Question 1

SCIARIO: An inpatient sustained an incomplete cervical spinal cord injury 2 months ago. The patient is upper extremity functional strength in trace (1/5) on the left and Poor Minus (2-/5) on the right. The patient's goal is to eat meals independently. Which factor MUST be considered when determining if this patient is a candidate for a mobile arm support?

Accepted Answer

Answer reason: A mobile arm support relies on the patient having adequate passive range of motion in the shoulder, elbow, wrist, and hand to position the limb for functional tasks like self-feeding. If passive joint mobility is limited (e.g., contractures or severe stiffness), the device cannot align properly and may cause pain, skin breakdown, or ineffective movement patterns. Setup time and wheelchair type affect practicality but do not determine basic candidacy. Athetoid movements may influence control and safety, but adequate passive mobility is the foundational prerequisite.

Question 2

What is the purpose of using the Barthel Index in patient care?

Accepted Answer

Answer reason: The Barthel Index is a standardized functional assessment tool that scores performance in basic self-care and mobility tasks such as feeding, bathing, toileting, transfers, and ambulation. It helps quantify how much assistance a patient requires and supports care planning, discharge readiness, and rehabilitation goal setting. It is not designed to screen for pressure-injury risk (e.g., Braden Scale), assess cognition (e.g., MMSE/MoCA), or measure pain intensity (e.g., numeric rating scale).

Question 3

An 80-year-old patient with arthritis has difficulty with activities of daily living (ADLs). What is the priority nursing intervention?

Accepted Answer

Answer reason: Promoting safe independence in ADLs is a core nursing priority in chronic musculoskeletal conditions, supporting function while minimizing fall risk and joint strain. Assistive devices (e.g., reachers, adaptive utensils, walkers) enable self-care despite pain and stiffness and help maintain dignity and quality of life. Pain management and referrals can be helpful, but they are supportive measures; restricting movement worsens stiffness, deconditioning, and functional decline.

Question 4

A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to?

Accepted Answer

Answer reason: Occupational therapy focuses on enabling safe, independent performance of activities of daily living through adaptive techniques and devices. Difficulty drawing up insulin due to arthritis reflects impaired fine-motor function and grip, which OT addresses by teaching joint-protection strategies and recommending aids (e.g., syringe magnifiers, stabilizers, or alternative delivery devices). Physical therapy primarily targets gross motor strength, gait, and mobility rather than medication self-administration tasks. A social worker or peer client may provide support/resources, but they are not the appropriate specialists to assess and train adaptive self-care techniques for insulin preparation.

Question 5

The most appropriate clothing for a client with osteoarthritis would be?

Accepted Answer

Answer reason: Hook-and-loop fasteners and slip-on footwear reduce the need for gripping, pinching, and sustained finger flexion that can exacerbate pain and limit independence. Rubber grippers provide friction to help open or hold items safely when hand strength and range of motion are decreased. Tied shoes and small buttons are common barriers because they require precise finger movements and prolonged hand use, increasing fatigue and frustration.

Question 6

A child is having increased difficulty getting out of his chair at school. Which recommendation should the nurse make to assist the child?

Accepted Answer

Answer reason: Raising the seat height improves hip and knee leverage, decreasing the muscle strength needed to stand and promoting independence at school. This is a low-risk, practical intervention that can be implemented immediately without specialized mobility equipment. A powered wheelchair is a much more restrictive escalation and does not specifically solve sit-to-stand from a standard chair, while braces address gait stability rather than chair transfer mechanics.

Question 7

Which of the following strategies would be the first choice in attempting to maximize function in a child with muscular dystrophy?

Accepted Answer

Answer reason: Bracing supports weak lower-extremity musculature and helps stabilize gait, allowing the child to remain mobile and independent earlier in the disease course. Wheelchairs are typically introduced when ambulation becomes unsafe or excessively fatiguing, so they are not the first-line strategy for maximizing function. A walker may provide stability, but it does not address the progressive muscle imbalance and contracture prevention as effectively as orthotic bracing.

Question 8

Which observation by a nurse indicates proper fit of crutches in a 9-year old boy?

