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Basic Care and Comfort

NCLEX Mobility and Immobility Practice Questions

Quick answer

Mobility questions test how you move, position and protect a client who cannot move well on their own. They sit inside Basic Care and Comfort (6 to 12 percent of the exam) and usually come as "what do you teach" or "which action is correct" items.

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This topic looks easy on paper and that is exactly the problem. Students know "turn every two hours" and "cane on the strong side," then lose the point because the question flips the detail (which leg leads on the stairs, which side of the bed you stand on, what angle the hip can bend to). The trap is answering from memory of the rule instead of picturing the client actually doing it. Before you pick an option, picture the client on the stairs, in the chair or on the pillow, and ask whether the move keeps weight off the weak or operated side. Most wrong answers on this page put weight or strain exactly where it should not go.

Practice questions

1

A nurse assesses a 78 year old client with a Braden scale score of 11 on day 5 of bed rest. The sacrum has an intact area of non-blanchable redness that feels warmer than the surrounding skin. Which action should the nurse take first?

  1. AMassage the reddened area to bring blood flow back to the skin
  2. BDocument a stage 1 pressure injury, start a turning schedule of at least every 2 hours and request a pressure redistribution mattress
  3. CApply a hydrocolloid dressing and keep the head of the bed at 45 degrees
  4. DDocument a stage 2 pressure injury and ask for a wound care consult
Show answer

Answer: B

Intact skin with non-blanchable redness is a stage 1 pressure injury, and a Braden score of 11 means high risk (18 or lower is at risk, 12 or lower is high risk). Off loading the area with scheduled turning and a pressure redistribution surface is the action that stops it from progressing.

Why the others are wrong

Massaging reddened tissue damages it further and is contraindicated. A dressing is not needed on intact skin, and a head of bed above 30 degrees adds shear to the sacrum. Stage 2 means partial thickness skin loss, so the skin would be open or blistered, not intact.

2

A nurse is teaching a client who will use axillary crutches after a right ankle fracture. Which statement by the client shows the teaching was understood?

  1. A"I will rest my armpits on the crutch pads so my hands do not get tired."
  2. B"When I go up the stairs I lead with my right foot and bring the crutches up after."
  3. C"When I go down the stairs I move the crutches and my right foot down first, then step down with my left."
  4. D"I will adjust the crutches so the pads press firmly under my arms when I stand."
Show answer

Answer: C

Going down stairs, the crutches and the injured (bad) leg go down first, then the good leg follows. "Up with the good, down with the bad" is the rule, and this client's bad leg is the right.

Why the others are wrong

Weight on the axillae compresses the brachial plexus and causes crutch palsy, so the hands carry the weight. Going up, the good (left) leg leads, not the injured right. The pads should sit 2 to 3 finger widths below the axilla, not pressing into it.

3

A client with left sided weakness after a stroke is learning to use a single point cane. Which observation tells the nurse the client is using the cane correctly?

  1. AThe client holds the cane in the left hand and moves it with the right leg
  2. BThe client holds the cane in the right hand and moves it forward with the left leg
  3. CThe client holds the cane in the left hand and moves it forward alone before each step
  4. DThe client holds the cane in the right hand and advances the right leg with it
Show answer

Answer: B

The cane goes in the hand on the strong side (right) and moves forward together with the weak leg (left). This widens the base of support and lets the cane take weight from the weak limb as it bears load.

Why the others are wrong

Holding the cane on the weak side gives no support when the weak leg is bearing weight. Advancing the cane alone and then stepping is a slower three point pattern not usually taught with a single cane. Moving the cane with the strong leg leaves the weak leg unsupported.

4

A nurse is teaching an older adult to walk with a standard walker after a fall. Which instruction is correct?

  1. A"Lift the walker and place it about 12 inches ahead, then step into it with both feet."
  2. B"Push the walker ahead of you and then pull yourself toward it by leaning forward."
  3. C"Carry the walker up and down the stairs at home the same way you use it on flat ground."
  4. D"Tie your cane to the walker so you have it ready when you get tired."
Show answer

Answer: A

The client lifts a standard walker, sets all four legs down about one step (around 12 inches) ahead, then steps into it, keeping the body inside the frame. Elbows should bend about 15 to 30 degrees when holding the grips.

Why the others are wrong

Leaning and pulling on the walker shifts the center of gravity forward and causes falls. Standard walkers are not safe on stairs. Attaching items to the frame unbalances the walker.

5

A client returns to the unit after a lumbar spinal fusion. The surgeon has ordered log rolling for position changes. Which action by the nurse is correct?

  1. ARaise the head of the bed to 30 degrees, then turn the client's shoulders first and hips second
  2. BKeep the bed flat, place a pillow between the knees, and turn the shoulders and hips together as one unit with another staff member
  3. CAsk the client to grab the side rail and pull the upper body over while the nurse moves the legs
  4. DTurn the client alone using a draw sheet so the move is faster and less painful
Show answer

Answer: B

Log rolling keeps the spine in alignment. The bed is flat, a pillow between the knees keeps the hips aligned, and at least two staff turn the head, shoulders, hips and legs at the same moment on a count.

Why the others are wrong

Raising the head and turning shoulders before hips twists the spine. Having the client pull the upper body over does the same. One person cannot keep the body in a straight line, so log rolling always needs two or more people.

6

A client is being discharged 3 days after a posterior approach total hip replacement. Which client statement should the nurse correct?

