Physical Therapy Nursing NCLEX Questions
Question A nurse is caring for a patient who has just undergone a total hip replacement. Which of the following activities should the nurse encourage the patient to perform to prevent post-operative complications?
A) Bed rest for the first 48 hours
B) Immediate full weight-bearing exercises
C) Leg crossing when seated
D) Use of an incentive spirometer
E) High-impact aerobic activities
Correct Answer: D) Use of an incentive spirometer
Rationale: The use of an incentive spirometer is critical in the post-operative care of patients who have undergone major surgeries like a total hip replacement. It helps prevent pulmonary complications, such as pneumonia, by encouraging deep breathing and facilitating lung expansion. Encouraging bed rest for prolonged periods can increase the risk of complications like deep vein thrombosis and pressure ulcers. Immediate full weight-bearing exercises, leg crossing when seated, and high-impact activities are contraindicated in the early post-operative period as they can jeopardize the surgical site and lead to dislocation or other complications.
Question A nurse is planning care for a patient with a lower extremity fracture who will require crutches for mobility. Which of the following instructions should the nurse prioritize to promote safety?
A) Advise the patient to carry heavy objects while using crutches.
B) Recommend using crutches on wet and slippery surfaces.
C) Instruct on the proper adjustment of crutch height for a comfortable fit.
D) Encourage the patient to use crutches on stairs frequently.
E) Suggest resting on the underarms for better stability.
Correct Answer: C) Instruct on the proper adjustment of crutch height for a comfortable fit.
Rationale: Proper adjustment of crutch height is essential to ensure safety and comfort while using crutches. If crutches are too high, they can press into the underarms, causing nerve damage, and if too low, they can lead to poor posture and imbalance. Advising patients to carry heavy objects, recommending use on wet surfaces, or suggesting resting on the underarms can increase the risk of falls and injuries. Encouraging frequent stair use without proper training and strength can also be hazardous.
Question During the post-operative period, a patient is at risk for developing deep vein thrombosis (DVT). Which of the following interventions should the nurse implement to reduce this risk?
A) Encourage prolonged bed rest
B) Apply a heating pad to the affected area
C) Administer prescribed anticoagulant therapy
D) Restrict fluid intake
E) Recommend high-intensity leg exercises
Correct Answer: C) Administer prescribed anticoagulant therapy
Rationale: Administering prescribed anticoagulant therapy is a key intervention for preventing DVT in post-operative patients. Anticoagulants decrease the blood’s ability to clot, significantly reducing the risk of clot formation in the deep veins. Prolonged bed rest, applying heat directly to the affected area, restricting fluids, and recommending high-intensity exercises without gradual progression can actually increase the risk of DVT or exacerbate the patient’s condition.
Question A nurse is assisting a patient with rheumatoid arthritis in developing a physical activity plan. Which of the following types of exercise should the nurse recommend?
A) High-impact aerobics
B) Competitive weightlifting
C) Gentle stretching exercises
D) Full-contact sports
E) Marathon running
Correct Answer: C) Gentle stretching exercises
Rationale: Gentle stretching exercises are beneficial for patients with rheumatoid arthritis as they help maintain joint flexibility, reduce stiffness, and improve range of motion without causing additional stress to the joints. High-impact aerobics, competitive weightlifting, full-contact sports, and marathon running can exacerbate joint pain and inflammation, leading to increased discomfort and potential injury. Stretching exercises can be tailored to the individual’s limitations and can be incorporated into a daily routine to manage symptoms effectively.
Question A nurse is educating a patient on the importance of maintaining skin integrity around a plaster cast. Which of the following instructions should the nurse include?
A) Keep the cast dry at all times.
B) Apply powder inside the cast for moisture absorption.
C) Use a pointed object to scratch under the cast if it itches.
D) Wet the cast regularly to maintain its shape.
E) Insert foreign objects under the cast to relieve pressure spots.
Correct Answer: A) Keep the cast dry at all times.
Rationale: Keeping the cast dry is crucial to maintaining skin integrity, as moisture can lead to skin breakdown, infection, and delayed healing. Applying powder can cause buildup and lead to skin irritation or infection. Using pointed objects to scratch under the cast or inserting foreign objects can damage the skin and increase the risk of infection. Wetting the cast can compromise its structural integrity and also lead to skin issues. Therefore, educating patients on the importance of keeping the cast dry and intact is essential for promoting healing and preventing complications.
