Chp. 19 Rehabilitation and restorative Care – Flashcards
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1. The goal of restorative care is a. Maintenance of baseline function b. Maximizing the abilities and functions of older adults c. The same for all residents with a specific medical diagnosis d. Based on the age of a longterm care resident
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1. ANS: B Restorative care is the essence of rehabilitation of functional abilities. Response A does not address the holistic approach of restorative care. Responses C and D are incorrect. Restorative care is not based onmedical diagnosis or age of the resident, but rather on functional ability.
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2. Which of the following statements best describes the practice role of the nurse in restorative care? a. Provide care to support adjustment to the disease process b. Provide care to avoid serious injury or disability c. Provide care until the resident is discharged to home d. Provide care to support the development of selfcare abilities
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2. ANS: D Restorative care is focused on supporting the resident's ability to perform selfcare. Responses A, B, and C are accurate descriptions of nursing care, but they do not address the focus of rehabilitation.
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3. Which of the following statements best describes the educator role of the nurse in restorative care? a. Teaching the resident and family the importance of rehabilitation b. Teaching the resident and family about the importance of activity after being disabled c. Teaching the resident and family about the disease process, treatment options, and management strategies d. Teaching the resident and family what they need to know to make choices and be involved in the restorative process
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3. ANS: D Teaching in the restorative process is directed at facilitating the ability of the resident and family to make informed decisions and assist with the planning of care. Responses A, B, and C are accurate descriptions of the content of teaching plans, but they do not address the specific goals for teaching the resident and family as part of the restorative care process.
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4. Which of the following statements best describes the counselor role of the nurse in restorative care? a. Counseling residents and their families is not within the usual scope of practical nursing practice b. Counseling residents and their families is aimed at assisting them with valuing the care they receive c. Counseling residents and their families is aimed at assisting them with expressing their feelings and developing positive strategies to express their feelings d. Counseling residents and their families is an important role for the interdisciplinary team
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4. ANS: C Counseling residents and their families has the goal of assisting them with developing positive ways to express their feelings and of coping with their disability. Response A is incorrect. The practical nurse counsels residents and families to express feelings and develop positive coping skills after developing trust and rapport with the resident and family. Response B is incorrect. The goal of counseling is not to assist residents to value the care they receive, but rather to provide an opportunity to assist them in dealing with their feelings. Response D is correct, but it does not address the counseling role of the practical nurse.
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5. Which of the following statements best describes the advocate role of the nurse in restorative care? a. As an advocate, the practical nurse uses his or her power and influence to promote an environment that supports the goals of restorative care b. As an advocate, the practical nurse intervenes when family members do not support the plan of care c. As an advocate, the practical nurse confronts the interdisciplinary team when their goals do not address their advocacy role d. As an advocate, the practical nurse develops an adversarial role with the interdisciplinary team
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5. ANS: A The practical nurse supports the attainment of the restorative care goals through encouraging the change in attitudes, care skills, and environment that would promote restorative care. Responses B and C are examples of advocacy but are too narrow to describe the advocacy of practical nurses. Response D is inappropriate. If the nurse becomes an adversary of the interdisciplinary team, the nurse is not acting in the resident's best interest.
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6. Which of the following statements describes a strength of a resident for restorative a. The resident cannot communicate verbally b. The resident verbalizes complaints of pain c. The resident has fallen when attempting to ambulate to the toilet care? d. The resident coughs when eating
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6. ANS: B If the resident can verbalize complaints of pain, this can work as an asset to involving the resident in his or her care. Responses A, C, and D are not assets to restorative care. Lack of verbal communication limits the resident's involvement in the care process. Residents who have fallen often require restorative care with goals aimed at decreasing fall risks. Residents who cough while eating are often exhibiting signs of aspiration.
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7. Alice Hoggan, 72 years old, is admitted to a longterm care facility after a serious myocardial infarction. After visiting with Mrs. Hoggan, the social worker is surprised that she is taking the loss of her independence and selfcare ability so well. Which of the following statements addresses this assessment? a. Mrs. Hoggan must be in the denial phase of grieving a loss b. Mrs. Hoggan has probably withdrawn and is depressed c. Mrs. Hoggan is probably just thankful to be alive d. Mrs. Hoggan is demonstrating the concept that loss and its meaning vary with individuals
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7. ANS: D Older adults are a diverse group of individuals. The adjustment to disability or loss of independence is affected by the older adult's life experiences, previous coping mechanisms, values and beliefs, and social support system. Often an older adult is depressed (response B), but Mrs. Hoggan does not exhibit symptoms of depression. The case study does not support responses A and C. Mrs. Hoggan is not exhibiting denial byaccepting her loss of independence. Believing that she is simply thankful to be alive is a trivial way toexpress acceptance.
