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Exam (elaborations)

Nurse aide test preparation

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Nurse aide test preparationA resident falls from her chair when she has a seizure. Before the nurse arrives, the seizure is finished and the nurse aide observes the resident is breathing. What should the nurse aide do next? A . Get the emergency cart B. Turn the resident onto her side C. Che...

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  • August 17, 2024
  • 83
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • Nurse aide
  • Nurse aide
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Item 1 of 150
A resident falls from her chair when she has a seizure. Before the
nurse arrives, the seizure is finished and the nurse aide observes the
resident is breathing. What should the nurse aide do next?
A
Get the emergency cart
.
B. Turn the resident onto her side
C. Check if the resident is able to talk
D
Help the resident back into the chair
.
Incorrect

Rationale: After a seizure, saliva may pool in the mouth and the individual may also vomit. Turning the resident onto
the side prevents aspiration by allowing the fluids to drain out of the mouth. This is the most important action for the
nurse aide to take in this situation. The nurse aide should not leave the resident unattended and should not move the
resident until checked by the nurse.
Reference(s):
Examples of references where knowledge for this question is covered include:
1. Carter, P. (2012). Lippincott Textbook for Nursing Assistants (3rd Ed.). Philadelphia, PA: Wolters Kluwer/Lippincott
Williams & Wilkins. Page 220.
2. Sorrentino, S. (2011). Mosby's Textbook for Long-Term Care Nursing Assistants (6th Ed.). St. Louis, MO: Elsevier
Mosby. Page 706.

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Item 2 of 150
To prevent skin tears or shearing when moving the resident, the nurse
aide should
A. wear gloves to reduce friction against the skin.
B. avoid pulling or sliding the resident when moved.
C
tell the resident to be careful and follow directions.
.
D
ask the resident to keep arms held over the resident's head.
.
Correct

Rationale: The skin of an elderly resident is thin and fragile. Pulling bed sheets against the resident’s skin, or sliding
the resident when moving or transferring, can cause injury to the skin, such as skin tears. This is the result of
shearing. Great care is needed to prevent skin tears. Actions like rolling or using a turning sheet, slide, or transfer
sheet can help reduce the risk of skin injury.
Wearing gloves when transferring a resident may be appropriate if the nurse aide is at risk of exposure to blood or
body fluids, but it will not prevent shearing or skin tears. Telling the resident to follow directions or having the resident
hold arms over the head will not prevent skin tears or shearing.
Understanding how to prevent skin tears is important for the nurse aide who shares responsibility for the safety of
residents. The nurse aide should be aware that skin tears are painful, and the skin opening also increases the
resident’s risk for infection.

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Reference(s):
Examples of references where knowledge for this question is covered include:
1. Alvare, S.. Fuzy, J., and Rymer, S. (2009). Hartman’s Nursing Assistant Care: Long-Term Care and Home Health.
Albuquerque, NM: Hartman Publishing, Inc. Pages 149 and 197.
2. Sorrentino, S. (2011). Mosby's Textbook for Long-Term Care Nursing Assistants (6th Ed.). St. Louis, MO: Elsevier
Mosby. Pages 225 and 538-539.

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Item 3 of 150
What should a nurse aide do with a used disposable razor?
A
Throw the razor away in a trash can.
.
B. Place the razor in a sharps container immediately.
C. Clean, rinse, and dry the razor so it can be used
again.
D
Wrap the razor in a paper towel until it can be thrown away.
.
Correct

Rationale: A disposable razor is a safety concern because it is considered a sharp and a used razor is likely to also
have blood cells on it. Since it is considered a sharp and potentially contaminated with blood cells, it must be
disposed of in the Sharps container. Safe disposal of sharps is a part of the nurse aide’s responsibility because it
pertains to the safety of the resident.
The nurse aide must always be aware of safety of all residents, but especially concerned for residents who are
confused and could be accidentally harmed handling a razor that was left out.
Reference(s):
Examples of references where knowledge for this question is covered include:
1. Carter, P. (2012). Lippincott Textbook for Nursing Assistants (3rd Ed.). Philadelphia, PA: Wolters Kluwer/Lippincott
Williams & Wilkins. Page 370.
2. Sorrentino, S. (2011). Mosby's Textbook for Long-Term Care Nursing Assistants (6th Ed.). St. Louis, MO: Elsevier
Mosby. Page 321.


