iii
Nursing Assisting A Foundation in Caregiving 5th Edition Dugan Test Bank
Table of Contents Preface
v
Lesson Plans
Appendices Appendix A Key Material
185
Appendix B Handouts
239
1. The Nursing Assistant in Long-Term Care
1
Appendix C Chapter Exams
291
2. Ethical and Legal Issues
8
Appendix D Answer Key for Chapter Exams
353
3. Communication Skills
15
Appendix E 2nd Set of Chapter Exams
365
4. Communication Challenges
23
Appendix F Answer Key for 2nd Set of Chapter Exams
417
5. Diversity and Human Needs and Development
29
Appendix G Final Exam
427
6. Infection Prevention and Control
35
Appendix H Answer Key for Final Exam
437
7. Safety and Body Mechanics
46
8. Emergency Care, First Aid, and Disasters
54
Appendix I Workbook Answer Key and Practice Exam Answer Key
441
9. Admission, Transfer, Discharge, and Physical Exams
61
10. Bedmaking and Unit Care
66
11. Positioning, Moving, and Lifting
71
12. Personal Care
75
13. Vital Signs
82
14. Nutrition and Fluid Balance
TESTBANKSE88L
15. The Gastrointestinal System
98
16. The Urinary System
107
17. The Reproductive System
113
18. The Integumentary System
117
19. The Circulatory or Cardiovascular System
123
20. The Respiratory System
127
21. The Musculoskeletal System
132
22. The Nervous System
138
23. The Endocrine System
151
24. The Immune and Lymphatic Systems and Cancer
155
25. Rehabilitation and Restorative Care
161
26. Subacute Care
166
27. End-of-Life Care
173
28. Your New Position
179
v 1
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 KEY MATERIAL 1-1 FACTs AbouT MEDICARE AND MEDICAID
different methods of nursing care and the survey process. The person-centered care model is introduced and should be continually emphasized.
KEY MATERIAL 1-2 REsIDENTs IN LTC FACILITIEs KEY MATERIAL 1-3 CHAIN oF CoMMAND CHAPTER 1: EXAM
Assignments TEXTbooK READINg, PP. 1–17
woRKbooK EXERCIsEs, PP. 1–7 Overview of Teaching Strategies 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
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
• Medicare is for people 65 or older or who have disabilities and illnesses.
• Skilled care
• Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice.
• Chronic • Residents Discuss job opportunities for nursing assistants and the importance of this work. Give students a brief description of long-term care, including:
• 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
Describe facts about Medicaid:
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
• Sandwich generation • Intergenerational care • Acute care
• Eligibility is determined by income and special circumstances. • People must qualify for Medicaid. Describe long-term care coverage under Medicare and Medicaid:
• Home health care • Adult day services
• Medicaid is funded by both federal government and each state.
• LTC facilities are paid a fixed amount for services. • Services are based on the resident’s needs upon TESTBANKSEL C.OM adL mEisRsi. on
• Subacute care • Outpatient care • Rehabilitation • Hospice care • Animal-assisted therapy (AAT)
4. Describe the residents in long-term care facilities Meeting the Learning Objective TEXTbooK PP. 5–6
woRKbooK P. 2
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 Key Material 1-1 FACTs AbouT MEDICARE AND MEDICAID Describe Medicare coverage:
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 Key Material 1-2 REsIDENTs IN LTC FACILITIEs Discuss these facts about residents in long-term care facilities in the U.S.: • 83.5% are over 65 • 68% are female
3 • More than 75% are white and non-Hispanic • About 1/3 come from a private residence
• Measuring vital signs (temperature, pulse, respiration, and blood pressure)
• Over 50% come from a hospital
• Helping residents with elimination needs
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 • Did not have caregivers available to give enough care at home
• Assisting with mouth care • Giving back rubs • Observing and reporting changes in conditions and complaints • Helping residents move safely around the facility • Caring for supplies and equipment Describe tasks that nursing assistants do not perform: • Inserting or removing tubes
These facts are true of residents with a length of stay of less than 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) Stress that residents require different kinds of care in a facility. Note that many residents in LTC lack outside support, and emphasize the importance of caring for the whole person.
• Changing sterile dressings
6. Discuss professionalism and list examples of professional behavior Meeting the Learning Objective TEXTbooK 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 term: • Professionalism Discuss important points about professional behavior guidelines, including the following:
Lecture Pronounce and define the following key terms:
• Being clean and neatly dressed and groomed
• Nursing assistant (NA)
• Not using personal phones in resident care areas
• Activities of daily living (ADLs)
• Being at work on time and avoiding absences
Discuss two ways NAs provide services for residents:
• 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 Describe common nursing assistant tasks: • Serving trays and helping residents eat and drink
• Not discussing personal problems with residents
• Keeping a positive attitude • Being polite and respectful
• Helping residents dress and undress
• Addressing residents and visitors in the way they wish to be addressed
• Bathing, shampooing, and shaving residents
• Not using profanity
• Bedmaking
• Keeping resident information confidential
• Tidying living areas
• Not gossiping about coworkers • 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 your uniform clean and neat. • Bathe and wear deodorant every day. • Brush your teeth at least twice a day. • Do not wear or use scented products.
7. List qualities that nursing assistants must have
• Keep your 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 your 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 your 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. 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 PP. 5–6
• Empathetic • Dependable and responsible
Lecture Pronounce and define the following key terms:
• Humble
• Care team
• Tolerant
• Registered nurse
• Unprejudiced
• Licensed practical nurse • Diagnosis
8. Discuss proper grooming guidelines
• Assistive 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 (APRN)
• Right Person
• Physician (MD or DO)
• Right Direction/Communication
• Physician assistant (PA)
• Right Supervision/Evaluation
• Physical therapist (PT or DPT) • Occupational therapist (OT or OTD) • Speech-language pathologist (SLP) • Registered dietitian (RDN) • Respiratory therapist (RT) • Medical social worker (MSW) • Activities director • Nursing assistant (NA) Emphasize that the resident is the most important member of the care team.
Discuss these questions that NAs may consider before accepting tasks: • Do I have all the information I need to do this job? Are there questions I should ask? • Do I believe that I can do this task? Do I have the necessary skills? • Do I have the needed supplies, equipment, and other support? • Do I know who my supervisor is, and how to reach him/her? • Have I told my supervisor of my special needs for help and support?
10. Discuss the facility chain of command
• Do we both understand who is doing what?
Meeting the Learning Objective
Emphasize that NAs can provide better care by asking questions and by asking for help when they need it.
TEXTbooK PP. 12–13
woRKbooK P. 6
12. Describe methods of nursing care and diRsc.uCsO s Mperson-centered care Pronounce and define the followinT gE keSyTteBrm s:KSELLE AN Lecture
• Chain of command • Charge nurse • Liability Display Key Material 1-3 CHAIN oF CoMMAND
Meeting the Learning Objective TEXTbooK PP. 14–15
woRKbooK PP. 6–7 Lecture Pronounce and define the following key term:
Emphasize the importance of following the chain of command to lessen the risk of liability. Discuss the chain of command (Fig. 1-13 in the textbook).
• Holistic care
11. Explain The Five Rights of Delegation
Define and discuss basic types of nursing care used at facilities and related terms:
Meeting the Learning Objective
• Team nursing
Explain how holistic care helps improve residents’ quality of life.
TEXTbooK PP. 13–14
• Team leader
woRKbooK P. 6
• Primary nursing • Continuity of care
Lecture Pronounce and define the following key term:
• Functional nursing
• Delegation
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.
Discuss each of the five rights: • Right Task • Right Circumstance
6 Discuss the boxes about trauma informed care and the National Center for Complementary and Integrative Health found on page 15 of the textbook.
Chapter Review Exam dIsTRIbuTE CHAPTER 1: EXAM (APPENDIX C)
13. Explain policy and procedure manuals Meeting the Learning Objective TEXTbooK P. 15
woRKbooK P. 7
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.
Lecture Pronounce and define the following key terms:
Answers to Chapter Review in Textbook
• Policy
1.
People who are 65 years of age or older and people of any age with permanent kidney failure or certain disabilities
2.
Women
3.
Answers include the following: inserting/ removing tubes; changing sterile dressings; giving tube feedings; giving medications.
• 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 4.
Answers can include the following: • Being clean and neatly dressed and groomed TEXTbooK PP. 15–16 TESTBANKSELL• EN Rot.dCisOcuMssing personal problems with residents woRKbooK P. 7 • Not using personal phones in resident care areas Lecture • Being at work on time and avoiding Pronounce and define the following key terms: absences • Cite • Not leaving work early without permission • Not reporting to work under the influence of • Joint Commission illegal drugs and/or alcohol Explain the survey process to students: • Keeping a positive attitude • Not gossiping about coworkers • Inspections are done periodically. • Being polite and respectful • Surveyors observe and interview residents and • Addressing residents and visitors in the way staff to find out how well residents’ needs are bethey wish to be addressed ing met. • Not using profanity • Nursing assistants should answer any questions • Keeping resident information confidential asked by surveyors to the best of their abilities. • Following procedures and policies They should not guess if they do not know the • Reporting concerns or problems to your answer. supervisor • Maintaining educational requirements Point out that surveys conducted by the Joint Com• Asking questions when you do not undermission are not affiliated with state inspections stand something and that facilities participate in Joint Commission • Being honest and documenting carefully surveys on a voluntary basis. • Accepting constructive feedback • Not accepting tips or gifts • Being loyal to your facility and being a positive role model Meeting the Learning Objective
7 5.
Answers will vary for each student.
6.
The resident
7.
The Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation
8.
Type of care that places the emphasis on the person needing care and his or her individuality, capabilities, choices, beliefs, interests, and preferences
9.
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
8
2 Ethical and Legal Issues 1. Define important words in this chapter 2. Define law, ethics, and etiquette 3. Discuss examples of ethical and professional behavior 4. Describe a nursing assistant code of ethics 5. Explain 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 KEY MATERIAL 2-1 NuRsINg AssIsTANT CodE oF ETHICs TESTBANKSMEeLetLinEgRth.eCLOeaMrning Objective TEXTbooK PP. 18–20 HANDouT 2-1 dECIsIoN quIZ HANDouT 2-2 wHo Is vulNERAblE To AbusE oR NEglECT? CHAPTER 2: EXAM
Assignments TEXTbooK READINg, PP. 18–34
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, HIPAA, and the PSDA.
WoRKbooK P. 9
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
2. Define law, ethics, and etiquette Meeting the Learning Objective TEXTbooK P. 20
woRKbooK P. 9 Lecture Pronounce and define the following key terms: • Ethics • Laws • Criminal laws • Civil law • Etiquette Explain the difference between laws and ethics and why both are important in healthcare settings.
9 3. Discuss examples of ethical and professional behavior
Optional Learning Activity If your facility has a nursing assistant code of ethics, share it with students.
Meeting the Learning Objective TEXTbooK PP. 20–22
woRKbooK P. 9 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: • Keep all resident and staff information confidential.
5. Explain OBRA Meeting the Learning Objective TEXTbooK P. 23
woRKbooK P. 10 Lecture Pronounce and define the following key terms: • OBRA (Omnibus Budget Reconciliation Act)
• Be honest at all times.
• NATCEP (Nurse Aide Training and Competency Evaluation Program)
• Be trustworthy.
• Scope of practice
• Do not accept gifts or tips. • Report abuse or suspected abuse of residents. • Do not report to work under the influence of alcohol, illegal drugs, or chemical substances.
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: • Do assigned tasks. Report mistakes promptly. • Give recognition through certification and • Be positive, professional, and tacT tfE ulS . TBANKSELLER re. giC stO raM tion • Treat all residents with respect and be empathetic. • Help define the nursing assistant’s scope of • Follow all facility policies, rules, and procedures.
• Be patient.
practice • Provide better uniformity of care
4. Describe a nursing assistant code of ethics Meeting the Learning Objective TEXTbooK P. 22
woRKbooK P. 10 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 Key Material 2-1 NuRsINg AssIsTANT CodE oF ETHICs Discuss the sample nursing assistant code of ethics in the key material. Ask students to suggest additions or clarifications.
• Promote educational standards
6. Explain Residents’ Rights Meeting the Learning Objective TEXTbooK PP. 23–26
woRKbooK PP. 11–12 Lecture Pronounce and define the following key terms: • Residents’ Rights • Resident Council • Misappropriation • Exploitation • Eviction Review the Residents’ Rights: • Quality of life
10 • Services and activities to maintain a high level of wellness
7. Explain types of abuse and neglect
• Right to be fully informed about rights and services
Meeting the Learning Objective
• Right to participate in their own care
TEXTbooK PP. 26–28
• Right to make independent choices
woRKbooK PP. 12–14
• Right to privacy and confidentiality • Right to security of possessions
Lecture Define and review each of the types of abuse and neglect covered:
• Rights during transfers and discharges
• Mistreatment
• Right to complain
• Abuse
• Right to visits
• Physical abuse
• Rights with regard to social services
• Psychological abuse
• Right to dignity, respect, and freedom
Distribute Handout 2-1 dECIsIoN quIZ
• Verbal abuse • Sexual abuse • Financial abuse
Tell students to think about all of the choices or • Assault decisions they made this morning and write six • Battery of them down on their handout. Allow six min• Domestic violence utes if needed for the class to finish this exercise. (Responses may include when to get up, what to • Intimate partner violence (IPV) eat for breakfast, what to wear, whether to stop at a • Workplace violence store on the way to work, whether to answer emails • False imprisonment or check social networking sites, whetherTtE oS drT ivB e ANKSELLER.COM • Involuntary seclusion the children to school or put them on the bus, etc.) After students are finished, make these points: • Sexual harassment • Everyday decisions may not seem that important • Substance abuse because you are able to make them. In fact, you • Defamation may get tired of deciding and wish someone • Libel would handle it all for you. But if you have had • Slander the experience of not being able to make all of your own choices, such as when you were recov• Neglect ering from an illness or surgery, you know it did • Negligence not take long to want to be in charge of your own • Malpractice 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.
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.
11 8. Recognize signs and symptoms of abuse and neglect
• Soiled clothes or bed linens or incontinence briefs not being changed
Meeting the Learning Objective TEXTbooK PP. 28–29
• Damaged or poorly fitting hearing aids, eyeglasses, dentures
woRKbooK P. 14
• Unanswered call lights
• Ripped or torn clothing
Lecture Pronounce and define the following key term:
Review other signs of abuse:
• Mandated reporters
• Changing doctors frequently
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
• Wearing makeup or sunglasses to hide injuries • 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
• Similar injuries that occur repeatedly • Burns of unusual shape and in unusual locations • Bite marks or scratches • Unexplained weight loss • Dehydration
• Missing doctor appointments
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 th. em seM lves. TESTBANKSELLER CO
• 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 • Mood swings • Fear and anxiety, especially when a certain caregiver is present • Fear of being left alone
• 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. • Caregivers may be overworked, tired, stressed, and unappreciated, on top of caring for someone who requires so much time and energy.
Review signs of neglect: • Weight loss or poor appetite
9. Describe the steps taken if a nursing assistant is suspected of abuse
• Dehydration
Meeting the Learning Objective
• Pressure injuries
• Frequent complaints of hunger or thirst • Strong smell of urine • Unclean body • Dirty, matted, or unstyled hair • Ragged or dirty fingernails
TEXTbooK P. 29
woRKbooK P. 14 Lecture Review the steps that follow a report of abuse by a nursing assistant:
12 • Notification
• Electronic health records (EHR)
• Investigation
• Invasion of privacy
• Hearing • Decision of hearing • Actions • 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.
10. Discuss the ombudsman’s role Meeting the Learning Objective
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.
TEXTbooK P. 29–30
• Do not discuss residents in public areas.
woRKbooK PP. 14–15
• Do not bring family or friends to the facility. • Double-check fax numbers and use cover sheets.
Lecture Pronounce and define the following key term:
• Return charts to their proper place after use.
• Dispose of personal notes regarding resident care prior to leaving work for the day. g out and exit the web browser when finished Review the typical duties of an ombudsman: TESTBANKS•ELLoL ER.COM with computer work. Do not share your personal • Advocates for Residents’ Rights and quality care passwords with others. • Educates consumers and care providers • Do not include private information in emails. • Investigates and resolves complaints • Do not share resident information, photos, or • Appears in court and/or legal hearings videos on any social networking site, such as • Gives information to the public Facebook, Instagram, or Twitter. • Ombudsman
Optional Learning Activity Provide students with information about the department in your state that handles elder care.
• Do not takes photos of residents and share them with anyone, including via phones, email, social networking sites, or other websites. • Give documents found with resident’s information to the nurse.
11. Explain HIPAA and related terms Meeting the Learning Objective TEXTbooK PP. 30–32
woRKbooK P. 15 Lecture Pronounce and define the following key terms: • HIPAA • Protected health information (PHI)
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 of a resident on her Facebook page, which is seen by another NA.
13 12. Discuss the Patient Self-Determination Act (PSDA) and advance directives
3.
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 to nursing assistant care. I will show a positive 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.
4.
75 hours
5.
Answers will vary.
6.
Report it to her supervisor immediately.
7.
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.
8.
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.
Meeting the Learning Objective TEXTbooK PP. 32–33
woRKbooK PP. 15–16 Lecture Pronounce and define the following key terms: • Advance directives • Living will • Durable power of attorney for health care • DNR Discuss the PSDA, including the following rights that must be given during admission: • The right to participate in and direct healthcare decisions • The right to accept or refuse treatment • The right to prepare an advance directive • Information on the facility’s policies that govern these rights 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.
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. Answers to Chapter Review in Textbook 1.
Ethics are the knowledge of what is right and wrong and help guide conduct.
2.
Answers will vary.
14 9.
Other care team members
10. The privacy of health information 11. HIPAA applies to all healthcare providers, including doctors, nurses, nursing assistants, and care team members. 12. 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. 13. Answers include the following: All facilities receiving Medicare and Medicaid money must offer new residents information about 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 educatioTnEtoStT heBANKSELLER.COM staff about advance directives. 14. B 15. C 16. B 17. A 18. D 19. A
15
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
KEY MATERIAL 3-1 CoMMuNICATIoN PRoCEss
TEXTbooK READINg, PP. 35–54
KEY MATERIAL 3-2 body lANguAgE
WoRKbooK EXERCIsEs, PP. 17–26
KEY MATERIAL 3-3 bARRIERs To CoMMuNICATIoN KEY MATERIAL 3-4 24-HouR CLoCK KEY MATERIAL 3-5 sAMPLE KARDEX KEY MATERIAL 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 at work. 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
• Tapping feet • Pointing at someone while speaking
Meeting the Learning Objective Review the following guidelines for proper communication:
TEXTbooK PP. 35–36
woRKbooK P. 17
• Use appropriate words.
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
• Be aware of your body language. • Use a friendly and professional tone of voice. • Wait for responses and let pauses happen. • Practice active listening.
2. Explain types of communication
• Use mostly facts when communicating.
Meeting the Learning Objective
Ask students how they can use verbal or nonverbal communication to reach a specific goal.
TEXTbooK PP. 36–38
woRKbooK P. 17 Lecture Pronounce and define the following key terms: • Verbal communication • Nonverbal communication
3. Explain barriers to communication
• Body language • Active listening Display Key Material
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.
Meeting the Learning Objective TEXTbooK PP. 38–39
TESTBANKSELLER.COM
woRKbooK PP. 17–19
3-1 CoMMuNICATIoN PRoCEss Describe the communication process. Emphasize that the process occurs over and over with the sender and receiver switching roles during a conversation.
Lecture Pronounce and define the following key term: • Barrier Display Key Material
Display Key Material 3-2 body lANguAgE Discuss the importance of body language in communication. Describe the signals that the two people are sending to each other through their body language.
3-3 bARRIERs To CoMMuNICATIoN Review the barriers to communication: • Resident does not hear, does not hear correctly, or does not understand. • Resident is difficult to understand. • NA, resident, or others use words that are not understood.
Review the following examples of positive nonverbal communication:
• NA uses slang or profanity.
• Smiling in a friendly manner
• NA uses clichés.
• Leaning forward to listen
• NA responds with “Why?”
• Nodding while a person is speaking
• NA gives advice.
Review examples of negative nonverbal communication:
• NA asks questions that only require yes/no answers.
• Rolling eyes
• Resident speaks a different language.
• Crossing arms in front of the body
• NA or resident uses nonverbal communication.
17 Discussion Ask the students to imagine a day or a lifetime without communication. Ask how that might make them feel. 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? Ask the students to describe a situation where effective communication resulted in a positive outcome.
4. List ways that cultures impact communication Meeting the Learning Objective TEXTbooK PP. 39–40
Lecture Review the many different people students will communicate with on the job, including: • Doctors, nurses, supervisors, and other staff members • Other departments • Residents • Families and visitors • The community 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.
woRKbooK P. 19 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: • Eye contact • Touch • Language Review the examples of acceptable and unacceptable touch on page 40 of the textbook. Ask students if they can think of any other examples. 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.
5. Identify the people a nursing assistant communicates with in a facility
6. Understand basic medical terminology and abbreviations Meeting the Learning Objective TEXTbooK PP. 41–42
woRKbooK P. 20 Lecture Pronounce and define the following key terms: • Edema • Root • Prefix • Suffix Distribute Handout 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 learn what the various word parts mean and be able to recognize them on the job. Distribute Handout 3-2 AbbREVIATIoNs
Meeting the Learning Objective TEXTbooK PP. 40–41
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.
• Resident’s history and results of exams • Care plans • Doctor’s orders and progress notes • Nursing assessments • Notes from nurses and other specialists • Flow sheets • Graphic record • Intake and output record
7. Explain how to convert regular time to military time Meeting the Learning Objective TEXTbooK PP. 42–43
woRKbooK PP. 20–21
• Consent forms • Lab and test results • Surgery reports • Advance directives Emphasize that the information in a resident’s chart must be kept confidential.
Display Key Material 3-4 24-HouR CLoCK
9. Explain guidelines for documentation
While looking at the key material, explain how to convert regular time to military time:
Meeting the Learning Objective
8. Describe a standard resident chart
• Sign each note you make and use the correct date and time.
Meeting the Learning Objective
• Use only facts when documenting.
TEXTbooK PP. 44–45 • To change regular hours between 1:00 p.m. and woRKbooK P. 21 11:59 p.m. to military time, add 12 to the regular time. TESTBANKSLEecLtuLrE e R.COM • To change from military time to regular time, Review the guidelines for accurate documentation: subtract 12. • Keep all information confidential. • Minutes and seconds do not change. • Document care immediately after it is given. • Midnight may be written as 0000 or 2400; follow Never document care before it is given. facility policy. • Use black ink when documenting by hand.
TEXTbooK PP. 43–44
woRKbooK P. 21 Lecture Pronounce and define the following key terms:
• If an error is made, draw one line through it and initial it and write the date. Write the correct information. Documentation done on a computer is time-stamped; it can only be changed by entering another notation.
• Medical chart
• Use only your facility’s accepted abbreviations and terms.
• Charting
• Use comparisons to describe size.
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.
19 10. Describe the use of computers in documentation Meeting the Learning Objective
• Detailed form for assessing residents • Details what to do if problems are identified • Completed for each resident within 14 days of admission and again each year
TEXTbooK PP. 45–46
• Must be reviewed every 3 months
woRKbooK P. 21
• New MDS is completed when there is any major change in a resident’s condition
Lecture Review the general rules for computer use in the facility: • Do not share passwords or login IDs with anyone.
Emphasize that nursing assistant reports on changes in a resident's condition are very valuable, as they may trigger needed assessments.
• Be careful about who can see PHI or EHRs on the screen, as HIPAA guidelines apply to computer use.
12. Describe how to observe and report accurately
• Make sure you are logged into the correct chart. Log out and/or exit the resident's chart when finished.
Meeting the Learning Objective TEXTbooK PP. 46–48 woRKbooK PP. 22–23
• Be sure autofill entries are accurate. • Change passwords when prompted. • Do not print documents unless directed to do so. • Do not send confidential information via email.
Lecture Pronounce and define the following key terms: • Care plan • Objective information
• Exit the web browser when finished with charting TESTBANKSELLE •R Su.bC jeO ctM ive information or using the computer. • Orientation • Do not access personal accounts or browse the • Vital signs internet from work. • Critical thinking 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 TEXTbooK P. 46
woRKbooK P. 22 Lecture Pronounce and define the following key term: • Minimum Data Set (MDS) Discuss the important points about the MDS: • Assessment tool developed by the federal government
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 Key Material 3-5 sAMPLE KARDEX Review the sample Kardex forms if these forms are used at your facility. Display Key Material 3-6 usINg youR sENsEs Explain the difference between objective and subjective information. Emphasize that objective information is collected by using the senses of sight, hearing, smell, and touch. Reinforce these points by using the key material.
20 • Note changes in orientation.
Lecture Pronounce and define the following key term:
• Check vital signs.
• Nursing process
• Report any changes in ability.
Review the five steps of the nursing process:
• Report other important changes, such as appetite, ability to go to the bathroom, and mood.
• Assessment
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:
• Planning
Review other ways to observe residents accurately:
• Falls • Wheezing • Difficulty breathing • Chest pain and pressure • Pain in calf or leg • Blurred vision
• Diagnosis • Implementation • Evaluation
14. Discuss the nursing assistant’s role in care planning and at care conferences Meeting the Learning Objective TEXTbooK PP. 48–49
woRKbooK P. 23
• Slurred speech
Lecture Pronounce and define the following key term:
• Vomiting
• Care conference
• Sudden limp or change in ability to walk
Emphasize the importance of nursing assistants’ e oErSinTBANKSoE • Numbness or loss of feeling in one sidT bsLeL rvE atR io. nsCiO nM planning care. arms or legs • Abdominal pain • Change in vital signs
15. Describe incident reporting and recording
• Sudden or severe headache • Mental status changes, confusion, or disorientation Optional Handout 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.
Meeting the Learning Objective TEXTbooK PP. 49–50
woRKbooK P. Lecture Pronounce and define the following key terms: • Incident • Incident report • Sentinel event • Adverse event
13. Explain the nursing process Meeting the Learning Objective TEXTbooK P. 48
woRKbooK P. 23
Review events in the facility that are considered incidents: • An accident or problem during the course of care • An error in care • A fall or injury to a resident or staff member • An accusation against staff members
21 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. Optional Learning Activity Describe to the students an occurrence in a facility in which a resident is given the wrong meal at dinner time and becomes slightly ill as a result. Have the students write individual incident reports, then lead a group discussion in which the class writes a final incident report.
16. Explain proper telephone etiquette
If available, show students the type of call system used at your facility and explain how to use it.
18. Describe the nursing assistant’s role in change-of-shift reports and rounds Meeting the Learning Objective TEXTbooK PP. 51–52
woRKbooK P. 25 Lecture Pronounce and define the following key term: • Rounds
Meeting the Learning Objective TEXTbooK P. 51
woRKbooK P. 24 Lecture Review the rules for telephone etiquette:
Review the guidelines for start-of-shift reports: • Arrive on time. • Listen for your assignment and for information about all residents in your area.
• Cheerfully greet callers.
• Listen carefully to information from the prior shift.
• Identify your facility, yourself, and your position.
• Ask any questions you have about your residents.
• Listen closely to the caller’s request and write Explain that the nursing assistant’s role for enddown any messages. of-shift reports is to report information gathered TESTBANKSELLE R.COM about residents during the shift. • Get a telephone number if needed. • Thank the caller and say “Goodbye.” Review rules for general telephone use: • Do not give out staff or resident information over the phone.
19. List the information found on an assignment sheet Meeting the Learning Objective
• Ask before placing a caller on hold.
TEXTbooK PP. 52–53
• 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
Lecture Pronounce and define the following key terms: • Code status • Code
Meeting the Learning Objective TEXTbooK P. 51
woRKbooK P. 24 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.
Review the information typically found on an assignment sheet: • Residents’ names and room numbers • Medical diagnosis • Code status • Activity level/transfer status • Range of motion (ROM) exercises • Bathing information
22 • Diet orders
3.
Answers will vary.
4.
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.
• Tests and procedures to be performed
5.
Introduce himself, identify the resident, and explain the procedure to be done
20. Discuss how to organize work and manage time
6.
2033 hours
7.
1110 hours
Meeting the Learning Objective
8.
Only other members of the care team
9.
Immediately after care is given
• Fluid orders • Bowel and bladder information • How often to measure vital signs • Treatments to be performed
TEXTbooK PP. 53–54
woRKbooK PP. 25–26
10. Yes Lecture Pronounce and define the following key term: • Prioritize Discuss the tips for organization and time management: • Plan ahead. • Prioritize. • Make a schedule.
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
TESTBANKSELLcoEmRp.leCteOd Mas soon as possible.
• Combine activities. • Get help when needed.
15. Answers may include the following: “Good morning,” “good afternoon,” or “good evening.”
Discuss how, when, and where NAs may seek help.
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 22. O
Answers to Chapter Review in Textbook
23. B
1.
Communicating verbally means using words. Nonverbal communication is communicating without using words.
24. B
Yes/no answers end a conversation.
26. D
2.
25. C
27. D
23
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 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 a resident who is comatose 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. 56–65
TEXTbooK P. 56
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. 56–57
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. Check the condition and fit.
• 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 the 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. 58-59
3. Identify communication guidelines for hearing impairment Meeting the Learning Objective TEXTbooK PP. 57-58 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 Meeting the Learning Objective TEXTbooK P. 59
woRKbooK P. 28
Review the guidelines for hearing impairment:
Lecture Pronounce and define the following key term:
• Get the 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: • Knock on the door, announce yourself, and greet the resident when you enter the room. Do not touch the resident until you have identified yourself. • Speak softly. Reduce the noise level. • Speak slowly and calmly. • Listen to the resident. Be patient. • Be empathetic, calm, and reassuring.
• Talk about feelings if the resident wishes. • Encourage social interaction.
7. Identify communication guidelines for anger Meeting the Learning Objective TEXTbooK PP. 60-61
woRKbooK PP. 29
• Avoid demanding behavior.
Lecture Review the guidelines for angry behavior:
6. Discuss communication guidelines for depression
• Be pleasant and supportive. • Try to find out what caused the anger. • Observe the resident’s body language.
Meeting the Learning Objective TEXTbooK PP. 59-60
woRKbooK P. 28 Lecture Pronounce and define the following key term:
• Empathize with the resident. • Do not argue with the resident. Stay calm. Speak in a normal tone. • Treat the resident with dignity and respect.
• Answer call lights promptly. • If the resident’s anger increases, get the nurse • Major depressive disorder immediately. Maintain a safe distance if the resiT E S T B A N KSELLER de.nC t bOeM comes violent. Emphasize that depression is an illness like any other and that people who are depressed cannot • Try to involve the resident in activities. simply choose to be well. Role Play Discussion Discuss the differences between assertive behavior Discuss the many losses and changes that occur and aggressive behavior. Have the students act as in a person’s life when he or she has to move into nursing assistants and residents in common situaa facility. Ask them to think about what this would tions, such as a resident asking for a different meal feel like, and ask for volunteers to describe what at dinner, a nursing assistant asking his supervisor would be the hardest loss or change for them to how to correctly perform a procedure, and a nursdeal with if they had to move into a facility. Withing assistant explaining a procedure to a resident. out using any names or personal details, tell the Each situation should be demonstrated twice. students about residents you have known who have The first time, the participants should behave aghad a particularly difficult time adjusting to facility gressively; the second time, they should behave life and how the staff helped them. assertively. Review the guidelines for communicating with residents with depression: • Be pleasant, respectful, and supportive. • Use touch if it helps comfort the resident. • Listen carefully to the resident. Lean forward and maintain eye contact. • Think before you speak and be empathetic. • Use a normal tone of voice and speak clearly.
8. Identify communication guidelines for combative behavior Meeting the Learning Objective TEXTbooK P. 61
woRKbooK P. 29
26 Lecture Pronounce and define the following key term: • Combative 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. Review the guidelines for handling combative behavior: • Call for the nurse immediately. Do not leave the resident alone.
• Do not judge the behavior or gossip about it. • 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 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.
• 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.
10. Identify communication guidelines for disorientation and confusion Meeting the Learning Objective TEXTbooK PP. 62-63
woRKbooK P. 30 Lecture Pronounce and define the following key terms: • Disorientation
TESTBANKSELLER.COM • Confusion
9. Identify communication guidelines for inappropriate sexual behavior Meeting the Learning Objective
Differentiate between disorientation and confusion and list some of the possible causes of confusion.
TEXTbooK PP. 61-62
Review the guidelines for disorientation or confusion:
woRKbooK PP. 29–30
• Do not leave a confused resident alone. • Stay calm and provide a quiet environment.
Lecture Pronounce and define the following key term:
• Speak in a lower tone of voice. Speak clearly and slowly.
• Masturbation
• Introduce yourself each time you see the resident. Remind the resident of the location, his name, and the date.
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.
• 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.
Review the guidelines for handling inappropriate sexual behavior:
• Encourage the use of eyeglasses and hearing aids.
• Do not overreact. Try to distract the resident or move her to a private area.
• Report observations to the nurse.
• Tell the resident when you are leaving the area.
27 11. Identify communication guidelines for a resident who is comatose Meeting the Learning Objective TEXTbooK PP. 63–64
woRKbooK P. 31 Lecture Pronounce and define the following key term: • Coma List some of the causes of coma, such as illness, drug overdose, or injury. Review the guidelines for caring for a resident who is comatose: • Introduce yourself when entering the resident’s room. • Explain each step of each procedure you will be performing. • Do not hold personal discussions while caring for the resident. • Let the resident know when you are going to leave the room.
• 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. • Ask the resident to write down anything you do not understand. • Allow for rest periods if resident becomes tired. • Do not remove a resident’s oxygen for any reason. • Report mouth sores, poorly-fitting dentures, or complaints of pain. • Use other methods of communication, such as writing notes, drawing pictures, and communication boards. • Be reassuring, calm, and empathetic.
Chapter Review Exam
dIsTRIbuTE CHAPTER 4: EXAM (A. PPENDIX C) TESTBANKSELLER COM Define and discuss related terms to coma: persisAllow students enough time to finish the test. See tent vegetative state (PVS) and minimally conAppendix D for answers to the chapter exams. scious state (MCS). Appendices E and F contain a second set of chapter exams and an answer key for those exams if 12. Identify communication guidelines for needed.
functional barriers Answers to Chapter Review in Textbook Meeting the Learning Objective TEXTbooK PP. 64–65
woRKbooK P. 31 Lecture Pronounce and define the following key terms:
1.
Announce yourself and greet the resident.
2.
By using the face of an imaginary clock
3.
The nursing assistant’s
4.
Even when a person is unconscious, she may still be able to hear what is going on around her.
5.
Answers include the following: communication boards, picture cards, writing notes, drawing pictures, and hand and eye signals.
6.
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.
• Dyspnea • 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
28 7.
B
8.
A
9.
C
10. A 11. D 12. B 13. D 14. B 15. C 16. A
29
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 KEY MATERIAL 5-1 MAslow’s HIERARCHY MR ee.tiC ngOtM he Learning Objective oF NEEDs TESTBANKSELLE TEXTbooK PP. 67–68 KEY MATERIAL 5-2 TRuE oR FALsE? HANDouT 5-1 MYTHs AbouT oldER ADulTs AND sEXuALITY CHAPTER 5: EXAM
Assignments TEXTbooK READINg, PP. 67–82
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. As nursing assistants, students will need to get to know their residents as individuals to provide excellent person-centered care.
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. 68
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 Key Material 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. 68
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. 70–71
woRKbooK P. 34 Lecture Pronounce and define the following key terms: • Cultural diversity
ltuCrO alMnursing 4. Identify basic human needs and T diEsS cuTsBsANKS•ETLraLnEscRu. • Cultural competence Maslow’s Hierarchy of Needs Meeting the Learning Objective TEXTbooK PP. 68–70
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. Sharing 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. 71–72
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
• Maintain professional boundaries.
• 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.
• Blended families Discuss the ways that families help residents: • Providing some care • Helping make care decisions • Relating routines and preferences to care team members
8. Explain ways to help residents with their spiritual needs Meeting the Learning Objective TEXTbooK PP. 73–75 woRKbooK P. 35
• Connecting residents to the outside world Lecture Pronounce and define the following key terms:
• Reading mail • Helping to prepare menus
• Religions
• Taking residents on walks • Going with residents to activities and outside functions
• Buddhism • Christianity
• Helping with personal care
• Hinduism
• Washing special clothing at home
• Islam
• Shopping for special items, gifts, or cards • Helping to prepare cards, letters, and gifts and
• Judaism • Spirituality
reading mail
TESTBANKSELLE R.COM • Agnostic • Atheist
7. Explain how to meet emotional needs of residents and their families Meeting the Learning Objective TEXTbooK P. 72
woRKbooK PP. 34–35 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.
Review some common religious and non-religious beliefs. Emphasize that nursing assistants must respect residents’ spiritual beliefs. Discuss the following ways that nursing assistants can help residents meet their spiritual needs: • Honor dietary restrictions. • Report requests to see clergy promptly. Give privacy for clergy visits. • Respect all religious items. • Allow time and privacy for prayer. Honor residents' requests to read religious material aloud. • 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 belief or religion is wrong
32 • Expressing judgments about a religious group
• Do not assume you know what impact a disability has on sexuality. Be sensitive to privacy needs.
• Insisting that a resident join in a religious activity
Discuss the ways NAs can help residents with their sexual needs:
• Interfering with a religious practice • Discussing your personal beliefs or opinions, either directly or indirectly 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.
• Knock and wait for permission to enter a resident’s room. • Provide privacy if you encounter sexual situations. Do not discuss what you saw. • Do not judge sexual choices or orientation or gender identity. • Always use a transgender person's chosen name and preferred pronouns.
9. Identify ways to accommodate sexual needs
• If you witness sexual abuse, remove the resident to a safe place and report to the nurse immediately.
Meeting the Learning Objective
• Do not view any expression of sexuality by the elderly as disgusting or cute.
TEXTbooK PP. 75–77
• If a sexual situation is disturbing or inappropriate, ask a nurse for help.
woRKbooK PP. 35–36 Lecture Discuss some terms defining sexual identity: • Asexual • Bisexual
Distribute Handout 5-1 MYTHs AbouT oldER ADulTs AND sEXuALITY
usEs R th.eC mOyM ths about older adults and sexuality TESTBANKSDEisLcL
• Celibate • Coming out • Cross-dresser • Gay • Heterosexual • Lesbian
included in the handout: • Myth #1 – Older men are not capable of having sexual relations. • Myth #2 – After menopause, older women are not interested in sexual relations. • Myth #3 – Any expression of sexuality by older people is either disgusting or cute.
• LGBT/LGBTQ • Transgender • Transition
10. Describe the stages of human growth and development
Emphasize to students that no matter what their feelings are about lesbian, gay, bisexual, or transgender people, 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.
Meeting the Learning Objective
Discuss the following important points about sexual needs:
• Puberty
• Humans continue to have sexual needs throughout their lives.
Review the different types of development:
• Sexual urges do not end due to age or admission to a care facility.
TEXTbooK PP. 77–80
woRKbooK P. 37 Lecture Pronounce and define the following key term:
• Cognitive development • Language development • Moral development
33 • Motor development • Physical development
• Middle Adulthood (Ages 40 to 65)
• Sexual development
• Usually become more comfortable and stable.
• Social development
• May take trips or start a second career.
Review important points about each age group: • Infancy (Birth to 12 months)
• May have a mid-life crisis. • Late Adulthood (65 years and older)
• Physical development moves from the head down.
• May retire from jobs.
• Learn to grasp, lift their heads, and crawl.
• Staying connected to others is vital to staying healthy.
• Touch is important as a communication tool. • Toddler (Ages 1 to 3) • Speech improves. • Gain coordination of limbs. • Important to protect them as they explore the world. • Learn to control bladder and bowels. • Preschool (Ages 3 to 5) • Become more independent. • Form social relationships.
• Health problems may limit mobility.
11. Discuss stereotypes of the elderly Meeting the Learning Objective TEXTbooK PP. 80–81
woRKbooK P. 37 Lecture Pronounce and define the following key terms: • Stereotype • Ageism
• Sense of imagination developT s.ESTBANKSELLE DiR sp.laCyOKM ey Material • School-age (Ages 5 to 10) • Cognitive and social development is important. • Begin to develop a conscience, morals, and self-esteem. • Preadolescence (Ages 10 to 12) • View life more realistically. • Use reason to analyze situations. • Girls may reach puberty, which is when a person develops secondary sex characteristics. • Adolescence (Ages 12 to 18) • Both genders become sexually mature. • May have mood swings. • Concerned about acceptance from others. • Young Adulthood (Ages 19 to 40)
5-2 TRuE oR FALsE? Discuss the statements on the key material. 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
• Make decisions about career and education.
TEXTbooK PP. 81–82
• May meet life partner.
woRKbooK PP. 37–38
• May decide to have children.
34 Lecture Pronounce and define the following key term: • Developmental disability
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.
2.
Holistic care involves considering the whole person, which includes his physical and psychosocial needs.
3.
Psychosocial needs include social contact, emotions, thought, and spirituality.
4.
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.
5.
Cultural competence is an ongoing process of learning about other cultures and applying that knowledge to help provide better health care.
6.
Provide privacy and leave the room.
Discuss important points about developmental disabilities: • A developmental disability is a chronic condition. • Developmental disabilities restrict physical and/ or mental ability. • They may cause difficulty with self-care and ADLs. Review types of developmental disabilities listed: • Intellectual disability • Cerebral palsy • Spina bifida • Autism spectrum disorder • Fragile X syndrome Review guidelines for caring for residents with developmental disabilities: • Treat adult residents as adults. • Praise and encourage positive behavior. • Teach ADLs by dividing tasks into small steps.
7.
Remove the resident from the situation. Make sure he or she is taken to a safe place, then TESTBANKSELLreEpoRr. t tC hO e aMbuse to the nurse immediately. • Repeat words to make sure they are understood. 8. A stereotype is a biased generalization about • Talk to residents even if they cannot speak. Use a group that is usually based on opinions and alternate methods of communication as directed. distorted ideas. • Promote independence while ensuring safety. 9. Answers may include the following: Because • Prevent falls. these generalizations are usually based on • Encourage residents to follow special diets and opinions and distorted ideas and often come be aware of any food allergies. from television or the movies. These unfair • Encourage social interaction. ideas create prejudices against the elderly. • Be patient. 10. Answers will vary, but may include something along the lines of the resident having a right to Chapter Review respect, dignity, and independence. Exam
11. B
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.
12. C 13. A 14. D 15. A 16. B 17. C 18. C
35
6 Infection Prevention and Control 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 KEY MATERIAL 6-1 THE CHAIN oF INFECTIoN KEY MATERIAL 6-2 PoRTALs oF EXIT KEY MATERIAL 6-3 PoRTALs oF ENTRY KEY MATERIAL 6-4 AIRboRNE PRECAuTIoNs KEY MATERIAL 6-5 dRoPLET PRECAuTIoNs KEY MATERIAL 6-6 CoNTACT PRECAuTIoNs
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.
CHAPTER 6: EXAM
Assignments TEXTbooK READINg, PP. 84–111
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
The chapter contains the first procedures in the book. 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. 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. 84–86
TEXTbooK P. 88
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. 86–88
• 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. 89–91
woRKbooK P. 40
• Communicable disease
Lecture Pronounce and define the following key terms:
• Contagious disease
• Normal flora
• Noncommunicable disease
• Incubation period
• Cross-infection
• Carrier
• Reinfection
• Body fluids
Because students are being introduced to such an important topic and to many key terms in this learning objective, emphasize how quality infection prevention practices are crucial in preventing the spread of disease.
• Direct contact • Indirect contact • Fomite • Mucous membranes • Vaccine • Immunity
37 Display Key Material
• 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 to reinforce how pathogens can enter and leave the body.
• 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. 92–94
woRKbooK PP. 40–41 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.
Lecture Pronounce and define the following key terms: • Centers for Disease Control and Prevention (CDC) • Standard Precautions
5. Explain why the elderly are at a higher ExRp. laC inOSM tandard Precautions. Emphasize that TESTBANKSELLE risk for infection Meeting the Learning Objective
Standard Precautions must be practiced with every resident.
TEXTbooK PP. 91–92
Review the elements of Standard Precautions:
woRKbooK P. 40
• Treat blood, body fluids, nonintact skin, and mucous membranes as if they were infected. • Wash hands before putting on gloves and after removing gloves.
Lecture Pronounce and define the following key terms: • Catheter • Malnutrition • Dehydration
• 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.
Explain that lack of thirst and appetite, illness, or medication may cause residents to become malnourished or dehydrated.
• Remove gloves when finished with a procedure.
Discuss the changes of aging that cause older people to have a greater risk for infection:
• 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.
• Hospitalized more often • Recovery from illness takes longer • Infections more dangerous • Skin becomes less elastic, thinner, and is easily torn • Limited mobility
• Wash all skin surfaces that have been contaminated with blood and body fluids.
• 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. 94–96
woRKbooK P. 41 Lecture Pronounce and define the following key terms: • Hand hygiene • Hand rub • Antimicrobial Explain your facility’s policy on the use of alcoholbased hand rubs. Emphasize that visibly soiled hands must be washed with soap and water.
• Before entering a clean supply room • Before leaving a dirty supply room • After contact with blood or any body fluids, mucous membranes, nonintact 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. Demonstration Demonstrate procedure Washing hands (hand hygiene). Include all of the numbered steps in your demonstration. We also have a corresponding video for this skill that you can show to the students. Have the students return the demonstration. Procedure checklists are located at the end of
39 the student workbook, as well as in the instructor’s guide as a supplementary handout.
• Before contact with mucous membranes or broken skin
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. 96–101 woRKbooK PP. 41–42
Demonstration Demonstrate procedure Putting on (donning) 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, as well as in the instructor’s guide as a supplementary handout.
Lecture Pronounce and define the following terms: • Personal protective equipment (PPE) • Don • Doff • Perineal care • Nonintact skin
Lecture Discuss the times when gloves must be removed: • Immediately after use • Before caring for another resident • Before touching surfaces
List the types of PPE used in a facility: Demonstration Demonstrate procedure Removing (doffing) gloves. • Gowns Include all of the numbered steps in your demon• Masks stration. We also have a corresponding video for this skill that you can show to the students. Have • Goggles t hR e. stC udOeM nts return the demonstration. Procedure TESTBANKSELLE • Face shields checklists are located at the end of the student workbook, as well as in the instructor’s guide as a Review the times when gloves must be worn: supplementary handout. • When there may be contact with blood, body • Gloves
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 nonintact 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
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 • Should fully cover torso • 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. We also have
40 a corresponding video for this skill that you can show to the students. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. 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 • Should fully cover nose and mouth • Prevent inhalation of microorganisms • Must be changed if wet or soiled, and between caring for different residents Review important information about goggles: • Used when blood or body fluids may be splashed or sprayed in eye area • Should fit snugly over and around eyes or eyeglasses
Here is the CDC’s link regarding proper sequence: http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence. pdf. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
9. List guidelines for handling linen and equipment Meeting the Learning Objective TEXTbooK PP. 101–102 woRKbooK P. 42 Lecture Discuss the guidelines for handling linen and equipment: • Wear gloves when handling, transporting, and processing soiled linens. • Check for items left inside linen. • Fold or roll linen so that the dirty area is inside.
• Hold dirty linen away from uniform. Demonstration • Do not shake dirty linen or clothes. Demonstrate procedure Putting on (donnT inE g)Sm TaBskANKS•EPLlaLceEoRr.dC isO poMse of linen and other equipment in and goggles. Include all of the numbered steps in the proper container. your demonstration. We also have a correspond• Do not touch the inside of disposal containers. ing video for this skill that you can show to the students. Have the students return the demonstra• Do not use reusable equipment again until it has tion. Procedure checklists are located at the end of been properly cleaned and reprocessed. Dispose the student workbook, as well as in the instructor’s of single-use equipment properly. guide as a supplementary handout. • Wear gloves to clean and disinfect surfaces. 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 P. 102
• 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. We also have a corresponding video for this skill that you can show to the students. Be sure to emphasize that respirators, not standard masks, should be removed after exiting the resident’s room and closing the door.
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.
41 • 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.
11. Discuss Transmission-Based Precautions
• Cover nose and mouth when sneezing or coughing. Dispose of tissues in a no-touch waste container and wash hands. • Visits from uninfected people may be restricted. Display Key Material 6-6 CoNTACT PRECAuTIoNs
TEXTbooK PP. 102–105
Explain that Contact Precautions are used when a resident may spread an infection by direct contact with another person or object. Clostridioides difficile (C. diff) is a contact disease.
woRKbooK P. 43
Review Contact Precautions:
Meeting the Learning Objective
Lecture Emphasize that Transmission-Based Precautions are always used in addition to Standard Precautions. Display Key Material 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.
• 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 the room, wash hands with antimicrobial soap after removing gloves. • Do not share resident’s equipment with other residents.
Review Airborne Precautions:
• Do not share resident’s towels, bedding, or clothing with other residents.
• Follow Standard Precautions.
• Resident will be placed in a private room.
• Resident will be in an 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 should wear surgical masks. Display Key Material 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 a mask when leaving a room.
12. Describe care of the resident in an isolation unit Meeting the Learning Objective TEXTbooK PP. 105–106
woRKbooK P. 43 Lecture Pronounce and define the following key term: • Isolate 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.
42 • 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. • Apply proper PPE before entering the isolation room. • Use disposable supplies whenever possible. Clean and disinfect dedicated equipment. • Dispose of trash in proper containers. • Dispose of waste containing blood, body fluids, or sharps in biohazard containers. • Bag used linen or equipment so that contaminated items do not touch outside of bag. Know the procedure for handling contaminated bags. • Disinfect furniture and surfaces regularly. • Assist visitors with putting on PPE as needed. • Make sure TV, telephone, and radio are working. • Encourage use of disposable reading material. • Place call light within resident’s reach.
• Cut from object containing potentially infectious body fluids • Nonintact skin, including acne 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 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.
14. Discuss two important bloodborne diseases Meeting the Learning Objective
TEXTbooK PP. 108–109 • Spend as much time with resident as possible if allowed. Be empathetic and reassuringT . ESTBANKSEwLoLRE KbRo. oC KO P.M 44
Remind students that Residents’ Rights must be protected when residents are in isolation.
Lecture Discuss important information about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS):
13. Explain OSHA’s Bloodborne Pathogen Standard
• AIDS is caused by HIV.
Meeting the Learning Objective
• HIV damages the immune system over time so that the body cannot fight infection.
TEXTbooK PP. 106–107
woRKbooK P. 43 Lecture Pronounce and define the following terms:
• The stage of the disease when tumors and central nervous system symptoms appear is known as AIDS.
• Bloodborne pathogens
• People with AIDS can die from illnesses that a person with a healthy immune system could fight.
• Occupational Safety and Health Administration (OSHA)
• HIV is transmitted by blood, infected needles, from mother to fetus, or by sexual contact.
• Bloodborne Pathogen Standard
Pronounce and define the following term:
• Exposure control plan
• Hepatitis
• Exposure incident Review significant exposures:
Review the different viruses that can cause hepatitis:
• Needle stick
• Hepatitis A (HAV)
• Mucous membrane contact
• Hepatitis B (HBV)
43 • Hepatitis C (HCV)
Review important information about VRE:
• Hepatitis D (HDV)
• Very difficult to treat and may require several medications
• Hepatitis E (HEV) Emphasize that HBV is a serious threat to healthcare workers. Review precautions to take to avoid being infected on the job: • Use proper PPE.
• Spread through direct or indirect contact • Symptoms include fever, fatigue, chills, and drainage • Much easier to prevent than to get rid of
• Handle needles and other sharps carefully.
• Proper hand hygiene can help prevent the spread
• Dispose of sharps properly in biohazard container.
Review important information about C. difficile:
• Get the free HBV vaccine.
15. Discuss MRSA, VRE, C. difficile, and CRE
• 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 • Spread by spores in feces that are difficult to kill
Meeting the Learning Objective TEXTbooK PP. 109–111
woRKbooK P. 44
• Alcohol-based hand sanitizers are not effective; soap and water must be used for hand hygiene • Symptoms include foul-smelling watery stools, fever, diarrhea that contains blood and mucus, nausea, lack of appetite, and abdominal cramps
Lecture Pronounce and define the following key terms: • Symptoms should be reported immediately • Multidrug-resistant organisms (MDROs) •R Ad ioM nal Transmission-Based Precautions are TESTBANKSELLE .dCitO used with residents who have C. difficile. NA may • MRSA (methicillin-resistant Staphylococcus use special disinfectants for cleaning surfaces. aureus) • VRE (vancomycin-resistant enterococcus) • Clostridioides difficile (C. diff, C. difficile)
Review important information about Carbapenemresistant Enterobacteriaceae (CRE):
• Carbapenem-resistant Enterobacteriaceae (CRE)
• Spread through direct contact with infected person
Review important information about MRSA:
• Catheter use, IV therapy, and ventilators increase the risk of acquiring CRE.
• Often acquired in healthcare facilities; also known as hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) • Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a type of MRSA infection that occurs in people who have not been in healthcare facilities and who have no past diagnosis of MRSA • Spread by direct contact with infected person or indirect contact through contaminated objects • Symptoms include drainage, fever, chills, and redness. Common infection sites include skin, respiratory tract, surgical wounds, urinary tract, perineum, and rectum. • Handwashing is best way to control it
• Proper, frequent hand hygiene is the most important way to prevent it. Review the additional infections that are found in the orange box on page 111 of the textbook.
Chapter Review Exam dIsTRIbuTE CHAPTER 6: EXAM (APPENDIX C) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams.
44 Appendices E and F contain a second set of chapter exams and an answer key for those exams if needed.
8.
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.
9.
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.
Answers to Chapter Review in Textbook 1.
An object can be called clean if it has not been contaminated with pathogens. An object that is dirty has been contaminated with pathogens.
2.
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.
10. Dirty linen should be held and carried away from the NA’s uniform. 11. After it has been properly cleaned and reprocessed
3.
Answers include the following: Multiple 12. Bloodborne pathogens are transmitted by changes of aging tend to make the elderly infected blood entering the bloodstream, or if more susceptible to infections. Elderly people infected semen or vaginal secretions contact are hospitalized more often, which increases mucous membranes. Sharing infected drug their chances of getting healthcare-associated needles is another way to spread bloodborne infections and other infections. When the diseases. Infected pregnant women may transelderly get sick, recovery may take longer and mit bloodborne diseases to their babies. In the infections themselves may be more danhealthcare professions, contact with infectious gerous. Skin becomes thinner, which makes it blood or body fluids is the most common way easier to tear. When fragile skin tears, pathoT E S TBANKSELL toEgR et.aCbO loM odborne disease. Infections may gens can enter the body. Both thinner skin be spread by accidental contact with contamiand limited mobility increase the risk of presnated blood or body fluids, skin, needles or sure injuries and skin infections. Bones beother sharp objects, or contaminated supplies come more brittle and can break more easily. or equipment. Decreased circulation and slow wound healing also contribute to infections in the elderly. 13. Hepatitis is inflammation of the liver caused Catheters and other types of tubing can by certain viruses and other factors, such as greatly increase the risk of infections. Older alcohol abuse, some medications, and trauma. adults are at risk for dehydration and malnutrition. When cells do not get proper nutrients 14. HIV damages the immune system so that over and fluids, the chance of infection greatly time, the body cannot effectively fight increases. infections.
4.
With every resident for whom the nursing assistant cares
5.
Hand hygiene is washing hands with either plain or antiseptic soap and water or using alcohol-based hand rubs.
6.
Artificial nails harbor bacteria, even if a person washes his hands often.
7.
A gown should be worn if the caregiver may come into contact with blood, body fluids, secretions or excretions, tissue, or when splashing or spraying blood or body fluids is likely.
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. 16. Through frequent, proper handwashing
45 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. B 20. A 21. D 22. D 23. B 24. C 25. B 26. A 27. B
46
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. KEY MATERIAL 7-1 body ALIgNMENT TMBANKSIE KEY MATERIAL 7-2 lIFTINg HEAVY obJECT TsEFS Ro nL thL isEcR ha.pC teO r, M 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. 113–127
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. 113–114
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. 114–118
woRKbooK P. 45
47 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. Fall Prevention Review the guidelines for preventing falls: • 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. Do not leave a spill area until the spill is gone. • Remove clutter from walkways. Keep purse, bag straps, and linens off the floor. • Get help when moving residents. • Lock bed wheels before giving care. Lock bed wheels before moving a resident into or out of bed.
• Report all falls to the nurse and always complete an incident report. Remind students that most of the accidents in a facility are related to falls, and that they may be caused by unsafe environments, loss of abilities, diseases, muscle weakness, poor vision, or disorientation. This would be a good time to demonstrate to students how to handle a falling resident. We also have a corresponding video for this topic that you can show to the students. Let them practice on each other after the demonstration. Resident Identification 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 the resident before providing care or serving food. • Check diet cards against resident’s identification.
• Call the resident by his name. • Lock wheelchair wheels before transferring residents into or out of them. BuRr. n/CSO caM ld Prevention TESTBANKSELLE • Return beds to their lowest position when finished with care. • Make sure residents’ clothing fits properly. Make sure residents are wearing sturdy, nonskid shoes with the laces tied. • Report any rugs or mats that move. Use nonskid mats in the shower or bath. • Report loose hand rails immediately. Report cracks or holes anywhere. • Report damage to outdoor furniture, benches, and ramps. • Clearly mark areas where floor is uneven. • Keep walkers and canes nearby. Allow residents time to sit before getting up to prevent lightheadedness. • Do not move furniture without an order from the nurse. • Offer trips to the bathroom often. Respond to requests for bathroom assistance promptly. • Report any areas that are not well-lit. • Do not try to catch or stop a falling resident. Use your body to slide him to the floor.
Pronounce and define the following key term: • Scalds Emphasize that burns are very painful and can occur quickly. Explain that elderly people and those with loss of sensation are at greater risk for burns. Review the guidelines for preventing burns and scalds: • Check water temperature before giving a resident a bath or shower. Temperature should not be over 105°F. • Check for proper temperature of warm water applications. Limit warm applications to 20 minutes at a time. • Use low setting on hair dryers. • Let liquids cool before serving. • Serve drinks when residents are seated. • Tell residents before pouring or setting down hot drinks. • Use lids on hot liquids. • Pour hot liquids away from residents. Keep hot drinks away from table edges and use lids if possible.
48 • Check plates that have been warmed.
• Approach doors slowly.
• Make sure anything that has been in the sun has cooled before use. Limit residents’ time in the sun and encourage use of sunscreen and hats.
• When moving residents in wheelchairs, protect their arms, legs, hands, and feet.
• Tell residents about smoking precautions.
• Push wheelchairs forward. Wheelchairs should face forward in elevators.
Poison Prevention
Review general safety guidelines:
Pronounce and define the following key term:
• Do not run in a facility.
• Hoarding
• Do not put your hand into a bed or anywhere else without looking first.
Review guidelines for poison prevention:
• Ask for help when you need it.
• Keep all items that may be poisonous away from confused or disoriented residents. Do not leave cleaning products in residents’ rooms. Keep plants and flowers away from disoriented or confused residents.
• Know which residents are combative and try to learn what triggers this behavior.
• Check expiration dates of foods to ensure that they are fresh. • Check residents’ drawers for hoarded food that has spoiled. • Make sure there is proper ventilation when chemical products are used. Choking Prevention Pronounce and define the following key terms: • Dysphagia • Aspiration Review the guidelines for choking prevention: • Residents should be sitting upright/90 degrees while eating. • Assist with feeding slowly. Never rush a resident during a meal.
• Follow facility policy if a skin splash or eye splash occurs. • Report all injuries immediately.
3. Explain the Safety Data Sheet (SDS) Meeting the Learning Objective TEXTbooK PP. 118–119
woRKbooK P. 45 Lecture Pronounce and define the following key term: • Safety Data Sheet (SDS) Discussion Hand out a sample SDS to students. Ask them to look for the following important information: • Chemical ingredients of the product • Dangers of the product
• Alternate between food and drink.
• Pictograms
• Cut food into small pieces.
• Protective items to be worn
• Report to nurse if you think a resident would be helped by softer foods or thickened liquids.
• How to use and clean up the chemical
• Make sure dentures are in place and fit properly.
• Emergency response if product is splashed onto skin or ingested
• Be aware of residents’ swallowing precautions.
• Safe handling, storage, and disposal procedures
Cuts and Other Injuries 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.
4. Describe safety guidelines for sharps and biohazard containers Meeting the Learning Objective TEXTbooK P. 119
woRKbooK P. 46
49 Lecture Review the guidelines for safe use of sharps and biohazard containers:
Display Key Material
• Don gloves before touching a sharps container.
List activities on the job that will require moving or lifting:
• Keep hands clear of the opening of container. Carry the container by the bottom only.
7-2 lIFTINg HEAVY obJECTs FRoM THE FLooR
• Lifting a resident
• Request that container be replaced when it is ¾ full or according to facility policy.
• Picking up a bag of laundry
• Remove gloves and wash hands after putting anything into sharps container.
• Taking heavy trash bags to appropriate site
• Use biohazard container or bag for anything contaminated with infectious waste except for sharps.
• Moving a bed into another room
• Wear gloves when disposing of infectious waste. • 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.
• Carrying new residents’ luggage • Cleaning a floor
Ask students to demonstrate doing these activities with proper body mechanics, using the following guidelines: • Raise beds to a safe working level. • Stand close to objects. • 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.
5. Explain the principles of boT •R Av.oC idOt M wisting or choppy movements. Face the dyES mTeB chAaNnK icSs ELLE object or person being moved. Pivot the feet and apply them to daily activities Meeting the Learning Objective TEXTbooK PP. 119–121
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. We also have a corresponding video for this topic that you can show to the students. Display Key Material 7-1 body ALIgNMENT Review the terms associated with body mechanics: • Alignment • Base of support • Center of gravity
instead of twisting at the waist. • Do not lift with one hand.
• Hold objects close to your body when lifting/ carrying. • Avoid bending and reaching. • Get help when you need it. • Talk to residents before moving them. Agree on a signal for moving.
6. Define two types of restraints and discuss problems associated with restraints Meeting the Learning Objective TEXTbooK PP. 121–122
woRKbooK P. 46 Lecture Pronounce and define the following key terms: • Restraint • Physical restraint • Chemical restraint
50 • Suffocation
To reinforce material, ask the following questions for discussion:
• Atrophy • Contractures
• Can restraints be used if staff do not have enough time to care for residents?
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.
• 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?
Review the potential negative effects of restraint use: • Bruises and cuts • Pressure injuries • Risk of suffocation or strangulation
• 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.
• Entrapment • Pneumonia
7. Discuss restraint alternatives
• Reduced blood circulation • Stress on the heart
Meeting the Learning Objective
• Blood clots
TEXTbooK PP. 122–123
• Poor appetite and malnutrition
woRKbooK P. 47
• Dehydration • Incontinence • Urinary tract infection • Constipation • Muscle atrophy and contractures • Loss of bone mass • Nerve injuries • Decreased mobility • Falls • Fractures • Depression and/or withdrawal • Social isolation • Loss of self-esteem • Sleep disorders
Lecture Pronounce and define the following key terms:
TESTBANKSELLER.COM
• Restraint-free care • Restraint alternatives Distribute Handout 7-1 REsTRAINT ALTERNATIVEs Discuss the examples of restraint alternatives on the handout. Ask the class if they can come up with additional creative ideas.
