Item m1mof m150
A resident falls from her chair when she has a seizure. Before the nurs
m m m m m m m m m m m m m
e arrives, the seizure is finished and the nurse aide observes the resid
m m m m m m m m m m m m
ent
A
is breathing. What should the nurse aide do next?
m m m m m m m m m
Get mthememergency mcart
.
B. Turn mthemresident monto mhermside
C. Check mif mthemresident mismablemto mtalk
D
Help mthemresident mback minto mthemchair
.
Incorrect
Rationale:mAftermamseizure,msaliva mmaympool minmthemmouth mand mthe mindividual mmaymalsomvomit.mTurningmthe mresiden
tmonto mthe mside mpreventsmaspirationmbymallowingmthe mfluidsmtomdrain moutmofmthemmouth.mThismismthe mmostmimportantm
action mformthemnursemaide mtomtake min mthismsituation.mThe mnursemaide mshouldmnotmleave mthemresidentmunattendedmand
mshould mnotmmove mthe mresidentmuntil mchecked mbymthe mnurse.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Carter,mP.m(2012).mLippincottmTextbookmformNursing mAssistantsm(3rdm Ed.).mPhiladelphia,mPA:mWoltersmKluwer/Lipp
incottmWilliamsm&mWilkins.mPage m220.
2. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPage m706.
Mark mitemmf ormreview
Item m2mof m150
To prevent skin tears or shearing when moving the resident, the nurse
m m m m m m m m m m m m
aide should m
A. wearmglovesmto mreducemfriction magainst mthemskin.
B. avoid mpullingmormslidingmthemresident mwhen mmoved.
C
tellmthemresident mto mbemcarefulmand mfollowmdirections.
.
D
ask mthemresident mto mkeep marmsmheld movermthemresident'smhead.
.
Correct
Rationale:mThe mskin mofmanmelderlymresidentmismthinmandmfragile.mPulling mbedmsheetsmagainstmthemresident’smskin,morms
lidingmthe mresidentmwhen mmoving mormtransferring,mcanmcauseminjurymtomthemskin,msuch masmskin mtears.mThismismthe mre
sultmof mshearing.mGreatmcare mismneeded mtompreventmskin mtears.mActionsmlikemrolling mormusingmamturning msheet,mslide,
mormtransfermsheetmcan mhelp mreduce mthe mriskmof mskin minjury.
Wearing mglovesmwhenmtransferring mamresidentmmaymbemappropriate mifmthemnurse maidemismatmriskmof mexposure mtomblo
odmormbodymfluids,mbutmitmwillmnotmpreventmshearing mormskin mtears.mTellingmthemresidentmtomfollow mdirectionsmormhavin
gmthe mresidentmhold marmsmovermthe mhead mwill mnotmpreventmskin mtearsmormshearing.
Understanding mhow mtompreventmskinmtearsmismimportantmformthe mnursemaidemwhomsharesmresponsibilitymformthemsafety
mof mresidents.mThe mnurse maide mshould mbe maware mthatmskin mtearsmare mpainful,mand mthe mskin mopening malso mincreases
mthe mresident’smriskmforminfection.
,Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Alvare,mS..mFuzy,mJ.,mand mRymer,mS.m(2009).mHartman’smNursing mAssistantmCare:mLong-
TermmCare mand mHome mHealth.mAlbuquerque,mNM:mHartman mPublishing,mInc.mPagesm149 mand m197.
2. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPagesm225mand m538-539.
Mark mitemmf ormreview
,Item m3mof m150
What should a nurse aide do with a used disposable razor?
m m m m m m m m m m
A
Throwmthemrazormaway min ma mtrash mcan.
.
B. Placemthemrazormin ma msharpsmcontainermimmediately.
C. Clean,mrinse,mand mdry mthemrazormso mitmcan mbemu
sed magain.
D
Wrap mthemrazormin ma mpapermtowelmuntilmitmcan mbemthrown maway.
.
