A nurse is preparing to administer enoxaparin sodium (Lovenox) subcutaneously to a client.
Which of the following is an appropriate action by the nurse?

Choice A rationale

Immobility generally leads to a decreased metabolic rate due to the reduced expenditure of energy for physical activity and muscle contraction. This lowered metabolic demand results in an overall reduction in oxygen consumption and nutrient utilization, often contributing to a negative nitrogen balance and weight loss, but it is not a direct increase.

Choice B rationale

Immobility significantly impairs the skeletal muscle pump mechanism, which normally assists venous return in the lower extremities. This failure results in venous pooling, or stasis, increasing hydrostatic pressure within the capillaries. This stasis elevates the risk for thrombus formation, commonly referred to as deep vein thrombosis (DVT), a potentially fatal complication.

Choice C rationale

Prolonged immobility, particularly in a supine position, hinders the complete emptying of the bladder due to the lack of gravity and ineffective detrusor muscle function. This leads to urinary stasis, where residual urine harbors bacteria, significantly increasing the risk of urinary tract infections (UTIs) and the potential for renal calculi formation due to calcium reabsorption.

Choice D rationale

Immobility, especially in a supine position, restricts the chest wall's excursion and the functional capacity of the diaphragm and intercostal muscles. This leads to decreased depth of respirations, or hypoventilation, which causes the pooling of secretions in the dependent lung fields and elevates the risk for atelectasis and pneumonia.

Choice E rationale

The absence of weight-bearing and regular muscle contraction stimuli due to immobility results in a rapid breakdown of muscle protein, exceeding the rate of synthesis. This physiological response causes muscle atrophy, characterized by a reduction in muscle mass and strength, leading to significant weakness and functional decline over time. 80mm.5pt.

Choice A rationale

Asking the child to turn to the side and remain relaxed is insufficient as it does not optimally expose or accentuate the characteristic anatomical deformities of scoliosis, which include lateral spinal curvature and vertebral rotation. A relaxed, upright posture may conceal mild curvature, thus making a reliable assessment of spinal symmetry and trunk rotation difficult or inconclusive for screening purposes.

Choice B rationale

These neck movements assess the range of motion of the cervical spine (neck flexion and extension), which is unrelated to the primary screening for idiopathic scoliosis, a condition characterized by a structural lateral curve and rotation predominantly in the thoracic and lumbar spine. This instruction would not provide the necessary positional change to observe the trunk asymmetry.

Choice C rationale

Lying prone on the examination table takes the gravitational load off the spine and alters the relationship of the trunk to gravity, making the observation of subtle curvatures or the characteristic rib hump extremely difficult. This position is unsuitable as a screening method, which relies on an upright, forward-bending posture to best reveal the rotational deformity inherent to structural scoliosis.

Choice D rationale

The instruction to "Bend forward from the waist with your head and arms downward" describes the Adam's forward bend test, the gold standard screening method for scoliosis. This position causes the rotational component of the scoliotic curve to become most prominent, revealing a rib or flank hump (asymmetry) due to the underlying vertebral rotation, which is crucial for early detection.