TEST BANK for Nursing Assisting A Foundation in Caregiving 4th Edition by Diana Dugan by ACADEMIAMILL

iii

Nursing Assisting A Foundation in Caregiving 4th Edition Dugan Test Bank

Table of Contents Preface

Lesson Plans

Appendices Appendix A Transparency Masters

181

Appendix B Handouts

235

1. The Nursing Assistant in Long-Term Care

Appendix C Chapter Exams

287

2. Ethical and Legal Issues

Appendix D Answer Key for Chapter Exams

349

3. Communication Skills

Appendix E 2nd Set of Chapter Exams

361

4. Communication Challenges

Appendix F Answer Key for 2nd Set of Chapter Exams

413

5. Diversity and Human Needs and Development

Appendix G Final Exam

423

6. Infection Prevention

Appendix H Answer Key for Final Exam

433

7. Safety and Body Mechanics

8. Emergency Care, First Aid, and Disasters

Appendix I Workbook Answer Key and Practice Exam Answer Key

437

9. Admission, Transfer, Discharge, and Physical Exams

10. Bedmaking and Unit Care

11. Positioning, Moving, and Lifting

12. Personal Care

13. Vital Signs

14. Nutrition and Fluid Balance 86 15. The Gastrointestinal System

16. The Urinary System

104

17. The Reproductive System

110

18. The Integumentary System

114

19. The Circulatory or Cardiovascular System

120

20. The Respiratory System

124

21. The Musculoskeletal System

129

22. The Nervous System

135

23. The Endocrine System

148

24. The Immune and Lymphatic Systems and Cancer

152

25. Rehabilitation and Restorative Care

158

26. Subacute Care

162

27. End-of-Life Care

169

28. Your New Position

175

1 The Nursing Assistant in Long-Term Care 1. Define important words in this chapter 2. Describe healthcare settings 3. Explain Medicare and Medicaid 4. Describe the residents in long-term care facilities 5. Describe the nursing assistant’s role 6. Discuss professionalism and list examples of professional behavior 7. List qualities that nursing assistants must have 8. Discuss proper grooming guidelines 9. Define the role of each member of the care team 10. Discuss the facility chain of command 11. Explain The Five Rights of Delegation 12. Describe methods of nursing care and discuss person-centered care 13. Explain policy and procedure manuals 14. Describe the long-term care survey process Supplemental Tools TRANsPARENCy 1-1 FACTs AbouT MEDICARE AND MEDICAID

care and the survey process. The person-directed care model is introduced and should be continually emphasized.

TRANsPARENCy 1-2 REsIDENTs IN LTC FACILITIEs TRANsPARENCy 1-3 CHAIN oF CoMMAND CHAPTER 1: EXAM

Assignments TEXTbooK READINg, PP. 1-16

woRKbooK EXERCIsEs, PP. 1-7 Overview of Teaching Strategies The purpose of the teaching strategy for this chapter is to describe various healthcare settings, with an emphasis on long-term care (LTC). Students will learn how LTC is paid for and will be introduced to the types of residents for whom they will care and the other members of the healthcare team. The roles and functions of the nursing assistant should be explained, along with the professional behavior expected in the healthcare setting. Students will also learn about the chain of command, as well as different methods of nursing

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 1-3

woRKbooK P. 1 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Describe healthcare settings Meeting the Learning Objective TEXTbooK PP. 3-5

woRKbooK P. 1 Lecture Pronounce and define the following key terms:

2 • Long-term care • Skilled care • Chronic • Residents Discuss job opportunities for nursing assistants and the importance of this work. Give students a brief description of long-term care, including:

• For people 65 or older or who have disabilities and illnesses • Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice. • Part B helps pay for doctor services and other medical services and equipment.

• LTC facilities provide 24-hour skilled care

• Part C allows private health insurance companies to provide Medicare benefits.

• LTC assists people with ongoing, chronic medical conditions

• Part D helps pay for medications prescribed for treatment.

• Other terms for LTC facilities Emphasize that the LTC facility is the resident’s home, and the resident’s room must be treated with respect. Define and briefly describe each of the following healthcare settings and terms: • Assisted living • Home health care • Adult day services • Sandwich generation • Inter-generational care

Describe facts about Medicaid: • Funded by both federal government and each state • Eligibility determined by income and special circumstances. • People must qualify for Medicaid. Describe long-term care coverage under Medicare and Medicaid: • Pays LTC facilities a fixed amount for services • Services are based on the resident’s needs upon admission.

• Acute care • Subacute care • Outpatient care • Rehabilitation • Hospice care • Animal-assisted therapy (AAT)

3. Explain Medicare and Medicaid Meeting the Learning Objective TEXTbooK P. 5

woRKbooK PP. 1-2 Lecture Pronounce and define the following key terms: • Medicare • Medicaid Display Transparency 1-1 FACTs AbouT MEDICARE AND MEDICAID Describe Medicare coverage:

4. Describe the residents in long-term care facilities Meeting the Learning Objective TEXTbooK PP. 5-6

woRKbooK P. 2 Lecture Emphasize to students that understanding each individual in their care is more important than understanding the entire population. Pronounce and define the following key terms: • Length of stay • Dementia Display Transparency 1-2 REsIDENTs IN LTC FACILITIEs Discuss these facts about residents in long-term care facilities in the U.S.: • 88% are over 65 • 71% are female

3 • More than 90% are white and non-Hispanic • About 1/3 come from a private residence • Over 50% come from a hospital Discuss length of stay and the reasons residents with different lengths of stay might be in an LTC facility. These facts are true of residents in LTC with a length of stay of six months or more: • Over 2/3 of residents • Require 24-hour care

• Measuring vital signs (temperature, pulse, respiration, blood pressure, and observing and reporting pain levels) • Helping residents with toileting needs • Assisting with mouth care • Giving back rubs • Observing and reporting changes in conditions and complaints • Helping residents move safely around facility • Caring for supplies and equipment

• Did not have caregivers available to give enough care at home

Describe tasks that nursing assistants do not perform:

These facts are true of residents with a length of stay of less then six months:

• Giving tube feedings

• May be admitted for terminal care (will die in facility)

• Giving medications

• May be admitted for rehabilitation or temporary illness (will recover and return to community)

• Inserting or removing tubes • Changing sterile dressings

6. Discuss professionalism and list examples of professional behavior

Stress that different kinds of care is needed in a facility. Note that many residents in LTC lack outside Meeting the Learning Objective support, and emphasize the importance of caring EXC Tb for the whole person. TESTBANKSELLERT. OoMoK PP. 7-8 woRKbooK PP. 2-3

5. Describe the nursing assistant’s role Meeting the Learning Objective TEXTbooK PP. 6-7

woRKbooK P. 2 Lecture Pronounce and define the following key terms: • Nursing assistant (NA) • Activities of daily living (ADLs)

Lecture Pronounce and define the following key term: • Professionalism Discuss important points about professional behavior guidelines, including the following: • Being clean and neatly dressed and groomed • Not discussing personal problems with residents • Being at work on time and avoiding absences • Not leaving work early without permission

• Performing assigned nursing tasks

• Not reporting to work under the influence of illegal drugs and/or alcohol

• Providing personal care or assisting with self-care

• Keeping a positive attitude

Discuss two ways NAs provide services for residents:

Describe common nursing assistant tasks: • Serving trays and feeding residents • Helping residents dress and undress • Bathing, shampooing, and shaving residents

• Not gossiping about coworkers • Being polite and respectful • Addressing residents and visitors in the way they wish to be addressed • Not using profanity

• Bedmaking

• Keeping resident information confidential

• Tidying living areas

• Following procedures and policies

4 • Reporting concerns or problems to your supervisor

Lecture Pronounce and define the following key term:

• Maintaining educational requirements

• First impression

• Asking questions when you do not understand something

Discuss the importance of making a positive first impression.

• Being honest and documenting carefully • Accepting constructive feedback • Not accepting tips or gifts • Being loyal to your facility and being a positive role model

Discuss these grooming guidelines: • Keep uniform clean and neat. • Bathe and wear deodorant every day. • Brush teeth at least twice a day. • Avoid using strongly-scented products.

7. List qualities that nursing assistants must have

• Keep hair neatly tied back. • Keep beards trimmed and clean. • Apply makeup lightly.

Meeting the Learning Objective

• Keep nails short, filed, and clean.

TEXTbooK PP. 8-9

• Do not wear artificial nails.

woRKbooK PP. 3-4

• Keep shoes and laces clean and in good condition.

Lecture and Discussion Pronounce and define the following key terms: • Trustworthy • Conscientious

• Wear as little jewelry as possible, except for a simple waterproof watch and identification badge. • Keep tattoos covered by clothing.

• Courteous • Empathetic • Accountable Ask students if they can think of examples of each quality as it pertains to care of residents: • Patient and understanding

Emphasize to the class that residents may dislike or be allergic to certain scents. Heavy scents should be avoided as a part of meeting residents’ needs.

9. Define the role of each member of the care team

• Honest and trustworthy • Conscientious

Meeting the Learning Objective

• Enthusiastic

TEXTbooK PP. 10-12

• Courteous and respectful

woRKbooK P. 5

• Empathetic • Dependable and responsible

Lecture Pronounce and define the following key terms:

• Humble and open to growth

• Care team

• Tolerant

• Registered nurse

• Unprejudiced

• Licensed practical nurse • Diagnosis

8. Discuss proper grooming guidelines

• Assistive or adaptive devices

Meeting the Learning Objective

Discuss the role of each of the following care team members:

TEXTbooK PP. 9-10

woRKbooK P. 5

• Resident and resident’s family • Nurse (RN, LPN, or LVN)

5 • Advanced practice nurse

• Right Person

• Physician

• Right Direction/Communication

• Physical therapist

• Right Supervision/Evaluation

• Occupational therapist

Discuss these questions that NAs may consider before accepting tasks:

• Speech-language pathologist • Registered dietitian

• Do I have all the information I need to do this job? Are there questions I should ask?

• Medical social worker

• Do I believe that I can do this task? Do I have the necessary skills?

• Activities director • Nursing assistant Emphasize that the resident is the most important member of the care team.

• Do I have the needed supplies, equipment, and other support? • Do I know who my supervisor is, and how to reach him/her?

10. Discuss the facility chain of command

• Have I told my supervisor of my special needs for help and support?

Meeting the Learning Objective

• Do we both understand who is doing what?

TEXTbooK PP. 12-13

woRKbooK PP. 5-6 Lecture Pronounce and define the following key terms: • Chain of command • Charge nurse

Emphasize that NAs can provide better care by asking questions and by asking for help when they need it.

12. Describe methods of nursing care and diRsc.uCsO s Mperson-centered care TESTBANKSELLE

• Liability Display Transparency 1-3 CHAIN oF CoMMAND Emphasize the importance of following the chain of command to lessen the risk of liability. Discuss the chain of command (Fig. 1-14 in the textbook).

11. Explain The Five Rights of Delegation Meeting the Learning Objective

Meeting the Learning Objective TEXTbooK PP. 13-14 WoRKbooK P. 6

Lecture Pronounce and define the following key term: • Holistic Explain how holistic care helps improve residents’ quality of life.

TEXTbooK P. 13

Define and discuss basic types of nursing care used at facilities and related terms:

woRKbooK P. 6

• Team nursing • Team leader

Lecture Pronounce and define the following key term: • Delegation

• Primary nursing • Continuity of care • Functional nursing

Discuss each of the five rights: • Right Task • Right Circumstance

Define the term person-centered care and discuss some of the core values, such as promoting an individual’s preferences, choices, dignity, interests, background, and quality of life.

6 13. Explain policy and procedure manuals Meeting the Learning Objective TEXTbooK P. 14

woRKbooK PP. 6-7 Lecture Pronounce and define the following key terms:

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

People who are 65 years of age or older and people of any age with permanent kidney failure or certain disabilities

Women

Answers include the following: inserting/ removing tubes; changing sterile dressings; giving tube feedings; giving medications.

Answers can include the following:

• Policy • Procedure Encourage students to ask questions about policies or procedures or to review the procedure manual when they are unsure about care.

14. Describe the long-term care survey process Meeting the Learning Objective TEXTbooK PP. 14-15

woRKbooK P. 7

Be neatly dressed and groomed. Keep your uniform and shoes clean. Do not discuss personal problems or personal situations with residents.

Be on time for work. Lecture Pronounce and define the following key T teE rm SsT: BANKSELLCE Mely manner if you are sick or canalR l i. nC aO tim • Cite not report for duty as scheduled. • Joint Commission Explain the survey process to students: • Inspections are done periodically. • Surveyors observe and interview residents and staff to find out how well residents’ needs are being met. • Nursing assistants should answer any questions asked by surveyors to the best of their abilities. They should not guess if they do not know the answer. Point out that surveys conducted by the Joint Commission are not affiliated with state inspections and that facilities participate in Joint Commission surveys on a voluntary basis.

Chapter Review Exam dIsTRIbuTE CHAPTER 1: EXAM (APPENDIX C)

Avoid unnecessary absences. Never leave your job early without permission. Do not report to work under the influence of illegal drugs and/or alcohol. Keep a positive attitude. Do not gossip or speak badly about coworkers or bosses. Speak politely to all people in the facility. Treat all visitors with courtesy and respect. Address residents, family members, and visitors in the way they wish to be addressed. Do not use profanity or inappropriate language. Keep all resident information confidential. Follow all facility policies and procedures.

7 Report concerns or problems to your supervisor. Meet and maintain all educational requirements. Ask questions when you do not understand something. Be honest. Document and report carefully and truthfully. Accept constructive feedback gracefully and learn from it. Do not accept tips or gifts from residents, their families, or other visitors. Be loyal to your facility. Be a positive role model. 5.

Answers will vary for each student.

The resident

The Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation

TpEhS Type of care that places the em asT isBoA nN thKeSELLER person needing care and his or her individuality, capabilities, choices, beliefs, and preferences Surveyors study how well the staff cares for its residents. They focus on how residents’ various needs are being met. They do this by interviewing residents and families. They observe the staff’s interactions with residents and the care given. They review resident charts and observe meals.

10. The NA should be honest and never guess. She should tell the surveyor that she does not know the answer but will find out as quickly as possible. 11. B 12. D 13. B 14. A 15. A

2 Ethical and Legal Issues 1. Define important words in this chapter 2. Define the terms law, ethics, and etiquette 3. Discuss examples of ethical and professional behavior 4. Describe a nursing assistant code of ethics 5. Explain the Omnibus Budget Reconciliation Act (OBRA) 6. Explain Residents’ Rights 7. Explain types of abuse and neglect 8. Recognize signs and symptoms of abuse and neglect 9. Describe the steps taken if a nursing assistant is suspected of abuse 10. Discuss the ombudsman’s role 11. Explain HIPAA and related terms 12. Discuss the Patient Self-Determination Act (PSDA) and advance directives Supplemental Tools 1. Define important words in this chapter TRANsPARENCy 2-1 NuRsINg AssIsTANT CodE oF ETHICs TESTBANKSMEeLetLinEgRth.eCLOeaMrning Objective TEXTbooK PP. 17-19 HANDouT 2-1 dECIsIoN quIZ HANDouT 2-2 wHo Is vulNERAblE To AbusE oR NEglECT? CHAPTER 2: EXAM

Assignments TEXTbooK READINg, PP. 17-32

woRKbooK EXERCIsEs, PP. 9-16 Overview of Teaching Strategies This chapter explains the legal, ethical, and professional behavior that nursing assistants will be expected to show in the healthcare setting. A sample code of ethics for nursing assistants is presented. Students will learn about OBRA and Residents’ Rights, and they will learn to recognize signs of abuse and what actions to take if they see or suspect that a resident is being abused. Students will learn about the ombudsman’s role in health care, and HIPAA and the PSDA will be explained.

WoRKbooK P. 9

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Define the terms law, ethics, and etiquette Meeting the Learning Objective TEXTbooK P. 19

woRKbooK P. 9 Lecture Pronounce and define the following key terms: • Ethics • Laws • Criminal laws • Civil law • Etiquette

9 Explain the difference between laws and ethics and why both are important in healthcare settings.

3. Discuss examples of ethical and professional behavior Meeting the Learning Objective TEXTbooK PP. 19-20

woRKbooK P. 9

Optional Learning Activity If your facility has a nursing assistant code of ethics, share it with students. Compare it to the example in the book.

5. Explain the Omnibus Budget Reconciliation Act (OBRA) Meeting the Learning Objective TEXTbooK PP. 21-22

woRKbooK P. 10

Lecture Explain that professional and ethical behavior is vital to the safety of residents. Discuss the following guidelines for behavior that nursing assistants must follow:

• Omnibus Budget Reconciliation Act (OBRA)

• Keep all resident and staff information confidential.

• Nurse Aide Training and Competency Evaluation Program (NATCEP)

• Be honest at all times.

• Scope of practice

• Be trustworthy. • Do not accept gifts or tips. • Report abuse or suspected abuse of residents. • Do not report to work under the influence of alcohol, drugs, or chemical substances. • Follow all facility policies, rules, and procedures. • Do assigned tasks. Report mistakes promptly. • Be positive, professional, and tactful.

Lecture Pronounce and define the following key terms:

Discuss the requirements of OBRA. If your state or facility requirements exceed OBRA requirements, explain the differences. Explain why OBRA regulations are important to nursing assistant practice, including the following: • Give recognition through certification and registration

• Treat all residents with respect and be empathetic.

• Help define the nursing assistant’s scope of practice

• Be patient.

• Provide better uniformity of care • Promote educational standards

4. Describe a nursing assistant code of ethics

6. Explain Residents’ Rights

Meeting the Learning Objective

TEXTbooK P. 21

TEXTbooK PP. 22-24

woRKbooK P. 10

woRKbooK PP. 11-12

Lecture and Discussion Explain that all facility codes of ethics revolve around the idea that the resident is a valuable person who deserves ethical care. Display Transparency 2-1 NuRsINg AssIsTANT CodE oF ETHICs Discuss the sample nursing assistant code of ethics on the transparency. Ask students to suggest additions or clarifications.

Lecture Pronounce and define the following key terms: • Residents’ Rights • Residents’ Council • Misappropriation Review the Residents’ Rights: • Quality of life • Services and activities to maintain a high level of wellness

10 • Right to be fully informed about rights and services • Right to participate in their own care • Right to make independent choices • Right to privacy and confidentiality • Right to dignity, respect, and freedom • Right to security of possessions • Rights during transfers and discharges • Right to complain • Right to visits • Rights with regard to social services

Lecture Define and review each of the types of abuse and neglect covered: • Abuse • Physical abuse • Psychological abuse • Verbal abuse • Sexual abuse • Financial abuse • Assault • Battery

Distribute Handout

• Domestic violence

2-1 dECIsIoN quIZ

• Workplace violence

Tell students to think about all of the choices or decisions they made this morning and write six of them down on their handout. Allow six minutes if needed for the class to finish this exercise. (Responses may include when to get up, what to eat for breakfast, what to wear, whether to stop at a store on the way to work, whether to drive the children to school or put them on the bus, etc.) After students are finished, make these points: • Everyday decisions may not seem that iT mEpS orTtaBnA t because you are able to make them. In fact, you may get tired of deciding and wish someone would handle it all for you. But if you have had the experience of not being able to make all of your own choices, such as when you were recovering from an illness or surgery, you know it did not take long to want to be in charge of your own life again! • Why do you want to make your own decisions? Possible responses: “It’s my life,” “I have the right to do what I want,” “I like to control my life.” • Residents probably feel much like you do. Making decisions about our own lives is a very important part of being an adult. It helps us feel capable and less like a child. • Residents’ Rights guarantee that residents can continue to make many decisions about their own lives.

• False imprisonment • Involuntary seclusion • Sexual harassment • Substance abuse • Defamation • Libel • Slander • Active neglect • Passive neglect • Negligence • Malpractice Emphasize that a nursing assistant is legally required to report any observed or suspected abuse of residents and assist residents who wish to make a complaint of abuse in every way possible. Remind students that staff must not retaliate in any way against a resident who makes a complaint. And if students witness a staff member retaliating against a resident who complained, they must report it.

8. Recognize signs and symptoms of abuse and neglect Meeting the Learning Objective TEXTbooK PP. 26-27

woRKbooK P. 14

7. Explain types of abuse and neglect Meeting the Learning Objective TEXTbooK PP. 24-26

woRKbooK PP. 12-14

Lecture Pronounce and define the following key term: • Mandated reporters

11 Remind students that nursing assistants are considered mandated reporters. Emphasize that all care team members must look for signs of abuse and report them. Review signs of abuse: • Broken bones • Bruises, contusions, and welts • Similar injuries that occur repeatedly • Burns of unusual shape and in unusual locations • Bite marks or scratches • Unexplained weight loss • Dehydration • Dry, cracked, torn or bleeding skin • Missing hair • Broken or missing teeth • Blood in underwear • Bruising, bleeding, or discharge from the genital area • Depression or withdrawal

• Family concern that abuse is occurring • Resident not taking medication • Private conversations not allowed, or the caregiver/family member is present during all conversations Distribute Handout 2-2 wHo Is vulNERAblE To AbusE oR NEglECT? Give students time to read the handout. Ask them, “Why are these people so vulnerable?” • Older people may be unable to stand up for themselves. • Older people may be unable to report abuse or neglect to others. • Older people may not understand that they have rights. • Older people may be much more demanding to care for. • Caregivers may not be trained properly. • Caregivers may not understand residents’ behavior.

• Mood swings • Caregivers may be overworked, tired, stressed, • Fear and anxiety, especially when a caregiver is an.dCuO nM appreciated, on top of caring for someone TESTBANKSELLER present who requires so much time and energy. • Fear of being left alone Review signs of neglect: • Pressure ulcers

9. Describe the steps taken if a nursing assistant is suspected of abuse

• Weight loss, poor appetite • Dehydration

Meeting the Learning Objective

• Frequent complaints of hunger or thirst

TEXTbooK PP. 27-28

• Strong smell of urine

woRKbooK P. 14

• Unclean body • Dirty, matted, or unstyled hair • Ragged or dirty fingernails

Lecture Review the steps that follow a report of abuse by a nursing assistant:

• Soiled clothes or bed linens or incontinence briefs not being changed

• Investigation

• Ripped or torn clothing

• Hearing

• Damaged or poorly fitting hearing aids, eyeglasses, dentures

• Decision of hearing

• Unanswered call lights Review other signs of abuse: • Missing doctor appointments • Changing doctors frequently • Wearing makeup or sunglasses to hide injuries

• Notification

• Appeals process Remind students that if abuse is found to have occurred, the nursing assistant is placed on the abuse registry in addition to other possible penalties. Emphasize that employers check this registry before hiring nursing assistants.

12 10. Discuss the ombudsman’s role

• Do not discuss residents in public areas. • Do not bring family or friends to the facility.

Meeting the Learning Objective

• Double-check fax numbers and use cover sheets.

TEXTbooK P. 28

• Return charts to proper place after use.

woRKbooK PP. 14-15

• Dispose of personal notes regarding resident care prior to leaving work for the day.

Lecture Pronounce and define the following key term: • Ombudsman

• Log out and exit web browser when finished with computer work. • Do not include private information in e-mails.

Review the typical duties of an ombudsman: • Advocates for Residents’ Rights and quality care • Educates consumers and care providers • Investigates and resolves complaints • Appears in court and/or legal hearings

• Do not share resident information on any social networking site (e.g., Facebook or Twitter). • Do not takes photos of residents and share them with anyone, including via cell phones, e-mail, social networking sites, or other websites.

• Gives information to the public

• Give documents found with resident’s information to the nurse.

Optional Learning Activity Provide students with information about the department in your state that handles elder care.

Explain that there are serious penalties, including fines and even prison time, for not following HIPAA guidelines.

Role Play Role-play a situation in which an NA posts photos a resident on her Facebook page, which is seen TESTBANKSoEf L LER.COM by another NA.

11. Explain HIPAA and related terms Meeting the Learning Objective TEXTbooK PP. 28-30

woRKbooK P. 15 Lecture Pronounce and define the following key terms: • HIPAA • Protected health information (PHI) • Invasion of privacy Discuss the HITECH (Health Information Technology for Economic and Clinical Health) Act as a law that expands the protection of electronic health records (EHR). Explain that it increases civil and criminal penalties for sharing PHI and expands the government’s ability to enforce these penalties. Review ways that nursing assistants can keep PHI confidential: • Do not give out health information on the phone except to approved staff members. • Do not give personal information to visitors. • Do not share medical records with anyone other than the care team.

12. Discuss the Patient Self-Determination Act (PSDA) and advance directives Meeting the Learning Objective TEXTbooK PP. 30-31

woRKbooK PP. 15-16 Lecture Pronounce and define the following key terms: • Advance directives • Living will • Durable power of attorney for health care • Do-not-resuscitate (DNR) Optional Learning Activity Bring in copies of your state’s advance directive forms to share with the class. Discuss why advance directives are important to residents of facilities and others.

13 Chapter Review Exam dIsTRIbuTE CHAPTER 2: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

is the unintentional failure to provide needed care, resulting in physical, mental, or emotional harm to a person. 6.

Answers will vary.

Report it to her supervisor immediately.

The NA is immediately suspended. The NATCEP (Nurse Aide Training and Competency Evaluation Program) is notified, as well as the facility administrator and possibly APS. A full, confidential investigation is conducted.

Answers include the following: visits the facility and listens to residents; decides what course of action to take if there is a problem; helps settle disputes and resolve conflicts; provides an ongoing presence in long-term care facilities; monitors care and conditions; advocates for Residents’ Rights and quality care; educates consumers and care providers; investigates and resolves complaints; works with investigators from the police, adult protective services, and health departments; appears in court and/or in legal hearings; and gives information to the public.

Answers to Chapter Review in Textbook 1.

Ethics are the knowledge of what is right and wrong and help guide conduct.

Answers will vary.

Answers include the following: I will strive to provide and maintain the highest quality of care for my residents. I will fully recognize and follow all of the Residents’ Rights. I will communicate well, serve on committees, and read all material as provided and required by my employer. I will attend educational in-services and join organizations relevant TBa A to nursing assistant care. I wilT lE shS ow poNsK itive attitude toward my residents, staff, family members, and other visitors. I will always provide privacy for my residents. I will maintain confidentiality of resident, staff, and visitor information. I will be trustworthy and honest in all dealings with residents, staff, and visitors. I will strive to preserve resident safety. I will report mistakes I make, along with anything that I deem dangerous, to the right person(s). I will have empathy for my residents, the staff, and all visitors, giving support and encouragement when needed. I will respect all people, without regard to age, sex, ethnicity, religion, economic situation, sexual orientation, or diagnosis. I will never abuse my residents in any way. I will always report any suspected abuse to my supervisor or the proper person immediately. I will strive to have the utmost patience with all people at my facility.

75 hours

Active neglect is purposeful failure to provide needed care, resulting in physical, mental, or emotional harm to a person. Passive neglect

10. Other care team members 11. The privacy of health information 12. Answers include the following: information that can be used to identify a person and relates to the patient’s past, present, or future physical or mental condition; any health care that patient has had; payment for that health care; the patient’s name, address, telephone number, medical record, social security number, and e-mail address. 13. HIPAA applies to all healthcare providers, including doctors, nurses, nursing assistants, and care team members. 14. Advance directives are legal documents that allow people to decide what kind of medical care they wish to have if they are unable to make those decisions themselves. They designate someone else to make medical decisions if that person is disabled. 15. Answers include the following: All facilities receiving Medicare and Medicaid money must offer new residents information about

14 their rights relating to advance directives. Residents have the right to participate in and direct healthcare decisions, the right to accept or refuse treatment, and the right to prepare advance directives. The PSDA requires that facilities give new residents the facility’s policies on handling advance directives. Each facility must ask residents what advance directives they have and obtain copies of these documents. Facilities must offer education to the staff about advance directives. 16. B 17. C 18. B 19. A 20. D 21. A

3 Communication Skills 1. Define important words in this chapter 2. Explain types of communication 3. Explain barriers to communication 4. List ways that cultures impact communication 5. Identify the people a nursing assistant communicates with in a facility 6. Understand basic medical terminology and abbreviations 7. Explain how to convert regular time to military time 8. Describe a standard resident chart 9. Explain guidelines for documentation 10. Describe the use of computers in documentation 11. Explain the Minimum Data Set (MDS) 12. Describe how to observe and report accurately 13. Explain the nursing process 14. Discuss the nursing assistant’s role in care planning and at care conferences 15. Describe incident reporting and recording 16. Explain proper telephone etiquette 17. Describe the resident call system 18. Describe the nursing assistant’s role in change-of-shift reports and rounds 19. List the information found on an assignment sheet 20. Discuss how to organize work and manage time Supplemental Tools

Assignments

TRANsPARENCy 3-1 CoMMuNICATIoN PRoCEss

TEXTbooK READINg, PP. 33-53

TRANsPARENCy 3-2 body lANguAgE

WoRKbooK EXERCIsEs, PP. 17-25

TRANsPARENCy 3-3 bARRIERs To CoMMuNICATIoN TRANsPARENCy 3-4 24-HouR CLoCK TRANsPARENCy 3-5 sAMPLE KARDEX TRANsPARENCy 3-6 usINg youR sENsEs HANDouT 3-1 PREFIXEs, RooTs, AND suFFIXEs HANDouT 3-2 AbbREVIATIoNs HANDouT 3-3 AbbREVIATIoNs FLAsH CARDs HANDouT 3-4 sCIENTIFIC METHod CHAPTER 3: EXAM

Overview of Teaching Strategies Nursing assistants need to communicate clearly and accurately with many different people on the job. This chapter describes the process of communication, barriers that make communication difficult, and techniques to overcome these difficulties. Students will learn how to properly document care, including the use of medical terminology and military time. They will also learn about care conferences and their role in them, as well as incident reporting and telephone etiquette. The importance of the resident call system will be emphasized, and students will learn strategies for organizing work and managing their time.

16 1. Define important words in this chapter

• Crossing arms in front of the body • Tapping feet

Meeting the Learning Objective

• Pointing at someone while speaking

TEXTbooK PP. 33-34

Review the following guidelines for proper communication:

woRKbooK P. 17 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

• Use appropriate words. • Be aware of your body language. • Use a friendly and professional tone of voice. • Wait for responses and let pauses happen.

2. Explain types of communication

• Practice active listening.

Meeting the Learning Objective

• Use mostly facts when communicating.

TEXTbooK PP. 34-36

Ask students how they can use verbal or nonverbal communication to reach a specific goal.

woRKbooK P. 17 Lecture Pronounce and define the following key terms: • Verbal communication • Nonverbal communication • Body language

3. Explain barriers to communication

• Active listening Display Transparency

Role Play Role-play a situation in which the verbal and nonverbal message is different. Ask the students to describe how this made them feel.

earning Objective TESTBANKSMEeLetLinEgRth.eCLO M

3-1 CoMMuNICATIoN PRoCEss

TEXTbooK PP. 36-37

woRKbooK PP. 17-19

Describe the communication process. Emphasize that the process occurs over and over with the sender and receiver switching roles during a conversation.

• Barrier

Display Transparency

3-2 body lANguAgE

Lecture Pronounce and define the following key term:

3-3 bARRIERs To CoMMuNICATIoN

Discuss the importance of body language in communication. Describe the signals that the two people on the transparency are sending to each other through their body language.

Review the barriers to communication shown on the transparency and in the book:

Review the following examples of positive nonverbal communication:

• Resident is difficult to understand.

• Resident does not hear, does not hear correctly, or does not understand.

• Smiling in a friendly manner

• NA, resident, or others use words that are not understood.

• Leaning forward to listen

• NA uses slang or profanity.

• Nodding while a person is speaking

• NA uses clichés.

• Putting your hand over a resident’s hand

• NA responds with “Why?”

Review examples of negative nonverbal communication: • Rolling eyes

• NA gives advice. • NA asks questions that only require yes/no answers.

17 • Resident speaks a different language. • NA or resident uses nonverbal communication. Discussion Ask the students to imagine a day or a lifetime without communication. Ask how that might make them feel.

Lecture Review the many different people students will communicate with on the job, including: • Doctors, nurses, supervisors, and other staff members • Other departments • Residents

Ask the students to describe a situation in which they wasted much time and effort because of a miscommunication. How could that have been avoided?

• Families and visitors

Ask the students to describe a situation where effective communication resulted in a positive outcome.

Role Play Ask students to take turns pretending to be working nursing assistants who are communicating with different people at the facility. Ask for class feedback on effective communication techniques for each interaction.

4. List ways that cultures impact communication Meeting the Learning Objective TEXTbooK PP. 37-38

• The community

6. Understand basic medical terminology and abbreviations

woRKbooK P. 19 Meeting the Learning Objective Lecture and Discussion Pronounce and define the following key term: • Culture Review some factors that are influenced by culture that are important to understand in a healthcare setting:

TEXTbooK PP. 39-40

woRKbooK P. 20 Lecture Pronounce and define the following key terms: • Edema

• Eye contact

• Root

• Touch

• Prefix

• Language

• Suffix

Review the examples of acceptable and unacceptable touch on page 35 of the textbook. Ask students if they can think of any other examples.

Distribute Handout

Discussion Ask students to share stories about the culture they grew up in. Ask them to describe how their culture influences the factors listed above, and if there are any other cultural considerations they can think of that would be useful on the job.

3-1 PREFIXEs, RooTs, AND suFFIXEs Discuss the structure of medical terms, explaining that many are formed by a root, prefix, and suffix. Emphasize that students will soon learn what the various word parts mean and be able to recognize them on the job. Distribute Handout 3-2 AbbREVIATIoNs

5. Identify the people a nursing assistant communicates with in a facility Meeting the Learning Objective TEXTbooK PP. 38-39

woRKbooK P. 20

Ask students to read the list of abbreviations at home. Explain that abbreviations help healthcare workers communicate more efficiently. Mention any abbreviations that are used at your facility.

18 Distribute Handout 3-3 AbbREVIATIoNs FLAsH CARDs Either cut along the dotted lines to make flash cards before class, or have students do this in class. Break the class into small groups. Show the flash cards to the class, one by one, and give points to the students who answer first. Alternate between showing abbreviations and showing meanings.

• Doctor’s orders and progress notes • Nursing assessments • Notes from nurses and other specialists • Flow sheets • Graphic record • Intake and output record • Consent forms • Lab and test results

7. Explain how to convert regular time to military time

• Surgery reports

Meeting the Learning Objective

Emphasize that the information in a resident’s chart must be kept confidential.

TEXTbooK PP. 40-41

woRKbooK PP. 20-21

• Advance directives

9. Explain guidelines for documentation

Display Transparency 3-4 24-HouR CLoCK

Meeting the Learning Objective TEXTbooK PP. 42-43

While looking at the transparency, explain how to convert regular time to military time:

woRKbooK P. 21

• To change regular hours between 1:00 p.m. and Lecture 11:59 p.m. to military time, add 12 to the regular Review the guidelines for accurate documentation: time. epEaR ll.inCfoOrM mation confidential. TESTBANKS•EKLeL

• To change from military time to regular time, subtract 12. • Minutes and seconds do not change.

• Midnight may be written as 0000 or 2400; follow facility policy.

8. Describe a standard resident chart Meeting the Learning Objective

• Document care immediately after it is given. Never document care before it is given. • Use black ink when documenting by hand. • Sign each note you make. • Use only facts when documenting. • If an error is made, draw one line through it and initial it and write the date. Write the correct information.

TEXTbooK PP. 41-42

• Use only your facility’s accepted abbreviations and terms.

woRKbooK P. 21

• Use comparisons to describe size.

Lecture Pronounce and define the following key terms: • Medical chart • Charting Emphasize that a resident’s chart is the legal record of a resident’s care, and that what is written on the chart is considered to be what actually happened. Review the information found on a resident’s chart: • Admission forms

Optional Learning Activity Bring in some blank medical charts. Using fictitious resident names and information, have the students practice documenting on the charts, including use of abbreviations and error correction.

10. Describe the use of computers in documentation Meeting the Learning Objective

• Resident’s history and results of exams

TEXTbooK P. 43

• Care plans

woRKbooK P. 21

19 Lecture Review the general rules for computer use in the facility:

Lecture Pronounce and define the following key terms:

• Do not share your password or log-in ID with anyone.

• Objective information

• Do not access personal e-mail or inappropriate websites from work.

• Orientation

• Log off and/or exit the web browser when finished with charting or using the computer. • Be careful about who can see PHI on the screen, as HIPAA guidelines apply to computer use. Optional Learning Activity Let students practice documenting using a computer if it is available and in use. Review HIPAA regulations and remind students to always be aware that PHI must be kept confidential.

11. Explain the Minimum Data Set (MDS) Meeting the Learning Objective

• Care plan • Subjective information • Vital signs • Critical thinking Emphasize to students that nursing assistants spend more time with residents than any other care team members and are more likely to observe changes in residents. Explain that care plans are created by nurses who collect information from staff. Display Transparency 3-5 sAMPLE KARDEX Review the sample Kardex forms if these forms are used at your facility. Display Transparency

TEXTbooK PP. 43-44

3-6 usINg youR sENsEs

woRKbooK P. 22

ExRp. laC inOthMe difference between objective and subTESTBANKSELLE

Lecture Pronounce and define the following key term: • Minimum Data Set (MDS)

jective information. Emphasize that objective information is collected by using the senses of sight, hearing, smell, and touch. Reinforce these points by using the transparency.

Discuss the important points about the MDS: Review other ways to observe residents accurately:

• Assessment tool developed by the federal government

• Note changes in orientation.

• Detailed form for assessing residents

• Check vital signs.

• Details what to do if problems are identified

• Report any changes in ability.

• Completed for each resident within 14 days of admission and again each year

• Report other important changes, such as appetite, ability to go to the bathroom, and mood.

• Must be reviewed every 3 months • New MDS is completed when there is any major change in resident’s condition Emphasize that nursing assistant reports on changes in residents’ conditions are very valuable, as they may trigger needed assessments.

12. Describe how to observe and report accurately Meeting the Learning Objective TEXTbooK PP. 44-46 woRKbooK PP. 22-23

Remind students that critical thinking for nursing assistants involves making careful observations, evaluating resident information, and immediately reporting all potential problems. Discuss signs and symptoms that should be reported right away, including the following: • Falls • Wheezing • Difficulty breathing • Chest pain and pressure • Pain in calf of leg • Blurred vision • Slurred speech

20 • Vomiting

15. Describe incident reporting and recording

• Sudden limp or change in ability to walk • Numbness or loss of feeling in one side or in arms or legs • Abdominal pain • Change in vital signs

Meeting the Learning Objective TEXTbooK PP. 47-48

woRKbooK P. 24

• Severe headache

Lecture Pronounce and define the following key terms:

Optional Handout

• Incident

3-4 sCIENTIFIC METHod Some states require that this information be taught to students. If required by your state, discuss the brief explanation of the scientific method found on the handout.

• Sentinel event • Incident report Review events in the facility that are considered incidents: • An accident or problem during the course of care • An error in care

13. Explain the nursing process Meeting the Learning Objective TEXTbooK P. 46

woRKbooK P. 23

• A fall or injury to a resident or staff member • An accusation against staff members Emphasize that an incident report must be filled out if a nursing assistant is injured on the job in any way, even if it seems minor.

Lecture Optional Learning Activity Pronounce and define the following key T teE rm S:TBANKSDEeLscLriEbeRt.o CthOe Mstudents an occurrence in a facility • Nursing process in which a resident is given the wrong meal at dinner time and becomes slightly ill as a result. Have Review the five steps of the nursing process: the students write individual incident reports, then • Assessment lead a group discussion in which the class writes a • Diagnosis final incident report. • Planning • Implementation • Evaluation

14. Discuss the nursing assistant’s role in care planning and at care conferences Meeting the Learning Objective TEXTbooK PP. 46-47

woRKbooK P. 23

16. Explain proper telephone etiquette Meeting the Learning Objective TEXTbooK P. 49

woRKbooK P. 24 Lecture Review the rules for telephone etiquette: • Cheerfully greet callers. • Identify your facility, yourself, and your position.

Lecture Pronounce and define the following key term:

• Listen closely to the caller’s request and write down any messages.

• Care conference

• Get a telephone number if needed.

Emphasize the importance of nursing assistants’ observations in planning care.

• Thank the caller and say “Goodbye.” Review rules for general telephone use: • Do not give out staff or resident information over the phone.

21 • Ask before placing a caller on hold.

TEXTbooK PP. 50-51

• Ask for training to transfer calls.

woRKbooK P. 25

• Follow facility policy regarding personal phone calls and cell phone use.

17. Describe the resident call system Meeting the Learning Objective

Lecture Pronounce and define the following key terms: • Code status • Code

TEXTbooK P. 49

Review the information typically found on an assignment sheet:

woRKbooK P. 24

• Residents’ names and room numbers

Lecture Emphasize that the call light is the resident’s lifeline and must always be answered immediately. Remind students that ignoring a call light is abuse. Emphasize that a call light must always be left within the resident’s reach before leaving the room. If available, show students the type of call system used at your facility and explain how to use it.

• Medical diagnosis • Code status • Activity level • Range of motion (ROM) exercises • Bathing information • Diet orders • Fluid orders • Bowel and bladder information

18. Describe the nursing assistant’s role in change-of-shift reports and rounds Meeting the Learning Objective TEXTbooK PP. 49-50

woRKbooK P. 25 Lecture Pronounce and define the following key term: • Rounds

• How often to measure vital signs • Treatments to be performed • Tests and procedures to be performed

20. Discuss how to organize work and manage time Meeting the Learning Objective TEXTbooK PP. 51-52

woRKbooK P. 25 Review the guidelines for start-of-shift reports: • Arrive on time. • Listen for your assignment and for information about all residents in your area.

Lecture Pronounce and define the following key term: • Prioritize

• Listen carefully to information from the prior shift.

Discuss the tips for organization and time management:

• Ask any questions you have about your residents.

• Plan ahead.

Explain that the nursing assistant’s role for endof-shift reports is to report information gathered about residents during the shift.

• Prioritize.

19. List the information found on an assignment sheet Meeting the Learning Objective

• Make a schedule. • Combine activities. • Get help when needed. Discuss how, when, and where NAs may seek help.

22 Chapter Review Exam dIsTRIbuTE CHAPTER 3: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

16. Listen closely. Take notes. Offer valuable information gathered about residents to staff. 17. Answers will vary, but may include visiting with residents while providing care. 18. S 19. O 20. S 21. O

Answers to Chapter Review in Textbook

22. O

Communicating verbally means using words. Nonverbal communication is communicating without using words.

23. B

Yes/no answers end a conversation.

25. A

Answers will vary.

26. C

Answers include the following: Use an interpreter. Use picture cards and flash cards. Learn a few words or phrases in a resident’s native language.

27. D

24. B

28. D

Introduce himself, identify the residT enEt,SaT nd explain the procedure to be done

2033 hours

1110 hours

Only other members of the care team

Immediately after care is given

10. Yes 11. When nursing assistants report changes in residents, it may trigger a needed assessment. 12. Sight, hearing, smell, and touch 13. An incident is an accident, problem, or unexpected event during the course of care. 14. After the incident occurs, the report must be completed as soon as possible. 15. Answers may include the following: “Good morning,” “good afternoon,” or “good evening.”

4 Communication Challenges 1. Define important words in this chapter 2. Identify communication guidelines for visual impairment 3. Identify communication guidelines for hearing impairment 4. Explain defense mechanisms as methods of coping with stress 5. List communication guidelines for anxiety or fear 6. Discuss communication guidelines for depression 7. Identify communication guidelines for anger 8. Identify communication guidelines for combative behavior 9. Identify communication guidelines for inappropriate sexual behavior 10. Identify communication guidelines for disorientation and confusion 11. Identify communication guidelines for the comatose resident 12. Identify communication guidelines for functional barriers Supplemental Tool CHAPTER 4: EXAM

1. Define important words in this chapter MR ee.tiC ngOtM he Learning Objective TESTBANKSELLE

Assignments TEXTbooK READINg, PP. 54-64

TEXTbooK P. 54

woRKbooK P. 27

woRKbooK EXERCIsEs, PP. 27-31 Overview of Teaching Strategies Proper communication skills are vital for a nursing assistant. The nursing assistant must be able to give accurate reports of observations about residents and communicate clearly and effectively with residents, visitors, and other members of the care team. This chapter focuses on situations that occur in healthcare that may make communication difficult. Students will learn to communicate with residents who have visual, hearing, or functional impairments. They will also learn methods for communicating with residents who are depressed, comatose, or exhibiting dangerous or inappropriate behavior. Emphasize that the role of the nursing assistant is to keep everyone safe.

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Identify communication guidelines for visual impairment Meeting the Learning Objective TEXTbooK PP. 54-55

woRKbooK P. 27 Lecture Pronounce and define the following key term: • Impairment Review the guidelines for visual impairment: • Knock, announce yourself, and greet the resident when entering the room. Explain the care you are going to provide.

24 • Face the resident while speaking to him. • Make sure there is proper lighting.

• Make sure hearing aids are worn and are turned on.

• Do not shout.

• Turn off TV or radio.

• Use the face of an imaginary clock to explain the position of objects.

• Speak clearly and do not shout.

• Make sure the resident has his eyeglasses on if he wears them.

• Do not chew gum, eat, or cover your mouth while speaking.

• Do not move personal items or furniture, and put everything back where it was found.

• Do not exaggerate pronunciation of words or mouth words in an exaggerated way.

• Read menus to the resident.

• Use simple words and short sentences.

• Encourage resident to use his other senses.

• Use pen and paper or picture cards.

• Lower the pitch of your voice.

• Let the resident know when you leave the area. • Do not play with, distract, or feed guide dogs. • Offer helpful items such as audiobooks, largeprint books, digital books, and large clocks. • Be empathetic.

4. Explain defense mechanisms as methods of coping with stress Meeting the Learning Objective TEXTbooK PP. 56-57

3. Identify communication guidelines for hearing impairment Meeting the Learning Objective TEXTbooK PP. 55-56 woRKbooK P. 27 Lecture Review symptoms of hearing loss: • Trouble hearing high-pitched noises

woRKbooK P. 28 Lecture and Discussion Pronounce and define the following key term: • Defense mechanisms Ask the class to come up with examples of each of the following defense mechanisms: • Denial • Displacement • Projection

• Trouble hearing soft consonants, such as “s” and “t”

• Rationalization

• Trouble hearing what is said in a setting that has background noise

• Regression

• Repression

• Not understanding the meaning of words • Being unable to hear people when they are not in the same room • Favoring one ear over the other one • Avoiding movies or special events due to not being able to understand the dialogue • Complaints of ringing in the ears • Complaints of pain in one or both ears

5. List communication guidelines for anxiety or fear Meeting the Learning Objective TEXTbooK P. 57

woRKbooK P. 28

Review the guidelines for hearing impairment:

Lecture Pronounce and define the following key term:

• Get resident’s attention before speaking.

• Anxiety

• Stand or sit so the resident can see your face.

Explain the differences between anxiety and fear and note that anxiety has physical symptoms.

• Look at the resident directly while speaking.

25 Review the guidelines for communicating with a resident who is anxious or fearful:

7. Identify communication guidelines for anger

• Knock on the door, announce yourself, and greet the resident when you enter the room.

Meeting the Learning Objective

• Speak softly. Reduce the noise level.

TEXTbooK PP. 58-59

• Speak slowly and calmly.

woRKbooK PP. 28-29

• Listen to the resident. Be patient. • Be empathetic, calm, and reassuring. • Avoid demanding behavior.

6. Discuss communication guidelines for depression Meeting the Learning Objective

Lecture Review the guidelines for angry behavior: • Be pleasant and supportive. • Try to find out what caused the anger. • Observe the resident’s body language. • Empathize with the resident. • Do not argue with the resident. Stay calm.

TEXTbooK PP. 57-58

• Treat the resident with dignity and respect.

woRKbooK P. 28

• Answer call lights promptly.

Lecture Pronounce and define the following key term: • Major depressive disorder

• If the resident’s anger increases, get the nurse immediately. • Try to involve the resident in activities.

Role Play Emphasize that depression is an illness like any Discuss the differences between assertive behavior other and that people who are depressed cannot anRd.aC ggOreMssive behavior. Have the students act as TESTBANKSELLE simply choose to be well. nursing assistants and residents in common situations, such as a resident asking for a different meal Discussion at dinner, a nursing assistant asking his supervisor Discuss the many losses and changes that occur how to correctly perform a procedure, and a nursin a person’s life when he or she has to move into ing assistant explaining a procedure to a resident. a facility. Ask them to think about what this would Each situation should be demonstrated twice. feel like, and ask for volunteers to describe what The first time, the participants should behave agwould be the hardest loss or change for them to gressively; the second time, they should behave deal with if they had to move into a facility. Withassertively. out using any names or personal details, tell the students about residents you have known who have 8. Identify communication guidelines for had a particularly difficult time adjusting to facility life and how the staff helped them. combative behavior Review the guidelines for communicating with residents with depression: • Be pleasant, respectful, and supportive. • Use touch to help comfort the resident.

Meeting the Learning Objective TEXTbooK PP. 59-60

woRKbooK P. 29

• Listen carefully to the resident. Lean forward and maintain eye contact.

Lecture Pronounce and define the following key term:

• Think before you speak and be empathetic.

• Combative

• Use a normal tone of voice. • Talk about feelings if the resident wishes. • Encourage social interaction.

Emphasize that combative behavior should not be taken personally, and that, when a resident becomes combative, the role of the nursing assistant is to keep everyone safe.

26 Review the guidelines for handling combative behavior: • Call for the nurse immediately. • Keep yourself and others at a safe distance. • Stay calm and try not to appear threatening to the resident. • Be reassuring. Consider what might have triggered the behavior. • Stay neutral. Do not respond to insults and do not argue. • Follow direction of the nurses. • Report facts you observed. • When the resident has calmed down, stay with her if she wishes to talk.

9. Identify communication guidelines for inappropriate sexual behavior Meeting the Learning Objective TEXTbooK P. 60

woRKbooK PP. 29-30 Lecture Pronounce and define the following key term: • Masturbation Discuss what kind of behavior is sexually inappropriate, including sexual advances, comments, or removing clothing in public places. Review causes of this behavior, such as illness, dementia, confusion, or medication. Emphasize that sometimes confused residents will show behavior that looks inappropriate but is due to a rash or uncomfortable clothes. Review the guidelines for handling inappropriate sexual behavior:

inappropriate and appropriate sexual behavior. Remind students that if they encounter consenting adults engaged in sexual behavior, they must provide privacy and leave the area.

10. Identify communication guidelines for disorientation and confusion Meeting the Learning Objective TEXTbooK PP. 60-61

woRKbooK P. 30 Lecture Pronounce and define the following key terms: • Disorientation • Confusion Differentiate between disorientation and confusion and list some of the possible causes of confusion. Review the guidelines for disorientation or confusion: • Do not leave a confused resident alone. • Stay calm and provide a quiet environment. • Speak in a lower tone of voice. Speak clearly and slowly. • Introduce yourself each time you see the resident. Remind the resident of the location, his name, and the date. • Explain what you are going to do, using short, simple sentences. Break tasks into steps. • Be patient with the resident. • Listen to the resident closely. Pay attention to body language. • Tell the resident the plans for the day. • Encourage the use of eyeglasses and hearing aids.

• Do not overreact. Try to distract the resident or move her to a private area.

• Tell the resident when you are leaving the area.

• Do not judge the behavior or gossip about it.

• Report observations to the nurse.

• Watch for problems that mimic inappropriate behavior. • Report inappropriate behavior to the nurse. Remind students that residents have the legal right to express their sexual needs. Make the distinction between inappropriate behavior and normal, appropriate sexual behavior. Discuss examples of

11. Identify communication guidelines for the comatose resident Meeting the Learning Objective TEXTbooK PP. 61-62

woRKbooK PP. 30-31

27 Lecture Pronounce and define the following key term:

• Ask the resident to write down anything you do not understand.

• Coma

• Allow for rest periods if resident becomes tired.

List some of the causes of coma, such as illness, drug overdose, or injury.

• Do not remove a resident’s oxygen for any reason.

Review the guidelines for caring for a comatose resident:

• Report mouth sores, poorly-fitting dentures, or complaints of pain.

• Introduce yourself when entering the resident’s room.

• Use other methods of communication, such as writing notes, drawing pictures, and communication boards.

• Explain each step of each procedure you will be performing.

• Be reassuring, calm, and empathetic.

• Do not hold personal discussions while caring for the resident.

Chapter Review

• Let the resident know when you are going to leave the room.

Exam

Define and discuss related terms to coma: persistent vegetative state (PVS) and minimally conscious state (MCS).

dIsTRIbuTE CHAPTER 4: EXAM (APPENDIX C)

12. Identify communication guidelines for functional barriers

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

Meeting the Learning Objective

Answers to Chapter Review in Textbook

TEXTbooK PP. 62-63

Announce yourself and greet the resident.

By using the face of an imaginary clock

Lecture Pronounce and define the following key terms:

The nursing assistant’s

• Dyspnea

Even when a person is unconscious, she may still be able to hear what is going on around her.

Answers include the following: communication boards, picture cards, writing notes, drawing pictures, and hand and eye signals.

An artificial airway is any plastic, metal, or rubber device inserted into the respiratory tract for the purpose of maintaining an airway and facilitating ventilation.

woRKbooK P. 31

• Airway • Artificial airway • Ventilation • Tracheostomy Review some of the functional problems that may cause residents to have difficulty speaking: • Lip, mouth, or tongue sores • Dental problems of any kind • Poorly-fitting dentures • Birth defects, such as cleft palate • Paralysis of one side of the mouth due to stroke Review the guidelines for functional barriers: • Give resident plenty of time to speak.

10. A

28 11. D 12. B 13. D 14. B 15. C 16. A

5 Diversity and Human Needs and Development 1. Define important words in this chapter 2. Explain health and wellness 3. Explain the importance of holistic health care 4. Identify basic human needs and discuss Maslow’s Hierarchy of Needs 5. Identify ways to accommodate cultural differences 6. Discuss the role of the family in health care 7. Explain how to meet emotional needs of residents and their families 8. Explain ways to help residents with their spiritual needs 9. Identify ways to accommodate sexual needs 10. Describe the stages of human growth and development 11. Discuss stereotypes of the elderly 12. Discuss developmental disabilities Supplemental Tools 1. Define important words in this chapter TRANsPARENCy 5-1 MAslow’s HIERARCHy MR ee.tiC ngOtM he Learning Objective oF NEEDs TESTBANKSELLE TEXTbooK PP. 65-66 TRANsPARENCy 5-2 TRuE oR FALsE? HANDouT 5-1 MyTHs AbouT oldER ADulTs AND sEXuALITy CHAPTER 5: EXAM

Assignments TEXTbooK READINg, PP. 65-81

woRKbooK EXERCIsEs, PP. 33-38 Overview of Teaching Strategies This chapter focuses on the kinds of needs that nursing assistants will help their residents meet. Health and wellness are defined, and the concept of holistic care is reviewed. Students will be introduced to Maslow’s Hierarchy of Needs, and emphasis is placed on meeting the individual needs of each resident, including emotional, spiritual, and sexual needs. The students will learn the various stages of human growth and development. Stereotypes of the elderly will be discussed. Emphasis should be placed on the fact that stereotypes are untrue and hurtful and that, as nursing assistants, students will need to get to know their residents as individuals to provide excellent care for them.

woRKbooK P. 33 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Explain health and wellness Meeting the Learning Objective TEXTbooK P. 66

woRKbooK P. 33 Lecture Pronounce and define the following key terms: • Health • Wellness • Mores Discussion Review the five types of wellness: • Physical • Social • Emotional

30 • Intellectual • Spiritual Ask the class to share things they do for themselves to achieve each kind of wellness.

Display Transparency 5-1 MAslow’s HIERARCHy oF NEEDs Discuss Maslow’s Hierarchy of Needs: • Physical needs • Safety and security needs

3. Explain the importance of holistic health care Meeting the Learning Objective TEXTbooK P. 66

woRKbooK P. 33 Lecture Pronounce and define the following key term: • Psychosocial needs

• Need for love • Need for self-esteem • Need for self-actualization Discuss how nursing assistants can help residents meet needs on each level of the hierarchy.

5. Identify ways to accommodate cultural differences Meeting the Learning Objective

Discussion Review the concept of holistic care. Explain how NAs can give holistic care by considering residents’ psychosocial needs as they give care. Ask the class for specific examples of holistic care, other than those mentioned in the book.

TEXTbooK PP. 68-69

woRKbooK P. 34 Lecture Pronounce and define the following key terms: • Cultural diversity

ltuCrO alMnursing 4. Identify basic human needs and T diEsS cuTsBs ANKS•ETLraLnEscRu. • Cultural competence Maslow’s Hierarchy of Needs Meeting the Learning Objective TEXTbooK PP. 66-67

woRKbooK PP. 33-34 Lecture Pronounce and define the following key term: • Need Review basic physical needs of human beings:

Discussion Discuss the influence that culture has on food choices, the way people seek health care, or the way people discuss health issues. Ask students to describe their own cultures, their cultures’ views on health care, and how a nursing assistant could best meet the needs of a resident from their culture. Encouraging the sharing of experiences and ideas can create a wonderful opportunity for students to ask questions and learn about others.

• Food and water • Protection and shelter • Activity

6. Discuss the role of the family in health care

• Sleep and rest • Comfort and freedom from pain

Meeting the Learning Objective TEXTbooK PP. 69-70

Review psychosocial needs: • Love and affection • Acceptance by others • Self-reliance and independence in daily living • Contact with other people • Success and self-esteem

woRKbooK P. 34 Lecture and Discussion Discuss the concept of family. Ask the students to share their own definitions of what family means. Review family types:

31 • Nuclear families • Single-parent families • Married or committed couples of the same sex or opposite sex, with or without children • Extended families

If time allows, you can give the students examples of professional boundaries and unprofessional boundaries, and ask them to identify which is which.

8. Explain ways to help residents with their spiritual needs

• Blended families Discuss the ways that families help residents: • Providing some care • Helping make care decisions • Relating routines and preferences to care team members • Connecting residents to the outside world • Reading mail

Meeting the Learning Objective TEXTbooK PP. 71-73 woRKbooK P. 35 Lecture Pronounce and define the following key terms: • Religions

• Helping to prepare menus

• Buddhism

• Taking residents on walks • Going with residents to activities and outside functions • Helping with personal care • Washing special clothing at home • Shopping for special items, gifts, or cards • Helping to prepare cards, letters, and gifts

• Christianity • Hinduism • Islam • Judaism • Spirituality

• Agnostic TESTBANKSELLE •R A. thC eiO stM

7. Explain how to meet emotional needs of residents and their families

Review some common religious and non-religious beliefs. Emphasize that nursing assistants must respect residents’ spiritual beliefs.

Meeting the Learning Objective TEXTbooK P. 70

Discuss the following ways that nursing assistants can help residents meet their spiritual needs:

woRKbooK PP. 34-35

• Honor dietary restrictions.

Lecture Discuss the reasons why residents and their families may turn to a nursing assistant in a time of crisis. Emphasize that the frequent contact a nursing assistant has with residents gives him an opportunity to play a large role in residents’ comfort and well-being. Discuss the best ways for a nursing assistant to respond when a resident or family member comes to them with problems or needs: • Listen closely and do not interrupt. • Offer support and encouragement. • Show that the NA cares. • Respond with a meaningful message instead of a cliché. • Maintain professional boundaries.

• Report requests to see clergy promptly. Give privacy for clergy visits. • Respect all religious items. • Allow time and privacy for prayer. • Make sure residents who want to go to religious services are ready on time and are helped to the proper site. • Report to nurse or social worker if resident needs help finding spiritual resources. • Remind students what is not permitted: • Trying to change someone’s religion or beliefs or telling a resident his/her belief or religion is wrong • Expressing judgments about a religious group • Interfering with a religious practice

32 Discussion Discuss different cultural and religious practices that relate to diet. Ask students to share their own diets, as they relate to culture and religion.

• If you witness sexual abuse, remove the resident to a safe place and report to the nurse immediately.

9. Identify ways to accommodate sexual needs

• If a sexual situation is disturbing or inappropriate, ask a nurse for help.

Meeting the Learning Objective

Distribute Handout

• Do not view any expression of sexuality by the elderly as disgusting or cute.

TEXTbooK PP. 73-74

5-1 MyTHs AbouT oldER ADulTs AND sEXuALITy

woRKbooK PP. 35-36

Discuss the myths about older adults and sexuality included in the handout:

Lecture Discuss some terms defining sexual identity:

• Myth #1 – Older men are not capable of having sexual relations.

• Asexual

• Myth #2 – After menopause, older women are not interested in sexual relations.

• Bisexual • Celibate

• Myth #3 – Any expression of sexuality by older people is either disgusting or cute.

• Cross-dresser • Gay

10. Describe the stages of human growth and development

• Heterosexual • Lesbian • Transgender • Transition

earning Objective TESTBANKSMEeLetLinEgRth.eCLO M TEXTbooK PP. 75-77

Emphasize to students that no matter what their feelings about lesbian, gay, bisexual, or transgender people are, they must respect all residents. Ask students if they can think of ways they can respect residents’ sexual identities, other than not assuming everyone is heterosexual.

Lecture Review the different types of development:

Discuss the following important points about sexual needs:

• Moral development

• Humans continue to have sexual needs throughout their lives.

• Physical development

woRKbooK P. 37

• Cognitive development • Language development • Motor development • Sexual development

• Sexual urges do not end due to age or admission to a care facility.

• Social development

• Do not assume you know what impact a disability has on sexuality.

Review important points about each age group:

Discuss the ways NAs can help residents with their sexual needs:

• Physical development moves from the head down.

• Knock and wait for permission to enter a resident’s room.

• Learn to grasp, lift their heads, and crawl.

• Provide privacy if you encounter sexual situations. Do not discuss what you saw. • Do not judge sexual choices or orientation.

• Infancy (Birth to 12 months)

• Touch is important as a communication tool. •

Toddler (Ages 1 to 3) • Speech improves.

33 • Gain coordination of limbs. • Important to protect them as they explore the world. • Preschool (Ages 3 to 6)

Lecture Pronounce and define the following key terms: • Stereotype • Ageism

• Become more independent.

Display Transparency

• Form social relationships.

5-2 TRuE oR FALsE?

• Sense of imagination develops. • School-age (Ages 6 to 10) • Cognitive and social development is important. • Begin to develop a conscience, morals, and self-esteem. • Preadolescence (Ages 10 to 13) • Views life more realistically • Uses reason to analyze situations • Girls may reach puberty, which is when a person develops secondary sex characteristics. • Adolescence (Ages 13 to 19) • Both genders become sexually mature. • May have mood swings.

Discuss the statements on the transparency. Ask the students whether they think the statements are true or false. Answers are as follows: 1. False, 2. False, 3. False, 4. True, 5. True, 6. False, 7. False, 8. False, and 9. True. Emphasize that stereotypes of the elderly are unfair and are not true of most older people. Discuss aging as a normal process and note that people do not always become ill or dependent. Stress that students must be able to tell what is true and what is not true about the aging process in order to provide quality care for their residents.

12. Discuss developmental disabilities Meeting the Learning Objective

ST .COM • Concerned about acceptance T frE om otB heArN s. KSELLER TEXTbooK PP. 79-80 • Young Adulthood (Ages 19 to 40) • Make decisions about career and education.

woRKbooK PP. 37-38

• May meet life partner.

Lecture Pronounce and define the following key term:

• May decide to have children.

• Developmental disability

• Middle Adulthood (Ages 40 to 65) • Usually become more comfortable and stable. • May take trips or start a second career. • May have a mid-life crisis. • Late Adulthood (65 years and older) • May retire from jobs.

Discuss important points about developmental disabilities: • A developmental disability is a chronic condition. • Developmental disabilities restrict physical or mental ability. • They may cause difficulty with self-care and ADLs.

• Health problems may limit mobility.

Review types of developmental disabilities listed:

• Staying connected to others is vital to staying healthy.

• Cerebral palsy

• Intellectual disability • Autism spectrum disorder

11. Discuss stereotypes of the elderly

• Fragile X syndrome

Meeting the Learning Objective

Review guidelines for caring for residents with developmental disabilities:

TEXTbooK PP. 77-78

woRKbooK P. 37

• Treat adult residents as adults. • Praise and encourage positive behavior.

34 • Teach ADLs by dividing tasks into small steps.

A stereotype is a biased generalization about a group that is usually based on opinions and distorted ideas.

Answers include the following: Because these generalizations are usually based on opinions and distorted ideas and often come from television or the movies. These unfair ideas create prejudices against the elderly.

• Repeat words to make sure they are understood. • Talk to residents even if they cannot speak. Use alternate methods of communication as directed. • Promote independence while ensuring safety. • Prevent falls. • Encourage residents to follow special diets. • Encourage social interaction. • Be patient.

Chapter Review Exam dIsTRIbuTE CHAPTER 5: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Wellness has to do with successfully balancing things that happen in our everyday lives.

Holistic care involves considering the whole person, which includes his physical and psychosocial needs.

Psychosocial needs include social contact, emotions, thought, and spirituality.

Cultural diversity has to do with the wide variety of people throughout the world. Each culture may have similar lifestyles, religions, traditions, customs, and behaviors.

Cultural competence is an ongoing process of learning about other cultures and applying that knowledge to help provide better health care.

Provide privacy and leave the room.

Remove the resident from the situation. Make sure he or she is taken to a safe place, then report the abuse to the nurse immediately.

10. Answers will vary, but may include something along the lines of the resident having a right to respect, dignity, and independence. 11. B 12. C 13. A 14. D 15. A 16. B 17. C 18. C

6 Infection Prevention 1. 2. 3. 4. 5. 6.

Define important words in this chapter Define infection prevention and discuss types of infections Discuss terms related to infection prevention Describe the chain of infection Explain why the elderly are at a higher risk for infection Describe Centers for Disease Control and Prevention (CDC) and explain Standard Precautions 7. Define hand hygiene and identify when to wash hands 8. Discuss the use of personal protective equipment (PPE) in facilities 9. List guidelines for handling linen and equipment 10. Explain how to handle spills 11. Discuss Transmission-Based Precautions 12. Describe care of the resident in an isolation unit 13. Explain OSHA’s Bloodborne Pathogen Standard 14. Discuss two important bloodborne diseases 15. Discuss MRSA, VRE, C. Difficile, and CRE Supplemental Tools TRANsPARENCy 6-1 THE CHAIN oF INFECTIoN TRANsPARENCy 6-2 PoRTALs oF EXIT TRANsPARENCy 6-3 PoRTALs oF ENTRy TRANsPARENCy 6-4 AIRboRNE PRECAuTIoNs TRANsPARENCy 6-5 dRoPLET PRECAuTIoNs TRANsPARENCy 6-6 CoNTACT PRECAuTIoNs CHAPTER 6: EXAM

Assignments TEXTbooK READINg, PP. 82-110

woRKbooK EXERCIsEs, PP. 39-44 Overview of Teaching Strategies This chapter introduces students to the concept of infection prevention. Students will learn about the infection prevention regulations established by OSHA, the CDC, and their facility (if applicable). Students will learn about the chain of infection and the techniques needed to break the chain and protect residents, staff, and visitors from infection. Students will also learn why the elderly are at greater risk

for infection and the specific infection prevention practices needed to protect them. Infection prevention guidelines set by the CDC and OSHA, including Standard Precautions, Transmission-Based Precautions, and the Bloodborne Pathogen Standard, should be discussed in depth. The instructor’s emphasis on consistently and correctly practicing infection prevention will be the foundation for ensuring that students follow these practices throughout their careers. The first procedures to be presented in the book are in this chapter. The instructor should demonstrate each procedure, emphasizing the importance of every step, and have students return the demonstration. Remind the students that they will be tested on these procedures before they are certified to work, and encourage them to practice them until they are comfortable and confident with them. This chapter also discusses the potential danger of bloodborne diseases to healthcare workers. Infection prevention will also be stressed as a method of preventing dangerous infections, including MRSA, VRE, C. difficile, and CRE, which are much easier to prevent than to cure.

36 1. Define important words in this chapter

3. Discuss terms related to infection prevention

Meeting the Learning Objective Meeting the Learning Objective

TEXTbooK PP. 82-84

TEXTbooK P. 86

woRKbooK P. 39

woRKbooK PP. 39-40 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

Lecture Pronounce and define the following key terms: • Transmission

2. Define infection prevention and discuss types of infections

• Medical asepsis • Clean • Contaminated

Meeting the Learning Objective

• Dirty

TEXTbooK PP. 84-86

• Disinfection

woRKbooK P. 39

• Sterilization

Lecture Pronounce and define the following key terms:

• Autoclave • Surgical asepsis

• Sanitation • Infection prevention • Microorganism • Microbe • Infections

Discussion Emphasize the difference between disinfection and sterilization. Remind students of the importance of shLinEgRh. an TESTBANKSwEaL CdOs Mafter touching items in the contaminated or dirty utility room.

• Pathogens • Localized infection • Systemic infection • Healthcare-associated infection • Drainage • Infectious disease • Resistance

4. Describe the chain of infection Meeting the Learning Objective TEXTbooK PP. 87-89

woRKbooK P. 40

• Communicable disease

Lecture Pronounce and define the following key terms:

• Contagious disease

• Normal flora

• Non-communicable disease

• Incubation period

• Cross-infection

• Vaccine

• Reinfection

• Immunity

Because students are being introduced to such an important topic and to many key terms in this learning objective, it is a good time to emphasize how quality infection prevention can help prevent the spread of disease.

• Carrier • Body fluids • Direct contact • Indirect contact • Fomite • Mucous membranes

37 Display Transparencies

• Bones more brittle and more easily broken

6-1 THE CHAIN oF INFECTIoN

• Decreased circulation and slow wound healing

6-2 PoRTALs oF EXIT 6-3 PoRTALs oF ENTRy

• May require catheters or other types of tubing

Review the six links in the chain of infection: • Causative agent • Reservoir • Portal of exit • Mode of transmission • Portal of entry • Susceptible host Go over each of the portals of exit and entry as reinforcement of how pathogens can enter and leave the body. Lecture and Discussion Ask the students to think of ways (not listed in the textbook) to break each link in the chain of infection. Emphasize that only one link in the chain must be broken to stop the spread of infection.

• At risk for malnourishment and dehydration Emphasize the importance of promoting healthy habits and using proper infection prevention methods to protect residents from infection.

6. Describe Centers for Disease Control and Prevention (CDC) and explain Standard Precautions Meeting the Learning Objective TEXTbooK PP. 90-92

woRKbooK PP. 40-41 Lecture Pronounce and define the following key terms: • Centers for Disease Control and Prevention (CDC) • Standard Precautions

ExRp. laC inOSM tandard Precautions. Emphasize that 5. Explain why the elderly are T atEaShTiB gh AeNrKSELLE Standard Precautions must be practiced with risk for infection every resident.

Meeting the Learning Objective TEXTbooK PP. 89-90

woRKbooK P. 40 Lecture Pronounce and define the following key terms: • Catheter • Malnutrition • Dehydration Explain that lack of thirst and appetite, illness, or medication may cause residents to become malnourished or dehydrated. Discuss the changes of aging that cause older people to have a greater risk for infection: • Hospitalized more often • Recovery from illness takes longer • Infections more dangerous • Skin becomes less elastic, thinner, and is easily torn • Limited mobility

Review the elements of Standard Precautions: • Treat blood, body fluids, non-intact skin, and mucous membranes as if they were infected. • Wash hands before putting on gloves and after removing gloves. • Wear gloves if there is possibility of coming into contact with blood, body fluids, secretions and excretions, broken or open skin, human tissue, or mucous membranes. • Remove gloves when finished with a procedure. • Wash all skin surfaces that have been contaminated with blood and body fluids. • Wear a disposable gown, mask, protective goggles, and/or a face shield when there is possibility of coming into contact with blood, body fluids, secretions and excretions, or when splashing or spraying blood or body fluids is likely. • Wear gloves and use caution when handling sharps. • Do not attempt to recap needles or sharps after use.

38 • Bag all disposable contaminated supplies. • Clean all surfaces that might be contaminated with infectious waste. • Practice Standard Precautions on every resident in the NA’s care.

Review the times when nursing assistants must wash their hands: • When arriving at work • Whenever hands are visibly soiled • Before, between, and after all contact with residents

Review the additional guidelines for preventing infection in a facility:

• Before putting on gloves and after removing gloves

• Clean cuts or breaks in skin immediately.

• Before and after touching meal trays and/or handling food

• Cover mouth and nose when coughing or sneezing and immediately dispose of used tissues in nearest no-touch waste container.

• Before and after feeding residents

• Never share a resident’s personal items with another resident.

• Before getting clean linen

• Never transfer personal items or equipment from one room to another.

• Before and after eating

• Hold equipment, personal care items, and soiled laundry and linens away from uniform. • Do not use equipment that has been dropped on the floor; obtain new items. • Clean all equipment after use. • Clean common areas. • Remove food and utensils from residents’ rooms. • Change and date water cups often. • Clean toothbrushes and shaving equipment often. • Never place contaminated items on overbed tables. • When cleaning, move from cleanest area to dirtiest area.

7. Define hand hygiene and identify when to wash hands Meeting the Learning Objective TEXTbooK PP. 92-94

woRKbooK P. 41 Lecture Pronounce and define the following key terms:

• Before entering a clean supply room • Before leaving a dirty supply room • After contact with blood or any body fluids, mucous membranes, non-intact skin, or wound dressings • After changing incontinence pads • After handling contaminated items • After contact with any object, including medical equipment, in the resident’s room • After touching garbage • After cleaning spills or picking up anything from the floor • Before and after using the toilet • After coughing, sneezing, or nose-blowing • After smoking • After touching areas on the body, such as the nose, mouth, eyes, face, ears, or hair • After touching jewelry • After handling animals/pets and after contact with pet care items • Before leaving work and after arriving home from work, before touching anything or anyone Emphasize that washing hands is the single most important thing a nursing assistant can do to prevent the spread of disease.

• Antimicrobial

Demonstration Demonstrate procedure Washing hands (hand hygiene). Include all of the numbered steps in your demonstration.

Explain your facility’s policy on the use of alcoholbased hand rubs. Emphasize that visibly soiled hands must be washed with soap and water.

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Hand hygiene • Hand rub

39 8. Discuss the use of personal protective equipment (PPE) in facilities

Remind students that they cannot exit the resident’s room with their gloves on.

Meeting the Learning Objective TEXTbooK PP. 94-99 woRKbooK PP. 41-42

Demonstration Demonstrate procedure Putting on (donning) gloves. Include all of the numbered steps in your demonstration.

Lecture Pronounce and define the following terms:

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Personal protective equipment (PPE) • Don • Doff

Lecture Discuss the times when gloves must be removed:

• Perineal care

• Immediately after use

• Non-intact skin

• Before touching surfaces

List the types of PPE used in a facility:

• Before caring for another resident

• Gloves • Gowns • Masks • Goggles • Face shields Review the times when gloves must be worn: • When there may be contact with blood, body fluids, open wounds, or mucous membranes • When performing or helping with mouth care or care of any mucous membrane • When performing or helping with perineal care • When performing care on a resident who has non-intact skin • When the nursing assistant has sores or cuts on her hands • When shaving a resident • When disposing of soiled bed linens, gowns, dressings, or pads • When the NA will have direct contact with residents who require Contact Precautions • When touching surfaces or equipment or handling equipment that is either visibly contaminated or may be contaminated Review the times when gloves must be changed: • If gloves become wet, worn, soiled, or torn • Before contact with mucous membranes or broken skin

Demonstration Demonstrate procedure: Removing (doffing) gloves. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. Lecture Review important information about gowns: • Worn if there may be contact with blood, body fluids, secretions or excretions, tissue, or when splashing or spraying blood or body fluids is likely • Worn if clothing will have direct contact with a resident or any contaminated equipment or surfaces • Worn when handling any equipment that is visibly soiled or may have had contact with blood or body fluids • Gown should fully cover torso • Gown should be changed if it becomes wet or soiled Demonstration Demonstrate procedure Putting on (donning) and removing (doffing) gown. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

40 Lecture Review important information about masks: • Worn when caring for residents who cough, sneeze, or have respiratory illness, or when it is likely that contact with blood or body fluids may occur • Prevent inhalation of microorganisms • Should fully cover nose and mouth

9. List guidelines for handling linen and equipment Meeting the Learning Objective TEXTbooK P. 99 woRKbooK P. 42

• Must be changed if wet or soiled, and between caring for different residents

Lecture Discuss the guidelines for handling linen and equipment:

Review important information about goggles:

• Wear gloves when handling, transporting, and processing soiled linens.

• Used when blood or body fluids may be splashed or sprayed in eye area

• Check for items left inside linen.

• Should fit snugly over and around eyes or eyeglasses

• Hold dirty linen away from uniform.

Demonstration Demonstrate procedure: Putting on (donning) mask and goggles. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Fold or roll linen so that the dirty area is inside. • Do not shake dirty linen or clothes. • Place or dispose of linen and other equipment in the proper container. • Do not touch the inside of disposal containers. • Do not use reusable equipment again until it has been properly cleaned and reprocessed. Dispose of single-use equipment properly.

r gRlo.vC esOtM o clean and disinfect surfaces. TESTBANKS•EW LeLaE

Lecture Review important information about face shields:

10. Explain how to handle spills

• Worn when blood or body fluids may be splashed or sprayed into the eyes or eye area

Meeting the Learning Objective

• Offer more protection than goggles

TEXTbooK PP. 99-100

• Should cover the forehead and reach below the chin

woRKbooK P. 42

• Use headband to secure on head Demonstration Demonstrate procedure: Donning and doffing a full set of PPE. Include all of the numbered steps in your demonstration. Be sure to emphasize that respirators, not standard masks, should be removed after exiting the resident’s room and closing the door. Here is the CDC’s link regarding proper sequence: http://www.cdc.gov/hai/pdfs/ppe/PPESequence.pdf. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Lecture Discuss guidelines for cleaning spills: • Don gloves immediately. • First, absorb the spill with proper product. • Scoop up the absorbed spill and dispose of it properly. • Apply proper disinfectant to area. Allow it to stand wet for proper length of time. • Do not pick up glass. • For large spills, call the nurse. • If a substance is spilled on the body, wash area immediately and follow exposure incident guidelines. • Wash hands after cleaning spills.

41 11. Discuss Transmission-Based Precautions Meeting the Learning Objective TEXTbooK PP. 100-102

woRKbooK PP. 42-43 Lecture Emphasize that Transmission-Based Precautions are always used in addition to Standard Precautions. Display Transparency 6-4 AIRboRNE PRECAuTIoNs Explain that Airborne Precautions prevent the spread of pathogens that travel through the air after being expelled. Tuberculosis is an airborne disease.

with another person or object. Clostridium difficile (C. diff) is a contact disease. Review Contact Precautions: • Follow Standard Precautions. • Put on a gown before entering a resident’s room. Remove and discard gown before leaving the room. • Put on gloves before entering the room. Change gloves if they become contaminated. Remove gloves before leaving the room. • While still in room, wash hands with antimicrobial soap after removing gloves. • Do not share resident’s equipment with other residents. • Do not share resident’s towels, bedding, or clothing with other residents. • Resident will be placed in a private room.

Review Airborne Precautions: • Follow Standard Precautions. • Resident will be in airborne infection isolation room (AIIR).

12. Describe care of the resident in an isolation unit

• Keep doors and windows closed. Do not open or Meeting the Learning Objective close door quickly. TESTBANKSELLER TE. XT CbOoM oK PP. 102-103 • Wear special mask during resident care. • Residents should wear surgical masks. Display Transparency 6-5 dRoPLET PRECAuTIoNs Explain that Droplet Precautions are used for diseases that are spread by droplets in the air that normally do not travel further than six feet. Influenza is a droplet disease. Review Droplet Precautions: • Follow Standard Precautions. • Wear a mask during resident care. • Residents will wear mask when leaving room. • Cover nose and mouth when sneezing or coughing. Dispose of tissues in a no-touch waste container and wash hands.

woRKbooK P. 43 Lecture Review the guidelines for residents in isolation: • Explain steps for setting up an isolation unit: • Wash hands and don gloves. • Adjust bed to proper height. • Put away supplies. • Leave clean pajamas in easy reach. • Make sure equipment, doors, and windows in room are in working order. • Restock bathroom supplies as needed and notify proper department if anything is damaged or is not working properly. • If asked to set up an isolation cart outside of the resident’s room, make sure the cart is stocked with all PPE needed.

• Visits from uninfected people may be restricted.

• Apply proper PPE before entering the isolation room.

Display Transparency

• Use disposable supplies whenever possible. Clean and disinfect dedicated equipment.

6-6 CoNTACT PRECAuTIoNs Explain that Contact Precautions are used when a resident may spread an infection by direct contact

• Dispose of trash in proper containers. • Dispose of waste containing blood, body fluids, or sharps in biohazard containers.

42 • Bag used linen or equipment so that contaminated items do not touch outside of bag. • Disinfect furniture and surfaces regularly.

control plan. Make copies of exposure report forms and distribute to students. Have them practice filling out the form so they become familiar with it.

• Assist visitors with putting on PPE as needed. • Encourage use of disposable reading material.

14. Discuss two important bloodborne diseases

• Place call light within resident’s reach.

Meeting the Learning Objective

• Make sure TV, telephone, and radio are working.

• Spend as much time with resident as possible if allowed. Remind students that Residents’ Rights must be protected when residents are in isolation.

13. Explain OSHA’s Bloodborne Pathogen Standard Meeting the Learning Objective TEXTbooK PP. 103-105

woRKbooK P. 43 Lecture Pronounce and define the following terms: • Bloodborne pathogens

TEXTbooK PP. 105-106

woRKbooK PP. 43-44 Lecture Discuss important information about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS): • AIDS is caused by HIV. • HIV damages the immune system over time so that the body cannot fight infection. • The stage of the disease when tumors and central nervous system symptoms appear is known as AIDS.

• People with AIDS can die from illnesses that a person with a healthy immune system could fgL htE . R.COM TESTBANKSEiL • Occupational Safety and Health Administration • HIV is transmitted by blood, infected needles, (OSHA) from mother to fetus, or sexual contact. • Bloodborne Pathogen Standard Pronounce and define the following term: • Exposure control plan • Exposure incident

• Hepatitis

Review significant exposures:

Review the different viruses that can cause hepatitis:

• Needle stick • Mucous membrane contact • Cut from object containing potentially infectious body fluids • Non-intact skin, including acne

• Hepatitis A (HAV) • Hepatitis B (HBV) • Hepatitis C (HCV) • Hepatitis D (HDV) • Hepatitis E (HEV)

Discuss the steps taken after an exposure incident: • Immediately follow facility policy regarding spill, splash, or cut. • Report exposure incident to supervisor. • Fill out exposure report form. • Go to employer’s health service department for any needed tests. Optional Activity Show students a copy of your facility’s exposure

Emphasize that HBV is a serious threat to healthcare workers. Review precautions to take to avoid being infected on the job: • Use proper PPE. • Handle needles and other sharps carefully. • Dispose of sharps properly in biohazard container. • Get the free HBV vaccine.

43 15. Discuss MRSA, VRE, C. Difficile, and CRE

• Spread by spores in feces that are difficult to kill

Meeting the Learning Objective

• Symptoms include foul-smelling watery stools, fever, diarrhea that contains blood and mucus, nausea, lack of appetite, and abdominal cramps

TEXTbooK PP. 106-108

woRKbooK P. 44 Lecture Pronounce and define the following key terms: • Multidrug-resistant organisms (MDROs) • MRSA (methicillin-resistant Staphylococcus aureus) • VRE (vancomycin-resistant enterococcus) • Clostridium difficile (C. diff, C. difficile) • Carbapenem-resistant Enterobacteriaceae (CRE) Review important information about MRSA:

• Alcohol-based hand sanitizers are not effective; soap and water must be used for hand hygiene

• Symptoms should be reported immediately Review important information about Carbapenemresistant Enterobacteriaceae (CRE): • Spread through direct contact with infected person • Catheter use, IV therapy, and ventilators increase the risk of acquiring CRE. • Proper, frequent hand hygiene is the most important way to prevent it.

Chapter Review

• Often acquired in healthcare facilities; also known as hospital-associated methicillin-resisExam tant Staphylococcus aureus (HA-MRSA) dIsTRIbuTE CHAPTER 6: EXAM • Community-associated methicillin-resistant (APPENDIX C) Staphylococcus aureus (CA-MRSA) is a type of MRSA infection that occurs in people who have Allow students enough time to finish the test. See R.COM not been in healthcare facilities aTnE dS wT hoBhAaN veKnSoELLE Appendix D for answers to the chapter exams. past diagnosis of MRSA Appendices E and F contain a second set of chap• Spread by direct contact with infected person or ter exams and an answer key for those exams if indirect contact through contaminated objects needed. • Symptoms include drainage, fever, chills, and Answers to Chapter Review in Textbook redness • Handwashing is best way to control it

An object can be called clean if it has not been contaminated with pathogens. An object that is dirty has been contaminated with pathogens.

Disinfection is a process that destroys pathogens and other types of microorganisms, but not all pathogens. Sterilization means all microorganisms are destroyed, including those that form spores.

Answers include the following: Multiple changes of aging tend to make the elderly more susceptible to infections. Elderly people are hospitalized more often, which increases their chances of getting healthcare-associated infections and other infections. When the elderly get sick, recovery may take longer and the infections themselves may be more dangerous. Skin becomes thinner, which makes

Review important information about VRE: • Very difficult to treat and may require several medications • Spread through direct or indirect contact • Symptoms include fever, fatigue, chills, and drainage • Much easier to prevent than to get rid of • Proper hand hygiene can help prevent the spread Review important information about C. difficile: • May flourish in intestinal tract when normal flora is altered • Enemas, nasogastric tube insertion, and GI tract surgery increase risk • May cause colitis or sepsis

44 it easier to tear. When fragile skin tears, pathogens can enter the body. Both thinner skin and limited mobility increase the risk of pressure ulcers and skin infections. Bones become more brittle and can break more easily. Decreased circulation and slow wound healing also contribute to infections in the elderly. Catheters and other types of tubing can greatly increase the risk of infections. Older adults are at risk for dehydration and malnutrition. When cells do not get proper nutrients and fluids, the chance of infection greatly increases. 4.

With every resident for whom the nursing assistant cares

healthcare professions, contact with infectious blood or body fluids is the most common way to get a bloodborne disease. Infections may be spread by accidental contact with contaminated blood or body fluids, skin, needles or other sharp objects, or contaminated supplies or equipment. 13. Hepatitis is inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications, and trauma. 14. HIV damages the immune system so that over time, the body cannot effectively fight infections. 15. HBV is spread through sexual contact, by sharing infected needles, from a mother to her baby during delivery, through improperly sterilized needles used for tattoos and piercings, and through grooming supplies, such as razors, nail clippers, and toothbrushes. It is also spread by exposure at work from accidental contact with a used, infected needle or other sharp instrument, or from splashing blood.

Hand hygiene is washing hands with either plain or antiseptic soap and water or using alcohol-based hand rubs.

Artificial nails harbor bacteria, even if a person washes his hands often.

A gown should be worn if the caregiver may come into contact with blood, body fluids, secretions or excretions, tissue, or when splash.gChOfrMequent, proper handwashing ing or spraying blood or body fluidsT isEliS keTlyB. ANKS1E 6.LL TE hrR ou

A mask should be worn when caring for residents who cough, sneeze, or have respiratory illnesses. Goggles are used whenever blood or body fluids may be splashed or sprayed into the eye area or the eyes.

PPE should be donned in this order: gown, mask or respirator, goggles or face shield, gloves; PPE should be doffed in this order: gloves, goggles or face shield, gown, mask or respirator.

17.

Answers include the following: proper handwashing with soap and water and proper handling of contaminated wastes; additional Transmission-Based Precautions; cleaning surfaces with an appropriate disinfectant; and limiting the use of antibiotics.

18.

CRE is normally spread through direct contact with an infected person.

19.

10. Dirty linen should be held and carried away from the NA’s uniform.

20.

21.

11. After it has been properly cleaned and reprocessed

22.

23.

24.

25.

26.

27.

