CRRN - HCR

Vitamin Deficiency Disorders (Q96)

Vit A - Decreased night vision, dry eyes, rough and dry skin, folliculosis, inresed respiratory and urinary infections and damage to tooth enamel. Vit B1 - Fatigue, irritabilité, anorexia, edema, and cardiac enlargement. Vit B2 - Chelosis, glossitis, purplish discolored tongue & personality changes Vit C - Characterized by swollen & bleeding gums, frequent nosebleeds, muscle aches & weakness, bruising, poor healing and anemia.

Traditional Chinese Medicine (TCM) (Q87, Q69B, Q70B)

(Q87) - Concerned w/ balancing the vital energy (Qi) of the body through: diet, meditation, herbs, massage, acupressure, moxibustion, cupping, acupuncture, and Tai Chi. - Includes concepts of yin/yang (two opposing forces) - Belief in 5 basic elements related to body function(earth, fire, water, wood, and metal) - Relies on herbs (Q69B) - Chinese believe that beef & eggs should not be served to those who are ill. (Q70B) - The number 4 is very bad for luck - (i.e Prefer not to do anything at the 4 o'clock hour or to live on the 4th floor.)

Definition/measure of one alcoholic drink (Q146)

- 12oz beer/wine cooler - 5oz wine -1.5oz liquor Moderate drinking = 2 or more per day for males and 1 drink for adult females

Addressing constipation/fecal incontinence in patients with MS (Q8)

- A bowel-training prog often necessary b/c 70% of pts experience bowel dysfunction. - Bowel training usually begins w/ timed BMs (sometimes aided by use of glycerin suppository), increased dietary fiber, adequate liquid intake and stool softeners if needed. - Laxatives should be avoided b/c they may increase constipation. - Regular use of a suppository may be indicated w/ persistent incontinence to better control defecation.

Components of reflective listening (Q22)

- Actively listening by looking directly at patient - Listen for expressions of feelings - Words such as scared, happy, excited, sad and afraid. Try to ID and understand feelings rather than just words or facts - Reflect back by restating the feelings the child expressed and try to state the probable reason for the patient's feelings (Example: "New exercises can be scary b/c you don't know what's going to happen.")

Long-term Care Hospitals (LTCH) p. 18/ARN guide p. 129

- Acute care facility that provides extended medical and rehab care to patients to chronically critically ill or who need invasive ventilator support - Average stay 25 days or greater

Frazier Free water Protocol p. 359

- Allows clients w/ dysphagia or NPO to drink water between meals - Rationale: Small amounts of water, even when aspirated, do not contribute to aspiration pneumonia. - Clients first screened w/ 3 oz of water at bedside - Good oral hygiene is key to this protocol - Water is permitted after oral care, before meals, and starting 30 minutes after meals. - Medications are administered whole or crushed in a spoonful of applesauce or pudding or thickens liquid -- Never with thin water

Symptoms of Central Sleep Apnea (Q15)

- Apneic & hypoepneic episodes w/out obstruction usually resulting from cardiac or neurological disorders causing ventilation impairment - Chest wall & abdominal movement doesn't occur during apnea periods -Cheyne-Stokes respirations may be present (apnea, 10-60 seconds of hyperventilation, followed by apnea) - Mild snoring - Individuals may complain of insomnia because the awaken frequently. - Nocturnal polysomnography shows decreased respiratory effort w/ decreased O2 sat.

How often should patients in wheelchairs do pressure relief? (Q37)

- At least every 15-30 min for 2-3 min. May vary from individual, so its should be advised to evaluate their own needs. - Factors to consider are age, weight, and posture. - Methods include leaning side to side, forward, and lifting the buttocks.

Signs/symptoms of autonomic dysreflexia (Q83)

- BP often >200 mm Hg systolic w/ autonomic dysreflexia - Patients w/ injuries above T6 often have chronically low BP. In these patients a BP rise >20-40 Hg can be indicative of autonomic dysreflexia - Other signs/symptoms: Headache, flushed and damp face and nasal congestion Interventions: - Sit patient up in bed or in wheelchair at 90 degrees to allow gravity to lower BP - Lower legs if possible - Monitor BP every 5 minutest until resolved

Nursing interventions to prevent osteoporosis p. 667

- Bone loading exercises such as physical exercise - Functional electrical stimulation - Early mobilization prevents bone loss

Steroid-induced bone loss

- Bone loss can occur from prolonged use of corticosteroids for COPD, asthma, RA, lupus and other disease processes where steroids are prescribed - Nurses can improve pt outcomes by advocating for minimizing steroid use and suggesting alternate treatment such as NSAIDs

Nero Levels & Functioning potential of patient w/ C5 Injury p. 533

- Can move head & neck, can shrug shoulders, can bend elbows and turn palms face up - Independent w/ eating & ADLS w/ assistance setting up & use of special equipment - Can push manual wheel chair for short distances; an electric wheelchair typically used for daily actuates; Driving may be possible

Nero Levels & Functioning potential of patient w/ T2 - T6 Injury p. 534

- Can move head, neck, shoulders, arms, hands and fingers; increased trunk control - Some individuals capable of limited walking w/ braces

Nero Levels & Functioning potential of patient w/ T7 - T12 Injury p. 534

- Can move head, neck, shoulders, arms, hands and fingers; increased trunk control & abdomen control

Key forces shaping the future of healthcare delivery in the US p. 210

- Changing demographics: Aging population; increasing ethnic diversity - Control spending of medicare, CHIP and medicaid programs - Public belief that our behaviors affect our health - The Affordable Care Act seeks to reduce the number of uninsured - Adoption of health technology - Genomics - linking human disease withe variations of specific genes - Shortages of health care professionals, redefinition of professional roles - Expanding roles of nurses - nurses practicing in more than 1 state need multi licenses. The National Council fo Sate Boards of Nursing has adopted a compact that grants one license that permits practice in participating states.

Neurogenic Shock p. 531

- Characterized by hypotension, bradycardia, hypothermia - More common in injuries above T6

Skilled Nursing Facility (SNF) p. 18

- Commonly called nursing homes - Provide daily skilled care given by or under the supervision of skilled nursing or rehab staff - Pts typically stable and can participate in some rehab. - Medicare beneficiaries must have a hospital stay of at least 3 days - Medicare will cover for up to 100 days

Constrained-induced Movement Therapy (CIMT) Mometrix Q28 https://www.maryfreebed.com/rehabilitation/cimt/

- Constraint of an uninvolved upper extremity - Forced use of weekend limbs for 90% of waking hrs - Massed practice exercises at least 6 hrs/5 days per wk for 2-3 wks

Types of community based care (p 20)

- Day care treatment programs and adult services - Independent living facilities

The Individuals with Disabilities Education Act (IDEA) p. 256

- Ensures that all children 3-21 receive free, appropriate public ed. - States special ed services should be delivered in the least restrictive environment. - Students entitled to an individualized education plan that is reviewed annually to meet child's needs - Student can received PT, OT, ST, nutrition therapy through the school - Early education services available for children (from birth to 3) at risk for disabilities

What symptoms do you see when there has been damage to the left cerebral hemisphere? p. 524

- Impaired speech & language; aphasia - Cautious, slow to perform - Aware of deficits - Depression & Anxiety

When a PEG tube is accidentally pulled out (Q122)

- Important to maintain opening, so place a foley Cath of similar size to the PEG tube into the PEG track - External stabilization devices can be applied to the skin to hold the tube in place or it can be taped to the abdomen or secured with a binder.

Guidelines for teaching a female patient to do a clean intermittent catheterization (CIC) and how often to IC (Q64)

- Initially insert the catheter 2-3 inches guiding it upward until urine begins to flow, then gently insert another inch. - Pt should sit on toilet being sure to clean the vulva and urethral opening with soap and water or packaged wipes containing benzalkonium chloride, wiping front to back. - Pt should Cath often so that the volume is <500 mL or consistent w/ patient's bladder which may be < 300 mL. - The patient should establish a strict regimen to avoid reflex contractions of the bladder or distention. - The number of people doing the catheterization should be limited to < incidence of infection.

What Does Medicare Part A (Hospital Insurance) Cover?

- Inpatient care in hospitals - Inpatient care in a SNF (not custodial or long-term care) - Hospice care services - Home health care services - Inpatient care in a Religious Non medical Health Care Institution

Osteoporosis in stroke patients p. 666

- It is common for stroke patients to have accelerated bone loss & increased risk of fracture as a result of impaired mobility - Femoral neck bone mineral density changes are associated with a shift in standing weight in hemiparetic stroke patients. When patients bare less weight on the effected side, they lose bone density in the femoral neck of the effected side

Interventions to prevent peripheral edema following an amputation p. 670

- Keep residual limb elevated to prevent fluid from pooling in the dependent extremity. - Periods of elevation must be alternated with stretching exercises to prevent contracture. - Increase protein in diet to elevate albumin levels if hypoalbuminemia is an issue

Barriers to Care

- Lack of health insurance - Older adults who must supplement their insurance with out of pocket money. Black and hispanic older adults are disportionately uninsured - Copayments and deductibles can discourage people from seeking preventive exams (immunizations/mammograms). - Although medicaid is comprehensive, many Drs don't accept it because of it's low level of payment.

Nursing interventions to prevent contractors in patients with amputations p. 572

- Limit sitting in a chair to <1 hr - Do not place pillows under surgical extremity - Have patient lie prone (unless contraindicated) for 30 min 3-4x per day

Key health care policy issues

- Limited access to care - Cost of care - Quality of care - care is not always accessible, effective, safe, and efficient - Health disparities - people from racial & ethnic minority groups and people w/ low incomes result in higher rates of chronic illnesses - Nursing services and workforce - Privacy & confidentiality

Nero Levels & Functioning potential of pt w/ C4 Injury p. 533

- May have head & neck control

Frontal Lobe damage caused from TBI (Q98)

- May result poor planning and sequencing when given instruction - May have difficulty initiating conversation and inability to self monitor - Patient may become egocentric, interrupting others and talking excessively

Inpatient Rehab Facilities (IRF) p. 17/ARN guide p. 129

- Medicare requires clients must be able to participate in 3 hours of rehab at least 5 days a week. - Must require two or more therapies. If only one therapy is needed it can be performed on an outpatient basis

Occupational Safety and Health Administration (OSHA) hiring requirements for employees with disabilities (Q14)

- OSHA is a federal agency that ensures worker safety - Agents carry out inspections & investigate accidents & reports of noncompliance. - OSHA does NOT make regulations regarding disabled workers except that they (as all workers) must be able to work safely w/o endangering themselves or others.

What are some interventions for decreasing spasticity?

- Oral anti spasticity meds such as valium, baclofen, klonopin and benzodiazepines - Exercise, stretching - Baclofen pump implantation - Botox injections

Interventions to prevent hospital acquired pneumonia in any one at risk for aspirating p. 681

- Patient must be out of bed or have head of bed elevated >45 degree (preferably 90 degrees) during feeding and 1 hour after - At all times, HOB should be at least 30 degrees - Good oral hygiene and dental hygiene is vital to decreasing amount of bacteria - Deep breathing exercises and use of incentive spirometry to expand lungs and mobilize secretions - Abdominal binders can stabilize abdomen and generate pressure through the thorax to increase inspiratory and expiratory muscle activation and improve lung volumes

Medicare requirement for home oxygen (Mometrix p. 150)

- Patient must have an O2 sat level <89% while resting or walking.

Kosher Diet Restrictions (Q72B)

- Pork & pork products - Shellfish (Only fish with fins and scales may be eaten)

Strategies for helping elderly patients overcome feeling of low self esteem (Q58)

- Provide opportunities for patient to make decisions. - Provide companionship & listening & encourage the pt to express feelings and concerns. - Positive feedback & feedback should be given when earned rather than praising everything.

Nero Levels & Functioning potential of patient w/ C1-C3 Injury p. 533

- Requires ventilator to breath - Can operate electric WC w/ head control, mouth stick or chin control - Tilt WC assists patient w/ pressure relief - Requires assistance with all ADLs Memory Jogger: Patient in room 26

Nero Levels & Functioning potential of patient w/ C6 Injury p. 533

- Same movement as C5 but can also turn palms up and down and extend wrists - Electric WC typically used; driving possible

Nero Levels & Functioning potential of patient w/ C7 Injury p. 533

- Same movement as C6, but can straighten elbows - Manual WC typically used - Can assist w/ household duties - Performs pressure relief by doing WC push ups

Nero Levels & Functioning potential of patient w/ C8-T1 Injury p. 534

- Same movement as C7 but has better control of fingers resulting in limited or natural hand function - Manual WC - Can transfer independently - Independent w/ ALL activies

Ways to lessen suicide risk in the elderly population

- Social Supports - Treat depression - Increase involvement in social activities - Taking action when suicidal ideations are expressed

Spinal Shock p. 531

- Temporary loss of spinal reflex activity that occurs after an injury to the spine - Initial increase in BP - Flaccid paralysis, including bowel & bladder - Lasts several hours to days

Health Belief Model (Q90B)

- The most convincing criteria to get a person to change health behaviors is perceived susceptibility. If a patient does not believe a negative consequence (i.e. lung cancer from smoking) will occur, then the patient has little motivation to change. Perceived susceptibility and perceived severity comprise a perceived threat.

Betty Neuman's Systems Model (Q52/dMometrix p. 190) https://www.youtube.com/watch?v=s9RFh-U3nTA

- This model views the client as an open system that responds to stressors in the environment. -The client variables are physiological, psychological, sociocultural, developmental, and spiritual. - The client system consists of a basic or core structure that is protected by lines of resistance. The usual level of health is identified as the normal line of defense that is protected by a flexible line of defense. -Stressors are intra-, inter-, and extrapersonal in nature and arise from the internal, external, and created environments. - When stressors break through the flexible line of defense, the system is invaded and the lines of resistance are activated and the system is described as moving into illness on a wellness-illness continuum. - If adequate energy is available, the system will be reconstituted with the normal line of defense restored at, below, or above its previous level. - Nursing interventions occur through three prevention modalities. Primary prevention - occurs before the stressor invades the system; Secondary prevention - occurs after the system has reacted to an invading stressor; Tertiary prevention - occurs after secondary prevention as reconstitution is being established.

Natural alternativeS to NSAID therapy (p. 160)

- Turmeric. Because turmeric does not possess COX-1 inhibition action there is no risk of GI problems as with the use of NSAIDS - Ginger - Omega 3

Effects of Lack of Adequate Care

- Uninsured patients are less likely to get preventive care and are more likely to end up hospitalized for preventable conditions - Delaying/not receiving treatment can lead to more serious illnesses. - Uninsured clients typically receive care from provider willing to provide care based on patients ability to pay (community clinics/hospitals) . Costs are often high increasing delivery of care costs. -

Signs of impending death p. 288

- decreased urine output - breathing changes - increased periods of unresponsiveness - mottling of extremities - changes in vital signs

3 Phases of the physiological stress response of the general adaption syndrome (Selye) (Q67)

1) Alarm - Fight or flight response 2) Resistance - Nonessential body systems slow (digestion, sexual response, growth) as the body adjusts to the hyper state of arousal 3) Exhaustion - Permanent damage results in chronic disease if stress response continues for extended periods of time.

Classification of incomplete SCIs p. 531

1) Central Cord Syndrome - Damage to the central part of the cord, usually in the cervical region 2) Brown-Sequard Syndrome - Caused damage to one side of the cord; causes loss of motor function and sense of position on the effected side and loss of sense pain, temp and light touch on the unaffected side. 3) Anterior Cord Syndrome - Damage to the anterior artery resulting in paralysis and loss of pain inadequate temp sensation below the lesion 4) Conus Medullaris Syndrome - Caused by damage to the conus & lumbar nerve roots 5) Cauda equina syndrome - Caused by damage below the conus & lumbar nerve roots

Steps to take when fitting a patient for a new prosthesis (Q35)

1) Educate pt on prosthetic use, including overuse and nerve entrapment 2). Demonstrate how to apply/remove 3) Once pt masters this, he is taught to control the prosthesis and preposition and use the terminal (grasping) device in a series of repetitive exercises, which can include picking up or manipulating items of different sizes and shapes while in different positions (sitting, walkings standing) as well as carrying out ADLs.

