Nursing Chapter 33 Deliver Compassionate Patient centered

Question 20

Type: MCSA

A client tells the nurse that bathing is done at the sink in the bathroom at home because it is difficult to physically

lift the legs to get into the shower. The nurse identifies which factor as influencing this client’s hygienic practice?

1. Religion

2. Personal preference

3. Culture

4. Health and energy

Question 21

Type: MCSA

During the morning bath of a client, the nurse identifies areas of erythema below the client’s breasts. What should

the nurse do to enhance comfort and healing for the client?

1. Wash the skin carefully.

2. Apply alcohol-free lotion.

3. Wash the area without soap.

4. Remove hair in the area.

Question 22

Type: MCSA

While providing a complete bed bath to a client, the nurse discovers abrasions along the client’s back and upper

buttock area. What should the nurse do to help this client?

1. Apply antiseptic spray to the abrasions.

2. Do not wash the client with soap.

3. Find assistance to help with the remainder of the bath.

4. Apply alcohol-free lotion to the abrasions.

Question 23

Type: MCMA

The nurse wants to assess a client during the morning bath. What will the nurse be able to assess during this time?

Standard Text: Select all that apply.

1. Skin status

2. Financial status

3. Psychosocial needs

4. Learning needs

5. Physical conditions

Question 24

Type: MCMA

A client is prescribed bed rest with bathroom privileges. Which types of bath would be appropriate for this client?

Standard Text: Select all that apply.

1. Shower

2. Tub bath

3. Self-help bed bath

4. Therapeutic bath

5. Partial bath

Question 25

Type: MCSA

A client with a skin rash is prescribed a bath in which medication is added to the bath water. The nurse should

plan for the client to receive which type of bath?

1. Shower

2. Tub

3. Partial

4. Complete

Question 26

Type: MCSA

A client tells the nurse that she does not want to get into the tub for a morning bath. The client has not been

bathed for several days. What should the nurse do?

1. Assign UAP the task of giving the client a bath.

2. Skip the client’s bath and document “refused” in the medical record.

3. Ask the client the usual way bathing occurs at home.

4. Tell the client that a bath is needed and ignore the client’s comment.

Question 27

Type: MCSA

An older client tells the nurse that showers are not taken because of a previous fall. What can the nurse do to

support the client’s bathing needs?

1. Obtain a shower chair and assist the client in the shower.

2. Document that the client “refused” a morning bath in the medical record.

3. Tell the client that shower shoes can be worn to prevent falls.

4. Hold the client during the shower.

Question 28

Type: MCMA

The nurse is preparing to provide a morning bath to a client diagnosed with dementia. What can the nurse do to

ensure a positive bathing experience for the client?

Standard Text: Select all that apply.

1. Move slowly.

2. Be flexible.

3. Help the client feel in control.

4. Avoid stopping once the bath is started.

5. Be prepared.

Question 29

Type: MCSA

A client has hard contact lenses. What should the nurse do to assist the client in the care of the lenses?

1. Pinch the lenses out of the client’s eyes to remove.

2. Remove both of the client’s lenses before storing in the appropriate storage cup.

3. Document when the lenses need to be removed and cleaned every 2 weeks.

4. Ask the client how many hours the lenses are worn each day.

Question 30

Type: MCSA

During an assessment, the nurse learns a client has soft contact lenses that have not been removed or cleaned for

weeks. What should the nurse do?

1. Nothing, because these types of lenses can be worn for months.

2. Remove the client’s lenses, wrap in tissue, and place in the bedside table.

3. Assist the client to remove and clean the contacts.

4. Ask the physician for ophthalmology consult because the client will need help removing the lenses.

Question 31

Type: SEQ

The nurse is assisting a client in removing soft contact lenses. Place in order the steps the nurse should take to

help this client.

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Using the pad of the index finger of the other hand, move the lens down to the sclera.

Choice 2. Have the client look forward.

Choice 3. Apply gloves.

Choice 4. Gently pinch the lens between the pads of the thumb and index finger.

Choice 5. Retract the lower lid with one hand.

Question 32

Type: MCSA

The client has a hearing aid with an earpiece that is connected by a cord to a receiver that the client keeps in a

shirt pocket. The nurse would document this as which type of hearing aid?

1. Body hearing aid

2. In-the-canal aid

3. Completely-in-the-canal aid

4. Eyeglasses aid

Question 33

Type: MCSA

The nurse has delegated the making of unoccupied beds to unlicensed assistive personnel. What should the nurse

assess regarding client safety once the beds are completed?

1. Folding of the top sheet

2. Direction of the pillow

3. Call light being readily available

4. Presence of mitered corners

Question 34

Type: MCMA

A client recovering from acute illness has just received a tub bath. When documenting the bath, what should the

nurse include?

Standard Text: Select all that apply.

1. Client’s ability to maintain a conversation during the procedure

2. Client’s tolerance of the procedure

3. Condition and integrity of the skin

4. Client strength

5. Percentage of bath done without assistance

Question 35

Type: MCSA

The nurse has completed foot care for a client as part of routine morning care. What should the nurse document

about the procedure?

1. The condition of the skin and nails

2. Nothing unless a problem is noted

3. The amount of time taken on foot care

4. The client’s comments about the foot care