Question 1

A nurse is caring for a client who has a spinal cord injury at level T₃.Which intervention should the nurse implement to assist with bladder dysfunction? A) Insert an indwelling urinary catheter. B) Stroke the medial aspect of the thigh. C) Use the Credé maneuver every 3 hours. D) Apply a Texas catheter with a leg bag.

Accepted Answer

Two techniques are used to facilitate voiding in a client with a flaccid bladder: the Valsalva maneuver and the Credé maneuver.Indwelling urinary catheters generally are not used because of the increased incidence of urinary tract infection.Stroking the medial aspect of the thigh facilitates voiding in clients with upper motor neuron problems.If the spinal cord injury is above T₁₂,the client is unaware of a full bladder and does not void or is incontinent.Therefore,the client would not benefit from a Texas catheter with a leg bag.

Question 2

A nurse collaborates with an occupational therapist when providing care for a rehabilitation client.With which activities should the occupational therapist assist the client? (Select all that apply.)&#10;A) Achieving mobility&#10;B) Attaining independence with dressing&#10;C) Using a walker in public&#10;D) Learning techniques for transferring&#10;E) Performing activities of daily living (ADLs)

Accepted Answer

The role of the occupational therapist is to assist the client with ADLs,dressing,and activities needed for job training.The physical therapist assists with muscle strength development and ambulation.Vocational counselors assist with job placement,training,and further education.

Question 3

A nurse performs passive range-of-motion exercises on a semiconscious client and meets resistance while attempting to extend the right elbow more than 45 degrees.Which action should the nurse take next?

A) Splint the joint and continue passive range of motion to the shoulder only.
B) Progressively increase joint motion 5 degrees beyond resistance each day.
C) Apply weights to the right distal extremity before initiating any joint exercise.
D) Continue to move the joint only to the point at which resistance is met.

Accepted Answer

Moving a joint beyond the point at which the client feels pain or resistance can damage the joint.The nurse should move the joint only to the point of resistance.Splinting the joint will not assist the client's range of motion.The client's joint should not be forced.Applying weights to the extremity will not increase range of motion of the joint but most likely will cause damage.

Question 4

A nurse teaches a client about performing intermittent self-catheterization.The client states,&#34;I am not sure if I will be able to afford these catheters.&#34; How should the nurse respond?&#10;A) &#34;I will try to find out whether you qualify for money to purchase these necessary supplies.&#34;&#10;B) &#34;Even though it is expensive, the cost of taking care of urinary tract infections would be even higher.&#34;&#10;C) &#34;Instead of purchasing new catheters, you can boil the catheters and reuse them up to 10 times each.&#34;&#10;D) &#34;You can reuse the catheters at home.Clean technique, rather than sterile technique, is acceptable.&#34;

Accepted Answer

At home,clean technique for intermittent self-catheterization is sufficient to prevent cystitis and other urinary tract infections.The nurse would refer the client to the social worker to explore financial concerns.The nurse should not threaten the client,nor should the client be instructed to boil the catheters.

Question 5

A nurse assesses a client who is admitted with hip problems.The client asks,&#34;Why are you asking about my bowels and bladder?&#34; How should the nurse respond?&#10;A) &#34;To plan your care based on your normal elimination routine.&#34;&#10;B) &#34;So we can help prevent side effects of your medications.&#34;&#10;C) &#34;We need to evaluate your ability to function independently.&#34;&#10;D) &#34;To schedule your activities around your elimination pattern.&#34;

Accepted Answer

Bowel elimination varies from client to client and must be evaluated on the basis of the client's normal routine.The nurse asks about bowel and bladder habits to develop a client-centered plan of care.The other answers are correct but are not the best responses.Oral analgesics may cause constipation,but they do not interfere with bladder control.The client is in rehabilitation to assist his or her ability to function independently.Elimination usually is scheduled around rehabilitation activities but should be taken into consideration when a plan of care is developed.

Question 6

A nurse teaches a client with a past history of angina who has had a total knee replacement.Which statement should the nurse include in this client's teaching prior to beginning rehabilitation activities?

A) "Use analgesics before and after activity, even if you are not experiencing pain."
B) "Let me know if you start to experience shortness of breath, chest pain, or fatigue."
C) "Do not take your prescribed beta blocker until after you exercise with physical therapy."
D) "If you experience knee pain, ask the physical therapist to reschedule your therapy."

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Accepted Answer

Participation in exercise may increase myocardial oxygen demand beyond the ability of the coronary circulation to deliver enough oxygen to meet the increased need.The nurse must determine the client's ability to tolerate different activity levels.Asking the client to notify the nurse if symptoms of shortness of breath,chest pain,or fatigue occur will assist the nurse in developing an appropriate cardiac rehabilitation plan.

Question 7

An interdisciplinary team is caring for a client on a rehabilitation unit.Which team members are paired with the correct roles and responsibilities? (Select all that apply.)&#10;A) Speech-language pathologist - Evaluates and retrains clients with swallowing problems&#10;B) Physical therapist - Assists clients with ambulation and walker training&#10;C) Recreational therapist - Assists physical therapists to complete rehabilitation therapy&#10;D) Vocational counselor - Works with clients who have experienced head injuries&#10;E) Registered dietitian - Develops client-specific diets to ensure client needs are met

Accepted Answer

Speech-language pathologists evaluate and retrain clients with speech,language,or swallowing problems.Physical therapists help clients to achieve self-management by focusing on gross mobility.Registered dietitians develop client-specific diets to ensure that clients meet their needs for nutrition.Recreational therapists work to help clients continue or develop hobbies or interests.Vocational counselors assist with job placement,training,or further education.

