NSE 111 EXAM QUESTIONS WITH
100% REVISED AND UPDATED
ANSWERS
Braden scale consists of - Answer-6 subscales (each containing 4 levels except friction)
and ranged from 6-23
Lower Braden Score - Answer-higher risk
Why use a Braden scale? - Answer-for assessment, skin always changed so its gokd to
chrck , prevents and treats pressure injuries
how to prevent immobility musculoskeletal movement - Answer-- Active ROM and
passive ROM.
- Integrate exercises into daily life
How to prevent immobility positioning (4) - Answer-turning schedule, head of bed
positioning to prevent sliding, bed positions (fowler, supine, prone, side, sims), supports
like pillows, foot boots, trochanter rolls, sandbags hand rolls, splints
maintain and improve mobility - Answer-rom exercises
active rom - Answer-Performed by client without assistance
Maintains mobility of joints
Active Assistive ROM - Answer-the nurse assists the resident in moving joints
Passive ROM - Answer-Range of Motion in which the resident is unable to assist with
movement so nurses move
principles of rom (7) - Answer-- ask perm and explain why
- stand on side of bed closest to joint and raise bed to centre of my gravity
- go from distal (ankles wrist etc) to proximal (knee elbow) one at a time
- provide support when joints are manipulated (cupping hands and cradling far joints of
extremity)
- assess for fatigue discomfort and tolerance
- dont force movement, move each joint about 5 times
- leave joint in correct alignment when done
areas of pressure injury points - Answer-back of head, shoulders, elbows, butt, heels,
sacrum, ribs, thighs, knees, toes, ears, hips,
, what is working height - Answer-90 degree elbow (around there or waist)
4 moments of hand hygiene - Answer-before entering room, before patieny, after
patient, exiting
its important to do active and passive ROMS - Answer-cramp and circulation (causes
blood clotting)
anti embolism stockings - Answer-Compression stockings to prevent blood clots.
exercise - Answer-physical activity to condition body, improve health and fitness and
therapeutic
active lifestyle - Answer-promotes and maintain health
cardiopulmonary physical activity - Answer-endurance
muscle/skeletal fitness - Answer-increaes strength, flexibility, bone integrity
fitness helps improve - Answer-psychological well being
activity tolerance - Answer-type and amount of exercise or work that a person is able to
perform
what influences activity tolerance - Answer-physiological, emotional, developmental
deconditioning - Answer-the loss of muscle strength from inactivity
functional decline - Answer-decline in physical and cognitive functioning when a person
is unable to engage in activities of daily living
physiological changes associated with immobility (5) - Answer-cardiovascular,
musculoskeletal, urinary elimination, gastrointestinal, integumentary
cardiovascular changes (2) - Answer-orthostatis hypotension and thrombus formation
Musculoskeletal changes (5) - Answer-weakness, atrophy, calcium reabsorption, joint
contractures, loss of ROM
Urinary Elimination Changes - Answer-decreased fluid intake so UTI and renal calculi
gastrointestinal changes - Answer-constipation cuz decrease movement
integumentary changes - Answer-decreased circulation to tissues causing pressure
injuries and prolong ischemia
100% REVISED AND UPDATED
ANSWERS
Braden scale consists of - Answer-6 subscales (each containing 4 levels except friction)
and ranged from 6-23
Lower Braden Score - Answer-higher risk
Why use a Braden scale? - Answer-for assessment, skin always changed so its gokd to
chrck , prevents and treats pressure injuries
how to prevent immobility musculoskeletal movement - Answer-- Active ROM and
passive ROM.
- Integrate exercises into daily life
How to prevent immobility positioning (4) - Answer-turning schedule, head of bed
positioning to prevent sliding, bed positions (fowler, supine, prone, side, sims), supports
like pillows, foot boots, trochanter rolls, sandbags hand rolls, splints
maintain and improve mobility - Answer-rom exercises
active rom - Answer-Performed by client without assistance
Maintains mobility of joints
Active Assistive ROM - Answer-the nurse assists the resident in moving joints
Passive ROM - Answer-Range of Motion in which the resident is unable to assist with
movement so nurses move
principles of rom (7) - Answer-- ask perm and explain why
- stand on side of bed closest to joint and raise bed to centre of my gravity
- go from distal (ankles wrist etc) to proximal (knee elbow) one at a time
- provide support when joints are manipulated (cupping hands and cradling far joints of
extremity)
- assess for fatigue discomfort and tolerance
- dont force movement, move each joint about 5 times
- leave joint in correct alignment when done
areas of pressure injury points - Answer-back of head, shoulders, elbows, butt, heels,
sacrum, ribs, thighs, knees, toes, ears, hips,
, what is working height - Answer-90 degree elbow (around there or waist)
4 moments of hand hygiene - Answer-before entering room, before patieny, after
patient, exiting
its important to do active and passive ROMS - Answer-cramp and circulation (causes
blood clotting)
anti embolism stockings - Answer-Compression stockings to prevent blood clots.
exercise - Answer-physical activity to condition body, improve health and fitness and
therapeutic
active lifestyle - Answer-promotes and maintain health
cardiopulmonary physical activity - Answer-endurance
muscle/skeletal fitness - Answer-increaes strength, flexibility, bone integrity
fitness helps improve - Answer-psychological well being
activity tolerance - Answer-type and amount of exercise or work that a person is able to
perform
what influences activity tolerance - Answer-physiological, emotional, developmental
deconditioning - Answer-the loss of muscle strength from inactivity
functional decline - Answer-decline in physical and cognitive functioning when a person
is unable to engage in activities of daily living
physiological changes associated with immobility (5) - Answer-cardiovascular,
musculoskeletal, urinary elimination, gastrointestinal, integumentary
cardiovascular changes (2) - Answer-orthostatis hypotension and thrombus formation
Musculoskeletal changes (5) - Answer-weakness, atrophy, calcium reabsorption, joint
contractures, loss of ROM
Urinary Elimination Changes - Answer-decreased fluid intake so UTI and renal calculi
gastrointestinal changes - Answer-constipation cuz decrease movement
integumentary changes - Answer-decreased circulation to tissues causing pressure
injuries and prolong ischemia