Question A nurse is preparing a patient for discharge after a minor knee surgery. Which of the following instructions is MOST important for the patient to follow to ensure a smooth recovery at home?
A) Engage in high-intensity interval training immediately to strengthen the knee.
B) Keep the surgical site clean and dry to prevent infection.
C) Consume a diet high in processed foods to increase calorie intake.
D) Limit mobility to avoid stress on the knee joint.
E) Avoid reporting minor pains to avoid unnecessary medical visits.
Correct Answer: B) Keep the surgical site clean and dry to prevent infection.
Rationale: Keeping the surgical site clean and dry is essential in preventing post-operative infections, which can delay healing, cause further complications, and even lead to re-hospitalization. High-intensity interval training should be avoided initially to prevent strain on the knee and allow for proper healing. A diet high in processed foods can contribute to inflammation and hinder recovery, while a balanced diet supports healing. Limiting mobility excessively can lead to stiffness and decreased range of motion; mobility should be gradually increased as recommended. Reporting pain is important to manage potential complications early.
Question A nurse is caring for a patient who is beginning to use a walker after hip replacement surgery. Which of the following safety tips should the nurse emphasize?
A) Drag the walker for more stability.
B) Use the walker to pull themselves up from a seated position.
C) Ensure the walker’s height is adjusted so the patient’s shoulders slump.
D) Check that the rubber tips on the walker’s legs are secure and not worn.
E) Skip using the walker on flat surfaces for quicker mobility.
Correct Answer: D) Check that the rubber tips on the walker’s legs are secure and not worn.
Rationale: Ensuring that the rubber tips on the walker’s legs are secure and not worn is crucial for preventing slips and falls, providing stability and safety while the patient is mobilizing. Dragging the walker, using it to pull up from a seated position, and adjusting it to cause shoulder slumping can lead to improper posture, decreased stability, and increased risk of falls or injuries. Skipping the walker on flat surfaces can jeopardize the healing process and safety of the patient, especially in the initial stages of rehabilitation after hip replacement surgery.
Question For a patient recovering from a stroke with left-sided weakness, which of the following nursing interventions is MOST effective in preventing skin breakdown?
A) Keeping the patient in a supine position most of the time.
B) Applying high-density foam to areas at risk.
C) Encouraging the patient to remain in a wheelchair for convenience.
D) Using a heat lamp to improve circulation.
E) Restricting fluid intake to reduce the need for repositioning.
Correct Answer: B) Applying high-density foam to areas at risk.
Rationale: Applying high-density foam to areas at risk of skin breakdown is an effective intervention for a patient with left-sided weakness due to a stroke. This intervention helps distribute pressure more evenly, reducing the risk of pressure ulcers. Keeping the patient in a supine position or in a wheelchair for extended periods can increase the risk of skin breakdown due to constant pressure on certain areas. Using a heat lamp can cause skin dryness and increase the risk of burns, while restricting fluid intake can lead to dehydration and further compromise skin integrity. Regular repositioning and the use of pressure-relieving devices are key in preventing skin breakdown.
Question A nurse is working with a patient on improving balance and coordination after a traumatic brain injury. Which of the following activities should the nurse include in the patient’s rehabilitation plan?
A) Static balance exercises on an unstable surface.
B) High-speed treadmill training without handrails.
C) Exercises that require sudden changes in direction.
D) Tai Chi or gentle yoga.
E) Jumping on a trampoline.
Correct Answer: D) Tai Chi or gentle yoga.
Rationale: Tai Chi and gentle yoga are excellent for improving balance and coordination in patients recovering from a traumatic brain injury. These activities promote slow, controlled movements that enhance proprioception, balance, and overall physical coordination in a safe manner. High-speed treadmill training, exercises requiring sudden changes in direction, and jumping on a trampoline pose a high risk of falls and injuries due to the patient’s compromised balance and coordination. Static balance exercises on an unstable surface should be introduced gradually and under close supervision.
Question A nurse is teaching a patient with chronic obstructive pulmonary disease (COPD) about the importance of physical activity. Which of the following types of exercise should the nurse recommend?
