Mixed Deck — All INACE Topics Flashcards

Which statement about SBAR communication is MOST accurate for nurse aides?

Answer: SBAR stands for Situation, Background, Assessment, and Recommendation

SBAR is a structured communication tool that helps nurse aides organize and clearly convey information when reporting to the charge nurse.

During care, a nursing assistant notices a new bruise on a patient's arm that the patient cannot explain. The appropriate action is to:

Answer: Document it and report it to the nurse, as it may indicate abuse or a fall

Unexplained bruises must be documented and reported to the nurse to rule out falls, abuse, or bleeding disorders.

Which statement about alcohol-based hand rub (ABHR) is TRUE?

Answer: ABHR is preferred over soap and water unless hands are visibly soiled or C. diff is suspected

ABHRs are effective for most pathogens and are preferred when hands are not visibly soiled, but soap and water must be used for C. difficile and visible contamination.

A resident begins choking on food during mealtime. The nursing assistant should first:

Answer: Encourage the resident to cough forcefully

If the resident can cough, speak, or breathe, encourage forceful coughing before escalating to abdominal thrusts.

Which of the following is an example of closed-ended communication that may hinder a resident's ability to express concerns?

Answer: 'Are you in pain? Yes or no?'

Closed-ended questions limit responses to yes or no, reducing the opportunity for residents to describe their concerns in their own words.

What does the term 'adverse drug reaction' (ADR) refer to?

Answer: A harmful or unintended response to a medication at a normal dose

An adverse drug reaction is an unintended, harmful response that occurs at doses normally used for therapeutic purposes.

What are the "Five Rights" of medication administration?

Answer: Right patient, right drug, right dose, right route, right time

The Five Rights are a fundamental safety framework for medication administration to prevent errors.

When a nurse aide witnesses an incident involving a resident, proper documentation should be:

Answer: Objective, factual, and completed promptly after the incident

Proper documentation must be objective, factual, and completed in a timely manner to ensure an accurate legal record.

Which of the following is the correct procedure when documenting a patient’s vital signs?

Answer: Record the vital signs in a timely manner, using the correct time and date.

Accurate and timely documentation of vital signs is crucial for patient safety and effective care planning. Recording them immediately after measurement ensures the information is current and prevents errors or omissions that could occur if documentation is delayed. This practice provides an accurate snapshot of the patient's condition at a specific moment, which is essential for monitoring changes and making informed medical decisions.

What should be done first when a needlestick injury occurs?

Answer: Wash the affected area immediately with soap and water

Immediate washing with soap and water helps reduce the risk of infection transmission after a needlestick injury.

A resident's urinary output for an 8-hour shift is 150 mL. This finding should be:

Answer: Reported to the nurse as it may indicate low output

Normal urine output is approximately 30 mL/hour; 150 mL in 8 hours (about 19 mL/hr) is below normal and must be reported.

What is the first action to take in any emergency situation?

Answer: Ensure scene safety and assess the situation

Scene safety assessment is always the first priority to prevent additional injuries to rescuers and bystanders.

When should documentation of a service or intervention be completed?

Answer: As soon as possible after the service is provided

Timely documentation ensures accuracy and completeness, as details are freshest immediately after service delivery.

Which of the following is the correct way to handle a medication error after it has occurred?

Answer: Report it immediately to the nurse and complete an incident report

Immediate reporting and completing an incident report ensures prompt treatment of the resident and proper documentation for safety review.

A patient's skin shows redness over a bony prominence that does not disappear when pressure is relieved. This is classified as a:

Answer: Stage 1 pressure injury

Non-blanchable redness over a bony prominence with intact skin is classified as a Stage 1 pressure injury.

A resident's stool appears black and tarry. The nursing assistant's best response is to:

Answer: Report the observation to the nurse right away

Black, tarry stool (melena) can indicate upper gastrointestinal bleeding and must be reported to the nurse immediately.

A nursing assistant notices a small reddened area over a resident's coccyx that does not blanch when pressed. This finding should be:

Answer: Documented and reported to the nurse immediately

Non-blanchable redness indicates a Stage 1 pressure injury and must be reported to the nurse right away for further assessment.

Which abbreviation correctly documents that a resident had a bowel movement?

Answer: BM

BM stands for bowel movement and is a standard, approved medical abbreviation used in care documentation.

When repositioning a resident to prevent pressure injuries, the nursing assistant should change the resident's position at minimum every:

Answer: 2 hours

Standard care guidelines require repositioning immobile residents at least every 2 hours to relieve prolonged pressure on tissue.

What is the proper technique for taking a patient's pulse?

Answer: Press the index and middle fingers on the patient’s wrist or neck.

The proper technique for taking a patient's pulse involves using the pads of your index and middle fingers, not your thumb, to gently press on an artery. Common sites are the radial artery in the wrist or the carotid artery in the neck. This allows you to feel the pulsations and accurately count the heart rate.