RN 4th Quarter FIM Quiz

1. Bladder - In acute care, Mr. Tate was incontinent every few hours, with staff constantly replacing his bed linen, hospital gowns and diapers. Upon admission to rehab, Mr. Tate is voiding when cued every 2 hours by staff during the day. Every night he is incontinent, the nurse finding his bed soaked and pajama pants and adult brief on the floor. The nurse must change his bed, clean and dry his skin, and replace the adult brief. What is the FIM score?

7 or Independent

3 or Mod Assist

5 or Supervision/Set up

1 or Total Assist

The FIM score is determined based on the level of assistance a patient requires to perform certain activities. In this case, Mr. Tate is unable to control his bladder and is incontinent every night, requiring the nurse to change his bed, clean and dry his skin, and replace the adult brief. This indicates that he needs total assistance for bladder management, resulting in a FIM score of 1 or Total Assist.

Explanation

The FIM score is determined based on the level of assistance a patient requires to perform certain activities. In this case, Mr. Tate is unable to control his bladder and is incontinent every night, requiring the nurse to change his bed, clean and dry his skin, and replace the adult brief. This indicates that he needs total assistance for bladder management, resulting in a FIM score of 1 or Total Assist.

2. Grooming - After the helper provides Mr. Tate with soap and a towel, he can wash his hands and face at the sink but needs assistance rinsing and drying them. Mr. Tate needs complete assistance with brushing his teeth. Mr. Tate is bald so does not require assistance with combing his hair. Lastly, Mr. Tate is unsafe with a razor, and requires a staff member to do all of his shaving needs. What is the FIM score?

1 or Total Assist

5 or Supervision/Set up

3 or Mod Assist

6 or Mod I

The FIM score for Mr. Tate is 1 or Total Assist because he requires complete assistance with grooming tasks such as rinsing and drying his hands and face, brushing his teeth, and shaving.

Explanation

The FIM score for Mr. Tate is 1 or Total Assist because he requires complete assistance with grooming tasks such as rinsing and drying his hands and face, brushing his teeth, and shaving.

3. If a patient needs help getting in and out of bed to go to the bathroom, needs help transferring on and off the toilet, is able to do self hygiene but needs help with clothing management and takes medication to control bladder sphincter, what FIM categories are you observing?

Bed/Chair/WC transfer and Toilet Transfer

Bladder Management

Bed/Chair/WC transfer, Toileting and Bladder Management

Bed/Chair/WC transfer, Toilet Transfer, Toileting and Bladder Management

The correct answer is Bed/Chair/WC transfer, Toilet Transfer, Toileting and Bladder Management. This is because the patient needs help with transferring in and out of bed and on and off the toilet, indicating the need for Bed/Chair/WC transfer and Toilet Transfer categories. Additionally, the patient requires assistance with clothing management, which falls under the Toileting category. Finally, the patient takes medication to control bladder sphincter, indicating the need for Bladder Management category.

Explanation

The correct answer is Bed/Chair/WC transfer, Toilet Transfer, Toileting and Bladder Management. This is because the patient needs help with transferring in and out of bed and on and off the toilet, indicating the need for Bed/Chair/WC transfer and Toilet Transfer categories. Additionally, the patient requires assistance with clothing management, which falls under the Toileting category. Finally, the patient takes medication to control bladder sphincter, indicating the need for Bladder Management category.

4. Bathing - Mr. Tate refuses to sit on a shower bench and refuses to bathe in bed. Bathing is not attempted on Day 2 due to the level of his agitation and safety considerations. The staff plan to assess Bathing on Day 3. What is the FIM score?

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5 or Supervision/Set up

7 or Independent

4 or Min Assist

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Explanation

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5. Upper Body Dressing - Mr. Tate is observed removing his shirt independently. When dressing he needs verbal cues for the order of the clothes (t-shirt before sweater). Mr. Tate's wife lays his clothes out for him next to the bed. What is the FIM score?

1 or Total Assist

2 or Max Assist

3 or Mod Assist

5 or Supervision/Setup

The FIM score for this scenario is 5 or Supervision/Setup. This means that Mr. Tate requires supervision or setup to complete the task of upper body dressing. Although he is able to remove his shirt independently, he needs verbal cues for the order of putting on his clothes. His wife lays out his clothes for him, indicating that he requires some assistance in organizing and initiating the dressing process.

