3101 Skills- Chap. 28 Immobility EAQs Exam 2

Osteoporosis Rationale In a postmenopausal patient, osteoporotic changes in the bone increase the risk of fractures. Impaired calcium metabolism causes bone resorption, making it less dense. Bones affected by resorption are fragile and more susceptible to fractures. Osteosarcoma and osteoclastoma are bone tumors. Osteomyelitis is an infection of the bone. p. 412

A 60-year-old female patient sustained a femur fracture due to a fall in the bathroom. The patient complains of severe pain and expresses that she did not expect a fracture as the fall was not very severe. The nurse tells the patient that fracture is common for people her age. Which condition should the nurse cite as the most common cause of fracture in postmenopausal patients? Osteosarcoma Osteoclastoma Osteomyelitis Osteoporosis

Calcium Rationale In osteoporosis the bones lack calcium due to demineralization. Therefore, calcium supplements are added to the prescription to improve bone strength. Zinc is useful in cellular metabolism but has no role in bone health. Sodium is important for cells to function but has no role in promoting bone health. Iron is needed for hemoglobin production. It does not help in managing osteoporosis related to bone changes. p. 424

A 60-year-old female patient sustained a femur fracture due to a fall in the bathroom. The patient complains of severe pain. Which mineral supplement is likely to be added to the patient's prescription to manage osteoporosis? Zinc Calcium Sodium Iron

1 2 5 Rationale The patient should increase dietary intake of calcium to strengthen the bones. Green leafy vegetables and milk products like yogurt and cheese are high in calcium. Beans are a good source of protein but contain less calcium. Cereals are good sources of carbohydrates but lack calcium. p. 424

A child has rickets. The health care provider suggests an increase of calcium, vitamin D, and phosphorus in the patient's diet. Which food items are good sources of calcium? Select all that apply. Green leafy vegetables Yogurt Beans Cereals Cheese

1 3 5 Rationale Range of motion is limited in patients with limited nerve supply. Range of motion may be limited in patients with arthritis due to severe pain. Decreased synovial fluid in the joints also leads to decreased range of motion. If the patient has a ligament tear, it may lead to increased range of motion beyond normal. If the patient has a connective tissue disorder, the patient may have increased range of motion. p. 414

A patient complains of limited mobility. While assessing the past medical history of the patient, the nurse finds that the patient underwent surgery for a hip fracture. Which reason does the nurse suspect is responsible for the patient's condition? Select all that apply. The patient has contractures. The patient has ligament tears. The patient has a history of arthritis. The patient has connective tissue disorders. The patient has decreased synovial fluid in the joint.

Ball-and-socket joint

A patient sustained a femur fracture due to a fall in the bathroom. The attending nurse understands that the femur bone forms a hip joint with the pelvic bone. Which type of joint is the hip joint? Hinge joint Pivot joint Cartilaginous joint Ball-and-socket joint Rationale The head of the femur acts as a ball and the pelvic bone as a socket, and together they form a ball-and-socket type of joint , which is a freely movable synovial joint. The elbow and knee joints are examples of hinge joints. The joints in the neck are pivot joints. Cartilaginous joints are found in the sternum where cartilage unites with the bone. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the question, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, determine what you would give as the answer. For this question, picture the hip joint in your mind. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. pp. 416, 417

2, 4, 5 Rationale Immobility affects normal metabolic functioning. Calcium imbalance occurs because immobility causes the release of calcium into circulation. Calcium resorption may cause pathological fracture. Gastrointestinal disturbances occur due to lack of mobility, which may lead to constipation. Immobility causes alteration in the metabolism of protein. The body is constantly synthesizing proteins and breaking them down into amino acids to form other proteins. In immobile patients, the body excretes more nitrogen than it ingests as proteins. This causes negative nitrogen balance. Immobility decreases appetite as well as peristalsis. p. 411

A patient sustained a severe injury in a motor vehicle accident. The patient is unable to perform any movement. Which metabolic changes would be found in the patient due to immobility? Select all that apply. Increase in appetite Calcium imbalance Increase in peristalsis Gastrointestinal disturbances Alteration in the metabolism of protein

Pathological fractures Rationale Osteoporosis results in decreased bone mass and brittle bones, which make the patient prone to pathological fractures. Joint contractures are a complication of immobility of joints. Footdrop is a type of joint contracture, where the foot is permanently fixed in plantar flexion. Urinary stasis is a complication of immobility, in which the urine gets stagnated in the bladder. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 409

