Nail :

A. Comprised of connective tissue

B. Living cells

C. Extension of the epidermis

D.Form from the tissue of the integument (body shell)

C. Extension of the epidermis

A. Wrong-living cells comprised of  connective tissue, nail is epithelial cells/"dead cells"

B. Wrong-nail is "dead" cells

D. Wrong-the teeth are formed from the tissues of the integument (body shell), nail is extension of the epidermis

What is right about hair, accept :

A. Hair lubricated and kept flexible by oil lglands

B. Protein composition

C. Grown out of follicles

D. Cover all body surfaces included palms of the hands and the soles of the feet

D. Cover all body surfaces included palms of the hands and the soles of the feet.

Hair cover all body surfaces axcept for palms of the hands and the soles of the feet.

Epidermis is :

A. Contains blood vessels, nerve fibers and two kinds of glands

B. consists of dead outer cells

C. Contains the apocrine glands

D. Injury to this layer cause bleeding

B. consists of dead outer cells

A. Wrong - dermis contains blood vessels, nerve fibers and two kinds of glands,

C. Wrong - epidermis doesn't contain glands. the apocrine glands located mainly in the underarm and genital areas (it is odorless, body odor is caused by the ation of the skin's normal bacteria on the sweat).

D. Wrong - injury to this layer does'nt cause bleeding,  but the nerve ending reach into epidermis layer. Nerve ending called receptor receive information about : heat, cold, pain, pressure, temperature regulation.

• Protection - first line of defense and gives humans individualized appearance
• Storage - Vitamin (vit D) and fat
• Elimination - loses water, salts and heat through perspiration
• Sensory perception - contain nerve ending that keep us aware of environmental changes, Regulates body temperature.

Aging change in the skin :

• Dry and fragile (tears, breaks, bruises)
• increased sensitivity to heat and cold
• Loss fat and elasticity (thinning, scaling)
• Thinning hair (baldness;facial hair in women)
• Thickening of fingernails and toenails
• Skin irregularities (wart, moles, skin tabs, "age" spots)

The different between pediculosis (lice) and scabies :

A. Scabies are microscope, lice can be seen with the eye

B. Scabies spread by direct contact, lice indirect

C. Scabies are severe, maddening itching, lice mild severe

D. Scabies cause rash, lice no.

A. Scabies are microscope, lice can be seen with the eye

hematoma

examp : baby born with suction can develop hematoma

Senile purpula

use tepid water 80ºF - 95%F

When bathing patient with skin lessions, following safety precaution :

A. Change the dressing during  admission

B. Pour the special products when patient in the tub

C. Use regular bed linen

D. Pat the skin dry

D. Pat the skin dry - do not rub

A. Wrong - Observe the pts's skin on admission, but do not remove dressing.

B. Wrong - pour special product and hot water before pts in the tub

C. Wrong - Use special bed linen such as sterile linen, linen that has been washed in special detergent, or disposable linen

When bathing patient with skin lession use :

A. Soap and water

B. Rubbing lotions

C. Hot water 

D. Colloidal oatmeal

D. Colloidal oatmeal - to relieve irritation, reduce itching, and moisturize, soften and protect skin

A & B.  Wrong - contraindicated (not permitted)

C. Wrong - use tepid water (80ºF - 93ºF)

pg 651

Pressure ulcers, bedsores or dermal ulcers

Decubitus (latin : lying down) ulcer is an older term that continues to be used, it is not as accurate as pressure ulcers because it can occur when a patient is not in bed.

Literal position pressure ulcer appear :

A. Rim of ears, Occiput, elbow, shoulder, sacrum and coccyx, buttocks, lateral knee, heels, toes

B. Side of head, ears, elbows, shoulders, perineum, hips, anterior knee, ankles

C. Back of head, shoulder blade, elvows, spine, sacrum and coccyx, hip bones, buttocks, toes, medial knee, especially the heels.

D. Back of the upper and lower arm, shoulder blades and spine, buttocks, coccyx

Stage I : skin develops a redness or blue-gray discoloration over the pressure area. Skin is not broken. For dark skinned people, the area may appear drier or it may appear dark blue or black.

Stage II : The skin is reddened and there are abrasions, blisters, or a shallow crater at the site. Involved epidermis alone or both the epidermis and dermis.

Stage III : All the layers of the skin are destroyed and a deep crater forms.

Stage IV :Ulcer extends through the skin and subcutaneous tissues and may involve bone, muscle and other structures. Fluid loss and is at great risk for infection.

