Assisting with Range of Motion Exercises Flashcards

A resident with a recent hip replacement is scheduled for passive ROM exercises. During abduction of the hip, the resident suddenly reports a sharp 'clicking' sensation without pain. What is the most appropriate immediate action?

Answer: Stop the exercise immediately and report the finding to the nurse

Any unusual sensation during ROM exercises on a resident with a hip replacement — including clicking, popping, or snapping — must be stopped immediately and reported to the nurse, even if the resident denies pain. A click could indicate early prosthetic dislocation or impingement, which requires clinical evaluation before exercises resume. CNAs must not interpret or dismiss joint noises unilaterally.

While performing active-assistive ROM on a resident's shoulder, you notice the affected arm moves approximately 30 degrees less than the unaffected arm. What should the CNA do with this information?

Answer: Document the asymmetry and report it to the nurse as a change in baseline

A measurable loss of range compared to the contralateral limb is a clinically significant change in baseline that must be documented and reported to the nurse. It could indicate joint inflammation, new contracture formation, or neurological changes. The CNA should never force a joint beyond its comfortable range to achieve symmetry, nor dismiss observable changes without reporting them.

A resident with rheumatoid arthritis is scheduled for ROM exercises at 10:00 AM. Upon assessment, the nurse's morning note documents that the resident's joints are 'warm and swollen bilaterally.' What is the CNA's most appropriate action?

Answer: Defer the ROM exercises and notify the nurse before proceeding

Active joint inflammation — evidenced by warmth and swelling — is a contraindication to ROM exercises in rheumatoid arthritis. Exercising an acutely inflamed joint can increase tissue damage and pain. The CNA must defer and notify the nurse rather than independently modify the exercise type, intensity, or range, as those decisions fall outside the CNA scope of practice.

When performing passive ROM on a resident's wrist, the CNA should support the joint both proximal and distal to where movement is occurring. What is the PRIMARY reason for this dual-hand support technique?

Answer: It stabilizes the proximal joint and controls movement so stress is isolated to the intended joint only

Supporting both above and below the joint being exercised ensures that movement is isolated to the target joint rather than transferred to adjacent joints. The proximal hand stabilizes the limb segment to prevent unwanted movement at neighboring joints, while the distal hand guides the controlled motion. Without this, stress can inadvertently be placed on joints not intended to be exercised, risking injury.

A resident who was previously able to perform active ROM exercises independently now requires active-assistive ROM due to increased fatigue from a new medication. The physical therapist's care plan has not yet been updated to reflect this change. How should the CNA proceed?

Answer: Perform active-assistive ROM based on the resident's current functional level and immediately report the change to the nurse for care plan update

A CNA must adapt to the resident's current functional status while working within safe practice boundaries. If a resident cannot safely perform the documented level of activity, the CNA should provide appropriate assistance to prevent injury, then promptly report the change to the nurse so the interdisciplinary team can update the care plan. Skipping exercises or continuing at an unsafe level both risk harm; letting the resident self-direct the clinical decision is outside the resident's role.

During ROM exercises, a resident with a history of deep vein thrombosis (DVT) reports new-onset calf pain and visible redness in the lower leg. Which response by the CNA reflects the highest priority standard of care?

Answer: Stop all exercises immediately, keep the resident still, and notify the nurse at once without massaging or rubbing the area

New calf pain with redness in a resident with DVT history is a medical emergency suggesting possible thrombus. The CNA must stop all activity immediately to prevent embolization, avoid massaging the area (which can dislodge a clot), keep the resident still, and notify the nurse immediately. Any intervention beyond stopping and notifying — including elevation, warm compresses, or continuing exercises elsewhere — could delay emergency response or worsen the outcome.