If, upon gathering information from the scenario the nurse does NOT have to use hand
sanitizer use, rather wash hands- ANSWER When hands are visibly soiled
with certain infections- C-diff
To prepare a sterile field
Before and after eating
After using the restroom
Where must the table be when one prepares a sterile field? -ANSWER At waist level
At what point does one don and doff gloves with PPE -ANSWER At the end with applying
initiated w/t removal
can a sterile field be assigned to a UAP? - ANSWER no not w/o special training
when adding supplies to a sterile field, what is done? - ANSWER -hands are not gloved-
package on the outside is not sterile
-open package away from you and drop the supplies 10inches on to the center to the
sterile field
-stand to the side so you do not reach over the field
what is the purpose for bathing a patient - ANSWER provides routine hygienic care
reduces body odor
promotes circulation and blood flow
prevents skin breakdown
provides ROM
provides comfort and relaxation
strengthens a general feeling of health and wellness
,what is preprocedure? - ANSWER 1. Check PCP and patient care plan
2. Gather supplies
3. Perform hand hygiene
4.maintain standard precautions
5. introduce yourself
6. provide privacy
7. identify patient with 2 identifiers
8. explain procedure to the patient
what are the 3 types of massage - ANSWER -Efflerage- long hard movements along the
length of the back muscles: promotes relaxation, trust, sense of caring
-Petrissage- kneading motion with fingers and thumb: promotes specific muscle
relaxation
-Tapotement- tapping or percussion motion with palm or ulnar side of hand: promotes
circulation, respiratory function, and relaxation
what is postprocedure - ANSWER 1. Return bed to lowest position
2. ask if the patient needs anything else
3. dispose of PPE
4. clean equipment
5. perform hand hygiene
6. document date, time, assessment, procedure, and patient response
what to do when doing foot care on a person with diabetes? - ANSWER do not soak
hands and feet; may cause skin breakdown or infection
what is it called when there is little skin loss and it is red? - ANSWER excoriation
,what is it called when the skin is white? - ANSWER maceration
what do you do if the patient has matted blood in the hair - ANSWER mix 25% hydrogen
peroxide with 75% saline
apply with cotton balls and use a comb to work through
What would you do if the patient had a bleeding disorder or had received anticoagulant
therapy while providing oral care? -ANSWER soft-bristle brush and Light gentle brush
strokes
-Do not floss
What position would you place the patient in if unconscious while providing mouth care?
-ANSWER on their side facing you
What type of razor would you use on a male client with a bleeding disorder? -ANSWER
electric
when do you use two point for crutches - ANSWER both feet bear partial weight
when do you use three point for crutches - ANSWER one foot bears weight, and the
other foot can be used for balance
when do you use four-point for crutches - ANSWER both feet bear weight
when do you use swing-to for crutches - ANSWER both feet are able to bear weight, but
there is hip and leg paralysis and weaker upper body strength
when do you use swing-through for crutches - ANSWER both feet bear weight: there is
his and leg paralysis, but the patient has stronger upper body strength
, if a patient is unable to be placed into SIMS when administering an enema what position
would you place him in - ANSWER dorsal recumbent
what would the nurse do if the patient complains of abdominal pain or cramping during
instillation of an enema - ANSWER lower the bag and slow the rate
If, at any time during the instillation of the enema, the abdomen distends, the nurse
should do what? - ANWER stop the procedure and notify the PCP
name the seven rights of medication - ANWER Right Patient
Right medication
Right dose
Right route
Right time
Right Rational
Right documentation
which types of oral medications should never be crushed or cut? - ANWER capsules
should not be divided
if enteric coated- should not be crushed or divided
extended release should not be crushed or divided
when would you use an oral syringe vs a graduated medication cup ANSWER oral
syringe for under 10ml
medication up for over 10ml
Before administering an inhaled medication, what prechecks do you need to make?
ANSWER auscultate the lung fields
respiratory and heart rates
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