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    Ati Fundamentals 2023 Proctored Exam

    A nurse is caring for a client who is immobile. Which of the following interventions should the nurse plan to take to prevent plantar flexion contractures?

    Explanation & Rationale

    Rationale A. Apply an abduction pillow to the legs: An abduction pillow is used to maintain proper hip alignment, especially after hip surgery, but it does not prevent plantar flexion contractures. Its purpose is to keep the lower extremities in proper abduction rather than address ankle mobility. B. Use a trochanter roll: A trochanter roll helps prevent external rotation of the hip in immobile clients but does not influence ankle positioning. While important for hip alignment, it does not prevent plantar flexion contractures of the feet. C. Use foot splints: Foot splints (or ankle-foot orthoses) maintain the feet in a neutral position, preventing plantar flexion and subsequent contracture. Regular use supports joint flexibility, reduces muscle shortening, and helps preserve functional mobility in immobile clients. D. Prop the feet up: Elevating the feet may relieve pressure and promote circulation, but it can allow the toes to point downward and contribute to plantar flexion over time. This method is not effective in preventing contractures and may worsen the problem if used as the sole intervention.

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