transfer the patient back into bed.
D. Remove the sling and replace it when you return to transfer the patient back into bed.
____ 8. Which of the following is true of a sit-to-stand lift?
A. The sit-to-stand lift equipment does not include a foot plate.
B. The sling for the sit-to-stand lift supports only the upper body.
C. The sling for the sit-to-stand lift supports only the lower body.
D. The sling for the sit-to-stand lift is typically applied with the patient in a supine position.
____ 9. Which of the following patients would be the best candidate for use of a sit-to-stand lift?
A. A 49-year-old man with multiple leg fractures and a full-leg cast
B. A 57-year-old woman who is able to comply with her right lower-extremity partial
weight-bearing restriction
C. A 62-year-old woman who has had a stroke and requires maximum assistance to maintain
static sitting balance
D. A 73-year-old man with severe dementia
____ 10. Which of the following is involved in the setup for a sit-to-stand lift transfer?
A. The anterior aspects of the patient’s lower legs are placed in contact with the leg pads.
B. The lower seam of the sling is placed at the patient’s gluteal fold.
C. The patient places both hands in his or her lap to avoid injury during the lift.
D. The patient’s knees are positioned in approximately 45° flexion.
____ 11. Your patient is a 48-year-old woman who fractured her pelvis when she fell off a porch. You have been using
a sit-to-stand lift to transfer her between the bed and the chair. You would like to work with her on standing
tolerance. Which of the following would be your best option for accomplishing this goal?
A. Enlist the assistance of another clinician to help you block the patient’s knees while the
patient maintains a standing position for increasing lengths of time.
B. Have the patient sit at the edge of the bed and encourage her to push to standing while you
block her knees for stability.
C. Transfer her to standing in the sit-to-stand lift and work on standing tolerance in the
device.
D. Wait until she can transfer out of bed independently and then work on standing tolerance
with a walker.
____ 12. Which of the following statements regarding the use of lateral transfer devices for supine patient transfers is
true?
A. During lateral transfers, the patient typically slides across the transfer device.
B. Most lateral transfer devices rely on pulling forces rather than on pushing forces.
 C. Shearing on the skin is an unavoidable consequence of a dependent lateral transfer.
D. All lateral transfer devices require the assistance of four people.
____ 13. You are performing a lateral transfer of your patient from the bed to a stretcher in the ICU. No one is
available to assist you with the transfer, but you do have an air cushion transfer device. Where should you
position yourself for the safest transfer once the device is in place?
A. At the foot of the device so that you can have maximum control of it
B. At the head of the device so you can protect the patient’s head
C. On the far side of the stretcher, positioned at the patient’s trunk
D. Beside the bed, positioned at the patient’s trunk
____ 14. Which of the following positions creates the greatest risk of injury to the clinician during a lateral supine
transfer requiring the assistance of two or more people?
A. Standing at the patient’s feet with nothing obstructing the lateral movement
B. Standing at the patient’s head with nothing obstructing the lateral movement
C. Standing beside the patient and leaning forward as the patient is moved laterally
D. Standing beside the patient and moving onto the transfer surface as the patient is moved
laterally
____ 15. When transferring a supine patient using a lateral transfer device, which of the following maneuvers should
always be avoided?
A. Lifting a patient with the device
B. Performing the transfer by yourself
C. Transferring between slightly uneven surfaces
D. Transferring patients heavier than 300 lbs.
____ 16. Which of the following lateral transfer devices is particularly well-suited for use with patients with
integumentary problems?
A. Air-assisted devices
B. Patient rollers
C. Semirigid transfer boards
D. Slippery sheets
____ 17. Which of the following is appropriate when repositioning a patient who has slid down toward the foot of the
bed?
A. Lowering the overall height of the bed before repositioning the patient
B. Elevating the head of the bed 30° prior to repositioning the patient
C. Positioning yourself at the head of the bed, grasping the top edge of the draw sheet, and
pulling the patient up
D. Positioning yourself beside the bed in a semilunge stance
____ 18. Which of the following items is generally not advised for repositioning of the seated patient?
A. Friction-reducing sheet
B. Sit-to-stand lift
C. Rigid transfer board
D. Total body lift
____ 19. You are about to transfer a patient who weighs 348 lbs. from the bed to a gurney. Which of the following is
the most appropriate method of transferring this patient?
A. Securing the assistance of one additional person and moving the patient laterally in one
swift motion
B. Securing the assistance of two additional people and moving the patient laterally in one
swift motion
 C. Securing the assistance of two additional people and moving the patient laterally in a
series of small motions
D. Securing the assistance of three additional people and moving the patient in two motions

Short Answer

1. Describe the Trendelenburg position.

____________________.

2. List three things you must consider when positioning a sling for a dependent transfer.
____________________

3. ____________________ is the branch of medicine concerned with the management of obesity and allied
illnesses.

