CRRN Post Test Questions and Answers 2023

CRRN Post Test Questions and Answers 2023 What criteria must be met in order for a patient to qualify for Medicaid? Must meet state eligibility requirements (Medicaid was initiated under Title XIX of the Social Security Act of 1965 and provides federal grants to states for medical assistance. Each state sets its own eligibility requirements) What symptom should a pt taking Digoxin be instructed to report to the physician? Anorexia (Anorexia can be a sign of Digoxin toxicity. Other signs could be nausea, vomiting, diarrhea, and visual disturbances). The nurse is monitoring a pt for s/s of autonomic dysreflexia. Which symptom would indicate a need for further assessment of the pt? Blood pressure of 130/60 (range has been 110-125/60-70), a blood pressure of 20-40 mm above the pt's baseline may indicate autonomic dysreflexia) Which of the following are facilitated within the nursing team by the use of the nursing process? Continuity of care (The nursing process is a sequence of problem identification, data gathering, options assessment, decision-making, actions, and reassessment. The nurse provides care and makes decisions in collaboration with pt's and fellow team members. This process facilitates continuity of the patient's care) Pt w/ diabetes and stroke wants his wife to bring his ginseng mixture from home. The patient also drinks coffee with each meal. What potential problems should the nurse monitor for? Monitor for hypoglycemia and increased effects of caffeine.(Asian Ginseng has been noted to lower blodd sugar and should be used cautiously in pt's being treated for diabetes. It is also noted to increase the effects of caffeine) The nurse is proactive in teaching the pt self-care activities each shift, communicating and coordinating with other team members. She tells the pt "On rehab, every day counts!" What moral principle is she demonstrating? Fiduciary Responsibility CM is discussing options for care with a pt who received a traumatic amputation in the course of work. The pt is self-employed. What may be a significant barrier for this pt? Lack of insurance (due to self-employment) Prosthetic devices are costly and must be custom-fitted to the pt. What is the purpose of pressure-reduction mattresses? To protect the pt from bottoming out or excessive pressure on conventional mattresses. Position is important to adequate bowel emptying. Which pt response in bed indicates the need for upright positioning during elimination? Bowel emptying takes 40 minutes and includes use of suppositories, digital stimulation, and manual evacuation. (Bowel emptying that takes a long period of time and a great deal of effort will likely be improved by upright positioning) What is the most common cause in vertical compression spinal injuries? A high-velocity blow to the top of the head (such as occurs in diving accidents, these injuries most often impact the cervical spine area) Which term is defined as the situation that occurs when a person knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress The nurse is counseling a pt, who has had a stroke, and her sexual partner. Which comment by the nurse is MOST accurate? Future sexual activity is best predicted by their pre-injury sexual activity. Newly-admitted pt w/ stroke to home health services has a history of CRPS (Complex Regional Pain Syndrome- also known as reflex sympathetic dystrophy or shoulder-hand syndrome). What does the nurse expect in caring for this pt? The pt will have continuous, intense burning pain that may worsen over time. Compulsory Hospital Insurance Program for workers over the age of 65. Medicare Part A (payment into this system occurred during working years) What poses a significant hazard in the community for pt's utilizing walkers? Stairs (Walkers are not safe on stairs) The amount of resistance during passive range of motion in a relaxed pt is: muscle tone What level of evidence is most sound, reliable and reproducible regarding research on staffing patterns for rehab nursing (or other research)? Level 1 (Level 1 is evidence from a systematic review or meta-analysis or an evidence-based practice guideline based on a systematic review of randomized, controlled trials) A child with quadriparesis cerebral palsy uses a universal cuff. What is the purpose of this device? To hold small objects when grasp is impaired. (Device that slips over the hand, allowing a person with minimal hand function to hold small objects such as a spoon, toothbrush, etc..., by sliding them into the holder) For what beneficiaries did the Balanced Budget Act of 1997 direct the development of funding service guidelines? Medicare (Required Medicare budget cuts for services provided in post-acute settings) What exam is used in testing the function of the cerebellum? Romberg exam- (A +Romberg exam would indicate a pt has damage to the cerebellum and will be at risk for falls. Ask the pt to stand with both feet together and arms at the side. Ask the pt to close eyes and stand quietly for 20-30 seconds. A normal response is minimal swaying. More significant swaying indicates cerebellar damage) The nurse is caring for a pt with expressive aphasia. She cannot understand what the pt is trying to tell her. What action is best on the part of the nurse? Acknowledge that you do not understand. What is the therapeutic purpose of supporting pt's with pillows or foam when positioning them? Provide pressure relief and support proper alignment. What is a significant role of CM following discharge of a pt into the community? Monitoring for adherence to the plan and achievement of benchmarks. What is the most common cause of bladder incontinence in the elderly? Transient conditions, such as UTI, that impair function, irritate the bladder, or cause confusion. What is the purpose of discharge planning? To promote continuity of care Nurse is caring for a pt following an amputation who is experiencing phantom pain. What does the nurse anticipate in the care of this pt? This tends to be more common if pain was already present in the extremity prior to the amputation. What is the biggest/most serious complication risk for patients receiving tube feedings via a gastrostomy tube? Aspiration How can risk for aspiration in a tube feeding pt be reduced? 1)Feeding the pt when upright in a chair or at least at 45 degrees in bed 2)If bolus feedings are used, the pt should remain upright for at least an hour following feedings. Teaching instructions for a pt who is taking Baclofen would be: 1)Avoid activities that require alertness until the drug's CNS effects are known. 