Correct
Rationale:mAmdisposable mrazormismamsafetymconcernmbecausemitmismconsidered mamsharpmand mamusedmrazormismlikelymt
omalso mhave mblood mcellsmonmit.mSince mitmismconsidered ma msharpmand mpotentiallymcontaminatedmwith mblood mcells,mitm
mustmbemdisposed mofminmthemSharpsmcontainer.mSafemdisposal mof msharpsmismampartmofmthemnursemaide’smresponsibili
tymbecause mitmpertainsmto mthe msafetymof mthemresident.
Themnurse maidemmustmalwaysmbemawaremofmsafetymof mall mresidents,mbutmespeciallymconcerned mformresidentsmwho mare
mconfused mand mcould mbe maccidentallymharmed mhandling ma mrazormthatmwasmleftmout.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Carter,mP.m(2012).mLippincottmTextbookmformNursingmAssistantsm(3rd mEd.).mPhiladelphia,mPA:mWoltersmKluwer/Lippi
ncottmWilliamsm&mWilkins.mPage m370.
2. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPage m321.
Item m4mof m150
Which of the following is the best example of using reality orientation f
m m m m m m m m m m m m
or a resident with early dementia?
m m m m m
A. "Yourmson mplansmto mvisit mtoday mat m2:00 mp.m."
B. "You maremin mthemnursingmhome.mI mam mheremto mhelp myou."
C. "ThismismyourmdaughtermAnna.mDo myou mremembermher?"
D
"Look mat mthemtime.mLunch mismin m30 mminutes.mAremyou mfeelingmhungry?"
.
Incorrect
Rationale:mRealitymorientation mismamprocessmof mreminding mandmorienting mthemresidentmtomperson,mplace,mand mtime.m
Forma mresidentmwith mearlymdementia,mputtingmtimemintomthe mcontextmof mthe mdaymand mroutine mcanmbemhelpful.mLunchmi
smampartmof mamlife mroutine,mand mreminding mthemresidentmaboutmthatmandmrelatingmitmtomeating mandmbeing mhungrymcan
mbe mreassuring mand mhelpful.
Inmthe mearliermstagesmofmAlzheimer’smdisease,mwhen mamresidentmmaymbe maware mandmfrightenedmbymlossmofmmemory,
mavoid mcontributing mto mthemresident’smanxietymbymmaking mstatementsmsuch mas,m"Don’tmyou mremembermyourmdaughter
?"
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. DuganmD.m(2012).mNursing mAssisting:mAmFoundation min mCaregivingm(3rdmEd.).mAlbuquerque,mNM.mHartmanmPubli
shing,mInc.mPage m415.
2. Hedman,mS.,mFuzy,mJ.,mandmRymer,mS.m(2010).mHartman'smNursing mAssistantmCare:mLong-
TermmCare m(2nd mEd.).mAlbuquerque,mNM:mHartman mPublishing,mInc.mPage m359.
Mark mitemmf ormreview
, Itemm5 mof m150
While feeding a resident, the nurse aide notices that the resident is co
m m m m m m m m m m m m
ughing a lot after each drink of fluid. What is the appropriate response
m m m m m m m m m m m m m
by the nurse aide?
m m m
A
Allowmthemresident mmoremtimemto mswallow.
.
B. Usema mstrawmwhen mgivingmthemresident mfluids.
C. Add ma mthickeningmproduct mto mthemresident'smfluids.
D
Stop mfeedingmand mask ma mnursemto mcheck mthemresident.
.
Correct
Rationale:mWhen mamresidentmcoughsmfrequentlymaftermdrinkingmfluids,mitmmaymindicate mthatmthemresidentmismhaving ms
omemdifficultymswallowing.mThismdifficultymswallowing mcan mresultminmfluidsmgoingminto mthemresident’smlung.mThismcond
ition mismknown masmaspiration.mItmcanmresultmin mthemdevelopmentmofmseriousmmedical mconditions,msuch masmpneumoni
a,mwhich mmaymrequire mmedical mattention.
Themnurse maid mshould mnotifymthemnurse mimmediately.mThe mresidentmwill mrequiremanmevaluation mofmthe mresident’smabil
itymto mswallow.mThickening magentsmaremsometimesmadded mtomliquidsmformresidentsmthatmhave mdifficultymswallowing mflu
ids,mbutmthe muse mof mthese mthickenersmismdecided mbymthe mphysician mandmnotmthe mnurse maide.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPagesm386-387.
