Deck 33: Hygiene
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Deck 33: Hygiene
1
The nurse is making an occupied bed.Which step will provide comfort for the client during this linen change?
A)Allow for a toe pleat.
B)Place a bath blanket over the client.
C)Slide the mattress to the head of the bed.
D)Raise the side rail.
A)Allow for a toe pleat.
B)Place a bath blanket over the client.
C)Slide the mattress to the head of the bed.
D)Raise the side rail.
Allow for a toe pleat.
2
The nurse is preparing to provide a client with mouth care.What should the nurse do to ensure safe handling of the client's dentures?
A)Clean biting surfaces.
B)Place a washcloth in the bowl of the sink.
C)Replace the upper dentures first.
D)Rinse dentures thoroughly with hot water.
A)Clean biting surfaces.
B)Place a washcloth in the bowl of the sink.
C)Replace the upper dentures first.
D)Rinse dentures thoroughly with hot water.
Place a washcloth in the bowl of the sink.
3
A client's hearing aid needs to be cleaned.What action should the nurse take to complete this task?
A)Clean with a dry,soft cloth.
B)Leave the battery in place when not in use.
C)Store the aid in the bathroom cabinet.
D)Use alcohol to remove any earwax.
A)Clean with a dry,soft cloth.
B)Leave the battery in place when not in use.
C)Store the aid in the bathroom cabinet.
D)Use alcohol to remove any earwax.
Clean with a dry,soft cloth.
4
The nurse is preparing to bath a client on the first postoperative day.Which nursing intervention should take priority?
A)Apply lotion to the extremities.
B)Change the water when it becomes cold.
C)Raise side rails when gathering supplies.
D)Remove the soiled dressing during the bath.
A)Apply lotion to the extremities.
B)Change the water when it becomes cold.
C)Raise side rails when gathering supplies.
D)Remove the soiled dressing during the bath.
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5
The nurse is preparing to remove ticks from a client's scalp.Which actions should the nurse perform to safely remove these pathogens from the client?
Standard Text: Select all that apply.
A)Grasp the tick with blunt tweezers.
B)Apply heat to the tick with a match.
C)Wash the area with antibacterial soap.
D)Pull the tick away in a perpendicular movement.
E)Apply petroleum jelly to the surface of the tick.
Standard Text: Select all that apply.
A)Grasp the tick with blunt tweezers.
B)Apply heat to the tick with a match.
C)Wash the area with antibacterial soap.
D)Pull the tick away in a perpendicular movement.
E)Apply petroleum jelly to the surface of the tick.
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6
A client needs to have soft contact lenses removed.What should the nurse do when removing the lenses?
A)Gently pinch the lens and lift it out.
B)Have the client look up.
C)Pull the lower eyelid upward.
D)Use the pad of the ring finger.
A)Gently pinch the lens and lift it out.
B)Have the client look up.
C)Pull the lower eyelid upward.
D)Use the pad of the ring finger.
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7
A client has the nursing diagnosis Risk for Impaired Skin Integrity related to immobility.Which nursing intervention should be identified for this client's problem?
A)Encourage the client to eat at least 40% of meals.
B)Keep linens dry and wrinkle-free.
C)Restrict fluid intake.
D)Turn client every 3 hours.
A)Encourage the client to eat at least 40% of meals.
B)Keep linens dry and wrinkle-free.
C)Restrict fluid intake.
D)Turn client every 3 hours.
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8
A connection on a client's intravenous solution was dislodged and solution saturated the client's gown and bed linens.The nurse will provide which type of hygienic care to the client?
A)Hour-of-sleep care
B)As-needed care
C)Early morning care
D)Morning care
A)Hour-of-sleep care
B)As-needed care
C)Early morning care
D)Morning care
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9
The nurse is preparing to shave a client.Which action step should the nurse consider when providing this care?
A)Assist the client to a prone position.
B)Pull the skin taut with the dominant hand.
C)Rinse the razor after each stroke.
D)Use long strokes.
A)Assist the client to a prone position.
B)Pull the skin taut with the dominant hand.
C)Rinse the razor after each stroke.
D)Use long strokes.
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10
The nurse is making a client's bed.What safety measure should the nurse implement at this time?
A)Begin at the head and move toward the foot,loosening bottom linens.
B)Miter corners at the head of the bed.
C)Place the soiled sheet in a laundry bag.
D)Prepare the client.
A)Begin at the head and move toward the foot,loosening bottom linens.
B)Miter corners at the head of the bed.
C)Place the soiled sheet in a laundry bag.
D)Prepare the client.
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11
Unlicensed assistive personnel are caring for a client's ears.What information should be reported to the nurse?
A)Excessive earwax
B)Loud talking
C)Presence of a hearing aid
D)Presence of any drainage
A)Excessive earwax
B)Loud talking
C)Presence of a hearing aid
D)Presence of any drainage
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12
A client tells the nurse that bathing is done at the sink in the bathroom at home because it is difficult to physically lift the legs to get into the shower.The nurse identifies which factor as influencing this client's hygienic practice?
