| Course | NR 341 Complex Adult Health |
|---|---|
| Week | 1 |
| Paper type | Discussion post with one reply |
| Length | About 550 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 341 Week 1
Week 1 Discussion: Two Problems, One Hour
Twenty Milliliters an Hour and a Glucose of 312: Which One I Moved on First at 1400
Initial Post
My patient at 1400 was a 70-year-old man, 82 kilograms, on the first day after an open repair of an abdominal aortic aneurysm, with type 2 diabetes managed at home on metformin. Two problems appeared on the same check. His urine output had been 20 mL an hour for the past two hours, down from 60 to 70 mL an hour in the morning. And his fingerstick glucose was 312 mg/dL, up from 188 at 1000.
Both have a correct response. For the urine, the response is to find out why it has fallen: check the catheter and tubing for a kink or clot, scan the bladder, look at his blood pressure and heart rate trend, check the wound and drain for bleeding, and call the surgical team. For the glucose, the response is to give the correction insulin ordered on his sliding scale and recheck in an hour, and to ask whether his basal insulin needs adjusting. The inpatient standards from the American Diabetes Association set a range of 140 to 180 mg/dL for most adults on a hospital ward (ElSayed et al., 2024); at 312 he was far outside it.
I moved on the urine first, and the reason is in his chart, not in a rule. His blood pressure had drifted from 132/76 at 1000 to 106/64 at 1400, and his heart rate from 84 to 102. Twenty mL an hour in an 82-kilogram man is about 0.24 mL per kilogram per hour, under half the 0.5 mL/kg/h used in the KDIGO criteria for acute kidney injury (Khwaja, 2012). After an aortic repair, a falling pressure, a rising pulse and falling urine together raise the question of bleeding, and bleeding is the problem that could become an emergency within the hour. The glucose, while high, was not causing symptoms, and a correction dose given 15 minutes later would do its work the same way.
The glucose was not dropped. I gave the correction insulin at 1420, after the surgical resident had been called and the bladder scan done, and I asked the resident in the same call whether his insulin plan should change, since stress after major surgery can raise glucose for several days.
What would have flipped the order: if the bladder scan had shown 600 mL in his bladder with a blocked catheter, the urine problem would have been fixed in two minutes and the glucose would have been next. And if his glucose had been 450 with confusion, or he had been unable to take fluids, it would have come first.
My question for the class: what value in your patient's chart would make you reverse my order?
Reply to a Classmate
Tyler, you chose to give the pain medication before calling about a potassium of 3.2 because your patient rated her pain 9. I think that order holds at 3.2, but I would test it by changing one number: if her potassium had been 2.8, with extra beats showing on the monitor, would you still medicate first? At that level, I would call first and medicate while waiting for the replacement order.
References
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Galindo, R. J., Hilliard, M. E., Johnson, E. L., Khunti, K., Lingvay, I., Matfin, G., McCoy, R. G., Perry, M. L., Pilla, S. J., Polsky, S., Prahalad, P., Pratley, R. E., Segal, A. R., . . . Gabbay, R. A. (2024). 16. Diabetes care in the hospital: Standards of care in diabetes-2024. Diabetes Care, 47(Suppl. 1), S295-S306. https://doi.org/10.2337/dc24-S016
Khwaja, A. (2012). KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice, 120(4), c179-c184. https://doi.org/10.1159/000339789
NR 341 Week 1 instructions, in plain terms
The opening NR 341 discussion asks you to describe two competing patient needs and explain how you decided which came first. Most versions of the prompt want a clinical example, the nursing response to each need, a justified decision, a scholarly source and a peer reply. Name both responses before ranking either, so the reader sees you know what each problem needs. Argue the order from this patient's own numbers, such as a pressure trend, rather than from a mnemonic. Say what you did about the second problem and when, so it is clear it was not dropped. State what finding would have reversed your order. Your reply should test a classmate's order instead of approving it.
How this NR 341 Week 1 example is built
The post opens with the patient at 1400: 70 years old, 82 kilograms, first day after aneurysm repair, type 2 diabetes on metformin. The second paragraph lists the full response for each problem, from checking the catheter and scanning the bladder to correction insulin. The third explains the choice: blood pressure drifting from 132/76 to 106/64 and heart rate rising from 84 to 102 made the low urine a possible sign of bleeding or low volume, supported by the KDIGO kidney injury guideline. The fourth reports insulin given at 1420 after the call to the resident, with the ADA standards cited. The fifth states what would have reversed the order. The reply to Tyler changes his patient's potassium.
NR 341 Week 1 rubric: what full points look like
Chamberlain discussion rubrics generally assign points for meeting every prompt element, quality of clinical reasoning, application of evidence, peer interaction and APA, with deadlines also checked. Clinical reasoning carries the most weight here, and it is earned when the order rests on figures from the chart rather than on a stock framework. Content accuracy is credited because both responses are complete and correct. Evidence counts when KDIGO and the ADA standards each support one decision. The post scores further for naming the condition that would reverse its order, which shows judgment instead of rule-following. The peer reply earns its points by changing one value in Tyler's case and asking whether his order still holds. Clean references finish the rubric.
NR 341 Week 1 help from the desk
The post that costs the most names both actions, calls both important and never chooses, when the choice is the whole assignment. Close behind is an order defended only by ABCs or Maslow, with nothing from the patient. Some students also drop the second problem completely, which suggests it was forgotten rather than scheduled. Posts that list ten interventions instead of reasoning about two lose depth. Replies that agree with a classmate without testing the order add little. Use real units and times, since vague figures make an order impossible to judge. If you have two problems from a clinical day that you are unsure how to rank, describe them and an NR 341 Week 1 post can be built around your decision.
Get a NR 341 Week 1 example written to your instructions
Send the Week 1 prompt, whatever case your classroom handed out and the posting pattern it expects, and a custom example gets written to those instructions and comes back inside 24 to 48 hours. The first one costs nothing. It is there to read your own draft beside, not to hand in.
More NR 341 papers and pre-licensure samples
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NR 341 Week 1 questions, answered
Does the post need to reach a final answer?
It needs to reach an ordering, which is a smaller thing. The patient can still be undecided at the end as long as the first action and the reason behind it are unambiguous. What sinks a draft is closing with both actions recommended and no sequence between them, because the marker then has no way to tell whether a decision was made or simply avoided.
How do I keep it from turning into a list of interventions?
Cut the number of problems until only two remain and let those two argue. Most drafts read as inventories because they carry five problems, none with room to press on any other. Two problems, both real, both with a correct response, force out the sentence this week is actually marking: this one first, and here is what the other was left holding.
Can the two problems come from different body systems?
They usually have to. A pair drawn from one system tends to share a response, and then there is nothing to weigh. The pairings that make Week 1 work are the ones where the correct action for the first genuinely makes the second harder, which is easier to build across systems than inside one. Many sections supply the pair already.
Where can I find a free NR 341 Week 1 sample paper?
The complete Week 1 post on ranking low urine output above a high glucose after aneurysm repair, with the reversal conditions, the reply to Tyler and both references, is on this page.
Why does the NR 341 Week 1 post act on the urine output first?
Because the patient's blood pressure had fallen from 132/76 to 106/64 and his heart rate had risen from 84 to 102, so the low urine could signal bleeding or low volume that would not wait.