Itemu1uofu150
A resident falls from her chair when she has a seizure. Before the nurse
u u u u u u u u u u u u u u
arrives, the seizure is finished and the nurse aide observes the resident i
u u u u u u u u u u u u
s breathing. What should the nurse aide do next?
u u u u u u u u
A. Getutheuemergencyucart
B. Turnutheuresidentuontouheruside
C. Checkuifutheuresidentuisuableutoutalk
D. Helputheuresidentubackuintoutheuchair
Incorrectu
Rationale:uAfteruauseizure,usalivaumayupooluinutheumouthuandutheuindividualumayualsouvomit.uTurningutheuresidentuonto
utheusideupreventsuaspirationubyuallowingutheufluidsutoudrainuoutuofutheumouth.uThisuisutheumostuimportantuactionuforuthe
unurseuaideutoutakeuinuthisusituation.uTheunurseuaideushouldunotuleaveutheuresidentuunattendeduandushouldunotumoveut
heuresidentuuntilucheckedubyutheunurse.u
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uCarter,uP.u(2012).uLippincottuTextbookuforuNursinguAssistantsu(3rduEd.).uPhiladelphia,uPA:uWoltersuKluwer/Lippincottu
Williamsu&uWilkins.uPageu220.
2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPageu706.
Markuitemuforureview
Itemu2uofu150
To prevent skin tears or shearing when moving the resident, the nurse ai
u u u u u u u u u u u u
de should
u
A. wearuglovesutoureduceufrictionuagainstutheuskin.
B. avoidupullinguoruslidingutheuresidentuwhenumoved.
C. tellutheuresidentutoubeucarefuluandufollowudirections.
D. askutheuresidentutoukeepuarmsuhelduoverutheuresident'suhead.
Correctu
Rationale:uTheuskinuofuanuelderlyuresidentuisuthinuandufragile.uPullingubedusheetsuagainstutheuresident’suskin,uoruslidingu
theuresidentuwhenumovinguorutransferring,ucanucauseuinjuryutoutheuskin,usuchuasuskinutears.uThisuisutheuresultuofusheari
ng.uGreatucareuisuneededutoupreventuskinutears.uActionsulikeurollinguoruusinguauturningusheet,uslide,uorutransferusheetuc
anuhelpureduceutheuriskuofuskinuinjury.u
Wearinguglovesuwhenutransferringuauresidentumayubeuappropriateuifutheunurseuaideuisuaturiskuofuexposureutoublooduorub
odyufluids,ubutuituwillunotupreventushearinguoruskinutears.uTellingutheuresidentutoufollowudirectionsuoruhavingutheuresident
uholduarmsuoverutheuheaduwillunotupreventuskinutearsuorushearing.u
Understandinguhowutoupreventuskinutearsuisuimportantuforutheunurseuaideuwhousharesuresponsibilityuforutheusafetyuofure
sidents.uTheunurseuaideushouldubeuawareuthatuskinutearsuareupainful,uandutheuskinuopeningualsouincreasesutheuresiden
t’suriskuforuinfection.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uAlvare,uS..uFuzy,uJ.,uanduRymer,uS.u(2009).uHartman’suNursinguAssistantuCare:uLong-
TermuCareuanduHomeuHealth.uAlbuquerque,uNM:uHartmanuPublishing,uInc.uPagesu149uandu197.u
,2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPagesu225uandu538-539.
Markuitemuforureview
,Itemu3uofu150
What should a nurse aide do with a used disposable razor?