12. Bloodborne pathogens are transmitted by infected blood entering the bloodstream, or if infected semen or vaginal secretions contact mucous membranes. Sharing infected drug needles is another way to spread bloodborne diseases. Infected pregnant women may transmit bloodborne diseases to their babies. In

7 Safety and Body Mechanics 1. Define important words in this chapter 2. List common accidents in facilities and ways to prevent them 3. Explain the Safety Data Sheet (SDS) 4. Describe safety guidelines for sharps and biohazard containers 5. Explain the principles of body mechanics and apply them to daily activities 6. Define two types of restraints and discuss problems associated with restraints 7. Discuss restraint alternatives 8. Identify what must be done if a restraint is ordered 9. List safety guidelines for oxygen use 10. Identify safety guidelines for intravenous (IV) lines 11. Discuss fire safety and explain the RACE and PASS acronyms 12. List general safety steps for working in a healthcare facility Supplemental Tools be stressed, and emphasis should be placed on the use of restraint alternatives whenever possible. TRANsPARENCy 7-1 body ALIgNMENT EbSJETCB KMSELLE TRANsPARENCy 7-2 lIFTINg HEAVT yo TsAFN Ro InRt. hiC sO chM apter, students will learn how to safely THE FLooR care for residents who are using oxygen or who have IV lines. They will also learn how to prevent HANDouT 7-1 REsTRAINT ALTERNATIVEs fires and what to do if a fire occurs, as well as genCHAPTER 7: EXAM eral guidelines for keeping themselves and others safe in the facility. Assignments TEXTbooK READINg, PP. 111-126

woRKbooK EXERCIsEs, PP. 45-48 Overview of Teaching Strategies One of the most important concerns in any facility is the safety of residents and staff. This chapter discusses some of the accidents that may occur in a facility and how to prevent them. It should be emphasized that it is much better to be proactive and prevent accidents than to be reactive by simply addressing accidents that have already occurred. This chapter will introduce students to the SDS, as well as the containers and procedures used to dispose of biohazardous waste and sharps. Students will also learn how using proper body mechanics can improve safety for themselves and for their residents. This chapter also discusses restraints. The negative effects of restraints should

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 111-112

woRKbooK P. 45 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. List common accidents in facilities and ways to prevent them Meeting the Learning Objective TEXTbooK PP. 112-116

woRKbooK P. 45

46 Lecture Discuss the types of accidents that can occur in a facility and how to prevent them. Emphasize the importance of being proactive to prevent accidents from occurring.

caused by unsafe environments, loss of abilities, diseases, muscle weakness, poor vision, or disorientation.

Fall Prevention

This would be a good time to demonstrate to students how to handle a falling resident. Let them practice on each other after the demonstration.

Review the guidelines for preventing falls:

Resident Identification

• Know which residents may be at risk and report unsteadiness. • Keep frequently-used items close to residents, including call lights. Respond to call lights promptly. Make sure eyeglasses are within reach and that they are not damaged. • Wipe up spills immediately. • Remove clutter from walkways. Keep purse, bag straps, and linens off the floor.

Failure to identify residents can result in illness or even death. Disoriented residents may have special bands with alarms on them. Review the guidelines for identifying residents: • Identify residents before providing care or serving food. • Check diet cards against resident’s identification. • Call resident by name.

• Get help when moving residents.

Burn/Scald Prevention

• Lock bed wheels before giving care. Lock bed wheels before moving a resident into or out of bed.

Pronounce and define the following key term: • Scalds

• Lock wheelchair wheels before transferring residents into or out of them.

Emphasize that burns are very painful and can occur quickly. Explain that elderly people and those sation are at greater risk for burns. nS fin • Return beds to their lowest position whTeE T-BANKSwEitLhLloEssRo.f CseOnM ished with care. Review the guidelines for preventing burns and • Make sure residents’ clothing fits properly. Make scalds: sure residents are wearing sturdy, nonskid shoes • Check water temperature before giving a resident with the laces tied. a bath or shower. Temperature should not be • Report any rugs or mats that move. Use nonskid over 105°F. mats in the shower or bath. • Check for proper temperature of warm water • Report loose hand rails immediately. Report applications. cracks or holes anywhere. • Use low setting on hair dryers. • Report damage to outdoor furniture, benches, • Let liquids cool before serving. and ramps. • Serve drinks when residents are seated. • Clearly mark areas where floor is uneven. • Keep walkers and canes nearby.

• Tell residents before pouring or setting down hot drinks.

• Do not move furniture without an order from the nurse.

• Use lids on hot liquids.

• Offer trips to the bathroom often. Respond to requests for bathroom assistance promptly.

• Pour hot liquids away from residents. • Check plates that have been warmed.

• Report any areas that are not well-lit.

• Make sure anything that has been in the sun has cooled before use.

• Do not try to catch or stop a falling resident. Use your body to slide him to the floor.

• Tell residents about smoking precautions.

• Report all falls to the nurse and always complete an incident report.

Poison Prevention

Remind students that most of the accidents in a facility are related to falls, and that they may be

Pronounce and define the following key term: • Hoarding

47 Review guidelines for poison prevention: • Keep all items that may be poisonous away from confused or disoriented residents. Do not leave cleaning products in residents’ rooms.

• Follow facility policy if a skin splash or eye splash occurs. • Report all injuries immediately.

• Check expiration dates of foods to ensure that they are fresh.

3. Explain the Safety Data Sheet (SDS)

• Check residents’ drawers for hoarded food that has spoiled.

Meeting the Learning Objective

• Make sure there is proper ventilation when chemical products are used.

TEXTbooK PP. 116-117

woRKbooK P. 45

Choking Prevention

Lecture Pronounce and define the following key term:

Pronounce and define the following key terms:

• Safety Data Sheet (SDS)

• Dyphagia • Aspiration Review the guidelines for choking prevention:

Discussion Hand out a sample SDS to students. Ask them to look for the following important information:

• Residents should be sitting upright/90 degrees while eating.

• Chemical ingredients of the product

• Assist with feeding slowly. Never rush a resident during a meal.

• Protective items to be worn

• Alternate between food and drink. • Cut food into small pieces.

• Dangers of the product • How to use and clean up the chemical • Emergency response if product is splashed onto skin or ingested

TESTBANKSELLER.COM

• Report to nurse if you think a resident would be helped by softer foods or thickened liquids.

• Make sure dentures are in place and fit properly. • Be aware of residents’ swallowing precautions.

• Safe handling, storage, and disposal procedures

4. Describe safety guidelines for sharps and biohazard containers

Cuts and Other Injuries Meeting the Learning Objective Review the guidelines for preventing cuts, scrapes, and other injuries: • Do not leave sharp objects out. • Prevent skin tears when dressing residents by guiding clothing over the body. • Approach doors slowly. • When moving residents in wheelchairs, protect their arms, legs, hands, and feet. • Push wheelchairs forward. Wheelchairs should face forward in elevators. Review general safety guidelines: • Do not run in a facility. • Do not put your hand into a bed or anywhere else without looking first. • Ask for help when you need it. • Know which residents are combative and try to learn what triggers this behavior.

TEXTbooK P. 117

woRKbooK P. 46 Lecture Review the guidelines for safe use of sharps and biohazard containers: • Don gloves before touching a sharps container. • Keep hands clear of the opening of container. Carry the container by the bottom only. • Request that container be replaced when it is ¾ full or according to facility policy. • Remove gloves and wash hands after putting anything into sharps container. • Use biohazard container or bag for anything contaminated with infectious waste except for sharps. • Wear gloves when disposing of infectious waste.

48 • Remove gloves and wash hands after putting anything into the biohazard container or bag. Demonstration Bring a biohazard container, a biohazard bag, and a sharps container to show the class. Demonstrate safe ways to touch and carry these bags and containers, and how to empty the containers.

5. Explain the principles of body mechanics and apply them to daily activities

• Stand with a wide base of support. • Push or slide objects rather than lifting. • Use the strong muscles in the thighs, upper arms, and shoulders to lift. • Bend at the knees (squat) instead of at the waist. • Avoid twisting or choppy movements. Face the object or person being moved. Pivot the feet instead of twisting at the waist. • Do not lift with one hand. • Hold objects close to your body when lifting. • Avoid bending and reaching.

Meeting the Learning Objective

• Get help when you need it.

TEXTbooK PP. 117-119

• Talk to residents before moving them. Agree on a signal for moving.

woRKbooK P. 46 Lecture Pronounce and define the following key term: • Body mechanics Emphasize the risks of injury that nursing assistants face on the job and how using body mechanics helps prevent these injuries. Display Transparency

6. Define two types of restraints and discuss problems associated with restraints Meeting the Learning Objective TEXTbooK PP. 119-120

woRKbooK P. 46

TESTBANKSLEecLtuLrE e R.COM

7-1 body ALIgNMENT

Pronounce and define the following key terms:

Review the terms associated with body mechanics:

• Restraint

• Alignment

• Physical restraint

• Base of support

• Chemical restraint

• Center of gravity

• Suffocation • Atrophy

Display Transparency 7-2 lIFTINg HEAVy obJECTs FRoM THE FLooR List activities on the job that will require moving or lifting: • Lifting a resident • Picking up a bag of laundry • Carrying new residents’ luggage • Taking heavy trash bags to appropriate site • Cleaning a floor

• Contractures Explain to the class that restraint use has declined in facilities and that laws have been passed restricting their use due to abuse by caregivers. Emphasize that restraints may never be used without a doctor’s order. Review the potential negative effects of restraint use: • Bruises and cuts

• Moving a bed into another room

• Pressure ulcers

Ask students to demonstrate doing these activities with proper body mechanics, using the following guidelines:

• Entrapment

• Raise beds to safe working level.

• Reduced blood circulation

• Stand close to object.

• Stress on the heart

• Risk of suffocation or strangulation • Pneumonia

49 • Blood clots • Poor appetite and malnutrition

Lecture Pronounce and define the following key terms:

• Dehydration

• Restraint-free care

• Incontinence

• Restraint alternatives

• Urinary tract infection

Distribute Handout

• Constipation • Muscle atrophy and contractures

7-1 REsTRAINT ALTERNATIVE s Discuss the examples of restraint alternatives on the handout. Ask the class if they can come up with additional creative ideas.

• Loss of bone mass • Nerve injuries • Decreased mobility • Falls

8. Identify what must be done if a restraint is ordered

• Fractures • Depression and/or withdrawal

Meeting the Learning Objective

• Social isolation • Loss of self-esteem

TEXTbooK PP. 121-122

• Sleep disorders

woRKbooK P. 47

• Loss of dignity • Loss of independence

Lecture Pronounce and define the following key term:

• Stress and anxiety

• Cyanosis

• Increased agitation • Confusion • Severe injury

Review the guidelines for restraint use:

TESTBANKSELLE R.COM • Follow the care plan’s and the nurse’s instruc-

• Death To reinforce material, ask the following questions for discussion:

tions for monitoring. • Place call light within resident’s reach and respond immediately to call lights. • Perform care as ordered.

• Can restraints be used if staff do not have enough time to care for residents?

• Document appropriately.

• Can restraints be used if the resident has made a staff member mad by arguing with the staff member or being in a bad mood?

9. List safety guidelines for oxygen use

• How would you feel if you were restrained in your chair or geri-chair, or by side rails or other devices? Optional Activity Bring in restraints to show the class. If anyone is comfortable doing so, ask for volunteers to wear the restraints and describe what it feels like.

7. Discuss restraint alternatives Meeting the Learning Objective

Meeting the Learning Objective TEXTbooK PP. 122-123

woRKbooK P. 47 Lecture Pronounce and define the following key terms: • Combustion • Flammable Review the guidelines for safety with oxygen: • Post No Smoking and Oxygen in Use signs. • Remove fire hazards from room.

TEXTbooK PP. 120-121

• Remove flammable liquids from the area.

woRKbooK P. 47

• Do not allow candles, lighters, or matches around oxygen.

50 • Check nasal area, cheeks, and behind the ears for signs of irritation from tubing.

11. Discuss fire safety and explain the RACE and PASS acronyms

• Do not use petroleum-based products on the resident or on any part of the cannula or mask.

Meeting the Learning Objective

• Make sure that the resident is not lying on the oxygen tubing and that there are no kinks in it. • Learn how to turn off oxygen in case of fire. Never adjust oxygen levels.

10. Identify safety guidelines for intravenous (IV) lines Meeting the Learning Objective TEXTbooK P. 123

woRKbooK P. 48 Lecture Pronounce and define the following key term: • Intravenous therapy Remind students to always wear gloves when touching the IV area. Discuss things that a nursing assistant should not do when caring for a resident with an IV: • Take blood pressure on the arm with the IV • Get the IV site wet

TEXTbooK PP. 124-125

woRKbooK P. 48 Lecture and Discussion Explain that heat, fuel, and oxygen must all be present for a fire to occur. Discuss the list of potential fire hazards in care facilities that are listed on page 124 of the textbook. Ask the students to think of additional examples. Review the guidelines for fire prevention and responding to fires: • Stay with a resident who is smoking. Check ashtrays for lit cigarettes or matches. Put out burning cigarettes. Make sure that cigarettes or smoking materials do not fall anywhere. Make sure there are no hot ashes, matches, or cigarette butts in an ashtray before emptying it. • Follow any policies regarding e-cigarettes and their batteries. * • Report unsafe electrical equipment and cords immediately. • Report smell of gas.

• Pull on or catch tubing in anything

Explain the RACE acronym:

• Leave tubing kinked

• Rescue anyone in danger.

• Lower IV bag below IV site

• Activate alarm or call 911.

• Touch the clamp

• Contain fire by closing all doors and windows.

• Disconnect IV from pump or turn off alarm

• Extinguish the fire or fire department will extinguish.

Review observations to report to nurse: • Needle or catheter has fallen out • The armboard or handboard becomes loose • Tubing is disconnected • Blood appears in tubing • IV fluid in bag or container is gone or almost gone

Explain the PASS acronym for using a fire extinguisher: • Pull the pin. • Aim at the base of fire. • Squeeze the handle. • Sweep back and forth at base of fire.

• IV fluid is not dripping or is leaking, or bag breaks

If possible, bring in fire extinguishers for the class to practice with.

• IV pump is beeping

Review general procedures to follow in case of fire:

• Resident complains of pain, has difficulty breathing, or has a fever

• Know the location of the fire evacuation plan.

• Resident pulls out or attempts to pull out IV

• Remove all persons in immediate area.

• Remain calm.

51 • Stay low in room to escape a fire. • Check closed doors for heat before opening them. Use wet towels to block doorways. • Use damp covering over face to reduce smoke inhalation.

ter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: the chemical ingredients of the product; the dangers of the product; what protective items to wear when using certain chemicals; the correct method of using and cleaning up a chemical; the emergency response actions to be taken when a chemical is splashed, sprayed, or ingested by a person; the safe handling, storage, and disposal procedures for the product

Anything contaminated with infectious waste (blood, body fluids, or human tissue), except for anything sharp

12. List general safety steps for working in a healthcare facility

Close to the body

At the knees

Meeting the Learning Objective

In the past, restraint usage was often abused by caregivers. This abuse led to new laws on restricting their use.

Restraint alternatives are any measure used in place of a restraint or that reduces the need for a restraint.

Restraints are used only after everything else has been ruled out and only with a doctor’s order.

Answers include the following: the needle or catheter has fallen out; the armboard or handboard becomes loose; the tubing is disconnected; blood appears in the tubing; the IV fluid in the bag or container is gone or almost gone; the IV fluid is not dripping, is leaking, or the bag breaks; the IV pump is beeping; the area around the IV is wet, bleeding, swollen, red, or hot to the touch; the resident complains of pain or has difficulty breathing.

Heat makes the flame, fuel is the object that burns, oxygen is the gas that will keep the fire burning.

• Stop, drop, and roll if clothing catches fire. • Never get into an elevator during a fire. • Turn off oxygen and electrical equipment if facility policy allows. * In addition to being a potential fire hazard, the liquid nicotine in e-cigarettes has also caused poisoning (http://www.cdc.gov/media/releases/2014/ p0403-e-cigarette-poison.html). Research on e-cigarettes is ongoing, and rules and regulations regarding their use may change.

TEXTbooK P. 125

woRKbooK P. 48 Lecture Review guidelines for safety in a facility: • Report anything suspicious. • Keep valuables at home. • Ask nurse to lock up residents’ valuables. • If a visitor or staff member makes you uneasy, do not leave the resident alone with the person. • Follow guidelines for number of visitors allowed in residents’ rooms. • Do not share personal or confidential information with anyone. • Report any situation or person who makes you feel unsafe.

Chapter Review Exam dIsTRIbuTE CHAPTER 7: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chap-

10. RACE is: Rescue anyone in danger if you are not in danger. Activate alarm (or call 911).

52 Contain the fire by closing all doors and windows if possible. Extinguish the fire, or fire department will extinguish; evacuate if instructed to do so. PASS is: Pull the pin. Aim at the base of the fire when spraying. Squeeze the handle. Sweep back and forth at the base of the fire. 11. Check for heat coming from the door before opening it. 12. Answers include the following: If you notice anything suspicious, report it immediately. Keep valuable personal items at home. Ask the nurse to lock up residents’ valuable items. If any visitor or staff member makes you uneasy, do not leave the resident alone with the person. Follow guidelines for the number of visitors allowed at one time in a resident’s room. Do not share your personal information with anyone; do not share residents’ or other staff members’ information with anyone.TREeS poTr any situation or person who makes you feel unsafe or concerned to your supervisor. 13. B 14. A 15. C 16. C

8 Emergency Care, First Aid, and Disasters 1. 2. 3. 4. 5.

Define important words in this chapter Demonstrate how to respond to medical emergencies Demonstrate knowledge of first aid procedures Explain the nursing assistant’s role on a code team Describe guidelines for responding to disasters

Supplemental Tools CHAPTER 8: EXAM

Lecture Pronounce and define the following key term: • Conscious

Assignments TEXTbooK READINg, PP. 127-140

woRKbooK EXERCIsEs, PP. 49-51

Review the signs of a serious medical emergency: • The person is unconscious. • The person is not breathing.

• The person has no pulse. Overview of Teaching Strategies A nursing assistant must know how to recognize • The person is bleeding severely. and respond to medical emergencies calmly and Remind students that they should have two pairs capably. This chapter will give students the skills of loC veO sM and a mask or other barrier device in the they need to perform first aid in thT eE evS en t o f a n TBANKSELLERg. event of an emergency. emergency. This chapter will also explain the functions of a code team and the nursing assistant’s role on the team. Students will learn their role in the event of a disaster. Emphasis should be placed on remaining calm and reassuring residents that they are being cared for during an emergency or disaster.

Discuss the steps to take in an emergency situation: • Make sure the area is safe. Put on gloves. • Assess the situation. Notice the time. Try to find out what happened.

1. Define important words in this chapter

• Assess the victim. Ask the injured or ill person what happened. Determine if the person is conscious.

Meeting the Learning Objective

• Call for help or send someone to call for help right away.

TEXTbooK PP. 127-128

woRKbooK P. 49 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

• If the person is conscious, listen to him and reassure him that he is being taken care of. Review things to look for when checking for injury: • Severe bleeding • Changes in consciousness • Irregular breathing

2. Demonstrate how to respond to medical emergencies Meeting the Learning Objective TEXTbooK PP. 128-129

woRKbooK P. 49

• Unusual color or feel to skin • Swollen places on the body • Medical alert tags • Pain

54 After the emergency is over, the NA should document the emergency and complete an incident report. She should remember as many details as possible and report only facts. Explain the acronym PPE SCC as used to help students remember how to prepare to perform first aid: • PPE: Grab and apply personal protective equipment.

obstructed airway: poor air exchange, trouble breathing, silent coughing, cyanosis, inability to breathe or speak. Shock Lecture Pronounce and define the following key term: • Shock

• Safety first! Are you safe?

Explain that shock is a life-threatening situation that may be worsened by fear or pain.

• Call for help or point to a person and say: “You, get help now!”

Review the symptoms of shock:

• Care for victims.

3. Demonstrate knowledge of first aid procedures

• Pale or cyanotic skin • Staring • Increased pulse and respiration rates • Low blood pressure • Extreme thirst

Meeting the Learning Objective TEXTbooK PP. 129-138

woRKbooK PP. 49-51 Lecture Pronounce and define the following key terms:

Bleeding Lecture Discuss facts about bleeding, i.e., that severe bleeding can cause death quickly and must be controlled.

• Respiratory arrest • Cardiac arrest

Burns

• Cardiopulmonary resuscitation (CPR)

Lecture Explain that care of a burn depends on its depth, size, and location. There are three types of burns: first-degree (superficial), second-degree (partialthickness), and third-degree (full-thickness) burns.

• First aid Emphasize that the first few minutes of any emergency can determine the victim’s ability to survive. Optional Activity If students are to be trained in CPR, this would be a good time to bring in an instructor to explain the details. Emphasize that only people who are properly trained should perform CPR, and that some facilities do not allow nursing assistants to perform CPR without the direction of the nurse. Remind students that some residents may have advance directives that prohibit CPR from being performed. Choking Lecture Pronounce and define the following key terms:

Fainting Lecture Pronounce and define the following key terms: • Syncope • Hypoglycemia Explain that fainting occurs as a result of decreased blood flow to the brain. Review the possible causes of fainting: • Abnormal heart rhythm • Hunger • Hypoglycemia

• Obstructed airway

• Fear

• Abdominal thrusts

• Pain

Stress that abdominal thrusts should not be performed unless the person shows signs of a severely

• Fatigue • Standing for a long time

55 • Poor ventilation

Review the signs and symptoms of a heart attack:

• Pregnancy

• Sudden, severe pain, pressure, squeezing, or fullness in the chest

• Overheating Review the signs and symptoms of fainting: • Dizziness

• Pain or discomfort in other areas of the body • Indigestion or heartburn • Nausea and vomiting

• Nausea

• Shortness of breath

• Perspiration

• Dizziness

• Pale skin

• Lightheadedness

• Weak pulse • Shallow respirations

• Pale, gray, or cyanotic skin color or mucous membranes

• Blackness in the visual field

• Perspiration • Cold and clammy skin

Poisoning Lecture Review signs and symptoms of poisoning:

• Weak and irregular pulse rate • Low blood pressure

• Vomiting

• Anxiety and a sense of doom

• Heavy, difficult breathing

• Denial of a heart problem

• Drowsiness

Emphasize that women may experience different symptoms than men, and are somewhat more likely to experience the following: • Shortness of breath

• Confusion • Burns or red areas around the mouth Nosebleed

TESTBANKSELLE •R Pr.esCsO urM e or pain in the lower chest or upper abdomen

Lecture Pronounce and define the following key term:

• Dizziness

• Epistaxis

• Lightheadedness

Discuss the possible causes of a nosebleed:

• Fainting

• Dry air

• Pressure in the upper back, or extreme fatigue

• Injury

• Flu-like symptoms

• Medication Vomiting Lecture Pronounce and define the following key term: • Emesis Emphasize that the nursing assistant should soothe the resident and report to the nurse when vomiting occurs. Myocardial Infarction Lecture Pronounce and define the following key term: • Myocardial infarction

Insulin Reaction and Diabetic Ketoacidosis Lecture Pronounce and define the following key terms: • Insulin reaction • Diabetic ketoacidosis (DKA) • Hyperglycemia Review the causes of insulin reaction: • Too much insulin • Too little food • Additional activity that causes the body to rapidly absorb food • Vomiting • Diarrhea

56 Review signs and symptoms of insulin reaction:

• Low blood pressure

• Feeling weak or different

• Shortness of breath or air hunger

• Nervousness

• Weakness

• Dizziness

• Drowsiness

• Perspiration

• Confusion

• Headache

• Unconsciousness

• Blurred vision • Numbness of the lips and tongue

Emphasize that DKA can lead to diabetic coma and death if left untreated.

• Cold, clammy skin • Trembling

Seizures

• Hunger

Lecture Discuss the causes of seizures:

• Rapid pulse • Low blood pressure • Confusion • Unconsciousness Emphasize that these are signs that the resident needs food, and that a diabetic resident should always have a quick source of sugar handy.

• Abnormality in the brain • High fever • Serious illness • Head injury • Seizure disorder Emphasize that the main goal during a seizure is to make sure the resident is safe.

Explain hypoglycemia unawareness, which is a Discuss signs of seizure: condition in which hypoglycemia occurs without causing any symptoms. Blood glucose levTeE lsSfaTllB , ANKS•ESLevLeE reRs. haCkO inM g but the person does not experience any symptoms. • Uncontrolled thrusting of arms and legs Review the causes of diabetic ketoacidosis (DKA): • Clenching jaw • Undiagnosed diabetes

• Drooling

• Infection

• Inability to swallow

• Not enough insulin • Eating too much • Not getting enough exercise • Physical and emotional stress

Review the types of seizures: • Absence or Petit Mal • Myoclonic • Atonic

Review the signs and symptoms of DKA:

• Tonic

• Increased hunger, thirst, or urination

• Clonic

• Abdominal pain

• Tonic-clonic

• Deep or difficult breathing • Breath that smells sweet or fruity

CVA or Stroke

• Headache

Lecture Pronounce and define the following key terms:

• Blurred vision • Dry skin, dry mouth • Flushed cheeks • Nausea and vomiting • Loss of appetite • Rapid, weak pulse

• Hemiplegia • Hemiparesis • Expressive aphasia • Receptive aphasia Explain that a cerebrovascular accident (CVA) or stroke occurs when the blood supply to a portion of

57 the brain is cut off. Stress that a TIA is a warning sign of a CVA and symptoms should be reported to the nurse immediately. Review the signs that a TIA or stroke is occurring: • Difficulty speaking • Weakness on one side of the body • Temporary loss of vision • Numbness or tingling • Facial numbness, weakness, or drooping, especially on one side • Paralysis on one side of the body • Arm or leg numbness or weakness, especially on one side • Trouble walking, loss of balance • Slurred speech or inability to speak • Inability to understand spoken or written words • Use of inappropriate words • Severe headache

• (F)ace: Is one side of the face drooping? Is it numb? Ask the person to smile. Is the smile uneven? • (A)rms: Is one arm numb or weak? Ask the person to raise both arms. Check to see if one arm drifts downward. • (S)peech: Is the person’s speech slurred? Is the person unable to speak? Can the person be understood? Ask the person to repeat a simple sentence and see if the sentence is repeated correctly. • (T)ime: Time is of the utmost importance when responding to a stroke. If the person shows any of the symptoms listed above, report to the nurse immediately. Let students know that websites for the American Stroke Association (strokeassociation.org) and The National Stroke Association (stroke.org) have more information.

• Blurred vision or trouble seeing in one or both eyes • Ringing in the ears • Redness in the face • Noisy breathing • Slow pulse rate

Demonstrations Demonstrate each of the following procedures. Include all of the numbered steps in your demonstration: TESTBANKSELLE Ming abdominal thrusts for the conscious •R Pe.rfCoO rm person (do not practice this procedure on a live person)

• Elevated blood pressure

• Responding to shock

• Nausea or vomiting

• Controlling bleeding

• Loss of bowel and bladder control

• Treating burns

• Seizures

• Responding to fainting

• Dizziness

• Responding to a nosebleed

• Loss of consciousness

• Responding to vomiting

In addition to the symptoms listed above, women may have these symptoms: • Pain in the face, arms, and legs • Hiccups • Shortness of breath

• Responding to a myocardial infarction • Responding to seizures Have the students return the demonstrations. Procedure checklists are located at the end of the Student Workbook.

• Palpitations • Chest pain • Agitation • Hallucinations • Disorientation It may be helpful to describe the acronym F.A.S.T. because it can be used as a way to remember the sudden signs that a stroke is occurring.

4. Explain the nursing assistant’s role on a code team Meeting the Learning Objective TEXTbooK PP. 138-139

woRKbooK P. 51

58 Lecture Pronounce and define the following key term: • Code team Discuss the nursing assistant’s role as a member of the code team:

Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook

• May be asked to get special equipment.

Assess the situation, assess the victim

• May do chest compressions during CPR.

• Respond to codes from wherever you are in the facility.

Respiratory arrest means that breathing stops; cardiac arrest is when the heart stops.

Within four to six minutes

Lying down on the back

Have the person bend forward and place her head between her knees if possible.

Apply firm pressure on both sides of the nose, on the soft part

Answers include the following: shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness, fainting, pressure in the upper back, extreme fatigue, flu-like symptoms

• Do not panic. • Get another staff member to take over any care you are performing.

5. Describe guidelines for responding to disasters Meeting the Learning Objective TEXTbooK PP. 139-140

woRKbooK P. 51

Lecture and Discussion Discuss the types of disasters that may occur in your area. Review the nursing assistant’sTroEleSiT nB thAeNKSELLER.COM 9. T he signs of onset of diabetic ketoacidosis event of a disaster: include increased hunger, thirst, or urination; • Know his facility’s disaster plan. abdominal pain; deep or labored breathing; and breath that smells sweet or fruity. • Pay close attention during classes on disasters and disaster drills. 10. Answers include the following: try to stop the • Listen carefully and follow instructions. seizure or restrain the person; force anything • Remain calm. between the person’s teeth; place hands in the mouth for any reason; and give liquids or • Know location of all exits and stairwells. food. • Know where fire alarms and fire extinguishers are located. 11. A transient ischemic attack (TIA) is a warning sign of a CVA. It is the result of a temporary • Know the appropriate action to take. lack of oxygen in the brain. Ask the students to share any experiences they 12. Cardiac arrest have had with disasters and what actions they took at the time that were appropriate or not helpful. 13. Answers may vary but could include fire, flood, earthquake, hurricane, tornado, severe Chapter Review weather, and acts of terrorism. Exam dIsTRIbuTE CHAPTER 8: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams.

14. A 15. D 16. B 17. D 18. C

9 Admission, Transfer, Discharge, and Physical Exams 1. 2. 3. 4. 5. 6. 7.

Define important words in this chapter List factors for families choosing a facility Explain the nursing assistant’s role in the emotional adjustment of a new resident Describe the nursing assistant’s role in the admission process Explain the nursing assistant’s role during an in-house transfer of a resident Explain the nursing assistant’s role in the discharge of a resident Describe the nursing assistant’s role during physical exams

Supplemental Tools

1. Define important words in this chapter

TRANsPARENCy 9-1 body PosITIoNs FoR EXAMs HANDouT 9-1 quIZ: you ARE MovINg! HANDouT 9-2 MEAsuRINg AbdoMINAL gIRTH CHAPTER 9: EXAM

Assignments TEXTbooK READINg, PP. 141-154

Meeting the Learning Objective TEXTbooK P. 141 WoRKbooK P. 53

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

woRKbooK EXERCIsEs, PP. 53-55 Overview of Teaching Strategies This chapter focuses on the nursing assistant’s role in the admission, transfer, and discharge of residents, as well as assistance that will be provided during physical exams. Emphasis should be placed on empathizing with the resident and providing a helpful, comforting presence during these potentially difficult times. Students will learn what families look for when choosing a facility for a loved one and how to make a positive first impression. During the admission process, the resident should feel welcome and wanted. It is important to mention that residents have the right to be informed of any in-house transfer and the reasons for it as early as possible. During discharge, the nursing assistant should have a positive attitude and be reassuring. Physical exams can be frightening, embarrassing, or uncomfortable, and the nursing assistant can be of great help in comforting the resident, providing privacy, and explaining why certain positions are necessary. Throughout this chapter, the critical role of the nursing assistant in helping residents deal with stressful changes should be emphasized.

2. List factors for families choosing a facility Meeting the Learning Objective TEXTbooK PP. 141-142

woRKbooK P. 53 Lecture Discuss some of the questions families might consider when choosing a facility for a loved one: • Do the staff seem courteous and friendly? • Do most of the staff speak the resident’s native language? Is an interpreter available? • Are there enough staff members on duty at the facility? What is the ratio of nurses and nursing assistants to residents? How is the facility staffed on evenings and weekends? • Are foul odors present? • What is the food like at the facility? Is attention paid to individual food preferences? Is a dietitian available for meetings? • Are residents up and dressed in the morning? • Do staff interact positively with the residents?

60 • Do staff speak courteously to other staff members? • Do residents look groomed, taken care of, and happy? • How are residents’ complaints resolved? • Is the facility licensed? • Have the state survey and other inspection results been satisfactory? • Does the facility explain Residents’ Rights? • Does the facility provide assistance with activities of daily living (ADLs)? If so, how is it provided, and what are the associated fees? • Are physical, occupational, and speech therapists available? • How often do falls, infections, and pressure ulcers occur? • Do volunteers work with residents? If so, are their interactions positive? • How involved can the family be in creating the resident’s care plan?

Read the scenario in Handout 9-1 aloud. Instruct the students to think about their answers carefully and then fill in the blanks on their handouts. Tell them they have five minutes to do this activity. Ask the following questions: • What did you decide to take with you to your sister’s? • How did you feel as you tried to decide what to take? • Did anyone get angry? Sad? Frustrated? • How did you feel about your mail and your sister’s response to you? Make the following points: • In many ways our homes are our personal museums. They house the souvenirs of our lives, the pictures of our families, the decorative items we like, the furnishings we have chosen. It can be very difficult to part with these things, even for a short time.

• Residents’ Rights recognize how important personal property is by assuring that residents • Does the facility provide the level of care the resican bring belongings into the facility as space dent needs? What about future needs? permits, unless doing so would infringe on the d ESTBANKSErL • Is the environment safe, functional, anT igL htEs,Rh. eaCltO h,Mor safety of other residents. homelike? • You can probably understand why Residents’ • Is there an activities department? What kinds of Rights state that “the resident has the right to activities are offered? privacy in written communications, including the right to send and promptly receive mail that • What are the steps to take if a resident wants to is unopened.” move out of the facility? • What policies does the facility have on advance directives and end-of-life decisions? Discussion Ask the students which of these questions are the most important, and ask them to think of additional questions. If training in a facility, the instructor should answer the above questions about the facility.

3. Explain the nursing assistant’s role in the emotional adjustment of a new resident Meeting the Learning Objective TEXTbooK PP. 142-144

woRKbooK PP. 53-54 Distribute Handout 9-1 quIZ: you ARE MovINg!

Summarize the points made in this exercise by asking this question: What might this exercise tell you about residents’ experiences when they are admitted to a facility? Lecture Discuss the following reasons that adjusting to life in a facility may be difficult for residents: • Move may have been sudden, due to health reasons. • Resident may have had to leave home and give up personal belongings and beloved pets. • Resident may have had loved ones who have died. • Residents may be experiencing a decline in health and independence. Stress that nursing assistants must empathize with residents to help make the adjustment to facility

61 life easier. Review the guidelines for helping new residents adjust: • Have a positive attitude. • Be tactful.

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Communicate clearly.

Lecture Pronounce and define the following key terms:

• Show respect for residents’ belongings.

• Pound

• Be responsible.

• Metric

• Be honest.

• Kilogram

• Listen to residents.

• Bedridden

• Pay attention to residents’ wishes. • Respect residents’ privacy. • Be patient and kind.

4. Describe the nursing assistant’s role in the admission process Meeting the Learning Objective TEXTbooK PP. 144-150

woRKbooK P. 54

Emphasize that any change in a resident’s weight must be reported right away, as this can be a sign of illness. Demonstration Demonstrate each of the following procedures, including all of the numbered steps in your demonstration. • Measuring and recording weight of an ambulatory resident • Measuring and recording weight of a bedridden resident • Measuring and recording height of an ambula-

Lecture Pronounce and define the following key terms: TESTBANKSELLER to. ryCrO esM ident • Admission pack • Measuring and recording height of a bedridden • Baseline resident Review the guidelines for admission: • Wash hands and gather necessary equipment to bring to resident’s room. • Prepare the resident’s room before he arrives. • Make the bed and open curtains or blinds. • Introduce yourself to resident and call him by his formal name. • Do not rush the process. • Introduce the new resident to roommate and other residents. • Explain day-to-day life in the facility. • Show resident how to work bed controls. • Make sure call light is close to bed and explain how to use it. • Explain how to work television and phone. • Handle personal items with care and respect. Demonstration Demonstrate procedure Admitting a resident. Include all of the numbered steps in your demonstration.

Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook. You may want to briefly explain the demi-span method of measuring height for a person with contractures if this procedure is used at your facility. Using this method, the NA measures the distance from the middle of the top of the chest, called the sternal notch, to the tip of the middle finger. Ideally the left arm is used. The arm is held up straight out from the shoulder. Once this measurement is obtained, a calculation is done for females and males. The final height is recorded in centimeters. Optional Handout 9-2 MEAsuRINg AbdoMINAL gIRTH This procedure was moved from the textbook to the instructor’s guide in this edition. Review the procedure if this is a skill your students need to know.

62 5. Explain the nursing assistant’s role during an in-house transfer of a resident Meeting the Learning Objective TEXTbooK PP. 150-151

woRKbooK PP. 54-55 Lecture Review the following important points about transfers: • The resident should be informed as soon as possible of the transfer. • The NA should pack the resident’s personal items carefully. • Find out the method of transfer and plan the move. • Introduce the resident to everyone at the new unit. • When leaving the room, report to the nurse in charge of the resident.

Demonstration Demonstrate procedure Discharging a resident. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

7. Describe the nursing assistant’s role during physical exams Meeting the Learning Objective TEXTbooK PP. 152-154

woRKbooK P. 55 Lecture Remind students that physical exams can be embarrassing and uncomfortable, and that part of their role during an exam will be to provide emotional support to residents by listening to them or holding their hands.

Demonstration Review some of the equipment that nursing asDemonstrate procedure Transferring a resident to sistants may be responsible for gathering for the a new room. Include all of the numbered T stE epSsT inBANKSnEuL rsL eE orRd. ocCtoOrM : your demonstration. • Sphygmomanometer Have the students return the demonstration. • Stethoscope Procedure checklists are located at the end of the • Alcohol wipes Student Workbook. • Flashlight

6. Explain the nursing assistant’s role in the discharge of a resident

• Thermometer

Meeting the Learning Objective

• Tuning fork

• Tongue depressor • Eye chart

TEXTbooK PP. 151-152

• Reflex hammer

woRKbooK P. 55

• Otoscope

Lecture Review the responsibilities of a nursing assistant during the discharge of a resident:

• Ophthalmoscope • Specimen containers • Lubricant

• Collect resident’s belongings and pack them carefully.

• Hemoccult card

• Be positive and reassuring.

• Gloves

• Know if the resident will need a wheelchair or stretcher.

• Drape

Remind students that the nursing assistant is responsible for the resident until she is safely in the vehicle, with the vehicle’s doors closed.

• Vaginal speculum

Display Transparency 9-1 body PosITIoNs FoR EXAMs

63 Pronounce and define the following key terms:

recommendations, review past survey results, check to see if the facility is accredited by the Joint Commission, and visit the facility.

• Dorsal recumbent • Lithotomy 2.

To get information on the resident’s personal preferences, history, rituals, and routines

Answers include the following: Change is always hard. The resident may have an illness or his condition may have worsened.

When the resident and his belongings are in the vehicle and the vehicle’s doors are closed.

• Follow Standard Precautions.

• Collect and label specimens as needed.

• Knee-chest Stress that students should expose only the parts of the body being examined and that residents should be told why the position is needed and how long the resident can expect to stay in the position. Emphasize that the NA should provide as much privacy as possible by draping the resident, closing the door, and pulling the privacy curtain. Lecture Review additional guidelines for assisting during an exam: • Wash hands before and after exam.

• Provide privacy measures. • Listen to and reassure resident. • Follow doctor’s or nurse’s instructions. • Make sure resident does not fall. • Provide light for doctor or nurseT . • Put instruments in proper place and hand them to doctor or nurse. • Help resident get cleaned up and dressed after exam. Dispose of trash and bring equipment to proper area. Label and transport specimens as needed.

Chapter Review Exam dIsTRIbuTE CHAPTER 9: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: Review information from federal agencies, ask friends for

10. D 11. A

10 Bedmaking and Unit Care 1. 2. 3. 4. 5. 6. 7.

Define important words in this chapter Discuss the importance of sleep Describe types of sleep disorders Identify factors affecting sleep Describe a standard resident unit and equipment Explain how to clean a resident unit and equipment Discuss types of beds and demonstrate proper bedmaking

Supplemental Tool CHAPTER 10: EXAM

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

Assignments TEXTbooK READINg, PP. 155-169

woRKbooK EXERCIsEs, PP. 57-59 Overview of Teaching Strategies The focus of this chapter is the resident’s home, or unit. It should be emphasized that theTrE esS idT enBt has the right to privacy in her room, as well as to security of personal possessions. The students will learn about the importance of sleep and factors that may cause residents to have problems sleeping. It is a good idea to remind students again to empathize with residents. Residents might be sharing a room for the first time with another person— and not just a room, but also an entire living space, i.e., the care facility. A standard unit is described; if applicable, this is a good time to show the students how units in your facility are set up. Students will learn how to clean a resident’s unit and equipment, with emphasis placed on proper infection prevention methods and body mechanics. They will also learn about the different kinds of beds found in a facility and proper bedmaking techniques.

1. Define important words in this chapter

2. Discuss the importance of sleep Meeting the Learning Objective TEXTbooK PP. 155-156 woRKbooK P. 57

Lecture Pronounce and define the following key terms: • Sleep • Biorhythms • Circadian rhythm Review the following important points about sleep: • The human body cannot survive for long without sleep. • Sleep is needed to replace old cells with new ones and provide energy to organs. • Sleep promotes healing and healthy body functioning. • Getting enough sleep helps decrease the risk of certain illnesses and disease. • Sleep helps improve cognitive function and promotes emotional health.

Meeting the Learning Objective TEXTbooK P. 155

woRKbooK P. 57

3. Describe types of sleep disorders Meeting the Learning Objective TEXTbooK P. 156

woRKbooK P. 57

65 Lecture Pronounce and define the following key terms: • Insomnia

• Dietary habits • Medications, alcohol, and cigarettes Review some of the problems that can be caused by not sleeping well:

• Parasomnias Review some of the reasons that people develop sleep disorders:

• Decreased mental function

• Illness

• Decreased immune system function

• Anxiety

• Irritability

• Fear

• Reduced reaction time

Ask the students to remember a time when they were adversely affected by not sleeping well. Ask them if they have ever had problems sleeping and whether they have any special methods to help them sleep.

• Stress • Medications • Trouble breathing • Noise • Hunger

5. Describe a standard resident unit and equipment

• Thirst Discuss the following sleep disorders:

Meeting the Learning Objective

• Somnambulism • Sleeptalking

TEXTbooK PP. 159-160

• Bruxism

woRKbooK P. 58

• REM behavior disorder • Sleep apnea

Lecture

TESTBANKSELLE R.COM Remind students that residents’ units are their

4. Identify factors affecting sleep Meeting the Learning Objective TEXTbooK PP. 157-159

woRKbooK PP. 57-58

homes. Emphasize that residents have a right to privacy, and that a nursing assistant must always knock and wait for permission before entering a resident’s room. Residents’ personal items should always be respected and handled carefully. Review some of the standard equipment that is found in residents’ rooms:

Lecture and Discussion Pronounce and define the following key terms:

• Bed

• Incontinent

• Overbed table

• Depressant • Stimulant

• Bedside stand and dresser • Chair • Bath basin

Review some factors that may affect residents’ sleep:

• Emesis basin

• Environment

• Urinal for males

• Noise level and lighting

• Water pitcher and cup

• Problems with odors and inadequate ventilation

• Privacy screen or curtain

• Temperature problems

• Call light

• Anxiety • Illness • Aging changes

• Bedpan

Review the items that are usually stored in the bedside stand: • Emesis basin

66 • Bath basin

• Refill water pitchers regularly.

• Urinal • Bedpan

• Remove anything that might cause odor or safety hazards.

• Soap

• Report signs of insects or pests immediately.

• Toothbrush and toothpaste

• Leave residents’ personal items where you found them.

• Comb and brush Explain that personal articles are usually kept in the top drawer, and that they must be kept separately from basins, urinals, and bedpans. Discuss the use of the overbed table for meals and personal care, emphasizing that it must be kept clean. Bedpans, urinals, and soiled linen should never be placed on it. It should be kept free of clutter.

6. Explain how to clean a resident unit and equipment Meeting the Learning Objective TEXTbooK PP. 160-161

woRKbooK PP. 58-59 Lecture Pronounce and define the following key T teE rm S: • Disposable Explain that disposable equipment is used to prevent the spread of microorganisms. Review common disposable equipment found in facilities: • Cups • Tissues

• After providing care, leave the unit neat and tidy. Review the guidelines for cleaning a unit after a transfer, discharge, or death: • Wash hands. • Wear proper PPE. • Make sure area is well-ventilated when using strong cleaning solutions. • Remove and dispose of equipment and supplies carefully. • Raise bed to safe working level and remove soiled linen. Make the bed. • Clean all other unit items and equipment as instructed. • Report any damaged or broken furniture to the proper department. • Remove PPE and wash hands. • Place new equipment and supplies in room for new resident.

7. Discuss types of beds and demonstrate proper bedmaking Meeting the Learning Objective

• Gloves

TEXTbooK PP. 162-169

• Paper gowns

woRKbooK P. 59

• Masks • Disposable razors • Pads Review the guidelines for residents’ units: • Keep residents’ units neat and clean. • Keep call light within resident’s reach. • Straighten bed linens and remove crumbs before leaving the room. • Re-stock resident supplies daily. • Notify housekeeping department if bathroom needs cleaning. • Check equipment to make sure it is working and not damaged.

Lecture Review some of the reasons that proper bedmaking is important: • The resident will spend a great deal of time in bed. • Neat, well-made beds help the resident sleep better. • Careful bedmaking prevents infection. • A clean, neat, and dry bed helps prevent skin breakdown and odors and promotes health. Discuss the different kinds of beds and features that may be found in a facility: • Electric beds

67 • Beds with built-in weight scales

Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

• Alternating pressure mattresses • Bariatric beds Emphasize that beds should remain locked in their lowest positions whenever residents are in the beds. If applicable, tell the students about the different kinds of beds that are used in your facility. Lecture Review guidelines for bedmaking: • Change bed linens when they are wet, soiled, or wrinkled. • Wash hands and use proper infection prevention methods. Wear gloves when removing soiled linens. • Gather linen in order of placement on the bed.

Information about trapezes was removed from the textbook in the newest edition. If needed, briefly explain information about trapezes: The trapeze is a triangular piece of equipment that attaches to the bed frame of a person in traction or a person who requires help with movement in bed. Residents grasp the trapeze with their hands and are able to lift themselves more easily. This helps caregivers change bed linens, pads, and gowns, and perform other tasks. The nursing assistant should make sure the trapeze is secure before the resident uses it. The resident must be shown how to use the trapeze. The NA should ask for help if she is not sure how the trapeze is used.

• Carry clean linen away from uniform. • Bring linen into one resident’s room at a time.

Chapter Review

• Never transfer linen from one room to another. • Place clean linen on a clean surface within reach. • Use proper body mechanics. • Look for personal items. • Roll dirty linen away from you.

Exam dIsTRIbuTE CHAPTER 10: EXAM (APPENDIX C)

TESTBANKSELLER.COM

• Do not shake linen. • Place used linen in proper container. • Make one side of bed first to save energy. • Keep beds free of wrinkles and crumbs.

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

• Wash hands after handling linens.

Answers to Chapter Review in Textbook

Pronounce and define the following key terms:

Answers include the following: Sleep is a natural period of rest for the mind and body. Energy is restored. Sleep helps to replace old cells with new ones and provides new energy to organs.

Answers include the following: emesis basins, bath basins, urinals and bedpans; soap, toothbrushes, toothpaste, combs and brushes; a telephone and/or radio, along with other personal items

The overbed table may be used for residents’ meals or personal care. Bedpans, urinals, and soiled linen should not be placed on overbed tables because these tables are used for food.

Within the resident’s reach

• Closed bed • Open bed • Occupied bed • Unoccupied bed • Surgical bed Demonstration Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Making a closed bed • Making an open bed • Making an occupied bed • Making a surgical bed

68 5.

Disposable equipment will be used one time and then discarded.

If clean linen touches the nursing assistant’s uniform, the linen becomes contaminated.

Shaking linen may spread airborne contaminants.

A closed bed is usually made for a resident who will be out of bed all day. It is a completely made bed with the bedspread, blankets, and pillows in place. A closed bed is turned into an open bed by folding the linen down to the foot of the bed.

The NA should observe the resident’s skin for signs of breakdown.

10. A surgical bed is made to accept residents returning to bed on stretchers, after they have had treatments or a hospital visit. 11. B 12. A 13. B 14. D

11 Positioning, Moving, and Lifting 1. Define important words in this chapter 2. Explain body alignment and review the principles of body mechanics 3. Explain why position changes are important for bedbound residents and describe basic body positions 4. Describe how to safely transfer residents 5. Discuss ambulation Supplemental Tools

1. Define important words in this chapter

TRANsPARENCy 11-1 FIVE bAsIC PosITIoNs HANDouT 11-1 sPECIAL body PosITIoNs HANDouT 11-2 TuRNINg A REsIDENT AWAy FRoM you CHAPTER 11: EXAM

TEXTbooK P. 170

woRKbooK P. 61 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

Assignments TEXTbooK READINg, PP. 170-193

woRKbooK EXERCIsEs, PP. 61-63

Meeting the Learning Objective

TESTBANKSELLE 2.RE.xC plOaM in body alignment and review the

Overview of Teaching Strategies Nursing assistants will be moving residents regularly during personal care and ambulation. It is important that no injuries occur to the resident or the NA. Building on the learned principles of body mechanics in Chapter 7, the student will focus in this chapter on safely and comfortably transferring, holding, ambulating, and positioning residents. In addition, the student will learn the five basic positions for safely positioning residents when they must remain in bed for long periods of time. Assisting residents with ambulation, with an emphasis on the many benefits of regular ambulation and exercise, will be discussed in this chapter. Each procedure in this chapter is related to transfer, ambulation, positioning, and comfort measures. During their working lives, NAs will use these procedures over and over. Therefore, it is extremely important for them to understand the steps involved in each one, and to be able to demonstrate the skills properly and safely. The instructor should demonstrate each step in all procedures, using a student as a substitute resident. Then the students should return the demonstrations in teams of two, so they experience actually working with a person.

principles of body mechanics Meeting the Learning Objective TEXTbooK PP. 171-172

woRKbooK P. 61 Lecture Pronounce and define the following key term: • Posture Discuss proper body alignment and how it helps the body to function: • It helps the body to balance without causing muscle or joint strain. • The lungs are able to expand and contract. • Blood circulation is more efficient. • Digestion is easier. • The kidneys are better able to clean the body of wastes. • It helps prevent complications of immobility, such as contractures and atrophy. Review the principles of proper body mechanics

70 learned in Chapter 7. Discuss some rules of using proper body mechanics:

• Resident lying on either side

• Think ahead, plan, and communicate the move.

• Pillows support arm and leg on upper side, back and head; upper knee on pillow; pillow under bottom foot and between the legs.

• Check base of support. Have a firm footing.

Prone position

• Face what you are lifting. Do not twist.

• Resident lying on abdomen

• Keep back straight.

• Small pillow under head and legs

• Assess the load.

• Begin in squatting position. Lift with legs. • Tighten stomach muscles when beginning.

Fowler’s position

• Keep object close to the body.

• Partially-reclined sitting position, head and shoulders elevated

• Push, rather than lift.

• Pillow at flexed knees; footboard at flexed feet • Spine is straight

3. Explain why position changes are important for bedbound residents and describe basic body positions

• High-Fowler’s position: the upper body is sitting nearly straight up (between 60 and 90 degrees). Semi-Fowler’s position: the upper body is not raised as high (30 to 45 degrees).

Meeting the Learning Objective

Sims’ position

TEXTbooK PP. 172-180

• Variation on lateral side position, left side-lying position

woRKbooK PP. 61-62 Lecture Pronounce and define the following key terms: • Positioning

• Lower arm behind the back and upper knee flexed

TESTBANKS•EPLilL .nCdOerMhead, arms, flexed knee, and foot loE wR su

• Supine • Lateral • Prone • Fowler’s • Sims’

Distribute Handout 11-1 sPECIAL body PosITIoNs Discuss the Trendelenburg and Reverse Trendelenburg positions, mentioning that they always require a doctor’s order.

• Shearing • Logrolling • Dangle Display Transparency 11-1 FIVE bAsIC PosITIoNs Discuss the five basic body positions, using Figures 11-1 to 11-5 (pp. 172-173 in textbook).

Demonstrations Demonstrate the five basic body positions, using a student as a volunteer. Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Assisting a resident to move up in bed

Supine position:

• Assisting a resident to move up in bed with assistance (using assist device)

• Resident lying flat on back

• Moving a resident to the side of the bed

• Pillows under head and shoulders, arms, hands, calves; footboard with feet

• Moving a resident to the side of the bed with assistance (using assist device)

Lateral position

• Turning a resident toward you • Logrolling a resident with assistance

71 • Assisting a resident to sit up on side of bed: dangling Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook. Distribute Handout 11-2 TuRNINg A REsIDENT AWAy FRoM you If this procedure is performed at your facility, review and demonstrate the procedure and have the students return the demonstration.

4. Describe how to safely transfer residents Meeting the Learning Objective TEXTbooK PP. 180-190

woRKbooK PP. 62-63 Lecture and Discussion Pronounce and define the following key terms: • Ergonomics • Transfer belt • Gait belt

Lecture Review the following guidelines for wheelchairs/ geriatric chairs: • Lock before transfer; unlock after. • Open by pulling on both sides. Close by lifting center of seat. • Remove armrests by pressing a button. Attach armrests by lining up the button. • Remove footrests by pulling back on lever and off knob. Attach footrests by lining up knobs. • Squeeze lever to adjust footrest. • Go backwards down ramps. Turn chair around before entering elevators. • When a resident is in a wheelchair or any chair, reposition him at least every 15 minutes. • To move resident to back of chair, stand in front of the wheelchair. Bracing your knees against the resident’s knees, he grasps armrests and pushes with his feet into the floor.

• Lock wheels on geri-chair before transferring resident into or out of the chair. Use caution when raising and lowering the tray table. Remind students that when the tray table is attached, ge.riC -cO haMirs may be considered restraints. TESTBANKSELLER

• Mechanical lift Emphasize that students need to know which side is stronger and which is weaker, and to move the stronger side first. Discuss the terms affected and involved. Remind students not to refer to a “bad side” or “bad” leg or arm. If you have any equipment for bariatric residents or special procedures for transferring bariatric residents, you can discuss the modifications now or while demonstrating the transferring procedures. You can also show students safety devices used for transferring, such as transfer belt, slide board, sliding sheet, etc. Demonstration Demonstrate procedure: Applying a transfer belt. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Transferring a resident from bed to a chair or wheelchair • Transferring a resident from bed to stretcher with assistance • Transferring a resident using a mechanical lift with assistance • Transferring a resident onto and off of a toilet • Transferring a resident into a vehicle Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

5. Discuss ambulation Meeting the Learning Objective TEXTbooK PP. 190-192

woRKbooK P. 63

72 Lecture Pronounce and define the following key term:

better able to clean the body of wastes. It helps prevent complications of immobility, such as contractures and atrophy.

• Ambulation Discuss ways that regular ambulation and exercise help to improve body functioning:

This enables her to move her body as one unit, and keeps her back straight.

• Quality and health of the skin

Begin in a squatting position

Lift with the legs

Keeping objects close to the body decreases stress to the back.

Draw sheets or other assist devices help prevent skin damage caused by shearing.

The stronger side moves first because it is difficult for a resident to move a weak arm and leg first and be able to bear enough weight to allow for the move.

Discuss how to assist a visually-impaired resident with ambulation:

Resident should be facing the top of the ramp.

• Resident walks beside and slightly behind NA.

For a resident to be able to use a toilet, he must be able to bear some weight on his legs.

• Circulation • Strength • Sleep and relaxation • Appetite • Elimination • Oxygen level Demonstration Demonstrate procedure Assisting a resident to ambulate.

• Walk at normal pace.

10. D • Inform resident of any directional changes or approaching steps. TESTBANKS1E 1.LL BER.COM Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Chapter Review Exam dIsTRIbuTE CHAPTER 11: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: It helps the body achieve balance without causing muscle or joint strain. It helps the lungs to expand and contract. Blood circulation is more efficient. Digestion is easier. The kidneys are

12. A 13. B 14. C

12 Personal Care 1. Define important words in this chapter 2. Explain personal care of residents 3. Describe different types of baths and list observations to make about the skin during bathing 4. Explain safety guidelines for bathing 5. List the order in which body parts are washed during bathing 6. Explain how to assist with bathing 7. Describe how to perform a back rub 8. Explain guidelines for performing oral care 9. Define dentures and explain care guidelines 10. Discuss guidelines for performing oral care for an unconscious resident 11. Explain how to assist with grooming Supplemental Tools students focus on learning how to perform each procedure correctly and professionally. The habTRANsPARENCy 12-1 AssIsTINg WITH its they develop now will become the foundation PERsoNAL CARE TESTBANKSELLE R.COM of their workdays, and will continue throughout TRANsPARENCy 12-2 sAFETy guIDELINEs their caregiving careers. That foundation should AND bATHINg be based on holistic care, respect for the resident, TRANsPARENCy 12-3 bATHINg WHEEL skills that follow time-honored techniques, and a sense of pride in caring for others. CHAPTER 12: EXAM Assignments TEXTbooK READINg, PP. 194-222 WoRKbooK EXERCIsEs, PP. 65-69

Overview of Teaching Strategies Providing personal care is one of the most important tasks the nursing assistant will do. Whether the care is only to assist the resident or to do all the personal care for the resident, NAs will spend most of their time doing these tasks. It is important for the students to understand that personal care procedures should be done properly using the step-bystep techniques that are taught in this chapter. How they apply these guidelines and how they perform the procedures can make the difference between average and excellent caregiving. The instructor should emphasize this point so the

All the procedures should be demonstrated to the class. In addition, the students should learn each of them completely, step-by-step, and return the demonstration at a competent level. If the students take a state examination in the future to become certified, they will be expected to pass a skills competency test on many of these procedures.

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK P. 194 WoRKbooK P. 65

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

74 2. Explain personal care of residents

Lecture Pronounce and define the following key terms:

Meeting the Learning Objective

• Partial bath

TEXTbooK PP. 194-196

• Additive

WoRKbooK P. 65

• Edema

Lecture and Discussion Pronounce and define the following key terms:

Discuss four basic types of baths and how each is best suited to particular residents:

• Hygiene

• Partial bath is best suited to a resident who has drier, fragile, and more sensitive skin, should not have daily full baths, is unable to get up to take a shower or tub bath, and/or wants a quick bath before a meal and plans on taking a shower or bath later in the day.

• Grooming Discuss what types of tasks may be done during a.m. and p.m. care. Ask the students if they can think of any other examples. Display Transparency 12-1 AssIsTINg WITH PERsoNAL CARE Discuss the following points about assisting with personal care:

• Shower is best suited to a resident who is able to stand during a shower, and/or is able to safely sit in a shower chair. • Tub bath is best suited to a resident who is able to transfer into and out of a tub and/or has a doctor’s order for a special bath using an additive.

• Encourage residents to perform self-care when• Complete bed bath is best suited to a resident ever they can. This promotes dignity, indepenwho is unable to get out of bed to shower or dence, and proper body functioning. bathe, and requires a full bath. • Be empathetic to emotions residents are iz. eC thO atMduring personal care, NAs can obexperiencing. TESTBANKSEEmLpLhaEsR tain information about residents through making • Always explain what you will be doing and observations and asking questions. answer any questions. Let the resident make as many choices as possible about the care that will Review what is important to observe and report be performed. during bathing on page 197 of the textbook. • Allow enough time for residents to use the bathroom, without rushing or interrupting them. • Provide for personal choice. • Be patient while residents perform care tasks. • Be respectful and provide privacy during phone calls and visits. • Keep residents covered during bathing and dressing. • Promote residents’ safety. • Talk to residents during personal care and report changes, concerns, or problems.

3. Describe different types of baths and list observations to make about the skin during bathing Meeting the Learning Objective TEXTbooK PP. 196-197 WoRKbooK PP. 65-66

4. Explain safety guidelines for bathing Meeting the Learning Objective TEXTbooK PP. 197-198 WoRKbooK P. 66

Display Transparency 12-2 sAFETy guIDELINEs AND bATHINg Review the guidelines on the transparency: • Ask for help if you need it. • Follow the care plan. • If this is the NA’s responsibility, clean areas and equipment before and after use. • Make sure floor in shower or tub room is dry. • Place nonslip mats in regular tubs. • Make sure safety bars are in working order. Encourage residents to use them.

75 • Gather all needed supplies and equipment, and place these items within reach.

6. Explain how to assist with bathing

• Do not use bath oils, gels, or powders.

Meeting the Learning Objective

• Make sure water is at a comfortable temperature for each resident. Temperature should not be higher than 105°F.

TEXTbooK PP. 198-206 WoRKbooK P. 67

• Store electrical appliances away from water source.

Lecture Discuss the following points about bathing:

• Do not leave residents alone while bathing.

• Bathing increases circulation and provides an opportunity for NAs to observe the skin. • Prepare the shower or tub room and gather supplies before moving the resident there.

5. List the order in which body parts are washed during bathing

• Keep the room warm enough.

TEXTbooK P. 198

• Wear gloves while bathing a resident and change gloves before giving perineal care.

WoRKbooK P. 66

• Make sure all soap residue is removed.

Meeting the Learning Objective

• Observe the skin closely during bathing. Lecture Pronounce and define the following key term:

Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Giving a complete bed bath

• Axilla

Emphasize the concept of washing from the cleanest area to the dirtiest to reduce the risk of transferring microorganisms. TESTBANKSELLE •R Sh.aC mOpM ooing a resident’s hair in bed • Giving a shower or tub bath

Display Transparency 12-3 bATHINg WHEEL

Tell students that they should change the bath water whenever it becomes too cool, soapy, or dirty. Point out that perineal care is considered a procedure and should be done as a step-by-step technique, which is different for males and females. Remind the students to turn the resident on his side and to clean the anal area to complete the procedure. Emphasize that students must clean the anal area without contaminating the perineal area.

Review the correct order to wash body parts as listed on the wheel: 1.

Eyes

Face

Ears

Neck

Arms, axilla (axillae), and hands

Chest and abdomen

Legs and feet

Back

Perineal area

10. Buttocks

Discuss the differences between shampooing hair at a sink versus on a stretcher. Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

Describe how to perform a back rub Meeting the Learning Objective TEXTbooK PP. 206-207 WoRKbooK P. 67

76 Demonstration Demonstrate procedure Giving a back rub. Include all of the numbered steps in your demonstration. Remind students to wear gloves if the resident has broken or open skin. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

8. Explain guidelines for performing oral care Meeting the Learning Objective TEXTbooK PP. 207-210

• Gagging or choking • Resident reports of mouth pain Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Providing oral care • Flossing teeth Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

9. Define dentures and explain care guidelines

WoRKbooK PP. 67-68

Lecture Pronounce and define the following key terms:

Meeting the Learning Objective

• Halitosis

TEXTbooK PP. 211-212

• Plaque

WoRKbooK P. 68

• Tartar • Gingivitis • Edentulous

Lecture Pronounce and define the following key terms: • Dentures

TESTBANKSELLER.COM

Point out that oral care consists of brushing the teeth, tongue, and gums, flossing with dental floss, caring for the lips, and caring for dentures. Emphasize that gloves must always be worn when performing oral care. Review what the NA should observe and report about oral care: • Dry, cracked, bleeding, or chapped lips • Cold sores on the lips • Raised areas • Swollen, irritated, red, bleeding, or whitish gums • Loose, cracked, chipped, broken, or decayed teeth • Yellow-filled or red sores, such as canker sores inside the mouth • White spots inside the mouth • Pus or drainage • Coated or swollen tongue • Bad breath or fruity-smelling breath • Change in the resident’s ability to drink, suck on a straw, or swallow

• Bridge Point out the following about denture care: • Dentures are expensive and must be handled carefully. • NAs must wear gloves when cleaning dentures. • Dentures should be stored in clean, moderate/ cool water in a covered, labeled denture cup, or returned to the resident. Demonstration Demonstrate procedure: Cleaning and storing dentures. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

10. Discuss guidelines for performing oral care for an unconscious resident Meeting the Learning Objective TEXTbooK PP. 212-214 WoRKbooK PP. 68-69

77 Lecture Point out the following about oral care for an unconscious resident:

• Promote self-care and independence whenever possible.

• Oral care must be done frequently.

Lecture Discuss the following points for assisting with shaving:

• Oral care keeps the mouth clean and moist. • Oral care removes sordes and helps prevent them from developing. • The NA should use as little liquid as possible to prevent aspiration and turn the resident’s head to the side.

• Respect personal preferences regarding shaving. • Wash and comb beards and mustaches every day. Do not trim facial hair. • Wear gloves.

• Unconscious residents may still be able to hear. NAs should explain the procedure and behave normally. Point to the Residents’ Rights box on page 213.

• Soften hair first if using disposable or safety razor.

Demonstration Demonstrate procedure Providing oral care for the unconscious resident. Include all of the numbered steps in your demonstration.

• Discard disposable shaving products properly.

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Shave in direction of hair growth. • Use shaving products only with resident’s permission. • Do not share razors between residents. • Do not use electric razors near water or oxygen. • Handle safety razor blades carefully, and discard old blades in sharps container.

Demonstration Demonstrate procedure Shaving a resident. Include T E S T B A N K SELLE allRo. fC thO eM numbered steps in your demonstration. Discuss guidelines for giving eye care for an unconscious resident: Have the students return the demonstration. Lecture

• Don gloves.

• When cleaning the eye, use a different area of the washcloth for each stroke. Rinse it thoroughly, then use a clean washcloth for the opposite eye. • Wipe from the inner area of the eye to the outer area of the eye when cleaning. • Use moist compresses as directed.

11. Explain how to assist with grooming Meeting the Learning Objective TEXTbooK PP. 214-222 WoRKbooK P. 69

Lecture Make the following general points about grooming: • Appearance has a great deal to do with the way people feel about themselves. Regular grooming can have a positive effect on self-esteem, attitude, and independence; it also helps a person feel better physically.

Procedure checklists are located at the end of the Student Workbook. Lecture Discuss the following points for assisting with nail care: • Cleaning and caring for nails is part of the bathing process. • Be gentle when using orangewood sticks. • Follow facility policy regarding trimming fingernails or toenails. • Do not use nail equipment on more than one resident. Demonstration Demonstrate procedure Providing fingernail care. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

78 Lecture Discuss the following points for assisting with hair care:

• Do not rush residents when dressing.

• Allow residents to choose their own hairstyles.

• Treat clothing carefully.

• Do not comb residents’ hair in childish styles.

• Allow residents to choose their own clothing.

• Be gentle when handling hair.

• Make sure clothing fits properly.

• Do not cut residents’ hair.

• Provide privacy when dressing and undressing. Keep residents covered.

Pronounce and define the following key terms: • Dandruff

• Make sure all clothing is marked with resident’s name.

• Put clothing on the weaker, or affected, side first

• Pediculosis

• Gently smooth socks and stockings to remove wrinkles and twists.

Discuss causes of dandruff:

• Front-fastening bras are easier for residents to work by themselves.

• Climate, especially dry, cold areas • Stress • Excessive sweating • A type of fungus • Hormonal changes • Some types of dermatitis Demonstration Demonstrate procedure Combing or brushing hair. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. Discuss the following points about lice: • Parts of the body that may have lice infestation include the head, the pubic area, and other areas of the body, such as the underarms. • Signs and symptoms of lice include intense itching, scratching, and scratch marks or rashes on the scalp, neck, or body. Lice eggs can be seen on the hair, behind the ears, and on the neck. Lice droppings look like a fine black powder. • Report symptoms immediately. Lice can spread very quickly. Lecture Discuss the following points for assisting with dressing and undressing: • Weaker side is called weaker, affected, or involved side. Do not refer to it as “bad side” or talk about “bad” leg or arm. • Encourage independence with dressing and undressing.

• Put back-fastening bras on waist and fasten them in front first before rotating around. • Clothing with elastic waistbands is easier to get on and off. • Use assistive devices when needed. • When undressing, start with the stronger, or unaffected, side. Demonstration Demonstrate procedure Dressing a resident. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. If you have an IV available to use, demonstrate how to dress and undress a resident with an IV.

Chapter Review Exam dIsTRIbuTE CHAPTER 12: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Hygiene consists of practices to keep the body clean. Grooming consists of practices to care for oneself.

79 2.

Answers include the following: Promote selfcare. Be patient. Be understanding and sympathetic. Explain care you are going to provide. Let the resident make choices. Provide privacy. Do not rush or interrupt residents. Be respectful during phone calls. Keep residents covered. Promote safety. Talk with residents during personal care.

Pressure ulcers

No higher than 105°F

Comfortable temperature varies for each person.

Bath oils, gels, and powders can create slippery surfaces and can put residents at risk of falling.

Every day

Answers include the following: relaxes tired, tense muscles, improves circulation, and relieves pain or discomfort.

Use as little liquid as possible during oral care

10. Because even residents who aT reEuS ncToB nsAcN ioK us may be able to hear 11. Yes, due to risk of exposure to blood 12. An electric razor should not be used near water or any water source or where oxygen is in use. 13. Problems with circulation can lead to a serious infection if skin is accidentally cut while caring for the nails. For a resident with diabetes, an infection can lead to a severe wound or amputation. 14. Weaker, affected, or involved side 15. B 16. A 17. B 18. D 19. A

13 Vital Signs 1. 2. 3. 4. 5. 6. 7. 8. 9.

Define important words in this chapter Discuss the relationship of vital signs to health and well-being Identify factors that affect body temperature List guidelines for measuring body temperature Explain pulse and respirations List guidelines for counting pulse and respirations Identify factors that affect blood pressure List guidelines for measuring blood pressure Describe guidelines for pain management

Supplemental Tools

1. Define important words in this chapter

TRANsPARENCy 13-1 RANgEs FoR ADulT VITAL sIgNs

Meeting the Learning Objective TEXTbooK PP. 223-224

CHAPTER 13: EXAM

WoRKbooK P. 71

Assignments TEXTbooK READINg, PP. 223-243

TESTBANKSLEecLtuLrE e R.COM

WoRKbooK EXERCIsEs, PP. 71-76

Overview of Teaching Strategies This chapter explains many more of the handson procedures the NA will be doing for residents. There are many procedures for the students to learn in this chapter. Some are performed daily by NAs and are general to all types of residents. The largest amount of time for this chapter should be devoted to demonstration and return demonstration of the vital sign procedures until students are completely comfortable with the techniques. The vital signs procedures should be practiced in a lab setting so that students have a chance to perform them on each other.

Pronounce and define each of the key terms listed in the Learning Objective.

2. Discuss the relationship of vital signs to health and well-being Meeting the Learning Objective TEXTbooK P. 224 WoRKbooK P. 71

Lecture Pronounce and define the following key term: • Vital signs Review what vital signs consist of:

The last part of the chapter focuses on pain management. It is important to emphasize that students take residents’ complaints of pain seriously. Remind them to be empathetic and to remember that nobody likes to be in pain. If you use pain scales at your facility or school, bring them in to show the students.

• Measuring temperature • Counting pulse • Counting rate of respirations • Measuring blood pressure • Observing and reporting pain level Discuss the fact that vital signs are often the first indication that a person is ill.

81 Display Transparency 13-1 RANgEs FoR ADulT VITAL sIgNs Use the transparency to emphasize ranges as you go over each of the vital signs in the following learning objectives.

3. Identify factors that affect body temperature Meeting the Learning Objective TEXTbooK PP. 225-226 WoRKbooK PP. 71-72

Lecture Discuss the following factors that affect body temperature: • Age • Amount of exercise • Circadian rhythm • Stress

• Fahrenheit • Celsius Discuss common sites for measuring temperature: • Mouth • Rectum • Armpit • Ear • Temporal artery Review points about different types of thermometers: • Mercury-free thermometers can be used to take an oral, rectal, or axillary temperature. • Mercury-free thermometers are usually green for oral thermometers and red for rectal. • Digital thermometers are commonly used for oral, rectal, and axillary temps. They register temperature within two to 60 seconds. • Digital thermometers require a sheath to cover the probe.

• Electronic thermometers are commonly used for oral, rectal, and axillary temps. They register t mC peOrM ature within two to 60 seconds. TESTBANKSELLERe. Pronounce and define the following key term: • Electronic thermometers require a probe cover that must be discarded after a single use. • Hypothermia • Illness • Environment

Review signs of hypothermia: • Temperature below 97°F

• Disposable thermometers can be used to take oral or axillary temps.

• Shivering

• Disposable thermometers are used once and discarded. They do not require a disposable sheath.

• Numbness

• Tympanic thermometers are fast and accurate.

• Quick and shallow breathing

• Temporal artery thermometers are moved across the forehead and are non-invasive.

• Slow movements • Mild confusion • Changes in mental status • Pale and cyanotic skin

4. List guidelines for measuring body temperature Meeting the Learning Objective TEXTbooK PP. 226-232 WoRKbooK PP. 72-73

Lecture Pronounce and define the following key terms: • Thermometers

Review when not to take an oral temperature: person is unconscious, using oxygen, confused or disoriented, paralyzed, has facial trauma, likely to have a seizure, has a nasogastric or orogastric tube, younger than five years old, has sores, redness, swelling, or pain in her mouth, or has an injury to the face or neck. Demonstration Demonstrate procedure Measuring and recording oral temperature. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

82 Lecture Review these points about rectal, tympanic, and axillary temperatures: Rectal temperatures: • Rectal temperatures are most accurate. • NA must explain what he will do before starting. • Be reassuring. • NA must hold onto the thermometer at all times. • Gloves must be worn. • Thermometer must be lubricated for this procedure. • The privacy of the resident is important. • Thermometer must be held the entire time it is in the rectum.

• Respiration • Inspiration • Expiration Discuss the following factors that affect pulse rate: • Age • Gender • Exercise • Stress • Hemorrhage • Medications • Fever and illness Pronounce, define, and discuss the different types of respirations: • Apnea

Tympanic temperatures: • The tip will only go into the ear 1/4 to 1/2 inch. Axillary temperatures: • Axillary temperatures are not as accurate as other sites. • Axillary area must be clean and dry.

• Dyspnea • Eupnea • Orthopnea • Tachypnea • Cheyne-Stokes respiration

TESTBANKS6E. L LiLsE t gRu.idCeOliM nes for counting pulse and

Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration:

respirations Meeting the Learning Objective

• Measuring and recording rectal temperature

TEXTbooK PP. 233-236

• Measuring and recording tympanic temperature

WoRKbooK P. 73

• Measuring and recording axillary temperature Lecture Pronounce and define the following key terms:

Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

• Radial pulse

5. Explain pulse and respirations

Review the following points about the pulse rate:

Meeting the Learning Objective

• Pulse is the number of heartbeats per minute. Normal rate is 60 to 100 beats per minute for adults.

TEXTbooK PP. 232-233 WoRKbooK P. 73

Lecture Pronounce and define the following key terms: • BPM • Tachycardia • Bradycardia • Dilate

• Stethoscope

• Observe for the overall pattern of the pulse and the quality or type of the pulse. Review the following points about respirations: • Do the counting immediately after taking the pulse. • Do not let the resident know you are counting breaths.

83 • Normal rate is 12 to 20 breaths per minute. • Observe for the overall pattern of the respirations and the quality or type of breathing Demonstration Demonstrate procedure Counting and recording radial pulse and counting and recording respirations. Include all of the numbered steps in your demonstration.

Discuss the following factors that affect blood pressure: • Age • Exercise • Stress • Race • Heredity • Obesity/unhealthy diet

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Alcohol

Lecture Pronounce and define the following key term:

• Illness

• Apical pulse

8. List guidelines for measuring blood pressure

Mention that the apical pulse is normally about the same as the radial pulse. Define the pulse deficit as being the difference between an apical pulse and another pulse. Demonstrations Demonstrate each of the following procedures, including all of the numbered stepT sE inSyT ouBr demonstration:

• Tobacco products • Time of day

Meeting the Learning Objective TEXTbooK PP. 237-240 WoRKbooK PP. 74-75

Lecture Pronounce and define the following key terms: • Sphygmomanometer

• Counting and recording apical pulse

• Brachial pulse

• Counting and recording apical-radial pulse

Discuss different types of sphygmomanometers:

Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

• Manual • Digital Review the following points about blood pressure:

7. Identify factors that affect blood pressure Meeting the Learning Objective

• Brachial pulse is used. • The cuff must first be completely deflated.

TEXTbooK PP. 236-237

Remind students not to take blood pressure when these situations exist:

WoRKbooK PP. 73-74

• An intravenous line (IV) is present.

Lecture Pronounce and define the following terms:

• The cuff does not fit the arm properly. • The arm has a cast.

• Systolic

• Burns or injuries are present.

• Diastolic

• The arm is being used for dialysis.

• Hypertension

• The arm or side has had recent trauma.

• Hypotension

• The arm or side is paralyzed due to stroke.

• Orthostatic hypotension

• An amputation has been performed.

• Prehypertension

• The side has had a mastectomy (or any other surgery or incision).

84 Review additional points about blood pressure: • Cuff must be correct size.

Discuss signs and symptoms of pain to observe and report:

• Observe for normal readings and the quality or type of sounds.

• Increased pulse, respirations, and blood pressure

• Other sites for measuring blood pressure are forearm, thigh, and calf. Other sites may be required due to the size of the upper arm or blood pressure cuff or due to recent surgeries or conditions. For the forearm measurement, the cuff or device is wrapped around the inner side of the wrist before blood pressure is measured, and the fingers and arm should remain still. The radial artery is used for obtaining this measurement. For the thigh blood pressure measurement, the popliteal artery is used, and the person should be placed in the prone position if possible. When measuring blood pressure in the calf, the dorsalis pedis artery may be used, and the limb must be level with the heart.

• Nausea and vomiting

It is not always easy to perfect the skill of hearing the first and last sounds of the blood pressure. Students may have to do the procedure over and over again and have the instructor or another student check technique and results for correctness.

• Sweating • Tightening the jaw • Squeezing eyes shut • Holding or guarding a body part • Frowning • Grinding teeth • Increased restlessness • Agitation or tension • Change in behavior • Crying • Sighing • Groaning • Breathing heavily • Difficulty moving or walking Use measures listed on pp. 241-242 in textbook to reduce pain.

Demonstration Demonstrate procedure Measuring and recording blood pressure (one-step method). Include all of the numbered steps in your demonstration.

Chapter Review

Have the students return the demonstration. Provide them with enough time to practice this important procedure on each other, until they feel comfortable doing it. Procedure checklists are located at the end of the Student Workbook.

(APPENDIX C)

Exam dIsTRIbuTE CHAPTER 13: EXAM

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

9. Describe guidelines for pain management Answers to Chapter Review in Textbook Meeting the Learning Objective TEXTbooK PP. 240-242

Body temperature, pulse, respirations, blood pressure, and pain level

It is illegal and can cause harm to the resident.

Answers include the following: elevated temperature reading, headache, fatigue, muscle aches, and chills. Skin may feel warm and look flushed.

10 to 20 minutes

1/4 to 1/2 inch

WoRKbooK PP. 75-76

Lecture Review the following points about pain: • It is as important to monitor as vital signs. • It is uncomfortable and an individual experience. • Take complaints of pain seriously. • Ask questions to get accurate information.

85 6.

Radial pulse

Because people tend to breathe more quickly if they know they are being observed

The apical pulse is on the left side of the chest, just below the nipple.

To make sure that the reading will not be falsely high or low

10. Brachial pulse 11. Answers include the following: Report complaints of pain or unrelieved pain promptly to the nurse. Check on the resident often and ask if the pain has been relieved. Give back rubs frequently. Assist in frequent changes of position. Offer warm baths or showers. Assist the resident to the bathroom or commode or offer the bedpan or urinal. Encourage slow, deep breathing. Be patient, caring, gentle, empathetic, and responsive. 12. B 13. C 14. D 15. B 16. A 17. D 18. D 19. B 20. B

14 Nutrition and Fluid Balance 1. Define important words in this chapter 2. Describe common nutritional problems of the elderly and the chronically ill 3. Describe cultural factors that influence food preferences 4. Identify six basic nutrients 5. Explain the USDA’s MyPlate 6. Explain the role of the dietary department 7. Explain the importance of following diet orders and identify special diets 8. Explain thickened liquids and identify three basic thickening consistencies 9. List ways to identify and prevent unintended weight loss 10. Describe how to make dining enjoyable for residents 11. Describe how to serve meal trays and assist with eating 12. Describe how to assist residents with special needs 13. Discuss dysphagia and list guidelines for preventing aspiration 14. Describe intake and output (I&O) 15. List ways to identify and prevent dehydration 16. List signs and symptoms of fluid overload and describe conditions that may require fluid restrictions Supplemental Tools TRANsPARENCy 14-1 MyPLATE TRANsPARENCy 14-2 PREVENTINg AsPIRATIoN

It is a good idea for the students to share their cultural or religious preferences so that others get a feel for differences they may encounter. An emphasis on respect for all differences is important.

TRANsPARENCy 14-3 CoNVERsIoN TAblE HANDouT 14-1 bAsIC MATH CHAPTER 14: EXAM

Assignments TEXTbooK READINg, PP. 244-271 WoRKbooK EXERCIsEs, PP. 77-86

Overview of Teaching Strategies Proper nutrition is important for all human beings. It is imperative that the students in this course learn the basics about nutrition, the purpose of nutrients, and the sources of essential vitamins and minerals. The USDA’s MyPlate is explained, and the students should have an opportunity in class to apply the food groups to their own lives as well as to examples of special types of diets that are included in this chapter.

Emphasize the importance of fluid balance, and as an experiment have the students actually drink eight glasses of water in one day and keep track of it in a log as they would for a resident. Emphasize signs of dehydration and remind students how serious dehydration and unintended weight loss are. They should be able to recognize these signs and report them immediately.

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 244-245 WoRKbooK P. 77

87 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Describe common nutritional problems of the elderly and the chronically ill

Discuss the following points: • Know and honor residents’ food preferences. • Report requests for diet substitutions immediately. Encourage students to discuss their own regional, cultural, or religious food preferences.

Meeting the Learning Objective TEXTbooK PP. 245-246 WoRKbooK P. 77

Lecture Pronounce and define the following key terms: • Nutrition

4. Identify six basic nutrients Meeting the Learning Objective TEXTbooK PP. 246-247 WoRKbooK P. 78

• Malnutrition

Lecture Pronounce and define the following key terms:

Review problems that can affect nutrition:

• Nutrient

• Less saliva

• Metabolism

• Side effects from medication • Decrease in activity and mobility • Weakened sense of smell and taste

Review the following six basic nutrients: Water

• Water is the most essential nutrient for life. • Water helps with digestion and absorption TESTBANKSELLER of.foCoO d.MIt helps to maintain normal body • Depression and lack of interaction temperature. • Loss of vision • Dentures, tooth loss, or poor dental health

• Special diets that restrict foods

Fats Discuss conditions that make it more difficult to eat or swallow: • Stroke • Cancer • Parkinson’s disease • Multiple sclerosis • Alzheimer’s disease

3. Describe cultural factors that influence food preferences

• Good source of energy • Add flavor to food • Fall into four categories: saturated, trans fat, monounsaturated, and polyunsaturated • Saturated and trans fats can increase cholesterol levels and the risk of some diseases, like cardiovascular disease. • Monounsaturated and polyunsaturated fats can be helpful in the diet, and can decrease the risk of cardiovascular disease and type 2 diabetes. Carbohydrates

Meeting the Learning Objective TEXTbooK P. 246 WoRKbooK P. 77

Lecture and Discussion Pronounce and define the following terms: • Fasting • Vegetarians • Vegans

• Provide fuel for energy • Provide fiber Protein • Essential for tissue growth and repair • Provides a supply of energy

88 • Vitamins are essential to body functions.

• Choose lean meat and poultry. Include eggs and egg whites on a regular basis.

• Fat-soluble vitamins are A, D, E, and K.

• Eat plant-based protein foods more often.

• Water-soluble vitamins are B and C.

• Some nuts and seeds (flax, walnuts) are excellent sources of essential fatty acids.

Vitamins

Minerals • Minerals form and maintain body functions. • Examples of minerals include zinc, iron, calcium, and magnesium.

5. Explain the USDA’s MyPlate

• Provide protein, vitamins, and minerals • Includes all of the foods made from milk that retain their calcium content, such as yogurt and cheese • Most dairy group choices should be fat-free or low-fat (1%).

Meeting the Learning Objective

• Choose fat-free or low-fat milk or yogurt more often than cheese.

TEXTbooK PP. 247-250 WoRKbooK PP. 78-79

• Soy products enriched with calcium are an alternative to dairy foods.

Display Transparency

Review additional tips for making healthy food choices:

14-1 MyPLATE Referring to Figure 14-6 (p. 247 in textbook), discuss the following points about food groups and MyPlate: Vegetables and fruits

Dairy

• Balance calories. • Enjoy your food, but eat less. • Avoid oversized portions.

odEsR to.eC atOm TESTBANKS•EFLoL More often are vegetables, fruits,

• Make half your plate fruits and vegetables.

• Dark green, red, and orange vegetables have the best nutritional content. • Vegetables are low in fat, calories, and have no cholesterol. • Vegetables provide fiber and vitamins. • Fruits are low in fat, sodium, calories, and have no cholesterol. • Fruits provide vitamins and fiber.

whole grains, and fat-free or 1% milk and low-fat dairy products. • Foods to eat less often are foods high in solid fats, added sugars, and salt. These foods include fatty meats, like bacon and hot dogs, cheese, fried foods, ice cream, and cookies. • Compare sodium in foods. Select canned foods that are labeled sodium free, very low sodium, low sodium, or reduced sodium. • Drink water instead of sugary drinks.

Grains • At least half of all grains consumed should be whole grains.

6. Explain the role of the dietary department

• Whole grains contain bran and germ, as well as the endosperm. Refined grains retain only the endosperm.

Meeting the Learning Objective

• Grains are found in cereal, bread, rice, and pasta. Proteins • Meat, poultry, seafood, and eggs are animal sources of proteins. Beans, peas, soy products, nuts, and seeds are plant sources of proteins. • Eat seafood twice a week in place of meat or poultry.

TEXTbooK P. 250 WoRKbooK PP. 79-80

Lecture Pronounce and define the following key term: • Diet cards Discuss the dietary department’s responsibilities: to meet residents’ different nutritional needs, to take into account likes and dislikes, and to make

89 sure residents can manage the food they’re eating and that it looks appealing. Infection prevention measures must be strictly followed.

7. Explain the importance of following diet orders and identify special diets Meeting the Learning Objective TEXTbooK PP. 250-254 WoRKbooK PP. 80-81

Lecture Pronounce and define the following key terms: • Special diet • Puree • Lactose intolerance • Diuretics

be vegetarians and can discuss what types of food they eat. Others may be diabetics and will be familiar with counting carbohydrates. Group Exercise Ask each student to choose a special diet from the above list and give a five-minute report to the rest of the class, including an example of a one day/ three meals menu plan. The food choices should be made based on the foods allowed and the foods the student prefers. The other students could ask the presenter questions about certain foods and whether they are allowed on that special diet. For example: Can you eat salt on your special diet? Can you eat chips on your special diet? What do you eat in restaurants?

8. Explain thickened liquids and identify three basic thickening consistencies

• Glucose Describe the differences in the following special diets:

Meeting the Learning Objective TEXTbooK P. 254 WoRKbooK P. 81

• Liquid diets • Soft diet and mechanical soft diet

Lecture

• Pureed diet

Discuss thickened liquids:

• Bland diet • Lactose-free diet

• Thickening improves the ability to control fluid in the mouth and throat.

• High-residue or high-fiber diet

• A doctor orders the necessary thickness.

• Low-residue or low-fiber diet

• Some beverages arrive already thickened.

• Modified calorie diets • Low-sodium diet

• NAs cannot offer regular liquids, including water, to residents who must have thickened liquids.

• High-protein diet

Define the three basic thickened consistencies:

• Low-protein diet

• Nectar thick

• Low-fat/low-cholesterol diet

• Honey thick

• High-potassium diet

• Pudding thick

• Fluid-restricted diets • Diabetic diet • Gluten-free diet • Vegetarian diets (lacto-ovo, lacto, ovo, vegan) Point out that residents who are NPO should not be offered drinks (even water) or snacks. Discussion Encourage students to share their own diets with the class. Some may be Jewish and can tell others what they eat and special restrictions. Some may

9. List ways to identify and prevent unintended weight loss Meeting the Learning Objective TEXTbooK PP. 254-256 WoRKbooK P. 81

Lecture Pronounce and define the following key term: • Apathy

90 Emphasize that NAs must report any weight loss, no matter how small. Discuss the problem of unintended weight loss.

• Talk about eating and food being served in a positive way. • Check to make sure proper diet is being served.

Review the signs and symptoms of unintended weight loss to report, including:

• Respond promptly to complaints about food.

• Needing help eating or drinking

• Use adaptive equipment as needed.

• Eating less than 70% of meals/snacks

• Record meal/snack intake.

• Having mouth pain

• Ask for dietitian, OT, or SLP consultation if necessary.

• Having dentures that do not fit properly

• Season foods to residents’ preferences.