A patient who has attained menopause is diagnosed with osteoporosis. Which consequences of osteoporosis should the nurse consider in the patient? Joint contractures Pathological fractures Footdrop Urinary stasis

Footdrop Rationale The inability to dorsiflex and invert the feet indicates that the patient has footdrop which is usually found in patients who are bedridden and immobile. The foot becomes permanently fixed in plantar flexion, making ambulation difficult. The patient is unable to lift the toes off the ground. Exaggeration of the anterior convex curve of the lumbar spine is called lordosis. One or both legs bent outward at the knee indicates genu varum. Legs curved inward so that the knees come together while walking is a sign of genu valgum. p. 412

A patient who has hemiplegia is unable to dorsiflex and invert the feet. Which condition does the patient likely have? Lordosis Footdrop Genu varum Genu valgum

The patient has venous thrombus formation. Rationale The absence of pedal pulses and abnormally cold extremities indicate that the patient has venous thrombus formation. Venous thrombus formation occurs because of stagnation or alteration in the blood flow as a result of immobility or injury to the vessel wall during surgery. The thrombus may block the blood supply to the extremities. The clinical manifestations in the patient are not age-related effects. Hip joint dislocation may not result in absence of pedal pulses. A cool room temperature may cause the extremities to become cold but may not lead to an absence of pedal pulses. p. 420

An elderly patient has undergone hip replacement surgery. On the second postoperative day, the nurse finds that the pedal pulses are absent and the lower extremities are cold to the touch. What should the nurse interpret from this finding? It is an age-related effect. The patient's hip joint has dislocated. The room temperature is too cold. The patient has venous thrombus formation.

Cardiovascular changes Rationale Patients with immobility are at a risk of thrombus formation. Cardiovascular changes in the body lead to orthostatic hypotension, increased cardiac work load, and thrombus formation. The metabolic changes seen in patients with impaired mobility are altered endocrine metabolism and calcium resorption. The respiratory changes seen in patients with impaired mobility are pulmonary complications like atelectasis and hypostatic pneumonia. The musculoskeletal changes seen in patients with impaired mobility are temporary impairment and permanent disability. p. 411

The laboratory reports of an immobilized patient indicate the presence of thrombus. Which changes in the body are responsible for this condition in the patient? Metabolic changes Respiratory changes Cardiovascular changes Musculoskeletal changes

Move the leg back toward the medial position. Rationale The nurse should ask the patient to move the leg back toward the medial position and beyond if possible to assess adduction in the hip joint. To assess flexion in the hip joint, the leg should be moved forward and up. To assess extension in the hip joint, the leg should be moved behind the other leg. To assess abduction in the hip joint, the leg should be moved laterally away from the body. p. 416

The nurse is assessing a patient for the movement of the hip ball and socket joint. Which range-of-motion (ROM) exercise should the nurse ask the patient to perform to assess adduction? Move the leg forward and up. Move the leg behind the other leg. Move the leg laterally away from body. Move the leg back toward the medial position.

Nonsurgical treatment with braces Rationale Nonsurgical treatment with braces is the best possible treatment for a patient with scoliosis. Gentle range of motion is suggested in cases of torticollis. Spine-stretching exercises can be suggested in cases of lordosis and kyphosis. p. 409

The nurse is assessing a patient with postural abnormality. The nurse observes a C-shaped column with vertebral rotation, and anticipates a diagnosis of scoliosis. Which treatment does the nurse expect the primary health care provider to prescribe for the patient? Surgical treatment Gentle range of motion Spine-stretching exercises Nonsurgical treatment with braces

2 Rationale Most functions of the hand are best carried out with the forearm in moderate pronation. When the forearm is fixed in a position of full supination, the patient's use of the hand is limited. When the wrist is fixed in even a slightly flexed position, the grasp is weakened. When the patient has limited movement in the shoulder, he/she may have difficulty moving the arms. When there is impaired range of motion in the fingers and thumbs, the patient is less able to perform fine-motor skills such as carpentry and painting. p. 414

The nurse is assessing range of motion of a patient. Which condition does the nurse observe when the forearm of the patient is fixed in a position of full supination? The patient's grasp is weakened. The patient's use of hand is limited. The patient has difficulty moving the arms. The patient cannot perform fine motor skills, like painting.

