NU 155 EXAM 3 TESTED QUESTIONS AND COMPLETE
SOLUTIONS
◉ active ROM
Answer: patient performs 100% on their own
◉ partial assisted
Answer: patient does part of ROM with help of nurse
◉ Passive ROM
Answer: patient needs assistance with ROM
◉ How to promote lung expansion
Answer: raise head of bed
,cough-turn-
reposition
◉ preventing cardiovascular immobility
Answer: -ankle twists
-early ambulation after injury/surgery (promotes strength, retains joint flexibility, minimizes pain and
stiffness)
-compression devices
◉ incentive spirometer steps
Answer: helps deep breathing, prevents pneumonia, volume set by provider
-hold at eye level
-sit upright (semi-Fowler)
-in through mouth, hold for 3 secs
-remove mouthpiece and exhale slowly
,- repeat ^^ steps 5-12 times
- end with 2 controlled coughs
- repeat every 1-2 hours per order
◉ How often do you turn immobile patients
Answer: every 2 hours
◉ psychosocial support
Answer: contact with family, spiritual support if applicable, allow for sleep/rest, orientation of reality,
refer any community resources
◉ Effects of immobility on Nervous system
Answer: Proprioception (ability to sense movement, action, location) and equilibrium can be altered
◉ isometric exercise
, Answer: tension and relaxation of muscles without joint movement.
EX: Kegel exercises
◉ how to prevent contractures & muscle atrophy
Answer: ROM
◉ how to prevent worsening of contracture
Answer: use of splints and braces
◉ cardiac output
Answer: how much blood is reaching tissues and extremities
◉ poor heart pump =
Answer: poor tissue perfusion
SOLUTIONS
◉ active ROM
Answer: patient performs 100% on their own
◉ partial assisted
Answer: patient does part of ROM with help of nurse
◉ Passive ROM
Answer: patient needs assistance with ROM
◉ How to promote lung expansion
Answer: raise head of bed
,cough-turn-
reposition
◉ preventing cardiovascular immobility
Answer: -ankle twists
-early ambulation after injury/surgery (promotes strength, retains joint flexibility, minimizes pain and
stiffness)
-compression devices
◉ incentive spirometer steps
Answer: helps deep breathing, prevents pneumonia, volume set by provider
-hold at eye level
-sit upright (semi-Fowler)
-in through mouth, hold for 3 secs
-remove mouthpiece and exhale slowly
,- repeat ^^ steps 5-12 times
- end with 2 controlled coughs
- repeat every 1-2 hours per order
◉ How often do you turn immobile patients
Answer: every 2 hours
◉ psychosocial support
Answer: contact with family, spiritual support if applicable, allow for sleep/rest, orientation of reality,
refer any community resources
◉ Effects of immobility on Nervous system
Answer: Proprioception (ability to sense movement, action, location) and equilibrium can be altered
◉ isometric exercise
, Answer: tension and relaxation of muscles without joint movement.
EX: Kegel exercises
◉ how to prevent contractures & muscle atrophy
Answer: ROM
◉ how to prevent worsening of contracture
Answer: use of splints and braces
◉ cardiac output
Answer: how much blood is reaching tissues and extremities
◉ poor heart pump =
Answer: poor tissue perfusion