Layers of the GI tract (Q36B)

1) Epithelium - innermost layer; protects the esophagus 2) Lamina - Contains blood and lymph vessels 3) Muscularis mucosal layer - Contains smooth muscle fibers

Stages of Changes (Q29)

1) Exploration - Patient explores info about & feelings regarding a new occupation w/out pressure or demands. The CRRN should provide opportunities for the patient's experimental learning. 2) Competency - Patient learns new skills & accepts a new role and new routines, developing new habits. 3) Achievement - Patient is self sufficient in new occupation, integrating the new role into all areas of life, altering old routines and habit to accommodate the changes.

Cardiac Rehab Stages (P. 79 Mometrix)

1) Inpatient - Begins during hospitalization. Usually only about 3-4 days long. 2) Early Outpatient - Supervised program for up to 2 months after release 3) Lifetime maintenance -

Anal manometry procedure

1) Lower bowel cleaned usually w/ fleet enema 2 hrs before assessment 2) A balloon catheter is inserted in the rectum w/ patient lying on left side. A machine connects to a catheter to measure pressure 3) Pressure measurements are taken while the patient tightens, relaxes, and pushes with the anal sphincter muscles, stimulating holding and expelling stool.

Head Injury Classifications p. 517

1) Mild Brain Injury - May result in LOC for 30 min or less; GCS score 13-15 2) Mod Brain injury - LOC more than 30 min but < 24 hrs; GCS score 9-12 3) Severe Brain Injury - LOC > 24 hr; GCS <8; Posttraumatic amnesia lasting > 7 days

Percent of stroke patients who recover 100% (Q26B)

10%. The odds go up when treatment is given w/in the "golden hr" which starts when the onset of symptoms occur.

Daily sodium recommendations for patients on a cardiac diet Mometrix p. 192

1500 mg

What year id the Americans with Disabilities go into effect? Mometrix Q 155

1990

Cranial nerves that effect pupil size, pupil equality and reaction to light as well as extraoccular eye movements (Q97B)

3, 4, and 6

How do you measure an adequate fluid intake over 24 hr period (Q66)

30ml/kg/day

Case Mix Group (CMG) Mometrix Q32

A classification system based on clinical characteristics of patients

A patient with a traumatic brain injury exhibits restlessness, combativeness, hyponatremia, and diminished urine. Which of the following is the patient likely experiencing? A. Syndrome of inappropriate antidiuretic hormone secretion B. Diabetes insipidus C Thalamic syndrome D Urinary retention

A

A patient who experienced sudden loss of the family home reports signs and symptoms of anxiety, sleep disturbance, emotional numbing, and difficulty with concentration. Newly diagnosed with post traumatic stress disorder, what pharmacological class does the nurse anticipate will be ordered for this patient? A . SSRIs B. Monoamine oxidase inhibitors C. Tricyclic antidepressants D. Hypnotics

A Reference Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment in PTSD. Monoamine oxidase inhibitors and tricyclic antidepressants are older medications with significant side effects and have been replaced by SSRIs. Hypnotics may address sleep disturbance but would not relieve the other symptoms.

Communicating physically (caressing, stroking, kissing, and coitus) and emotionally (feeling valued, needed, and cared about and experiencing trust in another) expresses which sexual "need" between two human beings? A. Intimacy B. Libido C. Affection D. Romance

A Reference Intimacy involves much more than sexual intercourse. It is an essential physical and emotional means of communicating within a human relationship. Intimacy helps persons with disability to cope and to retain their sense of masculinity, femininity, and self-worth. Libido refers to one's sex drive and is a part of one's sexuality. Affection is a way to express tenderness and may be more important than sexual activity for some people. Romance involves creating experiences and environments that promote affection, intimacy, and sexual activity. All of these factors are important to human relationships.

Which method of paying health care providers places all of the risk on the payer of health care? A. Fee-for-service payment B. Prospective payment C. Capitation payment D. Cost sharing

A Reference Under fee- for-service payment, the financial risk is borne by the health plan that pays providers for all covered services. Under prospective payment, health plans shift part of the financial risk to hospitals by paying a fixed amount based on admission diagnosis. Capitation involves a fixed monthly payment. All three methods of payment may include cost sharing using deductibles and co- payments.

86 Which cranial nerves are MOST affected in individuals with multiple sclerosis? A. II and III B. IVandX C. V and VII D. VIII and XI

A Reference: Demyelination or destruction of the myelin sheath of axons in the CNS, as a result of multiple sclerosis, most frequently affects cranial nerve II (Optic) and cranial nerve III (Oculomotor), causing symptoms such as blurred central vision, blind spots, and double vision.

A 38-year-old woman has been admitted to the spinal cord injury unit following a drunk driving accident in which her husband was the driver. The family expresses concern to the rehabilitation nurse about the husband visiting because of alleged physical abuse before the accident. The wife expresses a desire to see her husband. Which ethical principle should guide the nurse in addressing the family's concerns? A. Autonomy B. Nonmaleficence C. Beneficence D. Confidentiality

A Reference: Rehabilitation nurses must acknowledge that individuals for whom they care have freedom regarding their bodies and actions.

Mutual goal setting is important for successful rehabilitation and may influence the effectiveness of coping strategies. Which of the following statements regarding the process of mutual goal setting is TRUE? A. Goals should be relevant to the patient and within the expertise of the rehabilitation team to achieve. B. Goals should be easy to achieve. C. The process of mutual goal setting is relatively unproblematic. D. Goals should be established by the rehabilitation team and communicated in the process to the patient.

A Reference: - Established patient goals need to be relevant and achievable. This is accomplished by ensuring that the goals are desired by the patient and something that the rehabilitation team can deliver. - Goals should be moderately difficult to achieve in order to establish motivation to achieve them. Goals that are easy or too difficult inhibit motivation. - Mutual goal setting requires a partnership between the patient and the team member. This relationship does not occur at a first meeting and often requires several encounters before trust can be developed. The term mutual goal setting refers to a process by which goals are established through negotiation, not in a unilateral manner.

In a hospital setting, a patient requiring nursing care for wound care, medication management, and two therapies is unable to tolerate 30-minute therapy sessions. What level of care should the nurse recommend for this patient's post-acute care? A. Skilled nursing facility B. Inpatient rehabilitation facility C. Long-term acute care hospital D. Home with home health therapy

A Reference: - Sending a patient home with home health may occur, yet this patient has nursing needs that qualify for an SNF setting. - This patient does not qualify for the IRF setting: the inability to tolerate therapy sessions consistently leads to the expectation that he or she would not be able to tolerate and progress in the short-time, intensive therapy program mandated by CMS. - The LTACH setting is primarily for the chronically complex patient requiring invasive ventilator support, so this patient does not qualify. - The nurse is using the ethical principles of financial responsibility (stewardship of resources) and advocacy in determining that an SNF setting is the most appropriate setting in this scenario.

A nurse is meeting with a client and family to resolve a conflict about the client's discharge plans. The nurse uses logic and explores the participants' values and opinions to work out the differences over the discharge plans. What theory is the nurse using to resolve the conflict? A. Dissonance theory B. Cognitive theory C. Social learning theory D. Personality theory

A Reference: - The nurse is using the nursing process and an interactional theory to assist in solving an issue in which there is conflict. - dissonance theory is the interactional theory that uses logic, value, and moral aspects of a situation to explore a decision. - While awareness of various cognitive theories such as Piaget's - developmental theories such as Erikson's, and - personality assessments such as the Myers-Briggs Type may all contribute to the understanding of the situation **Disonance means lack of harmony

An 18-year-old patient with a mild traumatic brain injury memory deficit wants to return to cohabitating with his significant other. His parents are vehemently opposed to this plan and advocate for the patient to live with them. The rehabilitation team believes the patient is capable of living with his significant other with short-term supervision. What ethical principle is the nurse using when she offers to speak with the parents about the post-discharge living arrangements? A. Advocacy B. Nonmaleficence C. Autonomy D. Competency

A Reference: Advocacy is championing the needs and interests of another and is required under RN licensure. Nonmaleficence is the concept of doing no harm. Autonomy is defined as individual actions and will of others. Competency is the ability or legal right to make appropriate decisions. In this example, the patient is not a minor and has not been declared to be incompetent. This situation does not address whether there is a values conflict over cohabitation, a fear over potential short-term safety concerns, or another issue. This scenario could present an ethical conflict due to the recent advancement from minor child to adult. Regardless, the nurse should seek understanding and advocate.

As a result of traumatic injuries from a motorcycle accident, a patient is diagnosed with a spinal cord injury and traumatic brain injury and undergoes a below-the-knee amputation. On admission to the rehabilitation unit, the patient complains of increased pain and stiffness in the elbow and has limited range of motion of the joint as well as a fever. What medical complication should the nurse consider? A. Heterotopic ossification B. Chronic pain C. Autonomic dysreflexia D. Perseveration

A Reference: Pain can be difficult to assess in a client with an altered mental state (dementia, brain injury, cerebrovascular accident). Perseverative behavior can be common in a client with a traumatic brain injury. The symptoms of autonomic dysreflexia do not generally include fever and limited range of motion of a joint. The key is to recognize that this client has multiple risk factors (spinal cord injury, traumatic brain injury, amputation) and is in the peak incidence time of 4-12 weeks post-injury and up to five months after trauma for HO formation. The acute signs and symptoms start off with pain and stiffness and loss of range of motion.

Which of the following would be the BEST approach for the rehabilitation nurse with a new interest in political activism? A. Identify one issue of interest and act on it. B. Serve on a local disability commission. C. Work on the campaign of an elected official. D. Subscribe to newsletters that inform nurses about legislation.

A Reference: A neophyte to the political process should identify one issue of interest per year and act on it. This fosters the development of expertise on the topic, and the nurse learns how to create positive changes. The rehabilitation nurse might find it helpful to serve on a local board, develop a relationship with an elected official, or subscribe to a newsletter, but these may not be valuable experiences or relate to the issue of interest.

Which statement BEST describes the importance of advocacy in rehabilitation nursing? A. Advocacy empowers clients, families, and populations through knowledge. B. Advocacy empowers nurses to gain power in specialty nursing practice. C. Advocacy empowers the team to address resources at the bedside. D. Advocacy empowers the payers to evaluate nursing care for clients.

A Reference: Advocacy is a process whereby nurses intervene to empower their clients, families, and populations with knowledge about critical issues such as the rehabilitation process. Advocacy is not focused on the nurse, team, or payers.

What is the name of the legislative act that allows a three-year-old child with spina bifida to receive therapy services through the public school system? A. Individuals with Disabilities Education Act B. No Child Left Behind Act C. Rehabilitation Act of 1973 D. Americans with Disabilities Act

A Reference: All are real legislation created to assist the person with a disability. - IDEA mandates free and appropriate education and therapy services for children ages 3 to 21 in the public school setting. - NCLB addresses areas of reading and mathematics and possible exclusion in testing for those with a disability. - The Rehabilitation Act of 1973 addresses the need for supportive services for children with physical disabilities who do not quality for special education. - The Americans with Disabilities Act focuses on the prevention of discrimination in housing, employment, and access.

A patient demonstrates language difficulty in expressing thoughts and ideas. What type of aphasia is this and in which area of the brain would damage be present? A. Broca's aphasia, which indicates damage to the posterior region of the frontal lobe often located on the left in persons who are left dominant B. Broca's aphasia, which indicates damage to the parietal lobe on the left in persons who are left dominant C. Wernicke's aphasia, which indicates damage to the left frontal lobe in persons who are left dominant D. Wernicke's aphasia, which indicates damage to the left temporal lobe in persons who are left

A Reference: Broca's (non- fluent) aphasia is a speech disorder in which the patient has difficulty in expressive speech. The patient demonstrates word finding sequencing and sentence formation while having problems expressing their thoughts ideas and needs. Damage to the left posterior section of the frontal lobe, which houses the Broca's area of speech, is to blame for expressive aphasia disorders.

What is the ideal time to involve the external case manager? A. Onset of the disability B. Transfer to acute rehabilitation C. Admission to a subacute facility D. Discharge to home

A Reference: External case managers should ideally be involved as early as possible after the onset of disability. External case managers most often obtain referrals from the insurance company or funding source. It is important that the external case manager educate the referral source in the benefits of early involvement of the external case manager in order to accomplish the goal of ensuring quality care in a cost-effective manner.

How often should wheelchair- bound patients be taught to perform weight shifts? A. Every 15 minutes B. Every hour C. Four times per day D. When they become uncomfortable

A Reference: Frequent weight shifts are critical in the prevention of pressure ulcers. Weight shifts should be done every 15 minutes.

A client with a left CVA with right-sided hemiparesis is assessed by the nurse for swallowing safety. The nurse determines that the client needs increased time to form a bolus of food and has trace pocketing of food in the right cheek. What phase of swallowing does the nurse suspect is a problem for the client? A. Oral preparatory phase B. Anticipatory phase C. Pharyngeal phase D. Esophageal phase

A Reference: In normal swallowing there are four phases. A bolus of food is formed in the oral preparatory phase and pushed posteriorly toward the oropharynx. Pocketing of food can initiate in the oral preparatory phase. The key tip-off to the answer is the formation of the bolus.

Metered dose inhalers (MDIs) deliver medicine to patients with lung disease. Which of the following is an ADVANTAGE of this delivery method? A. Less likelihood for systemic side effects B. Less likelihood for carbon dioxide retention C. Less potential for interaction with liquids D. Less potential for hypoxia

A Reference: Inhalers allow medications to be given in smaller doses with the same positive effects and less risk of side effects than if given systemically. A spacer device or air chamberwith the inhaler helps deposit the medicine deep in the airways rather than

A patient is admitted to the unit with a left hemispheric stroke. Which of the following impairments should the rehabilitation nurse expect the patient to exhibit? A. Inability to do mathematical computations or interpret symbols B. Inability to distinguish directional concepts such as up and down Problems with depth C. perception and spatial relationships D. Lack of awareness of others' nonverbal communication; flat affect

A Reference: Left hemispheric stroke patients are unable to do mathematical computations or interpret symbols.

A female patient has undergone several surgeries and a long hospitalization. Transitioned from several acute areas of the hospital, she is taking numerous routine medications for health issues as well as medication for pain. The patient has told the nurse that she is having trouble sleeping. What intervention could be implemented to assist with managing the inability to sleep? A. Review her medication lists for potential medications that affect sleep patterns. B. Promote the use of pain medication to promote sleep. C. Explain that sleep disturbance is normal after transitioning from one area of the hospital to another. D. Work with the attending physician to add additional medication to her current regimen.

A Reference: Medications - particularly sedatives, pain medications, and tranquilizers - disrupt normal sleep patterns. Reviewing the patient's medication lists for potential interactions and side effects could reveal culprits. Providing the patient with alternative interventions at bedtime that promote sleep and relaxation will help to provide an atmosphere to promote sleep patterns.

What type of patient assessment includes bed mobility, toilet transfers, wheelchair mobility, and ambulation? A. Functional mobility assessment B. Activities of daily living assessment C. Adapted coping assessment D. Balance and disuse assessment

A Reference: Nursing assessment for mobility includes bed mobility, toilet transfers, wheelchair mobility, and ambulation. This assessment is called the functional mobility assessment and typically includes these four parameters.

Which of the following isincorporated in Orem's self- care theory? A. Investigation/decision making in which the patient has control and input regarding activity B. Handicap as the. limitation of a person's. normal role function C. Sociobiological activities such as bathing and dressing that are hierarchically related to each other D. Reciprocal interaction,simultaneous action and reaction

A Reference: Orem's self- care theory is recognized by rehabilitation nurses for its usefulness in identifying the multiple levels of a patient's capabilities and valuing patient control and input. Self-care is essential for health and well-being and Orem focuses on the individual's self-care needs/demands and his or her ability to meet those needs.

Which of the following is incorporated in Orem's self- care theory? A. Investigation/decision-making in which the patient has control and input regarding activity B. Handicap as the limitation of a person's normal role function C. Sociobiological activities such as bathing and dressing that are hierarchically related to each other D. Reciprocal interaction simultaneous action and reaction

A Reference: Orem's self- care theory is recognized by rehabilitation nurses for its usefulness in identifying the multiple levels of a patient's capabilities and valuing patient control and input. Self-care is essential for health and well-being and Orem focuses on the individual's self-care needs/demands and his or her ability to meet those needs.

Autonomic dysreflexia is an autonomic dysfunction most commonly seen with what type of spinal cord damage? A. T6 Asia A injury B. Myelomeningocele C. Transverse myelitis D . Anterior cord syndrome

A Reference: Patients with spinal cord injuries occurring at T6 and above are at greatest risk for developing autonomic dysreflexia.

