Question 1

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,what should the nurse do?

Accepted Answer

Assess all surfaces exposed to casts,cloth restraints,bandages and dressings,tubing,or orthopedic braces.An external device applied to or around the skin exerts pressure or friction on the skin,which leads to skin impairment.When restricted from moving,dependent body parts are exposed to pressure that reduces circulation to affected tissues.Nurses should know which patients require assistance to turn and change positions.In patients with limited caloric and protein intake,wound healing becomes impaired or is delayed.Keeping the blood pressure artificially low may decrease arterial blood supply,which leads to ischemia and breakdown.

Question 2

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

Accepted Answer

In community health and home care settings,it is particularly important to inspect the hair for lice so that appropriate hygienic treatment can be provided.Suspicions cannot be ignored.If pediculosis capitis (head lice)is suspected,the nurse must protect himself or herself against self-infestations by hand hygiene and by using gloves or tongue blades to inspect the patient's hair.Shaving hair off affected areas is the treatment for pediculosis pubis (crab lice)and is rarely used for head lice.

Question 3

The nurse is caring for a patient who refuses "A.M.care." When asked why,the patient tells the nurse that she always bathes in the evening.What should the nurse do?

Accepted Answer

Each patient has individual desires and preferences about when to bathe,shave,and perform hair care.Knowing the patient's personal preferences assists the nurse in providing individualized care for the patient.Hygiene care is never routine.Maintaining individual personal preferences is important unless new hygiene practices are indicated by an illness or condition.Cancelling hygiene care is not an option.Practices must be adapted to meet individual needs.No evidence demonstrates greater benefit with morning or evening hygiene care.

Question 4

The nurse is caring for a patient who is immobile.Why is the nurse aware that the patient is at risk for impaired skin integrity?

Accepted Answer

Body parts exposed to pressure have reduced circulation to affected tissue.In patients with limited caloric and protein intake,the skin becomes thinner and less elastic,with loss of subcutaneous tissue.Inadequate blood flow causes ischemia and breakdown.Patients with paralysis,circulatory insufficiency,or local nerve damage are unable to sense an injury to affected parts of the skin.

Question 5

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

Accepted Answer

Inflammatory lesions and fungus of the nail bed cause nails to become thickened and horny and to separate from the nail bed.If a female patient is affected,the nurse should ask whether she frequently polishes her nails and uses polish remover because chemicals in these products cause excessive nail dryness.Friction and pressure from ill-fitting or loose shoes causes keratosis (corns).It is seen mainly on or between toes,over bony prominences.

Question 6

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

Accepted Answer

While a patient is bathing,the nurse should assess the status of sensory nerve function by checking for pain,tactile sensation,and temperature sensation.When restricted from moving freely,dependent body parts are exposed to pressure that reduces circulation.However,a mobile patient is able to change positions.Limiting caloric and protein intake may cause wound healing to become impaired or delayed.The presence of perspiration,urine,watery fecal material,and wound drainage on the skin also causes wound healing to become impaired or delayed.However,a mobile patient can use bathroom facilities or a urinal.

Question 7

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

Accepted Answer

Depending on severity of pain and the size of the corn,surgical removal may be necessary.Oval corn pads should be avoided because they increase pressure on the toes and reduce circulation.Warm water soaks help soften corns before gentle rubbing with a callus file or pumice stone.Wider and softer shoes,especially shoes with a wider toe box,are helpful.

Question 8

The nurse is caring for an unresponsive patient who has a nasogastric tube in place for continuous tube feedings.Why does the nurse assess the patient's oral hygiene?

Accepted Answer

Early identification of poor oral hygiene practices and common oral problems reduces the risk for gum disease and dental caries.Patients frequently develop common oral problems as a result of inadequate oral care or as a consequence of disease (e.g. ,oral malignancy)or as a side effect of treatments such as radiation therapy and chemotherapy.These problems include receding gum tissue,inflamed gums (gingivitis),coating of the tongue,glossitis (inflammation of the tongue),discoloration of teeth (particularly along gum margins),dental caries,missing teeth,and halitosis (foul-smelling breath).

Question 9

When the nurse provides hygiene care for an older patient,why is it important for the nurse to closely assess the skin?

Accepted Answer

Daily bathing,as well as bathing with water that is too hot or soap that is harsh,causes the skin to become excessively dry.As the patient ages,the skin loses its resiliency and moisture,and sebaceous and sweat glands become less active.The epithelium thins,and elastic collagen fibres shrink,which makes the skin fragile and prone to bruising and breaking.

Question 10

The patient receives a diagnosis of 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.What does the nurse explains about athlete's foot?

Accepted Answer

Athlete's foot spreads to other body parts,especially the hands.It is contagious and frequently recurs.It is caused by a fungus,not the papillomavirus.It is not treated with salicylic acid or electrodesiccation;those are treatments for plantar warts.