  1. A"I will sit in a chair with arms and a firm, high seat."
  2. B"I will put a pillow between my legs when I lie on my side."
  3. C"I will bend over to put on my own socks and shoes."
  4. D"I will use a raised toilet seat at home."
Show answer

Answer: C

Bending forward to reach the feet flexes the hip well past 90 degrees and can dislocate the new joint. The client needs a sock aid and long handled shoe horn, or help from someone else.

Why the others are wrong

A high, firm chair with arms keeps the hip under 90 degrees of flexion. An abduction pillow or wedge between the legs prevents adduction and crossing. A raised toilet seat stops the hip from flexing too deeply when sitting.

7

A client on strict bed rest for 10 days after pelvic trauma reports new pain in the right calf. The nurse notes the right calf is warm and 2 cm larger than the left. Which action should the nurse take first?

  1. AApply a warm compress to the calf and reassess in 30 minutes
  2. BMassage the calf gently to relieve the cramp
  3. CKeep the client in bed, elevate the leg, and notify the health care provider
  4. DHelp the client walk to the bathroom to see if the pain improves with movement
Show answer

Answer: C

Unilateral calf pain, warmth and swelling after prolonged immobility point to a deep vein thrombosis. The leg stays still and elevated while the provider is called so a clot is not dislodged before anticoagulation and imaging.

Why the others are wrong

Warm compresses delay the assessment and do nothing for a clot. Massage can break the thrombus free and send it to the lungs. Walking does the same and could cause a pulmonary embolism.

8

A nurse is positioning a client with right sided hemiplegia after a stroke. Which action is most appropriate to prevent complications?

  1. APlace the right arm flat at the side with the hand in a fist to keep the fingers from curling
  2. BSupport the right arm on a pillow with the shoulder slightly abducted, and perform passive range of motion to the right side at least twice a day
  3. CAvoid moving the right limbs so the client does not feel pain
  4. DKeep the client supine at all times so the right side is not compressed
Show answer

Answer: B

The weak arm is supported to stop shoulder subluxation, and passive range of motion two to three times a day prevents contractures. A hand roll keeps the fingers in slight flexion rather than a fist.

Why the others are wrong

A tight fist encourages flexion contracture. Leaving the limbs still is what causes contractures and joint stiffness. Staying supine all the time increases pressure injury risk; the client should be turned, including onto the weak side for short periods with the arm protected.

9

A client has right sided weakness and needs to move from the bed to a wheelchair. Where should the nurse place the wheelchair?

  1. AOn the client's right side, facing the foot of the bed
  2. BOn the client's left side, close to the bed, with the brakes locked
  3. CAt the foot of the bed so the client can move in either direction
  4. DOn the client's right side so the nurse can guard the weak leg
Show answer

Answer: B

The chair goes on the strong (left) side so the client pivots toward the strong leg, which bears the weight during the move. The brakes are locked and the footrests moved out of the way before the transfer.

Why the others are wrong

Placing the chair on the weak right side forces the client to pivot onto a leg that cannot hold them. The foot of the bed makes the pivot too long and does not favor the strong side. Guarding the weak leg does not matter if the client is asked to pivot on it.

10

A nurse is teaching a client on bed rest after abdominal surgery to use an incentive spirometer. Which instruction is correct?

  1. A"Blow out hard and fast into the mouthpiece to make the ball rise."
  2. B"Breathe in slowly and deeply through the mouthpiece, hold for 3 to 5 seconds, then exhale, and repeat 10 times every hour while awake."
  3. C"Use the device once in the morning and once at night."
  4. D"Take a quick sniff through the mouthpiece so the indicator jumps to the top."
Show answer

Answer: B

The incentive spirometer works by sustained slow inspiration, which opens collapsed alveoli and prevents atelectasis. The usual order is 10 breaths an hour while awake, holding each breath for a few seconds at the top.

Why the others are wrong

It is an inhaling device, not a blowing device. Twice a day is far too little to prevent atelectasis in the first days after surgery. A quick sniff moves the indicator but does not expand the lung bases.

Quick tips

  • Stairs with crutches: good leg goes up first, bad leg and crutches go down first. Say the rule out loud as "up with the good, down with the bad" and then check which leg the stem calls injured.
  • A cane lives in the hand on the strong side and moves with the weak leg. If the stem says left weakness, the cane goes in the right hand.
  • Any transfer moves toward the strong side. Put the chair, the walker or yourself on the side that can hold weight.
  • After a posterior hip replacement, think 90, legs apart, no twisting: no hip flexion past 90 degrees, no crossing the legs, no internal rotation, and an abduction pillow in bed.
  • Immobility complications follow a pattern: lungs (atelectasis, pneumonia), veins (DVT), gut (constipation), joints (contractures) and skin (pressure injury). If a question asks what to assess on day 3 of bed rest, run through that list.

Related topics

FAQ

How often should a bed bound patient be turned to prevent pressure injuries?

At least every 2 hours in bed and every 15 minutes of weight shifting when sitting in a chair. Clients with a low Braden score or fragile skin may need turning more often, and heels should be floated off the mattress.

Which leg goes first on stairs with crutches?

Going up, the unaffected (good) leg steps up first and the crutches and injured leg follow. Going down, the crutches and the injured (bad) leg go down first and the good leg follows. The same rule applies to a cane.

What are the hip replacement precautions after surgery?

For a posterior approach: do not bend the hip past 90 degrees, do not cross the legs or ankles, do not turn the toes inward, and sleep with an abduction pillow between the legs. Use a raised toilet seat, a high chair with arms and a reacher for dressing.

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