What is the definition of self- efficacy? A. A sense of control over one's life B. A person's sense of personal value C. A person's picture of one's appearance D. The way one thinks about oneself

A Reference: Self-efficacy is the sense of control over one's life. Personal value is self-esteem. Appearance is body image. Thoughts about oneself involve self- concept and self- perception.

A patient with weakened hand strength asks about the purpose of a small cloth with a pocket wrapped around a fork. What is the nurse's best response? A. The cloth is referred to as a universal cuff and used to improve the grip on the utensil. B. The cloth is used as a barrier to germs to reduce the risk of infection. C. The cloth is a cover to protect the blade of a rocker knife, which is used to cut food. D. The cloth increases the weight of the utensil to minimize hand fatigue when eating.

A Reference: The cloth is referred to as a universal cuff. It is a type of adaptive equipment used to improve grasp for patients with decreased hand function.

Which of the following is a reason for rehabilitation nurses to help clients take a proactive approach to change within the health care environment? A. To make the adaptations needed to maintain change B. To decrease the cost effectiveness of care delivery C. To improve fear and fatigue of clients D. To improve comfort for clients and families

A Reference: The reasons for taking a proactive approach to change and seeking out opportunities for change include improving the quality of care, improving the cost- effectiveness of care delivery, and making the adaptions needed to maintain change.

A patient presenting with a pressure ulcer on the sacrum is complaining of worsening pain at the site. On assessment, the rehabilitation nurse notes increased serous exudation and a new foul odor. What should the nurse be considering as a potential reason for this change? A. The patient is showing signs of infection or colonization at the site of the ulcer. B. The patient's pressure ulcer is responding to treatment and the findings are expected. C. The patient is showing signs of vascular supply and wound stabilization at the ulcer site. D. The patient's pressure ulcer stage of wound healing is showing proliferation of fibrin.

A Reference: The signs of serous exudation and a new foul odor are indicative of an infection at the pressure ulcer site. The phases of wound healing include wound stabilization and proliferation of fibrin.

What is another name for mild traumatic brain injury? A. Concussion B. Seizures C. Paraplegia D. Discrimination

A Reference: The term concussion is commonly used to describe a mild traumatic brain injury (mTBI). The other medical terms do not relate to mTBI.

Use of intermittent catheterization at four- to six- hour intervals and fluid management programs would be seen in which type of bladder dysfunction? A. Neurogenic retention B. Lower motor neuron injuries C. Stress incontinence D. Urge incontinence

A Reference: Urinary retention is the inability to voluntarily void urine. Initial management includes bladder catheterization with prompt and complete decompression.

The rehabilitation team disagrees with a patient's decision to stop all rehabilitation and medical services and be allowed to die because of the patient's acute spinal cord injury. What should the rehabilitation team leader do to resolve this clinical dilemma? A. Consult with the organization's ethics committee. B. Ignore the request because the patient has been traumatized. C. Request that team members inform the patient that they will not comply. D. Inform the patient and family that removal of care is illegal.

A Reference: When ethical issues occur in the rehabilitation setting, the rehabilitation team consults the ethics committee for clinical dilemmas.

Autonomic Dysreflexia (Q6)

A complication of central cord lesions at or above T6 and may be precipitated by a UTI, bladder distention, kidney stones, or fecal impaction, but numerous other stresses such as ingrown toenail, pressure ulcers, sunburns, sexual intercourse or tight clothing can cause disorder. **Bladder distention & fecal impaction are the most common causes. Patient should keep the head elevated . Lidocaine should be used for bladder catherizaiton or rectal exam to reduce stimulation.

Accommodations related to Sikhism religious belief (Q102B)

A monotheistic religion founded in Punjab. Sikhism preaches a message of devotion and remembrance of God at all times, truthful living and equality of mankind; it denounces superstitions and blind rituals. The steel bracelet (Kara) worn by patients of this faith is a symbol of the patient's religious faith and should not be removed.

Difference between a power of attorney and a healthcare proxy. Mometrix Q165

A power of attorney is a person that is assigned by the patient to have legal authority to make financial decisions on their behalf when they are unable to. (This is the one paying for the care) A healthcare Proxy is a legal document that assigns all healthcare decision making to a person when the patient is unable to.

Why is the Failure Mode Effects Analysis

A systematic, proactive approach to evaluating a process.

Ayurveda (Q93)

A traditional Eastern Indian method of healing focusing on the mind, body and spirit to prevent or cure illnesses. Practioners believe that when the life force (prank) and basic metabolism (dosa) are out of balance, the person becomes ill.

What is the National Quality Forum (NQF)

A voluntary consensus standard setting organization. The mission is to improve the quality of healthcare by setting national priorities for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs.

Which of the following theorists developed the health care systems model utilizing an open system in interaction with the environment? A. Betty Neuman B. Jacqueline Fawcett C. Marjory Gordon D. Dorothea Orem

A. Reference Betty Neuman developed a health care systems model in which the person is viewed as an open system in interaction with the environment. Fawcett identified four central concepts that provide the foundation for nursing theories: person, environment, health, and nursing. A standardized model of data collection, including 10 patterns that represent a composite of the individual's life experiences (including internal and external forces), was developed by Marjory Gordon. Orem's model focuses on the person's ability to perform self-care.

In educating children and youth with congenital and acquired disabilities, which of the following reflects content that is more appropriate for teenagers than for children who are 8-11 years old? A. Ways of expressing sexuality, including communication, dating, love, intercourse, and reproduction B. Signs of puberty (e.g.,female menses and malenocturnal emission) C. Family communication about sexuality, values, and decision-making D. Self-pleasuring (masturbation), reproduction, pregnancy, and sexual abuse issue

A. Reference In addition to the content in A, teens should learn about health maintenance (breast and testicular exams, safe sex, disease prevention, drug and alcohol use), making choices based on values, expression of sexuality including intercourse and masturbation, birth control, pregnancy, responsibilities with child rearing, and genetic counseling. Age- appropriate information will help youth understand their changing bodies, enhance their social skills to potentially prevent acting out sexually, increase their awareness of potential exploitation and abuse, help clarify values, and help them make healthy choices.

A patient describes spontaneous memories of previous military combat, episodes of flashbacks triggered by loud noises, and emotional distress. What should the nurse suspect is occurring in this patient? A. Manifestations of posttraumatic stress disorder B. Adverse drug reaction to a new medication C. Ineffective pain management for non-healing wounds D. Systematic response that will subside within seven days

A. Reference: Episodes of flashbacks, noise triggers, and emotional distress are manifestations of PTSD. PTSD does not subside within seven days.

Levels of consciousness (Q128)

Alert - A normal tone of voice should arouse patient Lethargic - A loud tone of voice should arouse patient Obtuned -Requires shaking to arouse Stuporous - Painfus stimulus is indicated to arouse the patient. Patient may have slow or absent verbal response and immediately becomes unresponsive when stimulus stops Comatose - Repeated painful stimuli fails to arouse patient

The rehabilitation nurse reflects on her individual beliefs and values about disability and societal expectations about health. What is the nurse's PRIMARY rationale for this action? A. One's individual beliefs and values can influence decision-making in rehabilitation nursing. B. Individual beliefs and values should be recognized by the nurse and used to influence care. C. The nurse reflects on her individual beliefs and values to cultivate a shared belief system. D. Reflection is considered best practice in nursing but does not need to be done routinely.

A. Reference: Individual beliefs, values, and personal philosophy are factors that can influence a nurse's decision- making. Reflection fosters an awareness of personal biases that may factor into the nurse's decision-making.

A nurse is admitting an elderly patient from the community to a skilled nursing facility. Upon admission, the nurse notes the patient has multiple bruises, is malnourished, and has poor hygiene. What should the nurse suspect and investigate further? A. Elder abuse B. Episodes of mania C. New-onset dementia D. Survivor guilt

A. Reference: The patient has many of the possible manifestations of elder abuse, including bruising, malnourishment, and poor hygiene. While some of these manifestations may occur with mania, dementia, and survivor guilt, the combination of the three manifestations requires a nurse to further investigate for abuse.

Orem's Self-Care Deficit Theory (Q52/(Mometrix p. 183) Memory Jogger: Your'e not going to do it for "em". You're going to help them do it for "em" selves

AKA Orem's Model of Nursing. Used primarily in rehabilitation and primary care settings, where patients are encouraged to be as independent as possible. Goal of nursing - serve individuals & assist them to provide self-care by identifying reason he needs care, planning and managing care. Agents: Self-care agent - Patient Dependent-care agent - Caregiver F Categories of Needs: Universal Needs (food, air) Developmental Needs (from maturation or events) Health Needs (from illness or injury)

Autonomic Dysreflexia occurs at which level of the spine (Q33B)

Above T6 If not treated promptly, can lead to complications such as hypertension, retinal cerebral hemorrhage, pulmonary edema, and seizures. Treatment: Elevated head of bed to cause orthostatic hypotension and assess for and resolve cause of AD.

Medications commonly used to treat patients w/ a decreased level of consciousness following a TBI Mometrix Q67

Acute Phase (<1 mo) Bromocriptine - helpful for patients in a vegetative state or those w/ minimal consciousness. Chronic Phase (> 1 mo) Amitriptyline & Methylphenidate - Usually given for agitation Levedopa - When combined w/ carbidopa, often given for patients in a vegetative state

The U.S. Surgeon General recommends how much exercise per week

Aerobic exercises 30 min per day/3 days per week and strengthening exercise twice per week

A form of NEGLECT in which the pt fails to recognize the severity of paralysis is?

Anosognosia

Medications that may slow rehab in brain injury patients Mometrix Q75/76

Anticholinergics - Associated w/ cognitive impairment, dizziness and confusion. **Seroquel can have noticeable anticholinergic effects including dry mouth, constipaation, urinary retention.

Percent of stroke patients who recover with minor deficits (Q28B)

Aprox 25%

Nursing Proces (Q79B) (Q136B) Memory Mnemonic - ADPIE

Assess - Gather Info Diagnose - ID Prob Plan - Develop plan/outcomes Implement - Perform Actions Evaluate - Evaluate Plan/Were outcomes met?

Assessing Long/Short Term Memory(Q43)

Assessing Short Term Memory - Ask questions that can be verified w/ personal experience. Patients may sometimes make up answers to questions such as "what did you have for breakfast?" to cover their memory loss. Testing Attention - Have patient spell words backwards Assessing Long-term Memory - Ask questions about past events, such as birth date

Types of Agnosia (neurological disorder that results in an inability to recognize objects) (Q134)

Associative visual agnosia - Pt can describe an item but is unable to recognize it when perceived visually Astereognosis - Pt can describe an item or recognize it when perceived visually but is unable to identify the item by touch Prosopagnosia - Can not recognize faces, even of self or family (AKA face blindness) Form Agnosia - Able to recognize parts but not the whole

How much liquid should a patient who performs self-catheterization take in each day? Mometrix Q92

At least 2 quarts daily. Drink most in first 1/2 of day. Drink mostly water and try to avoid citrus juices making the urine more alkaline which can lead to bacteria. Apox 7 oz of cranberry juice should be drunk each day to make urine more acidic to decrease bacteria growth

Leadership Styles (Q25) - ABCD

Autocratic - Leader makes decisions independently and strictly enforces rules. Team members feel left out and often not supportive. Bureaucratic - Leader follows org rules exactly and expects everyone else too. Consultative - Leader presents decisions & welcomes input although decisions rarely change. Most effective when gaining support of staff is critical to the success of the proposed change Democratic - Leader presents problem & asks team to develop solution; leader usually makes final decision.

A patient's family does not want to put in a feeding tube, but the physicians do want the family to place the tube. The rehabilitation nurse speaks to the physician on behalf of the family. What ethical principle is the rehabilitation nurse using? A. Sanctity of life B. Advocacy C. Quality of life D. Confidentiality

B

What type of urinary incontinence uses Kegel exercises to help with management? A. Functional incontinence B. Stress incontinence C. Urge incontinence D. Neurogenic retention

B

A patient with traumatic brain injury on the unit has loss of short-term memory and is confused, aggressive, and unable to cooperate with staff. What Rancho Los Amigos level is this patient? A Level III B Level IV C Level V D Level VI

B Reference: Individuals at Rancho level IV are confused/agitated, absent short-term memory, and unable to cooperate with treatment efforts. They may exhibit aggressive or flight behavior.

Which spinal cord injury syndrome causes paralysis and loss of position sense on the same side as the injury and loss of pain and temperature sensations on the opposite side? A. Anterior cord syndrome B. Brown-Sequard syndrome C. Cauda equina syndrome D. Central cord syndrome

B Reference: - Brown- Sequard syndrome is caused by damage to one side of the spinal cord. This syndrome produces loss of motor function and position sense on the same side as the damage and loss of pain and temperature sensation on the opposite side. - Anterior cord syndrome produces paralysis and loss of pain and temperature sensation below the level of injury with preservation of position sense. - Cauda equina syndrome is caused by damage below the conus medullaris to lumbar-sacral nerve roots. - Central cord syndrome, caused by damage to the central part of the spinal cord, produces loss of motor function and sensation affecting the upper extremities more than the lower extremities.

What type of urinary incontinence uses Kegel exercises to help with management? A. Functional incontinence B. Stress incontinence C. Urge incontinence D. Neurogenic retention

B Reference: - Kegel exercises can help strengthen a weak external sphincter to manage stress incontinence. - Timed or prompted voiding can help manage functional incontinence. - Neurogenic retention is managed with intermittent catheterization. - Urge suppression training is used for urge incontinence. Meds such as oxybutynin o, tolterodine, imipramine are also used.

Which of the following theories did Bandura develop to guide the assessment of the individual's ability to promote health and reduce risk? A. Hardiness B. Self-efficacy C. Locus of control D. Conservation

B Reference: - The key concept in Bandura's theory (1977) is self- efficacy. - Kobasa (1979) formulated the theory of hardiness based on research of stressful life events. - Rotter, Seeman, and Liverant (1962) described a contingency relationship between behavior and wellness outcomes and internal and external locus of control. - Levine (1966) presented a model whose key concepts are the principles of energy, structural integrity, personal integrity, and social integrity conservation.

Which method of paying health care providers shifts part of the financial risk to hospitals by paying a fixed amount based on admission diagnosis? A. Fee-for-service payment B. Prospective payment C. Capitation payment D. Cost sharing

B Reference: - Under prospective payment, health plans shift part of the financial risk to hospitals by paying a fixed amount based on admission diagnosis. - Under fee-for-service payment, the financial risk is borne by the health plan that pays providers for all covered services. - Capitation involves a fixed monthly payment. - All three methods of payment may include cost sharing using deductibles and co- payments.

A patient presents with a spinal cord injury at the 12th thoracic vertebra level (T12). The patient has complete sensory function below T12 but no motor function below the injury. Using the American Spinal Injury Association (ASIA) scale, what level of classification does the nurse identify? A T12 ASIA A B T12 ASIA B C. T12 ASIA C D. T12 ASIA D

B Reference: ASIA A - (Complete) complete loss of both sensory and motor function. ASIA B - (Incomplete) Sensory function is preserved but there is no motor function. ASIA C- (Incomplete) sensory function, and muscle strength is at the grade level 3/5 or lower. ASIA D - (Incomplete) there is sensory function, and muscle strength is at the grade level of 3/5 or higher. ASIA E - Normal

Comparing one facility's selected outcomes with another facility's outstanding outcomes is representative of which process? A. Projected resource utilization B. Benchmarking C. Cost-effectiveness analysis D. Evaluation of clinical pathways

B Reference: Benchmarking is identifying and adapting best practices to improve processes of care. The benchmarking process involves comparing the outcomes of one facility with outcomes achieved by a recognized outstanding facility. Clinical pathways is a mechanism to decrease the cost and length of stay, outlining the activities for each member of the health care team and the projected utilization of resources. Cost- effectiveness analysis is a specific technique that achieving similar outcomes.

Which of the following represents the rehabilitation nurse's grasp of the significance of a capitated fee system for services? A. Categorizes care as to technical skill and physical effort B. Understands the costs associated with care C. Negotiates with Centers or Medicare and Medicaid Services (CMS) for appropriate reimbursement D. Assigns a principal diagnosis based on use of resources

B Reference: A capitated fee system is based on prospective payment, whereby the provider agrees to render services to a group of individuals for a fixed amount, regardless of the amount of services delivered. Understanding the costs associated with care is essential because the provider will only receive the capitated fee. If services are provided above the fee, the provider must assume responsibility for those costs.

