RN FIM Competency 2nd Qtr
Mrs P is a 75 y. O. Married woman who lives with her husband. She was in fair health until 3/15/13 when she had a left anterior cerebral artery occlusion. She was admitted to the acute care hospital, became medically stable and was transferred to SCC for rehabilitation.
- 1.
EATING: Mrs. P passed her modified barium swallow, with safe swallow for all consistencies. She is left handed and is able to pick up a utensil and feed herself with her right hand. She needs help opening milk containers and removing lids. What level of assistance is needed?
- A.
2 or Max Assist
- B.
4 or Min Assist
- C.
7 or Independent
- D.
5 or Supervision/Set up
- E.
3 or Mod Assist
Correct Answer
D. 5 or Supervision/Set upExplanation
Based on the given information, Mrs. P is able to feed herself with her right hand but needs assistance in opening milk containers and removing lids. This indicates that she requires supervision or set up to ensure that the containers are opened and lids are removed properly before she can independently feed herself. Therefore, the level of assistance needed is 5 or Supervision/Set up.Rate this question:
-
- 2.
GROOMING: Mrs. P is able to wash her face and hands, after much prompting by the helper. She brushes her teeth independently, after a helper finds the toothbrush for her and prompts her to initiate the task. She needs help brushing her hair. What level of assistance is needed? (Hint: Grooming consists of 4 tasks)
- A.
Min Assist - 4
- B.
Mod Assist - 3
- C.
Dependent - 1
- D.
Activity did not occur - 0
- E.
Supervision/Set up - 5
Correct Answer
A. Min Assist - 4Explanation
Mrs. P requires minimal assistance for grooming tasks. Although she is able to wash her face and hands independently, she needs prompting from the helper. She also requires assistance in finding the toothbrush and initiating the task of brushing her teeth. However, she is able to brush her teeth on her own once prompted. The only task she needs help with is brushing her hair. Therefore, the level of assistance needed for grooming is minimal assistance (Min Assist) - 4.Rate this question:
-
- 3.
BATHING: Mrs. P has a delayed response when following commands or initiating tasks. She requires verbal cues and a helper must put the washcloth in her hand before she can begin to bathe. Mrs. P can then wash her chest, abdomen and left upper leg while a helper finishes the rest of the bathing. (Hint: How many areas of the body are included in bathing?)
- A.
4 or Min Assist
- B.
1 or Dependent
- C.
2 or Max Assist
- D.
6 or Mod I
- E.
3 or Mod Assist
Correct Answer
C. 2 or Max AssistExplanation
The correct answer is 2 or Max Assist because Mrs. P requires verbal cues and assistance to initiate and complete the bathing task. Although she can wash her chest, abdomen, and left upper leg independently, she still needs a helper to finish the rest of the bathing process. This indicates that she is able to perform some parts of the task with assistance, but requires maximum assistance for the overall bathing activity.Rate this question:
-
- 4.
DRESSING-UPPER BODY: Mrs. P needs a helper to remove her bra. She is in a lot of pain in her right upper extremity, and is unable to take either arm out of her shirt or pull it over her head without assistance. What level of assistance is needed?
- A.
Mod A - 3
- B.
Max A - 2
- C.
Dependent/Total Assist - 1
- D.
Supervision/set up - 5
- E.
Min A - 4
Correct Answer
C. Dependent/Total Assist - 1Explanation
Mrs. P is unable to perform the task of removing her bra independently due to her pain and limited mobility in her right upper extremity. She requires complete assistance from a helper to accomplish this task. Therefore, the level of assistance needed is Dependent/Total Assist - 1.Rate this question:
-
- 5.
DRESSING - LOWER BODY: Mrs. P is able to lift her right leg so a helper can thread her underwear and pants. She is not able to lift her left leg. While in bed, Mrs. P is able to pull her underwear and pants up without help. She wears antiembolic stockings that are applied and removed by a helper. A helper applies and removes Mrs. P's shoes and socks. Patient performs less than 50% of lower body dressing. What level of assistance is needed?
- A.
Dependent - 1
- B.
Min Assist - 4
- C.
Mod I - 6
- D.
Max Assist - 2
- E.
Mod Assist - 3
Correct Answer
D. Max Assist - 2Explanation
Mrs. P is able to lift her right leg and perform some aspects of lower body dressing on her own, such as pulling up her underwear and pants while in bed. However, she is unable to lift her left leg and requires assistance from a helper to thread her underwear and pants. Additionally, a helper applies and removes her shoes and socks. Since Mrs. P performs less than 50% of lower body dressing, she requires a maximum level of assistance, which is indicated by the answer choice "Max Assist - 2".Rate this question:
-
- 6.