A) Prolonged, high-intensity aerobic exercises.
B) Short bursts of anaerobic activity.
C) Swimming in cold water.
D) Walking at a comfortable pace.
E) Resistance training with heavy weights.
Correct Answer: D) Walking at a comfortable pace.
Rationale: Walking at a comfortable pace is an ideal form of exercise for patients with COPD, as it improves cardiovascular fitness without overexerting the lungs. Prolonged, high-intensity aerobic exercises and short bursts of anaerobic activity can be too demanding for patients with COPD, leading to exacerbation of symptoms. Swimming in cold water may trigger bronchospasm and worsen breathing difficulties. Resistance training with heavy weights should be approached with caution and tailored to the individual’s capabilities, focusing on low-intensity exercises to prevent undue strain on the respiratory system.
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Physical Therapy Nursing
The principal goal of occupational and physical therapy is the prevention and treatment of scar contracture, deformity, and hypertrophic scarring. In the hospital or in the field, therapy must begin on the same day of admission (beginning with the assessment). This continues daily and is focused on:
∙ Survival: to get wound/graft closed
∙ Function: of hands, feet, joints, face and,
∙ Appearance: psychosocial
What are the primary aspects of the evaluation for therapy?
• ROM: able to perform active/passive
• AROM: active maintaining muscle mass
• PROM: passive prevent joint stiffness in limited and debilitated patients
• Strength – endurance and muscle strength
• Sensation – present on all burned areas specially on upper and lower extremities
• Burn wound assessment – open/closed wound and percent of grafting taken
What are the main rehabilitative interventions?
• Positioning – for comfort and prevent skin breakdown
• Splinting – to prevent contractures and promote position of function
• Range of Motion Exercises
• Function and gait – early ambulation
• ADL’s and adaptation – self feeding, dressing, oral care, and toiletry
• Eschar control (Wolff’s law – the principle that changes in the form and function are followed by changes in its internal structure)
What factors may affect physical therapy?
• Pain is one the most important factor affecting the daily physical therapy interventions. Assess pain level before/after therapy. The Visual Analogue Scale, VAS, (0-10 points scale) and the Wong-Baker Faces Pain Rating Scale, FPRS, (0-5 scale points) are important tools that measure more effective the sensory component of the patient’s pain (see burn pain chapter)
• Itching of the skin is another factor that will prevent to have a good response to therapy. Assess the need for antihistamine, (Diphenhydramine “Benadryl” or Hydroxyzine “Atarax” 25-50 mg PO every 4-6 hours as needed).
Burn wound assessment
• Extent of burn TBSA%
• Location/distribution of TBSA%
– location, some areas are difficult to optimize ROM
– compare location of TBSA% (anterior vs. posterior vs. lateral vs. medial )
• Depth of wounds – 2nd and 3rd degree burn
Daily
• Time of day – optimal time in AM
• Frequency of treatment – twice a day
• Duration of treatment – series of repetitions that last 2 to 30 minutes
• Intensity of Treatment – advance as patient tolerate
Goals of Exercise
The goal of exercise is to reduce edema and promote circulation increasing ROM and strength
• Prevent scar tissue contractures and deformity
• Preserve muscle strength and it mobility
• Promote maximum functional and independence
• Maintain cardiovascular endurance and muscle strength
• Education of patient and family members – compare location of TBSA% (anterior vs. posterior vs. lateral vs. medial )
• Depth of wounds – 2nd and 3rd degree burn
Indications for Exercise
• Control edema
• Prevent contractures
• Prevent atrophy
• Prevent tendon adherence
• Prevent joint stiffness
Contraindications to Exercise
• Fractures – external fixators
• Early grafting, mesh graft = 3 to 5 days, sheet graft = 5 to 7 days
• Exposed tendons (relative)
• Wet donors – too painful
What is the role of positioning and splinting?
Remember, the patient’s position of comfort promotes the early formation of scar contractures. The primary goals of splinting are to:
• Prevent the shearing and destruction of newly grafted areas
• Control and prevent edema
• Prevent tissue destruction
• Maintain anatomical position and ROM
• Correct and prevent contractures
• Assist function – activity of daily living
How is splinting and positioning used post-operatively?