• Having difficulty chewing or swallowing • Coughing or choking while eating • Being sad or withdrawing from others • Being confused, wandering, or pacing

10. Describe how to make dining enjoyable for residents Meeting the Learning Objective

Review the signs of malnourishment:

TEXTbooK PP. 256-257

• Feeling of coldness throughout body

WoRKbooK PP. 81-82

• Weight loss • Abdominal distention • Abdominal pain • Constipation • Edema

Lecture Point out that meals are not only a time for getting nourishment but also a time for socialization. NAs must understand how integral they are to making sure that residents get proper nutrition.

ouEthSTBANKSREeL • Cracks or splits at the corners of the mT viL ewEtR h. e fCoO lloMwing guidelines for dining: • Inflammation of the mucous membranes of the • Follow a routine. mouth • Assist with grooming. • Dry or peeling skin • Encourage use of dentures, eyeglasses, and hear• Brittle, easily-cracked nails ing aids. • Rapidly thinning hair that breaks off easily; hair • Give oral care before eating. that changes or loses color • Assist with handwashing. • Frequent infections • Offer a trip to the bathroom before eating. • Muscle weakness • Seat residents next to friends. • Fainting • Properly position residents for eating, normally • Fatigue in the upright position. • Withdrawal or apathy • Place residents in appropriate chairs. • Anxiety and irritability

• Serve food at correct temperature.

• Problems with sleeping

• Provide proper eating tools.

• Low body temperature • Slow pulse

• Cut food when necessary before bringing it to the table.

• Low blood pressure

• Do not share a resident’s food with others.

Discuss the following guidelines for preventing unintended weight loss: • Report warning signs immediately. • Report any decrease in appetite.

• Allow enough time for eating. • Keep noise level low. Do not shout or bang plates or cups. • Be cheerful, positive, and helpful. • Honor requests regarding food. Give additional food when requested.

91 11. Describe how to serve meal trays and assist with eating

• Put hand over food to test temperature. Do not blow on it or touch it.

Meeting the Learning Objective

• Make appropriate conversation. Say positive things about the food.

TEXTbooK PP. 257-261 WoRKbooK P. 82

• Pay attention to person you are helping. Do not talk to other staff. • Alternate between food and drink.

Lecture Review the guidelines for serving trays: • Wash hands first. • Check the diet card for special diet orders, and identify each resident before serving a meal tray. • Serve all residents at one table before serving another table. • Maintain proper temperature of food. • Wearing gloves, prepare food, only doing what residents cannot do for themselves. Open milk or juice cartons. Put in straw if resident uses one. Butter roll, bread, and vegetables as resident likes.

• Honor requests for different food. • Respect a resident’s right to refuse to eat. Demonstration Demonstrate procedure Feeding a resident. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Group Activity Give everyone one very small jar or portion of baby food (preferably a meat flavor) and a plastic spoon. Then simply ask them to taste it. Many will refuse • Offer to season all food as resident likes, includand this is an excellent learning point (after all, ing pureed food. our elderly residents don’t think pureed food looks ap etizing, either). Participants who do taste will Remind students about the followiT ngEw ShTeBnAseNrvKinSgELLERp. COM probably describe to the class how unpleasant the meal trays to residents in isolation: food tastes. Whatever happens, you’ve made your • Follow Isolation Precautions, along with Stanpoint. If the group is very open or small, or you dard Precautions. know the participants personally or are comfort• Apply PPE as needed. able with this idea, you can even have a volunteer • Do not share food with anyone. restrained in her chair and have another volunteer feed her. This learning approach goes deeper and Discuss the following points about assisting resifosters discussion regarding the emotional side of dents with eating: being fed a pureed diet (or other type of diet) by • Residents will need different levels of help. another person. Feelings of helplessness, being demeaned, etc., can be explored in discussion. • Prepare residents who require the least assisExample: Does being fed this way make you want tance first. to continue eating? • Some residents will need to be fed. Be sensitive and give privacy. • Do not judge food choices. • Follow infection prevention precautions. • Offer a clothing protector but respect the resident’s right to refuse to wear it. • Sit at resident’s eye level and give him full attention. • Identify food and fluids in front of resident, including pureed foods. • Ask resident which food he wants first. • Do not mix foods.

12. Describe how to assist residents with special needs Meeting the Learning Objective TEXTbooK PP. 261-263 WoRKbooK PP. 82-84

Lecture Review the guidelines for dining techniques: • Use assistive devices, when necessary. • Use physical and verbal cues.

92 • Always put food into the stronger side of the mouth. • Read menus to visually-impaired residents. Allow time for eating and use the face of an imaginary clock to explain the position of food. Lecture and Discussion Review the special problems that NAs may see, and discuss the tips on how to deal with them found on pages 262-263 of the textbook: • Resident eats too quickly

Lecture Review signs and symptoms of dysphagia that must be reported to the nurse: • Slow eating • Avoidance of eating • Spitting out pieces of food • Difficulty chewing food • Difficulty swallowing small bites of food or pills • Several swallows needed per mouthful • Dribbling saliva, food, or fluid from the mouth

• Resident bites down on utensils • Resident cannot or will not chew

• Food residue inside the mouth or cheeks during and after meals

• Resident will not stop chewing

• Vomiting while eating or drinking

• Resident holds food in his mouth

• Frequent throat clearing

• Resident pockets food in his cheek

• Food or fluid coming up into the nose

• Resident has poor lip closure

• Coughing during or after meals

• Resident has no teeth

• Choking during meals

• Resident has dentures that do not fit properly

• Gurgling sound in voice during or after meals, or loss of voice

• Resident has change in vision that causes problems seeing food clearly

• Problems breathing while eating or drinking

• Resident has protruding tongue or tongue thrust

• Visible effort to swallow

• Resident will not open his mouth

TESTBANKS•EW LaLteEriRn. gC eyO esMwhen eating or drinking

• Resident falls asleep while eating • Resident chokes when drinking • Resident is susceptible to choking

Display Transparency 14-2 PREVENTINg AsPIRATIoN

• Resident forgets to eat

Review the guidelines for preventing aspiration:

• Resident drools excessively • Resident has poor sitting balance

• Position in a straight, upright position at a 90-degree angle.

• Resident tends to lean on one side

• Feed resident slowly.

• Resident tends to fall forward

• Avoid distractions.

• Resident has poor neck control

• Offer small pieces of food or small spoonfuls of pureed food.

Ask students if they can think of any other ways to help with these problems.

• Offer food and then a liquid.

13. Discuss dysphagia and list guidelines for preventing aspiration

• Make sure food is actually swallowed before next bite of food or sip of drink.

Meeting the Learning Objective

• Have residents stay in upright position for at least 30 minutes after eating and drinking.

• Place food in the non-paralyzed side of the mouth.

TEXTbooK PP. 263-265

• Provide mouth care after eating.

WoRKbooK P. 84

• Observe residents closely. Report signs of aspiration immediately.

93 14. Describe intake and output (I&O) Meeting the Learning Objective TEXTbooK PP. 265-267 WoRKbooK PP. 84-85

Remind students that drinking at least 64 ounces (eight 8-ounce glasses) of water or other fluids per day can help prevent constipation, urinary incontinence, and dehydration. Review the signs and symptoms of dehydration to report, including:

Lecture Pronounce and define the following key terms:

• Drinking less than six 8 ounce glasses of liquid per day

• Intake/input

• Drinking little or no fluids at meals

• Output

• Needing help drinking from cup

• Fluid balance

• Having trouble swallowing liquids

• Graduate

• Having frequent vomiting, diarrhea, or fever

Show students a sample intake and output (I&O) form, if one is available.

• Being easily confused or tired • Dry mouth

Display Transparency

• Decrease in urinary output

14-3 CoNVERsIoN TAblE If in a facility, discuss the facility’s particular methods of documenting units of measure. Optional Handout 14-1 bAsIC MATH

• Severe thirst

Also report if the resident has any of these signs or symptoms: • Severe thirst • Dry mouth and mucous membranes • Cracked lips

TESTBANKSELLE OaMrm, wrinkled, or clammy skin •R D. ryC ,w

If students need a review of mathematics, distribute this handout for them to take home and study. They can also reference the mathematics review at the end of the textbook on pages 501 and 502.

Demonstration Demonstrate procedure Measuring and recording intake and output. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Sunken eyes • Flushed face • Decrease in urinary output • Dark urine • Strong-smelling urine • Constipation or weight loss • Weakness, dizziness, lightheadedness, or confusion • Headache • Irritability • Rapid or weakened pulse

15. List ways to identify and prevent dehydration

• Irregular heartbeat

Meeting the Learning Objective TEXTbooK PP. 267-270

Discuss the following guidelines for preventing dehydration:

WoRKbooK P. 85

• Report warning signs immediately.

Lecture Pronounce and define the following key term: • Force fluids

• Low blood pressure

• Encourage residents to drink every time you see them. • Offer fluids that residents prefer.

94 • Make sure pitcher and cup are close by and are light enough for resident to lift.

• Increased heart rate

• Offer assistance.

• Swollen abdomen

• Tight, smooth, or shiny skin

• Offer other forms of liquids. • Record fluid I&O.

Chapter Review

• Follow posted schedules for fluids. Discuss approaching residents positively with, “Would you like water or juice?” rather than, “Do you want anything to drink?” Caregivers should make an effort to find out what resident’s favorite beverages are and offer them at least three times a day, in addition to meals. Emphasize that prevention of dehydration is an ongoing effort! Point out the POURR acronym in the textbook on page 269 as a way of encouraging fluids.

Exam dIsTRIbuTE CHAPTER 14: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook

Demonstration Demonstrate procedure Serving fresh water. Include all of the numbered steps in your demonstration.

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Answers include the following: less saliva; side effects from medication; decrease in activity and mobility; weakened sense of smell and taste; loss of vision; dentures, tooth loss, or poor dental health; depression and lack of interaction; and special diets that restrict foods.

TESTBANKS2E. LLVE egR et. abCleOsMand fruits 16. List signs and symptoms of fluid overload and describe conditions that may require fluid restrictions

Beans, peas, soy products, nuts, and seeds are plant sources of proteins.

Most dairy group choices should be fat-free (0%) or low-fat (1%).

Resident’s name and information about special diets, allergies, likes and dislikes, as well as any other dietary instructions

Lecture Pronounce and define the following key terms:

Low Na or NAS

• Fluid overload

A clear liquid diet consists of fluids that you can see through, such as clear soups and juices. A full liquid diet includes all of the liquids served on a clear liquid diet, with the addition of cream soups, milk, and ice cream.

Thickened liquids move down the throat more slowly, reducing coughing and limiting the risk for choking.

Upright at 90 degrees

Meeting the Learning Objective TEXTbooK P. 270 WoRKbooK PP. 85-86

• Restrict fluids Review the signs and symptoms of fluid overload, including: • Weight gain • Fatigue • Difficulty breathing or shortness of breath • Swelling of extremities • Coughing • Decreased urine

10. Respect the resident’s refusal.

95 11. Put her hand over the food to sense the heat. 12. Stronger side 13. By using the face of an imaginary clock 14. Output includes urine, feces, vomitus, perspiration, moisture in the air that a person exhales, suctioned material, and wound drainage. 15. 30 16. 64 ounces 17. A restrict fluids (RF) order means the person is allowed to drink, but must limit the daily amount to a level set by the doctor. 18. B 19. A 20. C 21. B 22. C

15 The Gastrointestinal System 1. 2. 3. 4. 5. 6.

Define important words in this chapter Explain key terms related to the body Explain the structure and function of the gastrointestinal system Discuss changes in the gastrointestinal system due to aging List normal qualities of stool and identify signs and symptoms to report about stool List factors affecting bowel elimination and describe how to promote normal bowel elimination 7. Discuss common disorders of the gastrointestinal system 8. Discuss how enemas are given 9. Demonstrate how to collect a stool specimen 10. Explain occult blood testing 11. Define ostomy and identify the difference between colostomy and ileostomy 12. Explain guidelines for assisting with bowel retraining Supplemental Tools

regular bowel movements for maintaining health

elL deE rlR y. peCoO plM e. Students will learn signs and EL TRANsPARENCy 15-1 THE gAsTRoINTEsTIT NE ALSTBANKSin sysTEM TRANsPARENCy 15-2 FACToRs AFFECTINg boWEL ELIMINATIoN HANDouT 15-1 gIVINg A RECTAL suPPosIToRy CHAPTER 15: EXAM

Assignments TEXTbooK READINg, PP. 272-297 WoRKbooK EXERCIsEs, PP. 87-91

Overview of Teaching Strategies This chapter introduces the students to terms related to the body and the ten body systems. The concept of homeostasis is also introduced. The structure and function of the gastrointestinal system is briefly explained, and normal changes of the gastrointestinal system due to aging are described. The normal changes of aging for each body system should be emphasized so that students are better able to recognize abnormal changes. This chapter describes the process of bowel elimination and describes normal qualities of stool. Emphasis should be placed on the importance of

symptoms about stool that should be reported to the nurse. Factors affecting bowel elimination are described. Stress that the NA has an important role in promotion of bowel elimination for his or her residents. Common disorders of the gastrointestinal system are described in this chapter. It may be a good idea to have students make flash cards for these disorders and those described in the other body systems chapters. An important component of this chapter is the emphasis on providing plenty of privacy for all elimination and support for residents who have ostomies or who are incontinent. Ask students to think about what it would feel like if they could not control their bowels and had to rely on others for assistance with elimination.

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 272-274 WoRKbooK P. 87

97 Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Explain key terms related to the body Meeting the Learning Objective

• Gastrointestinal tract • Peristalsis • Chyme • Duodenum • Absorption • Feces

TEXTbooK P. 274

• Electrolytes

WoRKbooK P. 87

• Colon • Defecation

Lecture Pronounce and define the following key terms: • Biology • Anatomy • Physiology • Cells • Tissues • Organs • Body systems • Homeostasis

• Ingestion • Digestion • Elimination Display Transparency 15-1 THE gAsTRoINTEsTINAL sysTEM Discuss the following points: • Digestion prepares food for absorption into cells. • Elimination is expelling solid wastes.

Review the functions of the gastrointestinal system: Review the ten systems that make T upEtS hT e hu m a n •R In.gC esO tioMn of food and fluids BANKSELLE body: • Digestion of food • Gastrointestinal or digestive • Absorption of nutrients • Urinary • Elimination of waste products from food/fluids • Reproductive • Pathophysiology

• Integumentary or skin • Circulatory or cardiovascular • Respiratory • Musculoskeletal

4. Discuss changes in the gastrointestinal system due to aging Meeting the Learning Objective

• Nervous

TEXTbooK P. 276

• Endocrine

WoRKbooK P. 88

• Immune and lymphatic

3. Explain the structure and function of the gastrointestinal system Meeting the Learning Objective TEXTbooK PP. 274-276 WoRKbooK P. 87

Lecture Pronounce and define the following key terms:

Lecture Review normal changes of aging: • Ability to taste decreases. • Process of digestion takes longer and is less efficient. • Body waste moves more slowly through the intestines, causing more frequent constipation. • Difficulty chewing and swallowing may occur. • Absorption of vitamins and minerals decreases. • Production of saliva and digestive fluids decreases.

98 5. List normal qualities of stool and identify signs and symptoms to report about stool

• Physical activity and exercise • Personal habits • Medications

Meeting the Learning Objective TEXTbooK PP. 276-277 WoRKbooK P. 88

Demonstration Demonstrate each of the following procedures, including all of the numbered steps in your demonstration:

Lecture Pronounce and define the following key term:

• Assisting a resident with use of a bedpan

• Bowel elimination

• Assisting a male resident with a urinal • Helping a resident use a portable commode

Discuss normal bowel elimination: • Stool is normally brown, soft, moist, and formed. • No pain with passing stool • There should not be blood, pus, mucus, or worms in the stool. Review signs and symptoms to report about stool: • Bloody or abnormally-colored stool • Hard, dry stools

Have the students return each demonstration. Procedure checklists are located at the back of the Student Workbook.

7. Discuss common disorders of the gastrointestinal system Meeting the Learning Objective

• Diarrhea

TEXTbooK PP. 283-286

• Constipation • Pain with bowel movements

WoRKbooK PP. 88-89

e R.COM TESTBANKSLEecLtuLrE

• Blood, pus, mucus, or discharge in stool

Pronounce and define the following key term:

• Fecal incontinence

• Heartburn

6. List factors affecting bowel elimination and describe how to promote normal bowel elimination

Review the following points about heartburn:

Meeting the Learning Objective TEXTbooK PP. 277-282 WoRKbooK P. 88

Lecture Pronounce and define the following key terms: • Fracture pan • Portable commode

• Cause: weakening of the sphincter muscle that joins the esophagus and the stomach • Symptoms: burning feeling in the esophagus, pain in the chest, around the breastbone, or the rib area, bitter taste in the mouth, feeling of food coming back up into the throat or the mouth • Pain usually occurs directly after a meal and may worsen when person is lying down. • Treatment: medication, change in diet or sleep position Pronounce and define the following key term: • Gastroesophageal reflux disease (GERD)

Display Transparency 15-2 FACToRs AFFECTINg boWEL ELIMINATIoN Discuss the factors listed on the transparency: • Growth and development • Psychological factors • Diet • Fluid intake

Review the following points about GERD: • Cause: liquid contents of the stomach back up into the esophagus; can inflame and damage lining of the esophagus and cause bleeding, ulcers, or difficulty swallowing • Symptoms: frequent heartburn, chest pain, hoarseness in the morning, difficulty swallowing, tightness in the throat, coughing, bad breath

99 • Possible causes: obesity, hiatal hernia, weak lower esophageal sphincter, slow digestion, diets high in acidic and spicy foods, smoking, alcohol use • Treatment: medication; losing weight; stopping smoking and drinking alcohol; wearing loosefitting clothing; serving frequent, small meals throughout the day; serving last meal of the day three to four hours before bedtime; sitting up for at least two to three hours after eating; elevation of the head of the bed; and using extra pillows Review the following points about ulcers: • Raw sores in the stomach or small intestine

• Symptoms: diarrhea, rectal bleeding, abdominal cramping and pain, fever, and weight loss • Treatment: Medications, dietary changes, stopping smoking, surgery Pronounce and define the following key term: • Ulcerative colitis Review the following points about ulcerative colitis: • Symptoms: diarrhea, abdominal pain, cramping, rectal bleeding, poor appetite, fever, weight loss • Treatment: Medications, dietary changes, stopping smoking, surgery

• Cause: excessive acid

Pronounce and define the following key terms:

• Symptoms: dull or burning pain after eating, belching, vomiting

• Diverticulitis

• Treatment: antacids and medications, change in diet

• Diverticulosis

Review the following points about diverticulosis and diverticulitis:

• Avoid alcohol, caffeine, and cigarettes

• Diverticulosis is a disorder that causes sac-like pouches to develop in weakened areas of the Review the following points about gallbladder intestinal wall. disorders: • Some people with diverticulosis will develop • Types of disorders include gallstones, pancreatic diverticulitis, or inflammation inside the disorders, and tumors TESTBANKSELLER Mgs. po.uC chOin • Decreased or stopped bile flow • Cause: low-fiber diet • Treatment: medications, dietary changes, surgery • Treatment: rest, medications, special diets, surgery Review the following points about cirrhosis: • Cause: liver damage from alcohol abuse, hepatitis, and fatty liver syndrome

Define the following terms:

• Symptoms: fatigue, bruising easily, itchy skin, jaundice, ascites in the abdomen, and edema in the legs

• Malabsorption

• Treatment: eliminating alcohol, maintaining a healthy weight, medications Review the following points about hernia • Cause: pressure pushing a body cavity out through a muscle or tissue due to heavy lifting or constipation

• Flatulence • Irritable bowel syndrome (IBS) Review the following points about flatulence: • Presence of excessive air in the digestive tract • Causes: high fiber foods, intolerance of foods, swallowing air when eating, antibiotics, malabsorption, IBS • May be relieved by positioning, rectal tube

• Symptoms: swelling in the area of the abdomen or the groin and discomfort in the abdominal area or groin when lifting

Define the following terms:

• Treatment: surgery

• Enema

Review the following points about Crohn’s disease: • Causes the lining of the digestive tract to become inflamed

• Constipation • Suppository Optional Handout 15-1 gIVINg A RECTAL suPPosIToRy

100 If regulations require you to teach this procedure, distribute the handout and discuss how to safely administer a rectal suppository. Review the following points about constipation: • Inability to eliminate stool, or the infrequent, difficult and often painful elimination of a hard, dry stool • Causes: changes of aging, poor diet, lack of exercise, decrease in fluid intake, medication, disease, or ignoring the urge to eliminate • Signs include abdominal swelling, gas, irritability • Treatment: increasing fiber, physical activity, and medication Pronounce and define the following key term: • Diarrhea

Pronounce and define the following key term: • Hemorrhoids Review the following points about hemorrhoids: • Enlarged veins in the rectum • Causes: constipation, obesity, pregnancy, diarrhea, overuse of enemas and laxatives, straining during bowel movements • Symptoms: rectal itching, burning, pain, and bleeding • Treatment: changes in diet, surgery Students can use the online resources to locate more information. Discuss the risk obesity poses for certain gastrointestinal diseases or disorders.

8. Discuss how enemas are given

Review the following points about diarrhea: • It is the frequent elimination of liquid or semiliquid feces. • Causes: infections, microorganisms, irritating foods, medication • Treatment: medication, change of diet

Meeting the Learning Objective TEXTbooK PP. 286-291 WoRKbooK P. 89

Lecture Review different types of enemas:

S:TBANKS•ETLapLE R.COM Pronounce and define the following key T teE rm water enema • Fecal incontinence • Soapsuds enema Review the following points about fecal incontinence: • It is an inability to control the bowels. • Causes: muscle and nerve damage, disorders of the spinal cord or anus, fecal impaction, constipation, tumors • Treatment: changes in diet, medication, bowel training, surgery Pronounce and define the following key term: • Fecal impaction Review the following points about fecal impaction: • Buildup of dry, hardened feces in the rectum • Signs include: no stool for several days, cramping, abdominal and rectal pain, abdominal swelling, nausea, and vomiting. • Nurse or doctor will break mass into fragments. • Can be fatal if complete bowel obstruction occurs

• Saline enema • Commercial enema Tell students that residents must be in Sims’ position to receive an enema. Emphasize that an enema should be stopped immediately if the resident complains of pain or if the NA feels resistance. This must be reported to the nurse. Demonstration If your facility allows, demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Giving a cleansing enema • Giving a commercial enema Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook. Emphasize that these procedures should only be performed if allowed by the facility and if the NA is trained to perform the procedure.

101 9. Demonstrate how to collect a stool specimen

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Meeting the Learning Objective TEXTbooK PP. 291-293 WoRKbooK PP. 89-90

Lecture Pronounce and define the following key term: • Specimen Discuss these points about stool specimens: • Stool is tested for blood, pathogens, and other things. • Stool must be warm if being tested for ova and parasites. • Urine or tissue in a stool sample can ruin the sample. Demonstration Demonstrate procedure Collecting a stool specimen. Include all of the numbered steps in your demonstration. Have the students return the demoTnE stS raT tioBnA. Procedure checklists are located at the end of the Student Workbook.

10. Explain occult blood testing Meeting the Learning Objective TEXTbooK P. 293 WoRKbooK P. 90

Lecture Pronounce and define the following key term: • Occult Discuss the fact that blood in the stool may be a sign of a serious problem, such as cancer. The Hemoccult test is one test that checks for occult blood. Demonstration If this test is performed by nursing assistants, demonstrate procedure Testing a stool specimen for occult blood. Include all of the numbered steps in your demonstration.

11. Define ostomy and identify the difference between colostomy and ileostomy Meeting the Learning Objective TEXTbooK PP. 294-296 WoRKbooK P. 90

Lecture Pronounce and define the following key terms: • Ostomy • Stoma • Colostomy • Ileostomy • Ureterostomy • Urostomy Point out the body locations of the types of openings and why the care of the skin and the stoma are very important. Discuss and show different types of commercially sold ostomy appliances and equipment. Point out which types are most appropriate for certain ostomies. Emphasize that some residents are embarrassed about having an ostomy and promoting privacy is very important. Review the guidelines for ostomy care: • Follow Standard and/or Transmission-Based Precautions. • Provide careful skin care and proper hygiene. • Remove ostomy pouches carefully. • Before removing pouches, allow a little air out of the bag. • Observe contents of pouch. • Empty, clean, and replace the ostomy pouch whenever stool is eliminated. • Assist residents to wash hands. • Observe for skin irritation, rashes, swelling or bleeding around stoma. • Use skin barriers as ordered.

102 • Make sure bottom of pouch is securely clamped before applying to stoma.

Chapter Review

• Make sure pouch is attached securely before completing care and before residents go out or receive visitors.

Exam dIsTRIbuTE CHAPTER 15: EXAM (APPENDIX C)

• Be supportive, empathetic, and caring. Demonstration Demonstrate procedure Caring for an ostomy. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Ingestion of food, digestion of food, absorption of nutrients, and elimination of waste products from food/fluids

Answers include the following: Ability to taste decreases. Process of digestion takes longer and is less efficient. Body waste moves more slowly through the intestines, causing more frequent constipation. Difficulty chewing and swallowing may occur. Absorption of vitamins and minerals decreases. Production of saliva and digestive fluids decreases.

Brown in color, soft, moist, and formed

A fracture pan is used for small or thin people or those who cannot lift their buttocks onto a standard bedpan.

Position a standard bedpan so that the wider end is aligned with a resident’s buttocks. Position a fracture pan with the handle toward the foot of the bed.

Answers include the following: increasing fiber, fluids, and physical activity, and medications such as laxatives, enemas, or suppositories

• Dispose of wastes properly.

• Praise attempts and successes in controlling bowels.

Excessive cleaning and wiping of the area, scented soaps

Sims’ position

Stop immediately

12. Explain guidelines for assisting with bowel retraining Meeting the Learning Objective TEXTbooK P. 296 WoRKbooK PP. 90-91

Lecture Discuss how NAs may assist in bowel retT raE inSinTgB , including the following: • Explain the schedule to the resident. Follow the schedule. • Follow Standard Precautions. Wear gloves. • Observe resident’s elimination habits. • Keep a record of elimination. • Offer bedpan or trip to the bathroom at specific times each day. • Answer call lights promptly. • Provide privacy. Do not rush resident. • Help with perineal care. • Encourage fluids and proper diet.

• Never show frustration or anger. Discuss with students how to keep a positive attitude when assisting residents who are going through bowel retraining and have “accidents.” Ask students how they would feel if they were unable to control elimination. Create empathy for residents.

10. Tests must be done while the stool is still warm. 11. Urine or toilet paper

103 12. With a microscope or special chemical test 13. An ostomy may be necessary due to bowel disease, such as diverticulitis, Crohn’s disease, or colon cancer. 14. A colostomy is a surgically-created opening into the large intestine to allow feces to be expelled. With a colostomy, stool may be semisolid. An ileostomy is a surgically-created opening into the end of the small intestine, the ileum, to allow feces to be expelled. Stool will be liquid and may be irritating to the skin. 15. Answers include the following: Follow the plan consistently. Follow Standard Precautions. Observe residents’ elimination habits. Keep a record of elimination, including episodes of incontinence. Offer bedpan or trip to the bathroom at specific times each day. Answer call lights promptly. Provide privacy. Do not rush the resident. Help with perineal care as needed. Encourage fluids. Encourage proper diet. Dispose of wastes properly. Praise attempts and successes in controlling the bowels. Never show frustration or anger toward residents who are incontinent.

16. D 17. A 18. B

104

16 The Urinary System 1. Define important words in this chapter 2. Explain the structure and function of the urinary system 3. Discuss changes in the urinary system due to aging 4. List normal qualities of urine and identify signs and symptoms to report about urine 5. List factors affecting urination and describe how to promote normal urination 6. Discuss common disorders of the urinary system 7. Discuss reasons for incontinence 8. Describe catheters and related care 9. Explain how to collect different types of urine specimens 10. Explain types of tests that are performed on urine 11. Explain guidelines for assisting with bladder retraining Supplemental Tools TRANsPARENCy 16-1 THE uRINARy sysTEM TRANsPARENCy 16-2 FACToRs AFFECTINg uRINATIoN

this. Tests performed on urine vary from facility to facility. The chapter has an introduction to restorative care with the section on bladder retraining. A positive, helpful attitude should be encouraged.

HANDouT 16-1: CHANgINg dRAINAgE bAg To lEg bAg

1. Define important words in this chapter

HANDouT 16-2: CHANgINg lEg bAg To dRAINAgE bAg

Meeting the Learning Objective

HANDouT 16-3: TAKINg A uRINARy sPECIMEN FRoM A PoRT

TEXTbooK PP. 298-299 WoRKbooK PP. 93-96

HANDouT 16-4: suPRAPubIC CATHETERs CHAPTER 16: EXAM

Assignments

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

TEXTbooK READINg, PP. 298-316 WoRKbooK EXERCIsEs, PP. 93-96

Overview of Teaching Strategies This chapter focuses on the urinary system and related care. Students will learn more personal care skills as they read about elimination and their role in assisting. An emphasis on promoting privacy and dignity should be made, along with empathizing with residents. Students are given in-depth information on incontinence and how to help prevent it. Adhering to infection prevention measures is important and should be made an integral part of the discussion. A risk of infection is especially high with catheter care. Students need to be aware of

2. Explain the structure and function of the urinary system Meeting the Learning Objective TEXTbooK PP. 299-300 WoRKbooK P. 93

Lecture Pronounce and define the following key terms: • Sphincter • Micturition • Voiding

105 • Urinary incontinence

• Dark or rust-colored urine

• Renal calculi

• Strong-, offensive-, or fruity-smelling urine • Pain, burning, or pressure when urinating

Display Transparency

• Blood, pus, mucus, or discharge in urine

16-1 THE uRINARy sysTEM

• Episodes of incontinence

Review the functions of the urinary system: • Elimination of waste products from the blood • Maintenance of water balance in the body

5. List factors affecting urination and describe how to promote normal urination

• Regulation of the levels of electrolytes in the body

Meeting the Learning Objective

• Assistance in regulation of blood pressure

TEXTbooK PP. 301-302 WoRKbooK P. 94

3. Discuss changes in the urinary system due to aging

Display Transparency

Meeting the Learning Objective

Discuss the factors listed on the transparency:

16-2 FACToRs AFFECTINg uRINATIoN

TEXTbooK P. 300

• Growth and development

WoRKbooK P. 93

• Psychological factors

Lecture Review normal changes of aging: • The kidneys do not filter blood as efficiently. • Bladder muscle tone weakens.

• Fluid intake • Physical activity and exercise • Personal habits

TESTBANKSELLE •R M. edCicOaM tions

• Bladder holds less urine, causing more frequent urination.

• Disorders

• Bladder may not empty completely, causing increased chance of infection.

6. Discuss common disorders of the urinary system

4. List normal qualities of urine and identify signs and symptoms to report about urine

Meeting the Learning Objective TEXTbooK PP. 302-304 WoRKbooK P. 94

Meeting the Learning Objective TEXTbooK PP. 300-301 WoRKbooK P. 93

Lecture Discuss normal characteristics of urine: • Light, pale yellow, or amber in color • Clear or transparent • Faint smell • Adults produce about 1200 to 1500 mL of urine, although elderly may produce less. Review signs and symptoms of urine to report: • Cloudy urine

Lecture Pronounce and define the following key term: • Urinary tract infection Review the following points about UTIs: • Cause: entrance of bacteria into the bladder through the urethra • Women are more susceptible than men. • Symptoms: burning or pain with urination, blood in urine, frequency of and urgency with urination • Prevention: drinking plenty of fluids and juices rich in Vitamin C, wiping from front to back after elimination, taking showers rather than baths

106 • Treatment: antibiotics

• Confinement to bed

• Report cloudy, dark, or foul-smelling urine, burning or discomfort with urination, or frequent urination in small amounts.

• Illness

Pronounce and define the following key terms:

• Prostate problems

• Chronic renal failure (CRF)

• Childbirth

• Dialysis

• Paralysis • Circulatory or nervous system disorders

• End-stage renal disease (ESRD)

Emphasize that incontinence is not a normal part of aging and must be reported.

Review the following points about CRF:

Describe the different types of incontinence:

• Kidneys cannot filter waste products from the blood.

• Stress incontinence

• Becomes worse over time • Causes: diabetes, hypertension, chronic urinary tract infections, nephritis • Initial signs and symptoms: unintended weight loss, nausea, vomiting, fatigue, headache, frequent hiccups, itching • Dialysis is done when the kidneys are no longer able to perform their function. • ESRD occurs when kidneys have failed and dialysis or transplantation is required to sustain life.

• Urge incontinence • Mixed incontinence • Functional incontinence • Overflow incontinence Remind students to be professional and positive when dealing with episodes of incontinence. Review the guidelines for preventing incontinence: • Know routines, habits, and signs.

• Follow toileting schedules and the care plan. • Leave call lights within reach and answer call Review the following points about urine T reE teS ntTioBnA : NKSELLER.COM lights promptly. • Inability to adequately empty the bladder • Offer bedpans or take residents to the bathroom • Causes: surgery, obstruction, infection, disorders often. such as multiple sclerosis and diabetes, enlarge• Encourage fluids. ment of prostate gland • Take daily walks near bathroom. • Symptoms: lower abdominal pain, painful • Check incontinence briefs at least every two urge but inability to urinate, distended bladder, hours. Change wet or soiled incontinence briefs abdominal swelling, frequent urge to urinate, immediately. difficulty starting to urinate, weak flow of urine, dribbling • Change wet or soiled clothing immediately. • Treatment: medication and catheterization • Change wet or soiled bed linens. Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

• Use disposable absorbent pads. • Give careful skin care and perineal care. • Provide privacy. • Be calm, patient, and professional.

7. Discuss reasons for incontinence Meeting the Learning Objective TEXTbooK PP. 304-305 WoRKbooK PP. 94-95

Lecture Review causes of incontinence:

• Be reassuring and positive.

8. Describe catheters and related care Meeting the Learning Objective TEXTbooK PP. 305-310 WoRKbooK P. 95

107 Lecture Pronounce and define the following key terms: • Straight catheter

If these procedures are taught at your facility, go over the information on the handouts with students.

• Indwelling catheter • Condom catheter • Catheter-associated urinary tract infection (CAUTI) Remind students that NAs do not insert, irrigate, or remove catheters.

9. Explain how to collect different types of urine specimens Meeting the Learning Objective TEXTbooK PP. 310-314 WoRKbooK P. 96

Review guidelines for catheter care: Lecture Pronounce and define the following key terms:

• Wash hands thoroughly. • Wear gloves.

• Routine urine specimen

• Keep genital area clean. • When cleaning meatus, move in one direction, away from meatus. • Secure tubing properly. • Make sure drainage bag hangs lower than hips or bladder. • Do not hang drainage bag from bedrail. • Keep tubing straight. • Keep drainage bag off floor. Keep catheter tubing from touching floor.

• Clean-catch specimen • 24-hour urine specimen Discuss the following points about urine specimens: • Identify the resident. • Labeling and storing specimens correctly is important. Discuss what urine straining is. Demonstrate how

TESTBANKSELLE R.COM to strain urine if it is a requirement at your facility.

• Do not touch tip of clamp to any other object. • Do not let drainage spout touch graduate. • Do not disconnect catheter during positioning. Do not re-attach disconnected tubing.

Demonstration Demonstrate the following procedures: • Collecting a routine urine specimen

• Report blood in urine, leaks, bag filling suddenly or not filling for several hours, pain, pressure, or odor.

• Collecting a clean-catch (mid-stream) urine specimen

Demonstration Demonstrate the following procedures:

Include all of the numbered steps in your demonstration.

• Providing catheter care

Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook.

• Emptying a catheter drainage bag • Changing a condom catheter Include all of the numbered steps in your demonstration. Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook. Optional Handouts 16-1 CHANgINg dRAINAgE bAg To lEg bAg 16-2 CHANgINg lEg bAg To dRAINAgE bAg

• Collecting a 24-hour urine specimen

Optional Handouts 16-3 TAKINg A uRINARy sPECIMEN FRoM A PoRT 16-4 suPRAPubIC CATHETERs If these procedures are taught at your facility, go over the information on the handouts with students. Lecture Review the Five “Rights” of specimen collection:

108 • The right resident

• Encourage fluids.

• The right specimen • The right container

• Offer a bedpan or urinal or a trip to the bathroom before and after long procedures.

• The right date/time

• Answer call lights promptly.

• The right storage/delivery

• Provide privacy and do not rush resident. • Have resident lean forward to put pressure on the bladder.

10. Explain types of tests that are performed on urine

• Help with perineal care.

Meeting the Learning Objective

• Dispose of wastes properly.

• Keep accurate I&O records.

TEXTbooK PP. 314-315

• Offer praise.

WoRKbooK P. 96

• Never show frustration or anger.

Lecture Pronounce and define the following key terms:

Chapter Review

• Ketones

Exam

• Specific gravity

dIsTRIbuTE CHAPTER 16: EXAM (APPENDIX C)

Discuss what urine may be tested for: • pH level • Glucose and ketones • Blood • Specific gravity

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapt erLeL xaE mRs . anCdOaM n answer key for those exams if TESTBANKSE needed.

Demonstration Demonstrate procedure Testing urine with reagent strips. Include all of the numbered steps in your demonstration.

Answers to Chapter Review in Textbook 1.

Answers include the following: elimination of waste products from the blood; maintenance of water balance in the body; regulation of the levels of electrolytes in the body; assistance in regulation of blood pressure

Answers include the following: The kidneys do not filter blood as efficiently. Bladder muscle tone weakens. Bladder holds less urine, causing more frequent urination. Bladder may not empty completely, causing increased chance of infection.

Answers include the following: light, pale yellow, or amber in color; clear or transparent; faint smell; adults produce about 1200 to 1500 mL of urine, although elderly may produce less.

• Explain schedule to resident. Follow plan.

Sitting, standing

• Follow Standard Precautions.

The female urethra is shorter than the male urethra. In addition, because the female ure-

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

11. Explain guidelines for assisting with bladder retraining Meeting the Learning Objective TEXTbooK PP. 315-316 WoRKbooK P. 96

Lecture Discuss how NAs may assist in bladder retraining:

• Observe residents’ elimination habits.

109 thra is located directly in front of the vagina and the anus, it is closer to potential sources of bacteria. 6.

From front to back

Dialysis is an artificial means of removing the body’s waste products.

Stress incontinence: loss of urine due to an increase in intra-abdominal pressure. Urge incontinence: involuntary voiding due to an abrupt urge to void. Mixed incontinence: symptoms of both urge and stress incontinence are present. Functional incontinence: urine loss caused by environmental, cognitive or physical reasons. Overflow incontinence: due to overflow or over-distension of bladder.

Urine that flows back into the bladder from the tubing or bag can cause infection.

10. Toilet paper or stool 11. Answers include the following: pH level, glucose, ketones, blood, and specific gravity. 12. B 13. C

110

17 The Reproductive System 1. 2. 3. 4. 5.

Define important words in this chapter Explain the structure and function of the reproductive system Discuss changes in the reproductive system due to aging Discuss common disorders of the reproductive system Describe sexual needs of the elderly

Supplemental Tools TRANsPARENCy 17-1 THE REPRoduCTIVE sysTEM CHAPTER 17: EXAM

Assignments TEXTbooK READINg, PP. 316-324 WoRKbooK EXERCIsEs, PP. 97-98

Overview of Teaching Strategies This chapter focuses on the reproductive system. Students will learn how the male and female reproductive systems allow human beings to cT reEatSeT nB ew life. Normal changes of aging in the reproductive system are described, as well as common disorders, which include sexually-transmitted infections. This chapter emphasizes that residents are sexual beings and must be given respect and privacy to meet sexual needs. It should be stressed that residents are adults who may choose how they express themselves sexually, which includes a wide variety of sexual behavior.

2. Explain the structure and function of the reproductive system Meeting the Learning Objective TEXTbooK PP. 318-319 WoRKbooK P. 97

Lecture Pronounce and define the following key terms: • Sperm • Ovum • Gonads • Glands • Hormones • Menstruation Display Transparency 17-1 THE REPRoduCTIVE sysTEM Review the following points about the reproductive system:

1. Define important words in this chapter

• Reproductive organs and hormones are different in males and females.

Meeting the Learning Objective

• The reproductive system allows human beings to reproduce, or create new human life.

TEXTbooK PP. 317-318 WoRKbooK P. 97

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

Review the function of the male reproductive system: • Manufacture sperm and the male hormone, testosterone Review the functions of the female reproductive system: • Manufacture ova and female hormones, estrogen and progesterone

111 • Provide environment for development of fetus

Pronounce and define the following key term:

• Produce milk for the nourishment of a baby after birth

• Chlamydia

3. Discuss changes in the reproductive system due to aging Meeting the Learning Objective TEXTbooK PP. 319-320 WoRKbooK P. 97

Review the following points about chlamydia: • Cause: bacteria • Symptoms: burning with urination, discharge from the penis or vagina, swelling of the testes, painful intercourse, abdominal and low back pain • In many cases, no symptoms are apparent. • May cause infertility or pelvic inflammatory disease

Lecture Pronounce and define the following key term:

• Treatment: antibiotics

• Menopause

• Genital herpes

Review normal changes of aging for males:

Review the following points about genital herpes:

• Prostate gland enlarges.

Pronounce and define the following key term:

• Number and capability of sperm decreases.

• Cause: herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2)

• Sexual response slows; it may take longer to achieve an erection and to reach orgasm.

• Cannot be cured

• Decrease in production of estrogen and progesterone leads to a loss of calcium, causing brittle bones, and, potentially, osteoporosis. Decrease in estrogen also makes females more prone to urinary tract infections.

• Treatment: anti-viral medications to lessen frequency of episodes

• Symptoms: itching, painful red blisters or open sores, burning sensation during urination or Review normal changes of aging for females: intercourse, fever, headache, muscle aches • Menopause occurs 12 months after a woman’s • Infection can be spread even when sores are not last menstrual period and ends tT heEaS bili tyAtoNKSELLE TB Rpresent. .COM reproduce.

Pronounce and define the following key term: • Genital HPV infection

• Vaginal walls become drier and thinner.

Review the following points about genital HPV infection:

4. Discuss common disorders of the reproductive system

• Cause: human papillomavirus (HPV) • Infects genital areas of both men and women • May have no signs or symptoms

Meeting the Learning Objective

• Symptoms: abnormal pap test, genital warts

TEXTbooK PP. 320-323

• Treatment: removal of warts, medication

WoRKbooK PP. 97-98

• Vaccine licensed by FDA is available.

Lecture Pronounce and define the following key term: • Sexually-transmitted infections (STIs)

Pronounce and define the following key term: • Gonorrhea Review the following points about gonorrhea:

Review the following points about STIs:

• Cause: bacteria

• Transmitted through sexual contact, via needles, or through childbirth or breastfeeding

• Easier to detect in men than women

• Transmission of some can be reduced or stopped by using latex condoms.

112 • Symptoms: painful or burning urination; white, yellow, or green cloudy pus-like discharge from penis; swollen testes; cloudy vaginal discharge; vaginal bleeding; rectal itching, soreness; painful elimination of stool • Treatment: antibiotics Pronounce and define the following key term: • Syphilis Review the following points about syphilis: • Cause: bacteria • Easier to detect in men than women • Symptoms: chancres, rashes, headache, fever, sore throat, weight loss, muscle aches • Infection can spread to the heart, brain, and other vital organs. • Can be fatal • Treatment: antibiotics Pronounce and define the following key term: • Trichomoniasis Review the following points about trichomoniasis: • Cause: protozoa • May have no symptoms in men • Symptoms in men: mild discharge, irritation, burning sensation after urination or ejaculation

Review the following points about female reproductive cancers: • Ovarian cancer begins in the ovaries. Symptoms are not always apparent. There is no definitive screening test for ovarian cancer. Pelvic examinations and ultrasound testing help diagnose this type of cancer. Treatment includes surgery, radiation, and chemotherapy. • Endometrial cancer begins in the uterus. Symptoms include vaginal bleeding and pelvic pain. Pelvic examinations and ultrasounds are used to diagnose this type of cancer. If detected early, endometrial cancer is highly curable by removing the uterus. • Cervical cancer begins in the cervix. Symptoms are not always apparent, but include vaginal bleeding, change in menstrual cycles, painful intercourse, and blood-tinged vaginal discharge. Pap tests, scopes, and biopsies are tests that check for cervical cancer. A vaccine for cervical cancer is available for younger women. If detected early, cervical cancer is curable. Pronounce and define the following key term: • Benign prostatic hypertrophy Review the following points about benign prostatic hypertrophy: • Common in men over the age of 60

• Symptoms in women: green-yellow vaginal discharge with strong odor, irritation, itching

• Cause: enlarged prostate causes pressure on urethra, making urination difficult.

• Treatment: metronidazole Pronounce and define the following key term:

• Symptoms: feeling of incomplete urination, frequent urination, weak stream of urine, dribbling, need to urinate often at night, incontinence

• Vaginitis

• Treatment: medication and surgery

Review the following points about vaginitis:

Pronounce and define the following key terms:

• Cause: overgrowth of normal bacteria inside the vagina, overproduction of fungus, lower estrogen levels post-menopause, irritation, or an allergic reaction

• Prostate cancer

• Symptoms: vaginal discharge, itching, and pain • Treatment: creams, suppositories, antibiotics, and estrogen supplements Pronounce and define the following key terms: • Ovarian cancer • Endometrial cancer • Cervical cancer

• Testicular cancer Review the following points about male reproductive cancers: • Prostate cancer forms in the prostate gland, normally in older men. Symptoms of prostate cancer are urinating during the night, a weak flow of urine, painful urination, blood in urine, and problems with maintaining an erection. This type of cancer tends to be slow-growing and treatable, if caught early. Treatment includes removal of the prostate, hormone therapy, and chemotherapy.

113 • Testicular cancer occurs in the testes. Symptoms include a noticeable lump in the testes, pain in the testicles, breast tenderness, and an ache in the groin. Testicular cancer is highly curable. Treatment includes surgical removal of the testes, chemotherapy, and radiation therapy.

is no longer performed (and hasn’t been for some time). If you would like a handout created for this topic, please do not hesitate to contact our managing editor, Susan Alvare Hedman, at susan@hartmanonline.com. Thank you!

Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

Chapter Review Exam dIsTRIbuTE CHAPTER 17: EXAM

5. Describe sexual needs of the elderly Meeting the Learning Objective TEXTbooK PP. 323-324 WoRKbooK P. 98

Lecture Discuss sexual needs. Emphasize that respect and privacy are very important when encountering any sexual situation.

(APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook

Male – Manufacture sperm and the male hormone, testosterone. Female – Manufacture Review the following points about sexual needs: ova and the female hormones, estrogen and progesterone; provide environment for de• Sexual needs continue throughout a person’s life. velopment of fetus; and produce milk for the • The ability to engage in sexual activities continnCoO urM ishment of a baby after birth T E S TBANKSELLER. ues unless a disease or injury occurs. • NAs can help by providing privacy and respecting residents’ sexual needs.

Male – Prostate gland enlarges. Number and capacity of sperm decreases. Sexual response delays. It may take longer to achieve an erection and to reach orgasm. Female – Menopause occurs 12 months after a woman’s last menstrual period and ends the ability to reproduce. Decrease in production of estrogen and progesterone leads to a loss of calcium, causing brittle bones and, potentially, osteoporosis. Decrease in estrogen also makes females more prone to urinary tract infections. Vaginal walls become drier and thinner.

STIs are transmitted through sexual contact, such as sexual intercourse (vaginal and anal), contact of the mouth with the genitals or anus, and contact of the hands with the genital area.

Provide privacy and leave the area.

Pronounce and define the following key term: • Erectile dysfunction (ED) Review some things that affect sexual activity in the elderly: • Illness affecting ability to perform sexually • Erectile dysfunction • Vaginal atrophy, pain, and dryness • Fear of inadequate performance • Depression • Lack of privacy • Medications Remind students that residents are sexual beings, like all adults, and have the right to choose how they express their sexuality. Emphasize respect for the dignity and privacy of residents. We deleted the learning objective about vaginal irrigations in this edition of the textbook after hearing from customers and reviewers that the procedure

114

18 The Integumentary System 1. 2. 3. 4. 5. 6. 7.

Define important words in this chapter Explain the structure and function of the integumentary system Discuss changes in the integumentary system due to aging Discuss common disorders of the integumentary system Discuss pressure ulcers and identify guidelines for preventing pressure ulcers Explain the benefits of warm and cold applications Discuss non-sterile and sterile dressings

Supplemental Tools

1. Define important words in this chapter

TRANsPARENCy 18-1 THE INTEguMENTARy sysTEM TRANsPARENCy 18-2 PREssuRE ulCER DANgER zoNEs TRANsPARENCy 18-3 obsERVINg THE sKIN CHAPTER 18: EXAM

Assignments TEXTbooK READINg, PP. 325-344 WoRKbooK EXERCIsEs, PP. 99-102

Overview of Teaching Strategies This chapter focuses on the integumentary system. Students will learn that the skin is the largest organ in the human body, as well as learning the functions, normal changes of aging, and common disorders of the skin. Emphasis should be placed on observations; stress that NAs are in the best position to notice the early signs of skin breakdown or other problems. This chapter contains detailed information about pressure ulcers, including risk factors, signs of skin breakdown, stages of pressure ulcers, and prevention. It is a good idea at this time to show students some of the positioning devices that can help prevent pressure ulcers and to emphasize that they are much easier to prevent than to heal. The vital role of nursing assistants in this prevention should be stressed. This chapter also describes the benefits and risks of warm and cold applications. Emphasize the twenty-minute rule and the fact that moisture increases the effects of hot and cold applications.

Meeting the Learning Objective TEXTbooK PP. 325-326 WoRKbooK P. 99

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Explain the structure and function of the integumentary system Meeting the Learning Objective TEXTbooK PP. 326-327 WoRKbooK P. 99

Lecture Pronounce and define the following key terms: • Integument • Epidermis • Melanocyte • Melanin • Dermis Display Transparency 18-1 THE INTEguMENTARy sysTEM Review the following points about the integumentary system: • Natural, protective covering • Largest organ and system

115 • Covers and protects the body

• Second-degree, or partial-thickness, burns affect the dermis and cause some skin damage, redness, pain, swelling, and blistering.

• Skin is a sense organ Review the functions of the integumentary system: • Protects internal organs from injury • Protects body against bacteria • Prevents loss of too much water • Regulates body temperature • Responds to heat, cold, pain, pressure, and touch • Excretes waste products in sweat • Helps with production of vitamin D

• Third-degree, or full-thickness, burns affect the epidermis, dermis, and underlying tissue and cause serious scarring, which may affect muscle and bone; white or charred skin; pain, swelling, and peeling skin. • Very painful • May require surgery • Can cause resident’s condition to deteriorate rapidly • Offer pain medication before beginning care.

3. Discuss changes in the integumentary system due to aging Meeting the Learning Objective

• Be gentle with moving and positioning. • Report pus or other fluids around burn area or complaints of pain.

TEXTbooK PP. 327-328

Pronounce and define the following key term:

WoRKbooK P. 99

• Scabies

Lecture Review normal changes of aging: • Amount of fat and collagen decreases. • Elastic fibers lose elasticity.

Review the following points about scabies: • Cause: mites that burrow into the skin to lay eggs • Symptoms: rash, intense itching, sores that may become infected

TESTBANKSELLER.COM

• Hair and nail growth slows. • Skin becomes drier. • Skin becomes thinner and more fragile. • Protective fatty layer thins. • Hair thins and turns gray. • Brown spots may appear on the skin.

• Usually transmitted by person-to-person contact • Elderly and those with weak immune systems at higher risk

• Treatment: special lotions Pronounce and define the following key term: • Shingles Review the following points about shingles:

4. Discuss common disorders of the integumentary system

• Cause: viral infection (varicella-zoster virus, same virus that causes chickenpox) • Can occur in anyone who has had chickenpox

Meeting the Learning Objective TEXTbooK PP. 328-333

• Symptoms: begins with pain or itching where rash will appear; fever, chills

WoRKbooK P. 100

• Pain may last for many years.

Lecture Review the following points about burns and scalds: • Causes: fire, hot liquids, warm water applications, electrical equipment, hot objects, certain chemicals • First-degree, or superficial, burns affect the epidermis and cause redness and pain.

• Virus is spread when in blister form. • Keep rash covered at all times. • Treatment: medication Pronounce and define the following key terms: • Closed wound • Bruise • Open wound

116 Review the following points about wounds: • Types of open wounds: abrasion, avulsion, incision, laceration, puncture wound • A common type of closed wound is a contusion, or bruise. • Symptoms: pain, tissue damage, discoloration, bleeding, fever, chills, trouble breathing • New wounds require immediate attention. • Treatment: stopping bleeding, cleaning wound, applying dressing Pronounce and define the following key term: • Lesion Review the types of skin lesions: • Macules • Papules

• Causes: stress, allergies, family history, irritating agents in environment • Treatment: topical steroid creams, soothing or drying lotions • Report: worsening of eczema, severe itching or pain, signs of infection Pronounce and define the following key term: • Cellulitis Review the following points about cellulitis: • Caused by bacteria moving deep into the tissues due to a break in the skin • Diabetes, edema, obesity, and a weakened immune system also put a person at a higher risk for cellulitis. • Antibiotics are common treatment.

• Pustules

Pronounce and define the following key term:

• Vesicles

• Psoriasis

• Wheals

Review the following points abut psoriasis:

• Hematoma

• Chronic skin condition in which skin cells grow too fast • Purpura • Symptoms: white or silver patches on skin, itchPronounce and define the following key T teE rm S:TBANKSELLER.COM ing and discomfort, arthritis, pain • Gangrene • Causes: usually inherited; may be caused by dry climate, cold weather, stress, or weakened imReview the following points about gangrene: mune system • Means death of tissue • Caused by lack of blood flow • Must be treated immediately • Causes: burns, diabetes, injuries, circulatory disorders, weakened immune system, complications from surgery • Symptoms: discoloration of skin, sores that do not heal, pain, loss of feeling, foul-smelling discharge, chills, change in vital signs • Report elevated temperature, pulse, or respiration rate; changes in blood pressure; or difficulty breathing.

• Treatment: topical creams, shampoos, lotions, medication, phototherapy, dietary changes, and sun therapy Pronounce and define the following key term:

• Tinea Review the following points about fungal infections: • Commonly occur in moist areas of the body • Symptoms: red scaly patches, itching, rawness, pain

• Treatment: antibiotics, surgery, amputation, hospitalization

• Examples: jock itch, vaginal yeast infections, athlete’s foot, tinea

Pronounce and define the following key term:

• Causes: overgrowth of fungus due to overuse of antibiotics and reduced immune system function

• Dermatitis Review the following points about dermatitis: • Different types include atopic dermatitis (eczema) and contact dermatitis

• Treatment: topical antifungal creams, medications • Report: skin changes, skin abrasions, flaking, redness, sores, scratching

117 Pronounce and define the following key term: • Wart Review the following points about warts: • Rough, hard bump on the skin • Cause: contagious virus enters skin through cut or tear

Referring to Figure 18-9 (p. 334 in textbook), describe the four stages of pressure ulcers. Stress that each resident’s skin should be inspected every time care is provided. Discuss the unstageable stage, including three categories as described by CMS.

• Treatment: medication, removal with laser or special instrument

Display Transparency

Pronounce and define the following key term:

Review signs of skin breakdown:

• Skin cancer

• Pale, white, reddened, gray, or purple skin

Review the following points about skin cancer:

• Dry, cracked, or flaking skin

• Most serious form is malignant melanoma.

• Torn skin

• Symptoms: changes in a mole, wart, or spot on the skin, sores that do not heal, itching, pain, and skin that is oozing or bleeding.

• Blisters, bruises, or wounds on the skin

• Causes: sun exposure

• Itching or scratching

• Treatment: removing cancerous area and tissue, as well as interferon

• Swelling of skin

Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

• Broken skin anywhere on the body • Changes in existing wounds or ulcers

5. Discuss pressure ulcers and identify guidelines for preventing pressure ulcers Meeting the Learning Objective TEXTbooK PP. 333-336 WoRKbooK P. 100

Lecture Pronounce and define the following key terms: • Pressure points

18-3 obsERVINg THE sKIN

• Rashes or any discoloration • Tingling, warmth, or burning of skin

• Wet skin

List risk factors for pressure ulcers, including • Immobility • Wrinkled linens that do not lie flat • Crumbs or other irritating objects in bed • Malnutrition or dehydration • Urinary and fecal incontinence Review the guidelines for prevention of pressure ulcers: • Report changes in skin.

• Bony prominences

• Perform regular skin care and closely observe skin.

• Necrosis

• Keep skin clean and dry.

• Pressure ulcers

• Use moisturizers as ordered on unbroken skin.

Display Transparency

• Do not massage any white, red, or purple areas, bony areas, or pressure points.

18-2 PREssuRE ulCER DANgER ZoNEs Discuss the common sites for pressure ulcers illustrated on the transparency and on p. 333 in the textbook. Emphasize the importance of observation in preventing pressure ulcers and the increased risk of pressure ulcers for bedbound residents.

• Assist immobile residents to change position often, at least every two hours. • Ask residents in wheelchairs to change position at least every 15 minutes. • Avoid rubbing skin against surfaces during transfers or repositioning.

118 • Keep linens dry, clean, and wrinkle-free. • Perform ROM exercises as ordered. • Use special positioning devices. • Use pillows to separate skin surfaces. • Follow diet and fluid orders.

Have the students return each demonstration. Procedure checklists are located at the end of the Student Workbook. Emphasize that these procedures should only be performed if allowed by the facility and if the NA is trained to perform the procedure.

6. Explain the benefits of warm and cold applications

Lecture Review the following points about cooling or tepid sponge baths:

Meeting the Learning Objective

• Can reduce body temperature

TEXTbooK PP. 336-342 WoRKbooK PP. 100-101

Lecture Discuss the following points: • Heat relieves pain and muscular tension, decreases swelling, elevates temperature in the tissues, increases waste removal, and brings more oxygen and nutrients to tissues for healing.

• Check vital signs prior to the bath and during the procedure at specific intervals. • Possible complications include chills, shivering, sudden change in vital signs, or breathing problems. Remind students that warm or cold applications should be limited to 20 minutes at a time.

7. Discuss non-sterile and sterile dressings • Cold helps stop bleeding, minimizes swelling, reduces pain, and brings down high temperatures. Meeting the Learning Objective • Moisture strengthens the effect of heat and cold. TEXTbooK PP. 342-344 • Observe for excessive redness, pain, bliT stE erS s,ToB r ANKSELLER.COM WoRKbooK PP. 101-102 numbness Pronounce and define the following key term: • Sitz bath Explain to students that sitz baths cause circulation to be increased to the pelvic area, which means blood flow to other parts of the body decreases. Residents may feel weak, faint, or dizzy after a sitz bath. Stop the bath if the resident complains of feeling dizzy or faint. Sitz baths may cause the urge to void. Always wear gloves when helping with a sitz bath. Demonstration If your facility allows, demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Applying warm moist compresses • Administering warm soaks

Lecture Review the following points about sterile and nonsterile dressings: • Open wounds increase risk of infection. • Non-sterile dressings are applied to wounds that have less chance of infection. • Sterile dressings are required when the wound is new, open, or draining, or when there is a higher risk of infection. Demonstration Demonstrate procedure Assisting the nurse with changing a non-sterile dressing. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Applying an Aquamatic K-Pad • Assisting with a sitz bath • Applying ice packs

Lecture Review the following points about sterile dressing care: • Sterile field is created.

119 • Supplies that are considered sterile: sterile dressings, sterile drapes or pads, tubing, and catheters. • If any part of the sterile field becomes contaminated, the entire process must be restarted.

ous scarring, which may affect muscle and bone; white or charred skin; pain, swelling, and peeling skin. 4.

By direct person-to-person contact

Non-sterile dressings are applied to wounds that have less chance of infection. Sterile dressings are required when the wound is new, open, or draining, or when there is higher risk of infection.

Demonstration Demonstrate procedure Applying sterile gloves. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

Chapter Review Exam dIsTRIbuTE CHAPTER 18: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: protects internal organs from injury; protects body against bacteria; prevents loss of too much water; regulates body temperature; responds to heat, cold, pain, pressure, and touch; excretes waste products in sweat; and helps with production of vitamin D.

Answers include the following: Amount of fat and collagen decreases. Elastic fibers lose elasticity. Hair and nail growth slows. Skin becomes drier. Skin becomes thinner and more fragile. Protective fatty layer thins. Hair thins and turns gray. Brown spots may appear on the skin.

First-degree (superficial) burns affect the epidermis and cause redness and pain. Seconddegree (partial-thickness) burns affect the dermis and cause some skin damage, redness, pain, swelling, and blistering. Third-degree (full-thickness) burns affect the epidermis, dermis, and underlying tissue and cause seri-

120

19 The Circulatory or Cardiovascular System 1. 2. 3. 4.

Define important words in this chapter Explain the structure and function of the circulatory system Discuss changes in the circulatory system due to aging Discuss common disorders of the circulatory system

Supplemental Tools TRANsPARENCy 19-1 THE CIRCulAToRy sysTEM

Lecture Pronounce and define the following key terms:

CHAPTER 19: EXAM

• Heart • Atria

Assignments

• Ventricles

TEXTbooK READINg, PP. 345-356

• Systole

WoRKbooK EXERCIsEs, PP. 103-104

• Diastole

• Artery Overview of Teaching Strategies • Capillaries This chapter focuses on the circulatory system. Students will learn about the function of the heart • Veins and the composition and functions of the blood. Display Transparency Normal changes of aging are described so that T E S T B ANKSE LLER.COM students will be well-prepared to recognize abnor19-1 THE CIRCulAToRy sysTEM mal changes that may signal a problem. It should be emphasized that nursing assistants can help Review the following points about the circulatory residents maintain health by promoting a healthy system: lifestyle and diet. • Made up of heart, blood vessels, and blood

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 345-346 WoRKbooK P. 103

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Explain the structure and function of the circulatory system Meeting the Learning Objective TEXTbooK PP. 346-348 WoRKbooK P. 103

• White blood cells protect the body from bacteria, viruses, and other foreign substances. • Plasma, the liquid portion of the blood, carries nutrients, waste products, hormones, salts, antibodies, and the substance necessary for blood to clot. Review the function of the heart: • Pumps blood through blood vessels to every cell in the body Review the functions of the blood: • Transports oxygen, nutrients, hormones, salts, and antibodies to cells • Removes carbon dioxide and other waste products from the cells • Controls pH level and body temperature • Clots and fights pathogens and poisons

121 3. Discuss changes in the circulatory system due to aging

• Unstable angina

Meeting the Learning Objective

Review the following points about CAD:

TEXTbooK P. 348 WoRKbooK P. 103

Lecture Review normal changes of aging:

• Nitroglycerin • Cause: vessels in coronary arteries narrow after build-up of arterial plaque, reducing blood to heart • Symptom: angina pectoris Review care guidelines for angina:

• Heart pumps less efficiently.

• Reduce stress.

• Blood vessels narrow. • Blood vessels become less elastic.

• Notify the nurse immediately if the resident needs help taking his prescribed medication.

• Blood flow decreases.

• Make sure residents get enough rest. • Resident should avoid big meals.

4. Discuss common disorders of the circulatory system Meeting the Learning Objective

• Encourage resident to follow exercise plan. • Resident may need to avoid hot, humid weather. • Encourage residents who are quitting smoking.

TEXTbooK PP. 348-356

Pronounce and define the following key term:

WoRKbooK P. 104

• Cardiomyopathy

Review the following points about cardiomyopathy: Lecture • Causes: CAD, heart muscle that no longer Pronounce and define the followinT gE keSyTteBrm s:KSELLE AN R.COM pumps effectively, virus, diabetes, thyroid prob• Occlusion lems, drug and alcohol use, birth defect, or • Ischemia unknown cause Review the following points about hypertension:

• Most common reason for heart transplants

• Causes: hardening and narrowing of blood vessels, kidney disease, adrenal tumors, pregnancy, stress, pain, or medication

Review the following points about myocardial infarctions (MIs):

• Prehyptertension means that a person does not have hypertension now, but is likely to in the future.

• Cause: block of blood flow to heart muscle • Chapter 8 of textbook has warning signs of MI. Review the components of cardiac rehabilitation:

• Symptoms: headache, blurred vision, dizziness

• Low-cholesterol, low-fat, low-sodium diet

• Can lead to MI, CVA, kidney disease, or blindness

• Regular exercise program

• Treatment: medication, including diuretics; exercise program; diet; stopping smoking; lowering stress levels

• Blood testing

Lecture Pronounce and define the following key terms: • Coronary artery disease (CAD) • Myocardial ischemia • Angina pectoris • Stable angina

• Medication to regulate heart rate and blood pressure • Stopping smoking • Avoidance of cold temperatures • Stress management program Pronounce and define the following key terms: • Peripheral vascular disease (PVD) • Phlebitis • Anti-embolic stockings

122 Review the following points about PVD: • Causes: build-up of arterial plaque over time, reduction in cardiac output, phlebitis • Most common type is peripheral arterial disease (PAD). • Symptoms: cramping in hips, thighs, legs, or calves; cyanotic hands or feet; bluish nailbeds; arms and/or legs that are cool to the touch; edema in hands or feet; ulcers on legs or feet; or gangrene • Report: complaints of pain or change in hands, legs or feet; change in vital signs; increased edema; weight gain; I&O change; headache; inability to see clearly; discomfort in head, neck, jaw, shoulder, chest, or back; disorientation; or dizziness, or confusion • Treatment: fluid restrictions or special diets, quitting smoking, anti-embolic stockings

• Symptoms associated with each side of the heart: Left-sided failure: fatigue, orthopnea, coughing, rapid pulse, and weight gain Right-sided failure: fatigue, weakness, edema of the extremities (especially the ankles), bulging neck veins, irregular heartbeat, and fainting • Treatment: medication, care plan that includes rest Review care guidelines for CHF: • Follow orders for activity and exercise. • Measure daily weight and I&O. • Encourage resident to follow fluid and diet orders. • Use special stockings as ordered. • Provide extra pillows in bed. • Assist with ADLs.

• Assist with ROM exercises. • Report changes in activity level; fatigue; dizziDemonstration ness, confusion, or fainting; increased respiraDemonstrate procedure Applying knee-high elastic tory rate, pulse, or blood pressure; irregular stockings. Include all of the numbered steps in your heartbeat; palpitations; chest tightness or chest demonstration. pain; dyspnea; coughing; wheezing; lack of appeHave the students return the demonstration. TBANKSEtL iteL; E abRd. om al swelling or pain; edema; bulging CiOnM TES Procedure checklists are located at the end of the neck veins; weight gain from fluid retention; and Student Workbook. change in urinary output. Lecture Pronounce and define the following key term:

Lecture Pronounce and define the following terms:

• Sequential compression device (SCD)

• Pulmonary edema

Review the following points about SCDs:

Review these points about pulmonary edema:

• Used to improve circulation and prevent blood clots

• Cause: buildup of fluid in the lungs

• Report damaged equipment to nurse

• Symptoms: shortness of breath; wheezing; coughing; gurgling when breathing; anxiety; restlessness

Pronounce and define the following key terms:

• Emergency treatment is necessary.

• Congestive heart failure (CHF)

Pronounce and define the following key terms:

• Orthopnea

• Anemia

Review the following points about CHF:

• Hypoxia

• Applied during or after surgery

• Cause: failure of heart muscle to pump effectively due to damage

Review the following points about anemia:

• Symptoms: fatigue, reduction in ability to be active, dyspnea, orthopnea, increased pulse, irregular heartbeat, chest pain, dizziness, confusion, weight gain, lack of appetite, edema, abdominal distention or pain, increased urination

• Symptoms: fatigue, weakness, pale skin, problems with the tongue, brittle nails, difficulty concentrating

• Cause: amount of red blood cells or hemoglobin in the body is less than normal

123 • Treatment for iron-deficiency anemia: diet of foods rich in iron, vitamins, iron supplements, and methods to treat constipation that may occur Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

Chapter Review Exam dIsTRIbuTE CHAPTER 19: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: transports oxygen, food, and hormones to cells; removes carbon dioxide and other waste products from the cells; controls pH level and y tBem peKraS- ture; and clots TbEoSdT AN the blood and fights pathogens and poisons.

Answers include the following: Heart pumps less efficiently. Blood vessels narrow. Blood vessels become less elastic. Blood flow decreases.

Answers include the following: medication, diuretics, exercise programs, special diet, stopping smoking, and lowering stress level.

Angina is usually described as intense pressure in the chest, a tightness in the chest, or pain in the back, neck, jaw, or shoulder.

Answers include the following: fatigue, weakness, pale skin, problems with the tongue, brittle nails, and difficulty concentrating.

124

20 The Respiratory System 1. 2. 3. 4. 5. 6. 7.

Define important words in this chapter Explain the structure and function of the respiratory system Discuss changes in the respiratory system due to aging Discuss common disorders of the respiratory system Describe oxygen delivery Describe how to collect a sputum specimen Describe the benefits of deep breathing exercises

Supplemental Tools TRANsPARENCy 20-1 THE REsPIRAToRy sysTEM

2. Explain the structure and function of the respiratory system

HANDouT 20-1 oXygEN THERAPy usINg A HuMIDIFICATIoN DEVICE

Meeting the Learning Objective

CHAPTER 20: EXAM

TEXTbooK PP. 358-359 WoRKbooK P. 105

Assignments TEXTbooK READINg, PP. 357-368 WoRKbooK EXERCIsEs, PP. 105-107 Overview of Teaching Strategies This chapter focuses on the respiratory system. The structure and function of the respiratory system is described. Normal changes of aging are described so that students will be well-prepared to recognize abnormal changes that may signal a problem. Specific disorders of the respiratory system are addressed. Explain the need for empathy for residents who have difficulty breathing, along with the importance of taking all medication prescribed for respiratory illnesses.

Lecture Pronounce and define the following key terms: • Trachea • Bronchi • Alveoli • Lungs • Inspiration • Expiration • Respiration Display Transparency 20-1 THE REsPIRAToRy sysTEM

1. Define important words in this chapter

Review the following points about the respiratory system:

Meeting the Learning Objective

• The epiglottis shuts off the larynx during the swallowing process.

TEXTbooK PP. 357-358

• The larynx enables humans to speak.

WoRKbooK P. 105

• Respiration, the body’s taking in of oxygen and removing of carbon dioxide, involves inspiration (breathing in) and expiration (breathing out).

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

Review the functions of the respiratory system: • Serves as an air filter, cleaning inhaled air • Supplies oxygen to body cells

125 • Removes carbon dioxide from cells • Produces the sounds associated with speech

3. Discuss changes in the respiratory system due to aging Meeting the Learning Objective

• Treatment of chronic bronchitis: reducing triggers, quitting smoking, medications • Symptoms of emphysema: shortness of breath, coughing, difficulty breathing • Treatment for emphysema: providing comfort, relieving symptoms, quitting smoking, oxygen, medication, respiratory therapy

TEXTbooK P. 359

Review the general symptoms of COPD:

WoRKbooK PP. 105-106

• Coughing or wheezing • Dyspnea

Lecture Review normal changes of aging:

• Shortness of breath • Chest pain or tightness

• Lung strength decreases. • Alveoli become less elastic and decrease in number.

• Cyanosis • Weakness

• Airways become stiff and less elastic.

• Weight loss or loss of appetite

• Lung capacity decreases.

• Fear and anxiety

• Chest muscles become weaker.

• Confusion

• Cough reflex becomes less effective and cough becomes weaker.

Review care guidelines for COPD:

• Oxygen in the blood decreases. • Decreased lung capacity causes voice to weaken.

• Be supportive, calm, and empathetic. • Use pillows to help residents sit up or lean forward.

TESTBANKSELLE R.COM • Be supportive of residents who are quitting

4. Discuss common disorders of the respiratory system

smoking. • Offer fluids and encourage healthy diet. • Encourage rest.

Meeting the Learning Objective

• Use proper infection prevention practices.

TEXTbooK PP. 359-363

• Report signs of colds or flu immediately.

WoRKbooK P. 106

• Residents must take medication as ordered.

Lecture Pronounce and define the following key terms:

• Follow safety guidelines for oxygen therapy.

• Emphysema

• Report change in breathing patterns, especially shortness of breath, change in color or consistency of mucus or sputum, chest pain, fever, refusal to take ordered medications, inability to sleep due to anxiety or fear, and confusion or changes in mental state.

Review the following points about COPD:

Pronounce and define the following key term:

• Cause: obstruction of airways

• Asthma

• Includes chronic bronchitis and emphysema

Review the following points about asthma:

• Chronic bronchitis occurs when lining of the bronchial tubes becomes inflamed, causing scarring.

• Chronic, episodic disorder in which irritants, allergens, infections and cold air cause inflammation and swelling in the air passages in the lungs

• Symptoms of chronic bronchitis: excessive mucus production, long-lasting cough

• Can be worsened by exercise or stress

• Chronic obstructive pulmonary disease (COPD) • Bronchitis • Sputum

126 • Symptoms: heavy wheezing, coughing, tight feeling in chest

• Cause: bacterium that is carried on mucous droplets suspended in the air

• Treatment: medication, avoidance of triggers, reducing stress levels

• Can be spread by infected person coughing, breathing, singing, sneezing, or laughing

• Report: changes in vital signs, especially respiratory rate; wheezing, shortness of breath or dyspnea; cyanosis; chest pain or tightness; refusal to use inhaler

• Symptoms: fatigue, loss of appetite, weight loss, slight fever and chills, night sweats, prolonged coughing, hemoptysis, chest pain, shortness of breath, dyspnea

• Chest percussion

• MDR-TB is caused by an organism that is resistant to medication that is used to treat TB and may develop when a person infected with TB does not take all of his prescribed medication.

Review the following points about bronchiectasis:

Review care guidelines for tuberculosis:

• Condition in which the bronchi become permanently dilated

• Follow Standard Precautions and Airborne Precautions.

• Causes: infection of the airways, cystic fibrosis, presence of tumors, inhaling foreign material

• Wear PPE.

Pronounce and define the following key terms: • Bronchiectasis

• Symptoms: chronic coughing, shortness of breath, wheezing, weight loss, cyanosis, coughing up blood, respiratory infections, halitosis

• Keep doors to AIIRs closed except when entering or exiting the room. When entering the room, do not open or close the door rapidly. • Be careful when handling sputum.

• Treatment: postural drainage, chest percussion • Report: fever, chest pain, change in mucus or phlegm production

• Resident must take all of the medication prescribed.

Pronounce and define the following key term:

more information. Discuss the risk obesity poses for certain diseases or disorders.

usMe the online resources to locate TESTBANKSSEtuLdLenEtsRc.anCO

• Pneumonia Review the following points about pneumonia: • Inflammation of the lungs • Causes: viral, bacterial, or fungal infection; chemical irritants • Two types are healthcare-associated pneumonia and ventilator-associated event (VAE)

5. Describe oxygen delivery Meeting the Learning Objective TEXTbooK PP. 363-365 WoRKbooK PP. 106-107

• Symptoms: high fever, chest pain, coughing, difficulty breathing, shortness of breath, chills, rapid pulse, thick secretions coughed up from the lungs

Lecture Pronounce and define the following key term:

• Treatment: antibiotics and other medication, inhaler, special diet, increased fluid intake

Review methods of oxygen delivery:

• Report if resident is not taking medication.

• Compressed oxygen in cylinders

Pronounce and define the following key terms:

• Liquid oxygen in special reservoirs

• Tuberculosis

• Oxygen concentrators

• Hemoptysis • Multidrug-resistant TB (MDR-TB)

Remind students that oxygen is a drug and cannot be applied or adjusted by nursing assistants.

Review the following points about tuberculosis:

Review care guidelines for residents using oxygen:

• Highly contagious disease

• Perform frequent skin care.

• Oxygen therapy • Piped into room through wall outlet at facility

127 • Observe for redness, sores, bruising, or discomfort in ear, nose, mouth, or chin area. • Lubricate sensitive areas; however, do not use petroleum-based lubricants. • Check device for fit and comfort. • Check vital signs as ordered. • Notify nurse if equipment does not seem to be working.

Demonstration Demonstrate procedure Collecting a sputum specimen. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Make sure that portable oxygen tanks are always in an upright position and in a proper oxygen cylinder holder when in use or when stored.

7. Describe the benefits of deep breathing exercises

• Post No Smoking and Oxygen in Use signs.

Meeting the Learning Objective

• Know location of fire alarms and extinguishers.

TEXTbooK PP. 366-368

• Add pillows as needed to improve breathing.

WoRKbooK P. 107

• Encourage activity. • Provide emotional support. • Report sores or crusts on nasal area, dry or reddened areas on the skin, discomfort or pain, shortness of breath, changes in vital signs, cyanosis, and chest pain or tightness.

Lecture Review the following points about deep breathing exercises: • Help expand the lungs, clear them of mucus, and prevent infections

• The care plan may include using an incentive spirometer. Distribute Optional Handout • Do not assist with these exercises if you have not 20-1 oXygEN THERAPy usINg A HuMIDIFICATIoN TESTBANKSELLER be.eC nO traMined to do so. dEVICE • Do not share incentive spirometers between If this procedure is taught at your facility, review residents. the information on the handout with students. • Make sure you and the resident wash hands prior

6. Describe how to collect a sputum specimen

to using the spirometer. Don gloves before assisting with this procedure. • Encourage, but do not force, the resident to use the incentive spirometer.

Meeting the Learning Objective TEXTbooK PP. 365-366 WoRKbooK P. 107

Lecture Review the following points about collecting a sputum specimen: • Sputum is mucus that comes from inside the respiratory system.

Demonstration Demonstrate procedure Assisting with deep breathing and coughing exercises. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Sputum may show evidence of cancer or bacteria.

Chapter Review

• Some facilities do not allow nursing assistants to collect sputum specimens; always follow facility policy.

Exam

• Early morning is the best time to collect sputum. • Resident should rinse mouth with water but not with mouthwash before specimen collection.

dIsTRIbuTE CHAPTER 20: EXAM (APPENDIX C)

128 Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: serves as an air filter, cleaning inhaled air; supplies oxygen to body cells; removes carbon dioxide from cells; and produces the sounds associated with speech.

Answers include the following: Lung strength decreases. Alveoli become less elastic and decrease in number. Airways become stiff and less elastic. Lung capacity decreases. Rib cage changes and chest muscles become weaker. Cough reflex becomes less effective and cough becomes weaker. Oxygen in the blood decreases. Decreased lung capacity causes voice to weaken.

COPD causes difficulty breathing. Residents may be fearful about not being able to breathe.

Someone with latent TB infection caTrrEieS sT thBe disease but does not show symptoms and cannot infect others. A person with TB disease shows symptoms of the disease and can spread TB to others.

When the full course of proper medication is not taken, bacteria that is resistant to medication remains in the body. This means that this bacteria is less likely to be killed by medication used to treat TB. The disease then becomes more difficult to cure.

Being paralyzed or having had abdominal surgery are two conditions that can require deep breathing exercises.

129

21 The Musculoskeletal System 1. 2. 3. 4. 5.

Define important words in this chapter Explain the structure and function of the musculoskeletal system Discuss changes in the musculoskeletal system due to aging Discuss common disorders of the musculoskeletal system Describe elastic bandages

Supplemental Tools

Meeting the Learning Objective

TRANsPARENCy 21-1 THE MusCulosKELETAL sysTEM

TEXTbooK PP. 370-372

HANDouT 21-1 APPLyINg AN ELAsTIC bANDAgE

WoRKbooK PP. 109-110

CHAPTER 21: EXAM

Assignments

Lecture Pronounce and define the following key terms:

TEXTbooK READINg, PP. 369-383

• Muscles

WoRKbooK EXERCIsEs, PP. 109-112

• Bones • Joints

Overview of Teaching Strategies This chapter focuses on the musculoskeletal system. Types and functions of musclT esE, S boTnB esA, N anKd joints are explained. Normal changes of aging are described so that students will be well-prepared to recognize abnormal changes that may signal a problem. Specific disorders of the musculoskeletal system are addressed. Emphasis is placed on maintaining resident independence and mobility. The physical and psychological effects of falls are discussed, as well as how to prevent them.

• Cartilage • Bursae • Tendons • Ligaments Display Transparency 21-1 THE MusCulosKELETAL sysTEM Discuss the three types of muscles: • Skeletal muscles • Smooth muscles

1. Define important words in this chapter

• Cardiac muscle

Meeting the Learning Objective

Discuss the four types of bones:

TEXTbooK PP. 369-370

• Long bones

WoRKbooK P. 109

• Short bones

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

• Flat bones • Irregular bones Discuss the three types of joints: • Immovable joints

2. Explain the structure and function of the musculoskeletal system

• Slightly movable joints • Movable joints

130 Review the functions of the musculoskeletal system:

• Symptoms: muscle weakness, stiffness, twitching of the hands and arms

• Gives shape and form to the body

• Cause: specific gene in the body

• Maintains posture

• Generally appears at birth or during childhood

• Permits movement

• There is currently no cure.

• Protects internal organs

Review care guidelines for muscular dystrophy:

• Stores calcium and phosphorus • Produces heat • Produces some blood cells

3. Discuss changes in the musculoskeletal system due to aging

• Allow time for movement. • Give frequent skin care to prevent pressure ulcers. • Reposition residents often to prevent contractures. • Perform ROM exercises as directed. • Assist with ADLs. Encourage independence.

Meeting the Learning Objective TEXTbooK P. 372 WoRKbooK P. 110

Lecture Review normal changes of aging:

• Report red skin; pale skin; signs of the beginning of a pressure ulcer; stiffening of muscles; pain, swelling, or burning in a leg; swallowing problems; symptoms of UTI; constipation; signs of pneumonia; shortness of breath; or changes in blood pressure or pulse rate.

• Muscles weaken and lose tone.

Pronounce and define the following key terms: • Bones lose calcium, causing them to become • Osteoporosis porous and brittle. TESTBANKS•EOLsLteEopRe.niCa OM • Height is gradually lost due to shrinkage of space between the vertebrae in the spine. Review the following points about osteoporosis: • Loss of muscle mass in the body causes weight loss. • Joints are less flexible and stiffer, which slows normal body movements and decreases range of motion.

4. Discuss common disorders of the musculoskeletal system Meeting the Learning Objective TEXTbooK PP. 372-382 WoRKbooK PP. 110-111

• Bones lose mass, causing them to become brittle. • Causes: lack of calcium in diet, loss of estrogen, lack of regular exercise, reduced mobility, age • More common in women, especially after menopause • Symptoms: low back pain, loss of height, fractures, stooped posture • Treatment: medication, exercise, calcium supplements • Be patient and reposition residents carefully. • Report any decline in activity or movement. Pronounce and define the following key terms:

Lecture Pronounce and define the following key terms:

• Arthritis

• Muscular dystrophy

• Rheumatoid arthritis

• Atrophy

• Osteoarthritis

Review the following points about arthritis:

Review the following points about muscular dystrophy:

• General term for inflammation of joints that cause pain, stiffness, and swelling

• Hereditary, progressive disease in which muscle tissue is destroyed and muscles atrophy

• May cause decreased mobility

131 Review the following points about osteoarthritis: • Condition in which cartilage between bones and the pads at the ends of bones begins to erode. • Symptoms: pain, redness, swelling, stiffness, limited motion

• Symptoms: tissue around joint may become painful, swollen, and tender • Treatment: application of ice, immobilization to rest joint, medication, removal of fluid from joint, and cortisone injections

• Generally occurs due to aging and may be due to joint injury

Pronounce and define the following key terms:

• Cold, damp weather can increase pain and stiffness.

• Prosthesis

Review the following points about rheumatoid arthritis: • Form of arthritis that may become crippling

• Amputation • Phantom sensation • Phantom limb pain • Flexion

• Symptoms: stiffness, swelling, severe pain, deformities which may be severe and disabling, fever, fatigue, weight loss

Review the following points about amputations:

• Cause: autoimmune illness

• Person may have prosthesis or transplant.

• Treatment: rest, controlled exercise, ROM exercises, medication, weight loss, heat applications, joint replacement Review the care guidelines for arthritis:

• Surgical removal of an extremity • Causes: disease, cancer, injury, accidents

Emphasize to students that phantom sensation, phantom limb pain, and stump pain are real and should not be ignored or ridiculed.

Review guidelines for amputation and prosthesis • Assist with exercise program. care: • Perform ROM exercises as directed. •R Be.cCaO reM ful when handling prostheses. TESTBANKSELLE • Let nurse know, before exercise, if pain medica• Condition in which bursae become inflamed tion is needed. • Assist with ADLs as needed. • Encourage use of handrails and safety bars in bathroom. • Be positive and supportive; listen if resident wants to talk. • Report pain, stiffness, swelling, reduced ability to perform ROM exercises, or decline in activity. Review the following points about fibromyalgia: • FMS has no definitive cause, but can occur following surgery, infection, or extreme stress. • Symptoms: widespread pain, fatigue, sleep disturbances, problems with thinking and memory, and depression • Cannot be cured • Treatment: medications, exercises, and some complementary and alternative therapies Pronounce and define the following key term: • Bursitis Review the following points about bursitis:

• Follow instructions to apply or remove prostheses. • Apply special compression bandages and/or stump shrinkers as ordered. • Change socks often and place sock seams facing outside to prevent abrasions. • Give regular, careful skin care to avoid complications with the stump and the prosthesis. • Bathe and rinse the stump. • Clean and dry the socket of the prosthesis when it is removed. • Before applying a prosthesis, make sure the area is completely dry. • Do not react negatively to the stump or the prosthesis during care. • Follow orders for bed elevation or positioning. • Follow orders for positioning of the leg. • Assist with ADLs. • Encourage activity. • Perform range of motion exercises as directed. • Physical therapists will assist resident in learning to bear weight on prosthesis.

132 • Provide support for phantom pain, phantom sensation, or stump pain. The pain or sensation is real and should be treated that way. • Be supportive during process of adjustment. • Report redness or swelling; drainage, bleeding, or sores; stump pain, phantom pain, or phantom sensation; reduced ability to move extremity; cyanosis; or problems with the prosthesis. Pronounce and define the following key terms: • Fracture • Sling

• Elevation: Elevating the extremity also helps prevent or reduce swelling. When an extremity is elevated above the level of the heart, swelling may decrease. Review guidelines for cast care: • Pad cast edges as needed. • Do not get cast wet. • Keep cast clean. • Follow orders on moving and repositioning. • Extremity may need to be elevated. • Help with ROM exercises as ordered.

Review the following points about fractures:

• Allow time for movement.

• A fracture is a broken bone.

• Assist with use of cane, walker, or crutches.

• Causes: trauma or accidents; falling is a common cause

• Use bed cradles to reduce pressure from bed linens.

• Symptoms: pain, swelling, bruising

• Report numbness, tingling, or increased swelling; complaints that cast feels too tight; pain, burning, or pressure; redness, drainage, bleed• Treatment: bone must be set and allowed to heal ing, or sores of any kind; wetness in or around a in normal alignment cast; odor around the cast; changes in tempera• Can take four to eight weeks to heal; longer in ture of the skin (hot or cold skin); cyanosis or elderly people pale skin; or if resident places sharp object inside heLcE asRt..COM TESTBANKSEtL Review the types of fractures: • Generally diagnosed with X-ray or MRI scan

• Closed or simple fracture

Pronounce and define the following key terms:

• Hairline fracture

• Total hip replacement (THR)

• Open or compound fracture

• Partial weight-bearing (PWB)

• Greenstick fracture

• Non-weight-bearing (NWB)

• Comminuted fracture

• Full weight-bearing (FWB)

• Compression fracture

• Abduction

• Pathologic fracture

• Adduction

If needed, explain the acronym RICE as a way to reduce pain, swelling, and further injury until emergency help arrives. The acronym stands for rest, ice, compression, and elevation:

Review guidelines for total hip replacement (THR): • Follow care plan exactly.

• Rest: Rest is important to help an injury heal properly. Putting any weight on the injury could cause more harm.

• Never perform ROM exercises on side of hip replacement without orders from nurse.

• Follow orders regarding positioning and elevation of head of bed.

• Ice: Ice helps to prevent or reduce swelling. The skin should always be protected when using ice.

• Caution resident not to cross legs.

• Compression: As you have learned, elastic bandages are used to compress the injured area, hold the extremity in place, and reduce discomfort. In addition, elastic bandages help decrease tissue swelling that occurs with an injury.

• Apply anti-embolic stockings as ordered.

• Assist with dressing, starting with weaker side. • Use adaptive devices. • Ask resident to use handrails in shower. • Ask nurse for pain medication prior to moving and positioning.

133 • Assist with coughing and deep breathing exercises.

• Do not disconnect traction assembly or adjust the weights.

• Encourage fluids.

• Keep resident in proper body alignment.

• Never rush resident.

• Report numbness or tingling; pain, burning, pressure, swelling; redness, drainage, bleeding, or sores; wetness on sling; odor around sling or boot; changes in skin temperature; cyanosis or pale skin; resident moving to the side or sliding down in bed; or sling or boot loosening or coming off or weights coming off, touching the floor, or moving.

