Medium NCLEX Mobility Practice Questions

Mastering mobility and immobility is a cornerstone of nursing care, as physical activity impacts every body system from the cardiovascular to the integumentary. These Medium NCLEX Mobility Practice Questions are designed to test your clinical judgment regarding safe patient handling, complication prevention, and rehabilitative techniques.

Concept Explanation

Mobility in nursing refers to the ability of a patient to move freely, easily, rhythmically, and purposefully within their environment. It is not merely the act of walking but encompasses range of motion (ROM), gait, alignment, and the physiological responses to activity. When mobility is compromised, nurses must intervene to prevent the hazards of immobility, such as deep vein thrombosis (DVT), pneumonia, muscle atrophy, and pressure injuries. According to the CDC's NIOSH guidelines, safe patient handling is critical to protecting both the patient from falls and the nurse from musculoskeletal injuries.

Effective mobility management requires an understanding of different levels of assistance and the correct use of assistive devices. Nurses must evaluate a patient's weight-bearing status, balance, and cognitive ability before initiating a transfer. For more foundational concepts, you can review our NCLEX Fundamentals Practice Questions with Answers. Key interventions include frequent repositioning every two hours, encouraging incentive spirometry to prevent atelectasis, and implementing early ambulation protocols which have been shown to significantly reduce hospital stay durations.

Solved Examples

1. Example 1: Crutch Safety
   A patient is being fitted for axillary crutches. How should the nurse verify the correct height?
   
   1. The nurse should ensure there is a 2 to 3 finger-width space (approximately 1 to 1.5 inches) between the crutch pad and the axilla.
   2. The elbows should be flexed at an angle of $20^\circ$ to $30^\circ$.
   3. This prevents pressure on the brachial plexus nerve, which can cause "crutch palsy."
2. Example 2: Transferring a Hemiparetic Patient
   A nurse is preparing to transfer a patient with left-sided weakness from the bed to a chair. Where should the chair be placed?
   
   1. The nurse places the chair on the patient's stronger (right) side.
   2. The chair should be angled at $45^\circ$ to the bed.
   3. This allows the patient to lead with their strong leg and use their strong arm for support during the pivot.
3. Example 3: Cane Usage
   Which side should a patient hold a cane, and how do they move it?
   
   1. The patient holds the cane on the unaffected (stronger) side.
   2. The sequence is: Move the cane forward, then move the weaker leg to the cane, then move the stronger leg past the cane.
   3. This provides a wider base of support and mimics natural gait.

Practice Questions

1. A nurse is caring for a client who has been on prolonged bed rest. Which assessment finding should the nurse prioritize as a potential complication of immobility?

2. A client with a fractured right femur is ordered to be non-weight-bearing. Which gait should the nurse teach the client to use with crutches?

3. While performing range-of-motion (ROM) exercises for a client, the nurse meets resistance while attempting to abduct the client's shoulder. What is the nurse's most appropriate action?

4. The nurse is assisting a client with osteoporosis to ambulate. Which instruction is most important for the nurse to provide to the client to prevent injury?

5. A nurse is preparing to move a client up in bed using a drawsheet. Which action by the nurse demonstrates proper body mechanics?

6. A client who is post-operative day 2 from a total hip arthroplasty (posterior approach) is being assisted out of bed. Which movement must the nurse instruct the client to avoid?

7. The nurse is assessing a client’s gait. The nurse notes that the client takes small, shuffling steps and has a stooped posture. This gait is most characteristic of which condition?

8. Which intervention is most effective in preventing external rotation of the hips in a client who is in the supine position?

9. A nurse is evaluating a client using a walker for the first time. Which observation indicates the client needs further instruction?

10. A client with right-sided weakness is learning to climb stairs with a cane. What is the correct sequence for going up the stairs?

Answers & Explanations

1. Answer: Diminished breath sounds in the lower lobes. Immobility leads to reduced chest expansion and pooling of secretions, which can cause atelectasis or hypostatic pneumonia. While skin redness (pressure injury risk) is important, respiratory compromise is a higher priority on the ABC (Airway, Breathing, Circulation) scale.
2. Answer: Three-point gait. In a three-point gait, the client moves both crutches and the affected (non-weight-bearing) leg forward together, then moves the unaffected leg. This is the standard for non-weight-bearing status.
3. Answer: Stop the movement and document the limitation. ROM should never be forced beyond the point of resistance or pain, as this can cause muscle or joint injury. Documentation helps track progress or decline in joint mobility.
4. Answer: "Wear well-fitting, rubber-soled shoes." Proper footwear provides traction and stability, reducing the risk of falls which are particularly dangerous for clients with osteoporosis. You may also want to review NCLEX Patient Safety Practice Questions for more on fall prevention.
5. Answer: Flexing the knees and hips while keeping the back straight. This lowers the nurse's center of gravity and uses the large muscles of the legs rather than the small muscles of the back to perform the work.
6. Answer: Adducting the affected leg past the midline. Following a posterior hip replacement, clients must avoid hip flexion greater than $90^\circ$, internal rotation, and adduction to prevent dislocation of the prosthesis.
7. Answer: Parkinson's disease. A shuffling, propulsive gait is a hallmark sign of Parkinson's. For more on this, see our NCLEX Neurology Practice Questions.
8. Answer: Placing trochanter rolls against the greater trochanters. Trochanter rolls prevent the femur from rotating outward, maintaining neutral alignment of the hips.
9. Answer: The client lifts the walker and moves it forward while stepping. The walker should be moved forward first, and then the client should step into it. Moving the device and the body simultaneously increases the risk of losing balance.
10. Answer: Lead with the left (unaffected) leg, followed by the cane and the right leg. The mnemonic "Up with the good, down with the bad" applies. When going up, the strong leg goes first to pull the body up; the cane and weak leg follow.

1. Which position is most appropriate for a client receiving a tube feeding to prevent aspiration?

• ASupine
• BFowler's
• CTrendelenburg
• DProne

Frequently Asked Questions

What is the difference between active and passive range of motion?

Active ROM is performed by the patient independently to maintain muscle strength and joint flexibility. Passive ROM is performed by the nurse or therapist for a patient who cannot move independently, focusing solely on maintaining joint flexibility without building muscle strength.

How often should an immobile patient be repositioned?

Standard nursing practice requires repositioning a bedbound patient at least every 2 hours to prevent pressure injuries and respiratory complications. Patients in chairs should be repositioned or encouraged to shift weight every 15 to 30 minutes.

Why is orthostatic hypotension a risk for immobile patients?

Prolonged bed rest causes the cardiovascular system to become less efficient at constricting lower extremity vessels upon standing. This results in a sudden drop in blood pressure and potential fainting when the patient attempts to move from a lying to a standing position.

What is the proper way to use a gait belt?

A gait belt should be secured snugly around the patient's waist over their clothing, never on bare skin. The nurse should grasp the belt at the back or sides using an underhand grip to provide stability during ambulation or transfers.

What are the signs of a Deep Vein Thrombosis (DVT)?

Common signs of DVT include unilateral leg swelling, warmth, redness, and tenderness in the calf area. Nurses should monitor immobile patients closely for these symptoms and utilize mechanical prophylaxis like sequential compression devices as ordered.

How do you measure a patient for a walker?

The height of the walker should be adjusted so that the handgrips are at the level of the patient's wrist crease when their arms are hanging at their sides. This ensures a comfortable $15^\circ$ to $30^\circ$ bend in the elbows during use.