RN 3rd Quarter FIM
Mrs. M is a 70 y. O, married white female who lives with her husband. She has PVD, Hypertension, DM and is obese. She had bilateral knee replacement on 8/14/13 due to degenerative joint disease and is transferred to SCC on 8/20/13 for acute rehab.
Questions and Answers
- 1.
Eating - Mrs. M requires dentures to chew a regular diet without problems; she can feed herself independently. What is the FIM score?
- A.
6 or Mod I
- B.
5 or Supervision
- C.
2 or Max Assist
- D.
7 or Independent
- E.
4 or Min Assist
Correct Answer
A. 6 or Mod IExplanation
The FIM score for Mrs. M is 6 or Mod I. This means that she requires moderate assistance or supervision to perform the activity of eating. Although she can feed herself independently, she requires dentures to chew a regular diet without problems. Therefore, she may need some assistance or supervision to ensure that she is able to eat properly with the dentures.Rate this question:
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- 2.
Grooming - Mrs. M keeps her grooming supplies in a basket at the sink. She does not need a helper to set her up. Once she is seated at the sink, while sitting on a chair, she is able to wash, rinse and dry her face and hands, clean her dentures and comb her hair. Mrs. M does not wear makeup. What is the FIM score?
- A.
6 or Mod I
- B.
4 or Min Assist
- C.
7 or Independent
- D.
5 or Supervision
- E.
1 or Total Assist
Correct Answer
C. 7 or IndependentExplanation
Based on the given information, Mrs. M is able to perform all the grooming tasks independently without the need for any assistance or supervision. Therefore, she would be scored as 7 or Independent.Rate this question:
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- 3.
Bathing - Mrs. M is able to wash, rinse and dry her chest, abdomen and both arms. A helper has to wash rinse and dry both upper and lower legs/feet, perineal area and buttocks. (Start with the definition; how many body parts are included in the definition of bathing? Then calculate a percentage based on the definition.) What is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
3 or Mod Assist
- D.
2 or Max Assist
- E.
7 or Independent
Correct Answer
D. 2 or Max AssistExplanation
The definition of bathing includes washing, rinsing, and drying the chest, abdomen, and both arms. However, a helper is required to wash, rinse, and dry the upper and lower legs/feet, perineal area, and buttocks. Based on this information, it can be concluded that Mrs. M requires maximum assistance (Max Assist) for bathing.Rate this question:
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- 4.
Dressing: Upper Body - Mrs. M is not able to gather her clothes from their customary place. After the helper places them on her nightstand, she is able to apply and remove her bra and shirt on her own. What is the FIM score?
- A.
4 or Min assist
- B.
5 or Supervision
- C.
7 or Independent
- D.
1 or Total Assist
- E.
3 or Mod Assist
Correct Answer
B. 5 or SupervisionExplanation
The FIM score would be 5 or Supervision because Mrs. M is able to apply and remove her bra and shirt on her own once her clothes are placed on her nightstand by the helper. This indicates that she requires only supervision to complete the task.Rate this question:
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- 5.
Lower Body: Dressing - Due to having had bilateral knee replacement, Mrs. M requires 2 helpers for undressing her lower body. She requires mod assist for removing her underwear and total assist to remove her pants, shoes and socks. What is the FIM score?
- A.
Activity did not occur because she was undressing, not dressing
- B.
6 or Mod I
- C.
2 or Max Assist
- D.
1 or Total Assist
- E.
4 or Min Assist
Correct Answer
D. 1 or Total AssistExplanation
The FIM score is 1 or Total Assist because Mrs. M requires total assistance to remove her pants, shoes, and socks. This indicates that she is unable to perform the activity independently and requires someone to assist her completely. The fact that the activity is undressing rather than dressing does not affect the scoring, as the level of assistance needed remains the same.Rate this question:
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- 6.
Toileting - During the first FIM Day, Mrs. M uses a bedpan when she needs to void. She needs a helper to pull down her pants and underwear. She requires help to clean herself and to pull up her pants and underwear. What is the FIM score?
- A.
1 or Total Assist
- B.
3 or Mod Assist
- C.
5 or Supervision
- D.
7 or Independent
- E.
4 or Min Assist
Correct Answer
A. 1 or Total Assist -
- 7.
Toileting - By her third day of admission, Mrs. M can use the bedside commode. She is able to pull her own pants and underwear down, clean herself and pull her own pants and underwear up. However, she requires 1 helper to steady her during these 3 tasks. The helper does not assist with the tasks themselves, but the helper is touching or applying contact guard/steadying assist to help to the patient. What is the FIM score?