TOILETING; When in a standing position, Mrs. P needs a helper to pull down her pants and adult brief. She is able to clean herself. The helper must pull up both pants and the adult brief. What level of assistance is needed?
- A.
Mod I - 6
- B.
Max Assist - 2
- C.
Dependent - 1
- D.
Mod Assist - 3
- E.
Activity did not occur - 0
Correct Answer
B. Max Assist - 2Explanation
Mrs. P requires a helper to pull down her pants and adult brief when she is in a standing position. However, she is able to clean herself. The helper is also responsible for pulling up both her pants and the adult brief. This indicates that Mrs. P requires a high level of assistance, but she is still able to participate in the activity to some extent. Therefore, the appropriate level of assistance needed would be Max Assist - 2.Rate this question:
-
- 7.
BLADDER: Mrs. P is taking medication to help with bladder management. Half of her voids are incontinent. She is wearing a brief. A helper must change the brief for her when she is incontinent. The brief is successfully keeping her clothing and linen dry. What level of assistance is needed?
- A.
Mod I - 6
- B.
Max Assist - 2
- C.
Min Assist - 4
- D.
Supervision - 5
- E.
Dependent - 1
Correct Answer
E. Dependent - 1Explanation
The answer "Dependent - 1" is the correct choice because the scenario describes Mrs. P as needing assistance to change her brief when she is incontinent. This indicates that she is unable to manage this task independently and is dependent on a helper for assistance.Rate this question:
-
- 8.
BOWEL: Though Mrs. P is aware when she needs to have a bowel movement , she still needs to wear a brief just in case. The first day of admission, while waiting for the staff to take her to the toilet, she became incontinent. The brief was soiled but not her clothing or linens. The helper had to change her brief and clean her. What level of assistance is needed?
- A.
Max Assist - 2
- B.
Mod I - 6
- C.
Min Assist - 4
- D.
Dependent - 1
- E.
Supervision - 5
Correct Answer
D. Dependent - 1Explanation
The patient is dependent on the helper for assistance with bowel movements. She is aware of when she needs to have a bowel movement but still needs to wear a brief just in case. On the first day of admission, she became incontinent and the helper had to change her brief and clean her. This indicates that the patient is unable to independently manage her bowel movements and requires complete assistance, making the level of assistance needed Dependent - 1.Rate this question:
-
- 9.
TRANSFERS; Bed/Chair/Wheelchair: Mrs. P does a stand pivot transfer from bed to the wheelchair. She needs a helper to arrange her wheelchair next to the bed, only requiring contact guard/steadying assistance. However, when moving from wheelchair to the bed, she needs some lifting assistance rather than just contact guard, but she still does the majority (or more than 50%) of the work in transferring from wheelchair to bed. What level of assistance is needed?
- A.
Supervision - 5
- B.
Min Assist - 4
- C.
Max Assist - 2
- D.
Mod Assist - 3
- E.
Dependent - 1
Correct Answer
D. Mod Assist - 3Explanation
The correct answer is Mod Assist - 3 because Mrs. P requires some lifting assistance when transferring from the wheelchair to the bed. Although she does the majority of the work, she still needs help with the transfer, indicating a moderate level of assistance.Rate this question:
-
- 10.
TRANSFERS; Toilet: Transferring onto a regular toilet seat, Mrs. P uses her quad cane and a helper provides verbal assistance to help her get situated on the toilet. Mrs. P needs just a slight amount of lifting assistance when rising from the toilet. What level of assistance is needed?
- A.
Supervision - 5
- B.
Min Assist - 4
- C.
Mod Assist - 3
- D.
Max Assist - 2
- E.
Dependent - 1
Correct Answer
C. Mod Assist - 3Explanation
The correct answer is Mod Assist - 3 because Mrs. P requires verbal assistance and uses her quad cane to transfer onto the toilet seat. She also needs a slight amount of lifting assistance when rising from the toilet. This level of assistance indicates that she is able to perform most of the task with some help and supervision.Rate this question:
-
- 11.
TRANSFERS; Tub/Shower: The unit's tub area is currently being remodeled, so Mrs. P does not attempt a tub transfer. Using her quad cane, she is able to walk into the shower and sit onto a shower bench with steadying assistance. She requires steadying assistance to stand up and walk out of the shower area. What level of assistance is needed?
