Deck 38: Hygiene

Question 1

The nurse is caring for a patient who has undergone external fixation of a broken leg and has a cast in place.To prevent skin impairment,what should the nurse do?

A)Not allow the patient to turn in bed because that may lead to redislocation of the leg.
B)Restrict the patient's dietary intake to reduce the number of times on the bedpan.
C)Assess all surfaces exposed to the cast for pressure areas.
D)Keep the patient's blood pressure low to prevent overperfusion of tissue.

Answer 1

Assess all surfaces exposed to the cast for pressure areas.

Question 2

The nurse is bathing a patient and notices movement in the patient's hair.The nurse should

A)Ignore the movement and continue.
B)Use gloves or a tongue blade to inspect the hair.
C)Examine the hair without gloves to make picking lice easier.
D)Shave the hair off of the patient's head.

Answer 2

Use gloves or a tongue blade to inspect the hair.

Question 3

The nurse is caring for a patient who refuses "A.M.care." When asked why,the patient tells the nurse that she always bathes in the evening.What should the nurse do?

A)Defer the bath until evening and pass on the information to the next shift.
B)Tell the patient that she must bathe in the morning because that is the "normal" routine.
C)Explain to the patient the importance of maintaining morning hygiene practices.
D)Cancel hygiene care for the day and attempt again in the morning.

Answer 3

Defer the bath until evening and pass on the information to the next shift.

Question 4

The nurse is caring for a patient who is immobile.Why is the nurse aware that the patient is at risk for impaired skin integrity?

A)Pressure reduces circulation to affected tissue.
B)Patients with limited caloric intake develop thicker skin.
C)Inadequate blood flow leads to decreased tissue ischemia.
D)Local nerve damage leads to pain sensation.

Question 5

When assessing a patient's feet,the nurse notices that the toenails are thick and separated from the nail bed.What is this condition caused by?

A)Fungi.
B)Nail polish.
C)Friction.
D)Nail polish remover.

Question 6

Of the following interventions,which would be the most important for preventing skin impairment in a mobile patient with local nerve damage?

A)Turning the patient every 2 hours.
B)Limiting caloric and protein intake.
C)Inserting an indwelling urinary catheter.
D)Assessing for pain while the patient is bathing.

Question 7

The nurse is caring for a patient who is complaining of severe foot pain from corns.The patient states that she has been using oval corn pads to self-treat the corns,but they seem to be getting worse.What does the nurse explain?

A)Corn pads are an adequate treatment and should be continued.
B)The patient should avoid soaking her feet before using a pumice stone.
C)Tighter shoes would help to compress the corns and make them smaller.
D)Depending on severity,surgery may be needed to remove the corns.

Question 8

The nurse is caring for an unresponsive patient who has a nasogastric tube in place for continuous tube feedings.Why does the nurse assess the patient's oral hygiene?

A)It helps prevent gingivitis.
B)It may cause glossitis.
C)It may lead to halitosis.
D)It causes tongue coating.

Question 9

When the nurse provides hygiene care for an older patient,why is it important for the nurse to closely assess the skin?

A)As people age,skin becomes more resilient.
B)As people age,sweat glands become more active.
C)As people age,skin becomes less subject to bruising.
D)As people age,less frequent bathing may be required.

Question 10

The patient receives a diagnosis of athlete's foot (tinea pedis).The patient says that she is relieved because it is "only athlete's foot" and it can be treated easily.What does the nurse explains about athlete's foot?

A)It is generally isolated to the feet and never recurs.
B)It is contagious and frequently recurs.
C)It is caused by the papillomavirus.
D)It is treated with salicylic acid or electrodesiccation.

Question 11

Successful critical thinking requires synthesis of knowledge,experience,information gathered from patients,critical thinking qualities,and intellectual and professional standards.Once the assessment has been done,what is important for the nurse to understand?

