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Clinical Nursing Skills and Techniques

8th Edition Perry Test Bank


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Chapter 10: Exercise and Ambulation

MULTIPLE CHOICE

1. The patient has been admitted for hypertension. His blood pressure is normally in the 160/90
range. He has been on bed rest for the past few days, and the doctor has started him on a new
blood pressure medication. The nurse is assisting the patient to move from the bed to the chair
for breakfast, but when the patient tries to sit up on the side of the bed, he complains of being
dizzy and nauseous. The nurse lays the patient down and takes his vital signs. His pulse is
124. His blood pressure is 130/80. This blood pressure is indicative of what?
a. A normal blood pressure for this patient
b. Orthostatic hypotension
c. Orthostatic hypertension
d. Effective baroreceptor function
ANS: B
Orthostatic hypotension is a drop in blood pressure that occurs when the patient changes from
a horizontal to a vertical position. It traditionally is defined as a drop in systolic or diastolic
blood pressure of 20 or 10 mm Hg, respectively. Those at higher risk are immobilized
patients, those undergoing prolonged bed rest, the older adult patient, those receiving
antihypertensive medications, and those with chronic illness, such as diabetes mellitus or
cardiovascular disease. Signs and symptoms of orthostatic hypotension include dizziness,
light-headedness, nausea, tachycardia, pallor, and even fainting. Orthostatic hypertension
would be an increase in blood pressure. Physiological changes associated with aging and
prolonged bed rest may reduce the effectiveness of the baroreceptors. In these patients,
moving to the dangling position may cause a gravity-induced drop in blood pressure; thus, it
is recommended to raise the head of the bed and allow a few minutes before dangling.

DIF: Cognitive Level: Analysis REF: Text reference: p. 236


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Orthostatic Hypotension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. The patient is an elderly gentleman who has been on bed rest for the past several days. When
getting the patient up, the nurse should:
a. tell the patient not to move his legs when dangling.
b. tell the patient to hold his breath while dangling.
c. raise the head of the bed and allow a few minutes before dangling.
d. have the patient stand without dangling.
ANS: C
Physiological changes associated with aging and prolonged bed rest may influence the
effectiveness of the baroreceptors. For these patients, moving to the dangling position may
cause a gravity-induced drop in blood pressure; thus, it is recommended to raise the head of
the bed and allow a few minutes before dangling. Interventions to minimize orthostatic
hypotension include movement of the legs and feet in the dangling position to promote venous
return via intermittent contraction and relaxation of the skeletal leg muscles, and asking the
patient to take several deep breaths before and during dangling. Dangling a patient before
standing is an intermediate step that allows assessment of the individual before changing
positions to maintain safety and prevent injury to the patient.
DIF: Cognitive Level: Application REF: Text reference: p. 236
OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Dangling KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. An appropriate technique for the nurse to use when performing range of motion (ROM)
exercises is to:
a. repeat each action five times during the exercise.
b. perform the exercises quickly and firmly.
c. support the proximal portion of the extremity being exercised.
d. continue the exercise slightly beyond the point of resistance.
ANS: A
Each movement should be repeated five times during an exercise period. Be sure that ROM
exercises are performed slowly and gently. When performing active-assisted or passive ROM
exercises, support the joint by holding the distal portion of the extremity, or by using a cupped
hand to support the joint. Discontinue exercise if the patient complains of discomfort, or if
you note resistance or muscle spasm.

DIF: Cognitive Level: Application REF: Text reference: p. 223


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Range of Motion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. A patient is admitted to the medical unit following a cerebrovascular accident (CVA).


Evidence of left-sided hemiparesis is noted, and the nurse will be following up on ROM and
other exercises performed in physical therapy. The nurse should correctly teach the patient
and family members which of the following principles of ROM exercises?
a. Flex the joint to the point of discomfort.
b. Medicate the patient after the ROM exercise session.
c. Move the joints quickly.
d. Provide support for distal joints.
ANS: D
When performing active-assisted or passive ROM exercises, support the joint by holding the
distal portion of the extremity, or by using a cupped hand to support the joint. The joint should
be flexed to the point of resistance, not to the point of discomfort. Assess the patient’s level of
comfort (on a scale of 0 to 10, with 10 being the worst pain) before performing exercises.
Before beginning ROM exercises, determine whether the patient would benefit from pain
medication. Joints should be moved slowly through the ROM. Quick movement could cause
injury.

