Fundamentals of Nursing NCLEX Practice Questions Quiz Set 4 | 75 Questions

Fundamentals of Nursing NCLEX Practice Questions Quiz Set 4 | 75 Questions 1. 1. Question All of the following can cause tachycardia except: o A. Fever o B. Exercise o C. Sympathetic nervous system stimulation o D. Parasympathetic nervous system stimulation Incorrect Correct Answer: D. Parasympathetic nervous system stimulation Parasympathetic nervous system stimulation of the heart decreases the heart rate as well as the force of contraction, rate of impulse conduction and blood flow through the coronary vessels. Fever, exercise, and sympathetic stimulation all increase the heart rate. The parasympathetic nervous system (PNS) releases the hormone acetylcholine to slow the heart rate. Such factors as stress, caffeine, and excitement may temporarily accelerate your heart rate, while meditating or taking slow, deep breaths may help to slow your heart rate. • Option A: Tachypnea and tachycardia develop, and the patient becomes dehydrated because of sweating and vapor losses from the increased respiratory rate. Many manifestations of fever are related to the increased metabolic rate, increased need for oxygen, and use of body proteins as an energy source. • Option B: Often, ventricular tachycardia will occur during the recovery period post exercise due to increased levels of adrenaline. In a study conducted in 1991, it was found that 70% of patients tested experienced idiopathic ventricular tachycardia as a result of exercise. Exercising for any duration will increase your heart rate and will remain elevated for as long as the exercise is continued. At the beginning of exercise, your body removes the parasympathetic stimulation, which enables the heart rate to gradually increase. As you exercise more strenuously, the sympathetic system “kicks in” to accelerate your heart rate even more. • Option C: Heart rate is controlled by the two branches of the autonomic (involuntary) nervous system. The sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The sympathetic nervous system (SNS) releases the hormones (catecholamines – epinephrine and norepinephrine) to accelerate the heart rate. 2. 2. Question Palpating the midclavicular line is the correct technique for assessing: • A. Baseline vital signs • B. Systolic blood pressure • C. Respiratory rate • D. Apical pulse Incorrect Correct Answer: D. Apical pulse The apical pulse (the pulse at the apex of the heart) is located on the midclavicular line at the fourth, fifth, or sixth intercostal space. Assessing whether the rhythm of the pulse is regular or irregular is essential. The pulse could be regular, irregular, or irregularly irregular. Changes in the rate of the pulse, along with changes in respiration is called sinus arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and slows down during expiration. Irregularly irregular pattern is more commonly indicative of processes like atrial flutter or atrial fibrillation. • Option A: Baseline vital signs include pulse rate, temperature, respiratory rate, and blood pressure. Vital signs are an objective measurement for the essential physiological functions of a living organism. They have the name “vital” as their measurement and assessment is the critical first step for any clinic evaluation. The first set of clinical examinations is an evaluation of the vital signs of the patient. • Option B: Blood pressure is typically assessed at the antecubital fossa. The arm should be supported at the heart level. Unsupported arm leads to 10 mmHg to the pressure readings. The patient’s blood pressure should get checked in each arm, and in younger patients, it should be tested in an upper and lower extremity to rule out the coarctation of the aorta. • Option C: Respiratory rate is assessed best by observing chest movement with each inspiration and expiration. The respiratory rate is the number of breaths per minute. The normal breathing rate is about 12 to 20 beats per minute in an average adult. In the pediatric age group, it is defined by the particular age group. Parameters important here again include its rate, depth of breathing, and its pattern rate of breathing is a crucial parameter. 3. 3. Question The absence of which pulse may not be a significant finding when a patient is admitted to the hospital? • A. Apical • B. Radial • C. Pedal • D. Femoral Incorrect Correct Answer: C. Pedal Because the pedal pulse cannot be detected in 10% to 20% of the population, its absence is not necessarily a significant finding. However, the presence or absence of the pedal pulse should be documented upon admission so that changes can be identified during the hospital stay. Absent peripheral pulses may be indicative of peripheral vascular disease (PVD). PVD may be caused by atherosclerosis, which can be complicated by an occluding thrombus or embolus. This may be life-threatening and may cause the loss of a limb. • Option A: Apical pulse rate is indicated during some assessments, such as when conducting a cardiovascular assessment and when a client is taking certain cardiac medications (e.g., digoxin). Sometimes the apical pulse is auscultated pre and post medication administration. It is also a best practice to assess apical pulse in infants and children up to five years of age because radial pulses are difficult to palpate and count in this population. • Option B: Examiners frequently evaluate the radial artery during a routine examination of adults, due to the unobtrusive position required to palpate it and it’s easy accessibility in various types of clothing. Like other distal peripheral pulses (such as those in the feet) it also may be quicker to show signs of pathology. Palpation is at the anterior wrist just proximal to the base of the thumb. • Option D: The femoral pulse may be the most sensitive in assessing for septic shock and is routinely checked during resuscitation. It is palpated distally to the inguinal ligament at a point less than halfway from the pubis to the anterior superior iliac spine. 4. 4. Question Which of the following patients is at greatest risk for developing pressure ulcers? • A. An alert, chronic arthritic patient treated with steroids and aspirin. • B. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home. • C. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula. • D. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed. Incorrect Correct Answer: B. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home. Pressure ulcers are most likely to develop in patients with impaired mental status, mobility, activity level, nutrition, circulation and bladder or bowel control. Age is also a factor. Thus, the 88-year old incontinent patient who has impaired nutrition (from gastric cancer) and is confined to bed is at greater risk. Pressure injuries are defined as localized damage to the skin as well as underlying soft tissue, usually occurring over a bony prominence or related to medical devices. They are the result of prolonged or severe pressure with contributions from shear and friction forces. • Option A: Risk factors for developing pressure injuries, in general, include immobility, reduced perfusion, malnutrition, and sensory loss. Other patients at increased risk for pressure injury development include those with cerebrovascular or cardiovascular disease, recent fracture of a lower extremity, diabetes, and incontinence. Older patients are also at increased risk for the formation of pressure injuries due to skin changes associated with aging, including thinning of the dermis and epidermis, resulting in decreased resistance to shear forces. • Option C: The pressure of an individual’s body weight or pressure from a medical device above a certain threshold for a prolonged period is thought to be the cause of pressure injuries. In patients with sensory deficits, an absent pressure feedback response may result in sustained pressure for a prolonged period, leading to tissue injury. Many factors are identified in contributing to pressure ulcer and injury formation, such as increased arteriole pressure, shearing forces, friction, moisture, and nutrition status. • Option D: Pressure injuries of the skin and soft tissues affect an estimated 1 to 3 million people in the United States each year. The incidence differs based on the clinical setting. For example, the prevalence of pressure injuries among hospitalized patients is 5% to 15%, with the percentage considerably higher in some long-term care environments and intensive care units. 