A)Religion
B)Personal preference
C)Culture
D)Health and energy
A)Religion
B)Personal preference
C)Culture
D)Health and energy
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13
A client who is ambulatory is able to get out of bed for morning care.What should the nurse assess before assisting the client out of the bed to change the linen?
Standard Text: Select all that apply.
A)Pulse
B)Respirations
C)Urine output
D)Blood pressure
E)Mobility status
Standard Text: Select all that apply.
A)Pulse
B)Respirations
C)Urine output
D)Blood pressure
E)Mobility status
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14
The nurse is preparing to provide hygienic care to a client.On what will the nurse focus this care?
A)Clothes
B)Family
C)Hair
D)Nutritional
A)Clothes
B)Family
C)Hair
D)Nutritional
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15
The nurse is shampooing a client's hair.Which assessment finding should the nurse consider as expected?
A)Dry,dark,thin
B)Smooth,taut,shiny
C)Smooth texture and not oily or dry
D)Tender,warm scalp
A)Dry,dark,thin
B)Smooth,taut,shiny
C)Smooth texture and not oily or dry
D)Tender,warm scalp
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16
A client's hearing aid needs to be removed.What action should the nurse perform?
A)Assist the client with removal when necessary.
B)Instruct the client to remove the aid in the sunroom.
C)Leave the aid in place when bathing.
D)Send the aid home with the family.
A)Assist the client with removal when necessary.
B)Instruct the client to remove the aid in the sunroom.
C)Leave the aid in place when bathing.
D)Send the aid home with the family.
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17
The nurse identifies the diagnosis Self-Care Deficit related to cognitive impairment as appropriate for a client.What should the nurse select as an expected outcome for this client?
A)The client will be able to name the staff that works on the day shift.
B)The client will eliminate safety hazards in her environment.
C)The client,with supervision,will brush her teeth.
D)The nurse will stress the importance of adequate fluid intake.
A)The client will be able to name the staff that works on the day shift.
B)The client will eliminate safety hazards in her environment.
C)The client,with supervision,will brush her teeth.
D)The nurse will stress the importance of adequate fluid intake.
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18
The nurse is preparing to provide morning care to a client.What should the nurse explain to the client as the reason for a daily bath?
A)Assess skin integrity
B)Develop a nurse-client relationship
C)Moisturize the skin
D)Stimulate circulation
A)Assess skin integrity
B)Develop a nurse-client relationship
C)Moisturize the skin
D)Stimulate circulation
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19
During the morning bath of a client,the nurse identifies areas of erythema below the client's breasts.What should the nurse do to enhance comfort and healing for the client?
A)Wash the skin carefully.
B)Apply alcohol-free lotion.
C)Wash the area without soap.
D)Remove hair in the area.
A)Wash the skin carefully.
B)Apply alcohol-free lotion.
C)Wash the area without soap.
D)Remove hair in the area.
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20
The nurse is reviewing assigned clients for morning care needs.Which situation could pose a threat to one client's personal hygiene?
A)A client has a newly formed ileostomy.
B)A client performs meticulous foot care.
C)A German client refuses to bathe everyday.
D)The room temperature is set at 72°F.
A)A client has a newly formed ileostomy.
B)A client performs meticulous foot care.
C)A German client refuses to bathe everyday.
D)The room temperature is set at 72°F.
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21
The nurse has completed foot care for a client as part of routine morning care.What should the nurse document about the procedure?
A)The condition of the skin and nails
B)Nothing unless a problem is noted
C)The amount of time taken on foot care
D)The client's comments about the foot care
A)The condition of the skin and nails
B)Nothing unless a problem is noted
C)The amount of time taken on foot care
D)The client's comments about the foot care
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22
The nurse is preparing to provide a morning bath to a client diagnosed with dementia.What can the nurse do to ensure a positive bathing experience for the client?
Standard Text: Select all that apply.
A)Move slowly.
B)Be flexible.
C)Help the client feel in control.
D)Avoid stopping once the bath is started.
E)Be prepared.
Standard Text: Select all that apply.
A)Move slowly.
B)Be flexible.
C)Help the client feel in control.
D)Avoid stopping once the bath is started.
E)Be prepared.
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23
A client recovering from acute illness has just received a tub bath.When documenting the bath,what should the nurse include?
Standard Text: Select all that apply.
A)Client's ability to maintain a conversation during the procedure
B)Client's tolerance of the procedure
C)Condition and integrity of the skin
D)Client strength
E)Percentage of bath done without assistance
Standard Text: Select all that apply.
A)Client's ability to maintain a conversation during the procedure
B)Client's tolerance of the procedure
C)Condition and integrity of the skin
D)Client strength
E)Percentage of bath done without assistance
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24
While providing a complete bed bath to a client,the nurse discovers abrasions along the client's back and upper buttock area.What should the nurse do to help this client?
A)Apply antiseptic spray to the abrasions.
B)Do not wash the client with soap.
C)Find assistance to help with the remainder of the bath.
D)Apply alcohol-free lotion to the abrasions.
