The 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.” This nursing response is appropriate because it accurately describes the purpose of the FIM, which is a standardized instrument that measures the client's level of independence in performing 18 activities of daily living and mobility tasks.

Choice B reason: "It is a test that determines which activities you feel most comfortable performinG.” This nursing response is not appropriate because it does not describe the purpose of the FIM, which is not a test that measures the client's comfort level, but rather their functional ability.

Choice C reason: "It is a tool used by insurance companies to determine qualifications for medical reimbursement." This nursing response is not appropriate because it does not describe the purpose of the FIM, which is not a tool that determines the client's eligibility for insurance coverage, but rather their functional status and progress.

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." This nursing response is not appropriate because it does not describe the purpose of the FIM, which is not a tool that evaluates the client's need for home care services, but rather their functional capacity and improvement.

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Correct Answer is C

Explanation

Choice A reason: Gradual onset of several hours is not a manifestation of a hemorrhagic strokE. Hemorrhagic strokes occur when a blood vessel bursts in or near the brain, causing rapid bleeding and increased intracranial pressurE.

Choice B reason: Maintains consciousness is not a manifestation of a hemorrhagic strokE. Hemorrhagic strokes often cause loss of consciousness due to compression or damage of brain tissuE.

Choice C reason: Sudden severe headache is a manifestation of a hemorrhagic strokE. Hemorrhagic strokes can cause intense pain in the head due to bleeding and pressure on nerve endings.

Choice D reason: History of neurologic deficits lasting less than 1 hour is not a manifestation of a hemorrhagic strokE. Neurologic deficits lasting less than 1 hour are more indicative of a transient ischemic attack (TIA), which is caused by temporary blockage or narrowing of blood vessels in or leading to the brain.

A. Hypertension B. Tinnitus C. Hypotension D. Tachycardia

Correct Answer is A

Explanation

Choice A reason: Hypertension is a manifestation of increased intracranial pressure because it is part of the Cushing's triad, which is a set of signs that indicate increased intracranial pressure and impaired cerebral perfusion. The other signs of Cushing's triad are bradycardia and irregular respirations.

Choice B reason: Tinnitus is not a manifestation of increased intracranial pressure because it is a symptom of hearing loss, ear infection, or ear damage, not increased intracranial pressurE. Tinnitus is a ringing, buzzing, or hissing sound in the ears that can be caused by various factors such as exposure to loud noise, aging, or medication side effects.

Choice C reason: Hypotension is not a manifestation of increased intracranial pressure because it is a sign of decreased blood pressure, not increased intracranial pressurE. Hypotension can be caused by various factors such as dehydration, blood loss, or shock.

Choice D reason: Tachycardia is not a manifestation of increased intracranial pressure because it is a sign of increased heart rate, not increased intracranial pressurE. Tachycardia can be caused by various factors such as anxiety, fever, or pain.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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The 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?