The nurse educates a client about how to reduce their risk for osteoporosis. Which of these statements by the nurse is correct? (Select all that apply)

Correct Answer: B

Rationale: **Rationale:** **Correct Answer (B): Reducing caffeine intake can decrease the risk of osteoporosis.** Caffeine has a mild diuretic effect, increasing calcium excretion through urine. Over time, excessive caffeine consumption (typically >3–4 cups of coffee per day) may contribute to decreased bone mineral density, particularly if calcium intake is insufficient. While caffeine alone is not a primary cause of osteoporosis, moderation helps preserve calcium balance, supporting bone health. **Incorrect Answer (A): Avoiding vitamin D would increase, not decrease, osteoporosis risk.** Vitamin D is essential for calcium absorption in the intestines. Without sufficient vitamin D, the body cannot effectively utilize dietary calcium, leading to weakened bones. Avoiding vitamin D would exacerbate bone loss, directly contradicting osteoporosis prevention strategies. **Incorrect Answer (C): Decreasing alcohol intake is correct, but the question asks for the nurse’s incorrect statement.** Excessive alcohol impairs osteoblast function (bone-forming cells) and interferes with calcium and vitamin D metabolism, increasing osteoporosis risk. However, this option is factually accurate, so its inclusion here suggests a misinterpretation of the question. If the question intended to identify only incorrect statements, this would not fit. **Incorrect Answer (D): Reducing protein intake would harm bone health.** Adequate protein is crucial for maintaining bone matrix integrity. Low protein intake is associated with reduced bone density and slower healing of fractures. While excessive protein without sufficient calcium may pose risks, protein restriction is not a recommended osteoporosis prevention strategy. **Key Takeaways:** - **Bone health requires balance:** Calcium, vitamin D, and protein are critical; caffeine and alcohol should be moderated. - **Misleading choices:** Avoiding vitamin D or protein directly undermines bone strength, while alcohol reduction (though correct) does not align with the question’s framing if seeking incorrect statements. - **Context matters:** The question likely tests recognition of harmful advice (A and D) versus beneficial actions (B and C), but assuming it requests incorrect statements, B stands alone as the accurate selection. **Clarifying Nuances:** - Caffeine’s effect is dose-dependent; moderate intake with adequate calcium may not pose significant risk. - Alcohol’s harm is dose-dependent, but abstinence is not required—moderation is key. - Vitamin D and protein are non-negotiable for bone health; their restriction is never advised. This rationale ensures students understand not just the correct answer but the physiological principles underlying each option, empowering them to apply this knowledge in clinical judgment.

Correct Answer: D

Rationale: Open reduction with internal fixation (ORIF) is the most common method for reducing and immobilizing fractures because it provides direct visualization and alignment of bone fragments while offering stable fixation through implants like plates, screws, or rods. This approach ensures anatomical reduction, which is critical for proper healing, especially in displaced or complex fractures. The internal fixation hardware maintains alignment during the healing process, allowing for early mobilization and rehabilitation, reducing complications like malunion or nonunion. ORIF is preferred for intra-articular fractures (where joint surfaces are involved) and comminuted fractures (multiple bone fragments) because it restores function and stability more effectively than external methods. Choice A (Open reduction with external fixation) is incorrect because external fixation is typically reserved for severe open fractures, cases with significant soft tissue damage, or temporary stabilization. While open reduction allows direct visualization, external fixators are bulkier, limit mobility, and carry a higher risk of pin-site infections. They are not as stable as internal fixation for long-term fracture healing and are usually a bridge to definitive treatment rather than the primary method. Choice B (External reduction and internal fixation) is incorrect because "external reduction" is not a standard medical term. Reduction refers to realigning bone fragments, which can only be done through closed (non-surgical) or open (surgical) methods. Pairing "external reduction" with internal fixation is a contradiction—internal fixation requires surgical access, making the phrase nonsensical in clinical practice. Choice C (External fixation with closed reduction) is incorrect because while closed reduction (manipulation without surgery) is less invasive, it is often insufficient for unstable or complex fractures. External fixation alone lacks the precision of internal fixation and may not maintain adequate alignment, leading to poor healing outcomes. This method is more commonly used in emergency settings or for temporary stabilization before ORIF, not as the definitive treatment for most fractures. The superiority of ORIF lies in its ability to combine precise anatomical alignment with robust mechanical stability, facilitating optimal bone healing and functional recovery. Other methods either lack the necessary stability (external fixation) or are misrepresented concepts (external reduction), making them unsuitable as the most common or effective approach.

