Functional Ability Comprehension Check

Which rehabilitation team member would help the patient re-learn to use eating utensils? 1. Physiatrist 2. activity therapist 3. physical therapist 4. occupational therapist

4

The nurse assesses a home that has been set up for an 85-year-old patient with dementia and history of falls. After surveying the rooms, the nurse makes which recommendation? 1. Removing the scatterrugs that are reminiscent of the patients travels 2. Adding a side rail to the patient's bed 3. Replacing the raised toilet seat with a standard seat 4. Applying a lock to the bathroom door to allow for patient privacy

1

Which member of the health care team would the nurse consult when caring for a patient who has difficulty chewing or swallowing? 1. dietician 2. psychiatrist 3. geriatrician 4. anesthesiologist

1

Which symptom of anemia occurs most commonly? 1. Fatigue 2. headache 3. palpitations 4. sore tongue

1

Which potential alteration to the medication regimen would the nurse anticipate when a patient with Parkinson's disease states that the previously controlled symptoms return well before the time scheduled for the next dose of carbidopa/levodopa? Select all that apply 1. A medication holiday 2. Change in the selected medications 3. Reduction in medication dosage 4. Addition of a second medication 5. Change in those frequency 6. Change in the route of administration

1, 2, 3, 5 The healthcare provider will likely consider a reduction in dosage, a change of medication, change of those frequency, or medication holiday. Until trying the other options, there is not an indication for a second medication at this time. A change in the administration route will not affect the present outcomes. Page 857

Which physical aging change may affect the nutritional status in older patients? SATA 1-tooth loss 2-ill-fitting dentures 3-inc metabolism 4-diminished sense of taste 5-diminished sense of smell

1, 2, 4, 5

The nurse is assessing a patient with RA who presents for an examination. Which finding would lead the nurse to believe the disease has become systemic? Select all that apply 1. Dry mouth and eyes 2. Temperature of 99.9°F or 37.7°C 3. 10 pound weight loss 4. Serum creatinine 2.6 5. Numbness and tingling in feet

1-5 Signs of stomach are a disease include Sjogren syndrome, which would manifest as oral and ocular dryness. Other signs of systemic disease include a low-grade fever, as evidenced by the patient's temperature of 99.9°F or 37.7°C, and weight loss. The serum creatinine level of 2.6 indicates renal impairment, which is a sign of systemic disease. The patient with systemic RA would also report numbness and tingling in the feet because of peripheral neuropathy Page 1017 and 1018

The nurse is reviewing the health record of a patient with a 20 year history of RA. Based on the information in the record, which perimeter with the nurse plan to assess? Select all that apply history and physical: 52-year-old woman, rheumatoid arthritis, sjogren syndrome, positive boutonniere deformities hands Laboratory data: White blood cell count 6.2, red blood cell count 4.2, hemoglobin 13.4, hematocrit 40%, platelets 275,000, rheumatoid factor 1:120, anticyclic citrullinated peptide antibodies present, anti-nuclear antibody 1:65, erythrocyte sedimentation rate 69 1. Mobility 2. Pain level 3. Eye dryness 4. Mental health 5. Self care ability

1-5 The patient has rheumatoid arthritis, which can be painful to the point of affecting mobility. Therefore the nurse should assess the patient's mobility and pain level. The patient also has Sjogren syndrome, which can cause ocular, oral, and vaginal dryness. Therefore the nurse should assess for Idrus. The nurse should also assess the patient's mental health to determine if the patient is experiencing frustration or depression from health limitations. Because of the Boutonniere deformities of the hands, the nurse should assess the patient's ability to meet self-care needs.

Which finding would the nurse expect during the assessment of a patient with new onset rheumatoid arthritis? Select all that apply 1. Fatigue 2. anemia 3. weight gain 4. hypothermia 5. ulnar deviation

1. Early manifestations of RA are fatigue, anorexia, and a low-grade fever. Later symptoms include anemia and weight loss. The patient would present with a low-grade fever, not hypothermia. All our deviation is a sign of advanced disease. Page 1017 through 1018

Which type of assessment is used to measure a patient's ability to perform activities? 1. Physical assessment 2. Functional assessment 3. Vocational assessment 4. Psychosocial assessment