• Keep often-used items in easy reach. • Report incisions that are red, draining, bleeding or warm; increase in pain; fever or other change in vital signs; numbness or tingling; edema (swelling) of the legs; cyanosis or pale skin; problems with appetite; constipation; or if resident is not following the doctor’s orders for exercise and activity. Pronounce and define the following key term: • Total knee replacement (TKR)

Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

5. Describe elastic bandages

Review care guidelines for total knee replacement: • Apply special stockings to prevent blood clots. • Do not perform special exercises unless trained and ordered. • Assist with coughing and deep breathing exercises as ordered. • Encourage fluids. • Ask nurse for pain medication prior to moving and positioning.

Meeting the Learning Objective TEXTbooK PP. 382-383 WoRKbooK P. 112

Lecture Review the following points about elastic bandages: • Bandages that are wrapped around a body part

TESTBANKSELLE •R U. seC dO toMkeep dressings in place, hold splints in

• Report incisions that are red, draining, bleeding or warm; an increase in pain or a burning sensation, especially on the operated side or in the calves; fever or other change in vital signs; numbness or tingling; edema (swelling) of the legs; cyanosis or pale skin; problems with appetite; constipation; resident not following the doctor’s orders for exercise and activity; or reduced mobility in the extremity. Review the following points about continuous passive motion (CPM) machines: • May be used for people who have had TKR • Moves joint through normal range of motion

place, and provide protection, compression and support for body parts, decrease swelling from injuries and hold ice in place • Must be snug enough to provide proper compression and support but not interfere with circulation • Report numbness or tingling; resident complaints of the bandage feeling too tight; swelling; indentation marks on the skin; pain or discomfort; skin that is cold to the touch; or pale, gray, cyanotic, or white skin. Optional Handout 21-1 APPLyINg AN ELAsTIC bANDAgE

• Notify nurse if the resident complains of pain or discomfort or if the extremity moves out of the proper position.

If taught at your facility, you can review the procedure for applying elastic bandages.

Discuss the following points about traction:

Chapter Review

• Method of treating fractures that keeps bones in place • Uses weights and pulleys to keep bones in proper position

Exam dIsTRIbuTE CHAPTER 21: EXAM (APPENDIX C)

134 Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Skeletal muscles, smooth muscles, and cardiac muscle

Bones lend support to body structures, allow the body to move, and protect the organs.

Answers include the following: Muscles weaken and lose tone. Bones lose calcium, causing them to become porous and brittle. Height is gradually lost due to space between the vertebrae in the spine shrinking. Loss of muscle mass in the body causes weight loss. Joints are less flexible and stiffer, which slows normal body movements and decreases range of motion.

It wastes away, decreases in size, and weakens.

They can easily break.

Falls contribute to many physical injuries and can have psychological consequences as well.

Answers include the following: numbness or tingling; complaints of the bandage feeling too tight; swelling; indentation marks on the skin; pain or discomfort; skin that is cold to the touch; or pale, gray, cyanotic, or white skin.

TESTB

10. C 11. D

135

22 The Nervous System 1. Define important words in this chapter 2. Explain the structure and function of the nervous system 3. Discuss changes in the nervous system due to aging 4. Discuss common disorders of the nervous system 5. Discuss dementia and related terms 6. Discuss Alzheimer’s disease and identify its stages 7. List strategies for better communication with residents with Alzheimer’s disease 8. Identify personal attitudes helpful in caring for residents with Alzheimer’s disease 9. Describe guidelines for problems with common activities of daily living (ADLs) 10. Describe interventions for common difficult behaviors related to Alzheimer’s disease 11. Discuss ways to provide activities for residents with Alzheimer’s disease 12. Describe therapies for residents with Alzheimer’s disease 13. Discuss mental health, mental illness, and related disorders 14. Discuss substance abuse and list signs of substance abuse to report Supplemental Tools

1. Define important words in this chapter

TRANsPARENCy 22-1 THE NERVous sysTEM TRANsPARENCy 22-2 PARTs oF THE EyE TRANsPARENCy 22-3 PARTs oF THE EAR CHAPTER 22: EXAM

Assignments TEXTbooK READINg, PP. 384-419

Meeting the Learning Objective TEXTbooK PP. 384-386 WoRKbooK P. 113

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

WoRKbooK EXERCIsEs, PP. 113-121

Overview of Teaching Strategies This chapter focuses on the nervous system. Students will learn about the structure and function of the nervous system, including the sense organs. Disorders of the nervous system are described, with stress on empathy for residents and effective communication. There is detailed information on Alzheimer’s disease, including guidelines for communication and assistance with ADLs, and interventions for difficult behaviors that often occur with Alzheimer’s disease. Information about care of residents with mental illness is also included, as well as signs of substance abuse.

2. Explain the structure and function of the nervous system Meeting the Learning Objective TEXTbooK PP. 386-389 WoRKbooK P. 113

Lecture Pronounce and define the following key terms: • Neuron • Central nervous system • Peripheral nervous system • Brain • Spinal cord

136 Display Transparency 22-1 THE NERVous sysTEM Explain that the two main parts of the nervous system are the central nervous system (CNS) and the peripheral nervous system (PNS). Review the following points about the central nervous system:

Review the parts of the ear listed on the transparency and the functions of each: • Outer ear • Middle ear • Inner ear • Eardrum • Ossicles

• Consists of the brain and spinal cord

Review the functions of the nervous system:

• The brain controls speech, motor and sensory activity, intelligence, reasoning, coordination, reflexes, breathing, emotions, and heart rate.

• Controls and coordinates mental processes and voluntary movements

• The spinal cord conducts messages between the brain and the body within its pathways. Review the following points about the peripheral nervous system: • Consists of the cranial and spinal nerves • Nerves carry messages to and from the brain from the rest of the body. • The somatic nervous system (SNS) helps with conscious movement of the skeletal system. • The two parts of the autonomic nervous system (ANS) conserve body’s energy and provT idEeS foTr relaxation of the body and activate the body’s fight-or-flight response. Review the following points about the sense organs: • Consist of the skin, tongue, nose, eyes, and ears • Receive impulses from the environment and relay these impulses to the brain Display Transparency

• Provides reflex centers of heartbeat and respiration • Senses and responds to changes occurring both inside and outside of the body

3. Discuss changes in the nervous system due to aging Meeting the Learning Objective TEXTbooK P. 389 WoRKbooK P. 113

Lecture Review normal changes of aging: • Responses and reflexes slow. • Some memory loss occurs, especially short-term memory loss. • Sensitivity of nerve endings in skin decreases, resulting in diminished sense of touch. • Some hearing loss occurs. • Senses of vision, smell, and taste weaken.

22-2 PARTs oF THE EyE Review the parts of the eye listed on the transparency and the functions of each: • Sclera • Cornea • Iris • Pupil

4. Discuss common disorders of the nervous system Meeting the Learning Objective tEXTbooK PP. 389-400 WoRKbooK PP. 113-115

• Retina

Lecture Pronounce and define the following key terms:

Display Transparency

• Cerebrovascular accident (CVA)

22-3 PARTs oF THE EAR

• Hemianopsia

137 Review the following points about CVA:

• Observe for swallowing problems.

• Cause: obstruction inside a blood vessel or the rupture of a blood vessel

• Encourage fluids and proper nutrition.

• Ischemic stroke is the most common type of stroke. With this type of stroke, the blood supply is blocked, and brain cells begin to die. • Hemorrhagic stroke, another type of stroke, occurs when there is leaking or a rupture of a blood vessel inside the brain. • Transient ischemic attack (TIA) is a warning sign. • Symptoms differ, depending on which side of the brain is affected.

• Carefully assist with shaving, grooming, and bathing. • Make sure a clock and calendar are visible. • With emotional lability, redirect resident’s attention. • Use praise often. • Listen to resident if he or she wants to talk. Review guidelines for communication with a resident post-CVA: • Speak clearly and face the resident.

Review some of the problems that can result from right side or left side brain damage from a CVA:

• Do not rush the resident.

• Hemiparesis

• Use yes or no questions.

• Hemiplegia • One-sided neglect

• Keep questions and directions simple. Use special methods, such as communication boards.

• Loss of ability to identify affected body parts

Pronounce and define the following key terms:

• Expressive aphasia

• Parkinson’s disease

• Receptive aphasia

• Progressive

• Emotional lability • Loss of sensations

• Use signals, such as nodding and pointing.

ReRv. ieC wO thMe following points about Parkinson’s TESTBANKSELLE

• Loss of bowel or bladder control • Cognitive impairments • Changes in personality • Loss of thinking and learning abilities • Dysphagia or total inability to swallow • Vision impairments or blurred vision • Hemianopsia Review the guidelines for residents recovering from CVA: • Encourage independence and self-esteem. • Be patient with self-care and communication. • Encourage resting in between self-care tasks. • Assist with ROM exercises. • Reposition often, using proper alignment. • Do not refer to resident’s affected side as “bad.” • Assist with ambulation to prevent falls. • For one-sided neglect, remind residents about weaker side of body. • Always place food in the unaffected side of the mouth.

disease: • Progressive disorder that causes part of brain to degenerate • Cause: neurons in the brain that produce dopamine begin to break down and die • Symptoms: tremors or shaking; mask-like face; pill-rolling; rigid muscles; shuffling gait; slurred speech; mood swings; gradual behavior changes • Treatment: drug therapy, surgery Review the care guidelines for Parkinson’s disease: • Encourage self-care. • Assist with ADLs. • Assist with ROM exercises. • Assist with ambulation to prevent falls. • Encourage residents to stand as straight as possible for ambulation. • Encourage fluids and proper nutrition. • Listen to residents if they want to talk. • Report severe trembling, severe muscle rigidity/ contractures, mood swings, sudden incontinence, constipation, dehydration, weight loss, or signs of depression.

138 Pronounce and define the following key term: • Multiple sclerosis (MS) Review the following points about multiple sclerosis: • Progressive disorder that affects the way impulses are transmitted to and from the brain • Cause: loss of myelin • Symptoms: numbness and tingling; muscle weakness; extreme fatigue; tremors; vertigo; reduced sensation; blurred or double vision; poor balance; difficulty walking; incontinence; paralysis

Review care guidelines for head or spinal cord injuries: • Allow as much independence as possible with ADLs. • Offer rest periods as necessary. • Perform ROM exercises as ordered. • Give frequent skin care. • Be gentle when turning and repositioning. • Protect residents from harm due to lack of sensation. • Check water temperature carefully.

• Treatment: medication

• Use special stockings to increase circulation as ordered.

Review the care guidelines for multiple sclerosis:

• Encourage fluids and proper diet.

• Be patient with self-care and movement.

• Give careful catheter care and encourage fluids.

• Offer rest periods as necessary.

• Help with bladder and bowel training.

• Assist with ROM exercises.

• Encourage deep breathing exercises.

• Encourage residents to follow exercise programs.

• Provide privacy and be sensitive if involuntary erections occur.

• Assist with ambulation to prevent falls.

• Listen to the resident. • Encourage proper nutrition and fluid intake. • Report red skin, pale skin, start of pressure ulcer • Do not rush communication. • or contracture, UTI symptoms, shortness of LLERconstipation, .COM Try to provide a stress-free environmenTt.ESTBANKSEbreath, dehydration, weight loss, or depression. • Offer support and encouragement as symptoms change. Pronounce and define the following term: • Report red skin, pale skin, start of pressure ulcer, start of contracture, UTI symptoms, or signs of depression. Pronounce and define the following key terms:

• Epilepsy Review the following points about seizures: • Involuntary contractions of muscles

• Paraplegia

• Causes: tumors, head injuries, injuries to the brain during birth, high fever, stroke, dementia, genetic factors, and alcohol and drug abuse

• Quadriplegia

• Treatment: medication, surgery, rehabilitation

Review the following points about head and spinal cord injuries:

Pronounce and define the following terms:

• Concussion

• Causes: accidents, sporting injuries, gunshot wounds, stab wounds, falls • Symptoms of head injury: confusion or disorientation; coma; death; headaches; drowsiness; loss of consciousness; seizures; fractures; drainage from the ears, nose, or mouth; irritability; poor coordination; slurred speech; blurred vision; vomiting; stiff neck; decreased sense of smell • Symptoms of spinal cord injury: paralysis, loss of function, paraplegia, quadriplegia

• Nearsightedness • Farsightedness Remind students that vision changes affect people of all ages and that myopia and hyperopia are usually treated with eyeglasses, contact lenses, or surgery. Pronounce and define the following key term: • Cataract Review the following points about cataracts:

139 • Develops when the lens of the eye becomes cloudy

• Use the face of an imaginary clock to explain the position of objects in a room.

• Causes: diabetes, eye injury, may be inherited or result from normal aging

• Make sure there is enough lighting in every room.

• Symptoms: blurred vision, glare when driving at night, yellowing of vision

• Walk a little ahead of the resident as she holds your arm.

• Treatment: surgery

• Walk at the resident’s pace.

Pronounce and define the following key term:

• Assist residents to complete menus. Set up meal trays as needed.

• Glaucoma Review the following points about glaucoma:

• Use large-print books, audio books, and digital books.

• Leading cause of blindness in the U.S.

• Read to residents if they desire it.

• Cause: intraocular pressure increases, damaging the optic nerve

• Assist with vision screening.

• The majority of people have open-angle, or primary, glaucoma.

Demonstration Demonstrate procedure Caring for eyeglasses. Include all of the numbered steps in your demonstration.

• Symptoms of open-angle glaucoma: not always apparent, but over time, there is a decrease in vision, especially in the peripheral vision • Another form of glaucoma is angle-closure, which can be chronic or acute. • Symptoms of angle-closure glaucoma: pain, nausea, vomiting, seeing a halo around lights, reddening of the eye, blurred vision • Treatment: eye drops and other medications, surgery

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook. Review the following points about the artificial eye: • Is a type of prosthetic and does not provide vision • Necessary for people who have lost an eye to cancer, other disease, or injury • Most are made from plastic.

Pronounce and define the following key term:

• Held in place by suction

• Age-related macular degeneration (AMD)

• Carefully follow care instructions.

Review the following points about AMD:

• Do not use alcohol or abrasives to clean the eye.

• Condition in which part of the retina degenerates

• Act professionally during care.

• Two forms are wet and dry AMD; the dry form is more common.

• Keep eye covered completely in solution when stored.

• Risk factors: aging, smoking, sun exposure, heredity, gender, and race

Pronounce and define the following key terms:

• Treatment: laser surgery, injections, zinc, antioxidants Review the care guidelines for vision impairment: • Encourage use of eyeglasses or contact lenses if worn. • Keep eyeglasses clean and safe. • Change cases for contact lenses regularly. • Always identify yourself as you enter the room. • Keep doors completely open or closed. • Leave furniture in place.

• Otitis media • Meniere’s disease • Hearing aid Review the following points about otitis media: • Cause: infection in the middle ear • Symptoms: pain, pressure, fever, and reduced ability to hear • Treatment: antibiotics Review the following points about Meniere’s disease:

140 • Cause: build-up of fluid in the inner ear caused by infections, allergies, or a genetic link

• AIDS

• Symptoms: vertigo, hearing loss, tinnitus, and pain or pressure

• Excessive alcohol or drug use

• Treatment: medications, salt restriction and other dietary changes, cognitive therapy, antibiotic or corticosteroid injections, and, in extreme cases, surgery Review the guidelines for hearing aids:

• Huntington’s disease • Head injuries • Thyroid disorders • Nutritional deficiencies Explain that while some forms of dementia may be treated, many forms of dementia are irreversible.

• Be careful when handling a hearing aid. • Turn volume down before inserting. • Turn off when not in use. • Replace batteries as needed. • Do not submerge in water. • Remove hearing aid before bathing, showering, or shampooing hair. • Do not spray hair care products near hearing aid. • Check for hearing aids before removing bed linen and meal trays.

6. Discuss Alzheimer’s disease and identify its stages Meeting the Learning Objective TEXTbooK PP. 401-402 WoRKbooK PP. 115-116

Lecture Pronounce and define the following key term: • Alzheimer’s disease (AD)

• Report any signs of sores or abrasions in the ear, as well as wax build-up.

Review the following points about Alzheimer’s disease: Students can use the online resources toT loE caSteTBANKS•EALDLiE sR pr. ogCrO esM sive and irreversible. more information. Discuss the risk obesity poses • Occurs when tangled nerve fibers and protein for certain diseases or disorders. deposits form in the brain

5. Discuss dementia and related terms Meeting the Learning Objective TEXTbooK PP. 400-401 WoRKbooK P. 115

Lecture Pronounce and define the following key terms: • Cognition • Dementia • Irreversible Emphasize that dementia is not a normal part of aging. Review causes of dementia: • Alzheimer’s disease

• Cause is unknown. • Older skills are usually kept longer. Referring to the descriptions on p. 402 in the textbook, discuss the three general stages of Alzheimer’s disease. Emphasize the difference in behaviors and ability for self-care at different stages of the disease. Emphasize the following: • Every victim progresses differently, showing different symptoms at different times. • AD residents should be encouraged to do selfcare and keep their minds and bodies active for as long as possible.

7. List strategies for better communication with residents with Alzheimer’s disease

• Vascular dementia • Lewy body dementia • Parkinson’s disease

Meeting the Learning Objective TEXTbooK PP. 402-404 WoRKbooK PP. 116-117

141 Lecture Pronounce and define the following key term: • Perseveration Review the general guidelines for communication with residents with AD: • Always identify yourself and greet resident by name. • Look at resident while speaking to her. • Speak slowly and quietly. • Reduce background noise.

If the resident is disoriented to time and place: • Post reminders in early stages of disease. If the resident does not remember how to perform basic tasks: • Break each activity into simple steps. If the resident insists on doing something that is unsafe or not allowed: • Redirect activities. Try to limit saying “don’t.” If the resident hallucinates, is paranoid, or accusing:

• Use touch and gestures. • Only talk about one subject at a time. • Repeat directions and answers as many times as needed. • Use pictures.

• Do not take it personally. • Try to redirect or ignore behavior. If the resident is depressed or lonely: • Take time to ask how the resident feels, and listen closely.

• Praise often. If resident is frightened or anxious:

• Try to involve resident in activities.

• Move and speak slowly.

If the resident repeatedly asks to go home:

• Speak in a quiet area with few distractions.

• Ask the resident to tell you what home was like and how he felt being there. • Redirect the conversation to something the resi-

• Try and see yourself as they might. • Use simple language and short sentences. • Check your body language.

TESTBANKSELLER de.nC t eOnM joys.

If resident forgets or shows memory loss:

• Expect that the resident may continue to ask to go home.

• Repeat yourself, using the same words. Do not try to stop a resident who is perseverating.

If the resident is verbally abusive or uses bad language:

• Keep messages simple. Break complex tasks into smaller, simpler steps. If resident has trouble finding words or names: • Suggest a word that sounds correct. Use touch if it is welcome. If the resident seems not to understand basic instructions or questions: • Ask resident to repeat your statements. • Pay attention to communication methods that are useful. • Watch for nonverbal cues. • Use signs, pictures, gestures, or written messages. If the resident wants to say something but cannot: • Encourage resident to point, gesture, or act it out. • Offer comfort or try to distract resident.

• Remember it is the dementia speaking and not the resident. Try to ignore the language and redirect attention. If the resident has lost most verbal skills: • Use nonverbal communication. • Assume that resident is aware of losses in abilities.

8. Identify personal attitudes helpful in caring for residents with Alzheimer’s disease Meeting the Learning Objective TEXTbooK PP. 405-406 WoRKbooK PP. 117-118

142 Lecture Pronounce and define the following key term:

• Show resident the clothing.

• Burnout

• Encourage resident to pick out clothing. Lay out clothes in the order to be put on.

Review the following helpful attitudes for caring for residents with AD. Ask the students to think of situations in which each attitude might be helpful on the job:

• Work with the symptoms and behaviors noted. • Work as a team.

• Mark the bathroom with a sign. • Make sure there is enough light. • Check for episodes of incontinence.

• Be aware of difficulties associated with caregiving.

• Observe toilet patterns. • Take resident to bathroom before meals and bedtime.

• Work with family members. • Remember the goals of the care plan.

• Put lids on garbage cans or waste baskets.

9. Describe guidelines for problems with common activities of daily living (ADLs)

WoRKbooK PP. 118-119

• Praise and encourage resident often. • Encourage fluids.

• Be empathetic.

TEXTbooK PP. 406-409

• Do not rush the resident.

Review guidelines for toileting:

• Do not take it personally.

Meeting the Learning Objective

• Provide privacy.

• Follow toileting schedule. • Support family and friends. Review guidelines for nutrition:

• Encourage nutritious foods. • Schedule meals at the same time each day with am dsM. TESTBANKSEfL LiEliaRr.foCoO

Lecture Review guidelines for bathing:

• Make sure there is proper lighting. • Keep noise and distractions low.

• Schedule bathing when resident is least agitated. Be organized.

• Keep task of eating simple.

• Prepare resident before bathing.

• Use plain plates without patterns or colors.

• Walk with resident down the hall, stopping at tub room.

• Put only one item of food on plate at a time.

• Make sure bathroom is well-lit.

• Guide resident through meal.

• Provide privacy. • Be calm and quiet and keep the process simple. • Offer the resident a washcloth to hold. • Ensure safety. • Do not try to force the resident to bathe. • Allow resident to enjoy the bath. Be encouraging and positive. • Observe the skin. Review guidelines for grooming and dressing:

• Avoid steaming or hot foods.

• Give simple, clear instructions. • Use assistive devices as needed. • Make mealtimes simple and relaxed. • Seat residents with others to encourage socializing. • Observe and report changes or problems in eating habits. • Promptly report changes in intake or output. Review the guidelines for physical health: • Prevent infections and follow Standard Precautions.

• Assist with grooming to help resident feel attractive and dignified.

• Help residents wash hands.

• Avoid delays or interruptions.

• Report potential problems.

143 • Reduce risk of falls.

Violent behavior:

• Provide excellent skin care.

• Causes: frustration, overstimulation, change in roommate, caregiver, or routine

• Watch for and report signs of pain. Review the guidelines for mental and emotional health: • Maintain self-esteem. • Share in enjoyable activities. • Reward positive and independent behavior with smiles and warm touches.

10. Describe interventions for common difficult behaviors related to Alzheimer’s disease Meeting the Learning Objective

• Interventions: notify nurse, block blows but never hit back, remove triggers, remove others from the area, do not try to restrain resident, care conference may be needed Pronounce and define the following key terms: • Hallucinations • Delusions Hallucinations or delusions: • Interventions: ignore the behavior, reassure resident, do not argue with resident, redirect resident to other activities Depression:

TEXTbooK PP. 409-412

• Causes: losing independence, facing incurable disease, feelings of failure, fear, chemical imbalance Lecture • Interventions: report to nurse, medications may Pronounce and define the following key terms: help, try to note triggers, encourage indepen• Intervention dence and self-care, reward activities that im• Agitated prove mood, foster social relationships, listen to TESTBANKSELLER re. siC deOnM t, offer comfort and concern, be as pleas• Trigger ant as possible, use touch if it does not bother the person Agitation: WoRKbooK PP. 119-120

• Causes: feeling insecure or frustrated, encountering new people and places, changes in routine • Interventions: recognize and eliminate triggers, keep a regular routine, avoid frustration, use slow and soothing tone, reduce noise and distractions, focus on familiar activities, listen carefully, reassure resident

Pronounce and define the following key term: • Disruptive behavior Disruptiveness: • Causes: pain, constipation, frustration, wish for attention

• Catastrophic reaction

• Interventions: get resident’s attention, stay calm, be friendly, try to direct resident to quiet area, try to find out why behavior is occurring

Catastrophic reaction:

Inappropriate sexual behavior:

Pronounce and define the following key term:

• Causes: fatigue; change of routine, environment, or caregiver; overstimulation; physical pain or discomfort • Interventions: respond as you would to agitation, remove triggers, help resident focus on soothing activity Pronounce and define the following key term: • Violence

• Causes: rash, tight clothing, need to urinate • Interventions: direct resident to private area, distract resident, report to nurse, consider appropriate ways to provide physical stimulation Inappropriate social behavior: • Interventions: do not take it personally, try to remove resident from area, try to find out what caused the behavior, stay calm

144 Perseveration or repetitive phrasing: • Interventions: be patient, respond to questions with the same words each time, do not try to silence or stop resident Pronounce and define the following key terms: • Pillaging • Hoarding • Rummaging Pillaging, rummaging, and hoarding: • Interventions: remember that behaviors are not within resident’s control, label resident’s belongings, remember hiding places, notify family and friends and enlist help, create a drawer for rummaging Pronounce and define the following key term: • Sundowning

Role-Play and Discussion Have the students role-play several of these behaviors. Other students can role-play the NAs and demonstrate how to appropriately respond.

11. Discuss ways to provide activities for residents with Alzheimer’s disease Meeting the Learning Objective TEXTbooK PP. 412-413 WoRKbooK P. 120

Lecture Encourage students to find out information from residents’ friends and family about residents’ likes, dislikes, and interests. Explain the distinction between meaningful activities and “doing” activities and when each is useful.

Sundowning:

Review tips for meaningful activities: • Causes: hunger, fatigue, change in routine or • Encourage family participation. caregiver • Limit some activities to small groups. • Interventions: provide adequate lighting; avoid • Use quiet areas. stressful situations during this time; play soft T E S T B ANKS OeMframes for activities. •ESLetLsE hR or. t tC im music; discourage naps; set a bedtime routine; plan calming activities; serve evening meal long • Plan events based on residents’ interests. before bedtime; eliminate caffeine; give back • Plan activities for the time of day when residents rubs; redirect behavior; maintain exercise routine are feeling best. Suspicion

• Encourage exercise.

• Interventions: do not argue, offer calm reassurance, be understanding and supportive

• Plan activities that allow residents to make things that can be utilized.

Pronounce and define the following key terms:

• Encourage specific skills.

• Pacing • Wandering • Elopement

• Read or play music for immobile residents.

12. Describe therapies for residents with Alzheimer’s disease

Pacing and wandering: • Causes: restlessness, hunger, disorientation, the need to use the bathroom, constipation, pain, forgetting how or where to sit down, too much daytime napping

Meeting the Learning Objective

• Interventions: encourage exercise, minimize napping, let residents pace in safe area, redirect attention, place stop signs on doors

Lecture and Discussion Pronounce and define the following key terms:

Caring for someone with Alzheimer’s disease can be very difficult. Remind students that they can never abuse residents in any way. Go over the box on page 414 together.

TEXTbooK PP. 413-414 WoRKbooK P. 120

• Validation therapy • Validating • Reminiscence therapy • Remotivation therapy

145 Describe each creative therapy and ask students to think of situations in which each one is appropriate. We removed the discussion of reality orientation from the textbook, but kept the definition and description here in case some instructors would like to continue teaching this topic. Reality orientation uses calendars, clocks, signs, and lists to reorient the residents to person, place, and time. It can help reduce confusion or disorientation. It is useful in the early stages of Alzheimer’s disease before a person is totally disoriented. In later stages, it may only frustrate residents. When using reality orientation, the nursing assistant should always identify himself and call the resident by name. He can ask about the resident’s family, photos, personal items, recent meals, or activities. Newspapers, magazines, TV, radio, and computers and tablets can help residents be informed about current events. Clocks and calendars help remind the resident what time it is and what day of the week it is. The NA should explain why he does things as he does them. He can say, for example, “We use your walker, Mrs. Martinez, to

Review the following points about GAD: • Characterized by chronic anxiety and excessive worrying even when there is no cause for these feelings • Symptoms: headache, muscle aches, sweating, shaking, difficulty swallowing, irritability • Treatment: medication and psychotherapy Pronounce and define the following key term: • Social anxiety disorder Review the following points about social anxiety disorder: • Disorder in which a person has excessive anxiety about social situations • Symptoms: sweating, shaking, upset stomach • Treatment: medication and psychotherapy Pronounce and define the following key term: • Panic disorder Review the following points about panic disorder:

• Anxiety disorder that causes repeated episodes of intense fear and physical symptoms •R Sy.mCpO toM ms: dizziness, rapid heartbeat, chest pain, TESTBANKSELLE help make walking easier.” When selecting clothes difficulty breathing, upset stomach, feeling of or when looking out the window, mentioning the doom season or month helps remind the resident what • Treatment: medication and psychotherapy time of the year it is. Pronounce and define the following key term:

13. Discuss mental health, mental illness, and related disorders

• Obsessive-compulsive disorder (OCD)

Meeting the Learning Objective

• Characterized by repetitive behavior used to cope with anxiety

TEXTbooK PP. 414-416 WoRKbooK PP. 120-121

Review the following points about OCD:

• Treatment: medication and psychotherapy Pronounce and define the following key term:

Lecture Pronounce and define the following key terms:

• Posttraumatic stress disorder (PTSD)

• Mental health

Review the following points about PTSD:

• Mental illness

• May develop after a traumatic experience, crime, disaster, or accident

Discuss the ways that mental illness affects a person’s daily life, including the ability to function in family, at home, at work, or in the community.

• Symptoms: flashbacks, withdrawal, sleep disturbances • Treatment: medication and psychotherapy

Pronounce and define the following key terms: • Generalized anxiety disorder (GAD) • Psychotherapy • Cognitive behavioral therapy (CBT)

Review the following points about depression: • Serious mental illness in which overwhelming sadness makes it difficult for person to function normally

146 • Symptoms: pain, fatigue, apathy, weight loss, sleep problems, irritability, feelings of worthlessness • A person who is depressed cannot simply choose to be well. • Treatment: medication and psychotherapy Pronounce and define the following key term: • Bipolar disorder

tion; any person(s), activity, program, telephone call, specific date, object, article of clothing, or place that makes the person’s behavior change in some way

14. Discuss substance abuse and list signs of substance abuse to report Meeting the Learning Objective

Review the following points about bipolar disorder:

TEXTbooK P. 417

• Causes a person to have mood swings, changes in energy levels and ability to function

WoRKbooK P. 121

• Symptoms: high energy, little sleep, high selfesteem, poor judgment • Treatment: long-term medication

Lecture Pronounce and define the following key terms: • Substance abuse • Withdrawal

Pronounce and define the following key terms: • Schizophrenia

Review some types of substances that are abused:

• Paranoid schizophrenia

• Alcohol

Review the following points about schizophrenia:

• Legal and illegal drugs

• Brain disorder that affects a person’s ability to think clearly • Symptoms: hallucinations, delusions, disorganized thinking and speech, lack of interest in life and planning activities, poor hygiene, problems with memory • Treatment: anti-psychotic medication

• Tobacco • Glue • Paint • Permanent markers Review risk factors for substance abuse: • Family history of addiction • Having a mental illness

Review care guidelines for mentally ill residents:

• Unstable home environment

• Encourage self-care.

• Poor coping skills

• Encourage independence with ADLs.

• Taking a highly addictive drug

• Observe for changes in behavior. • Watch your body language. • Always treat adults like adults. • Do not yell or use a harsh tone of voice. • Use eye contact when communicating. • Provide support for resident, family, and friends. • Report change in ability to perform ADLs; changes in mood and behavior; behavior that seems extreme or dangerous; excessive fatigue or insomnia; headaches; constipation; weight loss or weight gain; appetite changes; social withdrawal, or lack of participation in activities; hallucinations or delusions; any comments about suicide, even jokes; concerns that the resident is not properly taking a medication or is hiding medica-

Review signs of substance abuse to report: • Changes in physical appearance • Changes in personality • Smell of alcohol, cigarettes, or other substances in room or on clothing • Strong smell of room fresheners • Increased use of breath fresheners • Constricted or dilated pupils • Slurred speech • Loss of appetite • Forgetfulness • Confusion • Blackouts or memory loss

147 • Hiding substances or alcohol

• Stealing money or valuables

10. Report it immediately to the nurse.

• Problems with other residents, staff, friends, or family • Thoughts of suicide

11. B 12. A 13. D

Chapter Review

14. C Exam

15. A

dIsTRIbuTE CHAPTER 22: EXAM

16. B

The neuron

The brain and spinal cord make up the central nervous system; the peripheral nervous system consists of the cranial and spinal nerves.

TESTBANKS

Answers include the following: controls and coordinates mental processes and voluntary movements; provides reflex centers of heartbeat and respiration; and senses and responds to changes occurring both inside and outside of the body.

Answers include the following: Responses and reflexes slow. Some memory loss occurs, especially short-term memory loss. Sensitivity of nerve endings in skin decreases, resulting in weakened sense of touch. Some hearing loss occurs. Senses of vision, smell, and taste weaken.

The artificial eye can be permanently damaged by improper cleaning.

Alzheimer’s disease

Helping residents keep their minds and bodies active may help slow the progress of the disease.

If an activity is not engaging a resident, another one can be offered.

17. C 18. C

148

23 The Endocrine System 1. 2. 3. 4. 5. 6.

Define important words in this chapter Explain the structure and function of the endocrine system Discuss changes in the endocrine system due to aging Discuss common disorders of the endocrine system Describe care guidelines for diabetes Discuss foot care guidelines for diabetes

Supplemental Tools TRANsPARENCy 23-1 THE ENDoCRINE sysTEM CHAPTER 23: EXAM

Assignments TEXTbooK READINg, PP. 420-428

Lecture Display Transparency 23-1 the endocrine system Review the following points about the endocrine system:

• Glands secrete hormones, which are chemical substances that control numerous body functions. Overview of Teaching Strategies This chapter focuses on the endocrine system. Stu• Hormones are carried in the blood for delivery to EcStiT dents will learn about the structure and fT un onBoAf NKSEtL arL geEt R tis.sC ueOs M or organs. the endocrine system, including normal changes • The pituitary gland controls the hormone proof aging that will enable them to better recognize duction of other glands. abnormal changes that might signal a potential • The pancreas produces the hormone insulin, problem. Disorders of the endocrine system are which regulates the amount of glucose available described, with detailed information on care for to the cells for metabolism. diabetic residents, including foot care. WoRKbooK EXERCIsEs, PP. 123-124

Review the functions of the endocrine system:

1. Define important words in this chapter

• Maintains homeostasis through hormone secretion

Meeting the Learning Objective

• Influences growth and development

TEXTbooK P. 420 WoRKbooK P. 123

• Regulates levels of vitamin D, calcium, and phosphate in the body • Maintains blood sugar levels

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Explain the structure and function of the endocrine system Meeting the Learning Objective TEXTbooK PP. 420-422 WoRKbooK P. 123

• Regulates the body’s ability to reproduce • Determines how quickly cells burn food for energy

3. Discuss changes in the endocrine system due to aging Meeting the Learning Objective TEXTbooK P. 422 WoRKbooK P. 123

149 Lecture Review normal changes of aging:

• Usually diagnosed in children and young adults

• Levels of estrogen and progesterone decrease, which signal the onset of menopause in women.

• Condition will continue throughout person’s life

• Testosterone levels in males usually decrease, but production does not stop.

• Cause: pancreas does not produce any insulin • Treatment: daily injections, special diet, monitoring blood glucose level

• Insulin production decreases.

Review the following points about type 2 diabetes:

• Body is less able to handle stress.

• Most common form of diabetes

4. Discuss common disorders of the endocrine system Meeting the Learning Objective TEXTbooK PP. 422-424 WoRKbooK PP. 123-124

• Cause: body does not produce enough insulin or fails to properly use insulin • Treatment: monitoring blood glucose levels, diet, weight loss, medication, stopping smoking, exercise Describe signs and symptoms of diabetes, including the following: • Excessive thirst

Lecture Pronounce and define the following key terms:

• Excessive hunger

• Diabetes

• High blood sugar levels

• Hyperglycemia • Hypoglycemia • Pre-diabetes • Hypothyroidism

• Excessive urination • Glucose in the urine • Very dry skin • Fatigue

• Hyperthyroidism

• Blurred vision or visual changes • Slow-healing sores, cuts, or bruises

Review the following points about diabetes:

• Tingling or numbness in the hands or feet

• Condition in which the pancreas does not produce insulin or does not produce enough insulin

• Unexplained weight loss

• Risk factors: family history of the disease, advanced age, obesity • Complications caused by diabetes: hypoglycemia; DKA; problems with circulation; increased risk of heart attack, stroke, or impaired circulation of the legs; increased risk of infection and gangrene; diabetic retinopathy, damage to vital organs, including the kidneys; diabetic peripheral neuropathy Review the following points about pre-diabetes:

• Increased number of infections Optional Activity The American Diabetes Association (ADA) has a test on their website (diabetes.org) to see whether or not a person is at risk for developing type 2 diabetes. The person answers a few questions and the score determines if he is at risk for developing these conditions. Students can take this test if you would like to discuss the risk of developing diabetes further.

• Condition in which glucose levels are elevated, but not high enough to establish a diagnosis of diabetes

Review the following points about hypothyroidism:

• People with pre-diabetes may already have damage to the vital organs.

• Autoimmune disorder

• Condition in which the body lacks thyroid hormone

• Change in diet can reduce weight and lower the risk of pre-diabetes or diabetes.

• Causes: Hashimoto’s thyroiditis, surgical removal of the thyroid gland, radioactive iodine therapy, thyroiditis

Review the following points about type 1 diabetes:

• Symptoms: fatigue and weakness, weight gain, constipation, intolerance to cold, dry skin, thin-

150 ning hair or hair loss, brittle hair or fingernails, slow heart rate, low blood pressure, abnormally low temperature, goiter, hoarseness, heavier menstrual periods, absent menses, depression • Treatment: thyroid replacement therapy Review these points about hyperthyroidism: • Condition in which thyroid gland produces too much thyroid hormone • Primary cause: Grave’s disease • Symptoms: nervousness, restlessness, fatigue, visual problems or eye irritation, exopthalmos, trembling, intolerance to heat, excessive perspiration, rapid heartbeat, high blood pressure, increase in appetite, weight loss, changes in bowel movements, irregular or absent menses, goiter • Treatment: anti-thyroid drugs, beta-blockers, radioactive iodine, surgery Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

5. Describe care guidelines for diabetes Meeting the Learning Objective

• Keep track of residents’ tests. • Perform blood glucose tests only as directed and if trained. • Report if resident is not following care plan. • Report the following: signs of skin breakdown; visual changes; changes in appetite or increased thirst; fruity or sweet-smelling breath; weight change; nausea or vomiting; change in urine output; any signs of urinary tract infection; fruity or sweet-smelling urine; changes in mobility; numbness or tingling in the arms or legs; nervousness or anxiety; dizziness or loss of coordination; or irritability or confusion.

6. Discuss foot care guidelines for diabetes Meeting the Learning Objective TEXTbooK PP. 426-427 WoRKbooK P. 124

Lecture Review the guidelines for safe diabetic foot care: • Inspect and clean the feet each day.

oiE dR ha.rsChOsM oaps and hot water. TESTBANKS•EALvL • Always dry feet carefully.

TEXTbooK PP. 424-426

• Never cut toenails, corns, or calluses.

WoRKbooK P. 124

• Do not use objects to remove dirt from toenails.

Lecture Explain to students that diabetes must be carefully controlled to prevent complications and serious illness, and that care guidelines include a plan of care associated with every system in the body. Review care guidelines for diabetes: • Give frequent skin care. • Observe the feet carefully for breaks in the skin. • Encourage residents to follow their exercise plans. • Report complaints of pain, numbness, or tingling in the arms or legs.

• Use doctor-recommended cream or lotion on feet, but not between the toes. • Check shoes for rocks or other objects. • Remind resident not to go barefoot. • Report the following: painful, tender, soft, or fragile areas, or burning in the feet; rashes or bruises; change in color of the skin or nails, especially reddening or blackening; change in the temperature of the skin; excessive dryness of the skin of the feet; breaks or tears in the skin; drainage or bleeding on the feet or toes; corns, blisters, calluses, or warts; or ingrown toenails.

• Carefully follow diet instructions.

Demonstration Demonstrate procedure Providing foot care for a resident with diabetes. Include all of the numbered steps in your demonstration.

• People with diabetes can work with a registered dietitian (RDT) or a certified diabetes educator (CDE).

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Perform foot care carefully. • Encourage proper footwear.

151 Chapter Review Exam dIsTRIbuTE CHAPTER 23: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: maintains homeostasis through hormone secretion; influences growth and development; regulates levels of calcium in the blood; maintains blood sugar levels; regulates the body’s ability to reproduce; and determines how quickly cells burn food for energy.

Answers include the following: Levels of estrogen and progesterone decrease, which signal the onset of menopause in women. Testosterone levels in males usually decrease, but TlE production does not stop. Insu inSpT roBdA ucNtiK on decreases. Body is less able to handle stress.

Family history, advanced age, obesity

152

24 The Immune and Lymphatic Systems and Cancer 1. 2. 3. 4. 5. 6. 7. 8.

Define important words in this chapter Explain the structure and function of the immune and lymphatic systems Discuss changes in the immune and lymphatic systems due to aging Describe a common disorder of the immune system Discuss infection prevention guidelines for a resident with HIV/AIDS Discuss care guidelines for a resident with HIV/AIDS Describe cancer Discuss care guidelines for a resident with cancer

Supplemental Tools TRANsPARENCy 24-1 THE LyMPHATIC sysTEM HANDouT 24-1 MyTHs AbouT HIV AND AIDs CHAPTER 24: EXAM

Meeting the Learning Objective TEXTbooK PP. 430-431

Assignments TEXTbooK READINg, PP. 429-441 WoRKbooK EXERCIsEs, PP. 125-128

2. Explain the structure and function of the immune and lymphatic systems

WoRKbooK P. 125

e R.COM TESTBANKSLEecLtuLrE

Overview of Teaching Strategies This chapter describes the immune and lymphatic systems and how they work together to protect the body from disease. Different types of immunity are described, as well as normal changes of aging for these systems. There is detailed information about HIV/AIDS, including activities that do and do not spread HIV/AIDS. Infection prevention guidelines are described, with emphasis on the fact that if Standard Precautions are consistently followed, care for a resident with HIV/AIDS is no different from care for any other resident. This chapter also contains information about cancer, including risk factors, treatment, and care guidelines.

Review the following points about the immune system: • Protects the body from harmful substances • Non-specific immunity is present at birth and protects the body from disease in general. • Specific immunity is acquired by the body and manufactures antibodies as a response to an antigen in the body. • With active immunity, vaccines cause the body to produce antibodies to protect against a particular disease. • With passive immunity, a person is given the antibodies needed to defend against the antigen. Display Transparency

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK P. 429 WoRKbooK P. 125

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

24-1 THE LyMPHATIC sysTEM Pronounce and define the following key term: • Lymph Review the following points about the lymphatic system: • Removes excess fluids and waste products from the tissues • Helps the immune system fight infection

153 • Thymus gland makes T-cells, which attack and destroy specific types of pathogens. Review the functions of the immune and lymphatic systems: • Protect against the invasion of foreign substances and pathogens • Return extra fluid to the circulatory system

3. Discuss changes in the immune and lymphatic systems due to aging Meeting the Learning Objective TEXTbooK P. 431 WoRKbooK P. 125

• Unprotected or poorly-protected vaginal sex with an infected person • Sexual contact with many partners • Sharing drug needles or syringes Explain to students that in the healthcare setting, infections can be spread through accidental contact with contaminated body fluids, needles, or other sharp objects, or contaminated supplies or equipment. Distribute Handout 24-1 MyTHs AbouT HIV AND AIDs Review the activities on the handout that do not spread HIV. In addition, review the ways in the textbook that HIV is not spread:

Lecture Review normal changes of aging:

• Through air or water or food

• Immune system weakens, causing increased risk of all types of infections.

• In saliva, tears, or sweat

• By pets or insects, including mosquitoes

• Through casual contact, such as hugging, shaking hands, sharing dishes, or touching doorknobs or toilet seats • T-cells decrease in number. • Through closed-mouth or casual kissing, such as • Response to vaccine decreases. ki. ssC inOgMsomeone’s cheek TESTBANKSELLER • Antibody response slows.

4. Describe a common disorder of the immune system

Review ways to protect against the spread of HIV/ AIDS: • Practicing Standard Precautions

Meeting the Learning Objective TEXTbooK PP. 431-434 WoRKbooK PP. 125-126

Lecture Pronounce and define the following key terms: • Acquired immune deficiency syndrome (AIDS) • Human immunodeficiency virus (HIV)

• Handling and disposing of sharps properly • Covering cuts, sores, tears, breaks, or rashes before caring for residents • Never sharing needles or syringes • Not having unprotected sex • Staying in a monogamous relationship • Practicing abstinence • Getting tested for HIV and re-tested if necessary

Review the following points about HIV and AIDS: • HIV attacks the body’s immune system and damages or destroys cells.

Review the signs and symptoms of HIV infections and AIDS:

• Cause: HIV virus acquired through blood or body fluids from an infected person

• Flu-like symptoms • Headaches

• AIDS is the final stage of HIV infection.

• Blurred vision

Review the most common methods of transmission of HIV: • Unprotected or poorly-protected anal sex with an infected person

• Loss of appetite • Nausea and vomiting • Weight loss • Night sweats

154 • Shaking, chills • Dry cough • Shortness of breath • Swollen lymph nodes • Sore throat • Cold sores or fever blisters on the lips • Mouth sores • White patches in the mouth or on the tongue • Cauliflower-like warts on the skin and in the mouth • Bleeding, inflamed gums • Yeast infections • Skin rashes or sores • Bruising that does not go away • Dry skin • Memory loss Lecture Pronounce and define the following key term: • Opportunistic infection Explain to students that people with weakened immune systems due to HIV/AIDS may getTdEisS eaTsB es that a healthy person would be able to fight off. Emphasize that lack of treatment for HIV/AIDS increases the risk of serious complications and death from the disease. Pronounce and define the following key term: • Autoimmune disease Review the following points about autoimmune diseases: • The body is unable to recognize its own tissue and attacks it.

5. Discuss infection prevention guidelines for a resident with HIV/AIDS Meeting the Learning Objective TEXTbooK PP. 434-435 WoRKbooK P. 126

Lecture Remind students that it is very important to follow Standard Precautions with every single resident in their care. Explain that if they do that, there should be no difference in the care given to residents with HIV/AIDS and care given to any other resident. Review infection prevention guidelines for HIV/AIDS: • Follow Standard Precautions. • Cover all broken skin with appropriate bandages before giving care. • Wear appropriate PPE. • Wash hands and other areas of body immediately after contact with blood or body fluids. • Handle and dispose of sharps carefully. • Remind residents and visitors to wash their hands often. • Do not share residents’ personal items. • Properly disinfect surfaces.

6. Discuss care guidelines for a resident with HIV/AIDS Meeting the Learning Objective TEXTbooK PP. 435-436 WoRKbooK PP. 126-127

• Examples: systemic lupus erythematosis and rheumatoid arthritis

Lecture Pronounce and define the following key term:

• Cause: unknown, but may be genetic links, microorganisms, or medications that act as triggers

• Homophobia

• Signs and symptoms: fever, fatigue, dizziness

Review the guidelines for HIV/AIDS:

• Treatment: hormone supplements, medications, blood transfusions, insulin Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.

• Wash hands often and help resident wash hands. • Disinfect surfaces often. • Protect resident from people having known contagious diseases. • Change linen whenever it is soiled. • Observe for skin breakdown.

155 • Change positions every two hours or as directed.

7. Describe cancer

• Give back rubs for comfort. • Monitor vital signs often.

Meeting the Learning Objective

• Allow rest and recognize limitations.

TEXTbooK PP. 436-438

• Encourage independence.

WoRKbooK P. 127

• Ambulate carefully. • Allow time for ADLs.

Lecture Pronounce and define the following key terms:

• Perform ROM exercises as ordered.

• Cancer

• Give mouth care frequently.

• Tumor

• Use soft toothbrushes or swabs for oral care.

• Benign

• Carefully measure weight and intake and output.

• Malignant

• Report if resident is not eating or not enjoying food.

• Metastasize

• Encourage resident to follow his special diet. • Encourage fluids. • Give small meals throughout day or BRAT diet for nausea and diarrhea.

Review causes of cancer: • Genetic factors • Certain lifestyle choices, such as tobacco use • Alcohol use

• Offer a trip to the bathroom or bedpan as often as needed.

• Poor diet/obesity

• Give emotional support. • Be aware of other support systems.

• Certain infections • Environmental exposure, such as radiation

Review symptoms to report to the nurse for HIV/ AIDS:

• Lack of physical activity

• Sun exposure

• Changes in vital signs, especially fever

Review the American Cancer Society’s signs of cancer:

• Loss of appetite, nausea, vomiting, or diarrhea

• Unexplained weight loss

• Reduced intake of fluids

• Fever

• Weight loss

• Fatigue

• Dysphagia (difficulty swallowing)

• Pain

• Mouth sores or discomfort

• Skin changes

• Bruising of the skin

• Change in bowel/bladder function

• Cracks, breaks, rashes, lumps, or sores anywhere on the skin

• Sore that does not heal

• Pressure ulcers

• Unusual bleeding/discharge

• Bleeding from anywhere on the body

• Any thickening in breast, testicle, or other areas

• Blood in the stool

• Indigestion, difficulty swallowing

• Nervousness, withdrawal, severe mood swings, or depression

• New mole or change in appearance of existing mole or wart

• Behavior that puts resident or others at risk, suicidal thoughts or comments

• Nagging cough or hoarseness

• White patches inside the mouth or on the tongue

Pronounce and define the following key terms: • Biopsy • Remission

156 Briefly describe each of the following treatments for cancer:

Review nutrition guidelines for residents with cancer:

• Surgery • Radiation therapy

• Provide small, frequent meals to reduce nausea and prevent weight loss.

• Chemotherapy

• Serve favorite foods and nutritious snacks.

• Hormone therapy

• Provide food when hunger occurs.

• Immunotherapy

• Try cool or cold foods.

Explain that these treatments are often used in combination.

8. Discuss care guidelines for a resident with cancer Meeting the Learning Objective

• Cut foods into small pieces. • Use plastic utensils. • Weigh residents as ordered and report loss or gain. • Encourage fluids. • Monitor I&O and report changes.

TEXTbooK PP. 439-441

Review guidelines for bladder and bowel changes for residents with cancer:

WoRKbooK PP. 127-128

• Assist residents with toileting often.

Lecture Review infection prevention guidelines for residents with cancer: • Follow Standard Precautions. • Wear PPE as required. Review skin care guidelines for residents with cancer: • Observe skin to prevent pressure ulcers. • Change position every two hours or as directed. • Follow special skin care orders exactly. • Use special mattresses or pads in beds and chairs to reduce risk of pressure ulcers. • Keep skin clean and dry. • Apply lotion to dry skin. • Do not use lotion on areas receiving radiation therapy. • Do not remove any markings used with radiation therapy.

• Give catheter care as needed. • Carefully measure output. • Test stool for occult blood as ordered. Review guidelines for mobility for residents with cancer: • Allow plenty of time for rest. • Recognize limitations. • Assist with ambulation. Review guidelines for pain in residents with cancer: • Be alert for signs of pain and report immediately. • Provide comfort measures, such as back rubs and repositioning. Play soft music, read, or talk quietly with residents. • Notify nurse of side effects of pain medication. • Report irritation around transdermal patches or resident having more than one patch on the body.

• Report signs of infection.

• Observe for redness, swelling, or warmth around the insertion site of PCA pump.

Review oral care guidelines for residents with cancer:

• Report signs of breakthrough pain.

• Give oral care often.

Review vital signs guidelines for residents with cancer:

• Be gentle. • Use soft brushes or special swabs. • Use mild mouth rinses to reduce bad taste from medication or vomiting.

• Monitor all vital signs, especially temperature. • Report changes in vital signs to nurse.

157 Review guidelines for supporting self-image in residents with cancer:

• Flatus, diarrhea, or constipation

• Help residents stay clean and well-groomed.

• Change in output

• Offer wigs, scarves, or hats for hair loss.

• Any change in urine or blood in urine

• Assist with application of makeup as requested.

• Urinary tract infection

Review guidelines for mental status and emotional needs of residents with cancer:

• Anxiety, fear, or angry feelings

• Be sensitive to residents’ wishes.

• Signs of depression

• Blood in the stool

• Change in mental status or confusion

• Listen if residents want to express feelings. • Spend as much time with residents as possible.

Chapter Review

• Encourage activities. • Ask social worker about support groups.

Exam

• Do not use clichés.

dIsTRIbuTE CHAPTER 24: EXAM

• Provide support during painful episodes and difficult times.

(APPENDIX C)

• Observe and report signs of depression or comments about suicide.

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

Review symptoms to observe and report:

Answers to Chapter Review in Textbook

• Remind residents that there can be good days ahead.

• Pain or increased pain • Changes in vital signs

1. R.NCoO nsMpecific immunity is present at birth and TESTBANKSELLE

protects the body from disease in general. Specific immunity is a type of immunity acquired by the body.

• Signs of new bumps or lumps or changes in skin • Rashes, cracks, sores, breaks, or reddened areas on the skin

Answers include the following: Immune system weakens, causing increased risk of all types of infections. Antibody response slows. T-cells decrease in number. Response to vaccine decreases.

Benign tumors grow slowly and do not spread to other parts of the body. Malignant tumors grow rapidly and invade surrounding tissue.

• Shortness of breath

• Appetite changes or weight loss

• Difficulty chewing or swallowing

• Odors • Burns or skin irritation • Bruising of the skin • Difficulty with ambulation • Fainting • Increased fatigue or weakness • Chest pain or tightness

• Dry, sore mouth and mouth or lip sores • Inflammation or irritation of the mucous membranes in the mouth • Bleeding from inside the mouth • Nausea or vomiting

158

25 Rehabilitation and Restorative Care 1. 2. 3. 4. 5. 6. 7.

Define important words in this chapter Discuss rehabilitation and restorative care Describe the importance of promoting independence Explain the complications of immobility and describe how exercise helps maintain health Describe canes, walkers, and crutches Discuss other assistive devices and orthotics Discuss range of motion exercises

Supplemental Tools TRANsPARENCy 25-1 REHAbILITATIoN AND REsToRATIVE CARE TRANsPARENCy 25-2 bENEFITs oF EXERCIsE TRANsPARENCy 25-3 body MoVEMENTs

1. Define important words in this chapter

CHAPTER 25: EXAM

Assignments TEXTbooK READINg, PP. 442-457 WoRKbooK EXERCIsEs, PP. 129-132

onstrate assistive/adaptive devices, or the school could order catalogs from such companies which could be used to make a collage picture of rehabilitation equipment.

Meeting the Learning Objective TEXTbooK PP. 442-443

TESTBANKSEWLoLRE R.COM KbooK P. 129

Overview of Teaching Strategies Many of the residents these students will be caring for will be in the process of regaining their lives after an illness or injury. The NA will be expected to assist the resident throughout this difficult period and to do so with skills learned in this chapter. It is vital that the students learn to provide supportive care that encourages dignity and independence. A positive attitude toward recovery, coupled with an excellent comprehension of the rehabilitation process, is the basis of such care. This chapter emphasizes sensitivity and patience. Assisting residents with range of motion exercises is an important skill for the NA to learn. If possible, time should be spent reinforcing how to properly do these exercises. If the instructor can take the students to a rehabilitation center for a hands-on experience, it would reinforce this chapter most effectively. If this is not possible, a rehabilitation specialist such as a rehab nurse or therapist could be invited to the classroom to offer case studies and personal experiences to share with the students. An equipment company could dem-

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Discuss rehabilitation and restorative care Meeting the Learning Objective TEXTbooK PP. 443-445 WoRKbooK P. 129

Lecture Pronounce and define the following key terms: • Rehabilitation • Physiatrists • Restorative care Discuss the factors that affect progress of rehabilitation: • How soon it began • Any pre-existing diseases or injuries • Overall motivation of the resident

159 • Type of facility where resident lives • Combined efforts of staff and others • Attitude of the rehabilitation team • Consistency in following the care plan Review the goals of rehabilitation:

• Mr. D has been told he will never walk again as he and the physicians hoped he would. • Mr. H has been trying unsuccessfully for two weeks to learn to use special eating utensils.

• Maintain or regain abilities

3. Describe the importance of promoting independence

• Promote independence and help resident to adapt

Meeting the Learning Objective

• Prevent complications of immobility

TEXTbooK P. 445 WoRKbooK PP. 129-130

Display Transparency 25-1 REHAbILITATIoN AND REsToRATIVE CARE Review the guidelines for rehabilitation and restorative care found on the transparency: • Understand the diagnosis, the disability, and any limitations the resident has.

Lecture and Discussion Emphasize the importance of encouraging residents’ independence while assisting with or performing all tasks. Discuss how independence positively relates to self-image, attitude, and abilities, and may help speed recovery.

• Be patient and offer praise frequently. • Maintain a positive attitude. • Listen as much as possible. • Provide plenty of privacy. • Encourage independence. • Encourage daily activity.

Start a discussion to emphasize empathy with residents who must accept help with ADLs. Ask students how they might feel if confined to a wheelchair, or if they were not able to lift a fork to their lips, or how it might feel to have another peRrs.oC nO drM ess them. TESTBANKSELLE

• Accept setbacks and focus on what the resident can do. Report observations to the nurse: • Any change in ability • Decreased strength • Lack of motivation • Signs of withdrawal or depression Case Studies Discuss how NAs can adapt their motivational styles to fit the different and unique personalities of the following residents: • Mrs. T is a shy, quiet, elderly woman learning to dress herself. • Mr. M is a very proud ex-Marine major who must learn to feed himself. • Mrs. G is a grandmother who must learn to use a leg brace to walk. • Mr. J is an athlete who must accept being confined to a wheelchair. • Mrs. C must now wear a pad for permanent incontinence.

4. Explain the complications of immobility and describe how exercise helps maintain health Meeting the Learning Objective TEXTbooK P. 446 WoRKbooK P. 130

Lecture and Discussion Go over the complications, organized by body system, that result from a lack of exercise and activity: • Gastrointestinal: constipation • Urinary: urinary tract infection (UTI) • Integumentary: pressure ulcers and slow-healing wounds • Circulatory: blood clots, especially in the legs • Respiratory: pneumonia • Musculoskeletal: muscle atrophy and contractures • Nervous: depression or insomnia • Endocrine: weight gain

160 • Stay near the person on the weaker side.

Display Transparency

• Do not rush resident.

25-2 bENEFITs oF EXERCIsE Review the benefits of regular exercise and activity, organized by body system, found on the transparency: • Gastrointestinal: promotes appetite and aids regular elimination • Urinary: improves elimination, helping to decrease infection • Integumentary: improves the quality and health of the skin • Circulatory: improves circulation • Respiratory: reduces the chance of infections, such as pneumonia, and improves oxygen level • Musculoskeletal: increases blood flow to the muscles and improves strength • Nervous: improves relaxation and sleep • Endocrine: increases metabolism, helping to maintain healthy weight

5. Describe canes, walkers, and crutches

• Move resident to bed or chair if he experiences pain. • Return resident to bed or chair when finished. Demonstration Demonstrate procedure Assisting with ambulation for a resident using a cane, walker, or crutches. Include all the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

6. Discuss other assistive devices and orthotics Meeting the Learning Objective TEXTbooK PP. 449-450 WoRKbooK PP. 130-131

Lecture

Meeting the Learning Objective

TESTBANKSPEroLnLouEnRc. eC anO dMdefine the following key terms:

TEXTbooK PP. 446-449

• Assistive or adaptive devices

WoRKbooK P. 130

• Foot drop

Lecture Discuss the following points:

• Orthotic devices

• Cane helps with balance but does not completely support weight.

Referring to Figures 25-8 through 25-11 (pp. 449450 in textbook), review the items that help residents adapt to certain conditions.

• Different types of canes are C cane, functional grip cane, and quad cane.

7. Discuss range of motion exercises

• Walkers help with stability and some weakness. • Crutches are used when a person can bear limited weight or no weight. Review the cane, walker, and crutches guidelines: • Check cane, walker, or crutches for damage before using. • Watch for and avoid unsafe environmental situations. • Make sure resident is wearing nonskid shoes with laces tied or straps fastened. • Have resident use cane on his stronger side. • Do not hang heavy items on the walker. • Encourage proper posture.

Meeting the Learning Objective TEXTbooK PP. 450-456 WoRKbooK PP. 131-132

Lecture Pronounce and define the following key terms: • Range of motion (ROM) • Passive range of motion (PROM) • Active range of motion (AROM) • Active assisted range of motion (AAROM) • Hyperextension

161 Display Transparency 25-3 body MoVEMENTs Define the following terms, pointing to each illustration on the transparency: • Abduction • Adduction

Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed. Answers to Chapter Review in Textbook 1.

Answers include the following: maintain or regain abilities; promote independence and help resident to adapt; and prevent complications of immobility.

Answers include the following: positive effects on self-image, attitude, abilities, and may help speed recovery.

Answers include the following: Gastrointestinal–constipation; Urinary–urinary tract infection (UTI); Integumentary–pressure ulcers and slow-healing wounds; Circulatory–blood clots, especially in the legs; Respiratory–pneumonia; Musculoskeletal–muscle atrophy and contractures; Nervous–depression or insomnia; and Endocrine–weight gain.

• Extension • Flexion • Dorsiflexion • Rotation • Pronation • Supination • Opposition Review the guidelines for ROM: • Follow the care plan. • Maintain privacy at all times. • Use proper body mechanics. • Support the joint above and below.

4. Answers include the following: Gastrointes• Keep the body in proper alignment. tinal–promotes appetite and aids in regular • Begin at the shoulders and work down. elimination; Urinary–improves elimination, T E ST B A N K S ELLER. CelOpM h ing to decrease infection; Integumentary– • Follow instructions for limiting ROM exercises. improves the quality and health of the skin; • Never push further than what is comfortable. Circulatory–improves circulation; Respira• Provide holistic care while performing ROM tory–reduces the chance of infections, such exercises. Praise often. as pneumonia, and improves oxygen level; Musculoskeletal–increases blood flow to the Demonstration muscles and improves strength; Nervous–imDemonstrate procedure Assisting with passive range proves relaxation and sleep; and Endocrine– of motion exercises. Include all of the numbered increases metabolism, helping to maintain steps in your demonstration. Refer to Figures 25-13 healthy weight. through 25-30. 5. B Have the students return the demonstration by 6. D creating teams of two, one NA and one resident receiving each of the three types of ROMs. Procedure 7. D checklists are located at the end of the Student Workbook. 8. A

Chapter Review Exam dIsTRIbuTE CHAPTER 25: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams.

162

26 Subacute Care 1. Define important words in this chapter 2. Discuss the types of residents who are in a subacute setting 3. List care guidelines for pulse oximetry 4. Describe telemetry and list care guidelines 5. Explain artificial airways and list care guidelines 6. Discuss care for a resident with a tracheostomy 7. Describe mechanical ventilation and explain care guidelines 8. Describe suctioning and list signs of respiratory distress 9. Describe chest tubes and explain related care 10. Describe alternative feeding methods and related care 11. Discuss care guidelines for dialysis Supplemental Tools

1. Define important words in the chapter

TRANsPARENCy 26-1 TubE FEEDINgs

Meeting the Learning Objective

HANDouT 26-1 gAsTRosToMIEs CHAPTER 26: EXAM

boRo.KCPO . 4M 58 TESTBANKSETLEXLTE WoRKbooK P. 133

Assignments TEXTbooK READINg, PP. 458-471 WoRKbooK EXERCIsEs, PP. 133-136

Overview of Teaching Strategies This chapter provides an introduction to the NA’s role in subacute care. Students need to be acquainted with types of residents they will see in subacute care. Instructors should emphasize that students’ responsibilities are mostly observing and reporting and helping when needed. It is also important for them to be reassuring and calm with subacute residents who may feel fear and anxiety about their situations, especially residents on mechanical ventilators. It would be helpful to bring in some of the devices students will see in a subacute unit, e.g., pulse oximeter, telemetry unit, etc. If possible, have someone who has a tracheostomy come talk to the class about challenges they face. Students can prepare a list of questions ahead of time.

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

2. Discuss the types of residents who are in a subacute setting Meeting the Learning Objective TEXTbooK P. 459 WoRKbooK P. 133

Lecture Pronounce and define the following key term: • Mechanical ventilator Review types of residents found in subacute units: • Residents who need more care and observation than other residents • Residents having had recent surgery and chronic illnesses, such as AIDS and cancer • Residents with serious burns, who need special administration of nutrients or medicine, or who need dialysis

163 3. List care guidelines for pulse oximetry

Lecture Pronounce and define the following key term:

Meeting the Learning Objective

• Telemetry

TEXTbooK PP. 459-460

Discuss the following guidelines for telemetry:

WoRKbooK P. 133

• Report to nurse if alarm sounds.

Lecture Pronounce and define the following key term:

• Check vital signs as ordered.

• Pulse oximeter

• Do not get the unit, wires, pads, or electrodes wet during bathing.

Review the following points about the pulse oximeter: • Warns of low blood oxygen level before signs develop • Normal pulse oximeter reading is between 95% and 100%, but it can differ. • Report to nurse any change in oxygen levels. Discuss the following guidelines for pulse oximetry: • Tell the nurse right away if alarm sounds. • Do not place the sensor on an artificial nail. • Be careful when moving and positioning so oximeter does not move or come off .

• Report if pads become loose.

• Check for signs of skin irritation under or around pads. • Remind resident not to leave the monitoring area. • Report change in vital signs, rapid pulse, chest pain or discomfort, shortness of breath or dyspnea, sweating, or dizziness to the nurse.

5. Explain artificial airways and list care guidelines Meeting the Learning Objective TEXTbooK PP. 461-462

WoRKbooK P. 134 TESTBANKSELLER .COM

• Report difficulty breathing. • Report pale, cyanotic, darkening, or grayish skin, or mucous membranes.

Lecture Pronounce and define the following key term:

• Report signs of skin breakdown from the device.

• Intubation

• Check vital signs as ordered, and report changes to the nurse.

Discuss the following guidelines for artificial airways:

Demonstration Demonstrate procedure Applying a pulse oximetry device. Include all the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

• Tell nurse if tubing comes out. • Follow orders for positioning. • Check vital signs as ordered. • Perform oral care often, at least every two hours. • Report biting or tugging on the tube. • Write notes, draw pictures, and use communication boards and hand and eye signals if resident cannot speak.

4. Describe telemetry and list care guidelines

• Be supportive and encouraging.

Meeting the Learning Objective

• Report signs of respiratory distress, including wheezing or other unusual breathing sounds or difficulty breathing; cyanosis, pale, gray, or darkening skin or mucous membranes; change in vital signs; drainage; secretions in tubing; or nervousness or anxiety.

TEXTbooK PP. 460-461 WoRKbooK PP. 133-134

• Do not move or remove spare artificial airway tubes or other equipment from the bedside.

164 6. Discuss care for a resident with a tracheostomy Meeting the Learning Objective TEXTbooK PP. 462-464

breathing sounds or difficulty breathing; cyanosis, pale, gray, or darkening skin or mucous membranes; change in vital signs, especially respiratory rate; mouth sores or discomfort; cracks, breaks, or sores on the skin; or loose or wet tape or dressings.

WoRKbooK P. 134

Lecture Discuss why tracheostomies are necessary: • Obstruction • Cancer • Infection • Severe injuries • Serious allergic reaction

7. Describe mechanical ventilation and explain care guidelines Meeting the Learning Objective TEXTbooK PP. 464-466 WoRKbooK PP. 134-135

• Coma

Lecture Pronounce and define the following key terms:

• Facial burns

• Sedation

• Gunshot wounds

• Delirum

• To prevent aspiration in an unconscious person

Review the following points about delirium

• Causes: dehydration, malnutrition, fever, pain, Remind nursing assistants to use alternate methpoisons, alcohol and drug use, prescribed mediods of communication if the resident cannot speak cation, hypoxia, head injury, illness, infections and to answer call lights promptly. Emphasize that, even if tracheostomy care isn’t an NA duty, careful ptoms: disorganized thinking; inability to TESTBANKS•ESconcentrate; Lym LE R.COproblems M observation and reporting is necessary. with speech, agitation, anger, or irritability; drowsiness or sleep disturDiscuss the following guidelines for bances; decrease in short-term memory; lack of tracheostomies: attention span; disorientation; changes in con• Answer call lights promptly. sciousness; decrease in ability to move; pulling out tubing; hallucinations • Use alternate methods of communication. • Treatment: medication, emergency care, hospital • Follow orders for positioning. stay • Do not tire resident. Make the following points about mechanical • Check vital signs as ordered. ventilators: • Inspect ties or tape often. • Keep the dressing dry, and do not cover the tracheostomy opening.

• Resident will not be able to speak, which can greatly increase anxiety.

• Report kinks or disconnected tubing.

• Being on a ventilator has been compared to breathing through a straw.

• Perform oral care often, at least every two hours. • Observe for mouth sores, cracks, breaks or sores on skin. • Provide careful skin care. • Observe for pale, bluish, or darkening skin or mucous membranes. • Do not move spare tracheostomy tubes or bag valve mask. • Report disconnected tubing; signs of respiratory distress, including wheezing or other unusual

• Be supportive. Enter the room so the resident can see you often. • Use other methods of communication. • Act and speak as if resident can understand everything, even if he or she is unconscious or heavily sedated. • Being on a ventilator puts a person at a higher risk for developing complications, including a type of pneumonia, considered a ventilator-associated event (VAE).

165 Discuss the following guidelines:

• Skin rash

• Wash hands thoroughly.

• Shortness of breath

• Answer call lights promptly.

• Confusion or change in mental status

• Tell nurse right away if alarm sounds. • Report kinks or disconnected tubing right away. • Report biting or pulling on the tube. • Give oral care often. Report mouth sores or discomfort. • Reposition at least every two hours. Follow positioning orders. • Give regular skin care to prevent pressure ulcers.

Emphasize that NAs should be familiar with residents’ normal vital signs in order to better recognize changes.

8. Describe suctioning and list signs of respiratory distress Meeting the Learning Objective

• Allow time for rest.

TEXTbooK PP. 466-467

• Follow orders for ROM exercises.

WoRKbooK P. 135

• Be patient during communication. • Provide emotional support.

Lecture Review the following points about suctioning:

• Do not move spare artificial airway tubes or bag • Necessary when a person has increased secrevalve masks. tions that he cannot expel • Report the alarm sounding; tubing moves or dis• Suctioning can be performed orally, nasally, and connects; signs of respiratory distress; secretions through the trachea and bronchi. in tubing; mouth sores or discomfort, cracks, • Nursing assistants do not perform suctioning. breaks, or sores on the skin; swollen or red area • Suction comes from wall or pump, and bottle colof an extremity; change in vital signs; nervousle. ctC s sOuM ctioned material. ness or anxiety; or depression. TESTBANKSELLER • Sterile water or sterile saline is used to rinse sucCase Study tion catheter. Mrs. G is on a mechanical ventilator. She is se• Signs of respiratory distress are gurgling, high dated, but she is conscious. She bites on her tube respiratory rate, shortness of breath, dyspnea, sometimes and looks anxious when the NA enters pallor, or cyanosis. the room. Discuss the following guidelines for assisting with • What can the NA do to reassure Mrs. G? suctioning: • What care can the NA give to help increase Mrs. • Follow Standard Precautions. G’s comfort? • Monitor vital signs closely. Lecture • Report signs of respiratory distress immediately. Pronounce and define the following key term: • Observe for pale, bluish, or darkening skin or • Sepsis mucous membranes. Review the signs of sepsis:

• Answer call lights promptly.

• Elevated heart rate and respiratory rate

• Follow orders for positioning.

• Slightly elevated temperature or low temperature

• Place pad or towel under chin before suctioning.

• Chills

• Give oral and nasal care after suctioning.

• Excessive sweating

• Give emotional support during difficult periods.

• Feeling of sickness or weakness

• Low blood pressure • Decreased urine output • Headache

166 in the color, amount, or quality (thickness/thinness) of secretions coughed up; or nervousness or anxiety.

9. Describe chest tubes and explain related care Meeting the Learning Objective

sounds; complaints of pain; coughing up blood; warmth, redness, swelling, sores, or pus; an increase or decrease in bubbling in the drainage system; kinks or clots in the tubing; any change in the amount, color, consistency, or odor of chest drainage; wet or loose dressings; or signs of subcutaneous emphysema (crepitus), such as bulging of the skin or skin that produces a crackling sound.

TEXTbooK PP. 467-468 WoRKbooK P. 135

Lecture Pronounce and define the following key term: • Chest tubes Review the following points about chest tubes: • Can be inserted at bedside or during surgery • Drain air, blood, pus, or fluid • Allow a full expansion of the lungs • Conditions requiring chest tubes include pneumothorax, hemothorax, empyema, surgery, injuries • Chest tube is connected to bottle of sterile water.

10. Describe alternative feeding methods and related care Meeting the Learning Objective TEXTbooK PP. 468-470 WoRKbooK P. 136

Lecture Pronounce and define the following key terms: • Nasogastric tube • PEG tube • Gastrostomy Discuss the types of tube feedings and emphasize

haL tL thE eR N. A’C sO roM le is assisting the nurse and po• System must be airtight when attachedTtoESTBANKStE suction. Discuss the following guidelines for chest tubes: • Report signs of respiratory distress and pain. • Check vital signs as directed and report changes. • Be aware of where chest tubes are located. • Keep drainage system below level of chest. • Keep drainage containers upright and level. • Keep tubing coiled neatly. • Report clots in tubing. • Observe chest drainage for amount, color, and consistency. • Observe dressings for drainage, saturation, or bleeding. • Do not remove equipment in the area. • Follow orders for positioning. • Encourage deep breathing exercises. • Provide rest periods. • Follow fluid orders and measure I&O carefully. • Report disconnected tubing; any signs of respiratory distress and cyanosis; changes in vital signs; change in oxygen level or if pulse oximetry alarm

sitioning the resident. Careful observation for problems and changes is important. Display Transparency 26-1 TubE FEEDINgs Discuss the following guidelines for tube feedings: • Wash hands thoroughly. • Observe carefully for signs of aspiration. • Notify the nurse if the alarm sounds. • Follow orders for positioning. • Follow fluid and weight orders. Be aware of NPO orders. • Give frequent mouth and nose care. • Do not pull or tug on tubing. Keep tubing free of kinks. • Observe for clip falling off. • Make feeding time a social time. • Report disconnected tubing; tube comes out of abdomen; any signs of respiratory distress; feeding pump alarm sounds; signs of aspiration; tube feeding liquid gathering in the mouth; cyanosis; pale, gray, or darkening skin or mucous

167 membranes; kinked, plugged, cracked, or broken tubing; leaking or empty bag or container; resident pulling on the tube; or signs of infection at the tube site, such as warm skin, reddened skin, sores, swelling, or pus. Pronounce and define the following key terms: • Total parenteral nutrition • Central venous line

• Make sure the resident has reading material, the TV remote, and the call light within reach. • Report signs of respiratory distress; changes in vital signs, especially pulse or blood pressure; pain, drainage, redness, swelling, or bleeding from the insertion site; abdominal cramps, nausea, or vomiting; muscle cramps; swelling of extremities (edema); change in intake and output; or itchy skin.

Review what to observe regarding TPN: • Fever

Chapter Review

• Headache

Exam

• Swelling

dIsTRIbuTE CHAPTER 26: EXAM

• Redness

(APPENDIX C)

• Bleeding

• Making sure there is no interruption of TPN delivery

Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

Distribute Handout

Answers to Chapter Review in Textbook

• Leaking at insertion site • Signs of fluctuation in blood sugar

26-1 gAsTRosToMIEs

Answers include the following: recent surgery

TESTBANKSELLER.oCr O acM ute conditions, chronic illnesses, serious Distribute this handout and discuss the informaburns, the need for special administration of nutrients or medicine, or dialysis.

tion with students.

11. Discuss care guidelines for dialysis Meeting the Learning Objective TEXTbooK P. 470

Artificial airways help maintain an airway and facilitate ventilation.

General tracheostomy care includes keeping the skin around the opening, or stoma, clean, assisting with dressing changes, and helping with the cleaning of the inner part of the device.

Answers should include some variations of: Residents on ventilators cannot speak, which can cause intense anxiety. The resident may think that no one will know if he has trouble breathing.

Answers include the following: changes in amount, color, or consistency of chest drainage.

Answers include the following: signs of respiratory distress; changes in vital signs, especially pulse or blood pressure; pain, drainage, redness, swelling, or bleeding from the insertion site; abdominal cramps, nausea, or

WoRKbooK P. 136

Lecture Review point about dialysis: • Can be done via the arm, neck, abdomen, or leg Discuss the following guidelines for dialysis: • Wash hands thoroughly. • Keep the access arm area clean. • Help residents dress in proper attire. • Encourage residents to follow their special diets. • Follow orders for fluid restrictions. • Measure intake and output (I&O) and weight carefully. • Check vital signs as ordered.

168 vomiting; muscle cramps; swelling of extremities (edema); change in intake and output; or itchy skin. 7.

10. A

169

27 End-of-Life Care 1. 2. 3. 4. 5. 6. 7.

Define important words in this chapter Describe palliative care Discuss hospice care Discuss the grief process and related terms Explain legal rights for a resident who is dying Explain how to care for a resident who is dying Discuss factors that influence feelings about death and list ways to meet residents’ individual needs 8. Identify common signs of approaching death 9. List changes that may occur in the human body after death 10. Describe ways to help family and friends deal with a resident’s death 11. Describe ways to help staff members cope with a resident’s death 12. Describe postmortem care Supplemental Tools

involved with hospice may wish to invite a repre-

SELLE seR nt.atC ivO eM from the local hospice organization to TRANsPARENCy 27-1 RIgHTs To RET ME ES MT bEB RA WN HK EN CARINg FoR THE TERMINALLy ILL TRANsPARENCy 27-2 sIgNs oF APPRoACHINg dEATH HANDouT 27-1 THE DyINg PERsoN’s bILL oF RIgHTs CHAPTER 27: EXAM

Assignments TEXTbooK READINg, PP. 472-483 WoRKbooK EXERCIsEs, PP. 137-141

Overview of Teaching Strategies It is important for NAs to understand the stages and signs of dying, as well as the grieving process, so that they may be a support system for the resident and the family. Exploring their own attitudes about death will be a part of the teaching approach. This will facilitate a deeper understanding of how others feel about death, especially the residents themselves. Hospice may be a career direction for some of the students, so a clear overview of the philosophy and goals of hospice care is included in this chapter. An instructor who has never been

speak to the students. The emphasis here, as with hospice itself, is to maintain as much dignity as is possible for the resident going through the dying process. The Dying Person’s Bill of Rights, on page 476 of the textbook, helps illustrate this. Most students will voice difficulty with the prospect of caring for a body during postmortem care. This is a common human response, and the instructor should first discuss why this creates anxiety and fear in the students. Encourage the class to discuss their feelings, which will lower their anxiety about care of the dying resident and care of the body after death.

1. Define important words in this chapter Meeting the Learning Objective TEXTbooK P. 472 WoRKbooK P. 137

Lecture Pronounce and define each of the key terms listed in the Learning Objective.

170 2. Describe palliative care

Emphasize that NAs should report complaints of pain or signs of pain immediately. Emphasize making sure that residents who are dying feel independent and retain control over their lives for as long as possible.

Meeting the Learning Objective TEXTbooK P. 473 WoRKbooK P. 137

Lecture Pronounce and define the following key term: • Palliative care

4. Discuss the grief process and related terms Meeting the Learning Objective

Review the following goals of palliative care:

TEXTbooK PP. 474-475

• Control symptoms

WoRKbooK PP. 137-138

• Reduce suffering

Lecture Pronounce and define the following key term:

• Prevent side effects • Maintain quality of life

• Grief

• Emphasize holistic approach Emphasize that palliative care works to manage symptoms, not cure the disease.

• Denial: refusal to believe they are dying • Anger: “Why me?”

3. Discuss hospice care Meeting the Learning Objective TEXTbooK PP. 473-474

Discuss Dr. Kubler-Ross’s five stages of grief (On Death and Dying):

• Bargaining: “Yes me, but…” • Depression: need to mourn and review their lives

TESTBANKS•EALcL .cCe:OpMreparing for death ceE ptRan

WoRKbooK P. 137

Lecture Pronounce and define the following key terms:

Emphasize that not every resident goes through all these stages or in this order. Pronounce and define the following key terms:

• Terminal illness

• Anticipatory grief

• Death

• Bereavement

Review the following points about hospice care:

• Complicated grief

• Ordered by a doctor for a person who has six months or less to live

• Grief process

• Can be given in a hospital, care facility, or in the home

• Mourning

• Uses a holistic approach

5. Explain legal rights for a resident who is dying

• Focuses on resident and family as a unit

• Grief counseling

• Offers medically-directed, team-managed care • Offers compassionate care • Focuses on soothing and comfort care, rather than curative care • Emphasizes pain and symptom management • Provides alternative to traditional care • Helps family obtain financial counseling and legal assistance • Offers assistance for psychosocial needs

Meeting the Learning Objective TEXTbooK PP. 475-476 WoRKbooK P. 138

Display Transparency 27-1 RIgHTs To REMEMbER WHEN CARINg FoR THE TERMINALLy ILL

171 Discuss the rights listed on the transparency. Ask the following questions and make the following points to lead a discussion about rights.

6. Explain how to care for a resident who is dying

Meeting the Learning Objective

The right to have visitors • It may be inconvenient to have visitors coming and going at odd hours, but when death is close, it is an emotional time for all involved. • Saying goodbye can be a very important part of dealing with a loved one’s death. • It may also be very reassuring to the dying person to have someone in the room, even if they do not seem to be aware of their surroundings. • Only report a visitor if he is disruptive or he becomes a threat. The right to privacy • Privacy is a basic right, but why may privacy for visiting be even more important now? The right to be free from pain • It is very important to monitor dying residents for signs that they are in pain. If they can no longer speak, how else can you tell if a resident may be in pain?

TEXTbooK PP. 476-477 WoRKbooK P. 139

Lecture Review the following guidelines for care of a dying resident: Skin, Nose and Mouth Care • Give frequent skin care. • Bathe often. • Change gowns and sheets often. • Give incontinence care promptly. • Turn and reposition often. • Give oral care frequently. • Offer ice chips. • Use lubricant on nose and mouth.

Breathing Problems • Report gurgling or rattling. TESTBANKSELLE •R El. evCaO teM the head of the bed and change positions The right to honest and accurate information as ordered. • Residents have the right to honest informaFood and Fluid Issues tion about their diagnosis and care as the situation evolves. Refer medical questions • Feed residents slowly. that are outside your scope of practice to the • Encourage fluids. nurse. • Do not force residents to eat or drink. The right to refuse treatment • Report nausea, vomiting, and diarrhea. • Have you ever cared for someone who did • Elevate head of bed. not want more treatment? How did you feel? • We need to remember that whether we Pain Control and Comfort agree or disagree with the decisions, the • Pain relief is critical. choice is not ours, but belongs to the person • Observe and report signs of pain. involved. Sometimes, when residents are not capable of making a decision, they have told • Adjust blankets for temperature changes. their family how they wish for things to be Diminished Senses done. Be supportive of family members; do not judge them. They are probably following • Keep room softly lit. the person’s wishes. • Use alternate forms of communication.

Distribute Handout 27-1 THE DyINg PERsoN’s bILL oF RIgHTs

Go over each right on the handout and ask students why they think these rights are important for a dying person.

• Speak normally and describe care that is being performed.

172 7. Discuss factors that influence feelings about death and list ways to meet residents’ individual needs

Display Transparency

Meeting the Learning Objective

• Cyanotic, pale, or darkening skin or mucous membranes

TEXTbooK PP. 477-478 WoRKbooK P. 139

27-2 sIgNs oF APPRoACHINg dEATH Review the following signs of approaching death:

• Cold skin • Skin that looks bruised (mottling)

Lecture and Discussion Pronounce and define the following key term:

• Heavy perspiration

• Cremation

• Low blood pressure

Discuss the factors that influence feelings and attitudes about death:

• Increased pulse

• Experience with death

• Gurgling and rattling sound when breathing

• Personality type

• Difficulty swallowing

• Religious beliefs

• Decreased appetite and sense of thirst

• Cultural background

• Dry mouth

Ask students to share some of their own experiences and backgrounds.

• Fever

• Cheyne-Stokes breathing

• Nausea, vomiting, and diarrhea • Decreased sense of touch

• Loss of feeling, beginning in the legs and feet Remind students that it is important to honor • Extreme weakness and exhaustion individual practices and traditions without judging them. TESTBANKS•ELLoL ssEoR fm .C usOclM e tone Review the following guidelines for psychosocial and spiritual needs for dying residents:

• Fallen jaw, causing the mouth to stay open • Inability to speak

• Listen more; talk less.

• Loss of vision

• Provide privacy for visits.

• Dilated pupils and staring eyes

• Notify the nurse if resident requests visit from spiritual leader.

• Urinary and fecal incontinence

• Do not discuss personal religious beliefs or try to change resident’s beliefs.

• Hallucinations

• Do not judge. • Never share anything private with others, except for the nurse. • Do not isolate or avoid resident. • Inform the nurse if resident has expressed fear of dying.

8. Identify common signs of approaching death Meeting the Learning Objective TEXTbooK P. 479 WoRKbooK P. 140

• Decreased urinary output • Extreme drowsiness • Disorientation or confusion • Loss of hearing

9. List changes that may occur in the human body after death Meeting the Learning Objective TEXTbooK P. 479 WoRKbooK P. 140

Lecture Review the following points about the body after death: • No pulse, respiration, or blood pressure

173 • Eyelids partially open • Fixed and dilated pupils • Jaw drops • Urinary and fecal incontinence Pronounce and define the following key term: • Rigor mortis Review the terms to describe the body after death.

10. Describe ways to help family and friends deal with a resident’s death Meeting the Learning Objective TEXTbooK PP. 479-480 WoRKbooK P. 140

11. Describe ways to help staff members cope with a resident’s death Meeting the Learning Objective TEXTbooK PP. 480-481 WoRKbooK PP. 140-141

Lecture Discuss your facility’s policy on grief counseling if it is available. Emphasize that NAs have a right to their feelings when someone dies. Review ways that staff can cope with a resident’s death: • Expressing feelings—they are normal • Getting enough sleep, eating nutritious meals, drinking only in moderation, and not smoking • Participating in enjoyable activities and exercising regularly

Lecture Discuss some of the feelings family and friends may experience after a loved one dies:

• Spending quality time with people they love

• Feeling numb or being in shock

• Sharing memories

• Disbelief or denial of the death • Intense sadness and crying

• Joining a support group • Talking to a counselor

• Anxiety or fear • Anger

12. Describe postmortem care

• Physical reactions or symptoms, such as pain, especially chest pain, nausea, or difficulty breathing

Meeting the Learning Objective

• Feelings of guilt, especially if there were any unresolved problems or issues with the relationship

TEXTbooK PP. 481-482 WoRKbooK P. 141

• Feelings of relief

Lecture Pronounce and define the following key terms:

Remind students that complaints from family and friends should be referred to the nurse.

• Postmortem care

Make sure students understand that family and friends should be allowed to express their feelings. They should be treated with respect and compassion.

• Pathologist

Review guidelines for NAs to follow to help families and friends:

Demonstration Demonstrate procedure Postmortem care. Include all the numbered steps in your demonstration.

• Allow the family to show their feelings. • Be available. Listen when they want to talk. • Do not be afraid to show your feelings. • Do not make inappropriate comments or use clichés. • Report requests for spiritual leaders to the nurse.

• Autopsy

Remind students to be aware of religious or cultural practices that the family wants to observe.

Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.

174 • Loss of feeling, beginning in the legs and feet • Extreme weakness and exhaustion • Loss of muscle tone • Fallen jaw, causing the mouth to stay open • Inability to speak • Loss of vision • Dilated pupils and staring eyes • Urinary and fecal incontinence • Decreased urinary output • Hallucinations • Extreme drowsiness • Disorientation or confusion • Loss of hearing

Discussion Discuss the fact that facilities may have special policies on postmortem care. Ask the students to talk about their feelings regarding this care. Do they think they would have a problem touching a dead body? How can they show respect to families after a loved one has died?

Chapter Review Exam dIsTRIbuTE CHAPTER 27: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

Inform the nurse

Answers include the following: Allow the family to show their feelings. Be available. Listen when they want to talk. Do not be afraid to show your feelings. Do not make inappropriate comments or use clichés. Report requests for spiritual leaders to the nurse.

Bereavement therapy is a way to identify feelings to help with grieving.

After death

Answers to Chapter Review in Textbook 1.

Answers include the following: relieve pain, control symptoms, reduce suffering, prevent side effects, and maintain quality of life.

Denial: refusal to believe they are dying; Anger: “Why me?”; Bargaining: “Yes me, but…”; Depression: need to mourn and review their lives; Acceptance: preparing for death

Answers include the following: The right to have visitors. The right to privacy. The right to be free from pain. The right to honest and accurate information. The right to refuse treatment.