2. Alvare,mS..mFuzy,mJ.,mand mRymer,mS.m(2009).mHartman’smNursing mAssistantmCare:mLong-
TermmCare mand mHome mHealth.mAlbuquerque,mNM:mHartman mPublishing,mInc.mPage m268.
Item m6mof m150
A resident wears a hand splint. Which observation should the nurse ai
m m m m m m m m m m m
de report to the nurse immediately?
m m m m m
A
Themresident'smfingersmaremcold mand mbluemin mcolor.
.
B.
Themsplint mwasmremoved masmscheduled min mth
emcaremplan.
C
Themresident masksmto mhavemthemsplint mremoved mforma mfewmminutes.
.
D. Themresident masksmthemnursemaidemto mreposition mthemarm mwith mthemsplint.
Correct
Rationale:mWhen mamresidentmwearsmamsplint,mitmismimportantmtommakemsure mthemsplintmismappliedmproperlymandmismn
otmcausing mpressure mthatmcouldmaffectmcirculation.mIf mnotmproperlymapplied,mthe msplintmcanmcausempressure.mWhenma
mresidentmwearsma msplint,mthe mcare mplan mmaymalso mincludemscheduled mperiodsmformremoving mthe msplintmto mallow mthe
mskin mto mbe mopenmto mairmandmto mpromote mcirculation.mWhenma mresidentmwearsma msplint,mitmismimportantmto mobserve m
formanymchangesminmskin mcolorminmthemextremity,mwhichmif mobserved mshould mbemreported mto mthemnursemimmediately.
mSkin mcolormchangesmand mchangesmin mthe mtemperaturemofmthemextremitymcould malsombemsignsmofmimpaired mcirculati
on.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
A resident falls from her chair when she has a seizure. Before the nurs
m m m m m m m m m m m m m
e arrives, the seizure is finished and the nurse aide observes the resid
m m m m m m m m m m m m
ent
A
is breathing. What should the nurse aide do next?
m m m m m m m m m
Get mthememergency mcart
.
B. Turn mthemresident monto mhermside
C. Check mif mthemresident mismablemto mtalk
D
Help mthemresident mback minto mthemchair
.
Incorrect
Rationale:mAftermamseizure,msaliva mmaympool minmthemmouth mand mthe mindividual mmaymalsomvomit.mTurningmthe mresiden
tmonto mthe mside mpreventsmaspirationmbymallowingmthe mfluidsmtomdrain moutmofmthemmouth.mThismismthe mmostmimportantm
action mformthemnursemaide mtomtake min mthismsituation.mThe mnursemaide mshouldmnotmleave mthemresidentmunattendedmand
mshould mnotmmove mthe mresidentmuntil mchecked mbymthe mnurse.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Carter,mP.m(2012).mLippincottmTextbookmformNursing mAssistantsm(3rdm Ed.).mPhiladelphia,mPA:mWoltersmKluwer/Lipp
incottmWilliamsm&mWilkins.mPage m220.
2. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPage m706.
Mark mitemmf ormreview
Item m2mof m150
To prevent skin tears or shearing when moving the resident, the nurse
m m m m m m m m m m m m
aide should m
A. wearmglovesmto mreducemfriction magainst mthemskin.
B. avoid mpullingmormslidingmthemresident mwhen mmoved.
C
tellmthemresident mto mbemcarefulmand mfollowmdirections.
.
D
ask mthemresident mto mkeep marmsmheld movermthemresident'smhead.
.
Correct
Rationale:mThe mskin mofmanmelderlymresidentmismthinmandmfragile.mPulling mbedmsheetsmagainstmthemresident’smskin,morms
lidingmthe mresidentmwhen mmoving mormtransferring,mcanmcauseminjurymtomthemskin,msuch masmskin mtears.mThismismthe mre
sultmof mshearing.mGreatmcare mismneeded mtompreventmskin mtears.mActionsmlikemrolling mormusingmamturning msheet,mslide,
mormtransfermsheetmcan mhelp mreduce mthe mriskmof mskin minjury.
