Final Exam | Patient Care Skills

A 41 year old female recieving chemotherapy has been referred to you for therapy. She currently has a peripherally inserted central catheter (PICC) line inserted at her right basilic vein. She has a history of hypertension and you wish to assess blood pressure prior to therapy. Where should you apply the blood pressure cuff?

Left arm

Which of the following is true regarding chest tubes?

Collection box must remain upright at all times

Your patient is a 21 year old male recovering from a traumatic brain injury (TBI). The patient has a ventriculostomy placed. Which of the following is NOT a sign of increased Intracranial pressure (ICP)?

Red colored cerebral spinal fluid

What should you do if a patient's Foley Catheter falls out?

Notify nursing

Rank the oxygenation devices from least to most assistive.

Nasal Cannula, Oxygen Mask, Tracheostomy, Ventilator

Which of the following choices would help ease bed mobility for a patient?

Provide patient with cues to use bed rails to perform bed mobility

Which is the most effective approach to physically assist this patient with bed mobility?

Apply force more centrally upon the trunk

Which of the following options described proper body mechanics to help the patient perform bed mobility?

Shift weight from the front leg to the back leg when assiting patient

The patient has a non-weight bearing status of the right lower extremity, what technique will help you assist with scooting up the bed?

Ask patient to bend the left lower extremity to bridge and assist with arms

Which body region should be moved first when assisting the patient to scoot to the right side after bending both knees?

Assist patient at the upper body

Which option is appropriate with helping the patient roll to the left?

Push through the heels and reach across with the right arm

Which bed mobility activity will be the most difficult for the patient below with hemiparesis after a cerebrovascular accident?

Rolling to the stronger side

Which of the following is the key element of log-rolling?

Maintaining a neutral spine throughout the task

What is the advantage of moving both legs off the edge of bed together when transitioning from supine to sitting through a side-lying position?

The legs provide a counterweight to the upper body

Where should the patient be positioned in the bed to transition from sitting to supine?

One third of the way down from the head of the bed

What is the purpose of proper positioning for patients that are dependent?

Provide pressure relief and prevent soft tissue injuries

Which option is the area of greatest pressure when a patient is supine?

Sacrum

Which option is the area of greatest pressure when a patient is side-lying?

Medial and lateral malleoulus

Which option is the area of greatest pressure for a patient sitting in a wheelchair?

Ischial tuberosities

How often should positional changes be performed in bed ?

Every 2 hours

How often should positional changes be performed in sitting ?

Every 15 minutes

What description matches independent physical assistance level?

Patient does not require any assistance to consistently complete the task safely.

What description matches Modified Independent physical assistance level?

Patient is safe and independent with the assistance of an equipment.

What description matches Supervision (Sup) physical assistance level?

Patient requires clinician to oberve throughout completion of the task.

What description matches Standby Assist (SBA) physical assistance level?

Assisting person is close, but not touching the patient.

What description matches Contact Guard Assist (CGA) physical assistance level?

Patient requires a clinician to maintain contact to complete the task.

What description matches Minimal Assist physical assistance level?

Pateint requires 25% assist to complete the task

What description matches Moderate Assist physical assistance level?

Patient requires 50% assist to complete the task

What description matches Maximal Assist physical assistance level?

Patient requires 75% assist to complete the task

What description matches Dependent physical assistance level?

Patient is unable to participate and the clinician must provide all of the effort to perform the task

In order to prepare a patient for a sit to stand transfer, what is the first step?

Have the patient scoot forward to edge of the bed or chair

How should a patient with a non-weight bearing status of the left lower extremity prepare to properly and safely perform a sit to stand transfer with two axillary crutches?

Place the right lower extremity beneath them with both axillary crutches in the right hand

Idenitfy the proper cue to provide when preparing a patient for a stand to sit transfer.

Back up until the lower extremities are in contact with the chair/bed

Select the proper wheelchair set up prior to a transfer.

Remove both leg rests and lock brakes on both sides

When is a slide board transfer indicated?

Patient has bilateral lower extremity weakness and/or injury

Select the proper set up for a slide board transfer from bed to wheelchair.

Remove the armrest closest to patient

What is the first step in cueing the patient to use a slide board transfer?

Place a gait belt around the patient to assist with transfer

Select the proper set up for a slide board transfer from wheelchair to bed.

Adjust height of the bed to the same or lower than wheelchair

When is a partial stand pivot transfer indicated?

Patient is unable to come to a full stand

When is a stand pivot transfer indicated?

Patient is able to come to a full stand on one lower extremity

Which of the following options provides the greatest stability and safety for patients?

Parallel bars

How should the clinician adjust the parallel bars for proper lateral clearance and stability on both sides of the patient's pelvis?

Provide 2 inches of clearance

To what height should the parallel bars be adjusted to and how much elbow flexion should the patient have when holding onto them?

To the patient's ulnar styloid process with 20-25 degrees of elbow flexion

The patient is now ready for ambulation with a walker. What anatomical landmark should the handle of the walker be aligned with?

To the ulnar styloid process

When holding the handles of the walker, what degrees of elbow flexion should the patient have?

20-25 degrees

Which of the following cases indicates the use of a forearm trough as an attachment?

Below elbow amputation

What is the ideal degree of elbow flexion when using the forearm trough?

90 degrees

How should the handgrip of the forearm trough be adjusted?