5. 5. Question The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler’s position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation? • A. Encourage the patient to increase her fluid intake to 200 ml every 2 hours. • B. Place a humidifier in the patient’s room. • C. Continue administering oxygen by a high humidity face mask. • D. Perform chest physiotherapy on a regular schedule. Incorrect Correct Answer: A. Encourage the patient to increase her fluid intake to 200 ml every 2 hours Adequate hydration thins and loosens pulmonary secretions and also helps to replace fluids lost from elevated temperature, diaphoresis, dehydration, and dyspnea. Encourage patients to increase fluid intake to 3 liters per day within the limits of cardiac reserve and renal function. Fluids help minimize mucosal drying and maximize ciliary action to move secretions. • Option B: Consider the need for humidifiers in-home care settings. This facilitates the liquefaction of secretions. Teach the patient the proper ways of coughing and breathing. (e.g., take a deep breath, hold for 2 seconds, and cough two or three times in succession). The most convenient way to remove most secretions is coughing. So it is necessary to assist the patient during this activity. Deep breathing, on the other hand, promotes oxygenation before controlled coughing. • Option C: Maintain humidified oxygen as prescribed. Increasing humidity of inspired air will reduce the thickness of secretions and aid their removal. Provide supplemental oxygen if the patient experiences bradycardia, an increase in ventricular ectopy, and/or significant desaturation. Oxygen therapy is recommended to improve oxygen saturation and reduce possible complications. • Option D: Coordinate with a respiratory therapist for chest physiotherapy and nebulizer management as indicated. Chest physiotherapy includes the techniques of postural drainage and chest percussion to mobilize secretions from smaller airways that cannot be eliminated by means of coughing or suctioning. 6. 6. Question The most common deficiency seen in alcoholics is: • A. Thiamine • B. Riboflavin • C. Pyridoxine • D. Pantothenic acid Incorrect Correct Answer: A. Thiamine Chronic alcoholism commonly results in thiamine deficiency and other symptoms of malnutrition. Chronic alcohol consumption can cause thiamine deficiency and thus reduced enzyme activity through several mechanisms, including inadequate dietary intake, malabsorption of thiamine from the gastrointestinal tract, and impaired utilization of thiamine in the cells. • Option B: Riboflavin, vitamin B2, is a water-soluble and heat-stable vitamin that the body uses to metabolize fats, protein, and carbohydrates into glucose for energy. In addition to boosting energy, riboflavin functions as an antioxidant for the proper function of the immune system, healthy skin, and hair. Riboflavin deficiency can result from inadequate dietary intake or by endocrine abnormalities. Riboflavin deficiency also correlates with other vitamin B complexes. • Option C: Vitamin B6 deficiency is usually caused by pyridoxine-inactivating drugs (eg, isoniazid), protein-energy undernutrition, malabsorption, alcoholism, or excessive loss. Deficiency can cause peripheral neuropathy, seborrheic dermatitis, glossitis, and cheilosis, and, in adults, depression, confusion, and seizures. • Option D: Pantothenic acid deficiency is very rare in the United States. Severe deficiency can cause numbness and burning of the hands and feet, headache, extreme tiredness, irritability, restlessness, sleeping problems, stomach pain, heartburn, diarrhea, nausea, vomiting, and loss of appetite. 7. 7. Question Which of the following statements is incorrect about a patient with dysphagia? • A. The patient will find pureed or soft foods, such as custards, easier to swallow than water. • B. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing. • C. The patient should always feed himself. • D. The nurse should perform oral hygiene before assisting with feeding. Incorrect Correct Answer: C. The patient should always feed himself. A patient with dysphagia (difficulty swallowing) requires assistance with feeding. Feeding himself is a long-range expected outcome. Dysphagia is defined as objective impairment or difficulty in swallowing, resulting in an abnormal delay in the transit of a liquid or solid bolus. The delay may be during the oropharyngeal or esophageal phase of swallowing. • Option A: The Academy of Nutrition and Dietetics has created a diet plan for people with dysphagia. The plan is called the National Dysphagia Diet. The dysphagia diet has 4 levels of foods. Level 1 foods are foods that are pureed or smooth, like pudding. They need no chewing. This includes foods such as yogurt, mashed potatoes with gravy to moisten it, smooth soups, and pureed vegetables and meats. • Option B: While eating or drinking, it may help to sit upright, with the back straight. The client may need support pillows to get into the best position. It may also help to have few distractions while eating or drinking. Changing between solid food and liquids may also help the swallowing. Stay upright for at least 30 minutes after eating. This can help reduce the risk for aspiration. • Option D: After meals, it’s important to do proper oral care. The SLP (speech-language pathologist) can give the client instructions for the teeth or dentures. Make sure to not swallow any water during the oral care routine. While on a dysphagia diet, the client may have trouble taking in enough fluid. This can cause dehydration, which can lead to serious health problems. Talk with the healthcare team about how it can be prevented. In some cases drinking thicker liquids may make some of the medicines work less well. Because of this, the client may need some of the medicines changed for a while. 8. 