Which of the following is included in the Hierarchy of Pain Assessment Techniques? A. Recognize that the communication of pain may not be acceptable within a culture. B. Assess pain-related behaviors. C. Acknowledge that health care providers may believe that if the client does not report pain, he or she is not experiencing it. D. Develop personal awareness of values and beliefs that may affect responses to pain.

B Reference: Answers A and D are part of Strategies for Culturally Appropriate Assessment and Management of Pain. Answer C is a factor that may impede appropriate pain management in older adults.

Which of the following are the PRIMARY symptoms of multiple sclerosis? A. UTIs and bowel/bladder incontinence B. Ataxia, nystagmus, dysarthria, and dysphagia C. Denial and ineffective coping with anxiety D. Interruption in rest and disrupted sleep

B Reference: Ataxia, nystagmus, dysarthria, and dysphagia are the primary symptoms of multiple sclerosis.

Which term BEST describes the discounts from full charges available to governments and some other third-party payers? A. Contribution margin B. Contractual allowance C. Cross-subsidization D. Cost reimbursement

B Reference: Discounts from normal charges given to large payers for health care services are called contractual allowances. The contribution margin is the amount by which the price exceeds the variable cost. If the margin is positive, the organization benefits by that amount. Cross- subsidization is when some patients are assigned more costs than they create and others less. Cost reimbursement is the revenue based on the organization receiving payment for costs incurred.

What ethical principle is demonstrated when the rehabilitation nurse states, "I am obligated to tell you the truth about your medications"? A. Quality of life B. Veracity C. Confidentiality D . Advocacy

B Reference: Veracity is best described as the nurse's responsibility to tell the truth.

Piaget's cognitive and developmental theory states that growth results from which of the following? A. Adaptation to the environment only B. Social and neurological maturity in which children develop strategies for interacting with the environment and knowing its properties C. Behavior that is shaped with positive and negative reinforcers increasing or decreasing the likelihood of repeating the interaction D. Building upon previously learned experiences and ideas

B Reference: Piaget's theory develops in stages and is based on social and neurological maturity. Option A is made up, option C is part of Pavlov's theory of behavior, and option D is Vygotsky's theory.

A male patient complains of waking several times throughout the night and difficulty staying asleep due to muscle spasms. He was admitted to the acute rehabilitation unit with the diagnoses of deconditioning, pneumonia, and exacerbation of multiple sclerosis. What health issues related to the patient's diagnoses could cause his sleep disturbances? A. Lack of a neurotransmitter associated with the multiple sclerosis diagnosis B. Pulmonary compromise due to recent pneumonia coupled with restless leg syndrome often associated with a multiple sclerosis diagnosis C. Low endurance often demonstrated wit multiple sclerosis patients coupled with electrolyte imbalances D. Side effects of his medications and being in the hospital for an extended period

B Reference: Recent pneumonia could result in increased secretions blocking airways. This interrupts breathing patterns, often causing the patient to be awakened. Posture and supine postures also lead to pooling of secretions that affect oxygen and carbon dioxide exchange resulting in abnormal breathing patterns. MS patients often demonstrate issues with restless leg syndrome, muscle twitching, or clonus. These are symptoms of their disease process.

Which of the following is included in the Americans with Disabilities Act of 1990? A. Prohibits discrimination against the disabled when they rent or purchase federally subsidized property B. Mandates relay services by telephone companies for patients who have telecommunication devices for the deaf C. Mandates the provision of funding for mortgage loans to developers to build housing for the elderly and the handicapped D. Mandates subsidized rent payments to low-income families

B Reference: The Americans with Disabilities Act of 1990 (effective June 26, 1993) mandates 24-hour relay services by telephone companies so that individuals with telecommunication devices for the deaf can communicate with those who do not have those devices.

The Americans with Disabilities Act of 1990 is an expansion of which previous law? A. Urban Mass Transportation Act of 1964 B. Rehabilitation Act of 1973 C. Housing and Community Development Act of 1974 D. Public Access Act of 1979

B Reference: The Rehabilitation Act of 1973 established new laws governing physical access to public accommodations operated by private entities. The Americans with Disabilities Act component that addressed public accommodations made virtually every entity open to the public accessible to individua

To prevent constipation, an individual with a central nervous system disorder is taught to use an appropriate chemical suppository or mechanical rectal stimulant, a consistent personalized schedule, and appropriate adaptive equipment. What type of central nervous system disorder is this individual likely experiencing? A. Traumatic brain injury B. Multiple sclerosis C. Parkinson's D. Spina bifida

B Reference: The interventions described are for an upper motor neuron injury. TBI is uninhibited, Parkinson's is other, and spina bifida is lower motor neuron.

In which rehabilitation team model is communication more vertical than lateral, with the leader controlling team conferences? A. Medical model B. Multidisciplinary model C. Interdisciplinary model D. Transdisciplinary model

B Reference: The multidisciplinary team is one that takes on a pyramid-like shape with a physician or nurse at the top. The leader controls team activities and communication is vertical. This model is effective when there are different team members for different patients.

A female patient suffered traumatic injuries from a diving accident, including an incomplete cervical spinal cord injury and a blow to the head resulting in brain injury. Currently confused and agitated, the patient requires maximum assistance by nurses and therapists to complete her activities of daily living and mobility tasks. What Rancho Los Amigos level of cognitive functioning best describes her current level? A. Level II B. Level IV C. Level V D. Level VI

B Reference: The patient is at a level IV (4) cognitive level of functioning on the Rancho scale. Patients at this level would be agitated throughout the day and demonstrate periods of confusion and often heightened state of activity marked without apparent purpose or upon request. This patient would require maximum assistance to perform ADLs. Rancho level IV patients can exhibit brief periods of crying out and demonstrate hostile behaviors. Verbalizations are often incoherent and inappropriate.

What should the rehabilitation nurse do prior to discharging an elderly patient with urge incontinence to the home environment? A. Advise the patient to reduce fluid intake to between 1,200 ml and 1,500 ml. B. Perform a home evaluation to ensure that obstacles are removed from the path to the bathroom. C. Encourage the patient to replace water with grapefruit juice for hydration. D Insert a Foley catheter.

B Reference: The rehabilitation nurse should discourage the use of fluids with diuretic, dehydrating, or irritating effects on the bladder such as grapefruit juice, tea, and coffee. A Foley catheter increases the risk of multiple urological complications and should be used only as a last resort. Falls are a potential consequence of incontinence and the home should be evaluated for potential environmental risk factors for falls.

Which of the following individuals would be protected under the Americans with Disabilities Act? A. A woman who has carpal tunnel syndrome and cannot type 30 words per minute(an essential function of the job) with or without reasonable accommodation B. A man who has AIDS and will raise the employer's health insurance premiums C. A woman with poorly controlled epilepsy who is applying for a job as a forklift operator D. A man with unstable angina who is applying for a job as a warehouse worker

B Reference: Under the ADA, an employer may legitimately refuse employment to an individual who (1) cannot perform the essential functions of the job with or without reasonable accommodation (2) would pose a direct threat to him/herself or others (3) cannot meet job prerequisites (except those that cannot be met due to disability). Higher health insurance or workers' compensation costs, in the absence of any of the above factors, are not sufficient justification for excluding a worker with a disability.

Types of hearing aids (Q132)

Behind the ear - Appropriate for profound hearing loss. Economical and powerful and easy to use. Body Hearing Aid - Appropriate for profound hearing loss. Requires a long wire and is not as cosmetically acceptable as other hearing aids. Has some high frequency response In-the-ear & In-the-Canal Models - Quite small, require good manual dexterity and intended for mild-mod hearing loss

Bowel training tips (Mometrix Q7/p 447)

Best time for scheduled evacuation: 20-30 min after meal. Same time daily; 3-4x per week Stimulants: Drinking hot liquids, rectal stimulation Best Position: Upright & leaning forward w/ knees elevated

Spinal Cord Injury (SCI) Classifications (Q75)

Brown-Sequard - Cord hemisected--->spastic paresis, loss of sense of position & vibration on the injured side; loss of pain and temp sensations on the unaffected side side Anterior cord - Complete paralysis below the injury. Patient will have sensations of touch, vibration and position below the injury but will not have sensation of pain or temp. Central cord - Results in quadriparesis w/ some loss of sensations of pain and temp. Fine motor skills are often impaired in upper extremities. Posterior Cord - Motor function is preserved w/o sensation

Religious considerations related to the Buddhist faith (Q76B)

Buddhists believe that mindfulness is very important and being awake and alert is essential. They often refuse pain medications to remain 100% alert.

Which of the following factors should be considered when deciding which ambulatory aid to use for a client? A. Physical therapy recommendations B. Patient's wishes C. Discharge destination D. Lower body strength

C

A male patient has had damage to his right parietal lobe as a result of a brain injury. He will probably have difficulty with which of the following activities? A. Hearing and responding to communications B. Standing and walking C. Finding his room D. Seeing items on a food plate

C Information about directions, spatial orientation, and body schema are processed in the right parietal lobe. A patient with a lesion in this area will often need assistance in geographic orientation, such as finding one's room.

Which of the following ascending spinal cord tracts is responsible for transmitting pain and temperature sensations? A. Anterior spinocerebellar tract B. Anterior spinothalamic tract C. Lateral spinothalamic tract D. Posterior columns

C Reference The lateral spinothalamic tract relays pain and temperature impulses from spinal cord segmental levels to the thalamus and cerebral cortex. - The spinocerebellar tract is responsible for transmitting impulses regarding body position. - The posterior columns convey impulses regarding touch, pressure, two-point tactile discrimination, and vibration. - The anterior spinothalamic tract transmits impulses regarding touch and some types of pressure.

What are the three phases identified by Kaplan (1990) as a triphasic model of human sexual response? A. Intimacy, self-esteem, and body image B. Psychogenic, reflexogenic, and emotional response C. Desire, excitement, and orgasm D. Fertility, reproduction, and ejaculation

C Reference Most sexual problems can be classified as desire, excitement, and orgasm phase disorders, or a combination of the three. The phases are a triphasic model identified by Kaplan. Psychogenic, reflexogenic, and emotional are responses but not the triphasic model identified by Kaplan

All members of the rehabilitation team work with the patient to set goals, provide treatment, and evaluate care and progress of the goals. Which model of care is the team practicing? A. Transdisciplinary B. Multidisciplinary C. Interdisciplinary D. Medical model

C Reference: - A medical model is a physician-centered model of care. - In a multidisciplinary setting, each discipline works toward specific goals with very little overlap between the disciplines. - In an interdisciplinary model, there is more collaboration, with both the patient and the team members working together to establish and implement goals. - In a transdisciplinary model, the patient has a primary provider who provides care for the patient based on advice and counsel received from the team.

One lump sum payment made to the provider for each patient's treatment during a month or year is referred to as which of the following? A. Prospective payment B. Fee-for-service reimbursement C. Episode-of-illness reimbursement D. Capitation payment

C Reference: - Capitation refers to a lump sum payment paid to the provider for a patient's treatment during a specific period of time. The payment rate to the health care facility is predetermined based on the diagnosis or treatment in the prospective payment system, regardless of the cost. - In fee-for-service reimbursement, the unit of payment relates to the visit or procedure. - In episode-of-illness reimbursement, the provider is paid one sum for all services provided during one illness episode.

In which of the following health care delivery models does a health maintenance organization contract with more than one physician group practice to provide services? A. Group model B. Independent practice association model C. Network model D. Staff model

C Reference: The network model allows referrals to a wider range of physicians and services than other health care delivery models. The group model, the HMO contracts exclusively with a group of physicians and separately with hospitals. The IPA, the fastest- growing model, enters into a contractual relationship with solo or group practitioners. The staff model type of HMO employs its own practitioners who are salaried.

A 70-year-old male diagnosed with stroke has no family support and is unable to live independently and meet his self-care needs. He cannot follow commands, has impaired cognition, is impulsive, and has experienced two falls. Which of the following settings and models of rehabilitation nursing community-based care is BEST for this patient? A Home health care B Independent living C. Long-term care D Subacute care

C Reference: A safe discharge setting for this patient is important to prevent falls and promote safety. Long-term care serves clients who are unable to live independently and meet self-care needs. This patient does not have the family support needed for home health care. He reached the highest level of independence and is not functioning at the independent living level. This patient also does not qualify for a standard subacute rehabilitation program.

Which of the following diseases is an acute inflammatory polyneuropathy with predominantly motor involvement that is caused by an autoimmune response? A. Multiple sclerosis B. Amyotrophic lateral sclerosis C. Guillain-Barré syndrome D. Parkinson's disease

C Reference: Guillain- Barré syndrome (GBS) is classified as an acute inflammatory polyneuropathy with predominantly motor involvement. It's an autoimmune response that is triggered by a viral or bacterial infection, systemic illness, or immunizations.

Which of the following strategies, when implemented prior to discharge, promotes communication, defines the roles of each party, clearly outlines expected outcomes, defines the limitations of care, and establishes home health care agency liability? A. Life care plan B. Discharge instructions C. Health contract D. Limited cost projection

C Reference: Health contracts can be effective for patients who are admitted into a home health care service but who wish to limit the care they receive. Establishing a contract enables all parties to address the issue of refusal of care before the care is initiated and to appropriately define the responsibilities of each care provider.

How does an independent living program support an individual with a disability? A. Provides 24-hour care in the home environment B. Integrates patients with multiple disabilities in one setting C. Allows patients to remain in their own dwellings while offering support services D. Provides caregivers as needed by the patient

C Reference: Independent living programs allow people with disabilities to remain in their own dwellings while offering, but not managing, provision of support services. Education and training are provided. The support services include, but are not limited to, advocacy services, peer counseling, training in communication techniques, etc.

Parasomnias such as sleepwalking and enuresis occur during which phase of sleep? A. Stage 1 B. Stage2 C. Stage 4 D. REM

C Reference: Parasomnias occur during stage 4 when the individual is most difficult to awaken.

Which of the following statements BEST depicts the relationship between physical and spiritual pain? A. There is no relationship between physical and spiritual pain. B. Physical pain can be felt by almost everyone, but spiritual pain is only felt by the religious. C. Physical pain often provokes spiritual pain. D. Lack of physical pain. generally means a lack of spiritual pain.

C Reference: Physical pain, especially that associated with long-term physical illness, can provoke spiritual pain as persons, families, and providers try to find meaning and hope in the suffering. Spirituality is not specific to those who profess a belief in religion and spiritual pain is not always connected with physical causes.

Which research design is considered the strongest and most rigorous design? A. Correlational design B. Nonexperimental design C. Experimental design D. Descriptive design

C Reference: Research designs are rated from lowest strength to highest strength based on a hierarchy scale. While correlational, descriptive, and nonexperimental designs can provide the structure for empirical evidence, the strongest design is experimental. Experimental design is considered the best- controlled and most effective way to test hypotheses.

Which statement is consistent with the principle of social justice? A. Distribution of health care is based on market demand. B. Acquisition of health care services is an individual responsibility. C. Equitable distribution of health care is a societal responsibility. D. Health care services are based on ability to pay.

C Reference: Social justice regards health care as a social good that should be collectively financed and available to all regardless of the ability to pay. Market justice views health care as an economic good with production and distribution determined by market-based demand. The individual's responsibility for health and medical care distribution is based on the ability to pay.

What is the first step in the PLUS decision-making model for ethical issues? A. Identify the alternatives. B. Evaluate the alternatives PLUS. C. Define the problem PLUS. D. Implement the decision.

C Reference: The PLUS (Policies, Legal, Universal, Self) Decision Making Model is an alternative model that ensures that ethical issues inherent in practice can be effectively addressed by all persons on the health care team. The first step is to define the problem PLUS.

Which member of the rehabilitation team has the PRIMARY responsibility for assisting patients in gaining skills for community reentry? A. Case manager B. Speech therapist C. Recreational therapist D. Music therapist

C Reference: The primary role of the recreational therapist is to address leisure pursuits and skills needed for successful community reentry.

What MUST be present for a patient to qualify for home health care under the Medicare program? A. Need for assistance with bathing B. Need for assistance with dressing C. Homebound status D. Physical disability

C Reference: To qualify under Medicare for home health care, the patient must be homebound. The individual must have a skilled need defined by requiring skilled assessments of a medical condition, teaching needs, injections, Foley catheter care, case management on a short-term basis, or wound care, physical therapy, speech therapy, or an ongoing need for occupational therapy once nursing, physical therapy, or speech therapy has established a plan of care.