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8. Jonas Roundy, 68 years old, had a cerebrovascular accident (CVA) 7 months ago. The physical and occupational therapy staff are very concerned regarding his slow progress. Which of the following rehabilitation principles should guide his rehabilitation? a. Convalescence is a gradual process that can take a long time b. The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition c. Loss and its meaning vary with every person d. Values are examined and limitations are put in perspective over time
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8. ANS: A Convalescence is often a slow process, with older adults demonstrating small improvements over time. Older adults, families, and healthcare workers often can become frustrated with the slowness of the process. Responses B, C, and D all are principles of rehabilitation, but they do not address rehabilitation as a slow process.
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9. Oliver Jones, 71 years old, has been admitted to the longterm care facility with endstage emphysema. He refuses to have physical therapy. He continues to smoke. He asks other residents to push his wheelchair down to the smoking room, leaves his oxygen tank in the hall, and goes into the room to smoke two to three cigarettes. When this behavior has been confronted, he responds that he enjoys smoking and that he knows that he will eventually die from emphysema. Which of the following rehabilitation principles should guide his rehabilitation? a. Convalescence is a gradual process that can take a long time b. The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition c. Loss and its meaning vary with every person d. Values are examined and limitations are put into perspective over time
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9. ANS: D Mr. Jones' continued smoking is distressing, but he has verbalized an acceptance of his disability and has expressed a desire to continue smoking. This is an expression of his values and beliefs about his health and qualityoflife choices. Responses A, B, and C do not address Mr. Jones' conscious choice to continue to smoke as an expression of his values and beliefs.
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10. Donna Edelman, 79 years old, has been diagnosed with situational depression after she had to have her left leg amputated above the knee. Ms. Edelman has severe peripheral vascular disease related to diabetes mellitus. Which of the following rehabilitation principles should guide her rehabilitation? a. Convalescence is a gradual process that can take a long time b. The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition c. Loss and its meaning vary with every person d. More severe emotional reactions are produced when disability is traumatic
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10. ANS: D The loss of a limb is a very disfiguring and traumatic event. There is a connection between traumatic disability and an increased emotional reaction during rehabilitation. Responses A, B, and C all are principles of rehabilitation, but Mrs. Edelman's depression is most likely explained by the traumatic nature of her disability.
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11. Ingrid Farnston, 82 years old, has the reputation of being a "difficult resident." She has lived at the longterm care facility for 2 years. She is very particular about how her care is performed and how her room is arranged. She commonly yells at the nursing assistants and complains about them to her family. The family is supportive of the staff and the care that they provide. The family often comments that their mother is "a difficult woman." Which of the following rehabilitation principles should guide her rehabilitation? a. Personality problems are generally related to personality characteristics of the older person before he or she was disabled b. The duration of rehabilitation depends on the psychological acceptance of the older adult of his or her condition c. Loss and its meaning vary with every person d. More severe emotional reactions are produced when disability is traumatic
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11. ANS: A An older adult's personality characteristics and traits do not change with aging but sometimes seem to intensify. Responses B, C, and D could affect Mrs. Farnston's rehabilitation; however, from the case presentation, she does not seem to be denying her disability (response B), having difficulty accepting her loss (response C), or having a severe emotional reaction to her functional limitations (response D).
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12. Which of the following is a rehabilitation goal for an older adult? a. Resident will have no signs of skin breakdown through longterm care stay b. Resident will reach full rehabilitation potential in the next 30 days c. Resident will allow therapy staff to design his or her rehabilitation program d. Resident will not have any setbacks during the rehabilitation period
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12. ANS: A Maintaining skin integrity is a goal for rehabilitation. Responses B, C, and D do not reflect the principle of rehabilitation. Rehabilitation is not a shortterm process (response B) and often is continued throughout the life of an older adult with a chronic disease or disability. Rehabilitation and restorative care require active participation of the older adult and his or her family. Exclusion of the older adult in planning the rehabilitation program (response C) is inappropriate. It is inappropriate to expect that an older adult will notexperience setbacks (response D) through the rehabilitation process.
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13. Sara Simpson, 69 years old, has had a cerebrovascular accident that has affected her ability to move and ambulate. Which of the following interventions would be part of her plan of care? a. Encourage her to transfer without assistance to determine ability to transfer b. Encourage her to ambulate without assistance to determine walking ability c. Perform passive range of motion to all joints d. Encourage weightlifting exercises to increase strength
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13. ANS: D Performing weightlifting exercises is the most appropriate intervention. Responses A and B are inappropriate and could place Mrs. Simpson at risk for falls. Response C does not encourage active participation of Mrs. Simpson in her rehabilitation plan of care.
