NU 301 Exam 3 Comprehensive Questions And 100% Correct Answers.
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Module
NU301
Institution
NU301
You notice a respiratory change in your immobilized postoperative patient. The change you note is most consistent with:
A. atelectasis.
B. hypertension.
C. orthostatic hypotension.
D. coagulation of blood. - Answer A. atelectasis
Metabolic NI for an immobilized pt - Answer -high protei...
NU 301 Exam 3 Comprehensive
Questions And 100% Correct Answers.
You notice a respiratory change in your immobilized postoperative patient. The change you note is most
consistent with:
A. atelectasis.
B. hypertension.
C. orthostatic hypotension.
D. coagulation of blood. - Answer A. atelectasis
Metabolic NI for an immobilized pt - Answer -high protein, high calorie diet with vitamins B & C
-may need enteral feedings
-assess likes and dislikes
-may need to feed the patient
Respiratory NI for an immobilized pt - Answer -TCDB
-prevention of atelectasis/ pneumonia
-incentive spirometer
-PO hydration
CV NI for an immobilized pt - Answer -TEDs/SCDs
-dangle legs prior to standing
-ambulate
-heparin/ lovenox
-ROM exercises (active and passive)
Musculoskeletal NI for an immobilized pt - Answer -assess for muscle atrophy
-ROM exercises (active and passive)
-appropriate diet
,Urinary and bowel NI for an immobilized pt - Answer -I&O every 24 hours
-be sure the pt is receiving the right amount and method of fluid (IV or PO)
-assess urine color and consistency
-assess bowel sounds, abdominal distention, and bowel patterns for consistency and frequency
What are the complications of being immobile? - Answer -muscular deconditioning (disuse atrophy,
physiological, psychosocial, social)
What are the common patient positions? - Answer Fowler's, high Fowler's, semi Fowler's, supine,
prone, lateral, Sim's, Trendelenburg, reverse Trendelenburg, dorsal recumbent
How to set up a pt with a cane for the first time? - Answer -with pt standing, place cane 4 inches away
from side of foot
-top of cane should reach top of hip joint
-want arm flexed about 30 degrees when holding the cane
-use: hold cane on unaffected side, injured leg moves with the cane
-keep cane on stronger side of body
-place cane forward 6-10 inches keeping body weight on BOTH legs
-weaker leg is moved forward, divide weight between cane and stronger leg
, -stronger leg is advanced past cane, divide weight between cane and weaker leg
How to set up a pt with a set of crutches for the first time? - Answer -2,3,4 point gait
-stairs= foot first when going up and crutch first when going down
-gradually shift weight to healthy leg
-move crutches in front then shift weight from healthy leg to arms and swing body thru
-NEVER support with armpits
A nurse is teaching a client with left leg weakness to walk with a cane. What teaching points should the
nurse include? - Answer -hold cane on uninvolved side of body
-handle should be at hip bone
-avoid leaning on cane to get in and out of a chair
-leg stride should be equal on involved and uninvolved side
A pt with a long standing hx of DM is voicing concerns about kidney disease. Pt asks the nurse where
urine is formed in the kidney. The nurse responds: - Answer nephron
What is the desired hourly urinary output for an adult? - Answer 30-60 mL/ hour so 720-1440 mL/ day
What intervention is most important for the nurse to implement for a male client who is experiencing
urinary retention? - Answer Assess for bladder distention
A health care provider may suspect that a client is experiencing urinary retention when the client has: -
Answer small amounts of urine voided 2-3 times per hour
A young girl is having problems urinating postoperatively. You remember children may have trouble
urinating: - Answer in the presence of a person that is not their parent
SAFETY MEASURES - Answer
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