CNA Assisting with Range of Motion Exercises 3 — Questions and Answers
Question 1: A CNA is performing passive range of motion (PROM) on a resident who has had a stroke, resulting in hemiplegia of the right arm. The CNA notices that the resident's fingers are tightly curled into a fist. What is the appropriate initial action?
- Apply gentle, steady pressure to the curled fingers to gradually encourage them to extend. (Correct answer)
- Avoid touching the hand and only perform ROM exercises on the shoulder and elbow.
- Use a splint to force the fingers open before starting any wrist exercises.
- Immediately report the finding to the nurse without attempting any hand exercises.
Correct answer: Apply gentle, steady pressure to the curled fingers to gradually encourage them to extend.
For a resident with contractures or spasticity, such as a tightly curled fist post-stroke, the correct approach is to apply gentle, steady pressure. This technique helps the spastic muscles to relax slowly, allowing for a gradual opening of the hand. Forcing the joint or avoiding it altogether is incorrect. A splint would only be used under the direction of a nurse or therapist.
Question 2: While assisting a resident with active-assistive ROM, the resident, who has severe arthritis, can only move their shoulder part of the way through abduction before reporting pain. Which action should the CNA take?
- Encourage the resident to push through the pain to increase their range of motion.
- Stop the exercise for that joint and document the resident's refusal to participate.
- Support the joint and move it only to the point of resistance or pain, then stop. (Correct answer)
- Switch to passive ROM and complete the full range of motion for the resident.
Correct answer: Support the joint and move it only to the point of resistance or pain, then stop.
The guiding principle for ROM exercises is to move the joint only to the point of resistance or pain, and never force it beyond that limit. For a resident with arthritis, this is especially important to prevent further inflammation and injury. Pushing through pain is contraindicated. The resident is not refusing, but reporting a limitation. Forcing the joint through a full passive range would be painful and potentially harmful.
Question 3: A resident is recovering from hip replacement surgery and the care plan includes specific ROM exercises. However, the resident expresses significant fear and anxiety, stating, 'I'm afraid I'll damage the new joint if I move it.' What is the CNA's most therapeutic response?
- "The doctor ordered these, so we have to do them to prevent problems."
- "Don't worry, I'm trained to do this and I won't let you get hurt."
- "I understand you're concerned. Let's start very slowly, and you tell me the moment you feel any discomfort. We'll only do what feels safe to you." (Correct answer)
- "If you don't do these exercises, your recovery will be much slower."
Correct answer: "I understand you're concerned. Let's start very slowly, and you tell me the moment you feel any discomfort. We'll only do what feels safe to you."
Psychological factors like fear and anxiety can be significant barriers to rehabilitation. The most therapeutic approach is to acknowledge and validate the resident's feelings, provide reassurance, and empower them by giving them control over the process. This builds trust and encourages participation. The other options are either dismissive, authoritarian, or use negative reinforcement, which are less effective.
Question 4: A CNA is tasked with performing circumduction of the shoulder. Which of the following descriptions accurately represents this movement?
- Moving the arm in a cone-shaped, circular motion from the shoulder joint. (Correct answer)
- Bending the elbow to bring the hand toward the shoulder.
- Moving the arm straight out to the side, away from the body.
- Turning the forearm so the palm faces upward.
Correct answer: Moving the arm in a cone-shaped, circular motion from the shoulder joint.
Circumduction is a compound movement that involves flexion, extension, abduction, and adduction performed in sequence, resulting in the distal end of the limb moving in a circle. It is accurately described as moving the arm in a cone-shaped or circular motion.
Question 5: Which of the following scenarios is a contraindication for a CNA to perform passive range of motion exercises for a resident's leg?
- The resident has moderate, chronic arthritis in the knee joint.
- The resident has a new diagnosis of an acute deep vein thrombosis (DVT) in that leg. (Correct answer)
- The resident has muscle atrophy from being bed-bound for several weeks.
- The resident is unconscious following a stroke.
Correct answer: The resident has a new diagnosis of an acute deep vein thrombosis (DVT) in that leg.
Performing ROM exercises on a limb with an acute DVT is contraindicated because the movement could dislodge the blood clot, leading to a life-threatening pulmonary embolism. While caution is needed with arthritis, and ROM is indicated for atrophy and unconscious patients, an acute DVT is a situation where these exercises should not be performed without specific clearance from a nurse or physician.
Question 6: When performing passive ROM for an ankle, the CNA performs dorsiflexion and plantar flexion. To perform dorsiflexion correctly, the CNA would gently bend the foot in which direction?
- Inward, toward the body's midline.
- Outward, away from the body's midline.
- Downward, as if pointing the toes.
- Upward, toward the resident's shin. (Correct answer)
Correct answer: Upward, toward the resident's shin.
Dorsiflexion of the ankle involves flexing the foot upward, decreasing the angle between the top of the foot and the shin. Plantar flexion is the opposite motion, pointing the toes downward. Moving the foot inward is inversion, and outward is eversion.
CNA Assisting with Range of Motion Exercises 3
A CNA is performing passive range of motion (PROM) on a resident who has had a stroke, resulting in hemiplegia of the right arm.
The CNA notices that the resident's fingers are tightly curled into a fist.
What is the appropriate initial action?