- A.
1 or Total Assist
- B.
3 or Mod Assist
- C.
4 or Min Assist
- D.
5 or Supervision
- E.
7 or Independent
Correct Answer
C. 4 or Min AssistExplanation
The FIM score for Mrs. M's toileting ability is 4 or Min Assist. Although she is able to perform the tasks of pulling her pants and underwear down, cleaning herself, and pulling her pants and underwear up on her own, she requires the assistance of one helper to steady her during these tasks. The helper does not directly assist with the tasks but provides touch or contact guard/steadying assist to ensure the patient's safety. This level of assistance falls under the category of Min Assist in the FIM scoring system.Rate this question:
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- 8.
Bladder Management - Since her surgery, Mrs. M has had some bladder urgency. During your shift, she had an accident wetting around the pad and onto her pants. A helper changed the bed and clothing for her. While lying in bed, she was able to place and remove the absorbent pads but required a staff member to moderately assist her onto the bedpan. What is the FIM score? Remember; there are 2 function modifiers for Bladder Management - 1. Level of Assistance and 2. # of accidents. If staff are changing linens or clothing after an accident, regardless of needing mod assist onto the bedpan, what is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
3 or Mod Assist
- D.
7 or Independent
- E.
4 or Min Assist
Correct Answer
A. 1 or Total AssistExplanation
The FIM score would be 1 or Total Assist. This is because the patient is unable to independently manage her bladder and requires assistance from staff members. The fact that staff members had to change her bed and clothing after an accident indicates that she is unable to control her bladder effectively. Therefore, she would receive a score of 1, indicating that she requires total assistance for bladder management.Rate this question:
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- 9.
Bowel Management - Mrs. M has been continent of bowel since admission, with no accidents during your shift. She uses a bedpan on her own but needs a helper to stand by, just in case she needs assistance. The helper empties the bedpan. What is the FIM score?
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
4 or Min Assist
- D.
6 or Mod I
- E.
2 or Max Assist
Correct Answer
B. 5 or SupervisionExplanation
The FIM score for this situation is 5 or Supervision because Mrs. M is able to use the bedpan on her own but requires a helper to stand by in case she needs assistance. This indicates that she can perform the task with supervision, but may need occasional support.Rate this question:
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- 10.
Transfers: Bed/chair/wheelchair - Using a walker, Mrs. M is able to stand up with the help of 1 person, and pivot into the wheelchair. You provide less than 50% of the lifting. The patient is able to do more than 50% but less than 75% of the task. What is the FIM score?
- A.
5 or Supervision
- B.
6 or Mod I
- C.
3 or Mod Assist
- D.
1 or Total Assist
- E.
3 or Mod Assist
Correct Answer
C. 3 or Mod AssistExplanation
Based on the given information, Mrs. M is able to stand up with the help of 1 person and pivot into the wheelchair using a walker. The question states that the person providing assistance (you) provides less than 50% of the lifting, and the patient is able to do more than 50% but less than 75% of the task. This indicates that the patient requires moderate assistance. Therefore, the FIM score for this transfer would be 3 or Mod Assist.Rate this question:
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- 11.
Transfers: Toilet - Mrs. M uses a bedpan for toileting, with a helper emptying the bedpan after use. (hint; trick question)
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
4 or Min Assist
- D.
0 or Activity did not occur
- E.
3 or Mod Assist
Correct Answer
D. 0 or Activity did not occurExplanation
The correct answer is 0 or Activity did not occur because the activity of using a bedpan for toileting did not occur. This is indicated by the statement that Mrs. M uses a bedpan for toileting, with a helper emptying the bedpan after use. However, there is no mention of the actual activity taking place, suggesting that it did not occur.Rate this question:
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- 12.
Comprehension - Mrs. M easily follows concrete commands during therapy sessions but needs occasional repitition. She has no hearing aid batteries and asked her husband to bring some in. .
- A.
6 or Mod I
- B.
5 or Supervision
- C.
2 or Max Assist
- D.
1 or Total Assist
- E.
7 or Independent
Correct Answer
B. 5 or SupervisionExplanation
The correct answer is 5 or Supervision. Mrs. M is able to easily follow concrete commands during therapy sessions but occasionally needs repetition. This suggests that she is able to perform tasks independently with some supervision and guidance.Rate this question:
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- 13.
Expression - Mrs. M has no difficulty expressing herself . She is able to state her basic needs adequately to staff 90% of the time, and is currently calling her husband to make sure he brings the batteries in for her hearing aids.
- A.
3 or Mod Assist
- B.
1 or Total Assist
- C.