Question 11

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

Accepted Answer

A patient's condition is always changing,which necessitates ongoing critical thinking and changing of nursing diagnoses.Because hygienic care is so important for a patient to feel comfortable,refreshed,and renewed,the nurse should avoid making hygiene care a simple routine.

Question 12

The patient received a diagnosis of diabetes 12 years ago.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,what must the nurse understand?

Accepted Answer

Each patient has individual desires and preferences about when to bathe,shave,and perform hair care.However,they are not unchangeable.In addition,the nurse must assist the patient in developing new hygiene practices when indicated by an illness or condition.For example,the nurse will need to teach a patient with diabetes proper foot hygiene.Patients who appear unkempt often need further assessment regarding their ability to participate in daily hygiene.Patients with certain types of physical limitations or disabilities often lack the physical energy or dexterity,or both,to perform hygienic care.Culturally,maintaining cleanliness does not hold the same importance for some ethnic groups as it does for others.

Question 13

When assessing a patient's skin,what does the nurse need to know?

Accepted Answer

Moisture on the surface of the skin serves as a medium for bacterial growth and causes irritation,softens epidermal cells,and leads to skin maceration.When restricted from moving freely,dependent body parts are exposed to pressure that reduces circulation to affected tissues.Nurses should know which patients require help to turn and change positions.Patients with paralysis,circulatory insufficiency,or local nerve damage are unable to sense an injury to affected parts of the skin.In patients with limited caloric and protein intake,the skin becomes thinner and less elastic,with loss of subcutaneous tissue,which results in impairment of or delay in wound healing.

Question 14

The nurse is caring for a patient who has diabetes mellitus and circulatory insufficiency,with peripheral neuropathy and urinary incontinence.What does the nurse know about patients with these conditions?

Accepted Answer

Patients with paralysis,circulatory insufficiency,or local nerve damage are unable to sense an injury to affected parts of the skin.The presence of perspiration,urine,watery fecal material,and wound drainage on the skin results in breakdown and infection.In patients with limited caloric and protein intake,the skin becomes thinner and less elastic,with loss of subcutaneous tissue.This results in impairment in or delay of wound healing.Impaired venous return decreases circulation to the extremities.Inadequate blood flow causes ischemia and breakdown.

Question 15

The nurse is providing education about the importance of proper foot care to a patient who has diabetes mellitus.Why is this important?

Accepted Answer

Foot ulceration is the most common single indication for lower extremity amputation among persons with diabetes.Plantar warts are caused by the papillomavirus,not a fungus.Palpation of the dorsalis pedis and posterior tibial pulses indicates that adequate blood flow is reaching peripheral tissues.Neuropathy is a degeneration of the peripheral nerves usually that is due to poor control of blood glucose levels;it is not a direct result of poor foot care.

Question 16

The patient has been brought to the emergency department after a motor vehicle accident.The patient is unresponsive.His driver's licence states that he needs glasses to operate a motor vehicle,but no glasses were brought in with the patient.What should the nurse do?

Accepted Answer

An important aspect of an eye examination is to determine if the patient wears contact lenses,especially in patients who are unresponsive.To determine whether a contact lens is present,stand to the side of the patient's eye and observe the cornea for the presence of a soft or rigid lens.It is also important to observe the sclera to detect the presence of a lens that has shifted off the cornea.An undetected lens causes severe corneal injury when left in place too long.Nurses must never assume that glasses were lost or were not worn.Contacting ambulance personnel takes time.The patient's eyes should be examined.

Question 17

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?

Accepted Answer

During childhood,family customs influence hygiene.As children enter their adolescent years,peer group behaviour often influences personal hygiene.During the adult years,involvement with friends and work groups shapes the expectations people have about their personal appearance.Some older persons' hygiene practices change because of living conditions and available resources.

Question 18

A number of factors influence a patient's personal preferences for hygiene.Because of this,what is important for the nurse to realize?

Accepted Answer

No two individuals perform hygiene care in the same manner;it is important to individualize the patient's care according to knowledge about the patient's unique hygiene practices and preferences.Hygiene care by nurses is never routine;this care requires intimate contact with the patient and communication skills to promote the therapeutic relationship.In addition,during hygiene care,the nurse should take time to learn about the patient's health promotion practices and needs,emotional needs,and health care education needs.

Question 19

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

Accepted Answer

Halitosis is the term for "bad breath." Alopecia is hair loss.Dental caries is tooth decay.Neuropathy is a degeneration of peripheral nerves that leads to loss of sensation in the extremities.

Question 20

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

Accepted Answer

Plantar warts appear on the sole of the foot and are due to the papillomavirus.Corns are caused by friction and pressure from ill-fitting or loose shoes.Athlete's foot (tinea pedis)is a fungal infection.A callus is caused by local friction or pressure.

Quiz 38: Hygiene