Item 4 of 150
Which of the following is the best example of using reality orientation
for a resident with early dementia?
A. "Your son plans to visit today at 2:00 p.m."
B. "You are in the nursing home. I am here to help you."
C. "This is your daughter Anna. Do you remember her?"
D
"Look at the time. Lunch is in 30 minutes. Are you feeling hungry?"
.
Incorrect

Rationale: Reality orientation is a process of reminding and orienting the resident to person, place, and time. For a
resident with early dementia, putting time into the context of the day and routine can be helpful. Lunch is a part of a
life routine, and reminding the resident about that and relating it to eating and being hungry can be reassuring and
helpful.
In the earlier stages of Alzheimer’s disease, when a resident may be aware and frightened by loss of memory, avoid
contributing to the resident’s anxiety by making statements such as, "Don’t you remember your daughter?"
Reference(s):
Examples of references where knowledge for this question is covered include:
1. Dugan D. (2012). Nursing Assisting: A Foundation in Caregiving (3rd Ed.). Albuquerque, NM. Hartman Publishing,
Inc. Page 415.
2. Hedman, S., Fuzy, J., and Rymer, S. (2010). Hartman's Nursing Assistant Care: Long-Term Care (2nd Ed.).
Albuquerque, NM: Hartman Publishing, Inc. Page 359.

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Item 5 of 150
While feeding a resident, the nurse aide notices that the resident is
coughing a lot after each drink of fluid. What is the appropriate
response by the nurse aide?
A
Allow the resident more time to swallow.
.
B. Use a straw when giving the resident fluids.
C. Add a thickening product to the resident's fluids.
D
Stop feeding and ask a nurse to check the resident.
.
Correct

Rationale: When a resident coughs frequently after drinking fluids, it may indicate that the resident is having some
difficulty swallowing. This difficulty swallowing can result in fluids going into the resident’s lung. This condition is
known as aspiration. It can result in the development of serious medical conditions, such as pneumonia, which may
require medical attention.
The nurse aid should notify the nurse immediately. The resident will require an evaluation of the resident’s ability to
swallow. Thickening agents are sometimes added to liquids for residents that have difficulty swallowing fluids, but the
use of these thickeners is decided by the physician and not the nurse aide.
Reference(s):
Examples of references where knowledge for this question is covered include:
1. Sorrentino, S. (2011). Mosby's Textbook for Long-Term Care Nursing Assistants (6th Ed.). St. Louis, MO: Elsevier
Mosby. Pages 386-387.
2. Alvare, S.. Fuzy, J., and Rymer, S. (2009). Hartman’s Nursing Assistant Care: Long-Term Care and Home Health.
Albuquerque, NM: Hartman Publishing, Inc. Page 268.


Item 6 of 150
A resident wears a hand splint. Which observation should the nurse
aide report to the nurse immediately?
A
The resident's fingers are cold and blue in color.
.
B. The splint was removed as scheduled in the care
plan.
C
The resident asks to have the splint removed for a few minutes.
.
D. The resident asks the nurse aide to reposition the arm with the splint.
Correct

Rationale: When a resident wears a splint, it is important to make sure the splint is applied properly and is not
causing pressure that could affect circulation. If not properly applied, the splint can cause pressure. When a resident
wears a splint, the care plan may also include scheduled periods for removing the splint to allow the skin to be open
to air and to promote circulation. When a resident wears a splint, it is important to observe for any changes in skin
color in the extremity, which if observed should be reported to the nurse immediately. Skin color changes and
changes in the temperature of the extremity could also be signs of impaired circulation.
Reference(s):
Examples of references where knowledge for this question is covered include:

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