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14. Leon Simon, 84 years old, has been cared for in his home by his wife. He was admitted to a longterm care facility with pressure ulcers on his coccyx and both of his hips. Which of the following interventions would be inappropriate for Mr. Simon's plan of care? a. Bed rest with dressing changes twice a day b. Hourly turning and repositioning program c. Assisted active range of motion and assisted ambulation d. Toileting program to reduce incontinent episodes
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14. ANS: A Bed rest would cause Mr. Simon to have all of the negative outcomes of immobility. The complexity and extensive nature of Mr. Simon's skin breakdown would make rehabilitation a challenge, but responses B, C, and D should be part of his rehabilitation plan of care.
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15. Ada Coleman, 88 years old, fractured her ankle when she fell in the facility dining room. She was determined to be a poor surgical risk, so the ankle was splinted, and she was ordered to be on bed rest for 2 weeks before the leg was scheduled to be casted. What is the appropriate rehabilitation intervention for Ms. Coleman? a. Use a walker to teach her how to stand on one foot b. Have her perform active rangeofmotion and weightlifting exercises in bed c. Transfer from wheelchair to toilet for activity d. Use a Hoyer lift to transfer her to the tub for bathing
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15. ANS: B An older adult who is ordered to be on bed rest has treatmentinduced immobility. All nursing interventions should be aimed at preventing the negative effects of immobility. Range of motion and weight lifting in bed can help to maintain joint flexibility and muscle strength. Responses A, C, and D are inappropriate activities for an older adult who has been ordered to bed rest.
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16. Matthew Drabinski, 81 years old, is admitted from the hospital with a Foley catheter 3 days after hip replacement surgery. Which of the following would not be a part of his bladder training program? a. Straight catheterize his bladder after he voids to assess for the amount of residual urine in the bladder b. Teach him how to use a urinal c. Reinsert Foley catheter if he is unable to void on his own in 8 hours d. Increase fluid intake up to 2000 mL/day
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16. ANS: C Reinserting the Foley catheter is not part of a bladder training program if the older adult does not have stage 3 or 4 pressure ulcers or a neurogenic bladder or is not terminally ill. Straight catheterization for residual volume of urine after voiding (response A) is part of the evaluation of bladder function. Teaching the older adult how to use a urinal (response B) and the importance of a good fluid intake to promote urinary function (response D) are part of a bladder training program.
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17. Pat Wagner, 88 years old, has become increasingly weak and has been admitted to the longterm care facility. On admission, he is found to have a fecal impaction. Which of the following would not be part of his restorative care program? a. Ambulate him to the bathroom after meals b. Increase fluid intake to 1500 mL/day c. Administer Fleet's enema every other day to ensure bowel evacuation d. Increase dietary fiber
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17. ANS: C Enemas are used to promote bowel function only if the older adult does not have full control of the voluntary muscles used to evacuate the bowel. Stool softeners and suppositories are the laxative methods of choice because they promote normal bowel evacuation. Responses A, B, and D all are nursing interventions that promote bowel function. Ambulating Mr. Wagner to the bathroom is an excellent way to increase ambulation.
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18. Thaddeus Hartman, 78 years old, has been started on a feeding program. He has severely debilitating endstage Parkinson's disease. He has been having difficulty swallowing and had a nasogastric tube for a while. Which of the following would not be part of his feeding program? a. Staff feeding Mr. Hartman and encouraging him to feed himself his toast or roll b. Instructing Mr. Hartman's wife how to feed him c. Setting up the meal tray and encouraging Mr. Hartman to feed himself d. Supplementing Mr. Hartman's meals with snacks
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18. ANS: C Mr. Hartman has Parkinson's disease and has probably lost the strength and movement necessary to feed himself. Although it is desirable to involve him in his feeding program, it would be inappropriate to set his meal tray in front of him and expect him to feed himself. Responses A, B, and D are appropriateinterventions for a restorative feeding program. Each of these interventions is aimed at promoting Mr. Hartman's nutritional status and active participation in his care.
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19. The researcher role in restorative care is one that is new for most LPNs. The LPN's role in research includes all of the following behaviors except a. Designing the research methodology for the project b. Gathering data under the direction of the registered nurse researcher c. Interviewing older persons to determine if they qualify for the research project d. Answering questions asked by the patient and family members
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19. ANS: A The LPN involved in a restorative nursing research project works under the direction of the registered nurse. The RN serves as the principal investigator, which means designing the research, writing a proposal for funding, and ensuring the integrity of the research being done. The LPN is qualified to do items B, C, and D, assuming that the RN has properly instructed the LPN.