8. Identify what must be done if a restraint is ordered Meeting the Learning Objective
• Loss of dignity
TEXTbooK PP. 123–124
• Loss of independence
woRKbooK P. 47
• Stress and anxiety • Increased agitation • Confusion • Severe injury • Death
Lecture Pronounce and define the following key term: • Cyanosis Review the guidelines for restraint use: • Follow the care plan’s and the nurse’s instructions for monitoring.
51 • Place call light within resident’s reach and respond immediately to call lights.
Discuss things that a nursing assistant should not do when caring for a resident with an IV:
• Check the resident at least every 15 minutes. Every two hours, release the restraint and perform care as ordered.
• Take blood pressure on the arm with the IV
• Document appropriately.
9. List safety guidelines for oxygen use Meeting the Learning Objective
• Get the IV site wet • Pull on or catch tubing in anything • Leave tubing kinked • Lower IV bag below IV site • Touch the clamp • Disconnect IV from pump or turn off alarm
TEXTbooK PP. 124–125
Review observations to report to nurse:
woRKbooK P. 47
• Needle or catheter has fallen out
Lecture Pronounce and define the following key terms:
• The armboard or handboard becomes loose • Tubing is disconnected
• Combustion
• Blood appears in tubing
• Flammable
• IV fluid in bag or container is gone or almost gone
Review the guidelines for safety with oxygen:
• IV fluid is not dripping or is leaking, or bag breaks
• Post No Smoking and Oxygen in Use signs. • Remove fire hazards from room. • Remove flammable liquids from the area. • Do not allow candles, lighters, or matches around oxygen. • Check nasal area, cheeks, and behind the ears for signs of irritation from tubing. • Do not use petroleum-based products on the resident or on any part of the cannula or mask. • 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. 125
woRKbooK P. 48 Lecture Pronounce and define the following key term: • Intravenous therapy Remind students to always wear gloves when touching the IV area.
• IV pump is beeping • Resident complains of pain, has difficulty breathing, or has a fever • Resident pulls out or attempts to pull out IV
11. Discuss fire safety and explain the RACE and PASS acronyms Meeting the Learning Objective TEXTbooK PP. 126–127
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 126 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 ashtrays before emptying them.
52 • Follow any policies regarding e-cigarettes and their batteries.
Lecture Review guidelines for safety in a facility:
• Report unsafe electrical equipment and cords immediately.
• Report anything suspicious.
• Report smell of gas.
• Ask nurse to lock up residents’ valuables.
Explain the RACE acronym:
• If a visitor or staff member makes you uneasy, do not leave the resident alone with the person.
• Remove anyone from danger if you are not in danger. • Activate alarm or call 911. • Contain fire by closing all doors and windows. • Extinguish the fire or fire department will extinguish. Evacuate if instructed to do so. Explain the PASS acronym for using a fire extinguisher: • Pull the pin. • Aim at the base of fire.
• Keep valuables at home.
• 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
• Squeeze the handle.
dIsTRIbuTE CHAPTER 7: EXAM
• Sweep back and forth at the base of the fire.
(APPENDIX C)
If possible, bring in fire extinguishers for the class to practice with. Review general procedures to follow in case of fire:
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 chapTESTBANKStE erLeL xaE mRs . anCdOaM n answer key for those exams if • Know the location of the fire evacuation plan. needed. • Remain calm. Answers to Chapter Review in Textbook • Remove all persons in immediate area. • Stay low to escape a fire.
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
• Turn off oxygen and electrical equipment if facility policy allows.
2.
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
3.
Close to the body
4.
At the knees
5.
In the past, restraint usage was often abused by caregivers. This abuse led to new laws on restricting their use.
• Check closed doors for heat before opening them. Use wet towels to block doorways. Wait for help if there is no safe exit. • Use damp covering over face to reduce smoke inhalation. • Stop, drop, and roll if clothing catches fire. • Never get into an elevator during a fire.
Meeting the Learning Objective TEXTbooK P. 127
woRKbooK P. 48
53 6.
Restraint alternatives are any measure used in place of a restraint or that reduces the need for a restraint.
7.
Restraints are used only after everything else has been ruled out and only with a doctor’s order.
8.
9.
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.
10. RACE is: Remove anyone from danger if you are not in danger. Activate alarm (or call 911). 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. Report any situation or person who makes you feel unsafe or concerned to your supervisor. 13. B 14. A 15. C 16. C
54
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. 129–141
woRKbooK EXERCIsEs, PP.
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 fL glL ovE esRa.nC dO aM mask or other barrier device in the they need to perform first aid in the evenT t oEfSaT n BANKSoE 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.
1. Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 129–130
woRKbooK PP. 49–51 Lecture Pronounce and define each of the key terms listed in the Learning Objective.
2. Demonstrate how to respond to medical emergencies Meeting the Learning Objective TEXTbooK PP. 130–131
woRKbooK P. 49
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. • Assess the victim. Ask the injured or ill person what happened. Determine if the person is conscious. • Call for help or send someone to call for help right away. • 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 • Unusual color or feel to skin • Swollen places on the body • Medical alert tags • Pain
55 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, or an 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. 131–140
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
• 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 • Decreased blood supply to the brain • Hunger
• Obstructed airway
• Hypoglycemia
• Abdominal thrusts
• Dehydration
Stress that abdominal thrusts should not be performed unless the person shows signs of a severely
• Fear • Pain
56 • Fatigue
Myocardial Infarction
• Standing for a long time • Poor ventilation
Lecture Pronounce and define the following key term:
• Pregnancy
• Myocardial infarction
• Overheating
Review the signs and symptoms of a heart attack:
Review the signs and symptoms of fainting:
• Sudden, severe pain, pressure, squeezing, or fullness in the chest
• Dizziness
• Pain or discomfort in other areas of the body
• Nausea
• Indigestion or heartburn
• Perspiration
• Nausea and vomiting
• Pale skin
• Shortness of breath
• Weak pulse
• Dizziness
• Shallow respirations
• Lightheadedness
• Blackness in the visual field
• Pale, gray, or cyanotic skin color or mucous membranes
Poisoning Lecture Review signs and symptoms of poisoning:
• Perspiration • Cold and clammy skin
• Vomiting
• Weak and irregular pulse rate
• Heavy, difficult breathing
• Low blood pressure
• Drowsiness
• Anxiety and a sense of doom
• Confusion • Burns or red areas around the mouth
ial of a heart problem TESTBANKS•EDLeLnE R.COM
Nosebleed Lecture Pronounce and define the following key term: • Epistaxis
Emphasize that women may experience different symptoms than men, and are somewhat more likely to experience the following: • Shortness of breath • Nausea • Vomiting
Discuss the possible causes of a nosebleed:
• Lightheadedness
• Dry air
• Fainting
• Injury
• Dizziness
• Medication
• Stomach pain
Vomiting Lecture Pronounce and define the following key term:
• Sweating • Fatigue • Back, neck, and jaw pain
• Emesis
• Flu-like symptoms
Emphasize that the nursing assistant should soothe the resident and report to the nurse when vomiting occurs.
Insulin Reaction and Diabetic Ketoacidosis Lecture Pronounce and define the following key terms: • Insulin reaction • Diabetic ketoacidosis (DKA) • Hyperglycemia
57 Review the causes of insulin reaction:
• Breath that smells sweet or fruity
• Too much insulin
• Headache
• Too little food
• Blurred vision
• Additional activity that causes the body to rapidly absorb food
• Dry skin, dry mouth
• Vomiting
• Nausea and vomiting
• Diarrhea
• Loss of appetite
Review signs and symptoms of insulin reaction:
• Rapid, weak pulse
• Feeling weak or different
• Low blood pressure
• Nervousness
• Shortness of breath or air hunger
• Dizziness
• Weakness
• Perspiration
• Drowsiness
• Headache
• Confusion
• Blurred vision
• Unconsciousness
• Numbness of the lips and tongue • Cold, clammy skin • Trembling
• Flushed cheeks
Emphasize that DKA can lead to diabetic coma and death if left untreated.
• Hunger
Seizures
• Rapid pulse
Lecture Discuss the causes of seizures: • Abnormality in the brain
• Low blood pressure • Confusion • Unconsciousness
TESTBANKSELLE R.COM • High fever
Emphasize that these are signs that the resident needs food, and that a diabetic resident should always have a quick source of sugar handy.
• 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 condition in which hypoglycemia occurs without causing any symptoms. Blood glucose levels fall, but the person does not experience any symptoms.
• Severe shaking
Review the causes of diabetic ketoacidosis (DKA):
• Uncontrolled thrusting of arms and legs
• Undiagnosed diabetes
• Clenching jaw
• Infection
• Drooling
• Going without or not taking enough insulin
• Inability to swallow
• Eating too much • Not getting enough exercise
Discuss signs of seizure:
CVA or Stroke
• Physical and emotional stress
Lecture Pronounce and define the following key terms:
Review the signs and symptoms of DKA:
• Hemiplegia
• Increased hunger, thirst, or urination
• Hemiparesis
• Abdominal pain
• Expressive aphasia
• Deep or difficult breathing
• Receptive aphasia
58 Explain that a cerebrovascular accident (CVA) or stroke occurs when the blood supply to a portion of 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:
• Hallucinations
• Difficulty speaking
• (F)ace: Is one side of the face drooping? Is it numb? Ask the person to smile. Is the smile uneven?
• 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 (hemiplegia) • Arm or leg numbness or weakness, especially on one side (hemiparesis) • Trouble walking, loss of balance • Slurred speech or inability to speak (expressive aphasia) • Inability to understand spoken or written words (receptive aphasia) • Use of inappropriate words • Severe headache
• Disorientation It is 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.
• (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 the website for The National Stroke Association (stroke.org) has more information.
r bSoT thBANKSELLER.COM • Blurred vision or trouble seeing in oneToE eyes Demonstrations Demonstrate each of the following procedures. • Ringing in the ears Include all of the numbered steps in your • Redness in the face demonstration: • Noisy breathing • Performing abdominal thrusts for the conscious • Slow pulse rate person (do not practice this procedure on a live • Elevated blood pressure person) • Nausea or vomiting • Responding to shock • Loss of bowel and bladder control
• Controlling bleeding
• Seizures
• Treating burns
• Dizziness
• Responding to fainting
• Loss of consciousness
• Responding to a nosebleed
In addition to the symptoms listed above, women may have these symptoms: • Pain in the face, arms, and legs • Hiccups • Shortness of breath • Palpitations • Chest pain • Agitation
• Responding to vomiting • 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, as well as in the instructor’s guide as a supplementary handout.
59 4. Explain the nursing assistant’s role on a code team
Chapter Review Exam
Meeting the Learning Objective
dIsTRIbuTE CHAPTER 8: EXAM
TEXTbooK PP. 140–141
(APPENDIX C)
woRKbooK P. 51 Lecture Pronounce and define the following key term: • Code team
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.
Discuss the nursing assistant’s role as a member of the code team:
Answers to Chapter Review in Textbook
• May be asked to get special equipment.
1.
Assess the situation, assess the victim
• May do chest compressions during CPR.
2.
Respiratory arrest means that breathing stops; cardiac arrest is when the heart stops.
• Do not panic.
3.
Within four to six minutes
• Get another staff member to take over any care you are performing.
4.
Lying down on the back
5.
No
5. Describe guidelines for responding to disasters
6.
Have the person bend forward and place her head between her knees if possible.
• Respond to codes from wherever you are in the facility.
TESTBANKSELLE R.COM 7. Apply firm pressure on both sides of the nose,
Meeting the Learning Objective TEXTbooK P. 141
woRKbooK P. 51 Lecture and Discussion Discuss the types of disasters that may occur in your area. Review the nursing assistant’s role in the event of a disaster: • Know his facility’s disaster plan. • Listen carefully and follow instructions. • Remain calm. • Know the location of all exits and stairwells. • Know where fire alarms and fire extinguishers are located. • Know the appropriate action to take. • Pay close attention during classes on disasters and disaster drills. Ask the students to share any experiences they have had with disasters and what actions they took at the time that were appropriate or not helpful.
on the soft part 8.
Answers include the following: shortness of breath, nausea, vomiting, lightheadedness, fainting, dizziness, stomach pain, sweating, fatigue, back, neck, and jaw pain, and flu-like symptoms.
9.
The signs of onset of diabetic ketoacidosis include increased hunger, thirst, or urination; abdominal pain; deep or labored breathing; and breath that smells sweet or fruity.
10. Answers include the following: try to stop the seizure or restrain the person; force anything between the person’s teeth; place hands in the mouth for any reason; and give liquids or food. 11. A transient ischemic attack (TIA) is a warning sign of a CVA. It is the result of a temporary lack of oxygen in the brain. 12. Cardiac arrest
60 13. Answers may vary but could include fire, flood, earthquake, hurricane, tornado, severe weather, and acts of terrorism. 14. A 15. D 16. B 17. D 18. C
61
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
KEY MATERIAL 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. 143–156
Meeting the Learning Objective TEXTbooK P. 143 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. 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. 143–144
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 a translator 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?
62 • 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 injuries 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. 145–146
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. • Residents may have had to leave home and give up personal belongings and beloved pets. • Residents 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
63 life easier. Review the guidelines for helping new residents adjust: • Have a positive attitude. • Be tactful. • Communicate clearly. • Show respect for residents’ belongings. • Be responsible. • Be honest. • Listen to residents. • Pay attention to residents’ wishes. • Respect residents’ privacy. • Be patient and kind.
Demonstration Demonstrate procedure Admitting 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, as well as in the instructor’s guide as a supplementary handout. Lecture Pronounce and define the following key terms: • Pound • Metric • Kilogram • Bedridden
4. Describe the nursing assistant’s role in the admission process
Emphasize that any change in a resident’s weight must be reported right away, as this can be a sign of illness.
Meeting the Learning Objective
Demonstration Demonstrate each of the following procedures, including all of the numbered steps in your demonstration.
TEXTbooK PP. 146–152
woRKbooK P. 54
Lecture • Measuring and recording weight of an ambulaPronounce and define the following key terms: tory resident TESTBANKSELLER .COM • Admit • Measuring and recording weight of a bedridden resident • Return • Measuring and recording height of an ambula• Admission pack tory resident • Baseline • Measuring and recording height of a bedridden Review the guidelines for admission: resident • Wash hands and gather necessary equipment to Have the students return each demonstration. We bring to resident’s room. also have a corresponding video for the weight of • Prepare the resident’s room before he arrives. an ambulatory resident skill that you can show to the students. Procedure checklists are located at • Make the bed and open curtains or blinds. the end of the student workbook, as well as in the • Introduce yourself to resident and call him by his instructor’s guide as a supplementary handout. 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.
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.
64 5. Explain the nursing assistant’s role during an in-house transfer of a resident
• Collect resident’s belongings and pack them carefully. • Be positive and reassuring.
Meeting the Learning Objective TEXTbooK PP. 152–153
woRKbooK PP. 54–55 Lecture Pronounce and define the following key term: • Transfer 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.
• Know if the resident will need a wheelchair or stretcher. Remind students that the nursing assistant is responsible for the resident until she is safely in the vehicle, with the vehicle’s doors closed. 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, as well as in the instructor’s guide as a supplementary handout.
7. Describe the nursing assistant’s role during physical exams
• Introduce the resident to everyone at the new unit. When unpacking, arranging items as they Meeting the Learning Objective were in the old room will help the resident feel TEXTbooK PP. 154–156 more comfortable. woRKbooK P. 55 • When leaving the room, report to the nTuE rsS eT inBANKSELLER.COM charge of the resident. Lecture Demonstration Demonstrate procedure Transferring a resident to a new room. Include all of the numbered steps in your demonstration.
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.
Have the students return the demonstration. Procedure checklists are located at the end of the Student Workbook.
Review some of the equipment that nursing assistants may be responsible for gathering for the nurse or doctor:
6. Explain the nursing assistant’s role in the discharge of a resident Meeting the Learning Objective
• Sphygmomanometer • Stethoscope • Alcohol wipes • Flashlight
TEXTbooK PP. 153–154
• Thermometer
woRKbooK P. 55
• Tongue depressor • Eye chart
Lecture Pronounce and define the following key term: • Discharge Review the responsibilities of a nursing assistant during the discharge of a resident:
• Tuning fork • Reflex hammer • Otoscope • Ophthalmoscope • Specimen containers
65 • Lubricant
Chapter Review
• Hemoccult card • Vaginal speculum
Exam
• Gloves
dIsTRIbuTE CHAPTER 9: EXAM
• Drape
(APPENDIX C)
Display Key Material 9-1 body PosITIoNs FoR EXAMs 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.
• Dorsal recumbent • Lithotomy
Answers to Chapter Review in Textbook
• Knee-chest
1.
Answers include the following: Review information from federal agencies, ask friends for recommendations, review past survey results, check to see if the facility is accredited by the Joint Commission, and visit the facility.
2.
To get information on the resident’s personal preferences, history, rituals, and routines
3.
Answers include the following: Change is always hard. The resident may have an illness or his condition may have worsened.
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 TESTBANKSELLE R.COM an exam: 4. When the resident and his belongings are in • Wash hands before and after exam. • Follow Standard Precautions.
the vehicle and the vehicle’s doors are closed 5.
D
• Provide privacy measures.
6.
A
• Listen to and reassure resident.
7.
A
8.
C
• Provide light for doctor or nurse.
9.
C
• Put instruments in their proper place and hand them to doctor or nurse.
10. D
• Help resident get cleaned up and dressed after exam. Dispose of trash and bring equipment to proper area. Label and transport specimens as needed.
11. A
• Collect and label specimens as needed.
• Follow doctor’s or nurse’s instructions. • Make sure resident does not fall.
66
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 HANDouT 10-1 How MuCH slEEP Do wE NEED? CHAPTER 10: EXAM
Assignments TEXTbooK READINg, PP. 158–172
woRKbooK EXERCIsEs, PP. 57–60
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
2. Discuss the importance of sleep Meeting the Learning Objective TEXTbooK P. 159 woRKbooK P. 57
Overview of Teaching Strategies TESTBANKSELLER.COM The focus of this chapter is the resident’s home, Lecture or unit. It should be emphasized that the resident Pronounce and define the following key terms: has the right to privacy in her room, as well as to security of personal possessions. The students will • Sleep learn about the importance of sleep and factors • Biorhythms that may cause residents to have problems sleep• Circadian rhythm ing. It is a good idea to remind students again to empathize with residents. Residents might be sharReview the following important points about sleep: ing a room for the first time with another person— • The human body cannot survive for long without and not just a room, but also an entire living space, sleep. i.e., the care facility. A standard unit is described; if applicable, this is a good time to show the students • Sleep is needed to replace old cells with new how units in your facility are set up. Students will ones and provide energy to organs. learn how to clean a resident’s unit and equipment, • Sleep promotes healing and healthy body with emphasis placed on proper infection prevenfunctioning. tion methods and body mechanics. They will also • Getting enough sleep helps decrease the risk of learn about the different kinds of beds found in a certain illnesses and disease. facility and proper bedmaking techniques. • Sleep helps improve cognitive function and promotes emotional health.
1. Define important words in this chapter Meeting the Learning Objective TEXTbooK P. 158
woRKbooK P. 57
Distribute Handout 10-1 How MuCH slEEP Do wE NEED? The students can review the recommended amount of sleep that humans require at various stages in class or at home.
67 3. Describe types of sleep disorders
• Noise level and lighting • Problems with odors and inadequate ventilation
Meeting the Learning Objective
• Temperature problems
TEXTbooK PP. 159–160
• Anxiety
woRKbooK P. 57
• Illness
Lecture Pronounce and define the following key terms: • Insomnia • Parasomnias
• Aging changes • Dietary habits • Medications, alcohol, and cigarettes Review some of the problems that can be caused by not sleeping well:
Review some of the reasons that people develop sleep disorders:
• Decreased mental function
• Illness
• Reduced reaction time
• Anxiety
• Irritability
• Fear
• Depression
• Stress
• Obesity
• Medications
• Type 2 diabetes
• Trouble breathing
• Cardiovascular disease
• Noise
• Decreased immune system function
• Hunger
Ask the students to remember a time when they were adversely affected by not sleeping well. Ask thR em TESTBANKSELLE .CifOthMey have ever had problems sleeping and Discuss the following sleep disorders: whether they have any special methods to help • Somnambulism them sleep. • Sleeptalking • Thirst
• Bruxism • REM behavior disorder • Sleep apnea • Obstructive sleep apnea
4. Identify factors affecting sleep Meeting the Learning Objective TEXTbooK PP. 160–162
woRKbooK PP. 57–58 Lecture and Discussion Pronounce and define the following key terms: • Depressant • Stimulant Review some factors that may affect residents’ sleep: • Environment
5. Describe a standard resident unit and equipment Meeting the Learning Objective TEXTbooK PP. 162–163
woRKbooK P. 58 Lecture Remind students that residents’ units are their 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: • Bed • Bedside stand and dresser • Overbed table • Chair
68 • Bath basin
• Disposable razors
• Emesis basin
• Pads
• Bedpan
Review the guidelines for residents’ units:
• Urinal for males • Water pitcher and cup • Privacy screen or curtain • Call light Review the items that are usually stored in the bedside stand: • Emesis basin • Bath basin • Urinal • Bedpan • Soap
• 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 the bathroom needs cleaning. Report nonworking plumbing to the proper department. • Check equipment to make sure it is working and not damaged. • Refill water pitchers regularly.
• Toothbrush and toothpaste
• Remove anything that might cause odor or safety hazards.
• Comb and brush
• Report signs of insects or pests immediately.
• Leave residents’ personal items where you found Explain that personal articles are usually kept in them. the top drawer, and that they must be kept separate from basins, urinals, and bedpans. Discuss the use • After providing care, leave the unit neat and tidy. of the overbed table for meals and personal care, Review the guidelines for cleaning a unit after a emphasizing that it must be kept clean. Bedpans, T E S T B ANKS t raL E nsLfeEr,Rd. isC chOaM rge, or death: urinals, and soiled linen should never be placed on • Wash hands. it. It should be kept free of clutter. • Wear proper PPE.
6. Explain how to clean a resident unit and equipment
• Make sure area is well-ventilated when using strong cleaning solutions.
Meeting the Learning Objective
• Remove and dispose of equipment and supplies carefully.
TEXTbooK PP. 163–165
woRKbooK PP. 58–59 Lecture Pronounce and define the following key term: • Disposable Explain that disposable equipment is used to prevent the spread of microorganisms. Review common disposable equipment found in facilities:
• 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.
• Cups • Tissues • Gloves • Paper gowns • Masks
7. Discuss types of beds and demonstrate proper bedmaking Meeting the Learning Objective TEXTbooK PP. 165–172
woRKbooK PP. 59–60
69 Lecture Pronounce and define the following key terms: • Bariatrics
• Keep beds free of wrinkles and crumbs. • Wash hands after handling linens.
• Incontinence
Pronounce and define the following key terms:
Review some of the reasons that proper bedmaking is important:
• Open bed
• The resident will spend a great deal of time in bed.
• Occupied 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:
• Closed bed • Draw sheet • Unoccupied bed • Surgical bed Demonstration Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Making a closed bed
• Electric beds
• Making an open bed
• Beds with built-in weight scales
• Making an occupied bed
• Alternating pressure mattresses
• Making a surgical bed
• Bariatric beds
Have the students return each demonstration. We also have corresponding videos for occupied and Emphasize that beds should remain locked in their unoccupied skills that you can show to the stulowest positions whenever residents are in the de tsC . POroMcedure checklists are located at the end T E S T B A N K S ELLE Rn. beds. If applicable, tell the students about the difof the student workbook, as well as in the instrucferent kinds of beds that are used in your facility. tor’s guide as a supplementary handout. 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. • Carry clean linen away from uniform. • Bring linen into one resident’s room at a time. • Never transfer linen from one room to another. • Place clean linen on a clean surface within reach.
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.
• Use proper body mechanics. • Look for personal items. • Roll dirty linen away from you. • Do not shake linen. • Place used linen in proper container. • Make one side of bed first to save energy.
Chapter Review Exam dIsTRIbuTE CHAPTER 10: EXAM (APPENDIX C)
70 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: 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.
2.
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.
3.
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.
4.
Within the resident’s reach
5.
Disposable equipment will be used oTnEeS tiT mB e ANKSELLER.COM and then discarded.
6.
If clean linen touches the nursing assistant’s uniform, the linen becomes contaminated.
7.
Shaking linen may spread airborne contaminants.
8.
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.
9.
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
71
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
KEY MATERIAL 11-1 FIVE bAsIC PosITIoNs HANDouT 11-1 sPECIAL body PosITIoNs HANDouT 11-2 TuRNINg A REsIDENT AWAY FRoM You CHAPTER 11: EXAM
Assignments TEXTbooK READINg, PP. 174–195
Meeting the Learning Objective TEXTbooK P. 174 WoRKbooK P. 61
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
WoRKbooK EXERCIsEs, PP. 61–63
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, this chapter focuses on safely and comfortably transferring, holding, ambulating, and positioning residents. 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 workdays, 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. 175–176 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 learned in Chapter 7. We also have a corresponding
72 video for this skill that you can show to the students. Discuss some rules of using proper body mechanics:
Lateral position (We also have a corresponding video for this skill that you can show to the students.)
• Assess the load.
• 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. • Face what you are lifting. Do not twist. • Keep back straight.
Prone position
• Begin in squatting position. Lift with legs.
• Resident lying on abdomen
• Tighten stomach muscles when beginning.
• Small pillow under head and legs
• Keep object close to the body.
Fowler’s position
• Push, rather than lift.
• Partially-reclined sitting position, head and shoulders elevated
3. Explain why position changes are important for bedbound residents and describe basic body positions
• Pillow at flexed knees; footboard at flexed feet • Spine is straight
TEXTbooK PP. 176–183
• 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).
WoRKbooK PP. 61–62
Sims’ position
Meeting the Learning Objective
• Variation on lateral side position, left side-lying Lecture pLoL sitEioRn.COM T E S T BANKSE Pronounce and define the following key terms: • Lower arm behind the back and upper knee • Positioning flexed • Supine • Pillows under head, arms, flexed knee, and foot • Lateral • Prone • Fowler’s • Sims’ • Shearing • Logrolling • Dangle Display Key Material 11-1 FIVE bAsIC PosITIoNs
Distribute Handout 11-1 sPECIAL body PosITIoNs Discuss the Trendelenburg and Reverse Trendelenburg positions, mentioning that they always require a doctor’s order. Demonstrations Demonstrate the five basic body positions, using a student as a volunteer.
Discuss the five basic body positions, using Figures 11-1 to 11-5 in the textbook.
Demonstrate each of the following procedures, including all of the numbered steps in your demonstration:
Supine position:
• Assisting a resident to move up in bed with assistance (using assist device)
• Resident lying flat on back • Pillows under head and shoulders, arms, hands, calves; footboard against the feet
• Moving a resident to the side of the bed • Moving a resident to the side of the bed with assistance (using assist device)
73 • Turning a resident toward you (We also have a corresponding video for this skill that you can show to the students.) • Logrolling a resident with assistance • Assisting a resident to sit up on the side of the bed: dangling Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. 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
demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. 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 hour.
Meeting the Learning Objective
• To move resident to back of chair, stand in front of the wheelchair. Bracing your knees against the resident’s knees, he grasps the armrests and WoRKbooK PP. 62–63 pu heOsMwith his feet into the floor. TESTBANKSELLER.sC Lecture and Discussion • Lock wheels on geri-chair before transferring Pronounce and define the following key terms: resident into or out of the chair. Use caution when raising and lowering the tray table. Remind • Ergonomics students that when the tray table is attached, • Transfer belt geri-chairs may be considered restraints. • Gait belt TEXTbooK PP. 183–193
• 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.
Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Transferring a resident from a bed to a chair or wheelchair (We also have a corresponding video for this skill that you can show to the students.)
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.
• Transferring a resident from a bed to a stretcher with assistance
You can also show students safety devices used for transferring, such as transfer belt, slide board, sliding sheet, etc.
• Transferring a resident onto and off of a toilet
Demonstration Demonstrate procedure: Applying a transfer belt. Include all of the numbered steps in your
• Transferring a resident using a mechanical lift with assistance • Transferring a resident into a vehicle Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
74 5. Discuss ambulation
Answers to Chapter Review in Textbook
Meeting the Learning Objective
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 better able to clean the body of wastes. It helps prevent complications of immobility, such as contractures and atrophy.
Discuss ways that regular ambulation and exercise help to improve body functioning:
2.
This enables her to move her body as one unit, and keeps her back straight.
• Quality and health of the skin
3.
Begin in a squatting position
4.
Lift with the legs
5.
Keeping objects close to the body decreases stress to the back.
6.
Draw sheets or other assist devices help prevent skin damage caused by shearing.
TEXTbooK PP. 193–195 WoRKbooK P. 63
Lecture Pronounce and define the following key term: • Ambulation
• Circulation • Strength • Sleep and relaxation • Appetite • Elimination • Oxygen level
7. The stronger side moves first because it is Demonstration difficult for a resident to move a weak arm and Demonstrate procedure Assisting a resident to leg first and be able to bear enough weight to ambulate. Have the students return the demonstraallow for the move. tion. We also have a corresponding videoTfoErSthTisBANKSELLER.COM 8. Resident should be facing the top of the ramp. skill that you can show to the students. Procedure checklists are located at the end of the student 9. For a resident to be able to use a toilet, he workbook, as well as in the instructor’s guide as a must be able to bear some weight on his legs. supplementary handout. 10. D Discuss how to assist a resident who has a visual impairment with ambulation: 11. B • Resident walks beside and slightly behind NA. 12. A • Walk at normal pace. 13. B • Inform resident of any directional changes or approaching steps. 14. C
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.
75
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 mouth care 9. Define dentures and explain care guidelines 10. Discuss guidelines for performing mouth 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 habKEY MATERIAL 12-1 AssIsTINg WITH its they develop now will become the foundation PERsoNAL CARE TESTBANKSELLE R.COM of their workdays, and will continue throughout KEY MATERIAL 12-2 sAFETY guIDELINEs their caregiving careers. That foundation should AND bATHINg be based on holistic care, respect for the resident, KEY MATERIAL 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. 196–224 WoRKbooK EXERCIsEs, PP. 65–70
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 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. 196 WoRKbooK P. 65
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
76 2. Explain personal care of residents
Lecture Pronounce and define the following key terms:
Meeting the Learning Objective
• Partial bath
TEXTbooK PP. 196–198
• 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 Key Material 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 199 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. 198–199 WoRKbooK PP. 65–66
4. Explain safety guidelines for bathing Meeting the Learning Objective TEXTbooK PP. 199–200 WoRKbooK P. 66
Display Key Material 12-2 sAFETY guIDELINEs AND bATHINg Review the guidelines on the key material: • 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.
77 • 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. 200–208 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.
5. List the order in which body parts are washed during bathing
• Prepare the shower or tub room and gather supplies before moving the resident there. • Keep the room warm enough.
TEXTbooK P. 200
• 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: • Axilla
Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Giving a complete bed bath
Emphasize the concept of washing from the cleanest area to the dirtiest to reduce the risk of transferring microorganisms. TESTBANKSELLE •R Pr.oC viO diM ng perineal care Display Key Material 12-3 bATHINg WHEEL Review the correct order to wash body parts as listed on the 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
• Shampooing a resident’s hair in bed • Giving a shower or tub bath 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. Discuss the differences between shampooing hair at a sink versus on a stretcher. Have the students return each demonstration. We also have corresponding videos for the bed bath and perineal care skills that you can show to the students. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
78 7. Describe how to perform a back rub
• Pus or drainage • Coated or swollen tongue
Meeting the Learning Objective
• Bad breath or fruity-smelling breath
TEXTbooK PP. 208–210
• Change in the resident’s ability to drink, suck on a straw, or swallow
WoRKbooK P. 67
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, as well as in the instructor’s guide as a supplementary handout.
• 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 mouth care • Flossing teeth
8. Explain guidelines for performing mouth care Meeting the Learning Objective TEXTbooK PP. 210–213 WoRKbooK PP. 67–68
Have the students return each demonstration. We also have a corresponding video for the mouth care skill that you can show to the students. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
9. Define dentures and explain care TESTBANKSgEuLidLeElinRe.sCOM
Lecture Pronounce and define the following key terms: • Halitosis • Plaque
Meeting the Learning Objective
• Tartar
TEXTbooK PP. 213–214
• Gingivitis
WoRKbooK P. 68
• Edentulous Point out that mouth 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 mouth care.
Lecture Pronounce and define the following key terms: • Dentures • Bridge Point out the following about denture care:
Review what the NA should observe and report about mouth care:
• Dentures are expensive and must be handled carefully.
• Dry, cracked, bleeding, or chapped lips
• NAs must wear gloves when cleaning dentures.
• Cold sores on the lips
• Dentures should be stored in clean, moderate/ cool water in a covered, labeled denture cup, or returned to the resident.
• 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
Demonstration Demonstrate procedure: Cleaning and storing dentures. Include all of the numbered steps in your demonstration. We also have a corresponding video for this skill that you can show to the
79 students. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
10. Discuss guidelines for performing mouth care for an unconscious resident Meeting the Learning Objective TEXTbooK PP. 215–216 WoRKbooK P. 69
Lecture Point out the following about mouth care for an unconscious resident: • Mouth care must be done frequently. • Mouth care keeps the mouth clean and moist. • Mouth care removes sordes and helps prevent them from developing.
11. Explain how to assist with grooming Meeting the Learning Objective TEXTbooK PP. 216–224 WoRKbooK PP. 69–70
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. • Promote self-care and independence whenever possible. Lecture Discuss the following points for assisting with shaving:
• Respect personal preferences regarding shaving. • The NA should use as little liquid as possible to • Wash and comb beards and mustaches every day. prevent aspiration and turn the resident’s head to Do not trim facial hair. the side. • Wear gloves. • Unconscious residents may still be able to hear. •R So.ftC en hair first if using disposable or safety SdTbBehAaNveKSELLE OM NAs should explain the procedurTeE an razor. normally. • Shave in direction of hair growth. Demonstration • Use shaving products only with resident’s Demonstrate procedure Providing mouth care for an permission. unconscious resident. Include all of the numbered • Discard disposable shaving products properly. steps in your demonstration. We also have a cor• Do not share razors between residents. responding video for this skill that you can show to the students. Have the students return the demon• Do not use electric razors near water or oxygen. stration. Procedure checklists are located at the end • Handle safety razor blades carefully, and discard of the student workbook, as well as in the instrucold blades in sharps container. tor’s guide as a supplementary handout. Lecture Discuss guidelines for giving eye care for an unconscious resident: • 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.
Demonstration Demonstrate procedure Shaving 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, as well as in the instructor’s guide as a supplementary handout. Lecture Discuss the following points for assisting with nail care: • Cleaning and caring for nails is part of the bathing process.
80 • 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. We also have a corresponding video for this skill that you can show to the students. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. Lecture Discuss the following points for assisting with hair care: • Allow residents to choose their own hairstyles. • Do not comb residents’ hair in childish styles.
• 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. • Residents’ combs, brushes, clothes, wigs, hairpieces, caps, hats, and scarves should not be shared with others. 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 the “bad side” or talk about “bad” leg or arm. • Encourage independence with dressing and undressing. • Do not rush residents when dressing.
• Be gentle when handling hair.
• Make sure all clothing is marked with resident’s name.
• Do not cut residents’ hair.
• Treat clothing carefully.
Pronounce and define the following key T teE rm SsT: BANKS•EALllLow ERre.siCdeOnMts to choose their own clothing. • Make sure clothing fits properly. • Dandruff • Pediculosis
• Provide privacy when dressing and undressing. Keep residents covered.
Discuss causes of dandruff:
• Put clothing on the weaker, or affected, side first.
• Climate, especially dry, cold areas • Stress • Excessive sweating • A type of fungus • Hormonal changes
• Gently smooth socks and stockings to remove wrinkles and twists. • Front-fastening bras are easier for residents to work by themselves. Make sure the bra cups fit over the breasts.
• Some types of dermatitis
• Put back-fastening bras on waist and fasten them in front first before rotating around.
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, as well as in the instructor’s guide as a supplementary handout.
• Clothing with elastic waistbands is easier to get on and off.
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.
• 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. We also have a corresponding video for this skill that you can show to the students. Have the students return the demonstration. Procedure
81 checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. If you have an IV available to use, demonstrate how to dress and undress a resident with an IV. Guidelines for dressing a resident with an IV are found on page 234 of the textbook.
Chapter Review Exam
9.
Use as little liquid as possible during mouth care
10. Because even residents who are unconscious 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. Weaker, affected, or involved side
dIsTRIbuTE CHAPTER 12: EXAM
14. B
(APPENDIX C)
15. A
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.
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.
3.
Pressure injuries
4.
No higher than 105°F
5.
Comfortable temperature varies for each person.
6.
Bath oils, gels, and powders can create slippery surfaces and can put residents at risk of falling.
7.
Every day
8.
Answers include the following: relaxes tired, tense muscles, improves circulation, and relieves pain or discomfort.
16. B 17. D 18. A
82
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
KEY MATERIAL 13-1 RANgEs FoR ADulT VITAL sIgNs
Meeting the Learning Objective TEXTbooK PP. 226–227
CHAPTER 13: EXAM
WoRKbooK P. 71
Assignments TEXTbooK READINg, PP. 226–245
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 applicable to all types of residents. The largest amount of time for this chapter should be devoted to demonstrations and return demonstrations 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. 227 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 Discuss the fact that vital signs are often the first indication that a person is ill.
83 • Fahrenheit
Display Key Material 13-1 RANgEs FoR ADulT VITAL sIgNs Use the chart 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 WoRKbooK PP. 71–72
Lecture Discuss the following factors that affect body temperature: • Age
• Mouth • Rectum • Armpit • Ear • Temporal artery
• 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 temperature within two to 60 seconds.
• Amount of exercise • Circadian rhythm
• Electronic thermometers require a probe cover that must be discarded after a single use.
• Stress
• Tympanic thermometers are fast and accurate.
TESTBANKSELLE •R Te.mCpO orMal artery thermometers are moved across
Pronounce and define the following key term: • Hypothermia Review signs of hypothermia: • Temperature below 97°F • Pale and cyanotic skin • Shivering • Numbness • Quick and shallow breathing • Slow movements • Changes in mental status
4. List guidelines for measuring body temperature Meeting the Learning Objective TEXTbooK PP. 229–235 WoRKbooK PP. 72–73
Lecture Pronounce and define the following key terms: • Thermometers
Discuss common sites for measuring temperature:
Review points about different types of thermometers:
TEXTbooK PP. 228–229
• Illness • Environment
• Celsius
the forehead and are noninvasive. • 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. 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, as well as in the instructor’s guide as a supplementary handout. Lecture Review when not to take a rectal temperature: person is unconscious, has missing teeth or
84 improperly-fitting dentures, has difficulty breathing through the nose, has a seizure disorder, has been vomiting, or person has had recent rectal surgery or has a colostomy.
• Tachycardia
Review these points about rectal, tympanic, and axillary temperatures:
• Inspiration
Rectal temperatures: • Rectal temperatures are most accurate. • NA must explain what he will do before starting. • Be reassuring.
• Bradycardia • Dilate • Respiration • Expiration Discuss the following factors that affect pulse rate: • Age • Gender • Exercise
• Gloves must be worn. • Thermometer must be lubricated for this procedure.
• Stress • Hemorrhage
• The privacy of the resident is important.
• Medications
• Thermometer must be held the entire time it is in the rectum.
• Fever and illness
Tympanic temperatures:
Pronounce, define, and discuss the different types of respirations:
• The tip will only go into the ear 1/4 to 1/2 inch.
• Apnea • Dyspnea
Axillary temperatures: • Axillary temperatures are not as accurate as other sites. • Axillary area must be clean and dry.
• Eupnea • Orthopnea
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Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: • Measuring and recording rectal temperature • Measuring and recording tympanic temperature • Measuring and recording axillary temperature Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
• Cheyne-Stokes respiration • Kussmaul breathing
6. List guidelines for counting pulse and respirations Meeting the Learning Objective TEXTbooK PP. 236–239 WoRKbooK P. 73
Lecture Pronounce and define the following key terms: • Radial pulse
5. Explain pulse and respirations Meeting the Learning Objective TEXTbooK PP. 235–236 WoRKbooK P. 73
Lecture Pronounce and define the following key terms: • BPM
• Stethoscope Review the following points about the pulse rate: • Pulse is the number of heartbeats per minute. Normal rate is 60 to 100 beats per minute for adults. • Observe for the overall pattern of the pulse and the quality or type of the pulse. Review the following points about respirations:
85 • Do the counting immediately after taking the pulse.
• Diastolic
• Do not let the resident know you are counting breaths.
• Hypotension
• Normal rate is 12 to 20 breaths per minute. • Observe for the overall pattern of the respirations and the quality or type of breathing.
• Hypertension • Orthostatic hypotension Discuss the following factors that affect blood pressure: • Age
Demonstration Demonstrate procedure Counting and recording radial pulse and counting and recording respirations. Include all of the numbered steps in your demonstration. We also have a corresponding video for this skill that you can show to the students. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. Lecture Pronounce and define the following key term: • Apical pulse Mention that the apical pulse is normally about the same as the radial pulse.
• Exercise • Stress • Race • Heredity • Obesity/unhealthy diet • Alcohol • Tobacco products • Time of day • Illness
8. List guidelines for measuring blood pressure Meeting the Learning Objective TEXTbooK PP. 240–244
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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 steps in your demonstration: • Counting and recording apical pulse • Counting and recording apical-radial pulse Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
7. Identify factors that affect blood pressure Meeting the Learning Objective
WoRKbooK PP. 74–75
Lecture Pronounce and define the following key terms: • Sphygmomanometer • Brachial pulse Discuss different types of sphygmomanometers: • Manual • Digital Review the following points about blood pressure: • Brachial pulse is used. • The cuff must first be completely deflated. Remind students not to take blood pressure when these situations exist:
TEXTbooK PP. 239–240
• An intravenous line (IV) is present.
WoRKbooK P. 74
• The cuff does not fit the arm properly.
Lecture Pronounce and define the following terms: • Systolic
• The arm has a cast. • Burns or injuries are present.
86 • The arm is being used for dialysis.
9. Describe guidelines for pain management
• The arm or side has had recent trauma. • The arm or side is paralyzed due to stroke.
Meeting the Learning Objective
• An amputation has been performed.
TEXTbooK PP. 244–245
• The side has had a mastectomy (or any other surgery or incision).
WoRKbooK P. 76
Review additional points about blood pressure:
Lecture Review the following points about pain:
• Cuff must be correct size.
• It is as important to monitor as vital signs.
• Observe for normal readings and the quality or type of sounds.
• It is uncomfortable and an individual experience.
• Take complaints of pain seriously. • Other sites for measuring blood pressure are • The nurse may direct the NA to ask questions to forearm, thigh, and calf. Other sites may be reget accurate information, such as the following: quired due to the size of the upper arm or blood • Where is the pain? pressure cuff or due to recent surgeries or condi• When did the pain start? Please describe the tions. For the forearm measurement, the cuff or pain. device is wrapped around the inner side of the • How long does the pain last? Minutes? wrist before blood pressure is measured, and the Seconds? fingers and arm should remain still. The radial • How often does it occur? artery is used for obtaining this measurement. • How severe is the pain? For the thigh blood pressure measurement, the • What makes the pain better? What makes popliteal artery is used, and the person should the pain worse? be placed in the prone position if possible. When • Have you experienced this pain before? measuring blood pressure in the calf, the dorsalis • Do you remember what you were doing pedis artery may be used, and the limbTmEuSstTbBe ANKSELLE wR he.nCtO heMpain started? level with the heart. Review types of pain in the orange box on page It is not always easy to perfect the skill of hearing 245. the first and last sounds of the blood pressure. StuDiscuss signs and symptoms of pain to observe dents may have to do the procedure over and over and report: again and have the instructor or another student check technique and results for correctness. • Increased pulse, respirations, and blood pressure Demonstration Demonstrate each of the following procedures, including all of the numbered steps in your demonstration:
• Sweating • Nausea and vomiting • Tightening the jaw • Squeezing eyes shut
• Measuring and recording blood pressure manually
• Holding or guarding a body part
• Measuring and recording blood pressure electronically
• Grinding teeth
Have the students return each demonstration. We also have corresponding videos for these skills that you can show to the students. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
• Frowning • Increased restlessness • Agitation or tension • Change in behavior • Crying • Sighing • Groaning
87 • Breathing heavily • Difficulty moving or walking Use measures listed on page 245 in textbook to reduce pain.
the bedpan or urinal. Encourage slow, deep breathing. Be patient, caring, gentle, empathetic, and responsive. 12. B 13. C
Chapter Review Exam dIsTRIbuTE CHAPTER 13: 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.
14. B 15. A 16. D 17. D 18. B
Answers to Chapter Review in Textbook 1.
Body temperature, pulse, respirations, and blood pressure
2.
It is illegal and can cause harm to the resident.
3.
Answers include the following: elevated temBA perature reading, headache, faTtiE guSeT ,m usN clK e SELLER.COM aches, and chills. Skin may feel warm and look flushed.
4.
10 to 20 minutes
5.
1/4 to 1/2 inch
6.
Radial pulse
7.
Because people tend to breathe more quickly if they know they are being observed
8.
The apical pulse is on the left side of the chest, just below the nipple.
9.
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
88
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 KEY MATERIAL 14-1 MYPLATE KEY MATERIAL 14-2 PREVENTINg AsPIRATIoN KEY MATERIAL 14-3 CoNVERsIoN TAblE HANDouT 14-1 bAsIC MATH CHAPTER 14: EXAM
Assignments TEXTbooK READINg, PP. 247–274 WoRKbooK EXERCIsEs, PP. 77–85
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 provide examples of special types of diets that are included in this chapter. It is a good idea for the students to share their cultural or religious backgrounds so that others get a feel for differences they may encounter. An emphasis on respect for all differences is important. Emphasize the importance of fluid balance. 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. 247–248 WoRKbooK P. 77
89 Lecture Pronounce and define each of the key terms listed in the Learning Objective.
• Vegans Discuss the following points: • Know and honor residents’ food preferences.
2. Describe common nutritional problems of the elderly and the chronically ill Meeting the Learning Objective
• Report requests for diet substitutions immediately. Encourage students to discuss their own regional, cultural, or religious backgrounds.
TEXTbooK P. 248 WoRKbooK P. 77
Lecture Pronounce and define the following key terms: • Nutrition • Malnutrition Review problems that can affect nutrition: • Less saliva • Side effects from medication • Decrease in activity and mobility
4. Identify six basic nutrients Meeting the Learning Objective TEXTbooK PP. 249–250 WoRKbooK P. 78
Lecture Pronounce and define the following key terms: • Nutrient • Metabolism
• Weakened sense of smell and taste
Review the following six basic nutrients:
• Loss of vision
Water
• Dentures, tooth loss, or poor denTtaEl S heTaB lthANKSELLE •R W. atC erOiM s the most essential nutrient for life. • Depression and lack of interaction • Water helps with digestion and absorption of food. It helps to maintain normal body • Special diets that restrict foods temperature. Discuss conditions that make it more difficult to Fats eat or swallow: • Good source of energy • Stroke • Cancer
• Add flavor to food
• Parkinson’s disease
• Fall into four categories: saturated, trans fat, monounsaturated, and polyunsaturated
• Multiple sclerosis • Alzheimer’s disease
3. Describe cultural factors that influence food preferences Meeting the Learning Objective TEXTbooK P. 249 WoRKbooK P. 77
Lecture and Discussion Pronounce and define the following terms: • Fasting • Vegetarians
• 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 • Provide fuel for energy • Provide fiber Protein • Essential for tissue growth and repair • Provides a supply of energy
90 • 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
• Provides 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. 250–253 WoRKbooK PP. 78–79
• Soy products enriched with calcium are an alternative to dairy foods.
Display Key Material
Review additional tips for making healthy food choices:
14-1 MYPLATE Referring to Figure 14-6 (page 250 in the 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. 253 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
91 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. 253–257 WoRKbooK PP. 80–81
Lecture Pronounce and define the following key terms: • Special diets • Puree • Lactose intolerance • Diuretics • Glucose Describe the differences in the following special diets: • Liquid diet • Soft diet and mechanical soft diet
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 be vegetarians and can discuss what types of food they eat. Others may have diabetes 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 Meeting the Learning Objective
• Pureed diet
TESTBANKSELLER .COM TEXTbooK P. 257
• Bland diet
WoRKbooK P. 81
• Lactose-free diet • High-residue or high-fiber diet • Low-residue or low-fiber diet
Lecture Discuss thickened liquids:
• Modified calorie diets
• Thickening improves the ability to control fluid in the mouth and throat.
• Low-sodium diet
• A doctor orders the necessary thickness.
• High-protein diet
• Some beverages arrive already thickened.
• Renal diet • Low-fat diet
• NAs cannot offer regular liquids, including water, to residents who must have thickened liquids.
• High-potassium diet
Define the three basic thickened consistencies:
• Fluid-restricted diet
• Nectar thick
• High-iron diet
• Honey thick
• Diabetic diet
• Pudding thick
• Gluten-free diet • Vegetarian diet (lacto-ovo, lacto, ovo) • Vegan diet
9. List ways to identify and prevent unintended weight loss
• Limited animal-based diet Meeting the Learning Objective Point out that residents who are NPO should not be offered drinks (even water) or snacks.
TEXTbooK PP. 258–259 WoRKbooK P. 81
92 Lecture Pronounce and define the following key term:
Discuss the following guidelines for preventing unintended weight loss:
• Apathy
• Report warning signs immediately.
Emphasize that NAs must report any weight loss, no matter how small. Discuss the problem of unintended weight loss. Review the signs and symptoms of unintended weight loss to report, including: • Needing help eating or drinking
• Talk about eating and food being served in a positive way. • Check to make sure residents are receiving the correct food. • Respond promptly to complaints about food. • Season foods to residents’ preferences.
• Eating less than 70% of meals/snacks
• Use assistive equipment as needed.
• Having mouth pain • Having dentures that do not fit properly • Having difficulty chewing or swallowing • Coughing or choking while eating • Being sad or withdrawing from others
• Record the meal/snack intake. • Ask the nurse for a dietitian, OT, or SLP consultation if necessary.
10. Describe how to make dining enjoyable for residents
• Being confused, wandering, or pacing Review the signs of malnourishment:
Meeting the Learning Objective
• Feeling of coldness throughout body
TEXTbooK PP. 259–260
• Weight loss
WoRKbooK PP. 81–82
• Abdominal distention • Abdominal pain
• Report any decrease in appetite.
TESTBANKSLEecLtuLrE e R.COM
• Constipation • Edema • Cracks or splits at the corners of the mouth • Inflammation of the mucous membranes of the mouth
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. Review the following guidelines for dining:
• Dry or peeling skin
• Follow a routine.
• Brittle, easily-cracked nails
• Assist with grooming.
• Rapidly thinning hair that breaks off easily; hair that changes or loses color
• Encourage the use of dentures, eyeglasses, and hearing aids.
• Frequent infections
• Give mouth care before eating.
• Muscle weakness
• Assist with handwashing.
• Fainting
• Offer a trip to the bathroom before eating.
• Fatigue
• Seat residents next to their friends.
• Withdrawal or apathy
• Properly position residents for eating, normally in the upright position.
• Anxiety and irritability • Problems with sleeping • Low body temperature • Slow pulse • Low blood pressure
• Place residents in appropriate chairs. • Serve food at the correct temperature. • Provide proper eating tools. • Cut food when necessary before bringing it to the table. • Do not share a resident’s food with others.
93 • Allow enough time for eating.
• Follow infection prevention precautions.
• Keep the noise level low. Do not shout or bang plates or cups.
• Offer a clothing protector but respect the resident’s right to refuse to wear it.
• Be positive and make conversation when residents wish to talk.
• Sit at the resident’s eye level and give him full attention.
• Honor requests regarding food. Give additional food when requested.
• Identify food and fluids in front of the resident, including pureed foods. • Ask the resident which food he wants first.
11. Describe how to serve meal trays and assist with eating
• Do not mix foods.
Meeting the Learning Objective
• Make appropriate conversation. Say positive things about the food.
TEXTbooK PP. 260–264 WoRKbooK P. 82
Lecture Review the guidelines for serving trays: • Wash your hands first. • Check the diet card for special diet orders, and identify each resident before serving a meal tray.
• Put your hand over the food to test its temperature. Do not blow on it or touch it.
• Pay attention to the person you are helping. Do not talk to other staff members. • Alternate between food and drink. • Honor requests for different food. • Respect a resident’s right to refuse to eat.
Demonstration • Serve all residents at one table before serving Demonstrate procedure Feeding a resident. Include another table. all of the numbered steps in your demonstration. H ave the students return the demonstration. Proce• Maintain the proper temperatureToEf S foT od B.ANKSELLEdure R .checklists COM are located at the end of the student Wearing gloves, prepare the food, only doing • workbook, as well as in the instructor’s guide as a what residents cannot do for themselves. Open supplementary handout. milk or juice cartons. Place a straw in the container if the resident uses one. Butter roll, bread, Group Activity and vegetables as the resident likes. Give everyone one very small jar or portion of baby • Offer to season all food as the resident likes, food (preferably a meat flavor) and a plastic spoon. including pureed food. Then simply ask them to taste it. Many will refuse and this is an excellent learning point (after all, Remind students about the following when serving our elderly residents don’t think pureed food looks meal trays to residents in isolation: appetizing, either). Participants who do taste will • Follow Isolation Precautions, along with Stanprobably describe to the class how unpleasant the dard Precautions. food tastes. Whatever happens, you’ve made your Apply PPE as needed. point. If the group is very open or small, or you • know the participants personally or are comfort• Do not share food with anyone. able with this idea, you can even have a volunteer Discuss the following points about assisting resirestrained in her chair and have another volunteer dents with eating: feed her. This learning approach goes deeper and fosters discussion regarding the emotional side of • Residents will need different levels of help. being fed a pureed diet (or other type of diet) by • Prepare residents who require the least assisanother person. Feelings of helplessness, being tance first. demeaned, etc., can be explored in discussion. • Some residents will need to be fed. Be sensitive Example: Does being fed this way make you want and give privacy. to continue eating? • Do not judge food choices.
94 12. Describe how to assist residents with special needs
Ask students if they can think of any other ways to help with these problems.
Meeting the Learning Objective
13. Discuss dysphagia and list guidelines for preventing aspiration
TEXTbooK PP. 264–266 WoRKbooK PP. 82–84
Meeting the Learning Objective Lecture Review the guidelines for dining techniques: • Use assistive devices when necessary. • Use physical and verbal cues. • Always put food into the stronger side of the mouth. • Read menus to residents who have a visual impairment. 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 264–266 of the textbook: • Resident eats too quickly • Resident bites down on utensils
TEXTbooK PP. 266–268 WoRKbooK P. 84
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 • Food residue inside the mouth or cheeks during and after meals
TESTBANKS•EVLoLmEitR in. gC wO hiM le eating or drinking
• Resident cannot or will not chew
• Frequent throat clearing
• Resident will not stop chewing
• Food or fluid coming up into the nose
• Resident holds food in his mouth
• Coughing during or after meals
• Resident pockets food in his cheek
• Choking during meals
• Resident has poor lip closure • Resident has no teeth
• Gurgling sound in voice during or after meals, or loss of voice
• Resident has dentures that do not fit properly
• Problems breathing while eating or drinking
• Resident has change in vision that causes problems seeing food clearly
• Visible effort to swallow • Watering eyes when eating or drinking
• Resident has protruding tongue or tongue thrust • Resident will not open his mouth • Resident falls asleep while eating
Display Key Material 14-2 PREVENTINg AsPIRATIoN
• Resident chokes when drinking
Review the guidelines for preventing aspiration:
• Resident is susceptible to choking • Resident forgets to eat
• Position in a straight, upright position at a 90-degree angle.
• Resident drools excessively
• Feed residents slowly.
• Resident has poor sitting balance
• Avoid distractions.
• Resident tends to lean on one side
• Offer small pieces of food or small spoonfuls of pureed food.
• Resident tends to fall forward • Resident has poor neck control
• Offer food, then a liquid.
95 • Place food in the nonparalyzed side of the mouth.
15. List ways to identify and prevent dehydration
• Make sure food is actually swallowed before offering more food or fluids.
Meeting the Learning Objective
• Keep residents sitting upright for at least 30 minutes after eating and drinking.
TEXTbooK PP. 270–273 WoRKbooK P. 85
• Provide mouth care after eating. • Observe residents closely. Report signs of aspiration immediately.
14. Describe intake and output (I&O) Meeting the Learning Objective TEXTbooK PP. 268–270 WoRKbooK PP. 84–85
Lecture Pronounce and define the following key terms: • Intake/input • Output • Fluid balance • Graduate
Lecture Remind students that drinking enough water or other fluids each day can help prevent constipation, urinary incontinence, and dehydration. Review the signs and symptoms of dehydration to report, including: • Drinking fewer than six 8-ounce glasses of liquid per day • Drinking little or no fluids at meals • Needing help drinking from a cup • Having trouble swallowing liquids • Having frequent vomiting, diarrhea, or fever • Being easily confused or tired • Severe thirst • Dry mouth
NOK)SELLE R.COM Show students a sample intake andToEuS tpTuB t (A I& • Decrease in urinary output form, if one is available. Also report if the resident has any of these signs or symptoms: Display Key Material 14-3 CoNVERsIoN TAblE If in a facility, discuss the facility’s particular methods of documenting units of measure.
• Severe thirst • Dry mouth and mucous membranes • Cracked lips • Dry, warm, wrinkled, or clammy skin
Optional Handout
• Sunken eyes
14-1 bAsIC MATH
• Flushed face
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 508 and 509. 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, as well as in the instructor’s guide as a supplementary handout.
• Decrease in urinary output • Dark urine • Strong-smelling urine • Constipation or weight loss • Weakness, dizziness, lightheadedness, or confusion • Headache • Irritability • Rapid or weakened pulse • Irregular heartbeat • Low blood pressure
96 Discuss the following guidelines for preventing dehydration:
Review the signs and symptoms of fluid overload, including:
• Report warning signs immediately.
• Weight gain
• Encourage residents to drink every time you see them.
• Fatigue
• Offer fluids that residents prefer.
• Swelling of extremities
• Make sure you know if the resident requires thickened liquids.
• Coughing
• Make sure the pitcher and cup are close by and are light enough for resident to lift.
• Increased heart rate
• Offer assistance. • Offer other forms of liquids. • Record fluid I&O.
• Difficulty breathing or shortness of breath
• Decreased urine • Tight, smooth, or shiny skin • Swollen abdomen
• Follow posted schedules for fluids.
Chapter Review
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 each 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!
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 Point out the POURR acronym in the textbook on n eeded. page 272 as a way of encouraging fluids. TESTBANKSELLER.COM 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, as well as in the instructor’s guide as a supplementary handout.
16. List signs and symptoms of fluid overload and describe conditions that may require fluid restrictions Meeting the Learning Objective
Answers to Chapter Review in Textbook 1.
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.
2.
Vegetables and fruits
3.
Beans, peas, soy products, vegetarian meat substitutes, nuts, and seeds are plant sources of proteins.
4.
Most dairy group choices should be fat-free (0%) or low-fat (1%).
5.
Resident’s name and information about special diets, allergies, likes and dislikes, as well as any other dietary instructions
6.
Low Na or NAS
TEXTbooK P. 273 WoRKbooK P. 85
Lecture Pronounce and define the following key terms: • Fluid overload • Restrict fluids
97 7.
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.
8.
Thickened liquids move down the throat more slowly, reducing coughing and limiting the risk for choking.
9.
Upright at 90 degrees
10. Respect the resident’s refusal. 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. Drinking enough water each day can help prevent constipation, urinary incontinence, and dehydration. Proper fluid intake also helps to dilute wastes and flush out the urinary system, which lessens the risk of infection. 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
98
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 ileostomy and colostomy 12. Explain guidelines for assisting with bowel retraining 13. Discuss bariatrics and related care Supplemental Tools KEY MATERIAL 15-1 THE gAsTRoINTEsTINAL sysTEM KEY MATERIAL 15-2 FACToRs AFFECTINg boWEL ELIMINATIoN HANDouT 15-1 gIVINg A RECTAL suPPosIToRY CHAPTER 15: EXAM
Assignments TEXTbooK READINg, PP. 275–302 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 regular bowel movements for maintaining health in elderly people. Students will learn signs and 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 promoting bowel elimination for 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.
99 1. Define important words in this chapter
3. Explain the structure and function of the gastrointestinal system
Meeting the Learning Objective Meeting the Learning Objective
TEXTbooK PP. 275–276
TEXTbooK PP. 277–279
WoRKbooK P. 87
WoRKbooK P. 87
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
Lecture Pronounce and define the following key terms: • Gastrointestinal tract
2. Explain key terms related to the body
• Peristalsis • Chyme
Meeting the Learning Objective
• Duodenum
TEXTbooK P. 277
• Absorption
WoRKbooK P. 87
• Feces
Lecture Pronounce and define the following key terms:
• Electrolytes
• Biology
• Defecation
• Anatomy
• Ingestion
• Physiology
• Digestion
• Cells
• Elimination
• Tissues • Organs
• Colon
TESTBANKSELLE R.COM Display Key Material
• Body systems
15-1 THE gAsTRoINTEsTINAL sysTEM
• Homeostasis
Discuss the following points:
• Pathophysiology
• Digestion prepares food for absorption into cells.
Review the ten systems that make up the human body:
• Elimination is expelling solid wastes.
• Gastrointestinal or digestive
Review the functions of the gastrointestinal system:
• Urinary
• Ingestion of food and fluids
• Reproductive
• Digestion of food
• Integumentary or skin
• Absorption of nutrients
• Circulatory or cardiovascular
• Elimination of waste products from food/fluids
• Respiratory • Musculoskeletal • Nervous
4. Discuss changes in the gastrointestinal system due to aging
• Endocrine • Immune and lymphatic
Meeting the Learning Objective TEXTbooK P. 279 WoRKbooK P. 88
100 Lecture Review normal changes of aging: • Ability to taste decreases.
6. List factors affecting bowel elimination and describe how to promote normal bowel elimination
• Process of digestion takes longer and is less efficient.
Meeting the Learning Objective
• Body waste moves more slowly through the intestines, causing more frequent constipation.
TEXTbooK PP. 280–285 WoRKbooK P. 88
• Difficulty chewing and swallowing may occur. • Absorption of vitamins and minerals decreases. • Production of saliva and digestive fluids decreases. Here are links to more information about normal changes of aging: • hhs.gov/aging/healthy-aging/index.html • ncoa.org/healthy-aging/ • medlineplus.gov/healthyaging.html • nursing.uc.edu/content/dam/nursing/docs/ CFAWD/Aging%20Series/Part%202%20 Aging%20Physical%20Changes.pdf
Lecture Pronounce and define the following key terms: • Fracture pan • Portable commode Display Key Material 15-2 FACToRs AFFECTINg boWEL ELIMINATIoN Discuss the factors listed on the key material: • Growth and development • Psychological factors • Diet • Fluid intake
5. List normal qualities of stool and identify • Physical activity and exercise signs and symptoms to report abouTtEsS toToBl ANKS•EPLeL rsE onRa. l hCaO biM ts • Medications
Meeting the Learning Objective TEXTbooK PP. 279–280 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
Discuss normal bowel elimination:
• Helping a resident use a portable commode
• 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
Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
7. Discuss common disorders of the gastrointestinal system
• Hard, dry stools • Diarrhea
Meeting the Learning Objective
• Constipation
TEXTbooK PP. 286–290
• Pain with bowel movements
WoRKbooK PP. 88–89
• Blood, pus, mucus, or discharge in stool • Fecal incontinence
101 Lecture Pronounce and define the following key term:
• Types of disorders include gallstones, pancreatic disorders, and tumors
• Heartburn
• Decreased or stopped bile flow
Review the following points about heartburn: • 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
• Treatment: medications, dietary changes, surgery Review the following points about cirrhosis: • Cause: liver damage from alcohol abuse, hepatitis, and fatty liver syndrome • Symptoms: fatigue, bruising easily, itchy skin, jaundice, ascites in the abdomen, and edema in the legs
• Pain usually occurs directly after a meal and may worsen when person is lying down.
