Adapted Quizzing Pro Nursing Practice I 310-Test One Study Guide with Complete Solutions

Adapted Quizzing Pro Nursing Practice I 310-Test One Study Guide with Complete Solutions A registered nurse teaches a nursing student about body image and hygiene. Which statement if made by the nursing student indicates the need for further teaching? - Ans:-"I should force the patient to perform hygiene practices." The nurse should avoid forcing the patient to perform hygiene practices unless the issue directly affects a patient's health. The nurse should consult with the patient before making decisions about how to provide hygiene. The nurse should educate the patient about the importance of hygiene. The nurse should consider the details of grooming when planning care. Which statement is true regarding the oral cavity? - Ans:-Stimulation of the sympathetic nervous system can completely inhibit the release of saliva. The release of saliva is strongly inhibited when the sympathetic nervous system is strongly inhibited. The periodontal membrane lies below the gum margins. Saliva is secreted by glands GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 2/39 present within and outside the oral cavity. The undersurface of the tongue and the floor of the mouth are richly supplied with blood vessels What is the priority concern when providing oral hygiene for a patient who is unconscious? - Ans:-Preventing aspiration Although thorough and effective cleaning is needed, measures to prevent aspiration of oral secretions or cleaning agents into the lungs take priority, because aspiration can lead to lower respiratory infections. The nurse is making an occupied bed. Which actions would help in reducing the transmission of microorganisms? - Ans:-Perform hand hygiene and apply clean gloves. Wipe off any moisture on exposed mattress with a towel. If the bedspread and linens are soiled, place them in a linen bag. Performing hand hygiene and using clean gloves [1] [1] [2] prevent the spread of infection from the nurse to the patient. Any moisture on the bed should be wiped off to prevent the transmission of infection. The soiled bedspread and bed linens should be disposed of in the GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 3/39 linen bag to reduce transmission of microorganisms. Pulling room curtains around the bed maintains the patient's privacy but does not prevent the spread of microorganisms. Turning the patient onto the side provides space for the placement of clean linens. A patient who is cognitively impaired and has dementia requires hygiene care. The patient often displays aggressive behavior, such as screaming and hitting during the bath. Which techniques would make the bathing experience less stressful for both the nurse and the patient? - Ans:- Allow the patient to perform as much of the care as possible. Try an alternative to traditional bathing, such as the bag bath. Patients with cognitive impairment may respond to bathing by acting out aggressively. Studies have indicated a number of triggering events, including washing the face first. The bag bath has been shown to result in a lower incidence of aggressive behavior than traditional bathing. Use of restraints is not warranted and can actually lead to injury, because the patient often fights against the restraints. Cognitively impaired patients respond better when the nurse uses a gentle approach and avoids rushin Which statement is true regarding the skin? - Ans:-The dermis is formed by bundles of collagen and elastic fibers. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 4/39 The dermis is a layer of skin formed by bundles of collagen and elastic fibers. It is thick and underlies the epidermis. The epidermis is comprised of several thin layers of epithelial cells. Dead cells are replaced by new cells generated by the innermost layer of the epidermis. Hair follicles, sebaceous glands, and sweat glands are present in the dermal layer of the skin. The nurse is assisting a patient with rheumatoid arthritis to bathe at the sink. During the bath the patient states that she is tired. The nurse notices the patient is breathing rapidly and the pulse is rapid. What is the nurse's best response? - Ans:-Help the patient return to bed The report of fatigue and rapid respirations and pulse indicate that the patient is not tolerating the activity and needs to rest. Leaving the patient alone at the sink is not safe. The nurse is explaining how to provide eye care to a nursing student. Which statement made by the nursing student indicates effective learning? - Ans:-"I should avoid chlorhexidine gluconate (CHG) solution for cleaning the eyes." A male nurse is caring for a 32-year-old female Muslim patient who has an indwelling Foley catheter. After introducing himself to the patient, the nurse learns that the patient does not want him to help her with personal hygiene care. Which actions are appropriate? - Ans:- Finding a