Wearing mglovesmwhenmtransferring mamresidentmmaymbemappropriate mifmthemnurse maidemismatmriskmof mexposure mtomblo
odmormbodymfluids,mbutmitmwillmnotmpreventmshearing mormskin mtears.mTellingmthemresidentmtomfollow mdirectionsmormhavin
gmthe mresidentmhold marmsmovermthe mhead mwill mnotmpreventmskin mtearsmormshearing.
Understanding mhow mtompreventmskinmtearsmismimportantmformthe mnursemaidemwhomsharesmresponsibilitymformthemsafety
mof mresidents.mThe mnurse maide mshould mbe maware mthatmskin mtearsmare mpainful,mand mthe mskin mopening malso mincreases
mthe mresident’smriskmforminfection.
,Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Alvare,mS..mFuzy,mJ.,mand mRymer,mS.m(2009).mHartman’smNursing mAssistantmCare:mLong-
TermmCare mand mHome mHealth.mAlbuquerque,mNM:mHartman mPublishing,mInc.mPagesm149 mand m197.
2. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPagesm225mand m538-539.
Mark mitemmf ormreview
,Item m3mof m150
What should a nurse aide do with a used disposable razor?
m m m m m m m m m m
A
Throwmthemrazormaway min ma mtrash mcan.
.
B. Placemthemrazormin ma msharpsmcontainermimmediately.
C. Clean,mrinse,mand mdry mthemrazormso mitmcan mbemu
sed magain.
D
Wrap mthemrazormin ma mpapermtowelmuntilmitmcan mbemthrown maway.
.
Correct
Rationale:mAmdisposable mrazormismamsafetymconcernmbecausemitmismconsidered mamsharpmand mamusedmrazormismlikelymt
omalso mhave mblood mcellsmonmit.mSince mitmismconsidered ma msharpmand mpotentiallymcontaminatedmwith mblood mcells,mitm
mustmbemdisposed mofminmthemSharpsmcontainer.mSafemdisposal mof msharpsmismampartmofmthemnursemaide’smresponsibili
tymbecause mitmpertainsmto mthe msafetymof mthemresident.
Themnurse maidemmustmalwaysmbemawaremofmsafetymof mall mresidents,mbutmespeciallymconcerned mformresidentsmwho mare
mconfused mand mcould mbe maccidentallymharmed mhandling ma mrazormthatmwasmleftmout.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Carter,mP.m(2012).mLippincottmTextbookmformNursingmAssistantsm(3rd mEd.).mPhiladelphia,mPA:mWoltersmKluwer/Lippi
ncottmWilliamsm&mWilkins.mPage m370.
2. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPage m321.
Item m4mof m150
Which of the following is the best example of using reality orientation f
m m m m m m m m m m m m
or a resident with early dementia?
m m m m m
A. "Yourmson mplansmto mvisit mtoday mat m2:00 mp.m."
B. "You maremin mthemnursingmhome.mI mam mheremto mhelp myou."
C. "ThismismyourmdaughtermAnna.mDo myou mremembermher?"
D
"Look mat mthemtime.mLunch mismin m30 mminutes.mAremyou mfeelingmhungry?"
.
Incorrect
Rationale:mRealitymorientation mismamprocessmof mreminding mandmorienting mthemresidentmtomperson,mplace,mand mtime.m
Forma mresidentmwith mearlymdementia,mputtingmtimemintomthe mcontextmof mthe mdaymand mroutine mcanmbemhelpful.mLunchmi
smampartmof mamlife mroutine,mand mreminding mthemresidentmaboutmthatmandmrelatingmitmtomeating mandmbeing mhungrymcan
mbe mreassuring mand mhelpful.
Inmthe mearliermstagesmofmAlzheimer’smdisease,mwhen mamresidentmmaymbe maware mandmfrightenedmbymlossmofmmemory,
mavoid mcontributing mto mthemresident’smanxietymbymmaking mstatementsmsuch mas,m"Don’tmyou mremembermyourmdaughter
?"
