Assisting with Range of Motion Exercises Flashcards

A CNA is performing passive ROM on a resident's shoulder when the resident suddenly grimaces and says 'it feels tight but I'm okay.' What is the most appropriate next action?

Answer: Stop the movement at the point of resistance and report the resident's subjective complaint to the nurse

ROM should never be forced past the point of pain or resistance. The resident's grimace and report of tightness signals the CNA to stop at that position and report to the nurse, who can assess whether the tightness represents a clinical change, contracture progression, or injury risk. Continuing through or pushing past resistance risks joint damage or muscle tears.

During ROM exercises for a resident with left-sided hemiplegia following a stroke, the CNA should:

Answer: Perform active ROM on the right side and passive ROM on the left side

With hemiplegia, the unaffected side retains voluntary motor function and should receive active-assistive or active ROM to preserve strength and function. The affected (paralyzed) side requires passive ROM performed by the CNA to prevent contractures, maintain joint integrity, and promote circulation — since the resident cannot initiate movement there. Both sides require ROM, but the type differs based on ability.

A nurse's care plan orders 'ROM to bilateral lower extremities, hip flexion to 90 degrees maximum.' While assisting a resident, the CNA notices the resident's hip reaches 90 degrees of flexion easily and the resident asks to go further. The CNA should:

Answer: Stop at 90 degrees as ordered and inform the nurse of the resident's request for increased range

Care plan ROM restrictions are clinical orders — not suggestions — and often reflect post-surgical precautions (e.g., hip replacement dislocation precautions), injury history, or physician parameters. The CNA must adhere strictly to the documented limit regardless of how well the resident tolerates the movement. The resident's request for increased range is valuable information that must be communicated to the nurse, who can consult the care team about modifying the order.

Which of the following sequences correctly describes the anatomical positions used when performing circumduction of the shoulder joint?

Answer: Flexion → abduction → extension → adduction, tracing a cone-shaped arc

Circumduction combines four cardinal movements in sequence — flexion (forward), abduction (lateral), extension (backward), and adduction (return toward midline) — creating a cone-shaped arc at the joint. It is a compound movement unique to ball-and-socket joints like the shoulder and hip. The other options describe different movement combinations: option B includes forearm movements, option C describes scapular movements, and option D describes horizontal plane movements only.

A resident with rheumatoid arthritis has ROM ordered twice daily. The resident reports that their joints feel 'extra stiff and achy' this morning. The CNA observes bilateral hand joint swelling that was not documented in yesterday's notes. The most appropriate CNA action is:

Answer: Defer ROM for that session, report the new swelling and increased symptoms to the nurse before proceeding

New joint swelling with increased pain in a resident with rheumatoid arthritis may signal an acute flare, infection (septic arthritis), or injury — conditions that contraindicate ROM until evaluated by a nurse or physician. The CNA's role is to recognize this change in condition, defer the exercise, and report immediately. Performing ROM on acutely inflamed joints can worsen synovial damage. Applying warmth or modifying the approach independently falls outside the CNA's scope and could cause harm.

When performing passive ROM on a resident's knee, a CNA hears and feels a distinct 'clicking' sensation during flexion and extension. The resident reports no pain. Which action is MOST appropriate?

Answer: Stop the movement, document the crepitus with its characteristics, and report the finding to the nurse

Although painless crepitus is common and often benign (resulting from gas bubbles, tendon snapping, or articular surface changes), the CNA cannot clinically determine the cause or significance of a new or unusual sound/sensation in a joint. The CNA must stop, document the objective finding (clicking sensation during knee flexion/extension, painless), and report it to the nurse for clinical evaluation. Continuing, increasing speed, or adding resistance without nursing assessment would be outside the CNA's scope and could cause harm if the underlying cause is pathological (e.g., meniscal tear, loose body).