8. Question To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. She should notify the physician if the urine output is: • A. Less than 30 ml/hour • B. 64 ml in 2 hours • C. 90 ml in 3 hours • D. 125 ml in 4 hours Incorrect Correct Answer: A. Less than 30 ml/hour A urine output of less than 30ml/hour indicates hypovolemia or oliguria, which is related to kidney function and inadequate fluid intake. Urine output is a noninvasive method to measure fluid balance once intravascular volume has been restored. Normal urine output is defined as 1.5 to 2 mL/kg per hour • Option B: Micturition process entails contraction of the detrusor muscle and relaxation of the internal and external urethral sphincter. The process is slightly different based on age. Children younger than three years old have the micturition process coordinated by the spinal reflex. • Option C: It starts with urine accumulation in the bladder that stretches the detrusor muscle causing activation of stretch receptors. The stretch sensation is carried by the visceral afferent to the sacral region of the spinal cord where it synapses with the interneuron that excites the parasympathetic neurons and inhibits the sympathetic neurons. The visceral afferent impulse concurrently decreases the firing of the somatic efferent that normally keeps the external urethral sphincter closed allowing reflexive urine output. • Option D: Low bladder volume activates the pontine storage center which activates the sympathetic nervous system and inhibits the parasympathetic nervous system cumulatively allowing the accumulation of urine in the bladder. High bladder volume activates the pontine micturition center which activates the parasympathetic nervous system and inhibits the sympathetic nervous system as well as triggers awareness of a full bladder; consequently leading to relaxation of the internal sphincter and a choice to relax the external urethral sphincter once ready to void. 9. 9. Question Certain substances increase the amount of urine produced. These include: • A. Caffeine-containing drinks, such as coffee and cola • B. Beets • C. Urinary analgesics • D. Kaolin with pectin (Kaopectate) Incorrect Correct Answer: A. Caffeine-containing drinks, such as coffee and cola. Fluids containing caffeine have a diuretic effect. Drinking caffeine-containing beverages as part of a normal lifestyle doesn’t cause fluid loss in excess of the volume ingested. While caffeinated drinks may have a mild diuretic effect — meaning that they may cause the need to urinate — they don’t appear to increase the risk of dehydration. • Option B: In some people, eating beets turn urine pink or red—which can be alarming because it looks like blood in the urine. These odor and color changes are harmless. But if urine smells sweet, that’s a cause for concern because it could mean diabetes. • Option C: Pyridium will most likely darken the color of urine to an orange or red color. This is a normal effect and is not cause for alarm unless there are other symptoms such as pale or yellowed skin, fever, stomach pain, nausea, and vomiting. • Option D: Kaopectate is an antidiarrheal medication. This medication is used to treat occasional upset stomach, heartburn, and nausea. It is also used to treat diarrhea and help prevent travelers’ diarrhea. It works by helping to slow the growth of bacteria that might be causing diarrhea. This product should not be used to self-treat diarrhea if there is also fever or blood/mucus in the stools. These could be signs of a serious health condition. 10. 10. Question A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate? • A. Encourage the patient to walk in the hall alone. • B. Discourage the patient from walking in the hall for a few more days. • C. Accompany the patient for his walk. • D. Consult a physical therapist before allowing the patient to ambulate. Incorrect Correct Answer: C. Accompany the patient for his walk. Accompanying him will offer moral support, enabling him to face the rest of the world. Ambulation stimulates circulation which can help stop the development of stroke-causing blood clots. Walking improves blood flow which aids in quicker wound healing. The gastrointestinal, genitourinary, pulmonary and urinary tract functions are all improved by walking. • Option A: A hospitalized surgical patient leaving his room for the first time fears rejection and others staring at him, so he should not walk alone. Refusal to ambulate correlated with those that eventually developed a complication. Those that eventually developed a postoperative complication were more likely to be in the higher refusal group. Thorn et al. suggested that patient compliance may be a marker of underlying complications. If patients are not engaged in their recovery, there may be a physiologic reason for refusal (i.e., a developing abscess). • Option B: Patients should begin ambulation as soon as possible after surgery to decrease complications and to regain strength and confidence. The multiple physiological benefits of patient ambulation have been documented including the prevention of muscular and cardiovascular deconditioning, reducing the risk of pulmonary and thromboembolic events, and stimulating gastrointestinal recovery through prokinetic effects • Option D: Waiting to consult a physical therapist is unnecessary. Daily ambulation requires collaboration between hospital resources, patient education and available personnel. Second, aggressive non-opioid pain medication regimens are critical to maintain a low mLOS. The increasing use of narcotics especially with a PCA prolonged the LOS. Third, refusal of ambulation often predicted the development of a postoperative complication. 11. 11. Question A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. An appropriate nursing diagnosis would be: • A. Ineffective airway clearance related to thick, tenacious secretions • B. Ineffective airway clearance related to dry, hacking cough • C. Ineffective individual coping to COPD • D. Pain related to immobilization of affected leg Incorrect Correct Answer: A. Ineffective airway clearance related to thick, tenacious secretions. Thick, tenacious secretions, a dry, hacking cough, orthopnea, and shortness of breath are signs of ineffective airway clearance. Chronic obstructive pulmonary disease (COPD) is a common and treatable disease characterized by progressive airflow limitation and tissue destruction. It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases most commonly cigarette smoke. Chronic inflammation causes airway narrowing and decreased lung recoil. The disease often presents with symptoms of cough, dyspnea, and sputum production. • Option B: Ineffective airway clearance related to dry, hacking cough is incorrect because the cough is not the reason for the ineffective airway clearance. COPD is an inflammatory condition involving the airways, lung parenchyma, and pulmonary vasculature. The process is thought to involve oxidative stress and protease-antiprotease imbalances. Emphysema describes one of the structural changes seen in COPD where there is the destruction of the alveolar air sacs (gas-exchanging surfaces of the lungs) leading to obstructive physiology. • Option C: Ineffective individual coping related to COPD is wrong because the etiology for a nursing diagnosis should not be a medical diagnosis (COPD) and because no data indicate that the patient is coping ineffectively. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation. • Option D: Pain related to immobilization of affected legs would be an appropriate nursing diagnosis for a patient with a leg fracture. COPD will typically present in adulthood and often during the winter months. Patients usually present with complaints of chronic and progressive dyspnea, cough, and sputum production. Patients may also have wheezing and chest tightness. While a smoking history is present in most cases, there are many without such history. 12. 