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Question 1

The nursing assistant is gathering the necessary supplies to apply an ice pack to a client’s knee. Which step should the nursing assistant prioritize to help prevent blistering of the client’s skin during this process?

Answer 1

Wrapping the cold plastic or rubber bag in a protective cloth before applying to the skin. (Dry cold applications should be placed in a protective cloth to prevent the icy cold plastic from coming in direct contact with the person’s skin. When applied directly to a person’s skin, cold can cause severe burns and blisters. A cold application should not be left in place longer than 20 minutes and should be checked at least every 10 minutes. If the skin is shiny white, it is already damaged.)

Question 2

A long-term care resident’s ability to dress has decreased in recent months as arthritis in the hands has worsened. Which strategy should the nursing assistant prioritize to accommodate this change?

Answer 2

Arrange for buttons and zippers to be replaced with Velcro™.
(Making it easier for a person to put on and fasten his or her clothes can promote and protect independence in dressing. This can best accomplished by replacing buttons and zippers with VelcroTM. The other choices would not be appropriate in this situation.
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Question 3

It has been 3 days since the male resident last received a shave. After you verify what method, razor or electric shaver, should be used, which technique should the nursing assistant perform before shaving?

Answer 3

Applying a warm, wet cloth for a few minutes
(A warm, wet washcloth applied for 2 or 3 minutes before shaving can make the beard softer and easier to shave. Too much time may have passed since washing the face that the beard can benefit from the application of the warm, wet cloth just before the shave. Shaving lotion is applied after shaving. A face massage may feel good to the resident but will not soften the beard or make the hair easier to cut.
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Question 4

The nursing assistant is helping a resident clean and disinfect any belongings to prevent a reinfection of head lice. Which method should be prioritized to treat the resident’s clothing and bed linens?

Answer 4

washed in very hot water (The person’s clothing and bed linens must be washed in very hot water to prevent reinfection with head lice. Bleach would not prevent a reinfection. It would not be necessary to discard these belongings. If they are not treated properly, then the reinfection will continue and will spread to other residents.
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Question 5

The nursing assistant is helping the resident change a gown. Which action by the nursing assistant would be most appropriate to accommodate the resident’s weak and stiff right arm?

Answer 5

Place the clean gown on the right arm first.
(Placing a garment’s sleeve or leg onto an affected or weak extremity first makes the procedure easier for both the nursing assistant and the person being dressed. Removing the garment is the reverse procedure.
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Question 6

A resident who is dying talks to the nursing assistant about reincarnation. What is the best response from the nursing assistant?

Answer 6

Listen to the resident without being judgmental.
When cultural and religious or spiritual beliefs provide an explanation for what happens to a person after death, they can be a source of comfort for the dying person (as well as for the person’s family members). You must respect the beliefs of other people, even if you do not share these beliefs.

Question 7

The nurse has informed the nursing assistant that a resident is dying. What is the best interpretation if the nursing assistant notes the resident is perspiring heavily and the client’s skin feels cool and clammy?

Answer 7

Circulatory system is failing.
As circulation fails, the blood pressure drops and the pulse becomes rapid and weak. The skin feels cool and clammy, the person may perspire heavily, and the skin may appear mottled (blotchy), very pale, cyanotic (blue-tinged), or grayish.

Question 8

The nursing assistant instructor has completed a session on postmortem care. The instructor determines the session is successful when the students correctly choose which definition for rigor mortis?

Answer 8

The stiffening of the muscles that usually develops within 2 to 4 hours after death.
Rigor mortis is the stiffening of the muscles that usually develops within 2 to 4 hours after death. Once rigor mortis occurs, it is difficult to reposition the body. The care of a person’s body after the person has died is referred to as postmortem care. The examination of a person’s body after death is referred to as an autopsy. The body bag used to transport the body is called a shroud.

Question 9

The unconscious resident is in need of oral care. Which technique will the nursing assistant provide this edentulous resident?

Answer 9

Turn the resident to the side, clean the resident’s gums and tongue with a soft toothbrush or toothette.

A person who is edentulous has no teeth. He or she still needs oral care. This would be accomplished by gently cleaning the person’s gums and tongue with a toothbrush. The nursing assistant should never place his or her fingers in the resident’s mouth.

Question 10

A nursing assistant is concerned one of the residents may develop a pressure ulcer. Which observation of this resident is the nursing assistant finding concerning?

