Which of the following is a potential effect of immobility that can lead to reduced lung expansion?
Muscle atrophy
Impaired perfusion
Atelectasis
Venous stasis
The Correct Answer is C
A. Muscle atrophy is the wasting away of muscle tissue due to lack of physical activity, which primarily affects skeletal muscles like the quadriceps. While severe atrophy of the intercostal muscles can eventually weaken respiratory effort, it is not the immediate clinical effect that causes reduced lung expansion. This condition is a long-term musculoskeletal consequence of prolonged bed rest and deconditioning.
B. Impaired perfusion refers to the inadequate flow of blood through the pulmonary or systemic capillaries, affecting gas exchange at the alveolar level. While immobility can contribute to perfusion issues like pulmonary emboli, it does not directly restrict the mechanical expansion of the lung tissue. Perfusion is a circulatory process, whereas lung expansion is a mechanical, ventilatory process of the respiratory system.
C. Atelectasis is the collapse of alveoli that occurs when patients remain immobile and engage in shallow, restricted breathing patterns. The lack of deep inspiration and surfactant distribution causes the air sacs to deflate, significantly reducing the surface area available for gas exchange. This mechanical collapse is a direct result of reduced lung expansion and can lead to secondary hypoxemia and pneumonia.
D. Venous stasis is the slow or stagnant flow of blood in the veins, typically in the lower extremities, increasing the risk of thrombus formation. Although this is a major complication of immobility, it pertains to the vascular system rather than the respiratory mechanics of the lungs. Venous stasis does not have a direct anatomical effect on the ability of the lungs to expand.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A.Monitoring blood glucose levels is a metabolic assessment primarily indicated for patients with diabetes mellitus or those receiving parenteral nutrition. Immobility does not directly cause acute fluctuations in serum glucose concentrations in the absence of underlying endocrine pathology. While stress can elevate glucose, it is not a specific indicator of gastrointestinal function or peristaltic efficiency.
B.Vital signs such as heart rate and blood pressure provide critical data regarding the patient's hemodynamic stability and autonomic nervous system response. While significant gastrointestinal distress, such as a bowel perforation or severe obstruction, may eventually cause tachycardia or hypotension, these are late-stage systemic signs. They lack the specificity required to detect early-onset ileus or constipation.
C.Assessing bowel sounds via auscultation is the most direct clinical method for evaluating the mechanical effects of immobility on the digestive tract. Reduced physical activity often leads to decreased peristalsis, potentially resulting in constipation or a paralytic ileus. The presence of hypoactive or absent bowel sounds in all four quadrants specifically alerts the nurse to these common gastrointestinal complications.
D.Oxygen saturation levels reflect the efficiency of pulmonary gas exchange and peripheral tissue perfusion rather than digestive motility. Although severe abdominal distension from an obstruction can secondary impact respiratory excursion by elevating the diaphragm, it is an indirect and non-specific finding. Pulse oximetry is not a diagnostic tool for identifying primary gastrointestinal complications related to a sedentary state.
Correct Answer is C
Explanation
A.Increased technology awareness: While using digital systems might improve a staff member's technical skills, this is a secondary effect rather than a primary clinical advantage. The main goal of the EHR is to improve patient outcomes and documentation efficiency. Personal skill development is not a standard advantage cited for healthcare systems.
B.Required system changes: The need to constantly adapt to new software interfaces or hardware requirements is generally viewed as a challenge or burden. System changes require extensive staff training and can lead to temporary decreases in productivity. This represents a significant administrative hurdle rather than a benefit to patient care delivery.
C.Facilitation of effective communication: EHRs provide a centralized, real-time repository of patient data that is accessible by all members of the interdisciplinary team simultaneously. This reduces the risk of information silos and ensures that clinicians are making decisions based on the most current data. It enhances the continuity and safety of patient care.
D.Frequent technology updates needed: The necessity of regular software patches and hardware upgrades is a logistical and financial challenge for healthcare organizations. Updates can lead to system downtime and require ongoing education for the nursing staff. This is a maintenance requirement rather than a clinical advantage that improves patient outcomes.
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