Accepted Answer

Answer reason: The crutches end 2 in. (5 cm) below the axilla. Proper crutch fitting prevents neurovascular injury by keeping body weight off the axilla and distributing it through the hands. A 2-inch clearance between the axilla and the crutch top helps avoid compression of the brachial plexus and axillary vessels (“crutch palsy”). The handgrips should allow a small elbow flexion (about 20–30 degrees) to enable effective weight bearing and control; larger flexion angles like 60 or 90 degrees indicate an incorrect grip height. A snug fit in the axilla is unsafe because it encourages leaning on the crutches rather than supporting weight through the arms and hands.

Question 9

A client is being discharged from the hospital. The client has an unsteady gait and has weakness in the right leg. What assistive device would be most appropriate for the client?

Accepted Answer

Answer reason: The guiding principle is to match the assistive device to the client’s balance deficit and degree of unilateral lower-extremity weakness to maximize stability and prevent falls. A quad cane provides a wider base of support than a single-point cane, improving balance for an unsteady gait while still allowing the stronger leg to bear more weight. A single straight cane offers the least stability and is better for mild balance issues, making it less suitable when gait is clearly unsteady. A walker is typically reserved for clients who need maximal bilateral support or have significant generalized weakness, and forearm (Lofstrand) crutches require substantial upper-body strength and coordination, which may increase fall risk during discharge.

Question 10

Which patient would benefit most from a quad cane?

Accepted Answer

Answer reason: A quad cane provides a wider base of support than a standard cane, making it appropriate for clients who can bear some weight but need extra stability due to mild-to-moderate unilateral weakness. Partial leg paralysis after a stroke often allows some controlled stepping with support, so this device can improve balance and reduce fall risk. A client needing two-person assistance typically requires a higher-level device (e.g., walker) or close guarding, not a cane. Complete hemiplegia commonly limits safe cane use because of more profound weakness and potential inability to coordinate the device and gait safely.

Question 11

The client with diminished sight has problems with the glare from light. Which recommendation should the nurse make?

Accepted Answer

Answer reason: Glare reduction is a core low-vision safety strategy because excessive light scatter can worsen visual acuity and increase fall risk. Sunglasses (ideally with UV protection and tint) plus a brimmed hat decreases direct and reflected light entering the eyes, improving contrast and comfort during ambulation. Installing fluorescent lighting can increase glare and flicker sensitivity for some clients, and direct sunlight from windows often produces high glare and poor contrast indoors. Advising the client to avoid sunny days is unnecessarily restrictive and does not teach practical, adaptive self-management.

Question 12

A client with muscular dystrophy has lost complete control of his lower extremities. He has some strength bilaterally in the upper extremities but poor trunk control. Which mechanism would be the most important to have on the wheelchair?

Accepted Answer

Answer reason: A properly fitted wheelchair belt provides essential pelvic/trunk positioning support to maintain safe alignment and stability, especially when lower-extremity control is absent and upper-extremity strength is limited. Antitip devices help prevent backward tipping but do not address forward sliding or loss of sitting balance. Headrests mainly support the head/neck and comfort and are not the primary safety mechanism when trunk stability is the main deficit.

Question 13

The nurse is caring for multiple older adult clients with age-related visual changes. Which intervention should the nurse implement?

Accepted Answer

Answer reason: Age-related visual changes commonly include presbyopia and reduced ability to accommodate, making near tasks like reading difficult. An assistive device that enlarges print directly compensates for decreased visual acuity and supports independence with ADLs such as reading instructions and education materials. Reducing lamp intensity can worsen visibility because older adults generally require brighter, evenly distributed light, while glare is better addressed with positioning and shades rather than dimming. Blended colors and low-contrast print make text harder to distinguish; high contrast and larger font are preferred, but magnification is the most broadly effective single intervention here.

Question 14

The client began wearing hearing aids 5 weeks earlier. Which statement to the nurse demonstrates that the client is successfully adapting to the hearing aids?

Accepted Answer

Answer reason: " Safe, consistent use and appropriate care of an assistive device indicate successful adaptation and self-management. Storing hearing aids in a protective case at night helps prevent loss and damage and reflects incorporation of the device into the client’s routine. Cleaning ears with cotton-tipped swabs is unsafe due to risk of cerumen impaction and canal trauma, which can interfere with hearing aid function. Wearing hearing aids only in public suggests inadequate daily use and poorer acclimatization to amplified sound.

Question 15

A client is admitted to the medical-surgical unit for osteoarthritis and weakness in the left lower extremity. The client uses a walker at home. The health care provider ordered a cane and physical therapy for the client. The client asks the nurse about the difference between the cane and walker. What is the best response by the nurse?

