med surg extra credit

A postanesthesia care unit (PACU) nurse teaches the student nurse about important neurological assessments that should be done on a patient who receives general anesthesia. Which assessment by the student nurse may be ineffective in determining the patient's return to consciousness after general anesthesia? 1 Sense of touch 2 Recognition of pain 3 Restlessness and delirium 4 Ability to reason and control behavior

1 Postoperative neurological assessments are completed for patients to determine their return of consciousness and the return of motor and sensory functioning postanesthesia. The sense of touch is a return of motor and sensory functioning in a patient postanesthesia but is not related to level of consciousness. Recognition of pain, restless and delirium, and ability to reason and control behavior are the return of consciousness assessments post-surgery.

In conducting a postoperative assessment of a patient, what is important for the nurse to examine first? 1 Breathing pattern 2 Level of consciousness 3 Oxygen saturation 4 Surgical site

1 Respiratory assessment is the most important. Assessing oxygen saturation, the surgical site, and the level of consciousness are important, but not the priority

The nurse is caring for a patient who underwent abdominal surgery. How does the nurse assist the patient with early recovery? 1 Assist the patient to turn every 2 hours and take deep breaths. 2 Allow the patient to get out of bed only on the third day after surgery. 3 Provide pain medication 30 minutes after a walk. 4 Ask the patient to avoid coughing to prevent harm to incisions.

1 The nurse can assist the patient to turn from one side to the other every 2 hours if the patient is unable to get out of bed. The patient should also be encouraged to take deep breaths to facilitate lung expansion. The patient is generally asked to get out of bed the day or the first day after surgery to help remove secretions. The patient is given pain medication 30 minutes before, not after, a walk. The nurse should teach the patient to splint the incision when coughing to prevent harm to incisions.

Which statement made by the student nurse indicates the need for further teaching about immediate postoperative care? 1 "I should auscultate the lung sounds every 8 hours." 2 "I should maintain the oxygen saturation at 95%." 3 "I should assess the ability of the patient to raise the head." 4 "I should report when the respiratory rate is 10 breaths per minute."

1 The nurse must assess the lung function every 4 hours during first 24 hours and then every 8 hours postoperatively to prevent respiratory complications. The nurse should ensure that an oxygen saturation of 95% is maintained to prevent respiratory distress and hypoxemia. Assessing the ability of the patient to raise his or her head assesses muscle strength. The nurse should report and call the rapid response team if the patient's breathing rate falls to 10 breaths per minute.

The nurse is assessing the abdominal incision of a patient on the fifth day after surgery. Which observation does the nurse report to the surgeon? 1 Serum-like or yellow drainage 2 Slight swelling under the sutures 3 Crusting on the incision line 4 Pink coloration on the incision

1 The presence of serum-like or yellow drainage on the fifth day after surgery should be reported to the surgeon because it indicates the possibility of dehiscence. Slight swelling under the sutures, crusting on the incision line, and pink coloration on the incision are all normal findings and not a cause for concern.

Which nonpharmacological interventions may help reduce pain and promote comfort in a patient being treated with analgesics who asks the nurse about alternative therapies for pain management? Select all that apply. 1 "Elevate and cushion the painful areas." 2 "Massage the calves to promote relaxation." 3 "Apply some ice to reduce and prevent swelling." 4 "Stimulate the area that is contralateral to the painful area." 5 "Refrain from splinting the wound when you are first able to get out of bed."

1, 3, 4 Alternative therapies include nonpharmacological comfort measures that may lower the amount of drugs needed to control pain. Elevating and cushioning painful areas prevents pressure or tension on those areas. Application of ice helps in reducing swelling and pain through reactive vasodilation mechanisms. Contralateral stimulation of the painful area is an alternative therapy to alleviate the pain. The calves should not be massaged because this can increase the risk of loosening a clot and causing a life-threatening pulmonary embolus. Splinting stabilizes and protects an injured body part

What would the nurse expect to find in a patient when the endotracheal tube (ET) has moved into the right bronchus? 1 Oxygen saturation of 95% 2 Decreased left-sided lung sounds 3 Respiratory rate of 8 breaths per minute 4 Wheezing and crackles during inspiratio

2 A patient with an endotracheal tube that has slipped into the right bronchus would present with absent or decreased breath sounds in the left side and only the right chest wall rises and falls with breathing. An oxygen saturation of 95% is a normal finding. A respiratory rate of 10 breaths per minute may indicate anesthetic or opioid analgesic-induced respiratory depression. Mucosal obstruction may lead to wheezing or crackles during inspiration.

