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 that their affected joints feel unusually warm and appear swollen compared to yesterday. What is the most appropriate action by the CNA?

Answer: Perform only passive ROM on the unaffected joints and report the findings to the nurse before proceeding further

Warmth and new or increased swelling in a joint can indicate active inflammation or a flare-up, which contraindicate ROM on those joints. The CNA should stop, report the objective findings to the nurse promptly, and may continue ROM on unaffected joints as permitted. Applying heat to an acutely inflamed joint can worsen inflammation, and proceeding on affected joints risks injury. Documenting refusal is inaccurate since the issue is a clinical finding, not resident refusal.

When performing passive ROM on a resident's shoulder, the CNA feels crepitus (a grating sensation) during abduction but the resident reports no pain. Which action is MOST appropriate?

Answer: Stop the movement at the point of crepitus, support the joint, and report the finding to the nurse

Crepitus is an abnormal finding that must be reported to the nurse regardless of whether pain is present, because it can indicate joint degeneration, loose bodies, or other pathology that may worsen with continued movement. The CNA should not push through or past crepitus, nor attempt to determine its full extent. Switching to active-assistive ROM does not address the clinical concern.

A CNA is assisting a post-stroke resident with right-sided hemiplegia through ROM exercises. The care plan specifies 'active-assistive ROM' for the right upper extremity. Which technique best reflects this order?

Answer: The CNA guides and supports the right arm while encouraging the resident to exert whatever voluntary effort they can

Active-assistive ROM means the resident contributes voluntary muscle effort while the CNA provides assistance to complete the movement through the full range. This differs from passive ROM (CNA does all the work) and active ROM (resident does all the work independently). Having the resident use the unaffected limb to move the affected one is a self-ROM technique, not what the care plan ordered.

During dorsiflexion of a resident's ankle, the CNA notices the foot only reaches a neutral (90-degree) position before significant resistance is felt, whereas yesterday the resident achieved 10 degrees past neutral. The resident denies any pain. What should the CNA do FIRST?

Answer: Note the change in ROM and report it to the nurse during this session, before the end of the shift

A measurable decrease in ROM compared to a recent baseline is a significant clinical change that must be reported to the nurse promptly — not at the end of the week or after a few more sessions. This change can indicate developing contracture, new pathology, DVT, or other conditions requiring evaluation. Forcing through resistance risks injury, and delaying the report allows potential harm to progress.

A resident with a healing femur fracture (cleared for ROM by the physician) is receiving passive ROM to the hip. The care plan states 'hip flexion to 70 degrees maximum.' During the exercise, the resident grimaces but says 'I'm fine, keep going — I want to get better faster.' The CNA has reached 68 degrees. What is the correct action?

Answer: Stop just before 70 degrees because the grimace indicates pain and the care plan limit should not be reached if nonverbal signs of discomfort appear

Nonverbal signs of pain — such as grimacing, facial tension, or guarding — must be respected even when a resident verbally denies discomfort. The care plan states a maximum of 70 degrees, which is a hard limit; however, the CNA should stop short of that limit when nonverbal cues indicate distress and report this to the nurse. Verbal consent does not allow exceeding physician-ordered limits, and grimacing alone is not an absolute contraindication if a nurse reassesses and clears continued movement.

A CNA is performing ROM on a resident who has a peripherally inserted central catheter (PICC) in the right antecubital fossa (inner elbow). The care plan includes ROM for both upper extremities. Which modification is MOST appropriate for the right arm?

Answer: Perform full ROM to the right shoulder and wrist but avoid extreme elbow flexion and extension that could stress the insertion site

A PICC line at the antecubital fossa requires the CNA to modify ROM by avoiding extreme elbow flexion or extension that could dislodge, kink, or stress the catheter at the insertion site. However, the shoulder, wrist, and fingers can still receive ROM. Avoiding the entire arm is overly restrictive and not supported by standard practice. Treating the arm identically to the left arm risks line integrity. The correct approach is targeted modification at the joint near the insertion site.