2 3 4 Rationale A patient confined to bed may have a negative nitrogen balance, because the body excretes more nitrogen than it ingests through proteins. The basal metabolic rate (BMR) may decrease as a result of reduced food intake. A patient confined to bed experiences decreased appetite and slowing of peristalsis in response to the low BMR. Immobility also results in calcium resorption from bones, in which the calcium is released into circulation, resulting in hypercalcemia. The muscle mass may decrease due to tissue catabolism. p. 411

The nurse is caring for a bedridden patient. The nurse understands that immobility results in many metabolic changes. Which metabolic changes may be found in this patient? Select all that apply. Low calcium levels in the blood Negative nitrogen balance Decrease in the basal metabolic rate Decreased appetite and slowing of peristalsis Increased muscle mass due to tissue anabolism

Denis Browne splint Rationale Denis Browne splints are used for children with clubfoot to align the foot in the correct position. Knee braces are used for patients with knock-knee (genu valgum). Abduction splints are used for children with congenital hip dysplasia. An ankle-foot orthotic is used to maintain the position of the foot in patients with footdrop. p. 410

The nurse is caring for a child with clubfoot. Which should the nurse advise the caregiver to apply on the child? Denis Browne splint Knee braces Abduction splints Ankle-foot orthotic

Urinary output decreases. Urinary stasis occurs. Risk for developing urinary tract infection increases Rationale Fluid intake is often diminished during immobility, causing a decrease in urine output and an increase in the concentration (not dilution) of the urine. The urine produced by the kidneys needs gravitational force to enter the ureters. During immobility, the urine in the kidney fills up the pelvis. This condition is called urinary stasis. It increases the risk of urinary infection, because microorganisms can grow well in stagnated urine. Chronic renal failure will not happen in the first 72 hours after surgery, but untreated renal calculi and urinary tract infections may gradually lead to chronic renal failure. pp. 412, 413

The nurse is caring for a patient who has been immobile after a spine surgery. Which urinary changes are likely to occur in the first 72 postoperative hours? Select all that apply. Urinary output decreases. Risk for developing chronic renal failure increases. Urine is more diluted. Urinary stasis occurs. Risk for developing urinary tract infection increases.

1 3 5 Rationale When a patient is on prolonged bed rest, the patient is exposed to the risk of developing atelectasis and hypostatic pneumonia. The secretions in the lungs may block a bronchiole or a bronchus, resulting in the collapse of the distal lung tissue. This causes hypoventilation and atelectasis. Hypostatic pneumonia frequently results because mucus pooled in the lung tissue is an excellent place for bacteria to grow. With prolonged immobility, there is an associated decline in the patient's ability to cough productively. Tension pneumothorax is caused after trauma. Pulmonary tuberculosis results from exposure to the causative microorganism. p. 411

The nurse is caring for a patient who has been immobile for a month due to quadriplegia. Which risks should the nurse be prepared for? Select all that apply. Risk of developing atelectasis Risk of developing tension pneumothorax Risk of developing hypostatic pneumonia Risk of developing pulmonary tuberculosis Risk of ineffective coughing

Atelectasis Hypostatic pneumoniaRationale Bedridden patients are at risk such as atelectasis and hypostatic pneumonia. Atelectasis, or lung collapse, occurs when secretions block the bronchus or the bronchiole, and the distal alveoli collapse due to hypoventilation. Due to immobility, the secretions may pool in the lungs, which promotes bacterial growth. The resultant infection is called hypostatic pneumonia. Asthma is due to hypersensitivity of the airways to specific allergens and is not due to immobility. Allergic rhinitis is caused by inflammation of the nasal passage due to allergic reactions. Tuberculosis is caused by infection with Mycobacterium tuberculosis. p. 411

The nurse is caring for a patient who is bedridden due to surgery on the spine. Which respiratory complications may occur if the patient is bedridden for a long duration? Select all that apply. Asthma Atelectasis Hypostatic pneumonia Allergic rhinitis Tuberculosis

1 2 4 Rationale Immobilization affects the cardiovascular system, frequently causing thrombus formation, increased cardiac workload, and orthostatic hypotension. As immobilization increases, cardiac output falls, further decreasing cardiac efficiency and increasing workload. In the immobilized patient, decreased circulating fluid volume and pooling of blood in the lower extremities occurs. p. 411