What framework can be used to guide a quality improvement project? A. Rankin scale B. Functional Independence Measure instrument C. Plan, Do, Study, Act D. Modified Mann

C Reference: The PDSA - also known as Plan, Do, Check, Act (PDCA) - is one of the models used in performance improvement projects. Modified Mann is a dysphagia screening. tool. Rankin scale is a commonly used scale for measuring the degree of disability or dependence in activities for stroke p The Functional Independence Measure (FIM) measures severity of disability and the need for assistance (burden of care).

A patient is admitted to the unit with a spinal cord injury that is causing loss of motor power and sensory loss greater in the upper extremities than the lower extremities. What is the name of this spinal cord syndrome? A. Conus medullaris syndrome B. Anterior cord syndrome C. Central cord syndrome D. Brown-Sequard syndrome

C. Reference: Central cord syndrome is caused by damage to the central. part of the cord and produces loss of motor power and sensation that affects the upper extremities more than the lower limbs.

A 45-year-old male client was in a motor vehicle accident six weeks ago that left him with a C5-C6 spinal cord injury. A drunk driver ran a red light and hit the passenger side of the car, killing the client's wife and infant daughter. The client is experiencing daily nightmares, survival guilt, self-blame, and anger toward family and the staff. The client is suffering from which of the following? A Depression B Normal coping C. Posttraumatic stress disorder D Helplessness

C. Reference: PTSD is the state in which an individual experiences a sustained, painful response for more than one month to one or more overwhelming traumatic events that have not been assimilated. Assessment for PTSD is re- experiencing the event in one or more of the following ways: flashbacks, repetitive dreams or nightmares, excessive verbalization of the event, survival guilt, painful emotions, self- blame or shame, fear of repetition, angry outburst, reduced interest in significant activities, psychic or emotional numbness, and altered lifestyle.

A female patient had a videofluoroscopic swallowing evaluation, which allowed her to participate in the Frazier Free Water Protocol. What strategy will prevent the patient from aspiration pneumonia during the protocol? A. Chewing food slowly B. No talking while eating C. Good oral hygiene D. No straw with liquids

C. Reference: Three of the strategies are used by speech therapy to prevent pneumonia. The Frazier Free Water Protocol allows clients with dysphagia to drink water between meals provided the client practices good oral hygiene.

What level of SCI requires mechanical ventilation p. 243

C3 or above

Most common childhood disability p. 252

Cerebral Palsy - disorder of movement and posture caused by lesion in and mature brain occurring in utero or within the first 3 years of life. Types: Spastic - Most common; hyperactive reflexes, increased muscle tone, muscle spasm, motor weakness, persisted reflexes Dyskinetic - Abnormal involuntary movements, facial grimacing, dystonic moments, power speech, distorted posturing Ataxia - Hypotonia, floppy muscle tone, impaired balance, unsteady gate Mixed

Autism p. 253/ Mometrix p. 185

Characterize By: - Difficulties in social interaction (Avoid eye contact/touch) - Regressive language skills - Repetitive behaviors. - Sensitivity to light & sound - Insensitivity to pain - Contact activity

Technology dependence p. 254

Children who uses both a medical device to compensate for loss of a vital body function and substantial and ongoing nursing care to avert death. i.e. Children w/ teaches or GI tube or those who need home oxygen, mechanical ventilation, or other medical devices

Case Mix Group (CMG)

Classification system based on clinical characteristics of patients.

FIMS Scoring Criteria (Q36)

Complete Independence - can do task in normal canner Modified Independent - Pt requires use of an assistive device or requires more time than normal to accomplish. Supervision - someone needed to stand by or provide guidance in completing task Min Assist - Requires touching w/ pt providing >75% effort Mod Assist - Requires touching w/ pt providing 50-74% effort Max Assist - Pt provides 15-49% effort Total Assist- Pt provides <25% Assist. Pt cannot effectively participate

Hoff's Crisis Theory (Q52)

Considers those stress-related events that are turning points and can lead to danger or to opportunity.

Bristol Stool Chart (Q73)

Constipation = Types 1/2 Diarrhea = Type 7 Reflexic neurogenic bowel - Aim for #4 Arefexic Flaccid neurogenic bowel - Aim for #3

status epilepticus p. 686

Continuous seizure activity for > 30 minutes

Lydia Hall Care, Cure, Core Theory

Core = The patient Cure = Attention given to patient by medical professionals Care = Addresses the role of nurses, and is focused on performing the task of nurturing patients. Hall's theory emphasizes the total patient rather than looking at just one part and depends on all three components of the theory working together.

60% Rule (Formerly Known as the 75% Rule) ARN Gide p. 203

Criterion used to define IRFs; it requires that 60% of patients admitted to IRFs have 1 of 13 qualifying conditions: 1. Stroke 2. SCI 3. Congenital deformities 4. Amputation 5. Multiple Major Trauma 6. Hip Fracture 7. Brain injury 8. Neuro prob (MS, Parkinsons, Muscular dystrophy 9. Burns 10. Active polyarticular rheumatoid arthritis 11. Systematic vasculidities with joint inflammation 12. Severe or advanced osteoarthritis 13. Bilat Knee or Hip Replacement w/ BMI at least 50 or 85 years of age or higher

The rehabilitation nurse checks the eight rights of medication administration as well as two patient identifiers when giving medications every day. Which ethical principle is the rehabilitation nurse using during medication administration? A. Values B. Veracity C. Beneficence D. Nonmaleficence

D

Which of the following attributes or traits is a characteristic of a change- resilient person? A. Avoidance B. Distancing C. Cynicism D. Self-discipline

D Reference: Change- resilient people are positive thinkers with a sense of being in control. They are resourceful, focused, self-disciplined, flexible, and proactive. Traits that pose barriers to resilience to change are cynicism, distancing, and avoidance.

A nurse is facilitating a stroke survivor support group discussion. A patient's spouse asks about the best time to start having sex with his partner without causing a second stroke. What is the nurse's BEST next step? A. Refer the spouse to the patient's primary health care provider after discharge. B. Ask to speak with the patient's spouse in private after the support group ends. C. Defer the discussion with the spouse until the patient requests the information. D. Broaden the discussion to include other stroke survivor group members.

D Reference: Fear of having (or causing) a second stroke is very real in stroke survivors and their partners. Sexuality and sexual functioning are very human needs. While referring questions to a primary health care provider is an option, rehabilitation nurses play a major role in educating clients and their families about the effects of injury or illness in the sexual functioning of a patient. By broadening the discussion to include other stroke survivor group members, the nurse is allowing common questions and fears to be raised and giving permission to the group to talk about the subject. Limited information such as written material on sex education websites and positioning could be a second step as the discussion progresses and group members indicate their comfort level with the topic. Should a group member indicate discomfort, the facilitator should make arrangements to continue the discussion on an individual basis. Deferring the discussionwith the spouse ignores treating the family as a whole and should be avoided.

A female patient has recently had a right hemisphere stroke. It is likely that the patient's extremities will tend to be positioned in which of the following patterns? A. Upper extremity flexion and abduction with lower extremity flexion B. Upper extremity flexion and adduction with lower extremity extension C. Lower extremity flexion and upper extremity flexion and abduction D. Both upper and lower extremity extension and adduction

D Reference: Flexion and adduction of the upper extremities and lower extremity extension are commonly seen in

What is the physiologic cause of sleep disturbances among patients who are diagnosed with myasthenia gravis? A. Chemical imbalance A involving the basal ganglion and midbrain B. Interruptions in the neurotransmitter acetylcholine C. Congestion and pooling of secretions leading to reduced air exchange D. Skeletal muscle weakness leading to apnea and sleep disturbances

D Reference: Myasthenia gravis is an autoimmune disease process that impacts voluntary muscles. Skeletal and intercostal muscles are necessary to expand and relax the thoracic cage. Without this exchange, breathing slows, periods of apnea result, and the patient becomes restless.

What is ONE of the overall purposes of spirituality? A. To guide adherence to a particular religion such as Catholicism B. To assist individuals in times of great stress and help them adjust to change C. To provide a framework to determine moral action and consistent values D. To help people develop a cohesive view of their lives from which they derive meaning.

D Reference: One of the overall purposes of spirituality is to help people develop a cohesive view of their lives from which they can derive meaning. Spirituality is not only for when an individual has high stress nor is it solely to determine moral actions.

A male patient has had a stroke to his right hemisphere resulting in a left homonymous hemianopsia. What appropriate intervention will the rehabilitation nurse identify and implement to address the spatial and perceptual deficits? A. Place objects directly in A front of the patient to call attention to them. B. Place objects on the right since the patient can see them much better from that angle. C. Cue the patient to his deficits and remind him to use his right hand at all times to maintain safety. D. Place objects on the patient's left side past midline to encourage him to scan to the left.

D Reference: Patients with damage to the right side of the brain often suffer from a perceptional disorder known as left homonymous hemianopsia, which prevents the patients from seeing objects placed on the left side of their body. A rehab strategy to get these patients to "scan" their environment is to place objects on their left side and cue them to their presence. Encouraging patient to look left. Place patients so they must look left to see visitors or health care workers enter the room teaches them to "accommodate" and address their deficit. Rehab team members should always use simple one-step commands when working with those with sensory and perceptional impairment.

Patients with which of the following diagnoses would be likely to have restrictive lung disease? A Aspiration pneumonia B Parkinson's disease C Chronic bronchitis and emphysema D High-level spinal cord injury

D Reference: Persons with a spinal cord injury have restrictive lung disease because there is an interruption of nerve impulse conduction from the cerebral respiratory centers to the muscles involved in breathing. This restricts lung expansion and decreases lung volume and capacity. Breaths are shallow, weak, frequent, and often uncoordinated.

What is the nurse's PRIMARY rationale for addressing polypharmacy in elderly patients? A The cost of medications B. The lack of patient transportation C. The burden on the caregiver D. The increased risk of adverse drug events

D Reference: Polypharmacy in the elderly increases the risk for adverse drug events, a negative outcome to care. While polypharmacy can be expensive, require more time for the caregiver, or require transportation, an adverse drug event can be life-threatening.

A patient has a Rancho Los Amigos level III traumatic brain injury. Which characteristic would you expect to see from this patient? A. Absence of short-term memory B. Inability to cooperate with treatment efforts C. Inability to learn new information D. Inconsistent response to simple commands

D Reference: Rancho level III patients have localized responses, including responding inconsistently to simple commands.

Rebound occurs when an individual spends insufficient time in certain stages of sleep. For which of the following stages is rebound an IMPORTANT concept? A Stage 1 B Stage 2 C Stage 3 D Stage 4

D Reference: Rebound occurs when an individual is deprived of Stage 4 sleep. If an individual is denied Stage 4 sleep, he or she may demonstrate withdrawn behavior with vague somatic complaints. Rebound also occurs when individuals are deprived of REM sleep.

Self-efficacy is an important concept in relation to changing health behaviors. Which of the following statements BEST describes self-efficacy? A. The feelings one has about his or her physical self B. The amount of ambition a person has C. The degree to which someone has met his or her life goals D. The degree of confidence a person has about his or her ability to perform a specific activity

D Reference: Self-efficacy is the confidence a person has about being able to perform some activity. Self-efficacy is usually referred to in relation to individuals believing that their behaviors can make a difference in their health status.

A patient on the rehabilitation unit refuses to go to therapy on Saturday. The patient tells the nurse that in his religion, Saturday is a holy day and he does not work on the Sabbath. The nurse is perplexed because she knows that the patient is not Jewish. Which Christian sect maintains Saturday as the holy day? A. Methodist B. Christian Scientist C. Jehovah's Witness D. Seventh Day Adventist

D Reference: Seventh Day Adventists believe that Saturday is the seventh day of the week and the day upon which God rested. They maintain Saturday as the holy day.

Who is responsible for developing, implementing, documenting, and evaluating the treatment plan? A. Nurse B. Physician C. Social worker D. Interdisciplinary team

D Reference: The interdisciplinary team is responsible for setting up, evaluating, and carrying out the treatment plan. This is generally done at team meetings where members will report from a discipline perspective and then collaborate with team members in establishing a plan of care.

A male patient was admitted with multiple injuries and a severe concussion from a motor vehicle accident 10 days ago. He has been reported by therapy staff as sleepy and often drowsy during therapy sessions while nursing staff has reported that he is awake most of the night. He is confused. In which part of the brain is this patient displaying brain injury? A. Pituitary gland B. Frontal lobe C. Thalamus D. Hypothalamus

D Reference: The sleep and wake cycle is integrated into a 24-hour cycle known as a circadian rhythm. This activity is controlled by the hypothalamus.

What is the MOST appropriate intervention for a traumatic brain injury patient experiencing syndrome of inappropriate antidiuretic hormone secretion? A. Monitor for dehydration. B. Review medications. C. Perform a bladder scan. D. Limit fluids intake.

D Reference: Traumatic brain injury patients may experience an excess of antidiuretic hormone (ADH), which is called SIADH. Therapeutic modalities for the treatment of SIADH include nonspecific measures and means (fluid restriction, hypertonic saline, urea, demeclocycline), with fluid restriction and hypertonic saline commonly used.

Dysarthia Mometrix Q129

Damage to motor neurons responsible for lip, tongue and vocal cord control causing leading to difficulty forming words and speaking

Spinal nerves at which level are responsible for man to have an erection Mometrix Q 64

Damage to sacral nerves 2-4 can result in man being unable o attain an errection. Difficult or impaired response can occur with any injury that occurs at T11 and below.

Data presentation tools (Q33)

Dashboard - Easy to access & read computer program that integrates a variety of performance measures or key indicators into one display (usually graphs or charts) to provide an overview of an organization. Flowchart - Quality improvement tool used to provide a pictorial/schematic representation of a process Ishikawa "fishbone" diagram - Analysis tool to determine causes and effects. In performance improvement, it is used to help ID root causes. Balanced Scorecard - Based on the strategic plan & provides performance measures in relation to the mission and vision statement and goals and objectives

Posturing: Decorticate vs. Decerebrate

DeCortiCate Problems w/ spinal cord or cerebral hemisphere Arms are like Cs and turn towards the spinal cord (Flexor) DEcerEbratE Problem w/ pons or midbrain Arms are like Es. (Extensor)

Activity/task analysis steps (Q 27)

Definition: The breaking down and identification of the component parts of an activity/task 1) Determine the tasks patient does or needs to do 2) Divide activity into parts - so the patient can master task a little at a time. 3) Divise methods to assist patient master task 4) Determine Desired outcomes Flowcharts, outline or checklists can be used to guide therapy & divise strategies to help pt master steps

Ethical theory that refers to the duty of a nurse to provide care to patients because it is ethically correct. (Q16B/Mometrix Q161)

Deontology. This theory states that actions should NOT be judged on their outcome, but rather their intent. If an action is performed with good and honest intentions, it should be assessed based on that intent rather than a possible poor outcome Websters: de·on·tol·o·gy the study of the nature of duty and obligation.

Organization that provides health care providers with the National Guidelines Clearinghouse, which is a public resource for evidence-based practice guidelines for a multitude of diagnosis. It also provides health care providers with various aspects of the nursing process within the diagnosis. (Q9B)

Department of Health and Human Services

Theory of Integral Nursing (Dossey)

Developed to support the practice of holistic nursing

Defense mechanisms (Q88)

Displacement - when someone who is angry w/ one person directs anger towards another Compensation - when a person with a real or perceived weakness in one area compensates by developing skills in another. Denial - Occurs when one person refuses to acknowledge a situation or feelings Projection - When a person projects his feelings onto another person

Types of Massage Therapy (Q1)

Effleurage - Begins softly & increases in intensity. Palm of hands glidesover the tissue, in rhythmic, broad strokes. Trigger Point -Pressure is applied w/ the finger or the thumb to areas or points of tenderness to reduce spasticity and pain. Petrissage - Kneading massage usually used on large muscle areas, such as the calf or thighs, to increase circulation. Friction - Massage in line w/ muscle fibers or across the muscle fibers to stretch and reduce adhesions or scarring

Disability Theories (Q54)

Enable patients with physical/emotional impairments is to enable the individual to live and function as close to "normal" as possible, viewing impairments as an illness or a problem that requires correction.

life review and reminiscence p. 285

Ericson's stage for older age, ego integrity vs despair suggests older adults need to feel that their lives have purposed meaning. Rehab nurses can use reminiscence therapy to help older adults recall positive memories that an be shared & discussed.

