CNA Assisting with Range of Motion Exercises 2 — Questions and Answers
Question 1: A CNA is performing passive range of motion (PROM) on a resident with spasticity in their left arm. As the CNA gently extends the elbow, the muscle tightens and resists the movement. What is the most appropriate immediate action?
- Apply firm, steady pressure to overcome the resistance and complete the exercise.
- Stop the movement immediately and notify the nurse that the resident is non-compliant.
- Hold the joint in its current position with gentle pressure until the muscle relaxes. (Correct answer)
- Use a faster motion to get past the point of spasticity.
Correct answer: Hold the joint in its current position with gentle pressure until the muscle relaxes.
When encountering spasticity during PROM, the correct technique is to hold the limb with gentle, steady pressure. This allows the spastic muscle time to relax. Forcing the movement can cause pain, injury, and potentially increase the spasticity. A fast motion would also likely worsen the muscle tone. The resistance is a physiological reaction, not non-compliance.
Question 2: A resident who recently had a hip replacement has a care plan that includes active-assistive range of motion (AAROM) exercises. Which of the following best describes the CNA's role during these exercises?
- The CNA moves the resident's leg through the full range of motion while the resident relaxes completely.
- The resident performs the leg exercises independently while the CNA observes from a distance.
- The CNA encourages the resident to move their leg as much as possible and provides physical support to complete the movement. (Correct answer)
- The CNA instructs the resident on the exercises and provides only verbal cues without physical contact.
Correct answer: The CNA encourages the resident to move their leg as much as possible and provides physical support to complete the movement.
Active-assistive range of motion (AAROM) involves the resident actively participating in the movement to the best of their ability, with the CNA providing the necessary assistance to complete the full range of motion. This is different from passive ROM, where the caregiver does all the work, and active ROM, where the resident does the work independently.
Question 3: While assisting a resident with dementia with range of motion exercises, the resident becomes agitated and repeatedly says, 'No, stop!' but does not appear to be in physical pain. What is the CNA's best course of action?
- Continue the exercises quickly to finish them before the agitation escalates.
- Stop the exercises, attempt to gently distract and reassure the resident, and try again later if they become calm. (Correct answer)
- Explain the importance of the exercises in a loud, clear voice to ensure the resident understands.
- Document the refusal and omit the exercises for the rest of the week.
Correct answer: Stop the exercises, attempt to gently distract and reassure the resident, and try again later if they become calm.
For a resident with dementia, agitation can be a form of communication. The CNA's priority is the resident's well-being and respecting their expressed wishes, even if not verbally articulated in a standard way. Stopping the activity, providing reassurance, and attempting to redirect or try again later is the most person-centered approach. Continuing could increase distress, and simply documenting a refusal without trying other approaches is not optimal care.
Question 4: Which of the following describes the correct technique for performing circumduction of the shoulder during passive range of motion exercises?
- Moving the resident's arm in a circular motion, like drawing a circle in the air. (Correct answer)
- Bending the elbow to touch the hand to the shoulder.
- Moving the arm straight out to the side, away from the body.
- Turning the forearm so the palm faces up and then down.
Correct answer: Moving the resident's arm in a circular motion, like drawing a circle in the air.
Circumduction is a conical or circular movement of a limb that combines flexion, extension, abduction, and adduction. For the shoulder, this involves moving the resident's entire arm in a large, smooth circular motion. The other options describe flexion/extension, abduction, and pronation/supination, respectively.
Question 5: A CNA is assigned to perform PROM exercises for a resident with a severe, acute deep vein thrombosis (DVT) in their right leg. Which action is appropriate?
- Perform the exercises very gently on the right leg to prevent stiffness.
- Perform exercises on both arms and the left leg, but avoid any movement of the right leg. (Correct answer)
- Proceed with exercises on all extremities as ordered in the original care plan.
- Elevate the right leg on two pillows before beginning the exercises.
Correct answer: Perform exercises on both arms and the left leg, but avoid any movement of the right leg.
An acute DVT is an absolute contraindication for range of motion exercises on the affected limb. Moving the leg could dislodge the blood clot, leading to a life-threatening pulmonary embolism. The CNA must not perform exercises on the affected leg and should clarify with the nurse if there are any questions. Exercises can be safely performed on the unaffected limbs.
Question 6: When performing passive range of motion on a resident's hip and knee, what is the primary reason for placing one hand under the knee and the other under the ankle/heel?
- To tickle the resident and make the experience more pleasant.
- To allow the CNA to use maximum force when bending the joint.
- To support the joints above and below the one being exercised, ensuring stability and preventing injury. (Correct answer)
- To make the movement faster and more efficient for the CNA.
Correct answer: To support the joints above and below the one being exercised, ensuring stability and preventing injury.
The fundamental principle of performing ROM exercises is to support the joints being moved. Placing hands above and below the joint (e.g., supporting the knee and ankle when exercising the knee/hip) provides stability, prevents strain on the joint capsule and surrounding ligaments, and ensures the movement is controlled and safe for the resident.
CNA Assisting with Range of Motion Exercises 2
A CNA is performing passive range of motion (PROM) on a resident with spasticity in their left arm.
As the CNA gently extends the elbow, the muscle tightens and resists the movement.
What is the most appropriate immediate action?