Chapter 09: Chronic Illness and Rehabilitation My Nursing Test Banks

Chapter 09: Chronic Illness and Rehabilitation

MULTIPLE CHOICE

1. The rehabilitation nurse describes a patient who is blind, works full time as a Spanish interpreter, and lives with his wife in a downtown apartment. The nurse classifies this person as:

a.

impaired.

b.

disabled.

c.

handicapped.

d.

dependent.

ANS: A

The blindness is an impairment of vision that does not inhibit the patient from performing his job or enjoying a normal life.

DIF: Cognitive Level: Application REF: 177 OBJ: 1 (theory)

TOP: Concepts of Rehabilitation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A resident with advanced Parkinsons disease stays in his wheelchair all day because it is too tiring to walk and he is fearful of falling. In order to increase mobility, the best intervention would be to:

a.

instruct the resident in crutch walking.

b.

assist the resident to walk in the hallway with a gait belt.

c.

encourage the resident to rock back and forth in his wheelchair to off load weight.

d.

arrange for a walking cane.

ANS: B

Walking is the best exercise to prevent problems associated with immobility. The gait belt will make the resident more secure. Canes and crutches do not diminish the weakness or the fear of falling.

DIF: Cognitive Level: Application REF: 184 | Box 9-5

OBJ: 2 (theory) TOP: Preventing Problems of Immobility

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

3. The obese resident who lies on her back because it is difficult to turn due to her weight has a pressure ulcer on her coccyx that is covered with a dressing. The most effective intervention to encourage independence is:

a.

have staff turn the resident every 2 hours.

b.

turn the patient on her side and use pillows to stabilize her.

c.

arrange for short side rails to be used for positioning.

d.

arrange for a trapeze so the patient can assist with positioning.

ANS: D

The trapeze allows for self-positioning and is less confining than are bed rails. The other options do not foster independence.

DIF: Cognitive Level: Application REF: 186-187 OBJ: 2 (theory)

TOP: Preventing Problems of Immobility

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

4. When the nurse assesses reddened heels on the bed-bound stroke patient, the nurse modifies the care plan to include which intervention?

a.

Massage heels briskly.

b.

Apply socks to feet.

c.

Swab heels with alcohol.

d.

Elevate feet on pillows.

ANS: D

Elevation of the feet gets the weight off the heels and will allow them to heal. All other options are not helpful to damaged skin. Brisk massage may promote damage to the skin. Alcohol can be irritating and may further damage heel skin.

DIF: Cognitive Level: Application REF: 180 | Nursing Care Plan 9-1

OBJ: 2 (theory) TOP: Preventing Problems of Immobility

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

5. The nurse cautions the 70-year-old patient who just had the cast removed from a broken arm that the immobility during the time he was in a cast can cause:

a.

arthritis.

b.

phlebitis.

c.

frozen shoulder.

d.

painful swelling.

ANS: C

Immobility can cause loss of strength and flexibility in the older adult.

DIF: Cognitive Level: Knowledge REF: 178 | 180 | Table 9-1

OBJ: 3 (theory) TOP: Effects of Immobility: Joint Stiffness

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

6. The nurse assessing an 85-year-old patient who has been on bed rest for a fractured hip finds the patient flushed with a temperature of 100 F, pulse of 100, and respiration rate of 24. The next intervention should be to assess:

a.

BP.

b.

breath sounds.

c.

abdominal distention.

d.

amount of urinary output.

ANS: B

The initial assessments are the cardinal signs of pneumonia. The breath sounds should be assessed next to determine the presence of any adventitious breath sounds. BP will also need to be assessed, but the breath sounds are more important with the signs and symptoms present. Abdominal distention is indicative of a gastrointestinal problem. Amount of urinary output is important to an ongoing assessment but not a priority in the present circumstances.

DIF: Cognitive Level: Analysis REF: 179 | Table 9-1

OBJ: 3 (theory) TOP: Effects of Immobility: Hypostatic Pneumonia

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

7. The 76-year-old stroke patient in a long-term care facility has sent his food tray back to the kitchen untouched for the second time today. The most effective intervention to increase nutrition would be to:

a.

take the tray back and offer to feed the patient.

b.

request the dietitian to talk with the patient about food preferences.

c.

take a high-protein drink to the patient.

d.

sit with the patient during meals.

ANS: C

Taking the high-energy drink meets the immediate challenge of inadequate nutritional intake. Referral to the dietitian and sitting with the patient may be helpful. Offering to feed from a rejected tray is not supportive.

DIF: Cognitive Level: Analysis REF: 190-191 OBJ: 2 (theory)

TOP: Effects of Immobility: Anorexia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

8. When the nurse is assessing a bed-bound resident, a reddened area over the coccyx that does not blanch is discovered. The best intervention to prevent further skin damage is to:

a.

cover with a transparent film dressing.

b.

apply warm compress.

c.

turn the patient every 2 hours.

d.

continue to monitor the area.

ANS: A

Since this appears to be a stage 1 pressure area, the transparent film ensures the proper amount of moisture is present for healing while allowing monitoring of the area. A warm compress is not warranted. This patient will need to be turned every hour. Monitoring of the area should continue but does not meet the immediate need.

DIF: Cognitive Level: Analysis REF: 180 | Nursing Care Plan 9-1

OBJ: 3 (theory) TOP: Effects of Immobility: Impaired Circulation

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

9. The LPN/LVN making care assignments to nursing assistants would not assign a patient who has:

a.

manipulative behavior.

b.

an unstable condition.

c.

a draining wound.

d.

a communicable disease.

ANS: B

Nursing assistants are not assigned to patients who have an unstable condition. Care of an unstable patient does not fall into the scope of practice of the unlicensed personnel.

DIF: Cognitive Level: Comprehension REF: 183 | Assignment Considerations

OBJ: 5 (theory) TOP: Assigning Personnel

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

10. The chief goal of a long-term care facility is to:

a.

offer restorative services.

b.

promote individual independence.

c.

facilitate achievement of complete autonomy.

d.

manage medication protocols.

ANS: B

Promotion of independence is the chief goal, not complete autonomy. Other options are services directed at achieving increased independence.

DIF: Cognitive Level: Comprehension REF: 183 OBJ: 4 (theory)

TOP: Goal of Long-Term Care Facilities KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

11. The nurse reminds the nursing assistant that the purpose of locking the wheels of a wheelchair is to:

a.

supply a stable support for a patient to lift self.

b.

keep patient in a position at a table or bedside.

c.

prevent falls.

d.

keep the patient from moving self.

ANS: C

Fall prevention is the purpose of locking the wheels of a wheelchair.

DIF: Cognitive Level: Comprehension REF: 184 | Box 9-5

OBJ: 2 (clinical) TOP: Fall Prevention

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

12. To decrease the incidence of falls, the nurse will arrange for the replacement of:

a.

canes with 4 feet with a single-footed cane.

b.

hard-soled shoes with soft-soled bedroom slippers.

c.

area rugs with a nonslip pad.

d.

plain carpet with a highly patterned carpet.

ANS: C

Loose area rugs should be replaced with nonslip carpets.

DIF: Cognitive Level: Knowledge REF: 184 | Box 9-5

OBJ: 2 (clinical) TOP: Fall Prevention

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

13. The nurse instructing a family in the selection of a chair for an older adult with Parkinsons disease would stress selecting a chair that:

a.

is very wide to allow for position changes.

b.

has sturdy arms to aid in rising.

c.

is low to prevent falls.

d.

is soft and deep for added comfort.

ANS: B

Sturdy arms assist in rising and sitting. Soft, low, and wide chairs cause a person to lean forward to rise and to fall into the chair to be seated.

DIF: Cognitive Level: Comprehension REF: 184 | Box 9-5

OBJ: 2 (clinical) TOP: Fall Prevention

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

14. The charge nurse instructs the nursing assistants to answer the call lights promptly, especially for patients who are receiving:

a.

diuretics for fluid reduction.

b.

antibiotics for infection.

c.

proton pump medications for gastric reflux.

d.

NSAIDs for arthritis.

ANS: A

People taking diuretics need to go to the bathroom frequently, and oftentimes urgently. Prompt attention to call lights will reduce the probability of the patient getting up unassisted. Diuretics may also cause orthostatic hypotension, which increases the risk for falling.

DIF: Cognitive Level: Comprehension REF: 184 | Box 9-5

OBJ: 2 (clinical) TOP: Fall Prevention

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

15. The nurse is caring for a resident who has a security device for safety purposes. What intervention must the nurse include in the plan of care?

a.

Visually check the resident every hour.

b.

Turn and reposition the resident every hour.

c.

Assess condition of the skin every 4 hours.

d.

Reassess the need for the security device every 4 to 8 hours.

ANS: D

The need for continuing the use of the security device must be assessed every 4 to 8 hours. The patient should be visually checked every 30 minutes, and turned and skin assessed every 2 hours.

DIF: Cognitive Level: Application REF: 184 | Box 9-5

OBJ: 2 (clinical) TOP: Use of Security Devices

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

16. When the confused resident pours his cereal in a cup and drinks it, the nurse should:

a.

put his cereal back in the bowl and hand the resident a spoon.

b.

discard the cup with his cereal and bring fresh cereal in a bowl.

c.

calmly instruct the resident that cereal is to be eaten from a bowl.

d.

not interrupt the behavior.