A)The nursing diagnoses never change.
B)The patient's condition never changes.
C)Critical thinking is ongoing.
D)Hygiene care needs to become a simple routine.

Question 12

The patient received a diagnosis of diabetes 12 years ago.When admitted,the patient is unkempt and is in need of a bath and foot care.When questioned about his hygiene habits,the patient tells the nurse that baths are taken once a week where he comes from,although he takes a sponge bath every other day.To provide ultimate care for this patient,what must the nurse understand?

A)Personal preferences determine hygiene practices and are unchangeable.
B)Patients who appear unkempt place little importance on hygiene practices.
C)The patient's illness may require teaching of new hygiene practices.
D)All cultures value cleanliness with the same degree of importance.

Question 13

When assessing a patient's skin,what does the nurse need to know?

A)Restricted movement can increase blood circulation.
B)Paralyzed patients have normal sensory function.
C)Loss of subcutaneous tissue may increase the rate of wound healing.
D)Moisture on the skin can lead to skin maceration.

Question 14

The nurse is caring for a patient who has diabetes mellitus and circulatory insufficiency,with peripheral neuropathy and urinary incontinence.What does the nurse know about patients with these conditions?

A)They have decreased pain sensation and are at increased risk for skin impairment.
B)They are at decreased risk of developing infection because of urinary pH level.
C)They have decreased caloric intake,which results in accelerated wound healing.
D)They have impaired venous return,which allows for greater circulation and less breakdown.

Question 15

The nurse is providing education about the importance of proper foot care to a patient who has diabetes mellitus.Why is this important?

A)Plantar warts can develop from foot fungi.
B)Poor foot care leads to neuropathy.
C)A strong dorsalis pedis pulse indicates poor blood flow.
D)Foot ulcers are the most common precursor to amputation.

Question 16

The patient has been brought to the emergency department after a motor vehicle accident.The patient is unresponsive.His driver's licence states that he needs glasses to operate a motor vehicle,but no glasses were brought in with the patient.What should the nurse do?

A)Assume that the glasses were lost during the accident.
B)Stand to the side of the patient's eye and observe the cornea.
C)Assume that the patient was not wearing glasses while driving.
D)Assume that the ambulance personnel have them.

Question 17

Social groups influence hygiene preferences and practices,including the type of hygienic products used and the nature and frequency of personal care.Which of the following developmental stages is most likely to be influenced by family customs?

A)Adolescent.
B)Toddler.
C)Adult.
D)Older person.

Question 18

A number of factors influence a patient's personal preferences for hygiene.Because of this,what is important for the nurse to realize?

A)No two individuals perform hygiene care in the same manner.
B)It is important to standardize a patient's hygienic practices.
C)Hygiene care is always routine and expected.
D)Hygiene care is not the time to learn about patient needs.

Question 19

The nurse is providing oral care to an unconscious patient and notes that the patient has extremely bad breath.What is the term for "bad breath"?

A)Alopecia.
B)Halitosis.
C)Dental caries.
D)Neuropathy.

Question 20

Of the following disorders,which is caused by a virus?

A)Corns.
B)Plantar warts.
C)Athlete's foot.
D)Callus.

Question 21

The nurse is caring for an older patient with Alzheimer's disease who is ambulatory but requires total assistance with his activities of daily living (ADLs).The nurse notices that his skin is dry and wrinkled.What should the nurse do?

A)Make sure that the patient is receiving daily baths.
B)Reduce the number of baths per week if possible.
C)Be aware that sweat glands become more active with aging.
D)Be sure that the patient is using soap with his bath.

Question 22

The nurse is providing perineal care to an uncircumcised male patient.When providing such care,how should the nurse treat the foreskin?

A)Leave the foreskin alone because there is little chance of infection.
B)Retract the foreskin for cleansing and allow it to return on its own.
C)Retract the foreskin and keep retracted.
D)Retract the foreskin and return it to its natural position when done.

