A client is exhibiting diminished range of motion, loss of flexibility, stiffness, and loss of height. The history and physical findings are associated with age-related changes of which area?
Ligaments.
Bones.
Muscles.
Joints.
The Correct Answer is D
Choice A rationale
Ligaments connect bones and stabilize joints. Age-related changes in ligaments result in decreased elasticity, leading to joint stiffness but not directly causing loss of height.
Choice B rationale
Bones undergo resorption and may lose density with age, leading to osteoporosis. While this contributes to height loss, it is not typically associated with diminished range of motion or flexibility as primary symptoms.
Choice C rationale
Muscles lose mass and strength with aging, a condition known as sarcopenia. This affects flexibility and range of motion but does not lead directly to height loss.
Choice D rationale
Joints are affected by age-related changes such as cartilage wear and synovial fluid reduction, leading to stiffness, loss of flexibility, diminished range of motion, and height loss due to spinal disc compression and vertebral changes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D"]
Explanation
Choice A rationale
The trigeminal nerve is responsible for facial sensation and motor functions like chewing, not related to gag reflex impairment.
Choice B rationale
The facial nerve controls facial expressions, taste sensations, and other functions but does not influence the gag reflex.
Choice C rationale
The glossopharyngeal nerve (cranial nerve IX) plays a crucial role in the gag reflex as it innervates part of the pharynx and is responsible for sensory functions in the throat.
Choice D rationale
The vagus nerve (cranial nerve X) also contributes to the gag reflex, providing motor innervation to the pharyngeal muscles and aiding in swallowing and speech functions.
Correct Answer is D
Explanation
Choice A rationale
Administering a bolus of normal saline addresses fluid volume but does not directly address the respiratory effort increase or potential increased ICP, which is the most concerning aspect of the head injury.
Choice B rationale
Administering bronchodilators and monitoring LOC may help with respiratory issues but does not address the underlying problem of increased ICP, which could be causing the increased respiratory effort.
Choice C rationale
Increasing the client's bed height and reassessing in 30 minutes might temporarily help, but it is not the most immediate and appropriate intervention. The client’s symptoms suggest a more urgent issue.
Choice D rationale
Informing the care team and assessing for further signs of increased ICP is crucial. Increased respiratory effort in a client with head injury can indicate rising intracranial pressure, which requires immediate medical attention to prevent further complications.
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