What condition is indicated by the presence of a pulse deficit when assessing the vital signs of a postoperative patient? 1 Dyspnea 2 Dysrhythmia 3 Hypothermia 4 Deep vein thrombosis

2 A pulse deficit is a difference between the apical and peripheral pulses. While assessing the vital signs of a patient who is not being monitored continuously, the rate, rhythm, and quality of the apical pulse is compared with the rate, rhythm, and quality of a peripheral pulse. A pulse deficit can indicate a dysrhythmia. The presence of a pulse deficit is not due to dyspnea, or shortness of breath. Hypothermia is not indicated by the difference in the pulse. Deep vein thrombosis is assessed by peripheral vascular assessment before anesthesia.

A patient with heat stroke is admitted to the emergency department with a body temperature of 106° F. While using the rapid cooling method to reduce the body temperature in the patient, the nurse notices that the patient is shivering. What action should the nurse take? 1 Insert a urinary catheter 2 Provide a parenteral benzodiazepine 3 Provide high concentrated oxygen therapy 4 Provide 0.9% saline solution intravenously

2 A rapid cooling method is used to reduce the body temperature in the patient with heat stroke. If the patient begins shivering while using the cooling method, parenteral benzodiazepine is given because shivering may cause seizures, which will further elevate the temperature. The nurse inserts a urinary catheter to monitor temperature changes. The nurse provides high-concentration oxygen therapy to prevent ischemia in the patient. The nurse provides intravenous 0.9% saline solutions to prevent electrolyte imbalances.

What is the priority for the nurse in caring for a patient with sickle cell anemia who is in crisis? 1 Improving nutrition 2 Restoring tissue perfusion 3 Correcting decreased cardiac output 4 Restoring normal hemoglobin and hematocrit

2 Patients with sickle cell anemia who have decreased oxygen conditions develop crisis, causing reduction in oxygen supply and furthering development of sickled cells and organ damage. The nurse must encourage oral fluids and administer parenteral fluids to restore tissue perfusion. During a sickle cell crisis, restoring tissue perfusion is most important. Usually sickled cells go back to normal shape when the precipitating condition is removed, and the blood oxygen level is normalized, which allows tissue perfusion to resume. Improving nutrition, correcting decreased cardiac output, and restoring normal hemoglobin and hematocrit are not priorities during a sickle cell crisis.

The nurse is caring for a patient post-surgery who is experiencing postoperative nausea and vomiting (PONV). How does the nurse ease this distress? 1 Ask the patient to try not to get out of bed. 2 Assist the patient to a side-lying position. 3 Place the patient in supine position. 4 Ask the patient to use the call bell as needed

2 The nurse can assist the patient to a side-lying position before raising the head to ease the distress caused by nausea. The nurse should encourage the patient to get out of bed to promote faster healing. The patient with nausea should be placed in a side-lying position rather than a supine position to prevent choking on vomitus. The patient should be encouraged to use the call bell for assistance, but this does not directly ease the patient's nausea

In the postanesthesia care unit (PACU), the nurse is caring for a postsurgical patient. Which type of assessment is most important for the patient who was given general anesthesia? 1 Skin 2 Respiratory 3 Kidney or urinary 4 Wound

2 The respiratory assessment is the most important assessment for the patient who was given general anesthesia, moderate sedation, or has received sedative or opioid drugs. Skin assessment, kidney or urinary assessment, and wound assessment can be done after the patient's respiratory assessment has been performed and is all clear.