DIF: Cognitive Level: Application REF: Text reference: p. 222


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Range of Motion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5. A nurse should be concerned when observing a patient performing isometric exercises if the
patient is:
a. holding his or her breath while exerting.
b. performing the exercises four times per day.
c. tightening each muscle group for 8 seconds, then relaxing.
d. repeating each exercise 8 to 10 times for each muscle group.
ANS: A
Patients doing isometric exercises should be taught to exhale while exerting effort. Many
persons hold their breath (Valsalva maneuver), which increases intrathoracic pressure, causing
a decrease in venous return to the heart. Each exercise prescription is individualized according
to the patient’s needs and limitations. Gradual buildup of exercise repetitions improves both
muscle strength and endurance. Hold the muscles tightly contracted for 5 to 15 seconds, and
then relax completely for several seconds.

DIF: Cognitive Level: Application REF: Text reference: p. 228


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Isometric Exercises KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity

6. A nurse encourages a patient to prevent venous stasis by:


a. crossing the legs when sitting in a chair.
b. wearing thigh-length nylon stockings or garters.
c. elevating the legs on pillows while in bed.
d. increasing early ambulation.
ANS: D
Prevention is the best method to reduce the risk for deep vein thrombosis (DVT) secondary to
immobility. Early ambulation remains the most effective preventive measure. Discourage
patients from activities that promote venous stasis (e.g., crossing legs, wearing garters,
elevating legs on pillows).

DIF: Cognitive Level: Comprehension REF: Text reference: p. 234


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Venous Stasis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

7. Antiembolic stockings (TEDs) are ordered for the patient on bed rest after surgery. The nurse
explains to the patient that the primary purpose for the elastic stockings is to:
a. keep the skin warm and dry.
b. prevent abnormal joint flexion.
c. apply external pressure.
d. prevent bleeding.
ANS: C
The primary purpose of TEDs is to maintain external pressure on the muscles of the lower
extremities and thus promote venous return. The primary purpose of TEDs is not to keep the
skin warm and dry, prevent abnormal joint flexion, or prevent bleeding. They are used to
prevent clot formation due to venous stasis.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 234


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Antiembolic Stockings KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

8. When assessing the patient for risk for DVT, the nurse should consider which of the following
an indicator of increased risk?
a. A positive Homans’ sign
b. Pallor to the distal area
c. Edema noted in the extremity
d. Fever or dehydration
ANS: D
Indicators in Virchow’s triad include clotting disorders, fever, and dehydration. Additionally,
a swollen extremity, pain, and warm cyanotic skin, indicate an elevated risk. Less than 20% of
patients exhibit a positive Homans’ sign. Edema of the extremity may or may not occur.

DIF: Cognitive Level: Application REF: Text reference: p. 234


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: DVT KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

9. An appropriate procedure for the nurse to use when applying an elastic stocking is to:
a. remove the stockings every 24 hours.
b. keep the tops of the stockings rolled down slightly.
c. turn the stocking inside out to apply from the toes up.
d. wash stockings daily and dry in a dryer.
ANS: C
Turn elastic stocking inside out by placing one hand into the sock, holding the toe of the sock
with the other hand, and pulling. This allows easier application of the stocking. Elastic
stockings should be removed and reapplied at least twice a day. Instruct the patient not to roll
the socks partially down. Rolling the socks partially down has a constricting effect and can
impede venous return. Instruct the patient to launder elastic stockings every 2 days with mild
detergent and lay flat to dry.

DIF: Cognitive Level: Application REF: Text reference: pp. 234-235


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Applying Elastic Stockings KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
10. When using an SCD, the nurse should:
a. apply powder to the patient’s skin if redness and itching are present.
b. leave a two-finger space between the patient’s leg and the compression stocking.
c. keep the patient connected to the compression device when transferring into and
out of bed.
d. remove the elastic stockings before putting on the sequential pneumatic
compression stockings.
ANS: B
Check the fit of SCD sleeves by placing two fingers between the patient’s leg and the sleeve.
Observe for signs, symptoms, and conditions that might contraindicate the use of elastic
stockings or SCD: Elastic stockings and SCD sleeves may aggravate a skin condition or cause
it to spread. Remove SCD sleeves when transferring the patient into and out of bed to prevent
injury. If the patient is wearing elastic stockings, eliminate any wrinkles and folds before
applying SCD sleeves. Wrinkles lead to increased pressure and alter circulation.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 235