The nurse is caring for a patient who is immobile. Which cardiovascular changes does the nurse expect to observe in the patient? Select all that apply. Thrombus formation Orthostatic hypotension Increased cardiac output Increased cardiac workload Increased circulating fluid volume

1 3 4 Rationale Footdrop is the most common type of debilitating contracture. The patient is unable to lift the toes from the ground, making it difficult to ambulate. Patients who have suffered a right- or left-sided paralysis are at increased risk of developing footdrop due to immobility. The foot is permanently fixed in plantar flexion. Once footdrop occurs, it cannot be treated. However, it can be prevented through regular physiotherapy. p. 412

The nurse is caring for a patient with paralysis. The nurse understands that footdrop is a common but preventable complication in these patients. Which statements are true about footdrop? Select all that apply. Footdrop is a type of debilitating contracture. The foot is permanently fixed in dorsiflexion position. The patient is unable to lift the toes off the ground. Patients with left- or right-side paralysis are at increased risk of developing footdrop. Footdrop can be treated with regular physiotherapy.

"I'll check the label of my multivitamin. If it has calcium, I can save money by not taking another pill." Rationale Just because a multivitamin has calcium in it does not mean that the woman is receiving enough to meet her needs. She must know her requirement and make the decision based on that rather than on the value for calcium on the label. Any type of activity can help with calcium metabolism and is beneficial for helping to reduce the risk of osteoporosis. Patients should have a bone density scan yearly or according to their primary care physician's recommendations. To decrease the risk of osteoporosis, patients should be eating foods high in calcium and vitamin D. pp. 412, 424

The nurse is teaching a community group about ways to minimize the risk of developing osteoporosis. Which statements made by a woman in the audience reflect a need for further education? "I usually go swimming with my family at the YMCA three times a week." "I need to ask my doctor if I should have a bone mineral density check this year." "If I don't drink milk at dinner, I'll eat broccoli or cabbage to get the calcium that I need in my diet." "I'll check the label of my multivitamin. If it has calcium, I can save money by not taking another pill."

1, 4 Rationale Tendons are fibrous bands connecting muscles to bone. They are strong, flexible, and inelastic. Cartilage is nonvascular, supportive connective tissue located in the joints and thorax, trachea, larynx, nose, and ear. Ligaments help to hold joints together, and connect bones and cartilage. Some ligaments may also protect two bony surfaces against friction. p. 409

The nurse is teaching a group of nursing students about tendons. Which statements about tendons are true? Select all that apply. Tendons are fibrous bands connecting muscles to bone. Tendons are nonvascular supporting connective tissue. Tendons help to hold joints together; they connect bone and cartilage. Tendons are strong, flexible, and inelastic. Tendons may also have a protective function.

Kyphosis is the increased convexity in curvature of the thoracic spine. Lordosis is the exaggeration of the anterior convex curve of lumbar spine. Scoliosis is the lateral S- or C-shaped spinal column with vertebral rotation. Rationale Kyphosis is the increased convexity in the curvature of the thoracic spine, which may be caused by rickets, osteoporosis, or tuberculosis of the spine. Lordosis is the exaggeration of the anterior convex curve of the lumbar spine. This can be a congenital condition or a temporary condition as in the case of pregnancy. Scoliosis is the lateral S- or C-shaped spinal column with vertebral rotation. This can be a consequence of numerous congenital, connective tissue, and neuromuscular disorders. The medial deviation and plantar flexion of the foot is called clubfoot and is not a spinal deformity. The internal rotation of forefoot or entire foot is called pigeon toes, and it is not a spine deformity. STUDY TIP: Use visual imagery to memorize the spinal deformities. Picture the S or C of SColiosis superimposed over a spine with the condition. Picture a person bending the thoracic spine forward to fit inside the right side of the letter K for Kyphosis. Picture the angle of an L from Lordosis poking someone in the lumbar region to exaggerate the lumbar curve. p. 410

The nurse is teaching a nursing student about various deformities of the spine. Which statements are true about spine deformities? Select all that apply. Scoliosis is the medial deviation and plantar flexion of the foot. Kyphosis is the increased convexity in curvature of the thoracic spine. Kyphosis is the internal rotation of forefoot or entire foot. Lordosis is the exaggeration of the anterior convex curve of lumbar spine. Scoliosis is the lateral S- or C-shaped spinal column with vertebral rotation.