u u u u u u u u u u
A. Throwutheurazoruawayuinuautrashucan.
B. Placeutheurazoruinuausharpsucontaineruimmediately.
C. Clean,urinse,uandudryutheurazorusouitucanubeuuseduagain.
D. Wraputheurazoruinuaupaperutoweluuntiluitucanubeuthrownuaway.
Correctu
Rationale:uAudisposableurazoruisuausafetyuconcernubecauseuituisuconsidereduausharpuanduauusedurazoruisulikelyutoualsou
haveublooducellsuonuit.uSinceuituisuconsidereduausharpuandupotentiallyucontaminateduwithublooducells,uitumustubeudispos
eduofuinutheuSharpsucontainer.uSafeudisposaluofusharpsuisuaupartuofutheunurseuaide’suresponsibilityubecauseuitupertainsut
outheusafetyuofutheuresident.u
Theunurseuaideumustualwaysubeuawareuofusafetyuofualluresidents,ubutuespeciallyuconcerneduforuresidentsuwhouareuconf
useduanducouldubeuaccidentallyuharmeduhandlinguaurazoruthatuwasuleftuout.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uCarter,uP.u(2012).uLippincottuTextbookuforuNursinguAssistantsu(3rduEd.).uPhiladelphia,uPA:uWoltersuKluwer/Lippincot
tuWilliamsu&uWilkins.uPageu370.u
2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPageu321.
Itemu4uofu150
Which of the following is the best example of using reality orientation for
u u u u u u u u u u u u u
a resident with early dementia?
u u u u
A. "Yourusonuplansutouvisitutodayuatu2:00up.m."
B. "Youuareuinutheunursinguhome.uIuamuhereutouhelpuyou."
C. "ThisuisuyourudaughteruAnna.uDouyouurememberuher?"
D. "Lookuatutheutime.uLunchuisuinu30uminutes.uAreuyouufeelinguhungry?"
Incorrectu
Rationale:uRealityuorientationuisuauprocessuofuremindinguanduorientingutheuresidentutouperson,uplace,uandutime.uForuaur
esidentuwithuearlyudementia,uputtingutimeuintoutheucontextuofutheudayuanduroutineucanubeuhelpful.uLunchuisuaupartuofuauli
feuroutine,uanduremindingutheuresidentuaboututhatuandurelatinguitutoueatinguandubeinguhungryucanubeureassuringuanduhe
lpful.u
InutheuearlierustagesuofuAlzheimer’sudisease,uwhenuauresidentumayubeuawareuandufrightenedubyulossuofumemory,uavoid
ucontributingutoutheuresident’suanxietyubyumakingustatementsusuchuas,u"Don’tuyouurememberuyourudaughter?"
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uDuganuD.u(2012).uNursinguAssisting:uAuFoundationuinuCaregivingu(3rduEd.).uAlbuquerque,uNM.uHartmanuPublishing,
uInc.uPageu415.u
2.uHedman,uS.,uFuzy,uJ.,uanduRymer,uS.u(2010).uHartman'suNursinguAssistantuCare:uLong-
TermuCareu(2nduEd.).uAlbuquerque,uNM:uHartmanuPublishing,uInc.uPageu359.
Markuitemuforureview
Itemu5uofu150
, While feeding a resident, the nurse aide notices that the resident is coug
u u u u u u u u u u u u
hing a lot after each drink of fluid. What is the appropriate response by th
u u u u u u u u u u u u u u
e nurse aide?
u u
A. Allowutheuresidentumoreutimeutouswallow.
B. Useuaustrawuwhenugivingutheuresidentufluids.
C. Adduauthickeninguproductutoutheuresident'sufluids.
D. Stopufeedinguanduaskuaunurseutoucheckutheuresident.
Correctu
Rationale:uWhenuauresidentucoughsufrequentlyuafterudrinkingufluids,uitumayuindicateuthatutheuresidentuisuhavingusomeudi
fficultyuswallowing.uThisudifficultyuswallowingucanuresultuinufluidsugoinguintoutheuresident’sulung.uThisuconditionuisuknow
nuasuaspiration.uItucanuresultuinutheudevelopmentuofuseriousumedicaluconditions,usuchuasupneumonia,uwhichumayurequir
eumedicaluattention.u
Theunurseuaidushouldunotifyutheunurseuimmediately.uTheuresidentuwillurequireuanuevaluationuofutheuresident’suabilityutou
swallow.uThickeninguagentsuareusometimesuaddedutouliquidsuforuresidentsuthatuhaveudifficultyuswallowingufluids,ubututh
euuseuofutheseuthickenersuisudecidedubyutheuphysicianuandunotutheunurseuaide.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPagesu386-387.u
2.uAlvare,uS..uFuzy,uJ.,uanduRymer,uS.u(2009).uHartman’suNursinguAssistantuCare:uLong-
TermuCareuanduHomeuHealth.uAlbuquerque,uNM:uHartmanuPublishing,uInc.uPageu268.
