Chapter 36: Immobility

Chapter 36: Immobility

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. An elderly patient was admitted to the hospital after falling in the nursing home. The patient has a fractured right femur and is awaiting surgery. The surgeon orders bed rest. The patient asks the nurse what this means. What is the nurse’s best explanation?

a.	“You are to be immobile.”
b.	“You cannot move.”
c.	“You need restraints.”
d.	“You have to remain in bed.”

 

 

ANS:   D

A patient’s mobility can be restricted for therapeutic reasons, such as when bed rest is ordered. Therapeutic reasons for bed rest include decreasing the body’s oxygen needs, reducing cardiac workload, reducing pain, and allowing the debilitated or ill patient to rest. The duration of bed rest depends on the type and nature of the illness or injury and the patient’s prior state of health. Bed rest does not mean immobile, cannot move, or that restraints are needed.

 

PTS:    1                      DIF:    Cognitive Level: Applying (Application)

REF:    1035                OBJ:    Describe mobility and immobility.

TOP:    Nursing Process: Implementation

MSC:   Client Needs: Safe and Effective Care Environment

 

2. The patient is recovering from a cerebrovascular accident (stroke). The patient is having problems with balance and coordination. The patient asks the nurse what part of the brain has been damaged. How should the nurse respond?

a.	The hypothalamus has been damaged.
b.	The cerebellum has been damaged.
c.	The thalamus has been damaged.
d.	The medulla oblongata has been damaged.

 

 

ANS:   B

Damage to the cerebellum causes problems with balance, and motor impairment is directly related to the amount of destruction of the motor strip. The hypothalamus controls temperature. The thalamus controls the five senses: hearing, seeing, taste, smell, and touch. The medulla oblongata is part of the brainstem and controls breathing, heart rate, and digestion.

 

PTS:    1                      DIF:    Cognitive Level: Analyzing (Analysis)

REF:    1033

OBJ:    Describe common physical and physiological changes associated with immobility.

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Physiological Integrity

 

3. A student nurse is caring for a young adult patient who is immobile with a back injury. On auscultation, the student nurse hears rhonchi in the lower lobes. The student nurse reports this symptom because the patient is developing which complication?

a.	Increased lung expansion
b.	Hypostatic pneumonia
c.	Aspiration pneumonia
d.	Increased diuresis

 

 

ANS:   B

Decreased, not increased, lung expansion, generalized respiratory muscle weakness, and dependent stasis of secretions occur with immobility. These conditions often contribute to the development of atelectasis (collapse of alveoli) and hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions). Aspiration pneumonia results from aspiration, not from immobility. Diuresis is increased urine excretion.

 

PTS:    1                      DIF:    Cognitive Level: Analyzing (Analysis)

REF:    1035

OBJ:    Describe common physical and physiological changes associated with immobility.

TOP:    Nursing Process: Assessment            MSC:   Client Needs: Physiological Integrity

 

4. A young adult patient was involved in a motorcycle accident. The patient was in the intensive care unit of the hospital for 2 months with immobility and was just discharged to a rehabilitation hospital. The patient asks the nurse, “Why am I so weak?” What is the best response from the nurse?

a.	“When you are in bed for a long time, your body begins to break down its own protein.”
b.	“When you don’t use it, you lose it.”
c.	“You haven’t eaten much for the past couple of months.”
d.	“Your body has spent energy trying to heal itself by increasing the metabolic rate.”

 

 

ANS:   A

Immobility disrupts normal metabolic functioning, decreasing the metabolic rate and altering the metabolism of carbohydrates, proteins, and fats. A patient’s basal metabolic rate (BMR) decreases in response to reduced cellular energy because of the body’s decreased ability to produce insulin and metabolize glucose. The body then begins to breakdown its protein stores for energy resulting in a negative nitrogen balance and increased oxygen demands. However, in the presence of an infection, immobilized patients have an increased BMR. It is the immobility that has caused the weakness, not what was eaten. Not using it leads to losing it is a cliché and should be avoided. The metabolic rate is decreased in immobility not increased.

 

PTS:    1                      DIF:    Cognitive Level: Analyzing (Analysis)

REF:    1035                OBJ:    Identify changes in metabolic rate associated with immobility.

TOP:    Nursing Process: Implementation      MSC:   Client Needs: Physiological Integrity