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The nurse is caring for a client who has remained in skeletal traction for an extended period of time. The nurse is assessing for signs/symptoms of complications of immobility. Included would be: (SELECT ALL THAT APPLY)

possible skin breakdown.

Improved circulation.

increased gastric motility.

disuse atrophy

loss of appetite

Answer and Explanation

Correct Answer : A,D,E

A. Prolonged immobility can lead to skin breakdown due to pressure and reduced circulation.

B. Circulation typically worsens with immobility, not improves.

C. Immobility usually decreases gastric motility, not increases it.

D. Disuse atrophy occurs as muscles weaken from lack of use.

E. Loss of appetite can occur due to reduced activity and metabolic rate.

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Correct Answer is D

Explanation

A. Obtaining a walker does not address the acute neurological symptoms.

B. Applying a diaper addresses the incontinence but not the underlying cause.

C. Inserting a Foley catheter manages urinary incontinence but delays necessary evaluation.

D. Notifying the physician is critical as these symptoms suggest cauda equina syndrome, a surgical emergency.

A. Use adductor pillow while in bed B. Limit hip flexion to 90 degrees C. Use fracture pan D. Avoid adduction E. Avoid Internal rotation

Correct Answer is ["A","B","D","E"]

Explanation

A. An adductor pillow helps maintain proper alignment and prevents the hip from crossing the midline (adduction).

B. Limiting hip flexion to 90 degrees prevents dislocation by avoiding positions that could stress the hip joint.

C. A fracture pan is not a necessary precaution for a total hip replacement; it is more relevant for clients with fractures.

D. Adduction should be avoided to prevent the hip from dislocating.

E. Internal rotation can cause the hip to dislocate, so it should be avoided.

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The nurse is caring for a client who has remained in skeletal traction for an extended period of time. The nurse is assessing for signs/symptoms of complications of immobility. Included would be: (SELECT ALL THAT APPLY)

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Naxlex Comprehensive Predictor Exams

A client has been treated for low back pain which radiates down the posterior right leg. The client now has a new onset of urinary and bowel incontinence and weakness in both lower extremities. What is the nurse's first action?

Correct Answer is D

Explanation

The patient is post-op day 1 of a right total hip replacement. What precautions are necessary to prevent complications? (SELECT ALL THAT APPLY).

Correct Answer is ["A","B","D","E"]

Explanation

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When the nurse admits a client with anorexia nervosa for treatment, what factors should the therapeutic milieu provide? (SELECT ALL THAT APPLY)

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