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20. The rehabilitative care team includes the following caregivers: a. Physical therapists, occupational therapists, speech therapists b. Nurses, social workers, dietitians c. Psychologists, respiratory therapists, physicians d. All of the above
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20. ANS: D The rehabilitation team includes all of the above and potentially others, depending on the specific issues for each patient.
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21. Rehabilitation is not limited to specific locations. Factors that may limit care are a. Financial resources, environmental factors b. Religion, personal value systems c. Family support, team availability d. Both A and C
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21. ANS: D Religion and personal values should not prevent access to rehabilitation. Finances (insurance) could potentially limit access.
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22. Which of the following statements is true? a. Rehabilitation continues the process of strengthening and retraining over time b. Restorative care provides intensive shortterm strengthening and retraining c. Restorative care begins after the rehabilitation goals are reached and the patient is at a plateau d. Restorative care is fast paced
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22. ANS: C Restorative care begins after the rehabilitation goals are reached and the patient is at a plateau. Response A is incorrect; that is part of the definition of restorative care. Response B is the definition of rehabilitation. Response D is incorrect because speed is not the goal in rehabilitation or restorative care.
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23. Mr. Miner, an 82yearold retired teacher, is being admitted to your unit for rehabilitation. He recently sustained a pelvic fracture while riding his motorcycle. The existing health problems to consider while creating his rehabilitation plan include all of the following except a. Diabetes, benign prostatic hypertrophy b. Hypertension, osteoporosis, hearing loss c. Poor peripheral vision, arthritis, asthma d. Diabetes, arthritis, asthma
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23. ANS: A Diabetes and benign prostatic hypertrophy would have the least effect on Mr. Minor's rehabilitation plan. Musculoskeletal concerns and cardiovascular and respiratory problems would be of the most concern, along with renal, mental status, and perception changes.
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24. Mrs. Baker has a constant stream of visitors. Grandchildren come to have her read to them, former neighbors take her to lunch, and nieces and nephews stop by for a chat. Mrs.Baker is 95 years old and had a fall at home that resulted in a fractured hip and wrist. The staff is amazed at her motivation and desire for rehabilitation. The social worker believes this is because a. Her advanced age makes her motivated to make each day special b. She has positive selfesteem and selfimage c. The pain medication is altering her perception of her environment d. Her family has "threatened" not to visit if she does not put forth an effort to get well
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24. ANS: B It is possible that she is pushing to make each day count (response A) and probable that her perception is altered because of her pain medication (response C), and her family may have "threatened" her (response D). Her high degree of personal motivation most likely comes from feeling needed and wanted by all those around her, however, boosting her selfesteem and selfimage.
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25. Mrs. Singer is a 68yearold woman, 5 feet tall, 200 lb, admitted to a facility for complications related to her weight. She has lived alone since her spouse died 5 years ago. What is not a component of her rehabilitation? a. Reduced calorie intake b. Exercise program c. Review of health complications of obesity d. Diet and exercise education
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25. ANS: C Mrs. Singer is aware of the complications of obesity. The staff must be very encouraging and supportive so that Mrs. Singer can gain trust in sharing fears and concerns to the staff. Her selfimage and selfesteem will increase by positive reinforcement for weight loss, increased activity tolerance, and strength.
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26. Which area is not critical to an older adult's ability to be successful in his or her plan of care? a. Physical status b. Psychological status c. Family status d. Functional status
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26. ANS: C Responses A, B, and D are correct and are the three areas where changes must be noted. Response C is incorrect because family status plays only a part in psychological status.
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27. Passive range of motion is not a. A method of assisting an individual to resume independence of function b. A method of preventing deformities c. A method of preventing increased limitation of activity d. A form of exercise that the patient must do unassisted
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27. ANS: D Responses A, B, and C all refer to passive range of motion. Passive range of motion generally requires that another person, usually the nurse or therapist, takes responsibility for the exercise program.
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True/False Indicate whether the statement is true or false. 1. Spiritual health must be a part of a nursing assessment. 2. A delay in deterioration and accommodation to dysfunction are goals of rehabilitative and restorative nursing.
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1. ANS: T The spiritual health and wellbeing of the patient must be addressed so that appropriate resources can be made available if needed. 2. ANS: T Although a delay in deterioration and accommodation to dysfunction may not seem as positive as improvement in function and ability to perform ADLs, they are nonetheless appropriate goals for a rehabilitative and restorative program. Part of preventing deterioration may include recognizing and addressing depression, ensuring exercise to maintain joint mobility, and preventing pressure ulcers. The LPN can assist a patient with accommodating to a dysfunction by helping the patient practice walking when he or she has a foot problem and helping the patient use assistive devices such as crutches under the instructions of a physician or physical therapist.