2 3 5 Rationale Prolonged immobility increases the risk of thrombus formation. Slow blood flow in the calf veins may lead to formation of thrombus. Damage to the blood vessels caused by any surgical procedure may also cause a blood clot. Alterations in the constituents of blood, such as clotting factors and platelets, may also contribute to formation of thrombus. These three factors are referred to as Vircho's triad. Alteration in body weight and the patient's nutritional status have no effect on thrombus formation. p. 412

The nurse understands that an immobile patient is at high risk of thrombus formation. Which factors may contribute to the risk of thrombus formation? Select all that apply. Alteration in body weight Alteration or slowing of blood flow Damage to the wall of the blood vessels Alteration in the patient's nutritional status Alteration of the constituents in the blood

2 4 Rationale Isometric contractions involve energy expenditure without any active movement of the muscle; muscle tension increases, but no muscle shortening occurs. Isometric exercises improve activity tolerance, but they have no beneficial effect on preventing orthostatic hypotension. .Isometric exercises do not help in increasing muscle mass, because they involve energy expenditure, and they actually increase (rather than decrease) venous return. STUDY TIP: Recall that the prefix iso- means same. Isotonic means same tone. Isometric means same measure (or length). Isometric exercises are static; there is no change in muscle length. Text reference: pp. 789-790

The patient is advised to perform pelvic floor exercises. The nurse explains to the patient that pelvic floor exercise is a type of isometric contraction. Which statements are true about isometric contractions? Select all that apply. Isometric exercises increase the muscle mass of the body. Isometric exercises improve activity tolerance. They have a beneficial effect on preventing orthostatic hypotension. Muscle tension increases, but there is no muscle shortening. Isometric exercises decrease venous return.

1 2 Rationale Prolonged immobilization in infants, toddlers, and preschoolers may lead to delayed development of gross motor skills. Immobilization in older adults can be caused by degenerative disease, neurological trauma, or chronic illness. Decreased physical activity and hormonal changes can lead to loss of bone mass in older adults. Older adults may experience functional status changes secondary to hospitalization and altered mobility status. Prescribed medications may alter blood pressure when older adults change position too quickly, increasing their risk for falls. p. 413

The registered nurse is teaching a nursing student about developmental changes in older adults. Which statements made by the nursing student indicate the need for further learning? Select all that apply. "Prolonged immobilization in older adults delays gross motor skills." "Immobilization in older adults is only caused by degenerative disease." "Decreased physical activity can lead to loss of bone mass in older adults." "Older adults experience functional status changes secondary to hospitalization." "Medications may alter blood pressure when older adults change position too quickly."

2 5 Rationale Postural abnormalities can cause pain and impair alignment or mobility. Muscle abnormalities are more prevalent for muscle diseases in childhood. The nurse should observe body alignment in patients with postural abnormalities. The nurse should ask the patient to perform range of motion exercises to identify postural abnormalities. Lifting, transfer, and positioning are necessary for patients with postural abnormalities. p. 409

The registered nurse is teaching a nursing student about postural abnormalities. Which statements made by the nursing student indicate the need for further learning? Select all that apply. "Body alignment should be observed regularly." "Postural abnormalities will only impair alignment." "Patients should perform range of motion exercises." "Positioning is necessary for patients with postural abnormalities." "Postural abnormalities are more prevalent for muscle diseases in childhood."

1 5 Rationale Every patient responds to immobility in a different way. Withdrawn patients often do not want to participate in their own care. Patients with restricted mobility may experience depression. Impaired mobility can cause social isolation and loneliness. Immobilization often leads to emotional and behavioral responses, sensory alterations, and changes in coping. p. 412-413

The registered nurse is teaching a nursing student about psychosocial effects on patients with immobility. Which statements made by the nursing student indicate a need for further learning? Select all that apply. "Every patient responds to immobility in a same way." "Patients with restricted mobility may have depression." "Impaired mobility can cause social isolation and loneliness." "Immobilization leads to emotional and behavioral responses." "Withdrawn patients often want to participate in their own care."