12. Question Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be: • A. “Don’t worry. It’s only temporary” • B. “Why are you crying? I didn’t get to the bad news yet” • C. “Your hair is really pretty” • D. “I know this will be difficult for you, but your hair will grow back after the completion of chemotherapy” Incorrect Correct Answer: D. “I know this will be difficult for you, but your hair will grow back after the completion of chemotherapy” “I know this will be difficult” acknowledges the problem and suggests a resolution to it. The term alopecia means hair loss regardless of the cause. It is not exclusive to the scalp; it can be anywhere on the body. As an individual grows older, they will lose hair. The difference between male hair loss and female hair loss is the pattern. Men generally lose hair in the front and the temporal region, while women tend to lose hair from the central area of the scalp. Also, female hair loss will not end up with complete baldness, whereas male hair loss can end up with complete baldness. • Option A: “Don’t worry..” offers some relief but doesn’t recognize the patient’s feelings. The epidemiology is variable depending on the cause of alopecia and the type. In alopecia areata, the prevalence is 0.2% with no racial or sexual predilection, and it may affect any age group. Androgenetic alopecia is a common disorder affecting 50% of men and 15% of women, especially postmenopausal women. • Option B: “..I didn’t get to the bad news yet” would be inappropriate at any time. Pathophysiology is dependent on the type of alopecia. In alopecia areata, it is unknown, but the most common hypothesis involves autoimmunity in the form of a T-cell–mediated pathway. In androgenetic alopecia, both genetic and hormonal androgens play a role in pathogenesis. In telogen effluvium, the shedding of hair is under the influence of hormone or stress, but sometimes the trigger is not very clear. • Option C: “Your hair is really pretty” offers no consolation or alternatives to the patient. During the physical examination, it is essential to notice the pattern of hair loss. In a patient with androgenetic alopecia, patients tend to lose hair from the frontal and temporal area (male type) and the central scalp area (female type). In alopecia areata, the patient may lose hair from a single area (alopecia areata classical type), the whole scalp and eyebrows (alopecia totalis), or from the entire body (alopecia universalis). In tinea capitis, the classic presentation is black dots associated with broken hair, while the inflammatory type (favus) correlates with the scarring type of alopecia. 13. 13. Question An additional Vitamin C is required during all of the following periods except: • A. Infancy • B. Young adulthood • C. Childhood • D. Pregnancy Incorrect Correct Answer: B. Young adulthood Additional Vitamin C is needed in growth periods, such as infancy and childhood, and during pregnancy to supply demands for fetal growth and maternal tissues. Other conditions requiring extra vitamin C include wound healing, fever, infection and stress. Vitamin C is a water-soluble vitamin, antioxidant, and essential cofactor for collagen biosynthesis, carnitine and catecholamine metabolism, and dietary iron absorption. Humans are unable to synthesize vitamin C, so they can only obtain it through dietary intake of fruits and vegetables. • Option A: An infant requires Vitamin C. Although most vitamin C is completely absorbed in the small intestine, the percentage of absorbed vitamin C decreases as intraluminal concentrations increase. Proline residues on procollagen require vitamin C for the hydroxylation, making it necessary for the triple-helix formation of mature collagen. The lack of a stable triple-helical structure compromises the integrity of the skin, mucous membranes, blood vessels, and bone. • Option C: Children need lots of Vitamin C. Usual dietary doses of up to 100 mg/day are almost completely absorbed. The highest concentrations of ascorbic acid are in the pituitary gland, the adrenal gland, the brain, leukocytes, and eyes. Ascorbic acid functions as a cofactor, enzyme complement, co-substrate, and a powerful antioxidant in a variety of reactions and metabolic processes. It also stabilizes vitamin E and folic acid and enhances iron absorption. It neutralizes free radicals and toxins as well as attenuates inflammatory response, including sepsis syndrome. • Option D: A pregnant woman requires an abundant amount of Vitamin C. The average protective adult dose of vitamin C is 70 to 150 mg daily. Increase the dose to 300 mg to 1 g daily when scurvy is present. Daily need increases in patients with conditions like gingivitis, asthma, glaucoma, collagen disorders, heatstroke, arthritis, infections (pneumonia, sinusitis, rheumatic fever), and chronic illnesses. Hemovascular disorders, burns, and delayed wound healing are causes for an increase in daily intake. 14. 14. Question A prescribed amount of oxygen is needed for a patient with COPD to prevent: • A. Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2). • B. Circulatory overload due to hypervolemia. • C. Respiratory excitement. • D. Inhibition of the respiratory hypoxic stimulus. Incorrect Correct Answer: D. Inhibition of the respiratory hypoxic stimulus. Delivery of more than 2 liters of oxygen per minute to a patient with chronic obstructive pulmonary disease (COPD), who is usually in a state of compensated respiratory acidosis (retaining carbon dioxide (CO2)), can inhibit the hypoxic stimulus for respiration. Long-term oxygen therapy is used for COPD if the client has low levels of oxygen in the blood (hypoxia). It is used mostly to slow or prevent right-sided heart failure. It can help the client live longer. • Option A: An increased partial pressure of carbon dioxide in arterial blood (PACO2) would not initially result in cardiac arrest. Long-term oxygen therapy should be used for at least 15 hours a day with as few interruptions as possible. Regular use can reduce the risk of death from low oxygen levels.. To get the most benefit from oxygen, the client should use it 24 hours a day. Supplemental oxygen is a well-established therapy with clear evidence for benefit in patients with COPD and severe resting hypoxemia, which is defined as a room air Pao2 ? 55 mm Hg or ? 59 mm Hg with signs of right-sided heart strain or polycythemia. • Option B: Long-term use of supplemental oxygen improves survival in patients with COPD and severe resting hypoxemia. However, the role of oxygen in symptomatic patients with COPD and more moderate hypoxemia at rest and desaturation with activity is unclear. The few long-term reports of supplemental oxygen in this group have been of small size and insufficient to demonstrate a survival benefit. • Option C: Circulatory overload and respiratory excitement have no relevance to the question. Short-term trials have suggested beneficial effects other than survival in patients with COPD and moderate hypoxemia at rest. In addition, supplemental oxygen appeared to improve exercise performance in small short-term investigations of patients with COPD and moderate hypoxemia at rest and desaturation with exercise, but long-term trials evaluating patient-reported outcomes are lacking. 15. 