hygiene

Question 1

A number of factors influence a patient’s personal preferences for hygiene. Because of
this, it is important for the nurse to realize that

Answer 1

No two individuals perform hygiene in the same manner.

Question 2

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

Answer 2

toddler

Question 3

The patient has been diagnosed with diabetes for the past 12 years. When admitted, the
patient is unkempt and is in need of a bath and foot care. When questioned about his hygiene
habits, the patient tells the nurse that baths are taken once a week where he comes from, although
he takes a sponge bath every other day. To provide ultimate care for this patient, the nurse
understands that

Answer 3

The patient’s illness may require teaching of new hygiene practices.

Question 4

The nurse is caring for a patient who refuses “AM care.” When asked why, the patient
tells the nurse that she always bathes in the evening. The nurse should

Answer 4

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

Question 5

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

Answer 5

Critical thinking is ongoing.

Question 6

When providing hygiene for an elderly patient, it is important for the nurse to closely
assess the skin. This is because as the patient ages

Answer 6

Less frequent bathing may be required.

Question 7

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

Answer 7

Use gloves or a tongue blade to inspect the hair.

Question 8

The patient has been brought to the emergency department following a motor vehicle
accident. The patient is unresponsive. His driver’s license states that he needs glasses to operate a
motor vehicle, but no glasses were brought in with the patient. The nurse should

Answer 8

Stand to the side of the patient’s eye and observe the cornea.

Question 9

When assessing a patient’s skin, the nurse needs to know that

Answer 9

Moisture on the skin can lead to skin maceration.

Question 10

The nurse is caring for a patient who is immobile. The nurse is aware that the patient is
at risk for Impaired skin integrity because

Answer 10

Pressure reduces circulation to affected tissue.

Question 11

The nurse is caring for a patient who has diabetes mellitus and circulatory
insufficiency, with peripheral neuropathy and urinary incontinence. The nurse realizes that patients
with these conditions

Answer 11

Have decreased pain sensation and increased risk of skin impairment.

Question 12

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

Answer 12

Assess all surfaces exposed to the cast for pressure areas.

Question 13

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

Answer 13

During a bath, assess for pain.

Question 14

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

Answer 14

Plantar warts

Question 15

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

Answer 15

Depending on severity, surgery may be needed to remove the corns.

Question 16

The patient is diagnosed with athlete’s foot (tinea pedis). The patient says that she is
relieved because it is only athlete’s foot, and it can be treated easily. The nurse explains that
athlete’s foot is

Answer 16

Contagious and frequently recurs.

Question 17

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

Answer 17

Fungi.

Question 18

The nurse is providing education about the importance of proper foot care to a patient
who has diabetes mellitus. The nurses understands that this is important for the patient because

Answer 18

Foot ulcers are the most common precursor to amputation.

Question 19

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

Answer 19

Halitosis.

Question 20

The nurse is caring for an unresponsive patient who has a nasogastric tube in place for
continuous tube feedings. The nurse assesses the patient’s oral hygiene because good oral hygiene

Answer 20

Helps prevent gingivitis.

Question 21

The patient is being treated for cancer with weekly radiation and chemotherapy
treatments. The nurse is aware that the patient’s oral mucosa needs to be assessed because
chemotherapy and radiation can

Answer 21

Lead to oral problems.

Question 22

In providing oral care to an unconscious patient, it is important for the nurse to

Answer 22

Rinse the mouth and immediately suction the oral cavity.

Question 23

The nurse is teaching the patient about flossing and oral hygiene. The nurse teaches the
patient that

Answer 23

Flossing removes plaque and tartar from the teeth.

Question 24

The nurse is caring for a patient who has head lice (pediculosis capitis). The nurse
knows that in treating this condition, one must understand that

Answer 24

Head lice may spread to furniture and other people.

Question 25

Scaling of the scalp accompanied by itching is known as

Answer 25

Dandruff.

Question 26

In examining a patient for pediculosis capitis (head lice), the nurse would expect to
find

Answer 26

Pustules or bites behind ears and at the hairline.

Question 27

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

Answer 27

Use blunt tweezers and pull upward with steady pressure.