• Treatment: eliminating alcohol, maintaining a healthy weight, medications
• Treatment: medication, change in diet or sleep position
Review the following points about hernia:
Pronounce and define the following key term:
• Cause: pressure pushing a body cavity out through a muscle or tissue due to heavy lifting or constipation
• Gastroesophageal reflux disease (GERD) Review the following points about GERD:
• Symptoms: swelling in the area of the abdomen or the groin and discomfort in the abdominal area or groin when lifting
• Cause: liquid contents of the stomach back up into the esophagus; can inflame and damage lin• Treatment: surgery ing of the esophagus and cause bleeding, ulcers, or difficulty swallowing Review the following points about Crohn’s disease: • Symptoms: frequent heartburn, T chE esSt T paBin •R Ca.uC seOsMthe lining of the digestive tract to become A,NKSELLE hoarseness in the morning, difficulty swallowing, inflamed tightness in the throat, coughing, bad breath • Symptoms: diarrhea, rectal bleeding, abdominal • Possible causes: obesity, hiatal hernia, weak cramping and pain, fever, and weight loss lower esophageal sphincter, slow digestion, • Treatment: Medications, dietary changes, stopdiets high in acidic and spicy foods, smoking, ping smoking, surgery alcohol use Pronounce and define the following key term: • Treatment: medication; losing weight; stopping • Ulcerative colitis smoking and drinking alcohol; wearing loosefitting clothing; serving frequent, small meals Review the following points about ulcerative colitis: throughout the day; serving last meal of the day • Symptoms: diarrhea, abdominal pain, cramping, three to four hours before bedtime; sitting up for rectal bleeding, poor appetite, fever, weight loss at least two to three hours after eating; elevation • Treatment: Medications, dietary changes, stopof the head of the bed; and using extra pillows ping smoking, surgery Review the following points about ulcers: Pronounce and define the following key terms: • Raw sores in the stomach or small intestine • Diverticulosis • Cause: excessive acid • Diverticulitis • Symptoms: dull or burning pain after eating, belching, vomiting • Treatment: antacids and medications, change in diet • Avoid alcohol, caffeine, and cigarettes Review the following points about gallbladder disorders:
Review the following points about diverticulosis and diverticulitis: • Diverticulosis is a disorder that causes sac-like pouches to develop in weakened areas of the intestinal wall.
102 • Some people with diverticulosis will develop diverticulitis, or inflammation inside the pouchings. • Cause: low-fiber diet
• Causes: infections, microorganisms, irritating foods, medication • Treatment: medication, change of diet Pronounce and define the following key term:
• Treatment: rest, medications, special diets, surgery
• Fecal incontinence
Define the following terms:
Review the following points about fecal incontinence:
• Flatulence
• It is an inability to control the bowels.
• Malabsorption • 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
• 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:
Define the following terms:
• Buildup of dry, hardened feces in the rectum
• Constipation
• Signs include: no stool for several days, cramping, abdominal and rectal pain, abdominal swelling, nausea, and vomiting.
• Enema • Suppository Optional Handout
r doctor will break mass into fragments. TESTBANKS•ENLuLrsEeRo. COM
15-1 gIVINg A RECTAL suPPosIToRY 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
• Can be fatal if complete bowel obstruction occurs
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
• Signs include abdominal swelling, gas, irritability
• Treatment: changes in diet, surgery
• Treatment: increasing fiber, physical activity, and medication
Students can use the online resources to locate more information. Discuss the risk obesity poses for certain gastrointestinal diseases or disorders.
Pronounce and define the following key term: • Diarrhea
8. Discuss how enemas are given
Review the following points about diarrhea: • It is the frequent elimination of liquid or semiliquid feces.
Meeting the Learning Objective TEXTbooK PP. 290–295 WoRKbooK P. 89
103 Lecture Review different types of enemas: • Tap water enema • Soapsuds enema • 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
Demonstration Demonstrate procedure Collecting a stool 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, as well as in the instructor’s guide as a supplementary handout.
10. Explain occult blood testing Meeting the Learning Objective TEXTbooK PP. 296–297 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.
Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. Emphasize that these Demonstration procedures should only be performed if allowed by If this test is performed by nursing assistants, TESTBANKSELLER.COM the facility and if the NA is trained to perform the demonstrate procedure Testing a stool specimen for procedure. occult blood. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at 9. Demonstrate how to collect a stool the end of the student workbook, as well as in the specimen instructor’s guide as a supplementary handout. Meeting the Learning Objective TEXTbooK PP. 295–296 WoRKbooK PP. 89–90
Lecture Pronounce and define the following key term: • Specimen Discuss these points about stool specimens:
11. Define ostomy and identify the difference between ileostomy and colostomy Meeting the Learning Objective TEXTbooK PP. 297–299 WoRKbooK P. 90
• Stool is tested for blood, pathogens, and other things.
Lecture Pronounce and define the following key terms:
• Stool must be warm if being tested for ova and parasites.
• Ostomy
• Urine or tissue in a stool sample can ruin the sample.
• Ileostomy
• Stoma • Colostomy • Urostomy
104 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:
Lecture Discuss how NAs may assist in bowel retraining, including the following: • Follow the plan. Explain the schedule to the resident. • Follow Standard Precautions. Wear gloves. • Observe the resident’s elimination habits. • Keep a record of elimination. • Offer a bedpan or trip to the bathroom at specific times each day. • Answer call lights promptly.
• Follow facility policy.
• Provide privacy. Do not rush the resident.
• Follow Standard and/or Transmission-Based Precautions.
• Help with perineal care. • Encourage fluids and a proper diet.
• Provide careful skin care and proper hygiene.
• Dispose of wastes properly.
• Remove ostomy pouches carefully.
• Praise attempts and successes in controlling the bowels.
• Before removing a pouch, let a little air out of the pouch.
• Never show frustration or anger.
• Observe the contents of the pouch.
Discuss with students how to keep a positive attitude when assisting residents who are going • Replace the ostomy pouch whenever stool is through bowel retraining and have “accidents.” Ask eliminated, if a leak occurs, and as directed. • Assist residents to wash their hands properly. students how they would feel if they were unable to TESTBANKScEonLtrLoE l eRli. mC inOaM tion. Create empathy for residents. • Observe for skin irritation, rashes, swelling or bleeding around the stoma. • Use skin barriers as ordered.
13. Discuss bariatrics and related care
• Make sure the bottom of the pouch is securely clamped before applying to the stoma.
Meeting the Learning Objective
• Make sure the pouch is attached securely before completing care and before residents go out or receive visitors. • 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, as well as in the instructor’s guide as a supplementary handout.
TEXTbooK PP. 300–301 WoRKbooK P. 91
Lecture Discuss specialized equipment that may be used for residents who are obese: • Larger beds that are lower to the floor • Stronger bed rails • Oversized chairs for dining areas and lobbies • Extra-capacity wheelchairs • Bariatric stretchers • Larger gowns
12. Explain guidelines for assisting with bowel retraining
• Bariatric mechanical lifts, slings, trapezes, other types of support and transfer equipment, and extra-capacity scales
Meeting the Learning Objective
• Bariatric elimination equipment includes sturdier bedpans, portable commodes, and toilets mounted to the floor
TEXTbooK P. 300 WoRKbooK PP. 90–91
105 • Oversized shower areas and shower chairs with heavy-duty hand bars
2.
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.
3.
Brown in color, soft, moist, and formed
• Obesity is a risk factor for obstructive sleep apnea (OSA). Residents may be prescribed a CPAP machine to address OSA.
4.
A fracture pan is used for small or thin people or those who cannot lift their buttocks onto a standard bedpan.
• Regarding surgery, the ability to intubate a patient who is obese may be compromised, and the patient may need intubation for a longer period of time following surgery. The patient may be more prone to respiratory depression postoperatively and may require supplemental oxygen.
5.
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.
6.
Answers include the following: increasing fiber, fluids, and physical activity, and medications such as laxatives, enemas, or suppositories
• Bariatric vital signs equipment Review additional considerations for people who are obese: • At least two caregivers are needed for transfers. • Careful skin care should be a priority. Special lotions may be prescribed. The skin should be carefully rinsed and dried and observed closely.
Additional information to share with students includes the following:
7. Excessive cleaning and wiping of the area, Metabolic syndrome is a group of risk factors that scented soaps increases a person’s overall risk of certain diseases including diabetes, heart disease, aTnE dS stT roB keA(N CK VA . LLER.COM S)E 8. Sims’ position Risk factors for metabolic syndrome include age, being overweight or obese, a sedentary lifestyle, a 9. Stop immediately large waist (an apple-shaped body), hypertension, elevated blood sugar, low good cholesterol (HDL), 10. Tests must be done while the stool is still and high triglycerides. People who are overweight warm. or obese are at a higher risk for insulin resistance, 11. Urine or toilet paper which places them at a higher risk for metabolic syndrome. 12. With a microscope or special chemical test
Chapter Review Exam dIsTRIbuTE CHAPTER 15: 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.
Ingestion of food, digestion of food, absorption of nutrients, and elimination of waste products from food/fluids
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 semi-solid. 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.
106 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. At least two people 17. D 18. A 19. B
107
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 the discussion. A risk of infection is especially high Supplemental Tools with catheter care. Students need to be aware of KEY MATERIAL 16-1 THE uRINARY sysTEM this. Tests performed on urine vary from facility to KEY MATERIAL 16-2 FACToRs AFFECTINg facility. The chapter has an introduction to restoruRINATIoN TESTBANKSELLE atR ive.cCaO reMwith the section on bladder retraining. A HANDouT 16-1 CHANgINg dRAINAgE bAg positive, helpful attitude should be encouraged. To lEg bAg HANDouT 16-2 CHANgINg lEg bAg To 1. Define important words in this chapter dRAINAgE bAg HANDouT 16-3 TAKINg A uRINARY sPECIMEN Meeting the Learning Objective FRoM A PoRT TEXTbooK PP. 303–304 HANDouT 16-4 suPRAPubIC CATHETERs WoRKbooK P. 93 CHAPTER 16: EXAM Assignments TEXTbooK READINg, PP. 303–322
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
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 an integral part of
2. Explain the structure and function of the urinary system Meeting the Learning Objective TEXTbooK PP. 304–305 WoRKbooK P. 93
Lecture Pronounce and define the following key terms: • Sphincter
108 • Micturition
Review signs and symptoms of urine to report:
• Voiding
• Cloudy urine
• Urinary incontinence
• Dark or rust-colored urine
• Renal calculi
• Strong-, offensive-, or fruity-smelling urine • Pain, burning, or pressure when urinating
Display Key Material
• Blood, pus, mucus, or discharge in urine
16-1 THE uRINARY sysTEM
• Episodes of incontinence
Review the functions of the urinary system:
• Frequent voiding, voiding in small amounts
• 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
5. List factors affecting urination and describe how to promote normal urination Meeting the Learning Objective TEXTbooK PP. 306–307
3. Discuss changes in the urinary system due to aging
WoRKbooK P. 94
Display Key Material 16-2 FACToRs AFFECTINg uRINATIoN
Meeting the Learning Objective TEXTbooK P. 305
Discuss the factors listed on the key material:
WoRKbooK P. 93
• Growth and development • Psychological factors
Lecture Review normal changes of aging:
TESTBANKS•EFLluLidEiRn. taC keOM
• The kidneys do not filter blood as efficiently.
• Physical activity and exercise
• Bladder muscle tone weakens.
• Personal habits
• Bladder holds less urine, causing more frequent urination.
• Medications
• Bladder may not empty completely, causing increased chance of infection.
4. List normal qualities of urine and identify signs and symptoms to report about urine
• Disorders
6. Discuss common disorders of the urinary system Meeting the Learning Objective TEXTbooK PP. 307–309
Meeting the Learning Objective
WoRKbooK P. 94
TEXTbooK PP. 305–306 WoRKbooK P. 93
Lecture Pronounce and define the following key term:
Lecture Discuss normal characteristics of urine:
• Urinary tract infection
• Light, pale yellow, or amber in color
Review the following points about UTIs:
• Clear or transparent • Faint smell • Adults produce about 1200 to 1500 mL of urine, although elderly may produce less.
• 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
109 • Prevention: drinking plenty of fluids and juices rich in Vitamin C, wiping from front to back after elimination, taking showers rather than baths • Treatment: antibiotics • Report cloudy, dark, or foul-smelling urine, burning or discomfort with urination, or frequent urination in small amounts. Pronounce and define the following key terms: • Chronic renal failure (CRF) • Dialysis • End-stage renal disease (ESRD) Review the following points about CRF: • Kidneys cannot filter waste products from the blood.
Lecture Review causes of incontinence: • Confinement to bed • Illness • Paralysis • Circulatory or nervous system disorders • Prostate problems • Childbirth Emphasize that incontinence is not a normal part of aging and must be reported. Describe the different types of incontinence: • Stress incontinence • Urge incontinence
• Becomes worse over time
• Mixed incontinence
• Causes: diabetes, hypertension, chronic urinary tract infections, nephritis
• Overflow incontinence
• Initial signs and symptoms: unintended weight loss, nausea, vomiting, fatigue, headache, frequent hiccups, itching
• Functional 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. TESTBANKSELLER.COM • Follow elimination schedules and the care plan. • ESRD occurs when kidneys have failed and dialysis or transplantation is required to sustain life. • Leave call lights within reach and answer call lights promptly. Review the following points about urine retention: • Offer bedpans or take residents to the bathroom • Inability to adequately empty the bladder often. • Causes: surgery, obstruction, infection, disorders • Encourage fluids. such as multiple sclerosis and diabetes, enlarge• Take daily walks near the bathroom. ment of prostate gland • Dialysis is done when the kidneys are no longer able to perform their function.
• Symptoms: lower abdominal pain, painful urge but inability to urinate, distended bladder, abdominal swelling, frequent urge to urinate, difficulty starting to urinate, weak flow of urine, dribbling
• Always refer to incontinence products as briefs or pads.
• Treatment: medication and catheterization
• Change wet or soiled clothing immediately.
Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.
• Check incontinence briefs at least every two hours. Change wet or soiled incontinence briefs immediately. • Change wet or soiled bed linens. • Use disposable absorbent pads. • Give careful skin care and perineal care. • Provide privacy.
7. Discuss reasons for incontinence Meeting the Learning Objective TEXTbooK PP. 309–311 WoRKbooK PP. 94–95
• Be calm, patient, and professional. • Be reassuring and positive.
110 8. Describe catheters and related care Meeting the Learning Objective TEXTbooK PP. 311–316 WoRKbooK P. 95
Lecture Pronounce and define the following key terms:
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, as well as in the instructor’s guide as a supplementary handout. Optional Handouts 16-1 CHANgINg dRAINAgE bAg To lEg bAg
• Straight catheter
16-2 CHANgINg lEg bAg To dRAINAgE bAg
• Indwelling catheter
If these procedures are taught at your facility, review the handouts with students.
• 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
Review guidelines for catheter care:
TEXTbooK PP. 316–320
• Wash hands thoroughly.
WoRKbooK P. 96
• Wear gloves. • Keep the genital area clean.
Lecture Pronounce and define the following key terms:
• When cleaning the urinary meatus, move in one • Routine urine specimen direction, away from the meatus. n- catch specimen • Secure the tubing properly. TESTBANKS•ECLleLaE R.COM • 24-hour urine specimen • Make sure the drainage bag hangs lower than hips or bladder. Discuss the following points about urine • Do not hang the drainage bag from a bedrail.
specimens:
• Keep the tubing as straight as possible.
• Identify the resident.
• Keep the drainage bag off the floor. Keep the catheter tubing from touching the floor.
• Labeling and storing specimens correctly is important.
• Do not touch the tip of the clamp to any other object.
Discuss urine straining. Demonstrate how to strain urine if it is a requirement at your facility.
• Do not let the drainage spout touch the graduate. • Do not disconnect the catheter during positioning. Do not reattach disconnected tubing.
Demonstration Demonstrate the following procedures:
• Report blood in urine, leaks, bag filling suddenly or not filling for several hours, pain, pressure, or odor.
• Collecting a routine urine specimen
Demonstration Demonstrate the following procedures: • Providing catheter care • Emptying a catheter drainage bag • Changing a condom catheter
• Collecting a clean-catch (midstream) urine specimen • Collecting a 24-hour urine specimen 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, as well as in the instructor’s guide as a supplementary handout.
111 Optional Handouts 16-3 TAKINg A uRINARY sPECIMEN FRoM A PoRT 16-4 suPRAPubIC CATHETERs
11. Explain guidelines for assisting with bladder retraining Meeting the Learning Objective
If these procedures are taught at your facility, review the handouts with students. Lecture Review the Five “Rights” of specimen collection: • The right resident • The right specimen • The right container • The right date/time • The right storage/delivery
10. Explain types of tests that are performed on urine Meeting the Learning Objective TEXTbooK PP. 320–321 WoRKbooK P. 96
TEXTbooK PP. 321–322 WoRKbooK P. 96
Lecture Discuss how NAs may assist in bladder retraining: • Follow the plan. Explain the schedule to the resident. • Follow Standard Precautions. • Observe the resident’s elimination habits. • Encourage fluids. • Offer a bedpan or urinal or a trip to the bathroom before and after long procedures. • Answer call lights promptly. • Provide privacy and do not rush the resident. • Have the resident lean forward to put pressure on the bladder. • Help with perineal care as needed. • Keep accurate I&O records.
Lecture AN •R D. isC poOseMof wastes properly. Pronounce and define the followinT gE keSyTteBrm s:KSELLE • Ketones
• Offer praise.
• Specific gravity
• Never show frustration or anger.
Discuss what urine may be tested for: • pH level • Glucose and ketones
Chapter Review Exam
• Blood
dIsTRIbuTE CHAPTER 16: EXAM
• Specific gravity
(APPENDIX C)
Demonstration Demonstrate procedure Testing urine with reagent strips. 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, as well as in the instructor’s guide as a supplementary handout.
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: elimination of waste products from the blood; maintenance of water balance in the body; regulation of the levels of electrolytes in the body; and assistance in regulation of blood pressure.
112 2.
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.
3.
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.
4.
Sitting, standing
5.
One reason is that the female urethra is shorter than the male urethra. In addition, because the female urethra is located directly in front of the vagina and the anus, it is closer to potential sources of bacteria.
6.
From front to back
7.
Dialysis is an artificial means of removing the body’s waste products.
8.
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 distension of the bladder.
9.
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
113
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 KEY MATERIAL 17-1 THE REPRoduCTIVE sysTEM CHAPTER 17: EXAM
Assignments TEXTbooK READINg, PP. 323–330 WoRKbooK EXERCIsEs, PP. 97–98
2. Explain the structure and function of the reproductive system Meeting the Learning Objective TEXTbooK PP. 324–325 WoRKbooK P. 97
Lecture Pronounce and define the following key terms:
Overview of Teaching Strategies This chapter focuses on the reproductive system. • Sperm Students will learn how the male and female repro• Ovum ductive systems allow human beinT gsEtS oT crB eaAteNnKeS wELLER.COM • Gonads life. Normal changes of aging in the reproductive • Glands system are described, as well as common disorders, which include sexually-transmitted infections. • Hormones 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.
1.
Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 323–324 WoRKbooK P. 97
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
• Menstruation Display Key Material 17-1 THE REPRoduCTIVE sysTEM Review the following points about the reproductive system: • Reproductive organs and hormones are different in males and females. • The reproductive system allows human beings to reproduce, or create new human life. 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
114 • 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. 325–326 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 nfection can be spread even when sores are not last menstrual period and ends the abilT itE y tSoTBANKS•EIL LER.COM present. 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. 326–329
• 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.
• Symptoms: painful or burning urination; white, yellow, or green cloudy pus-like discharge from
115 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:
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.
• Cause: protozoa Pronounce and define the following key term: • Benign prostatic hypertrophy • May have no symptoms in men • Symptoms in men: mild discharT geE , iS rrT itB atA ioN n,KSELLER.COM Review the following points about benign prostatic burning sensation after urination or ejaculation hypertrophy: • Symptoms in women: green-yellow vaginal dis• Common in men over the age of 60 charge with strong odor, irritation, itching • Cause: enlarged prostate causes pressure on ure• Treatment: metronidazole thra, making urination difficult. Pronounce and define the following key term: • Symptoms: feeling of incomplete urination, frequent urination, weak stream of urine, dribbling, • Vaginitis need to urinate often at night, incontinence Review the following points about vaginitis: • Treatment: medication and surgery • Cause: overgrowth of normal bacteria inside the vagina, overproduction of fungus, lower estrogen levels post-menopause, irritation, or an allergic reaction • 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
Pronounce and define the following key terms: • Prostate 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.
116 • 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.
Chapter Review
Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.
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.
5. Describe sexual needs of the elderly
Exam dIsTRIbuTE CHAPTER 17: EXAM (APPENDIX C)
Answers to Chapter Review in Textbook Meeting the Learning Objective TEXTbooK PP. 329–330
1.
WoRKbooK P. 98
Lecture Discuss sexual needs. Emphasize that respect and privacy are very important when encountering any sexual situation.
2.
• Vaginal atrophy, pain, and dryness
4.
Male – Manufacture sperm and the male hormone, testosterone. Female – Manufacture ova and the female hormones, estrogen and progesterone; provide environment for development of fetus; and produce milk for the nourishment of a baby after birth
Male – Prostate gland enlarges. Number and capacity of sperm decreases. Sexual response Review the following points about sexual needs: delays. It may take longer to achieve an erection and to reach orgasm. Female – Meno• Sexual needs continue throughout a person’s life. pause occurs 12 months after a woman’s last • The ability to engage in sexual activities continTESTBANKSELL Rs.trC mE en uaOl M period and ends the ability to reproues unless a disease or injury occurs. duce. Decrease in production of estrogen and • NAs can help by providing privacy and respectprogesterone leads to a loss of calcium, causing residents’ sexual needs. ing brittle bones and, potentially, osteoporosis. Decrease in estrogen also makes females Pronounce and define the following key term: more prone to urinary tract infections. Vaginal • Erectile dysfunction (ED) walls become drier and thinner. Review some things that affect sexual activity in 3. STIs are transmitted through sexual contact, the elderly: such as sexual intercourse (vaginal and anal), • Illness affecting ability to perform sexually contact of the mouth with the genitals or anus, and contact of the hands with the genital area. • Erectile dysfunction • 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.
Provide privacy and leave the area.
117
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 injuries and identify prevention guidelines Explain the benefits of warm and cold applications Discuss nonsterile and sterile dressings
Supplemental Tools
1. Define important words in this chapter
KEY MATERIAL 18-1 THE INTEguMENTARY sysTEM KEY MATERIAL 18-2 PREssuRE INJuRY DANgER zoNEs KEY MATERIAL 18-3 obsERVINg THE sKIN CHAPTER 18: EXAM
Assignments TEXTbooK READINg, PP. 331–350 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 injuries, including risk factors, signs of skin breakdown, stages of pressure injuries, and prevention. It is a good idea at this time to show students some positioning devices that can help prevent pressure injuries 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 warm and cold applications.
Meeting the Learning Objective TEXTbooK PP. 331–332 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. 332–333 WoRKbooK P. 99
Lecture Pronounce and define the following key terms: • Integument • Epidermis • Melanocyte • Melanin • Dermis Display Key Material 18-1 THE INTEguMENTARY sysTEM Review the following points about the integumentary system: • Natural, protective covering • Largest organ and system
118 • 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
• 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
• Helps with production of vitamin D
• 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 P. 333
Pronounce and define the following key term:
WoRKbooK P. 99
• Scabies Review the following points about scabies:
Lecture Review normal changes of aging: • Amount of fat and collagen decreases. • Elastic fibers lose elasticity.
• 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. 334–339
• 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
119 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 about psoriasis:
• Hematoma
• Chronic skin condition in which skin cells grow too fast • Purpura • Symptoms: white or silver patches on skin, itchPronounce and define the followinT gE keSyTteBrm AN : KSELLER.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
120 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
servation in preventing pressure injuries and the increased risk of pressure injuries for bedbound residents. Describe the four stages of pressure injuries. Stress that each resident’s skin should be inspected every time care is provided.
• Treatment: medication, removal with laser or special instrument
Display Key Material
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 the 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 injuries
5. Discuss pressure injuries and identify prevention guidelines Meeting the Learning Objective TEXTbooK PP. 339–342 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 injuries, 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 injuries: • Report changes in skin.
• Bony prominences
• Perform regular skin care and closely observe skin.
• Necrosis
• Keep the skin clean and dry.
• Pressure injuries
• Use moisturizers as ordered on unbroken skin.
• Shearing
• Do not massage any white, red, or purple areas, bony areas, or pressure points.
Display Key Material
• Assist immobile residents to change position often, at least every two hours.
18-2 PREssuRE INJuRY DANgER ZoNEs Discuss the common sites for pressure injuries illustrated on the key material and on page 340 in the textbook. Emphasize the importance of ob-
• Ask residents in wheelchairs to change position at least every hour. • Do not pull residents across linen or other surfaces during transfers or repositioning.
121 • 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.
6. Explain the benefits of warm and cold applications Meeting the Learning Objective TEXTbooK PP. 342–347 WoRKbooK PP. 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.
Have the students return each demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout. Emphasize that these procedures should only be performed if allowed by the facility and if the NA is trained to perform the procedure. Lecture Review the following points about cooling or tepid sponge baths: • Can reduce body temperature • 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.
• Cold helps stop bleeding, minimizes swelling, reduces pain, and brings down high temperatures.
7. Discuss nonsterile and sterile dressings
• Moisture strengthens the effect of heat and cold.
Meeting the Learning Objective
TE. XT oK PP. 347–349 • Observe for excessive redness, paTin lisB teA rsN , oKrSELLER E,SbT CbOoM numbness. WoRKbooK PP. 101–102
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 • Applying an Aquamatic K-Pad • Assisting with a sitz bath • Applying ice packs
Lecture Review the following points about sterile and nonsterile dressings: • Open wounds increase risk of infection. • Nonsterile 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 nonsterile 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, as well as in the instructor’s guide as a supplementary handout. Lecture Review the following points about sterile dressing care:
122 • Sterile field is created.
dermis, and underlying tissue and cause serious scarring, which may affect muscle and bone; white or charred skin; pain, swelling, and peeling skin.
• 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. 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, as well as in the instructor’s guide as a supplementary handout.
Chapter Review
4.
By direct person-to-person contact
5.
Nonsterile 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.
6.
A
7.
A
8.
D
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 exT am s iT f BANKSELLER.COM ES 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.
2.
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.
3.
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,
123
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 KEY MATERIAL 19-1 THE CIRCulAToRY sysTEM
Lecture Pronounce and define the following key terms:
CHAPTER 19: EXAM
• Heart • Atria
Assignments
• Ventricles
TEXTbooK READINg, PP. 351–363
• 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 Key Material Normal changes of aging are described so that T E S T B A N K S ELLER .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. 351–352 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. 352–354 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
124 3. Discuss changes in the circulatory system due to aging Meeting the Learning Objective TEXTbooK P. 354 WoRKbooK P. 103
Lecture Review normal changes of aging: • Heart pumps less efficiently. • Blood vessels narrow. • Blood vessels become less elastic. • Blood flow decreases.
4. Discuss common disorders of the circulatory system Meeting the Learning Objective
Review the following points about CAD: • Cause: vessels in coronary arteries narrow after build-up of arterial plaque, reducing blood to heart • Symptom: angina pectoris Review care guidelines for angina: • Reduce stress. • Notify the nurse immediately if the resident needs help taking his prescribed medication. • Make sure residents get enough rest. • The resident should avoid overeating. • Encourage the resident to follow his exercise plan. • The resident may need to avoid hot, humid weather. • Be encouraging if the resident has quit or is trying to quit smoking.
TEXTbooK PP. 354–362
Pronounce and define the following key term:
WoRKbooK P. 104
• Cardiomyopathy
Review the following points about cardiomyopathy: Lecture uses: CAD, heart muscle that no longer Pronounce and define the following key T teE rm SsT: BANKS•ECLaL ER.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):
• Symptoms: headache, blurred vision, dizziness • Can lead to MI, CVA, kidney disease, or blindness
• Cause: block of blood flow to heart muscle • Chapter 8 of textbook has warning signs of MI. Pronounce and define the following key term:
• Treatment: medication, including diuretics; exercise program; diet; stopping smoking; lowering stress levels
• Sudden cardiac arrest
Lecture Pronounce and define the following key terms:
• Regular exercise program
Review the components of cardiac rehabilitation: • Low-fat, low-sodium diet
• Coronary artery disease (CAD)
• Medication to regulate heart rate and blood pressure
• Myocardial ischemia
• Blood testing
• Angina pectoris
• Stopping smoking
• Stable angina
• Avoiding cold temperatures
• Unstable angina
• Stress management program
• Nitroglycerin
• Mental health care to help deal with depression or anxiety
125 Pronounce and define the following key terms:
Review the following points about CHF:
• Peripheral vascular disease (PVD)
• Cause: failure of heart muscle to pump effectively due to damage
• Phlebitis • Deep vein thrombosis • Embolism • Pulmonary embolism (PE) • Elastic stockings Review the following points about PVD: • Causes: buildup of arterial plaque over time, reduction in cardiac output, phlebitis • The 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
• 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 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.
• Report: complaints of pain or change in hands, • Measure daily weight and I&O. legs, or feet; change in vital signs; increased • Encourage the resident to follow fluid and diet edema; weight gain; I&O change; headache; inorders. ability to see clearly; discomfort in head, neck, • Be encouraging if the resident has quit or is tryjaw, shoulder, chest, or back; disorientation; or ing to quit smoking. dizziness, or confusion TESTBANKSELLER .COM • Use special stockings as ordered. • Treatment: fluid restrictions or special diets, quitting smoking, anti-embolic stockings Demonstration Demonstrate procedure Applying knee-high elastic stockings. 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, as well as in the instructor’s guide as a supplementary handout. Lecture Pronounce and define the following key term: • Sequential compression device (SCD) Review the following points about SCDs: • Used to improve circulation and prevent blood clots • Applied during or after surgery • Report damaged equipment to nurse Pronounce and define the following key terms: • Congestive heart failure (CHF) • Orthopnea
• Provide extra pillows in bed. • Assist with ADLs. • Assist with ROM exercises. • Report changes in activity level; fatigue; dizziness, confusion, or fainting; increased respiratory rate, pulse, or blood pressure; irregular heartbeat; palpitations; chest tightness or chest pain; dyspnea; coughing; wheezing; lack of appetite; abdominal swelling or pain; edema; bulging neck veins; weight gain from fluid retention; and change in urinary output. Lecture Pronounce and define the following terms: • Pulmonary edema Review these points about pulmonary edema: • Cause: buildup of fluid in the lungs • Symptoms: shortness of breath; wheezing; coughing; gurgling when breathing; anxiety; restlessness • Emergency treatment is necessary.
126 Pronounce and define the following key terms:
5.
Answers include the following: fatigue, weakness, pale skin, a sore or swollen tongue, brittle nails, and difficulty concentrating.
6.
B
• Anemia • Hypoxia Review the following points about anemia: • Cause: amount of red blood cells or hemoglobin in the body is less than normal • Symptoms: fatigue, weakness, pale skin, problems with the tongue, brittle nails, difficulty concentrating • 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 theTtE esS t. T SeBeANKSELLER.COM 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 body temperature; and clots the blood and fights pathogens and poisons.
2.
Answers include the following: Heart pumps less efficiently. Blood vessels narrow. Blood vessels become less elastic. Blood flow decreases.
3.
Answers include the following: medication, diuretics, exercise programs, special diet, stopping smoking, and lowering stress level.
4.
Angina is usually described as intense pressure in the chest, a tightness in the chest, or pain in the back, neck, jaw, or shoulder.
127
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 KEY MATERIAL 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. 365–366 WoRKbooK P. 105
Assignments TEXTbooK READINg, PP. 364–376 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 Key Material 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. 364–365
• 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
128 • 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 TEXTbooK P. 366
• Symptoms of chronic bronchitis: excessive mucus production, long-lasting cough • 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
WoRKbooK PP. 105–106
Review the general symptoms of COPD: Lecture Review normal changes of aging:
• Coughing or wheezing
• Lung strength decreases.
• Shortness of breath
• Alveoli become less elastic and decrease in number. • Airways become stiff and less elastic. • Lung capacity decreases. • Chest muscles become weaker. • Cough reflex becomes less effective and the cough becomes weaker.
• Dyspnea • Chest pain or tightness • Cyanosis • Weakness • Weight loss or loss of appetite • Fear and anxiety • Confusion
• Oxygen in the blood decreases. Review care guidelines for COPD: • Decreased lung capacity causes the voice to • Be supportive, calm, and empathetic. TESTBANKS•EULsLe EpiRllo.wCsOtoMhelp residents sit up or lean weaken. forward.
4. Discuss common disorders of the respiratory system
• Be supportive of residents who are quitting smoking. • Offer fluids and encourage a healthy diet.
Meeting the Learning Objective
• Encourage rest.
TEXTbooK PP. 366–370
• Use proper infection prevention practices.
WoRKbooK P. 106
• Report signs of colds or flu immediately.
Lecture Pronounce and define the following key terms: • Chronic obstructive pulmonary disease (COPD) • Bronchitis • Sputum • Emphysema Review the following points about COPD:
• Residents must take medication as ordered. • Follow safety guidelines for oxygen therapy. • 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.
• Cause: obstruction of airways
Pronounce and define the following key term:
• Includes chronic bronchitis and emphysema
• Asthma
• Chronic bronchitis occurs when lining of the bronchial tubes becomes inflamed, causing scarring.
Review the following points about asthma: • Chronic, episodic disorder in which irritants, allergens, infections, or cold air cause inflammation and swelling in the air passages in the lungs
129 • Can be worsened by exercise or stress
Review the following points about tuberculosis:
• Symptoms: heavy wheezing, coughing, tight feeling in chest
• Highly contagious disease
• Treatment: medication, avoidance of triggers, reducing stress levels • Report: changes in vital signs, especially respiratory rate; wheezing, shortness of breath or dyspnea; cyanosis; chest pain or tightness; refusal to use inhaler Pronounce and define the following key terms: • Bronchiectasis • Chest percussion Review the following points about bronchiectasis: • Condition in which the bronchi become permanently dilated • Causes: infection of the airways, cystic fibrosis, presence of tumors, inhaling foreign material • Symptoms: chronic coughing, shortness of breath, wheezing, weight loss, cyanosis, coughing up blood, respiratory infections, halitosis
• Cause: bacterium that is carried on mucous droplets suspended in the air • Can be spread by infected person coughing, breathing, singing, sneezing, or laughing • Symptoms: fatigue, loss of appetite, weight loss, slight fever and chills, night sweats, prolonged coughing, hemoptysis, chest pain, shortness of breath, dyspnea • 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 care guidelines for tuberculosis: • Follow Standard Precautions and Airborne Precautions. • Wear PPE. • Keep doors to AIIRs closed except when entering or exiting the room. When entering the room, do not open or close the door rapidly.
• Treatment: postural drainage, chest percussion • Be careful when handling sputum. • Report: fever, chest pain, change in mucus or •R Th esM ident must take all of the medication TESTBANKSELLE .eCrO phlegm production prescribed. Pronounce and define the following key term: • 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) • Symptoms: high fever, chest pain, coughing, difficulty breathing, shortness of breath, chills, rapid pulse, thick secretions coughed up from the lungs • Treatment: antibiotics and other medication, inhaler, special diet, increased fluid intake
Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.
5. Describe oxygen delivery Meeting the Learning Objective TEXTbooK PP. 370–373 WoRKbooK PP. 106–107
Lecture Pronounce and define the following key term: • Oxygen therapy Review methods of oxygen delivery:
• Report if the resident is not taking medication.
• Piped into room through wall outlet at facility
Pronounce and define the following key terms:
• Compressed oxygen in cylinders
• Tuberculosis
• Liquid oxygen in special reservoirs
• Hemoptysis
• Oxygen concentrators
• Multidrug-resistant TB (MDR-TB)
Remind students that oxygen is a drug and cannot be applied or adjusted by nursing assistants.
130 Review care guidelines for residents using oxygen:
• Sputum may show evidence of cancer or bacteria.
• Perform frequent skin care.
• Some facilities do not allow nursing assistants to collect sputum specimens; always follow facility policy.
• 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 the device for fit and comfort. • Do not remove the delivery device or adjust oxygen levels. • Check vital signs as ordered. • Notify nurse if the equipment does not seem to be working. • 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. • Post No Smoking and Oxygen in Use signs. • Avoid using synthetic or wool fabrics that can cause static electricity discharges. • Know the location of fire alarms and fire extinguishers. • Add pillows as needed to improve breathing. • Encourage fluids and 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, or chest pain or tightness. Distribute Optional Handout 20-1 oXYgEN THERAPY usINg A HuMIDIFICATIoN dEVICE If this procedure is taught at your facility, review the information on the handout with students.
6. Describe how to collect a sputum specimen
• Early morning is the best time to collect sputum. • The resident should rinse mouth with water but not with mouthwash before specimen collection. 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, as well as in the instructor’s guide as a supplementary handout.
7. Describe the benefits of deep breathing exercises Meeting the Learning Objective TEXTbooK PP. 374–376 WoRKbooK P. 107
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. • Do not assist with these exercises if you have not been trained to do so. • Do not share incentive spirometers between residents. • Make sure you and the resident wash hands prior 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 P. 373 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 each of the following procedures, including all of the numbered steps in your demonstration: • Assisting with deep breathing and coughing exercises • Assisting with an incentive spirometer
131 Include all of the numbered steps in your demonstration. Have the students return the demonstrations. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
Chapter Review Exam dIsTRIbuTE CHAPTER 20: 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: 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.
2.
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.
3.
COPD causes difficulty breathing. Residents may be fearful about not being able to breathe.
4.
Someone with latent TB infection carries the 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.
5.
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.
6.
Being paralyzed or having had abdominal surgery are two conditions that can require deep breathing exercises.
7.
B
8.
C
9.
D
132
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 KEY MATERIAL 21-1 THE MusCulosKELETAL sysTEM HANDouT 21-1 APPLYINg AN ELAsTIC bANDAgE CHAPTER 21: EXAM
Assignments TEXTbooK READINg, PP. 377–391 WoRKbooK EXERCIsEs, PP. 109–112
2. Explain the structure and function of the musculoskeletal system Meeting the Learning Objective TEXTbooK PP. 378–380 WoRKbooK PP. 109–110
Lecture Pronounce and define the following key terms:
• Muscles Overview of Teaching Strategies This chapter focuses on the musculoskeletal sys• Bones tem. Types and functions of muscles, boT neEs,SaT ndBANKS•EJL oiL ntE s R.COM joints are explained. Normal changes of aging are • Cartilage described so that students will be well-prepared • Bursae to recognize abnormal changes that may signal a problem. Specific disorders of the musculoskel• Tendons etal system are addressed. Emphasis is placed on • Ligaments maintaining resident independence and mobility. The physical and psychological effects of falls are Display Key Material discussed, as well as how to prevent them. 21-1 THE MusCulosKELETAL sysTEM
1. Define important words in this chapter
Discuss the three types of muscles: • Skeletal muscles
Meeting the Learning Objective TEXTbooK PP. 377–378
• Smooth muscles • Cardiac muscle
WoRKbooK P. 109
Discuss the four types of bones: Lecture Pronounce and define each of the key terms listed in the Learning Objective.
• Long bones • Short bones • Flat bones • Irregular bones Discuss the three types of joints: • Immovable joints
133 • Slightly movable joints • Movable joints Review the functions of the musculoskeletal system:
Review the following points about muscular dystrophy: • Hereditary, progressive disease in which muscle tissue is destroyed and muscles atrophy
• Gives shape and form to the body
• Symptoms: muscle weakness, stiffness, twitching of the hands and arms
• Maintains posture
• Cause: specific gene in the body
• Permits movement
• Generally appears at birth or during childhood
• Protects internal organs
• There is currently no cure.
• Stores calcium and phosphorus • Produces heat • Produces some blood cells
3. Discuss changes in the musculoskeletal system due to aging Meeting the Learning Objective TEXTbooK P. 380
Review care guidelines for muscular dystrophy: • Allow time for movement. • Give frequent skin care to prevent pressure injuries. • Reposition residents often to prevent contractures. • Perform ROM exercises as directed. • Assist with ADLs. Encourage independence.
• Report red skin; pale skin; signs of the beginning of a pressure injury; stiffening of muscles; pain, swelling, or burning in a leg; swallowing Lecture problems; symptoms of UTI; constipation; signs Review normal changes of aging: of pneumonia; shortness of breath; or changes in • Muscles weaken and lose tone. TESTBANKSELLER bl. ooCdOpM ressure or pulse rate. • Bones lose calcium, causing them to become Pronounce and define the following key terms: porous and brittle. • Osteoporosis • Height is gradually lost due to shrinkage of space • Osteopenia between the vertebrae in the spine. WoRKbooK P. 110
• Loss of muscle mass in the body causes weight loss.
Review the following points about osteoporosis:
• Joints are less flexible and are stiffer, which slows normal body movements and decreases range of motion.
• Causes: lack of calcium in diet, loss of estrogen, lack of regular exercise, reduced mobility, age
4. Discuss common disorders of the musculoskeletal system Meeting the Learning Objective
• Bones lose mass, causing them to become brittle.
• More common in women, especially after menopause • Symptoms: low back pain, loss of height, fractures, stooped posture • Treatment: medication, exercise, calcium supplements
TEXTbooK PP. 380–390
• Be patient and reposition residents carefully.
WoRKbooK PP. 110–111
• Report any decline in activity or movement.
Lecture Pronounce and define the following key terms:
Pronounce and define the following key terms:
• Muscular dystrophy
• Osteoarthritis
• Atrophy
• Arthritis • Rheumatoid arthritis
134 Review the following points about arthritis:
Pronounce and define the following key term:
• General term for inflammation of joints that causes pain, stiffness, and swelling
• Bursitis
• May cause decreased mobility 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 • Generally occurs due to aging and may be due to joint injury • Cold, damp weather can increase pain and stiffness. Review the following points about rheumatoid arthritis: • Form of arthritis that may become crippling • Symptoms: stiffness, swelling, severe pain, deformities which may be severe and disabling, fever, fatigue, weight loss • Cause: autoimmune illness
Review the following points about bursitis: • Condition in which bursae become inflamed • 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 Pronounce and define the following key terms: • Amputation • Prosthesis • Phantom sensation • Phantom limb pain • Flexion Review the following points about amputations: • Surgical removal of an extremity • Causes: disease, cancer, injury, accidents
• Person may have prosthesis or transplant. • Treatment: rest, controlled exercise, ROM exerEmphasize to students that phantom sensation, cises, medication, weight loss, heat applications, TESTBA NKSELLER.COM phantom limb pain, and stump pain are real and joint replacement should not be ignored or ridiculed. Review the care guidelines for arthritis: Review guidelines for amputation and prosthesis • Assist with the exercise program. care: • Perform ROM exercises as directed. • Be careful when handling prostheses. • Let nurse know 30 minutes before exercise if • Follow instructions to apply or remove pain medication is needed. prostheses. • Assist with ADLs as needed. • Apply special compression bandages and/or • Encourage the use of handrails and safety bars in stump shrinkers as ordered. bathroom. • Change socks often and place sock seams facing • Be positive and supportive. outside to prevent abrasions. • Report pain, stiffness, swelling, reduced ability to • Give regular, careful skin care to avoid complicaperform ROM exercises, or decline in activity. tions with the stump and the prosthesis. Review the following points about fibromyalgia:
• Bathe and rinse the stump.
• FMS has no definitive cause, but can occur following surgery, infection, or extreme stress.
• Clean and dry the socket of the prosthesis when it is removed.
• Symptoms: widespread pain, fatigue, sleep disturbances, problems with thinking and memory, and depression
• Before applying a prosthesis, make sure the area is completely dry.
• Cannot be cured • Treatment: medications, exercises, and some complementary and alternative therapies
• 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.
135 • Assist with ADLs. • Encourage activity. • Perform range of motion exercises as directed. • Physical therapists will assist the resident in learning to bear weight on the prosthesis. • 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 the 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.
• 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. • 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 the cast wet. • Keep the cast clean.
Pronounce and define the following key terms:
• Follow orders for moving and repositioning.
• Fracture
• The extremity may need to be elevated.
• Sling
• Help with ROM exercises as ordered.
Review the following points about fractures: • A fracture is a broken bone.
• Allow time for movement. • Assist with the use of a cane, walker, or crutches.
• Use bed cradles to reduce pressure from bed linens. • Report numbness, tingling, or increased swell• Symptoms: pain, swelling, bruising ing; complaints that cast feels too tight; pain, • Generally diagnosed with X-ray oTr E MSRT IB scA anNKSELLER bu.rC niO ngM, or pressure; redness, drainage, bleeding, or sores of any kind; wetness in or around a • Treatment: bone must be set and allowed to heal cast; odor around the cast; changes in temperain normal alignment ture of the skin (hot or cold skin); cyanosis or • Can take four to eight weeks to heal; longer in pale skin; or if the resident places sharp object elderly people inside the cast. Review the types of fractures: Pronounce and define the following key terms: • Closed or simple fracture • Total hip replacement (THR) • Causes: trauma or accidents; falling is a common cause
• Hairline fracture
• Partial weight-bearing (PWB)
• Open or compound fracture
• Non-weight-bearing (NWB)
• Greenstick fracture
• Full weight-bearing (FWB)
• Comminuted fracture
• Abduction
• Compression fracture
• Adduction
• Pathologic fracture 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: • Rest: Rest is important to help an injury heal properly. Putting any weight on the injury could cause more harm. • Ice: Ice helps to prevent or reduce swelling. The skin should always be protected when using ice.
Review guidelines for total hip replacement (THR): • Follow the care plan exactly. • Follow orders regarding positioning and elevation of head of bed. • Never perform ROM exercises on the side of a hip replacement without orders from the nurse. • Caution the resident not to cross her legs. • Assist with dressing, starting with the weaker side.
136 • Apply elastic stockings as ordered.
Discuss the following points about traction:
• Use assistive devices. • Ask the resident to use handrails in the shower.
• Method of treating fractures that keeps bones in place
• Ask the nurse for pain medication prior to moving and positioning.
• Uses weights and pulleys to keep bones in proper position
• Assist with coughing and deep breathing exercises.
• Do not disconnect traction assembly or adjust the weights.
• Encourage fluids.
• Keep the resident in proper body alignment.
• Never rush the 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; the resident is 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 within 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 the resident is not following the doctor’s orders for exercise and activity. Pronounce and define the following key term:
Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.
• Total knee replacement (TKR) Review care guidelines for total knee replacement:
5. Describe elastic bandages
• Apply special stockings to prevent blood clots. Meeting the Learning Objective • Do not perform special exercises unlesT s tEraSinTeB d ANKSELLER.COM TEXTbooK PP. 390–391 and ordered. WoRKbooK P. 112 • Assist with coughing and deep breathing exercises as ordered. Lecture • Encourage fluids. Review the following points about elastic bandages: • Ask the nurse for pain medication prior to mov• Bandages that are wrapped around a body part ing and positioning. • Used to keep dressings in place, hold splints in • Report incisions that are red, draining, bleedplace, and provide protection, compression and ing, or warm; an increase in pain or a burning support for body parts, decrease swelling from sensation, especially on the operated side or in injuries and hold ice in place the calves; fever or other change in vital signs; • Must be snug enough to provide proper comnumbness or tingling; edema (swelling) of the pression and support but not interfere with legs; cyanosis or pale skin; problems with appecirculation tite; constipation; if the resident is not following • Report numbness or tingling; resident comthe doctor’s orders for exercise and activity; or plaints of the bandage feeling too tight; swelling; reduced mobility in the extremity. indentation marks on the skin; pain or discomReview the following points about continuous fort; skin that is cold to the touch; or pale, gray, passive motion (CPM) machines: cyanotic, or white skin. • May be used for people who have had TKR Optional Handout • Moves joint through normal range of motion • Notify nurse if the resident complains of pain or discomfort or if the extremity moves out of the proper position.
21-1 APPLYINg AN ELAsTIC bANDAgE If taught at your facility, you can review the procedure for applying elastic bandages.
137 Chapter Review Exam dIsTRIbuTE CHAPTER 21: 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.
Skeletal muscles, smooth muscles, and cardiac muscle
2.
Bones lend support to body structures, allow the body to move, and protect the organs.
3.
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 stiffTeE r, S wT hiB chAsN loK wS s ELLER.COM normal body movements and decreases range of motion.
4.
It wastes away, decreases in size, and weakens.
5.
They can break easily.
6.
Falls contribute to many physical injuries and can have psychological consequences as well.
7.
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.
8.
B
9.
C
10. C 11. D
138
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 and mental health disorders 14. Discuss substance abuse and list signs of substance abuse to report Supplemental Tools
1. Define important words in this chapter
KEY MATERIAL 22-1 THE NERVous sysTEM KEY MATERIAL 22-2 PARTs oF THE EYE KEY MATERIAL 22-3 PARTs oF THE EAR CHAPTER 22: EXAM
Assignments TEXTbooK READINg, PP. 392–429
Meeting the Learning Objective TEXTbooK PP. 392–394 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 health disorders 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. 394–397 WoRKbooK P. 113
Lecture Pronounce and define the following key terms: • Neuron • Central nervous system • Peripheral nervous system
139 • Brain • Spinal cord Display Key Material 22-1 THE NERVous sysTEM
Display Key Material 22-3 PARTs oF THE EAR Review the parts of the ear and the functions of each: • Outer ear
Explain that the two main parts of the nervous system are the central nervous system (CNS) and the peripheral nervous system (PNS).
• Middle ear
Review the following points about the central nervous system:
• 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.
• Inner ear • Eardrum
• 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 • The somatic nervous system (SNTSE ) hSeT lpB sA wN ithKSELLER.COM TEXTbooK P. 397 conscious movement of the skeletal system. WoRKbooK P. 113 • The two parts of the autonomic nervous system (ANS) conserve the body’s energy, provide for 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 Key Material
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 and the functions of each: • Sclera
4. Discuss common disorders of the nervous system Meeting the Learning Objective
• Cornea
TEXTbooK PP. 397–409
• Iris
WoRKbooK PP. 113–115
• Pupil • Retina
Lecture Pronounce and define the following key terms:
140 • Cerebrovascular accident (CVA) • Hemianopsia
• For one-sided neglect, remind residents about the weaker side of the body.
Review the following points about CVA:
• Always place food in the unaffected side of the mouth.
• Cause: obstruction inside a blood vessel or the rupture of a blood vessel
• Observe for swallowing problems.
• 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.
• Carefully assist with shaving, grooming, and bathing.
• Encourage fluids and proper nutrition.
• Hemorrhagic stroke, another type of stroke, occurs when there is leaking or a rupture of a blood vessel inside the brain.
• Make sure a clock and calendar are visible.
• Transient ischemic attack (TIA) is a warning sign.
• Use praise often.
• Symptoms differ, depending on which side of the brain is affected.
• With emotional lability, redirect the resident’s attention. • Listen to the resident if she wants to talk. Review guidelines for communication with a resident post-CVA:
Review some of the problems that can result from right side or left side brain damage from a CVA:
• Speak clearly and face the resident.
• Hemiparesis
• Use signals, such as nodding and pointing.
• Hemiplegia
• Use yes or no questions.
• One-sided neglect • Loss of ability to identify affected body parts • Expressive aphasia • Receptive aphasia
• Do not rush the resident.
• Keep questions and directions simple. Use special methods, such as communication boards.
TESTBANKSPEroLnLouEnRc. eC anO dMdefine the following key terms:
• Emotional lability • Loss of sensations • 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
• Parkinson’s disease • Progressive Review the following points about Parkinson’s disease: • Progressive disorder that causes a part of brain to degenerate • Cause: neurons in the brain that produce dopamine begin to break down and die
• Hemianopsia
• Symptoms: tremors or shaking; mask-like face; pill-rolling; rigid muscles; shuffling gait; slurred speech; mood swings; gradual behavior changes
Review the guidelines for residents recovering from CVA:
• Treatment: drug therapy, surgery
• Encourage independence and self-esteem.
Review the care guidelines for Parkinson’s disease:
• Be patient with self-care and communication.
• Encourage self-care.
• Encourage resting in between self-care tasks.
• Assist with ADLs.
• Assist with ROM exercises.
• Assist with ROM exercises.
• Reposition often, using proper alignment.
• Assist with ambulation to prevent falls.
• Do not refer to a resident’s affected side as “bad.”
• Encourage residents to stand as straight as possible for ambulation.
• Assist with ambulation to prevent falls.
• Encourage fluids and proper nutrition.
141 • Listen to residents if they want to talk.
Pronounce and define the following key terms:
• Report severe trembling, severe muscle rigidity/ contractures, mood swings, sudden incontinence, constipation, dehydration, weight loss, or signs of depression.
• Concussion
Additional information about treatment of Parkinson’s disease is available at these links if you would like to share them with students: • https://www.kvue.com/article/news/local/newtreatment-gives-those-with-parkinsons-a-newhope-in-lakeway/269-588850511 • https://www.barrowneuro.org/get-to-know-barrow/centers-programs/muhammad-ali-parkinson-center/parkinsons-disease-resources/ • https://www.barrowneuro.org/in-the-news/barrow-boston-scientific-dbs-system/ Pronounce and define the following key term:
• Paraplegia • Quadriplegia Review the following points about head and spinal cord injuries: • 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
• Multiple sclerosis (MS)
Review care guidelines for head or spinal cord injuries:
Review the following points about multiple sclerosis:
• Allow as much independence as possible with ADLs.
• Progressive disorder that affects the way impulses are transmitted to and from the brain
• Offer rest periods as necessary. • Perform ROM exercises as ordered.
• Cause: loss of myelin
TESTBANKSELLE R.COM • Give frequent skin care.
• Symptoms: numbness and tingling; muscle weakness; extreme fatigue; tremors; vertigo; reduced sensation; blurred or double vision; poor balance; difficulty walking; incontinence; paralysis
• Be gentle when turning and repositioning.
• 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. • Assist with ambulation to prevent falls.
• Provide privacy and be sensitive if involuntary erections occur.
• Encourage proper nutrition and fluid intake.
• Listen to the resident.
• Do not rush communication.
• Report red skin, pale skin, start of pressure injury or contracture, UTI symptoms, shortness of breath, constipation, dehydration, weight loss, or depression.
• Try to provide a stress-free environment. • Offer support and encouragement as symptoms change. • Report red skin, pale skin, start of pressure injury, start of contracture, UTI symptoms, or signs of depression.
• Protect residents from harm due to lack of sensation. • Check water temperature carefully.
Pronounce and define the following term: • Epilepsy
142 Review the following points about seizures:
Pronounce and define the following key term:
• Involuntary contractions of muscles
• Age-related macular degeneration (AMD)
• Causes: tumors, head injuries, injuries to the brain during birth, high fever, stroke, dementia, genetic factors, and alcohol and drug abuse
Review the following points about AMD: • Condition in which part of the retina degenerates
• Treatment: medication, surgery, rehabilitation
• Two forms are wet and dry AMD; the dry form is more common.
Pronounce and define the following terms:
• Risk factors: aging, smoking, sun exposure, heredity, gender, and race
• 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.
• Treatment: laser surgery, injections, zinc, antioxidants Review the care guidelines for vision impairment: • Encourage use of eyeglasses or contact lenses if worn.
Pronounce and define the following key term:
• Keep eyeglasses clean and safe.
• Cataract
• Change cases for contact lenses regularly.
Review the following points about cataracts:
• Always identify yourself as you enter the room.
• Develops when the lens of the eye becomes cloudy
• Keep doors completely open or closed. • Leave furniture in place.
• Causes: diabetes, eye injury, may be inherited or • Use the face of an imaginary clock to explain the result from normal aging position of objects in a room. • Symptoms: blurred vision, glare when driving at • Make sure there is enough lighting in every TESTBANKSErLooLmE.R.COM night, yellowing of vision • Treatment: surgery Pronounce and define the following key term: • Glaucoma Review the following points about glaucoma: • Leading cause of blindness in the U.S. • Cause: intraocular pressure increases, damaging the optic nerve
• Walk a little ahead of the resident as she holds your arm. • Walk at the resident’s pace. • Assist residents to complete menus. Set up meal trays as needed. • Use large-print books, audiobooks, and digital books. • Read to residents if they desire it.
• The majority of people have open-angle, or primary, glaucoma.
• Assist with vision screening.
• Symptoms of open-angle glaucoma: not always apparent, but over time, there is a decrease in vision, especially in the peripheral vision
Demonstration Demonstrate procedure Caring for eyeglasses. 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, as well as in the instructor’s guide as a supplementary handout.
• 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
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
143 • Most are made from plastic.
5. Discuss dementia and related terms
• Held in place by suction • Carefully follow care instructions.
Meeting the Learning Objective
• Do not use alcohol or abrasives to clean the eye.
TEXTbooK P. 409
• Act professionally during care.
WoRKbooK P. 115
• Keep eye covered completely in solution when stored.
Lecture Pronounce and define the following key terms:
Pronounce and define the following key terms:
• Cognition
• Otitis media
• Dementia
• Meniere’s disease
• Irreversible
• 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
Emphasize that dementia is not a normal part of aging. Review causes of dementia: • Alzheimer’s disease • Vascular dementia • Lewy body dementia
Review the following points about Meniere’s disease:
• Parkinson’s disease
• Cause: build-up of fluid in the inner ear caused by infections, allergies, or a genetic link • Symptoms: vertigo, hearing loss, tinnitus, and
• Huntington’s disease • Excessive alcohol or drug use
pain or pressure
• AIDS
TESTBANKSELLE •R H. eaCdOinMjuries
• Treatment: medications, salt restriction and other dietary changes, cognitive therapy, antibiotic or corticosteroid injections, and, in extreme cases, surgery
• Thyroid disorders • Nutritional deficiencies Explain that while some forms of dementia may be treated, many forms of dementia are irreversible.
Review the guidelines for hearing aids: • Be careful when handling a hearing aid. • Turn volume down before inserting. • Turn it off when not in use. • Replace batteries as needed.
6. Discuss Alzheimer’s disease and identify its stages Meeting the Learning Objective
• Do not submerge the hearing aid in water.
TEXTbooK PP. 409–411
• Remove hearing aid before bathing, showering, or shampooing hair.
WoRKbooK PP. 115–116
• Do not spray hair care products near the hearing aid. • Check for hearing aids before removing bed linen and meal trays. • Report any signs of sores or abrasions in the ear, as well as wax buildup. Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.
Lecture Pronounce and define the following key term: • Alzheimer’s disease (AD) Review the following points about Alzheimer’s disease: • AD is progressive and irreversible. • Occurs when tangled nerve fibers and protein deposits form in the brain
144 • Cause is unknown.
• Speak slowly and quietly.
• Older skills are usually kept longer.
• Repeat yourself as many times as needed.
Referring to the descriptions on page 410 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.
• Only talk about one subject at a time. • Use signs, pictures, gestures, or written words to communicate. • Break complex tasks into smaller, simpler ones. If resident is frightened or anxious:
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.
• Speak slowly. Speak in a quiet area with few distractions. • Try and see yourself as they might. • Use simple language and short sentences. • Check your body language.
Additional information about an experimental vaccine for Alzheimer’s disease is available at this link if you would like to share it with students:
If resident forgets or shows memory loss:
• https://www.usatoday.com/story/tech/ science/2018/11/24/alzheimers-vaccineaims-cut-dementia-half-may-see-human-trials/2097609002/
• Keep messages simple. Break complex tasks into smaller, simpler steps.
• Repeat yourself, using the same words. Do not try to stop a resident who is perseverating.
If resident has trouble finding words or names: • Suggest a word that sounds correct. Use touch if it is welcome.
7. List strategies for better communication f tL heLrEeR sid.eC ntOsM eems not to understand basic inwith residents with Alzheimer’s disT eaEsSeTBANKSIE structions or questions: Meeting the Learning Objective TEXTbooK PP. 411–413 WoRKbooK PP. 116–117
• Ask resident to repeat your statements. • Pay attention to communication methods that are useful. • Watch for nonverbal cues.
Lecture Pronounce and define the following key term: • Perseveration
• Use signs, pictures, gestures, or written messages. If the resident wants to say something but cannot:
Review the general guidelines for communication with residents with AD: • Always approach from the front, and do not startle the resident. • Smile and look happy to see the resident. Be friendly. • Determine how close the resident wants you to be. • Communicate in a calm area with little background noise and distraction. • Always identify yourself and greet resident by name. • Look at the resident while speaking to her.
• Encourage resident to point, gesture, or act it out. • Offer comfort or try to distract resident. 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.”
145 If the resident hallucinates, is paranoid, or accusing:
• Be empathetic.
• Do not take it personally.
• Work as a team.
• Try to redirect or ignore behavior. If the resident is depressed or lonely:
• Be aware of difficulties associated with caregiving.
• Take time to ask how the resident feels, and listen closely.
• Remember the goals of the care plan.
• Work with the symptoms and behaviors noted.
• Work with family members.
• Try to involve resident in activities. If the resident repeatedly asks to go home: • Ask the resident to tell you what home was like and how he felt being there. • Redirect the conversation to something the resident enjoys. • Expect that the resident may continue to ask to go home. If the resident is verbally abusive or uses bad language: • 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.
Meeting the Learning Objective TEXTbooK PP. 414–418 WoRKbooK P. 118
Lecture Pronounce and define the following key term: • Intervention Review guidelines for bathing:
• Schedule bathing when the resident is least agitated. Be organized. •R Pr.ep TESTBANKSELLE CaOreMthe resident before bathing.
Remember that even after verbal abilities are lost, • signs, labels, and gestures can reach people with dementia. •
9. Describe guidelines for problems with common activities of daily living (ADLs)
Assume that resident is aware of losses in abilities.
• Walk with resident down the hall, stopping at tub room. • Make sure bathroom is well-lit. • Provide privacy. • Be calm and quiet and keep the process simple. • Offer the resident a washcloth to hold.
8. Identify personal attitudes helpful in caring for residents with Alzheimer’s disease
• Ensure safety.
Meeting the Learning Objective TEXTbooK PP. 413–414
• Let the resident do as much as possible during the bath.
WoRKbooK PP. 117–118
• Observe the skin.
Lecture Pronounce and define the following key term: Burnout • 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: •
Do not take it personally.
• Do not try to force the resident to bathe. • Allow resident to enjoy the bath. Be encouraging and positive.
Review guidelines for grooming and dressing: • Assist with grooming to help resident feel attractive and dignified. • Avoid delays or interruptions. • Show the resident the clothing. • Provide privacy. • Encourage resident to pick out clothing. Lay out clothes in the order to be put on.