ANS: D

The nurse should leave the resident alone to feed himself independently. Staff should refrain from doing what the resident can do for himself.

DIF: Cognitive Level: Application REF: 186 OBJ: 4 (theory)

TOP: Long-Term Care Facility Goals: Autonomy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

17. The nurse planning a group TV activity in a long-term care facility would choose a channel that offers a(n):

a.

cartoon.

b.

travel documentary.

c.

dramatic two-part mini-series.

d.

opera performance.

ANS: B

Travel documentaries are colorful and do not have a plot to follow. Cartoons are juvenile, opera does not have universal appeal, and the two-part drama would require long attention spans and good short-term memory.

DIF: Cognitive Level: Application REF: 187 OBJ: 4 (theory)

TOP: Long-Term Care Facility Goals: Autonomy

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

18. To motivate a frustrated stroke patient who is learning to walk again, the most effective motivational intervention the rehabilitation nurse could make is to:

a.

show short movies on ambulation techniques.

b.

observe the patient while in physical therapy.

c.

arrange a visit with another stroke victim who has learned to ambulate.

d.

encourage a 1-week break from therapy, which will help the resident come back refreshed.

ANS: C

Talking with someone who can truly understand the frustration is helpful. Showing a short movie on ambulation techniques may be an effective teaching tool, but it is not a motivational tool. Observing the resident is necessary but does not provide motivation. A 1-week break will interrupt progress that has been made, thus decreasing motivation.

DIF: Cognitive Level: Application REF: 188 | Elder Care Points

OBJ: 4 (theory) TOP: Goals for Rehabilitation: Motivation

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

19. The nurse caring for the resident who is disoriented can provide the best care with which intervention?

a.

Ensuring activities are scheduled for the same time each day

b.

Changing care assignments for assistive personnel frequently to prevent burnout

c.

Encouraging autonomy by allowing the resident to choose clothes from the closet

d.

Administering sedatives to calm the patient

ANS: A

Keeping a routine leads to less confusion. Changing assistive personnel care assignments frequently is confusing for the resident. Choosing clothing from an entire closet is overwhelming for the confused resident; rather, giving the resident a few items to choose from encourages autonomy without increasing confusion. Sedatives should not be given to treat confusion.

DIF: Cognitive Level: Application REF: 185-186 OBJ: 4 (theory)

TOP: Managing Confusion and Disorientation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

20. Treatment resources that focus on restorative care for people with chronic illness and disabilities are: (Select all that apply.)

a.

outpatient clinics.

b.

long-term health care facilities.

c.

home care.

d.

rehabilitation agencies.

e.

hospice agencies.

ANS: A, B, C, D

Outpatient clinics, long-term care facilities, home care, and rehabilitation agencies are sources of rehabilitation for people with chronic illness or disability. Hospice agencies focus on care of the dying patient.

DIF: Cognitive Level: Knowledge REF: 179 OBJ: 1 (theory)

TOP: Locus of Treatment for Chronic Illness KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

21. The nurse reinforces that the multifocused goal of rehabilitation is to: (Select all that apply.)

a.

promote new coping skills.

b.

teach adaptive living skills.

c.

focus on self-care for increased independence.

d.

improve quality of life.

e.

restore former level of function.

ANS: A, B, C, D

Restoring former level of function is not a goal of rehabilitation because this may an impossible goal. New coping and adaptive skills, and self-care skills that improve the quality of life are all goals of rehabilitation.

DIF: Cognitive Level: Application REF: 187 OBJ: 7 (theory)

TOP: Goals of Rehabilitation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

22. The patient who has been in traction for bilateral femur fractures complains of constipation. To stimulate bowel action, the nurse will: (Select all that apply.)

a.

provide prune juice from the snack cart.

b.

increase fluid intake.

c.

arrange for high-fiber foods such as cauliflower and broccoli.

d.

give prescribed stool softeners.

e.

encourage milk products.

ANS: A, B, C, D

Milk products are constipating. Prune juice, extra fluid, high-fiber foods, and stool softeners will combat constipation.

DIF: Cognitive Level: Application REF: 180-181 OBJ: 2 (theory)

TOP: Preventing Problems of Immobility

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

23. The rehabilitation nurse outlines the impact of disability, which includes: (Select all that apply.)

a.

unchanged family roles.

b.

life patterns centered around treatment or rehabilitation.

c.

grief over what has been lost.

d.

spiritual distress.

e.

sense of powerlessness.

ANS: B, C, D, E

Family roles often change as a result of a disability. Life patterns will center around treatment and rehabilitation for at least the initial phase of incurring the disability, as well as grief, spiritual distress, and powerlessness.