3 Rationale Direct trauma to the musculoskeletal system results in bruises, sprains, and contusions. Damage to the cerebellum causes problems with balance and motor impairment. A person with right-sided cerebral hemorrhage with necrosis has destruction of the right motor strip that results in left-sided hemiplegia. A complete transection of spinal cord results in bilateral loss of voluntary motor control below the level of trauma because motor fibers are cut. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 409

The registered nurse is teaching a nursing student about the pathological influence on mobility. Which statement made by the nursing student indicates a need for further learning? "Damage to the cerebellum causes problems with balance." "Right-sided cerebral hemorrhage causes left-sided hemiplegia." "Direct trauma to the central nervous system results in bruises and contusions." "Complete transection of spinal cord causes bilateral loss of voluntary motor control below the level of the trauma."

3 4 Rationale The skeletal system is the supporting framework of the body and is made up of four types of bones: long, short, flat, and irregular. The skeletal muscle provides attachments for muscles and ligaments and the nervous system regulates movement and posture. The skeletal system protect vital organs and aids in calcium regulation. The skeletal muscles enables the bones to withstand weight bearing. p. 408

The registered nurse is teaching a nursing student about the skeletal system. Which statements by the nursing student indicate a need for further learning? Select all that apply. "The skeletal system protects the vital organs." "The skeletal system aids in calcium regulation." "The skeletal muscle includes three types of bones." "The skeletal system regulates movement and posture." "The skeletal system enables the bones to withstand weight bearing."

White, shiny, flexible bands of fibrous tissue Rationale Ligaments are white, shiny, flexible bands of fibrous tissue that bind joints together and connect bones, and cartilages. Joints are the connections between bones. Tendons are white, glistening fibrous bands of tissue that connect muscle to bone. Cartilage is a nonvascular, supporting connective tissue located chiefly in the joints. p. 408

What are ligaments? Connections between bones White, glistening fibrous bands of tissue Nonvascular, supporting connective tissue White, shiny, flexible bands of fibrous tissue

Provide support Regulate calcium Contribute balance Protect vital organs Rationale The functions of the skeletal system include providing joint flexibility and support, regulating calcium, and protecting vital organs. The nervous system regulates movement and posture. Body alignment contributes to balance of the body. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 408

What are the functions of the skeletal system? Select all that apply. Provide support Regulate calcium Regulate posture Contribute balance Protect vital organs

Knock-knee Rationale Knock-knee is the abnormality that curves the legs inward so that knees come together while walking. Patients with bowlegs have legs that bend outward at the knee. Footdrop is the inability to dorsiflex and invert the foot because of perineal nerve damage. Congenital hip dysplasia is an abnormality in which hip instability is seen with the limited abduction of the hips. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. p. 409

When assessing a patient, the nurse observes that the patient's legs are curved inward while walking. Which abnormality should the nurse anticipate in the patient? Bowlegs Footdrop Knock-knee Congenital hip dysplasia

The legs are bent outward. Rationale Genu varum , or bowlegs, is an abnormality where one or both of the legs are bent outward at the child's knee. This is a congenital condition and is considered normal until 2 to 3 years of age. If the legs are bent inward and the knees come together as the person walks, it is called knock-knee or genu valgum. S- and C-shaped spines are seen in scoliosis.

When reviewing the medical record of a 3-year-old child, the nurse finds that the child has genu varum. What finding should the nurse expect in the child? The legs are bent inward. The legs are bent outward. The spine is S-shaped. The spine is C-shaped.

Full-body sling Rationale To decrease the surface area and to reduce the friction when the patients are unable to assist with moving up in bed, the nurse uses an ergonomic assistive device such as a full-body sling to help lift the patient off the surface of the bed. Arm splints help in reducing musculoskeletal injury. A trapeze bar helps in performing upper arm exercises. Trochanter rolls prevent external rotation of the hips when a patient is in the supine position.

Which assistive device would the nurse use to reduce surface area and friction when patients are unable to assist with moving up in bed? Arm splints Trapeze bar Full-body sling Trochanter roll

The muscle fibers become shortened because of disuse. Rationale The adductor muscles are stronger than the abductor muscles; when patients are immobile and the joint is not exercised through its range of motion (ROM), the adductor muscle fibers shorten, resulting in the contracture of that joint, which is usually permanent. pp. 413, 415

Which can cause contracture of a joint? The adductors muscles are weakened as a result of immobility. The muscle fibers become shortened because of disuse. The calcium-to-phosphorus ratio becomes disrupted. There is a deficiency in vitamin D.