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. DuganmD.m(2012).mNursing mAssisting:mAmFoundation min mCaregivingm(3rdmEd.).mAlbuquerque,mNM.mHartmanmPubli
shing,mInc.mPage m415.
2. Hedman,mS.,mFuzy,mJ.,mandmRymer,mS.m(2010).mHartman'smNursing mAssistantmCare:mLong-
TermmCare m(2nd mEd.).mAlbuquerque,mNM:mHartman mPublishing,mInc.mPage m359.
Mark mitemmf ormreview
, Itemm5 mof m150
While feeding a resident, the nurse aide notices that the resident is co
m m m m m m m m m m m m
ughing a lot after each drink of fluid. What is the appropriate response
m m m m m m m m m m m m m
by the nurse aide?
m m m
A
Allowmthemresident mmoremtimemto mswallow.
.
B. Usema mstrawmwhen mgivingmthemresident mfluids.
C. Add ma mthickeningmproduct mto mthemresident'smfluids.
D
Stop mfeedingmand mask ma mnursemto mcheck mthemresident.
.
Correct
Rationale:mWhen mamresidentmcoughsmfrequentlymaftermdrinkingmfluids,mitmmaymindicate mthatmthemresidentmismhaving ms
omemdifficultymswallowing.mThismdifficultymswallowing mcan mresultminmfluidsmgoingminto mthemresident’smlung.mThismcond
ition mismknown masmaspiration.mItmcanmresultmin mthemdevelopmentmofmseriousmmedical mconditions,msuch masmpneumoni
a,mwhich mmaymrequire mmedical mattention.
Themnurse maid mshould mnotifymthemnurse mimmediately.mThe mresidentmwill mrequiremanmevaluation mofmthe mresident’smabil
itymto mswallow.mThickening magentsmaremsometimesmadded mtomliquidsmformresidentsmthatmhave mdifficultymswallowing mflu
ids,mbutmthe muse mof mthese mthickenersmismdecided mbymthe mphysician mandmnotmthe mnurse maide.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
1. Sorrentino,mS.m(2011).mMosby'smTextbookmformLong-
TermmCare mNursing mAssistantsm(6th mEd.).mSt.mLouis,mMO:mElseviermMosby.mPagesm386-387.
2. Alvare,mS..mFuzy,mJ.,mand mRymer,mS.m(2009).mHartman’smNursing mAssistantmCare:mLong-
TermmCare mand mHome mHealth.mAlbuquerque,mNM:mHartman mPublishing,mInc.mPage m268.
Item m6mof m150
A resident wears a hand splint. Which observation should the nurse ai
m m m m m m m m m m m
de report to the nurse immediately?
m m m m m
A
Themresident'smfingersmaremcold mand mbluemin mcolor.
.
B.
Themsplint mwasmremoved masmscheduled min mth
emcaremplan.
C
Themresident masksmto mhavemthemsplint mremoved mforma mfewmminutes.
.
D. Themresident masksmthemnursemaidemto mreposition mthemarm mwith mthemsplint.
Correct
Rationale:mWhen mamresidentmwearsmamsplint,mitmismimportantmtommakemsure mthemsplintmismappliedmproperlymandmismn
otmcausing mpressure mthatmcouldmaffectmcirculation.mIf mnotmproperlymapplied,mthe msplintmcanmcausempressure.mWhenma
mresidentmwearsma msplint,mthe mcare mplan mmaymalso mincludemscheduled mperiodsmformremoving mthe msplintmto mallow mthe
mskin mto mbe mopenmto mairmandmto mpromote mcirculation.mWhenma mresidentmwearsma msplint,mitmismimportantmto mobserve m
formanymchangesminmskin mcolorminmthemextremity,mwhichmif mobserved mshould mbemreported mto mthemnursemimmediately.
mSkin mcolormchangesmand mchangesmin mthe mtemperaturemofmthemextremitymcould malsombemsignsmofmimpaired mcirculati
on.
Reference(s):
Examplesmof mreferencesmwhere mknowledge mformthismquestion mismcovered minclude:
