Exam 4

Question 1

In order for rehabilitative nursing to be successful, does the client need to be restored to their previous state?

Answer 1

No

Question 2

What are symptoms of frailty?

Answer 2

-unplanned weight loss
-Slow walking speed
-Low grip strength
-Fatigue, poor endurance
-Low levels of activity

Question 3

What is Sarcopenia ?

Answer 3

Muscle loss due to aging. Leads to loss of strength and function

Question 4

People who need rehabilitation at risk for :

Answer 4

Falls
Disability
Hospitalization
Nursing home
Death

Question 5

What is coping capacity?

Answer 5

The ability to cope with a new disease

Question 6

What types of losses come with disability?

Answer 6

Functional
Role
Income
Status
Independence
Anatomic structure

Question 7

What are the guidelines for rehabilitative nursing?

Answer 7

-know the patience, capacities, and limitations
-Emphasize function rather than dysfunction
-Provide time and flexibility
-Recognize and praise accomplishments
-Do not equate physical disability with mental disability
-Try to prevent complications
-Demonstrate, hope optimism and humor
-Multidisciplinary team effort

Question 8

What is the supine position?

Answer 8

Laying flat on back

Question 9

What is the prone position?

Answer 9

Laying flat on stomach with head turned a lot early

Question 10

What is the lateral position?

Answer 10

Laying on side with head and spine align

Question 11

What is chair position?

Answer 11

Also known as high, Fowlers, sitting up straight

Question 12

How often should range of motion exercise be performed?

Answer 12

At least once per day

Question 13

How should the joint be moved during ROM exercises?

Answer 13

Slowly and smoothly

Question 14

Where should you provide support on a joint during ROM exercise?

Answer 14

Above and below the joint that is being exercise

Question 15

What is included in ADLs

Answer 15

Toileting
Feeding
Dressing
Grooming
Bathing
Ambulating

Question 16

What is included and I ADLs

Answer 16

Tasks required for community living

Shopping
Cleaning up after cooking
Meal prep
Laundry
Housekeeping
Using a phone
Money management
Medication management

Question 17

What is rehabilitative care?

Answer 17

focus on returning individuals to their previous level of function

However, it is not fully restored does not mean it was not successful

Question 18

What is restorative care?

Answer 18

maintaining or improving their current level of function.

Avoiding decline and complications

achieving the highest possible quality of life

Question 19

What is nonmaleficence?

Answer 19

Do no harm

Be careful when giving opioids due to respiratory distress

This is when you prevent harm to Patience, by not directly performing an act that causes harm and buy informing management that staffing is inadequate to provide safe care

Question 20

What should be provided to a Roman Catholic patient that is showing signs of impending death

Answer 20

Sacraments of the sick

Question 21

What is palliative care?

Answer 21

Care that relieves suffering, and promotes comfort, when I cure is not possible

Giving analgesics and opioids

Physical needs of patient: eye drops, turning them, oral hygiene, bathing, etc

Question 22

What is an advance directive?

Answer 22

A written statement of a persons wishes regarding medical treatment in the event they cannot communicate them

Question 23

What is hospice care?

Answer 23

A way to care for terminally, ill patients and their families

Aids in adding quality and meaning to the remaining period of life

Controls their manifestations (how they live now)

Efforts to assist, physical, emotional and spiritual needs

Question 24

What services are included in hospice care?

Answer 24

Pain relief
Symptom control
Home care and institutional care
Nurses and physicians
Social workers and counseling services
Medical equipment and supplies
Volunteer assistance and support
Bereavement, following up and counseling
Physical therapy

Question 25

How often does hospice need to be renewed?

Answer 25

Every six months

Question 26

What states is assisted suicide practiced in?

Answer 26

Washington, Oregon, California, Colorado, Vermont

Question 27

What is voluntary euthanasia?

Answer 27

assisted suicide The nurse is “volunteering” to help with euthanasia after client has requested

Question 28

What are the signs of impending death?

Answer 28

-decline and BP -Rapid, weak pulse -Dyspnea and periods of apnea -Slower or no pupil response to light -Perfuse perspiration -Cold extremities -Bladder and bowel incontinence -pallor and molting skin -loss of hearing and vision

Question 29

What are the five stages of grief?

Answer 29

Denial Anger Bargaining Depression Acceptance

Question 30

Is Hope one of the stages of grieving and if not, what is it?

