# Review the client's progressive-mobility timeline and determine how the nurse should advance activity safely.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395203&lang=en  
> language: en  
> subject: Mobility/Immobility  
> category: BCC

## Question

Review the client's progressive-mobility timeline and determine how the nurse should advance activity safely.

| Time | Data |
| --- | --- |
| Hospital day 4, supine | Afebrile, SpO2 95% on room air, BP 126/72 mm Hg, HR 84/min. The client needs help to sit and says the legs feel weak after several days in bed. |
| First standing trial | With gait belt and assistance, BP falls to 98/58 mm Hg and HR rises to 112/min. The client becomes dizzy and pale. The nurse returns the client safely to sitting. |
| Later after reassessment | The client tolerates dangling, standing, and transfer to a chair in stages. BP is 116/68 mm Hg, HR 94/min, and no dizziness occurs. The prescribed walker and one-person assist are used. |

Q1. How should the nurse interpret the overall mobility trend?

The client has permanent inability to ambulate
Deconditioning with initial orthostatic intolerance that improves with staged assisted mobility
The client can walk independently because oxygen saturation is normal

Q2. What was the priority response during the first standing trial?

Continue walking so the client adapts more quickly
Leave the client standing while obtaining another blood-pressure cuff
Stop the progression, protect the client from falling, return to sitting or supine, and reassess

Q3. Which plan is appropriate after the later stable response?

Resume strict bed rest for the remainder of admission
Allow unassisted hallway walking immediately
Use a wheelchair for all activity even if tolerance improves
Continue graded mobility with the prescribed device, assistance, and symptom-based stop criteria

## Explanation

Hospital immobility contributes to deconditioning and loss of function. Mobility should be progressive and matched to the client's current physiologic response. New dizziness, a substantial blood-pressure drop, and an excessive heart-rate rise when standing mean the nurse should stop the standing or walking attempt, sit or lie the client safely, reassess, and notify the clinician if symptoms persist. When the response later stabilizes, the nurse can advance activity in stages with appropriate footwear, assistive devices, a gait belt, and assistance. Neither prolonged bed rest nor pushing through symptomatic orthostasis is a safe mobility plan.

## In-depth explanation

Trend to recognize
The client is medically improving but has deconditioning after several bedbound days. The first standing trial produces symptomatic orthostatic intolerance; the later staged trial is tolerated.

Safe progression
Pause when symptoms and vital signs become unsafe, recover in a protected position, then resume graded assisted mobility only after reassessment.

Mobility rule
Use the least assistance that remains safe, plus the prescribed device, footwear, gait belt, and clear stop criteria.

Why the alternatives fail
Forcing ambulation through dizziness risks a fall. Returning to unrestricted bed rest accelerates functional decline. One successful stand does not justify unassisted hallway walking.

Sources
1AHRQ Improve Mobility and Activity
2AHRQ Progressive Patient Mobility Guidance
32026 NCLEX-RN Test Plan

## Clinical scenario

Recovery from acute illness
An older adult has improved after treatment for pneumonia but has spent 4 days mostly in bed. The team begins a staged mobility plan based on symptoms and physiologic response.

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