The nurse assesses a patient's wound 24 hours postoperatively. Which finding causes the nurse the greatest concern? 1 Crusting along the incision line Correct2 Redness and swelling around the incision 3 Sanguineous drainage at the suture site 4 Serosanguineous drainage on the dressing

2 Redness and swelling around the incision indicate an infection. Crusting along the incision line, sanguineous drainage, and serosanguineous drainage are normal

What are the respiratory complications associated with surgery? Select all that apply. 1 Asthma 2 Atelectasis 3 Pneumonia 4 Laryngeal edema 5 Chronic obstructive pulmonary disorder (COPD)

2, 3, 4 Respiratory complications occur mainly due to general anesthesia. Atelectasis is defined as the collapse or closure of the lung, resulting in reduced or absent gas exchange. Pneumonia is an inflammatory condition of the lungs affecting primarily the alveoli. Laryngeal edema is a part of acute inflammation of the laryngeal mucosa due to the inhalation of irritant materials. Asthma and chronic obstructive pulmonary disease (COPD) are not complications related to surgery or anesthesia.

A surgeon has ordered a nasogastric (NG) tube for a postoperative patient who experienced a wound evisceration. What could be the reasons for this? Select all that apply. 1 Prevent GI irritation 2 Relieve internal pressure 3 Decompress the stomach 4 Reduce the chances of infection 5 Remove the stomach contents

2, 3, 5 The surgeon may prescribe an NG tube to decompress the stomach and relieve internal pressure, or to remove the stomach's contents if the patient has been eating and general anesthesia is needed to close the eviscerated wound. An NG tube would not prevent GI irritation, nor would it reduce the chances of infection.

Which vital sign is most important for the nurse to monitor in a patient receiving general anesthesia in the postanesthesia care unit? 1 Pulse 2 Blood pressure 3 Respiratory rate 4 Body temperature

3 A patient receiving general anesthesia must be regularly monitored for respiratory rate because the medication may lead to respiratory depression. Pulse, blood pressure, and body temperature are evaluated and recorded in the patient's medical record but are not the most important vital sign to monitor.

What assessment should the nurse include of the patient's surgical incision site when he or she is transferred from the postanesthesia care unit (PACU) to the medical-surgical care unit? 1 Is the neck in proper alignment? 2 Does the patient respond to verbal stimuli? 3 How much drainage is present in the drainage container? 4 What type of solution is being infused and with what additives?

3 The nurse completes the initial assessment of the patient who arrives at the medical surgical unit upon transfer from the PACU. The nurse should assess the surgical incision site as well as the quantity of drainage present in the drainage container that is placed near the incision site. Checking the neck alignment helps to assess the airway. If the patient is responding to verbal stimuli, it indicates the mental status of the patient. The type of solution being infused and its additives refers to intravenous fluid assessment.

The home nurse is caring for an older patient with mild hypothermia at home. What first aid care does the nurse provide to the patient? 1 Provide a warm cup of coffee. 2 Administer warm intravenous (IV) fluids. 3 Provide warm high-carbohydrate liquids. 4 Monitor skin every hour when using a heating blanket

3 The nurse should provide the patient with warm high-carbohydrate liquids to provide rewarming. Warm coffee is not recommended as caffeine is a diuretic and can worsen dehydration and hypothermia. When using a heating blanket, the nurse should monitor the patient's skin every 15 to 30 minutes to reduce the risk for burn injury. Warm IV fluids are administered in the hospital for patients with moderate to severe hypothermia

The nurse is caring for a patient brought to the inpatient unit from the postanesthesia care unit (PACU). Which action does the nurse take with the postanesthesia patient? 1 Assess vital signs every 30 minutes. 2 Assess lungs every 6 hours. 3 Report 25% variation in blood pressure. 4 Examine the foot and leg every hour.

3 The nurse should report to the surgeon or anesthesia provider a 25% variation in blood pressure from the values obtained before surgery. Vital signs are assessed every 15 minutes until the patient's condition is stable. The patient's lungs should be assessed every 4 hours during the first 24 hours post-surgery. The nurse assesses the patient's foot and leg once during a nursing shift, once daily, or once per visit, depending on the patient's risk for complications.