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Applying SCD Sleeves KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

11. The patient is a paraplegic who possesses good arm and hand strength. When the following
devices are compared, which would be most appropriate for this patient?
a. Axillary crutch
b. Platform crutch
c. Lofstrand crutch
d. Standard crook cane
ANS: C
The Lofstrand crutch has a handgrip and a metal band that fits around the patient’s forearm.
Both the metal band and the handgrip are adjusted to fit the patient’s height. This type of
crutch is useful for patients with a permanent disability such as paraplegia. The axillary crutch
frequently is used by patients of all ages on a short-term basis. The platform crutch is used by
patients who are unable to bear weight on their wrists. It has a horizontal trough on which
patients can rest their forearms and wrists and a vertical handle for the patient to grip. The
standard crook cane provides the least support and is used by patients who require only
minimal assistance to walk.

DIF: Cognitive Level: Analysis REF: Text reference: p. 237


OBJ: Develop teaching plans for selected patients for safety precautions to use at home while using
an ambulation aid, applying and monitoring effects of elastic stockings and SCDs, using the CPM, and
performing ROM and isometric exercises. TOP: Crutches
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. An appropriate way for the nurse to measure a patient for crutches is to:
a. have a flexion of 45 degrees at both of the patient’s elbows.
b. have a space of two to three fingers between the top of the crutch and the axilla.
c. place the crutch tips 1 foot to each side of the patient’s feet, and observe the
positioning of the crutches.
d. place the crutch tips 1 foot to the front of the patient’s feet, and observe the
positioning of the crutches.
ANS: B
Following correct crutch adjustment, two to three fingers should fit between the top of the
crutch and the axilla. Following correct crutch adjustment, elbows should be flexed 15 to 30
degrees. Elbow flexion is verified with a goniometer. Position the crutches with the crutch tips
at 6 inches (15 cm) to the side and 6 inches in front of the patient’s feet, and the crutch pads 2
inches (5 cm) below the axilla.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 239-240


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutches KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

13. The patient has been using crutches for the past 2 weeks. When she comes for her follow-up
examination, she complains of tingling and numbness in her hands and upper torso. Possible
causes of these symptoms are:
a. the patient’s elbows are flexed 15 to 30 degrees when using the crutches.
b. crutch pad is approximately 2 inches below the patient’s axilla.
c. patient holds the cane 4 to 6 inches to the side of her foot.
d. handgrip does not allow for elbow flexion.
ANS: D
Instruct the patient to report any tingling or numbness in the upper torso, which may mean
that the crutches are being used incorrectly, or that they are the wrong size. If the handgrip is
too low, radial nerve damage can occur even if overall crutch length is correct, because the
extra length between the handgrip and the axillary bar can force the bar up into the axilla as
the patient stretches down to reach the handgrip. After correct crutch adjustment, two to three
fingers must fit between the top of the crutch and the axilla. Adequate space prevents crutch
palsy. Proper fit is when the crutch pad is approximately 2 inches or two to three finger widths
under the axilla, with the crutch tips positioned 6 inches (15 cm) lateral to the patient’s heel.

DIF: Cognitive Level: Analysis REF: Text reference: p. 239


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutches KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

14. The patient has a leg injury and is being fitted for a cane. The patient should be taught to:
a. hold the cane on the uninvolved side.
b. hold the cane on the weaker side.
c. extend the cane 15 inches from the foot when used.
d. maintain approximately 60 degrees of elbow flexion.
ANS: A
The patient holds the cane on the uninvolved side, 4 to 6 inches (10 to 15 cm) to the side of
the foot. This offers the most support when the cane is placed on the stronger side of the body.
The cane and the weaker leg work together with each step. The cane extends from the greater
trochanter to the floor while the cane is held 6 inches (15 cm) from the foot. Allow
approximately 15 to 30 degrees of elbow flexion. As weight is taken on by the hand and the
affected leg is lifted off the floor, complete extension of the elbow is necessary.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 245


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Cane Measurement KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

15. While ambulating, the patient becomes light-headed and starts to fall. What should the nurse
do first?
a. Call for help.
b. Try to reach for a chair.
c. Ease the patient down to the floor.
d. Push the patient back toward the bed.
ANS: C
If the patient begins to fall, gently ease the patient to the floor by holding firmly onto the gait
belt; stand with the feet apart to provide a broad base of support, extend the leg, and let the
patient gently slide to the floor. As the patient slides, the nurse bends the knees to lower the
body. The nurse can cause more damage to self and patient by trying to catch the patient.
The nurse certainly will call for help, but this is not the first priority. The nurse must ensure
the patient’s safety before getting help by easing him to the floor.