2

Which statement by the patient slowly diagnosed with multiple sclerosis indicates a correct understanding of the pathophysiology of the disease? 1. I can expect to die at an early age 2. Parts of my nervous system have plaques 3. I will have gradual deterioration with no healthy times 4. This was caused by getting too many x-rays as a child

2 MS is characterized by an inflammatory response that results in diffuse random or patchy areas of plaque in the white matter of the central nervous system. The patient with MS has no decrease in life expectancy. Frequent times of remission are common in patients with MS. There is no known cause for MS. Page 872

The plan of care for a patient taking methotrexate for RA includes the goal of decreased pain and inflammation. Which Cue would lead the nurse to conclude the goal has been met? 1. Decrease frequency of headaches 2. 1 mile walk taken every morning 3. Folic acid levels within normal range 4. White blood cell count 4.8 cells/MM^3

2 Methotrexate is an immuno suppressant medication that is used to decrease inflammation and therefore decrease pain in patients with RA. When the patient reports inability to walk 1 mile per day, this indicates increased activity because of decrease inflammation. Headaches a side effect of the medication; a decrease in their frequency is a sign that the patient can tolerate the medication. The patient should take daily folic acid supplementation with this medication, but normal blood levels do not reflect decrease inflammation and pain. The white blood cell count is normal, which indicates the patient is not experiencing neutropenia from the medication. Page 1021

Which intervention with the nurse implement to protect a patient with Parkinson disease from injury? 1. Decrease the patients level of activity 2. Monitor the patient sleep patterns 3. Encourage the patient to watch the feet when walking 4. Suggest the patient obtain assistance in performing ADLs

2 Patients with PD 10 not to sleep well at night because of the medication therapy and the disease itself. Some patients nap for short periods during the day and may not be aware they have done so. This sleep miss perception could put the patient at risk for injury. Active and passive range of motion exercises, muscle twitching, and activity are important to keep the patient with PD mobile and flexible. The patient with PD should avoid watching his or her feet when walking to prevent falls and should be encouraged to participate as much as and and management, including ADLs. Occupational and physical therapist can provide training and ADLs and PRN use of adaptive devices to facilitate independence. Page 856

Which patient skill with the nurse assess as instrumental ADLs? Select all that apply 1. Bathing 2. cooking 3. shopping 4. ambulating 5. housekeeping

2, 3, 5

Which goal would the nurse set for the care of a patient with multiple sclerosis? Select all that apply 1. Cure the disease 2. improve function 3. manage symptoms 4. prevent exacerbations 5. stop the effects on the immune system

2,3,4 The goal of managing multiple sclerosis is to improve function, manage symptoms, and prevent exacerbations. There is no cure for the disease, and it is not possible to stop the effects on the immune system, only to manage them. Page 875 through 876

The nurse teaches a patient who is newly diagnosed with MS about the disease. Which characteristic of MS with the nurse explained to the patient? Select all that apply 1. Drooping eyelids 2. Problems chewing 3. Exacerbation and remissions 4. Demineralization of the neurons 5. Breakdown of communication between nerves and muscles 6. Chronic degenerative disease of the central nervous system

2,3,4,6 MS may cause problems chewing. It is characterized by exacerbation and remissions and demineralization of the neurons. MS is a degenerative disease of the central nervous system. Dripping eyelids and the breakdown in communication between nerves and muscles are characteristic of myasthenia gravis, not MS Page 872-874

Which type of drug with the nurse expect to administer as part of the treatment plan for a patient with relapsing multiple sclerosis? 1. Antispasmodic 2. Immunomodulator 3. Calcium channel blocker 4. Penicillin based antibiotic

2. Immunomodulators Such as interferon beta, synthetic proteins like Gladimir acetate, and monoclonal antibodies such as natalizumab are among the current drug therapies recommended for early and continuous treatment of relapsing types of MS. Penicillin base antibiotics are used in the treatment of bacterial infections. Calcium channel blockers are commonly used in patients with hypertension and other cardiovascular issues. Anti-spasmodic's are used to suppress muscle spasms.

