Difficulty: Medium
Average Score: 95%
Simulated
A nurse is preparing a client for ambulation. Which of the following actions should the nurse take to determine the client's level of strength?
Correct answer
D
Rationale
The correct answer is D: Ask the client to push her feet against the nurse's palms. This action assesses the client's muscle strength, specifically in the lower extremities. The nurse can evaluate the client's ability to generate force by resisting the client's push. This test provides a direct measure of the client's strength and helps determine if the client is ready for ambulation. Palpating pedal pulses (A) assesses circulation, not strength. Asking how strong the client feels (B) is subjective and may not provide an accurate measure of strength. Asking the client to touch her finger to her nose (C) assesses coordination, not strength.