- A.
Dependent - 1
- B.
Max Assist - 2
- C.
Min Assist - 4
- D.
Supervision - 5
- E.
Mod I - 6
Correct Answer
C. Min Assist - 4Explanation
Mrs. P is able to walk into the shower using her quad cane, but she requires assistance to maintain her balance. She is able to sit onto a shower bench with assistance, indicating that she has some ability to perform the transfer independently. However, she requires assistance to stand up and walk out of the shower area, indicating that she needs some level of assistance for the transfer. Therefore, the appropriate level of assistance needed for Mrs. P is Min Assist - 4.Rate this question:
-
- 12.
COMPREHENSION: It is difficult to assess Mrs. P's comprehension for complex ideas, because she has such a great delay in response. With prompting, Mrs. P follows directions about her basic daily needs approximately 50%-74% of the time. The information she understands consists of more than just simple statements. What level of assistance is needed?
- A.
7 - No assistance required. Patient comprehends complex or abstract directions and conversation, and understands either spoken or written language.
- B.
3 - Moderate: Patient understands directions and conversations about basic daily needs and ideas 50-74% of the time.
- C.
1 - Total Assistance: Patient understands only simple, commonly used spoken expressions or gestures about basic daily needs less than 25% of the time, despite prompting.
- D.
5 - Comprehends directions and conversation about basic daily needs requiring prompting no more than 10% of the time to be understood.
- E.
4 - Minimal: Understands directions and conversations about basic daily needs and ideas 75-90% of the time.
Correct Answer
B. 3 - Moderate: Patient understands directions and conversations about basic daily needs and ideas 50-74% of the time.Explanation
Based on the given information, Mrs. P has a delay in response and requires prompting to follow directions about her basic daily needs. However, she is able to understand more than just simple statements, indicating that she can comprehend conversations and directions about basic daily needs and ideas to some extent. The level of assistance needed is considered moderate because Mrs. P understands these conversations and directions about basic daily needs and ideas between 50-74% of the time.Rate this question:
-
- 13.
EXPRESSION: Mrs. P communicates by gesturing and using one-word sentences. Staff members are usually able to understand the basic information that she is trying to express. When staff members need to prompt her to repeat herself more than 50% of the time, she becomes frustrated and waves them off, or laughs and cries inappropriately. What level of assistance is needed?
- A.
6 - No assistance required - Patient expresses complex or abstract ideas but requires a computer to assist with expressing ideas.
- B.
4- Minimal assistance - Patient expresses basic daily needs and ideas 75-90% of the time.
- C.
2 - Maximal Assistance required - Uses only single words or gestures to express basic needs; requiring prompting more than 50% of the time.
- D.
0 - activity did not occur
- E.
1 - Total Assistance - Expresses basic needs appropriately or consistently less than 25% of the time despite prompting
Correct Answer
C. 2 - Maximal Assistance required - Uses only single words or gestures to express basic needs; requiring prompting more than 50% of the time.Explanation
Based on the information provided, Mrs. P communicates using one-word sentences and gestures. Staff members are usually able to understand her basic information, but when they need to prompt her to repeat herself more than 50% of the time, she becomes frustrated and waves them off or laughs and cries inappropriately. This indicates that she requires maximal assistance, as she can only express basic needs using single words or gestures and needs prompting more than 50% of the time.Rate this question:
-
- 14.
SOCIAL INTERACTION: Mrs. P is emotionally labile and inappropriate the majority of the time. When her physicians come in to see her on the morning rounds, she starts crying uncontrollably and when her nurses greet her in the morning, she laughs hysterically. Mrs. P is appropriate less than 50% of the time, successfully redirected by the staff more than 50% of the time. What level of assistance is needed?
- A.
7 - No assistance to re-direct needed. No activity limitations
- B.
5 - She requires redirection, only under stressful or unfamiliar conditions, but no more than 10% of the time, she is encouraged to participate.
- C.
1 - Requires total assistance all or most of the time. Patient is appropriate less than 25% of the time.
- D.
2 - Maximal direction needed. Patient is appropriate 25-49% of the time.
- E.
4 - Minimal/occasional direction. Patient is appropriate 75-90% of the time.