DIF: Cognitive Level: Application REF: 177-178 OBJ: 4 (theory)

TOP: Impact of Disability KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

24. Long-term health care facilities are the center of treatment for people who are: (Select all that apply.)

a.

recovering after the most acute phase of their illness is over.

b.

receiving rehabilitation after a joint replacement.

c.

too weak from primary illness to care for themselves presently.

d.

in need of a permanent home because of effects of a chronic condition.

e.

under treatment for substance abuse.

ANS: A, B, C, D

Long-term health care facilities do not offer active treatment to substance abusers. Recovery from an acute illness, joint replacement rehabilitation, weakness from illness, and a permanent home for a chronic illness are common reasons individuals seek care from long-term care facilities.

DIF: Cognitive Level: Application REF: 179 | 183 OBJ: 4 (theory)

TOP: Purpose of Long-Term Health Care Facilities KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

25. The LPN/LVN in a long-term health care facility may perform in the roles of: (Select all that apply.)

a.

charge nurse.

b.

designer of nursing care plans.

c.

administrator of medications.

d.

administrator of wound care.

e.

assignment delegator.

ANS: A, C, D, E

The LPN/LVN does not design the nursing care plan but may contribute to the care plan. This is the responsibility of the RN. The LPN/LVN may act in the role of charge nurse while under the supervision of an RN. Administration of medications and wound care and delegation of care are commonly the LPN/LVNs responsibility.

DIF: Cognitive Level: Comprehension REF: 189 OBJ: 5 (theory)

TOP: LPN/LVN Role in Long-Term Health Care Facility KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

26. When delegating care to a nursing assistant, the LPN/LVN should: (Select all that apply.)

a.

give specific instruction as to what is to be done.

b.

instruct how the task is to be done.

c.

list information that needs to be reported.

d.

be aware that the nurse is responsible for outcome of delegated care.

e.

insist that the nursing assistant accept the responsibility.

ANS: A, B, C, D

In delegating to unlicensed assistive personnel, the LPN/LVN should first inquire if the nursing assistant is willing to take responsibility for the care assigned.

DIF: Cognitive Level: Comprehension REF: 183 | Assignment Considerations

OBJ: 5 (theory) TOP: Delegation KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

27. The LPN/LVN can apply a physical restraint to a resident in a long-term care facility when: (Select all that apply.)

a.

an order for the restraint is obtained within 12 hours of application.

b.

all other measures have been attempted and failed.

c.

documentation is made on all failed attempts.

d.

the family is unable to stay with the resident.

e.

the least restrictive device is chosen.

ANS: B, C, D, E

The order for the restraint must be obtained within 24 to 48 hours after application of the device. The LPN/LVN who applies a physical restraint must have satisfied all of the other options.

DIF: Cognitive Level: Application REF: 184-185 OBJ: 2 (clinical)

TOP: Use of Restraints KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

28. The student nurse is becoming familiar with Healthy People 2020 goals related to rehabilitation. The student nurse demonstrates an understanding of the goals when identifying which of the following as goals? (Select all that apply.)

a.

Increase the proportion of adults with disabilities who participate in social activities.

b.

Increase the proportion of adults with disabilities who report satisfaction with life.

c.

Increase the proportion of people with disabilities who report not having the assistive devices and technology needed.

d.

Reduce the proportion of adults with disabilities who report feelings such as sadness, unhappiness, or depression that prevent them from being active.

e.

Reduce the proportion of people with disabilities who report environmental barriers to participation in home, school, work, or community activities.

ANS: A, B, D, E

One of the goals of Healthy People 2020 is to reduce rather than increase the proportion of people with disabilities who report not having the assistive devices and technology needed. All other options are included as goals.

DIF: Cognitive Level: Comprehension REF: 187 OBJ: 7 (theory)

TOP: Healthy People 2020 Goals KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

29. The rehabilitation nurse makes the point that a dysfunction of a specific body part is termed __________.

ANS:

impairment

An impairment is a dysfunction of an organ or body part.

DIF: Cognitive Level: Comprehension REF: 177 OBJ: 1 (theory)

TOP: Concepts of Rehabilitation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. The nurse working in a long-term care facility is aware that in order to comply with Medicare guidelines, documentation of assessment findings which measure physical, psychological, and psychosocial functioning are necessary using the _____________________.

ANS:

Minimum Data Set

minimum data set

MDS

The Minimum Data Set (MDS) is a primary screening and assessment tool that is standard for all Medicare and Medicaid residents in a long-term care facility.

DIF: Cognitive Level: Application REF: 187 OBJ: 5 (theory)

TOP: Documentation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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