Answers include the following: • Cyanotic, pale, or darkening skin or mucous membranes • Cold skin • Skin that looks bruised (mottling) • Heavy perspiration • Fever • Low blood pressure • Increased pulse • Cheyne-Stokes breathing • Gurgling and rattling sound when breathing • Difficulty swallowing • Decreased appetite and sense of thirst • Dry mouth • Nausea, vomiting, and diarrhea • Decreased sense of touch

10. A 11. D

175

28 Your New Position 1. Define important words in this chapter 2. Describe how to write a résumé and cover letter 3. Identify information that may be required for filling out a job application 4. Discuss proper grooming guidelines for a job interview 5. List techniques for interviewing successfully 6. Describe a standard job description and list steps for following the scope of practice 7. Identify guidelines for maintaining certification and explain the state’s registry 8. Describe continuing education for nursing assistants 9. Describe employee evaluations and discuss feedback 10. Discuss conflict resolution 11. Define stress and explain ways to manage stress 12. Describe how to be a valued member of the healthcare community Supplemental Tools

programs are available on DVD or for streaming and would be very effective as a classroom experiHANDouT 28-1 Job APPLICATIoN en TESTBANKSELLERce.. CGOueMst speakers could speak to the class about CHAPTER 28: EXAM wellness and healthy lifestyles, which would add an interesting outside resource to the chapter. Assignments If the instructor is affiliated with a facility, it would TEXTbooK READINg, PP. 484-496 be beneficial if the students could review actual WoRKbooK EXERCIsEs, PP. 143-146 examples of hiring paperwork and employee applications. Any policies which explain company hirOverview of Teaching Strategies ing guidelines, criminal background check forms, This chapter is as much a motivational chapter hiring skills tests, competency-on-hire exams, as a learning one. It focuses on the nursing asor job descriptions could be brought to class and sistant, rather than the resident. In this chapter, reviewed by the students. If the students have an the students will be asked to stop and think about opportunity to practice a job interview or the hiring their career directions, including how to secure process first, they will be more confident during a job, how to have a good relationship with their an actual interview, when getting a job depends on employer, and the importance of maintaining their their success. continuing education. In addition, the students are encouraged to learn how to manage their stress effectively. Students will also be asking, “Where do 1. Define important words in the chapter I go from here?” Meeting the Learning Objective The instructor should encourage the students to TEXTbooK P. 143 think about how they see themselves in their new WoRKbooK P. 484 careers and how they will conduct themselves professionally now and in the future. Hopefully the students will be motivated to set some goals Lecture for themselves to stay as mentally and physically Pronounce and define each of the key terms listed healthy as possible. Many stress management in the Learning Objective.

176 2. Describe how to write a résumé and cover letter

• Names, addresses, and telephone numbers of the school or program where you were trained

Meeting the Learning Objective

• Certification numbers and expiration dates from certification cards, CPR cards, and first aid cards • Previous supervisors’ and employers’ names, addresses, email addresses, and phone numbers

TEXTbooK PP. 484-485 WoRKbooK P. 143

Lecture Pronounce and define the following key term: • Résumé Review what items a résumé should contain: • Objective • Education

Review guidelines for job applications:

• Skills

• Fill it out carefully and neatly.

• References

• Never lie on the application. • Do not leave anything blank.

Rules for writing a résumé are:

• Check spelling. • Do not staple anything to it.

• Availability (days and hours)

28-1 Job APPLICATIoN

• Volunteer work

• No borders or colors • 12-point font

• Complete names, addresses, e-mail addresses, and phone numbers of personal and professional references

Distribute Handout

• Experience

• One page

• Dates of previous and current employment and reasons for leaving each job

Discuss the fact that states perform a criminal background check when hiring, and neatness in appearance and paperwork is always a factor. Using TESTBANKStE heLhLaE ndRo. utC , aOsM k the students to fill out a sample job application.

Review guidelines for cover letters: • Should be brief

4. Discuss proper grooming guidelines for a job interview

• Serves as an introduction to the interviewer • Should include information about why you are seeking the job

Meeting the Learning Objective TEXTbooK P. 489 WoRKbooK P. 144

3. Identify information that may be required for filling out a job application

Lecture Review the proper grooming guidelines:

Meeting the Learning Objective

• Bathe and use deodorant.

TEXTbooK PP. 485-489

• Do not wear perfume or cologne.

WoRKbooK P. 143

• Wear simple makeup and jewelry or none at all.

Lecture Discuss the general information needed for a job application, including:

• Wash your hands and clean and file your nails. Nails should be medium length or shorter. Do not wear artificial nails.

• Your address and phone number

• Shave or trim facial hair right before the interview.

• Your e-mail address

• Wear your hair in a simple style.

• Your social security number

• Brush your teeth. Check your teeth right before the interview begins.

• Salary information

177 • Do not smoke. • Wear clean, nice clothes. Dresses and skirts should not be shorter than knee-length. Do not wear jeans or shorts. Do not wear t-shirts or anything with a logo or writing on it. Do not wear low-cut tops that show cleavage. • Make sure your shoes are polished. Do not wear sneakers or open-toed sandals.

5. List techniques for interviewing successfully Meeting the Learning Objective TEXTbooK PP. 489-490 WoRKbooK P. 144

Lecture Review the tips for interviewing: • Practice beforehand. • Find out beforehand if there will be a test. • Get directions to the interview site. • Do not bring children or friends with you. • Arrive early. • Turn off your cell phone. • Be courteous to staff members. • Introduce yourself and smile and shake hands. • Be positive and look happy.

6. Describe a standard job description and list steps for following the scope of practice Meeting the Learning Objective TEXTbooK PP. 490-491 WoRKbooK P. 144

Lecture Pronounce and define the following key term: • Job description If you have a job description used at your facility, show the students an example. Review the tips to help decide whether or not an NA should perform a procedure: • Do not perform a procedure if it is outside your scope of practice, not listed in the job description, or not listed in the care plan. • Do not perform a procedure if you have not been trained. • Do not perform the procedure if you have forgotten how to do all or part of it. • If you believe a procedure is not appropriate for a resident, ask the nurse.

7. Identify guidelines for maintaining certification and explain the state’s registry Meeting the Learning Objective

• Do not eat or chew gum.

TEXTbooK PP. 491-492

• Make eye contact.

WoRKbooK PP. 144-145

• Answer questions clearly and completely. • Do not use slang or curse words. • Do not exaggerate your accomplishments. • Relax and be confident. Role Play Using the job applications students completed, role-play job interviews with the students. The instructor will role play the interviewer asking general questions. Each student should take a turn being interviewed. Remind them to shake hands, make an exit remark, and write a follow-up thank you letter.

Lecture Present your state’s requirements for NAs’ maintaining their certification. Review these general guidelines: • Specific time frame to take the state test • Test must be taken within that timeframe or NA will have to take new training course • NA must work for pay during 24 months • NA usually has three chances to pass test • NA must keep certification current Discuss the information found on state registries: • NA’s name • NA’s address, DOB, and social security number

178 • Date NA was placed in registry and test results

10. Discuss conflict resolution

• Expiration dates of certificates • Information about investigations and hearings

Meeting the Learning Objective TEXTbooK PP. 493-494

8. Describe continuing education for nursing assistants Meeting the Learning Objective

WoRKbooK P. 145

Lecture Pronounce and define the following key term: • Conflict resolution

TEXTbooK P. 492

Review these points about conflict resolution:

WoRKbooK P. 145

Lecture Tell students that they must have 12 hours of continuing education every year (required by the government). Ask the students to review your facility’s policies on continuing education and discuss it in class. Discuss the NA’s responsibilities for completing continuing education: • Attend class. • Pay attention and complete requirements. • Keep certificates and records of attendance.

• Before reacting, think about reasons someone is behaving in an undesirable way. • Be reasonable with your requests. • Think about how to best solve the problem. • Know when to be firm, when to walk away, and when to compromise. Role-Play Role-play a situation between two NAs in which one NA is always late to work and the other NA has to do her job until she arrives.

e CstOreMss and explain ways to TESTBANKS1E1.LDLeEfiRn. 9. Describe employee evaluations and discuss feedback Meeting the Learning Objective TEXTbooK PP. 493 WoRKbooK P. 145

Lecture Pronounce and define the following key term:

manage stress

Meeting the Learning Objective TEXTbooK PP. 493-496 WoRKbooK P. 146

Lecture and Discussion Pronounce and define the following key terms: • Stress

• Constructive feedback

• Stressor

Discuss the difference between hostile criticism and constructive feedback.

Discuss how anything can be a stressor, including positive and negative situations. Ask students to come up with examples of stressors, e.g., a new baby, being fired, getting married, etc.

Discuss ways to make constructive feedback beneficial, such as: • Be open to suggestions. • Listen without becoming angry. • Consider how to address or fix the problems. • Ask for suggestions. Remind students that evaluations are often the basis for advancement and salary increases. They should be open to feedback and use suggestions for improvement.

Discuss signs of burnout from unrelieved stress: • Arguing frequently • Losing patience • Being angry • Wanting too much control • Obsessing over small, unimportant things • Being rude, irritated, and frustrated

179 • Having trouble focusing on residents and procedures

Answers to Chapter Review in Textbook 1.

Answers include: objective, education, experience, volunteer work, skills, and references

One page

Answers will vary, but may include something about keeping residents safe.

Do not perform a procedure if it is outside your scope of practice, not listed in the job description, or not listed in the care plan. Do not perform a procedure if you have not been trained. Do not perform the procedure if you have forgotten how to do all or part of it. If you believe a procedure is not appropriate for a resident, ask the nurse.

Discussion Read the box on page 495 on goal-setting. Ask students for examples of long- and short-term goals that they have set for themselves.

Answers include: NA’s name; NA’s address, DOB, and social security number; date NA was placed in registry and test results; expiration dates of certificates; and information about investigations and hearings

12. Describe how to be a valued member of the healthcare community

Constructive feedback is the process of giving opinions about the work of others, which includes helpful suggestions for change. It may involve both positive and negative feedback.

Think about possible reasons why someone is behaving in an undesirable way.

Stress is a mentally or emotionally disruptive or upsetting condition that occurs due to changes in the environment.

Answers include: Increase exercise levels. Get enough sleep. Eat a healthy diet. Do not smoke or take illegal drugs. Do one task at a time. Develop new hobbies. Seek help from others. Seek counseling. Set realistic goals. Use a personal reward system.

Review the guidelines for managing stress: • Increase exercise levels. • Get enough sleep. • Eat a healthy diet. • Do not smoke or take illegal drugs. • Do one task at a time. • Develop new hobbies. • Seek help from others. • Seek counseling. • Set realistic goals. • Use a personal reward system.

Meeting the Learning Objective TEXTbooK P. 496 WoRKbooK P. 146

Discussion Ask students what they think their favorite part of their new job will be. Remind them of how hard they worked. Tell them to be confident and kind as they move forward in the world of healthcare.

Chapter Review Exam dIsTRIbuTE CHAPTER 28: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.

10. D 11. B 12. A

180

181

Appendix A Transparency Masters

182

Facts about Medicare and Medicaid

Medicare • Medicare is for people age 65 or older and people of any age with permanent kidney failure or certain disabilities. • Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice. • Part B helps pay for doctor services and other medical services and equipment. • Part C allows private health insurance companies to provide Medicare benefits. • Part D helps pay for medications prescribed for treatment. Medicaid • Medicaid is a medical assistance program for people who have a low income and for people with disabilities. • People qualify based on income and special circumstances.

Transparency 1-1

183

Residents in LTC facilities

• • • • •

88% are over 65 71% are female More than 90% are white and non-Hispanic About 1/3 come from a private residence Over 50% come from a hospital

Transparency 1-2

184

Chain of Command

Administrator: manages non-medical aspects of the facility, administers finances, and coordinates policy in consultation with medical professionals Medical Director (MD): reviews and consults on medical aspects of care, coordinating with attending physicians and nursing staff and encouraging quality care

Director of Nursing (DON): manages the nursing staff at a facility Assistant Director of Nursing (ADON): assists the DON with management of nursing staff Staff Development Coordinator: directs the training of employees at a facility

Other Services Physical Therapist (PT): administers therapy to increase movement, promote healing, reduce pain, and prevent disability

Occupational Therapist (OT): helps residents TESTBANKSE Minimum Data Set (MDS) Coordina- L LER.COM learn to adapt to disabilities and trains tor/Resident Assessment Coordinathem to perform ADLs tor: manages the assessment of resident needs and delivery of Speech-Language required care in a long-term care Pathologist (SLP): facility (usually a specially trained identifies communicanurse) tion disorders and swallowing problems Nursing Supervisor: supervises and and develops a plan of supports nursing staff of entire care facility or multiple nursing units, assisting with resident care as needed Charge Nurse: supervises and supports nursing staff of a particular unit and treats a limited number of residents Staff Nurses (RNs, LPNs/LVNs): provide nursing care as prescribed by a physician Nursing Assistants (NAs, CNAs): perform assigned nursing tasks, assist with routine personal care, and observe and report any changes in residents’ conditions and abilities

Transparency 1-3

185

Nursing Assistant Code of Ethics

1. I will strive to provide and maintain the highest quality of care for my residents. I will fully recognize and follow all of the Residents’ Rights. 2. I will communicate well, serve on committees, and read all material as provided and required by my employer. I will attend educational in-services, and join organizations relevant to nursing assistant care. 3. I will show a positive attitude toward my residents, their family members, staff, and other visitors. 4. I will always provide privacy for my residents. I will maintain confidentiality of resident, staff, and visitor information. 5. I will be trustworthy and honest in all dealings with residents, staff, and visitors. 6. I will strive to preserve resident safety. I will report mistakes I make, along with anything that I deem dangerous, to the right person(s). 7. I will have empathy for my residents, other staff, and all visitors, giving support and encouragement when needed. 8. I will respect all people, without regard to age, gender, ethnicity, religion, economic situation, sexuTaEl SoT riBeA ntNaKtiSoE nL , oLrEdRi. agCnOoMsis. 9. I will never abuse my residents in any way. I will always report any suspected abuse to the proper person immediately. 10. I will strive to have the utmost patience with all people at my facility.

Transparency 2-1

186

Communication Process

Transparency 3-1

187

Body Language

Transparency 3-2

188

Barriers to Communication

Words are not understood

Cliché is used Yes/no answers end a conversation

Slang is used

Advice is given

“Why” questions make resident defensive Nonverbal communication changes the message Resident speaks different NA cannot language understand resident

Resident cannot hear NA

Transparency 3-3

189

24-Hour Clock

1200

2300

1300

12 11 1100

2200

2100

1000

0000 or 2400

0100

1400 0200

0900

0300

0800

1500

0400

4 0700

2000

0500

1600

0600

5 6

1900

1700 1800

Transparency 3-4

190

Sample Kardex

HEARING

TRANSFER

❑ Adequate ❑ Hard of hearing ❑ Wears hearing aids ❑ R ❑ L ❑ Face resident when speaking SPEAKS

OF CARE KARDEX ❑ PLAN Independent ❑ Assist of 1 1 ❑ Assist of 2 ❑ Mechanical lift 2

DAY

PERSONAL HYGIENE

❑ English ❑ Other (specify) ❑ Writing messages ❑ Utilizes sign language ❑ Braille ❑ Signs/gestures/sounds ❑ Communication board ❑ No communication skills

❑ Brush teeth ❑ Comb hair ❑ Perineum care ❑ Shaving ❑ Make-up application ❑ Independent ❑ Assist of 1 ❑ Assist of 2

ALERTS

DRESSING

VISION

❑ Independent ❑ Assist of 1 ❑ Assist of 2 ❑ Day clothes ❑ Pajamas/sleepwear ❑ Adaptive equipment

❑ Code status ❑ Allergies ❑ Adequate ❑ Impaired ❑ Wears glasses ❑ Wears contacts ❑ Blind AMBULATION

4 5 6 7

9 10 11

13 14 15

TESTBANKSELLE R.16COM

Location of dining: ❑ Breakfast ❑ Lunch ❑ Dinner

BATHING

❑ A.M. ❑ P.M. ❑ Shower ❑ Bathtub ❑ Whirlpool ❑ Bed Bath ❑ Independent ❑ Supervision ❑ Assist of 1 ❑ Assist of 2

Nights

EATING

❑ Independent ❑ Supervision (cueing) ❑ Set up ❑ Restorative feeding ❑ Dependent on staff ❑ Feed tube

❑ Independent ❑ Assist of 1 ❑ Assist of 2 ❑ Wheeled walker ❑ Walker ❑ Wheelchair ❑ Adaptive equipment ❑ Other (specify)

INITIALS Month/Year Days Evenings

17 18

TOILET USE Days: ❑ Mon. ❑ Tues. ❑ Wed. ❑ Thurs. ❑ Fri. ❑ Sat. ❑ Sun

BED MOBILITY

❑ Independent ❑ Assist of 1 ❑ Assist of 2 ❑ Turn q ❑ Trapeze bar ❑ Adaptive equipmnent

❑ Continent of Bladder ❑ Continent of Bowel ❑ Uses bathroom ❑ Uses bedside toilet ❑ Uses bedpan/urinal ❑ Independent ❑ Supervision ❑ Assist of 1 ❑ Assist of 2 ❑ Wears incontinent briefs ❑ Scheduled toilet plan (specify)

❑ Incontinent check and change

q ❑ Ostomy care ❑ Adaptive equipment

RESTRAINTS

RESTORATIVE

20 21 22 23 24 25

27 28 29

Specify:

30 31 Transcribed by:

NAME–Last

First

Middle

Attending Physician

Form 1138P Rev. 8/10 © BRIGGS, Des Moines, IA (800) 247-2343

Record No.

Room/Bed

PLAN OF CARE KARDEX

Unauthorized copying or use violates copyright law. www.BriggsCorp.com PRINTED IN U.S.A.

(Reprinted with permission of the Briggs Corporation, 800-247-2343, www.briggscorp.com)

Transparency 3-5

191

Sample Kardex (cont’d)

PLAN OF CARE KARDEX DIET: % Consumed 4 = 100% 3 = 75% 2 = 50% 1 = 25%

Month/Year

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Break Snack Lunch Snack Dinner Snack

BLADDER Day ACTION: C = Continent I = Incontinent After Night

BOWEL Day ACTION: C = Continent S/M/L/D I = Incontinent S = Small M = Medium L = Large D = Diarrhea

After S/M/L/D Night

TESTBANKSELLER.COM

S/M/L/D

BATH: S = Shower B = Bed T = Tub

Nights Days Evenings

INTAKE (mL)

Nights Days Evenings

OUTPUT (mL)

Nights Days Evenings

Initials

NAME–Last

Signature

First

Initials

Middle

Attending Physician

Signature

Record No.

Room/Bed

PLAN OF CARE KARDEX

(Reprinted with permission of the Briggs Corporation, 800-247-2343, www.briggscorp.com)

Transparency 3-5

192

Using Your Senses

Sight: Changes in resident’s appearance

Smell: Resident’s body or breath odor

Hearing: Resident’s words, tone, and breathing

Touch: Resident’s skin and pulse

Transparency 3-6

193

Maslow’s Hierarchy of Needs

Need for selfactualization

The need to learn, create, and realize one’s own potential

Need for self-esteem

Achievement, belief in one’s own worth and value

Need for love

Feeling loved and accepted, belonging

ER Safety andTsEeScTuBAriNtKySnEeLeLd s.COM

Physical needs

Transparency 5-1

Shelter, protection, and stability Oxygen, water, food, elimination, and rest

194

True or False?

1. Most older adults are lonely and depressed. 2. Elderly people cannot manage their bills and bank accounts. 3. Older adults are not interested in sex. 4. Aging is a normal process. 5. Many older adults continue to learn. 6. Most elderly people are grumpy. 7. Most elderly people are helpless and cannot do anything by themselves. 8. Elderly people are not as intelligent as younger people. 9. Most older adults are active and continue to have interests.

Transparency 5-2

195

The Chain of Infection

Transparency 6-1

196

Portals of Exit

Transparency 6-2

197

Portals of Entry

Transparency 6-3

198

Airborne Precautions

Airborne Precautions prevent the spread of pathogens that travel through the air after being expelled. Tuberculosis (TB) is an example of an airborne disease. For Airborne Precautions: • Follow Standard Precautions. • Resident will be in airborne infection isolation room (AIIR). • Keep doors and windows closed. Do not open or close door quickly. • Wear a special mask during resident care. • Residents must wear surgical masks if they leave the room.

Transparency 6-4

199

Droplet Precautions

Droplet Precautions are used for diseases that are spread by droplets in the air. Droplets normally do not travel further than six feet. Talking, singing, sneezing, laughing, or coughing can spread droplets. Influenza is an example of Ta EdSroTpBlA etNdKiS seEaLsL e.ER.COM For Droplet Precautions: • Follow Standard Precautions. • Apply a mask before entering the room. Wear a mask during resident care. • Residents must wear masks when leaving the room. • Cover your nose and mouth if you sneeze or cough. Dispose of tissue in no-touch waste container and wash your hands. • Visits from uninfected people may be restricted.

Transparency 6-5

200

Contact Precautions

Contact Precautions are used when a person may spread an infection by direct contact with another person or object. BpAlNeKoSf EaLcL EtRa.ctCdOiMsease. Clostridium difficile (C. diff ) is anTEexSaTm on For Contact Precautions: • Follow Standard Precautions. • Put on a gown before entering a resident’s room. • Put on gloves before entering the room. Change gloves if they become contaminated. Remove gloves before leaving the room. • Wash hands after removing gloves while still in the room. • Do not share residents’ equipment with other residents. • Do not share residents’ towels, bedding, or clothing with other residents. • Resident will be placed in a private room.

Transparency 6-6

201

Body Alignment

Transparency 7-1

202

Lifting Heavy Objects from the Floor

Back muscles must lift the object and half of the body

Legs and thighs do the lifting

Transparency 7-2

203

Body Positions for Exams

DORSAL RECUMBENT

LITHOTOMY

KNEE-CHEST

Transparency 9-1

204

Five Basic Positions

SUPINE

LATERAL

PRONE

FOWLER’S

SIMS’

Transparency 11-1

205

Assisting with Personal Care

• Encourage residents to perform self-care whenever they can. This promotes dignity, independence, and proper body functioning. • Be empathetic to emotions residents are experiencing. • Always explain what you will be doing and answer any questions. Let the resident make as many choices as possible about the care that will be performed. • Allow enough time for residents to use the bathroom, without rushing or interrupting them. • Provide for personal choice. • Be patient. • Be respectful and provide privacy during phone calls and visits. • Keep residents covered during bathing and dressing. • Promote residents’ safety. • Talk to residents during personal care and report changes, concerns, or problems.

Transparency 12-1

206

Safety Guidelines and Bathing

• • • • • • • • •

Ask for help if you need it. Follow the care plan. If this is the NA’s responsibility, clean areas and equipment before and after use. Make sure floor in shower or tub room is dry. Place nonslip mats in regular tubs. Make sure safety bars are in working order. Encourage residents to use them. Gather all needed supplies and equipment, and place these items within reach. Do not use bath oils, gels, or powders. Make sure water is at a comfortable temperature for each resident. Temperature should not be higher than 105°F. • Store electrical appliances away from water source. • Do not leave residents alone while bathing.

Transparency 12-2

207

Bathing Wheel

1. Eyes 2. Face 3. Ears 4. Neck 5. Arms, Axilla (axillae), and Hands 6. Chest and Abdomen 7. Legs and Feet 8. Back 9. Perineal Area 10. Buttocks

10. Buttocks

1. Eyes

2. Face

9. Perineal area

3. Ears

8. Back

4. Neck

7. Legs and feet

6. Chest and abdomen

5. Arms, axilla, and hands

Transparency 12-3

208

Ranges for Adult Vital Signs

Temp. Site Mouth (oral) Rectum (rectal) Armpit (axilla) Ear (tympanic) Temporal Artery

Fahrenheit 97.6° – 99.6° 98.6° – 100.6° 96.6° – 98.6° 96.6° – 99.7° 97.2° – 100.1°

Celsius 36.5° – 37.5° 37.0° – 38.1° 36.0° – 37.0° 35.8° – 37.6° 36.2° – 37.8°

Normal Pulse Rate: 60-100 beats per minute Normal Respiratory Rate: 12-20 respirations per minute Blood Pressure Normal

Systolic: 119 or lower Diastolic: 79 or lower

Low

Below 90/60

Prehypertensive

Systolic: 120-139 Diastolic: 80-89

High

140/90 or above

Transparency 13-1

209

MyPlate

TESTBANKSELLER.COM

Transparency 14-1

210

Preventing Aspiration

• • • • • • • •

Position resident in a straight, upright position at a 90-degree angle. Feed resident slowly. Avoid distractions. Offer small pieces of food or small spoonfuls of pureed food. Offer food and then a liquid. Place food in the non-paralyzed side of the mouth. Make sure food is actually swallowed before the next bite of food or sip of drink. Have residents stay in upright position for at least 30 minutes after eating and drinking. • Provide mouth care after eating. • Observe residents closely. Report signs of aspiration immediately.

Transparency 14-2

211

Conversion Table

One ounce equals 30 milliliters. To convert ounces to milliliters, the number of ounces must be multiplied by 30. 1 oz. = 30 mL 2 oz. = 60 mL 3 oz. = 90 mL 4 oz. = 120 mL 5 oz. = 150 mL 6 oz. = 180 mL 7 oz. = 210 mL 8 oz. = 240 mL ¼ cup = 2 oz. = 60 mL ½ cup = 4 oz. = 120 mL ¾ cup = 6 oz. = 180 mL 1 cup = 8 oz. = 240 mL 2 cups = 16 oz. = 480 mL 4 cups = 32 oz. = 960 mL

Transparency 14-3

212

The Gastrointestinal System

Transparency 15-1

213

Factors Affecting Bowel Elimination

• • • • • • •

Growth and development Psychological factors Diet Fluid intake Physical activity and exercise Personal habits Medications

Transparency 15-2

214

The Urinary System

Female Urinary System

Male Urinary System

Transparency 16-1

215

Factors Affecting Urination

• • • • • • •

Growth and development Psychological factors Fluid intake Physical activity and exercise Personal habits Medications Disorders

Transparency 16-2

216

The Reproductive System

Female Reproductive System

Male Reproductive System

Transparency 17-1

217

The Integumentary System

Sebaceous gland

Transparency 18-1

218

Pressure Ulcer Danger Zones

Lateral Position

Side of Head

Ear Shoulder Hip

Greater Knees Trochanter

Ankles

Prone Position

Cheek Collarbone Breasts Abdomen Genitals Knees Toes (Women) (Men)

Supine Position

Back of Shoulder Elbows Buttocks Sacrum Between Heels Head Blades (Spine Base) the Legs

Transparency 18-2

219

Observing the Skin

Observe the skin carefully for signs of skin breakdown, including the following: • Pale, white, reddened, gray, or purple skin • Dry, cracked, or flaking skin • Torn skin • Blisters, bruises, or wounds on the skin • Rashes or any discoloration • Tingling, warmth, or burning of skin • Itching or scratching • Swelling of skin • Wet skin • Broken skin anywhere on the body • Changes in existing wounds or ulcers

Transparency 18-3

220

The Circulatory System

Transparency 19-1

221

The Respiratory System

Transparency 20-1

222

The Musculoskeletal System

Transparency 21-1

223

The Nervous System

Transparency 22-1

224

Parts of the Eye

Transparency 22-2

225

Parts of the Ear

Inner ear

Transparency 22-3

226

The Endocrine System

Transparency 23-1

227

The Lymphatic System

Transparency 24-1

228

Rehabilitation and Restorative Care

• • • • • • • •

Understand the diagnosis, the disability, and any limitations the resident has. Be patient and offer praise frequently. Maintain a positive attitude. Listen as much as possible. Provide plenty of privacy. Encourage independence. Encourage daily activity. Accept setbacks and focus on what the resident can do.

Report observations to the nurse: • Any change in ability • Decreased strength • Lack of motivation • Signs of withdrawal and depression

Transparency 25-1

229

Benefits of Exercise

• • • • •

Gastrointestinal: promotes appetite and aids regular elimination Urinary: improves elimination, helping to decrease infection Integumentary: improves the quality and health of the skin Circulatory: improves circulation Respiratory: reduces the chance of infections, such as pneumonia, and improves oxygen level • Musculoskeletal: increases blood flow to the muscles and improves strength • Nervous: improves relaxation and sleep • Endocrine: increases metabolism, helping to maintain healthy weight

Transparency 25-2

230

Body Movements

Transparency 25-3

231

Tube Feedings

Guidelines for tube feedings include the following: • Wash hands thoroughly. • Observe carefully for signs of aspiration. • Notify the nurse if the alarm sounds. • Follow orders for positioning. • Follow fluid and weight orders. Be aware of NPO orders. • Give frequent mouth and nose care. • Do not pull or tug on tubing. Keep tubing free of kinks. • Observe for clip falling off. • Make feeding time a social time. • Report disconnected tubing; tube coming out of abdomen; any signs of respiratory distress; feeding pump alarm sounding; signs of aspiration; tube feeding liquid gathering in the mouth; cyanosis, pale, gray, or darkening skin or mucous membranes; kinked, plugged, cracked, or broken tubing; leaking or empty bag or container; resident pulling on the tube; or signs of infection at the tube site, such as warm skin, reddenedTsEkS inT, BsoArNeKs,SsEwLeLllEinRg.,CoOr Mpus.

Transparency 26-1

232

Rights to Remember When Caring for the Terminally Ill • • • • •

The right to have visitors The right to privacy The right to be free from pain The right to honest and accurate information The right to refuse treatment

Transparency 27-1

233

Signs of Approaching Death

• • • • • • • • • • • • • • • • • • • • • • • • • • •

Cyanotic, pale, or darkening skin or mucous membranes Cold skin Skin that looks bruised (mottling) Heavy perspiration Fever Low blood pressure Increased pulse Cheyne-Stokes breathing Gurgling and rattling sound when breathing Difficulty swallowing Decreased appetite and sense of thirst Dry mouth Nausea, vomiting, and diarrhea Decreased sense of touch Loss of feeling, beginning in the legs and feet Extreme weakness and eTxEhS au ioN TsBtA Loss of muscle tone Fallen jaw, causing the mouth to stay open Inability to speak Loss of vision Dilated pupils and staring eyes Urinary and fecal incontinence Decreased urinary output Hallucinations Extreme drowsiness Disorientation or confusion Loss of hearing

Transparency 27-2

234

235

Appendix B Handouts

236

Decision Quiz

Choices I have made today include the following: 1.

��

TESTBANKSELLER.COM

�� 4.

��

Handout 2-1

237

Who is Vulnerable to Abuse or Neglect?

Some people are more vulnerable to adult abuse or neglect than others. They include the following: • The elderly • The physically ill or disabled • The developmentally disabled • The mentally ill or disabled • People with communication problems, such as hearing, speech, and vision impairments All of these people have a few things in common that make them so vulnerable. They are often unable to stand up for themselves or to report abuse or neglect to others. They may not even understand that they have rights. Often these people can be much more demanding to care for, which increases caregivers’ stress. Caregivers may not have been properly trained to care for these particular people, and they may not understand why these people behave the way they do. Caregivers may also be overworked, tired, stressed, and unappreciated, on top of caring for someone who requires so much time and energy. These are the people who most need your help and protection from harm. They may not be able to speak for themselves, but the signs of abuse and neglect may speak volumes for them, if you just know how to recognize these signs.

Handout 2-2

238

Prefixes, Roots, and Suffixes

Prefixes

mal: bad, illness, disorder malformed = badly made

a, an: without, not, lack of analgesic = without pain

micro: small microscopic = too small for the eye to see

ante: before, in front of antepartum = before delivery

olig: small, scant oliguria = small amount of urine

bi: two, twice, double bifocal = two lenses

patho: disease, suffering pathology = study of disease

brady: slow bradycardia = slow pulse, heartbeat

per: by, through perforate = to make a hole through

contra: against contraceptive = prevents pregnancy

peri: around pericardium = sac around the heart

dis: apart, free from disinfected = free from microorganisms

poly: many, much polyuria = much urine

dys: bad, painful dysuria = painful urination endo: inner endoscope = instrument for examining the inside of an organ

post: after, behind postmortem = period after death pre: before, in front of prenatal = period before birth

epi: on, upon, over epidermis = outer layer of skin

sub: under, beneath subcutaneous = beneath the skin

erythro: red erythrocyte = red blood cell

supra: above, over suprapelvic = located above the pelvis

ex: out, away from exhale = to breathe out

tachy: swift, fast, rapid tachycardia = rapid heartbeat

hemi: half hemisphere = one of two parts of the brain hyper: too much, high hypertension = high blood pressure hypo: below, under hypotension = low blood pressure inter: between, within interdisciplinary = between disciplines leuk: white leukocyte = white blood cell Handout 3-1

239

Prefixes, Roots, and Suffixes (cont’d)

Roots

cyst(o): bladder, cyst cystitis = inflammation of the bladder

abdomin(o): abdomen abdominal = pertaining to the abdomen

derm, derma: skin dermatitis = inflammation of the skin

aden(o): gland adenitis = inflammation of a gland

duoden(o): duodenum duodenal = pertaining to the duodenum, the first part of the small intestine

angi(o): vessel angioplasty = surgical repair of a vessel using a balloon

encephal(o): brain encephalitis = inflammation of the brain

arterio: artery arteriosclerosis = hardening of artery walls

gaster(o), gastro: stomach gastritis = inflammation of the stomach

arthr(o): joint arthrotomy = cut into a joint

geron: aged gerontology = study of the aged

brachi(o): arm brachial = pertaining to the arm

gluco: sweet glucometer = device used to measure blood glucose glyco, glyc: sweet

bronchi, bronch(o): bronchus bronchopneumonia = inflammation of lungs card, cardi(o): heart cardiology = study of the heart

TESTBANKSELLE R.COM glycosuria = glucose (sugar) in the urine

gyneco, gyno: woman gynecology = study of diseases of the female reproductive organs

cephal(o): head cephalalgia = headache cerebr(o): cerebrum cerebrospinal = pertaining to the brain and spinal cord chole, chol(o): bile cholecystitis = inflammation of the gall bladder colo: colon colonoscopy = examination of the large intestine or colon with a scope cost(o): rib costochondral = pertaining to a rib

hema, hemato, hemo: blood hematuria = blood in the urine hepato: liver hepatomegaly = enlargement of the liver hyster(o): uterus hysterectomy = surgical removal of the uterus ile(o), ili(o): ileum ileorrhaphy = surgical repair of the ileum laryng(o): larynx laryngectomy = excision of the larynx

crani(o): skull craniotomy = cutting into the skull

lymph(o): lymph lymphocyte = type of white blood cell

cyan(o): blue cyanosis = blue, gray, or purple tinge to the skin due to lack of oxygen in the blood

mamm(o): breast mammogram = x-ray of the breast

Handout 3-1

240

Prefixes, Roots, and Suffixes (cont’d)

Roots (cont’d)

pod(o): foot podiatrist = foot doctor

mast(o): breast mastectomy = excision of the breast

proct(o): anus, rectum proctology = study of the rectum

melan(o): black melanoma = black mole or tumor, may be cancerous

pulm(o): lung pulmonary = relating to the lungs

mening(o): meninges; membranes covering the spinal cord and brain meningitis = inflammation of the membranes of the spinal cord or brain necro: death necrotic = dead tissue nephr(o): kidney nephrectomy = removal of a kidney neur(o): nerve neuritis = inflammation of a nerve onc(o): tumor oncology = study of tumors ophthalm(o): eye ophthalmologist = eye doctor oste(o): bone osteoarthritis = disease of the joints

splen(o): spleen splenomegaly = enlarged spleen stomat(o): mouth stomatitis = inflammation of mouth therm(o): hot, heat thermoplegia = heatstroke thorac(o): chest thoracotomy = incision into chest wall thromb(o): blood clot thrombus = blood clot blocking a vessel toxic(o), tox(o): poison toxicology = study of poisons trache(o): trachea, windpipe tracheostomy = incision to make an artificial airway urethr(o): urethra urethritis = inflammation of urethra

ot(o): ear otology = science of the ear pharyng(o): pharynx pharyngitis = inflammation of the throat, sore throat phleb(o): vein phlebitis = inflammation of a vein pneo/pnea: breathing tachypnea = rapid breathing pneum: air, gas, respiration pneumonia = inflammation of the lung

Handout 3-1

241

Prefixes, Roots, and Suffixes (cont’d)

Suffixes

-phasia: speaking aphasia = absence of speaking

-cyte: cell leukocyte = white blood cell

-phobia: exaggerated fear acrophobia = fear of high places

-ectomy: excision, removal of splenectomy = removal of spleen

-plasty: surgical repair angioplasty = surgical repair of a vessel using a balloon

-emesis: vomiting hyperemesis = excessive vomiting

-plegia: paralysis paraplegia = paralysis of lower portion of the body

-emia: blood condition anemia = lack of red blood cells

-rrhage: excessive flow hemorrhage = excessive flow of blood

-ism: a condition hyperthyroidism = condition caused by an excessive production of thyroid hormones

-scopy: examination using a scope colonoscopy = examination of the large intestine or colon with a scope

-itis: inflammation stomatitis = inflammation of the mouth -logy: study of hematology = study of the blood -megaly: enlargement splenomegaly = enlarged spleen -oma: tumor

-stomy: surgical creation of an opening colostomy = opening into the colon

TESTBANKSELLE -toRm.yC : iO ncMision, cutting into thoracotomy = incision into chest wall -uria: condition of the urine dysuria = painful urination

melanoma = mole or tumor, may be cancerous -osis: condition halitosis = bad breath -ostomy: surgical creation of an opening ileostomy = creation of an opening into the ileum -otomy: cut into laparotomy = cutting into the abdomen -pathy: disease myopathy = disease of the muscle -penia: lack leukopenia = a lack of white blood cells -phagia: to eat dysphagia = difficulty swallowing

Handout 3-1

242

Abbreviations

before

AROM

active range of motion

AAROM

active assisted range of motion

ASAP

as soon as possible

abd

abdomen

assist

assistance

ABR

absolute bedrest

as tol

as tolerated

ac, a.c.

before meals

A, T, D

admission, transfer, and discharge

Alzheimer’s disease

axillary

ADC

AIDS dementia complex

BID, b.i.d.

two times a day

ad lib

as desired

BKA

below-knee amputation

ADLs

activities of daily living

bld

blood

adm.

admission

BLS

basic life support

AED

automated external defibrillator

bowel movement

AHA

American Heart Association

BP, B/P

blood pressure

AIDS AIIR AKA

acquired immune deficienT cyESTBANKSBEPL HLER.CObM enign prostatic hypertrophy syndrome BPM beats per minute airborne infection isolation room BR bedrest above-knee amputation, also known BRP bathroom privileges as

am, AM

morning

BSC

bedside commode

AMA

against medical advice, American Medical Association

BSE

breast self examination

centigrade, Celsius

amb

ambulate, ambulatory

with

AMD

age-related macular degeneration

Ca/CA

calcium, cancer, carcinoma

amt.

amount

CAD

coronary artery disease

ANS

autonomic nervous system

cal

calorie

ant.

cath.

catheter

a.p./AP

apical pulse

CBC

complete blood count

approx.

approximately

CBI

continuous bladder irrigation

Handout 3-2

243

Abbreviations (cont’d)

CBR

complete bedrest

CRF

chronic renal failure

CCMS

clean-catch midstream

C.S.

Central Supply

CDC

Centers for Disease Control and Prevention

CSF

cerebrospinal fluid

CVA

cerebrovascular accident, stroke

CDE

certified diabetes educator

CVP

central venous pressure

C. diff

clostridium difficile

CVS

cardiovascular system

CEP

competency evaluation (testing) programs

CXR

chest x-ray

CEU

continuing education unit

DAT

diet as tolerated

CHD

coronary heart disease

DJD

degenerative joint disease

CHF

congestive heart failure

DKA

diabetic ketoacidosis

chol

cholesterol

diabetes mellitus

check

DNR

do not resuscitate

cl liq

clear liquid

centimeter

DOA

dead on arrival

CMS

Centers for Medicare and Medicaid Services

DOB

date of birth

DON

director of nursing

CNA

certified nursing assistant

Dr.

doctor

CNP

certified nurse practitioner

DRG

diagnostic related group

CNS

central nervous system

drsg

dressing

c/o

complains of, in care of

DVT

deep vein thrombosis

CO2

carbon dioxide

Dx/dx

diagnosis

COLD

chronic obstructive lung disease

ECG, EKG

electrocardiogram

COPD

chronic obstructive pulmonary disease

emergency department

cerebral palsy

EENT

eye, ear, nose, and throat

CPM

continuous passive motion

e.g.

for example

CPR

cardiopulmonary resuscitation

EMS

emergency medical services

TESTBANKSELLE DR O.COM

Handout 3-2

doctor of osteopathy

244

Abbreviations (cont’d)

emergency room

gastrointestinal

ESRD

end-stage renal disease

general practitioner

et al.

and other things

GSW

gunshot wound

ETOH

alcohol

GTT

glucose tolerance test

exam

examination

genitourinary

Fahrenheit, female

GYN/gyn

gynecology

FBS

fasting blood sugar

h, hr, hr.

hour

FDA

Food and Drug Administration

H2 0

water

iron

H202

hydrogen peroxide

force fluids

H/A

headache

family history

HAART

highly active anti-retroviral therapy

fld

fluid

H&P

history and physical

fingerstick

FSBS

fingerstick blood sugar

HBV

hepatitis B virus

foot

HCV

hepatitis C virus

F/U, f/u

follow-up

HDV

hepatitis D virus

FUO

fever of unknown origin

HEV

hepatitis E virus

FWB

full weight-bearing

mercury

fracture

HHA

home health aide

FYI

for your information

Hi-cal

high calorie

gram

HIPAA

GAD

generalized anxiety disorder

Health Insurance Portability and Accountability Act

gal

gallon

HIV

human immunodeficiency virus

gallbladder

HMO

health maintenance organization

GERD

gastroesophageal reflux disease

HOB

head of bed

geri chair

geriatric chair

HOH

hard of hearing

TESTBANKSHEALVLER.COhM epatitis A virus

Handout 3-2

245

Abbreviations (cont’d)

HPV

human papillomavirus

l, L

liter

HS/hs

hours of sleep

L, lt

left

height

lab

laboratory

HTN

hypertension

pound

H.U.C.

Health Unit Coordinator

LBP

low back pain

history

lower extremity

hyper

above normal, too fast, rapid

large

hypo

low, less than normal

liq

liquid

I&D

incision and drainage

LLE

left lower extremity

I&O

intake and output

LLQ

left lower quadrant

IBD

irritable bowel disease

LOC

level of consciousness, level of care

IBS

irritable bowel syndrome

Low-cal

low-calorie

ICU

intensive care unit

TESTBANKSELLE LoRw.-fC atO /M

low-fat, low-calorie

identification

Low-cal

i.e.

that is

Low-Na

low-sodium

IICU

intermediate intensive care unit

LPN

Licensed Practical Nurse

intramuscular

LTC

long-term care

inch

LTCF

long-term care facility

inc

incontinent

LUQ

left upper quadrant

inf

inferior

LVN

Licensed Vocational Nurse

intelligence quotient

M.D.

medical doctor

irr., irrig

irrigation

muscular dystrophy

isol

isolation

MDROs

multidrug-resistant organisms

I.V., IV

intravenous

MDR-TB

multidrug-resistant tuberculosis

potassium

MDS

minimum data set

kilogram

meds

medications

Kaposi’s sarcoma Handout 3-2

246

Abbreviations (cont’d)

milligram

nursing facility

myocardial infarction

NG, ng

nasogastric

min

minute

NIBP

milliliter

non-invasive blood pressure monitoring

millimeter

NKA

no known allergies

mm Hg

millimeters of mercury

NKDA

no known drug allergies

microorganism

number

mod

moderate

noc

night

MRI

magnetic resonance imaging

NPO

nothing by mouth

MRSA

methicillin-resistant staphylococcus aureus

NVD

nausea, vomiting, and diarrhea

NWB

non-weight-bearing

oxygen

multiple sclerosis

MSDs

musculoskeletal disorders TESTBANKSOE&LPLER.COoM va and parasites

MSDS

material safety data sheet

obstetrics

MSW

medical social worker

ob/gyn

obstetrics and gynecology

MUFA

monounsaturated fatty acid

OBRA

Omnibus Budget Reconciliation Act

MVA

motor vehicle accident

occ

occasionally

sodium

OCD

obsessive-compulsive disorder

N/A

not applicable

overdose

nursing assistant

O.D.

right eye

NaCl

sodium chloride (table salt)

orogastric

NAS

no added salt

OOB

out of bed

NATCEP

Nurse Aide Training and Competency Evaluation Program

OPD

outpatient department

O.R.

operating room

N/C

no complaints, no call ord.

orderly, ordered

NCS

no concentrated sweets ORIF

open reduction, internal fixation

neg

negative Handout 3-2

247

Abbreviations (cont’d)

ortho

orthopedics

PID

pelvic inflammatory disease

mouth

PM/pm

afternoon

O.S.

left eye

PMH

past medical history

OSHA

Occupational Safety and Health Administration

PNS

peripheral nervous system

by mouth (per os)

occupational therapist, occupational therapy

pos.

positive

OTC

over-the-counter (medication)

post op

after surgery

O.U.

both eyes

PPD

purified protein derivative (test for tuberculosis)

ounce

PPE

personal protective equipment

after

pre op

before surgery

P.A.

physician’s assistant

prep

preparation

PAD

peripheral artery disease

pc, p.c.

after meals

PCA

patient-controlled anesthesia

PDR

Physician’s Desk Reference

pulmonary embolism

Peds/peds

pediatrics

PEG

percutaneous endoscopic gastrostomy

peri care

p.R r.n..,CpO rnM TESTBANKSELLE

when necessary

prog.

progress

PROM

passive range of motion

Pt/pt

patient

pt.

pint

physical therapist, physical therapy

PTH

parathyroid hormone

perineal care

PTSD

post-traumatic stress disorder

per os

by mouth

PUFA

polyunsaturated fatty acid

PET

positron emission tomography

PVD

peripheral vascular disease

parts hydrogen

PWB

partial weight-bearing

past history

every

PHI

protected health information

q2h, q3h, q4h

every two hours, every three hours, every four hours

phy. ex.

physical exam QA

quality assurance

Handout 3-2

248

Abbreviations (cont’d)

qam

every morning

respiratory rate

Q&A

questions and answers

respiratory therapy/therapist

every day

RUE

right upper extremity

qh, qhr

every hour

RUQ

right upper quadrant

qhs

every night at bedtime

prescription, treatment

q.o.d.

every other day

without

qt.

quart

S&A

sugar and acetone

quad

quadrant, quadriplegic

S&S, S/S

signs and symptoms

respirations, rectal

s.c.

subcutaneously

R, rt.

right

SCA

sudden cardiac arrest

rheumatoid arthritis

SCDs

sequential compression devices

RBC

red blood cell

SIDS

sudden infant death syndrome

RDT

registered dietitian

reg.

regular

SLE

systemic lupus erythematosus

rehab

rehabilitation

SLP

speech-language pathologist

REM

rapid eye movement

sm.

small

req.

requisition

SNAFU

res.

resident

situation normal, all fouled up (slang)

resp.

respiration

SNF

skilled nursing facility

restrict fluids

SNS

somatic nervous system

RLE

right lower extremity

SOB

shortness of breath

RLQ

right lower quadrant

Standard Precautions

registered nurse

S.P.D.

Supply, Processing, and Distribution

RNA

restorative nursing assistant

spec.

specimen

R/O

rule out

one half

ROM

range of motion

SSE

soapsuds enema

TESTBANKSsEl LLER.COsuMblingually

Handout 3-2

249

Abbreviations (cont’d)

standard, speech therapy

UGI

upper gastrointestinal

staph

staphylococcus

UNK, unk

unknown

STAT/stat

immediately

URI

upper respiratory infection

Std prec

Standard Precautions

ultrasound

STDs

sexually transmitted diseases

USDA

STIs

sexually transmitted infections

United States Department of Agriculture

strep

streptococcus

UTI

urinary tract infection

supp.

suppository

vag.

vaginal

surg.

surgery

VAP

ventilator-acquired pneumonia

T., temp

temperature

venereal disease

tuberculosis

VRE

vancomycin-resistant enterococcus

tbsp.

tablespoon

VS, vs

vital signs

TLC

W/A, WA turn, cough, and deeT pE brSeT atB heANKSELLER.COM WBC total hip replacement w/c, W/C transient ischemic attack WNL three times a day wt. total knee replacement yr. tender loving care

TPN

total parenteral nutrition

T.P.R.

temperature, pulse, and respiration

trach.

tracheostomy

tsp.

teaspoon

TWE

tap water enema

Tx, tx

traction, treatment

U/A, u/a

urinalysis

upper extremity

T, C, DB THR TIA t.i.d., tid TKR

Handout 3-2

while awake white blood cell/count wheelchair within normal limits weight year

250

251

Abbreviations Flash Cards

Cut along the dotted lines to make flash cards so that you can study important abbreviations. The answers are on the back of each card.

abd ADLs amb BID, b.i.d. BM BPM BRP c

TESTBANKSEL LER.COM

Handout 3-3

ABR AKA as tol BKA BP, B/P BR BSC cath.

252

Abbreviations Flash Cards (cont’d)

absolute bedrest

abdomen

above-knee amputation, activities of daily living also known as as tolerated

ambulate, ambulatory

.Co OMtimes a day below-knee amputTaEtSiToBnAN KSELLERtw

blood pressure

bowel movement

bedrest

beats per minute

bedside commode

bathroom privileges

catheter

with Handout 3-3

253

Abbreviations Flash Cards (cont’d)

Cut along the dotted lines to make flash cards so that you can study important abbreviations. The answers are on the back of each card.

CBR CHF COPD CVA DM DOB EMS FF

CCMS c/o CPR DAT DNR Dx/dx FBS FWB

TESTBANKSEL LER.COM

Handout 3-3

254

Abbreviations Flash Cards (cont’d)

clean-catch midstream

complete bedrest

complains of, in care of congestive heart failure cardiopulmonary resuscitation

chronic obstructive pulmonary disease

diet as tolerated

cerebrovascular accident, stroke

do not resuscitate

diabetes mellitus

diagnosis

date of birth

fasting blood sugar

emergency medical services

full weight-bearing

force fluids

TESTBAN

Handout 3-3

255

Abbreviations Flash Cards (cont’d)

Cut along the dotted lines to make flash cards so that you can study important abbreviations. The answers are on the back of each card.

GERD H20 HCV HIV HS/hs hyper I&O isol

h, hr, hr. HBV HIPAA HOB HTN hypo inc I.V., IV

TESTBANKSELLER.COM

Handout 3-3

256

Abbreviations Flash Cards (cont’d)

hour

gastroesophageal reflux disease

hepatitis B virus

water

Health Insurance Portability and Accountability Act

hepatitis C virus

head of bed

human immunodeficiency virus

TESTBAN

hypertension

hours of sleep

low, less than normal

above normal, too fast, rapid

incontinent

intake and output

intravenous

isolation Handout 3-3

257

Abbreviations Flash Cards (cont’d)

Cut along the dotted lines to make flash cards so that you can study important abbreviations. The answers are on the back of each card.

kg LOC Low-cal Low-Na MDROs MDR-TB mg MI mL mm Hg MO MRSA MS NAS NKA NKDA TESTBANKSEL LER.COM

Handout 3-3

258

Abbreviations Flash Cards (cont’d)

level of consciousness, level of care

kilogram

low-sodium

low-calorie

multidrug-resistant tuberculosis

multidrug-resistant organisms

myocardial infarcTtEioSTnBAN M illigram millimeters of mercury

milliliter

methicillin-resistant staphylococcus aureus

microorganism

no added salt

multiple sclerosis

no known drug allergies

no known allergies Handout 3-3

259

Abbreviations Flash Cards (cont’d)

Cut along the dotted lines to make flash cards so that you can study important abbreviations. The answers are on the back of each card.

NPO NWB O&P p PCA peri care PO p.r.n., prn

NVD O2 OOB pc, p.c. PEG per os PPE PVD

TESTBANKSELLER.COM

Handout 3-3

260

Abbreviations Flash Cards (cont’d)

nausea, vomiting, and diarrhea

nothing by mouth

oxygen

non-weight-bearing

out of bed

ova and parasites

after meals TESTBAN after percutaneous endoscopic gastrostomy

patient-controlled anesthesia

by mouth

perineal care

personal protective equipment

by mouth (per os)

peripheral vascular disease

when necessary Handout 3-3

261

Abbreviations Flash Cards (cont’d)

Cut along the dotted lines to make flash cards so that you can study important abbreviations. The answers are on the back of each card.

PWB q reg. RF R/O ROM s S&S, S/S SOB STAT/stat T., temp TB THR TIA T.P.R. URI TESTBANKSELLER.COM

Handout 3-3

262

Abbreviations Flash Cards (cont’d)

every

partial weight-bearing

restrict fluids

regular

range of motion

rule out

ESTsBAN without signs and symptoTm

immediately

shortness of breath

tuberculosis

temperature

transient ischemic attack

total hip replacement

upper respiratory infection

temperature, pulse, and respiration Handout 3-3

263

Scientific Method

The scientific method is a process used to determine the best solution to solve certain problems. In order to do this, a problem must be identified. Once the problem is discovered, a hypothesis must be created. A hypothesis is a possible explanation for a problem or observation. After the hypothesis is created, it is tested through investigation and experiments. After performing tests, a conclusion is usually reached. In order to determine solutions using the scientific method, facts, not opinions or emotions, must be used.

Problem: Resident Mrs. S says that it hurts when she urinates.

Hypothesis: She has a UTI.

Conclusion: The urine was tested, and bacteria was found in the urine.

The resident has started taking antibiotics, and she states: “I feel much better now.” The resident is resting comfortably.

Handout 3-4

264

Myths About Older Adults and Sexuality

Myth #1: Older men are not capable of having sexual relations. There are some physical changes that may alter the way a couple engages in sexual relations. The man may need more direct contact, may take longer, and may need longer between relations to perform again. However, many men continue to have satisfying relations well into old age. Myth #2: After menopause older women are not interested in sexual relations. Many women relax and enjoy sex more in later years. With no fear of pregnancy, and older children leaving home, many women feel much freer. There may be some physical changes, such as less lubrication, but there are remedies available. Communication with a woman’s physician is important. The reason many older women stop having sexual relations is because they lose their partners when their partners die. Myth #3: Any expression of sexuality by older people is either disgusting or cute. This attitude deprives older people of their right to dignity and respect. Older adults have the same needs and rights to express their sexuality as other age groups, and they may do so in the same ways. In all age groups there is a wide variety of behavior. This is true of older people also. It is true, however, that our society discourages this expression by the messages sent through jokes, advertisements, and the media. Older people see and hear these messages and may believe that there is something wrong with them if they feel or act on their desires.

TESTBANKS

Handout 5-1

265

Restraint Alternatives

• Make sure call lights are within reach and answer call lights immediately. • Use fall prevention and other safety techniques, such as improving lighting. • Certain types of grab bars can assist with moving in bed and getting out of bed. • Take the resident on a walk. The doctor or nurse may add exercise into the care plan. • Let confused residents wander in designated safe areas. • Provide activities for those who wander at night. • Give frequent help with toileting. Help with cleaning immediately after an episode of incontinence. Make sure residents are clean, dry, and comfortable. • Encourage independence with all tasks. Provide meaningful activities. • Encourage participation in social activities. Escort the resident to social activities when needed. Increase visits and social interaction. • Offer reading materials that the resident enjoys. Read to the resident if needed. • Increase the number of familiar caregivers with family members and volunteers. Family members may decrease tension just by being with residents. • Offer food or drink. • Decrease the noise level. Offer backrubs or use relaxation techniques. • Listen to soothing music. • Monitor the resident closely and report complaints of pain to the nurse immediately.

Handout 7-1

266

Quiz: You Are Moving!

Your house has been sold, and you need to move in with your sister and her family for about six months or more. You are dealing with some difficult situations and may even be staying with them permanently. You do not know for sure. You will share a room with your niece. Your space is six feet wide by 12 feet long. There is a single bed, a chest of drawers, and a soft chair that you can use. There is also a screen available for your privacy. Decide what you will take with you. You can store anything you do not take, but you will not have access to any stored items until you move again. Name six things you will take with you. (Seven outfits of clothing count as one item.) Think of space. All six items must fit into your small room, or in your half of the closet, which is a five foot by three foot space.

��

TESTBANKSELLER.COM

�� 4.

��

During the first week your niece is looking at one of your treasured things and accidentally drops and breaks it. How do you feel? �� It is now the second week. You have still not received any of your mail, which you had notified the post office to forward. You mention this to your sister and she says offhandedly, “Oh, I did see some here yesterday. I don’t know where it is now.” Then she walks out of the room. What is your response? ��

Handout 9-1

267

Measuring Abdominal Girth

Abdominal girth is a measurement of the circumference around the abdomen at the umbilicus (navel). This measurement is required for some residents and may need to be included on an admission checklist form. Measuring Abdominal Girth

12. Return bed to lowest position. Remove privacy measures.

Equipment: measuring tape, pen and paper to record your findings

13. Leave call light within resident’s reach.

Identify yourself by name. Identify the resident. Greet the resident by name.

14. Wash your hands.

Wash your hands.

Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

16. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Provide for the resident’s privacy with a curtain, screen, or door.

15. Be courteous and respectful at all times.

5. Adjust the bed to a safe level, uTsE uaSllT yw BaAisNt high. Lock the bed wheels. 6. Position resident lying straight in the supine (back) position. 7. Turn linen down and raise gown or top enough to expose only the abdomen. Keep all areas covered that do not need to be exposed. Promote resident’s right to dignity and privacy. 8. Gently wrap measuring tape around the resident’s abdomen at the level of the navel. 9. Read the number where the ends of the tape meet. 10. Carefully remove the tape measure. Record abdominal girth measurement. 11. Make resident comfortable. Replace clothing and bed linen.

Handout 9-2

268

Special Body Positions

The Trendelenburg and Reverse Trendelenburg positions are used with residents who have special needs. For example, Trendelenburg may be used for a resident who has gone into shock and has poor blood flow.

Reverse Trendelenburg may be used for a resident who needs faster emptying of the stomach due to a digestive problem.

TESTB These positions always require a doctor’s order. Some electric beds have buttons or levers that place the bed in these two positions.

Handout 11-1

269

Turning a Resident Away From You

Turning a resident away from you 1.

Identify yourself by name. Identify the resident. Greet the resident by name.

10. Stand with feet shoulder-width apart, with one foot slightly in front of the other. Bend your knees. 11. Place one hand on the resident’s shoulder. Place the other hand on the resident’s nearest hip.

Wash your hands.

Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Provide for the resident’s privacy with a curtain, screen, or door.

Adjust the bed to a safe level, usually waist high. Lock the bed wheels.

Lower the head of bed.

Stand on side of bed opposite to where the resident will be turned. If the bT edEhSaT sB sid aiS ls,ELL ER.COM AeNrK raise the far side rail. Lower side rail nearest you if it is up.

Move resident to side of bed nearest you using previous procedure.

Cross resident’s arm over her chest. Move arm on side resident is being turned to out of the way. Cross leg nearest you over the far leg.

Cross leg nearest you over the far leg.

12. While supporting the body, gently roll resident onto side as one unit (toward raised side rail). Shift your weight from your back leg to your front leg. Make sure resident’s face is not covered by the pillow.

Gently push resident toward other side of bed while shifting your weight from your back leg to your front leg.

13. Position resident properly: •

Head supported by pillow (resident’s face should not be obstructed by pillow)

•

Shoulder adjusted so resident is not lying on arm or hand

•

Top arm supported by pillow

•

Back supported by supportive device

•

Hips properly aligned

•

Top knee flexed

Handout 11-2

270

Turning a Resident Away From You (cont’d)

•

Supportive device between legs with top knee flexed; knee and ankle supported

•

Pillow under bottom foot so that toes are not touching the bed

14. Cover resident with top linens and straighten. Make resident comfortable. 15. Return bed to lowest position. Return side rails to ordered position. Remove privacy measures. 16. Leave call light within resident’s reach. 17. Wash your hands. 18. Be courteous and respectful at all times. 19. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Handout 11-2

271

Basic Math

Nursing assistants need math skills when doing certain tasks, such as calculating intake and output. A basic math review is listed below:

Here are common values shown in decimal, fraction, and percentage forms: Decimal Fraction Percentage

Addition

0.01 0.1 0.2 0.25 0.333 0.5 0.75 1

2,905 174

3,079

53,138 3,008 56,146

Subtraction –

32,542 8,710

–

23,832

549,233 26,903

4,962 13

14,886 49,620

522,330

To convert from decimal to a percentage, you will multiply by 100 and add a percent sign (%). x

79 41

79 3,160

64,506

0.25 X 100 = 25% To convert from a percentage to decimal, you will divide by 100 and delete the percent sign (%). 80% ÷ 100 = 0.8

3,239

To convert a fraction to a decimal, you will divide the top number by the bottom number.

Division 34 22

1% 10% 20% 25% 331/3% 50% 75% 100%

Follow these rules for converting decimals, fractions, and percentages:

Multiplication x

1/ 100 1/ 10 1/5 1/4 1/3 1/2 3/4 1/1

748 – 66

546 – 42

88 – 88

126 – 126

To convert a decimal to a fraction, write the decimal over the number 1. Step 1

Converting Decimals, Fractions, and Percentages Decimals, fractions, and percentages are different ways of showing the same value. For example, one half can be written in the following ways: As a decimal: As a fraction: As a percentage:

0.5 1/2 50%

= 3 ÷ 4 = 0.75

0.5 1

Then multiply top and bottom by 10 for every number after the decimal point (10 for 1 number, 100 for 2 numbers, and so on.) Step 2

0.5 1

X 10 5 = X 10 10

The resulting fraction is 5/10 (or 1/2 if you simplify the fraction). Handout 14-1

272

Giving a Rectal Suppository

16. Wash your hands.

Giving a rectal suppository Equipment: 2 pairs of gloves, suppository, lubricant, bath blanket, toilet paper, supplies for perineal care 1.

Identify yourself by name. Identify the resident. Greet the resident by name.

Wash your hands.

Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

17. Remove bath blanket and cover the resident. Ask the resident to retain the suppository as long as possible. Make resident comfortable. 18. Don clean gloves to provide a bedpan or assistance to the bathroom if needed. Provide perineal care if needed. 19. Return bed to lowest position. Remove privacy measures. 20. Make resident comfortable.

Provide for the resident’s privacy with a curtain, screen, or door.

Adjust bed to safe working level, usually waist high. Lock bed wheels.

22. Wash your hands.

Help the resident to left-lying (Sims’) position.

23. Be courteous and respectful at all times.

Cover with a bath blanket.

24. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Fold back linens to expose only the rectal area.

Unwrap the suppository.

Put on gloves.

21. Place call light and fresh water within resident’s reach.

10. Lubricate suppository as needed. 11. Spread buttocks to expose anal area. 12. Insert the suppository, using your index finger. Place the suppository past the rectal sphincter, against the wall of the colon. 13. Ask the resident to take deep breaths, as it will help him or her relax and retain the suppository. 14. Withdraw the finger and hold toilet paper against the anus briefly. 15. Remove and discard gloves.

Handout 15-1

273

Changing Drainage Bag to Leg Bag

Some residents use smaller bags called leg bags to collect urine. This type of drainage bag attaches to the resident’s leg and is emptied at the end of each shift and as necessary. Care must be taken when attaching a leg bag to the leg. This is a sterile procedure and requires the use of sterile caps and possibly other sterile supplies. You should have special training before performing this procedure. In addition, the band that wraps around the leg must not be so tight that it affects the circulation to the leg or causes any harm to the skin. Changing a Catheter Drainage Bag to Leg Bag Equipment: gloves, sterile gloves (optional), 2 disposable bed protectors, sterile drape (optional), leg bag, catheter clamp, 2 sterile caps, disposable plastic bag

11. Pick up the end of the Foley catheter with the sterile cap and remove the sterile cap. Attach the Foley catheter to the leg bag. Do not touch the tip of the Foley catheter tubing or the leg bag tubing to any object.

Identify yourself by name. Identify the resident. Greet the resident by name.

12. Wrap leg bag around resident’s leg and secure using the straps.

Wash your hands.

13. Remove the catheter clamp. Make sure urine can flow freely into the leg bag.

Explain procedure to resident. Speak clearly, 14. Ensure that the straps for the leg bag are not slowly, and directly. Maintain face-to-face conTESTBANKSELLER. COM tact whenever possible. too tight on the leg.

4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust bed to safe working level, usually waist high. Lock bed wheels. 6. Put on gloves.

15. Remove bed protectors and place disposable bed protectors in plastic bag. Dispose of plastic bag properly. 16. Remove and discard gloves. Wash hands. 17. Replace gown or clothing and make resident comfortable.

7. Ensuring privacy, remove bed linen and lift gown or pull down pajamas. 8. Turn resident to side, place bed protector under resident, and return to back. 9. Place second bed protector or sterile drape on the bed for supplies. Prepare leg bag for hook-up.

18. Return bed to lowest position. Remove privacy measures. 19. Leave call light within resident’s reach. 20. Wash your hands. 21. Be courteous and respectful at all times.

10. Temporarily clamp Foley catheter using facilityapproved clamp. Remove the catheter from the drainage tubing and immediately apply a sterile cap to the catheter end and a plug to the drainage tubing end.

22. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Handout 16-1

274

Changing Leg Bag to Drainage Bag

Changing a Leg Bag to Drainage Bag Equipment: gloves, sterile gloves (optional), 2 disposable bed protectors, sterile drape (optional), leg bag, catheter clamp, 2 sterile caps, disposable plastic bag 1. Identify yourself by name. Identify the resident. Greet the resident by name.

12. Pick up the end of the Foley catheter with the sterile cap and remove the sterile cap. Remove plug from Foley catheter drainage tubing. Avoid touching the end of the Foley catheter or the tip of the drainage tubing to any object. Attach the end of the Foley catheter to the end of the drainage bag tubing.

2. Wash your hands.

13. Remove the catheter clamp. Make sure urine can flow freely into the Foley drainage bag.

3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

14. Remove bed protectors and place disposable bed protectors in plastic bag.

4. Provide for the resident’s privacy with a curtain, screen, or door.

15. Empty leg bag, measure urine if needed, and place leg bag in designated place. Dispose of plastic bag properly.

5. Adjust bed to safe working level, usually waist high. Lock bed wheels.

16. Remove and discard gloves. Wash hands.

6. Put on gloves.

TESTBANKS1E OwMn or clothing and make resident 7. LRLeE plR ac.eC go comfortable.

7. Ensuring privacy, remove bed linen and lift gown or pull down pajamas.

18. Return bed to lowest position. Remove privacy measures.

8. Turn resident to side, place bed protector under resident, and return to back. 9. Place second bed protector or sterile drape on the bed for supplies. 10. Carefully undo straps on leg bag from leg.

19. Leave call light within resident’s reach. 20. Be courteous and respectful at all times. 21. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

11. Temporarily clamp Foley catheter using facilityapproved clamp. Remove the catheter from the leg bag tubing and immediately apply a sterile cap to the catheter end and a plug to the end of the leg bag tubing.

Handout 16-2

275

Taking a Urinary Specimen from a Port

Specimens may need to be collected directly from catheters, such as when an infection is suspected. Before collecting urine specimens from a catheter port, nursing assistants must be trained in the proper use of needleless syringes and needleless catheter systems. The following should be included in this training: • Your facility’s policies concerning sterile urine specimen collection • The basic use of your facility’s “needleless systems” and needleless syringes • Information on facility-specific policies, including collections using specially-designed transport containers or specimen tubes. These may be required for specimens such as urine cultures. • Facility guidelines for temporary storage of urine specimens for later transport to the lab The urine specimen is collected from a specially-designed port that is a part of the catheter system. The urine cannot be collected from the catheter drainage bag when the person has an indwelling catheter because of bacteria in the bag itself. To collect the specimen, a special clamp or a small rubber band will be required to stop the flow of urine into the catheter drainage bag. This clamp, or band, is applied to the catheter that is inserted into the resident. The nurse will show you where to apply the clamp. The nursing assistant may need to wait 15 to 20 minutes for the urine to collect within the tubing above the catheter port. When the time is right to collect the specimen, the needleless catheter port is first cleaned with an alcohol wipe, and then the needleless syringe is properly screwed into the port. The specimen is then collected into the sterile syringe. The needleless syringe is removed by carefully unscrewing the device from the port. The catheter port reT -sE eaS lsTitB seAlfNoK ncSeEthLeLsE yrR in. geCiO sM removed. The urine is transferred into a sterile urine specimen cup without touching the tip of the needleless syringe to any object during the urine transfer. The specimen container must be capped without contaminating the inside of the lid. (In some facilities, special urine transport tubes or containers may be used for certain urine specimens such as urine cultures. You will need special training in the use of these containers.) The syringe must be placed safely into the appropriate biohazard container. The clamp or rubber band must be removed from the catheter tubing. Leaving the clamp or rubber band in place on the catheter tubing can cause discomfort, infection, and injury.

Collecting a sterile urine specimen from a needleless catheter port Equipment: gloves, sterile urine specimen container with label properly completed with resident’s name, room number, the date, and time, lab requisition slip, tube clamp or rubber band, proper-sized needleless sterile syringe, alcohol wipes, plastic bag 1.

Identify yourself by name. Identify the resident. Greet the resident by name.

Wash your hands.

Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Provide for the resident’s privacy with a curtain, screen, or door.

Put on gloves.

If needed, clamp the drainage tube on the catheter tubing. Wait for urine to collect within the tubing.

Handout 16-3

276

Taking a Urinary Specimen from a Port (cont’d)

Using an alcohol wipe, clean the needleless catheter drainage port.

Using the needleless syringe, screw the syringe into the needleless catheter port and withdraw the urine specimen from the port.

Carefully pull back on the syringe, and withdraw the correct amount of urine into the syringe.

10. With the syringe, slowly push plunger to transfer urine sample into sterile specimen container. Do not touch tip of needleless syringe to any object during the urine transfer.

18. Be courteous and respectful at all times. 19. Report any changes in the resident to the nurse. Document procedure using facility guidelines. Place specimen container in plastic bag and promptly take specimen container and attached lab slip to the designated place. If specimen cannot be transferred to the lab right away, refrigerate specimen immediately in specimen refrigerator.

11. Put the specimen container lid on securely without contaminating the inside of the lid. 12. Dispose of syringe in biohazard container. 13. Unclamp or remove the band from the catheter drainage tube. TESTBA Make sure urine is allowed to drain into the tubing and drainage bag again. Place clamp safely in designated area or dispose of rubber band in biohazard container. 14. Remove and discard gloves. Wash hands. 15. Make resident comfortable. 16. Place call light within resident’s reach. 17. Wash your hands.

Handout 16-3

277

Suprapubic Catheters

A suprapubic catheter is inserted above the pubic bone directly into the bladder. It functions by draining urine out of the bladder without having it drain through the urethra. This is done for a variety of reasons, such as urethral blockage, some types of trauma, problems with the neurological system that affect the ability to urinate normally, or after certain types of surgery. This type of catheter may be inserted temporarily or long-term. A suprapubic catheter is secured at the insertion site with sutures or a special type of seal. The catheter site is considered sterile, and sterile dressing changes are done by the nurse. She will clean the area and the tube and then cover the area with sterile gauze. The drainage system must remain closed. Blockages, kinks, and tugging of the tubing should be avoided. If you observe any pain, redness, or drainage, report it immediately to the nurse. Nursing care of this catheter includes observing the insertion site on the abdomen for changes, drainage or saturation, or signs of irritation or infection. Guidelines for a Suprapubic Catheter • Clamp and unclamp catheter at ordered times. Do not forget to unclamp the catheter at the designated time. Set a personal timer, if needed. • Do not pull or tug on the tubing. • Monitor insertion site area where the catheter enters the body.

TESTBANKSELLER.COM

• Notify the nurse if drainage is noted on the dressing, dressing needs changing, or redness or pain occurs. • Assist the nurse with the sterile dressing changes, as necessary. • Make sure drainage tubing stays clear of blockages. • Watch urine output regularly during your shift. • Provide fluids to help maintain urine output.

Handout 16-4

278

Oxygen Therapy Using a Humidification Device

Oxygen administration can dry out the mucous membranes of the nose and mouth. Because of this, humidifying devices are often added to oxygen therapy devices. The humidifying container is filled with sterile or distilled water. The oxygen moves through the water and collects moisture before it is transferred to the resident. Humidification devices are commonly pre-filled devices; nurses or respiratory therapists will replace the humidification device when its water level is low with a new, pre-filled container. Some facilities may use humidification devices that have to be refilled by the nurse or the respiratory therapist when the water level becomes low. The nursing assistant’s responsibility is to observe the humidification device and report promptly when the water level becomes low. In addition, if the device is not bubbling, or the bubbling decreases, report this promptly to the nurse. Guidelines for Oxygen Therapy using a Humidifying Device • Check the humidification device often to make sure it is bubbling. Carefully observe the water level in the humidification device. Notify the nurse if the following occurs: • Water in the humidification device stops bubbling • Decrease in bubbling • Water level in the humidification device becomes low

Handout 20-1

279

Applying an Elastic Bandage

Applying an elastic bandage Equipment: elastic bandage in the correct size, clip, or tape (if using self-adhering bandage, these are not needed) 1.

Identify yourself by name. Identify the resident. Greet the resident by name.

Wash your hands.

Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Make an anchor at the beginning spot.

Provide for the resident’s privacy with a curtain, screen, or door.

12. Wrap one more time around the spot where the anchor lies, and then begin slowly wrapping in overlapping spirals up the extremity.

Adjust bed to safe working level, usually waist high. Lock bed wheels.

13. Smooth out entire bandage, removing any wrinkles.

BrA 6. Avoid trauma or pain to the resTidEeS ntTth ouNgK h-SELLE 14R . . SeCcO urM e bandage with self-closure, clip, or tape. out the procedure. 15. Straighten all of the linens. 7. Assist resident to get into the supine (flat on 16. Remove and re-apply bandage as directed. the back) position. Wash and dry bandages as necessary. 8. Expose only the part to be bandaged. 17. Make resident comfortable. 9. Hold the rolled bandage with one hand and, with the other hand, put the loose end on top of the extremity. 10. Wrap extremity, beginning at the spot furthest from the heart. Circulation returns toward the heart, and this allows extra fluid to flow to the heart and leave the area. (For the wrist, begin wrapping at the hand. For the ankle, begin at the foot.) 11. Wrap bandage once around the beginning spot, and turn over the tip so that an anchor is made.

18. Return bed to lowest position. Remove privacy measures. 19. Leave call light within resident’s reach. 20. Wash your hands. 21. Be courteous and respectful at all times. 22. Report any changes in the resident to the nurse, including changes in temperature and color of the skin, or resident comments about changes in sensation. Document procedure using facility guidelines.

Handout 21-1

280

Myths About HIV and AIDS

Myth: If a person is HIV positive, that means he or she has AIDS.

Fact: Being HIV positive means that a person’s body was exposed to the virus. Since the person was exposed, there is a good chance that he or she is infected with the virus. But it does not mean that the person has AIDS. AIDS develops over time.

Myth: HIV is the same as AIDS.

Fact: HIV is the virus that can cause AIDS. AIDS is a group of symptoms that develops during the last stage of HIV infection.

Myth: HIV can be spread by shaking hands, hugging, or kissing an infected person.

Fact: HIV is not spread through casual contact. There is a slight possibility that a person could become HIV infected through kissing if both the infected and uninfected person had open, bleeding sores in their mouths, and the infected LLER.blood COM got into the uninfected person’s TESTBANKSEperson’s bloodstream. If this is a concern, partners can check for such sores before kissing.

Myth: HIV can be spread by touching telephones or cell phones used by an infected person.

Fact: The HIV virus cannot live outside of the body. It is not possible to become infected through saliva.

Myth: HIV can be spread by touching doorknobs, tables, chairs, or push buttons.

Fact: The HIV virus cannot live outside of the body.

Handout 24-1

281

Myths About HIV and AIDS (cont’d)

Myth: HIV can be spread by eating food that was prepared by an infected person.

Fact: Once again, HIV dies very quickly outside the body. Even if the food prep person cut his finger and then arranged food on a plate, nobody could become infected from eating this food. Once any body fluid is dry, the virus is dead. Just about the only way infection could be spread in this way is if the food preparer cuts a finger and is bleeding into the food while an uninfected person with open sores in his mouth is eating it. This scenario is rather unlikely.

Myth: HIV can be transmitted from toilets.

Fact: Toilets have been blamed for just about everything, from getting people pregnant to giving people sexually transmitted infections. The only way a person might possibly become HIV infected from a toilet seat is by having unprotected sex while sitting on it.

Myth: HIV can be transmitted t: Although it sounds possible, mosquitoes, TESTBA NKSELLERFa.cC OM fleas, ticks, and lice do not spread HIV. For this by mosquitoes. to happen, the HIV would have to survive in the insect saliva and salivary glands. HIV is a human virus and cannot survive outside of the human body. As a result, HIV does not survive in mosquitoes, fleas, ticks, or lice. If this were a route of transmission, many more people would have been infected a very long time ago. Myth: HIV can be spread by breathing the same air as an infected person.

Fact: HIV does not spread through the air. Being in the same room with someone who is infected with the virus does not pose any risk of transmission.

More information about HIV and AIDS is available at these websites: aids.gov, aidsinfo.nih.gov, and cdc.gov/hiv.

Handout 24-1

282

Gastrostomies

Another type of enteral feeding is called a gastrostomy. A gastrostomy is a tube placed surgically into the stomach that can bring food, fluids, and medications directly into the stomach by way of the abdomen. This is done for people who are unable to eat in a normal way. A gastrostomy is inserted in people who have swallowing difficulties, tumors of the throat, birth defects, or the tendency to choke or aspirate on food or fluids. It may also be used for a resident who is comatose or unconscious. Percutaneous endoscopic gastrostomy tubes, or PEG tubes, are commonly used because they do not require general anesthesia to insert them. The placement of the PEG tube is done by a physician. The PEG tube procedure includes using an endoscope inserted into the mouth to guide the doctor in the correct placement of the PEG tube into the stomach. There are certain important steps to take to prevent complications with a PEG tube. After any feeding, follow post-feeding directions regarding the length of time to keep the resident upright or in the HighFowler’s position. Usually, a period of about 30 to 45 minutes in the upright position is required. The head of the bed will be elevated throughout the feeding time and for the time directed after the feeding. If the tubing becomes loose or disconnected, notify the nurse right away. Guidelines for Gastrostomies For a new gastrostomy: • Watch for bleeding or drainage at the surgical site. Observe the dressing for saturation. • Observe for pain or discomfort. • Take vital signs as ordered and report any change, especially fever. • Follow instructions from the nurse on additional post-operative signs and symptoms to report. For an established gastrostomy: • Wash hands before touching area near insertion site. • Listen carefully for the sound of the alarm. • Answer the call light promptly. • Carefully monitor all vital signs, especially temperature and blood pressure. • Be alert for signs of aspiration or choking. • Give oral hygiene as needed. Excellent oral care must be performed when a gastrostomy is in place. Apply lubricant to the lips as necessary. • Position as directed during feedings. Generally the person should be in an upright position for enteral feeding. • Watch for clogging of the feeding tube. • Carefully follow post-feeding positioning order; the resident will need to sit upright or be positioned on the right side with his head slightly elevated for at least 30 to 60 minutes after feeding is completed. • Observe skin around insertion site carefully and often. Watch for irritation, redness, or broken skin. Follow skin care instructions around insertion site. The skin should be cleaned at least daily or as often as ordered. Handout 26-1

283

Gastrostomies (cont’d)

• Apply special lubricant to skin area around site, as directed. The nurse may apply antibiotic ointment to the area around the insertion site. • Never pull, tug, or twist tubing. • Inspect dressing and tape often. Observe for bleeding, drainage, or leakage around insertion site. • Take great care not to get dressing wet during care. You may need to notify the nurse if cleaning or dressing changes are needed. • Provide emotional support. Notify the nurse if any of the following occurs: • Alarm sounds • Resident shows signs of choking or aspiration • Resident has difficulty breathing or shortness of breath • Skin around insertion site or dressing changes, e.g., looks irritated, red, swollen, warm, broken, or has visible sores • Resident complains of pain or discomfort • Dressing becomes wet or tape comes off • Leakage is noted around insertion site • Bag or container is dripping or eT mE ptSy • Tubing becomes clogged • Tubing is kinked, cracked, broken, or disconnected • Tube comes out of abdomen • Vital signs change, especially fever or respiratory rate • Diarrhea or signs of fecal impaction are noted

Handout 26-1

284

The Dying Person’s Bill of Rights

(This was created at the workshop The Terminally Ill Patient and the Helping Person, sponsored by Southwestern Michigan In-service Education Council, and it appeared in the American Journal of Nursing, Vol. 75, January 1975, p. 99.)

Handout 27-1

285

Job Application

Email Address:

TESTBANKSELLER.COM

Handout 28-1

286

287

Appendix C Chapter Exams

Name: ��

288 Chapter 1: The Nursing Assistant in Long-Term Care

The amount that Medicare and Medicaid will pay long-term care facilities for services is based on (A) The resident’s background (B) The resident’s need upon admission and throughout his stay (C) The size of the facility (D) The financial contributions from the resident’s family

The residents with the longest average stay in long-term care facilities are (A) Residents admitted for terminal care (B) Residents admitted for rehabilitation or temporary illness (C) Residents who are developmentally disabled (D) Residents who have dementia

Multiple Choice. Choose the correct answer. 1.

Long-term care is offered in (A) Hospitals (B) Adult day services facilities (C) Skilled nursing facilities (D) Ambulatory surgical centers

Residents in �� are usually more independent and do not need skilled care. (A) Acute care facilities (B) Assisted living facilities (C) Subacute care facilities (D) Hospice facilities

Which of the following types of health care is generally for people who will die in six months or less? (A) Long-term care (B) Outpatient care (C) Inter-generational care (D) Hospice care �� is a federal health insurance program for people who are 65 years of age orToE ldS erToBr

people of any age with permanent kidney failure or certain disabilities. (A) Medicare (B) Medicaid (C) Occupational Safety and Health Administration (D) Health and Human Services 5. �� is a medical assistance program for people who have low income or disabilities. (A) Medicare (B) Medicaid (C) Department of the Treasury (D) Committee on the Budget 6. Medicare will pay for (A) All care requested by the recipient (B) All care requested by the doctor (C) All care requested by the facility (D) Care that it determines to be medically necessary

A disorder in which a person has a serious loss of mental abilities, including the ability to think, remember, and reason, is known as (A) A terminal illness (B) Dementia (C) Heart disease (D) Chronic disorder 10. Which of the following is a typical task that nursing assistants perform? (A) Administering medication (B) Bathing a resident (C) Changing sterile dressings (D) Giving tube feedings 11. Which of the following is a task that nursing assistants do not perform? (A) Shaving a resident (B) Inserting tubes into a resident’s body (C) Helping a resident with toileting needs (D) Caring for equipment 12. Professionalism is related to (A) How a person behaves at home (B) How a person behaves at work (C) How well a person performs on tests (D) How a resident behaves in a facility

Name:

��

13. A resident has purchased a special gift for her nursing assistant (NA). Which of the following would be the best response by the nursing assistant? (A) The NA should refuse the gift but thank the resident for thinking of her. (B) The NA should refuse the gift and let the resident know her employer is very unfair about employees accepting gifts from residents. (C) The NA should accept the gift if the resident will keep it confidential. (D) The NA should accept the gift and thank the resident for thinking of her.

289 17. What does the term empathetic mean? (A) Empathetic means being alert around others. (B) Empathetic means being able to document accurately. (C) Empathetic means identifying with and understanding the feelings of others. (D) Empathetic means taking responsibility for one’s own actions. 18. Which of the following is part of proper personal grooming by a nursing assistant? (A) Bathing once every other day (B) Applying perfume daily (C) Keeping hair neatly tied back away from the face (D) Wearing polished artificial nails to work

14. One example of professional behavior by nursing assistants when working with residents is (A) Keeping all resident information 19. The best type of jewelry for an NA to wear to confidential work is (B) Sharing funny stories about coworkers with (A) A broach the residents (B) A watch (C) Giving gifts to favorite residents (C) A bracelet (D) Asking residents for advice about personal (D) A necklace problems 20. The most important member of the care 15. Which of the following is the best example of T E S T B A N K S ELLER. OMis teC am how a nursing assistant is demonstrating that (A) The nurse she is dependable? (B) The nursing assistant (A) The nursing assistant shows an interest in (C) The physician others and their problems. (D) The resident (B) The nursing assistant performs tasks that she does not know how to do so she does 21. Which member of the care team assesses residents, monitors progress, and gives not bother her supervisor. treatments and medication? (C) The nursing assistant avoids excessive (A) The nurse absences from work. (B) The nursing assistant (D) The nursing assistant respects an individu(C) The medical social worker al’s background and beliefs. (D) The registered dietitian 16. To hold oneself accountable means to 22. Which member of the care team has the most (A) Admit mistakes and apologize for them direct contact with the residents? (B) Always speak positively about situations (A) The nursing assistant and people (B) The nurse (C) Be able to work with people of many differ(C) The physician ent backgrounds (D) The activities director (D) Care about the problems of others

290 23. The chain of command is (A) A legal term meaning a person can be held responsible for harming someone else (B) The person in charge of the department for each shift (C) The line of authority in a facility (D) The department that a nursing assistant goes to if he wants to report a problem 24. In which type of nursing care does the registered nurse give much of the daily care to the residents? (A) Facility nursing (B) Team nursing (C) Primary nursing (D) Functional nursing

Name: �� 28. Which of the following would be the best response by a nursing assistant if he forgets how to perform a procedure? (A) The NA should review the steps of the procedure in the procedure manual. (B) The NA should perform the procedure anyway, knowing the correct order will come to him. (C) The NA should check online for instructions on how to perform the procedure. (D) The NA should ask the resident for a reminder on how to perform the procedure. 29. What would be the best response by a nursing assistant if a surveyor asks her a question? (A) The NA should answer honestly and to the best of her ability. (B) The NA should offer suggestions for making improvements in the facility. (C) The NA should refuse to answer any questions until her supervisor is present. (D) The NA should make up an answer if she does not know the answer to the question.

25. What is one possible negative result of the functional nursing style of care? (A) There are too many tasks to be completed effectively. (B) Nursing assistants may not be adequately trained for their tasks. (C) Staff may overlook changes in a resident’s condition. (D) Residents may get tired of seeingTtE heSsTaB mA e care team members every day. 26. Which of the following is associated with person-centered care? (A) Nursing staff decide what a resident needs. (B) A resident’s personal preferences and individual choices are promoted. (C) All residents are treated the same way. (D) Nursing assistants make sure that all residents participate in the same activities. 27. A policy is (A) A course of action that should be taken every time a certain situation occurs (B) A specific method of doing something (C) The chain of command within the facility (D) Another term for a state inspection of a healthcare facility

Name:

��

Chapter 2: Ethical and Legal Issues Multiple Choice. Choose the correct answer. 1.

Which of the following statements is true of ethics? (A) Ethics are rules set by the government to protect people. (B) Ethics are the knowledge of what is right and wrong. (C) Misdemeanors are examples of ethics. (D) Ethics do not apply to healthcare workers. Which of the following statements is true of criminal laws? (A) They protect society from harmful people or organizations. (B) They relate to resolving disputes between individuals. (C) They include any crime which is not a felony. (D) They are the code of proper behavior and courtesy in a certain setting.

291 6. An example of ethical behavior by a nursing assistant is (A) Keeping a resident’s information confidential (B) Not telling anyone when a mistake is made (C) Pretending to be a nurse in order to get residents to be more cooperative (D) Letting a resident know that the nursing assistant is having a bad day 7. The Omnibus Budget Reconciliation Act (OBRA) was passed as a response to (A) Lack of funding for long-term care facilities (B) Reports of abuse and poor care in longterm care facilities (C) Complaints from long-term care facility staff about resident behavior (D) Nursing assistants being unable to pass competency examinations

8. How many hours of training does OBRA require for nursing assistants? (A) At least 150 hours Which of the following is an example of pro(B) At least 100 hours fessional and ethical behavior by a nursing (C assistant? TESTBANKSELLER.C) OAMt least 75 hours (A) Keeping quiet if he makes a mistake (B) Documenting care accurately and promptly (C) Telling his friend details about the residents he works with (D) Rushing a resident through tasks if there is not much time left in the nursing assistant’s shift

4. Which of the following is an example of unprofessional behavior by a nursing assistant? (A) Graciously accepting a gift from a favorite resident (B) Reporting all abuse or suspected abuse of residents (C) Coming to work every day on time (D) Being positive, pleasant, and tactful 5. A code of ethics revolves around (A) Getting tasks done as quickly as possible (B) Controlling costs in the facility (C) Valuing residents and giving ethical care (D) Sharing opinions and personal values with residents

(D) At least 50 hours 9. Which of the following behaviors promotes Residents’ Rights? (A) Deciding which clothing a resident should wear if she takes too long to decide for herself (B) Letting residents know when they are eating too slowly (C) Providing privacy during all care procedures (D) Restricting visitors for uncooperative residents 10. Which of the following behaviors violates Residents’ Rights? (A) A nursing assistant tells stories about her favorite residents to her family. (B) A nursing assistant helps a resident resolve a complaint. (C) A nursing assistant informs a resident in advance about a change of roommate. (D) A nursing assistant encourages a resident to choose her clothing for the day.

