11

Principles and Practices of Rehabilitation

I. Interpretation, Completion, and Comparison

Multiple Choice. Read each question carefully. Circle your answer.

1. Rehabilitation, an integral part of nursing, should begin:
a. after the patient feels comfortable in the c. when an exercise program has been initiated.
clinical setting. d. with initial patient contact.
b. after the physician has prescribed rehabilitative
goals.
2. In Canada, approximately _____ Canadians have some form of disability.
a. 1.4 million c. 3.6 million
b. 2.7 million d. 4.2 million
3. The normal first emotional reactions to a disability are:
a. anger and hostility. c. depression and regression.
b. confusion and denial. d. grief and mourning.
4. The key member of the rehabilitation team is the:
a. nurse. c. physical therapist.
b. patient. d. physician.
5. The occurrence of spinal cord and traumatic brain injuries is directly associated with substance abuse,
alcohol, and the use of illegal drugs. The percentage of patients who are under the influence at the time of
injury is as high as:
a. 50%. c. 80%.
b. 75%. d. 95%.
6. The least common position used in positioning a patient in bed to prevent musculoskeletal complications is:
a. prone. c. side-lying.
b. semi-Fowlers. d. supine
7. A nurse who wants to help a patient assume the side-lying position would:
a. align the lower extremities in a neutral position. c. place the uppermost hip slightly forward in a
b. extend the legs with a firm support under the position of slight abduction.
popliteal area. d. position the trunk so that hip flexion is minimized.

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 8. A quick method used to measure for crutches is to use the patients height and:
a. add 15 cm (6 inches). c. subtract 20 cm (8 inches).
b. add 30 cm (12 inches). d. subtract 40 cm (16 inches).
9. A pressure ulcer is associated with the presence of:
a. dehydration and skin dryness. c. inflammation and infection.
b. excessive skin moisture. d. small nutrient vessel compression.
10. Initial skin redness in a patient susceptible to pressure sores should be documented as tissue:
a. anoxia. c. hyperemia.
b. eschar. d. ischemia.
11. A patient at potential risk for a pressure ulcer is assessed by the nurse. A laboratory test result the nurse
should examine is:
a. serum albumin. c. prothrombin time.
b. serum glucose. d. sedimentation rate.
12. A diet recommended for hypoproteinemia that spares protein is one high in:
a. carbohydrates. c. minerals.
b. fats. d. vitamins.
13. Wound healing depends on collagen formation, which depends on vitamin:
a. A. c. D.
b. C. d. K.
14. A rehabilitation program for an elderly patient with a hip fracture must focus on the:
a. impact of multiple system pathology on c. periodic physiologic evaluation of bone repair.
recovery.
b. influence of mental status changes on health d. value of all of the above factors.
improvement.
15. Insufficient cerebral circulation can result from the use of the tilt table and can be identified by:
a. diaphoresis. c. tachycardia.
b. nausea. d. all of the above.
16. Weight bearing on long bones is essential for preventing:
a. calcium loss. c. protein loss.
b. potassium loss. d. sodium loss.
17. To initiate a schedule of bladder training, the nurse should:
a. encourage the patient to wait 30 minutes after c. teach bladder massage to increase intra-abdominal
drinking a measured amount of fluid before pressure.
attempting to void. d. do all of the above.
b. give up to 2500 mL of fluid daily.
18. Successful bowel training depends on:
a. a daily defecation time that is within 15 c. fluid intake between 2 and 4 L/day.
minutes of the same time every day. d. all of the above.
b. an adequate intake of fibre-containing foods.
19. Sexual problems faced by people with disabilities include:
a. impaired self-image. c. limited access to information about sexuality.
b. lack of opportunities to form friendships. d. all of the above.

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Fill-In. Read each statement carefully. Write your response in the space provided.
1. List the six areas of inclusion proposed by the federal government in the report entitled: Advancing the
Inclusion of Persons with Disabilities.
a. ________________________________________ d. ____________________________________________
b. ________________________________________ e. ____________________________________________
c. ________________________________________ f. ____________________________________________
2. Define the term contracture as it relates to impaired physical mobility.

3. List three complications commonly associated with prolonged or impaired physical immobility.
____________________, _____________________, and _______________________
4. Two common musculoskeletal complications for patients who are in bed for prolonged periods are:
______________________________and _______________________________.
5. Four factors that contribute to footdrop are:_________________________, ____________________________,
_______________________, and ________________________.
6. A joint should be moved through its range of motion ______ times, at least once a day.
7. For crutch-walking, the sequence for the four-point gait begins with the _______ crutch and ends with the
_______ foot.
8. Examples of orthotic devices include:

9. Life-threatening complications of pressure sores include:

10. Eschar covering an ulcer should be removed surgically because eschar:

Matching. Match the explanations of range-of-motion techniques listed in Column II with their associated terms in
Column I.
Column I Column II
1.____ adduction a. bending of the foot toward the leg
2.____ dorsiflexion b. increasing the angle of a joint
3.____ extension c. movement away from the midline of the body
4.____ inversion d. movement that turns the sole of the foot
inward
5.____ pronation
e. movement toward the midline of the body
6.____ abduction
f. rotating the forearm so that the palm is down

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II. Critical Thinking Questions, Exercises, and Issues

Discussion and Analysis

1. A 65-year-old woman is recovering from surgery to repair a compound fracture of the femur. She will be
discharged to home in 24 hours. One nursing diagnosis is Self-care deficit, bathing and dressing. After
assessing her limitations in performing activities of daily living (ADL), the nurse designs a plan of care. Refer
to Chart 112 on page 166 to outline specific nursing activities related to teaching ADL.
2. A patient has been diagnosed with impaired physical mobility due to a lower leg deformity. After
assessment, the nurse selects a nursing diagnosis that can be used to design a plan of care. List several
possible nursing diagnoses.