146 • Do not rush the resident.
• Watch for and report signs of pain.
• Praise and encourage resident often.
• Maintain a daily exercise routine.
Review guidelines for elimination: • Encourage fluids.
Review the guidelines for mental and emotional health:
• Mark the bathroom with a sign.
• Maintain self-esteem.
• Make sure there is enough light.
• Share in enjoyable activities.
• Check for episodes of incontinence.
• Reward positive and independent behavior with smiles and warm touches.
• Observe incontinence patterns. • Take the resident to the bathroom before meals and bedtime. • Put lids on trash cans or wastebaskets. • Follow the elimination schedule. • Support the family and friends.
10. Describe interventions for common difficult behaviors related to Alzheimer’s disease Meeting the Learning Objective
Review guidelines for nutrition:
TEXTbooK PP. 418–422
• Encourage nutritious foods.
WoRKbooK PP. 119–120
• Schedule meals at the same time each day with familiar foods. • Make sure there is proper lighting.
• Agitated
• Keep noise and distractions low.
• Trigger
• Keep task of eating simple. • Avoid steaming or hot foods.
Lecture Pronounce and define the following key terms:
TESTBANKSAEgLitaLtiEonR:.COM
• Use plain plates without patterns or colors. • Put only one item of food on a plate at a time. • Give simple, clear instructions. • Guide the resident through the meal. • Use assistive devices as needed. • Feed the resident slowly, using small pieces of food.
• 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, and reassure the resident Pronounce and define the following key term:
• Make mealtimes simple and relaxed.
• Catastrophic reaction
• Seat residents with others to encourage socializing.
Catastrophic reaction:
• Observe and report changes or problems in eating habits.
• Causes: fatigue; change of routine, environment, or caregiver; overstimulation; physical pain or discomfort
• Report changes in intake or output. Review the guidelines for physical health: • Prevent infections and follow Standard Precautions. • Help residents wash their hands. • Report potential problems. • Reduce the risk of falls. • Provide careful skin care.
• Interventions: respond as you would to agitation, remove triggers, and help the resident focus on soothing activity Pronounce and define the following key term: • Violence Violent behavior: • Causes: frustration, overstimulation, change in roommate, caregiver, or routine
147 • Interventions: notify the nurse, block blows but never hit back, remove triggers, remove others from the area, and do not try to restrain the resident
• Interventions: be patient, respond to questions with the same words each time, and do not try to silence or stop the resident
Pronounce and define the following key terms:
• Hoarding
• Hallucinations
• Rummaging
• Delusions Hallucinations or delusions: • Interventions: ignore the behavior, reassure the resident, do not argue with the resident, and redirect the resident to other activities Depression: • Causes: losing independence, facing incurable disease, feelings of failure, fear, chemical imbalance • Interventions: report to the nurse, medications may help, try to note triggers, encourage independence and self-care, foster social relationships, listen to the resident, offer comfort and concern, be as pleasant as possible, and report any comments about suicide immediately
Pronounce and define the following key terms:
Hoarding and rummaging: • Interventions: remember that behaviors are not within the resident’s control, label the resident’s belongings, remember hiding places, notify family and friends and enlist help, and create a drawer for rummaging Pronounce and define the following key term: • Sundowning Sundowning:
• Causes: hunger, fatigue, change in routine or caregiver • Interventions: provide adequate lighting; avoid stressful situations during this time; play soft music; discourage naps; set a bedtime routine; plan calming activities; serve the evening meal Pronounce and define the following key term: l ngCbOeM fore bedtime; eliminate caffeine; give TESTBANKSELLERo. • Disruptive behavior back rubs; redirect behavior; and maintain an exercise routine Disruptiveness: Suspicion • Causes: pain, constipation, frustration, wish for attention • Interventions: be calm and friendly, try to direct the resident to a quiet area, notice and praise improvements in the resident’s behavior, tell the resident about changes in schedule or routine, encourage the resident to join in independent activities, and help the resident find ways to cope
• Interventions: do not argue, offer calm reassurance, be understanding and supportive Pronounce and define the following key terms: • Pacing • Wandering • Elopes
Inappropriate sexual behavior:
Pacing and wandering:
• Causes: rash, tight clothing, the need to urinate
• Causes: restlessness, hunger, disorientation, the need to use the bathroom, constipation, pain, forgetting how or where to sit down, too much daytime napping
• Interventions: direct the resident to private area, distract the resident, report to the nurse, and consider appropriate ways to provide physical stimulation Inappropriate social behavior: • Interventions: do not take it personally, try to find out what caused the behavior, try to remove the resident from the area, and stay calm Perseveration or repetitive phrasing:
• Interventions: encourage exercise, minimize napping, let residents pace in safe area, redirect attention, and place stop signs on doors 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 422 together.
148 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. 422–423
• Remotivation therapy Describe each creative therapy and ask students to think of situations in which each one is appropriate.
13. Discuss mental health and mental health disorders Meeting the Learning Objective
WoRKbooK P. 120
TEXTbooK PP. 424–426
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.
WoRKbooK PP. 120–121
Lecture Pronounce and define the following key terms: • Mental health • Mental health disorder Discuss the ways that a mental health disorder affects a person’s daily life, including the ability to function in family, at home, at work, or in the community.
Review tips for meaningful activities: • Encourage family participation. • Limit some activities to small groups. • Use quiet areas. • Set short time frames for activities.
• Reminiscence therapy
e aCnO dMdefine the following key terms: TESTBANKSPEroLnLouEnRc.
• Plan events based on residents’ interests. • Plan activities for the time of day when residents are feeling best.
• Psychotherapy
• Cognitive behavioral therapy (CBT) • Panic disorder
• Encourage exercise.
Review the following points about panic disorder:
• Plan activities that allow residents to make things that can be utilized.
• Characterized by panic attacks
• Encourage specific skills. • Read or play music for residents who are immobile.
• Symptoms: rapid heartbeat, dizziness, chest pain, shortness of breath, an upset stomach; the person may think she is having a heart attack or is dying • Treatment: medication and psychotherapy
12. Describe therapies for residents with Alzheimer’s disease
• Social anxiety disorder
Meeting the Learning Objective
• Phobia
Pronounce and define the following key terms:
TEXTbooK PP. 423–424
Review the following about social anxiety disorder:
WoRKbooK P. 120
• Disorder in which a person has excessive anxiety about social situations and may feel judged or criticized by others
Lecture and Discussion Pronounce and define the following key terms:
• Symptoms: sweating, shaking, upset stomach
• Validation therapy
• Treatment: medication and psychotherapy
• Validating
149 Pronounce and define the following key term:
Review care guidelines for mental health disorders:
• Obsessive-compulsive disorder (OCD)
• Encourage self-care.
Review the following points about OCD:
• Encourage independence with ADLs.
• Characterized by intrusive repetitive thoughts or behaviors that cause anxiety or stress
• Observe for changes in behavior. • Watch your body language.
• Treatment: medication and psychotherapy
• Always treat adults like adults.
Pronounce and define the following key term: • Posttraumatic stress disorder (PTSD) Review the following points about PTSD: • May develop after a traumatic event, crime, disaster, domestic violence, or accident • Symptoms: flashbacks, withdrawal, sleep disturbances, avoidance of reminders of the event, negative thoughts, anger, and irritability • Treatment: medication and psychotherapy Review the following points about major depressive disorder: • Serious mental health disorder that makes it difficult for a person to function normally
• Do not yell or use a harsh tone of voice. • Use eye contact when communicating. • Provide support for the resident, and his 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; concerns that the resident is not properly taking a medication or is hiding medication; 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; and any comments about suicide, even jokes
• Symptoms: withdrawal, apathy, a lack of energy, pain, fatigue, apathy, weight lossT , sE leS epTpBrA obNleKmSsE , LLER.COM irritability, feelings of worthlessness, and sadness • A person who is depressed cannot simply choose to be well. • Treatment: medication and psychotherapy
14. Discuss substance abuse and list signs of substance abuse to report Meeting the Learning Objective
Pronounce and define the following key term:
TEXTbooK P. 426–428
• Bipolar disorder
WoRKbooK P. 121
Review the following points about bipolar disorder: • Causes a person to have mood swings, changes in energy levels and ability to function • Symptoms: high energy, little sleep, high selfesteem, poor judgment, and thoughts of suicide • Treatment: long-term medication Pronounce and define the following key terms: • Schizophrenia
Lecture Pronounce and define the following key terms: • Substance abuse Review some types of substances that are abused: • Alcohol • Tobacco • Legal and illegal drugs • Glue
Review the following points about schizophrenia:
• Paint
• Brain disorder that affects a person’s ability to think clearly
• Permanent markers
• Symptoms: hallucinations, delusions, disorganized thinking and speech, lack of interest in life and planning activities, poor hygiene, and problems with memory
Discuss points about opioid addiction: • Opioids are drugs used to relieve severe pain. • Opioids boost feelings of relaxation, happiness, and pleasure.
150 • Opioids can be legal or illegal.
Answers to Chapter Review in Textbook
• Positive feelings from opioids may create dependence, which can lead to addiction.
1.
The neuron
• Some people seek illegal drugs to alleviate pain when they are no longer able to obtain the prescribed drugs from physicians.
2.
The brain and spinal cord make up the central nervous system; the peripheral nervous system consists of the cranial and spinal nerves.
• When taking prescribed opioids, a person’s tolerance for the medication can increase, requiring higher doses, which can be fatal.
3.
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.
4.
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.
5.
The artificial eye can be permanently damaged by rubbing alcohol.
6.
Alzheimer’s disease
Review risk factors for substance abuse: • Family history of addiction • Having a mental health disorder • Unstable home environment • Poor coping skills • Taking a highly addictive drug 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
TESTBANKS7E. LLTE hiR s. heClpOsM keep the resident’s mind and body as active as possible.
• Constricted or dilated pupils • Slurred speech
8.
Offer another one
• Loss of appetite
9.
No
• Forgetfulness • Confusion
10. Report it immediately to the nurse.
• Blackouts or memory loss
11. B
• Hiding substances or alcohol • Stealing money or valuables
12. A
• Problems with other residents, friends, or family
13. D
• Comments about suicide
14. C 15. A
Chapter Review Exam
16. B 17. C
dIsTRIbuTE CHAPTER 22: 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.
18. C
151
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 KEY MATERIAL 23-1 THE ENDoCRINE sysTEM CHAPTER 23: EXAM
Assignments TEXTbooK READINg, PP. 430–438
Lecture Display Key Material 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 dents will learn about the structureTaEnS dT fuBnA c tN ioK nS ofELLER ta. rgC etOtiM ssues 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. 430 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. 430–432 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. 432 WoRKbooK P. 123
152 Lecture Review normal changes of aging: • Levels of estrogen and progesterone decrease, which signal the onset of menopause in women. • Testosterone levels in males usually decrease, but production does not stop. • Insulin production decreases. • Body is less able to handle stress.
Review the following points about type 1 diabetes: • Usually diagnosed in children and young adults • Cause: pancreas does not produce any insulin • Condition will continue throughout person’s life • Treatment: daily injections, special diet, monitoring blood glucose level Review the following points about type 2 diabetes: • Most common form of diabetes
4. Discuss common disorders of the endocrine system Meeting the Learning Objective TEXTbooK PP. 432–434 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:
Lecture Pronounce and define the following key terms:
• Excessive thirst
• Diabetes
• Excessive urination
• Hyperglycemia • Hypoglycemia • Prediabetes • Hypothyroidism
• Excessive hunger • High blood sugar levels • Glucose in the urine • Very dry skin
• Hyperthyroidism
• Fatigue • Blurred vision or visual changes
Review the following points about diabetes:
• Slow-healing sores, cuts, or bruises
• Condition in which the pancreas does not produce insulin or does not produce enough insulin
• Tingling or numbness in the hands or feet
• Risk factors: family history of the disease, advanced age, obesity
• Increased number of infections
• 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
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.
Review the following points about prediabetes: • Condition in which glucose levels are elevated, but not high enough to establish a diagnosis of diabetes • People with prediabetes may already have damage to the vital organs. • Change in diet can reduce weight and lower the risk of prediabetes or diabetes.
• Unexplained weight loss
Review the following points about hypothyroidism: • Condition in which the body lacks thyroid hormone • Autoimmune disorder • Causes: Hashimoto’s thyroiditis, surgical removal of the thyroid gland, radioactive iodine therapy, thyroiditis
153 • Symptoms: fatigue and weakness, weight gain, constipation, intolerance to cold, dry skin, thinning 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
• People with diabetes can work with a registered dietitian nutritionist (RDN) or a certified diabetes educator (CDE). • Keep track of residents’ tests. • Perform blood glucose tests only as directed and if trained. • Report if the resident is not following the 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
Students can use the online resources to locate more information. Discuss the risk obesity poses for certain diseases or disorders.
Meeting the Learning Objective
5. Describe care guidelines for diabetes
Lecture Review the guidelines for safe diabetic foot care:
Meeting the Learning Objective
• Inspect and clean the feet each day.
TEXTbooK PP. 436–438 WoRKbooK P. 124
TEXTbooK PP. 434–436
• Avoid harsh soaps and hot water.
WoRKbooK P. 124
• Always dry the feet carefully.
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.
• Never cut toenails, corns, or calluses. • Do not use objects to remove dirt from toenails. • Use doctor-recommended cream or lotion on feet, but not between the toes. • Check shoes for rocks or other objects.
Review care guidelines for diabetes:
• Remind resident not to go barefoot.
• Give frequent skin care.
• 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 on the feet; breaks or tears in the skin; drainage or bleeding on the feet or toes; corns, blisters, calluses, or warts; or ingrown toenails.
• Observe the skin 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. • Perform foot care carefully. • Encourage proper footwear. • Carefully follow diet instructions.
Demonstration Demonstrate procedure Providing foot care for a resident with diabetes. Include all of the numbered
154 steps in your demonstration. Have the students return the demonstration. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
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 quicTkE lyScT ellB s ANKSELLER.COM burn food for energy.
2.
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 production does not stop. Insulin production decreases. Body is less able to handle stress.
3.
Family history, advanced age, obesity
4.
C
5.
B
6.
A
7.
D
155
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 KEY MATERIAL 24-1 THE LYMPHATIC sysTEM HANDouT 24-1 MYTHs AbouT HIV AND AIDs CHAPTER 24: EXAM
2. Explain the structure and function of the immune and lymphatic systems Meeting the Learning Objective TEXTbooK PP. 440–441
Assignments WoRKbooK P. 125 TEXTbooK READINg, PP. 439–451 Lecture WoRKbooK EXERCIsEs, PP. 125–1T 28ESTBANKSELLER.COM Review the following points about the immune system: Overview of Teaching Strategies • Protects the body from harmful substances This chapter describes the immune and lymphatic systems and how they work together to protect the • Nonspecific immunity is present at birth and body from disease. Different types of immunity are protects the body from disease in general. described, as well as normal changes of aging for • Specific immunity is acquired by the body and these systems. There is detailed information about manufactures antibodies as a response to an HIV/AIDS, including activities that do and do not antigen in the body. spread HIV/AIDS. Infection prevention guidelines • With active immunity, vaccines cause the body to are described, with emphasis on the fact that if produce antibodies to protect against a particular Standard Precautions are consistently followed, disease. care for a resident with HIV/AIDS is no different • With passive immunity, a person is given the from care for any other resident. This chapter also antibodies needed to defend against the antigen. contains information about cancer, including risk factors, treatment, and care guidelines. Display Key Material
1. Define important words in this chapter Meeting the Learning Objective TEXTbooK P. 439 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
156 • Helps the immune system fight infection • 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
• 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.
3. Discuss changes in the immune and lymphatic systems due to aging
Distribute Handout
Meeting the Learning Objective
Review the activities on the handout that do not spread HIV. In addition, review the ways in the textbook that HIV is not spread:
TEXTbooK P. 441 WoRKbooK P. 125
24-1 MYTHs AbouT HIV AND AIDs
• Through air or water or food • By pets or insects, including mosquitoes
Lecture Review normal changes of aging:
• In saliva, tears, or sweat
• Immune system weakens, causing increased risk of all types of infections. • Antibody response slows. • T-cells decrease in number. • Response to vaccines decreases.
• Through casual contact, such as hugging, shaking hands, sharing dishes, or touching doorknobs or toilet seats • Through closed-mouth or casual kissing, such as mO eoMne’s cheek TESTBANKSEkLisLsiEngRs.oC
4. Describe a common disorder of the immune system
Review ways to protect against the spread of HIV/ AIDS: • Practicing Standard Precautions • Handling and disposing of sharps properly
Meeting the Learning Objective TEXTbooK PP. 441-444
• Covering cuts, sores, tears, breaks, or rashes before caring for residents
WoRKbooK PP. 125–126
• Never sharing needles or syringes
Lecture Pronounce and define the following key terms: • Acquired immunodeficiency syndrome (AIDS)
• Not having unprotected sex • Staying in a monogamous relationship • Practicing abstinence
• Human immunodeficiency virus (HIV)
• Getting tested for HIV and retested if necessary
Review the following points about HIV and AIDS:
• Following the pre-exposure prophylaxis (PrEP) approach
• HIV attacks the body’s immune system and damages or destroys cells. • Cause: HIV virus acquired through blood or body fluids from an infected person • AIDS is the final stage of HIV infection.
Review the signs and symptoms of HIV infections and AIDS: • Flu-like symptoms • Headaches • Blurred vision
Review the most common methods of transmission of HIV:
• Loss of appetite
• Unprotected or poorly protected anal sex with an infected person
• Weight loss
• Nausea and vomiting
157 • Night sweats • 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
5. Discuss infection prevention guidelines for a resident with HIV/AIDS Meeting the Learning Objective TEXTbooK P. 444 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.
• Dry skin
• Cover all broken skin with appropriate bandages before giving care.
• Memory loss
• Wear appropriate PPE.
Lecture Pronounce and define the following key term: • Opportunistic infection
• Wash hands and other areas of body immediately after contact with blood or body fluids.
• Handle and dispose of sharps carefully. • Re.m ndMresidents and visitors to wash their TESTBANKSELLER CiO Explain to students that people with weakened imhands often. mune systems due to HIV/AIDS may get diseases • Do not share residents’ personal items. that a healthy person would be able to fight off. • Properly disinfect surfaces. Emphasize that lack of treatment for HIV/AIDS increases the risk of serious complications and death from the disease. 6. Discuss care guidelines for a resident 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. • Examples: systemic lupus erythematosis and rheumatoid arthritis • Cause: unknown, but may be genetic links, microorganisms, or medications that act as triggers • Signs and symptoms: fever, fatigue, dizziness • 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.
with HIV/AIDS Meeting the Learning Objective TEXTbooK PP. 445-446 WoRKbooK PP. 126–127
Lecture Pronounce and define the following key term: • Homophobia Review the guidelines for HIV/AIDS: • Wash hands often and help resident wash hands. • Disinfect surfaces often. • Protect the resident from people having known contagious diseases. • Change linen whenever it is soiled. • Keep the skin clean and dry and observe for skin breakdown.
158 • 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. 446-448
• 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 mouth 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 injuries
• Unusual bleeding or discharge
• Bleeding from anywhere on the body
• Any thickening in breast, testicle, or other areas
• Blood in the stool
• Indigestion or 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 comments
• Nagging cough or hoarseness
• White patches inside the mouth or on the tongue
Pronounce and define the following key terms: • Biopsy • Remission
159 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
• Try cool or cold foods.
• Immunotherapy
• Cut foods into small pieces.
Explain that these treatments are often used in combination.
8. Discuss care guidelines for a resident with cancer Meeting the Learning Objective
• Use plastic utensils. • Weigh residents as ordered and report loss or gain. • Encourage fluids. • Monitor I&O and report changes. Review guidelines for bladder and bowel changes for residents with cancer:
TEXTbooK PP. 448-451
• Assist residents with elimination needs often.
WoRKbooK P. 128
• Give catheter care as needed.
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 the skin to prevent pressure injuries.
• 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.
• Change position every two hours or as directed.
Review guidelines for pain in residents with cancer:
• Follow special skin care orders exactly.
• Be alert for signs of pain and report immediately.
• Use special mattresses or pads in beds and chairs to reduce risk of pressure injuries. • Keep the skin clean and dry.
• Provide comfort measures, such as back rubs and repositioning. Play soft music, read, or talk quietly with residents.
• Apply lotion to dry skin.
• Notify nurse of side effects of pain medication.
• Do not use lotion on areas receiving radiation therapy.
• Report irritation around transdermal patches or resident having more than one patch on the body.
• Do not remove any markings used with radiation therapy. • Report signs of infection. Review mouth care guidelines for residents with cancer: • Give mouth care often. • Be gentle.
• Observe for redness, swelling, or warmth around the insertion site of PCA pump. • Report signs of breakthrough pain. Review vital signs guidelines for residents with cancer: • Monitor all vital signs, especially temperature.
• Use soft brushes or special swabs.
• Report changes in vital signs to nurse.
• Use mild mouth rinses to reduce bad taste from medication or vomiting.
Review guidelines for supporting self-image in residents with cancer:
160 • Help residents stay clean and well-groomed.
• Chest pain or tightness
• Offer wigs, scarves, or hats for hair loss.
• Shortness of breath
• Assist with application of makeup as requested.
• Anxiety, fear, or anger
Review guidelines for mental status and emotional needs of residents with cancer: • Be sensitive to residents’ wishes.
• Change in mental status or confusion • Signs of depression • Suicidal comments
• Listen if residents want to express feelings. • Spend as much time with residents as possible. • Encourage activities. • Do not use clichés.
Chapter Review Exam dIsTRIbuTE CHAPTER 24: EXAM
• Provide support during painful episodes and difficult times. • Remind residents that there can be good days ahead. • Observe and report signs of depression or comments about suicide.
(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.
Review symptoms to observe and report: • Pain or increased pain
Answers to Chapter Review in Textbook
• Changes in vital signs
1.
• Burns or skin irritation
2.
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.
3.
Benign tumors grow slowly and do not spread to other parts of the body. Malignant tumors grow rapidly and invade surrounding tissue.
• Flatus, diarrhea, or constipation
4.
D
• Blood in the stool
5.
C
• Appetite changes or weight loss
6.
A
• Any change in urine or blood in urine
7.
B
• Urinary tract infection
8.
D
Nonspecific immunity is present at birth and protects the body from disease in general. Spe• Signs of new bumps or lumps or changes in skin • Rashes, cracks, sores, breaks, or reddened areas cific immunity is a type of immunity acquired TESTBANKSELLbyEtRhe.bCoOdyM. on the skin • Bruising of the skin • Difficulty chewing or swallowing • 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
• Change in output
• Odors • Difficulty with ambulation • Increased fatigue or weakness • Fainting
161
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
dents. An equipment company could demonstrate assistive devices, or the school could order catalogs from such companies which could be used to make a collage picture of rehabilitation equipment.
KEY MATERIAL 25-1 REHAbILITATIoN AND REsToRATIVE CARE KEY MATERIAL 25-2 bENEFITs oF EXERCIsE KEY MATERIAL 25-3 body MoVEMENTs CHAPTER 25: EXAM
Assignments TEXTbooK READINg, PP. 452–466
1.
Define important words in this chapter Meeting the Learning Objective TEXTbooK PP. 452–453
TESTBANKSELLER .COM WoRKbooK P. 129
WoRKbooK EXERCIsEs, PP. 129–132
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 with the 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 practicing how to properly do these exercises. If the instructor can take the students to a rehabilitation center for a handson 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 stu-
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. 453-455 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 preexisting diseases or injuries
162 • Overall motivation of the resident • Type of facility where resident lives • Combined efforts of staff and others • Attitude of the rehabilitation team • Consistency in following the care plan
• Mrs. C must now wear an incontinence brief for permanent incontinence. • 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.
Review the goals of rehabilitation: • Maintain or regain abilities • Promote independence and help resident to adapt • Prevent complications of immobility
3. Describe the importance of promoting independence Meeting the Learning Objective TEXTbooK PP. 455–456
Display Key Material
WoRKbooK PP. 129–130
25-1 REHAbILITATIoN AND REsToRATIVE CARE Review the guidelines for rehabilitation and restorative care: • Understand the diagnosis, the disability, and any limitations the resident has. • Be patient and offer praise frequently.
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.
• Maintain a positive attitude.
Start a discussion about empathizing with residents who must accept help with ADLs. Ask stu• Listen as much as possible. dents how they might feel if confined to a wheel• Provide plenty of privacy. TESTBANKScEhaLirL, oErRif.thCeOy Mwere not able to lift a fork to their • Encourage independence. lips, or how it might feel to have another person • Encourage daily activity. dress them. • Accept setbacks and focus on what the resident can do. 4. Explain the complications of immobility 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.
and describe how exercise helps maintain health Meeting the Learning Objective TEXTbooK P. 456 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)
• Mr. M is a very proud retired Marine major who must learn to feed himself.
• Integumentary: pressure injuries and slow-healing wounds
• Mrs. G is a grandmother who must learn to use a leg brace to walk.
• Circulatory: blood clots, especially in the legs
• Mr. J is an athlete who must accept being confined to a wheelchair.
• Musculoskeletal: muscle atrophy and contractures
• Respiratory: pneumonia
163 • Nervous: depression or insomnia • Endocrine: weight gain
• Make sure the resident is wearing nonskid shoes with laces tied or straps fastened.
Display Key Material
• Have the resident use a cane on his stronger side. • Do not hang heavy items on the walker.
25-2 bENEFITs oF EXERCIsE Review the benefits of regular exercise and activity, organized by body system, found on the key material:
• Encourage proper posture. • Stay near the resident on the weaker side. • Do not rush the resident.
• Gastrointestinal: promotes appetite and aids regular elimination
• Move the resident to the bed or chair if he experiences pain.
• Urinary: improves elimination, helping to decrease infection
• Return the resident to the bed or chair when finished.
• 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
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, as well as in the instructor’s guide as a supplementary handout.
• Endocrine: increases metabolism, helping to maintain healthy weight
As discussed in the tip box on page 459, the following links discuss robotics further: TESTBANKSELLE •R ht. tpC s:O //M global.toyota/en/detail/15989382
5. Describe canes, walkers, and crutches Meeting the Learning Objective
• https://www.nbc-2.com/story/35134659/toyotashows-robotic-leg-brace-to-help-paralyzed-peoplewalk
TEXTbooK PP. 456-459 WoRKbooK P. 130
Lecture Discuss the following points: • Cane helps with balance but does not completely support weight. • Different types of canes are C cane, functional grip cane, and quad cane.
6. Discuss other assistive devices and orthotics Meeting the Learning Objective TEXTbooK PP. 459-460 WoRKbooK PP. 130–131
• Walkers help with stability and some weakness.
Lecture Pronounce and define the following key terms:
• Crutches are used when a person can bear limited weight or no weight.
• Assistive devices
Review the cane, walker, and crutches guidelines:
• Orthotic devices
• Check cane, walker, or crutches for damage before using. • Watch for and avoid unsafe environmental situations.
• Foot drop
Referring to Figure 25-6 (page 459 in textbook), review the items that help residents adapt to certain conditions.
164 7. Discuss range of motion exercises Meeting the Learning Objective TEXTbooK PP. 460-466 WoRKbooK PP. 131–132
through 25-26. Have the students return the demonstration by creating teams of two, one NA and one resident receiving each of the three types of ROMs. Procedure checklists are located at the end of the student workbook, as well as in the instructor’s guide as a supplementary handout.
Lecture Pronounce and define the following key terms:
Chapter Review
• Range of motion (ROM)
Exam
• Passive range of motion (PROM)
dIsTRIbuTE CHAPTER 25: EXAM
• Active range of motion (AROM)
(APPENDIX C)
• Active assisted range of motion (AAROM) • Hyperextension Display Key Material 25-3 body MoVEMENTs
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.
Define the following terms, pointing to each illustration on the key material:
Answers to Chapter Review in Textbook
• Abduction
1.
Answers include the following: maintain or regain abilities; promote independence and help resident to adapt; and prevent complications of immobility.
2.
Answers include the following: positive effects on self-image, attitude, and abilities, and may help speed recovery.
3.
Answers include the following: Gastrointestinal–constipation; Urinary–urinary tract infection (UTI); Integumentary–pressure injuries 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.
4.
Answers include the following: Gastrointestinal–promotes appetite and aids in regular elimination; Urinary–improves elimination, helping to decrease infection; Integumentary– improves the quality and health of the skin; Circulatory–improves circulation; Respira- tory– 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; and Endocrine– increases metabolism, helping to maintain healthy weight.
• Adduction • 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. • Keep the body in proper alignment. • Begin at the shoulders and work down. • Follow instructions for limiting ROM exercises. • Never push further than what is comfortable. • Provide holistic care while performing ROM exercises. Praise often. Demonstration Demonstrate procedure Assisting with passive range of motion exercises. Include all of the numbered steps in your demonstration. Refer to Figures 25-9
165 5.
B
6.
D
7.
D
8.
A
166
26 Subacute Care 1. Define important words in this chapter 2. Discuss the types of residents who are in a subacute setting 3. Describe preoperative and postoperative care 4. List care guidelines for pulse oximetry 5. Describe telemetry and list care guidelines 6. Explain artificial airways and list care guidelines 7. Discuss care for a resident with a tracheostomy 8. Describe mechanical ventilation and explain care guidelines 9. Describe suctioning and list signs of respiratory distress 10. Describe chest tubes and explain related care 11. Describe alternative feeding methods and related care 12. Discuss care guidelines for dialysis Supplemental Tools KEY MATERIAL 26-1 TubE FEEDINgs HANDouT 26-1 gAsTRosToMIEs
1. Define important words in this chapter
TESTBANKSMEeLetLinEgRth.eCLO eaMrning Objective
CHAPTER 26: EXAM
TEXTbooK P. 467 WoRKbooK P. 133
Assignments TEXTbooK READINg, PP. 467–481 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. 468 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 who have had recent surgery and chronic illnesses, such as AIDS and cancer
167 • Residents with serious burns, who need special administration of nutrients or medicine, or who need dialysis
3. Describe preoperative and postoperative care
Here is a link to a preopreative/surgical checklist from WHO if you would like to share more information with students: https://apps.who.int/iris/ bitstream/handle/10665/44186/9789241598590_ eng_Checklist.pdf
4. List care guidelines for pulse oximetry
Meeting the Learning Objective Meeting the Learning Objective
TEXTbooK PP. 468–469
TEXTbooK PP. 469–470
WoRKbooK P. 133
WoRKbooK P. 134
Lecture Discuss the following guidelines for preoperative and postoperative care:
Lecture Pronounce and define the following key term:
• Follow orders for fluid restrictions.
• Pulse oximeter
• Be calm and compassionate and listen to the resident.
Review the following points about the pulse oximeter:
• Store personal items like eyeglasses, contact lenses, hearing aids, and dentures as directed.
• Warns of low blood oxygen level before signs develop
• Provide catheter care as needed.
• Normal pulse oximeter reading is between 95% and 100%, but it can differ.
• Measure vital signs and monitor the pulse oximeter as directed. • Assist with an incentive spirometer as needed.
• Report any change in oxygen levels to the nurse.
TESTBANKSELLE DR isc.uC ssOtM he following guidelines for pulse
• Apply a sequential compression device as ordered. • Encourage the resident to follow special diet orders.
Here is additional material about anesthesia to review with students: Anesthesia causes a reduction or elimination of pain and a loss of feeling or sensation in the area it is delivered or throughout the body. The delivery of anesthesia may be by an anesthesiologist (MD), or a Certified Registered Nurse Anesthetist (CRNA). Some types of anesthesia are: • Local: injection into a limited area for a procedure • Regional: injection that eliminates sensation in a particular area; includes epidural block • General: intravenous or inhaled; creates unconsciousness and no pain sensations or feelings throughout the entire body
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 difficulty breathing. • Report pale, cyanotic, darkening, or grayish skin or mucous membranes. • Report signs of skin breakdown from the device. • Check vital signs as ordered, and report changes to the nurse. 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, as well as in the instructor’s guide as a supplementary handout.
168 5. 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 or darkening skin or mucous membranes; change in vital signs; drainage; secretions in tubing; or nervousness or anxiety.
TEXTbooK PP. 470–471 WoRKbooK P. 134
Lecture Pronounce and define the following key term:
• Do not move or remove spare artificial airway tubes or other equipment from the bedside.
• Telemetry Discuss the following guidelines for telemetry: • Report to nurse if alarm sounds. • Monitor vital signs as ordered.
7. Discuss care for a resident with a tracheostomy Meeting the Learning Objective
• Report if electrodes become loose.
TEXTbooK PP. 472–473
• Do not get the unit, wires, or electrodes wet during bathing.
WoRKbooK P. 134
• Check for signs of skin irritation under or around pads.
Lecture Discuss why tracheostomies are necessary:
6. Explain artificial airways and list care guidelines
• Facial burns
Meeting the Learning Objective
• To prevent aspiration in an unconscious person
• Obstruction • Remind the resident not to leave the monitoring • Cancer area. • Report change in vital signs, rapid pulse, chest • Infection • Severe injuries pain or discomfort, shortness of breath or dyspnea, sweating, or dizziness to the nurT seE . STBANKSELLER.COM • Serious allergic reaction • Coma
TEXTbooK PP. 471–472 WoRKbooK P. 134
Lecture Pronounce and define the following key term: • Intubation
• Gunshot wounds
Remind nursing assistants to use alternate methods of communication if the resident cannot speak and to answer call lights promptly. Emphasize that even if tracheostomy care isn’t an NA duty, careful observation and reporting is necessary. Discuss the following guidelines for tracheostomies:
Discuss the following guidelines for artificial airways:
• Answer call lights promptly.
• Tell nurse if tubing comes out.
• Use alternate methods of communication.
• Follow orders for positioning.
• Follow orders for positioning.
• Check vital signs as ordered.
• Do not tire resident.
• Perform mouth care often, at least every two hours.
• Check vital signs as ordered.
• Report biting or tugging on the tube.
• Keep the dressing dry, and do not cover the tracheostomy opening.
• Use other methods of communication if the resident cannot speak.
• Inspect ties or tape often.
• Report kinks or disconnected tubing.
169 • Perform mouth care often, at least every two hours.
• Being on a ventilator has been compared to breathing through a straw.
• Observe for mouth sores, cracks, breaks or sores on skin.
• Be supportive. Enter the room so the resident can see you often.
• Provide careful skin care.
• Use other methods of communication.
• Observe for pale, bluish, or darkening skin or mucous membranes.
• Act and speak as if resident can understand everything, even if he or she is unconscious or heavily sedated.
• Do not move spare tracheostomy tubes or bag valve mask. • Report disconnected tubing; signs of respiratory distress, including wheezing or other unusual breathing sounds or difficulty breathing; cyanosis 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.
• 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). Discuss the following guidelines: • Wash hands thoroughly. • Answer call lights promptly. • Tell nurse right away if alarm sounds. • Report kinks or disconnected tubing right away.
8. Describe mechanical ventilation and explain care guidelines
• Report biting or pulling on the tube.
• Give mouth care often. Report mouth sores or discomfort. Meeting the Learning Objective • Reposition at least every two hours. Follow posiTEXTbooK PP. 473–475 tioning orders. TESTBANKSELLE R WoRKbooK P. 135 • G. iveCrOeM gular skin care to prevent pressure injuries. Lecture • Allow time for rest. Pronounce and define the following key terms: • Follow orders for ROM exercises. • Sedation • Be patient during communication. • Delirium • Provide emotional support. Review the following points about delirium • Do not move spare artificial airway tubes or bag • Causes: dehydration, malnutrition, fever, pain, poisons, alcohol and drug use, prescribed medication, hypoxia, head injury, illness, infections • Symptoms: disorganized thinking; inability to concentrate; problems with speech, agitation, anger, or irritability; drowsiness or sleep disturbances; decrease in short-term memory; lack of attention span; disorientation; changes in consciousness; decrease in ability to move; pulling out tubing; hallucinations • Treatment: medication, emergency care, hospital stay Make the following points about mechanical ventilators: • Resident will not be able to speak, which can greatly increase anxiety.
valve masks. • Report the alarm sounding; tubing moves or disconnects; signs of respiratory distress; secretions in tubing; mouth sores or discomfort, cracks, breaks, or sores on the skin; swollen or red area of an extremity; change in vital signs; nervousness or anxiety; or depression. Case Study Mrs. G is on a mechanical ventilator. She is sedated, but she is conscious. She bites on her tube sometimes and looks anxious when the NA enters the room. • What can the NA do to reassure Mrs. G? • What care can the NA give to help increase Mrs. G’s comfort?
170 Lecture Pronounce and define the following key term:
• Monitor vital signs closely.
• Sepsis
• Observe for pale, bluish, or darkening skin or mucous membranes.
Review the signs of sepsis: • Elevated heart rate and respiratory rate • Slightly elevated temperature or low temperature • Chills • Excessive sweating • Feeling of sickness or weakness • Low blood pressure • Decreased urine output • Headache • Skin rash • Shortness of breath • Confusion or change in mental status Emphasize that NAs should be familiar with residents’ normal vital signs in order to better recognize changes.
• Report signs of respiratory distress immediately.
• Answer call lights promptly. • Follow orders for positioning. • Place pad or towel under chin before suctioning. • Give oral and nasal care after suctioning. • Give emotional support during difficult periods. • Report signs of respiratory distress, including wheezing or other unusual breathing sounds or difficulty breathing; cyanosis or darkening skin or mucous membranes; change in vital signs, especially respiratory rate; change in the color, amount, or quality (thickness/thinness) of secretions coughed up; or nervousness or anxiety. Here is a link to more information about suctioning: https://www.apria.com/wp-content/ uploads/2014/10/RES-2005-Oral-and-TrachealSuction.pdf
9. Describe suctioning and list signs of 10. Describe chest tubes and explain related respiratory distress TESTBANKScEaL reLER.COM Meeting the Learning Objective
Meeting the Learning Objective
TEXTbooK PP. 475–476
TEXTbooK PP. 476–477
WoRKbooK P. 135
WoRKbooK PP. 135–136
Lecture Review the following points about suctioning:
Lecture Pronounce and define the following key term:
• Necessary when a person has increased secretions that he cannot expel
• Chest tubes
• Suctioning can be performed orally, nasally, and through the trachea and bronchi.
Review the following points about chest tubes: • Can be inserted at bedside or during surgery
• Nursing assistants do not perform suctioning.
• Drain air, blood, pus, or fluid
• Suction comes from wall or pump, and bottle collects suctioned material.
• Allow a full expansion of the lungs
• Sterile water or sterile saline is used to rinse suction catheter.
• Conditions requiring chest tubes include pneumothorax, hemothorax, empyema, surgery, injuries
• Signs of respiratory distress are gurgling, high respiratory rate, shortness of breath, dyspnea, pallor, or cyanosis.
• Chest tube is connected to bottle of sterile water.
Discuss the following guidelines for assisting with suctioning:
Discuss the following guidelines for chest tubes:
• Follow Standard Precautions.
• System must be airtight when attached to suction. • Report signs of respiratory distress and pain.
171 • 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.
Display Key Material 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 • Report disconnected tubing; any signs of respiraabdomen; any signs of respiratory distress; feedtory distress and cyanosis; changes in vital signs; ing pump alarm sounds; signs of aspiration; tube change in oxygen level or if pulse oximetry alarm feeding liquid gathering in the mouth; cyanosounds; complaints of pain; coughing up blood; sis or darkening skin or mucous membranes; warmth, redness, swelling, sores, or pus; an kinked, plugged, cracked, or broken tubing; leakincrease or decrease in bubbling in the drainage ing or empty bag or container; resident pulling system; kinks or clots in the tubing; any change on the tube; or signs of infection at the tube site, in the amount, color, consistencyT , oErSoT doBrA ofNKSELLER CO su.ch asMwarm skin, reddened skin, sores, swellchest drainage; wet or loose dressings; or signs ing, or pus. of subcutaneous emphysema (crepitus), such as Pronounce and define the following key terms: bulging of the skin or skin that produces a crackling sound. • Total parenteral nutrition • Central venous line
11. Describe alternative feeding methods and related care
Review what to observe regarding TPN:
Meeting the Learning Objective
• Headache
• Fever
TEXTbooK PP. 478–479
• Swelling
WoRKbooK P. 136
• Redness • Bleeding
Lecture Pronounce and define the following key terms: • Nasogastric tube • PEG tube • Gastrostomy Discuss the types of tube feedings and emphasize that the NA’s role is assisting the nurse and positioning the resident. Careful observation for problems and changes is important.
• Leaking at insertion site • Signs of fluctuation in blood sugar • Making sure there is no interruption of TPN delivery • Making sure the infusion area does not get wet Distribute Handout 26-1 gAsTRosToMIEs Distribute this handout and discuss the information with students.
172 12. Discuss care guidelines for dialysis Meeting the Learning Objective TEXTbooK PP. 479–480
2.
Artificial airways help maintain an airway and facilitate ventilation.
3.
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.
4.
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.
5.
Answers include the following: changes in amount, color, or consistency of chest drainage.
6.
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 vomiting; muscle cramps; swelling of extremities (edema); change in intake and output; or itchy skin.
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.
• 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; TESTBANKSELLER.COM pain, drainage, redness, swelling, or bleeding 7. D from the insertion site; abdominal cramps, nau8. D sea, or vomiting; muscle cramps; swelling of extremities (edema); change in intake and output; 9. B or itchy skin. 10. C
Chapter Review Exam dIsTRIbuTE CHAPTER 26: 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: recent surgery or acute conditions, chronic illnesses, serious burns, the need for special administration of nutrients or medicine, or dialysis.
11. A
173
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-
SbTERBW AHNEKNSELLE seR nt.atC ivO eM from the local hospice organization to KEY MATERIAL 27-1 RIgHTs To RET ME EM CARINg FoR THE TERMINALLY ILL KEY MATERIAL 27-2 sIgNs oF APPRoACHINg dEATH HANDouT 27-1 THE DYINg PERsoN’s bILL oF RIgHTs CHAPTER 27: EXAM
Assignments TEXTbooK READINg, PP. 482–493 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 486 of the textbook, helps illustrate this. Most students will struggle 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. 482 WoRKbooK P. 137
Lecture Pronounce and define each of the key terms listed in the Learning Objective.
174 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 PP. 482–483 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. 484–485
• Control symptoms
WoRKbooK PP. 137–138
• Reduce suffering
Lecture Pronounce and define the following key term:
• Prevent side effects • Maintain quality of life • Emphasize holistic, person-centered approach Emphasize that palliative care works to manage symptoms, not cure the disease.
Discuss Dr. Kubler-Ross’s five stages of grief (On Death and Dying): • Denial: refusal to believe they are dying • Anger: “Why me?”
3. Discuss hospice care Meeting the Learning Objective TEXTbooK PP. 473–474
• Grief
• 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:
• Grief counseling
• Ordered by a doctor for a person who has six months or less to live • Can be given in a hospital, care facility, or in the home • Uses a holistic, person-centered approach
• Grief process • Mourning
5. Explain legal rights for a resident who is dying
• Focuses on resident and family as a unit • Offers medically-directed, team-managed care
Meeting the Learning Objective
• Offers compassionate care
TEXTbooK PP. 485–486
• Focuses on soothing and comfort care, rather than curative care
WoRKbooK P. 138
• Emphasizes pain and symptom management • Provides alternative to traditional care • Helps family obtain financial counseling and legal assistance • Offers assistance for psychosocial needs
Display Key Material 27-1 RIgHTs To REMEMbER WHEN CARINg FoR THE TERMINALLY ILL
175 Discuss the rights listed on the key material. 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
1.
Meeting the Learning Objective
2.
3.
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. 486–487 WoRKbooK P. 139
Lecture Review the following guidelines for care of a dying resident: Room Environment • Make sure room is adequately ventilated. • Keep personal objects within reach. • Remove scented items if requested. Do not wear scented products. Skin, Nose, and Mouth Care • Give frequent skin care. • Bathe often. • Change gowns and sheets often. • Give incontinence care promptly. • Turn and reposition often.
TESTBANKSELLE OM •R G. iveCm outh care frequently.
4.
5.
The right to honest and accurate information • Residents have the right to honest information about their diagnosis and care as the situation evolves. Refer medical questions that are outside your scope of practice to the nurse. The right to refuse treatment • Have you ever cared for someone who did not want more treatment? How did you feel? • We need to remember that whether we agree or disagree with the decisions, the choice is not ours, but belongs to the person involved. Sometimes, when residents are not capable of making a decision, they have told their family how they wish for things to be done. Be supportive of family members; do not judge them. They are probably following the person’s wishes.
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.
• Offer ice chips. • Use lubricant on nose and mouth. Breathing Problems • Report gurgling or rattling. • Elevate the head of the bed and change positions as ordered. Food and Fluid Issues • Do not force residents to eat or drink. • Feed residents slowly. • Encourage fluids. • Report nausea, vomiting, and diarrhea. • Elevate head of bed. Pain Control and Comfort • Pain relief is critical. • Observe and report signs of pain. • Adjust blankets for temperature changes.
176 8. Identify common signs of approaching death
Diminished Senses • Keep room softly lit. • Use alternate forms of communication. • Speak normally and describe care that is being performed.
Meeting the Learning Objective TEXTbooK P. 489 WoRKbooK P. 140
7. Discuss factors that influence feelings about death and list ways to meet residents’ individual needs
Display Key Material 27-2 sIgNs oF APPRoACHINg dEATH Review the following signs of approaching death:
Meeting the Learning Objective TEXTbooK PP. 488–489
• Cyanotic, pale, or darkening skin or mucous membranes
WoRKbooK P. 139
• Cold skin
Lecture and Discussion Pronounce and define the following key term:
• Skin that looks bruised (mottling) • Heavy perspiration
• Cremation
• Fever
Discuss the factors that influence feelings and attitudes about death:
• Increased pulse
• Low blood pressure
• Experience with death • Personality type • Religious beliefs • Cultural background
• Cheyne-Stokes breathing • Gurgling and rattling sound when breathing • Difficulty swallowing
TESTBANKS•EDLeLcrEeaRs. edCaO pM petite and sense of thirst • Dry mouth
Ask students to share some of their own experiences and backgrounds.
• Nausea, vomiting, and diarrhea
Remind students that it is important to honor individual practices and traditions without judging them.
• Loss of feeling, beginning in the legs and feet
Review the following guidelines for psychosocial and spiritual needs for dying residents:
• Fallen jaw, causing the mouth to stay open
• Listen more; talk less. • Provide privacy for visits. • Notify the nurse if the resident requests a visit from a spiritual leader.
• Decreased sense of touch • Extreme weakness and exhaustion • Loss of muscle tone • Inability to speak • Loss of vision • Dilated pupils and staring eyes • Urinary and fecal incontinence
• Do not discuss personal religious or spiritual beliefs or lack of beliefs or try to change or influence the resident’s beliefs.
• Decreased urinary output
• Do not judge anything you hear.
• Disorientation or confusion
• Never share anything private with others, except for the nurse.
• Loss of hearing
• Do not isolate or avoid the resident. • Inform the nurse if resident has expressed fear of dying. Do not respond with clichés or give reassurance using your religious or spiritual beliefs.
• Hallucinations • Extreme drowsiness
177 9. List changes that may occur in the human body after death Meeting the Learning Objective TEXTbooK P. 489
Make sure students understand that family and friends should be allowed to express their feelings. They should be treated with respect and compassion. Review guidelines for NAs to follow to help families and friends:
WoRKbooK P. 140
• Allow the family to show their feelings. Lecture Review the following points about the body after death: • No pulse, respiration, or blood pressure • Eyelids partially open
• 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.
• Fixed and dilated pupils • Jaw drops
11. Describe ways to help staff members cope with a resident’s death
• Urinary and fecal incontinence Pronounce and define the following key term:
Meeting the Learning Objective
• Rigor mortis
TEXTbooK PP. 490–491
Review the terms to describe the body after death.
WoRKbooK PP. 140–141
10. Describe ways to help family and friends deal with a resident’s death Meeting the Learning Objective
Lecture Discuss your facility’s policy on grief counseling if it R is.avCaO ilaMble. Emphasize that NAs have a right to TESTBANKSELLE their feelings when someone dies.
TEXTbooK P. 490 WoRKbooK P. 140
Lecture Discuss some of the feelings family and friends may experience after a loved one dies: • Feeling numb or being in shock • Disbelief or denial of the death • Intense sadness and crying • Anxiety or fear • Anger • Physical reactions or symptoms, such as pain, especially chest pain, nausea, or difficulty breathing • Feelings of guilt, especially if there were any unresolved problems or issues with the relationship • Feelings of relief Remind students that complaints from family and friends should be referred to the nurse.
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 • Spending quality time with people they love • Sharing memories • Joining a support group • Talking to a counselor
12. Describe postmortem care Meeting the Learning Objective TEXTbooK P. 491 WoRKbooK P. 141
178 Lecture Pronounce and define the following key terms:
to be free from pain. The right to honest and accurate information. The right to refuse treatment.
• Postmortem care • Autopsy
4.
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.
5.
Inform the nurse
6.
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.
7.
Bereavement therapy is a way to identify feelings to help with grieving.
8.
After death
9.
C
Answers include the following: • Cyanotic, pale, or darkening skin or mucous • Pathologist membranes Remind students to be aware of religious or cul• Cold skin tural practices that the family wants to observe. • Skin that looks bruised (mottling) • Heavy perspiration Demonstration • Fever Demonstrate procedure Postmortem care. Include • Low blood pressure all the numbered steps in your demonstration. • Increased pulse • Cheyne-Stokes breathing Have the students return the demonstration. • Gurgling and rattling sound when breathing Procedure checklists are located at the end of the • Difficulty swallowing student workbook, as well as in the instructor’s • Decreased appetite and sense of thirst guide as a supplementary handout. • Dry mouth • Nausea, vomiting, and diarrhea Discussion • Decreased sense of touch Discuss the fact that facilities may have special • Loss of feeling, beginning in the legs and policies on postmortem care. Ask the students to feet talk about their feelings regarding this care. Do • Extreme weakness and exhaustion they think they would have a problem touching a • Loss of muscle tone dead body? How can they show respect to families • Fallen jaw, causing the mouth to stay open after a loved one has died? • Inability to speak TESTBANKSELL• ELoRs.s C ofOvM ision • Dilated pupils and staring eyes Chapter Review • Urinary and fecal incontinence • Decreased urinary output Exam • Hallucinations dIsTRIbuTE CHAPTER 27: EXAM • Extreme drowsiness (APPENDIX C) • Disorientation or confusion • Loss of hearing Allow students enough time to finish the test. See
Answers to Chapter Review in Textbook 1.
2.
3.
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
10. A 11. D
179
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
grams are available on DVD or for streaming and would be very effective as a classroom experience. HANDouT 28-1 Job APPLICATIoN Gu peMakers could speak to the class about wellTESTBANKSELLE Re.stCsO CHAPTER 28: EXAM ness and healthy lifestyles, adding an interesting outside resource to the chapter. Assignments If the instructor is affiliated with a facility, it would TEXTbooK READINg, PP. 494–503 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 this chapter I go from here?” Meeting the Learning Objective The instructor should encourage the students to TEXTbooK P. 494 think about how they see themselves in their new WoRKbooK P. 143 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 proin the Learning Objective.
180 2. Describe how to write a résumé and cover letter
• Name, address, and telephone number 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. 494–495 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. 496 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. 495–496
• 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 email 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
181 • 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. 496–497 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. 497–498 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. 498–499
• Make eye contact.
WoRKbooK PP. 144–145
• Answer questions clearly and completely. • Do not exaggerate your accomplishments.
Lecture Present your state’s requirements for NAs’ maintaining their certification.
• Emphasize what you think you will enjoy about your work.
Review these general guidelines:
• Relax and be confident.
• Specific time frame to take the state test
• Do not use slang or curse words.
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 thankyou email or letter.
• Test must be taken within that time frame 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
182 • 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. 500–501
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. 499
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.
efiRn.eCsO trM ess and explain ways to TESTBANKS1E1L. D LE 9. Describe employee evaluations and discuss feedback Meeting the Learning Objective TEXTbooK PP. 499–500 WoRKbooK P. 145
manage stress
Meeting the Learning Objective TEXTbooK PP. 501–502 WoRKbooK P. 146
Lecture and Discussion Pronounce and define the following key terms:
Lecture Pronounce and define the following key term:
• 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
183 • Having trouble focusing on residents and procedures
Answers to Chapter Review in Textbook 1.
Answers include: objective, education, experience, volunteer work, skills, and references
2.
One page
3.
Answers will vary, but may include something about keeping residents safe.
4.
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 502 on goal-setting. Ask students for examples of long- and short-term goals that they have set for themselves.
5.
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
6.
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.
7.
Think about possible reasons why someone is behaving in an undesirable way.
8.
Stress is a mentally or emotionally disruptive or upsetting condition that occurs due to changes in the environment.
9.
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 PP. 502–503 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
186
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.
Key Material 1-1
187
Residents in LTC facilities
• • • • •
83.5% are over 65 68% are female More than 75% are white and non-Hispanic About 1/3 come from a private residence Over 50% come from a hospital
(From cdc.gov/nchs)
Key Material 1-2
188
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 Coordinator: manages the assessment of them to perform ADLs 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
Key Material 1-3
189
Nursing Assistant Code of Ethics
1. I will strive to provide and maintain the highest quality of care for all 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 all residents, their family members, staff, and other visitors. 4. I will always provide privacy for all 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 all 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 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.
Key Material 2-1
190
Communication Process
Key Material 3-1
191
Body Language
Key Material 3-2
192
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
Key Material 3-3
193
24-Hour Clock
1200
PM
2300
1300
12 11 1100
2200
10
2100
1
9
1000
0000 or 2400
0100
1400 0200
AM
0900
2
3
0300
0800
1500
0400
8
4 0700
2000
0500
1600
0600
7
5 6
1900
1700 1800
Key Material 3-4
194
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
3
ALERTS
DRESSING
8
VISION
❑ Independent ❑ Assist of 1 ❑ Assist of 2 ❑ Day clothes ❑ Pajamas/sleepwear ❑ Adaptive equipment
❑ Code status ❑ Allergies ❑ Adequate ❑ Impaired ❑ Wears glasses ❑ Wears contacts ❑ Blind
❑ A.M. ❑ P.M. ❑ Shower ❑ Bathtub ❑ Whirlpool ❑ Bed Bath ❑ Independent ❑ Supervision ❑ Assist of 1 ❑ Assist of 2 BED MOBILITY
❑ Independent ❑ Assist of 1 ❑ Assist of 2 ❑ Turn q ❑ Trapeze bar ❑ Adaptive equipmnent
7
13 14 15 16 17 18
❑ 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)
19
❑ Incontinent check and change
26
q ❑ Ostomy care ❑ Adaptive equipment
RESTRAINTS
6
11
TOILET USE Days: ❑ Mon. ❑ Tues. ❑ Wed. ❑ Thurs. ❑ Fri. ❑ Sat. ❑ Sun
5
12
Location of dining: ❑ Breakfast ❑ Lunch ❑ Dinner
BATHING
4
10
❑ Independent ❑ Supervision (cueing) ❑ Set up ❑ Restorative feeding ❑ Dependent on staff ❑ Feed tube
AMBULATION
Nights
9
EATING
❑ Independent ❑ Assist of 1 ❑ Assist of 2 ❑ Wheeled walker ❑ Walker ❑ Wheelchair ❑ Adaptive equipment ❑ Other (specify)
INITIALS
Month/Year Days Evenings
20 21 22 23 24 25
27 28
RESTORATIVE
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)
Key Material 3-5
195
Sample Kardex (cont’d)
PLAN OF CARE KARDEX DIET: % Consumed 4 = 100% 3 = 75% 2 = 50% 1 = 25%
Month/Year
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1
2
3
4
5
6
7
8
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 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)
Key Material 3-5
196
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
Key Material 3-6
197
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
Key Material 5-1
Shelter, protection, and stability Oxygen, water, food, elimination, and rest
198
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.
Key Material 5-2
199
The Chain of Infection
Key Material 6-1
200
Portals of Exit
Key Material 6-2
201
Portals of Entry
Key Material 6-3
202
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.
Key Material 6-4
203
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.
Key Material 6-5
204
Contact Precautions
Contact Precautions are used when a person may spread an infection by direct contact with another person or object. ApNlKeSoEf LaLcE Rt.aCctOdMisease. Clostridioides difficile (C. diff ) is T anESexTaBm 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 most likely be placed in a private room.
Key Material 6-6
205
Body Alignment
Key Material 7-1
206
Lifting Heavy Objects from the Floor
Back muscles must lift the object and half of the body
Legs and thighs do the lifting
Key Material 7-2
207
Body Positions for Exams
DORSAL RECUMBENT
LITHOTOMY
KNEE-CHEST
Key Material 9-1
208
Five Basic Positions
SUPINE
LATERAL
PRONE
FOWLER’S
SIMS’
Key Material 11-1
209
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.
Key Material 12-1
210
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 the floor in the shower or tub room is dry. Place nonslip mats in regular tubs. Make sure handrails and grab 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.
Key Material 12-2
211
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
Key Material 12-3
212
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 36.4°–37.6° 37.0°–38.1° 35.9°–37.0° 35.9°–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 90–119 mm Hg and Diastolic 60–79 mm Hg
Low
Below 90 mm Hg or Below 60 mmTH gTBANKSELLER.COM ES
Elevated
Systolic 120–129 mm Hg and Diastolic less than 80 mm Hg
Stage 1 hypertension
Systolic 130–139 mm Hg or Diastolic 80–89 mm Hg
Stage 2 hypertension
Systolic 140 mm Hg or higher or Diastolic 90 mm Hg or higher
Hypertensive crisis
Systolic 180 mm Hg or higher and/or Diastolic 120 mm Hg or higher
Key Material 13-1
213
MyPlate
TESTBANKSELLER.COM
Key Material 14-1
214
Preventing Aspiration
• • • • • • •
Position the resident in a straight, upright position at a 90-degree angle. Feed the resident slowly. Avoid distractions. Offer small pieces of food or small spoonfuls of pureed food. Offer food, then a liquid. Repeat this. Place food in the nonparalyzed side of the mouth. Make sure food is actually swallowed after each bite before offering more food or fluids. • Keep the resident sitting upright for at least 30 minutes after eating and drinking. • Provide mouth care after eating. • Observe residents who choke easily closely. Report signs of aspiration immediately.
Key Material 14-2
215
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
Key Material 14-3
216
The Gastrointestinal System
Key Material 15-1
217
Factors Affecting Bowel Elimination
• • • • • • •
Growth and development Psychological factors Diet Fluid intake Physical activity and exercise Personal habits Medications
Key Material 15-2
218
The Urinary System
Female Urinary System
Male Urinary System
Key Material 16-1
219
Factors Affecting Urination
• • • • • • •
Growth and development Psychological factors Fluid intake Physical activity and exercise Personal habits Medications Disorders
Key Material 16-2
220
The Reproductive System
Female Reproductive System
Male Reproductive System
Key Material 17-1
221
The Integumentary System
Sebaceous gland
Key Material 18-1
222
Pressure Injury 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
Key Material 18-2
223
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 • Differences in temperature of the skin when compared to the area around it • Rashes or any skin discoloration • Tingling, warmth, or burning of skin • Itching or scratching • Swelling of the skin • Wet skin • Broken skin anywhere on the body • Changes in existing injuries
Key Material 18-3
224
The Circulatory System
Key Material 19-1
225
The Respiratory System
Key Material 20-1
226
The Musculoskeletal System
Key Material 21-1
227
The Nervous System
Key Material 22-1
228
Parts of the Eye
Key Material 22-2
229
Parts of the Ear
Inner ear
Key Material 22-3
230
The Endocrine System
Key Material 23-1
231
The Lymphatic System
Key Material 24-1
232
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 activity and exercise daily. 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
Key Material 25-1
233
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
Key Material 25-2
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Body Movements
Key Material 25-3
235
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 the tubing. Keep tubing free of kinks. • Observe for the tape or 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 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, reddened skin, sorT esE,SsT wBeA lliNnKgS, E orLp LuEsR. .COM
Key Material 26-1
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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
Key Material 27-1
237
Signs of Approaching Death
• • • • • • • • • • • • • • • • • • • • • • • • • • •
Cyanotic 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 ioNnKSELLER.COM 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
Key Material 27-2
240
Decision Quiz
Choices I have made today include the following: 1.
2.
3.
4.
5.
6.
Handout 2-1
241
Who is Vulnerable to Abuse or Neglect?
Some people are more vulnerable to adult abuse or neglect than others. They include the following: • Elderly people • People who have a physical illness or are disabled • People who are developmentally disabled • People who have a mental health disorder or condition • People who have 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
242
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
243
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
244
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
245
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
246
Abbreviations
a
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
AD
Alzheimer’s disease
ax
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
BM
bowel movement
AHA
American Heart Association
BP, B/P
blood pressure
AIDS AIIR AKA
acquired immunodeficiencTy ESTBANKSBEPL 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
C
centigrade, Celsius
amb
ambulate, ambulatory
c
with
AMD
age-related macular degeneration
Ca/CA
calcium, cancer, carcinoma
amt.
amount
CAD
coronary artery disease
ANS
autonomic nervous system
cal
calorie
ant.
anterior
cath.
catheter
a.p./AP
apical pulse
CBC
complete blood count
approx.
approximately
CBI
continuous bladder irrigation
Handout 3-2
247
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
Clostridioides 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
DM
diabetes mellitus
ck
check
DNR
do not resuscitate
cl liq
clear liquid
cm
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
ED
emergency department
CPAP
continuous positive airway pressure
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
248
Abbreviations (cont’d)
ER
emergency room
GI
gastrointestinal
ESRD
end-stage renal disease
GP
general practitioner
et al.
and other things
GSW
gunshot wound
ETOH
alcohol
GTT
glucose tolerance test
exam
examination
GU
genitourinary
F
Fahrenheit, female
GYN/gyn
gynecology
FBS
fasting blood sugar
h, hr, hr.
hour
FDA
Food and Drug Administration
H2 0
water
Fe
iron
H202
hydrogen peroxide
FF
force fluids
H/A
headache
FH
family history
HAART
highly active anti-retroviral therapy
fld
fluid
H&P
history and physical
FS
fingerstick
FSBS
fingerstick blood sugar
HBV
hepatitis B virus
ft
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
Hg
mercury
fx
fracture
HHA
home health aide
FYI
for your information
Hi-cal
high calorie
g
gram
HIPAA
GAD
generalized anxiety disorder
Health Insurance Portability and Accountability Act
gal
gallon
HIV
human immunodeficiency virus
GB
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
249
Abbreviations (cont’d)
HPV
human papillomavirus
l, L
liter
HS/hs
hours of sleep
L, lt
left
ht
height
lab
laboratory
HTN
hypertension
lb
pound
H.U.C.