Correct Answer: D

Rationale: Let’s analyze each choice to understand why **D (All of the Above)** is correct and why the other options, while partially correct, are incomplete on their own. 1. **Wear sunglasses to filter ultraviolet (UV) light (A):** This is a crucial health promotion measure for vision. Prolonged UV exposure can lead to cataracts, macular degeneration, and photokeratitis (sunburn of the cornea). Sunglasses with UV-blocking lenses protect the eyes from these harmful effects. However, this alone does not cover all aspects of eye health promotion. 2. **Avoid nonsteroidal anti-inflammatory drug (NSAID) use (B):** While NSAIDs are generally safe for short-term use, chronic or excessive use can cause ocular side effects, such as dry eye syndrome or, in rare cases, retinal hemorrhages. However, this is a more specific and situational recommendation—not everyone needs to avoid NSAIDs outright. It is a valid point for certain populations, but it’s not universally applicable like other options. 3. **Wash your hands before touching your eyelids (C):** Hand hygiene is essential to prevent infections like conjunctivitis (pink eye) or styes, which can result from transferring bacteria or viruses to the eyes. This is a fundamental practice for maintaining eye health, but similar to the other options, it’s only one part of a comprehensive strategy. **Why D (All of the Above) is correct:** Each option (A, B, and C) represents a valid health promotion measure for vision, but none alone cover all necessary precautions. Sunglasses protect against environmental damage, NSAID avoidance prevents medication-related risks, and handwashing reduces infection risks. Combining these measures ensures a holistic approach to eye health, addressing multiple potential threats. **Why A, B, or C alone are insufficient:** - Choosing **only A** neglects infection prevention (C) and medication risks (B). - Choosing **only B** ignores UV protection (A) and hygiene (C). - Choosing **only C** disregards environmental and medication-related risks (A and B). Thus, the most comprehensive and correct answer is **D**, as it integrates all three critical aspects of vision health promotion.

Correct Answer: A

Rationale: Atelectasis refers to the partial or complete collapse of lung tissue, often caused by inadequate lung expansion due to immobility, shallow breathing, or obstruction. Preventing atelectasis in clients with impaired mobility requires interventions that promote lung expansion and ventilation. **Option A (Assist the client to orthopneic position)** is correct because the orthopneic position—sitting upright and leaning slightly forward with arms supported on a table or overbed tray—maximizes lung expansion by reducing pressure on the diaphragm and allowing for deeper breaths. This position is especially beneficial for clients with respiratory compromise, as it improves alveolar ventilation and prevents the pooling of secretions that could lead to atelectasis. By facilitating deeper inhalation, it counteracts the shallow breathing patterns common in immobile clients. **Option B (Offer a protein-rich diet)** is incorrect because while nutrition is important for overall health and tissue repair, a protein-rich diet does not directly address the mechanical issue of lung collapse. Atelectasis is primarily a respiratory complication, not a nutritional one. Although proper nutrition supports immune function and healing, it does not improve lung expansion or secretion clearance, which are the primary mechanisms for preventing atelectasis. **Option C (Offer the client a bedpan for toileting)** is incorrect because using a bedpan does not promote lung expansion. In fact, prolonged bedpan use may contribute to immobility and discomfort, which can exacerbate shallow breathing. Encouraging mobility (e.g., assisting the client to a chair or commode) would be more beneficial for respiratory function, as movement helps stimulate deeper breathing and circulation. **Option D (Turn the client every 4 hours)** is incorrect because turning every 4 hours is insufficient to prevent atelectasis in most cases. While repositioning is important for preventing pressure injuries and improving circulation, it does not guarantee adequate lung expansion. More frequent turning (e.g., every 2 hours) combined with deep breathing exercises or incentive spirometry would be more effective. The orthopneic position is a more targeted intervention for directly addressing lung ventilation. The key to preventing atelectasis lies in interventions that actively promote lung expansion and secretion mobilization. The orthopneic position achieves this by optimizing the mechanics of breathing, whereas the other options either address unrelated needs or are insufficiently targeted to respiratory function.

Correct Answer: A

Rationale: **Rationale:** **A: Client who had recent cataract surgery and worsening vision** This client is the highest priority due to the risk of **postoperative complications**, such as **endophthalmitis (infection inside the eye)**, **retinal detachment**, or **cystoid macular edema**, which can lead to **permanent vision loss** if not treated urgently. Cataract surgery involves an incision in the eye, making it susceptible to infection or inflammation. Worsening vision postoperatively is a **red flag** requiring **immediate evaluation** to prevent irreversible damage. **B: Client with an absent red reflex** An absent red reflex can indicate serious conditions like **retinoblastoma (in children)**, **cataracts**, or **vitreous hemorrhage**. While concerning, this finding is not **immediately life- or vision-threatening** unless accompanied by acute symptoms (e.g., pain, sudden vision loss). A thorough workup is needed, but it does not take precedence over an acute postoperative complication like worsening vision after surgery. **C: Client with an intraocular pressure (IOP) of 24 mm Hg** An IOP of **24 mm Hg is elevated** (normal range: 10–21 mm Hg) and may suggest **glaucoma**, but it is not an emergency unless accompanied by **acute angle-closure glaucoma symptoms** (severe eye pain, nausea, sudden vision loss, halos around lights). Chronic glaucoma management can wait for routine evaluation, whereas acute postoperative changes demand **urgent intervention**. **D: Client with a tearing, reddened eye with exudate** This presentation suggests **conjunctivitis (viral or bacterial)**, **allergic reaction**, or **blepharitis**. While uncomfortable, these are **not sight-threatening** and can typically be managed with topical treatments. **No immediate intervention** is needed unless signs of **corneal involvement** (e.g., photophobia, severe pain) are present. **Conclusion:** The **postoperative cataract patient with worsening vision (Option A)** is the **highest priority** due to the risk of **surgical complications** that can rapidly progress to **permanent visual impairment**. The other conditions (B, C, D) are either **non-emergent** or require further evaluation but do not pose the same **urgent threat** to vision.