Allow for a slightly pronated forearm

How much space is needed between the axilla and axillary pads of the crutches for proper fitting?

2-3 fingers width

What is the proper placement of the crutch tips in reference to the toe of the shoe?

4-6 inches anterior, 2 inches lateral

How many inches should the top of the cuff be from the olecranon when holding the hand grip?

1-1.5 inches

Where should the handle of a cane be aligned to for proper fitting?

To the ulnar styloid process

Which of the following assistive devices are appropriate for a 4-point gait pattern?

Two canes

Which of the following statements is true regarding a 4-point gait pattern?

It increases safety in crowded areas

Which option describes ambulating with a modified 4-point gait pattern?

Holding assistive device on the unaffected side

Which of the following assistive devices are appropriate for a 2-point gait pattern?

Two crutches

What option is true in regards to ambulating with a 2-point gait pattern?

Simulates a normal gait pattern

Which option describes ambulating with a modified 2-point gait pattern?

Patient utilizes one cane or crutch

Select the assistive device that can be used for a 3-point gait pattern.

One pick-up walker

Which option permits ambulation with a 3-point gait pattern?

Full weight bearing status of one lower extremity

Which of the following gait patterns would be indicated for someone with weakness of the trunk and/or bilateral lower extremities?

Swing-to or swing-through gait pattern

Which of the following is required for ambulation with a modified 3-point gait pattern?

Full weight bearing status of one lower extremity

What should be considered when selecting a gait pattern for a patient?

Weight bearing status

What describes Non-weight bearing (NWB) status?

No weight is to be placed on the affected limb

What describes Toe touch weight bearing (TTWB) status?

Affected limb is to be used only for balance; no weight should be placed on it

What describes Partial weight bearing (PWB) status?

What describes Weight bearing as tolerated (WBAT) status?

The amount of weight placed on the affected limb is determined by patient's comfort level

What describes Full weight bearing (FWB) status?

Full body weight is to be placed on the affected limb

What is the level of weight bearing status if the patient is bearing weight on his left leg and only placing the right lower extremity down for balance?

Toe touch weight bearing

What will be the appropriate gait pattern for a patient with a toe touch weight bearing status?

Modified 3-point gait pattern

What will be the appropriate gait pattern for a patient with a full weight bearing status of bilateral lower extremities to utilize bilateral axillary crutches with?

4-point gait pattern

What will be the appropriate gait pattern for a patient with a non-weight bearing status?

3-point gait pattern

What is the level of weight bearing status with a physician's orders of 10 lbs?

Partial weight bearing

What will be the appropriate gait pattern for a patient with a partial weight bearing status?

Modified 3-point gait pattern

Proper wheelchair measurement for seat height

Measure from the back of the heel to the back of the knee

Proper wheelchair measurement for seat depth

Measure from the posterior buttock along the lateral thigh to the popliteal fold

Proper wheelchair measurement for seat width

measure the patient at their widest point (usually from hip to hip)

Proper wheelchair measurement for armrest height

measure from the top of the seat to the olecranon process at 90 degrees elbow flexion

Proper wheelchair measurement for back height

measure from the top of the seat to the base of the axilla

Which of the following, when fitted improperly, would have the greatest affect on the alignment of the spine and head?

seat depth

What is the appropriate measurement for seat depth?

2-3 fingers width between the seat and popliteal fossa

Which of the following would result from an improper seat depth?

if seat depth is too deep, there can be increased pressure at the popliteal area

Select the option that results from a low seat height measurement.

lower center of gravity

Select the option that results from a high seat height measurement.

Increased pressure at the ischial tuberosities

How many inches should the footrest clearance be from the floor?

2 inches

Select the option that results from a improper seat width measurement.

if too wide, there can be difficulty with maneuvaring

What is the appropriate measurement for the back height?

4 fingers width between the top of the seat and axilla

Which complication may result from a wheelchair back that is too high?

Increased difficulty with propelling the wheelchair

Which complication may resulty from armrests that are too low?

difficulty with standing from wheelchair

what is the quickest, safest, and most effective method of pressure relief that a patient can perform in a wheelchair?

sitting push-up

Which of the following patient populations would be the most likely to utilize a bilateral lower extremity propulsion strategy?

Post coronary artery bypass graft (CABG) surgery with high fall risk

Which of the following patient populations would be most likely to utilize a bilateral upper extremity propulsion strategy?

Spinal cord injury with paraplegia

How might a patient with hemiplegia propel himself or herself in a wheelchair?

By using one upper extremity and the ipsilateral lower extremity

When does the propulsive phase of wheelchair propulsion begin and end?

Begins with initial hand contact on push-rim; ends with release of hand contact from push-rim

When does the recovery phase of wheelchair propulsion begin and end?

Begins with release of hand contact from push rim; ends with initial hand contact on push-rim

What is the wheelchair push/ stroke angle measured in?

Degrees

What functional measure of gait is the wheelchair push/ stroke angle comparable to?

step length

Which of the following is preferred to reduce the amount of stress to the upper extremities?

Increase stroke angle

Order the movements of the upper extremity from start to finish during one stroke of wheelchair propulsion

shoulder flexion, elbow flexion, shoulder and elbow extension, wrist radial deviation, wrist ulnar deviation

In order to ascend and descent a curb in a wheelchair, a patient must first learn how to perform which of the following?

a wheelie