Theorist who suggested interactions between caretaker and child are essential to healthy phycological growth

Erikson believed there are 8 psychosocial stages 1) Trust vs. mistrust (infancy) 2) Autonomy vs shame and doubt (toddler) 3) Initiative vs. guilt (preschool) 4) Industry vs inferiority (school age) 5) Identity vs. role confusion (adolescence) 6) Intimacy vs isolation (young adult) 7) Generativity vs stagnation (middle age) 8) Integrity vs. despair (older adulthood)

Cardiac Rehab (Mometrix Q3/Q19)

Essential Elements of Program according to the United States Public Health Service: Evaluation - Complete medical assessment & diagnosis Exercise - Individually designed and based on diagnosis and exercise testing. ECG monitoring may be used Education - Should be continuous Counseling - Critical to helping patient cope w/ physical/emotional stress Short Term Goals: - Reduce risk of reinfarction - Manage/control symptoms - Reduces psychological stress Long Term Goals: - Reversing or stabilizing atherosclerosis thru meds, diet exercise - ID & treat risk factors to prevent further CV disease

The Quality & Safety Education for Nurses Initiative Momentix Q169

Established in 2005 to prepare future nurses for the challenge of improving healthcare settings where they work. Provides nurses with knowledge, skills and attitudes (KSAs) needed to accomplish this goal

Shaker Exercise (Q137B)

Exercise used to improves swallowing ability by increasing top of esophagus. The patient lies flat on back on a supportive surface and lifts the head high enough to see the feet and then lowers the head and repeats. - Should be performed 3-6x/day for 6 weeks

FLACC Scale

Face Legs Activity Cry Consolability

Presbyopia

Farsightedness or trouble focusing on near objects

Medicare Part A (p. 198)

Federally funded hospital insurance plan financed through the CMS Hospital insurance Trust Fund by taxes paid by employers and their employees. Managed by CMS Eligibility: - Age 65 and older and if they or their spouses are eligible for SSI benefits, have made payroll tax contributions for 10 years or more (40qtrs), and are a us citizen **people 65 or older who are not entitled such as those who did not pay enough taxes during their working years, can pay a monthly premium to receive part A benefits and will also be eligible to enroll in part B. - Ends-stage renal disease or Lou Gehrig's disease as soon as they begin receiving SSDI payments - Have been disabled for 2 years or more and recieving SSDI for 24 months Covers: hospitalization, home health (skilled care only), hospice, short term SNF stays after a 3-day hospital stay, hospice care, durable medical equipment Does not cover: Custodian care Cost: No monthly premium, but there are deductibles Benefit Period: Ends 60 consecutive days after no hospital or SNF care. There is no limit of benefit periods per year, so costs may be higher for patients

Requirements to apply for Social Security Disability benefits (Q72)

For patients ages 31 or >-->recent work must includes 5 of last 10 years years ending with the quarter disability occurred. For Patients ages 24-31--->pt must work 1/2 of the time from the quarter pt turned 21 until the quarter of the disability For Patients disabled < 24-->work history includes 1.5 years during 3 year period.

Maslow's Hierarchy of Needs Theory

Human behavior is motivated by needs and there is a hierarchy of needs that begins with the basic needs and progresses to personal needs. **Mneumonic - Please Stop Liking Everyones Stuff

Time Limits for Worker's Compensation (Q117)

From 30-90 days in most states but up to 5 years in Ca. Exemptions to this time limit may be given for illness or injury that is so severe the person is unable to apply. This can include severe injuries that require immediate or extended hospitalization (such as burns), contagious diseases that require that the person remain isolated or quarantined (MRSA or TB)

Orthodic classifications (Q101)

Functional (including drop splint)- Provides stabilization for a joint and promotes function. Corrective - Used to repair/correct deformities Supportive - Supports the joint/body parts in anatomical position Protective - Prevents injury during healing while maintaining anatomical position.

Supplement alternative to gabapentin

GABA

Pain Theories

Gate Control Theory - the most widely accepted theory of pain. States that there are small fibers controlled by larger fibers which are responsible for communicating signals to the spinal cord. Specificity Theory - states that signals are sent to a specialized "pain center" Intensive Theory - states that pain is an emotion that occurs when a stimulus is stronger

Consolidated Omnibus Budget Reconciliation Act (COBRA) p. 205

Gives you the option to continue your health care coverage up to 18 months after voluntary or involuntary termination of employment as long as you pay the entire premium.

Global Aphasia (Q3)

Global Aphasia is asociated w/ left sided strokes and includes both expressive aphasia (inability to form words) & receptive aphasia (inability to comprehend spoken words). - Best method of communication: use of gestures & pictures. - Patients with expressive aphasia may benefit from repetition of sounds or words. (Brocca's area in the postural frontal lobe) - Patients with receptive aphasia may have some understanding if speech is slow and clear. (Wernicke's area in the temporal lobe)

Worker's Compensation (p. 200)

Government sponsored & employee-financed system to compensate employees injured on the job. Program administered by the state. Coverage: Medical care, disability payments, rehab, survivor benefits & funeral expenses, vocational rehab Eligibility: Workers disabled by and injury or families of a worker whose death arose on the job.

Housing option for people with disabilities (Q21)

Group Home - Group of individuals w/ similar disabilities, such as TBI or developmental disabilities live together w/ 24-hr supervision and often w/ an aide to assist w/ meals & other ADLs. Sizes vary but most have 4-6 residents.

Device used to treat C1-C2 fractures (Q142B &Q144B)

Halo device used to treat unstable cervical and upper thoracic fractures and dislocations from C1 - T3 The device controls rotation and lateral bending at C1-C3.

World Health Organization (WHO) key terms related to disabilities (Mometrix Q1)

Handicap - Limitations & disadvantages resulting from an impairment or a disability that interfere with social functioning and ability to fulfill normal roles (i.e. ability to be employed) Pathology - The underlying disorder (i.e. severing of spinal cord) Impairment - Loss of function or structure related to physiology, anatomy or psychology and is observable. Occurs at the organ level (.i.e hemiparesis or diabetes) Disability - Limit on function imposed by the pathology and impairment (i.e. inability to walk unassisted)

Medicaid (p. 199)

Health insurance for low income individuals & families managed by the state, financed through federal-state partnership with oversight by the Centers for Medicaid Services (CMS) The federal government matches state spending. To be eligible for federal funds, states are required to provide coverage to mandatory groups Mandatory Groups: - Families w/ limited income w/ children who meet eligibility requirements in the state's Aid to Families w/ Dependent Care Plan - Adults w/ disabilities Optional Groups: -Pregnant women, children & parents w/ incomes that exceed mandatory thresholds - Older people who are disabled and earn up to 100% of the federal poverty level - Working disabled people who earn up to 250% of the federal poverty level - People in nursing homes w/ incomes < 300% of SSI - Patients who would be institutionalized but who are receiving care under home and community based service waivers. Coverage: Include long-terms care, mental-health care and services and support for people with disabilities. Eligibility: - U.S. Citizen or Certain lawfully residing immigrants

Fitting patient for different transfer assistive devices (p. 169)

Hemiwalker - used for patients who hav use of only one upper extremity Canes held on opposite of the affected lower extremity. Elbows should be flexed 20-25 degrees Axillary crutches - Fit confirmed by having patient stand while grasping the hand pieces and placing the crutch tips 4-6 inches in front of the tip of the shoe. There should be 2 inches (2 fingers) between the top of the axilla rest on the crutch and the patient's axilla

Group types (Q143)

Homogeneous - Chosen on a selected basis, such as abused women Heterogeneous - An assortment of individuals w/ different diagnosis, ages, and genders Mixed - A group that shares some key features such as the same diagnosis but different in age or gender. Closed - A group win which new members is are excluded Open - A group in which members and leaders may change

Difference between palliative care and hospice p. 286

Hospice - Prescribed by a physician for its who are terminally ill and have 6 months or less to live. Promotes concept of "living until you die" - Provides pain management - Provides bereavement svs for family after death Palliative Care - Can occur in many settings and clients do not have to be terminally ill to benefit - Comprehensive care for the discomfort, symptoms, and stress of serious illness - Clients can receive treatment for conditions and still receive palliative care.

Freud's Self Concept Theory Mometrix Q125

How we think of ourselves and how we should think, behave and act out our various life roles. 1. Self-concept is learned. Self-concept is believed to develop as a person grows old. Our perceptions towards our selves can be shaped and can be altered. A person may have a perception of himself different from what other people thinks of him. For example, an individual feels that he is generous while others see him as a selfish person. 2. Self-Concept is organized. A person may have numerous views of himself. He may think that he is kind, patient, loving and caring, or selfish, cruel, rude and stubborn. No matter how many different perceptions you have on yourself, still, there is one perception that facilitates all of these insights, causing one organized self-concept. 3. Self-concept is dynamic. It is constantly changing based on our experiences.

Theorist who first proposed the idea of "transcultural nursing" (Q7B)

Madeline Leininger

Cranial Nerves

I. Olfactory nerve (S) - Smell II. Optic nerve (S) - Visual Acuity III. Oculomotor (M) - Eye movement/pupil dilation IV. Trochlear nerve (M) - Vertical eye movement V. Trigeminal nerve (B) - Facial Sensation (S)/Facial expression/mastication(M) VI. Abducens nerve (M) - Lateral movements of eye VII. Facial nerve (B) - Taste(S)/Facial expressions(M) VIII. Vestibulocochlear nerve (S) - Hearing and balance IX. Glossopharengeal nerve (B) - Taste (S)/Swollowing (M) X. Vagus nerve (B) - Throat sensations (S)/Vocal Chords (M) XI. Spinal accessory nerve (M) - Head & shoulder movement XII. Hypoglossal nerve (M) - tongue movements Mnemonic - Oh Oh Oh To Touch And Feel Very Good Velvet So Heavenly Mnemonic to remember whether the cranial nerves' functions are sensory, motor, or both - "Some Say Marry Money But My Brother Says Bad Boys Marry Money".

IMPACT Act of 2014

IMPACT = Improving Medicare Post-Acute Care - Quality initiative requiring standardized of data by LTCHs, SNFs, HHAs and IRFs. Standardized data to be collected by the commonly used assessment instruments: - The Long-Term Care Hospital CARE Data Set (LCDS) for LTCHs - The Minimum Data Set (MDS) for SNFs - The Outcome and Assessment Information Set (OASIS) for HHAs - The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI) for IRFs

Erickson's initiative vs guilt stage of development (Q54)

In this stage of development, children enjoy initiating play actives by they also become more independent and show initiative, which can include resisting activities they don't enjoy

ataxia

Inability to perform complex movements, especially as a result of damage to the brain.

Aparaxia Mometix Q129

Inability to perform specific functions or movements due to paralysis

Neuro Levels & Functioning potential of patient w/ S1-S5 Injury p. 534

Increased ability to walk w/ fewer braces or no support devices

BiPAP (Bilevel positive airway pressure) indicated for what type of apnea (Q28)

Indicated for patients w/ central sleep apnea, COPD and obesity hypoventilation syndrome.

Teaching strategies for major developmental stages (p. 122 ARN guide

Infant to toddler: - Focus teaching on caregiver - Encourage play and manipulation Early Childhood (3-5) - Separation anxiety/Need to build trust - Play is the child's work/ Use play therapy Middle to late childhood (6-11) - Wants concert info/Allay fears and be honest - Encourage active participation and independence - Use analogies Adolescence (12-19) - Motivated by social acceptance/Use peers for support & influence - Strong preoccupation with appearance - Ensure confidentiality and privacy Older Adulthood (65 and older) - Sensory changes (reduced vision and hearing especially high pitched noises)/ Avoid shouting, Used visual aides, provide sufficient light, use white backgrounds with black lettering, avoid pastels blues, greens, purples and yellows.

How can you minimize contractures?

Maintain a regular program of passive stretching of muscles and joints, walking, splinting, and proper positioning. Avoid static positioning.

Type of therapy most appropriate therapy for patients with diabetic peripheral neuropathy and reduced sensation in hands & feet. (Q9)

Injuries are common w/ neuropathy d/t reduced sensation. OT - Assists pt w/ home safety & self care issues such as wearing properly fitting shoes, checking skin, ambulating safely, cooking modifications, & housecleaning

BiPAP Settings (Q78)

Inspiratory Positive Airway Pressure (IPAP) is set higher than Expiratory Positive Airway Pressure (EPAP)

State Children's Health Insurance Plan (CHIP) p. 200

Insurance plan for children & families w/ incomes too high to qualify for Medicaid but too low for them to afford private insurance; jointly financed by Federal and State. Eligibility: States set the eligibility criteria

Types of Outcomes Data used in evaluating evidenced based practiced (Q59)

Integrative - Includes measures of mortality, longevity, and cost effectiveness Clinical - Includes symptoms, diagnoses, staging of disease, and those indicators of individual health Physiological - Includes measures of physical abnormalities, loss of function, and ADLs Psychosocial - Includes feelings, perceptions, beliefs, functional impairments, and role performance. Perception - Patient perceptions, evaluations and satisfaction Organizational-wide clinical - Includes readmissions, adverse reactions and dates

Worker's Compensation (Q10)

Intended for those who are injured on the job. It provides 3 types of benefits: 1) Cash to replace lost wages 2) Reimbursement for medical costs 3) Death benefits to survivors. **Focuses on returning people to work as quickly and safely as possible.

Imogene King's Open Systems Model/Goal Attainment Theory Mometrix Q51

King's conceptual system is based on the assumption that human beings are the focus of nursing. ... King states that, "nursing's domain involves human beings, families, and communities as a framework within which nurses make transactions in multiple environments with health as a goal". This system Involves three interacting sets of systems. The Personal Systems-->Comprised of individuals (nurses or patients) The Interpersonal Systems-->Comprised of small groups (family or when nurse interacts w/ patient) Social Systems-->Comprised of of a large group (i.e. and organization or a hospital) King's Theory of Goal Attainment states that "Nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perception in the nursing situation.

The temporal region of the brain controls what (Q50B)

Language comprehension and processing of sensory input. Patients may exhibit symptoms of dysnomia (difficulty remembering names) & comprehension difficulty.

Los Amigos Video https://www.youtube.com/watch?v=PcKt3Eir0Gk&feature=youtu.be

Levels 1-3 (requires total assistance) Level 1 - No response/Sleeping Level 2 - Generalized response to pain Level 3 - Localized response (turn to away from painful or auditory stimulation Levels 4-6 (Patient confused/very little learning occurs) Level 4 - Confused/Agitated/max assistance (how would you feel if you woke. up and had not idea where you were) Level 5- Confused/in appropriate behavior but not agitated (wandering/inappropriate use of objects)/max assistance-Can do highly familiar tasks w/ max assistance Level 6 - Confused/appropriate behavior/Mod assistance Levels 7-8 (Patient able to have new learning) Level 7 - Attention/Can perform tasks w/ min assistance

Ataxia Mometix Q129

Loss of body control

General guidelines for Renal Diet Mometrix Q69

Low Sodium Low Phosphorus, Low Potassium and Low Protein With renal disease, kidneys are not able to excrete potassium adequately, so it should be limited from the diet. They also retain phosphorus when they are not working properly which can lead to calcium bing pulled from the bones

Appropriate rehab exercises for patient with right sided hemiparesis (Q13)

Massed practice exercises w/ frequent repetition and assistance to cary out tasks. - Different techniques include: constrain-induced movement therapy, adaptive task practice (shaping), active assist, body weight supported treadmill training and robot assisted training - Based on the on the concept of neuroplasticity - the ability of the CNS to form new neural connections or repair damaged ones through axonal sprouting. - Neuroplasticity depends on neural stimulation through motor activities.

Nero Levels & Functioning potential of patient w/ L1-L5 Injury p. 534

May be able to walk w/ braces Memory Aid: Jenn's step brother was in a car accident and fractured his spine at L1. He walks with braces & a cane

long-term care insurance. p. 293

May cover an or all of at the following services: Assisted living Hospice Home Health Adult Day Care Respite Care Caregiver training - Premiums range from $1000 to $2650 per year

What is a performance measure

Measuring the quality and safety of care delivered by a clinician or team of clinicians.

Resource available to patients who can not afford insurance (Q118)

Medicaid - Federal/State welfare program to assist low income patients pay for medical care. Provides assistance to all ages.