Which patient requires immediate attention in the postanesthesia care unit? 1 A patient with a bleeding time of 5 minutes 2 A patient with a body temperature of 98.6° F 3 A patient with urine output of 400 mL per day 4 A patient with blood pressure of 110/80 mm Hg

3 The patient with inadequate urine output of 400 mL per day (normal range: 800-2000 mL per day) must be kept on continuous assessment to reduce complications. The patients with normal bleeding time (3 to 10 minutes), normal body temperature of 98.6° F, and stable blood pressure of 110/80 mm Hg may be discharged upon the primary health care provider's advice.

What is taking place in the body when hyperventilation occurs? 1 The brain is responding to a rise in lactate. 2 The respiratory system is responding to an increased pH. 3 The central nervous system is responding to a rise in carbon dioxide. 4 The brain and lungs are responding to an increased level of bicarbonate

3 When the amount of carbon dioxide in the brain, blood, and tissues rise, the central nervous system responds by increasing the rate and depth of breathing (hyperventilation). Hyperventilation is not a response to lactate rising in the body. It is most related to a decreased (not increased) pH and a decreased (not increased) level of bicarbonate.

Which assessment finding in a postoperative patient after general anesthesia requires immediate intervention? 1 Heart rate of 58 2 Pale, cool extremities Correct3 Respiratory rate of 6 4 suppressed gag reflex

3 The most important postoperative assessment is respiratory assessment, and a rate of 6 is too low. A heart rate of 58, pale and cool extremities, and a suppressed gag reflex are all normal postoperative findings.

Which intervention would be contraindicated in a postoperative patient reporting severe pain who has an eviscerated wound? 1 Notify the surgeon 2 Apply a sterile, nonadherent dressing 3 Obtain and record the patient's vital signs 4 Attempt to re-insert the protruding organ

4 An evisceration is a wound opening with protrusion of internal organs. It is a surgical emergency. The nurse should not attempt to reinsert the protruding organ. The nurse should notify the surgeon immediately after assessing the wound and determining the evisceration. The nurse should cover the wound by applying a sterile, nonadherent dressing which is premoistened with warmed sterile normal saline. While covering the wound, the nurse must note the patient's response and assess for manifestations of shock. The vital signs of the patient are to be assessed and documented.

Which parameter should the nurse monitor after a recovery unit patient has received general anesthesia? 1 Color of wound drainage 2 Texture and turgor of the skin 3 Redness and warmth in feet and legs 4 Snores and high-pitched crowing sounds

4 General anesthetics may cause respiratory depression, where the respiratory rate may slow to less than 10 breaths per minute. The patient may snore and may have high-pitched crowing sounds due to tracheal or laryngeal spasms and edema, mucus in the airway, and tongue relaxation. The color of the wound drainage is not altered by the use of general anesthesia. Skin texture and turgor are assessed in the patient in a medical surgical unit to assess the level of drainage. Redness and warmth of the legs and feet are assessed in the patient with deep vein thrombosis.

Which condition may arise due to nasogastric tube drainage? 1 Pneumonia 2 Constipation 3 Urinary retention 4 Metabolic alkalosis

4 Nasogastric tube drainage and vomitus lead to the elimination of hydrochloric acid, resulting in metabolic alkalosis. Pneumonia may result from nosocomial infection in the patient during the postoperative period. Constipation may result after surgery due to anesthesia, analgesics, decreased activity, and decreased oral intake. Urinary retention occurs after surgery, so the patient must be kept on catheterization to empty the bladder.

The nurse attends a patient who calls for assistance using the call bell. The nurse observes that the patient's abdominal incision is eviscerating after the patient coughed. What action does the nurse take first? 1 Call for help and ask to notify the surgeon immediately. 2 Place the patient in supine position with hips and knees bent. 3 Try to reinsert the protruding viscera. 4 Cover the wound with nonadherent premoistened sterile dressing

4 The nurse should cover the wound with nonadherent premoistened sterile dressings immediately. Then the nurse can call for help and instruct the person who responds to notify the surgeon. The patient should be placed in the supine position with hips and knees bent to reduce pressure on the wound. The nurse must not try to replace protruding internal organs using sterile gloves.