Explanation

The FIM score for this scenario is 5 or Supervision/Setup. This means that Mr. Tate requires supervision or setup to complete the task of upper body dressing. Although he is able to remove his shirt independently, he needs verbal cues for the order of putting on his clothes. His wife lays out his clothes for him, indicating that he requires some assistance in organizing and initiating the dressing process.

6. Eating - Usually, Mr. Tate can feed himself adequately, but requires supervision for reminders to slow down and take smaller bites. However, this morning the helper fed him using the hand-over-hand technique to pick up the utensils, scoop up the food and guide it to the patient's mouth over 50% of the time. In addition, patient needed hand-over-hand technique to bring the cup and glass to his mouth more than 50% of the time. The patient was able to complete all eating tasks 25-49% of the time. What is the FIM score?

6- Mod I

1 - Total Assist

2- Max Assist

5 - Supervision/Set up

The FIM score is 2- Max Assist because the patient requires assistance over 50% of the time for feeding tasks, including using utensils and bringing the cup and glass to their mouth. Max Assist indicates that the patient needs someone to provide significant physical assistance or perform the task for them.

Explanation

The FIM score is 2- Max Assist because the patient requires assistance over 50% of the time for feeding tasks, including using utensils and bringing the cup and glass to their mouth. Max Assist indicates that the patient needs someone to provide significant physical assistance or perform the task for them.

7. If the patient uses the toilet but needs you there for assistance with Toilet Transfer or Toileting, the FIM score for Bladder and Bowel Management is 7 or Independent. If the patient requires a medication to help control the sphincter, the FIM score for Bladder and Bowel Management is 6-Mod I

True

False

If the patient is able to use the toilet independently but requires assistance with transferring to and from the toilet or needs assistance with toileting tasks, their FIM score for Bladder and Bowel Management would be 7, indicating independence. However, if the patient requires medication to help control their sphincter, their FIM score would be 6, indicating modified independence. Therefore, the statement is true.

Explanation

If the patient is able to use the toilet independently but requires assistance with transferring to and from the toilet or needs assistance with toileting tasks, their FIM score for Bladder and Bowel Management would be 7, indicating independence. However, if the patient requires medication to help control their sphincter, their FIM score would be 6, indicating modified independence. Therefore, the statement is true.

8. Social Interaction: Mr. Tate is irritable and frequenly becomes aggressive during therapies. Staff treat him in a private area, because he yells at other patients and has picked up a chair and thrown it across the room. He is mad that he is being held "against his will" in the hospital. Mr. Tate takes medication throughout the day to calm him down, however he requires a sitter with him at all times. What is the FIMs score?

6 or Mod I

3 or Mod Assist

5 or Supervision/Set up

1 or Total Assist

Based on the given information, Mr. Tate frequently becomes aggressive and requires a sitter with him at all times. This indicates that he is completely dependent on assistance and requires total assistance (FIMs score of 1) for his social interactions.

Explanation

Based on the given information, Mr. Tate frequently becomes aggressive and requires a sitter with him at all times. This indicates that he is completely dependent on assistance and requires total assistance (FIMs score of 1) for his social interactions.

9. Problem Solving: Mr. Tate needs constant supervision. When he is thirsty, he grabs drinks out of visitor's hands. Because he thought it was "too stuffy in the room" he tried to open his window by banging his phone against it. When he needs to go to the bathroom, he presses the red button on the phone to call for help. What is the FIM score?

4 or Min Assist

3 or Mod Assist

2 or Max Assist

1 or Total Assist

The FIM score is a measure of a person's functional independence. In this case, Mr. Tate requires total assistance for his daily activities. He needs constant supervision, grabs drinks from visitors, tries to open the window with his phone, and calls for help when he needs to go to the bathroom. These actions indicate that he is unable to perform these activities independently and requires total assistance. Therefore, the FIM score for Mr. Tate is 1 or Total Assist.

Explanation

The FIM score is a measure of a person's functional independence. In this case, Mr. Tate requires total assistance for his daily activities. He needs constant supervision, grabs drinks from visitors, tries to open the window with his phone, and calls for help when he needs to go to the bathroom. These actions indicate that he is unable to perform these activities independently and requires total assistance. Therefore, the FIM score for Mr. Tate is 1 or Total Assist.

10. Memory: Mr. Tate easily recognizes his wife but calls her by the wrong name. He consistently recognizes the staff and calls therapies "the guards" or his sitter "the spy". He can remember more than 25% but needs reminding by the staff for the basic tasks and daily routines more than half of the time. What is the FIM score?