Health Unit Coordinator
LBP
low back pain
Hx
history
LE
lower extremity
hyper
above normal, too fast, rapid
lg
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
ID
identification
Low-cal
i.e.
that is
Low-Na
low-sodium
IICU
intermediate intensive care unit
LPN
Licensed Practical Nurse
IM
intramuscular
LTC
long-term care
in
inch
LTCF
long-term care facility
inc
incontinent
LUQ
left upper quadrant
inf
inferior
LVN
Licensed Vocational Nurse
IQ
intelligence quotient
M.D.
medical doctor
irr., irrig
irrigation
MD
muscular dystrophy
isol
isolation
MDROs
multidrug-resistant organisms
I.V., IV
intravenous
MDR-TB
multidrug-resistant tuberculosis
K
potassium
MDS
minimum data set
kg
kilogram
meds
medications
KS
Kaposi’s sarcoma Handout 3-2
250
Abbreviations (cont’d)
mg
milligram
NF
nursing facility
MI
myocardial infarction
NG, ng
nasogastric
min
minute
NIBP
mL
milliliter
noninvasive blood pressure monitoring
mm
millimeter
NKA
no known allergies
mm Hg
millimeters of mercury
NKDA
no known drug allergies
MO
microorganism
no
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
O2
oxygen
MS
multiple sclerosis
MSDs
musculoskeletal disorders TESTBANKSOE&LPLER.COoM va and parasites
MSDS
material safety data sheet
OB
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
Na
sodium
OCD
obsessive-compulsive disorder
N/A
not applicable
OD
overdose
NA
nursing assistant
O.D.
right eye
NaCl
sodium chloride (table salt)
OG
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
251
Abbreviations (cont’d)
ortho
orthopedics
PID
pelvic inflammatory disease
os
mouth
PM/pm
afternoon
O.S.
left eye
PMH
past medical history
OSHA
Occupational Safety and Health Administration
PNS
peripheral nervous system
PO
by mouth (per os)
OT
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)
oz
ounce
PPE
personal protective equipment
p
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
PE
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
PT
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
pH
parts hydrogen
PWB
partial weight-bearing
PH
past history
q
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
252
Abbreviations (cont’d)
qam
every morning
RR
respiratory rate
Q&A
questions and answers
RT
respiratory therapy/therapist
qd
every day
RUE
right upper extremity
qh, qhr
every hour
RUQ
right upper quadrant
qhs
every night at bedtime
Rx
prescription, treatment
q.o.d.
every other day
s
without
qt.
quart
S&A
sugar and acetone
quad
quadrant, quadriplegic
S&S, S/S
signs and symptoms
R
respirations, rectal
s.c.
subcutaneously
R, rt.
right
SCA
sudden cardiac arrest
RA
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
RF
restrict fluids
SNS
somatic nervous system
RLE
right lower extremity
SOB
shortness of breath
RLQ
right lower quadrant
SP
Standard Precautions
RN
registered nurse
S.P.D.
Supply, Processing, and Distribution
RNA
restorative nursing assistant
spec.
specimen
R/O
rule out
ss
one half
ROM
range of motion
SSE
soapsuds enema
TESTBANKSsEl LLER.COsuMblingually
Handout 3-2
253
Abbreviations (cont’d)
ST
standard, speech therapy
UGI
upper gastrointestinal
staph
Staphylococcus
UNK, unk
unknown
STAT/stat
immediately
URI
upper respiratory infection
Std prec
Standard Precautions
US
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
VD
venereal disease
TB
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
UE
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
255
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.
256
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
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.
CBR CHF COPD CVA DM DOB EMS FF
CCMS c/o CPR DAT DNR Dx/dx FBS FWB
TESTBANKSEL LER.COM
Handout 3-3
258
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 KSELLER.COM
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.
GERD H2O 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
260
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 KSELLER.COM
hypertension
hours of sleep
low, less than normal
above normal, too fast, rapid
incontinent
intake and output
intravenous
isolation 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.
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
262
Abbreviations Flash Cards (cont’d)
level of consciousness, level of care
kilogram
low-sodium
low-calorie
multidrug-resistant tuberculosis
multidrug-resistant organisms
M illigram myocardial infarcTtEioSTnBAN KSELLER.COm
millimeters of mercury
milliliter
methicillin-resistant Staphylococcus aureus
microorganism
no added salt
multiple sclerosis
no known drug allergies
no known allergies Handout 3-3
263
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
264
Abbreviations Flash Cards (cont’d)
nausea, vomiting, and diarrhea
nothing by mouth
oxygen
non-weight-bearing
out of bed
ova and parasites
after meals TESTBANKSELLER.COM 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
265
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
266
Abbreviations Flash Cards (cont’d)
every
partial weight-bearing
restrict fluids
regular
range of motion
rule out
ESTsBAN KSELLER.COMwithout 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
267
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
268
Myths About Older Adults and Sexuality
Myth #1: Older men are not capable of having sex. There are some physical changes that may alter the way a couple engages in sex. Men may need more direct contact, may take longer, and may need longer intervals between sexual contact to perform again. However, many men continue to have satisfying sexual relationships well into old age. Myth #2: After menopause women are not interested in sex. Many women relax and enjoy sex more in later years. With no risk of pregnancy, many women feel much freer. There may be some physical changes, such as less lubrication, but there are remedies available. Communication with their physicians is important. The reason many older women stop having sex 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 adults in 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 also true of older people. 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.
TESTBANKSELLER.COM
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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
270
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.
1.
2.
3.
4.
5.
6. 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
271
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. 11. Make the resident comfortable. Replace clothing and bed linen.
Measuring Abdominal Girth Equipment: measuring tape, pen and paper to record your findings
12. Return bed to its lowest position. Remove privacy measures.
1. Identify yourself by name. Identify the resident. Greet the resident by name.
13. Leave call light within resident’s reach.
2. Wash your hands.
14. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
15. Be courteous and respectful at all times.
4. Provide for the resident’s privacy with a curtain, screen, or door.
16. Report any changes in the resident to the nurse. Document procedure using facility guidelines.
5. Adjust the bed to a safe level, uTsE uaSllT yw BaAisNt KSELLER.COM high. Lock the bed wheels. 6. Position the resident lying straight in the supine (back) position. 7. Turn linen down and raise the gown or top enough to expose only the abdomen. Keep all areas covered that do not need to be exposed. Promote the 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.
Handout 9-2
272
How much sleep do we need?
Age
Sleep
Newborns (0–3 months)
14–17 hours each day
Infants (4–11 months)
12–15 hours each day
Toddlers (1–2 years)
11–14 hours each day
Preschoolers (3–5)
10–13 hours each day
School age children (6–13)
9–11 hours each day
Teenagers (14–17)
8–10 hours each day
Younger adults (18–25)
7–9 hours each day
Adults (26–64)
7–9 hours each day
Older adults (65+)
7–8 hours each day
Handout 10-1
273
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.
TESTBANKSELLER.COM 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
274
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. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.
10. Stand with your 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. 12. While supporting the body, gently roll the resident onto her side as one unit (toward raised side rail). Shift your weight from your back leg to your front leg. Make sure the resident’s face is not covered by the pillow.
5. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6. Lower the head of the bed. 7. Stand on the side of bed opposite to where the resident will be turned. If the bed hasTsE idS eT raB ilsA, NK SELLER.COM raise the far side rail. Lower the side rail nearest you if it is up. Gently push resident toward other side of bed while shifting your weight from your back leg to your front leg.
8. Move the resident to the side of the bed. 9. Cross the resident’s arm over her chest. Move the arm on the side the resident is being turned to out of the way. Cross the near leg over the far leg.
13. Position the resident properly: •
Head supported by a pillow (resident’s face should not be obstructed by the pillow)
•
Shoulder adjusted so the resident is not lying on her arm or hand
•
Top arm supported by pillow
•
Back supported by a supportive device
•
Hips properly aligned
Cross leg nearest you over the far leg.
Handout 11-2
275
Turning a Resident Away From You (cont’d)
•
Supportive device between the legs with the top knee flexed; knee and ankle supported
•
Pillow under the 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 its lowest position. Return side rails to ordered position. Remove privacy measures. 16. Leave call light within the 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
276
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 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
34 748 – 66
39 546 – 42
3
88 – 88
126 – 126
To convert a decimal to a fraction, write the decimal over the number 1.
0
0
14
4
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
277
Giving a Rectal Suppository
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. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.
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. 21. Place call light and fresh water within the resident’s reach. 22. Wash your hands.
5. Adjust the bed to a safe working level, usually waist high. Lock bed wheels.
23. Be courteous and respectful at all times.
6. Help the resident to left-lying (Sims’) position.
24. Report any changes in the resident to the
Cover with a bath blanket.
TESTBANKSELLER.nuCrO seM . Document procedure using facility guidelines.
7. Fold back linens to expose only the rectal area. 8. Unwrap the suppository. 9. Put on gloves. 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 relax and retain the suppository. 14. Withdraw the finger and hold toilet paper against the anus briefly. 15. Remove and discard gloves. 16. Wash your hands. Handout 15-1
278
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. 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 af fects the circulation to the leg or causes any harm to the skin.
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 catheter with the sterile cap and remove the sterile cap. Attach the catheter to the leg bag. Do not touch the tip of the catheter tubing or the leg bag tubing to any object.
1. Identify yourself by name. Identify the resident. Greet the resident by name.
12. Wrap the leg bag around the resident’s leg and secure using the straps.
2. Wash your hands.
13. Remove the catheter clamp. Make sure urine can flow freely into the leg bag.
Changing a Catheter Drainage Bag to Leg Bag
3. Explain procedure to resident. Speak clearly, 14. Ensure that the straps for the leg bag are not slowly, and directly. Maintain face-to-face conTESTBANKSEL LER.COM tact whenever possible. too tight on the leg. 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust the bed to a safe working level, usually waist high. Lock bed wheels. 6. Put on gloves. 7. Ensuring privacy, remove bed linen and lift the gown or pull down the pajamas. 8. Turn the resident on his side, place the bed protector under him and return him to his back.
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. 18. Return bed to its lowest position. Remove privacy measures. 19. Leave call light within the resident’s reach. 20. Wash your hands.
9. Place the second bed protector or sterile drape on the bed for supplies. Prepare the leg bag.
21. Be courteous and respectful at all times.
22. Report any changes in the resident to the 10. Temporarily clamp the catheter using facilitynurse. Document procedure using facility approved clamp. Remove the catheter from the guidelines. drainage tubing and immediately apply a sterile cap to the catheter end and a plug to the drainage tubing end. Handout 16-1
279
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 catheter with the sterile cap and remove the sterile cap. Remove the plug from the catheter drainage tubing. Avoid touching the end of the catheter or the tip of the drainage tubing to any object. Attach the end of the 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 drainage bag.
3. Explain procedure to the 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 the bed to a safe working level, usually waist high. Lock bed wheels.
16. Remove and discard gloves. Wash hands.
6. Put on gloves.
TESTBANKSELLE 17R. . ReCpO laM ce gown or clothing and make resident 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 the 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 the 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 the 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
280
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 re-seals T itsE elS fT onBcA e tNhK eS syE riL ngLeEisRr. em ed. CoOvM 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. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
Collecting a sterile urine specimen from a needleless catheter port Equipment: gloves, sterile urine specimen container (labeled with the 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.
4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Put on gloves. 6. If needed, clamp the drainage tube on the catheter tubing. Wait for urine to collect within the tubing.
2. Wash your hands. Handout 16-3
281
Taking a Urinary Specimen from a Port (cont’d)
7. Using an alcohol wipe, clean the needleless catheter drainage port. 8. Using the needleless syringe, screw the syringe into the needleless catheter port and withdraw the urine specimen from the port. 9. 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.
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. 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 the syringe in a biohazard container. 13. Unclamp or remove the band from the cathTESTBANKSELLER.COM eter drainage tube. Make sure urine is allowed to drain into the tubing and drainage bag again. Place the clamp safely in designated area or dispose of rubber band in a biohazard container. 14. Remove and discard gloves. Wash your hands. 15. Make the resident comfortable. 16. Place call light within resident’s reach.
Handout 16-3
282
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
283
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 prefilled devices; nurses or respiratory therapists will replace the humidification device when its water level is low with a new, prefilled 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 humidificationTdEeS vicTeBbA ecN oK mS esEloLwLER.COM
Handout 20-1
284
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. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
Make an anchor at the beginning spot.
4. 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.
5. Adjust bed to safe working level, usually waist high. Lock bed wheels.
13. Smooth out the entire bandage, removing any wrinkles.
6. Avoid trauma or pain to the resident T thE roSuT ghB- ANKS1E 4.LSLeE cuRre.tC heObMandage with a clip or tape. out the procedure. 15. Straighten all of the linens. 7. Assist the resident to get into the supine (flat 16. Remove and reapply the bandage as directed. on the back) position. Wash and dry bandages as necessary. 8. Expose only the part to be bandaged. 17. Make the resident comfortable. 9. Hold the rolled bandage with one hand and, 18. Return the bed to its lowest position. Remove with the other hand, put the loose end on top privacy measures. of the extremity. 19. Leave call light within the resident’s reach. 10. Wrap the extremity, beginning at the spot furthest from the heart. Circulation returns toward 20. Wash your hands. the heart, and this allows extra fluid to flow 21. Be courteous and respectful at all times. to the heart and leave the area. (For the wrist, begin wrapping at the hand. For the ankle, 22. Report any changes in the resident to the begin at the foot.) nurse, including changes in temperature and color of the skin, or resident comments about 11. Wrap the bandage once around the beginning changes in sensation. Document procedure spot, and turn over the tip so that an anchor is using facility guidelines. made.
Handout 21-1
285
Myths About HIV and AIDS
Myth: If a person is HIV positive, that means he 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 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 .COM blood got into the uninfected person’s TESTBANKSELLERperson’s bloodstream. If this is a concern, partners can check for such sores before kissing.
Myth: HIV can be spread by touching 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
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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 ct: Although it sounds possible, mosquitoes, TES TBANKSEFLaL ER.COM by mosquitoes. fleas, ticks, and lice do not spread HIV. For this 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. 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
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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 mouth 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
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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 empty • 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
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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
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Job Application
Email Address:
TESTBANKSELLER.COM
Handout 28-1
292 Chapter 1: The Nursing Assistant in Long-Term Care 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 2. 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
Name: 7. 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 8. 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
3. Which of the following types of health care is 9. A disorder in which a person has a serious generally for people who will die in six months loss of mental abilities, including the ability to or less? think, remember, and reason, is known as (A) Long-term care (A) A terminal illness (B) Outpatient care (B) Dementia (C) Intergenerational care (C) Heart disease (D) Hospice care (D) Chronic disorder 4. is a federal health insurance program 10. Which of the following is a typical task that for people who are 65 years of age orToE ldS erToBr ANKSELLER.COM nursing assistants perform? people of any age with permanent kidney fail(A) Administering medication ure or certain disabilities. (B) Bathing a resident (A) Medicare (C) Changing sterile dressings (B) Medicaid (D) Giving tube feedings (C) Occupational Safety and Health Administration (D) Health and Human Services 5.
is a medical assistance program for people who have a low income or certain 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
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 elimination 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.
293 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 SELLER. OMis teC am a nursing assistant demonstrating that she is (A) The nurse 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
294 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 NKSELLER.COM 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. 2. 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.
295 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 3. 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.
296 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 injuries (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
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298 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 2. 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 influences 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
3. An example of active listening is (A) NA looking around the room while the resident is speaking chRt. im TESTBANKS7E. LELaE 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
299 17. When using the computer at work, a nursing assistant should (A) Research different conditions that may affect the elderly (B) Exit the web browser when she is finished with charting (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 electronically? (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.
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 ELLER.COM 19. Which of the following is true of the MDS? and care (A) MDS stands for Multiple Diagnosis (D) Suggest the best treatment for the resident System. 14. A nursing assistant can share information (B) Every time an MDS is completed for a resiabout residents with dent, an investigation by the state is done. (A) Anyone she chooses (C) Not all residents will have an MDS. (B) The resident’s family and friends (D) A nursing assistant’s report may trigger a (C) Other members of the care team needed assessment for a resident. (D) No one 20. Which of the following is an example of objec15. Accurate documentation is important because tive information? (A) The NA does not want to get into trouble (A) “Mr. Castillo seems a little grouchy today.” (B) Documentation provides an up-to-date (B) “Mr. Castillo says that he has a record of a resident’s status and care stomachache.” (C) Family members will want to review the (C) “Mr. Castillo’s blood pressure is 115/68.” medical chart regularly (D) “Mr. Castillo doesn’t get along with the (D) The NA determines each resident’s diagnonurses.” sis based on her documentation 21. Which of the following is an example of sub16. When should documentation be recorded? jective information? (A) Immediately after care is given (A) “Mrs. Parker says she is dizzy.” (B) At the end of the shift (B) “Mrs. Parker has a temperature of 101°F.” (C) Whenever there is time (C) “Mrs. Parker had a visit from her son (D) Before the care is given today.” (D) “Mrs. Parker did not eat any of her dinner.”
300 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 members make scheduled visits to each resident's 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
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302 Chapter 4: Communication Challenges Multiple Choice. Choose the correct answer. 1. One way for a nursing assistant to communicate effectively with a resident who has a visual impairment 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 2. If a resident has a hearing impairment, 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
Name: 5. Which of the following is the best example of how a nursing assistant should communicate with a resident who is anxious? (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 has depression? (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. (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 nursing assistant to respond to a resident who TESTBANKSELiL ER.COM resident s angry? (A) The NA should ignore the resident until 3. While distributing meal trays, Shanice gives the resident calms down. the wrong meal to a resident who has diabetes. (B) The NA should try to find out what is She says that the resident distracted her by causing the resident’s anger. complaining about the food. Which defense (C) The NA should ask the resident to stop mechanism is she using? being angry. (A) Denial (D) The NA should restrain the resident. (B) Projection (C) Repression 8. Which of the following is an example of (D) Rationalization aggressive, rather than assertive, behavior? 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
(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
303 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
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 ELLER.COM 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
304 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. 2. 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 3. 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 Ebony 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) Teresa is very religious and likes to share her religious views with her residents. (D) Lemarcus 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
305 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
306 Chapter 6: Infection Prevention and Control 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 2. 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 3. One sign of a localized infection is (A) Chills (B) Headache (C) Drainage from a wound or cavity (D) Mental confusion
Name: 7. 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 8. How many links in the chain of infection must be broken to prevent infection? (A) One (B) Two (C) Three (D) Four 9. 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
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
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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 (B) Get vaccinated for common illnesses infected (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
308 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
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Chapter 7: Safety and Body Mechanics 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 2. 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
309 7. Which of the following needs to be disposed of in a biohazard container? (A) Trash (B) Sharps (C) Aluminum cans (D) Food 8. 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
3. 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 elimination (D) Locking the resident’s door from the outside
310 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
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Chapter 8: Emergency Care, First Aid, and Disasters 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. 2. 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
311 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. 8. 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 9. 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
3. 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.
312 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.
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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 2. 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.
313 6. There are (A) 10 (B) 12 (C) 15 (D) 20
inches in a foot.
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
314 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.
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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. 2. 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 3.
4.
5.
6.
7.
315 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 Sleep disorders are called (A) Leave the unit tidy (A) Insomnias (B) Move the resident’s belongings (B) Parasomnias (C) Leave spills for the next shift (C) Somnambulisms (D) Lock the resident’s door (D) Bruxisms 12. Where should the call light be placed when a 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
316 15. A resident who is at risk for pressure injuries 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
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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 2. 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 injuries. (C) NAs should check residents’ skin each time they are repositioned. (D) Bedbound residents should be repositioned every three hours.
317 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.
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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. 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 residTeE ntSwTitB hA - NKSELLER.COM out 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. 14. 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 15. When helping a resident who has a visual impairment to 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
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Chapter 12: Personal Care 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 2. 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
319 7. Observing residents’ skin during personal care and bathing is especially important in the prevention of (A) Depression (B) Abuse (C) Pressure injuries (D) Diabetes 8. 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 9. 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
3. 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 an Epsom (A) Wash from dirtiest to cleanest salts additive 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
320 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 residents who are unconscious 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 mouth care of residents who are unconscious include (A) Pouring mouthwash slowly into the resident’s mouth (B) Turning residents on their backs when giving mouth care (C) Avoiding performing mouth care on residents who are unconscious (D) Using as little liquid as possible when giving mouth care 22. A nursing assistant should give nail care
15. How often must mouth care be provided for residents? (A) Once a day (B) At least twice a day (C) Only when the resident requestsTitESTBANKSELLER.COM (A) Whenever she has time (D) Every other day (B) When she is bathing a resident 16. A resident who is edentulous (C) When she notices a resident’s nails are (A) Lacks teeth getting long (B) Has bad breath (D) When the resident’s nail polish wears off (C) Is wearing dentures 23. Which of the following statements is true? (D) Has tartar deposits on the teeth (A) Residents’ hair should be handled gently 17. Which of the following is true about mouth because hair can be pulled out when combcare? ing or brushing it. (A) Residents without teeth will not require (B) Residents’ hair should be combed or any mouth 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 mouth care. (C) Nursing assistants should cut residents’ (C) Mouth 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 mouth 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
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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 2. 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
321 8. An oral thermometer is usually color-coded (A) Green or blue (B) Red or orange (C) Black or white (D) White or gray 9. 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. 10. Which of the following thermometers is used to measure temperature in the ear? (A) Mercury thermometer (B) Axillary thermometer (C) Tympanic thermometer (D) Temporal artery thermometer
3. Common symptoms of a fever include (A) Muscle aches (B) Sleepiness (C) Slow movements (D) Nausea
11. Which of the following statements is true of taking rectal temperatures? (A) The nursing assistant should not explain the procedure before beginning so the resident will not feel anxious. T E S T B A N K S ELLER. C O (B) RM ectal thermometers should be inserted 4. If a nursing assistant suspects that a resident has a fever, he should two inches into the rectum. (A) Give the resident medication (C) The nursing assistant must hold on to the (B) Take the resident’s temperature thermometer at all times while taking a (C) Ask the resident how she is feeling rectal temperature. (D) Measure the resident’s pulse rate (D) To obtain an accurate temperature, the resident should move around slowly dur5. Which of the following is the normal temperaing the procedure. ture range for the oral method? (A) 97.6–99.6 degrees F (B) 96.6–98.6 degrees F (C) 93.6–97.9 degrees F (D) 98.6–100.6 degrees F 6. Which of the following is another word for armpit? (A) Tympanum (B) Rectum (C) Axilla (D) Temporal 7. Which method of taking temperature is considered to be the most accurate? (A) Oral (B) Rectal (C) Tympanic (D) Axillary
12. How far into the ear should a tympanic thermometer be inserted? (A) ¼ to ½ inch (B) ½ to 1 inch (C) 1 to 1 ½ inches (D) 1 to 2 inches 13. The normal pulse rate for adults is (A) 25 to 50 beats per minute (B) 60 to 100 beats per minute (C) 100 to 150 beats per minute (D) 150 to 175 beats per minute 14. 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
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15. 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
22. Blood pressure is measured using a (A) Thermometer (B) Watch (C) Finger (D) Sphygmomanometer
16. The medical term for difficulty breathing is (A) Eupnea (B) Apnea (C) Tachypnea (D) Dyspnea
23. Both the and pulses are used in taking blood pressure. (A) Radial and apical (B) Apical and brachial (C) Radial and brachial (D) Brachial and femoral
17. Why is respiration rate usually counted directly after taking the pulse rate, while the fingers are still on the wrist? (A) It is less work for the nursing assistant to count respirations right after taking the pulse. (B) People may breathe more quickly if they know they are being observed. (C) The chest will not rise and fall if the rate is not counted immediately. (D) The respiration rate will be different if the nursing assistant waits to take it.
24. Which of the following is an example of a correct way to write a blood pressure reading? (A) 110/70 (B) 110+70 (C) 110-70 (D) 110*70
25. Which of the following statements is true of pain? (A) Everyone experiences pain in the same way. (B) Everyone will express freely when they are in pain. 18. The difference between the apical and radial TESTBANKSEL L E Ra.inCiO pulse is called the (C) P sM a different experience for each (A) Pulse rate person. (B) Cheyne-Stokes (D) Pain levels do not need to be monitored. (C) Pulse deficit 26. Which of the following can help reduce pain? (D) BPM (A) Pounding the resident on the back 19. The blood pressure is the top number in (B) Jumping jacks a blood pressure reading, while the is (C) Squeezing the body part hard the bottom number. (D) Change of position (A) Radial, apical (B) Apical, radial (C) Diastolic, systolic (D) Systolic, diastolic 20. Which of the following blood pressure readings falls within the normal range? (A) 119/75 (B) 135/90 (C) 91/58 (D) 140/80 21. Hypertension is (A) High fever (B) High blood pressure (C) High pulse rate (D) Low blood pressure
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Chapter 14: Nutrition and Fluid Balance 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. 2. 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 3. 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
323 7. According to MyPlate, a person should choose dairy products that contain (A) 1% fat (B) 2% fat (C) 3% fat (D) 4% fat 8. According to MyPlate, what should half of the grains a person consumes be? (A) White (B) Refined (C) Whole (D) Flour 9. 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 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) Renal (D) Fluid-restricted 13. Which type of diet consists of only plant-based foods? (A) Lacto-ovo vegetarian diet (B) Lacto-vegetarian diet (C) Ovo-vegetarian diet (D) Vegan diet
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324 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 require thickened liquids. (A) Walking (B) Swallowing (C) Digesting food (D) Gaining weight
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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 the resi-
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(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 elimination needs 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) Put the plate to one side if the resident has a visual impairment 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 . ANKSELLER.COM (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
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326 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
2. The heart is an example of a(n) (A) Cell (B) Tissue (C) Organ (D) Body system
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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.
3. The muscular contractions that push food toward the stomach are called (A) Peristalsis (B) Mastication (C) Defecation (D) Absorption 4. Stool should normally 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
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
t pOoM sition for bowel elimination is TESTBANKS1E2.LTLhEe Rbe.sC
5. A 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. 18. Which of the following is one way that a bariatric bed may differ from a regular bed? (A) The bed may be lower to the floor. (B) The bed may be narrower. (C) The bed may not be able to be used. (D) The bed is made for people who weigh less than average.
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328 Chapter 16: The Urinary System Multiple Choice. Choose the correct answer. 1. What is another term for urinating? (A) Digesting (B) Eliminating (C) Ingesting (D) Voiding 2. 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 3. 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
Name: 7. 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 8. The best position for men to urinate is (A) Sitting (B) Standing (C) Lying (D) Crouching 9. One way for women to prevent UTIs is to (A) Reduce fluid intake to minimize work for the bladder (B) Drink plenty of water and other fluids (C) Urinate less often (D) Take baths rather than showers
10. is an artificial means of removing the 4. Which of the following statements is true of body’s waste products. urination? (A) Chronic renal failure (A) Indwelling catheters do not affect muscle (B) Kidney dialysis tone. (C) Urine retention (B) Fluids high in sodium increase uTriE nS arT y BANKSEL(L Re.pC DE )N hrOitM is output. 11. Which of the following is a guideline for deal(C) A lack of privacy can affect urination, as ing with urinary incontinence? can stress. (A) The nursing assistant should let room(D) The bladder holds more urine as people mates know when residents have been age, causing them to urinate less incontinent so that they can help notify the frequently. care team when incontinence occurs. 5. A way for a nursing assistant to promote nor(B) The nursing assistant should tell residents’ mal elimination for residents is to families about episodes of incontinence so (A) Encourage Kegel exercises they can encourage residents to do better. (B) Encourage residents to finish urinating as (C) The nursing assistant should change wet quickly as possible or soiled linens or incontinence briefs (C) Encourage female residents to lie flat on immediately. their backs when urinating (D) The nursing assistant should not offer flu(D) Discourage fluids for residents who uriids because this will help lessen episodes nate too frequently of incontinence. 6. What is one reason why women are more likely than men to have urinary tract infections? (A) Women's gonads have a different gonads (B) Women's kidneys do not filter blood properly (C) Women have a shorter urethra (D) Women have urinary incontinence
12. A(n) catheter is inserted to drain urine from the bladder several times a day and is removed each time after urine is drained. (A) Straight (B) Indwelling (C) Condom (D) Texas
Name: 13. 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 14. A urine specimen can be collected any time the resident voids. (A) Routine (B) Clean-catch (C) 24-hour (D) Sterile 15. Which type of urine specimen does not include the first and last urine in the sample? (A) Routine (B) Clean-catch (C) 24-hour (D) 36-hour 16. People who have diabetes may have , chemical substance(s) produced when the body burns fat for energy or fuel, inTthEeS irTuB riA neN. KSELLER.COM (A) Reagents (B) Glucose (C) Insulin (D) Ketones 17. 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 18. 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 is taking too long to urinate.
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330 Chapter 17: The Reproductive System 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 2. 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 3. 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.
Name: 7. A man with benign prostatic hypertrophy may have difficulty with (A) Walking (B) Reproducing (C) Urinating (D) Ejaculating 8. Which of the following is true of sexual needs in the elderly? (A) As a person ages, 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. 9. 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
4. 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.m CoOnM 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
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Chapter 18: The Integumentary System 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 2. The largest organ in the human body is the (A) Heart (B) Lungs (C) Skin (D) Kidneys 3. 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
331 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 8. Skin that is not intact is considered a(n) (A) Open wound (B) Closed wound (C) Contusion (D) Bruise 9. 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
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 injuries occur. 11. A stage 1 pressure injury has skin that is (C) Hair thickens. (A) Nonintact (D) Skin becomes thinner and more fragile. (B) A deep crater 5. A burn that affects the epidermis and causes (C) Deep purple redness and pain is a (D) Red or a different color than the surround(A) First-degree (superficial) burn ing area (B) Second-degree (partial-thickness) burn 12. A pressure injury with partial-thickness skin (C) Third-degree (full-thickness) burn loss that may look like a blister is a stage (D) Scald pressure injury. 6. Which of the following is true of scabies? (A) 1 (A) It is caused by a buildup of bacteria in the (B) 2 skin. (C) 3 (B) Symptoms include rash, intense itching, (D) 4 and sores that may become infected. 13. Which of the following is a condition that (C) It is not contagious. increases the risk of pressure injuries? (D) Teenage children and young adults are at a (A) Resident flexibility higher risk of acquiring scabies. (B) Cold air (C) Healthy circulation (D) Restricted mobility
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14. Which of the following statements is true of pressure injuries? (A) When skin begins to break down, it appears as a deep crater. (B) Pressure injuries are difficult to heal but do not hurt much. (C) Pressure injuries are impossible to prevent. (D) Pressure injuries 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 applieTdEfoSrTaBANKSELLER.COM 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. Nonsterile dressings are applied to (A) Open wounds (B) Draining wounds (C) Dry wounds that have less chance of infection (D) New wounds
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Chapter 19: The Circulatory or Cardiovascular System
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.
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 2. About 55% of blood is made up of (A) Erythrocytes (B) Leukocytes (C) Plasma (D) Platelets
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3. 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
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 elastic stockings be applied? (A) The heart pumps less efficiently (A) In the evening (B) Blood vessels widen (B) In the morning (C) Blood vessels become more elastic (C) Mid-afternoon (D) Blood flow increases (D) After residents have finished exercising 5. The medical term for high blood pressure is (A) Myocardial infarction (B) Hypotension (C) Hypertension (D) Peripheral vascular disease 6. One way for a person to keep hypertension under control and prevent complications is to (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
12. Residents with congestive heart failure may (A) Be on a high-sodium diet (B) Take medications that cause a decrease in urinary output (C) Have a force fluids medical order (D) Need to do range of motion exercises to improve muscle tone 13. The most common form of anemia is (A) Iron-deficiency anemia (B) Hypoxia (C) Pernicious anemia (D) Pulmonary anemia
334 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 2. 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 3. 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.
4. 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
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Chapter 21: The Musculoskeletal System
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.
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 2. 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
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 assistive 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 (DC) O AM n artificial arm to replace an arm that has 4. Weakening, wasting away, andTdE ecSreTaB seAiN nK siS zeELLER. 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
11. Before applying a prosthesis, the area must be (A) Dry (B) Damp (C) Cold (D) Warm
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 the diet. (A) Sodium (B) Calcium (C) Iron (D) Protein
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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
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.
336 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.
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Chapter 22: The Nervous System 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 2. The is/are part of the peripheral nervous system. (A) Brain (B) Spinal cord (C) Cerebrum (D) Spinal nerves 3. 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
337 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. 8. Parkinson’s disease typically causes (A) A shuffling gait (B) Extremely straight posture (C) Memory loss (D) Aggressive behavior 9. 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
4. The tiny bones within the middle ear that pick up vibrations and send impulsT esEtS oT thB eA brNaK inSELLE 10R . .COM is the loss of function of the lower are the body and legs. (A) Ossicles (A) Concussion (B) Eardrums (B) Paraplegia (C) Cochleas (C) Quadriplegia (D) Auricles (D) Hemiplegia 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
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.
338 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 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
339 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 disorder that is characterized by intrusive repetitive thoughts or behavior that cause anxiety is (A) Phobia disorder (B) Posttraumatic stress disorder (C) Obsessive-compulsive disorder (D) Social anxiety disorder
33. Signs and symptoms of major depressive disorder include (A) Intense hunger (B reath that smells fruity T E S T B A N K S ELLER. C) OBM 28. Which of the following would be the best way (C) Intense, sudden chest pain for a nursing assistant to respond to a resident with AD who is exhibiting inappropriate sexual (D) Apathy behavior? 34. Which of the following is a way for a nursing (A) The NA should let other residents know assistant to care for a resident who has a menwhat is happening. tal health disorder? (B) The NA should take the resident to a pri(A) The NA should do everything for the vate area. resident. (C) The NA should inform other nursing assis(B) The NA should give the resident her meditants that the resident has a dirty mind. cation when needed. (D) The NA should loudly reprimand the resi(C) The NA should support the resident and dent to shame him into stopping. her family and friends. 29. When a resident with AD hoards or rummag(D) The NA should let the resident know that es, the nursing assistant should mental health disorders are not real. (A) Let the family know that the resident is 35. Which of the following statements about stealing things observing a resident who has a mental health (B) Lock the resident in his room if the NA disorder is true? does not have time to watch him (A) An NA does not need to report a comment (C) Warn the other residents that the resident about suicide as long as it is a joke. with AD is a thief (B) An NA needs to report changes in mood. (D) Provide a rummage drawer (C) Social withdrawal does not need to be reported. (D) Changes in abilities to perform ADLs do not need to be reported.
340 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 clergyperson.
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Chapter 23: The Endocrine System 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 2. 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 3. 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 environment (D) Maintains blood sugar levels
341 7. Prediabetes can be delayed or prevented by (A) Change in diet and daily exercise (B) Medication (C) Surgery (D) Increasing intake of fluids 8. The most common form of diabetes is (A) Prediabetes (B) Type 1 diabetes (C) Type 2 diabetes (D) Hypoglycemia 9. Symptoms of hypothyroidism include (A) Intolerance to cold (B) Bulging or protruding eyes (C) Rapid heartbeat (D) Normal menstrual periods 10. A resident who has diabetes should (A) Skip meals (B) Go barefoot (C) Receive careful foot care (D) Avoid exercise
11. Which of the following is a guideline for safe foot care for a resident who has diabetes? (A he NA should inspect and clean the resiTESTBANKSELLER.C) OTM dent’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
342 Chapter 24: The Immune and Lymphatic Systems and Cancer 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 2. With immunity, a person is given the antibodies needed to defend against an antigen. (A) Acquired (B) Nonspecific (C) Deficient (D) Passive 3. 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
Name: 7. Which of the following statements is true of HIV or 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. 8. A resident who has AIDS and has an infection of the mouth may need to eat food that is (A) Spicy (B) Soft or pureed (C) Hot (D) Acidic 9. A resident who has AIDS and has nausea and is vomiting should (A) Eat small, frequent meals (B) Eat quickly (C) Not drink liquids (D) Not eat at all
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 13. The key treatment for malignant tumors of the skin, breast, and colon is 6. Which of the following is a sign or symptom (A) Surgery of the beginning stages of HIV infection? (B) Chemotherapy (A) Poor circulation (C) Radiation (B) Damage to the eyes (D) Diet and exercise (C) Open sores on the penis (D) Flu-like symptoms
Name: 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.
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344 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
Name: 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) The 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
2. 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 injuries
Name: 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
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346 Chapter 26: Subacute Care 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 2. A pulse oximeter measures (A) Blood pressure (B) Body temperature (C) Blood oxygen level (D) Blood glucose level
6. 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 7. 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 8. 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.
3. 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 or electrodes wet. (B) The NA should not monitor vital signs. 9. Symptoms of respiratory distress include (C) The NA should not report cracked skin T E S T B A NKSEL Ru.rC (L AE )G glO inM g because that is normal due to the electrode (B) Decreased respiratory rate placement. (C) Redness of the skin (D) The NA should make sure that the elec(D) Apathy trodes hang loosely from the resident’s chest. 4. What is the function of an artificial airway? (A) To feed a resident who cannot swallow or digest food (B) To keep the airway open for the lungs to perform air exchange (C) To check a resident’s vital signs (D) To prepare a resident for a medical test 5. The method used to insert an artificial airway is called (A) Telemetry (B) Intubation (C) Ventilation (D) Dyspnea
10. Which of the following statements is true of chest tubes? (A) The drainage system must be kept above the level of the resident’s chest. (B) The chest drainage must be observed for amount and color. (C) The tubing should be kinked. (D) Chest tubes will only be in the front of the body. 11. A tube that is inserted into the nose, through the esophagus, and into the stomach for feeding is called a(n) (A) Nasogastric tube (B) Orogastric tube (C) Percutaneous endoscopic gastrostomy (PEG) tube (D) Central venous line
Name: 12. What is one of the nursing assistant’s responsibilities for tube feedings? (A) Inserting tubes (B) Giving tube feedings (C) Positioning the resident (D) Cleaning or suctioning the tubes 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 14. One reason why a resident may not be allowed fluids before surgery is (A) The resident may drink more fluids than usual (B) Not drinking fluids can help prevent vomiting and aspiration (C) Having fluids increases the risk of incontinence after surgery (D) The surgery has a higher rate of success if no fluids are consumed
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348 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 2. 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 3. 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, Mr. 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
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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 generally 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
Name: 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 toSELLER.COM 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
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350 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 2. A cover letter should include (A) Detailed information about educational background and volunteer work (B) Information on why a person is seeking the job and why she is qualified for it (C) The salary that the person would expect to receive if she accepted the job (D) Recommendations from former employers
Name: 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
8. What is the minimum number of hours of 3. Which of the following statements is true 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
Name: 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.
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366 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 2. 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 3. Assistive 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.
367 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 care facility. 19. Under what condition is wearing artificial nails (A) Radiology technician in a long-term care facility acceptable? (B) Charge nurse (A) They may be worn as long as the nails are (C) Nurse aide clean, short, and filed. (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
368 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 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) Failure to provide needed care or service, 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
369 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
370 Chapter 3: Communication Skills 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 2. Edema is the medical term for (A) Breaking (B) Swelling (C) Shrinking (D) Sleeping 3. 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.
Name: 7. 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 8. 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 9. 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
10. A person’s orientation includes 4. 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.
371 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.
372 Chapter 4: Communication Challenges 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
2. 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
Name: 7. 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. 8. 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.
3. Ventilation is a term that means exchanging 9. is a type of mental health air between the lungs and the disorder that can cause withdrawal, lack of (A) Kidneys energy, and 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) Combative (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.
373 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 resident who is confused, 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
374 Chapter 5: Diversity and Human Needs and Development 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 2. 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 3.
4.
5.
6.
Name: 7. 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 8. 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
9. Privacy concerning sexual situations is vital in facilities because (A) Living environments in facilities encourage 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 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 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 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 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 milestone 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 unm arS riT edBANKSELLER.COM TE 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 support 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
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376 Chapter 6: Infection Prevention and Control Multiple Choice. Choose the correct answer. 1. A is administered to produce immunity to a specific disease. (A) Vesicle (B) Vector (C) Vacuum (D) Vaccine 2. The autoclave helps prevent 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 3. The process of ties prevent disease. (A) Sterilization (B) Sanitation (C) Asepsis (D) Immunity
helps communi-
7. Nonintact 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 8. 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 9. 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.
4. The carrier is a person who carries a disease 10. The guidelines known as and TE S T B A NKSEL aL reEuRs. edCfO orMdiseases that are spread through (A) Will always show signs of a communicable direct contact with another person or object. disease (A) Airborne Precautions (B) Is able to control the signs and symptoms (B) Droplet Precautions of the disease (C) Contact Precautions (C) Can transmit the disease to others (D) Standard Precautions although he is not symptomatic (D) Is unable to transmit the specific disease 11. Which of the following is true of the bacterium 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
C. diff? (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.
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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 mouth care for a resident
14. What is the incubation period? (A) It is the time frame that a spore survives in the environment. (B) It is the time frame that the surface of a fomite remains contaminated. 19. Which of the following is true of using a mask during care of a resident in isolation? (C) It is the time frame that an administered (AC) O TM he mask must be removed prior to the vaccine provides immunityT . ESTBANKSELLER. removal of gloves or gown. (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 15. What is one reason that dehydration can minutes. become a serious problem for an elderly (D) The mask can be reused only once. person? (A) Cells may not receive adequate nutrition, increasing the risk of infection. (B) The person will most likely experience fluid overload. (C) Bones become brittle and break more easily. (D) Dehydration increases the need for urinary catheters, which remove even more vital fluids from the body. 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
20. An additional way for a nursing assistant to help prevent infection in a facility is by (A) Holding soiled linens close to her uniform so that they do not spread contaminants (B) Moving from a dirty area toward a clean area when cleaning surfaces (C) Not using equipment that has been dropped on the floor (D) Coughing or sneezing into her hands if she does not have a tissue
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378 Chapter 7: Safety and Body Mechanics 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
7. 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
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
8. 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.
3. The medical term culty swallowing. (A) Dysarthria (B) Dyspnea (C) Dysphagia (D) Dyslexia
9. Fire safety responses at facilities include the following steps: (A) Using dry towels to block all doorways and stop smoke
means diffi-
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4. Collecting and putting things away in a guarded way is called (A) Heralding (B) Hobnobbing (C) Hoarding (D) Hashtagging 5. What does the acronym PASS stand for? (A) Push-Assist-Squeeze-Swipe (B) Push-Allow-Squeegee-Swipe (C) Pull-Aim-Squeeze-Sweep (D) Pull-Aim-Squeegee-Sweep 6. The process of burning is known as (A) Composition (B) Combustion (C) Composting (D) Compounding
(B) Encouraging residents and visitors to use the elevators during a fire to escape more quickly (C) Standing upright in a room when trying to escape a fire (D) Using a covering over the mouth and nose to prevent smoke inhalation 10. A weakening or wasting away of a muscle is known as (A) Autonomy (B) Anatomy (C) Atrophy (D) Autopsy 11. Which of the following is a potential fire hazard in a facility? (A) Overloaded electrical socket (B) Recycling container for plastic materials (C) Locked housekeeping supply closet (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 containTESTBANKSELLER.COM er, the NA 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.
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380 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 2. 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 3. 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, a nursing assis(A) Hemoptysis tant notices that the resident’s nose is bleed(B) Hemiplegia ing. 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 a 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.
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
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382 Chapter 9: Admission, Transfer, Discharge, and Physical Exams 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 2. 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 3.
4.
5.
6.
Name: 7. A resident’s weight is measured in (A) Inches or centimeters (B) Pounds or kilograms (C) Millimeters or kilometers (D) Quarts or gallons 8. 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
9. 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 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 Which of the following is equipment that may 10. When measuring the height of an ambulatory be used during a physical exam? resident, 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 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 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
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384 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 2. The natural cycle relating 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 3. 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 place5.
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
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386 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 2. 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 3. The term pertains to the way a person holds and positions his body. (A) Pronation (B) Postpartum (C) Posture (D) Projection 4. Which of the following is an effect of regular 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: 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
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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 2. 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 3. In which position should a nursing assistant place an unconscious resident before giving mouth care? (A) Supine (B) Lateral (C) Fowler’s (D) Prone
387 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 mouth care to a resident who is edentulous, 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
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388 Chapter 13: Vital Signs 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
7. 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 8. What is the medical term used to describe a rapid heartbeat? (A) Bradycardia (B) Hypertension (C) Arrhythmia (D) Tachycardia 9. The is the first measurement of blood pressure, when the heart is at work (A) Diastolic (B) Orthostatic (C) Systolic (D) Systole 10. What does the term dilate mean? (A) Close or contract (B) Speed up (C) Slow down (D) Widen or open
pe may be used to hear TESTBANKS1E1.LALsEteRth.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 of the body. (A) Inhaling (B) Expiration (C) Inspiration (D) Hypotension 13.
is blowing air out
hypotension exists when there is 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 elevated? (A) 120/85 (B) 110/76 (C) 118/72 (D) 114/66 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
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390 Chapter 14: Nutrition and Fluid Balance 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.
7. A sign of dehydration is (A) Moist mucous membranes (B) An increase in urinary output (C) Slowed heartbeat (D) Dizziness 8.
supply the body with energy and provide needed fiber. (A) Fats (B) Carbohydrates (C) Proteins (D) Vitamins
2. 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
9. Staff must report if a resident consumes less than of his meal. (A) 75% (B) 50% (C) 35% (D) 80%
3. 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
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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
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 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
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392 Chapter 15: The Gastrointestinal System 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 2.
is the study of all life forms.
7. 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 8. 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
(A) Anatomy (B) Physiology (C) Biology (D) Geology
9. 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 result of the breakdown of food in the 10. A rectal suppository is a medication given to a stomach. resident by a nurse for which of the following 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 pouchings develop in weakened areas of the large 11. A chronic inflammatory disease of the large intestine? intestine, or colon, is called (A) Malabsorption (A) Malabsorption (B) Lactose intolerance (B) Fecal impaction (C) Peristalsis (C) Crohn’s disease (D) Diverticulosis (D) Ulcerative colitis 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 prelubricated 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
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394 Chapter 16: The Urinary System Multiple Choice. Choose the correct answer. 1. What is another term for urination? (A) Micturition (B) Elimination (C) Defecation (D) Beynation 2.
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
3. 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 the reagent strip is left dipped in the urine (D) The color of the urine when testing it
Name: 7. 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 8. 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) Midstream 9. Which type of test is used for urine density? (A) Specific gravity test (B) pH test (C) Glucose test (D) Occult blood test
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. What causes the body to burn fat for fuel, producing substances called ketones? 11. One important step in catheter care is for the (A) Ketones are produced when there is too nursing assistant to much insulin in the body. (A) Clean at least two inches of catheter near (B) Ketones are produced when there is a high the body specific gravity in the urine. (B) Rinse at least four inches of catheter near(C) Ketones are produced when there is not est the body opening enough insulin in the body. (C) Close the clamp and replace it without (D) Ketones are produced when the blood is cleaning it acidic. (D) Allow the catheter clamp to touch the graduate 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 ELLER.COM 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
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396 Chapter 17: The Reproductive System 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 2.
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
3. 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 a 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
Name: 7. 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 8. What substances control certain human body functions, such as the ability to reproduce? (A) Electrolytes (B) Hormones (C) Vitamins (D) Minerals 9. 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 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
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398 Chapter 18: The Integumentary System 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 2. 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 3. 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
Name: 7. 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 8. 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 9. Death of tissue is known as (A) Eczema (B) Hematoma (C) Gangrene (D) Psoriasis 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 injury 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 injury? (A) Intact skin (B) Broken skin between the toenails (C) Clean skin (D) Adequate resident hydration
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400 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 2. A disorder that is related to the absorption of vitamin B12 is . (A) Pulmonary edema (B) Congestive heart failure (C) Pernicious anemia (D) Phlebitis 3. 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 buildup 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 buildup and 14. The receive(s) deoxygenated improve circulation is a(n) blood from the body through the superior vena (A) Antiembolic 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
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Chapter 20: The Respiratory System Multiple Choice. Choose the correct answer. 1. Tiny grape-like sacs within the lungs are called (A) Atria (B) Axilla (C) Arteries (D) Alveoli 2. 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 3. A condition in which the bronchi become permanently dilated is (A) Bronchitis (B) Bronchiectasis (C) Asthma (D) Pneumonia
401 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 8. An airborne infection isolation room (AIIR) is often used when a person has (A) Emphysema (B) Bronchitis (C) Bronchiectasis (D) Tuberculosis 9. The coughing up of blood from the respiratory tract is known as (A) Halitosis (B) Hemoptysis (C) Hepatitis (D) Hypoxia
10. What is one guideline for a nursing assistant who is caring for a resident receiving oxygen therapy? 4. 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
402 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
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403
Chapter 21: The Musculoskeletal System 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 2. Tough, fibrous bands that connect muscle to bone are called (A) Cartilages (B) Ligaments (C) Joints (D) Tendons 3. 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
7. Which of the following is a guideline for cast care? (A) Use a sharp scratcher inside the cast to help with itching (B) Pad the edge of the cast to reduce sharp edges (C) Keep cast damp or wet for comfort (D) Keep the extremity low, close to the ground 8. 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 9.
is warmth, itching, or tingling from a body part that has been amputated. (A) Osteoporosis (B) Bursitis (C) Phantom sensation (D) Osteoarthritis
10. What is the protective substance that covers the ends of bones? (A) Cartilage TESTBANKSELLER. (BC) O CM ollagen weight on one leg (C) Hormones 4. Which of the following disorders causes swol(D) Minerals len joints, restricted movement, intense pain, 11. Moving a body part toward the body is called and deformities? (A) Addition (A) Osteoarthritis (B) Adduction (B) Muscular dystrophy (C) Agitation (C) Rheumatoid arthritis (D) Abduction (D) Osteoporosis 12. Which type of fracture occurs in a bone that is 5. A continuous passive motion (CPM) machine weakened by a disease such as cancer? is used to treat (A) Compound fracture (A) Total hip replacement (B) Comminuted fracture (B) Bursitis (C) Greenstick fracture (C) Phantom limb pain (D) Pathologic fracture (D) Total knee replacement 6.
are tiny sacs of fluid located near joints. (A) Tendonitis (B) Bursae (C) Sepsis (D) Phlebitis
13. What is one factor that is associated with osteoarthritis? (A) Education level (B) Bacteria (C) Lack of calcium in the diet (D) Cold, damp weather
404 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
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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 2. 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 3. One part of the central nervous system is the (A) Brain (B) Nerves (C) Eyes and ears (D) Autonomic nervous system
405 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 buildup 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 pro4. The 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 has a mental health (D) Vision improves. disorder is to 7. A progressive disease that causes rigid mus(A) Take any suicide threat seriously cles, tremors, and pill-rolling is (B) Disregard a loss of appetite (A) Epilepsy (C) Avoid talking to the resident (B) Parkinson’s disease (D) Ignore dilated pupils (C) Meniere’s disease (D) Dementia
406 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
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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 2. 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 3.
are chemical substances created by the body that control numerous functions. (A) Nutrients (B) Minerals (C) Hormones (D) Vitamins
407 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
4. Thyroid hormones primarily rT egE uS latTeB thAeNKSELLER.COM 12. Which mineral required for proper thyroid following: gland function is found in common table salt? (A) Heart rate and respiration (A) Potassium (B) Bile production and potassium (B) Magnesium (C) Kidney and liver function (C) Iodine (D) Metabolism and growth (D) Copper 5. One guideline for a nursing assistant who is 13. What is a sign of diabetes? giving foot care to a resident with diabetes is to (A) Moist, firm skin (A) Never apply any product between the toes (B) Unexplained weight gain (B) Turn socks over at the tops (C) Excessive urination (C) Use all-nylon socks (D) Low blood pressure (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
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
408 Chapter 24: The Immune and Lymphatic Systems and Cancer 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 2. The disappearance of signs and symptoms of cancer is called (A) Metastasis (B) Remission (C) Breakthrough (D) Intervention 3. 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
Name: 7. 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 8. What organ works as a type of storage shed for the blood? (A) Gallbladder (B) Thymus (C) Spleen (D) Appendix 9. 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 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 injuries (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
409
410 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 2. A doctor who specializes in rehabilitation is called a (A) Psychiatrist (B) Psychologist (C) Physiatrist (D) Pulmonologist 3. 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
4. Weakness of muscles in the feet and ankles is (A) Pronation (B) Supination om TESTBANKS1E2.LOLnEeRc. 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 injuries 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
(C) (D)
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
411
412 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 2.
involves the use of medication to calm a person. (A) Ablation (B) Respiration (C) Supination (D) Sedation
3. 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
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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 2. What is the period of time following a loss in which mourning occurs? (A) Breakthrough (B) Burnout (C) Bereavement (D) Blackout 3. 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
413 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) Receiving 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
414 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
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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 2. An internal or external factor that can cause stress is called (A) Shock (B) Stimulant (C) Stressor (D) Stereotype 3. 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
415 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
4. 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 infections (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
417
Appendix F Answer Key for 2nd Set of Chapter Exams
418 Chapter 1: The Nursing Assistant in Long-Term Care 1.
C
2.
C
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B
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A
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D
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C
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C
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B
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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.
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C
3.
A
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B
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D
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B
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D
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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.
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TESTBANKS4E. LLBER.COM 5.
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10. B 11. D 12. B 13. D 14. C 15. C 16. C 17. D 18. C 19. B 20. A
419 Chapter 4: Communication Challenges
10. C
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C
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C
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Chapter 6: Infection Prevention and Control
11. B
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5.R.ACOM TESTBANKSEL LE
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B
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Chapter 5: Diversity and Human Needs and Development
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C
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A
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D
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420 Chapter 7: Safety and Body Mechanics 1.
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Chapter 9: Admission, Transfer, Discharge, and Physical Exams 1.
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10. B 11. C 12. C 13. D 14. B Chapter 10: Bedmaking and Unit Care 1.
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Chapter 8: Emergency Care, First Aid, and Disasters 1.
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10. D 11. B 12. A 13. D 14. C 15. A
421 Chapter 11: Positioning, Moving, and Lifting
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Chapter 12: Personal Care
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Chapter 14: Nutrition and Fluid Balance
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Chapter 13: Vital Signs
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Chapter 16: The Urinary System
Chapter 18: The Integumentary System
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Chapter 19: The Circulatory or Cardiovascular System
Chapter 21: The Musculoskeletal System
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Chapter 23: The Endocrine System
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Chapter 25: Rehabilitation and Restorative Care
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Chapter 24: The Immune and Lymphatic Systems and Cancer
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Name:
428 Multiple Choice. Choose the correct answer. 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
2.
What is the term for a device that replaces a missing body part? (A) Pronation (B) Prone (C) Personal protective equipment (D) Prosthesis
3.
4.
5.
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
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
8.
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
To maintain proper body mechanics while lifting or carrying an object, a nursing assistant Which of the following types of health care should is generally for people who will die in six months or less? (A) Hold the object out and away from her TESTBANKSELL ERbody .COM (A) Long-term care (B) Face the object or person she is moving (B) Outpatient care (C) Twist at the waist as she picks up the (C) Intergenerational care object (D) Hospice care (D) Try to keep her center of gravity as high Exercises that put each joint through its full as possible arc of motion are called (A) Weight lifting (B) Stretch and relax (C) Range of motion (D) Rotation
6.
7.
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 for him. (B) The nursing assistant should give the resident pain medication just before the rehabilitation session begins. (C) The nursing assistant should recognize that setbacks occur and be reassuring. (D) The nursing assistant should tell the family that progress is happening faster than it really is so they can feel better about the situation.
9.
10. When is it appropriate 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. How many times can disposable gloves be worn before being discarded? (A) Multiple times, as long as they are washed in between uses (B) Three times (C) Two times (D) One time
Name:
429
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
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 resident who has a visual impairment 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
430 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 injury (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
431 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 (D) Active data learning 41. Which of the following terms describes a bed that is made while a person is in the bed? (A) Occupied bed (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
47. Rapid breathing, over 20 breaths per minute, is called (A) Eupnea (B) Apnea (C) Dyspnea (D) Tachypnea 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
432
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) 91/55 (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 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? 60. A(n) stocking is a special stocking that (A) 3 ounces can help promote circulation. (B) 30 ounces (A) Sheer (C) 90 ounces (B) Clotting (D) 120 ounces ng TESTBANKSELL(CE) RR.oCtaOtiM 54. In which direction should the NA wipe when (D) Elastic providing perineal care? 61. A urine specimen can be collected (A) Wipe from front to back 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 62. To monitor a resident’s pulse rate, the NA will gray is most commonly check the pulse. (A) Dermatitic (A) Radial (B) Cyanotic (B) Brachial (C) Dysphagic (C) Carotid (D) Necrotic (D) Temporal 56. What is one of the first signs that a pressure 63. Which of the following canes has four rubberinjury is forming? tipped feet? (A) Cool skin (A) Curved cane (B) Full-thickness skin loss (B) Functional grip cane (C) Shallow crater on the skin (C) C cane (D) Discoloration of the skin (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) Prediabetes (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.
433 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 the 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 resident who has diabetes is to (A) Dystrophy (A) Inspect and clean the resident’s feet every (B) Atrophy day (C) Contracture (B) Clip the resident’s toenails whenever they (D) Dislocation are long Generally speaking, which is the last sense to (C) Use lotion between the toes to prevent leave a person who is dying? 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.
434 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 assistive devices for eating or dressing? (A) Speech-language pathologist (B) Occupational therapist (C) Activities director (D) Registered dietitian nutritionist 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 injuries
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 elimination needs
435 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 nutritionist (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
438 1. B
35. A
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36. C
3. C
37. B
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439 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
442 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.
2.
Answers will vary, but could include something about keeping the resident’s information confidential and not gossiping with coworkers.
3.
Answers will vary, but could include something about respecting residents’ beliefs and not trying to change them.
4.
Answers will vary, but could include something about listening to the resident, not judging the resident, and not discussing personal problems.
5.
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.
A
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Learning Objective 4 1.
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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.
7.
Answers will vary, but could include something about writing down tasks and asking questions when something needs to be explained again.
8.
Answers will vary, but could include something about being open and nonjudgmental and not making prejudiced comments.
Learning Objective 8 1.
B
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Answers will vary.
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Answers will vary.
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C
Learning Objective 6
Learning Objective 9
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Procedure manual
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Learning Objective 13
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Liability
Chapter 2: Ethical and Legal Issues
Learning Objective 11 1.
2.
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 stability? Is the nursing asTsiE stS anTtBthAeNriK gh StELLER.3.COBM person to do the job? Can the nurse give 4. D appropriate direction and communication? Is the nurse available to give the Learning Objective 3 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? Are there questions I should ask? Do I believe that I can do this task? Do I have the necessary skills? Do I have the needed supplies, equipment, and other support? Do I know who my supervisor is, and how to reach him/her? Have I told my supervisor of my special needs for help and support? Do we both understand who is doing what?
3.
Answers include the following: Ask for help. Talk to the nurse.
Learning Objective 12 1.
C
2.
A
2.
Empathy
5.
Confidential
6.
Gifts
Down 1.
Report it
3.
Tactful
4.
Honest
Learning Objective 4 1.
All revolve around the idea that a resident, patient, or client is a valuable person who deserves ethical care.
444 2.
3.
Answers include the following: reporting mistakes I make, and reporting anything I deem dangerous to the right person. Report any suspected abuse to the proper person immediately.
Learning Objective 5
Multiple Choice 1.
A
2.
B
3.
B
4.
C
5.
D
1.
A
2.
B
3.
C
1.
F
4.
D
2.
T
Learning Objective 6
3.
T
4.
F
5.
T
6.
F
7.
F
8.
T
All answers will vary, but should somehow relate to the Residents’ Right in question. Learning Objective 7 1.
P
2.
I
3.
H
4.
K
5.
O
6.
F
7.
J
8.
E
9.
R
10. T
Learning Objective 8
9. T 10. F Learning Objective 9 1.
B
2.
A
3.
A
Learning Objective 10 1.
The ombudsman is a legal advocate for residents.
2.
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.
11. D 12. A 13. Q 14. N 15. L 16. C 17. S 18. B 19. M 20. G
Learning Objective 11 1.
A
2.
B
3.
C
445 4.
D
5.
B
6.
B
2.
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.
3.
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.
4.
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.
5.
NA asks questions that only require yes/ no answers. Ask open-ended questions that need more than a yes or no answer.
6.
NA responds with “Why not?” Why questions make people feel defensive.
Learning Objective 12 1.
F
2.
T
3.
T
4.
F
5.
T
6.
T
Chapter 3: Communication Skills Learning Objective 2 1.
T
2.
F
3.
T
4.
F
5.
T
6.
T
7.
F
8.
T
Short Answer
7.
Resident speaks a different language. Speak slowly and clearly. Keep your mesTESTBANKSELLER.COsMages 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 family, friends, or other staff members who speak the resident’s language for help. Be patient and calm.
1.
P
2.
N
3.
N
1.
C
4.
P
2.
B
5.
N
3.
A
6.
N
4.
A
7.
N
8.
P
1.
T
Learning Objective 3
2.
T
3.
F
4.
F
5.
T
1.
NA asks questions that only require yes/ no answers. Ask open-ended questions that need more than a yes or no answer.
Learning Objective 4
Learning Objective 5
446 6.
T
3.
B
7.
F
4.
C
Learning Objective 6
Learning Objective 10
1.
C
1.
Retrieved
2.
O
2.
Legible
3.
E
3.
Computer
4.
G
4.
Password
5.
F
5.
Log out
6.
A
6.
HIPAA
7.
N
8.
B
1.
A
9.
L
2.
D
10. D
3.
C
11. M
Learning Objective 11
Learning Objective 12
12. K
1.
T
13. H
2.
T
14. I 15. J Learning Objective 7
TESTBANKSEL3L. ERF.COM 4.
T
5.
T
1.
1410
6.
F
2.
0430
7.
F
3.
1000
Short Answer
4.
2025
1.
O
5.
6:00 a.m.
2.
O
6.
11:20 p.m.
3.
O
7.
7:27 p.m.
4.
S
8.
6:00 p.m.
5.
S
6.
O
Learning Objective 8 1.
C
7.
O
2.
D
8.
O
Learning Objective 9
9.
O
1.
B
10. S
2.
B
11. O 12. O
447 13. S
Learning Objective 16
14. S
1.
B
15. S
2.
D
16. O 17. O
Learning Objective 17 1.
Residents signal staff that they need them by using the facility call system. It allows residents to call for help when needed.
2.
The call system is a resident’s lifeline. Ignoring call lights can be considered abuse and/or neglect.
18. S Short Answer 1.
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.
Learning Objective 18 1.
Falls, pain, move
2.
Residents
3.
Admissions, discharges
4.
Pulse, pressure injury
5.
Rounds
Learning Objective 19 1.
C
2. D EsShToB Touch: Note if the skin seT em t oArN coKldS. ELLER.COM Check to see if it is dry or moist. 3. B Learning Objective 13
4.
A
1.
C
2.
E
1.
B
3.
B
2.
C
4.
D
3.
A
5.
A
4.
B
Learning Objective 14
5.
B
Learning Objective 20
1.
C
Chapter 4: Communication Challenges
2.
B
Learning Objective 2
3.
C
1.
B
Learning Objective 15
2.
A
1.
B
3.
D
2.
C
4.
B
3.
A
5.
C
448 Learning Objective 3
3.
Eyes, fists
1.
A
4.
Silent
2.
D
5.
Care conference
Learning Objective 4
6.
Caused
1.
T
7.
Argue
2.
F
8.
Activities
3.
T
9.
Assertive, aggressive
4.
F
5.
T
1.
A
6.
F
2.
C
Learning Objective 5
3.
D
1.
Anxiety is unease or worry, often about a situation or condition.
2.
Answers include the following: nausea, shaking, sweating, chest pain, and palpitations.
Learning Objective 8
Learning Objective 9 Across 2.
Judge
5.