True/False
Indicate whether the statement is true or false.

____ 1. The use of friction-reducing devices to perform lateral patient transfers is recommended because it eliminates
the risk of injury to the clinician performing the transfer.

____ 2. “Super obesity” is defined as a body mass index (BMI) of 30 kg/m2.

Chapter 8: Transferring Dependent Patients
Answer Section

MULTIPLE CHOICE

1. ANS: C
With proper equipment, the size of the person completing the transfer should not be the primary issue. The
patient’s diagnosis and unexpected changes in the patient’s position may increase the risk of injury, but the
number of times the person repeats the activity is more highly correlated with risk of injury.

PTS: 1
2. ANS: D
Of the transfers listed, the transfer from chair to toilet is the most difficult, followed by chair to bed, bed to
chair, and bathtub to chair.

PTS: 1
3. ANS: A
Zero-lift transfers are better suited to dependent patient transfers (levels 3 and 4) than to minimum assistance
transfers. If an objective of the transfer is to teach the patient how to perform the activity independently, a
manual transfer is typically more appropriate. Zero lifts are not always indicated for patients with
weight-bearing restrictions, and weight alone does not determine the need for a zero-lift transfer.

PTS: 1
4. ANS: B
The amount of assistance the patient requires to complete the transfer will be your primary consideration. The
ability of the person assisting with the transfer is important, but that cannot be determined solely on the basis
of the person’s age. The height of the surfaces can affect the choice of assistance methods, but the patient’s
abilities are more important. The number of steps leading into the house does not affect the bed-to-chair
transfers.

PTS: 1
5. ANS: D
Because this patient has good upper-body strength, he is likely to be able to participate in a lateral transfer
with the use of an appropriately rated transfer board without bearing weight on his left lower extremity or
relying on the strength of his right lower extremity. This method, which requires the assistance of more than
one person, is the only safe option that allows the patient to receive the necessary wound care. The transfer
should never be performed using equipment that is not rated for the patient’s weight, and a transfer using a
bariatric lift is best performed with at least two people.

PTS: 1
6. ANS: A
Leaning forward into long-sitting can result in excess hip flexion, a violation of one of the total hip
arthroplasty precautions. Similarly, sidelying is generally contraindicated for patients after total hip
arthroplasty. Lying on the left side places pressure on the patient’s surgical side, and lying on the right side
allows the left hip to move into adduction. Bridging is the best choice for positioning the sling under this
patient’s hips.

PTS: 1
 7. ANS: A
Leaving the sling underneath the patient for 1 hour with the wrinkles smoothed out does not create undue risk
for the patient. Because it does not require additional effort to remove and then replace the sling, this method
poses the least risk to both the clinician and the patient. Placing a sheet between the patient and sling adds
effort to the task without any significant benefit. A sheet is a much riskier item to use than a lift sling.

PTS: 1
8. ANS: B
The sit-to-stand lift does include a foot plate. The sling supports only the upper body and is typically applied
when the patient is in a seated position.

PTS: 1
9. ANS: B
Patients with restricted weight-bearing on one lower extremity can use a standing lift as long as they are able
to comply with the restrictions. A full-leg cast would prevent the patient from achieving the hip and knee
flexion necessary for the standing lift. Good sitting balance and the ability to follow instructions are required
for this lift.

PTS: 1
10. ANS: A
Contact between the patient’s lower legs and the leg pads is an essential aspect of lower-extremity support
during the standing process. The lower seam of the sling is placed at the patient’s waist, not at the gluteal
fold. The patient is generally instructed to grasp the handles of the lift with the hands outside the sling, not to
place the hands in the lap. A knee position of 90° is optimal for the transfer.