3 or Mod Assist

1 or Total Assist

4 or Min Assist

2 or Max Assist

Based on the given information, Mr. Tate consistently recognizes people but often calls them by the wrong name. He also requires reminding by the staff for basic tasks and daily routines more than half of the time. This indicates that he needs maximum assistance (Max Assist) to perform these tasks. Therefore, the FIM score for Mr. Tate would be 2 or Max Assist.

Explanation

Based on the given information, Mr. Tate consistently recognizes people but often calls them by the wrong name. He also requires reminding by the staff for basic tasks and daily routines more than half of the time. This indicates that he needs maximum assistance (Max Assist) to perform these tasks. Therefore, the FIM score for Mr. Tate would be 2 or Max Assist.

11. Transfers: Bed/Chair/Wheelchair - Mr. Tate needs supervision to move from the bed to the chair. He uses a wheelchair for safety during the day, and a helper needs to make sure the brakes are locked, the foot rests are raised and cues are given before he transfers into the wheelchair. What is the FIM score?

6 or Mod I

5 or Supervision/Set up

4 or Min Assist

1 or Total Assist

The FIM score for Mr. Tate would be 5 or Supervision/Set up. This is because he requires supervision from a helper to move from the bed to the chair. The helper needs to ensure that the wheelchair brakes are locked, foot rests are raised, and cues are given before Mr. Tate transfers into the wheelchair. Although he requires assistance, it is not specified that the helper physically assists him in the transfer, hence the score of Supervision/Set up rather than Min Assist.

Explanation

The FIM score for Mr. Tate would be 5 or Supervision/Set up. This is because he requires supervision from a helper to move from the bed to the chair. The helper needs to ensure that the wheelchair brakes are locked, foot rests are raised, and cues are given before Mr. Tate transfers into the wheelchair. Although he requires assistance, it is not specified that the helper physically assists him in the transfer, hence the score of Supervision/Set up rather than Min Assist.

12. Lower Body Dressing - After the helper sets out his clothes, Mr. Tate is able to put his socks, boxers and slacks on with verbal cues. A helper needs to provide incidental assistance, helping him to put on his shoes and tie the laces. In the evening, he is independent with removing all of his lower body clothing. What is the FIM score?

5 or Supervision/Set up

1 or Total Assist

4 or Min Assist

3 or Mod Assist

Based on the given information, Mr. Tate requires minimal assistance (Min Assist) when it comes to lower body dressing. Although he can independently remove his lower body clothing in the evening, he still needs some assistance in putting on his shoes and tying the laces. This level of assistance falls under the category of Min Assist, where the helper provides minimal support to complete the task. Therefore, the FIM score for lower body dressing in Mr. Tate's case is 4 or Min Assist.

Explanation

Based on the given information, Mr. Tate requires minimal assistance (Min Assist) when it comes to lower body dressing. Although he can independently remove his lower body clothing in the evening, he still needs some assistance in putting on his shoes and tying the laces. This level of assistance falls under the category of Min Assist, where the helper provides minimal support to complete the task. Therefore, the FIM score for lower body dressing in Mr. Tate's case is 4 or Min Assist.

13. Comprehension; Mr. Tate is able to follow basic, one step commands more than 50% of the time with staff repeating the command and gesturing almost 50% of the time. What is the FIM score?

1 or Total Assist

7 or Independent

3 or Mod Assist

2 or Max Assist

Based on the given information, Mr. Tate is able to follow basic, one step commands more than 50% of the time. However, the staff needs to repeat the command and gesture almost 50% of the time. This suggests that Mr. Tate requires moderate assistance (Mod Assist) to follow these commands.

Explanation

Based on the given information, Mr. Tate is able to follow basic, one step commands more than 50% of the time. However, the staff needs to repeat the command and gesture almost 50% of the time. This suggests that Mr. Tate requires moderate assistance (Mod Assist) to follow these commands.

14. Expression: Mr. Tate often mixes up his words and thoughts, using inappropriate terms to describe objects. Often, he gets so frustrated that he swears and swings at staff when trying to express his needs. He resorts to pointing to what he needs when his wife asks him to repeat himself. He uses single words and common phrases less than half of the time. Staff must prompt him more than half of the time. What is the FIM score?

