Safety and Mobility Needs Flashcards

A nurse applies sequential compression devices (SCDs) to a post-operative patient. The PRIMARY purpose of this intervention is to:

Answer: Prevent deep vein thrombosis by promoting venous return

SCDs intermittently compress the legs to mimic the calf muscle pump, promoting venous return and preventing DVT in immobile post-operative patients.

When performing passive range-of-motion (ROM) exercises on a patient's hip, the nurse should stop and reassess if:

Answer: The patient reports pain during the exercise

Passive ROM should be performed within the pain-free range; pain indicates possible injury, inflammation, or exceeding the joint's safe limits.

A confused elderly patient keeps trying to climb out of bed despite interventions. Before applying a physical restraint, the nurse should first:

Answer: Obtain a physician's order and apply the least restrictive restraint available

Restraints require a physician's order and must be the least restrictive option necessary; this is the mandatory first step before application.

A nurse discovers a patient on the floor after a fall. After calling for help, the nurse's next priority action is to:

Answer: Assess the patient for injury before moving them

The patient must be assessed for injuries such as fractures or head trauma before any attempt to move them, to avoid worsening an existing injury.

Which nursing action is MOST effective in preventing hospital-acquired pressure injuries in an immobile patient?

Answer: Repositioning the patient at least every 2 hours

Regular repositioning every 2 hours relieves sustained pressure on vulnerable tissues and is the cornerstone of pressure injury prevention.

A nurse is preparing to ambulate a patient for the first time after three days of bed rest. Which action should the nurse take FIRST?

Answer: Have the patient sit upright at the bedside for several minutes before standing

Dangling at the bedside allows the cardiovascular system to adjust before the patient stands, preventing orthostatic hypotension and falls.

Which of the following is a contraindication for the use of a heating pad on a patient?

Answer: Decreased sensation in the extremity being treated

Decreased or absent sensation prevents the patient from detecting excessive heat, creating high risk for thermal burns.