292 11. �� means purposefully causing physical, mental, emotional, or financial pain or injury to someone. (A) Abuse (B) Assault (C) Battery (D) Malpractice 12. Threatening to harm a resident if he tells another caregiver about a problem is an example of which type of abuse? (A) Physical abuse (B) Psychological abuse (C) Financial abuse (D) Substance abuse 13. Negligence is (A) Threatening to touch a person without permission (B) Touching a person without permission (C) Actions or the failure to act or give care to a person, resulting in unintended injury (D) Insulting, humiliating, or treating a person as a child

Name: �� 17. Which of the following is a step taken when a nursing assistant is suspected of abuse? (A) A meeting of staff members and residents is held so that everyone can discuss the problem. (B) The nursing assistant continues to work while the investigation is being completed. (C) The name of the resident or staff member who reported the abuse is announced so opinions can be gathered. (D) The nursing assistant is suspended immediately and an investigation is completed. 18. Which of the following is an ombudsman’s responsibility? (A) Helping with resident care procedures (B) Assisting with resolving staff disputes (C) Investigating and resolving resident complaints (D) Organizing outings and activities for residents

19. With whom may a nursing assistant share a resident’s health information? (A) Anyone who asks 14. If a nursing assistant sees or suspects that a B)EA onOeMwho lives or works at the facility resident is being abused, he must TESTBANKSEL(L Rn.yC (C) The resident’s friends and family (A) Report it at once to his supervisor (D) Other care team members (B) Confront the abuser (C) Try to stop the abuse himself (D) Call the resident’s family to inform them 15. Which of the following is considered a sign of abuse? (A) Missing teeth or hair (B) Ripped clothing (C) Pressure ulcers (D) Unanswered call lights 16. Which of the following is considered a sign of neglect? (A) Burns shaped in certain ways (B) Weight loss (C) Changing doctors frequently (D) Wearing makeup to hide injuries

20. One reason that the Health Insurance Portability and Accountability Act (HIPAA) was passed was to (A) Make sure nursing assistants receive adequate health insurance coverage (B) Protect privacy of health information (C) Ensure that care procedures are performed properly (D) Prevent abuse and neglect of residents 21. Which of the following is the best way for a nursing assistant to keep residents’ health information confidential? (A) Discuss a resident’s information away from the facility so that other residents cannot hear it (B) Bring family and friends to the facility to meet the residents (C) Return charts to their proper place after use (D) Post updates about favorite residents on her Facebook page to avoid being overheard

Name:

��

22. A legal document that allows a person to decide what kind of medical care he wishes to have if he is unable to make those decisions himself is called a(n) (A) Will (B) Advance directive (C) CPR (D) Power of attorney 23. What is the purpose of the Patient SelfDetermination Act (PSDA)? (A) To offer in-service training for nursing assistants (B) To keep protected health information (PHI) private (C) To encourage people to make decisions about advance directives (D) To detail how abuse should be reported 24. Which of the following is an example of an advance directive? (A) Last Will and Testament (B) Power of Attorney (C) Divorce Decree (D) Durable Power of Attorney for Health Care

293

294 Chapter 3: Communication Skills Multiple Choice. Choose the correct answer. 1.

Which of the following is an example of nonverbal communication by a nursing assistant? (A) Writing a note in a resident’s chart (B) Giving an oral report to a supervisor (C) Smiling at a new resident (D) Speaking in an encouraging tone of voice to a resident who is moving slowly

Which of the following is an example of positive nonverbal communication by a nursing assistant? (A) Leaning forward to listen as a resident talks about her day (B) Rolling her eyes as the supervisor gives an assignment (C) Tapping her foot while waiting for a resident to get ready for his bath (D) Shaking her head when a resident has been incontinent

Name: �� 5. Why is it important to consider a resident’s cultural background when communicating with him or her? (A) It is not important to consider cultural background. (B) Because the resident will certainly want to tell stories about his culture. (C) Because the NA might know somebody with the same background and she can tell the resident about that person. (D) Because cultural background helps determine how people communicate and can help the NA communicate better with the resident. 6. If a resident’s native language is different from the nursing assistant’s, the nursing assistant should (A) Use an interpreter to translate the message (B) Ignore the resident unless she speaks in the NA’s language to encourage learning (C) Communicate with coworkers in the NA’s native language in front of the resident (D) Ask the resident only yes/no questions

An example of active listening is (A) NA looking around the room while the resident is speaking . LELaE chRt. im TESTBANKS7E CeOaMnursing assistant greets a resident, he should (B) NA finishing the resident’s sentences to (A) Assume that the resident knows who he is make communication faster (B) Explain the procedure to be performed (C) NA focusing on the resident and providing (C) Reassure the resident that she will not feedback have to do anything during the procedure (D) NA talking constantly so that there are no (D) Avoid telling the resident about the procepauses in the conversation dure if he thinks it will upset her 4. If a resident is difficult to understand, a nursing assistant should 8. One way for an NA to have a positive relation(A) Pretend to understand the resident even ship with a resident’s family and friends is to (A) Avoid talking to the resident when he has when she does not so the resident will not visitors feel embarrassed (B) Let the family take care of the resident’s (B) Restate what the resident is saying in needs themselves her own words to find out if she has (C) Tell the resident’s friends stories about the understood (C) Avoid communicating with the resident resident that will make them laugh (D) Use clichés to make it easier for the resi(D) Respond immediately when the resident dent to understand what is being said calls for help 9. The main part of a word that gives it meaning is the (A) Prefix (B) Root (C) Suffix (D) Abbreviation

Name:

��

10. When is it appropriate for nursing assistants to use medical terminology? (A) When communicating with the care team (B) When communicating with residents (C) When communicating with residents’ families (D) When communicating with visitors 11. Which of the following shows the correct conversion of 1330 to regular time? (A) 1:30 a.m. (B) 1:30 p.m. (C) 11:30 a.m. (D) 11:30 p.m. 12. Which of the following shows the correct conversion of 7:45 p.m. to military time? (A) 0745 hours (B) 1975 hours (C) 1945 hours (D) 0775 hours 13. A nursing assistant’s responsibility with a resident’s medical chart is to (A) Keep the chart in case it is needed later (B) Make changes to the care plan (C) Gather information and noTteEoSbT seB rvAatNioKnS s and care (D) Suggest the best treatment for the resident 14. A nursing assistant can share information about residents with (A) Anyone she chooses (B) The resident’s family and friends (C) Other members of the care team (D) No one 15. Accurate documentation is important because (A) The NA does not want to get into trouble (B) Documentation provides an up-to-date record of a resident’s status and care (C) Family members will want to review the medical chart regularly (D) The NA determines each resident’s diagnosis based on her documentation 16. When should documentation be recorded? (A) Immediately after care is given (B) At the end of the shift (C) Whenever there is time (D) Before the care is given

295 17. When using the computer at work, a nursing assistant should (A) Research different conditions that may affect the elderly (B) Log off the computer when she is finished using it (C) Look for websites she has a personal interest in (D) Share her password with the rest of the care team 18. Why must a nursing assistant be concerned about privacy if documentation is done on a computer? (A) It is common for computer hackers to target long-term care facilities. (B) Because the federal government is monitoring all computers in LTC facilities to ensure that HIPAA is followed. (C) Because residents will probably try to sneak a look at other residents’ information. (D) Because the information is confidential and someone who is not part of the care team might see the screen. 19. Which of the following is true of the MDS? (A) MDS stands for Multiple Diagnosis System. (B) Every time an MDS is completed for a resident, an investigation by the state is done. (C) Not all residents will have an MDS. (D) A nursing assistant’s report may trigger a needed assessment for a resident. 20. Which of the following is an example of objective information? (A) “Mr. Castillo seems a little grouchy today.” (B) “Mr. Castillo says that he has a stomachache.” (C) “Mr. Castillo’s blood pressure is 115/68.” (D) “Mr. Castillo doesn’t get along with the nurses.” 21. Which of the following is an example of subjective information? (A) “Mrs. Parker says she is dizzy.” (B) “Mrs. Parker has a temperature of 101°F.” (C) “Mrs. Parker had a visit from her son today.” (D) “Mrs. Parker did not eat any of her dinner.”

296 22. Which of the following senses is not used in making observations? (A) Sight (B) Touch (C) Smell (D) Taste 23. Choose the resident condition that the NA should report immediately to the nurse: (A) Family visiting (B) Chest pain (C) Watching too much TV (D) Acting lonely 24. Which of the following is the first step in the nursing process? (A) Diagnosis (B) Assessment (C) Evaluation (D) Planning

Name: �� 28. A sentinel event is (A) Any event requiring an incident report (B) An occurrence involving death or serious injury (C) A normal event that occurs in the course of the day (D) A complaint by a resident or family member 29. Under what conditions should a nursing assistant complete an incident report if he is injured on the job? (A) Only if the injury is serious (B) Only if the nursing assistant feels the facility is at fault (C) Only if another employee was involved (D) Any time he is injured on the job 30. Which of the following is the best example of using proper telephone etiquette at work? (A) “Yes, Mr. Garcia is a resident here; he was admitted for dementia.” (B) “Good afternoon, Hartman Skilled Care Facility, Brenda Johnson speaking.” (C) “We’re very busy here today. Can you call back some other time?”

25. What is the nursing assistant’s role in care planning? (A) The nursing assistant creates the care plan. (B) The nursing assistant shares observations that may affect the care plan. (C) The nursing assistant makes chaT nE geS sT toBANKSELLER.COM (D) “No, I’m sorry, Elizabeth no longer works the care plan. here. She was fired a few weeks ago.” (D) The nursing assistant discusses the diagnosis with the resident’s friends and 31. If a nursing assistant sees a call light for a resifamily. dent who is not assigned to her, she should (A) Answer the call light 26. If a nursing assistant is not sure what informa(B) Tell the nursing assistant assigned to that tion to share at the care conference, she should resident to answer it (A) Talk to the nurse before the meeting (C) Tell the supervisor (B) Not attend the meeting (D) Ignore it (C) Attend the meeting, but not say anything (D) Ask the other team members at the meeting what they need to know 27. Which of the following would be considered an incident? (A) Mrs. Storey eats half of her dinner. (B) Mrs. Desmond’s family thanks a nursing assistant for taking care of her. (C) Mr. Noble wants to go for a walk after his bath. (D) Ms. Martin falls in the bathroom but seems uninjured.

32. Rounds are (A) The group of residents assigned to each nursing assistant (B) The list of tasks that must be done on each shift (C) A method of reporting in which staff move from room to room (D) Meetings during which the care plan is written

Name:

��

33. What does a resident’s code status indicate? (A) The type of diet a resident has and how much food should be offered at each meal (B) The type of care that should be provided in the event of a cardiac arrest or other catastrophic failure (C) The type and amount of medication that a resident must take each day (D) The type of personal care tasks that must be completed each day for a resident 34. What is the first thing a nursing assistant should do after getting a work assignment? (A) Set up residents for mealtime (B) See if he can change some of his daily assignments (C) Check if any of his assigned residents requires immediate help or care (D) Take vital signs on all residents

297

Name: ��

298 Chapter 4: Communication Challenges Multiple Choice. Choose the correct answer. 1.

One way for a nursing assistant to communicate effectively with a visually-impaired resident is to (A) Wait until the resident speaks to her before identifying herself (B) Touch the resident on the arm before identifying herself to let her know the NA is there (C) Speak as little as possible while providing care (D) Use the face of an imaginary clock to explain the position of objects If a resident is hearing impaired, a nursing assistant should (A) Make sure the light is on the resident’s face, not the NA’s (B) Make sure the light is on the nursing assistant’s face, not the resident’s (C) Raise the pitch of her voice so that the NA is heard (D) Look at the ground when speaking to the resident

5. Which of the following is the best example of how a nursing assistant should communicate with an anxious resident? (A) The NA should gently ask the resident what is bothering him. (B) The NA should speak more loudly. (C) The NA should suggest medication that is commonly used for anxiety. (D) The NA should tell the resident that it is best to stop worrying so much. 6. Which of the following is the best way for a nursing assistant to communicate with a resident who is depressed? (A) The NA should use body language that shows interest. (B) The NA should avoid eye contact with the resident. (C) The NA should discourage other residents from talking to the resident who is depressed. (D) The NA should change the subject when the resident wants to talk about his feelings. 7. Which of the following is the best way for a

TESTBANKSELnLuErsRin.gCaO M ssistant to respond to a resident who

3. While distributing meal trays, Brenda gives the wrong meal to a resident who has diabetes. She says that the resident distracted her by complaining about the food. Which defense mechanism is she using? (A) Denial (B) Projection (C) Repression (D) Rationalization 4. Laura’s supervisor reprimands her for being late to work. Later that day, Laura yells at a resident for being incontinent. Which defense mechanism is she using? (A) Displacement (B) Regression (C) Denial (D) Rationalization

is angry? (A) The NA should ignore the angry resident until the resident calms down. (B) The NA should try to find out what is causing the resident’s anger. (C) The NA should ask the resident to stop being angry. (D) The NA should restrain the resident. 8. Which of the following is an example of aggressive, rather than assertive, behavior? (A) A resident tells a nursing assistant that she needs help cutting her food. (B) A nursing assistant tells her supervisor that she does not have the training to complete an assigned task. (C) A resident tells a nursing assistant that she is clumsy and is moving too slowly. (D) A nursing assistant tells a resident that he has a stain on his shirt and helps him clean it.

Name:

��

9. Which of the following is true of combative behavior? (A) The behavior is usually a reaction to a specific person. (B) The behavior is not a concern to staff or other residents. (C) The behavior may be caused by disease or medication. (D) The behavior does not need to be reported. 10. If a resident becomes combative, a nursing assistant should (A) Try to find out what triggered the behavior (B) Leave the resident alone to calm down (C) Tell the resident that he may be removed from the facility if he does not stop soon (D) Argue with the resident to make him understand what is best 11. When is it appropriate for a nursing assistant to hit a resident? (A) When a resident is uncooperative during care (B) When a resident threatens the nursing assistant or others (C) When a resident hits the nT urEsS inT gB asA siN stK anSt first (D) Never 12. Which of the following would be the best response by a nursing assistant if a resident is demonstrating inappropriate sexual behavior? (A) The NA should distract the resident or direct her to a private area. (B) The NA should ignore the behavior. (C) The NA should let the resident know that everyone is very upset by this behavior. (D) The NA should discuss the behavior with other residents to see if they found it upsetting. 13. When a resident is confused, the nursing assistant should (A) Leave the resident alone until she is oriented (B) Provide a quiet environment (C) Avoid telling the resident about plans for the day because it increases confusion (D) Speak quickly to distract the resident

299 14. A person in a coma may still be able to (A) Hear (B) Speak (C) See (D) Walk 15. When communicating with a resident who has a functional barrier, the nursing assistant should (A) Give the resident time to speak (B) Remove oxygen before the resident speaks (C) Insert the tracheostomy tube before the resident speaks (D) Insist that the resident speak

300 Chapter 5: Diversity and Human Needs and Development Multiple Choice. Choose the correct answer. 1.

What is the difference between health and wellness? (A) Health is the absence of disease; wellness is a state of physical, mental, and social well-being. (B) Health is a state of physical, mental, and social well-being; wellness has to do with balancing one’s life. (C) Health is merely the absence of disease; wellness looks at the whole person. (D) Health and wellness are the same thing.

If a nursing assistant encourages a resident to play cards with friends, what kind of wellness is she promoting? (A) Physical wellness (B) Social wellness (C) Emotional wellness (D) Intellectual wellness

Holistic care focuses on

Name: �� 6. Psychosocial needs include the following: (A) Bathing (B) Activity (C) Sleep and rest (D) Love and affection 7. Jenna knows that Mr. Warren, one of her residents, is very excited about an upcoming visit from his daughter. She takes a little extra time to help him get ready and tells him how good he looks. Which kind of need is Jenna helping her resident to meet? (A) Physical need (B) Safety and security need (C) Need for self-esteem (D) Need for self-actualization 8. Cultural diversity has to do with (A) Seeing all people from a certain culture as being the same (B) Preferring people of one culture over those of other cultures (C) Making assumptions about a person based on stereotypes about their culture (D) The wide variety of people throughout the world

(A) The whole person, including phyT siE caSl,TBANKSELLER.COM mental, and social well-being 9. What is transcultural nursing? (B) The person’s disease and disabilities (A) The study of various cultures with the goal (C) How sick a person is of providing care specific to each (D) The absence of disease and illness (B) Nursing that involves traveling to different countries 4. Which of the following examples demonstrates (C) Providing care to residents who are a holistic approach to care? transgender (A) While Claire is giving Ms. Potter a bath, (D) Nursing that involves a team approach to she asks her how her day has been and liscare tens carefully. (B) Jim rushes his residents through their meals without talking with them so that they can get their dinner faster. (C) Jessica is very religious and likes to share her religious views with her residents. (D) Thad often spends so much time chatting with his residents that he does not finish all of his work. 5. Which of the following is a physical need? (A) The need to be accepted (B) The need for self-esteem (C) The need to be free from pain (D) The need for independence

10. When should staff members become involved in family matters? (A) When family members visit too often (B) When staff disapprove of the family members’ lifestyle (C) When there is concern about the resident’s safety around family members (D) When visits disrupt the facility’s routine

Name:

��

11. Which of the following is an example of appropriate behavior by a nursing assistant with a resident’s family? (A) Giving them medical advice (B) Telling them everything will be fine if they seem worried (C) Telling the family all about the resident’s condition (D) Listening to the family’s concerns and fears and responding with a meaningful message 12. If a resident’s religious beliefs are different from a nursing assistant’s beliefs, the nursing assistant should (A) Respect the resident’s beliefs (B) Try to change the resident’s beliefs (C) Ignore the resident’s dietary restrictions (D) Refuse to care for the resident

301 16. �� is the period of human development in which a person develops secondary sex characteristics. (A) Preschool (B) Middle adulthood (C) Puberty (D) Late adulthood 17. Ageism is (A) The natural process of aging (B) Disabilities that occur with aging (C) Prejudice toward or discrimination against the elderly (D) The loss of memory associated with aging 18. Which of the following is true of most elderly people? (A) They have many interests. (B) They do not manage money well. (C) They are usually grouchy. (D) They do not like to leave home.

13. Which of the following statements is true of spiritual needs? 19. Which of the following is true of developmen(A) Residents will believe in God. tal disabilities? (B) Residents will be Christians. (A) Developmental disabilities are temporary. (C) Residents will have different spiritual (B) Developmental disabilities restrict physical needs and beliefs. TESTBANKSELLER.COanMd/or mental ability. (D) Residents will not believe in God or a high(C) Developmental disabilities are a form of er power. mental illness. 14. If a nursing assistant encounters a resident in (D) People with developmental disabilities can a sexual situation, she should never live or work independently. (A) Call the resident’s clergyperson to 20. How can a nursing assistant help a resident discuss it who has a developmental disability? (B) Provide privacy and leave the room (A) If the resident cannot speak, the nursing (C) Discuss it with the resident’s roommate to assistant should not speak to him. get his opinion (B) The nursing assistant can break tasks into (D) Ask the resident to stop what she is doing smaller steps. 15. If a nursing assistant sees a resident being (C) If an adult resident acts like a child, the sexually abused, she should nursing assistant should treat him like a (A) Remove the resident from the situation child. immediately and report it to the nurse (D) The nursing assistant should do everything (B) Pretend not to see it to avoid embarrassing for the resident. the resident (C) Tell the resident’s family (D) Confront the abuser herself

Name: ��

302 Chapter 6: Infection Prevention

Before a nursing assistant leaves a dirty utility room, what must she do to avoid transferring pathogens to other areas of the facility? (A) Change her gloves (B) Disinfect any equipment she has used (C) Wash her hands (D) Close the door securely

How many links in the chain of infection must be broken to prevent infection? (A) One (B) Two (C) Three (D) Four

A causative agent is (A) Any microorganism in the body (B) A pathogen or microorganism that causes disease (C) Normal flora that live in or on the body (D) The waiting period between the time the pathogen enters the body and the time it causes infection

Multiple Choice. Choose the correct answer. 1.

Infection prevention is (A) The way in which infections occur (B) An infection limited to a specific part of the body (C) A set of methods used to prevent the spread of disease (D) An object that has not been contaminated with pathogens When pathogens enter the bloodstream and move throughout the body, a �� has occurred. (A) Systemic infection (B) Localized infection (C) Healthcare-associated infection (D) Cross-infection One sign of a localized infection is (A) Chills (B) Headache (C) Drainage from a wound or cavity (D) Mental confusion

10. Infection prevention for the portal of exit link in the chain of infection could include TESTBANKSEL Ro.vC (L AE )C erO inM g the mouth when sneezing 4. An object can be called clean if (B) Keeping surfaces clean and dry (A) It has not been used on or near a sick (C) Getting a vaccine for a particular disease resident (D) Handwashing (B) No dirt or debris is visible on the object (C) It has been contaminated with pathogens (D) It has not been contaminated with pathogens 5. �� destroys pathogens but not all pathogens, while �� destroys all microorganisms, including those that form spores. (A) Sterilization, disinfection (B) Disinfection, sterilization (C) Asepsis, transmission (D) Transmission, asepsis 6. Making an area or object free of all microorganisms is called (A) Infection prevention (B) Disinfection (C) Transmission (D) Surgical asepsis

11. In which of the following parts of the body are mucous membranes found? (A) Feet (B) Hands (C) Genitals (D) Elbows 12. A susceptible host is (A) An infected person who could transfer disease to others (B) A pathogen that causes disease (C) An uninfected person who could get sick (D) A healthy person with strong resistance to disease

Name:

��

303

13. Which of the following is a reason that people are at greater risk for infection as they get older? (A) As people age, their immune systems become stronger. (B) Elderly people are hospitalized more often. (C) Older people recover from illness more quickly. (D) Infections tend to be less dangerous to older people.

18. Which of the following statements is true of gloves? (A) Gloves do not need to be worn when shaving a resident. (B) Disposable gloves can be washed and reused once they are clean. (C) Gloves should be worn when performing care on a resident who has broken skin. (D) After giving care, gloves are normally not contaminated.

14. Which of the following increases the risk of infection in older adults? (A) Thicker skin (B) Higher intake of fluids (C) Stronger appetite (D) Catheter use

19. A mask and goggles should be worn (A) During all care procedures (B) When caring for a resident with any infectious disease (C) If contact with splashing or spraying blood or body fluids is likely (D) At all times while in the facility

15. Standard Precautions means (A) Not performing care on residents who 20. The most important thing a nursing assistant have infectious diseases can do to prevent the spread of disease is to (B) Treating all blood, body fluids, and (A) Wear gloves and other PPE mucous membranes as if they were infect(B) Get vaccinated for common illnesses ed (C) Wash her hands (C) Asking all residents if they have infectious (D) Use lotions to reduce the risk of broken diseases before performingTcEaS reTBANKSELLER.CO skMin (D) Looking at residents’ charts to determine if 21. Hand hygiene is they have an infectious disease (A) Washing hands with soap and water only 16. With whom should a nursing assistant use (B) Using alcohol-based hand rubs only Standard Precautions? (C) Wearing gloves when performing care (A) With a resident who says he has an infecprocedures tious disease (D) Washing hands with either plain or anti(B) With a resident who suspects he might septic soap and water or using alcoholhave an infectious disease based hand rubs (C) With every resident in his care 22. When washing hands, a nursing assistant (D) With a resident who requests that they be should use friction for used (A) At least 25 seconds 17. Under Standard Precautions, the term (B) At least 20 seconds body fluids includes (C) At least 15 seconds (A) Sweat (D) At least 5 seconds (B) Water 23. Which of the following is the proper order to (C) Juice don personal protective equipment (PPE)? (D) Urine (A) Put on gown, mask, goggles, and gloves (B) Put on gloves, gown, and mask and goggles (C) Put on mask and goggles, gloves, and gown (D) Put on gown, gloves, and mask and goggles

304 24. When handling dirty linen, a nursing assistant should (A) Carry it close to her uniform (B) Wear gloves (C) Fold or roll it so the dirty area is on the outside (D) Shake it to remove any particles before removing it 25. Where is the best place to dispose of sharps? (A) In the trash can in the resident’s room (B) In the closest disposal container (C) In a puncture-proof biohazard container (D) With reusable equipment waiting to be cleaned and reprocessed

Name: �� 30. How should residents in isolation be treated? (A) They should be left alone. (B) Their behavior should be monitored closely to make sure they do not infect anyone else. (C) They should not be allowed to use the phone or use utensils. (D) They should be listened to and encouraged to share their feelings and concerns. 31. What is one responsibility of the Occupational Safety and Health Administration (OSHA)? (A) To make rules to protect workers from hazards on the job (B) To help resolve conflicts between residents and staff members (C) To provide PPE for employees, visitors, and residents of facilities (D) To provide training on cultural tolerance

26. What should a nursing assistant do if he spills a substance on his body? (A) Immediately wash the area using the proper cleaning agent (B) Ignore it unless it is painful or 32. How are bloodborne diseases transmitted? uncomfortable (A) By hugging an infected person (C) Finish cleaning the area before washing (B) By touching something an infected person the spill off his body has touched (D) Find the nurse and ask her what to do (C) By standing too close to an infected person w e coughs T E S TBANKSELLE Rh.eCn OhM 27. Droplets normally do not travel more than (D) By contact with blood or body fluids (A) Six feet (B) Two feet (C) Eight feet (D) Ten feet 28. Which of the following is true of Transmission-Based Precautions? (A) An NA does not need to practice Standard Precautions if he practices TransmissionBased Precautions. (B) They are exactly the same as Standard Precautions. (C) They are practiced in addition to Standard Precautions. (D) They will not be listed in the care plan so as not to alarm anyone. 29. Why would a resident be in isolation? (A) Because the resident requires Transmission-Based Precautions (B) Because the resident requires Standard Precautions (C) Because the resident cannot get along with other residents (D) Because the resident cannot be managed by staff

33. What is one way that the human immunodeficiency virus (HIV) is spread? (A) Through the air when an infected person coughs (B) By hugging an infected person (C) By standing next to an infected person (D) By contact with an infected person’s blood 34. Which of the following statements is true of hepatitis B (HBV)? (A) HBV is not a serious threat to healthcare workers. (B) The vaccine for HBV helps prevent the disease. (C) HBV is spread by drinking contaminated water. (D) HBV cannot cause death. 35. What is the best way to control methicillinresistant Staphylococcus aureus (MRSA)? (A) By placing residents in airborne infection isolation rooms (AIIRs) (B) Through proper handwashing (C) By wearing surgical masks (D) By taking the antibiotic vancomycin

Name:

��

Chapter 7: Safety and Body Mechanics

305 7.

Which of the following needs to be disposed of in a biohazard container? (A) Trash (B) Sharps (C) Aluminum cans (D) Food

To maintain proper body mechanics while lifting or carrying an object, a nursing assistant should (A) Hold the object out and away from her body (B) Face the object or person she is moving (C) Twist at the waist as she picks up the object (D) Try to keep her center of gravity as high as possible

Multiple Choice. Choose the correct answer. 1.

Most of the accidents in a facility are related to (A) Falls (B) Burns (C) Poisoning (D) Choking Which of the following is the best way that a nursing assistant can help prevent falls? (A) Clear walkways of clutter (B) Keep lights low (C) Move call lights further away from residents (D) Leave spills for housekeeping to clean

One way to prevent burns and scalds is to 9. One way to use proper body mechanics on the (A) Place hot drinks on the edges of tables so job is to that they will be easier to reach (A) Stand back from an object while lifting it (B) Serve residents drinks while they are (B) Keep feet close together when lifting standing (C) Use the muscles of the lower back to lift (C) Leave warm water applications on for 30 (D) Bend at the knees to lift something minutes at a time (D) Check water temperature before giving a 10. Restraints may be used bath or shower TESTBANKSELLER.(AC) OWMhenever it is convenient for the facility staff 4. When should a nursing assistant identify a (B) When a resident is being uncooperative resident? (C) When there are not enough staff members (A) After giving care to watch all the residents (B) When collecting meal trays (D) Only with a doctor’s order (C) When shifts change (D) Before helping with feeding 5. How should a resident be positioned for eating? (A) Lying flat on his back (B) Reclining at a 45-degree angle (C) Sitting as upright as possible (D) Lying on his side with his head propped up 6. What information does a Safety Data Sheet (SDS) contain? (A) Costs of the chemical (B) Comparisons with other chemicals (C) Names of other facilities using the chemical (D) Description of emergency response actions

11. Which of the following statements is true of restraints? (A) People tend to respond better to restraint alternatives than to restraints. (B) Laws allow the use of restraints when a facility is short-staffed. (C) Using restraints does not cause negative effects. (D) Restraint-free care means a facility uses restraints only for disciplining residents. 12. An example of a restraint alternative is (A) Tying the resident to the bed (B) Removing the resident’s call light (C) Giving frequent help with toileting (D) Locking the resident’s door from the outside

306 13. Restraint-free care means that (A) Restraints are only used if a resident is in danger of hurting himself or others (B) Restraints are only used with a doctor’s order (C) Restraints are only used when restraint alternatives fail (D) Restraints are not kept or used at the facility for any reason 14. At least every �� hours, a restraint must be removed and care must be provided. (A) 3 (B) 2 (C) 5 (D) 4 15. Why does working with oxygen require special safety precautions? (A) Oxygen is an expensive medication. (B) Oxygen is a dangerous fire hazard. (C) Oxygen levels must be adjusted often. (D) Oxygen equipment is very fragile. 16. Which of the following is a flammable liquid? (A) Water (B) Sweat (C) Nail polish remover (D) Urine 17. Which of the following guidelines is true of working around oxygen equipment? (A) The NA should not allow open flames around oxygen. (B) The NA should adjust oxygen levels when they are too high or too low. (C) The NA should replace oxygen tubing if it becomes clogged. (D) The NA should prescribe skin medication if the oxygen device is causing skin irritation. 18. When caring for residents who have IVs, a nursing assistant should (A) Keep the IV site dry (B) Leave the tubing kinked (C) Touch the clamp (D) Lower the IV bag below the IV site

Name: �� 19. RACE is an acronym for a safety rule, and means (A) Run to A Close Exit (B) Rescue residents, Activate alarm, Contain fire, Extinguish (C) Restore power, Activate alarm, Call fire department, Exit the building (D) Remove window, Access outside, Call for help, Extinguisher opened

Name:

��

Chapter 8: Emergency Care, First Aid, and Disasters

307 7.

In which of the following situations should a nursing assistant give abdominal thrusts to someone? (A) The person is coughing. (B) The person cannot speak, cough, or breathe. (C) The person is breathing very rapidly. (D) The person tells the nursing assistant that she feels short of breath.

One sign that a person is in shock is (A) Flushed or reddish skin (B) Decreased pulse and respiration rates (C) Increased blood pressure (D) Extreme thirst

To control bleeding, a nursing assistant should (A) Use her bare hands to stop it (B) Lower the wound below the heart (C) Hold a thick pad or clean cloth against the wound and press down hard (D) Apply light pressure with a Band-aid

Multiple Choice. Choose the correct answer. 1.

Which of the following conditions may mean a person needs emergency medical help? (A) Person is behaving rudely. (B) Person has a scratch. (C) Person does not want help. (D) Person is unconscious. The first two steps in approaching an emergency are (A) Perform first aid and assess the situation (B) Call the victim’s family and then call 911 (C) Assess the situation and the victim (D) Get assistance and perform CPR

After an emergency, the nursing assistant will need to (A) Document the incident (B) Give an opinion about what is wrong with the resident 10. If a resident has a minor burn, a nursing assis(C) Tell the resident she is very worried about tant should use �� to decrease the temperahis condition ture of the skin. (D) Prescribe medication for thTeErS esT idB enAtNKSELLER. (AC) O IcM e or ice water (B) Cool water 4. When a person’s breathing stops, it is called (C) Burn ointment (A) Cardiac arrest (D) Olive or canola oil (B) Respiratory arrest (C) CPR (D) Choking 5. If a person’s breathing and heartbeat stop, brain damage can occur within �� minutes. (A) 4-6 (B) 8-10 (C) 10-15 (D) 15-20 6. If a nursing assistant is in an emergency situation but has not been trained to perform CPR, she should (A) Perform CPR anyway (B) Ask someone at the scene to tell her how to do it (C) Give basic first aid until the emergency medical team arrives (D) Do nothing

11. If a resident feels faint, a nursing assistant should (A) Try to have the resident stand up before fainting occurs (B) Have the resident lean forward and place her head between her knees (C) Tighten the resident’s clothing (D) Leave the resident alone as soon as symptoms disappear 12. Which of the following can a nursing assistant do if poisoning is suspected? (A) Suggest the resident put his finger down his throat to induce vomiting. (B) Feed the resident crackers or bread to soak up the poison. (C) Give the resident medication and then call poison control. (D) Look for a container that will help him find out what the resident took or ate.

308 13. Which of the following is a correct response to a nosebleed? (A) Lower the head of the bed (B) Ask the person to lie down (C) Apply ice directly to the skin to stop the bleeding faster (D) Apply pressure near the bridge of the nose 14. Another word for fainting is (A) Syncope (B) Epistaxis (C) Dyspnea (D) Emesis 15. When a resident is suspected of having a heart attack, a nursing assistant should (A) Not give the resident food or fluids (B) Cover the resident with a heavy blanket (C) Make sure the resident is standing up to promote circulation (D) Leave the resident to call his family

Name: �� 20. A transient ischemic attack is a warning sign of (A) Cerebrovascular accident (B) Myocardial infarction (C) Hypoglycemia (D) Epistaxis 21. A sign that a stroke is occurring is (A) Abdominal pain (B) Gasping for air (C) Low blood pressure (D) Facial droop 22. In a healthcare facility, codes are used to (A) Keep track of residents (B) Inform staff of emergencies without alarming residents and visitors (C) Teach procedures to new nursing assistants (D) Welcome new residents to the facility

23. During code team procedures, a nursing assis16. Which of the following symptoms is more tant might be asked to often experienced by women during a heart (A) Give a resident oxygen attack? (B) Call the resident’s family (A) Normal breathing (C) Work with the suction machine TESTBANKSEL(LDE Ri.veCcOhM (B) Extreme fatigue )G est compressions during CPR (C) Anxiety and a sense of doom (D) Low blood pressure 17. Another term for insulin reaction is (A) Myocardial infarction (B) Diabetic coma (C) Hypoglycemia (D) Dyspnea 18. Diabetic ketoacidosis may be caused by (A) Having too much insulin in the body (B) Having too little insulin in the body (C) Eating too little food (D) Too much exercise 19. Which of the following would be the best response by the nursing assistant if a resident is having a seizure? (A) The NA should give the resident a glass of water and ask him to drink it. (B) The NA should hold the resident down if he is shaking severely. (C) The NA should move furniture away to prevent injury to the resident. (D) The NA should open the resident’s mouth to move the tongue to the side.

Name:

��

Chapter 9: Admission, Transfer, Discharge, and Physical Exams Multiple Choice. Choose the correct answer. 1.

One thing that would make a positive impression on a family visiting a facility is (A) Lack of physical, occupational, and speech therapists available (B) No interpreters available who speak the resident’s native language (C) A safe and homelike atmosphere (D) Poor results from previous inspections Which of the following is a reason that new residents may have trouble adjusting to life in a healthcare facility? (A) They will have more independence in a facility. (B) Their health is improving. (C) They have had to leave their home. (D) The other residents and staff are people they already know well.

309 6. There are �� inches in a foot. (A) 10 (B) 12 (C) 15 (D) 20 7. The permanent and painful shortening of a muscle, tendon, or ligament is called a(n) (A) Abdominal girth (B) Sternal notch (C) Contracture (D) Demi-span 8. How will a nursing assistant measure the height of a resident who cannot get out of bed? (A) The NA will use a scale. (B) The NA will use a tape measure. (C) The NA will estimate height by looking at the resident. (D) The NA will not be able to measure height.

9. What is a nursing assistant’s responsibility during an in-house transfer of a resident? (A) The NA decides that the resident must be 3. A good way for a nursing assistant to help a transferred. new resident adjust to life in the facility is to (B) The NA must keep the fact that a transfer (A) Think about how it would T feE elStoTh BaAveNtKo SELLER.COwMill occur a secret. move into a facility (C) The NA packs all of the resident’s (B) Tell the resident how much work it is to belongings. care for him (D) The NA tells the resident’s roommate (C) Cover up any mistakes to make the resiabout the transfer. dent feel more confident about the facil10. Which of the following would be the best ity’s care response by the nursing assistant if a resident (D) Push the resident to join in activities even wants to leave a facility against medical advice if he says he does not want to (AMA)? 4. One way for a nursing assistant to make a pos(A) The NA should counsel the resident as to itive first impression on a new resident is to why he should not leave the facility. (A) Place his personal items where the NA (B) The NA should remind the resident that thinks they look best he is very sick and needs to stay until his (B) Get the admission process completed as family arrives. quickly as possible (C) The NA should report to the charge nurse. (C) Allow the resident to introduce himself to (D) The NA should restrain the resident to preeveryone in the facility vent him from leaving. (D) Prepare his room before his arrival so that 11. How can a nursing assistant help make dishe feels expected and welcome charge easier for a resident? 5. When beginning to weigh a resident, the scale (A) Allow him to pack his belongings himself should be balanced at (B) Be positive and reassuring about the (A) Zero change (B) Five pounds (C) Let the resident walk to the car by himself (C) Ten pounds (D) Recommend exercises for the resident to (D) Negative two pounds do after discharge

310 12. A nursing assistant’s responsibility for the resident during discharge ends (A) When the doctor writes the discharge order (B) When the resident’s belongings are packed (C) When the resident is seated in the vehicle (D) When the vehicle’s doors are closed 13. In which position is the resident placed for examination of the breasts, chest, and abdomen? (A) Knee-chest position (B) Lithotomy position (C) Dorsal recumbent (D) Trendelenburg position 14. Why might a resident need emotional support during a physical exam? (A) Residents are always frightened of exams. (B) Doctors are not very sensitive to their patients’ emotions. (C) The resident has probably never had a physical exam before. (D) The resident may fear what the examiner will find.

Name: ��

Name:

��

Chapter 10: Bedmaking and Unit Care Multiple Choice. Choose the correct answer. 1.

Which of the following is true of sleep? (A) The elderly usually go to sleep faster than other groups. (B) The elderly are more able to tolerate sleep deprivation than other groups. (C) Lack of sleep can cause decreased mental function. (D) People can live in good health even without much sleep. The circadian rhythm is (A) A natural period of rest for the mind and body (B) Deep sleep that helps the body to renew (C) The 24-hour, day-night cycle (D) All of the natural biorhythms of the body

311 8. What can an overbed table be used for? (A) Placement of dirty linens (B) Placement of bedpans (C) Placement of meals (D) Placement of urinals 9. Why is disposable equipment used in healthcare facilities? (A) It is less expensive. (B) It prevents the spread of microorganisms. (C) It makes nursing assistants’ jobs easier. (D) It is safer. 10. An example of disposable equipment is (A) An autoclave (B) An electric razor (C) A sphygmomanometer (D) Gloves 11. When leaving a resident’s room, a nursing assistant should (A) Leave the unit tidy (B) Move the resident’s belongings (C) Leave spills for the next shift (D) Lock the resident’s door 12. Where should the call light be placed when a

Sleep disorders are called (A) Insomnias (B) Parasomnias (C) Somnambulisms (D) Bruxisms One dietary habit that a nursinTgEaS ssT isB taA ntNcK anSELLER.COM nursing assistant leaves a resident’s room? encourage to help residents sleep better is (A) On the bedside table beside the telephone (A) Limiting caffeine intake (B) Next to the television remote (B) Eating heavy meals before bedtime (C) Within the resident’s reach (C) Eating foods high in sugar (D) On a chair next to the resident’s bed (D) Serving meals later at night 13. When must a unit be completely cleaned and Lack of sleep can cause disinfected? (A) Increased mental function (A) Every day (B) Increased reaction time (B) When the resident has visitors (C) Increased immune system function (C) When a resident is transferred, discharged, (D) Increased irritability or dies (D) When a resident has a sleep disorder One way for a nursing assistant to be respectful to a resident in his room is to 14. Which of the following statements is true of (A) Allow the resident to clean the room linen? himself (A) Linen should be carried close to the nurs(B) Always knock and wait for permission ing assistant’s uniform. before entering the room (B) Linen should be shaken to remove (C) Rearrange the resident’s personal items so wrinkles. that they look better (C) Linen can be taken from one resident’s (D) Ignore any safety hazards in the room room into another resident’s room. The bedside stand is used for (D) Dirty linen should be removed by rolling it (A) Linen storage away from the nursing assistant. (B) Serving meals (C) Storing equipment (D) Storing valuables

312 15. A resident who is at risk for pressure ulcers may have (A) An alternating pressure mattress (B) A bariatric bed (C) An electric bed (D) A closed bed 16. Which of the following terms describes a bed that is completely made with the bedspread and blankets in place? (A) Closed bed (B) Open bed (C) Occupied bed (D) Unoccupied bed 17. A(n) �� bed is made so that it can easily accept residents who must return to bed on stretchers or gurneys. (A) Open (B) Closed (C) Surgical (D) Occupied 18. The branch of medicine that deals with the prevention and treatment of obesity is (A) Obstetrics (B) Bariatrics (C) Pediatrics (D) Dietetics

Name: ��

Name:

��

Chapter 11: Positioning, Moving, and Lifting Multiple Choice. Choose the correct answer. 1.

Which of the following is part of using proper body mechanics? (A) Twisting the back when carrying objects (B) Pushing when possible, rather than lifting (C) Using a narrow base of support (D) Lifting with the back, not the legs

Which of the following statements is true of positioning? (A) Residents will not need help getting into comfortable positions or changing positions. (B) Constant pressure on an area helps prevent pressure ulcers. (C) NAs should check residents’ skin each time they are repositioned. (D) Bedbound residents should be repositioned every three hours.

313 6. Draw sheets are used to (A) Keep the bed covers from pushing down on a resident’s feet (B) Keep a resident’s fingers from curling tightly (C) Keep a resident’s joints in the correct position (D) Prevent damage to a resident’s skin caused by shearing 7. If a nursing assistant feels it is not safe to move a resident by himself, he should (A) Find a coworker to help (B) Move the resident anyway because everyone else is probably busy (C) Refuse to move the resident (D) Ask the resident to move himself

8. Dangling means (A) Sitting up with legs hanging over the side of the bed (B) Sitting up in a wheelchair with feet flat on 3. In which position is a resident if he is lying the floor flat on his back with his head and shoulders (C) Lying in bed with feet resting over the side supported by a pillow? of the bed (A) Lateral position TESTBANKSELLER.(DC) OHManging both arms over chair rests (B) Sims’ position 9. When using a transfer belt, the nursing assis(C) Supine position tant should (D) Prone position (A) Place it under a resident’s clothing 4. In which position is a resident if he is on his (B) Place it around the fractured limb left side with his lower arm behind his back (C) Place it around a resident’s chest and his upper knee flexed? (D) Place it around a resident’s waist (A) Sims’ 10. When transferring a resident who has a weak (B) Prone side (C) Fowler’s (A) The weaker side moves first (D) Supine (B) The stronger side moves first 5. Which of the following statements is true of a (C) The strong side and weak side move at the high-Fowler’s position? same time (A) In this position, a resident is lying on his (D) It does not matter which side moves first abdomen. (B) In this position, a resident is sitting nearly straight up. (C) In this position, a resident is lying on either side. (D) In this position, a resident is flat on his back.

314 11. Which of the following is a guideline for safely using a wheelchair? (A) The NA goes down the ramp forward, with the resident facing the bottom of the ramp. (B) The NA leaves the wheelchair’s wheels unlocked while positioning a resident in it. (C) When using an elevator, the NA should make sure the chair faces the back of the elevator. (D) The NA should check that the resident’s hips are positioned at the very back of the chair. 12. A geriatric chair is used to (A) Help residents who are mostly bedbound avoid the need to stay in bed all day (B) Assist with resident transfers (C) Position residents properly for personal care (D) Place residents in the prone position 13. A person who has a body mass index (BMI) of 40 or higher is considered (A) Underweight (B) Morbidly obese (C) Terminal (D) Malnourished 14. Which of the following is true of mechanical lifts? (A) Mechanical lifts help prevent injury to the body. (B) It is safer for an NA to lift a resident without the help of a mechanical lift. (C) There is only one kind of mechanical lift. (D) When using a mechanical lift, the NA should pump it approximately five feet over the bed before moving the resident. 15. A resident who is ambulatory can (A) Feed himself (B) Remember who and where he is (C) Get out of bed and walk (D) Speak clearly 16. When helping a visually-impaired resident walk, where should the nursing assistant be? (A) Standing slightly in front of the resident (B) Standing slightly behind the resident (C) Standing a few feet off to the side (D) Sitting in a chair in front of the resident

Name: ��

Name:

��

Chapter 12: Personal Care

315 7.

Observing residents’ skin during personal care and bathing is especially important in the prevention of (A) Depression (B) Abuse (C) Pressure ulcers (D) Diabetes

Which of the following is the highest priority for nursing assistants when bathing residents? (A) Speed (B) Safety (C) Making sure every resident has a bath every day (D) Observing for mobility

A nursing assistant can make bathing safer for residents by (A) Asking for help if she cannot safely handle the task alone (B) Gathering all needed equipment after entering the bath/shower area (C) Making sure the water temperature is not over 120°F (D) Leaving residents alone while bathing or showering

Multiple Choice. Choose the correct answer. 1.

Hygiene is (A) Another word for bad breath (B) Methods of keeping the body clean (C) Activities of daily living, such as eating, drinking, and elimination (D) A.M. care and P.M. care One way to promote dignity and independence with personal care is to (A) Encourage residents to perform tasks independently even if it takes longer (B) Choose which clothes and cosmetics the resident will wear (C) Encourage residents to do their activities of daily living quickly (D) Leave residents alone while bathing

Ms. Martin is an elderly resident with very dry skin. What kind of bath would be appropriate for her? (A) Partial bath (B) Shower (C) Tub bath TESTBANKSELLER.COM (D) Complete bed bath 10. A general rule for bathing a person is 4. Mr. Reynosa has a doctor’s order for Epsom (A) Wash from dirtiest to cleanest salts additives during bathing. What kind of (B) Wash from cleanest to dirtiest bath would be most appropriate for him? (C) Wash body parts in whatever order the (A) Partial bath resident prefers (B) Shower (D) Wash body parts in whatever order the (C) Tub bath nursing assistant prefers (D) Complete bed bath 11. The part of the body that should be washed 5. Ms. Reid is unable to get out of bed due to last is the recent surgery. She is very concerned with (A) Face cleanliness and wants to bathe every day. (B) Legs Which kind of bath is most appropriate for (C) Buttocks her? (D) Hands (A) Partial bath 12. Which of the following should be washed (B) Shower every day? (C) Tub bath (A) Hair (D) Complete bed bath (B) Knees 6. The decision on which bath to give a resident (C) Chest is made by (D) Perineum (A) The physical therapist (B) The nursing assistant (C) The doctor and the resident (D) The resident’s family

316 13. Which of the following is true of giving a complete bed bath? (A) The nursing assistant should wash the anal area before the perineal area. (B) The nursing assistant should make sure that the water temperature is no higher than 110°F. (C) The nursing assistant should place a towel or bed pad under the part of the body that is being washed. (D) The nursing assistant should uncover the resident’s entire body before beginning the bath. 14. If the nursing assistant notices redness around bony areas during a massage, she should (A) Massage around these areas (B) Massage these areas (C) Discontinue the massage (D) Apply extra lotion to these areas

Name: �� 19. The primary risk for unconscious residents is (A) Mouth dryness (B) Aspiration (C) Gingivitis (D) Mouth sores 20. During which of the following procedures must a nursing assistant always wear gloves? (A) Shaving a resident (B) Combing or brushing hair (C) Dressing a resident (D) Turning a resident 21. Ways to prevent aspiration during oral care of unconscious residents include (A) Pouring mouthwash slowly into the resident’s mouth (B) Turning residents on their backs when giving oral care (C) Avoiding performing oral care on unconscious residents (D) Using as little liquid as possible when giving oral care

15. How often must oral care be provided for residents? (A) Once a day 22. A nursing assistant should give nail care (B) At least twice a day (A) Whenever she has time (C) Only when the resident requestsTitESTBANKSELLER.COM (B) When she is bathing a resident (D) Every other day (C) When she notices a resident’s nails are 16. A resident who is edentulous getting long (A) Lacks teeth (D) When the resident’s nail polish wears off (B) Has bad breath 23. Which of the following statements is true? (C) Is wearing dentures (A) Residents’ hair should be handled gently (D) Has tartar deposits on the teeth because hair can be pulled out when comb17. Which of the following is true about oral care? ing or brushing it. (A) Residents without teeth will not require (B) Residents’ hair should be combed or any oral care. brushed into childish hairstyles because (B) Residents who are unconscious and do not they look cute on elderly people. eat do not require any oral care. (C) Nursing assistants should cut residents’ (C) Oral care is not just care of the teeth, but hair when it gets long and when residents also the mouth, tongue, and gums. request it. (D) Residents who wear dentures do not (D) Pediculosis (lice) cannot spread quickly. require oral care. 24. When assisting a resident who has one weak 18. Which of the following is the proper temperaside with dressing, ture for rinsing and storing dentures? (A) Clothing should be put on the weak side (A) Warm first (B) Cool (B) Clothing should be put on the strong side (C) Hot first (D) Boiling (C) The weak side should be referred to as the “bad side” (D) It does not matter which side clothing is put on first

Name:

��

Chapter 13: Vital Signs Multiple Choice. Choose the correct answer. 1.

Which of the following is considered a vital sign? (A) Body temperature (B) Orientation (C) Telemetry (D) Glycemic index If a nursing assistant is unable to obtain a proper reading of a resident’s vital signs, she should (A) Guess (B) Use the previous reading from the same resident (C) Tell the nurse (D) Leave the space blank and move on to the next resident or procedure Common symptoms of a fever include (A) Muscle aches (B) Sleepiness (C) Slow movements (D) Nausea

317 8. Which method of taking temperature is considered to be the most accurate? (A) Oral (B) Rectal (C) Tympanic (D) Axillary 9. An oral thermometer is usually color-coded (A) Green or blue (B) Red or orange (C) Black or white (D) White or gray 10. Under which of the following conditions should a nursing assistant not take an oral temperature on a person? (A) The person has influenza. (B) The person almost certainly has a fever. (C) The person is over six years old. (D) The person is confused or disoriented.

11. Which of the following thermometers is used to measure temperature in the ear? (A) Mercury thermometer (B) Axillary thermometer (C) Tympanic thermometer T E S T B A N K S ELLER. C)OTM (D emporal artery thermometer If a nursing assistant suspects that a resident has a fever, he should 12. Which of the following statements is true of (A) Give the resident medication taking rectal temperatures? (B) Take the resident’s temperature (A) The nursing assistant should not explain (C) Ask the resident how she is feeling the procedure before beginning so the resi(D) Measure the resident’s pulse rate dent will not feel anxious. (B) Rectal thermometers should be inserted Which of the following is the normal temperature range for the oral method? two inches into the rectum. (A) 97.6 – 99.6 degrees F (C) The nursing assistant must hold on to the (B) 96.6 – 98.6 degrees F thermometer at all times while taking a (C) 93.6 – 97.9 degrees F rectal temperature. (D) 98.6 – 100.6 degrees F (D) To obtain an accurate temperature, the resident should move around slowly durA disposable thermometer can be used to meaing the procedure. sure a(n) �� temperature. (A) Oral 13. How far into the ear should a tympanic thermometer be inserted? (B) Rectal (A) ¼ to ½ inch (C) Tympanic (B) ½ to 1 inch (D) Temporal artery (C) 1 to 1 ½ inches Which of the following is another word for (D) 1 = to 2 inches armpit? (A) Tympanum 14. The normal pulse rate for adults is (B) Rectum (A) 25 to 50 beats per minute (C) Axilla (B) 60 to 100 beats per minute (D) Temporal (C) 100 to 150 beats per minute (D) 150 to 175 beats per minute

318 15. The most common site that is used for measuring pulse rate is the (A) Radial pulse (B) Brachial pulse (C) Carotid pulse (D) Pedal pulse 16. The normal respiration rate for adults is (A) 18-30 breaths per minute (B) 15-25 breaths per minute (C) 12-20 breaths per minute (D) 8-10 breaths per minute 17. The medical term for difficulty breathing is (A) Eupnea (B) Apnea (C) Tachypnea (D) Dyspnea

Name: �� 22. Hypertension is (A) High fever (B) High blood pressure (C) High pulse rate (D) Low blood pressure 23. Blood pressure is measured using a (A) Thermometer (B) Watch (C) Finger (D) Sphygmomanometer 24. Prehypertension means (A) A person’s blood pressure is too high (B) A person’s blood pressure is too low (C) A person does not have low blood pressure now but is likely to have it in the future (D) A person does not have high blood pressure now but is likely to have it in the future

18. Why is respiration rate usually counted directly after taking the pulse rate, while the fingers are still on the wrist? 25. Both the �� and �� pulses are used in (A) It is less work for the nursing assistant to taking blood pressure. count respirations right after taking the (A) Radial and apical pulse. (B) Apical and brachial (B) People may breathe more quickly if they (C) Radial and brachial TESTBANKSEL Rr.acChO know they are being observed. (L DE )B iaM l and femoral (C) The chest will not rise and fall if the rate is 26. Which of the following is an example of a cornot counted immediately. rect way to write a blood pressure reading? (D) The respiration rate will be different if the (A) 120/75 nursing assistant waits to take it. (B) 120+75 19. The difference between the apical and radial (C) 120-75 pulse is called the (D) 120*75 (A) Pulse rate 27. Which of the following statements is true of (B) Cheyne-Stokes pain? (C) Pulse deficit (A) Everyone experiences pain in the same (D) BPM way. 20. The �� blood pressure is the top number (B) Everyone will express freely when they are in a blood pressure reading, while the �� is in pain. the bottom number. (C) Pain is a different experience for each (A) Radial, apical person. (B) Apical, radial (D) Pain levels do not need to be monitored. (C) Diastolic, systolic 28. Which of the following can help reduce pain? (D) Systolic, diastolic (A) Pounding the resident on the back 21. Which of the following blood pressure read(B) Jumping jacks ings falls within the normal range? (C) Squeezing the body part hard (A) 119/75 (D) Change of position (B) 135/90 (C) 91/70 (D) 140/80

Name:

��

Chapter 14: Nutrition and Fluid Balance

319 7.

According to MyPlate, a person should choose dairy products that contain (A) 1% fat (B) 2% fat (C) 3% fat (D) 4% fat

According to MyPlate, what should half of the grains a person consumes be? (A) White (B) Refined (C) Whole (D) Flour

What information is found on a diet card? (A) Infection prevention procedures (B) Food allergies and likes and dislikes (C) Care team members’ names (D) Advance directives

Multiple Choice. Choose the correct answer. 1.

Which of the following is one of the nutritional problems of the elderly? (A) Increased appetite makes it hard to stay slender. (B) Reduced physical activity affects appetite. (C) Special diets increase food choices, so there are too many items to choose from. (D) Nutritional problems are no different for the elderly than for anybody else. Problems affecting nutritional intake among the elderly and chronically ill include (A) Fatigue and pain that occur with certain illnesses increase appetite (B) Older people produce more saliva (C) Increase in physical activity and mobility causes an increased appetite (D) Ability to smell and taste food and drink decreases as people age The most essential nutrient for life is �� (A) Protein (B) Fat (C) Carbohydrates (D) Water

4. �� help(s) the body grow new tissue and enable(s) tissue repair. (A) Proteins (B) Fats (C) Carbohydrates (D) Water 5. According to the USDA’s MyPlate icon, which food groups should make up at least half of a person’s plate? (A) Grains and proteins (B) Vegetables and fruits (C) Dairy and proteins (D) Grains and fruits 6. Which of the following is an example of a plant-based protein? (A) Salmon (B) Tofu (C) Steak (D) Bacon

10. When a nursing assistant is serving meals to residents, she must always (A) Prepare a diet card for each resident (B) Identify the resident (C) Prepare the meal for each resident (D) Prepare a diet plan for each resident 11. A �� diet restricts or eliminates foods that are hard to chew and swallow. (A) High-residue or high-fiber (B) Clear liquid or full liquid (C) Soft or mechanical soft (D) Bland 12. A resident who is taking diuretics or blood pressure medication may be on a �� diet. (A) High-potassium (B) Modified calorie (C) Low-protein (D) Fluid-restricted 13. Which type of vegetarian diet eliminates all poultry, meats, fish, eggs, and dairy products, along with foods that contain these products? (A) Lacto-ovo vegetarian diet (B) Lacto-vegetarian diet (C) Ovo-vegetarian diet (D) Vegan diet

Name: ��

320 14. Residents with the abbreviation �� on their diet cards cannot have anything to eat or drink by mouth. (A) NPO (B) NCS (C) LCS (D) ADA 15. Residents who have difficulty �� may require thickened liquids. (A) Walking (B) Swallowing (C) Digesting food (D) Gaining weight 16. Which of the following is a sign of unintended weight loss that should be reported to the nurse? (A) Eating lean cuts of meat (B) Eating dessert before dinner (C) Avoiding fried foods and sweets (D) Coughing or choking while eating 17. Which of the following can be an effective way to prevent unintended weight loss? (A) Promoting independence by insisting dents feed themselves without help resi-

20. Which of the following statements about mealtime is true? (A) Social interaction is an important part of mealtime. (B) Nursing assistants should do everything for residents during mealtime so residents will not be anxious. (C) Mealtime is a good time for nursing assistants to chat with colleagues since the residents are busy eating. (D) Nursing assistants should let residents know when their meal does not look appetizing. 21. At which angle should residents be positioned for eating? (A) 180 degrees (B) 120 degrees (C) 100 degrees (D) 90 degrees 22. One way that an NA can promote independence for a resident with special needs is to (A) Use physical and verbal cues (B) Make verbal cues lengthy and detailed (C) Put food into the weaker side of residents’

TESTBANKSELLEm R. ouCthOsM

(B) Serving favorite foods (C) Telling the resident when a meal looks unappetizing (D) Insisting that residents eat everything on their trays no matter what

18. One way to make dining enjoyable for residents is to (A) Vary mealtimes to make dining more interesting (B) Discourage residents from dressing up for dinner (C) Assist residents with toileting before meals (D) Place residents in a reclined position for eating 19. Guidelines for serving meal trays include (A) Serving the residents who need the most help with eating first (B) Doing as much as possible for residents to make mealtimes more efficient (C) Discouraging conversation during meals (D) Saying positive things about the food being served

(D) For visually-impaired residents, put the plate to one side of the resident 23. Which of the following is a symptom of dysphagia (difficulty swallowing)? (A) Eating everything on the tray at every meal (B) Sweating profusely during meals (C) Having a fever during meals (D) Watering eyes during meals 24. One way to prevent aspiration is to (A) Place residents on their sides for eating (B) Offer several bites of food before offering a liquid (C) Make sure food is swallowed before offering another bite (D) Have resident lie down right after eating 25. Fluid balance occurs when (A) A person consumes and eliminates equal amounts of fluid (B) A person consumes more fluid than he eliminates (C) A person eliminates more fluid than he consumes (D) A person consumes fluid but does not eliminate it

Name:

��

26. To convert ounces to milliliters, the nursing assistant should multiply by (A) 30 (B) 20 (C) 60 (D) 15 27. If a resident drinks four ounces of water with a meal, how many milliliters (mL) has he consumed? (A) 16 (B) 30 (C) 64 (D) 120 28. A warning sign of dehydration is (A) Resident drinks more than six 8-ounce glasses of liquids per day (B) Resident has trouble swallowing liquids (C) Resident drinks a lot of fluids at meals (D) Resident has increased urinary output 29. Which of the following is an effective way for a nursing assistant to help prevent dehydration? (A) Encourage a resident to drink every time she sees him. TkEjS (B) Insist that the resident drin uiT ceB . (C) Withhold fluids if a resident is incontinent. (D) Leave a carton of milk with the resident each time she leaves the room. 30. A symptom of fluid overload is (A) Skin that appears tight, smooth, and shiny (B) Weight loss (C) Increased urine output (D) Decreased heart rate 31. A resident who has a restrict fluids order (A) May not have any fluids at all (B) Can have water but no other fluids (C) Can only have fluids with meals (D) Must limit the daily amount of fluids consumed to a level set by the doctor

321

Name: ��

322 Chapter 15: The Gastrointestinal System Multiple Choice. Choose the correct answer. 1.

�� is the study of how body parts function. (A) Biology (B) Anatomy (C) Physiology (D) Pathophysiology The heart is an example of a(n) ��. (A) Cell (B) Tissue (C) Organ (D) Body system The muscular contractions that push food toward the stomach are called (A) Peristalsis (B) Mastication (C) Defecation (D) Absorption Normally, stool should be (A) Brown and soft (B) Black and hard (C) Brown and loose (D) Red and formed

8. What is a common symptom of gastroesophageal reflux disease (GERD)? (A) Diarrhea (B) Lactose intolerance (C) Constipation (D) Heartburn 9. An ileostomy or colostomy may be needed for a resident who has (A) Constipation (B) Crohn’s disease (C) Lactose intolerance (D) Flatulence 10.

Signs of constipation include (A) Liquid or frequent stools (B) Rapid heart rate (C) Fecal incontinence (D) Irritability

11. A resident who has hemorrhoids should avoid (A) Fiber in the diet (B) Excessive intake of water (C) Sitz baths (D) Excessive cleaning and wiping of the area

2.LTLhE eR be.sC t pOoM sition for bowel elimination is TESTBANKS1E

5. A good way for a nursing assistant to promote normal elimination for residents is to (A) Encourage fluid intake and nutritious meals (B) Encourage residents to wait as long as possible to go to the bathroom (C) Decrease fiber intake (D) Discourage too much physical activity 6. How should a standard bedpan be positioned? (A) The smaller end should be aligned with the resident’s buttocks. (B) The wider end should be aligned with the resident’s buttocks. (C) One of the longer sides should be aligned with the resident’s buttocks. (D) It should be turned on its side. 7. Portable commodes are used when (A) A resident cannot get out of bed (B) A resident can get out of bed but has difficulty walking to the bathroom (C) Nursing assistants do not have the time to assist a resident to the bathroom (D) A resident has an ostomy

(A) Lying flat on the bed (B) Squatting and leaning forward (C) Lying on the stomach (D) Sitting as straight as possible, with the feet flat on the floor

13. During an enema, the resident should be in the �� position. (A) Lateral (B) Supine (C) Sims’ (D) Fowler’s 14. A stool sample that is to be tested for �� must be delivered to the lab immediately. (A) Blood (B) Constipation (C) Mucus (D) Ova and parasites 15. Hidden, or ��, blood is found inside stool with a microscope or a special chemical test. (A) Occult (B) Hemoccult (C) Toxic (D) Pathogenic

Name:

��

16. Which of the following statements is true of ostomies? (A) Ostomies require no special care. (B) People with ostomies are rarely embarrassed by the ostomy. (C) Nursing assistants do not need to worry about privacy when providing ostomy care. (D) People with ostomies need to receive regular skin care and proper hygiene. 17. Which of the following is a guideline for assisting with bowel retraining? (A) NAs should encourage residents to drink plenty of fluids. (B) NAs do not need to wear gloves when handling body wastes. (C) NAs do not need to provide privacy during elimination if residents are in bed. (D) NAs should let residents know when they are taking too long to have a bowel movement.

323

Name: ��

324 Chapter 16: The Urinary System

When providing perineal care for a female resident, the nursing assistant should (A) Wipe from front to back (B) Wipe from back to front (C) Wipe the anal area first (D) Use the same area of the washcloth for each stroke

The best position for men to urinate is (A) Sitting (B) Standing (C) Lying (D) Crouching

A healthy person needs to consume at least �� ounces of fluid each day. (A) 36 (B) 26 (C) 64 (D) 80

Multiple Choice. Choose the correct answer. 1.

What is another term for urinating? (A) Digesting (B) Eliminating (C) Ingesting (D) Voiding

Normal qualities of urine include (A) Pink or red color (B) Cloudiness when freshly voided (C) Clear or transparent color and a faint smell (D) Presence of protein or glucose

Which of the following needs to be reported to the nurse? (A) Burning or pressure when urinating (B) Urinary output of 1200 to 1500 mL per day (C) Pale yellow urine (D) Clear urine

10. One way for women to prevent UTIs is to Which of the following statements is true of (A) Reduce fluid intake to minimize work for urination? the bladder (A) Indwelling catheters do not affect muscle (B) Drink juices with vitamin C to acidify tone. urine (B) Fluids high in sodium increase uTriE nS arT y BANKSEL(L Rr.inCaO CE )U teMless often output. (D) Take baths rather than showers (C) A lack of privacy can affect urination, as 11. �� is an artificial means of removing the can stress. body’s waste products. (D) The bladder holds more urine as people (A) Chronic renal failure age, causing them to urinate less (B) Kidney dialysis frequently. (C) Urine retention 5. A good way for a nursing assistant to promote (D) Nephritis normal elimination for residents is to 12. Which of the following is a guideline for deal(A) Encourage Kegel exercises ing with urinary incontinence? (B) Encourage residents to finish urinating as (A) The nursing assistant should let roomquickly as possible mates know when residents have been (C) Encourage female residents to lie flat on incontinent so that they can help notify the their backs when urinating care team when incontinence occurs. (D) Discourage fluids for residents who uri(B) The nursing assistant should tell residents’ nate too frequently families about episodes of incontinence so 6. Why are women more likely than men to have they can encourage residents to do better. urinary tract infections? (C) The nursing assistant should change wet (A) Due to the different location of the gonads or soiled linens or incontinence briefs (B) Due to not filtering blood in the kidneys immediately. properly (D) The nursing assistant should not offer flu(C) Due to having a shorter urethra ids because this will help lessen episodes (D) Due to urinary incontinence of incontinence. 4.

Name:

��

13. A(n) �� catheter is inserted to drain urine present in the bladder and is removed immediately after urine is drained. (A) Straight (B) Indwelling (C) Condom (D) Texas 14. Guidelines for the nursing assistant to give proper catheter care include (A) Making sure the drainage bag hangs higher than the level of the hips or bladder (B) Disconnecting the catheter when positioning or transferring the resident (C) Keeping the genital area clean to prevent infection (D) Hanging the drainage bag from the bedrail 15. A �� urine specimen can be collected any time the resident voids. (A) Routine (B) Clean-catch (C) 24-hour (D) Sterile 16. Which type of urine specimen does not include the first and last urineTinES thT eB saA mNpK leS ? (A) Routine (B) Clean-catch (C) 24-hour (D) 36-hour 17. People who have diabetes may have ��, chemical substance(s) produced when the body burns fat for energy or fuel, in their urine. (A) Reagents (B) Glucose (C) Insulin (D) Ketones 18. A resident should be offered a bedpan, urinal, or trip to the bathroom about �� minutes after fluids are consumed. (A) 10 (B) 30 (C) 45 (D) 60

325 19. Which of the following is true of bladder retraining? (A) The NA should encourage the resident to drink plenty of fluids even if incontinence is a problem. (B) The NA does not need to keep a record of the resident’s bladder habits. (C) The NA does not need to wear gloves when handling body wastes. (D) The NA should let the resident know when he or she is taking too long to urinate.

Name: ��

326 Chapter 17: The Reproductive System

A man with benign prostatic hypertrophy may have difficulty with (A) Walking (B) Reproducing (C) Urinating (D) Ejaculating

Which of the following is true of sexual needs in the elderly? (A) As a person ages, he or she completely loses interest in sex. (B) Impotence is a normal change of aging. (C) Vaginal dryness cannot be treated. (D) Lack of privacy in a facility can affect sexual activity.

If a nursing assistant encounters any sexual situation between two consenting adult residents, she should (A) Ask the residents to stop (B) Tell the residents how cute they are (C) Provide privacy and leave the area (D) Tell the residents’ friends and families what she saw

Multiple Choice. Choose the correct answer. 1.

The male and female sexual reproductive glands are called (A) Gonads (B) Hormones (C) Cowper’s glands (D) Fallopian tubes Which of the following is a function of the female reproductive system? (A) Manufacturing ova, estrogen, and progesterone (B) Manufacturing testosterone (C) Manufacturing sperm (D) Manufacturing insulin

Which of the following is a normal age-related change for the male reproductive system? (A) The prostate gland shrinks. (B) Number and capability of sperm decreases. (C) Sexual response is faster. (D) Menopause begins.

Which of the following is a normal age-related 10. When does menopause occur in females? change for the female reproductive sT ysE teS mT?BANKSEL(L AE ) 1R2.mCoO nM ths after a woman’s last menstrual (A) Lung capability increases. period (B) The response to vaccines decreases. (B) Once a woman has reached 60 years of age (C) The amount of calcium in the body (C) When a woman decides that she does not increases. want children (D) Vaginal walls become drier and thinner. (D) 3 months after giving birth

5. Sexually-transmitted infections are caused by sexual contact with an infected person. Sexual contact includes which of the following? (A) Mouth-to-mouth kissing (B) Contact of hands with the breasts (C) Holding hands (D) Contact of the mouth with the genitals 6. A person with �� cannot be treated with antibiotics or cured, and may have repeated outbreaks of the disease for the rest of his or her life. (A) Chlamydia (B) Genital herpes (C) Gonorrhea (D) Syphilis

Name:

��

Chapter 18: The Integumentary System

327 7.

Shingles is a viral infection caused by the same virus that causes �� and can occur in anyone who has had it. (A) Scabies (B) Herpes (C) Chickenpox (D) Eczema

Skin that is not intact is considered a(n) (A) Open wound (B) Closed wound (C) Contusion (D) Bruise

One of the nursing assistant’s responsibilities regarding eczema is (A) Prescribing topical lotions (B) Reporting signs of infection (C) Draining any oozing fluid from the skin (D) Administering medications

Multiple Choice. Choose the correct answer. 1.

The �� is the outer layer of the skin which is composed of dead cells. (A) Integument (B) Epidermis (C) Dermis (D) Melanocyte The largest organ in the human body is the (A) Heart (B) Lungs (C) Skin (D) Kidneys Which of the following is a function of the integumentary system? (A) Regulates hormone levels in the body (B) Prevents the loss of too much water (C) Allows the body to move (D) Provides an environment for the development of a fetus

10. In which part of the body do fungal infections often occur? (A) The groin 4. Which of the following is a normal age-related (B) The head change of the integumentary system? (C) The arms (A) Amount of fat and collagenTiE nS crT eaBseAsN . KSELLER. (DC) O TM he cheeks (B) Pressure ulcers occur. 11. The first sign of skin breakdown is (C) Hair thickens. (A) Muscle damage (D) Skin becomes thinner and more fragile. (B) Blackened skin with pressure ulcers 5. A burn that affects the epidermis and causes (C) Shallow crater redness and pain is a (D) Pale, white, reddened, or purple skin (A) First-degree (superficial) burn 12. A pressure ulcer with partial-thickness skin (B) Second-degree (partial-thickness) burn loss that looks like a blister or shallow crater is (C) Third-degree (full-thickness) burn a stage �� pressure ulcer. (D) Scald (A) 1 6. Which of the following is true of scabies? (B) 2 (A) It is caused by a build-up of bacteria in the (C) 3 skin. (D) 4 (B) Symptoms include rash, intense itching, 13. Which of the following is a condition that and sores that may become infected. increases the risk of pressure ulcers? (C) It is not contagious. (A) Resident flexibility (D) Teenage children and young adults are at a (B) Cold air higher risk of acquiring scabies. (C) Good circulation (D) Restricted mobility

328 14. Which of the following statements is true of pressure ulcers? (A) When skin begins to break down, it first turns black. (B) Pressure ulcers are difficult to heal but do not hurt much. (C) Pressure ulcers are impossible to prevent. (D) Pressure ulcers can lead to life-threatening infections. 15. One benefit of applying heat to the body is that (A) Heat helps stop bleeding (B) Heat increases muscular tension (C) Heat decreases blood flow due to constriction of blood vessels (D) Heat increases movement of oxygen and nutrients into the tissues 16. How does moisture affect warm and cold applications? (A) It strengthens their effects. (B) It reduces their effects. (C) It makes applications less likely to cause injury. (D) It allows applications to be applied for a longer time. 17. Warm or cold applications should generally be applied for (A) 10 minutes (B) 20 minutes (C) 30 minutes (D) 40 minutes 18. A sitz bath is used to (A) Relax the resident (B) Encourage slow, deep breathing (C) Measure a resident’s pulse (D) Increase blood flow to pelvic area 19. Non-sterile dressings are applied to (A) Open wounds (B) Draining wounds (C) Dry wounds that have less chance of infection (D) New wounds

Name: ��

Name:

��

Chapter 19: The Circulatory or Cardiovascular System Multiple Choice. Choose the correct answer. 1.

Oxygen-rich blood is pumped from the left ventricle via the (A) Right ventricle (B) Aorta (C) Capillaries (D) Veins

About 55% of blood is made up of ��. (A) Erythrocytes (B) Leukocytes (C) Plasma (D) Platelets

Which of the following is one of the functions that the circulatory system performs? (A) Senses and interprets information from the environment (B) Cushions the brain and spinal cord (C) Allows humans to reproduce (D) Transports oxygen, nutrients, and hormones to cells

329 8. Which of the following is true of residents who have angina? (A) Residents need to reduce emotional distress as much as possible. (B) Nursing assistants need to give residents nitroglycerin. (C) Residents should eat large meals to stay satisfied. (D) Nursing assistants should encourage residents to exercise most of the time. 9. One component of cardiac rehabilitation is (A) A diet high in sodium will be ordered (B) Resident will be discouraged from exercising (C) A stress management program will be initiated (D) Residents will be encouraged to smoke to help deal with stress

10. The most common type of peripheral vascular disease (PVD) is (A) Phlebitis (B) Myocardial infarction (MI) (C) Peripheral arterial disease (PAD) (D CM oronary artery disease (CAD) 4. A normal age-related change fT orEthSeTcB irA cuNlaK toSryELLER.C) O system is 11. When should anti-embolic stockings be (A) The heart pumps less efficiently applied? (B) Blood vessels widen (A) In the evening (C) Blood vessels become more elastic (B) In the morning (D) Blood flow increases (C) Mid-afternoon (D) After residents have finished exercising 5. The medical term for high blood pressure is (A) Myocardial infarction 12. Residents with congestive heart failure may (B) Hypotension (A) Be on a high-sodium diet (C) Hypertension (B) Take medications that cause a decrease in (D) Peripheral vascular disease urinary output (C) Have a force fluids medical order 6. One way for a person to keep hypertension (D) Need to do range of motion exercises to under control and prevent complications is to improve muscle tone (A) Take medications to increase fluid in the body (B) Increase the intake of sodium (C) Stop smoking (D) Avoid exercise 7. The medical term for chest pain, pressure, or discomfort is (A) Myocardial ischemia (B) Angina pectoris (C) Coronary artery disease (D) Hypertension

13. The most common form of anemia is (A) Iron-deficiency anemia (B) Hypoxia (C) Pernicious anemia (D) Pulmonary anemia

330 Chapter 20: The Respiratory System Multiple Choice. Choose the correct answer. 1.

The �� acts like a lid to shut off the larynx during the swallowing process. (A) Trachea (B) Epiglottis (C) Bronchi (D) Alveoli

What is the function of the larynx? (A) Enables speech (B) Blocks food from entering the trachea (C) Allows for passage of air and food (D) Transfers air to the lungs

The process of breathing in and out is called (A) Inspiration (B) Respiration (C) Expiration (D) Expansion

Name: �� 9. A person with �� TB infection does not show symptoms and cannot infect others; a person with TB �� shows symptoms of the illness and can spread it to others. (A) Latent, disease (B) Active, latent (C) MDR, active (D) Latent, MDR-TB 10. Why is it important for a resident with TB to take all of the prescribed medication? (A) The medication is very expensive. (B) The healthcare facility loses Medicare funding if all of the medication is not taken. (C) Failure to finish the medication makes the person more likely to spread the disease to others. (D) Failure to take all of the medication prescribed can weaken the person’s musculoskeletal system.

Which of the following is a function of the 11. Which of the following guidelines is true of respiratory system? working around oxygen equipment? (A) Regulates body temperature (A) Nursing assistants should not allow open (B) Pumps blood throughout the body oxygen. TESTBANKSELLEflames R.COaround M (C) Supplies oxygen to body cells (B) Nursing assistants should adjust oxygen (D) Gives the body shape and structure levels when they are too high or too low. 5. Normal age-related changes for the respiratory (C) Nursing assistants should replace oxygen system include tubing if it becomes clogged. (A) Lung strength decreases (D) Nursing assistants should prescribe a new (B) Airways become more elastic oxygen delivery device if the current one is (C) Cough becomes stronger causing skin problems. (D) Oxygen in the blood increases 12. The best time to collect a sputum specimen is 6. Residents with COPD have trouble with (A) Early in the morning (A) Breathing (B) After the resident has eaten a meal (B) Urination (C) Right before bedtime (C) Losing weight (D) Right before lunch (D) Vision 13. What is a possible benefit of using an incen7. How should a resident with COPD be tive spirometer? positioned? (A) Increasing heart strength (A) Flat on his back (B) Strengthening back muscles (B) Sitting upright (C) Opening nasal passages (C) Lying on his stomach (D) Helping clear the lungs (D) Lying on his side 8. What should a resident who has asthma avoid? (A) Inhalers (B) Talking (C) Fluids (D) Strong smells

Name:

��

Chapter 21: The Musculoskeletal System Multiple Choice. Choose the correct answer. 1.

Which of the following types of muscle is a voluntary muscle? (A) Skeletal muscle (B) Smooth muscle (C) Pulmonary muscle (D) Cardiac muscle

Which of the following is a function of the bones? (A) Protecting the body from disease (B) Lending support to body structures (C) Sending messages throughout the human body (D) Pumping blood throughout the body

331 8. Which of the following statements is true of osteoarthritis? (A) Jaw and neck are usually affected. (B) Pain and stiffness increase in cold or damp weather. (C) Antibiotics are usually the first type of medication to treat osteoarthritis. (D) Residents will not be able to perform any ADLs if they have osteoarthritis. 9. After an amputation, a resident may experience phantom sensation. Phantom sensation is (A) Not real (B) Sensation where the limb existed (C) The inability to use a new body part (D) The desire to get rid of a new body part

10. Which of the following is an example of a prosthesis? (A) An adaptive device to assist residents with dressing (B) Handrolls to keep residents’ fingers from curling too tightly (C) Special shoes to help residents with flat feet (D ) A n artificial arm to replace an arm that has 4. Weakening, wasting away, andTdE ecSreTaB seAiN nK siS zeELLER.COM been lost of a muscle is called 3.

Normal age-related changes for the musculoskeletal system include (A) Muscles weaken and lose tone (B) Bones gain calcium (C) Muscle mass increases, causing weight gain (D) Joints become more flexible

(A) Dystrophy (B) Atrophy (C) Contracture (D) Dislocation 5. The painful and permanent stiffening of a muscle is called (A) Dystrophy (B) Atrophy (C) Contracture (D) Dislocation 6. Osteoporosis is caused by a lack of �� in the diet. (A) Sodium (B) Calcium (C) Iron (D) Protein 7. Rheumatoid arthritis is an autoimmune illness. With an autoimmune illness, the body’s �� system attacks normal tissue. (A) Endocrine (B) Lymphatic (C) Circulatory (D) Immune

11. Before applying a prosthesis, the area must be (A) Dry (B) Damp (C) Cold (D) Warm 12. A fracture in which the skin is open and the bone may come through the skin is a(n) (A) Closed fracture (B) Open fracture (C) Greenstick fracture (D) Compression fracture 13. Which of the following statements is true of cast care? (A) Keep the cast wet or damp. (B) Use a sharp object to remove items that have fallen inside the cast. (C) Elevate an extremity that is in a cast. (D) Use warm water and soap to wash the cast when it gets dirty.

332 14. A full weight-bearing order for a resident with a total hip replacement means that (A) The resident is able to support some body weight on one or both legs (B) The resident is unable to support any body weight on one or both legs (C) The resident can bear full weight on both legs (D) The affected hip needs to be kept in abduction 15. After a total hip replacement, the hip cannot be bent or flexed more than �� degrees. (A) 45 (B) 75 (C) 90 (D) 100 16. Fluids are encouraged for residents who have had a total knee replacement to help prevent (A) Myocardial infarctions (B) Urinary tract infections (C) Depression (D) Side effects of medication 17. Elastic bandages are commonly used to (A) Treat reddened skin (B) Keep dressings in place (C) Cover cuts in the skin (D) Stop numbness and tingling 18. Which of the following is a nursing assistant’s responsibility regarding traction? (A) The nursing assistant should adjust weights if the resident’s limb starts to lower. (B) The nursing assistant should keep the traction unit’s weights flat on the floor. (C) The nursing assistant should give pain medication if traction is causing the resident pain. (D) The nursing assistant should report to the nurse if the weights move.

Name: ��

Name:

��

Chapter 22: The Nervous System

333 7.

Which of the following is a care guideline for residents recovering from a CVA? (A) The NA should do as much as possible for the resident so that care can be completed more efficiently. (B) The NA should encourage resident to finish tasks as quickly as possible to help speed recovery. (C) The NA should assist with ambulation to prevent falls. (D) The NA should place food in the affected/ weaker side of the mouth when feeding.

Parkinson’s disease typically causes (A) A shuffling gait (B) Extremely straight posture (C) Memory loss (D) Aggressive behavior

Guidelines for caring for a resident with multiple sclerosis include (A) Rushing resident through tasks (B) Administering medications (C) Preventing falls (D) Encouraging the resident to speak faster

Multiple Choice. Choose the correct answer. 1.

The basic working unit of the nervous system is the (A) Brain (B) Spinal cord (C) Neuron (D) Receptor

The �� is/are part of the peripheral nervous system. (A) Brain (B) Spinal cord (C) Cerebrum (D) Spinal nerves

The �� is the circular opening which dilates and constricts to adjust the amount of light coming into the eye. (A) Sclera (B) Iris (C) Retina (D) Pupil

The tiny bones within the middle ear that pick up vibrations and send impulsT esEtS oT thB eA brNaK inSELLE 10R .. ��C�O ��M� is the loss of function of the lower are the (A) Ossicles (B) Eardrums (C) Cochleas (D) Auricles

5. Which of the following is a function of the nervous system? (A) Gives the body shape and structure (B) Provides a natural protective covering to the body (C) Produces and supplies antibodies and other infection-fighting blood cells (D) Senses and interprets information from outside the body 6. Normal age-related changes for the nervous system include the following: (A) Responses and reflexes speed up (B) Some memory loss occurs (C) Sensitivity of nerve endings in skin increases (D) Senses of vision, smell, and taste become stronger

body and legs. (A) Concussion (B) Paraplegia (C) Quadriplegia (D) Hemiplegia 11. Treatment for seizures includes (A) Range of motion exercises (B) Restraining the resident when seizures occur (C) Medication or surgery (D) Physical therapy 12. Which of the following is a care guideline for visual impairments? (A) Use the face of an imaginary clock as a guide to explain position of objects in the room. (B) Keep the room as dark as possible. (C) Walk behind the resident while touching his back. (D) Touch the resident before identifying yourself, so as not to startle him or her.

334 13. How should an artificial eye be cleaned? (A) With alcohol (B) With water (C) With toothpaste (D) With bleach 14. Which of the following is a proper guideline for hearing aids? (A) Hearing aids should be left on when not in use. (B) The batteries in a hearing aid last for the life of the hearing aid and do not need to be changed. (C) Make sure residents with hearing aids have them turned on. (D) Soaking hearing aids in water makes cleaning them easier. 15. The ability to think logically is called (A) Cognition (B) Dementia (C) Awareness (D) Dysphagia

Name: �� 19. If a resident with AD has lost most of his verbal skills, the NA should (A) Assume the resident cannot understand what is being said (B) Use touch, smiles, and laughter (C) Ask the resident questions (D) Not involve resident in activities 20. If a resident with AD is incontinent, the nursing assistant should (A) Withhold fluids (B) Dim the bathroom lights (C) Mark the bathroom with a sign or picture (D) Wait longer periods of time before taking the resident to the bathroom so that he will really need to go when he gets there 21. If a resident with AD has problems with bathing, the nursing assistant should (A) Schedule bathing when the resident is least agitated (B) Hurry the resident through the bath (C) Insist that the resident bathe even if she does not want to (D) Surprise the resident with the bath

16. Which of the following terms means “a serious loss of mental abilities”? TESTBANKS2E2.LILf E CeOnM (A) Cognition a rRe. sid t with AD becomes violent, the NA (B) Irreversible should (C) Dementia (A) Step out of the way and remove triggers if (D) Onset possible (B) Restrain the resident 17. Which of the following statements is true of (C) Yell at the resident Alzheimer’s disease (AD)? (D) Ignore the resident (A) Skills a person has used over a lifetime are usually kept longer. (B) Residents with AD will show the same signs at the same times. (C) NAs should do everything for residents with AD. (D) Alzheimer’s disease is a normal part of aging. 18. Strategies for better communication with residents who have AD include (A) Only talking about one subject at a time, using simple, short sentences (B) Not repeating instructions or questions because this may upset the resident (C) Knowing that nonverbal cues are usually not helpful with residents with AD (D) Telling the resident “don’t” when he does something unsafe

23. One way for a nursing assistant to help a resident with AD with eating is to (A) Put a few types of food on the plate at the same time (B) Use dishes without a pattern and a simple place setting (C) Withhold food until the resident is really hungry (D) Serve steaming hot foods and drinks 24. If a resident with AD has problems with dressing, the nursing assistant should (A) Lay out clothes in the order they should be put on (B) Dress the resident in the hallway (C) Choose the resident’s clothing for the resident (D) Give the resident multiple steps to follow

Name:

��

25. A good way for a nursing assistant to respond to hallucinations is to (A) Tell the resident that what she thinks she sees is not real (B) Tell the resident that she can see the hallucination, too (C) Reassure a resident who is upset and worried (D) Laugh at the resident to ease tensions 26. A nursing assistant can respond to sundowning by (A) Adding more caffeine to the resident’s diet (B) Setting a bedtime routine and keeping it (C) Restricting exercise during the day (D) Scheduling activities during this time 27. If a resident with AD shows violent behavior, the nursing assistant should (A) Hit back (B) Remove triggers (C) Leave the resident alone until he calms down (D) Yell at the resident to scare him into stopping

335 30. Therapy that allows residents with AD to believe that they live in the past or in imaginary circumstances is (A) Reality orientation (B) Validation therapy (C) Reminiscence therapy (D) Remotivation therapy 31. A person who is mentally healthy (A) Cannot respond to emotions appropriately (B) Is unlikely to have relationships with others (C) Does not control impulses well (D) Performs well in professional settings 32. The anxiety disorder that is characterized by repetitive thoughts or behavior is (A) Generalized anxiety disorder (B) Posttraumatic stress disorder (C) Obsessive-compulsive disorder (D) Social anxiety disorder

33. Signs and symptoms of clinical depression include (A) Intense hunger (B) Breath that smells fruity T E S T B A N K S ELLER. C) OInMtense, sudden chest pain (C 28. Which of the following would be the best way (D) Apathy for a nursing assistant to respond to a resident with AD who is exhibiting inappropriate sexual 34. Which of the following is a good way for a behavior? nursing assistant to care for a mentally ill (A) The NA should let other residents know resident? what is happening. (A) The NA should do everything for the (B) The NA should take the resident to a priresident. vate area. (B) The NA should give the resident his or her (C) The NA should inform other nursing assismedication when needed. tants that the resident has a dirty mind. (C) The NA should support the resident and (D) The NA should loudly reprimand the resihis or her family and friends. dent to shame him into stopping. (D) The NA should let the resident know that 29. When a resident with AD pillages and hoards, mental illness is not real. the nursing assistant should 35. Which of the following statements about (A) Let the family know that the resident is observing mentally ill residents is true? stealing things (A) An NA does not need to report a comment (B) Lock the resident in his room if the NA about suicide as long as it is a joke. does not have time to watch him (B) An NA needs to report changes in mood. (C) Warn the other residents that the resident (C) Social withdrawal does not need to be with AD is a thief reported. (D) Provide a rummage drawer (D) Changes in abilities to perform ADLs do not need to be reported.