How does the nurse respond when an older adult expresses an increased fear of falling while performing ADLs? 1. Sit while you complete tasks like folding laundry 2. Consider routine swimming to build muscle 3. Try walking 30 minutes per day 3 to 5 times a week 4. Always look up while walking to see where you were going

3

Which nursing intervention is the most important for the older patient who reports decreased range of motion in the upper extremities? 1. Teaching and encouraging proper body mechanics 2. Providing moist heat such as warm showers and compresses 3. Assessing the patient's ability to perform ADLs 4. Prescribing a high dose NSAID

3

Which nursing intervention promotes independence for a patient with right sided hemiplegia who has been transferred to a rehapilitation unit? 1. Arranging to send the patient to a long-term care facility 2. Telling the patient to do the best that here she can 3. Instructing the patient step-by-step on how to put on a rope 4. Assisting the patient with all ADLs

3

Which question will the nurse ask to assess an older patients endurance in performing ADLs? 1. Can you prepare your own meals? 2. Has your weight changed by 5 pounds or more this year? 3. How is your energy level compared with last year? 4. What medication do you take daily, weekly, and monthly?

3

When preparing to discharge a patient with RA from home health services, which cue would lead the nurse to conclude the goal of promoting independence has been met? 1. Reports average pain level of 1 to 2 on a 10 point scale 2. Plans rest periods between activities 3. Uses adaptive equipment for self-care 4. Takes biological response modifiers as prescribed

3 The nurse should determine the patient is independent when using adaptive equipment for performing self-care tasks. Reporting a pain level of 1 to 2 on a 10 point scale indicates pain is fairly well-controlled. Planning rest periods between activities reflects balancing activities with rest. Taking biological response modifiers as prescribed indicates truck compliance. Page 1023

Which intervention would the rehabilitation nurse delegate to a nursing assistant who is caring for a 70-year-old patient with right sided hemiparesis after a stroke? 1. Arrange for family members to participate in planning for discharge. 2. Determine the frequency of the patient's passive range of motion exercises. 3. Reinforce the patient placing the weaker arm in the sleeve first when dressing. 4. Teach the patient to use an extended shoehorn when putting on shoes.

3.

Which nursing intervention takes priority in a patient with dysphasia? 1. Monitor intake and output hourly 2. Keep an emergency tracheostomy kit at the bedside 3. Maintain the head of the bed elevated 4. Keep the patient on strict NPO status until the ability to swallow is verified

4

Which older patient is at the highest risk for falling? 1. One who shows signs of confusion 2. one who practices yoga and has major visual impairment 3. one who has become considerably weaker after a long illness 4. One who has fallen twice in the past two months but is otherwise healthy

4

Which instruction would the nurse provide a patient spouse or caregiver when providing discharge instructions for home care of the patient with Parkinson disease? 1. Speak loudly to the patient for better understanding 2. Begin completing ADLs for the patient 3. Provide high calorie, high carbohydrate foods to maintain the patients weight. 4. Administer medications promptly on schedule to maintain therapeutic drug levels.

4 Administering medications promptly on schedule is a correct statement. The spot should encourage the patient to do as much as possible independently. Slow speech rather than loud speech and small, frequent meals are more effective for the patient with Parkinson's disease. Page 856

A patient with a new diagnosis of RA asks the nurse what causes the disease. Which information with the nurse provide? 1. Overuse of the joints damages the joint cartilage 2. Long-term cortico steroid use can damage bones 3. Excess body weight increases where in tear of joints 4. The bodies immune system destroys the joint cartilage

4 Our a occurs because the bodies immune system is attacking the joints, causing damage to the joints and bones. Joint overuse, long-term corticosteroid use, and increase body weight or risk factors for osteoarthritis. Page 1017

Which comment by a recently injured paraplegic patient indicates the patient is adapting to new self-care activities? 1. I don't want to do these activities today 2. I'm so tired today; I just want to rest 3. my dog can do this. Why can't I do it to? 4. This isn't working. I need to try something else.

4.

Which medication for Parkinson's disease is often the initial medication of choice and used by almost all patients with PD at some point in the progression of the disease? 1. Rotigotine 2. Pramipexole 3. Apomorphine 4. Carbidopa/levodopa

4. Carbon opa/Lea dopa is the initial drug of choice if the patients presenting symptoms are severe or interfere with worker school. At some point, healthcare providers prescribed this medication for almost all patients with PD. The others are not the initial drug of choice for patients with PD. Page 856

Which is a late manifestation of rheumatoid arthritis? 1. Anorexia 2. paresthesia 3. joint inflammation 4. morning stiffness

4. Late manifestations of RA include morning stiffness. Symptoms such as anorexia, paresthesia, and inflammation are early manifestations of RA Page 1018