female nurse to help the patient Asking the patient if she prefers a family member assist with the care GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 5/39 Cultural variations affecting hygiene care include gender-congruent concerns. Pressuring patients to accept cultural values that they do not believe in and value is inappropriate. Patients with Foley catheters require routine perineal care; skipping care is not a safe practice. During assessment, the nurse finds that a patient with dyspnea is excessively tired. Which actions should the nurse perform to comfort the patient? - Ans:-Elevate the head of the patient's bed A patient with dyspnea may be comforted by elevating the head of the bed. A primary health care physician should be notified about the patient's condition if there is a change in the patient's fatigue level. The nurse should obtain a special bed surface for a patient with a risk for skin breakdown to reduce dryness, rashes, and pressure ulcers. A sitz bath is recommended for a patient with an inflamed and swollen rectum, perineum, and genital area. The nurse and nursing assistive person (NAP) are performing the nail and foot care of three patients. The patients include a 30-year-old man with peripheral vascular disease, a woman with diabetes, and a 10-year-old child with otitis media. Which interventions performed by the nurse and NAP are appropriate? - Ans:-The nurse clips the nails of the child. The nurse soaks the nails of the child in warm water. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 6/39 Appropriate measures and delegations should be performed during foot and nail care. It is the nurse's responsibility to soak and clip the nails of the child. Care of the child should not be delegated to the nursing assistive person (NAP). The nails should be soaked in warm water to make them soft and help in clipping. The feet of the patients with diabetes or circulatory problems should not be soaked in water as doing so can cause maceration of the skin. These patients may have impaired peripheral sensation (diabetes) or circulation, so any injury to the foot while clipping the nails should be avoided. Clipping of the nails for these patients should not be delegated to the NAP. Soaking of the nails should be avoided in a patient with diabetes, because it can cause maceration of the skin. Which action would best help prevent skin breakdown in a patient who is very weak and drowsy and also incontinent of stools? - Ans:-Checking frequently for soiling Loose stool contains digestive enzymes that irritate the skin and should be cleaned from the skin as soon as possible after soiling to prevent skin breakdown. The perineal area can be cleansed with a mild soap or cleanser. Placing the call light within reach is an important safety feature; however, a very weak and drowsy patient may not be able to access or use it appropriately. Keeping a pad under the patient will not prevent skin breakdown. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 7/39 The nurse is assessing the skin of four patients. Which patient's findings indicate acne? - Ans:-Patient 1 Acne is a common skin problem characterized by inflammatory, papulopustular eruptions on the face involving the bacterial breakdown of sebum, as seen in Patient 1. Inflammation of skin characterized by abrupt onset with erythema, pruritus, and pain indicates contact dermatitis. Flat, localized, pruritic skin eruptions, as seen in Patient 3, are rashes. Like Patient 2, Patient 4 may also have contact dermatitis, which can manifest as scaly, oozing lesions on the hands, face, and neck. An elderly patient is admitted to the hospital with Rocky Mountain spotted fever. While examining the patient, the nurse finds a tick in his scalp. After removing the tick carefully with blunt tweezers, the nurse saves it in a bag and puts it in a freezer for identification. Which is a correct statement about the process followed by the nurse? - Ans:-The nurse has followed the correct procedure. Ticks are blood-sucking parasites that burrow into the skin. The nurse should use blunt tweezers and grasp the tick as close to the head as possible and pull upward with even, steady pressure, holding the tick for about 3 to 4 minutes until it pulls out. The nurse should save the tick in a plastic bag and put it in the freezer if it is necessary to identify the type of tick. If placed in an GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 8/39 autoclave, the tick would be killed. Ticks should not be thrown away, because they need to be identified to provide better treatment. The tick need not be sent for a culture and sensitivity test, because it is not a microorganism. A registered nurse evaluates a nursing student who is assisting a patient with a shower. Which nursing action indicates a need for further teaching? - Ans:-Asking the patient to use bath oils Bath oils may make bathtub surfaces slippery and put the pati