Which statements best describe the role of a nurse in the rehabilitation team? Select all that apply. Correct1 Provides and coordinates holistic patient care in a variety of health care settings 2 Assists the patients with job placement and training and teaches work-related skills 3 Counsels patients and families on psychological problems and strategies to cope with disability Correct4 Collaborates with the rehabilitation team to establish expected patient outcomes and develop a care plan Correct5 Communicates effectively with all members of the rehabilitation team, including the patient and patient's family

A nurse in the rehabilitation team provides and coordinates holistic patient care in a variety of health care settings, including the home. The nurse also collaborates with the rehabilitation team to establish expected patient outcomes to develop a plan of care. He or she communicates effectively with all members of the rehabilitation team, including the patient and patient's family. Vocational counseling assists patients with job placement, training, or further education and also teaches work-related skills. The clinical psychologist counsels patients and families with psychological problems and helps them develop strategies to cope with disability.

What do we call a physician who specializes in rehabilitative medicine? Correct1 Physiatrist 2 Pharmacist 3 Physiotherapist 4 Activity therapist

A physician who specializes in rehabilitative medicine is called a physiatrist. A person who collaborates with the other members of the health care team to ensure that the patient receives the most appropriate drug therapy to meet the patient's needs is called as a pharmacist. A person who intervenes to help the patient achieve self-management by focusing on gross mobility skills is called a physiotherapist. A person who works to help patients continue or to develop hobbies or interests is called an activity therapist.

Which team's focus is to restore and maintain the patient's function to the greatest extent possible? 1 Doctors team 2 Psychiatric team 3 Psychoanalysis team Correct4 Rehabilitation team

A rehabilitation works best when the patient, family, and rehabilitation staff work together as a team. The focus of the rehabilitation team is to restore and maintain the patient's function to the greatest extent possible. Doctors apply the principles and procedures of medicine to prevent, diagnose, and treat patients with illness, disease, and injury and to maintain physical and mental health. Mental health disorders are treated by the psychiatric team and psychoanalysis team.

What is one way in which the baby boomer generation's health affected the United States? 1 Reduction in the need for rehabilitation. Correct2 Marked negative impact on the country's economy. 3 Decrease in chronic and disabling conditions in the United States. 4 Less demand for health care services amongst them because they are a healthier group

As baby boomers continue to age, their health will continue to have a marked negative impact on the economy of the country with rising economic and social costs of diseases. The rate of chronic and disabling conditions is expected to increase, not decrease, as more baby boomers approach late adulthood. There will be a rise, not decrease, in the demand for rehabilitation with more chronic and disabling health conditions. There is more, not less, demand for health care amongst them.

Which nursing activity can the nurse delegate to a home health aide? 1 Changing the dressing for a patient with a low absolute neutrophil count. Correct2 Assisting with bathing for a patient with chronic rejection of a liver transplant. 3 Teaching a patient with bacterial pneumonia how to take the prescribed antibiotic. 4 Assessing incisional tenderness for a patient who had a recent kidney transplant.

Assisting with bathing for a patient with chronic rejection of a liver transplant can be delegated to the home health aide. Changing the dressing for a patient with a low absolute neutrophil count requires a licensed RN and should not be delegated because of the high risk for infection. Teaching about medications and assessments are within the scope of practice of the RN.

An RN and an LPN/LVN are working together in caring for a patient who needs all of these interventions after orthopedic surgery. Which actions would be best for the RN to accomplish? 1 Reinforce the need to cough and deep-breathe every 2-4 hours. Correct2 Develop the discharge teaching plan in conjunction with the patient. 3 Administer narcotic pain medications before assisting the patient with ambulation. 4 Listen for bowel sounds and monitor the abdomen for distention and pain.

Education and preparation for discharge are within the scope of practice of the RN. Reinforcing the need to cough and deep-breathe and monitoring the patient are within the scope of the LPN/LVN nurse. LPN/LVNs can also administer pain medications.