Increased nitrogen levels Rationale In an immobile patient, his or her body often excretes more nitrogen that in ingests, resulting in negative nitrogen balance. Immobility disrupts normal metabolic functioning, and causes gastrointestinal disturbances such as decreased appetite and slowing of peristalsis. The metabolic rate decreases in patients with immobility. p. 410

Which metabolic changes are observed in immobile patients? Increased appetite Increased peristalsis Increased metabolic rate Increased nitrogen levels

80-year-old woman who has suffered a hemorrhagic cerebrovascular accident (CVA) Rationale The older the patient and the greater the period of immobility, which can be significant following a hemorrhagic stroke, the greater is the number of systems that can be affected by the immobility. pp. 410-411

Which patient is at greatest risk for developing multiple adverse effects of immobility? 1-year-old child with a hernia repair 80-year-old woman who has suffered a hemorrhagic cerebrovascular accident (CVA) 51-year-old woman following a thyroidectomy 38-year-old woman undergoing a hysterectomy

1, 2, 5 Rationale When the head of the hospital bed is elevated, pressure ulcers often develop within the undermined tissue. When the bed is elevated to 60 degrees, gravity pulls a patient so that bony skeleton moves towards the foot of the bed while the skin remains against the sheet. The blood vessels in the underlying tissue are not strengthened; instead they are stretched and damaged, resulting in the impeded blood flow to the deeper tissues and blood vessels. p. 408

Which physiological changes are observed in a patient when the head of a hospital bed is elevated to 60 degrees? Select all that apply. Formation of pressure ulcers Skin remains against the sheets Increased blood flow in the blood vessels Blood vessels in the underlying tissues are strengthened Bony skeleton moves forward towards the foot of the bed

2 4 5 Rationale Flexor carpi radialis, extensor carpi radialis brevis, and extensor carpi radialis longus are the muscles used for the abduction of the condyloid joint in the wrist region. The flexor carpi ulnaris is the primary muscle used for flexion and adduction of the condyloid joint in the wrist region. The extensor carpi ulnaris is used for extension of the condyloid joint in the wrist region. p. 415

Which primary muscles are used for the abduction of the wrist joint? Select all that apply. Flexor carpi ulnaris Flexor carpi radialis Extensor carpi ulnaris Extensor carpi radialis brevis Extensor carpi radialis longus

"There is increased cough productivity in immobile patients." Rationale At some point in the development of respiratory complications, there is proportional decline in the patient's ability to cough productively. In patients with respiratory complications, mucus accumulates in dependent regions of the airways. Hypostatic pneumonia frequently results because mucus is an excellent place for bacteria to grow. Distribution of the mucus in the bronchi increases, particularly when the patient is in the supine or lateral position. p. 410

Which statement by a nursing student regarding the respiratory changes in immobile patients needs correction? "Mucus accumulates in dependent regions of the airways." "There is increased cough productivity in immobile patients." "Hypostatic pneumonia may develop in patients with immobility." "Distribution of mucus in the bronchi increases when the patient is in the supine position."

Muscle abnormalities cause degeneration of skeletal muscle fibers. Rationale Muscle abnormalities like muscular dystrophies can cause degeneration of skeletal muscle fibers. Postural abnormalities may affect body alignment. Muscle abnormalities would not affect the central nervous system of the body. Muscle abnormalities are most prevalent for the muscle diseases in childhood. p. 409

Which statement is true regarding muscle abnormalities? Muscle abnormalities can affect body alignment. Muscle abnormalities affect the central nervous system of the body. Muscle abnormalities cause degeneration of skeletal muscle fibers. Muscle abnormalities are most prevalent for muscle diseases in adulthood.

Entire lung lobe or a whole lung collapse may be due to immobility. Rationale Immobility sometimes may cause respiratory changes like atelectasis and hypostatic pneumonia. The atelectasis secretions may block a bronchiole or bronchus, which can sometimes collapse an entire lung lobe or a whole lung. The blockage of a bronchiole and collapse of the lung can lead to hypoventilation. Immobility can lead to a proportional decline in the patient's ability to cough productively. Distribution of mucus increases in the bronchi due to immobility. p. 410

Which statement is true regarding respiratory changes due to immobility? Hyperventilation may occur due to immobility. Increased cough productivity may be seen due to immobility. Entire lung lobe or a whole lung collapse may be due to immobility. Distribution of mucus in the bronchi may decrease due to immobility.