Accepted Answer

Answer reason: The principle is that an assistive device is positioned to maximize stability and reduce load on the weaker or painful extremity. Holding the cane in the stronger hand allows the cane and the affected leg to move together, creating a wider base of support and decreasing joint forces on the involved hip/knee. This improves balance and gait efficiency for left lower-extremity weakness by shifting some weight-bearing to the cane through the unaffected side. Using the cane on the affected side reduces this biomechanical advantage and can worsen instability and pain risk.

Question 16

A client with a recent ACL reconstruction has just received education on crutch use and safety. Which statement best indicates that the client has a complete understanding of the education?

Accepted Answer

Answer reason: Mastery of client teaching is best validated by both cognitive understanding and psychomotor performance in a real-use context. This option combines accurate verbalization of safety principles with an observed return demonstration while ambulating, which is the strongest evidence of learning and ability to apply the education. Option A reflects only one safety element (avoiding axillary pressure) and does not confirm overall technique. Options C and D each assess only one domain (performance alone or recall alone), making them less complete indicators of understanding.

Question 17

A client has just been admitted to the medical unit and the nurse is performing an initial physical assessment. The nurse finds that the client has difficulty hearing questions. The nurse also notices an empty glasses case that was sent up with the client from the emergency department. Based on this information, which action should first be taken by the nurse?

Accepted Answer

Answer reason: The priority is to optimize communication and safety during the assessment by identifying and using any needed assistive devices (e.g., hearing aid, glasses) before proceeding further. Asking the client directly respects autonomy and establishes what devices they normally rely on, which can immediately improve assessment accuracy and reduce misunderstandings. Searching belongings without permission is inappropriate and can violate privacy, and notifying the physician is not the first step for a nursing assessment/communication barrier. A focused ear-by-ear hearing check may be useful later, but addressing potential missing assistive devices and documenting the need comes first.

Question 18

A client has just been admitted to the medical surgical floor after having a total knee replacement. The nurse is reviewing the admission orders from the surgeon and notes the following order: “Please set up trapeze bar on hospital bed.” What is the best definition of a trapeze bar?

Accepted Answer

Answer reason: A trapeze bar is an assistive device that enables a patient to use upper-extremity strength to lift the torso and shift weight, improving independent repositioning and facilitating safer transfers. This function is particularly useful after lower-extremity surgery (e.g., total knee replacement) when weight-bearing and leg movement may be limited. The correct description specifies patient use, arm-pulling, and purposes such as repositioning and transfers, which match standard bedside trapeze use. A common distractor is equipment aimed at maintaining alignment/abduction or preventing hip rotation (e.g., abduction pillow, trochanter roll), which is different from a trapeze bar and not primarily for lifting the trunk.

Question 19

The nurse is supervising a student assisting a client with their newly prescribed crutches. Which action by the student requires follow-up by the nurse? The student?

Accepted Answer

Answer reason: Body weight should be supported by the hands on the handgrips, not the axillae. Bearing weight through the axilla can compress the brachial plexus and lead to nerve injury (crutch palsy). The other actions reflect correct crutch fitting and safety practices.

Question 20

A patient diagnosed with meningitis had his left lower leg amputated to prevent the infection from continuing to spread from the source. The patient now has a prosthesis and ambulates with a cane. Which of the following demonstrates the correct use of this assistive device?

Accepted Answer

Answer reason: When descending stairs, the safe sequence is “down with the bad”: the assistive device moves with the weaker limb first, then the stronger limb follows to the same step. With a left lower-limb prosthesis (functionally the weaker side), the cane should be in the right hand and advance together with the prosthetic limb when stepping down. Options placing the cane on the left side or moving the intact limb ahead of the assistive device increase fall risk by removing support when the weaker limb is advancing.

Question 21

A nurse is providing discharge instructions to a client about proper use of a cane for maximum support. Which of the following statements by the client indicates an understanding of the teaching?

Accepted Answer

Answer reason: " A cane is used to widen the base of support and reduce load on the affected/weaker leg by transferring weight through the upper extremity. Holding it on the stronger side provides the best stability and allows the cane to move with the weaker leg, decreasing the risk of falls. For safe gait, the cane should advance with (or slightly ahead of) the weaker leg rather than the weaker leg moving first. Proper fit is typically elbow flexion about 20–30 degrees (not 90 degrees), and the cane should be kept close to the body rather than far out to the side.

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