Answer 10

Poor nutrition and hydration

A person who is not receiving adequate nutrition or fluids is more likely to develop pressure ulcers. Moles need to be monitored for changes, as these can indicate skin cancer. Dark skin and an increase in exercise would not be concerning for a skin disorder.

Question 11

The nursing assistant notes a client has an open wound. Which complication does the client have the greatest risk of developing?

Answer 11

Infection
An open skin lesion is a significant risk for infection. The other choices are potential complications depending on the individual’s situation; however, the greatest risk with all individuals is for an infection.

Question 12

A dying client is showing signs of having difficulty breathing. Which position should the nursing assistant prioritize to ease the client’s breathing?

Answer 12

With the head elevated
Elevating a person’s head can ease the work of breathing as a person approaches death. The other positions would not accomplish this goal.

Question 13

A nurse and a nursing assistant are performing passive range-of-motion exercises with a client as they have for the previous several days. Which event should prompt discontinuation of the therapy session?

Answer 13

Reports of pain in the affected limb.
Passive range-of-motion exercises carry a particular risk of causing harm to the client; you should stop promptly if the person has any complaints of pain. The other choices may lead to reevaluation of the current therapy and result in changes of what is being done.

Question 14

A resident with osteoarthritis requires assistance with range-of-motion (ROM) exercises. Which joints are most likely affected with this disease process? Select all that apply.

Answer 14

Osteoarthritis usually affects weight-bearing joints, such as those in the knees, hips, and joints of the spinal column.

Question 15

An elderly client is postoperative day 2 following hip replacement surgery. Which measure should the nursing assistant prioritize when caring for this client?

Answer 15

Keeping the client’s legs in correct alignment
After hip replacement surgery, it is important to maintain correct positioning of the client’s legs in order to prevent dislocation of the hip joint. Passive range-of-motion exercises and ambulation at this early stage would cause injury. Ensuring a nutritious diet is important but not the priority at this moment.

Question 16

The nurse informs the nursing assistant that a client’s production of red blood cells is low. Which structure in the body should the nursing assistant point out is possibly not functioning correctly?

Answer 16

Flat bones and long bones
Blood cells form in the red bone marrow, which is found in flat bones and the ends of the long bones in adults. In young children, the shaft of the long bones also contains red bone marrow, but that red bone marrow is gradually replaced by yellow bone marrow as the person ages. Bone marrow is not found in the short or irregular bones.

Question 17

The nurse mentions a client’s uric acid levels are elevated. Which reaction should the nursing assistant anticipate if the increased uric acid crystallizes and deposits in the client’s joints?

Answer 17

The crystals irritate the joint, causing it to become inflamed and painful.
Uric acid is a waste product of metabolism that is usually eliminated from the body in the urine. If the body produces too much uric acid or the kidneys cannot properly process the uric acid, the uric acid builds up in the body, forming crystals that are deposited within the joints. These uric acid crystals are extremely irritating to the tissues in the joint, and as a result the joint becomes inflamed and painful. This is referred to as gout. The other choices may occur over time if the gout is not treated appropriately or the individual does not follow the orders of the physician.

Question 18

The nursing assistant cares for clients after they have undergone hip replacement surgery. Which responsibility will the nursing assistant prioritize when providing care to these individuals?

Answer 18

Be aware of specific ambulation and transfer techniques that are used with the person.
Following joint replacement surgery, a nursing assistant is responsible for assisting the client or resident with ambulating and transferring. The nursing assistant does not perform range-of-motion exercises and phantom pain does not occur after joint surgery. A reclining chair is inappropriate following this surgery.

Question 19

The nursing assistant is assisting a resident with meal ordering. Which food items can the nursing assistant suggest if the physician has ordered the resident to eat items rich in calcium? Select all that apply.

Answer 19

Most of the calcium we need to function on a daily basis is obtained from calcium-rich foods and beverages, such as milk, cheese, yogurt, broccoli, leafy greens, tofu, and calcium-fortified orange juice. Bananas are a good source of potassium. Oatmeal is a good source of fiber, vitamins, and minerals.

Question 20

The nursing assistant is assisting with the care of a client who is recovering from hip replacement surgery. Which position should the nursing assistant avoid for this client?

Answer 20

Hip flexion in excess of 90 degrees
In a client who has had recent hip replacement surgery, sitting in a chair with hip flexion in excess of 90 degrees can result in dislocation. The client should be placed in a supine or lateral position with the hips abducted.