• Ideally, this is done in the operating room
• Protects the integrity of new skingrafts • Joint(s) are splinted in anti-contracture position
• Mesh grafts: splint over occlusive dressings to a position of function
• Sheet grafts (with or without piecrusting): splints are carefully placed to allow graft exposure, fluid can be expressed from the skingraft edges (use cotton tips applicators). This is commonly used after skingrafting of the hands.
What is the role of compression?
• Compression is necessary for all burned, grafted or harvested areas when dependent
• Decreases orthostatic hypotension
• Decreases microcapillary trauma (tattoo)
• May convert to deeper wound without proper pressure
• Prelude to definitive control of hypertrophic scar formation
PREPARING FOR AMBULATION
• Recliner – out of the bed
• Standing/Tilt Table
Benefits of Early Ambulation
• Promotes independence
• Prevents thromboemboli/decubiti
• Maintains strength/cardiovascular conditioning
• Maintains bone density
• May be preceded with tilt/standing table
Concerns with Ambulation
• Vital signs
• Orthostatic hypotension
• Inhalation injury (on mechanical ventilation)
• IV lines (feet, groin)
Biomechanics of Scar Management
• Collagen deposition forms scar tissue
Burn Scar Assessment
• Vascularity
• Pliability
• Height
• Compliance
Scar Formation
• Normal Scarring: Scar is soft, flat, and good vascularization, minimal to none overgrowth
• Hypertrophic Scar: Overgrowth of dermal components within boundaries of wound
• Keloid Scar: Scar is overgrowth beyond boundaries of wound.
Wound Healing Phases
Inflammatory Phase
• From time of injury to 3-4 days post burn
• Vascular changes, vasodilatation
• Cellular proliferation, epithelialization
Fibroblastic Phase
• Last 4 – 30 days post burn
• Collagen formation and wound contraction
• Continue epithelialization
Maturation Phase:
• Last 1 month to 2 – 5 yrs
– pressure speeds up maturity stage of healing
• Immature Burn Scar
– red, raised, rigid/firm
– risks for contracture and hypertrophic scar
• Mature Burn Scar
– avascular/white, flat, pliable/soft
– no risks for contracture & hypertrophic eschar
Pressure is used to flatten scar and improve cosmesis
Apply Pressure:
• Approximately 24 mmHg (capillary pressure)
– Elastic Bandage to trunk about 3-4 mmHg
– Elastic Bandage to extremity10-15 mmHg
– Tubigrip to extremity 10-20 mmHg
– Pressure garment 25 mmHg
• Venous insufficiency 40 mmHg
• Loose 50% of compression after ~ 4 wks
Pressure Garments:
• No pressure support required
– burn heals < 10 days
• Pressure support may be required
– burn wound heals 10 – 14 days
• Any race or age advised to use pressure,
– burn wound heals in 14 – 21 days
• Pressure support is mandatory
– all burn wounds that require > 21 days to heal
Types of Pressure Dressings
• Elastic Wrap – Ace Wraps
• Self-Adherent Elastic Bandage – Coban Tape
• Tubular Support Bandage – Tubigrip
• Compressed Clothing – Pressure causes thin tissue
Other Forms of Scar Control
• Silicone Gel pads
• Plastic face mold
• Medical interventions – surgical revision
Additional role of therapy
• Prevent tissue destruction (skin breakdown, decubiti)
• Turning schedule – every 2 hours
• Provide devices to assist with alternating positions – side to side
• Positioning devices for drying of donor sites.
Careers in occupational and physical therapy
Choosing a career in healthcare is a noble path that involves caring for patients and promoting their overall well-being. There are several career paths to choose from, and among them, physical therapy nursing and physical therapy are some of the most fulfilling. Physical therapy nurses are trained healthcare professionals who provide patient care and support in collaboration with physical therapists. They are responsible for developing nursing care plans, implementing treatment plans, and communicating with other healthcare team members. To become a physical therapy nurse, one must complete a nursing program, which can either be an associate degree or a bachelor’s degree. The nursing degree provides students with the necessary knowledge and skills to become a registered nurse. Once a registered nurse, one can specialize in physical therapy nursing by pursuing additional training in physical therapy. Physical therapists, on the other hand, are trained healthcare professionals who specialize in treating patients with physical disabilities and conditions. They work in collaboration with nurses and other healthcare professionals to develop a comprehensive treatment plan for their patients. Physical therapists are required to have a doctorate in physical therapy, and they must be licensed to practice.