336 36. Which of the following is a common set of treatments for anxiety disorders? (A) Electroconvulsive (shock) therapy and psychosurgery (B) Medication and psychotherapy (C) Psychotherapy and psychosurgery (D) Medication and electroconvulsive (shock) therapy 37. A resident has been acting a little strangely lately. She gets upset very easily, and her eyes are always red. She does not eat much, and sometimes the nursing assistant can smell alcohol on her breath, even in the morning. What should the nursing assistant do? (A) The NA should confront the resident about what she has noticed. (B) The NA should call Alcoholics Anonymous. (C) The NA should report her observations to the nurse. (D) The NA should tell the facility’s chaplain.

Name: ��

Name:

��

Chapter 23: The Endocrine System

337 7.

Pre-diabetes can be delayed or prevented by (A) Change in diet and daily exercise (B) Medication (C) Surgery (D) Increasing intake of fluids

The most common form of diabetes is (A) Pre-diabetes (B) Type 1 diabetes (C) Type 2 diabetes (D) Hypoglycemia

Symptoms of hypothyroidism include (A) Intolerance to cold (B) Bulging or protruding eyes (C) Rapid heartbeat (D) Normal menstrual periods

Multiple Choice. Choose the correct answer. 1.

The �� gland is known as the master gland because it controls the hormone production of other glands. (A) Pituitary (B) Thyroid (C) Parathyroid (D) Adrenal The function of insulin is to (A) Regulate growth (B) Stimulate the growth of nervous tissue (C) Trigger the fight or flight response in the body (D) Regulate the amount of glucose available to the cells for metabolism

10. A diabetic resident should (A) Skip meals (B) Go barefoot (C) Receive careful foot care (D) Avoid exercise

Which of the following is a function of the endocrine system? (A) Regulates body temperature (B) Gives the body shape and structure (C) Senses and interprets messages from the 11. Which of the following is a guideline for safe environment diabetic foot care? (D) Maintains blood sugar leveTlsESTBANKSELLER. (AC) O TM he NA should inspect and clean the resident’s feet every day. 4. Normal age-related changes for the endocrine (B) The NA should clip the resident’s toenails system include the following: frequently. (A) Decrease in levels of hormones signal the (C) The NA should use lotion between the toes onset of menopause in women to prevent dryness and cracking. (B) Testosterone levels in males increase (D) The NA should use hot water for bathing (C) Insulin production increases the feet to help prevent infection. (D) Body is more able to handle stress 5. Which of the following conditions makes a person more likely to have diabetes? (A) The person is obese. (B) The person is malnourished. (C) The person is incontinent. (D) The person has chronic obstructive pulmonary disorder. 6. Diabetes can lead to which of the following complications? (A) Chronic cough (B) Problems with circulation (C) Lack of appetite (D) Improved ability to perform strenuous exercise

338 Chapter 24: The Immune and Lymphatic Systems and Cancer

Which of the following statements is true of HIV and AIDS? (A) AIDS can be cured. (B) Having unprotected sex puts a person at a high risk for HIV/AIDS. (C) Standard Precautions do not need to be practiced on a person who has AIDS. (D) A person with HIV can be fired because of the disease.

A resident with AIDS who has an infection of the mouth may need to eat food that is (A) Spicy (B) Soft or pureed (C) Hot (D) Acidic

A resident with AIDS who has nausea and is vomiting should (A) Eat small, frequent meals (B) Eat quickly (C) Not drink liquids (D) Not eat at all

Multiple Choice. Choose the correct answer. 1.

Immunity that protects the body from disease in general and is the first line of defense against invading bacteria or organisms is called: (A) Specific immunity (B) Nonspecific immunity (C) Active immunity (D) Passive immunity With �� immunity, a person is given the antibodies needed to defend against an antigen. (A) Acquired (B) Nonspecific (C) Deficient (D) Passive Which of the following is a function of the immune system? (A) Maintains blood sugar levels (B) Regulates the production of hormones (C) Protects against the invasion of foreign

10. The BRAT diet is helpful for (A) Diarrhea TESTBANKSEL R. (L BE )W eiC ghOt M gain substances and pathogens (C) Weight loss (D) Regulates body temperature (D) Numbness and tingling 4. A normal age-related change for the immune 11. A tumor that is cancerous is called a(n) �� and lymphatic systems is the tumor. (A) Immune system weakens (A) Opportunistic (B) Antibody response speeds up (B) Benign (C) Number of T-cells increases (C) Malignant (D) Response to vaccines increases (D) Ballistic 5. HIV can be transmitted 12. �� is a method of treatment for cancer (A) To a nursing assistant who touches an that uses high-energy waves to attempt to infected resident’s telephone destroy cancer cells in a specific area. (B) To anyone who uses the same toilet as an (A) Radiation therapy infected person (B) Chemotherapy (C) To people who hug an infected person (C) Hormone therapy when that person has a fever (D) Immunotherapy (D) To a healthcare worker who comes into contact with a contaminated needle 6. Which of the following is a sign or symptom of the beginning stages of HIV infection? (A) Poor circulation (B) Damage to the eyes (C) Open sores on the penis (D) Flu-like symptoms

13. The key treatment for malignant tumors of the skin, breast, and colon is (A) Surgery (B) Chemotherapy (C) Radiation (D) Diet and exercise

339 14. When is a resident with cancer most likely to suffer from nausea, vomiting, diarrhea, hair loss, and decreased resistance to infection? (A) Right after surgery (B) Just before the cancer is diagnosed (C) When the resident is near death (D) When undergoing chemotherapy 15. Which of the following is a good idea for a nursing assistant who is communicating with a resident who has cancer? (A) The NA should insist that the resident tell her what he is going through. (B) The NA should listen to the resident if he feels like talking. (C) If the resident is worried, the NA should tell him, “It’ll all be fine.” (D) The NA should tell the resident that her grandmother beat cancer and she is sure the resident will, too. 16. Which of the following is helpful when providing skin care for a resident with cancer? (A) Change positions at least every four hours. (B) Remove markings for radiation therapy each time you bathe the resident. (C) Avoid applying lotion to areas receiving radiation therapy. (D) Keeping the skin wet helps with the side effects of radiation therapy.

340 Chapter 25: Rehabilitation and Restorative Care Multiple Choice. Choose the correct answer. 1.

Which of the following issues regarding rehabilitation and restorative care should be reported to the nurse? (A) Whether the resident’s family is visiting (B) How much television the resident watches (C) Whether the resident uses the call light too many times per day (D) The resident shows signs of depression

5. How does regular activity and exercise benefit the integumentary system? (A) Interaction between the resident and his roommate is improved. (B) The resident’s spiritual needs are fulfilled. (C) Resident’s family has a better opinion of the facility. (D) Quality and health of the skin is improved. 6. Benefits of regular activity and exercise for the endocrine system include (A) Increased metabolism (B) Improved circulation (C) Improved relaxation and sleep (D) Increased blood flow to the muscles and improved strength

Which of the following statements is true of a nursing assistant’s role in restorative care? (A) If a resident takes too long to do a task by himself, the nursing assistant should do it 7. A cane is used for him. (A) To help a person with balance (B) The nursing assistant should give the resi(B) For residents who cannot bear weight on dent pain medication before the rehabilitaone leg tion session begins. (C) To provide stability when a person is (C) The nursing assistant should recognize unsteady or has some weakness that setbacks occur and be reassuring. (D) When a resident cannot get out of bed (D) The nursing assistant should tell the fam8. How many feet does a quad cane have? ily that progress is happening faster than T E S T B ANKSEL (L AE ) 1R.COM it really is so they can feel better about the (B) 2 situation. (C) 3 3. Guidelines for the NA for rehabilitation and (D) 4 restorative care include 9. When a resident has one weaker leg, (A) Not following the care plan if the resident (A) The cane should be held on the weaker seems to be making more progress than side expected (B) The cane should be held on the stronger (B) Discouraging activity to make sure the side resident gets enough rest (C) The resident should use a wheelchair (C) Providing plenty of privacy to avoid distrac(D) The resident should not get out of bed tions and embarrassment (D) Focusing on setbacks so the resident will 10. When a resident uses a cane, walker, or crutchbe motivated to do better es, the nursing assistant should 4. Complications of immobility for the nervous system include (A) Pneumonia (B) Depression or insomnia (C) Weight gain (D) Constipation

(A) Stay on the resident’s stronger side (B) Stay on the resident’s weaker side (C) Walk in front of the resident (D) Walk behind the resident 11. Orthotic devices are used to (A) Keep joints in correct position and improve function (B) Assist residents with ADLs (C) Maintain proper body alignment (D) Prevent rubbing, irritation, and pressure ulcers

341 12. Passive range of motion exercises are done (A) When a resident cannot move on her own (B) By the resident herself (C) By the resident with some help and support from the nursing assistant (D) By a doctor or physical therapist only 13. When assisting with ROM exercises, the nursing assistant should begin at the �� and work her way �� the body. (A) Abdomen, up (B) Feet, up (C) Shoulders, down (D) Thighs, down 14. Abduction is (A) Bending a body part backward (B) Another name for the hip (C) Another name for the leg (D) Moving a body part away from the body 15. Bending a body part is called (A) Extension (B) Rotation (C) Flexion (D) Supination

342 Chapter 26: Subacute Care

What might a nursing assistant do for a resident with a tracheostomy? (A) Provide skin care to the site around the tube (B) Perform suctioning (C) Remove the tube for cleaning (D) Insert the tube

Which of the following statements is true of a resident on a ventilator? (A) The resident will be especially relaxed. (B) Clipboards, pads, and communication boards can help with communication. (C) Being on a ventilator is not much different from regular breathing. (D) The resident will be able to speak.

Symptoms of respiratory distress include (A) Gurgling (B) Decreased respiratory rate (C) Redness of the skin (D) Apathy

Multiple Choice. Choose the correct answer. 1.

Subacute care is for residents who (A) Are relatively independent and do not need around-the-clock skilled care (B) Need less care than most long-term care facilities provide (C) Need more care than most long-term care facilities provide (D) Need emergency care for an accident or sudden illness A pulse oximeter measures (A) Blood pressure (B) Body temperature (C) Blood oxygen level (D) Blood glucose level

Which of the following statements is true of how a nursing assistant should care for a resident with a telemetry pack? (A) The NA should not get the unit, pads, or 10. Which of the following statements is true of electrodes wet. chest tubes? (B) The NA should not monitor vital signs. (A) The drainage system must be kept above (C) The NA should not report cracked skin TESTBANKSELLEtRh. e lC evOeM l of the resident’s chest. because that is normal due to the pad (B) The chest drainage must be observed for placement. amount and color. (D) The NA should make sure that the pads (C) The tubing should be kinked. hang loosely from the resident’s chest. (D) Chest tubes will only be in the front of the 4. What is the function of an artificial airway? body. (A) To feed a resident who cannot swallow or 11. A tube that is inserted into the nose, through digest food the esophagus, and into the stomach for feed(B) To keep the airway open for the lungs to ing is called a(n) perform air exchange (A) Nasogastric tube (C) To check a resident’s vital signs (B) Orogastric tube (D) To prepare a resident for a medical test (C) Percutaneous endoscopic gastrostomy 5. The method used to insert an artificial airway (PEG) tube is called (D) Central venous line (A) Telemetry 12. What is one of the nursing assistant’s respon(B) Intubation sibilities for tube feedings? (C) Ventilation (A) Inserting tubes (D) Dyspnea (B) Giving tube feedings 6. Alternate communication methods for a resi(C) Positioning the resident dent with an artificial airway include (D) Cleaning or suctioning the tubes (A) Playing charades (B) Shouting at the resident (C) Asking the resident’s family what they think he wants (D) Using communication boards

343 13. Care guidelines for dialysis include (A) Advising the resident to wear tight sleeves (B) Checking blood pressure readings on the access arm (C) Following instructions for intake and output measurement carefully (D) Encouraging residents to put pressure on the access arm

344 Chapter 27: End-of-Life Care Multiple Choice. Choose the correct answer. 1.

What does palliative care involve? (A) The resident’s recovery (B) Comfort and managing symptoms (C) Teaching the resident to care for himself (D) Curing the resident’s illness

When is hospice care usually ordered by a doctor? (A) When a diagnosis of an illness is made (B) When the long-term care facility can no longer care for the resident (C) When the resident requests it (D) When a person has six months or less to live

Ms. Fleming, a resident who has recently been diagnosed with terminal cancer, has accused the nursing assistants in her unit of taking poor care of her and causing her disease. In which stage of grief is Ms. Fleming? (A) Denial (B) Anger (C) Bargaining (D) Depression

6. A terminally ill resident, John Castillo, visits with his family. He discusses his funeral arrangements with them. He lets them know that he is concerned about their well-being after he is gone. He says he wants to spend as much time as possible with them before he dies. Mr. Castillo is going through the �� stage of grief. (A) Denial (B) Anger (C) Bargaining (D) Acceptance 7. Which of the following is part of The Dying Person’s Bill of Rights? (A) I have the right to be told what to believe about life after death. (B) I have the right to be cared for by someone who will always tell me what she thinks I want to hear. (C) I have the right to have my questions answered honestly. (D) I have the right to be treated with forced cheerfulness. 8. Which of the following is true of a resident

TESTBANKSELwLhEoRis.dCyO inM g?

4. Mr. Parker has always been cheerful and optimistic, but since his diagnosis of Alzheimer’s disease, he has been quiet and withdrawn. He does not seem to enjoy any of his favorite activities and rarely talks to anyone. In which stage of grief is Mr. Parker? (A) Depression (B) Bargaining (C) Denial (D) Acceptance 5. Mrs. Levine, a resident, prays about her terminal illness. She promises God that she will make peace with her sister, whom she has not seen in 20 years, if she is allowed to live. Which stage of grief is Mrs. Levine going through? (A) Denial (B) Anger (C) Bargaining (D) Acceptance

(A) Residents will always be able to express when they are in pain. (B) Residents should have their rooms brightly lit. (C) Residents should lie flat on their backs to ease problems with breathing. (D) Residents should be fed slowly to help prevent choking and aspiration. 9. Which is the last sense to leave a person? (A) Sight (B) Hearing (C) Touch (D) Smell 10. One way for nursing assistants to help meet the psychosocial and spiritual needs of a dying resident is to (A) Leave the resident alone as much as possible (B) Listen more, talk less (C) Share their religious beliefs with the resident (D) Tell the resident’s family things that the resident has told her about them

345 11. Which of the following is a sign of approaching death? (A) Low blood pressure (B) Sharper vision (C) Warm, dry skin (D) Heightened sense of touch 12. One change that might occur in the body after death is (A) The mouth closes (B) The body will not have a pulse, respiration, or blood pressure (C) The eyes close (D) The pupils constrict 13. Nursing assistants can help a resident’s family and friends deal with the resident’s death by (A) Trying to calm any family members or friends who are upset with staff (B) Asking them not to cry and reassuring them that they will get over it (C) Listening to them if they want to talk (D) Not showing any feelings for the resident who has died 14. Postmortem care is (A) Examination of a body by aTpEaS thT olB ogAisNt K to try to determine the cause of death (B) Meeting the emotional needs of the resident’s family and friends (C) Grief counseling for staff after a resident’s death (D) Care of the body after death

346 Chapter 28: Your New Position Multiple Choice. Choose the correct answer. 1.

How many pages long should a résumé be? (A) One page (B) Two pages (C) Three pages (D) As many pages as needed to convey all important information

A cover letter should include (A) Detailed information about your educational background and volunteer work (B) Information on why you are seeking the job and why you are qualified for it (C) The salary that you would expect to receive if you accepted the job (D) Recommendations from former employers

6. What should a candidate for a nursing assistant job be sure to do when going for an interview? (A) Find someone to care for her children so she does not have to take them along (B) Put on all of her most striking jewelry (C) Go to the salon for a new set of artificial nails (D) Arrive a few seconds before the interview time 7. A �� lists the tasks that nursing assistants are permitted to perform, as allowed by state or federal law. (A) Procedure manual (B) Cover letter (C) Scope of practice (D) Competency evaluation

Which of the following statements is true of 8. What is the minimum number of hours of nursing assistant training that is required by job applications? OBRA? (A) The applicant should leave anything blank (A) 30 hours that requires a long answer. (B) 50 hours (B) The applicant should write N/A for ques(C) 75 hours tions that do not apply to him. ( D) 100 hours (C) If the applicant does not understand someTESTBANKSELLER.COM thing on the application, he should leave it 9. A nursing assistant must usually take the state blank. test within �� months after training. (D) The applicant should not tell the truth if (A) 6 certain answers will make him look bad. (B) 12

4. Why must an employer perform a criminal background check on new aides hired? (A) Aides are known to steal from facilities. (B) It is best never to trust anyone. (C) Employers like to have power over their employees. (D) The law requires it for the protection of residents. 5. One way for a nursing assistant to make a positive first impression at a job interview is to (A) Bathe, use deodorant, and brush her teeth before the interview (B) Put on a pleasant perfume or cologne before the interview (C) Wear a lot of makeup and jewelry to make sure she looks her best (D) Smoke a cigarette right before the interview if it will help her to be calm

(C) 24 (D) 36 10. The federal government requires �� hours of continuing education for nursing assistants each year. (A) 10 (B) 12 (C) 15 (D) 18 11. Employee evaluations include ��, which involves giving opinions about the work of others and includes helpful suggestions for change. (A) Hostile criticism (B) Constructive feedback (C) A performance appraisal (D) A probationary period

347 12. Which of these statements is an example of constructive feedback? (A) “You really need to remember to speak kindly to the residents, even when you’re having a hard day.” (B) “You’re rude and disrespectful.” (C) “I’ve never seen somebody take such a long time to learn this job.” (D) “Don’t you remember anything from your training course?” 13. The first thing a nursing assistant should do when reacting to a conflict with another nursing assistant is to (A) Go to management to report the problem (B) Ask a favorite resident what she should do (C) Think about the possible reasons why a person is behaving in an undesirable way (D) Decide not to speak to that nursing assistant again until she apologizes 14. How much notice should a nursing assistant give when changing jobs? (A) Two days (B) Two months (C) One week (D) Two weeks 15. One way to manage stress is to (A) Decrease the level of exercise (B) Multi-task when possible to get things done more quickly (C) Develop new hobbies (D) Talk to residents and their families about stress 16. Which of the following is a strategy for a nursing assistant to use for managing stress? (A) The NA should drink whenever it makes her feel more relaxed. (B) The NA should get enough sleep. (C) The NA should skip meals so she can get more done. (D) The NA should take regular smoking breaks.

348

349

Appendix D Answer Key for Chapter Exams

350 Chapter 1: The Nursing Assistant in Long-Term Care 1.

10. B 11. B 12. B 13. A 14. A 15. C 16. A 17. C 18. C 19. B 20. D 21. A 22. A 23. C 24. C 25. C 26. B 27. A 28. A 29. A

Chapter 2: Ethical and Legal Issues 1.

10. A 11. A 12. B 13. C 14. A 5.LL AER.COM TESTBANKS1E 16. B 17. D 18. C 19. D 20. B 21. C 22. B 23. C 24. D Chapter 3: Communication Skills 1.

351 5.

Chapter 4: Communication Challenges

10. A

11. B

12. C

13. C

14. C

15. B

10. A

16. A

11. D

17. B

12. A

18. D

13. B

19. D

14. A

20. C 21. A 22. D 23. B 24. B 25. B 26. A 27. D 28. B 29. D 30. B 31. A 32. C 33. B 34. C

15R . .ACOM TESTBANKSELLE Chapter 5: Diversity and Human Needs and Development 1.

10. C 11. D 12. A 13. C 14. B

352 15. A

25. C

16. C

26. A

17. C

27. A

18. A

28. C

19. B

29. A

20. B

30. D

Chapter 6: Infection Prevention

31. A

32. D

33. D

34. B

35. B

Chapter 7: Safety and Body Mechanics

TESTBANKS4E. LLDER.COM

10. A

11. C

12. C

13. B

14. D

15. B

10. D

16. C

11. A

17. D

12. C

18. C

13. D

19. C

14. B

20. C

15. B

21. D

16. C

22. B

17. A

23. A

18. A

24. B

19. B

353 Chapter 8: Emergency Care, First Aid, and Disasters

10. C

11. B

12. D

13. C

14. D

Chapter 10: Bedmaking and Unit Care

10. B

11. B

12. D

13. D

14. A

15. A

7. R.CCOM TESTBANKSELLE

16. B

17. C

18. B

10. D

19. C

11. A

20. A

12. C

21. D

13. C

22. B

14. D

23. D

15. A

Chapter 9: Admission, Transfer, Discharge, and Physical Exams

16. A

17. C 18. B Chapter 11: Positioning, Moving, and Lifting 1.

354 5.

20. A

21. D

22. B

23. A

24. A

10. B

Chapter 13: Vital Signs

11. D

12. A

13. B

14. A

15. C

16. A

Chapter 12: Personal Care

0.LL DER.COM TESTBANKS1E

11. C

12. C

13. A

14. B

15. A

16. C

10. B

17. D

11. C

18. B

12. D

19. C

13. C

20. D

14. A

21. A

15. B

22. B

16. A

23. D

17. C

24. D

18. B

25. C

19. B

26. A

355 27. C

30. A

28. D

31. D

Chapter 14: Nutrition and Fluid Balance

Chapter 15: The Gastrointestinal System

10. B

10. D

11. C

11. D

12. A

12. B

13. D

13R . .CCOM TESTBANKSELLE

14. A

14. D

15. B

15. A

16. D

17. B

17. A

18. C

Chapter 16: The Urinary System

19. D

20. A

21. D

22. A

23. D

24. C

25. A

26. A

27. D

28. B

10. B

29. A

11. B

356 12. C

13. D

13. A

14. D

14. C

15. D

15. A

16. A

16. B

17. B

17. D

18. D

18. B

19. C

19. A

Chapter 19: The Circulatory or Cardiovascular System

Chapter 17: The Reproductive System 1.

10. A Chapter 18: The Integumentary System 1.

10. A 11. D 12. B

10. C 11. B 12. D 13. A Chapter 20: The Respiratory System 1.

357 10. C

11. A

10. B

12. A

11. C

13. D

12. A

Chapter 21: The Musculoskeletal System

13. B

14. C

15. A

16. C

17. A

18. A

19. B

20. C

21. A

22. A

10. D

23. B

11. A

24R . .ACOM TESTBANKSELLE

12. B

25. C

13. C

26. B

14. C

27. B

15. C

28. B

16. B

29. D

17. B

30. B

18. D

31. D

Chapter 22: The Nervous System

32. C

33. D

34. C

35. B

36. B

37. C

Chapter 23: The Endocrine System

358 3.

10. B

11. A

10. C

12. A

11. A

13. C

Chapter 24: The Immune and Lymphatic Systems and Cancer

14. D

Chapter 26: Subacute Care

11. C 12. A 13. A 14. D 15. B 16. C Chapter 25: Rehabilitation and Restorative Care D

TESTBANKS4E. LLBER.COM

10. A

15. C

10. B 11. A 12. C 13. C Chapter 27: End-of-Life Care 1.

359 6.

10. B 11. A 12. B 13. C 14. D Chapter 28: Your New Position 1.

10. B 11. B 12. A 13. C 14. D 15. C 16. B

360

361

Appendix E 2nd Set of Chapter Exams

362 Chapter 1: The Nursing Assistant in Long-Term Care Multiple Choice. Choose the correct answer. 1.

A surveyor may cite a facility for (A) Providing needed counseling to a resident (B) Making sure a resident has access to the religious services he prefers (C) Failing to provide a resident with the proper amount of daily calories (D) Making sure a resident’s social and emotional needs are being met Which of the following is part of a person’s activities of daily living? (A) Mending torn clothing items as needed (B) Removing soiled bed linens and replacing them with clean linens (C) Eating and drinking (D) Emptying the trash

Name: �� 6. Which of the following is commonly included in a facility’s procedure manual? (A) Vacation rules for facility staff (B) Guidelines for maternity and paternity leave (C) Instructions for making a surgical bed (D) Proper visiting hours for residents 7. The concept of continuity of care is based on (A) Giving caregivers regular breaks during daily care of residents (B) Assigning resident care to a wide variety of people who are not able to communicate with each other regularly (C) Coordinating resident care on an ongoing basis (D) Including family members in daily resident care

8. To delegate in a nursing facility means to (A) Transfer the care of a resident to a physician Adaptive devices are used to (B) Transfer the responsibility for a task to (A) Help residents with handwashing another team member (B) Help residents to perform activities of daily (C) Inform a nurse that a caregiver is unable living o. coCm OpMlete a task (C) Help residents learn to adapt to nTeE wSTBANKSELLEtR (D) Communicate to a nurse that a complaint roommates has been filed against a staff member (D) Help residents to use wheelchairs

4. Which of the following statements is true of adult day services? (A) This type of care is given to people who are not seriously ill and who do not live at the facility where care is provided. (B) This type of care offers families a way to care for a dying loved one. (C) This type of care provides a teenage caregiver for each elderly resident. (D) This type of care offers short-term skilled care for illnesses or injuries. 5. Which of the following statements best describes the care team? (A) The care team is a group of people who specialize in psychiatric care. (B) The care team is a team of caregivers who are not licensed. (C) The care team is a group of medical professionals who provide care for each other. (D) The care team is a group of people with different kinds of educational backgrounds who give resident care.

9. The identification of a disease by its signs and symptoms, as well as testing, is called (A) Differential (B) Didactic (C) Disability (D) Diagnosis 10. �� care involves the whole person, including his or her physical, social, emotional, and spiritual needs. (A) Hieroglyphic (B) Holistic (C) Holographic (D) Histrionic 11. Which of the following is true of the Joint Commission? (A) It is a for-profit organization. (B) It is a state inspection agency. (C) Membership is mandatory for all skilled nursing facilities. (D) Its goal is to improve the quality and safety of care given in healthcare facilities.

Name:

��

12. �� means that a person can be held legally responsible for harming someone else. (A) Liability (B) Lability (C) Litigious (D) Misdemeanor 13. Which of the following is true of outpatient care? (A) Outpatient care is given to people who are terminally ill. (B) Outpatient care is the same type of care as rehabilitative care. (C) Outpatient care is where a person has major surgery, such as heart bypass surgery. (D) Outpatient care is short-term skilled care given for less than 24 hours.

363 17. Subacute care is (A) Care given in a home setting (B) Care offered to people who are developmentally disabled (C) Care given for people needing less than acute care but more than long-term care (D) Care focused on elderly patients who are dying 18. Which of the following would be the best way for a nursing assistant to demonstrate patience when a resident is taking a long time to get dressed? (A) “Take your time. There is no need to rush.” (B) “Please hurry a little if you can. I have to bathe another resident.” (C) “Just so you know, I need to leave work soon.” (D) “When you’re feeling better, you will be able to move more quickly.”

14. The �� is the person responsible for a team of healthcare workers in a long-term 19. Under what condition is wearing artificial nails care facility. in a long-term care facility acceptable? (A) Radiology technician (A) They may be worn as long as the nails are (B) Charge nurse clean, short, and filed. (C) Nurse aide (D) Administrative assistant TESTBANKSELLER. (BC) O TM hey should not be worn in care facilities. (C) They should be worn only at special events 15. �� is a program of care given by a at facilities. specialist or team to help restore or improve (D) They may be worn as long as hands are function following an illness or injury. washed frequently. (A) Adaptation (B) Renovation (C) Rehabilitation (D) Conversion 16. The sandwich generation is a group of people who (A) Care for children and elderly parents at the same time (B) Develop menus and plan meals for residents in long-term care facilities (C) Provide care for neighbors and children on a daily basis (D) Care for children and pets at the same time

20. Special tags used by surveyors to cite problems in healthcare facilities are called (A) S-tags (B) F-tags (C) I-tags (D) P-tags

364 Chapter 2: Ethical and Legal Issues Multiple Choice. Choose the correct answer. 1.

Which of the following statements is true of a living will? (A) A living will goes into effect when a resident dies and leaves a large estate that needs to be distributed. (B) A living will is an important part of a resident’s wishes regarding his inheritance. (C) A living will is a document that states the medical care a resident wants or does not want if he becomes unable to make those decisions. (D) A living will helps a resident decide who will manage his financial affairs when he is no longer able to do that.

Name: �� 5. What does the term passive neglect mean? (A) Conspiring with others to commit malpractice (B) Separating a resident from her family members (C) Using verbal language to insult a resident (D) Unintentionally failure to provide needed care, resulting in harm to a resident 6. Private law or a law between individuals is (A) Criminal law (B) Civil law (C) Contract law (D) International law

7. Which of the following violates a resident’s legal right to privacy? (A) A caregiver shares something with a friend from a resident’s medical chart. 2. Battery is a legal term that means (B) A caregiver documents a resident’s care (A) Someone has improperly used a resident’s when nobody else is nearby. money (C) A caregiver pulls the privacy curtain (B) Someone has used profanity with a around a resident before giving care. resident (D) A caregiver refuses to share medical infor(C) Someone has touched a resident without mation with a resident’s niece. TESTBANKS8E. LTLhEe Rte.rm COmMisappropriation means his consent (D) Someone has shared a resident’s protected (A) Handling a resident’s possessions roughly health information with someone who is (B) Harming a resident purposefully not on the care team (C) Unlawfully restraining a resident 3. When a physician issues a DNR order, it (D) Taking something that does not belong to means that a person and using it for personal gain (A) A resident should not be resuscitated 9. Protected health information (PHI) includes (B) The resident’s family must be asked if they (A) The number of visitors a resident has on a want the resident to be resuscitated weekly basis (C) A doctor must be called before resuscita(B) A resident’s personal financial information tion is performed (C) A resident’s personal preferences regard(D) The resident’s attorney must be contacted ing roommates before resuscitation is done (D) A resident’s voting history 4. �� is any written or oral statement 10. A(n) �� is someone who is that is untrue and that injures a person’s required to report suspected or observed reputation. abuse. (A) Assault (A) Journalist (B) Defamation (B) Attorney (C) Battery (C) Mandated reporter (D) Misappropriation (D) Guardian

Name:

��

11. The term scope of practice relates to (A) The tasks a family member can perform for a resident (B) The duties that a clergyperson is allowed to provide to a resident (C) The tasks a healthcare provider can legally perform (D) The responsibilities an administrative assistant can carry out during a shift 12. What is false imprisonment? (A) False imprisonment is the unlawful restraint of someone that affects the person’s freedom of movement. (B) False imprisonment is unintentional failure to give care to a resident in need. (C) False imprisonment is any false accusation by a family member regarding the kidnapping of a resident. (D) False imprisonment is the failure to act when a caregiver suspects resident abuse. 13. �� is any unwelcome sexual advance or behavior that intimidates a person. (A) Sexual dysfunction (B) Sexual intimacy (C) Sexual etiquette (D) Sexual harassment 14. If a nursing assistant shares information about a resident’s care on Twitter, it would be considered (A) A breach of etiquette (B) Journalistic impropriety (C) A breach of confidentiality (D) Misappropriation 15. �� is verbal, physical, or sexual abuse of staff by other staff members or residents. (A) Workplace indiscretion (B) Office negligence (C) Office liability (D) Workplace violence

365 16. A durable power of attorney for health care is (A) A legal document that describes how a resident’s possessions from the care facility should be distributed after he has died (B) A legal document that appoints a family member to make financial decisions for a resident living in a care facility (C) A legal document that is sent to probate after a person has died (D) A legal document that appoints someone to make medical decisions for a person who is unable to do so for himself 17. Which of the following is an example of assault? (A) A nursing assistant tells a resident that he will hurt the resident if the resident tells anyone that he did not finish his work. (B) A resident tells a nursing assistant that she plans to report abuse by the nursing assistant. (C) A nursing assistant insists that a resident loan her twenty dollars. (D) A nursing assistant drinks alcohol in front of a resident while providing care. 18. Which of the following people may commit intimate partner violence (IPV)? (A) An uncle (B) A neighbor (C) A friend (D) A spouse 19. A(n) �� is a group of residents who meet on a regular basis to discuss facility issues. (A) Activity Group (B) Residents’ Council (C) Ombudsmen Committee (D) Society Advisory Group 20. A caregiver who smokes marijuana while working may have a (A) Sober relapse (B) Substance abuse problem (C) Legal substance appropriation (D) Workplace harassment issue

Name: ��

366 Chapter 3: Communication Skills

Which of the following is an example of a prefix? (A) Scope in otoscope (B) Logy in nephrology (C) Ostomy in colostomy (D) Tachy in tachycardia

Which of the following is an example of verbal communication? (A) Sending a text message (B) Crossing arms in front of the body (C) Tapping one’s feet during a meeting (D) Nodding one’s head

What does the term prioritize mean? (A) Identifying the most important things to get done and doing them first (B) Identifying the things that take the least amount of time to get done and doing them first (C) Identifying people who can help quickly in case of an emergency (D) Identifying the tasks that can be combined and combining them

Multiple Choice. Choose the correct answer. 1.

The part of a word that is added to the end of a root or a prefix is the (A) Prefix (B) Root (C) Suffix (D) Abbreviation Edema is the medical term for (A) Breaking (B) Swelling (C) Shrinking (D) Sleeping

Which of the following is true of body language? (A) Body language is a type of verbal communication. (B) Smiling is a part of body language. (C) Body language is an unimportant part of communication. (D) Body language is always a conscious act.

10. A person’s orientation includes Active listening involves T E S T B ANKSEL Rw.aCreOnM (A) A caregiver not looking directly at a resi(L AE )A ess of his vital signs (B) Awareness of the date and time dent when the resident is speaking (C) Awareness of his diagnosis (B) A caregiver giving a resident her full atten(D) Awareness of nonverbal communication tion while the resident is speaking (C) A resident paying attention while she is 11. How may a communication barrier affect a performing an activity nursing assistant? (D) Two residents talking to each other while (A) It promotes person-centered care. exercising (B) It encourages conversation with residents.

5. Which of the following is an example of a suffix? (A) Broncho in bronchoscopy (B) Rhino in rhinoplasty (C) Neuro in neuropathy (D) Scopy in endoscopy 6. Which of the following best describes a nursing assistant’s responsibilities regarding critical thinking? (A) Immediately reporting a potential problem to the nurse (B) Seeking the resident’s opinion about a potential problem (C) Asking the doctor to consider a medication change for a potential problem (D) Making changes in the resident’s care plan due to a potential problem

(C) It inspires a closer relationship with residents. (D) It prevents proper communication with residents. 12. Which of the following is an example of objective information? (A) Mrs. Lin Ho has a bad back. (B) Mrs. Lin Ho has a respiratory rate of 23 breaths per minute. (C) Mrs. Lin Ho wants to go home. (D) Mrs. Lin Ho is happy when her son visits. 13. Which of the following is the proper conversion of 1445 to regular time? (A) 2:15 a.m. (B) 2:15 p.m. (C) 2:45 a.m. (D) 2:45 p.m.

Name:

��

14. Which of the following is an example of subjective information? (A) Mrs. Osborn’s output is 45 milliliters of urine. (B) Mrs. Osborn is walking with a limp. (C) Mrs. Osborn is complaining of difficulty breathing. (D) Mrs. Osborn has a raised red area on her forehead. 15. Which of the following is part of a person’s vital signs? (A) Glucose level (B) Urine output (C) Blood pressure (D) Blood count 16. Which of the following is the proper conversion of 10:30 p.m. to military time? (A) 2115 (B) 2130 (C) 2230 (D) 2245 17. Which of the following is the proper conversion of 1615 to regular time? (A) 3:45 p.m. (B) 4:00 p.m. (C) 3:15 p.m. (D) 4:15 p.m. 18. A �� is a set of learned beliefs, values, and behaviors. (A) Community (B) Civilization (C) Culture (D) Cultivation 19. Which of the following is an example of subjective information? (A) Mr. Hartman walked up and down the hallway. (B) Mr. Hartman complained of elbow pain. (C) Mr. Hartman ate all of his snack today. (D) Mr. Hartman vomited.

367 20. Which of the following is an example of objective information? (A) A resident’s face is drooping on one side. (B) A resident does not like his caregiver. (C) A resident enjoyed his breakfast. (D) A resident does not want to go to religious services today.

Name: ��

368 Chapter 4: Communication Challenges

Which of the following conditions may cause a resident to become confused? (A) A resident receives the proper amount of oxygen. (B) A resident takes the wrong medication. (C) A resident eats dinner. (D) A resident exercises.

Which of the following would be the best response by a nursing assistant when a resident becomes angry? (A) The NA can listen closely to the resident to try to find out what caused the anger. (B) The NA can share some of her personal problems with the resident to distract him. (C) The NA can joke with the resident to make him laugh. (D) The NA can offer suggestions on how the resident can leave the facility.

Multiple Choice. Choose the correct answer. 1.

��means that a person is confused about person, place, and time (A) Disorganization (B) Disruptive (C) Disorientation (D) Disinfection A resident lashes out at a roommate on the same day that her relative cancelled a visit. Which defense mechanism is this example illustrating? (A) Projection (B) Rationalization (C) Displacement (D) Regression

Ventilation is a term that means exchanging 9. �� is a type of mental illness air between the lungs and the that can cause withdrawal, lack of energy, and (A) Kidneys loss of interest in activities. (B) Heart (A) Dementia (C) Small intestine (B) Disorientation (D) Environment (C) Assertiveness 4. An example of a type of impairment T isESTBANKSELLER.COM (D) Depression (A) A resident is unable to hear properly 10. Which of the following should the nursing (B) A resident does not get along well with cerassistant do when working with a resident who tain staff members has hearing loss? (C) A resident is unable to resolve an argu(A) The NA should discourage the resident’s ment between two roommates attendance at movies and special events. (D) A resident has few close friends (B) The NA should raise the pitch of his voice 5. The medical term for difficulty breathing is when speaking to the resident. (A) Airway (C) The NA should encourage the resident to (B) Ventilation wear his hearing aid. (C) Dyspnea (D) The NA should shout when the resident (D) Tracheostomy cannot hear him properly. 6. Which of the following is an example of inap11. A resident refuses to believe his roommate has propriate sexual behavior? died. He continues to talk to staff members (A) Two residents hugging each other for a and family and friends as if the roommate long time were still alive. Which defense mechanism is (B) A male resident holding hands with anoththis example illustrating? er male resident (A) Repression (C) A resident noticeably flirting with another (B) Denial resident (C) Projection (D) A resident touching his genitals in the (D) Displacement hallway

Name:

��

12. When a resident feels anxiety, it is the same as feeling (A) Frightened (B) Angry (C) Worried (D) Excited 13. Which of the following should the nursing assistant do when working with a resident who has a visual impairment? (A) The NA should encourage the resident to use his other senses such as smell and hearing. (B) The NA should shout at the resident upon entering the room to announce her arrival. (C) The NA should lower the room lighting to make the room more inviting to the resident. (D) The NA should change the location of familiar objects in the resident’s room to keep him mentally active.

369 17. A resident in a persistent vegetative state (PVS) (A) May have some facial movements (B) Will never open his eyes (C) Can cry occasionally (D) Might laugh at funny television shows 18. Which of the following is the best way for a nursing assistant to care for a resident with a functional barrier? (A) The NA should prevent the resident from resting to help keep his body active. (B) The NA should remove oxygen only long enough to clean the resident’s face and ears. (C) The NA should encourage the resident to speak quickly during conversations to keep the vocal cords strong. (D) The NA should use a communication board to help the resident ask questions.

19. Which is an example of assertive, rather than aggressive, behavior? 14. A resident who hugs a teddy bear throughout (A) A nursing assistant lets a resident know the day may be using a defense mechanism he has to hurry while eating or he will not called receive help when he gets ready for bed. (A) Repression TESTBANKSELLER.(BC) OAMresident makes fun of a nursing assis(B) Projection tant’s hairstyle. (C) Denial (C) A nursing assistant tells a resident that (D) Regression he is not working hard enough so he will never regain his ability to walk. 15. A resident who is disoriented might not be (D) A resident asks a nursing assistant for help able to correctly identify the following (A) The linen company the facility utilizes after he has urinated in the bed. (B) The current season of the year 20. A resident who says she failed a hearing test (C) The car the administrator drives because the machine was not working prop(D) The location of the emergency cart on the erly may be exhibiting the defense mechanism unit called 16. When dealing with a confused resident, a nursing assistant should (A) Provide enough time for the resident to be alone (B) Encourage the use of eyeglasses and hearing aids (C) Limit introducing herself to the first time she sees the resident (D) Turn up the volume of electronic devices such as radios and televisions

(A) Regression (B) Displacement (C) Rationalization (D) Denial

Name: ��

370 Chapter 5: Diversity and Human Needs and Development

Who is best equipped to help a nursing assistant communicate with a resident who speaks a different language than the nursing assistant does? (A) A language arts teacher (B) An interpreter (C) A spiritual advisor (D) The nursing assistant’s close friend

Spirituality consists of (A) A defined group of people who all believe the same thing (B) The concerns of the spirit, the sacred, or the soul (C) The belief in the paranormal (D) The fact that everyone believes in spirits

Multiple Choice. Choose the correct answer. 1.

Which of the following is one of the most important ways that a nursing assistant can help a resident’s family members? (A) By talking (B) By diagnosing (C) By treating (D) By listening The highest need a person may achieve according to Maslow is the need for (A) Self-aggrandizement (B) Self-awareness (C) Self-actualization (D) Self-assertion

Privacy concerning sexual situations is vital in facilities because (A) Living environments in facilities encourage 3. The mores of a group of people are privacy (A) The traditions and customs of that group (B) Aging residents can and do express (B) The emotional well-being levels of that sexuality group (C) Sexuality in the elderly is always (C) The annual census data of that group inappropriate (D) Stereotypes about that group ) IRn. tim atM e relationships are for young people TESTBANKSEL(LDE CO 4. �� describes the balance of the 10. Nursing assistants should be observant of resiphysical, social, and spiritual things that hapdents’ emotional needs because pen in a person’s daily life. (A) Nursing assistants let residents know how (A) Wastefulness they should be feeling on a regular basis (B) Willfulness (B) Compassionate care causes inappropriate (C) Wistfulness relationships with residents (D) Wellness (C) Residents sometimes rely on nursing assisWhat is the third level of Maslow’s Hierarchy tants for emotional support 5. of Needs? (D) Relationships without boundaries are vital (A) Safety and security needs in facilities (B) Need for love 11. What age range is associated with toddlers? (C) Need for self-actualization (A) 2 to 4 (D) Need for self-esteem (B) 6 to 12 Stereotyping of or prejudice toward the (C) 3 to 6 6. elderly is (D) 1 to 3 (A) Adaptation 12. A nursing assistant’s care for a person with a (B) Psychological abuse developmental disability includes (C) Ageism (A) Offering praise only following a big (D) Apathy accomplishment (B) Actively discouraging social interaction (C) Breaking tasks into small steps (D) Limiting conversation to residents who can verbalize

Name:

��

13. School-age children’s development includes (A) Social development (B) Pregnancy (C) Learning how to be walk correctly (D) Controlling bowels and bladders 14. Cerebral palsy can be caused by (A) Vehicular accidents (B) Accidents after the age of three (C) Birth trauma (D) Communicable diseases 15. What step can an infant generally accomplish? (A) Learning to control his bladder (B) Becoming active in social relationships (C) Learning to walk and jump (D) Learning to lift his head 16. A person with an intellectual disability (A) Has above-average mental functioning (B) Has difficulty with social skills (C) Has no problem with reading or writing (D) Always lives independently 17. An extended family may consist of (A) A single parent and an unmarried daughter (B) Two parents and two children (C) Families from two or more relationships (D) Aunts, cousins, and friends of a resident 18. How may friends and families provide care to residents? (A) Families and friends provide a link to the outside world. (B) Families and friends provide muchdeserved gifts to staff members. (C) Families and friends provide physical therapy. (D) Families and friends restrict mail and correspondence. 19. How does a nursing assistant help a resident with the resident’s spiritual beliefs? (A) By giving information to the resident about the NA’s specific religion (B) By encouraging the resident to participate in a roommate’s religious ceremonies (C) By expressing dismay over the resident’s family’s religious choices (D) By respecting the resident’s religion and religious practices

371

Name: ��

372 Chapter 6: Infection Prevention

A �� is administered to produce immunity to a specific disease. (A) Vesicle (B) Vector (C) Vacuum (D) Vaccine

Non-intact skin is skin that has been (A) Broken by a cut, pimple, or boil (B) Certified as smooth and unbroken (C) Cleaned by an antiseptic (D) Contaminated by a spore

The autoclave is vital in preventing infection because (A) It makes the facility free of all microorganisms (B) It cannot eliminate spores (C) It sterilizes objects (D) It disinfects disposable equipment

A localized infection (A) Has signs and symptoms such as fever and chills (B) Has signs and symptoms near the site of the infection (C) Is spread throughout the body (D) Will always become fatal

Which of the following is part of caring for a resident within an isolation unit? (A) The NA should limit reading materials because they can become contaminated. (B) The NA should never enter the isolation unit. (C) The NA should make sure that nobody talks to the resident until the isolation period has ended. (D) The NA should disinfect surfaces often.

Multiple Choice. Choose the correct answer. 1.

The process of �� helps communities prevent disease. (A) Sterilization (B) Sanitation (C) Asepsis (D) Immunity

10. The guidelines known as �� The carrier is a person who carries a disease TESTBANKSEL aL reEuRs. edCfO orMdiseases that are spread through and direct contact with another person or object. (A) Will always show signs of a communicable (A) Airborne Precautions disease (B) Droplet Precautions (B) Is able to control his signs and symptoms (C) Contact Precautions of the disease (D) Standard Precautions (C) Can transmit the disease to others although he is not symptomatic 11. Which of the following is true of the bacterium (D) Is unable to transmit the specific disease C. diff?

5. A systemic infection (A) Has signs and symptoms such as fever and chills (B) Has signs and symptoms near the site of the infection (C) Is limited to one area in the body (D) Will always become fatal 6. Indirect contact is a way to transmit infection in which (A) A person touches an infected person (B) A person touches an object contaminated by an infected person (C) A person touches an infected person’s mucous membranes (D) A person touches a carrier

(A) It may be a part of a person’s normal intestinal flora. (B) It is generally caused by a lack of antibiotic use. (C) It can be identified by swabbing a person’s nasal passages. (D) It is most often killed through the use of hand sanitizers.

Name:

��

373

12. For a resident who has tuberculosis, guidelines normally require that (A) Staff wear surgical masks while providing care (B) Residents wear a full set of personal protective equipment and be placed in special bubble-like environments (C) Residents wear surgical masks upon leaving the room (D) Staff open doors rapidly to ensure the contaminated air remains inside the room

17. An exposure incident requires that specific steps be taken, which include the following: (A) The NA should report the incident to his supervisor at the end of his shift. (B) The NA should report the exposure immediately to his supervisor. (C) The NA should leave the facility to get testing done at his doctor’s office. (D) The NA should leave the area immediately and warn all residents that he sees not to go to that area.

13. Diseases spread via a(n) �� can be spread up to six feet. (A) Airborne route (B) Droplet route (C) Direct contact route (D) Localized route

18. Under which of the following conditions should a nursing assistant always wear gloves? (A) When feeding a resident breakfast, lunch, or dinner (B) When opening a resident’s mail or correspondence (C) When placing the resident’s call light within the resident’s reach (D) While performing oral care for a resident

14. What is the incubation period? (A) It is the time frame that a spore survives in the environment. 19. Which of the following is true of using a mask (B) It is the time frame the surface of a fomite during care of a resident in isolation? remains contaminated. (A) The mask must be removed prior to the (C) It is the time frame that an administered reMmoval of gloves or gown. vaccine provides immunityT . ESTBANKSELLER.CO (D) It is the time frame before a pathogen (B) The mask must completely cover the nurscauses visible signs and symptoms of dising assistant’s nose and mouth. ease or illness. (C) The mask must be changed every 30 minutes. 15. What is one reason that dehydration can (D) The mask can be re-used only once. become a serious problem for an elderly person? 20. An additional way for a nursing assistant to (A) Cells may not receive adequate nutrition, help prevent infection in a facility is by increasing the risk of infection. (A) Holding soiled linens close to her uniform (B) The person will most likely experience so that they do not spread contaminants fluid overload. (B) Moving from a dirty area toward a clean (C) Bones become brittle and break more area when cleaning surfaces easily. (C) Not using equipment that has been (D) Dehydration increases the need for urinary dropped on the floor catheters, which remove even more vital (D) Coughing or sneezing into her hands if fluids from the body. she does not have a tissue 16. A spill that occurs on any surface within a healthcare facility (A) Requires a nursing assistant to pick out any pieces of glass from the spill and discard them (B) Can be absorbed by a special liquid soap (C) May require the use of heavy-duty gloves for clean up (D) Requires the use of an autoclave

Name: ��

374 Chapter 7: Safety and Body Mechanics

Which of the following is one way to prevent burns and scalds? (A) Using lids on all cold liquids served to residents (B) Ensuring objects left in the sun are cool before using (C) Serving liquids to residents while they are standing (D) Using the highest settings on hair dryers

Which of the following is one way that a nursing assistant can protect himself while working in a facility? (A) The NA should keep his valuable belongings locked up at work. (B) The NA should only share resident’s information with his closest friends. (C) The NA should limit visitors in a resident’s room to not more than 10. (D) The NA should report unsafe situations or people to a supervisor.

Multiple Choice. Choose the correct answer. 1. One condition or problem that can cause a lack of sensation is (A) Constipation (B) Diabetes (C) Hypertension (D) Vomiting 2.

The medical term cyanosis means (A) Dark red skin and mucous membranes due to an increase of oxygen in the system (B) Green-tinged vomit or emesis due to poisoning (C) An increase in the amount of bacteria in the bronchi and trachea of the respiratory system (D) Blue-tinged skin and mucous membranes due to a decrease of oxygen in the system

The medical term �� means diffi9. Fire safety responses at facilities include the culty swallowing. following steps: (A) Dysarthria (A) Using dry towels to block all doorways and (B) Dyspnea moke (C) Dysphagia TESTBANKSELLEsRto.pCsO M (B) Encouraging residents and visitors to use (D) Dyslexia the elevators during a fire to escape more 4. Collecting and putting things away in a quickly guarded way is called (C) Standing upright in a room when trying to (A) Heralding escape a fire (B) Hobnobbing (D) Using a covering over the mouth and nose (C) Hoarding to prevent smoke inhalation (D) Hashtagging 10. A weakening or wasting away of a muscle is 5. What does the acronym PASS stand for? known as (A) Push-Assist-Squeeze-Swipe (A) Autonomy (B) Push-Allow-Squeegee-Swipe (B) Anatomy (C) Pull-Aim-Squeeze-Sweep (C) Atrophy (D) Pull-Aim-Squeegee-Sweep (D) Autopsy 6. The process of burning is known as 11. Which of the following is a potential fire haz(A) Composition ard in a facility? (B) Combustion (A) Overloaded electrical socket (C) Composting (B) Recycling container for plastic materials (D) Compounding (C) Locked housekeeping supply closet 3.

(D) Clean, empty ashtray

Name:

��

12. Which of the following is a guideline for a nursing assistant who is caring for a resident with an IV line? (A) The NA should disconnect the IV line when the bag is empty. (B) The NA should not measure blood pressure on an arm with an IV. (C) The NA should only get the IV site wet during the resident’s bath. (D) The NA should lower the IV bag below the site for short intervals. 13. In order to prevent choking, in what position should the resident eat? (A) At 30 degrees, reclining (B) At 90 degrees, sitting upright (C) At 65 degrees, slightly reclining (D) At 0 degrees, lying flat 14. Which of the following is a safety guideline when using sharps containers? (A) Sharps containers must be replaced when they are one-half full. (B) Gloves should always be worn when touching the sharps container. (C) When dropping sharps inside the container, the NA TESTBANKS should put her hands just inside the top of the container to make sure the object is inside. (D) When carrying a sharps container, the NA should carry it by the top of the container. 15. A potential complication of restraint use is (A) Incontinence (B) Decreased agitation (C) Increased appetite (D) Diarrhea 16. When working with a resident who has an IV line, which of the following must the NA report to the nurse? (A) The resident’s IV bag is half-full. (B) The resident complains of pain. (C) Blood is not evident within the IV tubing. (D) The handboard is securely attached to the resident’s hand.

375

376 Chapter 8: Emergency Care, First Aid, and Disasters Multiple Choice. Choose the correct answer. 1.

If a resident starts to choke, what is the first step that a nursing assistant should take? (A) Call for help and begin giving abdominal thrusts if the resident indicates she is choking (B) Pound the resident on the back until the object in the throat is dislodged (C) Leave the area to go find the closest nurse (D) Give the resident water or another liquid to clear the throat A �� is when the heart stops beating. (A) Pulmonary arrest (B) Respiratory arrest (C) Cardiac arrest (D) Complete arrest

Name: �� 6. For a person with diabetes, having too little food in the body can cause (A) Diabetic alkalosis (B) Hypoglycemia (C) Insulin attack (D) Hyperglycemia 7. Which of the following is a sign or symptom that a resident is experiencing insulin reaction? (A) The resident has dry skin. (B) The resident has breath that smells like fruit. (C) The resident says he is full. (D) The resident says he is dizzy. 8. A superficial burn is also known as a (A) First-degree burn (B) Third-degree burn (C) Second-degree burn (D) Fourth-degree burn

9. One symptom of a heart attack is A resident slices his hand on his photo frame, (A) Painful thighs and his hand starts to bleed. After notifying (B) Indigestion the nurse, what is the next step that the nurs(C) Severe rash ing assistant should take? TESTBANKSEL(LDE ) FRr. eqCuO enMt urination (A) The NA should apply an ice pack to the 10. Expressive aphasia is the medical term that wound. means (B) The NA should give the resident (A) An inability to communicate through ibuprofen. speech or writing (C) The NA should put on gloves. (B) An inability to breathe (D) The NA should discard the photo frame. (C) An inability to see clearly 4. The medical term for paralysis on one side of (D) An inability to move normally the body is 11. While visiting with a resident, her nursing (A) Hemoptysis assistant notices that the resident’s nose is (B) Hemiplegia bleeding. The nursing assistant should (C) Hemophilia (A) Check the resident’s mouth (D) Hematuria (B) Elevate the head of the bed 5. A resident has just been informed that his wife (C) Count the resident’s respirations has died. The nursing assistant notes that he (D) Look around the bed to see if any is staring and his skin is pale. She suspects the medication is nearby resident is experiencing shock. What should 12. Receptive aphasia is the medical term that she do next? means (A) The NA should place the resident on his (A) Weakness on one side of the body side. (B) An inability to understand spoken or (B) The NA should offer food or a sip of water. written words (C) The NA should elevate the resident’s legs. (C) An abnormal heartbeat (D) The NA should ask the resident’s friend to (D) Blurred vision in one or both eyes help cheer him up. 3.

Name:

��

13. The medical term for nosebleed is (A) Epidermis (B) Epiglottis (C) Emesis (D) Epistaxis 14. If a person is conscious during a medical emergency, it means that (A) The victim has no pulse (B) The victim is breathing (C) The victim has an irregular heartbeat (D) The victim has lost the ability to speak

377

Name: ��

378 Chapter 9: Admission, Transfer, Discharge, and Physical Exams

A resident’s weight is measured in (A) Inches or centimeters (B) Pounds or kilograms (C) Millimeters or kilometers (D) Quarts or gallons

When weighing a resident, a nursing assistant should first (A) Document the resident’s height in the medical record (B) Ask the resident to stand up very straight on the scale (C) Balance the scale at zero to help ensure the weight is accurate (D) Turn the digital scale on and off before asking the resident to step onto it

Multiple Choice. Choose the correct answer. 1.

Knocking before entering an examination room is important because (A) It prevents unnecessary exposure and promotes the legal right to privacy (B) It is illegal not to knock before entering a room (C) It is the only legal way a healthcare provider can enter a room (D) It protects the person being examined from liability In the knee-chest position, the resident will be (A) Lying on his abdomen (B) Sitting upright (C) Lying on his back (D) Lying on his side with his knees straight

During an in-house transfer, one of the nursing assistant’s responsibilities is to (A) Drop the resident off at the new unit and return to the original unit immediately (B) Ensure the resident’s belongings arrive at 3. A new resident’s admission pack may include the new unit sometime later that evening (A) Special medication for the resident (C) Transfer all of the resident’s medications to (B) A stethoscope the new unit supervisor (C) A watch for measuring pulse rate ( D ) R orO t tMhe arrival of the resident to the TESTBANKSELLERe.pC (D) A water pitcher and cup charge nurse at the new unit 4. Which of the following is equipment that may 10. When measuring height of an ambulatory resibe used during a physical exam? dent, the nursing assistant should (A) Microscope (A) Ask the resident to firmly lower the rod (B) Ophthalmoscope until it is on top of the resident’s head (C) Endoscope (B) Help the resident to step off the scale (D) Kaleidoscope before recording height 5. Vital signs measured when a resident first (C) Face the resident toward the scale enters the facility are called (D) Make sure the resident is barefoot before (A) Basic vital signs walking to the scale (B) Initial vital signs 11. One important thing for the nursing assistant (C) Baseline vital signs to check when a resident is being discharged is (D) Instructional vital signs (A) Whether the resident will have enough 6. If a resident leaves a care facility without the food and drink for the trip home approval of a healthcare professional, it is (B) Whether the resident or his family knows called the address of his physician (A) Against physician’s advice (APA) (C) Whether the resident has had all of his (B) Against nurse’s advice (ANA) tubes and dressings removed by the nurse (C) Against facility advice (AFA) (D) Whether the resident or his family has (D) Against medical advice (AMA) paid his bill in full

Name:

��

12. What is one nursing assistant responsibility during the admission of a new resident? (A) The NA should make sure the resident unpacks all of his personal items right away. (B) The NA should give the resident a physical exam to help with care plan formulation. (C) The NA should explain how the bed controls and the call light work. (D) The NA should discuss the resident’s advance directive choices with the resident and his family. 13. The �� is used during a physical exam to test hearing with vibrations. (A) Tongue depressor (B) Reflex hammer (C) Otoscope (D) Tuning fork 14. The pound is a unit of weight based on the (A) Meter (B) Kilogram (C) Ounce (D) Inch

379

380 Chapter 10: Bedmaking and Unit Care Multiple Choice. Choose the correct answer. 1.

What is an important safety measure when a nursing assistant transfers a resident to a surgical bed? (A) Ensuring that the linen is tightly tucked all along the top and bottom of the bed (B) Having the bed and stretcher elevated to the highest position (C) Locking the stretcher and bed wheels before transferring (D) Positioning the bed and stretcher about six inches apart before transferring The natural cycle that relates to body functions that occurs due to daily, monthly, or yearly changes is called (A) Biofuel (B) Biology (C) Biodiversity (D) Biorhythm

Name: �� 6. When making a bed, the seam of the bottom sheet must be positioned so that it is (A) Seam side up on the bed (B) Seam side down on the bed (C) Seam turned over at one end of the bed (D) Seam tucked into the mattress on the bed 7. What is the medical term for being unable to control the bladder or the bowels? (A) Indwelling (B) Infectious (C) Incontinent (D) Infiltration 8. When making a closed bed, one important measure is to (A) Neatly cover the pillow with the bedspread (B) Carefully fold linen to one side of the bed (C) Place the bed in its highest position when finished (D) Place clean linen on a clean surface within reach

9. How often must a resident’s bed linen be A nursing assistant is making a resident’s bed changed? while the resident is in the bed. Before begin(A) At least twice a day ning, which side rail should be raised? T E S T BANKSEL LB)EN Ro.m CO ( orM e than once a week (A) Both side rails should be raised to their (C) When ordered by the physician highest position. (D) Whenever soiled or wet (B) The side rail should be raised on the far side of the bed (side farther away from 10. Which of the following is a helpful idea for the NA). dietary changes that may promote sleep? (A) Residents should drink soda before (C) The side rail should be raised on the near side of the bed (side closer to the NA). bedtime. (B) Residents should always be on fluid (D) Both side rails should be lowered to their lowest positions. restrictions. (C) Residents should eat a heavy meal just 4. In order to promote a resident’s right to privabefore bedtime. cy, which item is used to cover a resident while (D) Residents should eat meals earlier in the making an occupied bed? evening, rather than just before bedtime. (A) A bath blanket (B) A bedspread 11. One step a nursing assistant should take when (C) A waterproof bed protector preparing to make a bed is to (D) A fitted bottom sheet (A) Gather linen in the opposite order of place3.

5. �� is a parasomnia that consists of talking and violent movements and may be related to nervous system disorders such as Parkinson’s disease. (A) Somnambulism (B) Narcolepsy (C) Restless leg syndrome (D) REM behavior disorder

ment on the bed (B) Gather linen in the exact order of placement on the bed (C) Carry clean linen close to the body to protect it from bacteria (D) Move clean linen from one resident room to another when needed

Name:

��

12. A �� is a substance that causes calmness and drowsiness. (A) Depressant (B) Stimulant (C) Narcotic (D) Antibiotic 13. Which of the following is the best type of bed for a resident who is obese? (A) A barometric bed (B) A biologic bed (C) A gastronomic bed (D) A bariatric bed 14. The lower shelf of a bedside stand is generally used for storage of these items: (A) Water pitcher and cup (B) Linen and towel (C) Bedpan and urinal (D) Emesis basin and toothbrush 15. Which of the following is a type of disposable equipment that requires special handling when discarding? (A) Razor (B) Heavy-duty gloves (C) Paper gown (D) Cup

381

382 Chapter 11: Positioning, Moving, and Lifting Multiple Choice. Choose the correct answer. 1.

How often should residents in wheelchairs be repositioned? (A) At least every 15 minutes (B) At least every hour (C) At least every two hours (D) At least every five minutes A nursing assistant is transferring a resident from her bed into a wheelchair. The resident has a weaker right leg. Where should the NA place the wheelchair? (A) On the resident’s left side (B) On the resident’s weaker side (C) On the resident’s right side (D) On the resident’s affected side The term �� pertains to the way a person holds and positions his body. (A) Pronation (B) Postpartum (C) Posture (D) Projection

Name: �� 8. What is the body mass index (BMI) of a person who is considered overweight? (A) 30 to 39 (B) 40 or higher (C) 25 to 29 (D) 20 to 25 9. In order to lift objects safely, the nursing assistant should (A) Keep objects away from her body (B) Lift objects above her waist line (C) Pull objects when possible (D) Keep objects close to her body 10. A stretcher has safety devices to help protect the person who is on the stretcher. They are called (A) Safety stirrups (B) Safety sheets (C) Safety belts (D) Safety trays

4. Which of the following is an effect oT f rE egSuT laB r ambulation? (A) Decreased sleep (B) Improved circulation (C) Reduced oxygen level (D) Slower elimination 5. Shearing is rubbing or friction that can be prevented by (A) A rubber sheet (B) A bottom sheet (C) A top sheet (D) A draw sheet 6. When moving a resident up in bed, a nursing assistant must always (A) Keep his knees straight at all times (B) Position his back at a 60 degree angle (C) Keep his knees bent at all times (D) Position his arms tightly together 7. The Fowler’s position means the resident is positioned in a (A) 60 to 90 degree angle (B) 45 to 60 degree angle (C) 25 to 40 degree angle (D) 15 to 30 degree angle

Name:

��

Chapter 12: Personal Care Multiple Choice. Choose the correct answer. 1.

Before helping a resident into a shower, the nursing assistant should (A) Test the water temperature (B) Massage the resident’s head (C) Soak the resident’s fingertips (D) Exfoliate the resident’s skin with a brush A female resident’s perineal area should be cleaned (A) Without using soap (B) With a special oil (C) From front to back (D) From the anal area to the meatus In which position should a nursing assistant place an unconscious resident before giving oral care? (A) Supine (B) Lateral (C) Fowler’s (D) Prone

383 8. The advantage of a dental bridge is (A) The nursing assistant does not have to wear gloves while handling it (B) It replaces missing teeth (C) It will never crack (D) It cannot be cleaned 9. In what direction should a nursing assistant shave a resident’s face when using a disposable razor? (A) Away from the resident’s chin (B) Toward the resident’s chin (C) In the direction of hair growth (D) In the opposite direction of hair growth 10. Tartar is (A) Clenching the teeth (B) Gum inflammation (C) Bad-smelling breath (D) Bacterial deposits

11. When providing oral care to an edentulous resident, the NA should (A) Use swabs to clean the mouth (B) Use only mouthwash to clean the mouth 4. What is an example of an additive that may be (C) Use a firm toothbrush to clean teeth used for special baths? TESTBANKSELLER.(DC)OUMse dental floss as the final step (A) Sugar 12. What temperature should the lotion be for a (B) Corn meal back massage? (C) Oatmeal (A) Warm (D) Alcohol (B) Hot 5. The medical term for swelling in body tissues (C) Cold caused by excess fluid is (D) Icy (A) Emesis 13. The safest type of razor for a nursing assistant (B) Edema to use on residents is (C) Enema (A) A safety razor (D) Eczema (B) An electric razor 6. Pediculosis causes symptoms such as (C) A disposable razor (A) Itching and rashes (D) A straight edge razor (B) Acne and lesions (C) Cuts and abrasions (D) Boils and abscesses 7. Sticks commonly used for nail care are called (A) Rosewood sticks (B) Greasewood sticks (C) Sandalwood sticks (D) Orangewood sticks

Name: ��

384 Chapter 13: Vital Signs

The brachial pulse is the pulse located (A) On the arm inside the elbow (B) On the arm inside the wrist (C) On the left side of the chest (D) On the right side of the chest

What is the medical term used to describe a rapid heartbeat? (A) Bradycardia (B) Hypertension (C) Arrhythmia (D) Tachycardia

The �� is the first measurement of blood pressure, when the heart is at work (A) Diastolic (B) Orthostatic (C) Systolic (D) Systole

Multiple Choice. Choose the correct answer. 1.

An apical pulse is counted (A) On the right side, just below the nipple (B) On the left side, just to the right of the nipple (C) On the right side, just to the right of the nipple (D) On the left side, just below the nipple

2. When counting a radial pulse, the nursing assistant’s fingertips should be placed on the resident’s (A) Chest (B) Wrist (C) Knee (D) Elbow 3.

When measuring an oral temperature, the nursing assistant should place the thermometer (A) Under the tongue (B) Under the arm (C) In the rectum (D) Against the neck

10. What does the term dilate mean? (A) Close or contract (B) Speed up (C) Slow down (D) Widen or open

1.LALsEteRth pe may be used to hear TESTBANKS1E .oCscOoM

4. The vital signs include (A) Body temperature, urine output, and blood pressure (B) Body temperature, blood cell count, and respirations (C) Body temperature, pulse, and respirations (D) Body temperature, respirations, and fluid intake 5. The medical term for the absence of breathing is (A) Dyspnea (B) Apnea (C) Eupnea (D) Orthopnea 6. Tachypnea occurs when respirations are more than �� breaths per minute. (A) 14 (B) 10 (C) 20 (D) 18

(A) Air in the lungs (B) Urine flow (C) Body temperature (D) Blood pressure

12. The process of �� is blowing air out of the body. (A) Inhaling (B) Expiration (C) Inspiration (D) Hypotension 13. �� hypotension exists when thereis a sudden drop in blood pressure when a person stands or sits up. (A) Orthostatic (B) Severe (C) Multi-faceted (D) Hyperbolic 14. How far into the rectum should a rectal thermometer be inserted? (A) ¼ to ½ inch (B) ½ to 1 inch (C) ¾ to 1 inch (D) ½ to ¾ inch

Name:

��

15. Which of the following is normal temperature range for the axillary method? (A) 97.6 to 99.6 degrees Fahrenheit (B) 94.6 to 98.6 degrees Fahrenheit (C) 98.6 to 100.6 degrees Fahrenheit (D) 96.6 to 98.6 degrees Fahrenheit 16. Which of the following blood pressure measurements would be considered high? (A) 120/60 (B) 138/76 (C) 142/72 (D) 114/56 17. Which number of respirations would be considered abnormal? (A) 17 breaths per minute (B) 22 breaths per minute (C) 13 breaths per minute (D) 12 breaths per minute 18. Which of the following would be considered an abnormal count for a radial pulse? (A) 64 beats per minute (B) 72 beats per minute (C) 58 beats per minute (D) 88 beats per minute

385

Name: ��

386 Chapter 14: Nutrition and Fluid Balance

A sign of dehydration is (A) Moist mucous membranes (B) An increase in urinary output (C) Slowed heartbeat (D) Dizziness

�� supply the body with energy and provide needed fiber. (A) Fats (B) Carbohydrates (C) Proteins (D) Vitamins

Staff must report if a resident consumes less than �� of his meal. (A) 70% (B) 50% (C) 30% (D) 80%

Multiple Choice. Choose the correct answer. 1.

What is one reason that a resident might have an order to restrict her fluid intake? (A) The resident is sleepy. (B) The resident has an order for physical therapy. (C) The resident has a weight-reducing diet order. (D) The resident has a gastrointestinal illness.

A person who is fasting due to his religious beliefs would eat this type of diet during that day: (A) A mechanical soft diet (B) No food at all (C) A high-protein diet (D) A gluten-free diet

Fluid overload can occur when which of the following parts of the body are not working properly? (A) Stomach and colon (B) Esophagus and small intestine (C) Kidneys and lungs

10. Which of the following is a benefit to humans from water intake? (A) Water helps the body reduce perspiration. (B) Water helps cells retain waste products. (C) Water increases body temperature. (D) Water helps move oxygen into the cells.

(D) Liver and appendix

11. If a resident drinks 8 ounces of water with a meal, how many milliliters (mL) has she consumed? (A) 120 (B) 80 (C) 240 (D) 320

TESTBANKSELLER.COM

4. Following a �� diet means that a person avoids meat, fish, and poultry. (A) Vegetarian (B) High-fiber (C) Low-fat (D) Lactose intolerant 5. While residents have a legal right to receive fluids, in which of the following situations would fluids be restricted? (A) The resident has a force fluids order. (B) The resident has an NPO order. (C) The resident has an order for a high-calorie diet. (D) The resident has an order for no gluten in his diet. 6. �� is the process of breaking down and transforming nutrients that enter the body to provide growth, energy, and maintenance. (A) Microorganism (B) Micturition (C) Metabolism (D) Malnutrition

12. If a resident consumes ½ cup of a fluid, how many milliliters (mL) has he consumed? (A) 60 (B) 120 (C) 30 (D) 80 13. According to MyPlate, how many days a week should a person eat seafood as a protein source? (A) Once per week (B) Four times per week (C) Three times per week (D) Twice per week 14. Which of the following does output include? (A) Popsicle (B) Vomitus (C) Soup (D) Gelatin

Name:

��

15. In which side of the mouth should a nursing assistant place food for a resident who has had a stroke? (A) The unaffected side of the mouth (B) The affected side of the mouth (C) The weaker side of the mouth (D) The center of the mouth 16. A diuretic (A) Increases urine formation (B) Decreases urine output (C) Increases potassium (D) Reduces fluid volume 17. �� is a natural sugar that is used for energy. (A) Sodium (B) Cholesterol (C) Glucose (D) Gluten 18. When a resident is lactose intolerant, which of the following might be used as a substitute? (A) Fiber (B) Salt (C) Protein (D) Soy

387

Name: ��

388 Chapter 15: The Gastrointestinal System

Generally speaking, how much time should a nursing assistant wait before reading an occult blood test? (A) 1 to 2 minutes (B) 10 to 60 seconds (C) 30 to 90 seconds (D) 5 to 8 minutes

What is the term used to describe the condition in which all of the body systems are balanced? (A) Halitosis (B) Hemoptysis (C) Hepatitis (D) Homeostasis

Multiple Choice. Choose the correct answer. 1.

A guideline for bowel retraining that the nursing assistant should follow is to (A) Offer praise sparingly and restrict fluids after dinner (B) Observe skin closely for changes and answer call lights promptly (C) Avoid using gloves and offer foods not included in the diet order (D) Ignore episodes of incontinence and push independent perineal care �� is the study of all life forms. (A) Anatomy (B) Physiology (C) Biology (D) Geology

When a specimen is required from a resident in an isolation room, the nursing assistant should (A) Place the specimen into a biohazard bag while inside the room 3. What is a surgical procedure for diverting the (B) Place the specimen into a biohazard bag passage of urine? when outside the room (A) Colostomy (C) Collect the specimen outside the resident’s (B) Ileostomy room (C) Urostomy (D) Transfer the specimen outside of the (D) Gastrostomy TESTBANKSELLEroom, R.COkeeping M her gloves on 4. The �� is a substance made as a 10. A suppository is a medication given to a resiresult of the breakdown of food in the dent by a nurse for which of the following stomach. reasons? (A) Calculi (A) To reduce fecal incontinence (B) Chyme (B) To eliminate bouts of diarrhea (C) Cartilage (C) To induce a bowel movement (D) Emesis (D) To treat constipation 5. What is the disorder in which sac-like pouch11. A chronic inflammatory disease of the large ings develop in weakened areas of the large intestine, or colon, is called intestine? (A) Malabsorption (A) Malabsorption (B) Fecal impaction (B) Lactose intolerance (C) Crohn’s disease (C) Peristalsis (D) Ulcerative colitis (D) Diverticulosis 6. A �� is formed when the end of the intestine is brought out of the body through an artificial opening in the abdomen. (A) Stoma (B) Stomatitis (C) Hemorrhoid (D) Contracture

12. A commercial enema is pre-lubricated and is inserted into the rectum (A) 1 and ¼ inches (B) ½ inch (C) ¾ inch (D) 1 and ½ inches

Name:

��

13. What is the acronym used for a chronic stressrelated condition of the GI tract? (A) HAI (B) IBS (C) PVD (D) CHF 14. Electrolytes are chemical substances essential to maintaining �� in the body. (A) Normal fluid balance (B) Suitable nutritional intake (C) Proper absorption (D) Adequate elimination 15. Signs and symptoms of a fecal impaction include the following: (A) Urgency and black stools (B) Urination and flatus (C) Bleeding and itching (D) Abdominal cramps and vomiting 16. What is a condition that results from a weakened sphincter muscle joining the esophagus? (A) Gastroesophageal discomfort (B) Ulcers (C) Heartburn (D) Malabsorption 17. What is one normal age-related change in the gastrointestinal system? (A) Increase in the ability to taste (B) Difficulty chewing and swallowing (C) Increase of saliva production (D) More rapid movement of body waste through the intestines

389

Name: ��

390 Chapter 16: The Urinary System

One important task to complete when collecting a 24-hour urine specimen is to (A) Use a specimen kit to collect the urine (B) Clean the perineal area before collecting the specimen (C) Use strainers to filter all urine from the resident (D) Create a sign to hang near the bed to alert all staff

A clean-catch specimen is also called a �� specimen because the first and last voiding are not included in the urine sample. (A) Contaminated (B) Cleansing (C) Stop and start (D) Mid-stream

Which type of test is used for urine density? (A) Specific gravity test (B) pH test (C) Glucose test (D) Occult blood test

Multiple Choice. Choose the correct answer. 1.

What is another term for urinating? (A) Micturition (B) Eliminating (C) Defecating (D) Transferring

�� is a disorder of the urinary system in which the kidneys cannot filter some waste products. (A) Chronic renal failure (B) Urinary tract infection (C) Urinary incontinence (D) End-stage renal disease

The most important part of testing urine with reagent strips is (A) Touching the reagent bottle with the strip when reading (B) Using strips that have not expired (C) The length of time to leave reagent strip dipped in the urine (D) The color of the urine when testing it

10. When a resident has kidney stones, care by a 4. A type of catheter that fits over the pT enEisSiT s BANKSELnLuE rsR in.gCaO ssM istant includes called a(n) (A) Decreasing the resident’s fluid intake (A) Internal catheter (B) Discarding any kidney stones found in (B) Texas catheter filters (C) Straight catheter (C) Reporting blood in the urine promptly (D) Indwelling catheter (D) Straining only early morning urine through a filter 5. Why are ketones, substances produced when the body burns fat for fuel, produced by the 11. One important step in catheter care is for the body? nursing assistant to (A) Ketones are produced when there is too (A) Clean at least two inches of catheter near much insulin in the body. the body (B) Ketones are produced when there is a high (B) Rinse at least four inches of catheter nearspecific gravity in the urine. est body opening (C) Ketones are produced when there is not (C) Close clamp and replace without cleaning enough insulin in the body. clamp (D) Ketones are produced when the blood is (D) Allow catheter clamp to touch the graduate acidic. 6. A �� is a ring-like muscle that opens and closes an opening in the body. (A) Bursae (B) Sphincter (C) Ligament (D) Tissue

Name:

��

12. When cleaning the urinary meatus during catheter care, the nursing assistant should (A) Make sure catheter has only a maximum of two kinks in the tubing (B) Move toward the meatus, making circular motions (C) Use an incontinent brief to pad the area during care (D) Move in one direction, away from the urinary meatus 13. �� may be ordered for residents following surgery and is used to flush out a urinary catheter. (A) Indwelling catheter care (B) Straight catheterization (C) Continuous bladder irrigation (D) Bladder retraining 14. Urine production is increased when a resident drinks (A) Caffeinated beverages (B) Warm milk (C) Yogurt (D) High-sodium fluids 15. The following should be reporT teE dS toTtB heAnNuK rsS e when observing a resident’s urine: (A) Urine that is amber-colored (B) Urine that is transparent (C) Urine that has a strong odor (D) Urine that gets cloudy after standing

391

Name: ��

392 Chapter 17: The Reproductive System

What is a function of the male reproductive system? (A) To manufacture testosterone (B) To manufacture progesterone (C) To manufacture ova (D) To manufacture estrogen

What substances control certain human body functions, such as the ability to reproduce? (A) Electrolytes (B) Hormones (C) Vitamins (D) Minerals

One function of the female reproductive system is to (A) Manufacture sperm (B) Produce urine (C) Manufacture lymph (D) Produce milk to nourish a baby

Multiple Choice. Choose the correct answer. 1.

One primary responsibility for a nursing assistant helping with a gynecologic examination is to (A) Allow other staff to observe the gynecologic examination (B) Tell the resident the examination will be over in minutes (C) Make sure privacy is provided throughout the examination (D) Let the resident know when the doctor has made a diagnosis �� is a disorder in which the prostate becomes enlarged and causes problems with urination. (A) Genital herpes (B) Erectile dysfunction (C) Prostate cancer (D) Benign prostatic hypertrophy Which condition signifies the end of the female’s ability to reproduce? (A) Menopause (B) Menarche (C) Micturition (D) Masturbation

4. Testicular cancer is a form of cancer that (A) Begins within the ovaries (B) Is a common form of cancer in younger men (C) Is similar to chlamydia (D) Can only be detected by an exam given by doctor 5. Which type of sexually-transmitted infection is caused by a protozoa (single-cell animal)? (A) HPV infection (B) Genital herpes (C) Syphilis (D) Trichomoniasis 6. Erectile dysfunction is (A) A normal change of aging (B) Treated with medication (C) Incurable (D) An inflammation of the testes

10. What is a symptom of syphilis? (A) Green-yellow discharge (B) Yellow or white discharge (C) Small painless sores (D) Warts on the genitals 11. �� is a sexually-transmitted infection that include symptoms such as itching, swollen testes, or vaginal bleeding. (A) Gonorrhea (B) Vaginitis (C) Chlamydia (D) Trichomoniasis 12. A form of cancer that begins in the uterus is called (A) Cervical cancer (B) Ovarian cancer (C) Testicular cancer (D) Endometrial cancer 13. The risk of prostate cancer increases when a man is over the age of (A) 40 (B) 70 (C) 60 (D) 50

Name:

��

14. An ovum will die if it is not fertilized by a sperm within (A) 2 to 4 hours (B) 10 to 12 hours (C) 36 to 48 hours (D) 24 to 48 hours 15. A yeast infection is a type of vaginitis that is caused by a fungus known as (A) Staphylococcus (B) Pseudomonas (C) Candida albicans (D) Streptococcus

393

Name: ��

394 Chapter 18: The Integumentary System

An ice bag left on the body for longer than 20 minutes may cause (A) Blood vessels to open (B) A decrease in bleeding (C) Fever (D) Diminished swelling at the site

The shingles virus can cause (A) Scabs due to tiny mites on the skin (B) An abrasion due to friction (C) Chickenpox in a person who has never had it (D) A severe fungal infection

Death of tissue is known as (A) Eczema (B) Hematoma (C) Gangrene (D) Psoriasis

Multiple Choice. Choose the correct answer. 1.

One function of the integumentary system is to (A) Excrete waste through urine (B) Help with the production of vitamin C (C) Protect internal organs from injury (D) Increase body temperature When using sterile gloves, what is one important step that the nursing assistant should take? (A) Apply gloves before entering the room (B) Ensure sterile glove expiration date is current (C) Open dressing packages with sterile gloves on (D) Change gloves only once during sterile dressing changes Which of the following is a normal age-related change for the integumentary system? (A) Melanocyte production can cause brown spots. (B) The elasticity of fibers increases. (C) The person feels warmer. (D) Nails grow faster.

4. Which of the following situations would require a sterile dressing? (A) A paper cut (B) An intact wound (C) A draining wound (D) A clean, dry wound 5. A �� burn affects the epidermis, dermis, and underlying tissue. (A) Second-degree burn (B) First-degree burn (C) Partial-thickness burn (D) Third-degree burn 6. �� is a contagious disease that is transmitted by direct person-to-person contact. (A) Shingles (B) Scabies (C) Skin cancer (D) Eczema

10. One type of dry application is a(n) (A) Cold compress (B) Aquamatic K-pad (C) Sponge bath (D) Warm soak 11. Which of the following is a type of fungal infection? (A) Tinea (B) Warts (C) Wheals (D) Vesicles 12. What is one problem associated with atopic dermatitis (eczema)? (A) Change in size of a mole (B) Itching (C) Cancer (D) Yeast infection 13. A common type of closed wound is a(n) (A) Contusion (B) Puncture (C) Incision (D) Laceration 14. For a nursing assistant, pressure ulcer care includes (A) Restricting fluids (B) Changing position every four hours (C) Using moisturizers on open skin (D) Keeping skin dry

Name:

��

15. Which of the following should be reported by the nursing assistant because it is a possible sign of a pressure ulcer? (A) Intact skin (B) Broken skin between the toenails (C) Clean skin (D) Adequate resident hydration

395

396 Chapter 19: The Circulatory or Cardiovascular System Multiple Choice. Choose the correct answer. 1.

The phase of heart function in which the ventricles contract is referred to as (A) Flatlining (B) Diastole (C) Homeostasis (D) Systole

A disorder that is related to the absorption of vitamin B12 is ��. (A) Pulmonary edema (B) Congestive heart failure (C) Pernicious anemia (D) Phlebitis

A weakening of the heart muscle due to enlargement is ��. (A) Coronary artery disease (B) Angina pectoris (C) Myocardial ischemia (D) Cardiomyopathy

Name: �� 8. A common treatment for anemia is (A) Reducing vitamin intake (B) Increasing iron intake (C) Injections of vitamin K (D) Decreasing fiber in the diet 9. With myocardial ischemia, a person lacks (A) Oxygen (B) Fluids (C) White blood cells (D) Immune function 10. Signs and symptoms of congestive heart failure include (A) Decreased urination (B) Weight loss (C) Swelling in the ankles (D) Decreased pulse 11. One function of the blood is to (A) Remove oxygen from the cells (B) Control blood vessel size (C) Control pH levels (D) Increase body temperature

12. Nitroglycerin may come in pill form and is akEeR n .COM TESTBANKSELtL (A) Heart failure (A) As injections (B) Anemia (B) Intravenously (C) A lack of hemoglobin (C) Under the tongue (D) Plaque build-up in the arteries (D) Rectally 5. �� is the form of angina that occurs 13. One normal age-related change for the when the body is at rest. circulatory system is (A) Unstable angina (A) Increased blood circulation (B) Orthopnea (B) Increased elasticity of blood vessels (C) Ischemia (C) Decreased blood flow (D) Stable angina (D) Enlargement of blood vessels 6. A machine used to reduce fluid build-up and 14. The �� receive(s) de-oxygenated improve circulation is a blood from the body through the superior vena (A) Anti-embolic plastic sleeve cava. (B) Continuous bladder irrigation (A) Left ventricle (C) Catheter irrigation (B) Coronary arteries (D) Sequential compression stocking (C) Capillaries 7. What is one treatment for hypertension? (D) Right atrium (A) Reducing the amount of exercise (B) Increasing fat in the diet (C) Taking diuretics to reduce fluid volume (D) Increasing weight 4.

Pulmonary edema can be caused by

Name:

��

Chapter 20: The Respiratory System

397 7.

What piece of extra equipment is important for a resident using an oxygen concentrator? (A) Portable oxygen tank (B) Irrigation catheter (C) Specimen container (D) Nasal cannula

An airborne infection isolation room (AIIR) is often used when a person has (A) Emphysema (B) Bronchitis (C) Bronchiectasis (D) Tuberculosis

The coughing up of blood from the respiratory tract is known as (A) Halitosis (B) Hemoptysis (C) Hepatitis (D) Hypoxia

Multiple Choice. Choose the correct answer. 1.

Tiny grape-like sacs within the lungs are called (A) Atria (B) Axilla (C) Arteries (D) Alveoli A benefit from the regular use of deep-breathing exercises is (A) Increased mucus in the respiratory system (B) Decreased salivary production (C) Increased lung capacity (D) Decreased oxygen levels A condition in which the bronchi become permanently dilated is (A) Bronchitis (B) Bronchiectasis (C) Asthma (D) Pneumonia

10. What is one guideline for a nursing assistant who is caring for a resident receiving oxygen therapy? What is one important step that the nursing assistant should take when collecting a sputum (A) The NA should limit smoking to certain specimen? areas. (A) Have the resident eat dinnT erEpS riT orBtA oN thK e SELLER. (BC) O TM he NA should reduce the number of sputum collection pillows the resident uses. (B) Ask the resident to rinse with mouthwash (C) The NA should report changes in the resident’s respiratory rate. before the collection (D) The NA should use petroleum-based lip (C) Have the resident rinse mouth with water balms to help with irritation. before the collection (D) Collect the specimen at night, just before the resident goes to bed

5. The lungs are the main organs of respiration and are responsible for the exchange of oxygen and (A) Nitrogen (B) Hydrogen (C) Carbon dioxide (D) Carbon monoxide 6. The �� is an air passage that goes from the pharynx to the bronchi (A) Epiglottis (B) Trachea (C) Sphincter (D) Ventricle

11. What is one sign of pneumonia? (A) Low-grade fever (B) Chest pain when inhaling (C) Decreased pulse (D) Cyanosis 12. What is one important function of the respiratory system? (A) Move lymph throughout the body (B) Act as an air filter, cleaning inhaled air (C) Control body temperature (D) Protect internal organs from injury 13. One normal age-related change for the respiratory system is (A) Air sacs increase in the lungs (B) Chest muscles strengthen (C) Oxygen in the blood decreases (D) Lung capacity increases

398 14. Acute bronchitis can cause (A) Coughing up blood (B) Yellow or green sputum (C) Night sweats (D) Excessive urination 15. What is the membrane that covers and protects the lungs? (A) Plaque (B) Pancreas (C) Lymph (D) Pleura

Name: ��

Name:

��

Chapter 21: The Musculoskeletal System

399 7.

Which of the following is a guideline for cast care? (A) Using a sharp scratcher inside the cast to help with itching (B) Padding the edge of the cast to reduce sharp edges (C) Keeping cast damp or wet for comfort (D) Keeping the extremity low, close to the ground

A sling may be used to (A) Increase swelling in an extremity (B) Provide support to an extremity (C) Immobilize broken bones (D) Inflate and deflate an extremity

�� is warmth, itching, or tingling from a body part that has been amputated. (A) Osteoporosis (B) Bursitis (C) Phantom sensation (D) Osteoarthritis

Multiple Choice. Choose the correct answer. 1.

Moving a body part away from the body is called (A) Abduction (B) Addition (C) Adduction (D) Ambulation

Tough, fibrous bands that connect muscle to bone are called (A) Cartilages (B) Ligaments (C) Joints (D) Tendons

A non-weight bearing order for a resident means that (A) The resident can bear partial weight on one or both legs (B) The resident can touch the floor with at least one leg (C) The resident is unable to touch the floor with either leg (D) The resident can support some body

10. What is the protective substance that covers the ends of bones? TESTBANKSELLER.(AC) OCMartilage weight on one leg (B) Collagen 4. Which of the following disorders causes swol(C) Hormones len joints, restricted movement, intense pain, (D) Minerals and deformities? 11. Moving a body part toward the body is called (A) Osteoarthritis (A) Addition (B) Muscular dystrophy (B) Adduction (C) Rheumatoid arthritis (C) Agitation (D) Osteoporosis (D) Abduction 5. A continuous passive motion (CPM) machine 12. Which type of fracture occurs in a bone that is is used to treat weakened by a disease such as cancer? (A) Total hip replacement (A) Compound fracture (B) Bursitis (B) Comminuted fracture (C) Phantom limb pain (C) Greenstick fracture (D) Total knee replacement (D) Pathologic fracture 6. �� are tiny sacs of fluid located near 13. What is one factor that is associated with joints. osteoarthritis? (A) Tendonitis (A) Education level (B) Bursae (B) Bacteria (C) Sepsis (C) Lack of calcium in the diet (D) Phlebitis (D) Cold, damp weather

400 14. Simple movements, such as turning in bed or sitting down, are linked with fractures when a person has this disorder: (A) Osteoarthritis (B) Bursitis (C) Osteoporosis (D) Tuberculosis 15. Which of the following is a function of the musculoskeletal system? (A) Stores vitamin D (B) Supplies oxygen to cells (C) Stores calcium and phosphorous (D) Transports antibodies to cells

Name: ��

Name:

��

Chapter 22: The Nervous System Multiple Choice. Choose the correct answer. 1.