15. Question After 1 week of hospitalization, Mr. Gray develops hypokalemia. Which of the following is the most significant symptom of his disorder? • A. Lethargy • B. Increased pulse rate and blood pressure • C. Muscle weakness • D. Muscle irritability Incorrect Correct Answer: C. Muscle weakness Presenting symptoms of hypokalemia ( a serum potassium level below 3.5 mEq/liter) include muscle weakness, chronic fatigue, and cardiac dysrhythmias. The combined effects of inadequate food intake and prolonged diarrhea can deplete the potassium stores of a patient with GI problems. Significant muscle weakness occurs at serum potassium levels below 2.5 mmol/L but can occur at higher levels if the onset is acute. Similar to the weakness associated with hyperkalemia, the pattern is ascending in nature affecting the lower extremities, progressing to involve the trunk and upper extremities, and potentially advancing to paralysis. • Option A: Periodic paralysis is a rare neuromuscular disorder, which is inherited or acquired, that is caused by an acute transcellular shift of potassium into the cells. It is characterized by potentially fatal episodes of muscle weakness or paralysis that can affect the respiratory muscles. Clinical manifestations mainly involve the musculoskeletal and cardiovascular systems. Hence, the physical exam should focus on identifying neurologic manifestations and cardiac dysrhythmias. • Option B: Clinical symptoms of hypokalemia do not become evident until the serum potassium level is less than 3 mmol/L unless there is a precipitous fall or the patient has a process that is potentiated by hypokalemia. The severity of symptoms also tends to be proportional to the degree and duration of hypokalemia. Symptoms resolve with correction of the hypokalemia. • Option D: Affected muscles can include the muscles of respiration which can lead to respiratory failure and death. Involvement of GI muscles can cause an ileus with associated symptoms of nausea, vomiting, and abdominal distension. Severe hypokalemia can also lead to muscle cramps, rhabdomyolysis, and resultant myoglobinuria. 16. 16. Question Which of the following nursing interventions promotes patient safety? • A. Assess the patient’s ability to ambulate and transfer from a bed to a chair. • B. Demonstrate the signal system to the patient. • C. Check to see that the patient is wearing his identification band. • D. All of the above. Incorrect Correct Answer: D. All of the above Patient Safety is a healthcare discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors, and harm that occur to patients during the provision of health care. A cornerstone of the discipline is a continuous improvement based on learning from errors and adverse events. • Option A: Assisting a patient with ambulation and transfer from a bed to a chair allows the nurse to evaluate the patient’s ability to carry out these functions safely. Patient safety is fundamental to delivering quality essential health services. Indeed, there is a clear consensus that quality health services across the world should be effective, safe, and people-centered. In addition, to realize the benefits of quality health care, health services must be timely, equitable, integrated, and efficient. • Option B: Demonstrating the signal system and providing an opportunity for a return demonstration ensures that the patient knows how to operate the equipment and encourages him to call for assistance when needed. To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals, and effective involvement of patients in their care, are all needed. • Option C: Checking the patient’s identification band verifies the patient’s identity and prevents identification mistakes in drug administration. Safety of patients during the provision of health services that are safe and of high quality is a prerequisite for strengthening health care systems and making progress towards effective universal health coverage (UHC) under Sustainable Development Goal 3 (Ensure healthy lives and promote health and well-being for all at all ages). 17. 17. Question Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions? • A. Side rails are ineffective. • B. Side rails should not be used. • C. Side rails are a deterrent that prevent a patient from falling out of bed. • D. Side rails are a reminder to a patient not to get out of bed. Incorrect Correct Answer: D. Side rails are a reminder to a patient not to get out of bed. Since about 40% of patients fall out of bed despite the use of side rails, side rails cannot be said to prevent falls; however, they do serve as a reminder that the patient should not get out of bed. A process that requires ongoing patient evaluation and monitoring will result in optimizing bed safety. Many patients go through a period of adjustment to become comfortable with new options. Patients and their families should talk to their health care planning team to find out which options are best for them. • Option A: Patients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who get out of bed and walk unsafely without assistance, must be carefully assessed for the best ways to keep them from harm, such as falling. Assessment by the patient’s health care team will help to determine how best to keep the patient safe. • Option B: Historically, physical restraints (such as vests, ankle or wrist restraints) were used to try to keep patients safe in health care facilities. In recent years, the health care community has recognized that physically restraining patients can be dangerous. Although not indicated for this use, bed rails are sometimes used as restraints. Regulatory agencies, health care organizations, product manufacturers, and advocacy groups encourage hospitals, nursing homes, and home care providers to assess patients’ needs and to provide safe care without restraints. • Option C: Anticipate the reasons patients get out of bed such as hunger, thirst, going to the bathroom, restlessness, and pain; meet these needs by offering food and fluids, scheduling ample toileting, and providing calming interventions and pain relief. When bed rails are used, perform an on-going assessment of the patient’s physical and mental status; closely monitor high-risk patients. 18. 18. Question Examples of patients suffering from impaired awareness include all of the following except: • A. A semiconscious or over fatigued patient. • B. A disoriented or confused patient. • C. A patient who cannot care for himself at home. • D. A patient demonstrating symptoms of drugs or alcohol withdrawal. Incorrect Correct Answer: C. A patient who cannot care for himself at home A patient who cannot care for himself at home does not necessarily have impaired awareness; he may simply have some degree of immobility. • Option A: Fatigue is the feeling of tiredness and decreased energy that results from inadequate sleep time or poor quality of sleep. Fatigue can also result from increased work intensity or long work hours. Sleep deprivation has long been known to impair various cognitive functions, including mood, motivation, response time, and initiative. In a classic review of sleep deprivation and decision-making, investigators argued that effective performance in health care environments requires naturalistic decision-making and situation awareness. • Option B: Impaired self-awareness of deficits is a common finding in patients who have suffered a traumatic brain injury. Impaired awareness can limit motivation for treatment and contribute to a poor outcomes. Consequently, it is important for brain injury rehabilitation professionals to understand this phenomenon and utilize treatment approaches that may improve patient awareness. • Option D: Most alcoholics exhibit mild-to-moderate deficiencies in intellectual functioning, along with diminished brain size and regional changes in brain-cell activity. The most prevalent alcohol-associated brain impairments affect visuospatial abilities and higher cognitive functioning. Visuospatial abilities include perceiving and remembering the relative locations of objects in 2- and 3-dimensional space. Examples include driving a car or assembling a piece of furniture based on instructions contained in a line drawing. Higher cognitive functioning includes the abstract-thinking capabilities needed to organize a plan, set it in motion, and change it as needed. 19. 