Action of NA when skin breakdown occurs :

A. Assist with dressing change a dry sterile dressing (DSD)

B. Apply saline solution to loosen the tape to prevent injury

C. Assisting with whirpool baths, if ordered, to keep the area clean

D. Assisting with gauze soaked in a wound gel

C. Assisting with whirpool baths, if ordered, to keep the area clean

A. Wrong-Nurse or physician should perform the procedure (every 3-5 days), NA reporting indications of infection, such as fever, odor, drainage, bleeding and changes in size

B & D.Wrong-The wounds may be cleaned by the nurse or physician 

Ensuring adequte circulation to tissues is a major factor in preventing skin breakdown, accept :

• Positioning the patient properly
• Using mechanical aids
• Giving backrubs
• Performing active or passice range-of-motion exercises

1. Supine position
2. Semisupine
3. Lateral position
4. Semiprone position
5. Fowler's position

Prone position is a sixth position, special attention :

A. Turn position every 4 hours.

B. Elevated the head of bed 45ºangle.

C. Remain in the room for 10 to 15 minutes after positioning.

D. Encourage to raise themselves every 15 minutes.

C. Remain in the room for 10 to 15 minutes after positioning.

A. Wrong-turn position every 2 hours

B. Wrong - Fowler's position 45º angle

D. Wrong - For positioning patient in the wheel chair, encourage to raise themselves every 15 minutes

Used to prevent pressure ulcers :

A. Body mechanic

B. Standar precaution

C. Mechanical Aids

D. Ergonomic

Preventing pressure ulcer :

A. Rub skin vigorously

B. Apply moisturizers on dry skin by patting

C. Apply lotion include between toes

D. Use hot water during bathe

B. Apply moisturizers on dry skin by patting

A,B & C. Wrong 

 Preventing pressure ulcers, accept :

A. Do not use lotion on broken skin

B. Use turning sheet to move  dependent patients in bed

C. Elevate the bed higher than 30º angle

D. Protec areas at risk,such as heels and elbows

For patient on the wheel chairs/chair, to reduce pressure on buttocks and sacrum, use :

Mechanical Aids are used to prevent pressure ulcers, but they do not relieve pressure, accept :

A. Sheepskin pads

B. Foam pads

C. Low Air Loss Therapy Beds 

D. Protector for areas such as heels and elbows

C. Low Air Loss Therapy Beds 

Low air loss bed :

A. Filled with a sand-like material

B. CPR is not effective

C. Doesn't relief pressure

D. Tucking the bottom sheet in tightly

B. CPR is not effective

A. Wrong - Clinitron bed is filled with a sand-like material

C. Wrong - reduce pressure

D. Wrong - flat sheet should be loosely applied, use this bed with nylon cover only, without sheets. Facilities have several extra covers for each bed, special care for washing, must be aired dried)

Low air loss therapy beds provides pressure relief those who are at risk of prssure ulcers, and some patient with burns and keep patient cooler and drier than other types of beds. Patient using a low air loss bed must be, accept :

A. Turn and positioned regularly

B. Flat sheet should be loosely applied

C. Use nylon cover

D. Doesn't need disposable underpads 

Burn

• Thermal burn
• Chemical burn
• Electrical burn

• First-degree burns (partial thickness)-epidermis
• Second-degree burns (partial thickness)-When both epidermis and dermis are involved
• Third-degree burns  (full thickness) - When epidermis, dermis, and subcutaneous tissue are involved

The nurse documents the size of the lesion using a commercial scale in stage III

True

False

Pressure ulcers in stage IV are not painful because they are below the nerve

True

False

False

the nerve endings are expose around the edges

Sign and symptoms of decreased oxygenation, accept :

A. Unusual skin or lips color
B. Repiratory rate between 12 to 20 perminute
C. Slurred speed
D. Regular breathing (not too slow, not too rapid)

A. Unusual skin or lips color

B. Wrong - decreased oxygenation if repiration below 12 or above 20 per minute

C. Wrong - slurred speed sign for stroke

D. Wrong - decreased oxygenation if the breathing irregular, slow or rapid

pg 667

Patient's condition high-risk of hypoxemia :

A. Immobile 

B. Bedrest

C. Morbid obesity

D. Being postoperative

E. All above

E. All above

pg 668

URI (Upper Urinary Infection) include nose, sinuses and throat (pharynx)

Examp : Pneumonia

COPD (Chronic Obstructive Pulmonary Disease) or COLD (Chronic Obstructive Lung Disease)

include :

• Emphysema
• Chronic bronchitis
• Bronchiectasis

Asthma

• Constriction of the muscles of the bronchioles
• Swelling of the repiratory membranes
• Production of large amounts of mucus that fill the narrowed passageways

Asthma attack wether the patient is awake or asleep, all below is true about asthma, accept :

A. asthma attack during the night because the bronchi normally narrow during the night in everyone, increase resistance to air flow.

