Problem 1
A patient has been on bed rest for over 5 days. Which of these findings during the nurse's assessment may indicate a complication of immobility? a. Decreased peristalsis b. Decreased heart rate c. Increased blood pressure d. Increased urinary output
Problem 2
An older-adult patient has been bedridden for 2 weeks. Which of these complaints by the patient indicates to the nurse that he or she is developing a complication of immobility? a. Increase of appetite b. Gum soreness c. Difficulty in swallowing d. Left ankle joint stiffness
Problem 3
A patient is receiving \(40 \mathrm{mg}\) of enoxaparin subcutaneously every 12 hours while on prolonged bed rest to prevent thrombophlebitis. Because bleeding is a potential side effect of this medication, the nurse should continually assess the patient for what signs of bleeding? (Select all that apply.) a. Bruising b. Pale yellow urine c. Bleeding gums d. Coffee ground-like vomitus e. Light brown stool
Problem 5
The effects of immobility on the cardiac system include which of the following? (Select all that apply.) a. Thrombus formation b. Increased cardiac workload c. Weak peripheral pulses d. Irregular heartbeat e. Orthostatic hypotension
Problem 6
A 46 -year-old patient is admitted to the emergency department following an automobile accident. The patient has a pelvic fracture and is ordered on bed rest and placed in an immobilization device to limit further injury until the fracture can safely be repaired. Which measures would be appropriate for this patient to prevent complications of bed rest? (Select all that apply.) a. Administer intravenous analgesic as ordered. b. Have patient perform incentive spirometry. c. Support patient in active assistive ROM exercises of upper extremities. d. Provide patient a low-calorie diet. e. Apply sequential compression devices to legs.
Problem 9
A nurse is helping a patient perform active assisted range of motion in the right elbow. Which statement describes the correct technique? a. Support elbow by holding distal part of extremity. b. Grasp joint with fingers to provide support. c. Have patient move joint independently. d. Move the joint past the point of resistance. e. Perform the exercise a few times only, and gradually build up to more.
Problem 10
A middle-aged adult patient has limited mobility following a total knee arthroplasty. During assessment, the nurse notes that the patient is having difficulty breathing while lying supine. Which assessment data support a pulmonary issue related to immobility? (Select all that apply.) a. Oxygen saturation of \(89 \%\) b. Irregular radial pulse c. Diminished breath sounds bilateral bases on auscultation d. BP: \(132 / 84\) e. Pain reported at 3 on scale of 0 to 10 following medication f. Respiratory rate of 26