Question 23

How is basic eye care provided?

A)The nurse cleanses the eye with soap and water.
B)The nurse applies pressure directly to the eyeball.
C)The nurse cleanses from inner canthus to outer canthus.
D)The nurse provides less frequent care to unconscious patients.

Question 24

The nurse is providing a complete bed bath to a patient with a commercial bath cleansing pack (bag bath).What should the nurse do?

A)Use one towel for the entire bath.
B)Dry the skin with a towel.
C)Allow the skin to air dry.
D)Not use a bath blanket or towel.

Question 25

The patient is being treated for cancer with weekly radiation and chemotherapy treatments.The nurse is aware that the patient's oral mucosa needs to be assessed because radiation therapy and chemotherapy can have what effects?

A)Increase saliva production.
B)Decrease the risk of oral inflammation.
C)Decrease drying of oral mucosa.
D)Lead to oral problems.

Question 26

The patient received a diagnosis of pediculosis capitis (head lice),was treated upon admission and re-treated 24 hours later,and yet the patient still has the infestation.What should be the nurse's next action?

A)Re-treat the patient with a medicated shampoo for eliminating lice.
B)Use a product containing lindane to get rid of the lice.
C)Manually remove the lice using a fine-toothed comb.
D)Have the patient bathe or shower thoroughly.

Question 27

The uncooperative patient is resisting attempts by the nurse to provide oral hygiene care.To provide the needed care,what may the nurse do?

A)Use a padded tongue blade.
B)Hold the patient's mouth open with his or her own fingers.
C)Position the patient on his or her back.
D)Use undiluted hydrogen peroxide as a cleaner.

Question 28

The nurse is preparing to provide a complete bed bath to an unconscious patient.The nurse decides to use a bag bath.She does this for which of the following reasons?

A)Washbasins can harbour Gram-negative organisms.
B)Bag baths entail the use of soaps that enhance cleansing.
C)Bag baths do not contain emollients.
D)Bag baths increase skin flaking and scaling.

Question 29

The nurse is teaching the patient about flossing and oral hygiene.Which of the following is the nurse's instruction?

A)Flossing needs to be done at least three times a day.
B)To prevent bleeding,the patient should use waxed floss.
C)Flossing removes plaque and bacteria from the teeth.
D)Applying toothpaste to the teeth before flossing is harmful.

Question 30

The nurse is caring for a patient who has head lice (pediculosis capitis).What should the nurse know about treating this condition?

A)Products containing lindane are most effective.
B)Head lice may spread to furniture and other people.
C)Treatment must be repeated in 7 to 10 days.
D)Manual removal is not a realistic option as treatment.

Question 31

Scaling of the scalp accompanied by itching is known as which of the following?

A)Dandruff.
B)Pediculosis.
C)Alopecia.
D)Ticks.

Question 32

The nurse is teaching a patient about contact lens care.The patient has plastic lenses,so what does the nurse instruct the patient to do?

A)Use tap water to clean lenses.
B)Keep the lenses is a cool dry place when not being used.
C)Reuse storage solution for up to a week.
D)Wash and rinse lens storage case daily.

Question 33

In providing perineal care to a female patient,how should the nurse wash?

A)Upward from rectum to pubic area.
B)From back to front.
C)From pubic area to rectum.
D)In a circular motion.

Question 34

After the patient's bath,what should the nurse do?

A)Not offer a back rub because it is not therapeutic.
B)Routinely give back rubs of 2 minutes' duration or less.
C)Assume that all patients need back rubs after their bath.
D)Not offer a back rub for 48 hours after the patient has undergone coronary artery bypass surgery.

Question 35

The female nurse is caring for a male patient who is uncircumcised and not ambulatory,although he has full function of arms and hands.The nurse is providing the patient with a partial bed bath.What statement is true for perineal care for this patient?

