CPNRE Rehabilitation and Restorative Nursing — Questions and Answers
Question 1: A client who had a left-sided stroke is being assisted to transfer from bed to wheelchair. Which side should the wheelchair be positioned on to maximize the client's functional participation?
- On the left (affected) side to encourage use of the weaker limb
- On the right (unaffected) side so the client can use their stronger arm to assist (Correct answer)
- At the foot of the bed to minimize transfer distance
- Position does not matter — a full mechanical lift should always be used post-stroke
Correct answer: On the right (unaffected) side so the client can use their stronger arm to assist
Positioning the wheelchair on the client's unaffected (right) side allows the client to use their stronger arm and leg to assist with the transfer, promoting functional participation and independence. This also reduces the risk of injury to the affected limb.
Question 2: A PN is assisting a client who uses a standard cane following a right hip replacement. When walking, the cane should be held in which hand and advanced at which time?
- Right hand; advance the cane simultaneously with the right leg
- Left hand; advance the cane simultaneously with the right (affected) leg (Correct answer)
- Right hand; advance the cane before stepping with the left leg
- Left hand; advance the cane after the right leg completes the step
Correct answer: Left hand; advance the cane simultaneously with the right (affected) leg
A cane is held in the hand opposite the affected limb. The cane and the affected leg advance together, widening the base of support and reducing load on the operated hip. Holding the cane on the same side as the affected limb is incorrect and increases instability.
Question 3: A client recovering from a prolonged hospitalization has significant muscle weakness. Which of the following exercises should the PN initiate first?
- Resistive weight-bearing exercises
- Active range-of-motion (ROM) exercises
- Passive range-of-motion (ROM) exercises (Correct answer)
- Isotonic strengthening exercises
Correct answer: Passive range-of-motion (ROM) exercises
Passive range-of-motion exercises are initiated first when the client cannot move independently. The PN moves the joints through their range to maintain flexibility and prevent contractures, with progression to active-assisted and then active ROM as strength returns.
Question 4: Which nursing intervention best supports the rehabilitation principle of 'restorative care'?
- Completing tasks for the client to ensure efficiency and reduce fatigue
- Encouraging the client to do as much as possible for themselves with guidance and support (Correct answer)
- Delegating all rehabilitation activities to the physiotherapist
- Restricting activity until the client is fully recovered to prevent injury
Correct answer: Encouraging the client to do as much as possible for themselves with guidance and support
Restorative care promotes the client's independence and functional ability by encouraging self-care with appropriate support. 'Doing for' the client when they are capable of doing themselves undermines recovery and prolongs dependence.
Question 5: A client with a spinal cord injury at T6 is at risk for autonomic dysreflexia. A PN notices the client's blood pressure has risen to 178/100 mmHg and the client reports a pounding headache. What is the priority action?
- Administer a prescribed PRN antihypertensive immediately
- Sit the client upright, loosen restrictive clothing, and identify/remove the triggering stimulus (Correct answer)
- Place the client in a supine position and apply a cool cloth to the forehead
- Document findings and notify the physician at the next scheduled check
Correct answer: Sit the client upright, loosen restrictive clothing, and identify/remove the triggering stimulus
Autonomic dysreflexia is a medical emergency. The priority is to sit the client upright (which reflexively lowers BP) and identify and remove the trigger — most commonly a distended bladder or bowel. Placing the client supine would worsen hypertension. Prompt action is essential to prevent stroke.
Question 6: A PN is teaching a client with a below-knee amputation to care for their residual limb. Which instruction is correct?
- Soak the residual limb in warm water daily to keep the skin soft and pliable
- Wrap the residual limb with a figure-eight bandage to shape it for prosthetic fitting (Correct answer)
- Avoid touching the residual limb until the wound is fully healed
- Apply lotion between skin folds daily to prevent maceration
Correct answer: Wrap the residual limb with a figure-eight bandage to shape it for prosthetic fitting
Figure-eight bandaging of the residual limb reduces oedema and shapes the stump into a conical form suitable for prosthetic fitting. Soaking is contraindicated as it softens and maculates the skin. The client should be encouraged to handle the limb for desensitization and body image adjustment.
CPNRE Rehabilitation and Restorative Nursing
A client who had a left-sided stroke is being assisted to transfer from bed to wheelchair.
Which side should the wheelchair be positioned on to maximize the client's functional participation?