DIF: Cognitive Level: Application REF: Text reference: p. 240


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Patient Safety KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

16. When the four gaits listed below are compared, which is the most stable of the crutch gaits?
a. Four-point gait
b. Three-point gait
c. Two-point gait
d. Swing-to gait
ANS: A
Four-point gait is the most stable of crutch gaits because it provides at least three points of
support at all times. The patient must be able to bear weight on both legs. Each leg is moved
alternately with each opposing crutch, so that three points of support are on the floor all the
time. This gait is often used when the patient has some form of paralysis, such as for spastic
children with cerebral palsy. This is less stable than four-point gait because it requires the
patient to bear all weight on one foot. Weight is borne on the uninvolved leg and then on both
crutches. The affected leg does not touch the ground during the early phase of three-point gait.
This gait may be useful for patients with a broken leg or a sprained ankle. This is less stable
than four-point gait because it requires at least partial weight bearing on each foot. It is faster
than four-point gait and requires better balance because only two points support the body at
any one time. This is the easier of the two swinging gaits. It is less stable than four-point gait
because it requires the ability to partially bear body weight on both legs. This gait is
frequently used by patients whose lower extremities are paralyzed, or who wear
weight-supporting braces on their legs.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 241-242


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutch Gaits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

17. The nurse is caring for a patient who has just been treated for a broken leg. She needs to teach
the patient how to use crutches. Which crutch gait is most appropriate for this patient?
a. Four-point gait
b. Three-point gait
c. Two-point gait
d. Swing-to gait
ANS: B
The three-point gait requires the patient to bear all weight on one foot. Weight is borne on the
uninvolved leg and then on both crutches. The affected leg does not touch the ground during
the early phase of three-point gait. It is useful for patients with a broken leg or a sprained
ankle. The four-point gait is the most stable of crutch gaits because it provides at least three
points of support at all times. The patient must be able to bear weight on both legs. Each leg is
moved alternately with each opposing crutch, so that three points of support are on the floor
all the time. The two-point is used when the patient has some form of paralysis, such as for
spastic children with cerebral palsy. This gait requires at least partial weight bearing on each
foot. It requires better balance because only two points support the body at one time. This is
the easier of the two swinging gaits. It requires the ability to partially bear body weight on
both legs. The swing-to gait is used by patients whose lower extremities are paralyzed, or who
wear weight-supporting braces on their legs.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 241-242


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutch Gaits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
18. When teaching the use of a three-point crutch gait, the nurse should instruct the patient to
move:
a. both crutches and the affected leg first, then the stronger leg.
b. the right crutch, left foot, left crutch, and right foot in sequence.
c. the left crutch and right foot, then move the right crutch and left foot.
d. both crutches, then lift and swing the legs forward as far as the crutches.
ANS: A
The proper sequence for the three-point crutch gait is: begin in tripod position, advance both
crutches and the affected leg, and then move the stronger leg forward, stepping on the floor.
This is the proper sequence for the four-point gait, the two-point gait, and the swing-to gait.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 241


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Crutch Gaits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

19. A patient with left hemiparesis is using a quad cane for ambulation. Which of the following is
the correct technique for the nurse to use in teaching the patient?
a. Use the cane on the right side, with the cane moving forward first.
b. Use the cane on the left side, with the left leg moving forward with the cane.
c. Use the cane in either hand, with the right leg moving forward first.
d. Use the cane in either hand, with the left leg moving beyond the forward
placement of the cane.
ANS: A
To correctly use a quad cane, the patient places the cane on the side opposite the involved leg.
This provides added support for the weak or impaired side. Ambulation then begins by
moving the cane forward 6 to 10 inches (15 to 25 cm), keeping body weight on both legs. The
weak leg is then brought forward even with the cane while the body weight is supported by
the strong leg and the cane. The strong leg is then advanced past the cane. Moving a leg and
the cane forward at the same time will compromise balance and increase risk of fall.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 245


