A nurse has been assigned four patients of which one of the patients is completely immobile. Which complication should the nurse expect as a result of immobility? (Select all that apply.)

Pressure ulcers

Contractures of the extremities

development of deep vein thrombosis

Crackles in the lungs

Polyuria

Diarrhea

Answer and Explanation

Correct Answer : A,B,C,D

A. Immobile patients are at high risk for developing pressure ulcers due to prolonged pressure on the skin, leading to tissue breakdown.

B. Contractures of the extremities can occur as a result of muscle atrophy and lack of movement in immobilized patients.

C. Immobility increases the risk of venous stasis, leading to the development of deep vein thrombosis (DVT).

D. Crackles in the lungs may result from immobility due to fluid accumulation or atelectasis, particularly in patients who are not moving or changing position frequently.

E. Polyuria is not commonly associated with immobility.

F. Diarrhea is not commonly associated with immobility.

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Correct Answer is D

Explanation

A. Bimanual palpation is used to assess organs or masses, not pulse.

B. Deep palpation is used to feel internal organs and not appropriate for assessing pulse.

C. Percussion is used to assess the density of body tissues, not for pulse assessment.

D. Light palpation is the correct technique for assessing a client's pulse, allowing the nurse to feel the arterial pulse.

A. Elevated glucose levels B. Dysrhythmias C. Elevated blood pressure D. Impaired airway

Correct Answer is A

Explanation

A. Hydrochlorothiazide is known to increase blood glucose levels, particularly in clients with diabetes or those at risk for glucose intolerance.

B. Dysrhythmias are more commonly associated with electrolyte imbalances like low potassium, but elevated glucose is more specific to hydrochlorothiazide use.

C. Hydrochlorothiazide typically lowers blood pressure, so elevated blood pressure is not a common nontherapeutic response.

D. Impaired airway is unrelated to hydrochlorothiazide use.

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A nurse has been assigned four patients of which one of the patients is completely immobile. Which complication should the nurse expect as a result of immobility? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What physical assessment technique would the nurse use to obtain a pulse on a client?

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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