Which facility allows patients to live independently along with other disabled adults? 1 Residents 2 Care clinics Correct3 Group homes 4 Ambulatory care clinic

Group homes are facilities in which patients live independently along with other disabled adults. Patients in nursing homes or skilled nursing units in hospitals are called residents. A care clinic is a health care facility that is primarily devoted to the care of outpatients. The ambulatory care clinic is synonymous with the care clinic.

Which is generally covered by Medicare for the homebound patient? 1 Genetic testing 2 Care for moderate hypoxia 3 Long-term nursing home care Correct4 Dressing changes at home

If a patient is homebound and requires skilled care such as dressing changes or physical therapy, Medicare will cover this. The cost of genetic tests, care for moderate hypoxia, and long-term nursing home care are not covered by Medicare.

Members of the clergy may be part of the rehabilitation team that helps restore and maintain the patient's function to the greatest extent possible. What role do they play? Correct1 They help in spiritual assessments and care of the patient. 2 They work to help patients continue or develop hobbies or interests. 3 They help patients identify support services and resources, including financial assistance. 4 They intervene to help the patient achieve self-management by focusing on gross mobility skills.

Members of the clergy work within the rehabilitation team as spiritual counselors, and help in spiritual assessments and care of the patient. Recreational or activity therapists work to help patients continue or develop hobbies or interests. Social workers help patients identify support services and resources, including financial assistance. Physical therapists or physiotherapists intervene to help the patient achieve self-management by focusing on gross mobility skills.

Who teaches the skills related to motor coordination and cognitive retraining? 1 Physical therapists 2 Registered dietitians Correct3 Occupational therapists 4 Speech-language pathologists

Occupational therapists work to develop the patient's fine motor skills used for activities of daily living self-management. Physical therapists intervene to help the patient achieve self-management by focusing on gross mobility skills. Registered dieticians ensure that patients meet their needs for nutrition. Speech-language pathologists evaluate and retrain patients with speech, language, or swallowing problems.

Who collaborates with the other members of the health care team to ensure that the rehabilitation patient receives the most appropriate drug therapy? Correct1 Pharmacists 2 Physical therapists 3 Nursing technicians 4 Cognitive therapists

Pharmacists collaborate with the other members of the health care team to ensure that the patient receives the most appropriate drug therapy to meet the patient's needs. Physical therapists intervene to help the patient achieve self-management by focusing on gross mobility skills. Nursing technicians or nursing assistants assist in the care of patients. Cognitive therapists work primarily with patients who have experienced head injuries resulting in cognitive impairment.

Who teaches the techniques for performing certain activities of daily living such as transferring, ambulating, toileting, and cognitive retraining? Correct1 Physical therapist 2 Cognitive therapist 3 Recreational therapist 4 Occupational therapist

Physical therapists teach techniques for performing certain activities of daily living such as transferring (moving into and out of bed), ambulating, and toileting, and can assist with cognitive retraining (often for patients with traumatic brain injury). Cognitive therapists work primarily with patients who have experienced head injuries resulting in cognitive impairments. Recreational therapists work to help patients continue or develop hobbies or interests. Occupational therapists work to develop the patient's fine motor skills used for activities of daily living self-management, such as those required for eating, hygiene, and dressing.

Which activities of daily living are taught by physical therapists? Select all that apply. 1 Eating 2 Cooking 3 Dressing 4 Shopping Correct5 Ambulating Correct6 Transferring

Physical therapists teach techniques for performing certain activities of daily living, such as ambulating, transferring (moving into and out of bed), and toileting. They can assist with cognitive retraining (often for patients with traumatic brain injury. Occupational therapists work to develop the patient's fine motor skills such as those required for eating, hygiene, and dressing. Occupational therapists also teach patients how to perform independent living skills such as cooking and shopping.

After gastric surgery, a patient arrives in the postanesthesia care unit (PACU). Which nursing action is most appropriate for the RN to delegate to an experienced nursing assistant? 1 Monitor respiratory rate and airway patency. 2 Irrigate the nasogastric tube with saline. Correct3 Position the patient on the left side. 4 Assess the patient's pain level.