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Ambulation With a Cane KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. The patient had a stroke and is currently immobile. The nurse realizes that increasing mobility
is critical because immobility can result in alterations in which of the following? (Select all
that apply.)
a. Cardiovascular function
b. Pulmonary function
c. Skin integrity
d. Elimination
ANS: A, B, C, D
When mobility is altered, many body systems are at risk for impairment. Impaired mobility
can result in altered cardiovascular functioning, disruption of normal metabolic functioning,
increased risk for pulmonary complications, the development of pressure ulcers, and urinary
elimination alterations.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 221


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Complications of Immobility KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. The nurse is caring for an immobile patient. Which of the following may help reduce the
hazards associated with immobility? (Select all that apply.)
a. A high-fiber diet
b. Frequent repositioning
c. Muscle and joint exercises
d. Increased fluid intake
ANS: A, B, C, D
Frequent repositioning, deep breathing and coughing exercises, muscle and joint exercises,
increased fluid intake, and dietary intake of foods containing fiber are examples of measures
that help to reduce the hazards of immobility.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 221


OBJ: Discuss the hazards of immobility. TOP: Prevention of Complications of Immobility
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. The nurse is applying a CPM machine to the patient’s leg. To do so, she must: (Select all that
apply.)
a. provide analgesia 1 hour before starting the CPM.
b. stop the CPM when in extension and place a sheepskin on the machine.
c. align the patient’s joint with the CPM’s mechanical joint.
d. secure the patient’s extremity tightly with Velcro straps.
ANS: B, C
Provide analgesia 20 to 30 minutes before CPM is needed. Stop the CPM when in extension.
Place sheepskin on the CPM to ensure that all exposed hard surfaces are padded to prevent
rubbing and chafing of the patient’s skin. Align the patient’s joint with the mechanical joint of
the CPM.

DIF: Cognitive Level: Application REF: Text reference: p. 232


OBJ: Identify significant assessment data to be noted before and during the use of a machine.
TOP: CPM Machine KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. Factors that contribute to the development of DVT are: (Select all that apply.)
a. elevated sodium (Na+) levels.
b. hypercoagulability of the blood.
c. venous wall damage.
d. stasis of blood flow.
ANS: B, C, D
Three elements (commonly referred to as Virchow’s triad) contribute to the development of
DVT: hypercoagulability of the blood, venous wall damage, and stasis of blood flow.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 234


OBJ: Understand the pathophysiology of the development of DVTs.
TOP: Deep Vein Thrombosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

COMPLETION

1. ____________ refers to an ability to move about freely.

ANS:
Mobility
Mobility refers to an ability to move about freely.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 221


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Mobility KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

2. A person’s inability to move about freely is known as _______________.

ANS:
immobility
Immobility refers to a person’s inability to move about freely.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 221


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Immobility KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

3. A drop in blood pressure that occurs when the patient changes position from a horizontal to a
vertical position is known as _________________.

ANS:
orthostatic hypotension
Orthostatic hypotension is a drop in blood pressure that occurs when the patient changes
position from a horizontal to a vertical position.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 236


OBJ: Discuss indications for assisting with ambulation or using devices to assist with ambulation.
TOP: Orthostatic Hypotension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

4. The patient is performing ROM exercises independently. These are known as __________
exercises.

ANS:
active ROM
ROM exercises may be active, passive, or active-assisted. They are active if the patient is able
to perform the exercises independently and passive if the exercises are performed for the
patient by the caregiver. The exercises are active-assisted if the patient is able to perform
some of the actions independently with support and assistance from the caregiver.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 222


OBJ: Discuss indications for performing ROM and isometric exercises.
TOP: Active Range of Motion KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. Static exercises that involve tightening or tensing of muscles without moving a body part are
known as ______________.

ANS:
isometric exercises
Isometric or static exercises involve tightening or tensing of muscles without moving body
parts.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 227


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Isometric Exercises KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

6. _________________ increase muscle tension but do not change the length of muscle fibers.

ANS:
Isometric contractions
Isometric contractions increase muscle tension but do not change the length of muscle fibers.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 227


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Isometric Contractions KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

7. Virchow’s triad (hypercoagulability of blood, venous wall damage, and stasis of blood flow)
has been found to contribute to ________________.