"In the sagittal plane, movements are pronation and supination." Rationale In the sagittal plane, movements are flexion and extension of fingers and elbows. Ligaments, muscles, and the nature of the joint limit mobility in each of the planes, but some joint movements are specific to each plane. In the frontal plane, movements are abduction and adduction of arms and legs. In the transverse plane, the movements are internal and external rotation of hips, pronation, and supination. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. p. 414

Which statement made by a nursing student regarding the three planes of the body involved in maximum movement requires correction? "Some joint movements are specific to each plane." "In the frontal plane, movements are abduction of arms." "In the sagittal plane, movements are pronation and supination." "In the transverse plane, movements are internal and external rotation of hips."

Spine-stretching exercises Rationale Spine stretching exercises is a treatment provided for patients with lordosis. Knee braces are provided for patients with knock-knee. A Denis Browne splint is provided for patients with clubfoot. Bracing with ankle-foot orthotic is provided for patients with footdrop. p. 409

Which treatment is provided for patients with lordosis? Knee braces Denis Browne splint Spine-stretching exercises Bracing with ankle-foot orthotic

"You should provide a vitamin D-rich diet for your child." Rationale Outward bending of the legs at the knee indicates bowlegs. It is generally associated with rickets, which occurs due to deficiency of vitamin D. Therefore, the child should be provided with foods that are rich in vitamin D. Phosphorus reduces the risk of rickets in the children. Therefore, parents should not limit phosphorus in a child's diet. Limiting mobility in a child with rickets can impair mobility permanently. A Denis Browne splint is used to reduce the risk of clubfoot; however, it is not useful as a treatment for rickets. Test-Taking Tip: Key words or phrases in the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care. p. 410

While assessing a child, the nurse finds that the child's legs are bent outward at the knee. Which instruction to the parents is most beneficial for the child? "You need to limit phosphorus intake for your child." "You should provide a vitamin D-rich diet for your child." "You should limit mobility in your child for a few days." "You should purchase a Denis Browne splint for your child."

Respiratory Rationale Lack of movement and exercise places patients at risk for respiratory complications. The metabolic changes seen in patients with impaired mobility are altered endocrine metabolism and calcium resorption. An ulcer is characterized by inflammation and usually forms over a bony prominence. It is seen due to integumentary changes in patients with impaired mobility. The musculoskeletal changes seen in patients with impaired mobility are temporary impairment and permanent disability. According to Maslow's hierarchy of needs, physiological complications take priority over social isolation. Respiratory complications take top priority to ensure the ABCs: Airway, Breathing, Circulation. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 410

While assessing a patient with impaired mobility, the nurse prioritizes which type of related complication? Social isolation Respiratory Integumentary Musculoskeletal

1,2, 4, 5 Rationale Bowlegs is a postural abnormality in which one or both legs bend outward at the knee. It occurs due to a congenital condition or rickets. An increase in the intake of vitamin D, calcium, and phosphorus is useful for the treatment of bowlegs. These vitamins and minerals mineralize the bones and make them stronger. Increased intake of vitamin E and vitamin A are not helpful for the treatment of bowlegs as these do not affect bone health. p. 410

While assessing a patient with rickets, the nurse finds that the patient has bowlegs. Which appropriate interventions should the nurse suggest to the patient's parents? Select all that apply. Increase intake of vitamin D. Increase intake of calcium. Increase intake of vitamin E. Increase intake of vitamin A. Increase intake of phosphorus.

Kyphosis Rationale Increased convexity in the curvature of the thoracic spine is a sign of kyphosis due to congenital conditions, rickets, osteoporosis, and tuberculosis of the spine. Sleeping without pillows, using a bed board, bracing, spinal fusion, and spine-stretching exercises are common treatments for this condition. Exaggeration of the anterior convex curve of the lumbar spine is called lordosis. Lateral S- or C-shaped spinal column with vertebral rotation and an unequal height of the hips and shoulders is called scoliosis. Inclining of the head to the affected side, in which the sternocleidomastoid muscle is contracted, is a sign of torticollis. STUDY TIP: Think Lumbar- Lordosis to distinguish it from Thoracik (deliberately misspelled) Kyphosis. p. 410

While caring for a patient with osteoporosis, the nurse finds that the patient has increased convexity in the curvature of the thoracic spine. Which postural abnormality is the patient likely to have? Lordosis Kyphosis Scoliosis Torticollis