What is a negative effect of immobility on the cardiovascular system?

Correct Answer: D

Rationale: Immobility negatively impacts the cardiovascular system by disrupting normal hemodynamics, and the most significant consequence is **venous stasis (D)**. When a person is immobile for prolonged periods, skeletal muscle contractions—which normally assist venous return by compressing veins and propelling blood toward the heart—are minimized. This leads to blood pooling in the lower extremities, increasing venous pressure and causing stasis. Stasis raises the risk of **deep vein thrombosis (DVT)** due to sluggish blood flow, endothelial damage, and hypercoagulability. Additionally, immobility reduces the effectiveness of the venous valve system, further impairing circulation and exacerbating fluid accumulation in dependent tissues. **A ("Increased high-density lipoprotein")** is incorrect because immobility typically correlates with **reduced** HDL levels, not an increase. Physical inactivity is associated with unfavorable lipid profiles, including lower HDL (the "good" cholesterol) and higher LDL and triglycerides. HDL helps remove excess cholesterol, and its reduction worsens cardiovascular health. Immobility promotes metabolic dysregulation, contributing to atherosclerosis, contrary to the premise of this option. **B ("Increased circulation")** is incorrect because immobility **decreases** circulation. Normal circulation relies on movement—both physical activity and positional changes—to promote venous return via the muscle pump mechanism. Immobility stagnates blood flow, reducing cardiac output over time and impairing tissue perfusion. This can lead to complications like orthostatic hypotension (due to reduced vascular tone) and dependent edema, directly opposing the claim of improved circulation. **C ("Increased pumping action of the heart")** is incorrect because immobility **weakens** cardiac function. Prolonged inactivity reduces cardiac workload, leading to **cardiovascular deconditioning**. The heart’s pumping efficiency declines as stroke volume and cardiac output decrease due to reduced demand. Over time, this can cause myocardial atrophy (shrinking of heart muscle) and decreased aerobic capacity, the opposite of enhanced pumping action. The heart adapts to lower activity levels by becoming less efficient, not more. In summary, venous stasis (D) is the only plausible consequence of immobility, while the other choices describe outcomes that are either physiologically implausible (B, C) or opposite to the expected metabolic effects (A). The cardiovascular system relies on movement to maintain homeostasis, and immobilization disrupts this balance, posing significant risks like DVT, deconditioning, and impaired circulation.

Correct Answer: B

Rationale: The client's report of bilateral, painless blurred vision strongly suggests cataracts as the most likely condition. Cataracts develop when the lens of the eye becomes cloudy, leading to progressive, painless vision impairment that typically affects both eyes (though often asymmetrically). This clouding scatters light entering the eye, causing blurred vision that may be described as looking through a foggy window. Cataracts are particularly associated with aging (age-related cataracts), but can also result from trauma, medications like steroids, or systemic conditions like diabetes. The bilateral presentation without pain aligns perfectly with cataract symptoms, as they rarely cause discomfort unless they reach an advanced stage. Macular degeneration (A) primarily affects central vision rather than causing generalized blurring, and typically presents with specific distortions like straight lines appearing wavy (metamorphopsia) or central scotomas (blind spots). While it can be bilateral, macular degeneration wouldn't typically cause symmetrical blurring without these distinctive features. Retinal detachment (C) usually presents with unilateral symptoms like sudden flashes of light (photopsia), floaters, or a "curtain" over the visual field rather than gradual bilateral blurring. While painless, retinal detachment is typically an acute event with distinct symptoms that differ from the described presentation. Glaucoma (D) in its most common form (open-angle) is indeed painless, but visual changes typically begin with peripheral vision loss, not generalized blurring. Angle-closure glaucoma can cause sudden blurring but is accompanied by severe pain, nausea, and halos around lights, making it inconsistent with this presentation. The key distinguishing factors here are the bilateral nature of symptoms, absence of pain, and the characteristic blurred (rather than lost) vision. Cataracts progress slowly, explaining why the blurring develops gradually without other symptoms. The lens opacity in cataracts affects all light entering the eye uniformly, unlike macular degeneration which targets central vision or glaucoma that attacks peripheral vision first. None of the other options present with this exact combination of features, making cataract the only plausible explanation among the choices given. Additional supporting evidence would include age (most common in those over 60), possible complaints of glare sensitivity, or difficulty with night vision—all hallmark symptoms of cataracts that further confirm this as the correct answer.

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.