A)Apply antiseptic spray to the abrasions.
B)Do not wash the client with soap.
C)Find assistance to help with the remainder of the bath.
D)Apply alcohol-free lotion to the abrasions.
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25
The client has a hearing aid with an earpiece that is connected by a cord to a receiver that the client keeps in a shirt pocket.The nurse would document this as which type of hearing aid?
A)Body hearing aid
B)In-the-canal aid
C)Completely-in-the-canal aid
D)Eyeglasses aid
A)Body hearing aid
B)In-the-canal aid
C)Completely-in-the-canal aid
D)Eyeglasses aid
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26
A client tells the nurse that she does not want to get into the tub for a morning bath.The client has not been bathed for several days.What should the nurse do?
A)Assign UAP the task of giving the client a bath.
B)Skip the client's bath and document "refused" in the medical record.
C)Ask the client the usual way bathing occurs at home.
D)Tell the client that a bath is needed and ignore the client's comment.
A)Assign UAP the task of giving the client a bath.
B)Skip the client's bath and document "refused" in the medical record.
C)Ask the client the usual way bathing occurs at home.
D)Tell the client that a bath is needed and ignore the client's comment.
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27
The nurse has delegated the making of unoccupied beds to unlicensed assistive personnel.What should the nurse assess regarding client safety once the beds are completed?
A)Folding of the top sheet
B)Direction of the pillow
C)Call light being readily available
D)Presence of mitered corners
A)Folding of the top sheet
B)Direction of the pillow
C)Call light being readily available
D)Presence of mitered corners
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28
A client is prescribed bed rest with bathroom privileges.Which types of bath would be appropriate for this client?
Standard Text: Select all that apply.
A)Shower
B)Tub bath
C)Self-help bed bath
D)Therapeutic bath
E)Partial bath
Standard Text: Select all that apply.
A)Shower
B)Tub bath
C)Self-help bed bath
D)Therapeutic bath
E)Partial bath
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29
An older client tells the nurse that showers are not taken because of a previous fall.What can the nurse do to support the client's bathing needs?
A)Obtain a shower chair and assist the client in the shower.
B)Document that the client "refused" a morning bath in the medical record.
C)Tell the client that shower shoes can be worn to prevent falls.
D)Hold the client during the shower.
A)Obtain a shower chair and assist the client in the shower.
B)Document that the client "refused" a morning bath in the medical record.
C)Tell the client that shower shoes can be worn to prevent falls.
D)Hold the client during the shower.
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30
A client has hard contact lenses.What should the nurse do to assist the client in the care of the lenses?
A)Pinch the lenses out of the client's eyes to remove.
B)Remove both of the client's lenses before storing in the appropriate storage cup.
C)Document when the lenses need to be removed and cleaned every 2 weeks.
D)Ask the client how many hours the lenses are worn each day.
A)Pinch the lenses out of the client's eyes to remove.
B)Remove both of the client's lenses before storing in the appropriate storage cup.
C)Document when the lenses need to be removed and cleaned every 2 weeks.
D)Ask the client how many hours the lenses are worn each day.
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31
The nurse is assisting a client in removing soft contact lenses.Place in order the steps the nurse should take to help this client.
Standard Text: Click and drag the options below to move them up or down.
A)Using the pad of the index finger of the other hand,move the lens down to the sclera.
B)Have the client look forward.
C)Apply gloves.
D)Gently pinch the lens between the pads of the thumb and index finger.
E)Retract the lower lid with one hand.
Standard Text: Click and drag the options below to move them up or down.
A)Using the pad of the index finger of the other hand,move the lens down to the sclera.
B)Have the client look forward.
C)Apply gloves.
D)Gently pinch the lens between the pads of the thumb and index finger.
E)Retract the lower lid with one hand.
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32
During an assessment,the nurse learns a client has soft contact lenses that have not been removed or cleaned for weeks.What should the nurse do?
A)Nothing,because these types of lenses can be worn for months.
B)Remove the client's lenses,wrap in tissue,and place in the bedside table.
C)Assist the client to remove and clean the contacts.
D)Ask the physician for ophthalmology consult because the client will need help removing the lenses.
A)Nothing,because these types of lenses can be worn for months.
B)Remove the client's lenses,wrap in tissue,and place in the bedside table.
C)Assist the client to remove and clean the contacts.
D)Ask the physician for ophthalmology consult because the client will need help removing the lenses.
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33
A client with a skin rash is prescribed a bath in which medication is added to the bath water.The nurse should plan for the client to receive which type of bath?
A)Shower
B)Tub
C)Partial
D)Complete
A)Shower
B)Tub
C)Partial
D)Complete
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34
The nurse wants to assess a client during the morning bath.What will the nurse be able to assess during this time?
Standard Text: Select all that apply.
A)Skin status
B)Financial status
C)Psychosocial needs
D)Learning needs
E)Physical conditions
Standard Text: Select all that apply.
A)Skin status
B)Financial status
C)Psychosocial needs
D)Learning needs
E)Physical conditions
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