Overreact
6. Masturbation Answers include the following: Knock on the door, announce yourself, and greet the Down resident as soon as you enter theTrEoS om T.BANKSELLER.COM 1. Clothes Do not touch him before you have identified yourself. Speak softly. Reduce the 3. Dementia noise level. Speak slowly and calmly. Lis4. Privacy ten to the resident. Be patient. Ask gentle questions to try to identify the cause of the Learning Objective 10 anxiety or fear. Be empathetic. Be calm and reassuring. Avoid demanding 1. Confusion is the inability to think clearly behavior. and logically. Disorientation is confusion about person, place, or time. Learning Objective 6 2. Answers include the following: who the 1. T resident is; who the nursing assistant is; the city, state, and facility he is in; and the 2. F correct time. 3. T 3. Answers include the following: urinary 4. F tract infection; low blood sugar; head trauma or head injury; dehydration; nu5. F tritional problems; fever; sudden drop in 6. T body temperature; lack of oxygen; medications; infections; brain tumor; illness; loss 7. F of sleep; seizures; and not using a hearing 8. T aid when it is necessary. 3.
Learning Objective 7 1.
Anger
2.
Independence
4.
Answers include the following: Use short, simple sentences. Break tasks into steps.
449 Learning Objective 11
Learning Objective 6
1.
C
1.
B
2.
A
2.
A
Learning Objective 12
3.
A
Learning Objective 7
1.
Breathing, mouth, lips, airway
2.
Palate
Across
3.
Tracheostomy
3.
Substance abuse
4.
Write down
4.
Nurse
5.
Oxygen
5.
Boundaries
6.
Dentures
6.
Cliché
7.
Empathetic
Down
Chapter 5: Diversity and Human Needs and Development Learning Objective 2
1.
Scope of practice
2.
Interrupt
Learning Objective 8
1.
A
1.
T
2.
D
2.
F
Learning Objective 3
3.
T
TESTBANKSELLER.4.COTM
1.
D
2.
B
5.
3.
A
Matching
Learning Objective 4
1.
C
F
1.
Need
2.
G
2.
Belong
3.
D
3.
Physical
4.
B
4.
Anxiety
5.
E
5.
Dependent
6.
A
6.
Self-actualization
7.
F
Learning Objective 5
Learning Objective 9
1.
F
1.
J
2.
F
2.
F
3.
T
3.
B
4.
F
4.
K
5.
F
5.
D
6.
T
6.
C
450 7.
G
3.
F
8.
I
4.
F
9.
H
5.
F
10. E
6.
T
11. A
7.
T
Short Answer
8.
T
1.
9.
T
2.
3.
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. T 11. F 12. F 13. T 14. F 15. F 16. T 17. T
Learning Objective 10 1.
Growth
2.
Development
3.
Motor
4.
Moral
5.
Cognitive
6.
Social
7.
Sexual
Multiple Choice 1.
B
2.
B
3.
A
4.
C
Learning Objective 11 1.
A
2.
C
3.
B
Learning Objective 12 1.
T
2.
T
18. T 19. T
TESTBANKSEL2L0E. RT.COM 21. F 22. T 23. T 24. F Chapter 6: Infection Prevention and Control Learning Objective 2 1.
G
2.
F
3.
J
4.
I
5.
E
6.
A
7.
D
8.
H
9.
C
10. B
451 Learning Objective 3
7.
F
8.
F
1.
T
2.
F
3.
T
1.
A
4.
F
2.
C
5.
T
3.
D
6.
F
4.
C
7.
F
5.
A
Learning Objective 8
Learning Objective 4
Short Answer
1.
The chain of infection describes how disease is transmitted from one being to another.
2.
One
3.
Causative agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host
Learning Objective 9
Learning Objective 5 1.
B
2.
C
Across 4.
Biohazard
5.
Inside
6.
Shake
Down
TESTBANKSELLER.1.CODMisposable
Learning Objective 6 1.
CDC
2.
Transmission-Based Precautions
3.
Infected
4.
Contagious
5.
Mask, goggles
6.
Biohazard
7.
Personal, equipment
8.
Contaminated
9.
Cleanest, dirtiest
Learning Objective 7
A checkmark should be marked next to numbers 1, 3, 5, 6, and 8.
2.
Gloves
3.
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.
2.
Don gloves immediately
3.
Immediately wash that area using the proper cleaning agent and follow exposure incident guidelines
Learning Objective 11
1.
T
1.
C
2.
F
2.
C
3.
T
3.
A
4.
T
4.
D
5.
T
5.
A
6.
F
6.
C
452 Learning Objective 12 1.
Answers include the following: gives them a connection to the outside world, and helps reduce loneliness.
2.
Disposable
3.
Answers include gloves, gowns, masks, goggles, face shields, extra plastic bags, and laundry bags.
Learning Objective 13 1.
OSHA
2.
Bloodborne Pathogen
3.
Exposure control
4.
Infected blood, body fluids
5.
Hepatitis B
Learning Objective 14 1.
C
2.
B
3.
B
4.
C
Learning Objective 15
4.
F
5.
T
6.
F
7.
T
8.
T
9.
F
10. T 11. F 12. T 13. F 14. T 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 TESTBANKSELLERin.gCesOteMd by a person; and the safe handling, storage, and disposal procedures for the product.
1.
F
2.
T
3.
T
4.
F
1.
Gloves
5.
F
2.
Clear
6.
T
3.
Bottom
7.
F
4.
¾
8.
T
5.
Sharp
9.
F
10. F Chapter 7: Safety and Body Mechanics Learning Objective 2 1.
T
2.
F
3.
T
2.
Where they are located and how to read them
Learning Objective 4
Learning Objective 5 1.
C
2.
E
3.
A
4.
D
5.
B
453 Multiple Choice
6.
F
1.
A
7.
T
2.
B
8.
F
3.
C
9.
F
Learning Objective 6
Learning Objective 10
1.
B
1.
Medication, fluids
2.
B
2.
Gloves
3.
A
3.
Blood pressure
4.
Pump, alarm
5.
Catheter
6.
Infiltration
7.
Pain, breathing
Learning Objective 7 1.
Restraint-free
2.
Restraint alternatives
3.
Call lights
4.
Exercise
5.
Wander
6.
Social
7.
Caregivers
8.
Noise
9.
Music
Learning Objective 8
Learning Objective 11 1.
B
2.
A
3.
B
Learning Objective 12
TESTBANKSELLER.1.COFM 2.
F
3.
T
4.
F
5.
T
6.
F
Across 2.
Cyanotic
3.
Discipline
4.
Fifteen
Down 1.
Two
2.
Call light
Learning Objective 9 1.
F
2.
T
3.
T
4.
T
5.
F
Chapter 8: Emergency Care, First Aid, and Disasters Learning Objective 2 1.
Assess the situation and assess the victim
2.
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.
454 Learning Objective 3
5.
G
Across
6.
K
2.
Emesis
7.
C
4.
Cardiac arrest
8.
E
5.
Syncope
9.
M
Down
10. I
1.
Respiratory arrest
11. A
3.
Abdominal thrusts
12. H
4.
CPR
13. L
True or False
Learning Objective 4
1.
F
1.
Emergencies
2.
F
2.
Fire, cardiac arrest
3.
T
3.
Code team
4.
F
4.
Cart
5.
T
5.
Chest compressions
6.
F
7.
F
8.
T
9.
F
Learning Objective 5 swers will vary. TESTBANKSEL1L. ERA.nC OM 2.
10. T 11. F 12. F 13. F 14. T 15. T 16. F 17. T 18. T
Chapter 9: Admission, Transfer, Discharge, and Physical Exams Learning Objective 2 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.
2.
Answers will vary.
Matching 1.
B
2.
F
3.
D
4.
J
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.
455 Learning Objective 3 1.
2.
Learning Objective 7
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 residents may have been independent for a 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.
D
2.
A
3.
C
4.
B
5.
C
Chapter 10: Bedmaking and Unit Care Learning Objective 2 1.
Sleep, energy
2.
Cells, organs
3.
Biorhythms
4.
Circadian rhythm
Learning Objective 3 1.
B
1.
F
2.
D
2.
T
3.
E
3.
F
4.
T
5.
G
5.
T
6.
A
6.
F
7.
C
7.
F
8.
F
9.
F
TESTBANKSELLER.4.COFM
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 is taking; her roommate keeping the light on during the night; and roommate’s need to have NAs 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.
3.
Answers include the following: decreased mental function, reduced reaction time, decreased immune system function, and irritability.
10. T Learning Objective 5 1.
Change, ill, worsened
2.
Smooth
3.
Pack
4.
Introduce
5.
Nurse
Learning Objective 6 1.
A
2.
A
3.
D
456 Learning Objective 5
6.
Legs
A checkmark should be marked beside numbers 1, 3, 5, 6, and 8.
7.
Tighten
8.
Close
True or False
9.
Push
1.
T
2.
F
3.
T
4.
T
5.
F
6.
F
Learning Objective 3
Learning Objective 6
1.
E
2.
B
3.
A
4.
F
5.
J
6.
C
1.
B
7.
D
2.
C
8.
I
3.
A
9.
G
4.
B
10. H
Learning Objective 7 1.
C
2.
B
3.
B
4.
A
5.
B
6.
C
7.
D
8.
B
9.
A
Short Answer 1.
TESTBANKSELLER.COM
10. B 11. A Chapter 11: Positioning, Moving, and Lifting Learning Objective 2 1.
Assess
2.
Plan
3.
Support, footing
4.
Face
5.
Straight
Every two hours and every hour for wheelchairs
2.
Answers include the following: whiteness, redness, and warm spots, or skin that is a different color from surrounding skin, especially around bony areas.
Learning Objective 4 1.
B
2.
C
3.
D
4.
C
5.
A
6.
C
7.
A
8.
C
Learning Objective 5 1.
D
2.
A
3.
C
457 Chapter 12: Personal Care
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 injury (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 2 1.
T
2.
F
3.
F
4.
F
5.
F
6.
F
7.
T
8.
T
9.
F
10. F 11. T Learning Objective 3 1.
Partial bath is best suited to a resident who has drier, fragile, and more sensitive Learning Objective 4 skin, should not have daily full baths, is 1. A checkmark should be placed by numunable to get up to take a shower or tub T E S T B A N K SELLER.COM bath, and/or wants a quick bath before a bers 3, 4, 6, and 8. meal and plans on taking a shower or bath later in the day. Learning Objective 5 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.
1.
It helps reduce the risk of transferring microorganisms from a dirty area to a clean area of the body.
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.
2.
Wash from cleanest to dirtiest
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.
3.
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-
Labeling 1.
Eyes
2.
Face
3.
Ears
4.
Neck
5.
Arms, axillae, and hands
6.
Chest and abdomen
7.
Legs and feet
8.
Back
9.
Perineal area
10. Buttocks
458 Learning Objective 6
Learning Objective 9
1.
C
Across
2.
D
2.
Gloves
3.
C
3.
Crack
4.
C
4.
Denture cup
5.
C
5.
Bridge
6.
C
6.
Hot
Learning Objective 7
7.
Eat
1.
F
Down
2.
T
1.
Moderate
3.
F
4.
Dentures
4.
F
5.
F
1.
C
Learning Objective 8
2.
C
3.
C
4.
A
5.
A
1.
E
2.
A
3.
C
4.
B
5.
D
Learning Objective 10
TESTBANKSLEeaLrL ER.COM ning Objective 11
Short Answer 1.
2.
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.
1.
F
2.
F
3.
T
4.
F
5.
T
6.
F
7.
T
8.
F
9.
F
10. T 11. F 12. F 13. F 14. T 15. F 16. F
459 17. F
6.
A
18. T
7.
R
Chapter 13: Vital Signs
8.
T
Learning Objective 2
9.
R
1.
I
10. O
2.
E
11. TA
3.
J
4.
B
5.
C
6.
D
7.
F
8.
H
9.
G
10. A Short Answer
12. T 13. T Labeling 1.
101
2.
98.2
3.
101.6
4.
99.4
5.
100.8
6.
102.4
7. 102 Answers include the following: Vital signs 8. 99 are important readings that tell how well the organs of the body areTwEoS rkT inBgA . TNhKeS y ELLER. 9.CO1M00.4 can indicate whether the body is healthy 10. 97.6 or ill. The first sign that a person is ill may be a change in his or her vital signs. When Learning Objective 5 one or more vital signs is too high or too 1. A low, it signals a potential health problem. 2. G Learning Objective 3 3. F 1. A 4. J 2. C 5. B 3. A 6. D Learning Objective 4 7. L There should be an X by numbers 1, 2, 4, 6, 8. H and 7. 9. E Short Answer 10. I 1. R 11. C 2. R 12. K 3. TA 13. N 4. R 14. M 5. T 1.
460 Learning Objective 6 1.
B
2.
A
3.
D
promptly to the nurse. Check on the resident often. Give back rubs frequently. Assist in frequent position changes. Use pillows to support the body. Be careful when moving, lifting, or transferring. Offer warm baths or showers. Assist the resident to the bathroom or help him to use commode, bedpan, or urinal. Encourage slow, deep breathing. Be patient, caring, and gentle.
Learning Objective 7 Across 3.
Exercise
4.
Hypotension
Chapter 14: Nutrition and Fluid Balance
5.
Systolic
Learning Objective 2
Down
Across
1.
Hypertension
4.
Taste
2.
Diastolic
6.
Dysphagia
6.
Orthostatic hypotension
7.
Malnutrition
Learning Objective 8
Down
1.
T
1.
Parkinson’s disease
2.
F
2.
Nutrition
3.
F
3.
Teeth
4.
F
5.
T
6.
T
7.
T
1.
216/108, not in normal range
2.
136/88, not in normal range
3.
166/44, not in normal range
4.
140/86, not in normal range
TESTBANKSEL5L. ERS. alC ivO aM
Learning Objective 9 1.
Answers will vary.
2.
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; increased restlessness; agitation or tension; change in behavior; crying; sighing; groaning; breathing heavily; and difficulty moving or walking.
3.
Answers include the following: Report complaints of pain or unrelieved pain
Learning Objective 3 1.
Answers include the following: cultural and ethnic background; traditions in families and cultures; the country or area of the country that a person is from; religious reasons; or may be vegetarian or vegan.
2.
Answers will vary.
Learning Objective 4 1.
P
2.
W
3.
F
4.
V
5.
F
6.
C
7.
M
8.
W
9.
V
10. W
461 Learning Objective 5 1.
Vegetables
2.
Fruits
3.
Grains
4.
Protein
5.
Dairy
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; commerciallyprepared foods such as breads, canned soups and vegetables, and certain breakfast cereals.
Short Answer 6.
Water
1.
D
2.
G
3.
P
1.
B
4.
P
2.
A
5.
D
3.
C
6.
F
7.
V, F
1.
Clear liquid diet
8.
G
2.
Renal diet
9.
G
3.
High-residue or high-fiber diet
10. D
4.
Low-calorie diet
11. V
Learning Objective 6
Learning Objective 7
TESTBANKSELLER.5.COSMoft diet
12. P
6.
Fluid-restricted diet
Short Answer
7.
High-protein diet
1.
8.
High-potassium diet
9.
Pureed diet
2.
Calorie balance is the relationship between the calories obtained from consuming food and fluids and the calories used during normal body functions and physical activity. Eating too fast and eating without paying attention to your food
10. Low-sodium diet 11. Low-residue or low-fiber diet 12. Full liquid diet
Vegetables, fruits, whole grains, and fatfree or 1% milk and low-fat dairy products
13. Mechanical soft diet
4.
Foods high in solid fats, added sugars, and salt
15. High calorie diet
5.
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
3.
14. Bland diet
16. Diabetic diet 17. Gluten-free diet 18. Lactose-free diet 19. Lacto-ovo vegetarian diet 20. Vegan diet 21. High-iron diet
462 Learning Objective 8 1.
T
2.
T
3.
F
4.
T
5.
F
Learning Objective 9 1.
Medical, unappetizing
2.
Malnutrition
3.
Report
4.
Diet
5.
Dentures, swallowing
6.
Coldness, infections, sleeping
7.
Appetite
8.
Season
9.
Diet cards
10. Positive Learning Objective 10 1.
T
2.
F
3.
T
4.
F
5.
T
6.
T
7.
T
8.
F
9.
F
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.
2.
Use physical and verbal cues if needed. Allow enough time to chew and swallow. Place food and drinks within the resident’s reach.
3.
Read menus to them if needed. Allow enough time for decision-making on menu items. When assisting with eating, 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.
5.
Ask the resident to open his mouth. Wait until the jaw relaxes to pull the utensil out TESTBANKSELLERo. M outh. Offer finger foods instead. f tC heOm Use smaller utensils, but do not use plastic utensils. Avoid using forks. 6.
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.
7.
Ask him to stop chewing. Offer smaller bites of food and feed him softer foods that do not need as much chewing.
8.
Remind him to swallow after every bite. After feeding a bite of food, lightly press an empty teaspoon against the lips to encourage the person to swallow the food.
9.
Ask him to chew and swallow the food. Touch the outside of the cheek and ask him to use his tongue to get the food. Use your fingers on the cheek near the lower jaw, and gently push food toward teeth. Avoid offering food such as rice that can stick inside the mouth or on dentures. Give sips of fluids often. Check the mouth
Learning Objective 11 1.
A
2.
D
3.
D
4.
B
463 for food often before offering more food, but do not place your fingers inside the mouth. Ask the resident to open his mouth so that you can check for food. Ask resident not to stand up with food in his mouth. 10. Remind him to close his lips. Show him how to close his lips if necessary. 11. A dentist will do an assessment of oral health. Thickened liquids or soft or pureed diets may be ordered. 12. Report it to the nurse immediately. A dentist will evaluate the resident as soon as 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.
better swallowing techniques. If drooling interferes with basic safety, medications may be ordered to decrease the drooling. Clothing protectors, towels, or pads may be used to protect clothing. 20. Seat him in a regular dining room chair with armrests, rather than a wheelchair. Position him upright at a 90-degree angle. Knees should be flexed, and feet and arms should be fully supported. Push the chair under the table and place his forearms on the table. 21. Ask him to keep his elbows on the table. Using a wheelchair wedge cushion may help. 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.
14. Use special straws and cups to help. A Learning Objective 13 1. A speech-language pathologist or a nurse T E S T B A N K SELLER.COM may teach this resident to practice blowing a whistle to help him close his lips. 2. D 15. Touch his lower lip to encourage him to open his 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 resident should be seated, not standing, while drinking. 18. Remind him to take another bite. Offer praise and encouragement. Do not rush the person. 19. Make sure he is in an upright eating position, using good posture. A consultation with a speech-language pathologist may be ordered to help the resident learn
3.
D
Learning Objective 14 1.
145 mL
2.
Input 420 mL, output 480 mL
3.
360 mL
4.
450 mL
5.
30 mL
6.
540 mL
7.
330 mL
8.
24 oz
9.
540 mL
Learning Objective 15 1.
B
Short Answer 1.
Encourage residents to drink fluids
464 2.
Answers may vary but could include something about how the weight could prevent the resident from drinking water.
Learning Objective 16
Learning Objective 5 1.
B
2.
A
3.
A
1.
Enters, eliminated
2.
Kidneys
3.
Gain, breathing, increased
1.
B
4.
Swelling
2.
C
5.
Restrict fluids
3.
A
6.
Surgery, medical test, tube
4.
D
Chapter 15: The Gastrointestinal System Learning Objective 2
Learning Objective 6
Learning Objective 7 1.
N
1.
D
2.
A
2.
B
3.
B
3.
H
4.
M
4.
G
5.
F
5. 6.
F C
6. 7.
I K
7.
E
8.
O
8.
I
9.
H
9.
A
10. C
Learning Objective 3
11. D 12. G
1.
Gastrointestinal tract, accessory organs
2.
Trachea
13. J
3.
Small intestine
14. L
4.
Peristalsis
15. E
5.
Water, electrolytes
6.
Ingestion, digestion, elimination
Learning Objective 4
Learning Objective 8 1.
Eliminating stool
2.
Diagnostic test, surgery
1.
T
3.
Tap, saline, soapsuds
2.
T
4.
Sims’
3.
T
5.
Pain
4.
F
6.
Stool, straining
5.
F
465 Learning Objective 9
Chapter 16: The Urinary System
1.
T
2.
T
1.
Kidneys, ureters
3.
F
2.
Urine
4.
F
3.
Shorter
5.
T
4.
Waste, water
6.
T
7.
F
1.
T
Learning Objective 10
2.
F
Learning Objective 2
Learning Objective 3
1.
With a microscope or chemical test card
3.
T
2.
Card should be checked to make sure it has not expired
4.
T
Learning Objective 11
Learning Objective 4 1.
B
1.
B
2.
D
2.
B
3.
A
3.
A
4.
B
Learning Objective 12
Learning Objective 5 1.
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.
Across 3.
Retraining
5.
Positive
6.
Bedpan
7.
Call lights
2.
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.
3.
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.
Standard Precautions
2.
Elimination habits
4.
Perineal care
Learning Objective 13 1.
B
2.
A
3.
A
Growth and development: Aging affects
TESTBANKSELLER.COtMhe bladder’s ability to hold urine. Older
466 4.
5.
6.
7.
Physical activity and exercise: A lack of exercise lessens sphincter control. Childbirth can affect a woman’s muscle tone. Indwelling catheters and trauma can affect muscle tone and increase risk of infection. Personal habits: If a resident is confined to bed, urination may be more difficult due to his position. Complete emptying of the bladder may be difficult when having 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
Learning Objective 9 1.
A
2.
C
3.
B
4.
D
Learning Objective 10 1.
C
2.
A
3.
A
4.
D
Learning Objective 11 1.
T
2.
F
3.
T
4.
T
5.
F
6.
F
7.
T
1.
C
2.
A
3.
E
4.
D
Chapter 17: The Reproductive System
5.
B
Learning Objective 2
Learning Objective 7
TESTBANKSELLER.COM
1.
Ovulation
1.
B
2.
Gonads
2.
A
3.
Estrogen, progesterone
3.
D
4.
Ovaries, vagina
4.
D
5.
Penis, erectile, prostate
5.
C
6.
Uterus
Learning Objective 8
7.
Testosterone
8.
Sperm
1.
B
2.
A
3.
A
1.
T
4.
B
2.
T
5.
A
3.
F
4.
T
Learning Objective 3
467 5.
F
6.
T
1.
F
Learning Objective 4
2.
F
Learning Objective 3
1.
A
3.
T
2.
B
4.
T
3.
C
5.
T
4.
F
6.
T
5.
E
7.
F
6.
G
7.
H
8.
D
Learning Objective 5 1.
2.
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.
Learning Objective 4 1.
F
2.
I
3.
H
4.
E
5.
B
6.
D
7.
A
8.
G
Provide privacy and leave T thE eS arTeaB. ANKSELLER. 9.COJM
Chapter 18: The Integumentary System
10. C
Learning Objective 2
11. K
1.
Organ
2.
Melanin
1.
A
3.
Protects, sensation, water
2.
B
4.
Epidermis, dermis
3.
A
5.
Receptors
4.
D
Short Answer
5.
C
1.
2.
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 5
Learning Objective 6 1.
T
2.
F
3.
F
4.
T
5.
F
6.
T
7.
T
468 Multiple Choice
4.
T
1.
A
5.
F
2.
C
3.
A
1.
B
4.
C
2.
F
Learning Objective 7
3.
H
Open wounds increase the risk of infection because breaks in the skin are a way for bacteria and other microorganisms to enter the body.
4.
A
5.
M
6.
C
Nonsterile 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.
7.
K
8.
D
9.
G
Answers include the following: sterile dressings, sterile drapes or pads, and tubing and catheters.
11. I
1.
2.
3.
Learning Objective 4
10. E
12. L
13. J If any part of the sterile field becomes Chapter 20: The Respiratory System contaminated, the entire process must be T ES T B ANKS ELLER.COM restarted. Learning Objective 2 Chapter 19: The Circulatory or Cardiovascular 1. Supply, remove System 2. Respiration Learning Objective 2 3. Trachea 1. D 4. Lungs, inspiration 2. B 5. Speak 3. B 6. Pleura 4. B 7. Oxygen, carbon dioxide 5. A 8. Continuous 6. A 9. Alveoli 7. C Short Answer 8. B 1. Nose, nasal cavity, pharynx, larynx, traLearning Objective 3 chea, bronchi, lungs, and alveoli 4.
1.
F
2.
T
3.
F
2.
Answers include the following: serving as an air filter; cleaning the inhaled air; supplying oxygen to body cells; removing carbon dioxide from the cells; and producing the sounds associated with speech.
469 Learning Objective 3
Down
1.
T
1.
Microorganisms
2.
F
2.
Sputum
3.
T
3.
Water
4.
F
4.
Mouthwash
5.
T
6.
F
1.
D
7.
T
2.
A
8.
T
3.
B
Learning Objective 4
Learning Objective 7
Chapter 21: The Musculoskeletal System
1.
A
2.
D
1.
Shape, structure
3.
G
2.
Move, support, protection, heat
4.
H
3.
Tissues, contracting, relaxing
5.
C
4.
Bones, skeleton
6.
E
5.
Joints, flexibility
7.
F
8.
I
Short Answer
9.
B
1.
Muscles, bones, joints, tendons, ligaments
Learning Objective 5
2.
Skeletal muscles, smooth muscles, and cardiac muscle
3.
Long bones, short bones, flat bones, and irregular bones
4.
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.
1.
F
2.
F
3.
T
4.
F
5.
T
6.
T
7.
F
8.
T
9.
T
10. F Learning Objective 6 Across 5.
Early morning
6.
Saliva
Learning Objective 2
TESTBANKSELLER.6.COLMigaments, support
Learning Objective 3 1.
T
2.
F
3.
T
4.
F
5.
T
470 Learning Objective 4 1.
B
2.
F
3.
G
4.
O
5.
M
6.
H
7.
L
8.
P
9.
A
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. Assistive 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.
10. J 11. K 12. D 13. I 14. E 15. C
3.
Partial weight-bearing (PWB) means the resident is able to support some body 16. N TESTBANKSELLERw.eiCghOtMon one or both legs. Non-weightShort Answer bearing (NWB) means the resident is unable to touch the floor or support any 1. Answers include the following: Pad the body weight on one or both legs. Full cast edges as needed. Do not get the cast weight-bearing (FWB) means the resident wet. Keep cast clean. Follow orders for can bear full weight on both legs. moving and repositioning. Use pillows to assist with elevation. Help with range of Learning Objective 5 motion exercises. Allow enough time to 1. A move. Assist with cane, walker, or crutches. Use bed cradles. Report numbness, 2. B tingling, or increased swelling; resident complaints of cast feeling too tight; pain, 3. C burning, or pressure; redness, drainage, Chapter 22: The Nervous System bleeding, or sores of any kind; wetness in or around a cast; odor around the cast; Learning Objective 2 changes in temperature of the skin; cya1. Controls, coordinates nosis or pale skin; or resident places sharp object inside the cast. 2. Senses, interprets 2. Answers include the following: Follow 3. Neuron the care plan exactly. Follow care plan regarding positioning and elevation of the 4. Central, peripheral head of the bed. Do not perform range of 5. Cranial nerves, spinal nerves motion exercises on a leg on the side of a hip replacement. Caution the resident not 6. Brain, spinal cord to cross legs in bed or in a chair or turn 7. Balance, hearing
471 8.
Reflex
True or False
9.
Skin, nose, ears
1.
F
10. Retina
2.
T
Learning Objective 3
3.
T
1.
T
4.
T
2.
T
5.
F
3.
F
6.
T
4.
F
Multiple Choice
5.
T
1.
B
6.
F
2.
D
Learning Objective 4
3.
A
1.
F
4.
B
2.
J
5.
A
3.
M
4.
Q
1.
C
5.
E
2.
C
6.
S
3.
C
7.
C
8.
N
9.
V
Learning Objective 5
Learning Objective 6 1.
Alzheimer’s disease (AD) is a progressive, degenerative, and incurable disease that causes proteins (plaques and tangles) to 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.
10. I 11. U 12. A 13. D 14. L 15. K 16. O 17. H 18. B 19. R 20. T 21. G 22. P
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,
472 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.
4.
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.
5.
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: Helping residents keep their minds and bodies active may help slow the progress of the disease.
Learning Objective 7 Across 1.
Don’t
4.
Perseveration
Down 2.
Nonverbal
3.
Identify
5.
Subject
6.
Touch
Learning Objective 8 1.
2.
3.
6. Answers include the following: Family TeEoS .COM Answers include the following: P plT e BANKSELLERmembers can be a great resource. They with AD do not always have control over may know things you would have to learn their behavior. They may not be aware of by trial and error. Families can be of great what they say or do. Remember that it is comfort to victims of AD, helping you the disease causing the behavior. These provide quality care. actions are not within the person’s control. 7. Answers include the following: Along Answers include the following: Think with practical tasks, the care plan will call about what it would feel like to have Alfor maintaining residents’ dignity and zheimer’s disease. Imagine being unable self-esteem. Provide security and comfort. to perform your ADLs. Be understanding Promote independence for as long as and compassionate. Assume that resipossible. dents with AD have insight and are aware Learning Objective 9 of the changes in their abilities. Provide security and comfort. 1. T Answers include the following: Each per2. F son with Alzheimer’s disease is an individual. AD does not progress the same way in 3. T everyone. Each resident will do things that 4. F others may never do. Take an interest in each individual. Work with what you see 5. F today. Notice changes in behavior, mood, 6. T and independence and report your observations to the nurse. 7. T
473 8.
T
6.
T
9.
T
7.
F
10. F
8.
T
11. T
9.
T
12. T Learning Objective 10 1.
2.
Answers will vary, but could include something about responding calmly, using 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. Answers will vary, but could include using distraction and being calm.
Learning Objective 12 1.
C
2.
A
3.
B
Learning Objective 13 1.
Mental health
2.
Disorder
3.
Generalized anxiety disorder
4.
Posttraumatic stress disorder
3.
5. Repetitive Answers will vary but could include reporting the signs to the nurse. Other ideas 6. Social anxiety are encouraging independence and selfcare, and rewarding activities that improve 7. Clinical depression moods. Finding ways to help foster social 8. Medication, psychotherapy relationships and listeninT gE toSreTsB idA enNtsKSELLER.COM when they want to talk may help. 9. Bipolar disorder
4.
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 gently directing the resident to a private area and distraction. Report this behavior to the nurse.
5.
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.
10. Schizophrenia Learning Objective 14 1.
Answers include the following: that they are widely prescribed, they can be obtained legally and illegally, they cause positive feelings which lead to dependence, and tolerance increases with use, which can lead to overdosing.
2.
Answers include the following: a family history of addiction, having a mental illness, an unstable home environment, poor coping skills, and taking a highly addictive drug.
3.
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.
Learning Objective 11 1.
F
2.
T
3.
T
4.
F
5.
F
474 Chapter 23: The Endocrine System
7.
F
Learning Objective 2
8.
F
1.
Hormones
2.
Testes
1.
Immune, infections
3.
Glands
2.
Circulation
4.
Development, reproduce
3.
Amputation
5.
Pituitary
4.
Daily care
6.
Adrenaline, heart
5.
Harsh, hot
7.
Insulin
6.
Object
7.
Between
Learning Objective 3
Learning Objective 6
1.
T
8.
Barefoot
2.
F
9.
Reddening, blackening
3.
F
4.
T
Learning Objective 4 1.
F
2.
G
3.
H
4.
E
5.
B
6.
C
7.
A
8.
J
9.
D
10. K 11. I Learning Objective 5 1.
F
2.
T
3.
T
4.
T
5.
F
6.
F
Chapter 24: The Immune and Lymphatic Systems and Cancer Learning Objective 2 1.
Bacteria, microorganisms
2.
Nonspecific, specific
4.
Passive
5.
Nodes, thymus
6.
Lymph
7.
Blood
TESTBANKSEL3L. ERA.ctCivOe,Mvaccine
Learning Objective 3 1.
T
2.
F
3.
F
4.
T
Learning Objective 4 1.
HIV attacks the immune system and damages or destroys its cells. HIV gradually weakens the immune system.
2.
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;
475 having sexual contact with many partners; or sharing drug needles or syringes. 3.
4.
5.
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. An opportunistic infection is an illness caused by microorganisms that do not affect people with healthy immune systems but cause disease in people with weakened immune systems. Answers will vary but could include telling the resident that AIDS is not transmitted through casual touching; NA can explain how AIDS is transmitted.
Learning Objective 5 1.
C
2.
B
3.
A
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 injuries and infections.
3.
Mouth care can help with mouth pain or sores. Mild rinses can help with bad taste in the mouth.
4.
People with cancer need to eat and drink enough to maintain their energy levels. Unintended weight loss can occur with cancer or cancer treatment.
5.
Urine may have blood in it, and output may decrease. Urine can become more concentrated and have an odor. Diarrhea can occur, along with blood in stool.
TESTBANKSELLER.6.CORMesidents with cancer may have fatigue
and weakness, which can make movement difficult.
Learning Objective 6 1.
B
2.
B
3.
B
4.
A
5.
A
7.
Cancer can cause severe pain; it can affect the ability to sleep, eat, and move.
8.
Changes in vital signs can occur with 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.
Learning Objective 7 1.
A
2.
H
3.
J
4.
N
5.
G
6.
I
7.
D
8.
C
9.
L
10. E
10. Some people with cancer want to talk about their diagnosis and treatment. Others withdraw and avoid discussing their disease. 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.
2.
Answers include the following: assist the resident in maintaining and/or regaining
476 the ability to perform ADLs; promote resident’s independence and help resident adapt to the new disability; and prevent complications of immobility. 3.
Answers include the following: eliminating, range of motion exercises, positioning, mobility and ambulation, transferring, grooming, eating and drinking, splints or braces, and communication.
Learning Objective 3
Learning Objective 6 1.
Assistive
2.
Foot drop
3.
Abduction
4.
Outward
5.
Contractures
6.
Support, protection
Learning Objective 7
1.
F
1.
E
2.
T
2.
A
3.
T
3.
H
4.
F
4.
J
5.
T
5.
K
6.
T
6.
B
7.
T
7.
L
Learning Objective 4
8.
I
1.
9. F Gastrointestinal: promotes appetite and aids regular elimination TESTBANKSEL1L0E. RD.COM
2.
Urinary: improves elimination, helping to decrease infection
11. C
3.
Integumentary: improves the quality and health of the skin
13. G
4.
Circulatory: improves circulation
5.
Respiratory: reduces the chance of infections, such as pneumonia, and improves oxygen level
12. M
Labeling 1.
Abduction
2.
Adduction
3.
Extension
6.
Musculoskeletal: increases blood flow to the muscles and improves strength
4.
Flexion
7.
Nervous: improves relaxation and sleep
5.
Dorsiflexion
8.
Endocrine: increases metabolism, helping to maintain healthy weight
6.
Rotation
7.
Pronation
8.
Supination
9.
Opposition
Learning Objective 5 1.
D
2.
A
3.
D
4.
B
477 Chapter 26: Subacute Care
4.
Fowler’s
Learning Objective 2
5.
Aspiration
1.
2.
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 3 1.
B
2.
D
3.
C
4.
A
Learning Objective 4 1.
T
2.
F
3.
T
4.
F
5.
T
Down 1.
Cancer
2.
Speak
3.
Stoma
Learning Objective 8 1.
T
2.
F
3.
F
4.
T
5.
F
6.
T
7.
T
8.
F
Learning Objective 9 1.
themselves. 2.
Answers include the following: gurgling, an elevated respiratory rate, shortness of breath, difficulty breathing, or pallor or cyanosis.
3.
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,
Learning Objective 5 1.
Cardiac
2.
Rhythm, rate
3.
Chest
4.
Vital signs
5.
Loose
Learning Objective 6 1.
A
2.
D
3.
B
Learning Objective 7 Across 3.
Skin care
Suctioning is needed when a person has
TESTBANKSELLER.COiMncreased secretions that they cannot expel
478 amount, or quality of secretions coughed up; or nervousness or anxiety. Learning Objective 10 1.
A
2.
C
3.
D
4.
C
5.
B
Learning Objective 11 1.
E
2.
F
3.
D
4.
B
5.
A
6.
C
2.
F
4.
T
5.
T
6.
F
Learning Objective 4 1.
C
2.
B
3.
A
4.
E
5.
D
Learning Objective 5 1.
Chapter 27: End-of-Life Care
2.
5.
Learning Objective 2 1.
2.
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, Kidney dialysis is a process that cleans exams, and anything else the resident the body of waste that the kidneT ysEcS anTnB otANKSELLERw.isC hO esM . remove due to chronic renal failure. 3. Answers will vary, but could include the Answers include the following: signs following: Monitor response to pain mediof respiratory distress; changes in vital cation. Report if resident appears to be in signs; pain, drainage, or bleeding from the pain or is experiencing discomfort. insertion site; abdominal cramps, nausea, 4. Answers will vary, but could include the or vomiting; muscle cramps; swelling of following: Notify the nurse if the resident extremities (edema); change in I&O; or has questions. itchy skin.
Learning Objective 12 1.
3.
Answers will vary, but could include the following: Do not judge these decisions. Notify the nurse if the resident has any questions.
Palliative care is given to people who have serious, life-threatening diseases, as well as to people who are dying.
Learning Objective 6
Answers include the following: to control symptoms, reduce suffering, prevent side effects and complications, and maintain the best quality of life possible.
Learning Objective 7
Learning Objective 3 1.
T
2.
F
A checkmark should be placed by numbers 1, 3, 4, 5, 7, and 9.
1.
Answers will vary.
2.
Answers will vary.
3.
Answers will vary but could include something about the fact that listening is important because it gives the dying person a
479 chance to express his feelings and concerns, as well as any physical complaints. Learning Objective 8 A checkmark should be placed by numbers 2, 3, 4, 7, 8, and 9. Learning Objective 9 1.
Blood pressure
2.
Jaw, open
3.
Eyelids, fixed stare
4.
Urinary, fecal
5.
Fixed, dilated
F
2.
T
3.
F
4.
T
5.
F
6.
F
1.
F
2.
F
3.
T
4.
F
5.
T
Answers will vary. Learning Objective 4 A checkmark should be placed by numbers 2, 4, and 8. Learning Objective 5 A checkmark should be placed by numbers 2, 3, 5, and 7. Learning Objective 6 Across
TESTBANKSELLER.3.CORMead it
Learning Objective 11 1.
Check with her supervisor first to make sure it is appropriate
2.
Answers include the following: not hesitating to express their feelings; getting enough sleep, eating nutritious meals, drinking only in moderation, and not smoking; participating in enjoyable activities and exercising regularly; spending quality time with the people they love; sharing important memories about the resident with others; joining a special support group for grieving; and talking to a counselor if the need arises.
Learning Objective 12
Learning Objective 2
Learning Objective 3
Learning Objective 10 1.
Chapter 28: Your New Position
4.
Job description
Down 1.
Procedure
2.
Nurse
5.
Injury
Learning Objective 7 1.
C
2.
D
3.
C
4.
A
Learning Objective 8
1.
B
1.
T
2.
B
2.
F
3.
A
3.
T
4.
C
4.
T
480 Learning Objective 9
6.
A
1.
Evaluation, appraisal
7.
D
2.
Knowledge, conflict, team
8.
A
3.
Constructive
9.
B
4.
Hostile
10. D
5.
Open
11. D
6.
Mistake
12. C
7.
Salary increases
13. A
8.
Advancing
14. A
Learning Objective 10 1.
2.
Conflict resolution is the process of resolving conflicts in a positive way so that everyone is satisfied with the result. Give her employer at least two weeks’ written notice that she will be leaving
Learning Objective 11
15. C 16. B 17. A 18. B 19. A 20. D
1. 2.
D B
21. B
3.
F
23. B
4.
G
24. C
5.
C
25. B
6.
H
26. B
7.
A
27. D
8.
E
28. D
Learning Objective 12
29. B
22. C
1.
Answers will vary.
30. A
2.
Answers will vary.
31. B
3.
Answers will vary.
32. C
Answer Key for Workbook Practice Exam 1.
C
2.
D
3.
A
4.
C
5.
B
33. B 34. C 35. B 36. C 37. B 38. A 39. A
481 40. A 41. D 42. A 43. B 44. C 45. B 46. A 47. C 48. B 49. C 50. A
292 Chapter 1: The Nursing Assistant in Long-Term Care 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 2. 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
Name: 7. 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 8. 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
3. Which of the following types of health care is 9. A disorder in which a person has a serious generally for people who will die in six months loss of mental abilities, including the ability to or less? think, remember, and reason, is known as (A) Long-term care (A) A terminal illness (B) Outpatient care (B) Dementia (C) Intergenerational care (C) Heart disease (D) Hospice care (D) Chronic disorder 4. is a federal health insurance program 10. Which of the following is a typical task that for people who are 65 years of age orToE ldS erToBr ANKSELLER.COM nursing assistants perform? people of any age with permanent kidney fail(A) Administering medication ure or certain disabilities. (B) Bathing a resident (A) Medicare (C) Changing sterile dressings (B) Medicaid (D) Giving tube feedings (C) Occupational Safety and Health Administration (D) Health and Human Services 5.
is a medical assistance program for people who have a low income or certain 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
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 elimination 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.
293 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 SELLER. OMis teC am a nursing assistant demonstrating that she is (A) The nurse 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
294 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 NKSELLER.COM 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. 2. 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.
295 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 3. 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.
296 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 injuries (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
297
298 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 2. 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 influences 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
3. An example of active listening is (A) NA looking around the room while the resident is speaking chRt. im TESTBANKS7E. LELaE 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
299 17. When using the computer at work, a nursing assistant should (A) Research different conditions that may affect the elderly (B) Exit the web browser when she is finished with charting (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 electronically? (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.
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 ELLER.COM 19. Which of the following is true of the MDS? and care (A) MDS stands for Multiple Diagnosis (D) Suggest the best treatment for the resident System. 14. A nursing assistant can share information (B) Every time an MDS is completed for a resiabout residents with dent, an investigation by the state is done. (A) Anyone she chooses (C) Not all residents will have an MDS. (B) The resident’s family and friends (D) A nursing assistant’s report may trigger a (C) Other members of the care team needed assessment for a resident. (D) No one 20. Which of the following is an example of objec15. Accurate documentation is important because tive information? (A) The NA does not want to get into trouble (A) “Mr. Castillo seems a little grouchy today.” (B) Documentation provides an up-to-date (B) “Mr. Castillo says that he has a record of a resident’s status and care stomachache.” (C) Family members will want to review the (C) “Mr. Castillo’s blood pressure is 115/68.” medical chart regularly (D) “Mr. Castillo doesn’t get along with the (D) The NA determines each resident’s diagnonurses.” sis based on her documentation 21. Which of the following is an example of sub16. When should documentation be recorded? jective information? (A) Immediately after care is given (A) “Mrs. Parker says she is dizzy.” (B) At the end of the shift (B) “Mrs. Parker has a temperature of 101°F.” (C) Whenever there is time (C) “Mrs. Parker had a visit from her son (D) Before the care is given today.” (D) “Mrs. Parker did not eat any of her dinner.”
300 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 25. What is the nursing assistant’s role in care admitted for dementia.” planning? (B) “Good afternoon, Hartman Skilled Care (A) The nursing assistant creates the care plan. Facility, Brenda Johnson speaking.” (B) The nursing assistant shares observations (C) “We’re very busy here today. Can you call that may affect the care plan. ckCsO om (C) The nursing assistant makes chaT nE geS sT toBANKSELLEbRa. M e other time?” (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 members make scheduled visits to each resident's 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
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302 Chapter 4: Communication Challenges Multiple Choice. Choose the correct answer. 1. One way for a nursing assistant to communicate effectively with a resident who has a visual impairment 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 2. If a resident has a hearing impairment, 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
Name: 5. Which of the following is the best example of how a nursing assistant should communicate with a resident who is anxious? (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 has depression? (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. (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 nursing assistant to respond to a resident who TESTBANKSELiL resident sE anRg. ryC ? OM (A) The NA should ignore the resident until 3. While distributing meal trays, Shanice gives the resident calms down. the wrong meal to a resident who has diabetes. (B) The NA should try to find out what is She says that the resident distracted her by causing the resident’s anger. complaining about the food. Which defense (C) The NA should ask the resident to stop mechanism is she using? being angry. (A) Denial (D) The NA should restrain the resident. (B) Projection (C) Repression 8. Which of the following is an example of (D) Rationalization aggressive, rather than assertive, behavior? 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
(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
303 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
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 ELLER.COM 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
304 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. 2. 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 3. 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 Ebony 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) Teresa is very religious and likes to share her religious views with her residents. (D) Lemarcus 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
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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
306 Chapter 6: Infection Prevention and Control 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 2. 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 3. One sign of a localized infection is (A) Chills (B) Headache (C) Drainage from a wound or cavity (D) Mental confusion
Name: 7. 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 8. How many links in the chain of infection must be broken to prevent infection? (A) One (B) Two (C) Three (D) Four 9. 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
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
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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 (B) Get vaccinated for common illnesses infected (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
308 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
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Chapter 7: Safety and Body Mechanics 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 2. 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
309 7. Which of the following needs to be disposed of in a biohazard container? (A) Trash (B) Sharps (C) Aluminum cans (D) Food 8. 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
3. 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 elimination (D) Locking the resident’s door from the outside
310 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
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Chapter 8: Emergency Care, First Aid, and Disasters 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. 2. 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
311 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. 8. 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 9. 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
3. 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.
312 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.
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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 2. 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.
313 6. There are (A) 10 (B) 12 (C) 15 (D) 20
inches in a foot.
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
314 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.
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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. 2. 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 3.
4.
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315 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 Sleep disorders are called (A) Leave the unit tidy (A) Insomnias (B) Move the resident’s belongings (B) Parasomnias (C) Leave spills for the next shift (C) Somnambulisms (D) Lock the resident’s door (D) Bruxisms 12. Where should the call light be placed when a 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
316 15. A resident who is at risk for pressure injuries 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
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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 2. 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 injuries. (C) NAs should check residents’ skin each time they are repositioned. (D) Bedbound residents should be repositioned every three hours.
317 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.
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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. 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 residTeE ntSwTitB hA - NKSELLER.COM out 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. 14. 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 15. When helping a resident who has a visual impairment to 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
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Chapter 12: Personal Care 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 2. 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
319 7. Observing residents’ skin during personal care and bathing is especially important in the prevention of (A) Depression (B) Abuse (C) Pressure injuries (D) Diabetes 8. 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 9. 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
3. 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 an Epsom (A) Wash from dirtiest to cleanest salts additive 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
320 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 residents who are unconscious 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 mouth care of residents who are unconscious include (A) Pouring mouthwash slowly into the resident’s mouth (B) Turning residents on their backs when giving mouth care (C) Avoiding performing mouth care on residents who are unconscious (D) Using as little liquid as possible when giving mouth care 22. A nursing assistant should give nail care
15. How often must mouth care be provided for residents? (A) Once a day (B) At least twice a day (C) Only when the resident requestsTitESTBANKSELLER.COM (A) Whenever she has time (D) Every other day (B) When she is bathing a resident 16. A resident who is edentulous (C) When she notices a resident’s nails are (A) Lacks teeth getting long (B) Has bad breath (D) When the resident’s nail polish wears off (C) Is wearing dentures 23. Which of the following statements is true? (D) Has tartar deposits on the teeth (A) Residents’ hair should be handled gently 17. Which of the following is true about mouth because hair can be pulled out when combcare? ing or brushing it. (A) Residents without teeth will not require (B) Residents’ hair should be combed or any mouth 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 mouth care. (C) Nursing assistants should cut residents’ (C) Mouth 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 mouth 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
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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 2. 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
321 8. An oral thermometer is usually color-coded (A) Green or blue (B) Red or orange (C) Black or white (D) White or gray 9. 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. 10. Which of the following thermometers is used to measure temperature in the ear? (A) Mercury thermometer (B) Axillary thermometer (C) Tympanic thermometer (D) Temporal artery thermometer
3. Common symptoms of a fever include (A) Muscle aches (B) Sleepiness (C) Slow movements (D) Nausea
11. Which of the following statements is true of taking rectal temperatures? (A) The nursing assistant should not explain the procedure before beginning so the resident will not feel anxious. T E S T B A N K S ELLER. C O (B) RM ectal thermometers should be inserted 4. If a nursing assistant suspects that a resident has a fever, he should two inches into the rectum. (A) Give the resident medication (C) The nursing assistant must hold on to the (B) Take the resident’s temperature thermometer at all times while taking a (C) Ask the resident how she is feeling rectal temperature. (D) Measure the resident’s pulse rate (D) To obtain an accurate temperature, the resident should move around slowly dur5. Which of the following is the normal temperaing the procedure. ture range for the oral method? (A) 97.6–99.6 degrees F (B) 96.6–98.6 degrees F (C) 93.6–97.9 degrees F (D) 98.6–100.6 degrees F 6. Which of the following is another word for armpit? (A) Tympanum (B) Rectum (C) Axilla (D) Temporal 7. Which method of taking temperature is considered to be the most accurate? (A) Oral (B) Rectal (C) Tympanic (D) Axillary
12. How far into the ear should a tympanic thermometer be inserted? (A) ¼ to ½ inch (B) ½ to 1 inch (C) 1 to 1 ½ inches (D) 1 to 2 inches 13. The normal pulse rate for adults is (A) 25 to 50 beats per minute (B) 60 to 100 beats per minute (C) 100 to 150 beats per minute (D) 150 to 175 beats per minute 14. 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
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15. 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
22. Blood pressure is measured using a (A) Thermometer (B) Watch (C) Finger (D) Sphygmomanometer
16. The medical term for difficulty breathing is (A) Eupnea (B) Apnea (C) Tachypnea (D) Dyspnea
23. Both the and pulses are used in taking blood pressure. (A) Radial and apical (B) Apical and brachial (C) Radial and brachial (D) Brachial and femoral
17. Why is respiration rate usually counted directly after taking the pulse rate, while the fingers are still on the wrist? (A) It is less work for the nursing assistant to count respirations right after taking the pulse. (B) People may breathe more quickly if they know they are being observed. (C) The chest will not rise and fall if the rate is not counted immediately. (D) The respiration rate will be different if the nursing assistant waits to take it.
24. Which of the following is an example of a correct way to write a blood pressure reading? (A) 110/70 (B) 110+70 (C) 110-70 (D) 110*70
25. Which of the following statements is true of pain? (A) Everyone experiences pain in the same way. (B) Everyone will express freely when they are 18. The difference between the apical and radial in pain. TESTBANKSEL L E Ra.inCiO pulse is called the (C) P sM a different experience for each (A) Pulse rate person. (B) Cheyne-Stokes (D) Pain levels do not need to be monitored. (C) Pulse deficit 26. Which of the following can help reduce pain? (D) BPM (A) Pounding the resident on the back 19. The blood pressure is the top number in (B) Jumping jacks a blood pressure reading, while the is (C) Squeezing the body part hard the bottom number. (D) Change of position (A) Radial, apical (B) Apical, radial (C) Diastolic, systolic (D) Systolic, diastolic 20. Which of the following blood pressure readings falls within the normal range? (A) 119/75 (B) 135/90 (C) 91/58 (D) 140/80 21. Hypertension is (A) High fever (B) High blood pressure (C) High pulse rate (D) Low blood pressure
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Chapter 14: Nutrition and Fluid Balance 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. 2. 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 3. 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
323 7. According to MyPlate, a person should choose dairy products that contain (A) 1% fat (B) 2% fat (C) 3% fat (D) 4% fat 8. According to MyPlate, what should half of the grains a person consumes be? (A) White (B) Refined (C) Whole (D) Flour 9. 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 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) Renal (D) Fluid-restricted 13. Which type of diet consists of only plant-based foods? (A) Lacto-ovo vegetarian diet (B) Lacto-vegetarian diet (C) Ovo-vegetarian diet (D) Vegan diet
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324 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 require thickened liquids. (A) Walking (B) Swallowing (C) Digesting food (D) Gaining weight
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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 the resi-
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(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 elimination needs 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) Put the plate to one side if the resident has a visual impairment 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 . ANKSELLER.COM (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
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326 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
2. The heart is an example of a(n) (A) Cell (B) Tissue (C) Organ (D) Body system
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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.
3. The muscular contractions that push food toward the stomach are called (A) Peristalsis (B) Mastication (C) Defecation (D) Absorption 4. Stool should normally 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
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
t pOoM sition for bowel elimination is TESTBANKS1E2.LTLhEe Rbe.sC
5. A 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. 18. Which of the following is one way that a bariatric bed may differ from a regular bed? (A) The bed may be lower to the floor. (B) The bed may be narrower. (C) The bed may not be able to be used. (D) The bed is made for people who weigh less than average.
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328 Chapter 16: The Urinary System Multiple Choice. Choose the correct answer. 1. What is another term for urinating? (A) Digesting (B) Eliminating (C) Ingesting (D) Voiding 2. 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 3. 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
Name: 7. 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 8. The best position for men to urinate is (A) Sitting (B) Standing (C) Lying (D) Crouching 9. One way for women to prevent UTIs is to (A) Reduce fluid intake to minimize work for the bladder (B) Drink plenty of water and other fluids (C) Urinate less often (D) Take baths rather than showers
10. is an artificial means of removing the 4. Which of the following statements is true of body’s waste products. urination? (A) Chronic renal failure (A) Indwelling catheters do not affect muscle (B) Kidney dialysis tone. (C) Urine retention (B) Fluids high in sodium increase uTriE nS arT y BANKSEL(L Re.pC DE )N hrOitM is output. 11. Which of the following is a guideline for deal(C) A lack of privacy can affect urination, as ing with urinary incontinence? can stress. (A) The nursing assistant should let room(D) The bladder holds more urine as people mates know when residents have been age, causing them to urinate less incontinent so that they can help notify the frequently. care team when incontinence occurs. 5. A way for a nursing assistant to promote nor(B) The nursing assistant should tell residents’ mal elimination for residents is to families about episodes of incontinence so (A) Encourage Kegel exercises they can encourage residents to do better. (B) Encourage residents to finish urinating as (C) The nursing assistant should change wet quickly as possible or soiled linens or incontinence briefs (C) Encourage female residents to lie flat on immediately. their backs when urinating (D) The nursing assistant should not offer flu(D) Discourage fluids for residents who uriids because this will help lessen episodes nate too frequently of incontinence. 6. What is one reason why women are more likely than men to have urinary tract infections? (A) Women's gonads have a different gonads (B) Women's kidneys do not filter blood properly (C) Women have a shorter urethra (D) Women have urinary incontinence
12. A(n) catheter is inserted to drain urine from the bladder several times a day and is removed each time after urine is drained. (A) Straight (B) Indwelling (C) Condom (D) Texas
Name: 13. 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 14. A urine specimen can be collected any time the resident voids. (A) Routine (B) Clean-catch (C) 24-hour (D) Sterile 15. Which type of urine specimen does not include the first and last urine in the sample? (A) Routine (B) Clean-catch (C) 24-hour (D) 36-hour 16. People who have diabetes may have , chemical substance(s) produced when the body burns fat for energy or fuel, inTthEeS irTuB riA neN. KSELLER.COM (A) Reagents (B) Glucose (C) Insulin (D) Ketones 17. 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 18. 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 is taking too long to urinate.
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330 Chapter 17: The Reproductive System 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 2. 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 3. 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.
Name: 7. A man with benign prostatic hypertrophy may have difficulty with (A) Walking (B) Reproducing (C) Urinating (D) Ejaculating 8. Which of the following is true of sexual needs in the elderly? (A) As a person ages, 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. 9. 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
4. 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.m CoOnM 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
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Chapter 18: The Integumentary System 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 2. The largest organ in the human body is the (A) Heart (B) Lungs (C) Skin (D) Kidneys 3. 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
331 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 8. Skin that is not intact is considered a(n) (A) Open wound (B) Closed wound (C) Contusion (D) Bruise 9. 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
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 injuries occur. 11. A stage 1 pressure injury has skin that is (C) Hair thickens. (A) Nonintact (D) Skin becomes thinner and more fragile. (B) A deep crater 5. A burn that affects the epidermis and causes (C) Deep purple redness and pain is a (D) Red or a different color than the surround(A) First-degree (superficial) burn ing area (B) Second-degree (partial-thickness) burn 12. A pressure injury with partial-thickness skin (C) Third-degree (full-thickness) burn loss that may look like a blister is a stage (D) Scald pressure injury. 6. Which of the following is true of scabies? (A) 1 (A) It is caused by a buildup of bacteria in the (B) 2 skin. (C) 3 (B) Symptoms include rash, intense itching, (D) 4 and sores that may become infected. 13. Which of the following is a condition that (C) It is not contagious. increases the risk of pressure injuries? (D) Teenage children and young adults are at a (A) Resident flexibility higher risk of acquiring scabies. (B) Cold air (C) Healthy circulation (D) Restricted mobility
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14. Which of the following statements is true of pressure injuries? (A) When skin begins to break down, it appears as a deep crater. (B) Pressure injuries are difficult to heal but do not hurt much. (C) Pressure injuries are impossible to prevent. (D) Pressure injuries 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 applieTdEfoSrTaBANKSELLER.COM 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. Nonsterile dressings are applied to (A) Open wounds (B) Draining wounds (C) Dry wounds that have less chance of infection (D) New wounds
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Chapter 19: The Circulatory or Cardiovascular System
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.
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 2. About 55% of blood is made up of (A) Erythrocytes (B) Leukocytes (C) Plasma (D) Platelets
.
3. 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
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 ) Coronary artery disease (CAD) 4. A normal age-related change fT orEthSeTcB irA cuNlaK toSryELLER.COM system is 11. When should elastic stockings be applied? (A) The heart pumps less efficiently (A) In the evening (B) Blood vessels widen (B) In the morning (C) Blood vessels become more elastic (C) Mid-afternoon (D) Blood flow increases (D) After residents have finished exercising 5. The medical term for high blood pressure is (A) Myocardial infarction (B) Hypotension (C) Hypertension (D) Peripheral vascular disease 6. One way for a person to keep hypertension under control and prevent complications is to (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
12. Residents with congestive heart failure may (A) Be on a high-sodium diet (B) Take medications that cause a decrease in urinary output (C) Have a force fluids medical order (D) Need to do range of motion exercises to improve muscle tone 13. The most common form of anemia is (A) Iron-deficiency anemia (B) Hypoxia (C) Pernicious anemia (D) Pulmonary anemia
334 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 2. 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 3. 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.
4. 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
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Chapter 21: The Musculoskeletal System
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.
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 2. 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
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 assistive 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
11. Before applying a prosthesis, the area must be (A) Dry (B) Damp (C) Cold (D) Warm
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 the diet. (A) Sodium (B) Calcium (C) Iron (D) Protein
in
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
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.
336 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.
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Chapter 22: The Nervous System 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 2. The is/are part of the peripheral nervous system. (A) Brain (B) Spinal cord (C) Cerebrum (D) Spinal nerves 3. 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
337 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. 8. Parkinson’s disease typically causes (A) A shuffling gait (B) Extremely straight posture (C) Memory loss (D) Aggressive behavior 9. 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
4. The tiny bones within the middle ear that pick up vibrations and send impulsT esEtS oT thB eA brNaK inSELLE 10R . .COM is the loss of function of the lower are the body and legs. (A) Ossicles (A) Concussion (B) Eardrums (B) Paraplegia (C) Cochleas (C) Quadriplegia (D) Auricles (D) Hemiplegia 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
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.
338 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 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
339 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 disorder that is characterized by intrusive repetitive thoughts or behavior that cause anxiety is (A) Phobia disorder (B) Posttraumatic stress disorder (C) Obsessive-compulsive disorder (D) Social anxiety disorder
33. Signs and symptoms of major depressive disorder include (A) Intense hunger (B reath that smells fruity T E S T B A N K S ELLER. C) OBM 28. Which of the following would be the best way (C) Intense, sudden chest pain for a nursing assistant to respond to a resident with AD who is exhibiting inappropriate sexual (D) Apathy behavior? 34. Which of the following is a way for a nursing (A) The NA should let other residents know assistant to care for a resident who has a menwhat is happening. tal health disorder? (B) The NA should take the resident to a pri(A) The NA should do everything for the vate area. resident. (C) The NA should inform other nursing assis(B) The NA should give the resident her meditants that the resident has a dirty mind. cation when needed. (D) The NA should loudly reprimand the resi(C) The NA should support the resident and dent to shame him into stopping. her family and friends. 29. When a resident with AD hoards or rummag(D) The NA should let the resident know that es, the nursing assistant should mental health disorders are not real. (A) Let the family know that the resident is 35. Which of the following statements about stealing things observing a resident who has a mental health (B) Lock the resident in his room if the NA disorder is true? does not have time to watch him (A) An NA does not need to report a comment (C) Warn the other residents that the resident about suicide as long as it is a joke. with AD is a thief (B) An NA needs to report changes in mood. (D) Provide a rummage drawer (C) Social withdrawal does not need to be reported. (D) Changes in abilities to perform ADLs do not need to be reported.
340 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 clergyperson.
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Chapter 23: The Endocrine System 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 2. 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 3. 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 environment (D) Maintains blood sugar levels
341 7. Prediabetes can be delayed or prevented by (A) Change in diet and daily exercise (B) Medication (C) Surgery (D) Increasing intake of fluids 8. The most common form of diabetes is (A) Prediabetes (B) Type 1 diabetes (C) Type 2 diabetes (D) Hypoglycemia 9. Symptoms of hypothyroidism include (A) Intolerance to cold (B) Bulging or protruding eyes (C) Rapid heartbeat (D) Normal menstrual periods 10. A resident who has diabetes should (A) Skip meals (B) Go barefoot (C) Receive careful foot care (D) Avoid exercise
11. Which of the following is a guideline for safe foot care for a resident who has diabetes? (A he NA should inspect and clean the resiTESTBANKSELLER.C) OTM dent’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
342 Chapter 24: The Immune and Lymphatic Systems and Cancer 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 2. With immunity, a person is given the antibodies needed to defend against an antigen. (A) Acquired (B) Nonspecific (C) Deficient (D) Passive 3. 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
Name: 7. Which of the following statements is true of HIV or 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. 8. A resident who has AIDS and has an infection of the mouth may need to eat food that is (A) Spicy (B) Soft or pureed (C) Hot (D) Acidic 9. A resident who has AIDS and has nausea and is vomiting should (A) Eat small, frequent meals (B) Eat quickly (C) Not drink liquids (D) Not eat at all
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 13. The key treatment for malignant tumors of the skin, breast, and colon is 6. Which of the following is a sign or symptom (A) Surgery of the beginning stages of HIV infection? (B) Chemotherapy (A) Poor circulation (C) Radiation (B) Damage to the eyes (D) Diet and exercise (C) Open sores on the penis (D) Flu-like symptoms
Name: 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.
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344 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
Name: 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) The 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
2. 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 injuries
Name: 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
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346 Chapter 26: Subacute Care 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 2. A pulse oximeter measures (A) Blood pressure (B) Body temperature (C) Blood oxygen level (D) Blood glucose level
6. 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 7. 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 8. 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.
