Which complication(s) may result from prolonged periods of immobility? Select all that apply.
Joint contractures.
Pressure ulcers.
Polyuria.
Increased calcium.
Diarrhea.
Correct Answer : A,B,D
Choice A rationale
Joint contractures are a common complication of prolonged immobility. When joints are not moved through their full range of motion, the connective tissues, including muscles, tendons, and ligaments, begin to shorten and harden. This permanent shortening leads to a loss of joint mobility and can result in fixed deformities. Regular passive and active range of motion exercises are necessary to maintain tissue elasticity and prevent the functional limitations associated with these debilitating contracture formations.
Choice B rationale
Pressure ulcers, or decubitus ulcers, occur when prolonged pressure on bony prominences compromises blood flow to the skin and underlying tissues. This localized ischemia leads to tissue hypoxia and eventual necrosis. Patients who are immobile cannot shift their weight to relieve this pressure. Consistent turning schedules every two hours and the use of pressure-relieving devices are critical interventions to prevent the breakdown of skin integrity and the development of these painful, infection-prone wounds.
Choice C rationale
Polyuria is not a result of immobility. Immobility is more likely to cause urinary stasis because the lack of gravity-assisted drainage from the kidneys to the bladder allows urine to pool in the renal pelvis. This stasis increases the risk of urinary tract infections and the formation of renal calculi. Polyuria is typically associated with endocrine disorders like diabetes or the use of diuretic medications rather than a lack of physical movement or activity.
Choice D rationale
Increased calcium levels, or hypercalcemia, can result from prolonged immobility because the lack of weight-bearing activity leads to bone demineralization. When bones do not experience the stress of movement and gravity, osteoclast activity increases, causing calcium to be released from the bone matrix into the bloodstream. This can lead to serum calcium levels rising above the normal range of 8.5 to 10.5 mg/dL, potentially causing kidney stones and further weakening the skeleton.
Choice E rationale
Diarrhea is not a standard complication of immobility. In fact, the opposite is true; immobility significantly increases the risk of constipation. Reduced physical activity slows down gastrointestinal motility and peristalsis. Furthermore, being in a recumbent position makes it more difficult for patients to have effective bowel movements. This slowing of the digestive tract often leads to fecal impaction or chronic constipation rather than the frequent, loose stools characterized by diarrhea.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
High altitudes present a lower partial pressure of oxygen in the atmosphere, which directly leads to systemic hypoxemia. In patients with sickle cell anemia, deoxygenated hemoglobin S polymerizes into rigid, rod-like structures that distort the red blood cell into a sickle shape. This process occludes microvasculature, leading to tissue ischemia and infarction. Therefore, exercising at high altitudes is contraindicated as it significantly increases the risk of a vaso-occlusive sickling crisis.
Choice B rationale
Prescribed pain medications, such as opioids or non-steroidal anti-inflammatory drugs, are essential for managing the intense pain associated with an ongoing vaso-occlusive crisis. However, these medications do not address the underlying physiological triggers of sickling itself. While they provide symptomatic relief and improve the quality of life during an episode, they do not function as a primary preventative measure to stop the initial formation of sickled erythrocytes in the bloodstream.
Choice C rationale
Dehydration leads to increased blood viscosity and a higher concentration of hemoglobin S within the red blood cells. Reduced plasma volume slows down the transit time of erythrocytes through the narrow capillaries, providing more time for deoxygenation and subsequent polymerization of hemoglobin. Maintaining adequate hydration is a critical preventative strategy because it ensures optimal blood flow and dilutes the concentration of sickling-prone cells, thereby reducing the likelihood of vessel occlusion and crisis.
Choice D rationale
While a balanced diet is important for overall health, a specific high-protein or high-fat diet has no direct scientific link to the prevention of erythrocyte sickling. Sickle cell anemia is a genetic hemoglobinopathy, not a nutritional deficiency that responds to macronutrient manipulation. High-fat diets may actually increase cardiovascular risks or lead to gallbladder issues, which are already common complications in this population, but they do not stabilize the hemoglobin molecule or prevent crises.
Correct Answer is C
Explanation
Choice A rationale
Increased usable oxygen in the environment, such as that provided by supplemental oxygen therapy or a hyperbaric chamber, generally improves the pressure gradient between the alveoli and the pulmonary capillaries. This enhancement actually facilitates better gas exchange by increasing the amount of oxygen available for diffusion into the blood. Therefore, more oxygen in the environment is a treatment for impaired gas exchange rather than a cause of the impairment itself under normal conditions.
Choice B rationale
Hemoglobin is the primary protein responsible for the transport of oxygen from the lungs to the peripheral tissues. An increased amount of functional hemoglobin, provided the cardiovascular system is intact, typically enhances the oxygen-carrying capacity of the blood. This improves the overall efficiency of gas delivery to cells. Impaired gas exchange is more likely to occur when hemoglobin levels are low, such as in severe anemia, where the blood cannot carry enough oxygen.
Choice C rationale
An increased concentration of carbon dioxide in the ambient environment reduces the partial pressure gradient necessary for carbon dioxide to diffuse out of the blood and into the alveoli. This can lead to hypercapnia and respiratory acidosis. Furthermore, if the environment is saturated with carbon dioxide, it often displaces available oxygen, leading to hypoxia. High levels of environmental carbon dioxide actively interfere with the body's ability to maintain normal blood gas homeostasis.
Choice D rationale
The total surface area available for gas exchange is determined by the number of healthy, functioning alveoli. An increased number of alveoli, or maintaining the integrity of existing ones, ensures a larger area for the diffusion of gases across the alveolar-capillary membrane. Conditions that decrease the number of functioning alveoli, such as emphysema or pulmonary fibrosis, are what lead to impaired gas exchange. Having more alveoli would naturally support better respiratory function and efficiency.
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