Answer 30

No, it is not one of the stages Hope is used as a temporary but necessary form of denial as a rationalization for enduring unpleasant therapies and as a source of motivation Hope permeates all stages of grief

Question 31

What is the most appropriate nursing intervention when caring for a diet patient who is experiencing pain?

Answer 31

Prevent the pain before it occurs not after

Question 32

What are the types of range of motion degrees?

Answer 32

Active - independently done by patient Active assistive - with assistance to patient Passive - with no active involvement of patient

Question 33

What is Reminiscence?

Answer 33

Life review Helps improve memory, reduce depression, resolves past conflicts, validates existence, enhances quality of life Improve communication, mood, cognition, and quality of life

Question 34

What is reality orientation

Answer 34

Helps keeps patient mentally integrated with the world around them A total approach to keep the patient oriented Consistency is crucial to promote orientation

Question 35

What should a nurse do when a patient no longer wants to continue treatment and just wants to die?

Answer 35

Respect their autonomy and that they want to die Give resources for hospice

Question 36

Understand beliefs regarding gender if nurse when giving care to Muslim faith

Answer 36

Same gender as patient Woman nurse for woman patient

Question 37

Where can spiritual care be provided / in what areas of the hospital or facility?

Answer 37

Intensive care Hospice

Question 38

When is the need for support of the family after patient death the highest?

Answer 38

Weeks and month after death

Question 39

Understand how to provide postmortem care

Answer 39

Is there a particular faith they belong to? Remove excess machines and equipment Change bedding Place arms outside of the sheets Clean body Are they a candidate for an autopsy?

Question 40

How can music therapy help a patient?

Answer 40

Can help them express emotions Keeps them comfortable Form of palliative care

Question 41

Understand walker safety

Answer 41

Hands on walker with elbows slightly bent Lift walker and set it down to advance forward Stand up straight

Question 42

What resource can be provided if a patient cannot go out and get groceries

Answer 42

Meals on wheels

Question 43

Understand how to use crutches

Answer 43

6” forward and to side Arms slightly bent Step with strong side first, bring crutches and weaker side forward

Question 44

If a patient is immobile what is very important?

Answer 44

Listening to lung sounds every 2 hours

Question 45

When assessing a patient you should check their vital signs and their…

Answer 45

Medications

Question 46

Understand about falls

Answer 46

Want to promote safety -strength exercises -safety checks -lock beds and wheelchairs -bedside table close -complete safety check of surroundings

Question 47

When starting an exercise plan, what needs to be evaluated?

Answer 47

Evaluate their walking, if they can walk they may be able to exercise

Question 48

If a patient is being admitted with dementia what is something you may be able to ask them (during a moment of cognitive moment)

Answer 48

May be able to ask them what they like to eat and cook

Question 49

What to say to another nurse who is struggling with end of life

Answer 49

Get a grip and come to terms with your feelings about death

Question 50

If you are participating in an activity with a group and one person does not want to participants, do you stop activity?

Answer 50

No. Continue activity and offer that person an alternative activity

Question 51

Make sure that all planned activities are…..

Answer 51

Stimulating

Question 52

Understand examples of the stages of anger

Answer 52

Throw things Name calling Get very upset

Question 53

What do you say to a spouse when their significant other says they want to die ?

Answer 53

We need to respect their position and call the physician and have them withdraw care

Question 54

What do you say to a patient that tells you they want to die.

Answer 54

Respect their wishes and encourage them to talk to their family and the physician

Question 55

What do you say when a family member says they are happy their parent died?

Answer 55

Ask them to tell you more and why they feel that way

Question 56

What is maladaptive grief?

Answer 56

People who suffer from maladaptive grief tend to either push their grief away or react in unhealthy ways.

Question 57

Examples of someone experiencing maladaptive grief

Answer 57

-not accepting death after 10 years -not getting rid of others belongings -talking about their loved one like they are still there -could revert to old habits -may have low self esteem

Question 58

When a patient is depressed what do we want to assess they can still do?

Answer 58

ADLs

Question 59

When a person has a hematopoiesis (stroke) how will they use a cane?

Answer 59

On their no affected stronger side

Question 60

What do you do if you find a patient with no pulse and no DNR?

Answer 60

Call the code and alert team Then start cpr

Question 61

What would be the manifestations of an unconscious person you are giving a massage to?

Answer 61

-Pulse might equal out and fall within normal range -droopy shoulders -face muscles relaxed

Question 62

What are nursing interventions for suicide prevention?

Answer 62

Counseling Physician’s order