Itemu6uofu150
A resident wears a hand splint. Which observation should the nurse aide
u u u u u u u u u u u u
report to the nurse immediately?
u u u u
A. Theuresident'sufingersuareucolduandublueuinucolor.
B. Theusplintuwasuremoveduasuscheduleduinutheucareuplan.
C. Theuresidentuasksutouhaveutheusplinturemoveduforuaufewuminutes.
D. Theuresidentuasksutheunurseuaideutourepositionutheuarmuwithutheusplint.
Correctu
Rationale:uWhenuauresidentuwearsuausplint,uituisuimportantutoumakeusureutheusplintuisuapplieduproperlyuanduisunotucausi
ngupressureuthatucoulduaffectucirculation.uIfunotuproperlyuapplied,utheusplintucanucauseupressure.uWhenuauresidentuwear
suausplint,utheucareuplanumayualsouincludeuscheduleduperiodsuforuremovingutheusplintutouallowutheuskinutoubeuopenutouai
ruandutoupromoteucirculation.uWhenuauresidentuwearsuausplint,uituisuimportantutouobserveuforuanyuchangesuinuskinucolorui
nutheuextremity,uwhichuifuobservedushouldubeureportedutoutheunurseuimmediately.uSkinucoloruchangesuanduchangesuinut
heutemperatureuofutheuextremityucouldualsoubeusignsuofuimpaireducirculation.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uCarter,uP.uanduGoldschmidt,uW.u(2010).uuLippincott'suTextbookuforuLong-
TermuCareuNursinguAssistants:uAuHumanisticuApproachutouCaregiving.uPhiladelphia,uPA:uWoltersuKluwer/LippincottuW
illiamsu&uWilkins.uPageu159.u
2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPageu429.
Markuitemuforureview
A resident falls from her chair when she has a seizure. Before the nurse
u u u u u u u u u u u u u u
arrives, the seizure is finished and the nurse aide observes the resident i
u u u u u u u u u u u u
s breathing. What should the nurse aide do next?
u u u u u u u u
A. Getutheuemergencyucart
B. Turnutheuresidentuontouheruside
C. Checkuifutheuresidentuisuableutoutalk
D. Helputheuresidentubackuintoutheuchair
Incorrectu
Rationale:uAfteruauseizure,usalivaumayupooluinutheumouthuandutheuindividualumayualsouvomit.uTurningutheuresidentuonto
utheusideupreventsuaspirationubyuallowingutheufluidsutoudrainuoutuofutheumouth.uThisuisutheumostuimportantuactionuforuthe
unurseuaideutoutakeuinuthisusituation.uTheunurseuaideushouldunotuleaveutheuresidentuunattendeduandushouldunotumoveut
heuresidentuuntilucheckedubyutheunurse.u
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uCarter,uP.u(2012).uLippincottuTextbookuforuNursinguAssistantsu(3rduEd.).uPhiladelphia,uPA:uWoltersuKluwer/Lippincottu
Williamsu&uWilkins.uPageu220.
2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPageu706.