3. 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 or electrodes wet. (B) The NA should not monitor vital signs. 9. Symptoms of respiratory distress include (C) The NA should not report cracked skin T E S T B A NKSEL Ru.rC (L AE )G glO inM g because that is normal due to the electrode (B) Decreased respiratory rate placement. (C) Redness of the skin (D) The NA should make sure that the elec(D) Apathy trodes hang loosely from the resident’s chest. 4. What is the function of an artificial airway? (A) To feed a resident who cannot swallow or digest food (B) To keep the airway open for the lungs to perform air exchange (C) To check a resident’s vital signs (D) To prepare a resident for a medical test 5. The method used to insert an artificial airway is called (A) Telemetry (B) Intubation (C) Ventilation (D) Dyspnea
10. Which of the following statements is true of chest tubes? (A) The drainage system must be kept above the level of the resident’s chest. (B) The chest drainage must be observed for amount and color. (C) The tubing should be kinked. (D) Chest tubes will only be in the front of the body. 11. A tube that is inserted into the nose, through the esophagus, and into the stomach for feeding is called a(n) (A) Nasogastric tube (B) Orogastric tube (C) Percutaneous endoscopic gastrostomy (PEG) tube (D) Central venous line
Name: 12. What is one of the nursing assistant’s responsibilities for tube feedings? (A) Inserting tubes (B) Giving tube feedings (C) Positioning the resident (D) Cleaning or suctioning the tubes 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 14. One reason why a resident may not be allowed fluids before surgery is (A) The resident may drink more fluids than usual (B) Not drinking fluids can help prevent vomiting and aspiration (C) Having fluids increases the risk of incontinence after surgery (D) The surgery has a higher rate of success if no fluids are consumed
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348 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 2. 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 3. 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, Mr. 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
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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 generally 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
Name: 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 toSELLER.COM 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
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350 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 2. A cover letter should include (A) Detailed information about educational background and volunteer work (B) Information on why a person is seeking the job and why she is qualified for it (C) The salary that the person would expect to receive if she accepted the job (D) Recommendations from former employers
Name: 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
8. What is the minimum number of hours of 3. Which of the following statements is true 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
Name: 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.
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Chapter 1: The Nursing Assistant in Long-Term Care 1. 2. 3. 4. 5.
Whom does Medicare insurance cover (LO 3)? Who makes up the majority of residents in long-term care facilities—men or women (LO 4)? What are three tasks that NAs do not usually perform (LO 5)? What is one way that an NA can demonstrate professionalism (LO 6)? List each of the ten qualities in Learning Objective 7. For each quality, write one example of a way that an NA can demonstrate that quality (LO 7). 6. Who is the most important member of the care team (LO 9)? 7. List The Five Rights of Delegation (LO 11). 8. Define person-centered care (LO 12). 9. When surveyors visit a facility, what do they study and observe (LO 14)? 10. When a surveyor asks an NA a question she does not know the answer to, how should she respond (LO 14)? Multiple Choice 11. Which of the following statements is true of long-term care (LO 2)? (A) Long-term care is only given during certain hours of the day. (B) Long-term care assists people with ongoing, chronic medical conditions. (C) Long-term care is given in an adult day services setting. (D) Long-term care is for people who need care for a short time after surgery. 12. One common NA task is (LO 5) (A) Prescribing medication (B) Creating residents’ care plans (C) Managing other NAs’ work (D) Bathing residents 13. Which of the following is true of proper grooming for an NA (LO 8)? (A) Gel nails should be freshly applied. (B) A simple waterproof watch should be worn. (C) Earrings can dangle just past the earlobe. (D) Perfume should be applied behind the ears or on both wrists. 14. If an NA is following the chain of command, to whom would she normally report a problem (LO 10)? (A) Nurse (B) Administrator (C) Resident (D) Medical social worker 15. If an NA has forgotten the correct order in which to perform a procedure, which of the following would be the best way for her to proceed (LO 13)? (A) The NA should review the procedure manual before beginning. 1
(B) The NA should ask the resident to see if he remembers the correct order. (C) The NA should perform the procedure to the best of her memory, knowing that she will probably do it correctly. (D) The NA should consult with the administrator to find out the correct order.
Answers- Chapter 1: The Nursing Assistant in Long-Term Care 1. People who are 65 years of age or older and people of any age with permanent kidney failure or certain disabilities 2. Women 3. Answers include the following: inserting/ removing tubes; changing sterile dressings; giving tube feedings; giving medications. 4. Answers can include the following: • Being clean and neatly dressed and groomed • Not discussing personal problems with residents • Not using personal phones in resident care areas • Being at work on time and avoiding absences • Not leaving work early without permission • Not reporting to work under the influence of illegal drugs and/or alcohol • Keeping a positive attitude • Not gossiping about cowoT rkE erSs TBANKSELLER.COM • Being polite and respectful • Addressing residents and visitors in the way they wish to be addressed • Not using profanity • Keeping resident information confidential • Following procedures and policies • Reporting concerns or problems to your supervisor • Maintaining educational requirements • Asking questions when you do not understand something • Being honest and documenting carefully • Accepting constructive feedback • Not accepting tips or gifts • Being loyal to your facility and being a positive role model 5. Answers will vary for each student. 6. The resident 7. The Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation 8. Type of care that places the emphasis on the person needing care and his or her individuality, capabilities, choices, beliefs, interests, and preferences
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9. 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
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Chapter 2: Ethical and Legal Issues 1. 2. 3. 4.
What are ethics (LO 2)? Give one example of a law that must be followed (LO 2). Describe five elements of a typical nursing assistant code of ethics (LO 4). According to the Omnibus Budget Reconciliation Act’s (OBRA) requirements, how many hours of training must nursing assistants complete at a minimum (LO 5)? 5. Give one example of negligence (LO 7). 6. What is a nursing assistant’s responsibility if she sees or suspects abuse (LO 8)? 7. What generally happens to a nursing assistant after a report of abuse has been made about him (LO 9)? 8. Describe some of the typical duties of an ombudsman (LO 10). 9. With whom may a nursing assistant share a resident’s health information (LO 11)? 10. What does HIPAA protect (LO 11)? 11. To which members of the care team does HIPAA apply (LO 11)? 12. What are advance directives (LO 12)? 13. List four rights related to advance directives that the PSDA requires be given to new residents upon admission (LO 12). Multiple Choice 14. Which of the following is one reason that a nursing assistant should not accept money or gifts from residents (LO 3)? (A) The NA will start to depend on the extra income and will not be able to live within her TESTBANKSELLER.COM budget without it. (B) Receiving money or gifts is unprofessional and can lead to conflict. (C) Receiving money or gifts is unfair because not all residents can afford to tip staff or give gifts. (D) The NA will be unable to ask for an advance on her salary if she receives additional income from residents. 15. What is the name of the resident assessment system required by OBRA (LO 5)? (A) Resident Information Protocols (RIP) (B) Reporting and Recording Intake (RRI) (C) Minimum Data Set (MDS) (D) Evaluation Implementation Form (EIF) 16. Residents have a legal right not to be abused or mistreated. To which one of the Residents’ Rights does this relate (LO 6)? (A) Right to visits (B) Right to dignity, respect, and freedom (C) Right with regard to social services (D) Right to security of possessions 17. Residents have a legal right to be told of changes in their medical condition. To which one of the Residents’ Rights does this relate (LO 6)? (A) Right to participate in their own care 4
(B) Right to privacy and confidentiality (C) Right to complain (D) Rights during transfers and discharges 18. A nursing assistant takes money from a resident’s purse, planning to pay it back later. Which type of abuse is this considered (LO 7)? (A) Psychological abuse (B) Physical abuse (C) Substance abuse (D) Financial abuse 19. Emotional abuse of a resident by his wife is considered (LO 7) (A) Domestic violence (B) Physical abuse (C) Substance abuse (D) Sexual abuse
Answers- Chapter 2: Ethical and Legal Issues 1. Ethics are the knowledge of what is right and wrong and help guide conduct. 2. Answers will vary. 3. 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 to nursing assistant care. I will show a positive 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. 4. 75 hours 5. Answers will vary. 6. Report it to her supervisor immediately. 7. 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.
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15. 16. 17. 18. 19.
8. 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. 9. Other care team members 10. The privacy of health information 11. HIPAA applies to all healthcare providers, including doctors, nurses, nursing assistants, and care team members. 12. 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. 13. Answers include the following: All facilities receiving Medicare and Medicaid money must offer new residents information about 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. 14. B C B A D A
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Chapter 3: Communication Skills 1. What is the difference between verbal and nonverbal communication (LO 2)? 2. Why should a nursing assistant avoid asking yes or no questions (LO 3)? 3. A resident tells a nursing assistant that he is scared of a medical test that is going to be performed. How could the NA respond without using a cliché such as “Oh, everything will be fine” (LO 3)? 4. What can help an NA overcome a language barrier with a resident (LO 4)? 5. What should an NA do each time he greets a resident (LO 5)? 6. Convert 8:33 p.m. to military time (LO 7). 7. Convert 11:10 a.m. to military time (LO 7). 8. With whom can a nursing assistant’s observations about residents be shared (LO 8)? 9. When should care be documented (LO 9)? 10. Do HIPAA guidelines apply to computer use (LO 10)? 11. How does a nursing assistant’s reporting impact a resident’s Minimum Data Set (MDS) assessment (LO 11)? 12. List the four senses that are used in accurate observing and reporting (LO 12). 13. What is an incident (LO 15)? 14. When should an incident report be completed (LO 15)? 15. Give an example of a proper greeting when answering the phone (LO 16). 16. Describe the NA’s role in rounds at a facility (LO 18). 17. Give an example of how to combine activities to manage time better (LO 20). Short Answer For each of the following five statements, decide whether it is an objective sign or subjective symptom observation. Write S for subjective or O for objective (LO 12). 18. Resident says she has a sore throat. 19. Resident has dark red urine. 20. Resident states, “I have a hard time catching my breath.” 21. Resident is running a fever. 22. Resident has blisters on her feet. Multiple Choice 23. Which of the following is the correct abbreviation for nothing by mouth (LO 6)? (A) NBM (B) NPO (C) ZVM (D) NFF 24. What does the abbreviation PRN stand for (LO 6)? (A) Every hour (B) When needed (C) Two times per day (D) Immediately 25. How does a nursing assistant contribute to care planning (LO 14)? (A) By giving her suggestions regarding medication changes 7
(B) By diagnosing the resident’s current condition (C) By sharing her observations of residents (D) By demonstrating the types of treatment she gives to the resident for the resident’s family 26. Where should the call light be left when a nursing assistant leaves a resident’s room (LO 17)? (A) By the door leading to the hallway (B) Next to the toilet in the bathroom (C) On the resident’s windowsill (D) Within the resident’s reach 27. Which of the following is typically found on an assignment sheet (LO 19)? (A) Resident’s last known address (B) Resident’s television preferences (C) Names of the resident’s closest living relatives (D) Resident’s diet order
Answers- Chapter 3: Communication Skills 1. Communicating verbally means using words. Nonverbal communication is communicating without using words. 2. Yes/no answers end a conveTrE saS tioTnB . ANKSELLER.COM 3. Answers will vary. 4. 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. 5. Introduce himself, identify the resident, and explain the procedure to be done 6. 2033 hours 7. 1110 hours 8. Only other members of the care team 9. 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.” 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 22. O 8
23. B 24. B 25. C 26. D 27. D
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Chapter 4: Communication Challenges 1. What should the nursing assistant do first when dealing with a resident who has a visual impairment (LO 2)? 2. How can a nursing assistant explain the position of objects to a resident who is visually impaired (LO 2)? 3. When speaking with a hearing-impaired resident, whose face should the light be on—the nursing assistant’s or the resident’s (LO 3)? 4. Why should a nursing assistant explain procedures and introduce herself to a resident who is unconscious (LO 11)? 5. What are other possible methods of communication if a person cannot speak (LO 12)? 6. What is an artificial airway (LO 12)? Multiple Choice 7. A resident starts sleeping with a doll she had when she was a little girl. This is an example of which defense mechanism (LO 4)? (A) Repression (B) Regression (C) Displacement (D) Rationalization 8. A resident refuses to believe her diagnosis of a terminal illness. This is an example of which defense mechanism (LO 4)? (A) (B) Denial Projection (C) Displacement (D) Repression 9.
Which of the following is true of anxiety (LO 5)? (A) Feeling anxious is the same as feeling afraid. (B) Anxiety produces only mental and emotional symptoms; it does not cause physical symptoms. (C) A person may not always know why she feels anxious. (D) Speaking loudly and quickly is helpful for a person who is anxious. 10. Major depressive disorder is also known as (LO 6) (A) Clinical depression (B) Anxiety disorder (C) Mood therapy (D) Minor regression 11. Which of the following statements best describes anger (LO 7)? (A) Anger is only experienced by people who have a mental health disorder. (B) Nursing assistants do not need to report angry behavior by residents. (C) Anger is the first sign of an anxiety disorder. 10
(D) Anger is a natural emotion with many causes. 12. If a resident becomes combative, the best response by the nursing assistant would be to (LO 8) (A) Let the resident know what he did was wrong (B) Stay at a safe distance from the resident (C) Startle the resident into stopping the behavior (D) Threaten the resident by withholding something he likes 13. If a resident exhibits inappropriate sexual behavior, what would be the best response by the nursing assistant (LO 9)? (A) The NA should let the resident know that he is embarrassing himself. (B) The NA should tell other NAs what the resident is doing so that they can avoid him. (C) The NA should tell the resident that he is being inappropriate. (D) The NA should try to distract the resident. 14. What should a person be able to identify when she is oriented (LO 10)? (A) Favorite foods, city she resides in, mother’s maiden name (B) Who she is, correct year, facility she lives in (C) Medication she takes, doctor’s name, correct time (D) Her diagnosis, the names of her family members, and the date 15. Which of the following is a common cause of confusion (LO 10)? (A) Anxiety (B) Anger (C) Urinary tract infection (D) Diabetes 16. The medical term for difficulty breathing is (LO 12) (A) Dyspnea (B) Ventilation (C) Combative (D) Mechanism Answers- Chapter Communication Challenges 1. 2. 3. 4. 5.
Announce yourself and greet the resident. By using the face of an imaginary clock The nursing assistant’s 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. 6. 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. 7. B 11
8. A 9. C 10. A 11. D 12. B 13. D 14. B 15. C 16. A
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Chapter 5: Diversity and Human Needs and Development 1. 2. 3. 4. 5. 6.
What do the terms health and wellness mean (LO 2)? Describe what holistic health care involves (LO 3). What are psychosocial needs (LO 3)? What is cultural diversity (LO 5)? What is cultural competence (LO 5)? If an NA encounters a sexual situation between two consenting residents, what should she do (LO 9)? 7. What should an NA do if she sees a resident being sexually abused (LO 9)? 8. What is a stereotype (LO 11)? 9. Why should stereotyping be avoided (LO 11)? 10. Why is it important for NAs to treat residents who are developmentally disabled as adults, regardless of their behavior (LO 12)? Multiple Choice 11. Which of the following is an example of a physical need (LO 4)? (A) Acceptance (B) Sleep (C) Success (D) Affection 12. Which of the following is an example of a psychosocial need (LO 4)? TESTBANKSELLER.COM (A) Water (B) Rest (C) Independence (D) Food 13. According to Maslow, which of the following needs must be met first (LO 4)? (A) Physical needs (B) Safety needs (C) Psychosocial needs (D) Need for self-esteem 14. Which of the following terms describes a family made up of one parent and one child (LO 6)? (A) Blended family (B) Extended family (C) Nuclear family (D) Single-parent family 15. Which of the following is the best example of an extended family (LO 6)? (A) Mother, grandmother, and aunt living together (B) Father and son living together (C) Mother, father, and daughter living together (D) Divorced mother and daughter living together 13
16. Which of the following would be the best response by the NA if a resident wants to discuss health concerns he has (LO 7)? (A) “Everything works out for the best.” (B) “I understand you’re scared. Can you tell me more?” (C) “I read about a new medication that could help you.” (D) “It’s better for you to talk to your daughter rather than me.” 17. Which of the following sentences is true of spiritual beliefs (LO 8)? (A) All residents have the same spiritual needs. (B) NAs should let residents know when they do not agree with residents’ beliefs. (C) NAs should give privacy for prayer if residents request it. (D) NAs should insist that residents attend church services when residents seem lonely. 18. During which stage of human development might girls reach puberty (LO 10)? (A) Young adulthood (B) School-age (C) Preadolescence (D) Preschool Answers- Chapter 5: Diversity and Human Needs and Development
NeKnStaEl,LanLdEsR OeMll-being, and not merely the absence 1. Health is a state of completT eE phSysTicBalA ,m oc. iaC lw of disease or infirmity. Wellness has to do with successfully balancing things that happen in our everyday lives. 2. Holistic care involves considering the whole person, which includes his physical and psychosocial needs. 3. Psychosocial needs include social contact, emotions, thought, and spirituality. 4. 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. 5. Cultural competence is an ongoing process of learning about other cultures and applying that knowledge to help provide better health care. 6. Provide privacy and leave the room. 7. 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. 8. A stereotype is a biased generalization about a group that is usually based on opinions and distorted ideas. 9. Answers may 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. 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 14
13. A 14. D 15. A 16. B 17. C 18. C Chapter 6: Infection Prevention and Control 1. Describe the difference between the terms clean and dirty (LO 3). 2. What is sterilization? What is disinfection (LO 3)? 3. List four reasons the elderly are at a higher risk for infection (LO 5). 4. On whom should Standard Precautions be practiced (LO 6)? 5. What is hand hygiene (LO 7)? 6. Why should NAs avoid using artificial nails (LO 7)? 7. When should gowns be worn (LO 8)? 8. When should a mask and goggles be worn (LO 8)? 9. In what order should personal protective equipment (PPE) be put on and removed (LO 8)? 10. How should soiled linen be carried (LO 9)? 11. When can reusable equipment be used again (LO 9)? 12. How are bloodborne diseases transmitted (LO 13)? 13. What is hepatitis (LO 14)? 14. What does HIV do to the immune system (LO 14)? 15. How is hepatitis B (HBV) spread (LO 14)? 16. What is one of the best ways to prevent the spread of MRSA and VRE (LO 15)? 17. What are two ways to help prevent the spread of C. difficile (LO 15)? 18. How is carbapenem-resistant Enterobacteriaceae (CRE) usually spread (LO 15)? Multiple Choice 19. Which of the following is true of microorganisms (LO 2)? (A) They are only present in healthcare facilities. (B) They are on almost everything a person touches. (C) They are not present in a person’s home, as long as the home is cleaned regularly. (D) They are only found on the human body. 20. In a care facility, who has the responsibility for preventing infection (LO 2)? (A) All care team members (B) Doctors (C) Nursing assistants (D) The dietary department 21. Which type of infection is limited to a specific location in the body and has symptoms that are near the site of infection (LO 2)? (A) Cross-infection (B) Healthcare-associated infection (C) Systemic infection 15
(D) Localized infection 22. Which link in the chain of infection refers to any body opening on an infected person that allows pathogens to leave (LO 4)? (A) Reservoir (B) Susceptible host (C) Mode of transmission (D) Portal of exit 23. Which of the following is the primary route of disease transmission within the healthcare setting (LO 4)? (A) On the stethoscopes of care team members (B) On the hands of healthcare workers (C) On the elimination equipment used by residents (D) On the food trays served to residents 24. Under Standard Precautions, which of the following is not considered a body fluid (LO 6)? (A) Vomit (B) Feces (C) Sweat (D) Pus 25. What is the first step the NA should take when cleaning a spill (LO 10)? (A) The NA should scoop up the spill. (B) The NA should don gloves. (C) The NA should apply a disinfectant to the spill area. (D) The NA should place an absorbing powder on the spill. 26. Which of the following precautions is used for pathogens that are carried by moisture, by air currents, and by dust and remain floating for some time (LO 11)? (A) Airborne Precautions (B) Contact Precautions (C) Droplet Precautions (D) Standard Precautions 27. Which of the following is true of disposable supplies (LO 12)? (A) They should be avoided when a resident is in isolation. (B) They can be used once before they must be discarded. (C) They can be reused as long as they are disinfected between uses. (D) They can be reused as long as they are sterilized between use. Answers- Chapter 6: Infection Prevention and Control
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1. An object can be called clean if it has not been contaminated with pathogens. An object that is dirty has been contaminated with pathogens. 2. 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. 3. 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 it easier to tear. When fragile skin tears, pathogens can enter the body. Both thinner skin and limited mobility increase the risk of pressure injuries 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 5. Hand hygiene is washing hands with either plain or antiseptic soap and water or using alcoholbased hand rubs. 6. Artificial nails harbor bacteria, even if a person washes his hands often. 7. A gown should be worn if the caregiver may come into contact with blood, body fluids, secretions or excretions, tissue, or when splashing or spraying blood or body fluids is likely. 8. 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. 9. 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. 10. Dirty linen should be held and carried away from the NA’s uniform. 11. After it has been properly cleaned and reprocessed 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 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. 16. Through frequent, proper handwashing 17
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. B 20. A 21. D 22. D 23. B 24. C 25. B 26. A 27. B
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Chapter 7: Safety and Body Mechanics 1. What important information does the Safety Data Sheet (SDS) provide about chemicals (LO 3)? 2. What items should be disposed of in a biohazard container or bag (LO 4)? 3. Should objects be held close to the body or far away from the body when lifting or carrying them (LO 5)? 4. When lifting, is it better to bend at the waist or at the knees (LO 5)? 5. Why was restraint use restricted (LO 6)? 6. What are restraint alternatives (LO 7)? 7. When can a restraint be applied (LO 8)? 8. List six signs to report to a nurse about intravenous (IV) therapy (LO 10). 9. What three things need to be present for a fire to occur (LO 11)? 10. Identify what the acronyms RACE and PASS stand for (LO 11). 11. If a fire has started, what should the nursing assistant do before opening a closed door (LO 11)? 12. List two general safety steps to protect residents in a facility (LO 12). Multiple Choice 13. The most common accidents that occur in a healthcare facility are (LO 2) (A) Burns (B) Falls (C) Cuts (D) Poisonings
EtStoTbBeAinNwKhSileEeLaLtinEgRis.(C 14. The best position for a residT en LOO2M) (A) Sitting upright (B) Lying on his left side (C) Reclining with his head tilted back (D) On his stomach 15. Which of the following promotes a more stable base of support (LO 5)? (A) Standing with the feet together (B) Maintaining a narrow base of support (C) Standing with the feet shoulder-width apart (D) Keeping the knees locked 16. Which of the following is the best thing that a nursing assistant can do to help promote oxygen safety (LO 9)? (A) Keep lit matches at least two feet away from a resident using oxygen (B) Use Vaseline on irritated skin areas around the resident’s nose and ears (C) Remove flammable liquids from the resident’s room (D) Increase a resident’s oxygen level if he is having trouble breathing Answers-Chapter 7: Safety and Body Mechanics 19
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 2. Anything contaminated with infectious waste (blood, body fluids, or human tissue), except for anything sharp 3. Close to the body 4. At the knees 5. In the past, restraint usage was often abused by caregivers. This abuse led to new laws on restricting their use. 6. Restraint alternatives are any measure used in place of a restraint or that reduces the need for a restraint. 7. Restraints are used only after everything else has been ruled out and only with a doctor’s order. 8. 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. 9. Heat makes the flame, fuel is the object that burns, oxygen is the gas that will keep the fire burning. 10. RACE is: Remove anyone from danger if you are not in danger. Activate alarm (or call 911). 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. Report any situation or person who makes you feel unsafe or concerned to your supervisor. 13. B 14. A 15. C 16. C
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Chapter 8: Emergency Care, First Aid, and Disasters 1. List the two steps to follow in an emergency after making sure the area is safe and putting on gloves (LO 2). 2. What is the difference between respiratory and cardiac arrest (LO 3)? 3. How soon can brain damage occur after the heart stops beating and breathing stops (LO 3)? 4. In what position should a person be placed if he is in shock (LO 3)? 5. If blood seeps through the first pad over a wound, should the first pad be removed before applying a second pad (LO 3)? 6. If a person feels faint and is sitting down, what should the nursing assistant do (LO 3)? 7. After putting on gloves, what should a nursing assistant do for a person who has a nosebleed (LO 3)? 8. What symptoms are women more likely to experience than men if they are having an MI (LO 3)? 9. What are the first signs that a resident is experiencing diabetic ketoacidosis (LO 3)? 10. What are three things a nursing assistant should never do when a person is having a seizure (LO 3)? 11. What is a transient ischemic attack (TIA) (LO 3)? 12. What does the term Code Blue usually mean (LO 4)? 13. List five examples of disasters (LO 5). Multiple Choice 14. What document will need to be completed after an emergency occurs (LO 2)? (A) Incident report (B) Safety data set report (C) Cardiopulmonary resuscitation report (D) Activities of daily living report 15. Which of the following is appropriate to apply to a minor burn (LO 3)? (A) Ice (B) Butter (C) Herbal ointment (D) Water 16. When a resident is choking but can speak, cough, or breathe, what should the nursing assistant do (LO 3)? (A) The NA should begin cardiopulmonary resuscitation (CPR). (B) The NA should encourage the person to cough as forcefully as possible. (C) The NA should find an automated external defibrillator (AED) and follow its prompts. (D) The NA should put an oxygen mask on the resident. 17. What is the medical term for vomiting (LO 3)? (A) Hemiplegia (B) Epistaxis (C) Syncope (D) Emesis 21
18. What color is the skin if it is cyanotic (LO 3)? (A) Yellow (B) Red (C) Blue (D) Pink Answers-Chapter 8: Emergency Care, First Aid, and Disasters 1. 2. 3. 4. 5. 6. 7. 8.
Assess the situation, assess the victim Respiratory arrest means that breathing stops; cardiac arrest is when the heart stops. Within four to six minutes Lying down on the back No 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, nausea, vomiting, lightheadedness, fainting, dizziness, stomach pain, sweating, fatigue, back, neck, and jaw pain, and flu-like symptoms. 9. The signs of onset of diabetic ketoacidosis include increased hunger, thirst, or urination; abdominal pain; deep or labored breathing; and breath that smells sweet or fruity. ErR 10. Answers include the followiT ngE: S trT y tB oA stN opKtShE eL seL izu e. orCreOsM train the person; force anything between the person’s teeth; place hands in the mouth for any reason; and give liquids or food. 11. A transient ischemic attack (TIA) is a warning sign of a CVA. It is the result of a temporary lack of oxygen in the brain. 12. Cardiac arrest 13. Answers may vary but could include fire, flood, earthquake, hurricane, tornado, severe weather, and acts of terrorism. 14. A 15. D 16. B 17. D 18. C
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Chapter 9: Admission, Transfer, Discharge, and Physical Exams 1. What are two resources that families may use to help them choose a care facility for a loved one (LO 2)? 2. Why is it a good idea for nursing assistants to ask family members questions about residents upon admission (LO 4)? 3. Why might a transfer to a new room be difficult for a resident (LO 5)? 4. During discharge of a resident, when does a nursing assistant’s responsibility for the resident end (LO 6)? Multiple Choice 5. If a nursing assistant makes a mistake with resident care, he can demonstrate that he is responsible by (LO 3) (A) Coming up with a clever way to distract the resident from his mistake (B) Blaming another staff member so that he will not be the only one viewed negatively (C) Not documenting the mistake so that there is no legal record of it (D) Reporting the mistake to the nurse immediately 6. Which of the following would be the best response by the nursing assistant if a new resident says that he does not want to attend a facility activity (LO 3)? (A) “That’s okay. I’ll ask you again some other time.” (B) “I think you should go because it will probably make you feel better.” (C) “It is harder to make friends when you do not attend social events.” (D) “You will become depressed if you do not participate and socialize.” 7. What should the scale be balanced at before measuring a resident’s weight (LO 4)? (A) 0 (B) 5 (C) 50 (D) -.10 8. How many inches are there in five feet (LO 4)? (A) 20 (B) 30 (C) 60 (D) 80 9. In which position is a resident lying flat on her back with her knees flexed and her feet flat on the bed (LO 7)? (A) Lithotomy position (B) Lateral position (C) Dorsal recumbent position (D) Knee-chest position
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10. In which position is a resident lying on her abdomen with her knees pulled toward the abdomen and her legs separated (LO 7)? (A) Lithotomy position (B) Lateral position (C) Dorsal recumbent position (D) Knee-chest position 11. In which position is a resident lying on her back with her feet in padded stirrups (LO 7)? (A) Lithotomy position (B) Lateral position (C) Dorsal recumbent position (D) Knee-chest position Answers- Chapter 9: Admission, Transfer, Discharge, and Physical Exams
5. 6. 7. 8. 9.
1. Answers include the following: Review information from federal agencies, ask friends for recommendations, review past survey results, check to see if the facility is accredited by the Joint Commission, and visit the facility. 2. To get information on the resident’s personal preferences, history, rituals, and routines 3. Answers include the following: Change is always hard. The resident may have an illness or his condition may have worsened. 4. When the resident and his belongings are in the vehicle and the vehicle’s doors are closed D A A C C 10. D 11. A
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Chapter 10: Bedmaking and Unit Care 1. List three functions that sleep performs (LO 2). 2. What is usually stored in the bedside stan d (LO 5)? 3. What is the overbed table used for? Can a bedpan be placed on it (LO 5)? 4. Where should the call light always be placed (LO 6)? 5. Define disposable equipment (LO 6). 6. Why should NAs carry clean linen away from their uniforms (LO 7)? 7. Why should linen never be shaken (LO 7)? 8. Describe the difference between a closed bed and an open bed (LO 7). 9. While making an occupied bed, what should the NA observe (LO 7)? 10. When is a surgical bed made (LO 7)? Multiple Choice 11. A disruption of breathing while a person is sleeping is known as (LO 3) (A) Insomnia (B) Sleep apnea (C) REM behavior disorder (D) Bruxism 12. The inability to fall asleep or stay asleep is known as (LO 3) (A) Insomnia (B) Sleep apnea (C) REM behavior disorder (D) Bruxism 13. Which of the following is a type of stimulant that may prevent residents from sleeping (LO 4)? (A) Hot water (B) Nicotine (C) Ibuprofen (D) Beer 14. Which of the following is a type of depressant (substance that causes calmness and drowsiness (LO 4)? (A) Caffeine (B) Nicotine (C) Cigarettes (D) Wine Answers-Chapter 10: Bedmaking and Unit Care 1. 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. 25
2. 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. 3. 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. 4. Within the resident’s reach 5. Disposable equipment will be used one time and then discarded. 6. If clean linen touches the nursing assistant’s uniform, the linen becomes contaminated. 7. Shaking linen may spread airborne contaminants. 8. 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. 9. 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
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Chapter 11: Positioning, Moving, and Lifting 1. 2. 3. 4. 5. 6. 7.
How does proper body alignment benefit the human body (LO 2)? Why should a nursing assistant face what she is lifting (LO 2)? In what position should a nursing assistant be before lifting an object (LO 2)? Should objects be lifted by using muscles in the legs or the back (LO 2)? Explain why objects should be kept close to the body when carrying them (LO 2). What is the benefit of using a draw sheet or other assist device when repositioning (LO 3)? For a resident with one weak side and one strong side, which side should move first and why (LO 4)? 8. When moving a resident down a ramp in a wheelchair, in which direction should the resident be facing (LO 4)? 9. What must a resident be able to do in order to use the toilet (LO 4)? Multiple Choice 10. Which of the following is a description of the supine position (LO 3)? (A) Resident is in a semi-sitting position (45 to 60 degrees) with his head and shoulders elevated. (B) Resident is lying on either side. (C) Resident is lying on his abdomen. (D) Resident is lying flat on his back. 11. Which of the following is a description of the lateral position (LO 3)? (A) Resident is in a semi-sitting position (45 to 60 degrees) with his head and shoulders elevated. (B) Resident is lying on either side. (C) Resident is lying on his abdomen. (D) Resident is lying flat on his back. 12. Which of the following is a description of the Fowler’s position (LO 3)? (A) Resident is in a semi-sitting position (45 to 60 degrees) with his head and shoulders elevated. (B) Resident is lying on either side. (C) Resident is lying on his abdomen. (D) Resident is lying flat on his back. 13. Which of the following is a safety device used to help transfer residents who are weak, unsteady, or uncoordinated (LO 4)? (A) Compression sleeve (B) Transfer belt (C) Traction pulley (D) Back brace
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14. Where should a nursing assistant place a transfer belt before helping a resident to ambulate (LO 5)? (A) Underneath the resident’s shirt, above his waist (B) Around the resident’s weaker leg, under his clothing (C) Around the resident’s waist, over his clothing (D) Underneath the resident’s armpits, over his shirt Answers-Chapter 11: Positioning, Moving, and Lifting
10. 11. 12. 13. 14.
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 better able to clean the body of wastes. It helps prevent complications of immobility, such as contractures and atrophy. 2. This enables her to move her body as one unit, and keeps her back straight. 3. Begin in a squatting position 4. Lift with the legs 5. Keeping objects close to the body decreases stress to the back. 6. Draw sheets or other assist devices help prevent skin damage caused by shearing. 7. 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. 8. Resident should be facing the top of the ramp. 9. For a resident to be able to use a toilet, he must be able to bear some weight on his legs. D B A B C
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Chapter 12: Personal Care 1. 2. 3. 4. 5. 6. 7. 8. 9.
Define the terms hygiene and grooming (LO 2). List three ways NAs can help promote residents’ dignity when performing personal care (LO 2). Which serious skin wound can NAs help prevent by observing residents’ skin closely (LO 3)? In general, what should the water temperature be for bathing residents (LO 4)? Why should residents be involved in choosing a comfortable water temperature (LO 4)? Why should bath oils, gels, and powders be avoided when bathing residents (LO 4)? How often should the perineal area be bathed (LO 6)? What are two benefits of back rubs (LO 7)? What is the best way to prevent aspiration when performing mouth care on residents who are unconscious (LO 10)? 10. Why should NAs explain what they are doing when working with residents who are unconscious (LO 10)? 11. Should NAs wear gloves when shaving residents? Why or why not (LO 11)? 12. Under what circumstances should an electric razor not be used (LO 11)? 13. When dressing and undressing residents, how should NAs refer to the weaker side (LO 11)? Multiple Choice 14. Which of the following should be washed before the axillae (underarms) (LO 5)? (A) Legs (B) Face (C) Perineal area (D) Buttocks 15. When bathing a resident, which body part should be washed first (LO 5)? (A) Eyes (B) Face (C) Neck (D) Arms 16. At a minimum, how often should mouth care be performed (LO 8)? (A) Once a day (B) Two times a day (C) Three times a day (D) Four times a day 17. How should dentures be stored after they are cleaned if the resident does not want to wear them (LO 9)? (A) Dentures should be stored in a denture cup filled with icy water. (B) Dentures should be stored in a denture cup filled with hot water. (C) Dentures should be stored in a denture cup filled with boiling water. (D) Dentures should be stored in a denture cup filled with cool water.
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18. When dressing a resident, on which side should an NA start (LO 11)? (A) On the resident’s weaker side (B) On the resident’s unaffected side (C) On the resident’s stronger side (D) On the resident’s left side Answers-Chapter 12: Personal Care 1. Hygiene consists of practices to keep the body clean. Grooming consists of practices to care for oneself. 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. 3. Pressure injuries 4. No higher than 105°F 5. Comfortable temperature varies for each person. 6. Bath oils, gels, and powders can create slippery surfaces and can put residents at risk of falling. 7. Every day 8. Answers include the following: relaxes tired, tense muscles, improves circulation, and relieves pain or discomfort. 9. Use as little liquid as possible during mouth care LaLyEbR 10. Because even residents whoTaEreSuTnB coAnN scK ioS usEm e a.bC leOtoMhear 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. Weaker, affected, or involved side 14. B 15. A 16. B 17. D 18. A
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Chapter 13: Vital Signs 1. 2. 3. 4.
What are the four vital signs that are regularly monitored (LO 2)? List two reasons an NA should never document a guess of a resident’s vital signs (LO 2). What are four symptoms of a fever (LO 3)? If a resident has recently eaten or had something to drink, how long must an NA wait before she can measure his oral temperature (LO 4)? 5. Generally, how far should the tip of a tympanic thermometer be inserted into the ear (LO 4)? 6. What is the most common site for taking the pulse (LO 6)? 7. Why is the respiratory rate usually counted directly after taking the pulse, while the fingers are still on the person’s wrist (LO 6)? 8. Where is the apical pulse located (LO 6)? 9. Why must a blood pressure cuff be the proper size and put on the arm correctly (LO 8)? 10. What pulse point is commonly used to measure blood pressure (LO 8)? 11. What are five ways an NA can help reduce a resident’s pain (LO 9)? Multiple Choice 12. Which body site is generally considered to be the most accurate for obtaining temperatures (LO 4)? (A) The mouth (B) The rectum (C) The armpit (D) The ear 13. What color is a rectal thermometer (LO 4)? (A) Blue (B) Green (C) Red (D) White 14. What is the normal pulse rate for adults (LO 5)? (A) 40 to 90 beats per minute (B) 60 to 100 beats per minute (C) 25 to 50 beats per minute (D) 80 to 120 beats per minute 15. Which of the following falls within the normal respiration rate for adults (LO 5)? (A) 14 breaths per minute (B) 22 breaths per minute (C) 5 breaths per minute (D) 9 breaths per minute 16. Which side of a stethoscope is used for measuring pulse rate (LO 6)? (A) The left side (B) The classic side 31
(C) The dome side (D) The diaphragm side 17. Which blood pressure measurement reflects the phase when the heart relaxes and is always lower than the other measurement (LO 7)? (A) Systolic (B) Radial (C) Apical (D) Diastolic 18. When a resident complains of pain, which of the following would be the best response by the NA (LO 9)? (A) The NA should give the resident pain medication. (B) The NA should ask questions to find out more information about the pain. (C) The NA should ignore the complaint unless the resident repeats it. (D) The NA should contact the resident’s family to find out what course of action they would like to take.
Answers-Chapter 13: Vital Signs 1. Body temperature, pulse, respirations, and blood pressure 2. It is illegal and can cause harm to the resident. 3. Answers include the following: elevated temperature reading, headache, fatigue, muscle aches, and chills. Skin may feel warm and look flushed. 4. 10 to 20 minutes 5. 1/4 to 1/2 inch 6. Radial pulse 7. Because people tend to breathe more quickly if they know they are being observed 8. The apical pulse is on the left side of the chest, just below the nipple. 9. 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. B 15. A 16. D 17. D 18. B 32
Chapter 14: Nutrition and Fluid Balance 1. 2. 3. 4.
List five common nutritional problems that elderly people may experience (LO 2). According to MyPlate’s suggestions, what should half of a person’s plate be made up of (LO 5)? List some examples of plant sources of protein foods (LO 5). According to MyPlate, what fat percentages should a person choose most often from the dairy group (LO 5)? 5. List the information contained on diet cards (LO 6). 6. What is one common abbreviation for a sodium-controlled diet (LO 7)? 7. What is the difference between a clear liquid diet and a full liquid diet (LO 7)? 8. What is the benefit of thickening liquids (LO 8)? 9. What is the proper position in which to place a resident for eating (LO 10)? 10. If a resident refuses to wear a clothing protector, what should the NA do (LO 11)? 11. How should an NA properly test the temperature of food if she feels it might be too hot (LO 11)? 12. To which side of the mouth should food be directed if a resident has a weaker side—the weaker (affected) or stronger (unaffected) side (LO 12)? 13. When assisting a resident who is visually impaired, how should the NA describe the position of food and objects in front of the resident (LO 12)? 14. List four examples of output (LO 14). 15. How many milliliters (mL) equal one ounce (oz.) (LO 14)? 16. What are three ways that proper fluid intake benefits the body (LO 15)? 17. What is a restrict fluids (RF) order (LO 16)? Multiple Choice 18. Which of the following is the correct term for a person who does not eat any animals or animal products (LO 3)? (A) Omnivore (B) Vegan (C) Carnivore (D) Pescetarian 19. Which of the following is the most essential nutrient for life (LO 4)? (A) Water (B) Protein (C) Vegetables (D) Grains 20. Which of the following abbreviations means that a resident should not have anything to eat or drink (LO 7)? (A) RR (B) RF (C) NPO (D) ADA 21. Which of the following puts a resident at an increased risk of unintended weight loss (LO 9)? 33
(A) The resident is a vegetarian. (B) The resident has difficulty swallowing.
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(C) The resident enjoys socializing during mealtime. (D) The resident eats snacks between meals. 22. One way for an NA to help prevent aspiration is to (LO 13) (A) Place food in the resident’s weaker side of the mouth (B) Not offer the resident a drink until the meal has been eaten (C) Make sure the resident is sitting upright for eating and drinking (D) Feed the resident quickly Answers-Chapter 14: Nutrition and Fluid Balance 1. 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. 2. Vegetables and fruits 3. Beans, peas, soy products, vegetarian meat substitutes, nuts, and seeds are plant sources of proteins. 4. Most dairy group choices should be fat-free (0%) or low-fat (1%). 5. Resident’s name and information about special diets, allergies, likes and dislikes, as well as any other dietary instructions 6. Low Na or NAS 7. A clear liquid diet consists of fluids that you can see through, such as clear soups and juices. A full liquid diet includes all ofTtE heSlT iqB uiA dsNsK erS veEdLoL nE a cRle.aC r lO iqM uid diet, with the addition of cream soups, milk, and ice cream. 8. Thickened liquids move down the throat more slowly, reducing coughing and limiting the risk for choking. 9. Upright at 90 degrees 10. Respect the resident’s refusal. 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. Drinking enough water each day can help prevent constipation, urinary incontinence, and dehydration. Proper fluid intake also helps to dilute wastes and flush out the urinary system, which lessens the risk of infection. 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 35
Chapter 15: The Gastrointestinal System 1. 2. 3. 4. 5. 6. 7.
What are four functions of the gastrointestinal system (LO 3)? List five normal age-related changes of the gastrointestinal system (LO 4). List three normal qualities of stool (LO 5). When is a fracture pan, rather than a standard bedpan, used for elimination (LO 6)? How should a standard bedpan be positioned? How should a fracture pan be positioned (LO 6)? List three possible treatments for constipation (LO 7). What action should be avoided when providing perineal care for a resident who has hemorrhoids (LO 7)? 8. What position must the resident be in for an enema (LO 8)? 9. If a resident feels pain while receiving an enema, what should the NA do (LO 8)? 10. Why does a stool specimen need to be delivered to the lab immediately when testing for ova and parasites (LO 9)? 11. What items should not be included in a stool specimen (LO 9)? 12. How is occult blood found in stool (LO 10)? 13. When may an ostomy be necessary (LO 11)? 14. How do colostomies and ileostomies differ (LO 11)? 15. List ten guidelines for bowel retraining (LO 12). 16. How many people are needed to use a bariatric mechanical lift to safely transfer a resident who is obese (LO 13)? Multiple Choice 17. The basic structural units of all organisms are called (LO 2) (A) Tissues (B) Body systems (C) Organs (D) Cells 18.
is the condition in which all of the body’s systems are balanced and are working at their best (LO 2). (A) Homeostasis (B) Physiology (C) Circulatory (D) Pathophysiology
19. How should a resident who has gastroesophageal reflux disease (GERD) be positioned after eating (LO 7)? (A) Lying flat on her back (B) Sitting upright (C) Reclining at approximately 45 degrees (D) On her stomach
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Answers-Chapter 15: The Gastrointestinal System 1. Ingestion of food, digestion of food, absorption of nutrients, and elimination of waste products from food/fluids 2. 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. 3. Brown in color, soft, moist, and formed 4. A fracture pan is used for small or thin people or those who cannot lift their buttocks onto a standard bedpan. 5. 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. 6. Answers include the following: increasing fiber, fluids, and physical activity, and medications such as laxatives, enemas, or suppositories 7. Excessive cleaning and wiping of the area, scented soaps 8. Sims’ position 9. Stop immediately 10. Tests must be done while the stool is still warm. 11. Urine or toilet paper 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 semi-solid. 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. At least two people 17. D 18. A 19. B
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Chapter 16: The Urinary System 1. 2. 3. 4.
What are four functions of the urinary system (LO 2)? List four normal age-related changes of the urinary system (LO 3). List three normal qualities of urine (LO 4). What is the best position for women to urinate? What is the best position for men to urinate (LO 5)? 5. Why are women more susceptible to urinary tract infections (UTIs) than men (LO 6)? 6. How should residents wipe after elimination in order to prevent infection (LO 6)? 7. What is dialysis (LO 6)? 8. Define five different types of incontinence (LO 7). 9. Why should a catheter drainage bag always hang lower than the level of the hips or bladder (LO 8)? 10. What items should not be included in a urine specimen (LO 9)? 11. List four things reagent strips can detect in urine (LO 10). Multiple Choice 12. What type of catheter is removed immediately after urine is drained and does not remain inside the bladder (LO 8)? (A) Indwelling catheter (B) Straight catheter (C) Drainage catheter (D) Condom catheter 13. Approximately how long after fluids are consumed should an NA offer a resident a bedpan, urinal, or trip to the bathroom (LO 11)? (A) One hour (B) Ten minutes (C) Thirty minutes (D) Two hours Answers-Chapter 16: The Urinary System 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; and assistance in regulation of blood pressure. 2. 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. 3. 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. 4. Sitting, standing
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5. One reason is that the female urethra is shorter than the male urethra. In addition, because the female urethra is located directly in front of the vagina and the anus, it is closer to potential sources of bacteria. 6. From front to back 7. Dialysis is an artificial means of removing the body’s waste products. 8. 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 distension of the bladder. 9. 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
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Chapter 17: The Reproductive System 1. 2. 3. 4.
List the functions of the male and female reproductive systems (LO 2). List all normal age-related changes of the reproductive system for males and females (LO 3). How are sexually transmitted infections (STIs) transmitted (LO 4)? When encountering a sexual situation between consenting adult residents, what should an NA do (LO 5)?
Answers-Chapter 17: The Reproductive System 1. Male – Manufacture sperm and the male hormone, testosterone. Female – Manufacture ova and the female hormones, estrogen and progesterone; provide environment for development of fetus; and produce milk for the nourishment of a baby after birth 2. 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. 3. 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. 4. Provide privacy and leave the area.
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Chapter 18: The Integumentary System 1. List four functions of the integumentary system (LO 2). 2. List eight normal age-related changes of the integumentary system (LO 3). 3. Briefly describe the damage and/or symptoms caused by first-, second-, and third degree burns (LO 4). 4. How is scabies usually transmitted (LO 4)? 5. Under what circumstances are nonsterile dressings usually used? When are sterile dressings used (LO 7)? Answers-Chapter 18: The Integumentary System 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. 2. 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. 3. First-degree (superficial) burns affect the epidermis and cause redness and pain. Second degree (partial-thickness) burns affect the dermis and cause some skin damage, redness, pain, swelling, and blistering. Third-degreeT(fEuS ll-T thB icA knN esKs)SbEuL rnL sE afR fe. ctCthOeMepidermis, dermis, and underlying tissue and cause serious scarring, which may affect muscle and bone; white or charred skin; pain, swelling, and peeling skin. 4. By direct person-to-person contact 5. Nonsterile 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. 6. A 7. A 8. D
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Multiple Choice 6. Where does skin breakdown often occur (LO 5)? (A) At pressure points. (B) On the tops of the hands. (C) On all exposed skin. (D) At the fingertips. 7. How often should a resident in a wheelchair change positions in order to help prevent pressure injuries (LO 5)? (A) Every hour (B) Every 90 minutes (C) Every three hours (D) Every 30 minutes 8. Generally speaking, for how long should warm or cold applications be applied (LO 6)? (A) 5 minutes (B) 10 minutes (C) 15 minutes (D) 20 minutes Chapter 19: The Circulatory or Cardiovascular System 1. 2. 3. 4. 5.
List four functions of blood (LO 2). List three normal age-related changes of the circulatory system (LO 3). List three ways that hypertension is treated (LO 4). How is the pain of angina pectoris commonly described (LO 4)? List three common symptoms of anemia (LO 4).
Multiple Choice 6. When should elastic stockings be applied (LO 4)? (A) During the night (B) In the morning (C) In the early afternoon (D) Before going to bed at night Answers-Chapter 19: The Circulatory or Cardiovascular System 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 body temperature; and clots the blood and fights pathogens and poisons. 2. Answers include the following: Heart pumps less efficiently. Blood vessels narrow. Blood vessels become less elastic. Blood flow decreases. 3. Answers include the following: medication, diuretics, exercise programs, special diet, stopping smoking, and lowering stress level. 4. Angina is usually described as intense pressure in the chest, a tightness in the chest, or pain in the back, neck, jaw, or shoulder. 44
5. Answers include the following: fatigue, weakness, pale skin, a sore or swollen tongue, brittle nails, and difficulty concentrating. 6. B Chapter 20: The Respiratory System 1. 2. 3. 4. 5. 6.
List three functions of the respiratory system (LO 2). List six normal age-related changes of the respiratory system (LO 3). Why might a person with COPD be fearful or anxious (LO 4)? What is the difference between latent TB infection and TB disease (LO 4)? Why is it important for a resident to take all prescribed medication if he has TB (LO 4)? What conditions can be helped by deep breathing exercises (LO 7)?
Multiple Choice 7. The process of inhaling and exhaling is referred to as (LO 2) (A) Inspiration (B) Respiration (C) Expiration (D) Resuscitation 8.
Which of the following is one of the duties of an NA with regard to oxygen therapy (LO 5)? (A) The nursing assistant orders the type of oxygen delivery device needed for the resident. (B) The nursing assistant orders the amount of oxygen the resident needs. (C) The nursing assistant performs skin care on the areas of the face where the oxygen device TESTBANKSELLER.COM rests. (D) The nursing assistant refills oxygen cylinders once they are empty. 9. What time of day is best to collect a sputum specimen (LO 6)? (A) Middle of the night (B) Late afternoon (C) After lunch (D) Early morning Answers-Chapter 20: The Respiratory System 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. 2. 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. 3. COPD causes difficulty breathing. Residents may be fearful about not being able to breathe.
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4. Someone with latent TB infection carries the 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. 5. 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. 6. Being paralyzed or having had abdominal surgery are two conditions that can require deep breathing exercises. 7. B 8. C 9. D
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Chapter 21: The Musculoskeletal System 1. 2. 3. 4. 5. 6. 7.
List the three types of muscles that are found in the human body (LO 2). What are three functions of bones (LO 2)? List five normal age-related changes of the musculoskeletal system (LO 3). What happens when a muscle atrophies (LO 4)? What can happen to bones when they become brittle (LO 4)? Why is preventing falls so important for elderly residents (LO 4)? List six signs and symptoms of poor circulation due to elastic bandages that need to be reported to the nurse (LO 5).
Multiple Choice 8. After an amputation, a resident may experience phantom sensation. Phantom sensation is (LO 4) (A) Not real (B) Tingling from a body part that has been amputated (C) An artificial body part (D) The removal of a body part 9. When helping a resident who has had a hip replacement get dressed, how should the NA begin (LO 4)? (A) Start with the stronger side (B) Start with the left side (C) Start with the weaker side (D) Start with the feet and move upward 10. A person recovering from a total hip replacement should not bend or flex the hip more than degrees (LO 4). (A) 30 (B) 45 (C) 90 (D) 120 11. Which of the following means that the resident can bear some weight on one or both legs postoperatively (LO 4)? (A) Non-weight-bearing (NWB) (B) Full weight-bearing (FWB) (C) 100% weight-bearing (1WB) (D) Partial weight-bearing (PWB) Answers-Chapter 21: The Musculoskeletal System 1. Skeletal muscles, smooth muscles, and cardiac muscle 2. Bones lend support to body structures, allow the body to move, and protect the organs. 47
3. 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. 4. It wastes away, decreases in size, and weakens. 5. They can break easily. 6. Falls contribute to many physical injuries and can have psychological consequences as well. 7. 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. 8. B 9. C 10. C 11. D
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Chapter 22: The Nervous System 1. What is the basic working unit of the nervous system (LO 2)? 2. What makes up the central nervous system? What makes up the peripheral nervous system (LO 2)? 3. List three functions of the nervous system (LO 2). 4. List four normal age-related changes of the nervous system (LO 3). 5. Why is it important not to use rubbing alcohol to clean artificial eyes (LO 4)? 6. What is the most common cause of dementia (LO 5)? 7. Why is it important for NAs to encourage independence for as long as possible for residents who have AD (LO 6)? 8. If a resident with Alzheimer’s disease loses interest in an activity, what should the NA do (LO 11)? 9. Does a person usually overcome major depressive disorder through sheer will (LO 13)? 10. What should an NA do if a resident makes comments or jokes about suicide (LO 13)? Multiple Choice 11. When a cerebrovascular accident (CVA) occurs on the left side of the brain, which side of the body will be affected (LO 4)? (A) The left side (B) The right side (C) The underside (D) The front side 12. When assisting a resident who has had a CVA with eating, in which side of the resident’s mouth should food be placed (LO 4)? (A) Stronger side (B) Affected side (C) Weaker side (D) Right side 13. When a resident with Alzheimer’s disease repeats an action over and over, he is (LO 7) (A) Babbling (B) Intervening (C) Strategizing (D) Perseverating 14. One morning a resident with Alzheimer’s disease says he does not like eating with others and wants to eat breakfast by himself in his room. The next morning he tells his NA that he does not like to eat alone and wants help going to the dining room. What would be the best response by the NA to this shift in the resident’s preferences (LO 8)? (A) The NA should remind him that he prefers eating alone in his room. (B) The NA should explain that it is difficult for him to eat in the dining room because he requires additional help. (C) The NA should take the resident to the dining room. 49
(D) The NA should tell the resident that he must eat in his room because it is the facility’s policy. 15. Which of the following is a way for an NA to help a resident who has Alzheimer’s disease with his nutritional needs (LO 9)? (A) The NA should use a plain plate without a pattern and a single eating utensil for meals. (B) The NA should put multiple kinds of food, in different colors and textures, on the resident’s plate. (C) The NA should serve steaming hot foods. (D) The NA should avoid talking to the resident while he is eating. 16. When a resident with Alzheimer’s disease continues to ask the same question, the NA should (LO 10) (A) Ask the resident to stop asking that question (B) Answer the question, using the same words each time (C) Remind the resident that he has asked that question several times before (D) Ignore the behavior until it stops 17. A resident with Alzheimer’s disease tells his NA that he is not going to eat dinner today because he is meeting his wife for dinner at their favorite restaurant. The NA knows his wife has been dead for many years. What would be the best response by the NA (LO 12)? (A) The NA should tell the resident that he cannot eat in restaurants due to his disease. (B) The NA should remind the resident that his wife is no longer alive. (C) The NA should ask him what restaurant he is going to and what he will have. (D) The NA should let him know that if he does not go to the dining room soon, he will miss dinner. 18. Which of the following puts a person at a higher risk for substance abuse (LO 14)? (A) Having many friends (B) Exercising often (C) Having a mental health disorder (D) Not having tried illegal drugs Answers-Chapter 22: The Nervous System 1. The neuron 2. The brain and spinal cord make up the central nervous system; the peripheral nervous system consists of the cranial and spinal nerves. 3. 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. 50
4. 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. 5. The artificial eye can be permanently damaged by rubbing alcohol. 6. Alzheimer’s disease 7. This helps keep the resident’s mind and body as active as possible. 8. Offer another one 9. No 10. Report it immediately to the nurse. 11. B 12. A 13. D 14. C 15. A 16. B 17. C 18. C
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Chapter 23: The Endocrine System 1. List four functions of the endocrine system (LO 2). 2. List three normal age-related changes of the endocrine system (LO 3). 3. What are three conditions that make it more likely for a person to develop diabetes (LO 4)? Multiple Choice 4. Which form of diabetes is the most common (LO 4)? (A) Prediabetes (B) Type 1 diabetes (C) Type 2 diabetes (D) Diabetes mellitus 5. What is a common symptom of hypothyroidism (LO 4)? (A) Rapid heartbeat (B) Weight gain (C) High blood pressure (D) Bulging eyes 6. Which of the following is an appropriate guideline for a resident who has diabetes (LO 5)? (A) The resident will need to eat meals at the same time every day. (B) The resident will need to avoid exercising. (C) The NA will need to trim and clean the resident’s toenails. (D) The resident should go barefoot to avoid having material against his feet. 7. Which of the following should an NA do when giving foot care to a resident with diabetes (LO 6)? (A) The NA should use hot water to kill bacteria on the feet. (B) The NA should massage lotion in between the resident’s toes to keep the area soft. (C) The NA should use clippers to remove corns or calluses. (D) The NA should pat the feet completely dry after washing them. Answers-Chapter 23: The Endocrine System 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. 2. 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 production does not stop. Insulin production decreases. Body is less able to handle stress. 3. Family history, advanced age, obesity 4. C 5. B 52
6. A 7. D
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Chapter 24: The Immune and Lymphatic Systems and Cancer 1. Briefly describe nonspecific immunity and specific immunity (LO 2). 2. List four normal age-related changes of the immune and lymphatic systems (LO 3). 3. What is the difference between benign and malignant tumors (LO 7)? Multiple Choice 4. What is one way that the human immunodeficiency virus (HIV) is transmitted (LO 4)? (A) By insects such as mosquitoes (B) By hugging an infected person (C) By touching a contaminated doorknob (D) By contact with contaminated needles 5. What is one of the NA’s responsibilities when caring for a resident who has acquired immunodeficiency syndrome (AIDS) (LO 5)? (A) The NA should help determine when the resident should change medication. (B) The NA should inform others of the resident’s diagnosis. (C) The NA should help protect the resident from infections. (D) The NA should help keep the resident as isolated as possible. 6. A diet that is low in (A) Fiber (B) Fluids (C) Bananas (D) Applesauce
may help residents who have diarrhea (LO 6).
7. Which type of treatment for cancer involves using high-energy rays to attempt to destroy cancer cells in a specific area (LO 7)? (A) Immunotherapy (B) Radiation therapy (C) Chemotherapy (D) Surgery 8. If a resident with cancer expresses fear about her condition, which of the following would be the best response by the NA (LO 8)? (A) “Every cloud has a silver lining.” (B) “Good things come to those who wait.” (C) “It will be over before you know it.” (D) “I understand you’re scared. How can I help?” Answers-Chapter 24: The Immune and Lymphatic Systems and Cancer 1. Nonspecific immunity is present at birth and protects the body from disease in general. Specific immunity is a type of immunity acquired by the body. 54
2. 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. 3. Benign tumors grow slowly and do not spread to other parts of the body. Malignant tumors grow rapidly and invade surrounding tissue. 4. D 5. C 6. A 7. B 8. D
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Chapter 25: Rehabilitation and Restorative Care 1. List three goals of rehabilitation (LO 2). 2. List three positive effects that encouraging independence and self-care can have on a resident (LO 3). 3. List one complication for each body system that results from a lack of exercise and activity (LO 4). 4. List one benefit for each body system that results from regular activity and exercise (LO 4). Multiple Choice 5. Which type of cane has four rubber-tipped feet (LO 5)? (A) C cane (B) Quad cane (C) Functional grip cane (D) Crutch cane 6. When a resident uses a cane, walker, or crutches, on which side should the NA stay (LO 5)? (A) Right (B) Left (C) Stronger (D) Weaker 7. A type of device that is applied externally to a limb for support and protection is called a(n) (LO TESTBANKSELLER.COM 6) (A) Prosthetic device (B) Musculoskeletal device (C) Chiropractic device (D) Orthotic device 8. When performing ROM exercises, where on the body should the NA begin (LO 7)? (A) Shoulder (B) Wrist (C) Hip (D) Ankle Answers-Chapter 25: Rehabilitation and Restorative Care 1. Answers include the following: maintain or regain abilities; promote independence and help resident to adapt; and prevent complications of immobility. 2. Answers include the following: positive effects on self-image, attitude, and abilities, and may help speed recovery. 3. Answers include the following: Gastrointestinal– constipation; Urinary–urinary tract infection (UTI); Integumentary–pressure injuries and slow-healing wounds; Circulatory–blood clots, 56
4.
5. 6. 7. 8.
especially in the legs; Respiratory–pneumonia; Musculoskeletal–muscle atrophy and contractures; Nervous–depression or insomnia; and Endocrine–weight gain. Answers include the following: Gastrointestinal– promotes appetite and aids in 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; and Endocrine– increases metabolism, helping to maintain healthy weight. B D D A
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Chapter 26: Subacute Care 1. 2. 3. 4.
What kinds of conditions require subacute care (LO 2)? What is the purpose of artificial airways (LO 6)? What does tracheostomy care generally involve (LO 7)? Why is it important to enter the room often when a resident is using a mechanical ventilator (LO 8)? 5. What observations should NAs make about chest drainage (LO 10)? 6. What signs and symptoms should the NA report to the nurse when a resident is on dialysis (LO 12)? Multiple Choice 7. Preoperative fluid restrictions can help prevent (LO 3) (A) Blood clots (B) Contractures (C) Kidney stones (D) Vomiting 8. What does a pulse oximeter measure (LO 4)? (A) Pulse rate and blood glucose level (B) Pulse rate and white blood cell count (C) Pulse rate and calcium level (D) Pulse rate and blood oxygen level
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9. What does a telemetry device monitor (LO 5)? (A) The amount of blood stored in the spleen (B) The heart’s rhythm and rate (C) The number of CD4+ lymphocytes in the body (D) A person’s intake and output of fluids 10. What is one NA responsibility regarding suctioning (LO 9)? (A) The NA changes the tubing daily. (B) The NA performs the suctioning. (C) The NA reports signs of respiratory distress. (D) The NA decides when a resident needs suctioning. 11. What is one NA responsibility regarding feeding tubes (LO 11)? (A) The NA positions the resident for the feeding. (B) The NA performs the feeding. (C) The NA inserts the feeding tube. (D) The NA cleans the feeding tube.
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Answers-Chapter 26: Subacute Care 1. Answers include the following: recent surgery or acute conditions, chronic illnesses, serious burns, the need for special administration of nutrients or medicine, or dialysis. 2. Artificial airways help maintain an airway and facilitate ventilation. 3. 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. 4. 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. 5. Answers include the following: changes in amount, color, or consistency of chest drainage. 6. 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 vomiting; muscle cramps; swelling of extremities (edema); change in intake and output; or itchy skin. 7. D 8. D 9. B 10. C 11. A
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Chapter 27: End-of-Life Care 1. What are the goals of palliative care (LO 2)? 2. Briefly describe each of the five stages of grief (denial, anger, bargaining, depression, and acceptance) as defined by Elisabeth Kübler-Ross (LO 4). 3. List five legal rights to remember when caring for a resident who is terminally ill (LO 5). 4. List 20 physical signs that a person is approaching death (LO 8). 5. What should the NA do if he observes physical signs such as a dropped jaw after a resident has died (LO 9)? 6. List four ways that NAs can help families and friends after a loved one has died (LO 10). 7. What is bereavement therapy (LO 11)? 8. Define postmortem (LO 12). Multiple Choice 9. When is hospice care usually ordered by a doctor (LO 3)? (A) When a person has a chronic disease (B) When a person is not eating normally (C) When a person has approximately six months or less to live (D) When a person becomes depressed 10. Which sense is usually the last sense to leave the body (LO 6)? (A) The sense of hearing (B) The sense of smell (C) The sense of taste (D) The sense of touch 11. Which of the following would be the best way an NA can help meet a dying resident’s psychosocial needs (LO 7)? (A) Convincing the resident to believe in God (B) Bathing the resident (C) Making changes in the resident’s diet (D) Listening to the resident
Answers-Chapter 27: End-of-Life Care 1. Answers include the following: relieve pain, control symptoms, reduce suffering, prevent side effects, and maintain quality of life. 2. 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 3. 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. 4. Answers include the following: • Cyanotic, pale, or darkening skin or mucous membranes 60
• 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 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 5. Inform the nurse 6. 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. 7. Bereavement therapy is a way to identify feelings to help with grieving. 8. After death 9. C 10. A 11. D
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Chapter 28: Your New Position 1. 2. 3. 4. 5. 6. 7. 8. 9.