2 or Max Assist

1 or Total Assist

5 or Supervision/Set up

6 or Mod I

Based on the given information, Mr. Tate often mixes up his words and thoughts, uses inappropriate terms, gets frustrated, swears, and swings at staff when trying to express his needs. He resorts to pointing and uses single words and common phrases less than half of the time. Staff must prompt him more than half of the time. This indicates that Mr. Tate requires maximum assistance (Max Assist) in performing his daily activities. Therefore, the FIM score for Mr. Tate would be 2 or Max Assist.

Explanation

Based on the given information, Mr. Tate often mixes up his words and thoughts, uses inappropriate terms, gets frustrated, swears, and swings at staff when trying to express his needs. He resorts to pointing and uses single words and common phrases less than half of the time. Staff must prompt him more than half of the time. This indicates that Mr. Tate requires maximum assistance (Max Assist) in performing his daily activities. Therefore, the FIM score for Mr. Tate would be 2 or Max Assist.

15. Bowel - Mrs. Tate reported that before her husband's heart attack, he typically had a BM every morning after breakfast. On the second day of admission, the rehab staff toileted Mr. Tate after breakfast and he was continent of stool. On day 3 of rehab, Mr. Tate was not toileted after breakfast and was incontinent in his adult brief, which he removed, soiling his pants. The staff cleaned Mr. Tate's skin and replaced the brief. The staff in acute care did not have any data on bowel movements for Mr. Tate. What is the FIM score?

2 or Max Assist

6 or Modified Independent

1 or Total Assist

4 or Min Assist

Based on the given information, Mr. Tate was incontinent of stool on day 3 of rehab and required assistance from the staff to clean his skin and replace his brief. This indicates that he is unable to perform the task of toileting independently and requires total assistance, hence the FIM score would be 1 or Total Assist.

Explanation

Based on the given information, Mr. Tate was incontinent of stool on day 3 of rehab and required assistance from the staff to clean his skin and replace his brief. This indicates that he is unable to perform the task of toileting independently and requires total assistance, hence the FIM score would be 1 or Total Assist.

16. Transfers: Toilet - With verbal cues and contact guard assistance, Mr. Tate transfers on and off a toilet. What is the FIM score?

5 or Supervision/Set up

1 or Total Assist

3 or Mod Assist

4 or Min Assist

The FIM score for Mr. Tate's transfers to and from the toilet is 4 or Min Assist. This means that he requires minimal assistance from another person to complete the transfer. He may need some assistance, such as steadying or guiding, but is able to perform most of the transfer independently.

Explanation

The FIM score for Mr. Tate's transfers to and from the toilet is 4 or Min Assist. This means that he requires minimal assistance from another person to complete the transfer. He may need some assistance, such as steadying or guiding, but is able to perform most of the transfer independently.

17. A patient uses a urinal in bed and accesses it from the bedside table. He only needs assistance with emptying the urinal and placing it back near the bed. He is independent with clothing management and self hygiene. You are only observing Bladder Management. True or False

True

False

False. The patient is described as independent with clothing management and self hygiene, indicating that they are capable of managing their own bladder management. Therefore, they do not require assistance with emptying the urinal and placing it back near the bed.

Explanation

False. The patient is described as independent with clothing management and self hygiene, indicating that they are capable of managing their own bladder management. Therefore, they do not require assistance with emptying the urinal and placing it back near the bed.

18. Toileting - Mr. Tate is able to walk to the bathroom with supervision. He is able to pull down his slacks/boxers, and sit on the toilet with frequent cues. After using the toilet, he's not sure what to do next. The helper gives him toilet paper to do self hygiene but Mr. Tate tosses it into the nearby trash can. The helper must clean him and remind him to pull up his boxers and slacks. Patient is able to pull pants up without physical assistance. What is the FIM score?

1 or Total Assist

3 or Mod Assist

5 or Supervision/Set up

4 or Min Assist

The FIM score for this scenario is 3 or Mod Assist. This is because Mr. Tate requires moderate assistance for toileting. Although he is able to walk to the bathroom and perform some tasks independently, such as pulling down his pants and sitting on the toilet, he requires cues and reminders for other tasks, such as using toilet paper and pulling up his pants. The helper needs to clean him and provide reminders, indicating that Mr. Tate is not able to complete these tasks on his own.

Explanation

The FIM score for this scenario is 3 or Mod Assist. This is because Mr. Tate requires moderate assistance for toileting. Although he is able to walk to the bathroom and perform some tasks independently, such as pulling down his pants and sitting on the toilet, he requires cues and reminders for other tasks, such as using toilet paper and pulling up his pants. The helper needs to clean him and provide reminders, indicating that Mr. Tate is not able to complete these tasks on his own.