Models of Care

Medical Model - Physician Centered. Uncommon in rehab setting Multidisciplinary Model - Professionals work in tandem; each discipline works toward client goals w/ very little overlap between disciplines. Communication is more vertical than lateral. This model is effective when the team is not stable (e.g. when there are different team members for different clients) Interdisciplinary Model - Uses a more collaborative approach. Temp work together in setting goals, providing treatment and making decisions. Transdisciplinary Model - Client has a primary provider from the team who is guided by the team in caring fo the client. This requires team members to be trained in disciplines in addition to their own. It might be suited for situations in which the client is stable and in need of long term services.

Medicare Part C (p. 198)

Medicare Advantage program allows beneficiaries to enroll in private health plans. Covers: Provides hospital hospital and physical coverage. Often includes prescription drug coverage and is and alternative to Parts A, B, D Costs - Average $65

Payment Systems (Q30)

Medicare's Prospective Payment System (PPS) - Pays a set amount for patient care depending upon the diagnosis-related group (DRG) to which the pt is assigned. Pay-for-service Plans - Contracted by medicare w/ private insurance companies and may provide MORE benefits for patient but pt may be required to work directly w/. the company to determine benefits and may be charged and additional monthly fee. Medicare Managed Care - Provided by a health maintenance org (HMO) which receives payment for svcs rather than the traditional pay-for-svc Medicare payment system

Cognitive Assessments (Q5 & Mometrix p. 197)

Mini Cog - requires person to remember and later repeat names of 3 objects & to draw a face of a clock with all 12 numbers and 2 hands indicating a specific time. Mini Mental State Exam (MMSE) - Requires a number of tasks including counting backward from 100 by sevens, providing current location, repeating phrases, following directions and copying a picture of interlocking shapes. Patients over age 60 and those with a low education level are shown to score lower on the test then others. Instrument of Activities of Daily Living (IADL) - Scale measures 8 activities necessary for adults to function independently. Confusion Assessment Method - Used to assess for the development of delirium

Scale for measuring degree of disability or dependence in activities for stroke patients p. 492

Modified Rankin Scale

Scale to measure a patients near deficits following a stroke p. 492

NIHS Scale

Types of Cost (Q113)

Nonconformance Cost - costs related to errors, failures, and effects. May include adverse events (infections), poor access due to staffing shortages, duplications of service or malpractice. Error-free Cost - Costs of processes, services, equipment, time, materials and staffing necessary to providing product or processes that is without error. Conformance Costs - Costs elated to preventing errors such as monitoring and evaluation. Indirect Cost - Shared costs such as custodial services

Ethical Care Principals (Q68)

Nonmaleficence - Do no harm Beneficence - Performing actions that benefit another person Autonomy - Individual has right to make decisions about his care. Justice - health care benefits distributed fairly among members of society. Veracity - Honesty

Participants in health care have combined widely shared human beliefs about health and illness into four major ethical principles. What obligation requires health care providers to help people in need?

Nonmaleficence is the duty to do no harm Autonomy is the right to choose and follow an individual plan of action Justice is the concept of treating everyone in a fair manner.

Medical home. p. 238

Not a building, but an approach to providing comprehensive primary care. Pediatric health care professionals and parents act as partners to ID and access all medical/nonmedical services so patient can reach maximal potential. It is usually part of a pediatric primary care provider's office providing preventive care, acute illness management & chronic condition management

Appropriate interventions for toddler with spastic cerebral palsy who is having feeding issues and failing to thrive (Q11)

Nutritional management strategies are important to helping parents ensure that child has adequate nutrition which includes: - Position child upright for feedings - Place foods toward back of mouth to overcome tongue thrusting - Use soft or blended foods - feed slowly allowing extra time between bites for chewing - Use of adaptive equipment

Orthostatic hypotension (OH) following a SCI p. 671

OH = Decrease in systolic BP of at least 20 mmHg or a decrease in diastolic BP of at least 10 mmHg when a person moves from supine to an upright position - Loss of reflex vasoconstriction, lack of muscle tone in the lower extremities and the effects of gravity cause excessive blood pooling in the abdominal viscera and lower extremities. - OH is more common in tetraplegia than paraplegia - With SCI, continuous hypotension can result in pressure ulcers from reduced tissue perfusion Interventions - Apply abdominal binders to reduce thoracic venous pooling. Apply tight enough to exert gentle pressure while lying flat in bed, in the morning and remove when lying supine. - Apply compression stockings to improve venous return - Encourage adequate fluid intake to increase blood volume - Use elevated leg rests and partially reclined chair backs. - Monitor closely when showering when compression devices are off and warm water dilates blood vessel-->pt may need bed bath

CPAP (Continuous Positive Airway Pressure) indicated for what type of apnea (Q28)

Obstructive Sleep Apnea (OSA). **Most patients w/ OSA initially use a CPAP but if high pressure is needed, pt may have difficulty w/ expiration & may have air leaks, mouth leaks and difficulty tolerating treatment. Patients who are unable to tolerate the CPAP may use the BiPAP

Long-Term Care Ombudsman Program (Q53)

Ombudsmen provide services to residents of nursing homes & other long term care facilities and to ensure the care meets state standards. Ombudsman representatives attempt to help patients resolve issues, such as those involving. care, diet, conflicts, meds, hazards, and poor treatment or lack of respect.

Primary purpose of tracking and trending to develop evidence based training (Q104)

Once processes & outcomes measurements are selected, then at least one measure should be tracked for a number of periods of time, usually in increments of 4 weeks or quarterly. This tracking can be used to present graphical representation of results that will show trends. Although trends will show normal variation, if the trend becomes erratic & measures are inconsistent, this suggests that the processes of care are not consistent or are inadequate.

Swallowing phases (ARN guide p. 357)

Oral prepatory Oral Pharyngeal Esophageal

Types of Dysphagia (Q51)

Oropharyngeal Dysphagia - commonly occurs after a CVA or other neuro impairment b/c damage to nerves and muscles in the throat. Swallowing that results in coughing or choking Esophageal Dysphagia - Can occur w/ many disorders such as GERD, scleroderma, esophageal tumors and spinal injuries @ the thoracic level. Pts complain of food sticking in the mid chest. Functional Dysphagia - diagnosed when no cause can by found. Cognitive impairment - Can result in impaired swallowing, usually oropharyngeal dysphagia.

Medicare Part D (P. 198)

Outpatient prescription drug coverage offered though private companies. If beneficiary does not join when first eligible there could be a late enrollment penalty. Covers: Varies depending on plan

Ex-PLISSIT Model of Sex Therapy (Q92)

P - Permission giving. **This is a core feature. The CRRN asks permission before each stage and reviews previous interactions, encouraging reflection Li - Limited info SS - Specific Suggestion IT - Intensive therapy

Wong-Baker Faces Scale

Pain scale used with children that employs 6 faces to describe how a child is feeling. The FLACC pain scale is another pain scale used for children who are unable to verbalize their pain.

Components of a sleep diary(Q16)

Patient keeps record of sleep habits for a 2-wk period preceding the test. The record has two components: 1) Before sleep - patient rates mood using a 1 (Bad) - 5 (Excellent) scale, noting any medications taken and time that the lights were turned off. 2) Upon Waking - Patient estimates time it took to fall asleep and # of arousals . Patient again rates mood from 1-5.

With patients who have SCIs T6 and above, what special consideration must you take?

Patients with SCIs T6 and above, they unable to thermoregulate, meaning they do not have the ability to shiver or sweat, so they must be very careful in extreme heat or cold as it may lead to hypo/hyperthermia.

Area of spinal cord that affects functionality to the bladder (Q31B)

Peripheral nerve T12 provides functionality to the sex organs, uterus, bladder, prostate, and large intestine

Methods to promote phase delay/advancement (Q79)

Phase Delay - Expose patient to light immediately before time of minimum body temp (0300). Avoid early morning light and/or wear sunglasses and seek bright light in the evening Phase Advancement - Expose to light after the time of min body temp. Walk outside in sunlight after awakening and avoid bright light in the evening. Melatonin supplement

Explain how physical and spiritual pain are related

Physical pain, especially that associated with long-term physical illness, can provoke spiritual pain as persons, families, and providers try to find meaning and hope in the suffering. Spirituality is not specific to those who profess a belief in religion and spiritual pain is not always connected with physical causes.

What does the Ransford Scoring System rate (Q149)

Physiologically improbable/impossible pain, especially low back pain.

Models for Performance Imrovement (P. 105 ARN guide)

Plan, Do Check Act Approach a. Plan what you want to accomplish b. Do what you planned to do c. Check Results d. Acte on the info Six Sigma a. The focus is on reducing variation, then improving the prcess b. Certification is available through the Institute of Industrial Engineers and the American Societ of Wuality Lean Approach - A Toyota production system model designed to improve efficiency and effectiveness through process redesing - Requires participants in the process to come to high level of agreement

Pain Receptors/Nocioceptors Mometrix Q114

Polymodal Receptors - Sharp, intense pain & persistent dull pain Mechanical Nocioceptors - Pain from strong pressure or scarp objects Thermal Nocioceptors- Pain caused by burns Chemical Nocioceptors- Pain form pH extremes and environmental irritants

The Social Security Act of 1965

Popularly known as Medicare, resulted in a basic program of hospital insurance for persons aged 65 and older

Braden Scale p. 365

Pressure Injury Risk Assessment tool. Scores 6 different areas 1-4 points 23 (Best score) - No risk 15-18 - Mild Risk <14 - Mod Risk 10-12 (Worse Score) - High Risk Memory Aid. There are 6 letters in Braden

Types of prevention

Primary Prevention (Prevention) - trying to prevent yourself from getting a disease. (Immunizations, Activities for health promotion & disease prevention) Secondary Prevention (Screening)- trying to detect a disease early and prevent it from getting worse. (Screenings, i.e. mammograms, colorectal cancer screen, physical/dental checkups) Tertiary Prevention (Treatment)- trying to improve your quality of life and reduce the symptoms of a disease you already have.

What are three stages of prevention are in Neuman's Model

Primary, secondary and tertiary prevention. This helps clients maximize their defenses

Theories on Aging (P. 267 & Mometrix Q26

Programmed/cellular - cells & organisms have programmed life spans. Homeostatic - The body is composed of chemical elements that must maintain a proper balance; when body does not maintain this homeostatic balance, aging occurs Single organ - Aging is related to changes in a single organ system. Wear & Tear - The human body is similar to a machine & wears out over time.

A document that outlines a conversation bewteen a provider & patient outlining the specific medical treatments to be carried out by healthcare professionals in the events of a life-threatening crisis. Mometrix Q 163

Provider Orders for Life-Sustaining Treatment IT is a single sheet, brightly colored paper and will often include specific treatments that can bee carried out by emergency medical personnel before transporting to a medical facility

Habilitation .p. 238

Providing therapies for children w/ developmental disabilities and similar conditions to assist them in achieving function and skill never before acquired

Primary factors to consider when doing a transfer assessment (Q24)

Pt's physical, cognitive and emotional status Physical: Weight; Limb extensions; presence of muscle spasms; balance; mobility; need for assistive devices; weight bearing ability; upper/lower body strength Cognitive - Ability to communicate & understand Emotional - Motivation, fears, concerns

Breathing techniques

Pursed Lip Breathing - Decreases how often you take breaths and keeps your airways open longer - Breath in through your nostrils. Then slowly breath out throughout slightly pursed lips like you're blowing out a candle. Exhale 2-3x longer than you inhale. Abdominal Breathing - Enables the lungs to expand more fully and to expand more fully and expel Carbon Dioxide more effectively. - Adjust posture so your lungs, chest and abdomen can expand fully, place hand on abdomen to assess effectiveness of breathing , breathe through your nose, rest for a moment then slowly exhale through your mouth.

Most appropriate sleeping medication for patient who has parkinsonism type symptoms from a TBI and who is suffering from insomnia. Mometrix Q103

Rameron (an antidepressant that promotes sleep but does not have a high anticholinergic side effect) You want to avoid anticholinergic medications as they will increase parkinsonism symptoms. Dopamine agonist can cause severe nightmares or interfere with REM sleep

Paratransit (Q105)

Refers to alt transportation provided for the physically or mentally disabled who are not able to use standard transportation. This service picks people up and delivers them to a specific destination. May be a small bus or van. People using this type of device may be those who must be transported by gurney or who are too confused to go from a usual bus or train stop to a destination.

Rehabilitation

Relearning/regaining skills and abilities after a trauma or disease to meet age-related development expectations

Section 504 of the Rehabilitation Act of 1973 Requires

Requires all buildings and facilities that are designed, constructed or altered with federal funds or leased by a federal agency comply with federal standards to accommodate physical disability.

The Patient Self Determination Act p. 287/p. 56 ARN guide

Requires healthcare institutions receiving government subsidies provide patients with info about their legal rights to participate in making medical decisions, including the right to accept or refuse treatment and to formalize their wishes about treatments in an a written document known as advanced directives.

The Qality of Care act of 1991 regulates... P. 377

Residents entering a facility w/out an indwelling urinary catheter not receive one unless medically necessary. Hospital acquired complications d/t catheter-associated UTIs will not receive additional payment from Medicare or Medicaid Indications for a Foley: - Acute urinary retention - Urethral obstruction - Need for accurate urinary output measurements ion patients who may have hemodynamic or blood pressure instability = Anticipated prolonged surgery duration

Restrictive Vs Obstructive Lung Disease

Restrictive - Characterized by diminished lung expansion exacerbated by neuromuscular diseases, SCI, or bony deformations in the chest Obstructive - Characterized by an increased resistance to airflow d/t chronic bronchitis, emphysema, asthma, BPD or cystic fibrosis. These patients will the an increased respiratory rate

What side of the brain is effected when you see the following: - Impulsivity/Impaired Judgement - Impaired insight into condition (unaware of deficits) - Spatial-perceptual deficits P. 524

Right Sided **Think "R"rabbit/RIght CVA (patient w/ right sided CVA will be fast and impulsive like a rabbit) **Think "L"anguage & "L"ogic/Left sided CVA (patient w/ left sided CVA will have troubles w/ language and logic)

Roy Adaption Model (RAM) (Q76) https://www.youtube.com/watch?v=4S4Q1VBuN4Y

Roy purposes behavior is a response to a stimuli. Our response is either adaptive or not adaptive and ineffective. The response depends on a patient's coping mechanisms. Using the nursing process (ADPIE) You use RAM you can develop a care plan focusing on each of the four areas of RAM. Focuses on individual's ability to cope (adapt) in Modes Physiological - Ability to provide for basic needs, oxygen, food, elimination, sleep and protection. Assessment example: Cancer patient has severe pain, severe wight loss. Self Concept - Psychological & spiritual components includes body sensation and body image. Assessment example: Despite hair and weight loss, patient well dressed w/ scants amount of make up Role Functions - Role w/in the family, decision making, support systems Assessment example Patient cries when she talks about her family Inderdependence - Includes close relationships Assessment example: Cancer patient has family who is involved in care

Which area of the spine effects the bowels (Q32B)

Sacral

Terms related to evaluating data and results (Q4)

Sensitivity - Data should include all positive cases, taking into account variables, decreasing false negatives Specificity - Data includes only cases specific to the needs of the measurement, excluding those from a different. Stratification - Data classified according to subsets, taking variables into consideration. Recordability - Tool/indicator collects and measures necessary data Reliability - Results are reproducible Usability - Tool/indicator is easy to understand/use Validity - Collection measures the target adequately

Signs/Symptoms of young child/infant with SCI above T6 experiencing autonomic dysreflexia p. 243

Sleepiness, irritability, crying, unexplained flushing, or facial sweating. Management is usually started at 15-20 mm Hg above baseline BP in adolescents and 15 mm Hg above baseline in children. Children should wear a medical alert bracelet, carry an autonomic dysreflexia info card and keep care supplies in his travel backpack

Dysarthria is characterized by?

Slurred or thick-tongued speech

The most common barrier to community re-entry that a pt with disabilities encounters is?

Societal attitudes

Gerotransendence (p. 268)

Sociological theory that states older adults move towards oneness w/ the universe by maintaining close relationships, accepting impending death, and remaining connected w/ people of tother generations.

What does the acronym SOAP stand for (Q23)

Stands for: Subjective Objective Assessment Plan Subjective Notes - usually quote what the patient states directly ("I can't exercise b/c my foot hurts") Objective Notes - Record what is observed (Pt is limping & avoiding pressure on left foot so is unable to participate in dancing activity. Blister noted on left heel) Assessment - Evaluation of subjective & objective notes (i.e. Poorly fitting shoes causing friction rub heel blisters. Plan - Based on assessment: Treat & project blisters. Obtain properly fitted shoes.