Markuitemuforureview
Itemu2uofu150
To prevent skin tears or shearing when moving the resident, the nurse ai
u u u u u u u u u u u u
de should
u
A. wearuglovesutoureduceufrictionuagainstutheuskin.
B. avoidupullinguoruslidingutheuresidentuwhenumoved.
C. tellutheuresidentutoubeucarefuluandufollowudirections.
D. askutheuresidentutoukeepuarmsuhelduoverutheuresident'suhead.
Correctu
Rationale:uTheuskinuofuanuelderlyuresidentuisuthinuandufragile.uPullingubedusheetsuagainstutheuresident’suskin,uoruslidingu
theuresidentuwhenumovinguorutransferring,ucanucauseuinjuryutoutheuskin,usuchuasuskinutears.uThisuisutheuresultuofusheari
ng.uGreatucareuisuneededutoupreventuskinutears.uActionsulikeurollinguoruusinguauturningusheet,uslide,uorutransferusheetuc
anuhelpureduceutheuriskuofuskinuinjury.u
Wearinguglovesuwhenutransferringuauresidentumayubeuappropriateuifutheunurseuaideuisuaturiskuofuexposureutoublooduorub
odyufluids,ubutuituwillunotupreventushearinguoruskinutears.uTellingutheuresidentutoufollowudirectionsuoruhavingutheuresident
uholduarmsuoverutheuheaduwillunotupreventuskinutearsuorushearing.u
Understandinguhowutoupreventuskinutearsuisuimportantuforutheunurseuaideuwhousharesuresponsibilityuforutheusafetyuofure
sidents.uTheunurseuaideushouldubeuawareuthatuskinutearsuareupainful,uandutheuskinuopeningualsouincreasesutheuresiden
t’suriskuforuinfection.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uAlvare,uS..uFuzy,uJ.,uanduRymer,uS.u(2009).uHartman’suNursinguAssistantuCare:uLong-
TermuCareuanduHomeuHealth.uAlbuquerque,uNM:uHartmanuPublishing,uInc.uPagesu149uandu197.u
,2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPagesu225uandu538-539.
Markuitemuforureview
,Itemu3uofu150
What should a nurse aide do with a used disposable razor?
u u u u u u u u u u
A. Throwutheurazoruawayuinuautrashucan.
B. Placeutheurazoruinuausharpsucontaineruimmediately.
C. Clean,urinse,uandudryutheurazorusouitucanubeuuseduagain.
D. Wraputheurazoruinuaupaperutoweluuntiluitucanubeuthrownuaway.
Correctu
Rationale:uAudisposableurazoruisuausafetyuconcernubecauseuituisuconsidereduausharpuanduauusedurazoruisulikelyutoualsou
haveublooducellsuonuit.uSinceuituisuconsidereduausharpuandupotentiallyucontaminateduwithublooducells,uitumustubeudispos
eduofuinutheuSharpsucontainer.uSafeudisposaluofusharpsuisuaupartuofutheunurseuaide’suresponsibilityubecauseuitupertainsut
outheusafetyuofutheuresident.u
Theunurseuaideumustualwaysubeuawareuofusafetyuofualluresidents,ubutuespeciallyuconcerneduforuresidentsuwhouareuconf
useduanducouldubeuaccidentallyuharmeduhandlinguaurazoruthatuwasuleftuout.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uCarter,uP.u(2012).uLippincottuTextbookuforuNursinguAssistantsu(3rduEd.).uPhiladelphia,uPA:uWoltersuKluwer/Lippincot
tuWilliamsu&uWilkins.uPageu370.u
2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPageu321.
Itemu4uofu150
Which of the following is the best example of using reality orientation for
u u u u u u u u u u u u u
a resident with early dementia?
u u u u
A. "Yourusonuplansutouvisitutodayuatu2:00up.m."
B. "Youuareuinutheunursinguhome.uIuamuhereutouhelpuyou."
C. "ThisuisuyourudaughteruAnna.uDouyouurememberuher?"
D. "Lookuatutheutime.uLunchuisuinu30uminutes.uAreuyouufeelinguhungry?"
Incorrectu
Rationale:uRealityuorientationuisuauprocessuofuremindinguanduorientingutheuresidentutouperson,uplace,uandutime.uForuaur
esidentuwithuearlyudementia,uputtingutimeuintoutheucontextuofutheudayuanduroutineucanubeuhelpful.uLunchuisuaupartuofuauli
feuroutine,uanduremindingutheuresidentuaboututhatuandurelatinguitutoueatinguandubeinguhungryucanubeureassuringuanduhe
lpful.u
InutheuearlierustagesuofuAlzheimer’sudisease,uwhenuauresidentumayubeuawareuandufrightenedubyulossuofumemory,uavoid
ucontributingutoutheuresident’suanxietyubyumakingustatementsusuchuas,u"Don’tuyouurememberuyourudaughter?"