Correct Answer
D. 2 - Maximal direction needed. Patient is appropriate 25-49% of the time.Explanation
Based on the given information, Mrs. P is emotionally labile and inappropriate the majority of the time. She requires redirection more than 50% of the time, indicating that she needs maximal direction. Additionally, the statement mentions that Mrs. P is appropriate less than 50% of the time, which falls within the range of 25-49%. Therefore, the correct level of assistance needed for Mrs. P is 2 - Maximal direction needed. Patient is appropriate 25-49% of the time.Rate this question:
-
- 15.
PROBLEM SOLVING: Mrs. P is able to tackle routine basic problems more than 50% of the time. Sometimes she needs verbal cues and prompts to come to an appropriate solution to the problem. What assistance is required to make appropriate decisions to solve problems?
- A.
7- None. Consistently carries out sequence of steps to solve complex problems.
- B.
3 - Moderate Assistance; Some direction needed. Patient solves routine problems 50-74% of the time.
- C.
1 - Total Assistance - All or almost all of the time. Patient solves routine problems less than 25% of the time.
- D.
5 - Only under stressful or unfamiliar conditions, but no more than 10% of the time.
- E.
6 - No assistance needed. Only mild difficulty but is able to self correct and/or requires extra time to solve complex problems.
Correct Answer
B. 3 - Moderate Assistance; Some direction needed. Patient solves routine problems 50-74% of the time.Explanation
The explanation for the given answer is that Mrs. P requires moderate assistance and some direction to solve routine problems. She is able to solve these problems 50-74% of the time, indicating that she has some level of skill and understanding in problem-solving. However, she still needs verbal cues and prompts to come to an appropriate solution, suggesting that she may struggle with certain aspects of the problem or require guidance to reach the correct answer.Rate this question:
-
- 16.
MEMORY: Mrs. P recognizes her husband and children, but she needs occasional reminders about where she is, which way her room is, or how to use a call light. What level of assistance does she need?
- A.
4 - Minimal Assistance needed; Occasional prompting. Patient recognizes and remembers 75-90% of the time.
- B.
1 - Total Assistance needed: All or almost all of the time. Patient recognizes and remembers less than 25% of the time.
- C.
7 - None needed. No activity limitations
- D.
2 - Max Assistance; A lot of prompting. Patient recognizes and remembers 25-49% of the time.
- E.
5 - Only under stressful or unfamiliar conditions, but no more thatn 10% of the time.
Correct Answer
A. 4 - Minimal Assistance needed; Occasional prompting. Patient recognizes and remembers 75-90% of the time.Explanation
The patient, Mrs. P, recognizes her husband and children, indicating that she has some level of memory function. However, she needs occasional reminders about her surroundings and how to use a call light, suggesting that she requires minimal assistance. Additionally, the fact that she recognizes and remembers 75-90% of the time aligns with the level of assistance described in option 4.Rate this question:
-
- 17.
Adult Briefs/Diapers are considered undergarments/underwear and should be assessed/observed when scoring for Toileting.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Adult Briefs/Diapers are not considered undergarments/underwear. They are specifically designed for individuals with incontinence issues and are used as a form of protection and containment for urinary or fecal incontinence. When scoring for Toileting, the assessment/observation should focus on the individual's ability to independently use the toilet or perform toileting tasks, rather than the use of adult briefs/diapers. Therefore, the statement is false.Rate this question:
-
- 18.
Nursing is responsible for documenting bowel and bladder level of assistance and number of accidents in MEDITECH every shift throughout the patient's admission, not just the FIM days.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Nursing is responsible for documenting the level of assistance provided for bowel and bladder functions as well as the number of accidents in the MEDITECH system every shift throughout the patient's admission. This documentation is not limited to just the FIM days.Rate this question:
-
- 19.
If the patient is unable to perform half or more of the effort then you must choose either a 2- Max assist or 1-Total Assist.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
If the patient is unable to perform half or more of the effort, it means that they require significant assistance in completing the task. In such cases, it is appropriate to choose either a 2-Max assist or 1-Total assist, indicating that the patient needs either maximum assistance or complete assistance to perform the task. Therefore, the statement "If the patient is unable to perform half or more of the effort then you must choose either a 2-Max assist or 1-Total Assist" is true.Rate this question:
-
- 20.
If a patient is able to do their own intermittent self catheterization, but you have to gather the equipment for him/her, then the FIM score would be a 7 - Total independence. (HINT - look at the bowel and bladder grid for your answer)
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
If a patient is able to do their own intermittent self catheterization, but you have to gather the equipment for him/her, then the FIM score would not be a 7 - Total independence. The FIM score would be lower because the patient is not able to gather the equipment independently.Rate this question:
-
Back to top