PTS: 1
11. ANS: C
A patient can perform therapeutic exercises, including the development of standing tolerance, while standing
in a sit-to-stand lift. This method requires no additional personnel. It also does not require additional lifting
and therefore poses less risk of injury to the patient and the clinician. Encouraging standing from a seated
position can be a valuable therapeutic exercise for achieving the goal of moving from sitting to standing, but
it does not contribute significantly to the development of standing balance. Postponing the therapeutic
intervention is not correct, as the goal is appropriate and should be pursued, but safely.

PTS: 1
12. ANS: B
Most transfers rely on pulling rather than pushing. Typically the patient is placed on the device, and, rather
than moving the patient across the device, the device is moved across the surface. The devices are designed to
eliminate shearing forces on the skin during the transfer. The number of assistants required for transfers
varies.

PTS: 1
13. ANS: C
Standing at the patient’s head or feet does not allow the clinician to control the majority of the patient’s
weight. Standing beside the bed would require the clinician to push the patient across it. Pulling the patient
from the far side of the stretcher and near the trunk is a more effective way to complete the transfer.

PTS: 1
14. ANS: C
 All of these are possible positioning options during a multiperson assisted transfer, but flexing forward as the
patient is moved laterally places the greatest stress on the low back and therefore creates the greatest risk of
injury to the clinician.

PTS: 1
15. ANS: A
Lateral transfer devices are designed to facilitate lateral movement, not to lift the patient’s body weight
against gravity. Some lateral transfers can be performed by a single person, and lateral transfer devices are
especially useful when transferring a patient between slightly uneven surfaces. Many devices are rated for
patients weighing more than 300 lbs.

PTS: 1
16. ANS: A
Of the devices listed, air-assisted devices are best suited for use with patients with integumentary problems
because the air layer greatly reduces friction and distributes the pressure over the entire surface of the
patient’s body. All other devices function with some kind of patient contact, increasing the risk of injury to
the skin.

PTS: 1
17. ANS: D
The bed should be elevated to about the clinician’s waist level to minimize the necessary trunk flexion during
the activity. Elevating the head of the bed means the clinician will have the added task of moving the patient
upward against gravity. Having the head of the bed flat makes the repositioning maneuver less difficult. The
clinician should stand at the side of the bed, not at the head, and should enlist the assistance of another person
to reposition the patient. The semilunge stance is advised because it allows weight-shifting from one leg to the
other, minimizing the clinician’s need for trunk flexion and rotation while repositioning the patient.

PTS: 1
18. ANS: C
Friction-reducing sheets, sit-to-stand lifts, and total body lifts are all routinely used to reposition the seated
patient. The rigid transfer board is not well-suited to this type of maneuver, because it does not create any
vertical movement, which is required to lift and shift the patient’s body weight. The friction-reducing device,
however, allows lateral movement without lifting.

PTS: 1
19. ANS: C
This type of lateral transfer requires at least three people because of the patient’s weight. In addition, heavier
patients are generally easier to move in a series of smaller motions. If the transfer is attempted in one
movement, it is not likely to be successful, resulting in a less coordinated transfer. Attempting to perform the
transfer in two movements has the potential to leave the patient resting midway across the gap between the
two surfaces, the most vulnerable location in the transfer. Moving the patient in multiple small moves allows
the patient to feel more secure and the clinicians to reposition themselves as the transfer progresses to avoid
injury.

PTS: 1

SHORT ANSWER

1. ANS:
 When the bed is positioned with the foot of the bed higher than the head or with the head of the bed lower
than the foot of the bed.

PTS: 1
2. ANS:
The area of the body the sling will support, where the seat edge of the sling fits on the body, whether all
wrinkles have been removed from the sling, the location of the leg straps, the position of the overhead
sling-bar, the diagnosis of the patient and any associated precautions.

PTS: 1
3. ANS:
Bariatrics

PTS: 1

TRUE/FALSE

1. ANS: F
This type of transfer does result in a lower load on the back, but the loading is still adequate to result in injury
to the therapist transferring the patient.

PTS: 1
2. ANS: F
Super obesity is defined as a BMI of 50 kg/m2.

PTS: 1