Positioning the patient on the left side can be delegated to an unlicensed care provider. Airway patency requires the care of a nurse in case of emergency management requirements. Irrigating the nasogastric tube with saline is a nursing skill and care by a nurse would be required. Pain assessment is also within the scope of a nurse.

When caring for a patient with polycystic kidney disease, which goal is most important? 1 Performing genetic testing 2 Assessing for related causes 3 Consulting with the dialysis unit Correct4 Preventing progression of the disease

Preventing complications and progression of polycystic kidney disease is the goal. Genetic testing should be done, but this is not a priority. Assessment for related causes is an intervention, not a goal. Not all patients with polycystic kidney disease require dialysis.

What roles does the rehabilitation nurse have in the functioning of the rehabilitation team? Select all that apply. Correct1 Coordinates holistic care Correct2 Plans continuity of care for discharge 3 Develops the patient's fine motor skills Correct4 Coordinates rehabilitation team activities 5 Retrains patients with swallowing challenges

Providing holistic care and coordinating all activities of the rehabilitation team is a role for the rehabilitation nurse - perhaps the primary role. The rehabilitation team is diverse and multiskilled; getting the right skills and services to the patient is a primary role for the rehabilitation nurse. The rehabilitation nurse coordinates the care that the patient will continue to receive after discharge; this coordination actually begins as the patient is admitted to the rehabilitation unit. Fine motor skill development is the responsibility of specialized members of the rehabilitation team. The rehabilitation nurse may be the one who sees these needs and gets the physical therapist, the occupational therapist, and activity therapists involved. Working with patients who have swallowing difficulties is the responsibility of the speech therapist; this activity would not be a role for the rehabilitation nurse.

Which statements best describe the activities performed by the rehabilitation nurses in the rehabilitation milieu? Select all that apply. Correct1 Protecting patients from embarrassment 2 Helping the patient develop hobbies or interests Correct3 Encouraging patients and providing emotional support 4 Making the inpatient unit feel like a hospital environment Correct5 Allowing time for patients to practice self-management skills

Rehabilitation nurses coordinate the efforts of the health care team members and create a rehabilitation milieu, which includes protecting patients from embarrassment (bowel training), encouraging patients and providing emotional support, and allowing time for patients to practice self-management skills. Recreational or activity therapists work to help patients continue or develop hobbies or interests. The rehabilitation nurses make the patient unit a more homelike environment.

Which nursing intervention does the rehabilitation nurse delegate to a nursing assistant who is caring for a 70-year-old patient with right-sided weakness following a stroke? 1 Arrange for family members to participate in planning for discharge. 2 Determine whether the patient's passive range-of-motion (ROM) exercises should be increased. Correct3 Reinforce the patient's placing the right arm in the sleeve first when dressing. 4 Teach the patient to use an extended shoehorn when putting on shoes

Reinforcement of skills that have been taught by the occupational therapist or nurse is an action that should be done by all caregivers who are involved in the patient's care. Planning for discharge, assessing passive ROM exercises, and teaching the use of a shoehorn require broader education and scope of practice and should be done by a licensed staff member such as the RN.

Skilled rehabilitation and nursing services for older residents admitted to skilled nursing facilities (SNFs) are reimbursed through which part of Medicare? Correct1 Part A 2 Part B 3 Part C 4 Part D

Skilled rehabilitation and nursing services for older residents admitted to SNFs are reimbursed through Medicare Part A for the first 21 days after admission. After this, reimbursement is a combination of Medicare and other payer sources for a specified number of days. Of rehabilitation services, 80% are paid for by Medicare Part B for older adults for a specified period of time if they have this benefit. Medicare Part C is not involved. Medicare Part D pays for prescription drugs.