6 or Mod I
- D.
5 or Supervision
- E.
4 or Min Assist
Correct Answer
D. 5 or SupervisionExplanation
Based on the given information, Mrs. M is able to express her basic needs adequately to staff most of the time and is currently able to call her husband to remind him to bring batteries for her hearing aids. This suggests that she does not require any physical assistance or direct intervention (such as total assist, mod assist, or min assist) in expressing herself or making phone calls. However, she may still need some level of supervision (option 5) to ensure that she is able to communicate effectively and safely.Rate this question:
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- 14.
Social Interaction - Though at times she is in pain and a little tearful, she talks with other patients encouraging them to participate and get stronger in their therapies.
- A.
1 or Total Assist
- B.
5 or Supervision
- C.
2 or Max Assist
- D.
0 or Activity did not occur
- E.
7 or Independent
Correct Answer
E. 7 or IndependentExplanation
The given answer of "7 or Independent" is appropriate because the person in question is able to engage in social interaction, communicate with other patients, and provide encouragement despite being in pain and feeling tearful. This demonstrates a high level of independence in their ability to participate in activities and interact with others without requiring assistance or supervision.Rate this question:
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- 15.
.Problem Solving - Mrs. M tends to overestimate her functional abilities and doesn't ask for help during lower body dressing for example; when her feet get caught in her pants, she needs a cue to initiate use of a reacher. She needs verbal cuing occasionally, less than 10% of the time, for problem solving during ADLs.
- A.
7 or Independent
- B.
5 or Supervision
- C.
3 or Mod Assist
- D.
1 or Total Assist
- E.
6 or Mod I
Correct Answer
B. 5 or SupervisionExplanation
Mrs. M tends to overestimate her abilities and does not ask for help when dressing her lower body. However, she occasionally needs verbal cues to initiate the use of a reacher when her feet get caught in her pants. This indicates that she requires supervision during ADLs. Supervision means that someone needs to be present to ensure her safety and provide occasional verbal cues, but she can perform the tasks independently for the most part.Rate this question:
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- 16.
Memory - Mrs. M feels that her hospitalization has thrown her off kilter and she has come up with a daily planning system to remember the times and places of her therapy sessions, when visiting hours are, her room number, and the names of her rehab team.
- A.
3 or Mod Assist
- B.
4 or Min Assist
- C.
1 or Total Assist
- D.
7 or Independence
- E.
6 or Mod I
Correct Answer
E. 6 or Mod IExplanation
The given correct answer, 6 or Mod I, suggests that Mrs. M is able to perform her daily planning system with moderate independence. This means that she may require some assistance or support, but overall she is able to manage and remember the important information related to her therapy sessions, visiting hours, room number, and rehab team.Rate this question:
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- 17.
True or False: If you, the helper, is providing more than 50% of the effort to complete the task, the FIM score would be 3 - Mod Assist.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The correct answer is False. The FIM score is not determined based on the percentage of effort provided by the helper. The FIM score measures the level of assistance required by the individual to complete a task, ranging from total dependence to complete independence. The score is determined based on the individual's ability to perform the task without assistance, regardless of the amount of effort provided by the helper.Rate this question:
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- 18.
The definition of Bathing includes the washing, rinsing and drying of the face.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because the definition of bathing does not specifically include the washing, rinsing, and drying of the face. Bathing generally refers to the act of cleansing and immersing one's body in water, which typically involves washing the entire body, not just the face.Rate this question:
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- 19.
True or False: If you, the helper, only provide physical support, steadying, or contact guard while the patient on his/her own, completes the 3 tasks of Toileting, in Achieve, you would select "Incidental Assistance" NOT "Physical Assistance" for a FIM score of 4 - Min Assist.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
If the helper only provides physical support, steadying, or contact guard while the patient completes the 3 tasks of toileting, it indicates that the patient is able to perform the tasks on their own with minimal assistance. Therefore, the appropriate FIM score would be 4 - Min Assist, which corresponds to "Incidental Assistance." This means that the patient requires minimal assistance but is able to complete the tasks independently.Rate this question:
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- 20.
The information you document in Meditech for Bowel and Bladder, that includes Level of Assistance and Device used must match the Bowel and Bladder documentation in Achieve.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The explanation for the given correct answer is that the information documented in Meditech for Bowel and Bladder, including the Level of Assistance and Device used, should be consistent with the Bowel and Bladder documentation in Achieve. This means that both systems should have the same information regarding the patient's bowel and bladder management. It is important to ensure accuracy and consistency in the documentation across different systems to provide comprehensive and effective care for the patient.Rate this question:
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