Assisting with Range of Motion Exercises Flashcards

A resident with a recent hip replacement asks you to perform full ROM exercises on the operative leg because 'the therapist said to keep it moving.' What is the MOST appropriate action?

Answer: Perform only the ROM exercises specifically authorized in the care plan, then report the resident's request to the nurse

CNAs must follow the individualized care plan exactly. Hip replacement patients have specific precautions (e.g., no adduction past midline, no hip flexion beyond 90°) that the CNA may not override based on a resident's verbal report. The correct action is to follow what is authorized and escalate the discrepancy to the nurse.

While performing passive ROM on a resident's shoulder, you feel crepitus (a grinding sensation) and the resident grimaces but denies pain. What should the CNA do NEXT?

Answer: Stop the exercise, reposition the joint gently to a neutral position, and report the finding to the nurse before continuing

Crepitus accompanied by a pain grimace — even without verbal acknowledgment — is a clinical sign that warrants stopping. Residents may minimize or deny pain due to cognitive impairment, stoicism, or fear of losing independence. The CNA must stop, protect the joint, and report before proceeding.

Which sequence CORRECTLY describes the principle of 'moving from proximal to distal' when performing ROM on an upper extremity?

Answer: Shoulder → elbow → wrist → fingers

Proximal-to-distal means starting closest to the body's center and working outward: shoulder (most proximal), then elbow, wrist, and finally fingers (most distal). This sequence promotes circulation and ensures large joints are stabilized before smaller, more delicate joints are moved.

A nurse informs you that a resident has spasticity in the left arm due to a stroke. During passive ROM, the arm resists movement and suddenly 'gives way' (clasp-knife response). Which action is MOST appropriate?

Answer: Apply slow, steady, gentle movement and avoid quick or jerky motions to minimize triggering spasms

Spasticity responds poorly to fast or forceful movement, which can worsen reflexive muscle contraction. Slow, sustained, gentle movement is the evidence-based approach for spastic limbs. The CNA should never increase speed or apply resistance without a therapist's specific direction, and should never independently discontinue ordered ROM.

A resident on bed rest for a pressure injury has a care plan that orders ROM to all extremities twice daily. During the morning session you notice the right ankle is visibly swollen, warm, and slightly reddened compared to the left. You should:

Answer: Omit right ankle ROM for that session, cover the extremity, and notify the nurse immediately before performing any further exercises

Unilateral swelling, warmth, and erythema are classic signs of possible deep vein thrombosis (DVT). Performing ROM on a suspected DVT site could dislodge a clot and cause a pulmonary embolism — a life-threatening emergency. The CNA must stop, protect the limb, and report immediately. Care plan orders do not override newly observed clinical contraindications.

When documenting ROM exercises, a CNA records 'resident tolerated ROM well.' The charge nurse asks for more precise documentation. Which entry BEST meets professional charting standards?

Answer: 'Passive ROM performed to bilateral upper and lower extremities x2 sets each joint per care plan. Resident denied pain, no grimacing, skin intact. Right shoulder — slight resistance noted at full abduction; reported to nurse J. Smith, RN.'

Professional clinical documentation must be specific, objective, and actionable. The correct option identifies which extremities, the type of ROM, the number of sets, the resident's pain response, skin condition, any abnormal findings, and the follow-up action taken. Vague terms like 'tolerated well,' 'no problems,' or 'without complications' do not meet the standard of care for medical records.