Physical therapy nurses and physical therapists have similar job duties, which include assessing patients, developing treatment plans, and implementing interventions. However, physical therapy nurses focus on providing nursing care and support to patients, while physical therapists focus on treating the physical condition or disability. One of the most significant advantages of becoming a physical therapy nurse is the flexibility to switch between different healthcare roles. Physical therapy nurses can pursue careers as nurse practitioners or other healthcare professionals by advancing their education and skills. Additionally, physical therapy nurses have an average salary of around $68,000 per year, which can increase with experience and further education.
Communication skills are essential for physical therapy nurses and physical therapists, as they work closely with patients and other healthcare team members. They must be able to communicate effectively and provide clear instructions to ensure that patients receive proper care and treatment. Physical therapy nurses and physical therapists must also be able to collaborate effectively with other healthcare professionals to develop a comprehensive treatment plan. Becoming a physical therapist requires a doctorate in physical therapy, which can take several years to complete. Physical therapists have a higher average salary than physical therapy nurses, with an average salary of around $90,000 per year. However, physical therapy nurses can still have fulfilling careers and make a significant impact on patient care and well-being.
Physical therapy nursing provide patient care and promote their overall well-being. Physical therapy nurses work closely with physical therapists and other healthcare team members to develop treatment plans, implement interventions, and communicate with patients. Pursuing a nursing degree and additional training in physical therapy can lead to a fulfilling career as a physical therapy nurse. However, becoming a physical therapist requires a doctorate in physical therapy, but it can lead to a higher average salary and more significant job opportunities. Regardless of the career path, communication skills and teamwork are essential for success in healthcare.
The healthcare industry is a field that is always in demand and provides several career options for individuals interested in patient care. Two such options are becoming a physical therapy nurse or a physical therapist. To pursue a career in either field, one must have the necessary education and training, which includes an associate’s degree in nursing or a doctorate in physical therapy. Physical therapy nurses work with patients in rehabilitation centers, nursing homes, and other healthcare facilities to provide care for those with health conditions or physical disabilities. They work in conjunction with physical therapists to develop care plans and implement exercise techniques to improve the patient’s health. To become a physical therapy nurse, individuals must complete an associate degree in nursing and pass the NCLEX RN exam. Physical therapists, on the other hand, require a doctorate in physical therapy, which takes several years to complete. They work with patients who have health problems or physical disabilities to improve their mobility and overall health. Physical therapists work in various settings, including hospitals, private clinics, and nursing homes. Both physical therapy nurses and physical therapists work in different environments to provide care to patients. Physical therapy nurses work in nursing homes, rehabilitation centers, and other healthcare facilities to provide care to patients, whereas physical therapists may work in hospitals, private clinics, or nursing homes.
One major factor to consider when choosing a career in physical therapy nursing or physical therapy is salary expectations. Physical therapy nurses have a median salary of around $73,000 in the United States, whereas physical therapists have a median salary of around $90,000. The salary can vary depending on the practice role, location, and the healthcare system.,Another factor to consider when choosing a career in physical therapy nursing or physical therapy is job security. Both career options provide job security, as the demand for healthcare professionals continues to grow. Physical therapy nurses and physical therapists can find job opportunities in various healthcare settings and can work different shifts, including night shifts. Physical therapy education provides individuals with the necessary knowledge and skills to become healthcare professionals. In physical therapy education, students learn about the human body, different health conditions, and exercise techniques. Physical therapy nurses and physical therapists must continue to learn and update their knowledge to provide the best care possible to patients.
In conclusion, choosing a career in physical therapy nursing or physical therapy is a great career choice for individuals interested in patient care. Physical therapy nurses and physical therapists provide care to patients with different health conditions and disabilities in various healthcare settings. Individuals interested in physical therapy nursing can pursue an associate degree in nursing and pass the NCLEX RN exam. Those interested in becoming physical therapists require a doctorate in physical therapy. Both careers offer job security, different salary expectations, and opportunities for individuals interested in healthcare.