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uDuganuD.u(2012).uNursinguAssisting:uAuFoundationuinuCaregivingu(3rduEd.).uAlbuquerque,uNM.uHartmanuPublishing,
uInc.uPageu415.u
2.uHedman,uS.,uFuzy,uJ.,uanduRymer,uS.u(2010).uHartman'suNursinguAssistantuCare:uLong-
TermuCareu(2nduEd.).uAlbuquerque,uNM:uHartmanuPublishing,uInc.uPageu359.
Markuitemuforureview
Itemu5uofu150
, While feeding a resident, the nurse aide notices that the resident is coug
u u u u u u u u u u u u
hing a lot after each drink of fluid. What is the appropriate response by th
u u u u u u u u u u u u u u
e nurse aide?
u u
A. Allowutheuresidentumoreutimeutouswallow.
B. Useuaustrawuwhenugivingutheuresidentufluids.
C. Adduauthickeninguproductutoutheuresident'sufluids.
D. Stopufeedinguanduaskuaunurseutoucheckutheuresident.
Correctu
Rationale:uWhenuauresidentucoughsufrequentlyuafterudrinkingufluids,uitumayuindicateuthatutheuresidentuisuhavingusomeudi
fficultyuswallowing.uThisudifficultyuswallowingucanuresultuinufluidsugoinguintoutheuresident’sulung.uThisuconditionuisuknow
nuasuaspiration.uItucanuresultuinutheudevelopmentuofuseriousumedicaluconditions,usuchuasupneumonia,uwhichumayurequir
eumedicaluattention.u
Theunurseuaidushouldunotifyutheunurseuimmediately.uTheuresidentuwillurequireuanuevaluationuofutheuresident’suabilityutou
swallow.uThickeninguagentsuareusometimesuaddedutouliquidsuforuresidentsuthatuhaveudifficultyuswallowingufluids,ubututh
euuseuofutheseuthickenersuisudecidedubyutheuphysicianuandunotutheunurseuaide.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPagesu386-387.u
2.uAlvare,uS..uFuzy,uJ.,uanduRymer,uS.u(2009).uHartman’suNursinguAssistantuCare:uLong-
TermuCareuanduHomeuHealth.uAlbuquerque,uNM:uHartmanuPublishing,uInc.uPageu268.
Itemu6uofu150
A resident wears a hand splint. Which observation should the nurse aide
u u u u u u u u u u u u
report to the nurse immediately?
u u u u
A. Theuresident'sufingersuareucolduandublueuinucolor.
B. Theusplintuwasuremoveduasuscheduleduinutheucareuplan.
C. Theuresidentuasksutouhaveutheusplinturemoveduforuaufewuminutes.
D. Theuresidentuasksutheunurseuaideutourepositionutheuarmuwithutheusplint.
Correctu
Rationale:uWhenuauresidentuwearsuausplint,uituisuimportantutoumakeusureutheusplintuisuapplieduproperlyuanduisunotucausi
ngupressureuthatucoulduaffectucirculation.uIfunotuproperlyuapplied,utheusplintucanucauseupressure.uWhenuauresidentuwear
suausplint,utheucareuplanumayualsouincludeuscheduleduperiodsuforuremovingutheusplintutouallowutheuskinutoubeuopenutouai
ruandutoupromoteucirculation.uWhenuauresidentuwearsuausplint,uituisuimportantutouobserveuforuanyuchangesuinuskinucolorui
nutheuextremity,uwhichuifuobservedushouldubeureportedutoutheunurseuimmediately.uSkinucoloruchangesuanduchangesuinut
heutemperatureuofutheuextremityucouldualsoubeusignsuofuimpaireducirculation.
Reference(s):
Examplesuofureferencesuwhereuknowledgeuforuthisuquestionuisucovereduinclude:
1.uCarter,uP.uanduGoldschmidt,uW.u(2010).uuLippincott'suTextbookuforuLong-
TermuCareuNursinguAssistants:uAuHumanisticuApproachutouCaregiving.uPhiladelphia,uPA:uWoltersuKluwer/LippincottuW
illiamsu&uWilkins.uPageu159.u
2.uSorrentino,uS.u(2011).uMosby'suTextbookuforuLong-
TermuCareuNursinguAssistantsu(6thuEd.).uSt.uLouis,uMO:uElsevieruMosby.uPageu429.
Markuitemuforureview
