When planning care for the immobile client, the nurse includes which of the following?
1. Assess for complications resulting from immobility.
2. Plan for the client to obtain eight hours of uninterrupted sleep without repositioning.
3. Implement repositioning every hour.
4. Evaluate the client's ability to perform passive ROM.
1
Rationale: The nurse uses the nursing process to care for the immobile client and assesses for complications resulting from lack of mobility. While sleep is important, the client who is unable to reposition themselves must be repositioned every two hours, not hourly. The client performs active, not passive, ROM.
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