Which statements define the activities performed by social workers? Select all that apply. Correct1 Helps patients identify financial assistance 2 Refrains from providing emotional support 3 Helps patients develop hobbies or interests Correct4 Helps patients identify support services and resources Correct5 Coordinates discharges from the rehabilitation setting

Social workers help patients identify support services and resources, including financial assistance, and coordinate transfers to or from the rehabilitation setting. Recreational or activity therapists work to help patients continue or develop hobbies or interests. Social workers should provide emotional support to the patients in the rehabilitation setting

What are the essential genetic competencies for medical-surgical nursing practice identified by the American Association of Colleges of Nursing? Select all that apply. Correct1 Be aware of individual variation in responses to drug therapy due to genes. Correct2 Consider genetic transmission patterns when performing a detailed patient assessment. Correct3 Identify patients or families that are at high risk of a genetic disorder. 4 Construct a pedigree of at least two generations, using standard symbols. 5 Discuss any issues related to genetic testing with the patient and family.

The American Association of Colleges of Nursing has identified several genetic competencies essential for medical-surgical nurses. Nurses should be aware of individual variations in response to drugs based on genetic variations (e.g., the proper use of warfarin in patients who have gene mutations in CYP2CP genes). While performing a detailed assessment and obtaining the family history of a patient, the nurse considers any genetic patterns of disease in the family, which helps identify patients who are at increased risk of potential disease development. The nurse should use standard symbols and construct a pedigree of at least three generations. Confidentiality is crucial during genetic testing; the nurse must not discuss anything with the patient's family unless the patient requests it.

Under which health policy directive is a patient with severe hearing loss entitled to a sign language interpreter in the workplace? 1 Affordable Care Act Correct2 Americans with Disabilities Act 3 Patient Self-Determination Act (PSDA) 4 Needlestick Safety and Prevention Act

The Americans with Disabilities Act states that workers have the right to ask for special adaptations based on their disabilities; for instance, an employee with severe hearing loss may be entitled to a sign language interpreter in the workplace. The Affordable Care Act deals with health insurance reforms. The PSDA gives people the right to determine the medical care they want provided if they became incapacitated. The Needlestick Safety and Prevention Act requires the use of devices engineered with safety mechanisms and mandates that the staff who perform these tasks be directly involved in selecting such products.

The circulatory nurse and anesthesia provider accompany a patient to the postanesthesia care unit (PACU). How does the health care professional ensure an effective communication during "hand-off"? Select all that apply. 1 Receiving nurse documents the hand-off information Correct2 PACU nurse restates the report to the reporting professional 3 Circulating nurse stays in the PACU unit until the patient recovers Correct4 Hand-off is a two-way verbal communication Correct5 Reporting professional responds to all questions by the receiving professiona

The PACU nurse restates the hand-off report to the reporting professional to ensure understanding of the report. The hand-off is a two-way verbal communication which becomes effective only if both professionals communicate clearly. The language used by the person giving the report is clear and cannot be interpreted in more than one way. The reporting professional responds to all questions asked by the PACU nurse and clarifies all doubt. The receiving nurse does not document the hand-off information; the hand-off is verbal. The circulating nurse leaves the patient in the care of the PACU nurse until the patient recovers.

The anesthesia provider delivers a clear understanding of a patient's status to the postanesthesia care unit (PACU) nurse. What information does the anesthesia provider include in the postoperative hand-off report? Select all that apply. Correct1 Type and degree of surgical procedure Correct2 Type of anesthesia administered Correct3 Primary language of the patient 4 Presence of signed informed consent form 5 Availability of autologous blood

The anesthesia provider reports the type and degree of surgical procedure conducted for the patient. The reporting professional also provides information about the type of anesthesia administered and the duration for which it was administered. The PACU nurse is informed about the primary language of the patient for effective communication when the patient recovers from surgery. The reporting nurse need not discuss the signed informed consent form which is a preoperative procedure. The reporting nurse reports about estimated blood loss, not availability of autologous blood.

Which staff member does the manager of an inpatient rehabilitation unit assign as the case manager for a stroke patient with physical and speech deficits? 1 Physical therapist Correct2 Rehabilitation nurse 3 Recreational therapist 4 Speech-language pathologist

The rehabilitation nurse coordinates the efforts of the team members and may be designated as the patient's case manager. The physical therapist, the recreational therapist, and the speech-language pathologist will assist with specific aspects of the patient's care, but are not responsible for coordination of care.