Clinical Situations
View Figure 114, page 178 of the text, and answer the following clinically focused questions regarding impaired
skin integrity.

1. Define the term pressure ulcer.

2. The initial sign of pressure is ______________________ caused by ______________________.

3. The two most susceptible surfaces for pressure ulcer formation are the ______________________ and the
______________________.
4. The least favourable position to use to shift body weight would be:
a. prone. c. semi-Fowlers.
b. recumbent. d. side-lying.
5. The patient should be repositioned:
a. every 30 minutes. c. every 3 to 4 hours.
b. hourly. d. once per shift.
6. Based on the ___________ law, explain why a gel-type flotation pad and an air-fluidized bed reduce
pressure:

7. Explain why the shearing force is increased when the head of the bed is raised, even if only by a few
centimetres.

Read the following case studies. Circle the correct answers.

CASE STUDY: Traumatic Amputation Psychosocial Perspective

Oliver, a 42-year-old mechanical engineer, works at a major paper mill. While he was doing routine
maintenance work, his foot slipped, and he fell against an industrial paper cutter. He suffered a traumatic
amputation of his left hand.
1. The nurse expects Olivers initial emotional reaction on admission to the emergency department to be
one of:
a. adjustment and acceptance. c. denial and confusion.
b. anger and regression. d. grief and depression.
2. If Oliver begins to mourn for his missing body part, the nurse should:
a. emphasize all the abilities he has with his c. listen as he talks about his loss.
remaining hand. d. remind him of his limited abilities, to reinforce
b. encourage him to cheer up. reality.

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 3. The nurse notices that Oliver blames his loss on his family, because he has rationalized that he had to work
in a dangerous area to generate sufficient income to support his seven children and his dependent parents.
A nursing care plan for Oliver should include:
a. advising him about budgeting his income to c. demonstrating self-assistive devices that will help
minimize the stress associated with financial him meet his activities of daily living.
worries. d. encouraging him to have a positive attitude toward
b. allowing him to project his emotions. his disability to facilitate his recovery.
4. After several weeks, Oliver seems to be adjusting to his disability. Behaviours consistent with this period
include:
a. acceptance of his limitations. c. redirecting his energies toward coping.
b. interest in obtaining information about his d. all of the above.
disability.
CASE STUDY: Bucks Extension Traction
Mrs. Patrick is 67 years old and has limited mobility as a result of a right hip fracture. She is in Bucks extension
traction awaiting surgery.
1. During morning care, the nurse suggests that Mrs. Patrick attempt isometric exercises of her legs. This
suggestion is based on the nurses goal of:
a. encouraging normal muscle function. c. providing resistance to increase muscle strength.
b. maintaining muscle strength while d. retaining as much joint range of motion as
immobilizing the joints. possible.
2. The nursing goals associated with therapeutic isometric exercises include all of the following except:
a. enhanced joint mobility. c. increased strength of the musculature that controls
b. improved patient well-being. the joints.
d. prevention of venous stasis.
3. To assist Mrs. Patrick with isometric exercises of her lower extremities, the nurse should teach her to:
a. contract or tighten her thigh and calf muscles c. move her legs through their full range of motion
without moving her knees and hip joints, hold while the nurse supports each distal part.
for several seconds, and then let go. d. put each leg through full range of motion
b. slowly move her legs through limited range while the nurse offers slight resistance to the
of motion while the nurse stabilizes the movement.
proximal joint and supports the distal part.
CASE STUDY: Assisted Ambulation: Crutches
Rita, a 17-year-old college student, is in a full leg cast because of a compound fracture of the left femur. Rita is to
be discharged from the hospital in several days. She lives with her parents in a split-level house.
1. The exercises that the nurse would recommend to strengthen Ritas upper extremity muscles are:
a. isometric exercises of the biceps. c. gluteal setting.
b. push-ups performed in a sitting position. d. quadriceps setting.
2. Rita is 165 cm (5 feet, 5 inches) tall. Her crutches should measure:
a. 114 cm (3 feet, 9 inches) c. 137 cm (4 feet, 6 inches)
b. 124 cm (4 feet, 1 inch) d. 150 cm (4 feet, 11 inches)
3. Before teaching a crutch gait, the nurse directs Rita to assume the tripod position. In this basic crutch
stance, the crutches are placed in front and to the side of Ritas toes, at an approximate distance of:
a. 1015 cm (46 inches) c. 2025 cm (810 inches)
b. 1520 cm (68 inches) d. 2530 cm (1012 inches)
4. Because Rita is not allowed to bear weight on her casted leg, she should be taught the:
a. two-point gait. c. four-point gait.
b. three-point gait. d. swing-through gait.

Copyright 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer Business. Student Access to thePoint Solution for the Study Guide
for Brunner & Suddarths Textbook of MedicalSurgical Nursing, First Canadian Edition, by Pauline Paul, Rene A. Day, and Bev Williams 47