2)Take with meals or milk. 3)Avoid use of alcohol and over-the-counter antihistamines while taking this drug. As a case manager, the nurse is attending team meetings. What defines case management? A dynamic and systematic collaborative approach to providing and coordinating care to a defined population. Whose theory emphasizes that those who believe they are capable of an action are more likely to achieve it? Bandura's Social Cognitive Theory- says that Self-Efficacy, or the belief in one's ability to perform an activity, is the most important element in eliciting behavioral change. What theory? Self-Efficacy, or the belief in one's ability to perform an activity, is the most important element in eliciting behavioral change. Bandura's Social Cognitive Theory What intervention is best for a pt whose only speech problem is dysarthria? Allowing the pt to use an alphabet board to write/sign communication. This can be a substitute for them while speech therapy continues to try to improve speech. Self-Concept & Self-Esteem can significantly impact what? Recovery and gains in all skills. Nurses should be attentive to comments that indicate there are psychosocial risks. At what age can a nurse anticipate that a child is developing skills in logical problem solving and abstract thinking? Age 11-15 which is during the Formal Operative Period when a child develops the ability to use logical thought and abstract thinking to solve problems. Which of the following is NOT generally a symptom of autonomic dysreflexia? 1)Nasal congestion 2)Watery eyes 3)Feelings of apprehension and doom 4)Pounding headache 5)Blurry vision Watery eyes What area is at the most risk to develop pressure ulcers when patients are positioned properly in a wheelchair? Ischial tuberosities when properly positioned and not practicing effective pressure relief. When pt's slide down in their WC, they are then at risk for sacral area pressure ulcers. Which law requires the Centers for Medicare and Medicaid develop a standardized patient assessment tool that can be used across all post acute care settings to facilitate appropriate transitions and post acute payment reform? Deficit Reduction Act of 2005 Appetite and quality of taste can be negatively impacted when damage occurs to which cranial nerve? Cranial Nerve 1-Olfactory, sense of smell plays a huge role in appetite and quality of taste Pt was recently admitted to the rehab unit and is displaying apprehension and hypervigilance, writing down names of staff who come in the room and telling staff they do not provide care like the unit he came from. Which nursing diagnosis is most appropriate? Relocation Stress Syndrome Occurs when a pt is anxious and insecure following a move from one environment to another. CM is creating a life care plan for a pt following a brain injury. What is the purpose of the Medicare Set-Aside in the plan? A portion of a settlement is allocated to cover future medical expenses that would otherwise need to be covered by Medicare. (Medicare Set-Aside is regulated by CMS as part of a settlement of catastrophic injury cases, allocating part of the settlement to future medical expenses that would otherwise require coverage by Medicare) The nurse utilizes a holistic, wellness, and prevention-oriented approach to care. Which theory is being used? Neuman's Systems Theory Complex model focusing on the whole person in interaction with the environment. Nurse is caring for a pt who is having an autonomic dysreflexia event. The bladder is empty and the blood pressure is 180/90 mm Hg. What should the nurse do next? Administer a fast-acting antihypertensive Your pt is dysreflexic. You elevate her head, loosen tight clothing, check blood pressure, and empty the bladder. The blodd pressure is 118/80 (range has been 110-125/60-70). What does this tell you? The blood pressure is returning to normal, indicating that the dysreflexia is resolving. The next step is to determine what actions should be taken to prevent future episodes. What approach is best for a nurse to use with a pt who has a poor track record with compliance to diabetic management who indicates that "it hasn't killed her yet" and she is happier when she eats what she wants. Discuss alternatives and consequences to determine barriers to change. (The affective domain is best addressed with discussion of beliefs and perceptions to risk. Change will not likely take place until attitudes change) Requires that a choice be made between equally unattractive alternatives. There is uncertainty and a potential of having to defend the choice made. Definition of Dilemma Key function required of a rehab nurse based on the rehab nurse's scope of the generalist practice? Collaborates with the team in evaluating progress towards goals. (It is essential that the rehab nurse possesses the skills to collaborate with other team members to assess, plan, implement, evaluate, and document the pt's care and progress towards goals) What symptom would make the nurse suspect nerve impairment in a pt who recently had a hip replacement? Parasthesis (abnormal sensation in a peripheral nerve of numbness, tingling, or prickling sensations that occurs when the nerve is compromised) In order to begin bladder training the pt must have what 2 things? 1)Sufficient cognitive ability 2)Motivation top comply with the program What is CRPS and what 13-70% of pt's does it occur in? What are the s/s? Complex Regional Pain Syndrome (pain is continuous, increases over time and increases with emotional stress), occurs in 13-70% of pt's with hemiplegia, s/s are edema and skin blood flow abnormality. If CRPS is left untreated, what will occur? The limb becomes stiff, and muscle, skin and bones begin to atrophy. What strategies are sometimes used to decrease pain in CRPS? Pain meds, therapy modalities, nerve blocks, and spinal cord stimulators Which of the following best describes a patient at Ranchos Los Amigos Level of Cognitive Functioning Level 6? Confused-Appropriate, requiring moderate assistance for cognitive functioning. Describe the work of rehabilitation according to the World Health Organization. To minimize impairment in order to reduce activity limitations and lessen participation restrictions. This definition from WHO has been incorporated into CARF rehabilitation standards. Goals of what discipline? Improving quality through appropriate and timely use of resources, promoting optimum functioning, preventing complications, and improving coping, self-advocacy, and successful return to life roles. Case Management