19. Question The most common injury among elderly persons is: • A. Atherosclerotic changes in the blood vessels • B. Increased incidence of gallbladder disease • C. Urinary Tract Infection • D. Hip fracture Incorrect Correct Answer: D. Hip fracture Hip fracture, the most common injury among elderly persons, usually results from osteoporosis. Hip fractures from falls are one of the leading causes of injuries for seniors and result in the largest number of hospitalizations. Family members and hourly caregivers can take steps to prevent falls, such as removing area rugs, improving lighting throughout the home, and offering mobility support when needed. • Option A: Some changes in the heart and blood vessels normally occur with age. However, many other changes that are common with aging are due to modifiable factors. If not treated, these can lead to heart disease. Arteriosclerosis (hardening of the arteries) is very common. Fatty plaque deposits inside the blood vessels cause them to narrow and totally block blood vessels. The capillary walls thicken slightly. This may cause a slightly slower rate of exchange of nutrients and wastes. • Option B: Increasing age is a major risk factor for their formation, with the prevalence of gallstones being greatest at advanced age. While the majority of gallstones remain asymptomatic, seniors have a high risk for acute cholecystitis with atypical presentation, even when gangrene or perforation has occurred. • Option C: The main cause of UTIs, at any age, is usually bacteria. Escherichia coli is the primary cause, but other organisms can also cause a UTI. In older adults who use catheters or live in a nursing home or other full-time care facility, bacteria such as Enterococci and Staphylococci are more common causes. 20. 20. Question The most common psychogenic disorder among elderly person is: • A. Depression • B. Sleep disturbances (such as bizarre dreams) • C. Inability to concentrate • D. Decreased appetite Incorrect Correct Answer: A. Depression Depression typically begins before the onset of old age and usually is caused by psychosocial, genetic, or biochemical factors. Depression is a common problem among older adults, but it is NOT a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems. However, important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness. Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders. • Option B: Primary sleep disorders are more common in the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. Sleep apnea can lead to excessive daytime sleepiness. • Option C: A study finds that seniors’ attention shortfall is associated with the locus coeruleus, a tiny region of the brainstem that connects to many other parts of the brain. The locus coeruleus helps focus brain activity during periods of stress or excitement. Increased distractibility is a sign of cognitive aging. • Option D: Sleep disturbances, inability to concentrate, and decreased appetite are symptoms of depression, the most common psychogenic disorder among elderly persons. Other symptoms include diminished memory, apathy, disinterest in appearance, withdrawal, and irritability. 21. 21. Question Which of the following vascular system changes results from aging? • A. Increased peripheral resistance of the blood vessels • B. Decreased blood flow • C. Increased workload of the left ventricle • D. All of the above Incorrect Correct Answer: D. All of the above Aging decreases the elasticity of the blood vessels, which leads to increased peripheral resistance and decreased blood flow. These changes, in turn, increase the workload of the left ventricle. Some changes in the heart and blood vessels normally occur with age. However, many other changes that are common with aging are due to modifiable factors. If not treated, these can lead to heart disease. • Option A: Receptors called baroreceptors monitor the blood pressure and make changes to help maintain a fairly constant blood pressure when a person changes positions or is doing other activities. The baroreceptors become less sensitive with aging. This may explain why many older people have orthostatic hypotension, a condition in which the blood pressure falls when a person goes from lying or sitting to standing. This causes dizziness because there is less blood flow to the brain. • Option B: The main artery from the heart (aorta) becomes thicker, stiffer, and less flexible. This is probably related to changes in the connective tissue of the blood vessel wall. This makes the blood pressure higher and makes the heart work harder, which may lead to thickening of the heart muscle (hypertrophy). The other arteries also thicken and stiffen. In general, most older people have a moderate increase in blood pressure. • Option C: The heart has a natural pacemaker system that controls the heartbeat. Some of the pathways of this system may develop fibrous tissue and fat deposits. The natural pacemaker (the SA node) loses some of its cells. These changes may result in a slightly slower heart rate. A slight increase in the size of the heart, especially the left ventricle occurs in some people. The heart wall thickens, so the amount of blood that the chamber can hold may actually decrease despite the increased overall heart size. The heart may fill more slowly. 22. 22. Question Which of the following is the most common cause of dementia among elderly persons? • A. Parkinson’s disease • B. Multiple sclerosis • C. Amyotrophic lateral sclerosis (Lou Gehrig’s disease) • D. Alzheimer’s disease Incorrect Correct Answer: D. Alzheimer’s disease Alzheimer’s disease, sometimes known as senile dementia of the Alzheimer’s type or primary degenerative dementia, is an insidious; progressive, irreversible, and degenerative disease of the brain whose etiology is still unknown. Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. • Option A: Parkinson’s disease is a neurologic disorder caused by lesions in the extrapyramidal system and manifested by tremors, muscle rigidity, hypokinesia, dysphagia, and dysphonia. Parkinson’s disease is a neurodegenerative disorder that mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. Other associated features are a loss of smell, sleep dysfunction, mood disorders, excess salivation, constipation, and excessive periodic limb movements in sleep (REM behavior disorder). • Option B: Multiple sclerosis, a progressive, degenerative disease involving demyelination of the nerve fibers, usually begins in young adulthood and is marked by periods of remission and exacerbation. Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation, demyelination, gliosis, and neuronal loss. Pathologically, perivascular lymphocytic infiltrates, and macrophages produce degradation of myelin sheaths that surround neurons. • Option C: Amyotrophic lateral sclerosis, a disease marked by progressive degeneration of the neurons, eventually results in atrophy of all the muscles; including those necessary for respiration. Amyotrophic lateral sclerosis (ALS), also known as “Lou Gehrig’s disease,” is a neurodegenerative disease of the motor neurons. No single etiology has been proven; rather, multiple pathways (both heritable and sporadic) have been shown to result in unmistakably similar disease entities. ALS necessarily affects both upper and lower motor neurons with variable patterns of onset, most commonly beginning with signs of lower motor neuron degeneration within proximal limbs. 23. 