Types of walkers (Q140)

Stationary Walker - Provides stable support; used w/ 3-point gate for patients who are non weight bearing on one leg. Gliding Walker - Has plastic or metal gliding tips instead of rubber Wheeled Walker - Has wheels in front that lock when pressure is applied Reciprocal Walker - Has hinge that allows first one side to advance than the other.

Leading cause of long-term disability in the U.S. p. 274

Stroke

Quality measures address several aspects of care. Describe structure measures, process measures, and outcome measures

Structure Measures - track whether a particular mechanisms or system is in place. Process Measures - Track performance of a particular action. Outcome Measures - Consider the end results of care such as morbidity and mortality resulting from a disease

In order to improve quality and effectiveness of healthcare, the government established this organization. Mometrix Q 166

The Agency for Healthcare Research & Quality established in 1989

The organization that provides accreditation to rehabilitation facilities that meet their requirements. Mometrix Q147

The Commission of Accreditation or Rehab Facilities (CARF). It provides accreditation & certification to facilities offering services in Rehab, opined treatment plans, behavior health, aging services & others.

Medicare Part B (p. 198)

Supplemental Medical Insurance - optional. Covers: Physician, outpatient, home health, and preventive services. Cost: Beneficiaries pay $147, comes out of SSI check

What does the abnormal involuntary movement score (AIMS) evaluate (Q145)

Tardive dyskinesia in people taking antipsychotic meds. Before/after the exam, the patient is observed at rest for comparison. Patient is required to do a number of activities such as sitting in specific positions, opening mouth, protruding tongue, standing and walking. Nurse rates from 0(none) to 4(severe). A score 2 or more moments or a score equal to or greater than 3 is positive.

The legal statute put into place to ensure that patient care is delivered based on what the patient needs are Mometrix Q 158

The IMPACT Act It is also what calls for standardizing functional assessments across the 4 post acute settings

The organization that provides accreditation to thousands of health care facilities in the United States. Mometrix Q148

The Joint Commission Organizations must undergo on-site reviews and analysis of policies and procedures to ensure care is being provided effectively. Surveys are conducted every 3 years

What theory believes that an individual's behavior controls his/her outcomes?

The Locus of Control Theory

The Mini-Mental State Examination (MMSE) (Q57B)

The MMSE is a tool to assess cognitive impairment - Patient should be fluent in English - English as a 2nd language does not disqualify patient. - Should only be administered to patients with an 8th grade or higher education

How would you most easily access evidenced-based clinical practice guidelines?

The National Guideline Clearinghouse at www. guideline.gov provides the most comprehensive database condensed summaries of evidenced based clinical practice guidelines and a link to each full clinical practice guideline

Outcomes are used to communicate with other consumers of rehab services. List 3 types of outcome measurements used in the post acute health care setting.

The Outcome and Assessment Information Set (OASIS) - A dataset used by Home Health Agencies (HHA) to measure patient outcomes and risk factors with a specified time IRF-PAI. Used by rehabs to document admissions and reimburesement based on functional outcome data. Includes demographic, diagnostic and FIM(functional) data. Must be completed by day 5 post discharge (including day of discharge). IRFs submitted at least day 17 post discharge are late and those submitted by day 27 post discharge incur a 25% penalty. Minimum Data Set (MDS) - Used to by SNFs to assess resident's physical and clinical conditions.

Documentation of ongoing professional development, career planning, and continuing professional nursing development. Used as a tool to identify strengths and learning needs of nursing staff. Can also be used during hiring process to identify the most appropriate nurse for the position (Q18B)

The Professional Portfolio

Transactional Stress Appraisal & Coping Theory (Q34)

The Transactional Model of Stress and Coping Theory is a framework which emphasises appraisal to evaluate harm, threat and challenges, which results in the process of coping with stressful events. Key terms to know: Primary Appraisal: Considers & evaluates the importance of a current or future event. Secondary Appraisal: Considers the ability to control the stressor and to cope with in terms of personal & social resources. Coping: Develops strategies based on the primary/secondary appraisal to change the stressor or to things about it differently.

Which agency enforces federal laws related to employment discrimination agains a person with a disability

The U.S. Equal Employment Opportunity Commission

Waddell Pain Assessment (Q97)

The Waddell score, consisting of 8 non-organic or behavioral signs, was developed to measure illness behavior in patients with low back pain.Testing positive to 3 or > signs is indicative that pain is nonorganic or physiological Testing positive for Waddell's signs may correlate w/ patients who demonstrate depression.

What age is Wee FIM used? (P. 95 ARN guide0

The WeeFIM is a standardized measure of functional performance developed for use in children 6-months to 7-years of age but with application through adolescence.

How long are pressure garments worn following an acute pediatric burn (p. 245)

The are worn as part of contracture management and are typically worn for 6-24 months

Educating patients w/ spinal cord injuries about positioning for sexual activity (Q41)

The best method is to have the pt and partner practice different positions while fully clothed to help them find positions that are most comfortable for both and point out safety concerns. Safety concerns: Too much pressure, friction, hyperflexion or hyperextension

Resource Utilization Group (RUG)

The client classification system for the SNF PPS is the resource utilization group (RUG)

Medication used to help symptoms of neurogenic bladder with the least amount of anticholinergic side effects Mometrix Q87

Tolterodine

What is the average length of of a full sleep cycle? Mometrix Q104/105

The full rest cycle is aprox 3 hours REM sleep is essential to feeling truly rested. Usually occurs 90 minutes after falling asleep. The brain becomes more active. Respiratory rate and rapid eye movements increase. Dreaming occurs.

STEEP (p. 90 ARN Guide)

The institute of Medicine (IOM) identified 6 aims of healthcare delivery : Safe Care Timely Care Effective Care Equitable Care Patient Centered care

Who is the primary accreditation agency for rehab providers?

The joint commission. It may serve as an authority on behalf of CMS and enforce standards that meet the federal conditions of participation.

homonymous hemianopsia

The loss of the left or right side of the vertical midline

Lund and Browder Burn Assessment Chart/ Rule of 9sp. 244

Tool used in the management of burns for estimating the total body surface area affected. Rule of 9s: Arm = 9% (4.5%per side) Leg = 18% (9% per side) Abdomen/Chest = 18% Back= 18% Face = 9% Genitals = 1%

Orlando's Nursing Process Theory (Q52)

The nursing process includes the behavior of the individual, the nurse's reaction, and the subsequent actions. Applying Orlando's theory of deliberate nursing: Assess, Diagnose, Plan, Implement and Evaluate, the nurse would Assess the behavior of of the patient, React through diagnoses of the patient and her subsequent actions would be to plan, implement, and evaluate the interventions designed to address the initial diagnosis.

A patient who sustained a TBI can dress herself but puts her sweater on backward, becomes unsteady transferring and has difficulty ambulating when she encounters equipment or other people. What deficit is she exhibiting & what functional assessment is indicated? (Q18)

The patient's difficulty transferring, ambulating around equip or people and dressing suggests a spatial deficit - Appropriate therapy: practice following directions and using senses (kinetic & touch) to estimate distances - Adaptive Approaches: Limit obstructions and place items consistently in the same place. - The most appropriate functional assessment is to ask pt to place items in specific positions using directional guidance and record the # of errors

If a Milwauke brace causes skin irritation, denuding, and pain over the pelvic bone, what is the cause most likely due to? (Q102)

The pelvic piece is too loose and needs to be fastened tighter. A tight fitting cotton knit T-shirt may be worn under the brace.

Management Theories (Q89)

Theory X (McGregor)- The average worker is unmotivated, dislikes work, is resistive to change, is unintelligent, and does not care about the org but works for money Theory Y (McGregor)- Work can be enjoyable and workers can be motivated to meet goals if they result in feelings of self-fulfillment, causing workers to seek responsibility Scientific Management Theory (Taylor) - Managers plan and control, ID tasks and then assign the best person to complete tasks, using reward and punishment as motivating sources. Motivation Theory -Managers must take a more personal interest in the needs of workers b/c workers are motivated by increased manager involvement.

Stages of sleep (ARN guide p. 384)

There are 2 types of sleep: Rapid eye movement (REM) and non REM sleep REM - characterized by rapid eye movement, lack of muscle movement and vivid dreaming. Non REM - Characterized as quite sleep f/ a fully regulating brained fully moveable but inactive body. Non REM is divided into 4 stages Stage 1 - Person appears asleep but is easily aroused Stabe 2 - Deeper sleep, lasts 10-25 min. Stages 3/4 - Deep sleep, muscles relax and GI activity slowed. The sleep cycle is controlled by the hypothalamus

Navajos cultural beliefs (Q1-B)

They believe in the use of a medicine man for all ailments. They do NOT believe in modern medicine and are vary untrusting of Western health care methods and facilities. The presence of a med man can be beneficial as he knows the Navajo beliefs and is able to explain to the patient w/o casting confusion

Lewin's Change Theory (Q56) **Think fishing for change with a "Lure". When you can cast the lure, you unfreeze the water. It's unfrozen and after you take out the lure, the water freezes again.

This is a cognitive learning theory. Lewing believe the individuals can receive info but they will not change their behavior if they are not motivated. Motivation to learn is the key Motivation to change (unfreezing) - Dissatisfaction occurs when goals are not met, but as previous beliefs are brought into question, survival anxiety occurs. Sometimes learning anxiety about having to learn different strategies causes resistance that can lead to denial, blaming others, and trying to maneuver or bargain real change. Desire to change (unfrozen) - Dissatisfaction is strong enough to override defensive actions and the desire to change is strong, but it must be coupled w/ the identification of needed changes. Development of permanent change (refreezing) - New behavior becomes habitual, often requiring a change in perceptions of self and establishment of new relationships.

Acoustic Neroma Symptoms (Q45B)

This is a slow-growing tumor on the nerve that connects the ear to the brain. Symptoms include: hearing loss & vertigo. (This is due to the proximity to the 8th cranial nerve)

The Health Promotion Model Theory

This theory was developed by Dr Pender. It assumes that people seek to regulate their own behavior and that health professionals play an influential role throughout their clients' lifespan. The personal belief in one's own capacity to control life events is a tenet of the theory.

Rehab Assessments (Q32 & Mometrix p. 157 & Mometrix Q98)

Timed up and Go Test (TUG) - Evaluates time for a patient to stand from chair w/ armrests, walk 3 meters, turn, return, & sit back down. >14 seconds are at a risk for a fall. Katz Activities of Daily Living (ADL) Scale - Evaluates normal activities such as bathing dressing, transferring walking & includes timed tests. Instrument Activities of Daily Living (IADL) - Activities of daily living that are NOT essential to providing basic hygiene or self care. These include housekeeping, shopping, managing money and medications Functional Ability Rating - Evaluates limitations in major life activities such as self care, communications, self-direction, ability to live independently, learning, and ability to handle economic affairs. POMA - tests mobility and gate under different conditions. Score of 0 = marked limitation 1=moderate limitation 2 = No limitation

The Americans with Disabilities Act - Name roles of each of the 5 Titles contained in the Act

Title 1: prohibits discrimination in the work place due to disability Title 2: provides civil rights within the public entities Title 3: provides rights within private sector Title 4: telecommunication Title 5: provides coverage related to legal fees, prohibiting retaliation

According to Imogene King's Model of goal attainment, the goal of nursing is

To help individuals maintain their health so the can function in their roles.

Speech options post laryngectomy (Q121)

Transesophageal Puncture - Creation of a small opening between the trachea and esophagus and insertion of a one way air valve allows for the creation of vibrations to produce speech. Electrolarynx - Requires a handheld device that produces artificial voice sounds Esophageal speech Techniques - Requires considerable effort to swallow & regurgitate & produce little voice modulation. Electronic tablets - May be used to communicate immediately after surgery but not a good long term solution

Types of incontinence

Uninhibited - Disorders of the brain: stroke, MS, Alzheimers, Parkinsons - Awareness of urge impaired/sudden urge incontinence - Spincter in tact - BCR & Anal wink present Reflexic - SCI above T12 (upper neuron) - Urge to defecate is impaired - Anal Sphincter in tact (Anal wink & BCR present) - This means that when the rectum is full, the defecation reflex will occur, emptying the bowel (incontinence) Areflexic - SCI below T12 (lower neuron) - No urge awareness - Flaccid sphincter

How do you assess for pain in the cognitively impaired patient?

Use drawings or pictures (i.e. Wong-Baker FACES scale)

Knack maneuver (Mometrix Q4)

Use of kegal exercises to prevent stress incontinence. Woman taught to contract the pelvic floor muscles right before and during events that cause stress incontinence

Van Ness Rotionplasty p. 246

Used after osteosarcoma around the knee or congenital short femur. The foot and ankle are preserved, rotated 180 degrees, and reattached at the distal femur, making the joint functional

The supraglottic swallow maneuver (Q138B)

Used in patients with reduced closure of the airway. - Patients inhale, hold breath very tightly, bear down and then swallow; the patient then coughs when finished. The pressure that is created helps with swallowing and increases the strength of the muscles used with swallowing.

Harris-Benedict Formula Mometrix Q72

Used to estimate calorie requirements for acutely ill patients. Uses basal energy expenditure, activity factory, and injury to make estimation.

Glascow Coma Scale (GCS) Mometrix p. 189

Used to measure levels one consciousness. Injuries/conditions are classified according to the score. Categorized into three main assessment areas: MOTOR, VERBAL, & EYE OPENING RESPONSES Scores range from 3(Bad) --->15 (Good) Coma: 3-8 Severe Head Injury: 8 and below Moderate Head Injury: 9-12 Mild Head Injury: 13-15

Melodic Intonation Therapy (MIT) (Q99)

Used to treat aphasia. Many patients with aphasia are able to sing event though they cannot speak. Adults begin by tapping rhythms then humming and then repeating phrases by the therapist

How long does it take the brain to adapt so the patient can begin to understand words after getting a cochlear implant? (Q106)

Usually 3-5 months. Those w/ no previous history of hearing may have more difficulty than those who were initially hearing before becoming deaf.

Roger's Science of Unitary Human Beings Theory (Q45 & Mometrix Q52

Views nursing as a science & an art. **Energy Field - This is basic to all living/nonliving things Openness - The individual & environment exist together w/ an openness allowing a continuous exchange of energy Pattern - This energy wave distinguishes & identifies the source of energy. Pan-dimensionality - This domain is nonlinear and not constrained by time and space which are arbitrary means that people use to describe events.

Part of the brain that effects speech and naming objects (Q134B)

Wernicke's area located in the postural temporal lobe - Associated with language comprehension - Can cause difficulty speaking understandably, speech comprehension, confusion, and difficulty reading & writing & naming objects

Using crutches on stairs Mometrix Q34

When ascending, patient should place the well foot first on higher step, then crutches & injured foot. When descending, put crutches first on lower step, then the injured foot and then the well foot **Memory Aid: Good goes to heaven/ Bad goes to hell. Good leg goes first when going up and bad leg goes first when coming down

Spina bifida p. 248

Where the neural tube fails to close during the first 3-4 weeks of fetal development resulting incomplete closure of the spinal column Myelmeningocele - Most severe form. Motor & sensory nerves below lesion are affected resulting in paraplegia, neurogenic bowel and bladder and lack of sensation Risk factors: - Women taking valproic acid for seizures - Folic acid supplementation reduces risk **Latex allergy common in people w/ spina bifida

Accommodations related to Wiccanism religious belief (Q103B)

Wicca, a predominantly Western movement whose followers practice witchcraft and nature worship. The believe in a God and Goddess that are supreme deities. Those who practice the Wiccan religion often use amulets, talisman, or crystals sometimes inscribed with symbols or writings and are always in direct contact with the skin.

1% increase in CRRNs on the unit was associated with

a 6% decrease in length of stay (p. 10)

Nursing Theories

http://currentnursing.com/Quiz/nursing_theory_quiz1.html

dysgraphia

inability to write

Durable power of attorney for health care (p 56 ARN guide)

enables a competent person to appoint a surrogate decision maker who is empowered to act legally for the client

Highest risk for suicide

older white men

What disruption in sleep patterns are noticed in a client with myasthenia graves?

sleep apnea caused my muscle weakness

A person with verbal apraxia experiences difficulty with?

voluntary speech Most appropriate intervention: Having the pt use writing as an alternative to speaking