Question 8

A nurse delegates the ambulation of an older adult client to an unlicensed nursing assistant (UAP).Which statement should the nurse include when delegating this task?&#10;A) &#34;The client has skid-proof socks, so there is no need to use your gait belt.&#34;&#10;B) &#34;Teach the client how to use the walker while you are ambulating up the hall.&#34;&#10;C) &#34;Sit the client on the edge of the bed with legs dangling before ambulating.&#34;&#10;D) &#34;Ask the client if pain medication is needed before you walk the client in the hall.&#34;

Accepted Answer

Before the client gets out of bed,have the client sit on the bed with legs dangling on the side.This will enhance safety for the client.A gait belt should be used for all clients.The UAP cannot teach the client to use a walker or assess the client's pain.

Question 9

A nurse teaches a client who has a flaccid bladder.Which bladder training technique should the nurse teach?&#10;A) Stroking the medial aspect of the thigh&#10;B) Valsalva maneuver&#10;C) Self-catheterization&#10;D) Frequent toileting

Accepted Answer

With a flaccid bladder,the voiding reflex arc is not intact and additional stimulation may be needed to initiate voiding,such as with the Valsalva and Credé maneuvers.Intermittent catheterization may be used after the previous maneuvers are attempted.In reflex bladder,the voiding arc is intact and voiding can be initiated by any stimulus,such as stroking the medial aspect of the thigh.A consistent toileting routine is used to re-establish voiding continence with an uninhibited bladder.

Question 10

A rehabilitation nurse cares for a client who has generalized weakness and needs assistance with activities of daily living.Which exercise should the nurse implement?&#10;A) Passive range of motion&#10;B) Active range of motion&#10;C) Resistive range of motion&#10;D) Aerobic exercise

Accepted Answer

Active range of motion is a part of a restorative nursing program.Active range of motion will promote strength,range of motion,and independence with activities of daily living.

Question 11

A rehabilitation nurse is caring for an older adult client who states,&#34;I tire easily.&#34; How should the nurse respond? (Select all that apply.)&#10;A) &#34;Schedule all of your tasks for the morning when you have the most energy.&#34;&#10;B) &#34;Use a cart to push your belongings instead of carrying them.&#34;&#10;C) &#34;Your family should hire someone who can assist you with daily chores.&#34;&#10;D) &#34;Plan to gather all of the supplies needed for a chore prior to starting the activity.&#34;&#10;E) &#34;Try to break large activities into smaller parts to allow rest periods between activities.&#34;

Accepted Answer

The answer of A rehabilitation nurse is caring for an...

Question 12

A nurse assists a client with left-sided weakness to walk with a cane.What is the correct order of steps for gait training with a cane?
1)Apply a transfer belt around the client's waist.
2)Move the cane and left leg forward at the same time.
3)Guide the client to a standing position.
4)Move the right leg one step forward.
5)Place the cane in the client's right hand.
6)Check balance and repeat the sequence.

A) 3, 1, 5, 4, 2, 6
B) 1, 3, 5, 2, 4, 6
C) 5, 3, 1, 2, 4, 6
D) 3, 5, 1, 4, 2, 6

Accepted Answer

The answer of A nurse assists a client with left-sided...

Question 13

A nurse is caring for clients as a member of the rehabilitation team.Which activities should the nurse complete as part of the nurse's role? (Select all that apply.)&#10;A) Maintain the safety of adaptive devices by monitoring their function and making repairs.&#10;B) Coordinate rehabilitation team activities to ensure implementation of the plan of care.&#10;C) Assist clients to identify support services and resources for the coordination of services.&#10;D) Counsel clients and family members on strategies to cope with disability.&#10;E) Support the client's choices by acting as an advocate for the client and family.

Accepted Answer

The answer of A nurse is caring for clients as...

Question 14

A nurse cares for a client with decreased mobility.Which intervention should the nurse implement to decrease this client's risk of fracture?&#10;A) Apply shoes to improve foot support.&#10;B) Perform weight-bearing activities.&#10;C) Increase calcium-rich foods in the diet.&#10;D) Use pressure-relieving devices.

Accepted Answer

The answer of A nurse cares for a client with...

Question 15

A rehabilitation nurse prepares to move a client who has new bilateral leg amputations.Which is the best approach?&#10;A) Use the bear-hug method to transfer the client safely.&#10;B) Ask several members of the health care team to carry the client.&#10;C) Utilize the facility's mechanical lift to move the client.&#10;D) Consult physical therapy before performing all transfers.

Accepted Answer

The answer of A rehabilitation nurse prepares to move a...

Question 16

A nurse assesses a client recovering from coronary artery bypass graft surgery.Which assessment should the nurse complete to evaluate the client's activity tolerance?&#10;A) Vital signs before, during, and after activity&#10;B) Body image and self-care abilities&#10;C) Ability to use assistive or adaptive devices&#10;D) Client's electrocardiography readings

Accepted Answer

The answer of A nurse assesses a client recovering from...

Question 17

A nurse plans care for a client who is bedridden.Which assessment should the nurse complete to ensure to prevent pressure ulcer formation?&#10;A) Nutritional intake and serum albumin levels&#10;B) Pressure ulcer diameter and depth&#10;C) Wound drainage, including color, odor, and consistency&#10;D) Dressing site and antibiotic ointment application

Accepted Answer

The answer of A nurse plans care for a client...

Question 18

A rehabilitation nurse cares for a client who is wheelchair bound.Which intervention should the nurse implement to prevent skin breakdown?&#10;A) Place pillows under the client's heels.&#10;B) Have the client do wheelchair push-ups.&#10;C) Perform wound care as prescribed.&#10;D) Massage the client's calves and feet with lotion.

Accepted Answer

The answer of A rehabilitation nurse cares for a client...

Deck 6: Rehabilitation Concepts for Chronic and Disabling Health Problems