A type of depression that causes a person to have mood swings is called (A) Delirium (B) Bipolar disorder (C) Obsessive-convulsive disorder (D) Hemianopsia The �� cerebral hemisphere of the brain controls the motor activity on the right side of the body. (A) Right (B) Middle (C) Spinal (D) Left One part of the central nervous system is the (A) Brain (B) Nerves (C) Eyes and ears (D) Autonomic nervous system

401 8. A resident who has had a cerebrovascular accident and has diminished sensation may be at risk for (A) Rashes and warts (B) Decreased urination (C) Burns (D) Seizures 9. A disorder caused by a build-up of fluid in the inner ear is (A) Otitis media (B) Meniere’s disease (C) Glaucoma (D) Myopia 10. Which of the following statements about dementia is true? (A) It is always reversible. (B) It is a sudden state of confusion. (C) It affects the ability to reason and remember. (D) It is not a serious illness.

11. Mental or physical exhaustion due to proThe part of the eye that opens and closes to longed stress and frustration is called adjust to light is called the (A) Agitation (A) Sclera ocial anxiety disorder TESTBANKSELLER.(BC) OSM (B) Iris (C) Sundowning (C) Pupil (D) Burnout (D) Cornea 12. One method substance abusers use to try to 5. The type of aphasia that refers to difficulty hide their addiction is to communicating through speech or writing is (A) Avoid brushing their teeth called (B) Use room fresheners (A) Expressive (C) Consistently make eye contact (B) Cognitive (D) Have strong social relationships (C) Validating 13. What is the first symptom of a cataract? (D) Receptive (A) Reduced side vision 6. What is a normal age-related change for the (B) Vomiting nervous system? (C) Blurred vision (A) Reflexes speed up. (D) Double vision (B) The sense of taste intensifies. 14. One guideline for a nursing assistant who is (C) Some hearing loss occurs. caring for a resident who is mentally ill is to (D) Vision improves. (A) Take any suicide threat seriously 7. A progressive disease that causes rigid mus(B) Disregard a loss of appetite cles, tremors, and pill-rolling is (C) Avoid talking to the resident (A) Epilepsy (D) Ignore dilated pupils (B) Parkinson’s disease (C) Meniere’s disease (D) Dementia 4.

402 15. What is the form of therapy that encourages the person to remember past experiences? (A) Reality orientation (B) Validating (C) Reminiscence therapy (D) Remotivation therapy 16. The practice of repeating phrases over and over again is (A) Pillaging (B) Perseverating (C) Hoarding (D) Disrupting 17. The medical term for loss of vision on one-half of the visual field is (A) Hyperopia (B) Myopia (C) Hemianopsia (D) Macular degeneration

Name: ��

Name:

��

Chapter 23: The Endocrine System Multiple Choice. Choose the correct answer. 1.

A condition in which the thyroid gland produces too much thyroid hormone is called (A) Hypothyroidism (B) Hypertension (C) Hyperthyroidism (D) Hypothermia What is the normal fasting blood glucose range for a person who does not have diabetes? (A) 46 to 78 mg/dl (B) 70 to 100 mg/dl (C) 105 to 120 mg/dl (D) 115 to 132 mg/dl �� are chemical substances createdby the body that control numerous functions. (A) Nutrients (B) Minerals (C) Hormones (D) Vitamins

4. Thyroid hormones primarily rT egE uS latTeB thAe following: (A) Heart rate and respiration (B) Bile production and potassium (C) Kidney and liver function (D) Metabolism and growth 5. One guideline for a nursing assistant who is giving foot care to a resident with diabetes is to (A) Never apply any product between the toes (B) Turn socks over at the tops (C) Use all-nylon socks (D) Cut toenails carefully 6. What part of the body regulates calcium and phosphate in the bloodstream? (A) Thyroid gland (B) The pancreas (C) Adrenal glands (D) Parathyroid glands 7. Diabetes is a condition in which the �� does not produce enough insulin (A) Pancreas (B) Thyroid (C) Adrenal gland (D) Parathyroid gland

403 8. Hypoglycemia is also known as (A) Peripheral neuropathy (B) Insulin reaction (C) Diabetic retinopathy (D) Hypothyroidism 9. With hyperglycemia from diabetes, one method the body uses to find materials for energy is to (A) Burn sugar (B) Burn proteins (C) Burn fat (D) Burn minerals 10. One symptom of hyperthyroidism is (A) Reduced perspiration (B) Weight gain (C) Slowed pulse (D) Increased appetite 11. Hypothyroidism can cause which of the following symptoms? (A) Increased hair growth (B) Weight loss (C) Nausea or diarrhea (D) Brittle hair or fingernails 12. Which mineral required for proper thyroid gland function is found in common table salt? (A) Potassium (B) Magnesium (C) Iodine (D) Copper 13. What is a sign of diabetes? (A) Moist, firm skin (B) Unexplained weight gain (C) Excessive urination (D) Low blood pressure 14. Male testes secrete this hormone: (A) Potassium (B) Progesterone (C) Epinephrine (D) Testosterone 15. Type 2 diabetes usually occurs after age (A) 25 (B) 35 (C) 45 (D) 55

Name: ��

404 Chapter 24: The Immune and Lymphatic Systems and Cancer

A type of cancer treatment that uses antibodies or vaccines to fight malignant tumors is (A) Radiation therapy (B) Hormone therapy (C) Chemotherapy (D) Immunotherapy

What organ works as a type of storage shed for the blood? (A) Gallbladder (B) Thymus (C) Spleen (D) Appendix

What type of care helps to relieve symptoms and reduce pain for a person who has cancer? (A) Irreversible (B) Palliative (C) Generalized (D) Empathetic

Multiple Choice. Choose the correct answer. 1.

A(n) �� disease is a disease in which the body is unable to recognize its own tissue. (A) Opportunistic (B) Progressive (C) Autoimmune (D) Infectious The disappearance of signs and symptoms of cancer is called (A) Metastasis (B) Remission (C) Breakthrough (D) Intervention What is an opportunistic infection? (A) A disease in which abnormal cells grow quickly (B) A disease in which symptoms of cancer disappear (C) A disorder that causes inflammation of the bladder (D) An illness caused by microorganisms that causes disease in people with weakened immune systems

4. A type of severe pain that occurs unexpectedly in some people with cancer is (A) Expressive pain (B) Obstructive pain (C) Breakthrough pain (D) Receptive pain 5. A(n) �� is the removal of a sample of tissue for diagnosis (A) Biopsy (B) Arthroscopy (C) Telemetry (D) Bronchoscopy 6. When the body is exposed to an allergen, what substance is released? (A) Lymph (B) Histamine (C) Hormones (D) Platelets

10. A tumor that is not cancerous is called a (A) Nonspecific tumor (B) Malignant tumor (C) Septic tumor (D) Benign tumor 11. What type of immunity is present at birth? (A) Active (B) Passive (C) Nonspecific (D) Specific 12. One function of the immune and lymphatic systems is to (A) Provide reflex centers for respiration (B) Return fluid to the circulatory system (C) Protect internal organs (D) Absorb nutrients 13. Signs and symptoms of HIV/AIDS include (A) Bleeding gums (B) Pressure ulcers (C) Jaundice (D) Changes in moles 14. What is one type of autoimmune disease? (A) Hypothyroidism (B) Rheumatoid arthritis (C) Hepatitis (D) Gonorrhea

Name:

��

15. One method of transmission of HIV is (A) Kissing an infected person on the cheek (B) Shaking hands with an infected person (C) Eating with the same utensil as an infected person (D) Sharing a drug needle with an infected person 16. One type of cancer that can affect a person who has AIDS is (A) Pneumocystis pneumonia (B) Prostate cancer (C) Liver cancer (D) Kaposi’s sarcoma 17. A sudden loss of blood, called ��, can cause the spleen to release up to a pint of blood. (A) Hypotension (B) Hemorrhoid (C) Hemorrhage (D) Hemoptysis

405

406 Chapter 25: Rehabilitation and Restorative Care Multiple Choice. Choose the correct answer. 1.

Adduction is (A) Moving a body part away from the body (B) Straightening a body part (C) Moving a body part toward the body (D) Bending backward A doctor who specializes in rehabilitation is called a (A) Psychiatrist (B) Psychologist (C) Physiatrist (D) Pulmonologist Bending backward is also called (A) Rotation (B) Dorsiflexion (C) Supination (D) Opposition

Name: �� 8. When a resident is using crutches, where should her weight be concentrated? (A) On her thighs (B) On her underarms (C) On her hands and arms (D) On her shoulders 9. What is a benefit of regular activity and exercise for the respiratory system? (A) An increased chance of infection (B) A reduced chance of pneumonia (C) Diminished oxygen level (D) Decreased circulation 10. Turning upward is also called (A) Rotation (B) Pronation (C) Flexion (D) Supination 11. Turning downward is also called (A) Supination (B) Hyperextension (C) Pronation (D) Extension

Weakness of muscles in the feet and ankles is (A) Pronation (B) Supination 2.LO om TESTBANKS1E LnEeRc. CpOliMcation of immobility for the integu(C) Foot drop mentary system is (D) Phlebitis (A) Constipation

5. When a joint is extended beyond its normal motion, it is (A) Flexed (B) Opposed (C) Pronated (D) Hyperextended 6. A type of device used to help a disabled person perform activities of daily living is a(n) (A) Orthotic device (B) Assistive device (C) Restorative device (D) Range of motion device 7. Exercises that put a joint through its full arc of motion and are done by a resident alone, without help, are called (A) Active range of motion exercises (B) Assistive range of motion exercises (C) Passive range of motion exercises (D) Extended range of motion exercises

(B) Blood clots (C) Muscle atrophy (D) Pressure ulcers 13. Straightening a body part is also called (A) Flexion (B) Pronation (C) Extension (D) Adduction 14. One way for a nursing assistant to promote a successful restorative care program is to (A) Create a loud, vibrant environment (B) Discourage relationships between residents (C) Allow for private visits from family and friends (D) Make most of the daily decisions for residents

Name:

��

15. Which of the following is an example of a physical cue used to help promote independence? (A) The NA puts her hand around the resident’s hand and helps the resident bring a spoonful of food to her mouth. (B) The NA asks the resident to take a sip of water. (C) The NA tells the resident to swallow after putting food in her mouth. (D) The NA lists all of the steps in the procedure that the resident needs to complete. 16. A resident should place a cane about �� inches in front of his stronger leg. (A) 8 inches (B) 12 inches (C) 14 inches (D) 6 inches

17. The NA should perform range of motion exercises at least �� times for each joint. (A) 9 (B) 5 3 6 18. Rehabilitation revolves around the concept of (A) Palliative care (B) Holistic care (C) Outcome care (D) Primary care

407

408 Chapter 26: Subacute Care Multiple Choice. Choose the correct answer. 1.

The intravenous infusion of nutrients bypassing the digestive tract is referred to as TPN, which stands for (A) Total percutaneous nutrition (B) Total peripheral nutrition (C) Total portable nutrition (D) Total parenteral nutrition �� involves the use of medication to calm a person. (A) Ablation (B) Respiration (C) Supination (D) Sedation A serious illness usually caused by a bacterial infection is called (A) Gingivitis (B) Phlebitis (C) Sepsis (D) Diverticulosis

Name: �� 8. What is one problem associated with chest tubes that should be reported by the nursing assistant? (A) The drainage system is below chest level (B) Resident takes two naps per day (C) Clots are in the drainage tubing (D) The drainage containers are upright 9. One possible complication that can result from a tube feeding is (A) Aspiration (B) Cystitis (C) Loose lead (D) Phlebitis 10. Normal pulse oximetry readings are considered to be (A) From 75% to 85% (B) From 85% to 95% (C) From 65% to 85% (D) From 95% to 100%

11. What disorder can put a person at a higher risk for sepsis? (A) Diabetes 4. What is a type of intravenous line that is (B) Eczema inserted into a large vein in the bodyT ? ESTBANKSEL(L CE )O is OM Rt.itC (A) Peripheral line (D) Chlamydia (B) Central venous line 12. Repositioning a resident on a mechanical ven(C) Gastrostomy line tilator must be done at least every (D) Nasogastric line (A) 5 hours 5. A pulse oximeter sensor is normally clipped on (B) 4 hours a person’s (C) 3 hours (A) Neck (D) 2 hours (B) Finger 13. What is one condition that can require an (C) Stomach order for a tube feeding? (D) Lower arm (A) Depression 6. The process of removing poisons from the (B) Cancer body can be done by using (C) Dialysis (A) Bladder suctioning (D) Anaphylaxis (B) Gastric suctioning (C) Endotracheal suctioning (D) Intravenous suctioning 7. When using a pulse oximetry device, which of the following should be avoided? (A) Excessive fluids (B) Loose tape (C) Supine position (D) Nail polish

Name:

��

Chapter 27: End-of-Life Care Multiple Choice. Choose the correct answer. 1.

The term �� means an examination by a pathologist to determine cause of death. (A) Atrophy (B) Anatomy (C) Autopsy (D) Avulsion What is the period of time following a loss in which mourning occurs? (A) Breakthrough (B) Burnout (C) Bereavement (D) Blackout A guideline for skin, nose, and mouth care that the nursing assistant should provide for a dying resident is (A) Change the resident’s gown weekly (B) Offer ice chips to keep the mouth moist (C) Avoid using room humidifiers (D) Pour mouthwash into the resident’s mouth

409 8. The Latin term for the cooling of the body after death is (A) Rigor mortis (B) Algor mortis (C) Livor mortis (D) Algae mortis 9. The stage of dying in which a person prepares for death is identified as (A) Bargaining (B) Depression (C) Denial (D) Acceptance 10. The process of burning a dead body until it turns to ash is (A) Cremation (B) Libation (C) Pronation (D) Expiration

11. What is one way a nursing assistant can help a family respond to the death of a loved one? (A) Influencing the family with the NA’s religion (B) Promptly reporting a request for a clergy 4. A period of mourning in which thS eT dyBinAgNpK erS- ELLER.CO TE viM sit son or the family is expecting death is called (C) Isolating the family and friends (A) Reactive grief (D) Judging past behavior to make the family (B) Emotional grief feel better (C) Anticipatory grief 12. The dying person’s right to be free from pain (D) Actualized grief includes 5. The stage of dying in which the person feels (A) Being given pain medication when needed “no, not me” is the �� stage. (B) Ignoring a request from the family for pain (A) Anger pills (B) Bargaining (C) Advising the person that pain medication (C) Depression is not needed (D) Denial (D) Telling the person they are asking for pain medication too often 6. What is one thing that a caregiver may see happen to the body following death? 13. The stage of dying in which a person believes (A) Low blood pressure “yes me, but…..” is called (B) High fever (A) Depression (C) Jaw dropping (B) Denial (D) Perspiration (C) Acceptance 7. Postmortem care includes (A) Covering the body completely (B) Propping the eyes open (C) Positioning the body in proper alignment (D) Leaving on the oxygen

(D) Bargaining 14. A type of illness that will eventually cause death is known as a (A) Marginal illness (B) Palliative illness (C) Terminal illness (D) Complicated illness

410 15. When caring for a dying resident, the nursing assistant should (A) Keep the room light, bright, and sunny (B) Be aware that the sense of hearing is the last to leave (C) Speak loudly so the resident can hear her (D) Press the resident for answers to her questions 16. Signs of approaching death include (A) Dry, rashy skin (B) High blood pressure (C) Increased urinary output (D) Dilated pupils

Name: ��

Name:

��

Chapter 28: Your New Position Multiple Choice. Choose the correct answer. 1.

The process of resolving conflicts in a positive manner so that everyone is satisfied is called (A) Outcome resolution (B) Conflict resolution (C) Constructive resolution (D) Continuing resolution

An internal or external factor that can cause stress is called (A) Shock (B) Stimulant (C) Stressor (D) Stereotype

A résumé should include the following information: (A) Experience and education (B) Height and weight (C) Religion and marital status (D) Age and number of children

411 8. One way for a nursing assistant to determine whether to perform a procedure or not is to (A) Perform all procedures even if he has no training in the procedures (B) Perform a procedure if he has forgotten how to do it because he will know the steps once he starts (C) Perform a procedure if it is not in his job description, but he knows how to do it (D) Perform a procedure if it is within his scope of practice 9. A nursing assistant must work for pay within the �� month certification period. (A) 16 (B) 24 (C) 12 (D) 36 10. A nursing assistant must file the following promptly with the state licensing board: (A) New address (B) Marital status (C) New child (D) CPR certification

Under what circumstance should an applicant leave something blank in a job application? (A) Lack of prior salary TESTBANKSELLE CO 11R . . Em plM oyers are required to test staff members (B) Does not know an address for the following: (C) Never (A) Sexually-transmitted diseases (D) Does not know a phone number (B) Tuberculosis (C) Cancer 5. Something important that helps make a job (D) HIV/AIDS interview successful is if the job applicant (A) Exaggerates accomplishments (B) Arrives when the interview is starting (C) Makes eye contact during the interview (D) Brings a family member for support 6. What is one helpful way for a nursing assistant to reduce and manage stress? (A) Talk to a resident about her stress (B) Seek help from a supervisor (C) Multi-task as much as possible (D) Increase caffeine in her diet 7. One important way to try to resolve a conflict is to (A) Never meet halfway (B) Always challenge policy (C) Consider a compromise (D) Antagonize coworkers

12. Signs of burnout include (A) Being slow to anger (B) Obsessing over small things (C) Having lots of patience (D) Lack of frustration 13. At what point in an NA’s employment would a probationary performance review be completed? (A) At 6 months (B) At 9 months (C) At 18 months (D) At 3 months 14. Employers are required to provide �� vaccines free of charge to employees. (A) Measles (B) Ebola (C) Hepatitis B (D) Malaria

412

413

Appendix F Answer Key for 2nd Set of Chapter Exams

414 Chapter 1: The Nursing Assistant in Long-Term Care 1.

10. B 11. D 12. A 13. D 14. B 15. C 16. A 17. C 18. A 19. B 20. B Chapter 2: Ethical and Legal Issues 1.

10. C 11. C 12. A 13. D 14. C 15. D 16. D 17. A 18. D 19. B 20. B Chapter 3: Communication Skills 1.

TESTBANKS4E. LLBER.COM 5.

10. B 11. D 12. B 13. D 14. C 15. C 16. C 17. D 18. C 19. B 20. A

415 Chapter 4: Communication Challenges

10. C

11. D

12. C

13. A

14. C

15. D

16. B

17. D

18. A

19. D

10. C

Chapter 6: Infection Prevention

11. B

12. C

13. A

14. D

15. B

5.R.ACOM TESTBANKSEL LE

16. B

17. A

18. D 19. D

10. C

20. C

11. A

Chapter 5: Diversity and Human Needs and Development

12. C

13. B 14. D 15. A 16. C 17. B 18. D 19. B 20. C

416 Chapter 7: Safety and Body Mechanics 1.

10. C 11. A 12. B 13. B 14. B 15. A 16. B

Chapter 9: Admission, Transfer, Discharge, and Physical Exams 1.

10. B 11. C 12. C 13. D 14. B Chapter 10: Bedmaking and Unit Care 1.

Chapter 8: Emergency Care, First Aid, and Disasters 1.

10. A 11. B 12. B 13. D 14. B

10. D 11. B 12. A 13. D 14. C 15. A

417 Chapter 11: Positioning, Moving, and Lifting

10. D

11. A

12. B

13. A

14. B

15. D

16. C

10. C

17. B

Chapter 12: Personal Care

18. C

Chapter 14: Nutrition and Fluid Balance

10. D

11. A

10. D

12. A

11. C

13. B

12. B

Chapter 13: Vital Signs

13. D

14. B

15. A

16. A

17. C

18. D

3.R.CCOM TESTBANKSELLE

418 Chapter 15: The Gastrointestinal System

14. A

15. C

Chapter 17: The Reproductive System

10. C

11. D

12. D

10. C

13. B

11. A

14. A

12. D

15. D

3.LL CER.COM TESTBANKS1E

16. C

14. D

17. B

15. C

Chapter 16: The Urinary System

Chapter 18: The Integumentary System

10. C

10. B

11. B

11. A

12. D

12. B

13. C

13. A

419 14. D

14. B

15. B

15. D

Chapter 19: The Circulatory or Cardiovascular System

Chapter 21: The Musculoskeletal System

10. A

10. C

11. B

11. C

12. D

12. C 13. C

13R . .DCOM TESTBANKSELLE

14. D Chapter 20: The Respiratory System 1.

10. C 11. B 12. B 13. C

14. C 15. C Chapter 22: The Nervous System 1.

10. C 11. D 12. B 13. C

420 14. A

11. C

15. C

12. B

16. B

13. A

17. C

14. B

Chapter 23: The Endocrine System

15. D

16. D

17. C

Chapter 25: Rehabilitation and Restorative Care

10. D

11. D

TESTBANKS8E. LLCER.COM

12. C

13. C

10. D

14. D

11. C

15. B

12. D

Chapter 24: The Immune and Lymphatic Systems and Cancer

13. C

10. D

14. C 15. A 16. D 17. C 18. B Chapter 26: Subacute Care 1.

421 6.

10. A

10. D

11. B

11. A

12. B

12. D

13. D

13. B

14. C

Chapter 27: End-of-Life Care 1.

10. A 11. B 12. A 13. D 14. C 15. B 16. D Chapter 28: Your New Position 1.

422

423

Appendix G Final Exam

Name: ��

424 1.

Which of the following is a task that nursing assistants commonly do? (A) Give medication (B) Bathe residents (C) Change sterile dressings (D) Give tube feedings

What is the term for a device that replaces a missing body part? (A) Pronation (B) Prone (C) Personal protective equipment (D) Prosthesis

One reason that the Health Insurance Portability and Accountability Act (HIPAA) was passed is to (A) Make sure nursing assistants receive adequate pay (B) Protect privacy of health information (C) Ensure that care procedures are performed properly (D) Prevent abuse of residents

Which of the following is an example of professional and ethical behavior by a nursing assistant? (A) Keeping quiet if he makes a mistake (B) Documenting care accurately and promptly (C) Telling his friend details about the residents he works with (D) Rushing a resident through tasks if there is not much time left in the nursing assistant’s shift

Which of the following is an example of nonverbal communication? (A) Writing a note in a resident’s chart (B) Giving an oral report to a supervisor (C) Smiling at a new resident (D) Speaking in an encouraging tone of voice to a resident who is moving slowly

Which of the following types of health care 9. To maintain proper body mechanics while liftis generally for people who will die in six ing or carrying an object, a nursing assistant months or less? should: (A) Long-term care (A) Hold the object out and away from her (B) Outpatient care TESTBANKSELLERb.oC dyOM (C) Inter-generational care (B) Face the object or person she is moving (D) Hospice care (C) Twist at the waist as she picks up the object Exercises that put each joint through its full arc of motion are called (D) Try to keep her center of gravity as high (A) Weight lifting as possible (B) Stretch and relax 10. When is it appropriate to use medical (C) Range of motion terminology? (D) Rotation (A) When communicating with the care team (B) When communicating with residents Which of the following statements is true of a (C) When communicating with residents’ nursing assistant’s role in restorative care? (A) If a resident takes too long to do a task by families (D) When communicating with visitors himself, the nursing assistant should do it for him. 11. How many times can disposable gloves be (B) The nursing assistant should give the worn before being discarded? resident pain medication just before the (A) Multiple times, as long as they are rehabilitation session begins. washed in between uses (C) The nursing assistant should recognize (B) Three times that setbacks occur and be reassuring. (C) Two times (D) The nursing assistant should tell the (D) One time family that progress is happening faster than it really is so they can feel better about the situation.

Name:

��

12. Which of the following statements contains objective information? (A) Mr. Castillo seems a little grouchy today. (B) Mr. Castillo says that he has a stomachache. (C) Mr. Castillo’s blood pressure is 115/68. (D) Mr. Castillo does not get along with the nurses very well. 13. Which of the following is the correct way to remove a gown? (A) Unfasten gown at neck and waist and drop it to the floor. (B) Unfasten gown at neck and waist and pull the gown over the head. (C) Unfasten gown at neck and waist and pull the gown from the outside of the chest area until it comes off. (D) Unfasten gown at neck and waist and roll the dirty side in while holding gown away from the body. 14. If a resident is hearing impaired, a nursing assistant should (A) Approach the resident from behind (B) Make sure the light is on the nursing

425 17.

Which of the following is a physical need? (A) Social interaction (B) Intellectual stimulation (C) Food (D) Spirituality

18.

With which of the following people may an NA share a resident’s medical information? (A) NA’s friend (B) Resident’s doctor (C) Resident’s friend (D) Resident’s priest

19.

Which of the following is true of most elderly people? (A) They have many interests. (B) They do not manage money well. (C) They are grumpy. (D) They do not like to leave home.

20.

Making an area or object completely free of all microorganisms is called (A) Infection prevention (B) Disinfection (C) Transmission (D) Surgical asepsis

TESTBANKSELLER.COM

assistant’s face (C) Raise the pitch of her voice (D) Chew gum while speaking to the resident

15. An NA should use friction for at least �� seconds when washing her hands. (A) 20 (B) 30 (C) 35 (D) 60 16. The federal government requires �� hours of continuing education for nursing assistants each year. (A) 10 (B) 12 (C) 15 (D) 18

21. One way for a nursing assistant to communicate effectively with a visually-impaired resident is to (A) Wait until the resident speaks to her before identifying herself (B) Move the furniture in the resident’s room to make it easier for him to get around (C) Avoid talking to the resident during care (D) Use the face of an imaginary clock to explain the position of objects

22. Which of the following remarks is a cliché? (A) “Would you like me to go with you?” (B) “I understand you’re feeling scared.” (C) “How can I help?” (D) “It will all work out in the end.” 23. Infection prevention is (A) The way in which infections occur (B) An infection limited to a specific part of the body (C) A set of methods used to prevent the spread of disease (D) An object that has not been contaminated with pathogens

426 24. In military time, 7:45 p.m. is (A) 0745 hours (B) 1975 hours (C) 1945 hours (D) 0775 hours 25. In which type of environment do microorganisms grow best? (A) Bright (B) Light (C) Cold (D) Dark 26. In which of the following procedures must a nursing assistant always wear gloves? (A) While shaving a resident (B) While performing range of motion exercises (C) While dressing a resident (D) While repositioning a resident 27. An axillary temperature is measured (A) In the armpit (B) In the rectum (C) In the mouth (D) In the ear 28. How should an NA work when helping a resident with range of motion exercises? (A) Begin at the shoulders and work down the body (B) Begin at the feet and work up the body (C) Begin at the fingertips and work inward (D) Begin at the knees and work up to the shoulders 29. A(n) �� is the permanent and painful shortening of a muscle or tendon. (A) Contracture (B) Abrasion (C) Pressure ulcer (D) Fracture 30. Which of the following is used when documenting the amount of fluid a resident drinks? (A) Feet (B) Cups (C) Milliliters (D) Inches

Name: �� 31. A good way for an NA to help new residents adjust to life in the facility is to (A) Think about how it would feel to have to move into a facility (B) Tell the resident how much work it is to care for him (C) Cover up any mistakes to make the resident feel more confident about the facility’s care (D) Push residents to join in activities even if they say they do not want to 32. An appropriate resource for an NA to turn to if he is experiencing stress is (A) His resident (B) His resident’s family (C) His supervisor (D) His resident’s friends 33. Which of the following behaviors promotes Residents’ Rights? (A) Deciding which clothing a resident should wear if she takes too long to decide for herself (B) Letting residents know when they are eating too slowly (C) Providing privacy during all care procedures (D) Restricting visitors for uncooperative residents 34. Which of the following is an example of a whole grain food? (A) Whole wheat bread (B) Hard-boiled egg (C) White rice (D) Raw strawberries 35. Which of the following is a guideline that the NA should follow when assisting with bladder retraining? (A) The NA should encourage the resident to drink plenty of fluids even if incontinence is a problem. (B) The NA does not need to keep a record of the resident’s bladder habits. (C) The NA does not need to wear gloves when handling body wastes. (D) The NA should let the resident know when he or she is taking too long to urinate.

Name:

��

36. In which position is a resident if he is lying flat on his back with his head and shoulders supported by a pillow? (A) Lateral position (B) Sims’ position (C) Supine position (D) Prone position 37. Which of the following is an example of a plant-based protein? (A) Fried chicken (B) Refried beans (C) Roasted turkey (D) Poached salmon 38. When transferring a resident who has a weaker side, (A) The weaker side moves first (B) The stronger side moves first (C) Both sides move at the same time (D) It does not matter which side moves first

427 43. Which of the following occurrences is considered an incident and requires a report to be completed? (A) A nursing assistant arrives late for her shift. (B) A resident falls. (C) A resident requests a food item that is not included in his special diet. (D) A resident shows signs of improvement. 44. Which method of taking temperature is considered to be the most accurate? (A) Oral (B) Rectal (C) Tympanic (D) Axillary 45. The normal pulse rate for adults is (A) 25 to 50 BPM (B) 60 to 100 BPM (C) 100 to 150 BPM (D) 150 to 175 BPM

39. According to the USDA’s MyPlate, most fruit choices should be 46. If a nursing assistant sees a resident being (A) Fruit smoothies sexually abused, she should (B) Whole fruit (A) Remove the resident from the situation (C) Fruit juice immediately and report it to the nurse (D) Fruit-flavored drinks (B) Pretend not to see it to avoid embarrassing the resident 40. What does the abbreviation ADLs stand for? (C) Call the police to report the abuse (A) Activities of daily living (D) Confront the abuser herself (B) As doctor likes (C) After doctor leaves 47. Rapid breathing, over 20 breaths per minute, (D) Active data learning is called (A) Eupnea 41. Which of the following terms describes a bed (B) Apnea that is made while a person is in the bed? (C) Dyspnea (A) Occupied bed (D) Tachypnea (B) Open bed (C) Closed bed (D) Unoccupied bed 42. Which of the following shows the correct conversion of 4:00 p.m. to military time? (A) 1300 hours (B) 1400 hours (C) 1500 hours (D) 1600 hours

48. Draw sheets are used to (A) Keep the bed covers from pushing down on residents’ feet (B) Make residents more comfortable (C) Prevent the bed from getting wet from episodes of incontinence (D) Prevent skin damage caused by shearing 49. The normal respiration rate for adults is (A) 18 to 30 breaths per minute (B) 15 to 25 breaths per minute (C) 12 to 20 breaths per minute (D) 8 to 10 breaths per minute

428

Name: ��

50. Which is/are the most essential nutrient(s) for life? (A) Protein (B) Carbohydrates (C) Vitamins (D) Water

57. At which angle should residents be positioned for eating? (A) 180 degrees (B) 120 degrees (C) 100 degrees (D) 90 degrees

51. Which of the following abbreviations means nothing by mouth? (A) NBM (B) NOC (C) NPO (D) NWB

58. Which of the following blood pressure readings falls within the normal range? (A) 110/75 (B) 135/90 (C) 91/70 (D) 140/80

52. The artificial opening in the abdomen for an ostomy is called a(n) (A) Stoma (B) Stool (C) Bag (D) Anus

59. Which type of toileting equipment is used for elimination for residents who cannot assist with raising their hips onto a regular bedpan? (A) Fracture pan (B) Urinal (C) Portable commode (D) Raised toilet seat

53. How many ounces are equal to 90 milliliters? (A) 3 ounces 60. A(n) �� stocking is a special stocking that can help promote circulation. (B) 30 ounces (A) Sheer (C) 90 ounces (D) 120 ounces (B) Clotting ng TESTBANKSELL(CE) RR.oCtaOtiM 54. In which direction should the NA wipe when (D) Anti-embolic providing perineal care? (A) Wipe from front to back 61. A �� urine specimen can be collected any time the resident voids. (B) Wipe from back to front (A) Routine (C) Wipe the anal area then the genital area (B) Clean-catch (D) Use the same area of the washcloth for (C) 24-hour each stroke (D) Sterile 55. The medical term for skin that is blue or gray is 62. To monitor a resident’s pulse rate, the NA will (A) Dermatitic most commonly check the �� pulse. (B) Cyanotic (A) Radial (C) Dysphagic (B) Brachial (D) Necrotic (C) Carotid (D) Temporal 56. What is one of the first signs that a pressure ulcer is forming? 63. Which of the following canes has four rubber(A) Cool skin tipped feet? (B) Numb skin (A) Curved cane (C) Shallow crater on the skin (B) Functional grip cane (D) Discoloration of the skin (C) C cane (D) Quad cane

Name:

��

64. The process of breathing in and out is called (A) Inspiration (B) Respiration (C) Expiration (D) Expansion 65. The most common form of diabetes is (A) Type 2 diabetes (B) Type 1 diabetes (C) Pre-diabetes (D) Gestational diabetes 66. When a resident uses a cane, walker, or crutches, the nursing assistant should (A) Stay on the resident’s stronger side (B) Stay on the resident’s weaker side (C) Walk in front of the resident (D) Walk behind the resident 67. HIV can be transmitted by (A) Telephones (B) Toilets (C) Hugs (D) Blood 68.

69.

70.

71.

429 72. Which of the following is a care guideline for residents recovering from a CVA? (A) The NA should do as much as possible for the resident so that care can be completed more efficiently. (B) The NA should encourage resident to finish tasks as quickly as possible to help speed recovery. (C) The NA should assist with ambulation to prevent falls. (D) The NA should place food in the affected/weaker side of the mouth when helping the resident eat. 73. Tuberculosis is (A) A bloodborne disease (B) A sexually transmitted disease (C) An airborne disease (D) Completely eradicated (no longer exists)

74. Which of the following statements is true of Alzheimer’s disease (AD)? (A) Skills a person has used over a lifetime are usually kept longer. (B) Residents with AD will show the same The best time to collect a sputum specimen is (A) Early in the morning signs at the same times. (B) After the resident has eaten a meal (C) NAs should not allow residents with AD (C) Right before bedtime to perform tasks independently. (D) Right before lunch (D) Alzheimer’s disease is a normal part of aging. When a muscle weakens, wastes away, and decreases in size, it is called 75. The best way for an NA to provide foot care for a diabetic resident is to (A) Dystrophy (A) Inspect and clean resident’s feet every (B) Atrophy day (C) Contracture (B) Clip resident’s toenails whenever they are (D) Dislocation long Generally speaking, which is the last sense to (C) Use lotion between the toes to prevent leave a dying person? dryness and cracking (A) Sense of sight (D) Use hot water for bathing the feet to help (B) Sense of hearing prevent infection (C) Sense of touch (D) Sense of smell 76. Which of the following is the best way an NA can communicate with a resident who has Baseline vital signs are cancer? (A) Vital signs that are out of normal range (A) The NA should listen to the resident if he (B) Normal ranges for vital signs feels like talking. (C) Initial values that can be compared to (B) The NA should give the resident medical future measurements advice if the resident asks for it. (D) Changes in vital signs from one measure(C) If the resident is worried, the NA should ment to another tell him, “It’ll all be fine.” (D) The NA should insist that the resident tell the NA what he is going through.

430 77. A resident with diabetes should (A) Skip meals when he is not hungry (B) Go barefoot most of the time (C) Receive careful foot care (D) Avoid regular exercise 78. To convert four ounces to milliliters, the NA should multiply four by (A) 15 (B) 20 (C) 25 (D) 30 79. Which of the following thermometers is used to take a temperature from the ear? (A) Oral thermometer (B) Rectal thermometer (C) Tympanic thermometer (D) Axillary thermometer

Name: �� 84. What member of the care team might help a resident learn to use adaptive devices for eating or dressing? (A) Speech-language pathologist (B) Occupational therapist (C) Activities director (D) Registered dietitian 85. Orthotic devices are used to (A) Keep joints in correct position and improve function (B) Assist residents with activities of daily living (C) Maintain proper body alignment (D) Prevent rubbing, irritation, and pressure ulcers

86. Which of the following statements is true of documentation? (A) NAs should document care right after it 80. Which of the following statements is true of has been done. HIV and AIDS? (B) NAs should document care the next day (A) AIDS can be cured. before beginning work again. (B) Having unprotected sex puts a person at (C) NAs should document care before it is a high risk for HIV/AIDS. done if there will not be enough time to (C) Standard Precautions do not need to be do it later. practiced on a person with AIDT SE . STBANKSELLER.COM (D) NAs should let residents help document (D) A person with HIV can be fired because their own care. of the disease. 81. Alternate communication methods for a resident with an artificial airway include (A) Playing charades (B) Shouting at the resident (C) Asking the resident’s family what they think he wants (D) Using communication boards

87. In order for an object to be called clean in a healthcare setting, it must be (A) Contaminated with pathogens (B) Soaked in water (C) Washed in hot water, then dried with a clean towel (D) Free of pathogens

82. Which of the following shows the correct conversion of 1900 hours to standard time? (A) 7:00 a.m. (B) 10:00 a.m. (C) 7:00 p.m. (D) 10:00 p.m.

88. In which of the following parts of the body are mucous membranes found? (A) Neck (B) Hands (C) Mouth (D) Legs

83. In what position should residents eat? (A) Reclining at an angle (B) Resting flat on their backs (C) Sitting upright (D) Lying on their sides

89. Hypertension is the medical term for (A) Rapid heartbeat (B) Rapid pulse rate (C) Difficulty swallowing (D) High blood pressure

Name:

��

90. The chain of command is (A) A legal term meaning a person can be held responsible for harming someone else (B) The person in charge of the department for each shift (C) The line of authority in a facility (D) The department that a nursing assistant goes to if he wants to report a problem 91. Which of the following is an ombudsman’s responsibility? (A) Advocates for staff members involved in disputes with management (B) Resolves facility budget problems (C) Advocates for residents and helps settle disputes (D) Organizes activities and outings for residents 92. Nursing assistants are not allowed to (A) Change sterile dressings (B) Bathe residents (C) Help residents use walkers (D) Assist with toileting needs

431 96. Which of the following statements is an example of a fact? (A) Mrs. Christensen weighs 142 pounds. (B) Mrs. Christensen is too thin. (C) Mrs. Christensen seems happy when the facility offers meatloaf for dinner. (D) Mrs. Christensen is lonely. 97. How should a fracture pan be positioned? (A) With the handle toward the head of the bed (B) With the handle toward the foot of the bed (C) With the handle facing the side the nursing assistant is standing on (D) With the handle facing the window 98. A type of care that focuses on comfort and pain relief is called (A) Psychosocial care (B) Adult day care (C) Palliative care (D) Curative care

99. Where should the call light be placed when a nursing assistant leaves a resident’s room? T ES T B A N KSELLER. (C A)OM On the bedside table 93. Which member of the care team assesses (B) Next to the television remote residents, monitors progress, and gives treatments? (C) Within the resident’s reach (A) The nurse (D) On a chair next to the resident’s bed (B) The nursing assistant 100. Blood pressure is measured using a (C) The medical social worker (A) Thermometer (D) The registered dietitian (B) Watch (C) Finger 94. A temporal artery thermometer measures temperature via which site? (D) Sphygmomanometer (A) The ear (B) The rectum (C) The mouth (D) The forehead 95. A nursing assistant should reposition bedbound residents at least every (A) Two hours (B) Three hours (C) Ten minutes (D) Twenty minutes

432

433

Appendix H Answer Key for Final Exam

434 1. B

35. A

2. D

36. C

3. C

37. B

4. D

38. B

5. C

39. B

6. C

40. A

7. B

41. A

8. B

42. D

9. B

43. B

10. A

44. B

11. D

45. B

12. C

46. A

13. D

47. D

14. B

48. D

15. A

49. C

16. B

50. D

17. C

51. C

18. B

52. A

19. A

53. A

20. D

54. A

21. D

55. B

22. D

56. D

23. C

57. D

24. C

58. A

25. D

59. A

26. A

60. D

27. A

61. A

28. A

62. A

29. A

63. D

30. C

64. B

31. A

65. A

32. C

66. B

33. C

67. D

34. A

68. A

435 69. B 70. B 71. C 72. C 73. C 74. A 75. A 76. A 77. C 78. D 79. C 80. B 81. D 82. C 83. C 84. B 85. A 86. A 87. D 88. C 89. D 90. C 91. C 92. A 93. A 94. D 95. A 96. A 97. B 98. C 99. C 100. D

436

437

Appendix I Workbook Answer Key and Practice Exam Answer Key

438 Chapter 1: The Nursing Assistant in Long-Term Care

Learning Objective 7 1.

Answers will vary, but could include something about accepting responsibility and letting her supervisor know it won’t happen again.

Answers will vary, but could include something about keeping the resident’s information confidential and not gossiping with coworkers.

Answers will vary, but could include something about respecting residents’ beliefs and not trying to change them.

Answers will vary, but could include something about listening to the resident, not judging the resident, and not discussing personal problems.

Answers will vary, but could include not rushing the resident and allowing the resident to complete the task at his own pace.

Learning Objective 2 1.

Learning Objective 3 1.

T 6.

Learning Objective 4 1.

Answers will vary, but could include something about remaining positive, motivated, and professional, and not discussTESTBANKSELLERin.gCpOerMsonal feelings.

Learning Objective 5 1.

Activities of daily living (ADLs) are personal daily care tasks, such as bathing, skin, nail, and hair care, walking, eating and drinking, mouth care, dressing, transferring, and toileting.

Answers will vary, but could include something about writing down tasks and asking questions when something needs to be explained again.

Answers will vary, but could include something about being open and nonjudgmental and not making prejudiced comments.

Learning Objective 8 1.

Answers will vary.

Learning Objective 6

Learning Objective 9

439 5.

Policy

Policy manual

Procedure

Procedure manual

10. E Learning Objective 10

Learning Objective 13

Learning Objective 14 1.

Authority

Nurse

Charge

Liability

Chapter 2: Ethical and Legal Issues

Learning Objective 11 1.

Learning Objective 2 Answers include the following: Is there a 1. A match between the resident’s needs and the nursing assistant’s skills, abilities, and 2. C experience? What is the level of resident 3. B stability? Is the nursing assistant the right person to do the job? Can the nurse give 4. D appropriate direction and communicaLeRar.nC inO gM Objective 3 tion? Is the nurse availablT eE toSgT ivB e tAhN e KSELLE supervision, support, and help that the Across nursing assistant needs? 1. Respect Answers include the following: Do I have all the information I need to do this job? 2. Empathy Are there questions I should ask? Do I 5. Confidential believe that I can do this task? Do I have the necessary skills? Do I have the needed 6. Gifts supplies, equipment, and other support? Down Do I know who my supervisor is, and how to reach him/her? Have I told my supervi1. Report it sor of my special needs for help and sup3. Tactful port? Do we both understand who is doing what? 4. Honest Answers include the following: Ask for help. Talk to the nurse.

Learning Objective 12 1.

Learning Objective 4 1.

All revolve around the idea that a resident, patient, or client is a valuable person who deserves ethical care.

Answers include the following: reporting mistakes I make, and reporting anything I deem dangerous to the right person.

440 3.

Report any suspected abuse to the proper person immediately.

Learning Objective 5 1.

All answers will vary, but should somehow relate to the Residents’ Right in question.

10. S 11. U

Learning Objective 8

Learning Objective 6

Learning Objective 7

10. F Learning Objective 9 1.

TESTBANKSELLER.COM Learning Objective 10 1.

The ombudsman is a legal advocate for residents.

Answers include the following: a group of specially-selected people may investigate reports of abuse that occur in healthcare facilities; state agencies that can assist people with concerns about a facility; State Department of Health; State Department of Health and Human Services; and legal aid society.

12. A 13. R 14. Q 15. N 16. L 17. C

Learning Objective 11

18. T

19. B

20. M

21. G

Multiple Choice

441 Learning Objective 12 1.

NA, resident, or others use words that are not understood. Do not use medical terminology with residents or their families. Use simple, everyday words. Do not pretend to understand what a word means. Ask what a word means if you are not sure.

NA gives advice. Do not offer your opinion or give advice. Giving medical advice is not within the scope of your practice. It could be dangerous.

NA asks questions that only require yes/ no answers. Ask open-ended questions that need more than a yes or no answer.

NA responds with “Why not?” Why questions make people feel defensive.

Chapter 3: Communication Skills Learning Objective 2 1.

Short Answer 1.

Resident speaks a different language. Speak slowly and clearly. Keep your messages short and simple. Be alert for words the resident understands. Be alert for signs the resident is only pretending to understand you. Use pictures and gestures to communicate. Ask the resident’s TESTBANKSELLER.COfMamily, friends, or other staff members who speak the resident’s language for help. Be patient and calm.

Learning Objective 3 1.

NA asks questions that only require yes/ no answers. Ask open-ended questions that need more than a yes or no answer. Resident is difficult to understand. Be patient. Take the time to listen. Ask the resident to repeat or explain. State the message in your own words to make sure you have understood.

Learning Objective 4 1.

Learning Objective 5 1.

442 Learning Objective 6

Learning Objective 10

Retrieved

Legible

Computer

Password or log-in ID

Personal, websites

HIPAA

10. D

11. M

Learning Objective 11

Learning Objective 12

12. K

13. H

14. I

15. J

Learning Objective 7

TESTBANKSELLER.COM

1410

0430

1000

Short Answer

2025

6:00 a.m.

11:20 p.m.

7:27 p.m.

6:00 p.m.

Learning Objective 8 1.

Learning Objective 9

10. S

11. O

12. O

13. S 14. S

443 15. S

Learning Objective 17

16. O

Residents signal staff that they need them by using the facility call system. It allows residents to call for help when needed.

The call system is a resident’s lifeline. Ignoring call lights can be considered abuse and/or neglect.

17. O 18. S Short Answer 19. Answers include the following: Sight: Look for changes in appearance, such as redness, swelling, rashes, discharge, change in the eyes or ears, or ability to move. Hearing: Listen to what the resident tells you. Make sure he is making sense. Check to see if his breathing is normal. Note if he is coughing or gasping. Report if he is showing emotions, such as anger or sadness. Smell: Check for odors coming from the resident’s body or mouth. Touch: Note if the skin seems hot or cold. Check to see if it is dry or moist. Learning Objective 13

Learning Objective 18 1.

Falls, pain, move

Residents

Admissions, discharges

Pulse, pressure ulcer

Rounds

Learning Objective 19 1.

LeRar.nC inO gM Objective 20 TESTBANKSELLE

Across

Combining

Prioritizing

Help

Down

Learning Objective 14

Call light

Organizing

Schedule

Learning Objective 15

Chapter 4: Communication Challenges Learning Objective 2

Learning Objective 16

444 Learning Objective 3

Eyes, fists

Silent

Care conference

Learning Objective 4

Caused

Argue

Activities

Assertive, aggressive

Learning Objective 5

Anxiety is unease or worry, often about a situation or condition.

Answers include the following: nausea, shaking, sweating, chest pain, and palpitations.

Answers include the following: Knock on the door, announce yourself, and greet the resident as soon as you enter theTrEoS om T. Do not touch him before you have identified yourself. Speak softly. Reduce the noise level. Speak slowly and calmly. Listen to the resident. Be patient. Ask gentle questions to try to identify the cause of the anxiety or fear. Be empathetic. Be calm and reassuring. Avoid demanding behavior.

Learning Objective 8

Learning Objective 9 Across 2.

Judge

Overreact

Masturbation

Down 1.

Clothes

Dementia

Privacy

Learning Objective 10 1.

Confusion is the inability to think clearly and logically. Disorientation is confusion about person, place, or time.

Answers include the following: who the resident is; who the nursing assistant is; the city, state, and facility he is in; and the correct time.

Answers include the following: urinary tract infection; low blood sugar; head trauma or head injury; dehydration; nutritional problems; fever; sudden drop in body temperature; lack of oxygen; medications; infections; brain tumor; illness; loss of sleep; seizures; and not using a hearing aid when it is necessary.

Answers include the following: Use short, simple sentences. Break tasks into steps.

Learning Objective 6 1.

Learning Objective 7 1.

Anger

Independence

445 Learning Objective 11

Learning Objective 6

Learning Objective 12

Learning Objective 7

Breathing, mouth, lips, airway

Palate

Across

Tracheostomy

Substance abuse

Write down

Nurse

Oxygen

Boundaries

Dentures

Cliché

Empathetic

Down

Chapter 5: Diversity and Human Needs and Development Learning Objective 2

Scope of practice

Interrupt

Learning Objective 8

Learning Objective 3

TESTBANKSELLER.4.COTM

Matching

Learning Objective 4

Need

Belong

Physical

Anxiety

Dependent

Self-actualization

Learning Objective 5

Learning Objective 9

446 7.

Chapter 6: Infection Prevention

Learning Objective 2

10. A

Short Answer

Answers will vary, but could include that the NA should keep what she saw confidential and not gossip about it.

Answers will vary, but could include that the NA needs to knock and wait for permission before entering. The nursing assistant should keep what she saw confidential and not gossip about it.

Answers include the following: illness, disability, living environments, lack of privacy, and no available partner.

10. B

Learning Objective 10

Learning Objective 3 1.

Growth

Development

Motor

Moral

Cognitive

Social

Sexual

Multiple Choice

TESTBANKSEL5L. ERT.COM

Learning Objective 4 1.

The chain of infection describes how disease is transmitted from one being to another.

One

Causative agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host

Learning Objective 11 1.

Learning Objective 5 1.

Learning Objective 6 Learning Objective 12 1.

CDC

Transmission-Based Precautions

Infected

Contagious

Mask, goggles

447 6.

Biohazard

Don gloves immediately

Personal, equipment

Contaminated

Immediately wash that area using the proper cleaning agent and follow exposure incident guidelines

Cleanest, dirtiest

Learning Objective 7 1.

Learning Objective 11 1.

Learning Objective 12 1.

Answers include the following: gives them a connection to the outside world, and helps reduce loneliness.

Learning Objective 8 1.

Disposable

Answers include gloves, gowns, masks, goggles, face shields, extra plastic bags, and laundry bags.

Learning Objective 13 1.

OSHA

Bloodborne Pathogen

Exposure incident

Exposure control

Across

Infected blood, body fluids

Biohazard

Hepatitis B

Inside

Shake

Short Answer A check mark should be marked next to numbers 1, 3, 5, 6, and 8. Learning Objective 9

Learning Objective 14 1.

Down

Disposable

Gloves

CDC

Learning Objective 10 1.

Spilled blood, body fluids, and other fluids increase the risk of infection, and, in addition, spills put residents and staff at risk for falls.

Learning Objective 15 1.

448 5.

Clear

Bottom

Sharp

Learning Objective 5

10. F

Chapter 7: Safety and Body Mechanics

Learning Objective 2

Multiple Choice

Learning Objective 6 1.

TESTBANKSELLER.COM

10. T 11. F

Learning Objective 7

12. T

Restraint-free

13. F

Restraint alternatives

14. T

Call lights

Exercise

Wander

Social

Caregivers

Noise

Music

Learning Objective 3 1.

Answers include the following: the chemical ingredients of the product; the dangers of the product; what to wear when using certain chemicals; the correct method of using and cleaning up a chemical; the emergency response actions to be taken when a chemical is splashed, sprayed, or ingested by a person; and the safe handling, storage, and disposal procedures for the product. Where they are located and how to read them

Learning Objective 4 1.

Gloves

Learning Objective 8 Across 2.

Cyanotic

Discipline

Fifteen

449 Down 1.

Two

Call light

Learning Objective 9 1.

Learning Objective 10 1.

Medication, fluids

Gloves

Blood pressure

Kinked

Pump, alarm

Catheter

Infiltration

Pain, breathing

Learning Objective 11 1.

Learning Objective 12 1.

Chapter 8: Emergency Care, First Aid, and Disasters Learning Objective 2 1.

Assess the situation and assess the victim

Ask the injured or ill person what has happened. Determine whether the person is conscious. Tap the person and ask if he is all right. Speak loudly. Use the person’s name if known. If there is no response, assume that the person is unconscious. Call for help right away, or send someone else to call.

Learning Objective 3 Across 2.

Emesis

Cardiac arrest

Syncope

Down 1.

Respiratory arrest

TESTBANKSELLER.3.COAMbdominal thrusts 4.

CPR

True or False 1.

10. T 11. F 12. F 13. F 14. T 15. T

450 16. F

Chapter 9: Admission, Transfer, Discharge, and Physical Exams

17. T

Learning Objective 2

18. T Matching 1.

Answers include the following: look at information from federal agencies, ask for recommendations from friends, review facilities’ results from past state surveys or inspections, check to see if the facility has been accredited by the Joint Commission, and visit each facility they are considering.

Answers will vary.

Learning Objective 3 1.

Answers will vary, but may include the following: he could be more empathetic and caring; he needs to keep other resident information confidential; he could ask questions to try to find out how she is feeling; he could report to his supervisor that the resident seems depressed; and he should not document a guess regarding vital signs.

Answers include the following: New resi-

10. D 11. F 12. M 13. I

enCtsOm TESTBANKSELLERd. May have been independent for a

Learning Objective 4 1.

Emergencies

Fire, cardiac arrest

Code team

Cart

Chest compressions

Learning Objective 5

long time. They may be moving from family members’ homes. The move into a facility may have been sudden due to health reasons. They may have had to leave their home and get rid of their personal belongings. They may have had to give away beloved pets. Loved ones may have died. Learning Objective 4 1.

Answers will vary.

Answers include the following: Respond calmly and skillfully. Be responsible and efficient. Listen carefully to all directions. Know what your responsibilities are. Follow instructions. Know the locations of all exits and stairways. Know where the fire alarms and extinguishers are located. Emphasize that everyone should keep calm in an emergency. Take advantage of classes on disasters and disaster drills and pay close attention to the instructions.

10. F

451 Learning Objective 5 1.

Skilled

Change, ill, worsened

Smooth

Pack

Introduce

Nurse

is taking; her roommate keeping the light on during the night; and roommate’s need to have aides help during the night. 2.

Answers will vary but could include the following: eliminating caffeine from the diet late in the day, listening to the resident or finding help for her grief, and doctors and nurses evaluating her medication.

Answers include the following: decreased mental function, reduced reaction time, decreased immune system function, and irritability.

Learning Objective 6 1.

Learning Objective 7

Learning Objective 5 A check mark should be marked beside numbers 1, 3, 5, 6, and 8.

True or False

Chapter 10: Bedmaking and Unit Care

Learning Objective 2

Learning Objective 6

Sleep, energy

Cells, organs

Biorhythms

Circadian rhythm

Learning Objective 3 1.

Learning Objective 4 1.

Answers will vary, but may include the following: having caffeine late in the day; death of her husband; new medication she

Learning Objective 7 1.

Chapter 11: Positioning, Moving, and Lifting Learning Objective 2 1.

Assess

Plan

Support, footing

452 4.

Face

Chapter 12: Personal Care

Straight

Learning Objective 2

Legs

Tighten

Push

Learning Objective 3

10. F 11. F 12. T Learning Objective 3

Partial bath is best suited to a resident who has drier, fragile, and more sensitive n,Osh Short Answer TESTBANKSELLERsk.iC Mould not have daily full baths, is unable to get up to take a shower or tub 1. Every two hours and every 15 minutes for bath, and/or wants a quick bath before a wheelchairs meal and plans on taking a shower or bath later in the day. 2. Answers include the following: whiteness, redness, and warm spots, especially Shower is best suited to a resident who is around bony areas. able to stand during a shower, and/or is able to safely sit in a shower chair. Learning Objective 4 10. H

Learning Objective 5 1.

Tub bath is best suited to a resident who is able to transfer into and out of a tub and/ or needs a special bath with an additive. Complete bed bath is best suited to a resident who is unable to get out of bed to shower or bathe, and requires a full bath. 2.

The decision first rests with the doctor, then with the resident.

Answers include the following: change in size of one or both pupils; difference in appearance from one eye to another; yellow or red color in whites of the eyes; changes in vision, ability to hear, and sense of smell; drooping on one side of the face; weight loss; drainage coming from any area, including eyes, ears, nip-

453 ples, or genitals; foul odors from any body area; pale, blue-tinged (cyanotic), white, reddened, or purple areas on the skin; dry, flaky, broken, or cracked skin; lumps or bumps on the skin; moles or spots on the skin, especially those that are red, white, yellow, dark brown, gray, or black; rashes or any skin discoloration; bruises; blisters; cuts, scrapes, or scratches; open sores or ulcers on any area of the body; changes in open sore, wound, or ulcer (color, size, drainage, odor, overall depth of sore); swelling/edema of any area, especially the knuckles, fingers, groin, abdomen, legs, ankles, or feet; poor condition of fingernails or toenails; nails in need of trimming; dry, cracked, or broken skin in between toes or toenails; itching or scratching; change in emotional state; change in level of mobility; complaints of pain or discomfort; stiff neck; and numbness, burning, warmth, or tingling in the extremities or other areas. Learning Objective 4 1. A check mark should be placed by numbers 3, 4, 6, and 8. Learning Objective 5 1.

It helps reduce the risk of transferring microorganisms from a dirty area to a clean area of the body.

Wash from cleanest to dirtiest

Learning Objective 6 1.

Learning Objective 7 1.

Learning Objective 8 1.

3. 4.

C B

Short Answer 1.

Answers include the following: dry, cracked, bleeding, or chapped lips; cold sores on the lips; raised areas; swollen, irritated, red, bleeding or whitish gums; loose, cracked, chipped, broken or decayed teeth; yellow-filled or red sores, such as canker sores inside the mouth; white spots inside the mouth; pus or drainage; coated or swollen tongue; bad breath or fruity-smelling breath; change in the resident’s ability to drink, suck on a straw, or swallow; gagging or choking; and resident reports of mouth pain.

Answers include the following: Collect and set up supplies. Cover overbed table. Raise head of the bed. Provide a bath towel for the chest. Pour water and mouthwash. Help clean the face and neck. Remove towel, overbed table cover, and all supplies. Empty, clean, and store supplies.

Labeling 1.

Eyes

Face

Ears

Neck

Arms, axillae, and hands

Chest and abdomen

Legs and feet

Back

Perineal area

10. Buttocks

454 Learning Objective 9 Across

17. F 18. T

Gloves

Chapter 13: Vital Signs

Crack

Learning Objective 2

Denture cup

Bridge

Hot

Eat

Down

Moderate

Dentures

H G

Learning Objective 10 1.

10. A

Learning Objective 11

Short Answer 1.

Answers include the following: Vital signs are important readings that tell how well TESTBANKSELLERth.eCoOrgMans of the body are working. They can indicate whether the body is healthy or ill. The first sign that a person is ill may be a change in his or her vital signs. When one or more vital signs is too high or too low, it signals a potential health problem.

Learning Objective 3

Learning Objective 4

10. T

There should be an X by numbers 1, 2, 4, 6, and 7.

11. F

Short Answer

12. F

13. F

14. T

15. F

16. F

455 7.

Across

Exercise

10. O

Hypertension

11. TA

Systolic

12. T

Hypotension

13. T

Down

Labeling

Orthostatic hypotension

101

Diastolic

98.2

Prehypertension

101.6

99.4

101

102.4

102

100.4

10. 97.6 Learning Objective 5 1.

Learning Objective 7

Learning Objective 8

TESTBANKSELLER.1.CO2M16/108, not in normal range 2.

136/88, yes in normal range

166/44, not in normal range

140/86, not in normal range

Learning Objective 9 1.

Answers will vary.

Because it is as important to monitor pain as it is to monitor the other vital signs

Answers include the following: Where is the pain? When did the pain start? How long does the pain last? How severe is the pain? Does the pain come and go? Have you experienced this pain before? If so, has anything helped to relieve it? What medicine, if any, do you take for the pain? Do you remember what you were doing when the pain started?

Answers include the following: increased pulse, respirations, blood pressure; sweating; nausea; vomiting; tightening the jaw; squeezing the eyes shut; holding a body part tightly; frowning; grinding teeth;

10. I 11. C 12. K 13. M Learning Objective 6 1.

456 increased restlessness; agitation or tension; change in behavior; crying; sighing; groaning; breathing heavily; and difficulty moving or walking.

Protein

Dairy

Short Answer

Chapter 14: Nutrition and Fluid Balance

Learning Objective 2

Across

Taste

Dysphagia

Malnutrition

V, F

Down 1.

Alzheimer’s disease

Nutrition

Teeth

10. D

Saliva

11. V

Learning Objective 3

12. P

Answers include the following: cultural and ethnic background; traditions in families and cultures; the country or

Short Answer

Answers will vary.

Recognize when you feel hungry and when you are full. Notice what you are eating. Stop eating when you feel satisfied.

Vegetables, fruits, whole grains, and fatfree or 1% milk and low-fat dairy products

Foods high in solid fats, added sugars, and salt

Answers include the following: cured meats, including ham, bacon, lunch meat, sausage, salt pork, and hot dogs; salty or smoked fish, including herring, salted cod, sardines, anchovies, caviar, smoked salmon, or lox; processed cheese and some other cheeses; salted foods, including nuts, pretzels, potato chips, dips, and spreads, such as salted butter and margarine; vegetables preserved in brine, such as pickles, sauerkraut, pickled vegetables, olives, and relishes; sauces with high concentrations of salt, including Worcestershire, chili, steak, and soy sauces; ketchup, mustard, and mayonnaise; commercially-prepared

Calorie balance is the relationship between the calories obtained from food and

B;ANKSELLERfl.uiCdO M area of the country that a personTiE s fSroTm s consumed and the calories used religious reasons; or may be vegetarian or during normal body functions and physivegan. cal activity.

Learning Objective 4 1.

10. W Learning Objective 5 1.

Vegetables

Fruits

Grains

457 foods such as breads, canned soups and vegetables, and certain breakfast cereals. 6.

Water

Learning Objective 6

Learning Objective 9 1.

Medical, unappetizing

Malnutrition

Report

Diet

Dentures, swallowing

Coldness, infections, sleeping

Learning Objective 7

Appetite

Clear liquid diet

Season

Low-protein diet

Diet cards

High-residue or high-fiber diet

10. Positive

Low-calorie diet

Soft diet

Fluid-restricted diet

High-protein diet

High-potassium diet

Pureed diet

10. Low-sodium diet

Learning Objective 10

TESTBANKSELLER.6.COTM

11. Low-residue or low-fiber diet 12. Full liquid diet

13. Mechanical soft diet 14. Bland diet 15. High calorie diet

Learning Objective 11 1.

17. Diabetic diet

18. Gluten-free diet

19. Lactose-free diet

16. Low-fat/low-cholesterol diet

20. Lacto-ovo vegetarian diet 21. Vegan diet

Learning Objective 12 1.

Always put food into the stronger, or unaffected, side of the mouth. Make sure food is swallowed before offering more bites.

Use physical and verbal cues if needed. Allow enough time to chew and swallow. Place food and drinks within the resident’s reach.

Read menus to them if needed. Allow enough time for decision-making on menu items. When assisting with eat-

Learning Objective 8 1.

458 ing, face them when speaking and use a normal tone of voice. Place plate or tray directly in front of residents. Use the face of an imaginary clock to explain the position of what is in front of them. If necessary, let residents know when to open their mouths and what food they are eating. 4.

Remind him to chew, and set the utensils down between bites. Use smaller cups and plates and put less food on plates. Ask the resident to open his mouth. Wait until the jaw relaxes to pull the utensil out of the mouth. Offer finger foods instead. Use smaller utensils, but do not use plastic utensils. Avoid using forks. Lightly press on the edge of the lips or on the chin to stimulate chewing. Show him how to chew by doing it yourself. Serve softer foods that require less chewing. Dip meats and other foods in sauce or gravy.

possible for denture replacement. Thickened liquids or soft or pureed diets may be ordered until dentures are replaced. 13. Make sure resident wears eyeglasses and that they are clean. Report to the nurse if eyeglasses are damaged or broken. Read menus out loud and describe food in front of the resident using the imaginary clock. 14. Use special straws and cups to help. A speech-language pathologist or a nurse may teach this resident to practice blowing a whistle to help him close his lips. 15. Touch his lower lip to encourage him to open the mouth. Identify each bite of food you offer. Do not feed sticky food such as peanut butter. 16. Seat him with residents who talk a lot and are very social. Make appropriate conversation while he is eating.

17. Remind him to lift his chin before taking a sip of fluid. Offer fluids when he has no food in his mouth. Do not distract the resident by talking while he is eating. The T E S T B ANKSELLER 8. Remind him to swallow after every bite. re.sC idO enMt should be seated, not standing, while drinking. After feeding a bite of food, lightly press an empty teaspoon against the lips to 18. Remind him to take another bite. Offer encourage the person to swallow the food. praise and encouragement. Do not rush 9. Ask him to chew and swallow the food. the person. Touch the outside of the cheek and ask 19. Make sure he is in an upright eating him to use his tongue to get the food. Use position, using good posture. A consultayour fingers on the cheek near the lower tion with a speech-language pathologist jaw, and gently push food toward teeth. may be ordered to help the resident learn Avoid offering food such as rice that can better swallowing techniques. If drooling stick inside the mouth or on dentures. interferes with basic safety, medications Give sips of fluids often. Check the mouth may be ordered to decrease the drooling. for food often before offering more food, Clothing protectors, towels, or pads may but do not place your fingers inside the be used to protect clothing. mouth. Ask the resident to open his mouth so that you can check for food. Ask 20. Seat him in a regular dining room chair resident not to stand up with food in his with armrests, rather than a wheelchair. mouth. Position him upright at a 90-degree angle. Knees should be flexed, and feet and arms 10. Remind him to close his lips. Show him should be fully supported. Push the chair how to close his lips if necessary. under the table and place his forearms on the table. 11. A dentist will do an assessment of oral health. Thickened liquids or soft or pu21. Ask him to keep his elbows on the table. reed diets may be ordered. Using a wheelchair wedge cushion may 12. Report it to the nurse immediately. A denhelp. tist will evaluate the resident as soon as 7.

Ask him to stop chewing. Offer smaller bites of food and feed softer foods that do not need as much chewing.

459 22. Using a geriatric chair may help. A wheelchair wedge cushion may also help. 23. A soft neck brace may stabilize the head. A wedge cushion behind the head and shoulders can help a resident in a geriatric chair. Learning Objective 13 1.

Learning Objective 14 1.

1920 mL

145 mL

Input 420 mL, output 480 mL

360 mL

450 mL

30 mL

7. 8.

540 mL 330 mL

24 oz

10. 540 mL Learning Objective 15 1.

Short Answer 1.

Encourage residents to drink fluids

Answers may vary but could include something about how the weight could prevent the resident from drinking water.

Learning Objective 16 1.

Enters, eliminated

Kidneys

Gain, breathing, increased

Swelling

Restrict fluids

Surgery, medical test, tube

Chapter 15: The Gastrointestinal System Learning Objective 2 1.

Learning Objective 3 1.

Gastrointestinal tract, accessory organs

Trachea

Small intestine

Peristalsis

Water, electrolytes

Ingestion, digestion, elimination

Learning Objective 4 1.

Learning Objective 5 1.

Learning Objective 6 1.

460 Learning Objective 7

Card should be checked to make sure it has not expired

Across

Retraining

10. C

Positive

11. D

Bedpan

12. G

Call lights

13. J

Down

14. L

Standard Precautions

15. E

Elimination habits

Perineal care

Learning Objective 8

Learning Objective 11

Learning Objective 12

TESTBANKSELLER.COM

Eliminating stool

Chapter 16: The Urinary System

Diagnostic test, surgery

Learning Objective 2

Tap, saline, soapsuds

Kidneys, ureters

Sims’

Urine

Pain

Shorter

Stool, straining

Waste, water

Learning Objective 9 1.

Learning Objective 3 1.

Learning Objective 4 1.

Learning Objective 10 1.

Occult, microscope, chemical

Learning Objective 5 1.

Growth and development: Aging affects the bladder’s ability to hold urine. Older

461 people may have to urinate more often. Urination during the night occurs more frequently with the elderly. The bladder may not completely empty, causing a higher risk of infection. In males, an inability to urinate properly may be due to enlargement of the prostate gland. 2.

Learning Objective 7 Across

Psychological factors: A lack of privacy can affect urination. Having a roommate for the first time, being in a place that is not home, and needing help with urination can disrupt normal elimination patterns. Stress and fear can affect urination. Depression can alter urination patterns. A person may not be motivated to change exercise habits and increase fluid intake.

Frustration

Call light

Brief

Fluid intake: The sense of thirst generally decreases as a person ages. Reduced fluid intake decreases urine production. The body’s ability to remove wastes in the urine may be affected. Drinking alcoholic beverages and caffeinated beverages increases urine production. Fluids high in sodium decrease urine output.

Down 1.

Perineal

Urinary incontinence

Privacy

Fluids

Learning Objective 8 1.

3. A Physical activity and exercT isE e:SATlB acA kN ofKSELLER.COM 4. B exercise lessens sphincter control. Childbirth can affect a woman’s muscle tone. Learning Objective 9 Indwelling catheters and trauma can affect muscle tone and increase risk of 1. A infection. 2. C Personal habits: If a resident is confined 3. B to bed, urination may be more difficult due to his position. Complete emptying of 4. D the bladder may be difficult when having Learning Objective 10 to use a bedpan or urinal. Medications: Some medications affect urination. Residents who have high blood pressure may be taking diuretics, which increase urine output.

Disorders: Fevers cause increased sweating and may decrease urine production. Diabetes, diseases of the bladder or urethra, infection, congestive heart failure, and arthritis can affect urination.

Learning Objective 6 1.

Learning Objective 11 1.

462 6.

Chapter 18: The Integumentary System

Learning Objective 2

Chapter 17: The Reproductive System

Organ

Learning Objective 2

Melanin

Ovulation

Protects, sensation, water

Gonads

Epidermis, dermis

Estrogen, progesterone

Receptors

Ovaries, vagina

Penis, erectile, prostate

Uterus

Testosterone

Sperm

Short Answer 1.

The skin, hair, nails, oil glands, sweat glands, subcutaneous tissue, and nerve endings

Answers include the following: protects internal organs from injury; protects the body against bacteria; prevents the loss of too much water; regulates body temperature; responds to heat, cold, pain, pressure, and touch; excretes waste products in sweat; and helps with production of vitamin D

Learning Objective 3 1.

Learning Objective 4 1.

Answers include the following: Sexual needs continue throughout a person’s life. All people, regardless of age, have sexual needs and desires. The ability to engage in sexual activities continues unless a disease or injury occurs.

Provide privacy and leave the area.

11. K

Learning Objective 5 1.

Learning Objective 3

10. I

463 Learning Objective 5

Chapter 19: The Circulatory or Cardiovascular System

Learning Objective 2

Fill in the Blank

Learning Objective 6 1.

Multiple Choice 1.

Lungs, oxygen

Cells, plasma

Atrium

Clot, bleeding

Pump blood

Nutrients

Aorta

Iron

Learning Objective 3 1.

TESTBANKSELLER.2.COTM

Learning Objective 7 1.

Open wounds increase the risk of infection because breaks in the skin are a way for bacteria and other microorganisms to enter the body. Non-sterile dressings are applied to dry wounds that have less chance of infection. Sterile dressings are required when the wound is new, open, or draining. They are also required when there is a higher risk of infection. Answers include the following: sterile dressings, sterile drapes or pads, and tubing and catheters. If any part of the sterile field becomes contaminated, the entire process must be re-started.

Learning Objective 4 1.

10. J 11. I 12. F

464 13. L

14. M

Chapter 20: The Respiratory System

Learning Objective 2

Learning Objective 5

Supply, remove

Respiration

Trachea

Lungs, inspiration

Speak

Pleura

Oxygen, carbon dioxide

Continuous

Alveoli

Short Answer

10. F

Nose, nasal cavity, pharynx, larynx, trachea, bronchi, lungs, and alveoli Answers include the following: serving as an air filter; cleaning the inhaT leE dS aiT r; supplying oxygen to body cells; removing carbon dioxide from the cells; and producing the sounds associated with speech.

Learning Objective 3

Learning Objective 6 Across 5.

Early morning

Saliva

Down 1.

Microorganisms

Sputum

Water

Mouthwash

Learning Objective 4

Learning Objective 7

Chapter 21: The Musculoskeletal System Learning Objective 2

Shape, structure

Move, support, protection, heat

Tissues, contracting, relaxing

Bones, skeleton

465 5.

Joints, flexibility

Short Answer

Ligaments, support

Answers include the following: Pad the cast edges as needed. Do not get the cast wet. Keep cast clean. Follow orders for moving and repositioning. Use pillows to assist with elevation. Help with range of motion exercises. Allow enough time to move. Assist with cane, walker, or crutches. Use bed cradles. Report numbness, tingling, or increased swelling; resident complaints of cast feeling too tight; pain, burning, or pressure; redness, drainage, bleeding, or sores of any kind; wetness in or around a cast; odor around the cast; changes in temperature of the skin; cyanosis or pale skin; or resident places sharp object inside the cast.

Answers include the following: Follow the care plan exactly. Follow care plan regarding positioning and elevation of the head of the bed. Do not perform range of motion exercises on a leg on the side of a hip replacement. Caution the resident not to cross legs in bed or in a chair or turn toes inward or outward. The hip cannot be bent or flexed more than 90 degrees. The hip cannot be turned inward or outward. Assist with dressing the resident, starting with the weaker, or affected, side first. Apply anti-embolic stockings as ordered. Adaptive devices, such as a raised toilet seat, may be helpful for elimination. Ask resident to use available handrails when moving into or out of the shower. Ask the nurse to give pain medication prior to moving and positioning if needed. Encourage fluids. Never rush the resident. Keep often-used items within reach. Report incisions that are red, draining, bleeding, or warm to the touch; an increase in pain or a burning sensation, especially on the operated side or in the calves; fever or other change in vital signs; numbness or tingling; edema of the legs; cyanosis or pale skin; problems with appetite; constipation; or resident not following the doctor’s orders for exercise and activity.

Partial weight-bearing (PWB) means the resident is able to support some body weight on one or both legs. Non-weightbearing (NWB) means the resident is

Short Answer 1.

Muscles, bones, joints, tendons, ligaments

Skeletal muscles, smooth muscles, and cardiac muscle

Long bones, short bones, flat bones, and irregular bones

Answers include the following: gives shape and form to the body; maintains posture; permits movement; protects internal organs; stores calcium and phosphorus; produces heat; and produces some blood cells.

Learning Objective 3 1.

Learning Objective 4 1.

10. J 11. K 12. D 13. I 14. E 15. C 16. N

466 unable to touch the floor or support any body weight on one or both legs. Full weight-bearing (FWB) means the resident can bear full weight on both legs. Learning Objective 5

10. I 11. U 12. A

13. D

14. L

Chapter 22: The Nervous System

15. K

Learning Objective 2

16. O

Controls, coordinates

17. H

Senses, interprets

18. B

Neuron

19. R

Central, peripheral

20. T

Cranial nerves, spinal nerves

21. G

Brain, spinal cord

22. P

Balance, hearing

True or False

8. 9.

Reflex Skin, nose, ears

10. Retina Learning Objective 3 1.

Learning Objective 4 1.

Multiple Choice 1.

Learning Objective 5 1.

Learning Objective 6 1.

Alzheimer’s disease (AD) is a progressive, degenerative, and incurable disease that causes proteins (plaques and tangles) to

467 build up in and around nerve cells. They eventually cause dementia. As the disease progresses, it causes greater and greater loss of health and abilities. 2.

Mild Alzheimer’s Disease: At this stage, the person may show some problems, such as memory loss and forgetting some words and the location of familiar objects. However, the person may still be independent and able to work, drive, and do other activities.

Answers include the following: Think about what it would feel like to have Alzheimer’s disease. Imagine being unable to perform your ADLs. Be understanding and compassionate. Assume that residents with AD have insight and are aware of the changes in their abilities. Provide security and comfort.

Answers include the following: Each person with Alzheimer’s disease is an individual. AD does not progress the same way in everyone. Each resident will do things that others will never do. Take an interest in each individual. Work with what you see today. Notice changes in behavior, mood, and independence and report your observations to the nurse.

Answers include the following: Part of AD care is noticing changes in behavior, or physical and emotional health. When you work as a team, more subtle changes will be noticed. Share observations with the care team. Being with residents often allows you insights that others may not have. Make the most of this opportunity. People with AD may not distinguish between nursing assistants, nurses, or administrators, so be prepared to help when needed.

Answers include the following: Caring for someone with dementia can be both emotionally and physically demanding. Take care of yourself to be able to give the best care. Be aware of your body’s signals to slow down, rest, or eat better. Remember that your feelings are real, and you have a right to them. Share your feelings with others, especially those experiencing similar situations. Do not worry about mistakes. Use them as learning experiences.

Answers include the following: Family members can be a great resource. They may know things you would have to learn by trial and error. Families can be of great comfort to victims of AD, helping you provide quality care.

Moderate Alzheimer’s Disease: At this stage, the person may forget recent events, forget some of his own past experiences and background, have changes in personality, and may need some help with ADLs. Severe Alzheimer’s Disease: During this stage, a person may be unable to communicate with others, control movement, or respond to his or her surroundings. The person needs significant help with activities of daily living, including eating and toileting. The ability to walk, sit, and, eventually, swallow, may be affected. 3.

Answers include the following: Helping residents keep their minds and bodies active may help slow the progress of the disease.

Learning Objective 7 Across 1.

Don’t

Perseveration

Down 2.

Nonverbal

Identify

Subject

Touch

Learning Objective 8 1.

Answers include the following: People with AD do not always have control over their behavior. They may not be aware of what they say or do. Remember that it is the disease causing the behavior. These actions are not within the person’s control.

468 7.

Answers include the following: Along with practical tasks, the care plan will call for maintaining residents’ dignity and self-esteem. Provide security and comfort. Promote independence for as long as possible.

gently directing the resident to a private area and distraction. Report this behavior to the nurse. 5.

Learning Objective 9

Answers will vary, but could include the fact that she can explain to the family that it is part of the disease. A rummage drawer could be provided.

Learning Objective 11

10. B

11. G 12. G

Learning Objective 12

TESTBANKSEL1L. ERC.COM

Learning Objective 10 1.

2. 3.

Answers will vary, but could include something about using a calm response and a slow, soothing tone. Reducing noise and distractions can help. Focusing on a familiar activity may help. Listening carefully and asking gentle questions, as well as reassuring the resident that he is safe, can help.

Learning Objective 13 1.

Mental health

Disorder

Generalized anxiety disorder

Posttraumatic stress disorder

Repetitive

Answers will vary but could include reporting the signs to the nurse. Other ideas are encouraging independence and selfcare, and rewarding activities that improve moods. Finding ways to help foster social relationships and listening to residents when they want to talk may help.

Social anxiety

Clinical depression

Medication, psychotherapy

Bipolar disorder

Answers will vary, but could include staying calm and being professional. The caregiver should not be judgmental or overreact. Causes could be a rash, clothing that is too tight, or the need to urinate. Try

11. Persecution

Answers will vary, but could include using distraction and being calm.

10. Schizophrenia

Learning Objective 14 1.

Answers include the following: a family history of addiction, having a mental

469 illness, an unstable home environment, poor coping skills, and taking a highly addictive drug. 2.

Answers include the following: poor or absent relationships with family or friends; because elderly people are often taking prescribed medication, substance abuse can cause even more problems due to possible drug interactions with their medication.

Chapter 23: The Endocrine System Learning Objective 2

Learning Objective 5 1.

Learning Objective 6

Hormones

Testes

Immune, infections

Glands

Circulation, blood vessels

Development, reproduce

Amputation

Pituitary

Daily care

Adrenaline, heart

Harsh, hot

Insulin

6. 7.

Object Between

Barefoot

Reddening, blackening

Learning Objective 3 1.

Learning Objective 4 1.

10. K 11. I

Chapter 24: The Immune and Lymphatic Systems and Cancer Learning Objective 2 1.

Bacteria, viruses, and organisms

Nonspecific, specific

Active, vaccine

Passive

Nodes, thymus

Lymph

Blood

Learning Objective 3 1.

470 Learning Objective 4 1.

HIV attacks the immune system and damages or destroys its cells. HIV gradually weakens the immune system. HIV is most commonly transmitted by the following: having unprotected or poorly-protected anal sex with an infected person; having unprotected or poorly-protected vaginal sex with an infected person; having sexual contact with many partners; or sharing drug needles or syringes. HIV is not spread through air or water; by insects, including mosquitoes; in saliva, tears, or sweat; through casual contact, such as hugging, shaking hands, or sharing dishes; by touching doorknobs or toilet seats; or through closed-mouth or casual kissing.

10. E 11. K 12. F 13. M 14. B Learning Objective 8 1.

Due to weakened immune systems, preventing infection is important.

2. Skin care helps prevent pressure ulcers and infections. An opportunistic infection is an illness caused by microorganisms that do not af3. Oral care can help with mouth pain or fect people with healthy immune systems sores. Mild rinses can help with bad taste but cause disease in people with weakin the mouth. ened immune systems. 4. People with cancer need to eat and drink 5. Answers will vary but could inclT udEeSteTllB inA gNKSELLER.COM enough to maintain their energy levels. the resident that AIDS is not transmitted Unintended weight loss can occur with through casual touching; NA can explain cancer or cancer treatment. how AIDS is transmitted. 5. Urine may have blood in it, and output Learning Objective 5 may decrease. Urine can become more concentrated and have an odor. Diarrhea 1. C can occur, along with blood in stool. 2. B 6. Residents with cancer may have fatigue 3. A and weakness, which can make movement difficult. Learning Objective 6 7. Cancer can cause severe pain; it can affect 1. B the ability to sleep, eat, and move. 2. B 8. Changes in vital signs can occur with 4.

Learning Objective 7 1.

cancer and with cancer therapy. Fever can occur with some forms of cancer therapy. 9.

Hair loss, weakness, changed appearance, and dependency on caregivers can change a person’s self-image.

10. Some people with cancer want to talk about their diagnosis and treatment. Others withdraw and avoid discussing their disease.

471 Chapter 25: Rehabilitation and Restorative Care Learning Objective 2 1.

Rehabilitation is care used to restore a person to his highest level of functioning possible after an accident, illness or injury. Answers include the following: assist the resident in maintaining and/or regaining the ability to perform ADLs; promote resident’s independence and help resident adapt to the new disability; and prevent complications of immobility. Answers include the following: toileting, range of motion exercises, positioning, mobility and ambulation, transferring, grooming, eating and drinking, splints or braces, and communication.

Learning Objective 4

Learning Objective 6 1.

Adaptive

Foot drop

Abduction

Outward

Contractures

Support, protection

Learning Objective 7

Learning Objective 3 1.

Learning Objective 5

TESTBANKSELLER.5.COKM 6.

Gastrointestinal: promotes appetite and aids regular elimination

10. D

Urinary: improves elimination, helping to decrease infection

12. M

Integumentary: improves the quality and health of the skin

11. C

13. G Labeling

Circulatory: improves circulation

Abduction

Respiratory: reduces the chance of infections, such as pneumonia, and improves oxygen level

Adduction

Extension

Flexion

Dorsiflexion

Musculoskeletal: increases blood flow to the muscles and improves strength

Nervous: improves relaxation and sleep

Rotation

Endocrine: increases metabolism, helping to maintain healthy weight

Pronation

Supination

Opposition

472 Chapter 26: Subacute Care

A subacute setting is a special unit or facility that is for people who need more care than most long-term care facilities can provide. Hospitals and long-term care facilities may offer subacute care.

Answers include the following: recent surgery, acute conditions, chronic illnesses, serious burns, the need for special administration of nutrients or medicine, or dialysis.

Learning Objective 2 1.

Learning Objective 7

Learning Objective 8 Learning Objective 3 1.

Suctioning is needed when a person has increased secretions that they cannot expel themselves.

Answers include the following: gurgling, an elevated respiratory rate, shortness of breath, difficulty breathing, or pallor or cyanosis.

Answers include the following: Follow Standard Precautions. Monitor vital signs closely, especially respiratory rate. Report changes. Report signs of respiratory distress. Observe skin color carefully for pale, bluish, or darkening skin or mucous membranes. Answer call lights promptly. Place resident in position as directed by nurse, normally semi-Fowler’s or lateral. Place pad or towel under the chin before the nurse begins suctioning; have a wet washcloth ready. Give oral and nasal care after suctioning as directed. Apply ordered lubricant to the lips as needed. Be supportive during periods of difficult breathing. Use touch if appropriate. Report respiratory distress; cyanosis, pale, gray, or darkening skin or mucous membranes; change in vital signs; change in color, amount, or quality of secretions coughed up; or nervousness or anxiety.

Learning Objective 4 1.

Cardiac

Rhythm, rate

Chest

Vital signs

Loose

Learning Objective 5 1.

Learning Objective 6 Across 3.

Skin care

Fowler’s

Aspiration

Learning Objective 9 1.

Down

Cancer

Speak

Stoma

473 Learning Objective 10 1.

Learning Objective 11 1.

Kidney dialysis is a process that cleans the body of waste that the kidneys cannot remove due to chronic renal failure. Answers include the following: signs of respiratory distress; changes in vital signs; pain, drainage, or bleeding from the insertion site; abdominal cramps, nausea, or vomiting; muscle cramps; swelling of extremities (edema); change in I&O; or itchy skin.

Learning Objective 5 1.

Answers will vary, but could include the following: Provide privacy for visits. Allow visitors access to resident. Know that visitors may be coming at any time of the day or night.

Answers will vary, but could include the following: Provide privacy for visits, exams, and anything else the resident wishes.

Answers will vary, but could include the following: Monitor response to pain medication. Report if resident appears to be in pain or is experiencing discomfort.

Answers will vary, but could include the following: Notify the nurse if the resident has questions.

Answers will vary, but could include the following: Do not judge these decisions. Notify the nurse if the resident has any TESTBANKSELLER.COqMuestions. Palliative care is given to people who have Learning Objective 6 serious, life-threatening diseases, as well as to people who are dying. A check mark should be placed by numbers 1, 3, 4, 5, 7, and 9. Answers include the following: to control

Chapter 27: End-of-Life Care Learning Objective 2 1.

symptoms, reduce suffering, prevent side effects and complications, and maintain the best quality of life possible. Learning Objective 3 1.

Learning Objective 4

Learning Objective 7 1.

Answers will vary.

Answers will vary but could include something about the fact that listening is important because it gives the dying person a chance to express his feelings and concerns, as well as any physical complaints.

Learning Objective 8 A check mark should be placed by numbers 2, 3, 4, 7, 8, and 9. Learning Objective 9

Blood pressure

Jaw, open

Eyelids, fixed stare

474 4.

Urinary, fecal

Fixed, dilated

Learning Objective 10 1.

Learning Objective 11 1.

Check with her supervisor first to make sure it is appropriate

Learning Objective 4 A check mark should be placed by numbers 2, 4, and 8. Learning Objective 5 A check mark should be placed by numbers 2, 3, 5, and 7. Learning Objective 6 Across 3.

Read it

Job description

Down 1.

Procedure

2. Nurse Answers include the following: not hesitating to express their feelings; get5. Injury ting enough sleep, eating nutritious Learning Objective 7 meals, drinking only in moderation, and not smoking; participating in enjoyable 1. C activities and exercising regularly; spend2. D ing quality time with the people they love; sharing important memories abT ouEtS thTeBANKSEL3L. ERC.COM resident with others; joining a special sup4. A port group for grieving; and talking to a counselor if the need arises. Learning Objective 8 Learning Objective 12 1. T 1. B 2. F 2.

Learning Objective 9

Chapter 28: Your New Position

Evaluation, appraisal

Learning Objective 2

Knowledge, conflict, team

Constructive

Hostile

Open

Mistake

Salary increases

Learning Objective 3

Advancing

Answers will vary.

475 Learning Objective 10 1.

16. B

Conflict resolution is the process of resolving conflicts in a positive way so that everyone is satisfied with the result.

17. A

Give her employer at least two weeks’ written notice that she will be leaving

19. A

Learning Objective 11

18. B

20. D 21. B

22. C

23. B

24. C

25. B

26. B

27. D

28. D

29. B

Learning Objective 12

30. A

1. 2.

Answers will vary. Answers will vary.

31. B

Answers will vary.

33. B

Answer Key for Workbook Practice Exam

32. C

34. C

35. B

36. C

37. B

38. A

39. A

40. A

41. D

42. A

43. B

10. D

44. C

11. D

45. B

12. C

46. A

13. A

47. C

14. A

48. B

15. C

49. C 50. A