List six topics that should be included when preparing a résumé (LO 2). How long should a résumé be (LO 2)? Why do you think employers are required to do a criminal background check on NAs (LO 3)? List four ways an NA can make sure she is following her scope of practice before accepting a task (LO 6). List the information about NAs that is kept in the state registry (LO 7). What is constructive feedback (LO 9)? Before reacting to a conflict, what should an NA do (LO 10)? What is stress (LO 11)? List ten ways to manage stress (LO 11).
Multiple Choice 10. Which of the following is part of proper grooming for a job interview (LO 4)? (A) Wear a lot of nice jewelry (B) Wear a favorite perfume (C) Wear comfortable sneakers (D) Wear simple makeup 11. After a job interview is over, which of the following would be the best response by the NA (LO 5)? (A) The NA should ask, “Will I be hired?” (B) The NA should ask, “When can I expect to hear about the position?” (C) The NA should ask, “Would you like me to send a thank-you note?” (D) The NA should ask, “How soon can I start taking vacation days after I’m hired?” 12. How many hours of continuing education does the federal government require for NAs each year (LO 8)? (A) 12 (B) 25 (C) 7 (D) 18
Answers-Chapter 28: Your New Position 1. Answers include: objective, education, experience, volunteer work, skills, and references 2. One page 3. Answers will vary, but may include something about keeping residents safe. 62
4. 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. 5. 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 6. 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. 7. Think about possible reasons why someone is behaving in an undesirable way. 8. Stress is a mentally or emotionally disruptive or upsetting condition that occurs due to changes in the environment. 9. 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. 10. D 11. B 12. A
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Chapter 1: The Nursing Assistant in Long-Term Care 1. Whom does Medicare insurance cover (LO 3)? A: People who are 65 years of age or older and people of any age with permanent kidney failure or certain disabilities 2. Who makes up the majority of residents in long-term care facilities—men or women (LO 4)? A: Women 3. What are three tasks that NAs do not usually perform (LO 5)? A: Answers include the following: inserting/ removing tubes; changing sterile dressings; giving tube feedings; giving medications. 4. What is one way that an NA can demonstrate professionalism (LO 6)? A: Answers can include the following: • • • • • • • • • • • • • • • • • • • •
Being clean and neatly dressed and groomed Not discussing personal problems with residents Not using personal phones in resident care areas Being at work on time and avoiding absences Not leaving work early without permission Not reporting to work under the influence of illegal drugs and/or alcohol Keeping a positive attituTdE e STBANKSELLER.COM Not gossiping about coworkers Being polite and respectful Addressing residents and visitors in the way they wish to be addressed Not using profanity Keeping resident information confidential Following procedures and policies Reporting concerns or problems to your supervisor Maintaining educational requirements Asking questions when you do not understand something Being honest and documenting carefully Accepting constructive feedback Not accepting tips or gifts Being loyal to your facility and being a positive role model
5. List each of the ten qualities in Learning Objective 7. For each quality, write one example of a way that an NA can demonstrate that quality (LO 7). A: Answers will vary for each student. 6. Who is the most important member of the care team (LO 9)? A: The resident 1
7. List The Five Rights of Delegation (LO 11). A: The Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation 8. Define person-centered care (LO 12). A: Type of care that places the emphasis on the person needing care and his or her individuality, capabilities, choices, beliefs, interests, and preferences 9. When surveyors visit a facility, what do they study and observe (LO 14)? A: 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. When a surveyor asks an NA a question she does not know the answer to, how should she respond (LO 14)? A: 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.
12.
Multiple Choice Which of the following statements is true of long-term care (LO 2)? (A) Long-term care is only given during certain hours of the day. (B) Long-term care assists people with ongoing, chronic medical conditions. (C) Long-term care is given in an adult day services setting. (D) Long-term care is for people who need care for a short time after surgery. One common NA task is (LO 5) (A) Prescribing medication (B) Creating residents’ care plans (C) Managing other NAs’ work (D) Bathing residents 13. Which of the following is true of proper grooming for an NA (LO 8)? (A) Gel nails should be freshly applied. (B) A simple waterproof watch should be worn. (C) Earrings can dangle just past the earlobe. (D) Perfume should be applied behind the ears or on both wrists. 14. If an NA is following the chain of command, to whom would she normally report a problem (LO 10)? (A) Nurse (B) Administrator (C) Resident 2
(D) Medical social worker 15. If an NA has forgotten the correct order in which to perform a procedure, which of the following would be the best way for her to proceed (LO 13)? (A) The NA should review the procedure manual before beginning. (B) The NA should ask the resident to see if he remembers the correct order. (C) The NA should perform the procedure to the best of her memory, knowing that she will probably do it correctly. (D) The NA should consult with the administrator to find out the correct order.
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Chapter 2: Ethical and Legal Issues 1. What are ethics (LO 2)? A: Ethics are the knowledge of what is right and wrong and help guide conduct. 2. Give one example of a law that must be followed (LO 2). A: Answers will vary. 3. Describe five elements of a typical nursing assistant code of ethics (LO 4). A: 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 to nursing assistant care. I will show a positive 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. 4. According to the Omnibus Budget Reconciliation Act’s (OBRA) requirements, how many hours of training must nursing assistants complete at a minimum (LO 5)? A: 75 hours 5. Give one example of negligence (LO 7). A: Answers will vary 6. What is a nursing assistant’s responsibility if she sees or suspects abuse (LO 8)? A: Report it to her supervisor immediately. 7. What generally happens to a nursing assistant after a report of abuse has been made about him (LO 9)? A: 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. 8. Describe some of the typical duties of an ombudsman (LO 10). A: 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 4
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. 9. With whom may a nursing assistant share a resident’s health information (LO 11)? A: Other care team members 10. What does HIPAA protect (LO 11)? A: The privacy of health information 11. To which members of the care team does HIPAA apply (LO 11)? A: HIPAA applies to all healthcare providers, including doctors, nurses, nursing assistants, and care team members. 12. What are advance directives (LO 12)? A: 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. 13. List four rights related to advance directives that the PSDA requires be given to new residents upon admission (LO 12). A: Answers include the following: All facilities receiving Medicare and Medicaid money must offer new residents information about 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. Multiple Choice 14. Which of the following is one reason that a nursing assistant should not accept money or gifts from residents (LO 3)? (A) The NA will start to depend on the extra income and will not be able to live within her budget without it. (B) Receiving money or gifts is unprofessional and can lead to conflict. (C) Receiving money or gifts is unfair because not all residents can afford to tip staff or give gifts. (D) The NA will be unable to ask for an advance on her salary if she receives additional income from residents. 15. What is the name of the resident assessment system required by OBRA (LO 5)? (A) Resident Information Protocols (RIP) (B) Reporting and Recording Intake (RRI) (C) Minimum Data Set (MDS) (D) Evaluation Implementation Form (EIF) 5
16. Residents have a legal right not to be abused or mistreated. To which one of the Residents’ Rights does this relate (LO 6)? (A) Right to visits (B) Right to dignity, respect, and freedom (C) Right with regard to social services (D) Right to security of possessions 17. Residents have a legal right to be told of changes in their medical condition. To which one of the Residents’ Rights does this relate (LO 6)? (A) Right to participate in their own care (B) Right to privacy and confidentiality (C) Right to complain (D) Rights during transfers and discharges 18. A nursing assistant takes money from a resident’s purse, planning to pay it back later. Which type of abuse is this considered (LO 7)? (A) Psychological abuse (B) Physical abuse (C) Substance abuse (D) Financial abuse 19. Emotional abuse of a resident by his wife is considered (LO 7) (A) Domestic violence (B) Physical abuse (C) Substance abuse (D) Sexual abuse
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Chapter 3: Communication Skills 1. What is the difference between verbal and nonverbal communication (LO 2)? A: Communicating verbally means using words. Nonverbal communication is communicating without using words. 2. Why should a nursing assistant avoid asking yes or no questions (LO 3)? A: Yes/no answers end a conversation. 3. A resident tells a nursing assistant that he is scared of a medical test that is going to be performed. How could the NA respond without using a cliché such as “Oh, everything will be fine” (LO 3)? A: Answers will vary. 4. What can help an NA overcome a language barrier with a resident (LO 4)? A: 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 5. What should an NA do each time he greets a resident (LO 5)? A: Introduce himself, identify the resident, and explain the procedure to be done 6. Convert 8:33 p.m. to military time (LO 7). A: 2033 hours 7. Convert 11:10 a.m. to military time (LO 7). A: 1110 hour 8. With whom can a nursing assistant’s observations about residents be shared (LO 8)? A: Only other members of the care team 9. When should care be documented (LO 9)? A: Immediately after care is given 10. Do HIPAA guidelines apply to computer use (LO 10)? A: Yes 11. How does a nursing assistant’s reporting impact a resident’s Minimum Data Set (MDS) assessment (LO 11)? A: When nursing assistants report changes in residents, it may trigger a needed assessment. 12. List the four senses that are used in accurate observing and reporting (LO 12). A: Sight, hearing, smell, and touch 13. What is an incident (LO 15)? A: An incident is an accident, problem, or unexpected event during the course of care. 7
14. When should an incident report be completed (LO 15)? A: After the incident occurs, the report must be completed as soon as possible.
15. Give an example of a proper greeting when answering the phone (LO 16). A: Answers may include the following: “Good morning,” “good afternoon,” or “good evening.” 16. Describe the NA’s role in rounds at a facility (LO 18). A: Listen closely. Take notes. Offer valuable information gathered about residents to staff. 17. Give an example of how to combine activities to manage time better (LO 20). A: Answers will vary, but may include visiting with residents while providing care.
Short Answer For each of the following five statements, decide whether it is an objective sign or subjective symptom observation. Write S for subjective or O for objective (LO 12). 18. Resident says she has a sore throat. A:S 19. Resident has dark red urine. A:O 20. Resident states, “I have a hard time catching my breath.” A:S 21. Resident is running a fever. A:O 22. Resident has blisters on her feet. _A:O
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Multiple Choice 23. Which of the following is the correct abbreviation for nothing by mouth (LO 6)? (A) NBM (B) NPO (C) ZVM (D) NFF 24. What does the abbreviation PRN stand for (LO 6)? (A) Every hour (B) When needed (C) Two times per day (D) Immediately 25. How does a nursing assistant contribute to care planning (LO 14)? (A) By giving her suggestions regarding medication changes (B) By diagnosing the resident’s current condition (C) By sharing her observations of residents (D) By demonstrating the types of treatment she gives to the resident for the resident’s family 26. Where should the call light be left when a nursing assistant leaves a resident’s room (LO 17)? (A) By the door leading to the hallway (B) Next to the toilet in the bathroom (C) On the resident’s windowsill 8
(D) Within the resident’s reach
27. Which of the following is typically found on an assignment sheet (LO 19)? (A) Resident’s last known address (B) Resident’s television preferences (C) Names of the resident’s closest living relatives (D) Resident’s diet order
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Chapter 4: Communication Challenges 1. What should the nursing assistant do first when dealing with a resident who has a visual impairment (LO 2)? A: Announce yourself and greet the resident. 2. How can a nursing assistant explain the position of objects to a resident who is visually impaired (LO 2)? A: By using the face of an imaginary clock 3. When speaking with a hearing-impaired resident, whose face should the light be on—the nursing assistant’s or the resident’s (LO 3)? A: The nursing assistant’s 4. Why should a nursing assistant explain procedures and introduce herself to a resident who is unconscious (LO 11)? A: Even when a person is unconscious, she may still be able to hear what is going on around her. 5. What are other possible methods of communication if a person cannot speak (LO 12)? A: Answers include the following: communication boards, picture cards, writing notes, drawing pictures, and hand and eye signals. 6. What is an artificial airway (LO 12)? A: 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.
Multiple Choice 7. A resident starts sleeping with a doll she had when she was a little girl. This is an example of which defense mechanism (LO 4)? (A) Repression (B) Regression (C) Displacement (D) Rationalization 8. A resident refuses to believe her diagnosis of a terminal illness. This is an example of which defense mechanism (LO 4)? (A) Denial (B) Projection (C) Displacement (D) Repression 9.
Which of the following is true of anxiety (LO 5)? (A) Feeling anxious is the same as feeling afraid. 10
(B) Anxiety produces only mental and emotional symptoms; it does not cause physical symptoms. (C) A person may not always know why she feels anxious. (D) Speaking loudly and quickly is helpful for a person who is anxious. 10. Major depressive disorder is also known as (LO 6) (A) Clinical depression (B) Anxiety disorder (C) Mood therapy (D) Minor regression 11. Which of the following statements best describes anger (LO 7)? (A) Anger is only experienced by people who have a mental health disorder. (B) Nursing assistants do not need to report angry behavior by residents. (C) Anger is the first sign of an anxiety disorder. (D) Anger is a natural emotion with many causes. 12. If a resident becomes combative, the best response by the nursing assistant would be to (LO 8) (A) Let the resident know what he did was wrong (B) Stay at a safe distance from the resident (C) Startle the resident into stopping the behavior (D) Threaten the resident by withholding something he likes 13. If a resident exhibits inapprT opEriS atT eB seA xuNaK l bSeE haLvL ioE r, R w. haCt O wM ould be the best response by the nursing assistant (LO 9)? (A) The NA should let the resident know that he is embarrassing himself. (B) The NA should tell other NAs what the resident is doing so that they can avoid him. (C) The NA should tell the resident that he is being inappropriate. (D) The NA should try to distract the resident. 14. What should a person be able to identify when she is oriented (LO 10)? (A) Favorite foods, city she resides in, mother’s maiden name (B) Who she is, correct year, facility she lives in (C) Medication she takes, doctor’s name, correct time (D) Her diagnosis, the names of her family members, and the date 15. Which of the following is a common cause of confusion (LO 10)? (A) Anxiety (B) Anger (C) Urinary tract infection (D) Diabetes 16. The medical term for difficulty breathing is (LO 12) (A) Dyspnea (B) Ventilation 11
(C) Combative (D) Mechanism
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Chapter 5: Diversity and Human Needs and Development 1. What do the terms health and wellness mean (LO 2)? A: 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. 2. Describe what holistic health care involves (LO 3). A: Holistic care involves considering the whole person, which includes his physical and psychosocial needs. 3. What are psychosocial needs (LO 3)? A: Psychosocial needs include social contact, emotions, thought, and spirituality. 4. What is cultural diversity (LO 5)? A: 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. 5. What is cultural competence (LO 5)? A: Cultural competence is an ongoing process of learning about other cultures and applying that knowledge to help provide better health care. 6. If an NA encounters a sexual situation between two consenting residents, what should she do TESTBANKSELLER.COM (LO 9)? A: Provide privacy and leave the room 7. What should an NA do if she sees a resident being sexually abused (LO 9)? A: 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. 8. What is a stereotype (LO 11)? A: A stereotype is a biased generalization about a group that is usually based on opinions and distorted ideas. 9. Why should stereotyping be avoided (LO 11)? A: Answers may 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. 10. Why is it important for NAs to treat residents who are developmentally disabled as adults, regardless of their behavior (LO 12)? A: Answers will vary, but may include something along the lines of the resident having a right to respect, dignity, and independence. Multiple Choice 13
11. Which of the following is an example of a physical need (LO 4)? (A) Acceptance (B) Sleep (C) Success (D) Affection 12. Which of the following is an example of a psychosocial need (LO 4)? (A) Water (B) Rest (C) Independence (D) Food 13. According to Maslow, which of the following needs must be met first (LO 4)? (A) Physical needs (B) Safety needs (C) Psychosocial needs (D) Need for self-esteem 14. Which of the following terms describes a family made up of one parent and one child (LO 6)? (A) Blended family (B) Extended family (C) Nuclear family (D) Single-parent family 15. Which of the following is the best example of an extended family (LO 6)? (A) Mother, grandmother, and aunt living together (B) Father and son living together (C) Mother, father, and daughter living together (D) Divorced mother and daughter living together 16. Which of the following would be the best response by the NA if a resident wants to discuss health concerns he has (LO 7)? (A) “Everything works out for the best.” (B) “I understand you’re scared. Can you tell me more?” (C) “I read about a new medication that could help you.” (D) “It’s better for you to talk to your daughter rather than me.” 17. Which of the following sentences is true of spiritual beliefs (LO 8)? (A) All residents have the same spiritual needs. (B) NAs should let residents know when they do not agree with residents’ beliefs. (C) NAs should give privacy for prayer if residents request it. (D) NAs should insist that residents attend church services when residents seem lonely. 18. During which stage of human development might girls reach puberty (LO 10)? (A) Young adulthood 14
(B) School-age (C) Preadolescence (D) Preschool
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Chapter 6: Infection Prevention and Control 1. Describe the difference between the terms clean and dirty (LO 3). A: An object can be called clean if it has not been contaminated with pathogens. An object that is dirty has been contaminated with pathogens. 2. What is sterilization? What is disinfection (LO 3)? A: 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. 3. List four reasons the elderly are at a higher risk for infection (LO 5). A: 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 it easier to tear. When fragile skin tears, pathogens can enter the body. Both thinner skin and limited mobility increase the risk of pressure injuries 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.
On whom should Standard Precautions be practiced (LO 6)? A: With every resident for whom the nursing assistant cares 5. What is hand hygiene (LO 7)? A: Hand hygiene is washing hands with either plain or antiseptic soap and water or using alcohol-based hand rubs. 6. Why should NAs avoid using artificial nails (LO 7)? A: Artificial nails harbor bacteria, even if a person washes his hands often. 7. When should gowns be worn (LO 8)? A: A gown should be worn if the caregiver may come into contact with blood, body fluids, secretions or excretions, tissue, or when splashing or spraying blood or body fluids is likely. 8. When should a mask and goggles be worn (LO 8)? A: 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. 9. In what order should personal protective equipment (PPE) be put on and removed (LO 8)? 16
A: 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.
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10. How should soiled linen be carried (LO 9)? A: Dirty linen should be held and carried away from the NA’s uniform. 11. When can reusable equipment be used again (LO 9)? A: After it has been properly cleaned and reprocessed
12. How are bloodborne diseases transmitted (LO 13)? A: 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 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. What is hepatitis (LO 14)? A: Hepatitis is inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications, and trauma. 14. What does HIV do to the immune system (LO 14)? A: HIV damages the immune system so that over time, the body cannot effectively fight infections. 15. How is hepatitis B (HBV) spread (LO 14)? A: 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. 16. What is one of the best ways to prevent the spread of MRSA and VRE (LO 15)? A: Through frequent, proper handwashing 17. What are two ways to help prevent the spread of C. difficile (LO 15)? A: 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. How is carbapenem-resistant Enterobacteriaceae (CRE) usually spread (LO 15)? A: CRE is normally spread through direct contact with an infected person Multiple Choice 19. Which of the following is true of microorganisms (LO 2)? (A) They are only present in healthcare facilities. 18
(B) They are on almost everything a person touches. (C) They are not present in a person’s home, as long as the home is cleaned regularly. (D) They are only found on the human body. 20. In a care facility, who has the responsibility for preventing infection (LO 2)? (A) All care team members (B) Doctors (C) Nursing assistants (D) The dietary department 21. Which type of infection is limited to a specific location in the body and has symptoms that are near the site of infection (LO 2)? (A) Cross-infection (B) Healthcare-associated infection (C) Systemic infection (D) Localized infection 22. Which link in the chain of infection refers to any body opening on an infected person that allows pathogens to leave (LO 4)? (A) Reservoir (B) Susceptible host (C) Mode of transmission (D) Portal of exit 23. Which of the following is the primary route of disease transmission within the healthcare setting (LO 4)? (A) On the stethoscopes of care team members (B) On the hands of healthcare workers (C) On the elimination equipment used by residents (D) On the food trays served to residents 24. Under Standard Precautions, which of the following is not considered a body fluid (LO 6)? (A) Vomit (B) Feces (C) Sweat (D) Pus 25. What is the first step the NA should take when cleaning a spill (LO 10)? (A) The NA should scoop up the spill. (B) The NA should don gloves. (C) The NA should apply a disinfectant to the spill area. (D) The NA should place an absorbing powder on the spill. 26. Which of the following precautions is used for pathogens that are carried by moisture, by air currents, and by dust and remain floating for some time (LO 11)? 19
(A) Airborne Precautions (B) Contact Precautions (C) Droplet Precautions (D) Standard Precautions
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27. Which of the following is true of disposable supplies (LO 12)? (A) They should be avoided when a resident is in isolation. (B) They can be used once before they must be discarded. (C) They can be reused as long as they are disinfected between uses. (D) They can be reused as long as they are sterilized between use.
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Chapter 7: Safety and Body Mechanics 1. What important information does the Safety Data Sheet (SDS) provide about chemicals (LO 3)? A: 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 2. What items should be disposed of in a biohazard container or bag (LO 4)? A: Anything contaminated with infectious waste (blood, body fluids, or human tissue), except for anything sharp 3. Should objects be held close to the body or far away from the body when lifting or carrying them (LO 5)? A: Close to the body 4. When lifting, is it better to bend at the waist or at the knees (LO 5)? A: At the knees 5. Why was restraint use restricted (LO 6)? A: In the past, restraint usage was often abused by caregivers. This abuse led to new laws on restricting their use. 6. What are restraint alternatives (LO 7)? A: Restraint alternatives are any measure used in place of a restraint or that reduces the need for a restraint. 7. When can a restraint be applied (LO 8)? A: Restraints are used only after everything else has been ruled out and only with a doctor’s order. 8. List six signs to report to a nurse about intravenous (IV) therapy (LO 10). A: 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. 9. What three things need to be present for a fire to occur (LO 11)? A: Heat makes the flame, fuel is the object that burns, oxygen is the gas that will keep the fire burning. 10. Identify what the acronyms RACE and PASS stand for (LO 11). A: RACE is: 22
Remove anyone from danger if you are not in danger. Activate alarm (or call 911). 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. If a fire has started, what should the nursing assistant do before opening a closed door (LO 11)? A: Check for heat coming from the door before opening it. 12. List two general safety steps to protect residents in a facility (LO 12). A: 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. Report any situation or person who makes you feel unsafe or concerned to your supervisor. Multiple Choice 13. The most common accidents that occur in a healthcare facility are (LO 2) (A) Burns (B) Falls (C) Cuts (D) Poisonings 14. The best position for a resident to be in while eating is (LO 2) (A) Sitting upright (B) Lying on his left side (C) Reclining with his head tilted back (D) On his stomach 15. Which of the following promotes a more stable base of support (LO 5)? (A) Standing with the feet together (B) Maintaining a narrow base of support (C) Standing with the feet shoulder-width apart (D) Keeping the knees locked 16. Which of the following is the best thing that a nursing assistant can do to help promote oxygen safety (LO 9)? (A) Keep lit matches at least two feet away from a resident using oxygen (B) Use Vaseline on irritated skin areas around the resident’s nose and ears 23
(C) Remove flammable liquids from the resident’s room (D) Increase a resident’s oxygen level if he is having trouble breathing
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Chapter 8: Emergency Care, First Aid, and Disasters 1. List the two steps to follow in an emergency after making sure the area is safe and putting on gloves (LO 2). A: Assess the situation, assess the victim 2. What is the difference between respiratory and cardiac arrest (LO 3)? A: Respiratory arrest means that breathing stops; cardiac arrest is when the heart stops. 3. How soon can brain damage occur after the heart stops beating and breathing stops (LO 3)? A: Within four to six minutes 4. In what position should a person be placed if he is in shock (LO 3)? A: Lying down on the back 5. If blood seeps through the first pad over a wound, should the first pad be removed before applying a second pad (LO 3)? A: No 6. If a person feels faint and is sitting down, what should the nursing assistant do (LO 3)? A: Have the person bend forward and place her head between her knees if possible. 7. After putting on gloves, what should a nursing assistant do for a person who has a nosebleed TESTBANKSELLER.COM (LO 3)? A: Apply firm pressure on both sides of the nose, on the soft part 8. What symptoms are women more likely to experience than men if they are having an MI (LO 3)? A: Answers include the following: shortness of breath, nausea, vomiting, lightheadedness, fainting, dizziness, stomach pain, sweating, fatigue, back, neck, and jaw pain, and flu-like symptoms. 9. What are the first signs that a resident is experiencing diabetic ketoacidosis (LO 3)? A: The signs of onset of diabetic ketoacidosis include increased hunger, thirst, or urination; abdominal pain; deep or labored breathing; and breath that smells sweet or fruity. 10. What are three things a nursing assistant should never do when a person is having a seizure (LO 3)? A: Answers include the following: try to stop the seizure or restrain the person; force anything between the person’s teeth; place hands in the mouth for any reason; and give liquids or food. 11. What is a transient ischemic attack (TIA) (LO 3)? A: A transient ischemic attack (TIA) is a warning sign of a CVA. It is the result of a temporary lack of oxygen in the brain. 12. What does the term Code Blue usually mean (LO 4)? 25
A: Cardiac arrest
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13. List five examples of disasters (LO 5). A: Answers may vary but could include fire, flood, earthquake, hurricane, tornado, severe weather, and acts of terrorism. Multiple Choice 14. What document will need to be completed after an emergency occurs (LO 2)? (A) Incident report (B) Safety data set report (C) Cardiopulmonary resuscitation report (D) Activities of daily living report 15. Which of the following is appropriate to apply to a minor burn (LO 3)? (A) Ice (B) Butter (C) Herbal ointment (D) Water 16. When a resident is choking but can speak, cough, or breathe, what should the nursing assistant do (LO 3)? (A) The NA should begin cardiopulmonary resuscitation (CPR). (B) The NA should encourage the person to cough as forcefully as possible. (C) The NA should find an automated external defibrillator (AED) and follow its prompts. (D) The NA should put an oxygen mask on the resident.
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17. What is the medical term for vomiting (LO 3)? (A) Hemiplegia (B) Epistaxis (C) Syncope (D) Emesis 18. What color is the skin if it is cyanotic (LO 3)? (A) Yellow (B) Red (C) Blue (D) Pink
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Chapter 9: Admission, Transfer, Discharge, and Physical Exams 1. What are two resources that families may use to help them choose a care facility for a loved one (LO 2)? A: Answers may vary but could include fire, flood, earthquake, hurricane, tornado, severe weather, and acts of terrorism. 2. Why is it a good idea for nursing assistants to ask family members questions about residents upon admission (LO 4)? A: To get information on the resident’s personal preferences, history, rituals, and routines 3. Why might a transfer to a new room be difficult for a resident (LO 5)? A: Answers include the following: Change is always hard. The resident may have an illness or his condition may have worsened. 4. During discharge of a resident, when does a nursing assistant’s responsibility for the resident end (LO 6)? A: When the resident and his belongings are in the vehicle and the vehicle’s doors are closed Multiple Choice 5. If a nursing assistant makes a mistake with resident care, he can demonstrate that he is responsible by (LO 3) (A) Coming up with a clever way to distract the resident from his mistake (B) Blaming another staff member so that he will not be the only one viewed negatively (C) Not documenting the mistake so that there is no legal record of it (D) Reporting the mistake to the nurse immediately 6. Which of the following would be the best response by the nursing assistant if a new resident says that he does not want to attend a facility activity (LO 3)? (A) “That’s okay. I’ll ask you again some other time.” (B) “I think you should go because it will probably make you feel better.” (C) “It is harder to make friends when you do not attend social events.” (D) “You will become depressed if you do not participate and socialize.” 7. What should the scale be balanced at before measuring a resident’s weight (LO 4)? (A) 0 (B) 5 (C) 50 (D) -.10 8. How many inches are there in five feet (LO 4)? (A) 20 (B) 30 (C) 60 (D) 80 28
9. In which position is a resident lying flat on her back with her knees flexed and her feet flat on the bed (LO 7)? (A) Lithotomy position (B) Lateral position (C) Dorsal recumbent position (D) Knee-chest position 10. In which position is a resident lying on her abdomen with her knees pulled toward the abdomen and her legs separated (LO 7)? (A) Lithotomy position (B) Lateral position (C) Dorsal recumbent position (D) Knee-chest position 11. In which position is a resident lying on her back with her feet in padded stirrups (LO 7)? (A) Lithotomy position (B) Lateral position (C) Dorsal recumbent position (D) Knee-chest position
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Chapter 10: Bedmaking and Unit Care 1. List three functions that sleep performs (LO 2). A: 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. 2. What is usually stored in the bedside stan d (LO 5)? A: 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. 3. What is the overbed table used for? Can a bedpan be placed on it (LO 5)? A: 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. 4. Where should the call light always be placed (LO 6)? A: Within the resident’s reach 5. Define disposable equipment (LO 6). A: Disposable equipment will be used one time and then discarded. 6. Why should NAs carry clean linen away from their uniforms (LO 7)? A: If clean linen touches the nursing assistant’s uniform, the linen becomes contaminated.
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7. Why should linen never be shaken (LO 7)? A: Shaking linen may spread airborne contaminants. 8. Describe the difference between a closed bed and an open bed (LO 7). A: 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. 9.
While making an occupied bed, what should the NA observe (LO 7)? A: The NA should observe the resident’s skin for signs of breakdown. 10. When is a surgical bed made (LO 7)? A: A surgical bed is made to accept residents returning to bed on stretchers, after they have had treatments or a hospital visit. Multiple Choice 11. A disruption of breathing while a person is sleeping is known as (LO 3) (A) Insomnia (B) Sleep apnea (C) REM behavior disorder (D) Bruxism 30
12. The inability to fall asleep or stay asleep is known as (LO 3) (A) Insomnia (B) Sleep apnea (C) REM behavior disorder (D) Bruxism 13. Which of the following is a type of stimulant that may prevent residents from sleeping (LO 4)? (A) Hot water (B) Nicotine (C) Ibuprofen (D) Beer 14. Which of the following is a type of depressant (substance that causes calmness and drowsiness (LO 4)? (A) Caffeine (B) Nicotine (C) Cigarettes (D) Wine
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Chapter 11: Positioning, Moving, and Lifting 1. How does proper body alignment benefit the human body (LO 2)? A: 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 better able to clean the body of wastes. It helps prevent complications of immobility, such as contractures and atrophy. 2. Why should a nursing assistant face what she is lifting (LO 2)? A: This enables her to move her body as one unit, nd keeps her back straight. 3. In what position should a nursing assistant be before lifting an object (LO 2)? A: Begin in a squatting position 4. Should objects be lifted by using muscles in the legs or the back (LO 2)? A: Lift with the legs 5. Explain why objects should be kept close to the body when carrying them (LO 2). A: Keeping objects close to the body decreases stress to the back. 6. What is the benefit of using a draw sheet or other assist device when repositioning (LO 3)? A: Draw sheets or other assist devices help prevent skin damage caused by shearing.
NnKeSstEroLnL ChOicMh side should move first and why (LO 7. For a resident with one weaT kE siS deTaB nA do gE sidRe. ,w 4)? A: 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. 8. When moving a resident down a ramp in a wheelchair, in which direction should the resident be facing (LO 4)? A: Resident should be facing the top of the ramp. 9. What must a resident be able to do in order to use the toilet (LO 4)? A: For a resident to be able to use a toilet, he must be able to bear some weight on his legs. Multiple Choice 10. Which of the following is a description of the supine position (LO 3)? (A) Resident is in a semi-sitting position (45 to 60 degrees) with his head and shoulders elevated. (B) Resident is lying on either side. (C) Resident is lying on his abdomen. (D) Resident is lying flat on his back. 11. Which of the following is a description of the lateral position (LO 3)? (A) Resident is in a semi-sitting position (45 32
to 60 degrees) with his head and shoulders elevated. (B) Resident is lying on either side. (C) Resident is lying on his abdomen. (D) Resident is lying flat on his back. 12. Which of the following is a description of the Fowler’s position (LO 3)? (A) Resident is in a semi-sitting position (45 to 60 degrees) with his head and shoulders elevated. (B) Resident is lying on either side. (C) Resident is lying on his abdomen. (D) Resident is lying flat on his back. 13. Which of the following is a safety device used to help transfer residents who are weak, unsteady, or uncoordinated (LO 4)? (A) Compression sleeve (B) Transfer belt (C) Traction pulley (D) Back brace 14. Where should a nursing assistant place a transfer belt before helping a resident to ambulate (LO 5)? (A) Underneath the resident’s shirt, above his waist (B) Around the resident’s weaker leg, under his clothing (C) Around the resident’s waist, over his clothing (D) Underneath the resident’s armpits, over his shirt
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Chapter 12: Personal Care 1. Define the terms hygiene and grooming (LO 2). A: Hygiene consists of practices to keep the body clean. Grooming consists of practices to care for oneself. 2. List three ways NAs can help promote residents’ dignity when performing personal care (LO 2). A: 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. 3. Which serious skin wound can NAs help prevent by observing residents’ skin closely (LO 3)? A: Pressure injuries 4. In general, what should the water temperature be for bathing residents (LO 4)? A: No higher than 105°F 5. Why should residents be involved in choosing a comfortable water temperature (LO 4)? A: Comfortable temperature varies for each person. 6. Why should bath oils, gels, and powders be avoided when bathing residents (LO 4)? A: Bath oils, gels, and powders can create slippery surfaces and can put residents at risk of TESTBANKSELLER.COM falling. 7. How often should the perineal area be bathed (LO 6)? A: Every day 8. What are two benefits of back rubs (LO 7)? A: Answers include the following: relaxes tired, tense muscles, improves circulation, and relieves pain or discomfort. 9. What is the best way to prevent aspiration when performing mouth care on residents who are unconscious (LO 10)? A: Use as little liquid as possible during mouth care 10. Why should NAs explain what they are doing when working with residents who are unconscious (LO 10)? A: Because even residents who are unconscious may be able to hear 11. Should NAs wear gloves when shaving residents? Why or why not (LO 11)? A: Yes, due to risk of exposure to blood 12. Under what circumstances should an electric razor not be used (LO 11)? 34
A: An electric razor should not be used near water or any water source or where oxygen is in use.
13. When dressing and undressing residents, how should NAs refer to the weaker side (LO 11)? A: Weaker, affected, or involved side Multiple Choice 14. Which of the following should be washed before the axillae (underarms) (LO 5)? (A) Legs (B) Face (C) Perineal area (D) Buttocks 15. When bathing a resident, which body part should be washed first (LO 5)? (A) Eyes (B) Face (C) Neck (D) Arms 16. At a minimum, how often should mouth care be performed (LO 8)? (A) Once a day (B) Two times a day (C) Three times a day (D) Four times a day 17. How should dentures be stored after they are cleaned if the resident does not want to wear them (LO 9)? (A) Dentures should be stored in a denture cup filled with icy water. (B) Dentures should be stored in a denture cup filled with hot water. (C) Dentures should be stored in a denture cup filled with boiling water. (D) Dentures should be stored in a denture cup filled with cool water. 18. When dressing a resident, on which side should an NA start (LO 11)? (A) On the resident’s weaker side (B) On the resident’s unaffected side (C) On the resident’s stronger side (D) On the resident’s left side
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Chapter 13: Vital Signs 1.
What are the four vital signs that are regularly monitored (LO 2)? A: Body temperature, pulse, respirations, and blood pressure 2. List two reasons an NA should never document a guess of a resident’s vital signs (LO 2). A: It is illegal and can cause harm to the resident. 3. What are four symptoms of a fever (LO 3)? A: Answers include the following: elevated temperature reading, headache, fatigue, muscle aches, and chills. Skin may feel warm and look flushed. 4. If a resident has recently eaten or had something to drink, how long must an NA wait before she can measure his oral temperature (LO 4)? A: 10 to 20 minutes 5. Generally, how far should the tip of a tympanic thermometer be inserted into the ear (LO 4)? A: 1/4 to 1/2 inch 6. What is the most common site for taking the pulse (LO 6)? A: Radial pulse 7. Why is the respiratory rate usually counted directly after taking the pulse, while the fingers are still on the person’s wrist (LO 6)? A: Because people tend to breathe more quickly if they know they are being observed 8. Where is the apical pulse located (LO 6)? A: The apical pulse is on the left side of the chest, just below the nipple. 9. Why must a blood pressure cuff be the proper size and put on the arm correctly (LO 8)? A: To make sure that the reading will not be falsely high or low 10. What pulse point is commonly used to measure blood pressure (LO 8)? A: Brachial pulse 11. What are five ways an NA can help reduce a resident’s pain (LO 9)? A: 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. Multiple Choice 12. Which body site is generally considered to be the most accurate for obtaining temperatures (LO 4)? 36
(A) The mouth (B) The rectum (C) The armpit (D) The ear 13. What color is a rectal thermometer (LO 4)? (A) Blue (B) Green (C) Red (D) White 14. What is the normal pulse rate for adults (LO 5)? (A) 40 to 90 beats per minute (B) 60 to 100 beats per minute (C) 25 to 50 beats per minute (D) 80 to 120 beats per minute 15. Which of the following falls within the normal respiration rate for adults (LO 5)? (A) 14 breaths per minute (B) 22 breaths per minute (C) 5 breaths per minute (D) 9 breaths per minute 16. Which side of a stethoscopeTiE s uSsT edBfA orNmKeS asEuL rinLgEpR ul. seCrO atM e (LO 6)? (A) The left side (B) The classic side (C) The dome side (D) The diaphragm side 17. Which blood pressure measurement reflects the phase when the heart relaxes and is always lower than the other measurement (LO 7)? (A) Systolic (B) Radial (C) Apical (D) Diastolic 18. When a resident complains of pain, which of the following would be the best response by the NA (LO 9)? (A) The NA should give the resident pain medication. (B) The NA should ask questions to find out more information about the pain. (C) The NA should ignore the complaint unless the resident repeats it. (D) The NA should contact the resident’s family to find out what course of action they would like to take.
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Chapter 14: Nutrition and Fluid Balance 1. List five common nutritional problems that elderly people may experience (LO 2). A: 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. 2. According to MyPlate’s suggestions, what should half of a person’s plate be made up of (LO 5)? A: Vegetables and fruits 3. List some examples of plant sources of protein foods (LO 5). A: Beans, peas, soy products, vegetarian meat substitutes, nuts, and seeds are plant sources of proteins. 4. According to MyPlate, what fat percentages should a person choose most often from the dairy group (LO 5)? A: Most dairy group choices should be fat-free (0%) or low-fat (1%). 5. List the information contained on diet cards (LO 6). A: Resident’s name and information about special diets, allergies, likes and dislikes, as well as any other dietary instructions 6. What is one common abbreviation for a sodium-controlled diet (LO 7)? TESTBANKSELLER.COM A: Low Na or NAS 7. What is the difference between a clear liquid diet and a full liquid diet (LO 7)? A: 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. 8. What is the benefit of thickening liquids (LO 8)? A: Thickened liquids move down the throat more slowly, reducing coughing and limiting the risk for choking. 9. What is the proper position in which to place a resident for eating (LO 10)? A: Upright at 90 degrees 10. If a resident refuses to wear a clothing protector, what should the NA do (LO 11)? A: Respect the resident’s refusal. 11. How should an NA properly test the temperature of food if she feels it might be too hot (LO 11)? A: Put her hand over the food to sense the heat. 12. To which side of the mouth should food be directed if a resident has a weaker side—the weaker (affected) or stronger (unaffected) side (LO 12)? 38
A: Stronger side 13. When assisting a resident who is visually impaired, how should the NA describe the position of food and objects in front of the resident (LO 12)? A: By using the face of an imaginary clock 14. List four examples of output (LO 14). A: Output includes urine, feces, vomitus, perspiration, moisture in the air that a person exhales, suctioned material, and wound drainage. 15. How many milliliters (mL) equal one ounce (oz.) (LO 14)? A: 30 16. What are three ways that proper fluid intake benefits the body (LO 15)? A: Drinking enough water each day can help prevent constipation, urinary incontinence, and dehydration. Proper fluid intake also helps to dilute wastes and flush out the urinary system, which lessens the risk of infection. 17. What is a restrict fluids (RF) order (LO 16)? A: 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.
Multiple Choice 18. Which of the following is the correct term for a person who does not eat any animals or animal products (LO 3)? (A) Omnivore (B) Vegan (C) Carnivore (D) Pescetarian 19. Which of the following is the most essential nutrient for life (LO 4)? (A) Water (B) Protein (C) Vegetables (D) Grains 20. Which of the following abbreviations means that a resident should not have anything to eat or drink (LO 7)? (A) RR (B) RF (C) NPO (D) ADA 21. Which of the following puts a resident at an increased risk of unintended weight loss (LO 9)? 39
(A) The resident is a vegetarian. (B) The resident has difficulty swallowing. (C) The resident enjoys socializing during mealtime. (D) The resident eats snacks between meals. 22. One way for an NA to help prevent aspiration is to (LO 13) (A) Place food in the resident’s weaker side of the mouth (B) Not offer the resident a drink until the meal has been eaten (C) Make sure the resident is sitting upright for eating and drinking (D) Feed the resident quickly
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Chapter 15: The Gastrointestinal System 1. What are four functions of the gastrointestinal system (LO 3)? A: Ingestion of food, digestion of food, absorption of nutrients, and elimination of waste products from food/fluids 2. List five normal age-related changes of the gastrointestinal system (LO 4). A: 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. 3.
List three normal qualities of stool (LO 5). A: Brown in color, soft, moist, and formed 4. When is a fracture pan, rather than a standard bedpan, used for elimination (LO 6)? A: A fracture pan is used for small or thin people or those who cannot lift their buttocks onto a standard bedpan. 5. How should a standard bedpan be positioned? How should a fracture pan be positioned (LO 6)? A: 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. 6. List three possible treatmenTtsEfS orTcB onAstNipKatSioEnL(LL OE7R ). .COM A: Answers include the following: increasing fiber, fluids, and physical activity, and medications such as laxatives, enemas, or suppositories 7. What action should be avoided when providing perineal care for a resident who has hemorrhoids (LO 7)? A: Excessive cleaning and wiping of the area, scented soaps 8. What position must the resident be in for an enema (LO 8)? A: Sims’ position 9. If a resident feels pain while receiving an enema, what should the NA do (LO 8)? A: Stop immediately 10. Why does a stool specimen need to be delivered to the lab immediately when testing for ova and parasites (LO 9)? A: Tests must be done while the stool is still warm. 11. What items should not be included in a stool specimen (LO 9)? A: Urine or toilet paper 12. How is occult blood found in stool (LO 10)? 41
A: With a microscope or special chemical test 13. When may an ostomy be necessary (LO 11)? A: An ostomy may be necessary due to bowel disease, such as diverticulitis, Crohn’s disease, or colon cancer. 14. How do colostomies and ileostomies differ (LO 11)? A: A colostomy is a surgically created opening into the large intestine to allow feces to be expelled. With a colostomy, stool may be semi-solid. 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. List ten guidelines for bowel retraining (LO 12). A: 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. How many people are needed to use a bariatric mechanical lift to safely transfer a resident who is obese (LO 13)? A: At least two people Multiple Choice 17. The basic structural units of all organisms are called (LO 2) (A) Tissues (B) Body systems (C) Organs (D) Cells 18.
is the condition in which all of the body’s systems are balanced and are working at their best (LO 2). (A) Homeostasis (B) Physiology (C) Circulatory (D) Pathophysiology
19. How should a resident who has gastroesophageal reflux disease (GERD) be positioned after eating (LO 7)? (A) Lying flat on her back (B) Sitting upright (C) Reclining at approximately 45 degrees (D) On her stomach 42
Chapter 16: The Urinary System 1. What are four functions of the urinary system (LO 2)? A: 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; and assistance in regulation of blood pressure. 2. List four normal age-related changes of the urinary system (LO 3). A: 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. 3. List three normal qualities of urine (LO 4). A: 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. 4. What is the best position for women to urinate? What is the best position for men to urinate (LO 5)? A: Sitting, standing 5. Why are women more susceptible to urinary tract infections (UTIs) than men (LO 6)? A: One reason is that the female urethra is shorter than the male urethra. In addition, because the female urethra is located directly in front of the vagina and the anus, it is closer to potential sources of bacteria. 6. How should residents wipe after elimination in order to prevent infection (LO 6)? A: From front to back 7. What is dialysis (LO 6)? A: Dialysis is an artificial means of removing the body’s waste products. 8. Define five different types of incontinence (LO 7). A: 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 distension of the bladder. 9. Why should a catheter drainage bag always hang lower than the level of the hips or bladder (LO 8)? A: Urine that flows back into the bladder from the tubing or bag can cause infection. 10. What items should not be included in a urine specimen (LO 9)? A: Toilet paper or stool 44
11. List four things reagent strips can detect in urine (LO 10). A: Answers include the following: pH level, glucose, ketones, blood, and specific gravity.
Multiple Choice 12. What type of catheter is removed immediately after urine is drained and does not remain inside the bladder (LO 8)? (A) Indwelling catheter (B) Straight catheter (C) Drainage catheter (D) Condom catheter 13. Approximately how long after fluids are consumed should an NA offer a resident a bedpan, urinal, or trip to the bathroom (LO 11)? (A) One hour (B) Ten minutes (C) Thirty minutes (D) Two hours
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Chapter 17: The Reproductive System 1. List the functions of the male and female reproductive systems (LO 2). A: Male – Manufacture sperm and the male hormone, testosterone. Female – Manufacture ova and the female hormones, estrogen and progesterone; provide environment for development of fetus; and produce milk for the nourishment of a baby after birth 2. List all normal age-related changes of the reproductive system for males and females (LO 3). A: 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. 3. How are sexually transmitted infections (STIs) transmitted (LO 4)? A: 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. 4. When encountering a sexual situation between consenting adult residents, what should an NA do (LO 5)? A: Provide privacy and leave the area.
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Chapter 18: The Integumentary System 1. List four functions of the integumentary system (LO 2). A: 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. 2. List eight normal age-related changes of the integumentary system (LO 3). A: 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. 3. Briefly describe the damage and/or symptoms caused by first-, second-, and third degree burns (LO 4). A: First-degree (superficial) burns affect the epidermis and cause redness and pain. Second degree (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 serious scarring, which may affect muscle and bone; white or charred skin; pain, swelling, and peeling skin. 4.
How is scabies usually transmitted (LO 4)? A: By direct person-to-person contact 5. Under what circumstances are nonsterile dressings usually used? When are sterile dressings used (LO 7)? A: Nonsterile 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. Multiple Choice 6. Where does skin breakdown often occur (LO 5)? (A) At pressure points. (B) On the tops of the hands. (C) On all exposed skin. (D) At the fingertips. 7. How often should a resident in a wheelchair change positions in order to help prevent pressure injuries (LO 5)? (A) Every hour (B) Every 90 minutes (C) Every three hours (D) Every 30 minutes 47
8. Generally speaking, for how long should warm or cold applications be applied (LO 6)? (A) 5 minutes (B) 10 minutes (C) 15 minutes (D) 20 minutes
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Chapter 19: The Circulatory or Cardiovascular System 1. List four functions of blood (LO 2). A: 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 body temperature; and clots the blood and fights pathogens and poisons. 2. List three normal age-related changes of the circulatory system (LO 3). A: Answers include the following: Heart pumps less efficiently. Blood vessels narrow. Blood vessels become less elastic. Blood flow decreases. 3. List three ways that hypertension is treated (LO 4). A: Answers include the following: medication, diuretics, exercise programs, special diet, stopping smoking, and lowering stress level. 4. How is the pain of angina pectoris commonly described (LO 4)? A: Angina is usually described as intense pressure in the chest, a tightness in the chest, or pain in the back, neck, jaw, or shoulder. 5. List three common symptoms of anemia (LO 4). A: Answers include the following: fatigue, weakness, pale skin, a sore or swollen tongue, brittle nails, and difficulty concentrating.
Multiple Choice 6. When should elastic stockings be applied (LO 4)? (A) During the night (B) In the morning (C) In the early afternoon (D) Before going to bed at night
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Chapter 20: The Respiratory System 1. List three functions of the respiratory system (LO 2). A: 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. 2. List six normal age-related changes of the respiratory system (LO 3). A: 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. 3. Why might a person with COPD be fearful or anxious (LO 4)? A: COPD causes difficulty breathing. Residents may be fearful about not being able to breathe. 4. What is the difference between latent TB infection and TB disease (LO 4)? A: Someone with latent TB infection carries the 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. 5. Why is it important for a resident to take all prescribed medication if he has TB (LO 4)? A: 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. 6. What conditions can be helped by deep breathing exercises (LO 7)? A: Being paralyzed or having had abdominal surgery are two conditions that can require deep breathing exercises.
Multiple Choice 7. The process of inhaling and exhaling is referred to as (LO 2) (A) Inspiration (B) Respiration (C) Expiration (D) Resuscitation 8. Which of the following is one of the duties of an NA with regard to oxygen therapy (LO 5)? (A) The nursing assistant orders the type of oxygen delivery device needed for the resident. (B) The nursing assistant orders the amount of oxygen the resident needs. (C) The nursing assistant performs skin care on the areas of the face where the oxygen device rests. (D) The nursing assistant refills oxygen cylinders once they are empty.
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9. What time of day is best to collect a sputum specimen (LO 6)? (A) Middle of the night (B) Late afternoon (C) After lunch (D) Early morning
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Chapter 21: The Musculoskeletal System 1. List the three types of muscles that are found in the human body (LO 2). A: Skeletal muscles, smooth muscles, and cardiac muscle 2. What are three functions of bones (LO 2)? A: Bones lend support to body structures, allow the body to move, and protect the organs. 3. List five normal age-related changes of the musculoskeletal system (LO 3). A: 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. 4. What happens when a muscle atrophies (LO 4)? A: It wastes away, decreases in size, and weakens. 5. What can happen to bones when they become brittle (LO 4)? A: They can break easily. 6. Why is preventing falls so important for elderly residents (LO 4)? A: Falls contribute to many physical injuries and can have psychological consequences as well. 7. List six signs and symptomsT oE f pSoT orBcA ircNuK laS tioEnLdL ueEtR o. elC asO ticMbandages that need to be reported to the nurse (LO 5). A: 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.
Multiple Choice 8. After an amputation, a resident may experience phantom sensation. Phantom sensation is (LO 4) (A) Not real (B) Tingling from a body part that has been amputated (C) An artificial body part (D) The removal of a body part 9. When helping a resident who has had a hip replacement get dressed, how should the NA begin (LO 4)? (A) Start with the stronger side (B) Start with the left side (C) Start with the weaker side (D) Start with the feet and move upward 53
10. A person recovering from a total hip replacement should not bend or flex the hip more than degrees (LO 4). (A) 30 (B) 45 (C) 90 (D) 120 11. Which of the following means that the resident can bear some weight on one or both legs postoperatively (LO 4)? (A) Non-weight-bearing (NWB) (B) Full weight-bearing (FWB) (C) 100% weight-bearing (1WB) (D) Partial weight-bearing (PWB)
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Chapter 22: The Nervous System 1. What is the basic working unit of the nervous system (LO 2)? A: The neuron 2. What makes up the central nervous system? What makes up the peripheral nervous system (LO 2)? A: The brain and spinal cord make up the central nervous system; the peripheral nervous system consists of the cranial and spinal nerves. 3. List three functions of the nervous system (LO 2). A: 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. 4. List four normal age-related changes of the nervous system (LO 3). A: 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. 5. Why is it important not to use rubbing alcohol to clean artificial eyes (LO 4)? A: The artificial eye can be permanently damaged by rubbing alcohol.
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6. What is the most common cause of dementia (LO 5)? A: Alzheimer’s disease 7. Why is it important for NAs to encourage independence for as long as possible for residents who have AD (LO 6)? A: This helps keep the resident’s mind and body as active as possible. 8. If a resident with Alzheimer’s disease loses interest in an activity, what should the NA do (LO 11)? A: Offer another one 9. Does a person usually overcome major depressive disorder through sheer will (LO 13)? A: No 10. What should an NA do if a resident makes comments or jokes about suicide (LO 13)? A: Report it immediately to the nurse.
Multiple Choice 11. When a cerebrovascular accident (CVA) occurs on the left side of the brain, which side of the body will be affected (LO 4)? 55
(A) The left side (B) The right side (C) The underside (D) The front side 12. When assisting a resident who has had a CVA with eating, in which side of the resident’s mouth should food be placed (LO 4)? (A) Stronger side (B) Affected side (C) Weaker side (D) Right side 13. When a resident with Alzheimer’s disease repeats an action over and over, he is (LO 7) (A) Babbling (B) Intervening (C) Strategizing (D) Perseverating 14. One morning a resident with Alzheimer’s disease says he does not like eating with others and wants to eat breakfast by himself in his room. The next morning he tells his NA that he does not like to eat alone and wants help going to the dining room. What would be the best response by the NA to this shift in the resident’s preferences (LO 8)? (A) The NA should remind him that he prefers eating alone in his room. (B) The NA should explain that it is difficult for him to eat in the dining room because he requires additional help. (C) The NA should take the resident to the dining room. (D) The NA should tell the resident that he must eat in his room because it is the facility’s policy. 15. Which of the following is a way for an NA to help a resident who has Alzheimer’s disease with his nutritional needs (LO 9)? (A) The NA should use a plain plate without a pattern and a single eating utensil for meals. (B) The NA should put multiple kinds of food, in different colors and textures, on the resident’s plate. (C) The NA should serve steaming hot foods. (D) The NA should avoid talking to the resident while he is eating. 16. When a resident with Alzheimer’s disease continues to ask the same question, the NA should (LO 10) (A) Ask the resident to stop asking that question (B) Answer the question, using the same words each time (C) Remind the resident that he has asked that question several times before (D) Ignore the behavior until it stops 56
17. A resident with Alzheimer’s disease tells his NA that he is not going to eat dinner today because he is meeting his wife for dinner at their favorite restaurant. The NA knows his wife has been dead for many years. What would be the best response by the NA (LO 12)? (A) The NA should tell the resident that he cannot eat in restaurants due to his disease. (B) The NA should remind the resident that his wife is no longer alive. (C) The NA should ask him what restaurant he is going to and what he will have. (D) The NA should let him know that if he does not go to the dining room soon, he will miss dinner. 18. Which of the following puts a person at a higher risk for substance abuse (LO 14)? (A) Having many friends (B) Exercising often (C) Having a mental health disorder (D) Not having tried illegal drugs
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Chapter 23: The Endocrine System 1. List four functions of the endocrine system (LO 2). A: 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. 2. List three normal age-related changes of the endocrine system (LO 3). A: 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 production does not stop. Insulin production decreases. Body is less able to handle stress. 3. What are three conditions that make it more likely for a person to develop diabetes (LO 4)? A: Family history, advanced age, obesity
Multiple Choice 4. Which form of diabetes is the most common (LO 4)? (A) Prediabetes Type 1 diabetes (B) (C) Type 2 diabetes (D) Diabetes mellitus 5. What is a common symptom of hypothyroidism (LO 4)? (A) Rapid heartbeat (B) Weight gain (C) High blood pressure (D) Bulging eyes 6. Which of the following is an appropriate guideline for a resident who has diabetes (LO 5)? (A) The resident will need to eat meals at the same time every day. (B) The resident will need to avoid exercising. (C) The NA will need to trim and clean the resident’s toenails. (D) The resident should go barefoot to avoid having material against his feet. 7. Which of the following should an NA do when giving foot care to a resident with diabetes (LO 6)? (A) The NA should use hot water to kill bacteria on the feet. (B) The NA should massage lotion in between the resident’s toes to keep the area soft. (C) The NA should use clippers to remove corns or calluses. (D) The NA should pat the feet completely dry after washing them. 58
Chapter 24: The Immune and Lymphatic Systems and Cancer 1. Briefly describe nonspecific immunity and specific immunity (LO 2). A: Nonspecific immunity is present at birth and protects the body from disease in general. Specific immunity is a type of immunity acquired by the body. 2. List four normal age-related changes of the immune and lymphatic systems (LO 3). A: 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. 3. What is the difference between benign and malignant tumors (LO 7)? A: Benign tumors grow slowly and do not spread to other parts of the body. Malignant tumors grow rapidly and invade surrounding tissue. Multiple Choice 4. What is one way that the human immunodeficiency virus (HIV) is transmitted (LO 4)? (A) By insects such as mosquitoes (B) By hugging an infected person (C) By touching a contaminated doorknob (D) By contact with contaminated needles 5. What is one of the NA’s responsibilities when caring for a resident who has acquired immunodeficiency syndrome (AIDS) (LO 5)? (A) The NA should help determine when the resident should change medication. (B) The NA should inform others of the resident’s diagnosis. (C) The NA should help protect the resident from infections. (D) The NA should help keep the resident as isolated as possible. 6. A diet that is low in (A) Fiber (B) Fluids (C) Bananas (D) Applesauce
may help residents who have diarrhea (LO 6).
7. Which type of treatment for cancer involves using high-energy rays to attempt to destroy cancer cells in a specific area (LO 7)? (A) Immunotherapy (B) Radiation therapy (C) Chemotherapy (D) Surgery 8. If a resident with cancer expresses fear about her condition, which of the following would be the best response by the NA (LO 8)? (A) “Every cloud has a silver lining.” (B) “Good things come to those who wait.” 60
(C) “It will be over before you know it.” (D) “I understand you’re scared. How can I help?” Chapter 25: Rehabilitation and Restorative Care 1. List three goals of rehabilitation (LO 2). A: Answers include the following: maintain or regain abilities; promote independence and help resident to adapt; and prevent complications of immobility. 2. List three positive effects that encouraging independence and self-care can have on a resident (LO 3). A: Answers include the following: positive effects on self-image, attitude, and abilities, and may help speed recovery. 3. List one complication for each body system that results from a lack of exercise and activity (LO 4). A: Answers include the following: Gastrointestinal– constipation; Urinary–urinary tract infection (UTI); Integumentary–pressure injuries 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. 4. List one benefit for each body system that results from regular activity and exercise (LO 4). A: Answers include the following: Gastrointestinal– promotes appetite and aids in 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; and Endocrine– increases metabolism, helping to maintain healthy weight.
Multiple Choice 5. Which type of cane has four rubber-tipped feet (LO 5)? (A) C cane (B) Quad cane (C) Functional grip cane (D) Crutch cane 6. When a resident uses a cane, walker, or crutches, on which side should the NA stay (LO 5)? (A) Right (B) Left (C) Stronger (D) Weaker 7. A type of device that is applied externally to a limb for support and protection is called a(n) (LO 6) 61
(A) Prosthetic device (B) Musculoskeletal device (C) Chiropractic device (D) Orthotic device 8. When performing ROM exercises, where on the body should the NA begin (LO 7)? (A) Shoulder (B) Wrist (C) Hip (D) Ankle
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Chapter 26: Subacute Care 1. What kinds of conditions require subacute care (LO 2)? A: Answers include the following: recent surgery or acute conditions, chronic illnesses, serious burns, the need for special administration of nutrients or medicine, or dialysis. 2. What is the purpose of artificial airways (LO 6)? A: Artificial airways help maintain an airway and facilitate ventilation. 3. What does tracheostomy care generally involve (LO 7)? A: 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. 4. Why is it important to enter the room often when a resident is using a mechanical ventilator (LO 8)? A: 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. 5. What observations should NAs make about chest drainage (LO 10)? A: Answers include the following: changes in amount, color, or consistency of chest drainage. 6. What signs and symptoms should the NA report to the nurse when a resident is on dialysis (LO 12)? A: 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 vomiting; muscle cramps; swelling of extremities (edema); change in intake and output; or itchy skin.
Multiple Choice 7. Preoperative fluid restrictions can help prevent (LO 3) (A) Blood clots (B) Contractures (C) Kidney stones (D) Vomiting 8. What does a pulse oximeter measure (LO 4)? (A) Pulse rate and blood glucose level (B) Pulse rate and white blood cell count (C) Pulse rate and calcium level (D) Pulse rate and blood oxygen level 9. What does a telemetry device monitor (LO 5)? (A) The amount of blood stored in the spleen (B) The heart’s rhythm and rate 63
(C) The number of CD4+ lymphocytes in the body (D) A person’s intake and output of fluids 10. What is one NA responsibility regarding suctioning (LO 9)? (A) The NA changes the tubing daily. (B) The NA performs the suctioning. (C) The NA reports signs of respiratory distress. (D) The NA decides when a resident needs suctioning. 11. What is one NA responsibility regarding feeding tubes (LO 11)? (A) The NA positions the resident for the feeding. (B) The NA performs the feeding. (C) The NA inserts the feeding tube. (D) The NA cleans the feeding tube.
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Chapter 27: End-of-Life Care 1. What are the goals of palliative care (LO 2)? A: Answers include the following: relieve pain, control symptoms, reduce suffering, prevent side effects, and maintain quality of life. 2. Briefly describe each of the five stages of grief (denial, anger, bargaining, depression, and acceptance) as defined by Elisabeth Kübler-Ross (LO 4). A: 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 3. List five legal rights to remember when caring for a resident who is terminally ill (LO 5). A: 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. 4. List 20 physical signs that a person is approaching death (LO 8). A: 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 • 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
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5. What should the NA do if he observes physical signs such as a dropped jaw after a resident has died (LO 9)? A: Inform the nurse 6. List four ways that NAs can help families and friends after a loved one has died (LO 10). A: 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. 7. What is bereavement therapy (LO 11)? A: Bereavement therapy is a way to identify feelings to help with grieving. 8. Define postmortem (LO 12). A: After death
Multiple Choice 9. When is hospice care usually ordered by a doctor (LO 3)? (A) When a person has a chronic disease (B) When a person is not eating normally (C) When a person has approximately six months or less to live (D) When a person becomes depressed 10. Which sense is usually the laTsE t sSeT nsB eA toNleKaS veEtL heLbEoR dy.(C LOO6M)? (A) The sense of hearing (B) The sense of smell (C) The sense of taste (D) The sense of touch 11. Which of the following would be the best way an NA can help meet a dying resident’s psychosocial needs (LO 7)? (A) Convincing the resident to believe in God (B) Bathing the resident (C) Making changes in the resident’s diet (D) Listening to the resident
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Chapter 28: Your New Position 1. List six topics that should be included when preparing a résumé (LO 2). A: Answers include: objective, education, experience, volunteer work, skills, and references 2. How long should a résumé be (LO 2)? A: One page 3. Why do you think employers are required to do a criminal background check on NAs (LO 3)? A: Answers will vary, but may include something about keeping residents safe. 4. List four ways an NA can make sure she is following her scope of practice before accepting a task (LO 6). A: 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. 5. List the information about NAs that is kept in the state registry (LO 7). A: 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 6. What is constructive feedbaTckE(S LOT9B)?ANKSELLER.COM A: 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. 7. Before reacting to a conflict, what should an NA do (LO 10)? A: Think about possible reasons why someone is behaving in an undesirable way. 8. What is stress (LO 11)? A: Stress is a mentally or emotionally disruptive or upsetting condition that occurs due to changes in the environment. 9. List ten ways to manage stress (LO 11). A: 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.
Multiple Choice 10. Which of the following is part of proper grooming for a job interview (LO 4)? (A) Wear a lot of nice jewelry (B) Wear a favorite perfume (C) Wear comfortable sneakers 67
(D) Wear simple makeup 11. After a job interview is over, which of the following would be the best response by the NA (LO 5)? (A) The NA should ask, “Will I be hired?” (B) The NA should ask, “When can I expect to hear about the position?” (C) The NA should ask, “Would you like me to send a thank-you note?” (D) The NA should ask, “How soon can I start taking vacation days after I’m hired?” 12. How many hours of continuing education does the federal government require for NAs each year (LO 8)? (A) 12 (B) 25 (C) 7 (D) 18
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