NR224 WEEK 6 EDAPTS MOBILITY
EXAM QUESTIONS AND ANSWERS
1. A patient has been bedridden for several days following a major abdominal surgery. Which
physiological change should the nurse expect to see as a result of prolonged immobility?
A. Increased basal metabolic rate
B. Negative nitrogen balance
C. Decreased serum calcium levels
D. Enhanced protein synthesis
Answer: B
Conceptual Explanation: Immobility leads to the breakdown of muscle protein, which
releases nitrogen into the blood, resulting in a negative nitrogen balance. The metabolic
rate typically decreases, and calcium is released from the bones into the blood
(hypercalcemia).
,2. When assessing a patient for orthostatic hypotension, the nurse finds a drop in systolic
blood pressure by 25 mmHg when the patient moves from supine to standing. What is the
priority nursing action?
A. Administer an IV bolus of normal saline
B. Notify the physician of a potential stroke
C. Increase the patient’s oral fluid intake immediately
D. Return the patient to a supine or sitting position
Answer: D
Conceptual Explanation: Safety is the priority. If a patient experiences a significant drop
in blood pressure (defined as a drop of 20 mmHg systolic or 10 mmHg diastolic), the nurse
must ensure the patient does not fall by returning them to a safe resting position.
3. Which respiratory complication is a direct result of the collapse of alveoli in an immobile
patient?
A. Hypostatic pneumonia
B. Pulmonary edema
C. Atelectasis
D. Pneumothorax
Answer: C
, Conceptual Explanation: Atelectasis is the collapse of alveoli, preventing normal gas
exchange. While hypostatic pneumonia is an inflammation of the lungs from stasis of
secretions, atelectasis specifically refers to the alveolar collapse.
4. A nurse is caring for an immobile patient and notices redness over the sacrum that does
not blanch when pressed. What is the appropriate staging for this pressure injury?
A. Stage I
B. Stage II
C. Stage III
D. Unstageable
Answer: A
Conceptual Explanation: A Stage I pressure injury is characterized by intact skin with
non-blanchable erythema (redness) of a localized area, usually over a bony prominence.
5. To prevent thrombus formation in an immobile patient, the nurse should include which of
the following in the plan of care?
A. Massaging the legs daily
B. Placing a pillow under the knees
C. Encouraging early and frequent ambulation
D. Restricting oral fluid intake
Answer: C
EXAM QUESTIONS AND ANSWERS
1. A patient has been bedridden for several days following a major abdominal surgery. Which
physiological change should the nurse expect to see as a result of prolonged immobility?
A. Increased basal metabolic rate
B. Negative nitrogen balance
C. Decreased serum calcium levels
D. Enhanced protein synthesis
Answer: B
Conceptual Explanation: Immobility leads to the breakdown of muscle protein, which
releases nitrogen into the blood, resulting in a negative nitrogen balance. The metabolic
rate typically decreases, and calcium is released from the bones into the blood
(hypercalcemia).
,2. When assessing a patient for orthostatic hypotension, the nurse finds a drop in systolic
blood pressure by 25 mmHg when the patient moves from supine to standing. What is the
priority nursing action?
A. Administer an IV bolus of normal saline
B. Notify the physician of a potential stroke
C. Increase the patient’s oral fluid intake immediately
D. Return the patient to a supine or sitting position
Answer: D
Conceptual Explanation: Safety is the priority. If a patient experiences a significant drop
in blood pressure (defined as a drop of 20 mmHg systolic or 10 mmHg diastolic), the nurse
must ensure the patient does not fall by returning them to a safe resting position.
3. Which respiratory complication is a direct result of the collapse of alveoli in an immobile
patient?
A. Hypostatic pneumonia
B. Pulmonary edema
C. Atelectasis
D. Pneumothorax
Answer: C
, Conceptual Explanation: Atelectasis is the collapse of alveoli, preventing normal gas
exchange. While hypostatic pneumonia is an inflammation of the lungs from stasis of
secretions, atelectasis specifically refers to the alveolar collapse.
4. A nurse is caring for an immobile patient and notices redness over the sacrum that does
not blanch when pressed. What is the appropriate staging for this pressure injury?
A. Stage I
B. Stage II
C. Stage III
D. Unstageable
Answer: A
Conceptual Explanation: A Stage I pressure injury is characterized by intact skin with
non-blanchable erythema (redness) of a localized area, usually over a bony prominence.
5. To prevent thrombus formation in an immobile patient, the nurse should include which of
the following in the plan of care?
A. Massaging the legs daily
B. Placing a pillow under the knees
C. Encouraging early and frequent ambulation
D. Restricting oral fluid intake
Answer: C