ANS:
deep vein thrombosis (DVT)
Three elements (commonly referred to as Virchow’s triad) contribute to the development of
DVT: hypercoagulability of the blood, venous wall damage, and stasis of blood flow.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 237


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Deep Vein Thrombosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
8. The nurse is concerned that the patient may fall while he is ambulating. To help her maintain
control while the patient walks, the nurse may apply a ______________ around the patient’s
waist.

ANS:
gait belt
A gait belt encircles a patient’s waist and has space for the nurse to hold while the patient
walks. This gives the nurse better control and helps to prevent injury.

DIF: Cognitive Level: Application REF: Text reference: p. 240


OBJ: Demonstrate the following skills on selected patients: assisting with ambulation, assisting with
ambulation with the use of an ambulation aid, assisting with ROM exercises, assisting with isometric
exercises, applying a CPM, and applying elastic stockings and SCD.
TOP: Gait Belt KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
Another random document with
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The Project Gutenberg eBook of How it feels to
be colored me
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Title: How it feels to be colored me

Author: Zora Neale Hurston

Release date: May 5, 2024 [eBook #73549]

Language: English

Original publication: Carlisle, Mass: Applewood Books, 1928

Credits: Carla Foust, Steve Mattern and the Online Distributed


Proofreading Team at https://www.pgdp.net

*** START OF THE PROJECT GUTENBERG EBOOK HOW IT


FEELS TO BE COLORED ME ***
How It Feels to Be Colored Me
By

Zora Neale Hurston


I am colored but I offer nothing in the way of extenuating
circumstances except the fact that I am the only Negro in the United
States whose grandfather on the mother’s side was not an Indian
chief.
I remember the very day that I became colored. Up to my thirteenth
year I lived in the little Negro town of Eatonville, Florida. It is
exclusively a colored town. The only white people I knew passed
through the town going to or coming from Orlando. The native whites
rode dusty horses, the Northern tourists chugged down the sandy
village road in automobiles. The town knew the Southerners and
never stopped cane chewing when they passed. But the Northerners
were something else again. They were peered at cautiously from
behind curtains by the timid. The more venturesome would come out
on the porch to watch them go past and got just as much pleasure
out of the tourists as the tourists got out of the village.
The front porch might seem a daring place for the rest of the town,
but it was a gallery seat for me. My favorite place was atop the gate-
post. Proscenium box for a born first-nighter. Not only did I enjoy the
show, but I didn’t mind the actors knowing that I liked it. I usually
spoke to them in passing. I’d wave at them and when they returned
my salute, I would say something like this: “Howdy-do-well-I-thank-
you-where-you-go-in’?” Usually automobile or the horse paused at
this, and after a queer exchange of compliments, I would probably
“go a piece of the way” with them, as we say in farthest Florida. If
one of my family happened to come to the front in time to see me, of
course negotiations would be rudely broken off. But even so, it is
clear that I was the first “welcome-to-our-state” Floridian, and I hope
the Miami Chamber of Commerce will please take notice.
During this period, white people differed from colored to me only in
that they rode through town and never lived there. They liked to hear
me “speak pieces” and sing and wanted to see me dance the parse-
me-la, and gave me generously of their small silver for doing these
things, which seemed strange to me for I wanted to do them so
much that I needed bribing to stop, only they didn’t know it. The
colored people gave no dimes. They deplored any joyful tendencies
in me, but I was their Zora nevertheless. I belonged to them, to the
nearby hotels, to the county—everybody’s Zora.
But changes came in the family when I was thirteen, and I was sent
to school in Jacksonville. I left Eatonville, the town of the oleanders,
as Zora. When I disembarked from the river-boat at Jacksonville, she
was no more. It seemed that I had suffered a sea change. I was not
Zora of Orange County any more, I was now a little colored girl. I
found it out in certain ways. In my heart as well as in the mirror, I
became a fast brown—warranted not to rub nor run.
But I am not tragically colored. There is no great sorrow dammed up
in my soul, nor lurking behind my eyes. I do not mind at all. I do not
belong to the sobbing school of Negrohood who hold that nature
somehow has given them a lowdown dirty deal and whose feelings
are all but about it. Even in the helter-skelter skirmish that is my life, I
have seen that the world is to the strong regardless of a little
pigmentation more or less. No, I do not weep at the world—I am too
busy sharpening my oyster knife.
Someone is always at my elbow reminding me that I am the
granddaughter of slaves. It fails to register depression with me.