A)It is not necessary because he is not circumcised.
B)It should be postponed because it may cause him embarrassment.
C)It should be done by the patient.
D)It should be done by the nurse.

Question 36

In finding pediculosis capitis (head lice)in a patient,what would the nurse expect to observe?

A)Greyish-white parasites with red legs.
B)Pustules or bites behind ears and at the hairline.
C)Balding patches in periphery of the hairline.
D)Brittle and broken hair.

Question 37

The nurse is caring for a patient who has multiple ticks on her legs and body.To rid the patient of ticks,what should the nurse do?

A)Burn the ticks in an ashtray once removed.
B)Use blunt tweezers and pull upward with steady pressure.
C)Allow the ticks to drop off by themselves.
D)Use products containing lindane to kill the ticks.

Question 38

Patients with diabetes mellitus need special foot care to prevent the development of ulcers.Knowing this,what is the nurse's action?

A)Trimming the patient's toenails daily.
B)Having the patient soak his or her feet twice a day.
C)Requesting a consult with a nail care specialist.
D)Assessing the brachial artery.

Question 39

In providing oral care to an unconscious patient,what is an important action by the nurse?

A)Moistening the patient's mouth with lemon-glycerin sponges.
B)Holding the patient's mouth open with his or her fingers.
C)Rinsing the patient's mouth and immediately suctioning the oral cavity.
D)Using foam swabs to help remove plaque.

Question 40

A self-sufficient bedridden patient unable to reach all body parts needs which type of bath?

A)Complete bed bath.
B)Bag bath.
C)Sponge bath.
D)Partial bed bath.

Question 41

Of the following hearing aids,which interferes the most with wearing eyeglasses and using a phone?

A)In-the-canal hearing aid.
B)In- the-ear hearing aid.
C)Behind-the-ear hearing aid.
D)They are all equally useful.

Question 42

The patient complains to the nurse about a perceived decrease in hearing.When the nurse examines the patient's ear,she notices a large amount of cerumen (ear wax)buildup at the entrance to the ear canal.What should the nurse do?

A)Apply gentle,downward retraction of the ear canal.
B)Tell the patient to use a bobby pin to extract earwax.
C)Teach the patient how to use cotton-tipped applicators.
D)Instill hot water into the ear canal to melt the wax.

Question 43

Of the following patients,which are in need of help with perineal care? (Select all that apply. )

A)A patient with urinary and fecal incontinence.
B)A circumcised male who is ambulatory.
C)A patient with rectal and perineal surgical dressings.
D)A patient with an indwelling catheter.
E)A morbidly obese patient.

Question 44

The patient is being fitted with a hearing aid.In teaching the patient how to care for the hearing aid,the nurse instructs the patient to do which of the following?

A)Wear the hearing aid 24 hours per day except when sleeping.
B)Change the battery every day or as needed.
C)Avoid the use of hairspray,but aerosol perfumes are allowed.
D)Adjust the volume for a talking distance of 1 metre.

Question 45

The patient has been forcefully blowing his nose and now has a nosebleed.The nurse is concerned about the patient's condition and assesses the patient for which possible negative issues? (Select all that apply. )

A)Clearance of nasal passages.
B)Injury to the tympanic membrane (eardrum).
C)Damage to nasal mucosa.
D)Eye injury.
E)Decreased nasal passage pressure.

Question 46

The use of critical thinking attitudes is necessary to design a plan of care to meet the patient's hygiene needs.Which of the following are considered critical thinking attributes? (Select all that apply. )

A)Curiosity.
B)Communication principles.
C)Prior experience.
D)Humility.
E)Knowledge of cultural variations.

Question 47

The patient is complaining of an inability to clear his nasal passages.How should the nurse instruct the patient?

A)To blow his nose forcefully to clear the passage.
B)To insert a cotton-tipped applicator as far as possible.
C)To apply gentle suction with a pediatric bulb suction device.
D)To use a dry washcloth to absorb secretions.