B. Attack maybe result when the person contacts an allergen or by respiratory infection

C. constriction of the muscles of the bronchioles

D. Chronic blockage that is not reversible

D. Wrong - chronic blockage or obstruction is COPD, it can be very difficult to differentiate with asthma, particularly in older patients

B. Right - asthma resulting from swelling of the respiratory membranes cause by allergen or production of large amounts of mucus that fill the narrowed passageways cause by Repiratory infection

Effects of aging in repiratory :

A. Asthma

B. Emphysema

C. Pneumonia

D. Aspiration

E. All above

E. All above

Other aging effects

•  CHF (congestive heart failur) - increased work demand on heart causes"back up" of blood or fluid; lungs become congested with fluid
• Decreased elasticity of lungs

Alveoli loses elasticity and become permanently enlarged is called 

Emphysema

Patient can bring air into the lungs, but it becomes more difficult to expel air from the lungs

Assisting with the proper breathing techniques, such as pursed-lip breathing for :

A. Emphysima patient

B. Tracheostomy patient

C. CVA

 D. Non of the above

Sign and symptoms should be report to the nurse, relating to respiratory when :

• Blood pressure or pulse change significantly
• increased repiratory rate
• dyspnea
• diaphoresis
• anxiety
• uncontrollable coughing
• pulse oximeter value less than 90%

• Opening made into anterior trachea
• May be temporary or permanent
• The external opening on the skin surface is the stoma
• plastic or metal tube is inserted through the stoma is cannula 

NA could caring for  the tracheostomy 

True

False

False

Nurse's responsibility caring for the tracheostomy. Notify the nurse immediately if the ties are loose or any part of the device comes apart or is removed. Should be able to slide one finger underneath the tie

Safety measure where oxygen being use : 

Post "no smoking" or "oxygen in use" sign

Be certain there is no flame, no one smoke or matches

Oxygen is a prescription item, the amount is ordered by physician and changing the flow rate is the responsibility of a licensed nurse or RCP (Repiratory Care Practitioner)

True

False

Humidifier used for oxygen flow above 5 liter. The water used fr the humidifier is :

A. Sterile distilled water

B. Tap water

C. Saline Solution

D. None of above

Type of prefilled humidifiers is :

A. washed with soap and water every 24 hours

B. A sticker may be attached to this bottle showing the date and time it was change

C. Washed with 2% alkaline gluteraldehyde solution every 24 hours

D. commonly used in acute care hospital, usually changed once a week.

D. commonly used in acute care hospital, usually changed once a week.

A,B & C. Wrong - is type of refillable humidifiers

Oxygen Mask is use for :

A. Low flows of oxygen

B. Used in with oxygen concentrator

C. High liter flows of oxygen

D. Will not cause rebreathing of exhaled carbon dioxide if used with liter flows under 5 liter.

C. High liter flows of oxygen >5 L/min

A. Wrong - for low flows of oxygen use nasal cannula

B. Wrong - oxygen concentrator are used only for patients needing low liter flows of oxygen. 

C. Wrong - if used with liter flows under 5 liter will cause rebreathing of exhaled carbon dioxide

Axygen concentrators are used in emergency

True 

False

False

small tank is the best for an external oxygen source in an emergency 

NA responsibility during caring the oxygen concentrator, accept :

A. Never change the flow meter setting

B. Used damp cloth to wipe cannula 

C. Change cannula every 24-48 hours, write the date and time the tubing was changed and initials using permanent marker

D. Used soapy water to wipe the surface of the concentrator

D. Wrong - Use only damp cloth to wipe the surface of the concentrator. Change and Wash the filter in warm soapy water every week.

The benefit of using liquid oxygen and liquid canister because it can be stored in small, more convenient containers

True

False

Respiratory position except :

A. High Fowler's position

B. Tripod position

C. Orthopneic position

D. Prone position

Incentive spirometer

Used for postoperative patient 

Nabulizer/Aerosol therapy

Typically, drugs are ordered to open up obstructed airways for patient with COPD and asthma

CPAP (Continuous positive airway pressure (CPAP) pronounce see-pap

monitor the patient while connected to the CPAP machine, air leak that blow into the patient's eyes is very irritating, if the mask is too tight, the patient may feel pain. wash the mask with soap and water every morning.

Sputum

It is easier to collect the specimen when the patient wakes up in the morning and after the patient takes two or three deep breaths