Assisting with Range of Motion Exercises Flashcards

A resident with early-stage rheumatoid arthritis is scheduled for ROM exercises. During the session, the resident reports a pain level of 6/10 in their wrist joint, which is visibly warm and slightly swollen. What is the most appropriate action?

Answer: Stop all ROM exercises immediately and notify the nurse before continuing

Signs of active joint inflammation — warmth, swelling, and pain rated 6/10 — indicate a potential flare. Performing ROM on an acutely inflamed joint can cause joint damage. The CNA must stop and notify the nurse, who will reassess the care plan before any ROM is resumed. Proceeding on other joints without reporting is also incorrect because the nurse needs a full clinical picture.

When performing passive ROM on a resident's shoulder, the CNA notices crepitus (a grinding sensation) with no reported pain. The movement is within the previously documented range. What should the CNA do?

Answer: Stop the shoulder exercise, document the new finding, and report it to the nurse before continuing

Crepitus is a new objective finding that was not previously noted. Even without pain, it may indicate degenerative joint changes, loose bodies, or other pathology. The CNA must stop that specific exercise, document the observation accurately, and report it to the nurse promptly — not wait until end of shift — so the nurse can determine whether the care plan needs modification before further ROM is performed.

A resident has a documented contracture in the left elbow, limiting extension to 45°. During ROM, a new staff member extends the elbow to 30° (the resident's functional limit per the care plan) and then attempts to push slightly further, feeling resistance, arguing it will 'help break the contracture.' What principle does this violate?

Answer: The CNA must work only within the resident's existing range and never force movement beyond resistance

The fundamental safety rule of ROM is to move each joint smoothly through its available range and stop at the point of resistance or pain — never force beyond it. Breaking a contracture is a therapeutic goal managed by physical therapy under a physician's order, not something a CNA performs unilaterally. Forcing movement risks tearing soft tissue, fracturing osteoporotic bone, or causing severe pain.

A CNA is performing ROM on a resident who had a left-sided CVA (stroke) resulting in left hemiplegia. The care plan specifies passive ROM to the left extremities and active-assistive ROM to the right. The resident's right hand begins to shake noticeably during active-assistive finger flexion. What is the correct interpretation and response?

Answer: Tremor appearing during exercise on the unaffected side is a new neurological sign that must be reported to the nurse immediately

In a post-stroke resident, the right (ipsilateral-to-the-unaffected-hemisphere) side should not exhibit new tremors during routine exercise. A new-onset tremor on the presumed unaffected side is an unexpected neurological finding that could indicate a secondary stroke, medication effect, or other systemic issue. The CNA must stop, report immediately to the nurse, and not minimize it as coincidental.

A resident is on aspirin and warfarin following a deep vein thrombosis (DVT) in the right calf diagnosed 8 days ago. The physician's order now includes 'ROM to all extremities.' How should the CNA approach ROM to the right lower extremity?

Answer: Perform only gentle passive ROM to the right ankle and foot, avoiding aggressive hip or knee flexion, and report any calf tenderness or redness

A recent DVT requires extreme caution. While the physician has ordered ROM, the CNA must perform it very gently, focusing on distal joints (ankle/foot) to promote venous return without massaging or aggressively manipulating the affected calf, which could dislodge a thrombus. Any increase in calf warmth, pain, or redness must be reported immediately. Vigorous ROM or massage of the affected limb is dangerous and could cause a pulmonary embolism.

During ROM exercises, a resident who is cognitively intact suddenly becomes pale, diaphoretic, and says 'I feel like I might pass out.' The CNA has just completed hip abduction on the left leg. What is the priority sequence of actions?

Answer: Lower the resident to a supine position, call for the nurse immediately, and monitor vital signs while staying with the resident

Pallor, diaphoresis, and near-syncope constitute a cardiovascular or vasovagal emergency. The priority is to prevent injury from falling by positioning the resident safely supine (if tolerated), activating the nurse/emergency response immediately, and staying with the resident to monitor. Attempting to finish exercises, delaying the call, or performing glucose checks before calling the nurse are all incorrect prioritization. Only a licensed nurse can assess and direct next steps.