Slavery is sixty years in the past. The operation was successful and
the patient is doing well, thank you. The terrible struggle that made
me an American out of a potential slave said “On the line!” The
Reconstruction said “Get set!” and the generation before said “Go!” I
am off to a flying start and I must not halt in the stretch to look
behind and weep. Slavery is the price I paid for civilization, and the
choice was not with me. It is a bully adventure and worth all that I
have paid through my ancestors for it. No one on earth ever had a
greater chance for glory. The world to be won and nothing to be lost.
It is thrilling to think—to know that for any act of mine, I shall get
twice as much praise or twice as much blame. It is quite exciting to
hold the center of the national stage, with the spectators not knowing
whether to laugh or to weep.
The position of my white neighbor is much more difficult. No brown
specter pulls up a chair beside me when I sit down to eat. No dark
ghost thrusts its leg against mine in bed. The game of keeping what
one has is never so exciting as the game of getting.
I do not always feel colored. Even now I often achieve the
unconscious Zora of Eatonville before the Hegira. I feel most colored
when I am thrown against a sharp white background.
For instance at Barnard. “Beside the waters of the Hudson” I feel my
race. Among the thousand white persons, I am a dark rock surged
upon, and overswept, but through it all, I remain myself. When
covered by the waters, I am; and the ebb but reveals me again.
Sometimes it is the other way around. A white person is set down in
our midst, but the contrast is just as sharp for me. For instance,
when I sit in the drafty basement that is The New World Cabaret with
a white person, my color comes. We enter chatting about any little
nothing that we have in common and are seated by the jazz waiters.
In the abrupt way that jazz orchestras have, this one plunges into a
number. It loses no time in circumlocutions, but gets right down to
business. It constricts the thorax and splits the heart with its tempo
and narcotic harmonies. This orchestra grows rambunctious, rears
on its hind legs and attacks the tonal veil with primitive fury, rending
it, clawing it until it breaks through to the jungle beyond. I follow
those heathen—follow them exultingly. I dance wildly inside myself; I
yell within, I whoop; I shake my assegai above my head, I hurl it true
to the mark yeeeeooww! I am in the jungle and living in the jungle
way. My face is painted red and yellow and my body is painted blue.
My pulse is throbbing like a war drum. I want to slaughter something
—give pain, give death to what, I do not know. But the piece ends.
The men of the orchestra wipe their lips and rest their fingers. I creep
back slowly to the veneer we call civilization with the last tone and
find the white friend sitting motionless in his seat, smoking calmly.
“Good music they have here,” he remarks, drumming the table with
his fingertips.
Music. The great blobs of purple and red emotion have not touched
him. He has only heard what I felt. He is far away and I see him but
dimly across the ocean and the continent that have fallen between
us. He is so pale with his whiteness then and I am so colored.
At certain times I have no race, I am me. When I set my hat at a
certain angle and saunter down Seventh Avenue, Harlem City,
feeling as snooty as the lions in front of the Forty-Second Street
Library, for instance. So far as my feelings are concerned, Peggy
Hopkins Joyce on the Boule Mich with her gorgeous raiment, stately
carriage, knees knocking together in a most aristocratic manner, has
nothing on me. The cosmic Zora emerges. I belong to no race nor
time. I am the eternal feminine with its string of beads.
I have no separate feeling about being an American citizen and
colored. I am merely a fragment of the Great Soul that surges within
the boundaries. My country, right or wrong.
Sometimes, I feel discriminated against, but it does not make me
angry. It merely astonishes me. How can any deny themselves the
pleasure of my company? It’s beyond me.
But in the main, I feel like a brown bag of miscellany propped against
a wall. Against a wall in company with other bags, white, red and
yellow. Pour out the contents, and there is discovered a jumble of
small things priceless and worthless. A first-water diamond, an
empty spool, bits of broken glass, lengths of string, a key to a door
long since crumbled away, a rusty knife-blade, old shoes saved for a
road that never was and never will be, a nail bent under the weight of
things too heavy for any nail, a dried flower or two still a little
fragrant. In your hand is the brown bag. On the ground before you is
the jumble it held—so much like the jumble in the bags could they be
emptied that all might be dumped in a single heap and the bags
refilled without altering the content of any greatly. A bit of colored
glass more or less would not matter. Perhaps that is how the Great
Stuffer of Bags filled them in the first place—who knows?
*** END OF THE PROJECT GUTENBERG EBOOK HOW IT FEELS
TO BE COLORED ME ***

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