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113Postacute Care

QUESTIONS

  1.  Name the leading cause of institutionalization of stroke survivors who had been discharged to go home from the hospital after their stroke.

       A.  Noncompliance with medications resulting in complications

       B.  Recurrent stroke

       C.  New onset seizure disorder

       D.  Family members unable to sustain care needs

  2.  A 70-year-old hemiparetic patient who demonstrates ability to tolerate 3 hours of therapy a day, can eat with assistance, and has two sons who live next door can anticipate which discharge disposition?

       A.  Inpatient rehabilitation facility (IRF)

       B.  Skilled nursing facility (SNF)

       C.  Long-term acute care (LTAC) facility

       D.  Home

  3.  Botulinum toxin injection has proven effective poststroke for which condition?

       A.  Urinary incontinence

       B.  Focal spasticity

       C.  114Facial palsy

       D.  Balance deficit

  4.  Your neighbor was discharged to go home after her stroke. When you visit, she tells you that two therapists had come earlier in the day. The first showed her tips on using an adapted spoon for eating cereal/soup, and the second showed her practical tips for using her walker in the house. What types of therapists were they?

       A.  Occupational therapist and physical therapist

       B.  Recreational therapist and physical therapist

       C.  Physical therapist and occupational therapist

       D.  Vocational therapist and occupational therapist

  5.  Which is true of the Barthel Index?

       A.  There are 10 items that measure independence and self-care ability

       B.  Normal score is 100

       C.  It does not adequately quantify disability in high-functioning stroke patients

       D.  All of the above

  6.  Which of the following is also called a subacute rehabilitation facility?

       A.  Inpatient rehabilitation facility (IRF)

       B.  Skilled nursing facility (SNF)

       C.  Long-term acute care hospital (LTACH)

       D.  Home health care agency (HHCA)

  7.  Up to 70% of stroke patients will experience this during the first 6 months after discharge from the hospital or rehabilitation facility:

       A.  Shoulder subluxation

       B.  Urinary tract infection

       C.  Dysphagia

       D.  Falling

  8.  Which is not true regarding seizures after an ischemic stroke (Winstein et al., 2016)?

       A.  Prophylactic administration of antiepileptic drugs is recommended

       B.  Seizures are classified as early (within the first few days) or late

       C.  Seizures with lacunar strokes are rare

       D.  Seizures are more common in strokes involving the cerebral cortex

  9.  115Which functional measurement tool is the only one used by the Centers for Medicare & Medicaid Services (CMS) related to its prospective payment system?

       A.  Barthel Index (BI)

       B.  Functional Independence Measure (FIM^®)

       C.  Modified Rankin Score (mRS)

       D.  National Institutes of Health Stroke Scale (NIHSS)

10.  Your patient, Mr. White, has been in your acute rehabilitation hospital for 1 week now. He continues to eat only the food on the right half of his tray despite his wife’s insistence that he should clean his plate. What is your best nursing response to this situation?

       A.  Establish a behavioral contract with Mr. White that if he finishes his tray completely, he gets an extra dessert

       B.  Place all his food on the right half of the tray

       C.  Report this behavior to the provider and suggest a behavioral medicine consult

       D.  Educate/reeducate the wife and patient about inattention/neglect and reinforce the strategies provided by the occupational therapist

11.  After 10 days in the acute rehabilitation hospital, Mrs. Talbot says she just wants to go home to her apartment to her two cats and her canary. The care team has just discussed with her that her progress has not been as much as anticipated. Which of the following would make it more likely that she would be able to go home as she desires?

       A.  Doubling therapy times for the next week

       B.  Increasing doses of antidepressant

       C.  Daughter’s ability to move in with her for 6 months

       D.  Patient’s neighbor committing to check on her every day

12.  Poststroke spasticity occurs in 25% to 43% of stroke survivors and these patients get aggressive therapy. What is the outcome that these therapies are attempting to prevent?

       A.  Contractures

       B.  Hypoperfusion

       C.  Flaccid limb

       D.  Wrinkling

13.  116Your patient had an intracerebral hemorrhage (ICH) 10 days ago. The patient’s history of renal failure requiring dialysis and labile hypertension has complicated his hospital stay. The patient is able to participate in therapy services, and has made progress with swallowing, but still requires tube feed support. He is being discharged tomorrow; what is the most likely discharge disposition?

       A.  Inpatient rehabilitation facility (IRF)

       B.  Assisted living facility

       C.  Long-term acute care hospital (LTACH)

       D.  Skilled nursing facility (SNF)

14.  For Mr. White, a 74-year-old ischemic stroke patient to qualify for home health care, what condition must be present?

       A.  He must have supplemental insurance that covers home health care

       B.  He must be homebound

       C.  He must require at least two therapies and one nursing care need

       D.  He must be able to answer the door when the staff arrive

15.  In what setting would a physiatrist most likely be employed full time to oversee the functional recovery of a stroke patient?

       A.  Inpatient rehabilitation facility (IRF)

       B.  Assisted living facility

       C.  Home health care agency

       D.  Skilled nursing facility (SNF)

16.  The role of a rehabilitation nurse in an inpatient rehabilitation facility (IRF) would include

       A.  Coordinating care team activities

       B.  Reinforcing the care provided by other team members

       C.  Advocating for both the client and caregiver

       D.  All of the above

17.  During his acute rehabilitation stay, Mr. Smith receives cognitive therapy. Which care team member would provide him with this therapy?

       A.  Neuropsychologist

       B.  Occupational therapist

       C.  Speech and language pathologist

       D.  All of the above

18.  117Which of the following is true regarding rehabilitation nurses?

       A.  Certification programs for rehabilitation nursing require a bachelor of science in nursing (BSN) and 5 years rehabilitation experience

       B.  A 1% increase in the number of certified rehabilitation nurses on a unit is associated with a 6% decrease in length of stay

       C.  Rehabilitation nurses provide home visits after discharge from acute rehabilitation

       D.  None of the above

19.  You suspect that your patient is showing signs of depression. You know this is not uncommon poststroke, and that it is likely the result of which of the following?

       A.  Organic, related to the neuronal damage of the stroke

       B.  Premorbid, related to having risk factors for depression prior to stroke

       C.  Reactive, related to the loss of prestroke independence

       D.  All of the above

20.  Fecal incontinence and constipation are common after stroke and are attributable to

       A.  Polypharmacy resulting in decreased bowel motility

       B.  Frequent therapy sessions resulting in irritable bowel

       C.  Decreased mobilization and limited access to toilet

       D.  Spasticity of the smooth muscles of the bowel