23. Question The nurse’s most important legal responsibility after a patient’s death in a hospital is: • A. Obtaining a consent of an autopsy. • B. Notifying the coroner or medical examiner. • C. Labeling the corpse appropriately. • D. Ensuring that the attending physician issues the death certification. Incorrect Correct Answer: C. Labeling the corpse appropriately. The nurse is legally responsible for labeling the corpse when death occurs in the hospital. After a person dies it is important to give the family the time that they need with the body. Some family members might like to lie in bed with their loved one who has died, while others might like to be involved with washing the body. Others may not want to be there at all. Washing the body is particularly important in paediatric palliative care, as often parents feel it is a special ritual to have washed their baby after they are born, and it is the same after they die. It is important to discuss rigor mortis with families as people are often unaware of this. • Option A: She may be involved in obtaining consent for an autopsy. There are considerations regarding care and preparation of the body after someone dies. Traditionally this task was performed by families, but nowadays much of the preparation of a body is done by nursing staff or undertakers. The required procedures are often included in an organizations’ procedures manual or there may be local requirements regarding the preparation of a body. • Option B: The nurse may be responsible for notifying the coroner or medical examiner of a patient’s death; however, she is not legally responsible for performing these functions. Depending on the location of the death, the nurse would contact the medical examiner to notify them of the death, as well as the physician and other clinicians who were involved with the patient. The nurse can also contact the funeral home for the family as requested. • Option D: The attending physician may need information from the nurse to complete the death certificate, but he is responsible for issuing it. A doctor must certify the death. This involves completing a medical certificate of the cause of death and stating what the cause of death was. This should happen as soon as possible. If there are any unexpected or suspicious circumstances, or if the cause of death is not known, the doctor may not be able to issue a death certificate without talking to the coroner (England, Wales, and Northern Ireland) or procurator fiscal (Scotland). The doctor completing the certificate may wish to talk to you as part of their standard checks. 24. 24. Question Before rigor mortis occurs, the nurse is responsible for: • A. Providing a complete bath and dressing change. • B. Placing one pillow under the body’s head and shoulders. • C. Removing the body’s clothing and wrapping the body in a shroud. • D. Allowing the body to relax normally. Incorrect Correct Answer: B. Placing one pillow under the body’s head and shoulders. The nurse must place a pillow under the deceased person’s head and shoulders to prevent blood from settling in the face and discoloring it. A body undergoes complex and intricate changes after death. These post mortem changes depend on a diverse range of variables. Factors such as the ambient temperature, season, and geographical location at which the body is found, the fat content of the body, sepsis/injuries, intoxication, presence of clothes/insulation over the body, etc. determine the rate at which post-mortem changes occur in a cadaver. • Option A: She is required to bathe only soiled areas of the body since the mortician will wash the entire body. Changes that occur to a body after death are a result of complex physicochemical and environmental processes. They are affected by factors within the cadaver and outside it. These factors affect the onset and either increase the rate of post-mortem changes or retard it. Factors that hasten the rate of post mortem changes include hot and humid climate, presence of body fat, open injuries on the body, sepsis or infection, and the location of the cadaver in the open. • Option C: Before wrapping the body in a shroud, the nurse places a clean gown on the body and closes the eyes and mouth. Rigor Mortis appears in 1 to 2 hours after death, is completely formed 12 hours after death, is sustained for the next 12 hours, and vanishes over the next 12 hours, sometimes referred to as the ‘march of rigor.’ • Option D: Rigor mortis appears rapidly in children and old aged individuals, in cases of persons dying of diseases or conditions involving great exhaustion such as cholera, or due to convulsions as in cases of strychnine poisoning. In such cases, the rigor disappears early as well. The effect of rigor on individual muscles can be of additional significance. The rigor of erector pilae muscles may cause elevation of hair leading to the pimpled appearance of the skin. 25. 25. Question When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to: • A. Protect the patient from injury. • B. Insert an airway. • C. Elevate the head of the bed. • D. Withdraw all pain medications. Incorrect Correct Answer: A. Protect the patient from injury Ensuring the patient’s safety is the most essential action at this time. This phase is different for each patient, and the needs may differ for each patient and family, but it is vital for healthcare providers to provide care and support in a way that respects the patient’s dignity and autonomous wishes. • Option B: The vast majority of patients who experience a natural death, meaning no medical, life-saving interventions to counter the process, follow a stereotypical pattern of signs and symptoms in the time leading up to death. This time frame is often referred to as “actively dying” or “imminent death.” It is important for healthcare providers to be familiar with this process, not only so they know what to expect when providing direct care to patients during this time, but also so they can guide the family in understanding what to expect during this process and providing support as needed. • Option C: The self-determination of the patient with capacity must be respected. When the patient can make their own choices, their autonomy must be upheld. It is not the role of the provider to impart their values and beliefs onto patients. Patients’ families may experience anticipatory grief and have a hard time fully handling the current situation, and they may want to push their personal choices for the situation instead of respecting their loved one’s wishes and choices. • Option D: The primary goal in treatment for patients is alleviating suffering. Hospice care and palliative care are often confused. Hospice care is the term given to the care provided when a patient is given a prognosis of death within 6 months, and they do not pursue curative treatments. They focus on improving the quality of life which can mean many things. Palliative care can be incorporated into the plan of care at any time for any patient who is experiencing suffering and wants to ease that suffering without directly treating the cause of that suffering. 26. 26. Question Which element in the circular chain of infection can be eliminated by preserving skin integrity? • A. Host • B. Reservoir • C. Mode of transmission • D. Portal of entry Incorrect Correct Answer: D. Portal of entry In the circular chain of infection, pathogens must be able to leave their reservoir and be transmitted to a susceptible host through a portal of entry, such as broken skin. The portal of entry refers to the manner in which a pathogen enters a susceptible host. The portal of entry must provide access to tissues in which the pathogen can multiply or a toxin can act. Often, infectious agents use the same portal to enter a new host that they used to exit the source host. • Option A: The final link in the chain of infection is a susceptible host. Susceptibility of a host depends on genetic or constitutional factors, specific immunity, and nonspecific factors that affect an individual’s ability to resist infection or to limit pathogenicity. An individual’s genetic makeup may either increase or decrease susceptibility. • Option B: The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may not be the source from which an agent is transferred to a host. • Option C: An infectious agent may be transmitted from its natural reservoir to a susceptible host in different ways. There are different classifications for modes of transmission. In direct transmission, an infectious agent is transferred from a reservoir to a susceptible host by direct contact or droplet spread. Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors). 27. 27. Question Which of the following will probably result in a break in sterile technique for respiratory isolation? • A. Opening the patient’s window to the outside environment. • B. Turning on the patient’s room ventilator. • C. Opening the door of the patient’s room leading into the hospital corridor. • D. Failing to wear gloves when administering a bed bath. Incorrect Correct Answer: C. Opening the door of the patient’s room leading into the hospital corridor. Respiratory isolation, like strict isolation, requires that the door to the door patient’s room remain closed. Appropriate patient placement is a significant component of isolation precautions. A private room is important to prevent direct- or indirect-contact transmission when the source patient has poor hygienic habits, contaminates the environment, or cannot be expected to assist in maintaining infection control precautions to limit transmission of microorganisms (ie, infants, children, and patients with altered mental status). • Option A: Opening the patient’s window is acceptable because the room needs to be well-ventilated. A private room with appropriate air handling and ventilation is particularly important for reducing the risk of transmission of microorganisms from a source patient to susceptible patients and other persons in hospitals when the microorganism is spread by airborne transmission. Some hospitals use an isolation room with an anteroom as an extra measure of precaution to prevent airborne transmission. • Option B: The patient’s room should be well ventilated, so turning on the ventilator is desirable. • Option D: The nurse does not need to wear gloves for respiratory isolation, but good handwashing is important for all types of isolation. Wearing gloves does not replace the need for handwashing, because gloves may have small, apparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Failure to change gloves between patient contacts is an infection control hazard. 28. 28. Question Which of the following patients is at greater risk for contracting an infection? • A. A postoperative patient who has undergone orthopedic surgery. • B. A patient receiving broad-spectrum antibiotics. • C. A patient with leukopenia. • D. A newly diagnosed diabetic patient. Incorrect Correct Answer: C. A patient with leukopenia. Leukopenia is a decreased number of leukocytes (white blood cells), which are important in resisting infection. Leukopenia is a condition where a person has a reduced number of white blood cells. This increases their risk of infections. A person’s blood is made up of many different types of blood cells. White blood cells, also known as leukocytes, help to fight off infection. Leukocytes are a vital part of the immune system. • Option A: Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. • Option B: Antibiotic-mediated cell death, however, is a complex process that begins with the physical interaction between a drug molecule and its bacterial-specific target, and involves alterations to the affected bacterium at the biochemical, molecular and ultrastructural levels. Antibiotic-induced cell death has been associated with the formation of double-stranded DNA breaks following treatment with DNA gyrase inhibitors, with the arrest of DNA-dependent RNA synthesis following treatment with rifamycins, with cell envelope damage and loss of structural integrity following treatment with cell-wall synthesis inhibitors, and with cellular energetics, ribosome binding and protein mistranslation following treatment with protein synthesis inhibitors. • Option D: People who have had diabetes for a long time may have peripheral nerve damage and reduced blood flow to their extremities, which increases the chance for infection. The high sugar levels in your blood and tissues allow bacteria to grow and allow infections to develop more quickly. 29. 29. Question Effective handwashing requires the use of: • A. Soap or detergent to promote emulsification. • B. Hot water to destroy bacteria. • C. A disinfectant to increase surface tension. • D. All of the above. Incorrect Correct Answer: A. Soap or detergent to promote emulsification. Soaps and detergents are used to help remove bacteria because of their ability to lower the surface tension of water and act as emulsifying agents. Handwashing is the act of washing hands with soap, either antimicrobial or non antimicrobial, and water for at least 15 to 20 seconds with a vigorous motion to cause friction making sure to include all surfaces of the hands and fingers. • Option B: Hot water may lead to skin irritation or burns. Warm water would be enough for handwashing. Healthcare professionals caring for high-risk patients that are immunocompromised must take great care in performing proper hand hygiene as this patient population is at high risk for opportunistic infections • Option C: Handwashing with soap and water will remove nearly all transient gram-negative bacilli in 10 seconds while chlorhexidine may be more appropriate than soap and water for the removal of transient gram-positive bacteria. According to the CDC, established guidelines recommend that agents used for surgical hand scrubs should reduce microorganisms on intact skin in a substantial manner, contain a nonirritating antimicrobial preparation, have broad-spectrum activity, and be fast-acting and persistent. • Option D: Hand hygiene practices are paramount in reducing cross-transmission of microorganisms, hospital-acquired infections and the risk of occupational exposure to infectious diseases. According to the CDC, understanding the importance of hand hygiene and its impact on the pathogenic spread of microorganisms is best understood when one understands the anatomy of the skin. The skin serves as a protective barrier against water loss, heat loss, microorganisms, and other environmental hazards. 30. 30. Question After routine patient contact, handwashing should last at least: • A. 30 seconds • B. 1 minute • C. 2 minutes • D. 3 minutes Incorrect Correct Answer: A. 30 seconds Depending on the degree of exposure to pathogens, hand washing may last from 10 seconds to 4 minutes. After routine patient contact, hand washing for 30 seconds effectively minimizes the risk of pathogen transmission. According to the Centers for Disease Control and Prevention (CDC), hand hygiene is the single most important practice in the reduction of the transmission of infection in the healthcare setting. • Option B: According to the CDC, hand hygiene encompasses the cleansing of your hands with soap and water, antiseptic hand washes, antiseptic hand rubs such as alcohol-based hand sanitizers, foams or gels, or surgical hand antisepsis. Indications for handwashing include when hands are visibly soiled, contaminated with blood or other bodily fluids, before eating, and after restroom use. • Option C: Handwashing is the act of washing hand