A client is scheduled for a functional assessment using the Functional Independence Measure (FIM). The client asks the nurse, "What is the purpose of the FIM?" Which nursing response is appropriate?

It is a tool that is used to determine your maximum level of self-sufficiency.

It is a test that determines which activities you feel most comfortable performing.

It is a tool used by insurance companies to determine qualifications for medical reimbursement.

It is a tool that is used to assess what services you will need a home health aide to perform for you.

Answer and Explanation

The Correct Answer is A

Choice A reason: It is a tool that is used to determine your maximum level of self-sufficiency as the appropriate nursing response, as it accurately describes the purpose and function of the FIM. The FIM measures how much assistance you need to perform 18 activities of daily living, such as eating, dressing, toileting, walking, and communicating. The FIM helps to evaluate your functional status, monitor your progress, and plan your rehabilitation goals and interventions. ¹²³

Choice B reason: It is a test that determines which activities you feel most comfortable performing is not an appropriate nursing response, as it does not reflect the objective and standardized nature of the FIM. The FIM is not a subjective or self-reported measure of your preferences or comfort level, but rather an observational and rating scale that assesses your actual performance and independence in various tasks. The FIM uses a 7-point ordinal scale that ranges from 1 (total assistance) to 7 (complete independence) and requires trained and certified raters to administer and score it. ¹²³

Choice C reason: It is a tool used by insurance companies to determine qualifications for medical reimbursement is not an appropriate nursing response, as it does not capture the primary purpose and benefit of the FIM. The FIM is not a financial or administrative tool that determines your eligibility or coverage for medical services, but rather a clinical and research tool that measures your functional outcomes and quality of care. The FIM provides a uniform system of measurement for disability based on the International Classification of Impairment, Disabilities, and Handicaps and allows for comparison and evaluation of different rehabilitation programs and settings. ¹²³

Choice D reason: It is a tool that is used to assess what services you will need a home health aide to perform for you is not an appropriate nursing response, as it does not reflect the comprehensive and multidimensional scope of the FIM. The FIM is not a specific or limited tool that assesses only your home care needs or dependence on others, but rather a general and broad tool that assesses your functional abilities and disabilities in various domains and environments. The FIM covers both motor and cognitive aspects of functioning, such as comprehension, expression, social interaction, problem-solving, and memory. The FIM can be used with all diagnoses within rehabilitation and can be applied across different levels and settings of care.

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Correct Answer is B

Explanation

Choice A reason: Fluconazole (Diflucan) is an antifungal medication that is used to treat infections caused by fungi, such as candidiasis, cryptococcosis, and histoplasmosis. It is not effective against anthrax, which is a bacterial infection caused by Bacillus anthracis.

Choice B reason: Ciprofloxacin (Cipro) is an antibiotic medication that belongs to the class of fluoroquinolones. It is used to treat various bacterial infections, including anthrax. It works by inhibiting the DNA synthesis of the bacteria and preventing them from multiplying. Ciprofloxacin is one of the recommended medications for post-exposure prophylaxis and treatment of anthrax, according to the Centers for Disease Control and Prevention (CDC).

Choice C reason: Varenicline (Chantix) is a medication that is used to help people quit smoking. It works by blocking the effects of nicotine on the brain and reducing the cravings and withdrawal symptoms. It has no role in the prevention or treatment of anthrax.

Choice D reason: Potassium iodide (KI) is a medication that is used to protect the thyroid gland from radioactive iodine in the event of a nuclear or radiological emergency. It works by saturating the thyroid with non-radioactive iodine and preventing it from absorbing radioactive iodine. It has no role in the prevention or treatment of anthrax.

A. Gradual onset of several hours B. Maintains consciousness C. Sudden severe headache D. History of neurologic deficits lasting less than 1 hr.

Correct Answer is C

Explanation

Choice A reason: Gradual onset of several hours is not a manifestation of a hemorrhagic stroke. A hemorrhagic stroke occurs when a blood vessel in the brain bursts, causing bleeding into the surrounding tissue. This usually happens suddenly and without warning, and can cause rapid deterioration of the client's condition.

Choice B reason: Maintains consciousness is not a manifestation of a hemorrhagic stroke. A hemorrhagic stroke can cause increased intracranial pressure, which can compress the brain and impair its function. This can lead to loss of consciousness, coma, or death.

Choice C reason: Sudden severe headache is a manifestation of a hemorrhagic stroke. A hemorrhagic stroke can cause intense pain in the head, neck, or face, due to the pressure and irritation of the bleeding. The headache may be described as "the worst headache of my life" or "thunderclap headache".

Choice D reason: History of neurologic deficits lasting less than 1 hr. is not a manifestation of a hemorrhagic stroke. This is a characteristic of a transient ischemic attack (TIA), which is also known as a mini-stroke. A TIA occurs when a blood clot temporarily blocks an artery in the brain, causing temporary symptoms such as weakness, numbness, vision loss, or speech difficulty. A TIA does not cause permanent damage to the brain, but it is a warning sign of a possible future stroke.

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A client is scheduled for a functional assessment using the Functional Independence Measure (FIM). The client asks the nurse, "What is the purpose of the FIM?" Which nursing response is appropriate?

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Correct Answer is C

Explanation

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