Question 28

The patient is diagnosed with pediculosis capitis (head lice) and was treated upon
admission and was re-treated 24 hours later, yet the patient is still infested. The nurse should next

Answer 28

Manually remove the lice using a fine-toothed comb.

Question 29

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

Answer 29

Reduce the number of baths per week if possible.

Question 30

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

Answer 30

Partial bed bath

Question 31

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

Answer 31

Washbasins can harbor gram-negative organisms.

Question 32

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

Answer 32

Should be done by the patient.

Question 33

After the patient’s bath, the nurse should

Answer 33

Not offer a backrub for 48 hours after coronary artery bypass surgery.

Question 34

When providing the patient with a complete bed bath using soap and water (not a bag
bath), it is important to

Answer 34

Towel dry completely to prevent maceration.

Question 35

The nurse is providing a complete bed bath to a patient using a commercial bath
cleansing pack (bag bath). In doing so, the nurse should

Answer 35

Allow the skin to air dry.

Question 36

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

Answer 36

From pubic area to rectum.

Question 37

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

Answer 37

Retract the foreskin and return it to its natural position when done.

Question 38

Patients with diabetes mellitus need special foot care to prevent the development of
ulcers. Knowing this, the nurse

Answer 38

Requests a consult with a nail care specialist.

Question 39

The unconscious patient is resisting attempts by the nurse to provide oral hygiene. To
provide the needed care, the nurse may

Answer 39

Insert an oral airway upside down.

Question 40

When providing basic eye care, the nurse

Answer 40

Cleanses from inner canthus to outer canthus.

Question 41

The nurse is teaching a patient about contact lens care. The patient has plastic lenses,
so the nurse instructs the patient to

Answer 41

Wash and rinse lens storage case daily.

Question 42

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

Answer 42

Apply gentle, downward retraction of the ear canal.

Question 43

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

Answer 43

Adjust the volume for a talking distance of 1 yard.

Question 44

The patient is complaining of an inability to clear his nasal passages. The nurse
instructs the patient to

Answer 44

Apply gentle suction using a pediatric bulb suction device.

Question 45

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

Answer 45

Behind-the-ear hearing aid

Question 46

The nurse is admitting an elderly patient for failure to thrive and weight loss. A
nasogastric tube is inserted for supplemental tube feedings. The nurse should become concerned
when (Select all that apply.)

Answer 46

Bleeding is noted where the tube comes in contact with the nares.

d. Clear, watery discharge is noted.

Question 47

The use of critical thinking attitudes is necessary to design a plan of care to meet the
patient’s hygiene needs. Which of the following are considered critical thinking attitudes? (Select
all that apply.)
a. Curiosity
b. Communication principles
c. Prior experience
d. Humility
e. Knowledge of cultural variations

Answer 47

a. Curiosity

d. Humility

Question 48

Of the following developmental changes, which are most commonly associated with the
elderly? (Select all that apply.)
a. Increased eccrine and apocrine gland function

b. Fungal nail infections
c. Less resilient skin and bruising
d. Increased skin lubrication
e. Dry, itchy skin

Answer 48

b. Fungal nail infections
c. Less resilient skin and bruising

e. Dry, itchy skin

Question 49

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

a. A patient with urinary and fecal incontinence
b. A circumcised male who is ambulatory
c. A patient with rectal and perineal surgical dressings
d. A patient with an indwelling catheter
e. A morbidly obese patient

Answer 49

a. A patient with urinary and fecal incontinence

c. A patient with rectal and perineal surgical dressings
d. A patient with an indwelling catheter
e. A morbidly obese patient

Question 50

The patient has been forcefully blowing his nose and now has a nosebleed. The nurse is
concerned about the patient’s condition and assesses the patient for which possible negative issues?
(Select all that apply.)
a. Clearance of nasal passages
b. Injury to the tympanic membrane (eardrum)
c. Damage to nasal mucosa
d. Eye injury
e. Decreased nasal passage pressure

Answer 50

b. Injury to the tympanic membrane (eardrum)
c. Damage to nasal mucosa
d. Eye injury