Positioning and range of motion: Fowler's, Sims' and ROM terms

Normal range of motion and positioning is its own line in the federal training rule, and range of motion is one of the skills a nurse must watch the aide perform. The written questions are mostly vocabulary, positions by angle and movements by name, plus the one safety rule that never changes: stop at pain.

Questions and answers, explained

All 7 questions above, with the correct answer and why it is correct. Everything here is on positioning and range of motion: fowler's, sims' and rom terms.

1. In the Fowler's position, the client is:

   • ASemi-sitting, with the head of the bed raised about 45 to 60 degreesCorrect
   • BLying flat on the back with the bed level
   • CLying face down with the head turned to one side
   • DOn the left side with the upper knee bent and a pillow between the legs

   Why: Fowler's is a semi-sitting position with the head of the bed raised about 45 to 60 degrees; semi-Fowler's is about 30 to 45 degrees and high Fowler's 60 to 90 degrees. It eases breathing and is used for meals. Lying flat on the back is supine, face down is prone, and left-sided with the upper knee bent is Sims'.

   Reference 42 CFR 484.80(b)(3)(xi); positioning terminology

2. How often should a client who cannot move independently be repositioned in bed, unless the care plan says otherwise?

   • AOnce a day, at bath time
   • BAt least every 2 hoursCorrect
   • COnly when the client complains of discomfort
   • DEvery 8 hours, at each shift change

   Why: Constant pressure on the same spot cuts off blood flow and causes pressure injuries, sometimes within hours. Repositioning at least every 2 hours is the common standard in bed, with more frequent weight shifts for clients sitting in a chair, as the care plan directs.

   Reference NPIAP pressure injury prevention guidance

3. What is passive range of motion?

   • AExercises the client does alone without any help
   • BWalking around the house twice a day
   • CThe aide moves the client's joints through their rangeCorrect
   • DLifting light weights while sitting in a chair

   Why: In passive range of motion, the aide moves the client's joints because the client cannot. In active range of motion the client moves them alone, and in active-assistive the client moves with some help. The care plan specifies which joints and how many repetitions.

   Reference 42 CFR 484.80(b)(3)(xi); NNAAP range of motion skills

4. During range-of-motion exercises, the client says a movement hurts. What should the aide do?

   • APush a little further each time to break up the stiffness in the joint
   • BFinish the set quickly so the pain ends sooner
   • CSwitch to a faster motion to warm the joint
   • DStop that movement and report the pain to the nurseCorrect

   Why: Joints are moved gently and slowly only to the point of resistance or pain, never forced. If a movement causes pain, the aide stops it and reports to the nurse, because forcing a joint can cause injury.

   Reference NNAAP range of motion skills

5. Moving an arm out to the side, away from the body, is called:

   • AAdduction
   • BAbductionCorrect
   • CFlexion
   • DPronation

   Why: Abduction moves a limb away from the midline of the body; adduction brings it back toward the body (think of adding it back). Flexion is bending a joint and extension is straightening it; pronation turns the palm down and supination turns it up.

   Reference Range of motion terminology

6. What is a contracture?

   • AA permanent shortening of muscle that limits joint movementCorrect
   • BA bruise caused by bumping into furniture
   • CA sudden muscle cramp that lasts a few seconds
   • DA written agreement between the client and agency

   Why: A contracture is a permanent tightening of muscles and tendons that leaves a joint fixed in a bent position. It develops when joints are not moved. Regular range-of-motion exercises and good positioning help prevent it.

   Reference 42 CFR 484.80(b)(3)(xi)

7. A client lies on his back in bed. What helps keep his heels off the mattress?

   • AA rolled towel placed directly under each heel
   • BA pillow placed lengthwise under the calvesCorrect
   • CTucking the top sheet tightly over the feet
   • DRaising the head of the bed to 90 degrees

   Why: Heels are a common site for pressure injuries. A pillow under the calves 'floats' the heels so they bear no weight. A towel directly under the heel still puts pressure on it, and tight sheets push the feet down and add pressure on the toes.

   Reference NPIAP heel pressure injury prevention

Drill the whole domain

• Mobility, Transfers and Positioning (9%)

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• Perineal and catheter care: the steps HHAs get tested on
• Transfers, gait belts, canes and walkers for HHAs
• Pressure injuries and skin tears: what HHAs check and report
• Food safety for home health aides: the temperatures to know
• HHA scope of practice: what a home health aide can and cannot do
• Dementia care for home health aides: communication that works
• Hand hygiene, gloves and PPE order for home health aides
• Fire, oxygen and electrical safety in a client's home
• Client rights, abuse and neglect: what HHAs must report
• Emergencies for home health aides: choking, stroke, seizures
• Assisting with medications: an HHA's role and limits

See all topics · Study Guides · Full practice exam