Patient Care and Safety Flashcards

When measuring a resident's blood pressure, the cuff should be placed:

Answer: About 1 inch above the antecubital space

The lower edge of the blood pressure cuff should sit approximately 1 inch (2–3 cm) above the antecubital fossa for accurate readings.

A nursing assistant is caring for a resident with a urinary catheter. Which action increases the risk of a catheter-associated urinary tract infection (CAUTI)?

Answer: Allowing the drainage bag to rest on the floor

Placing the drainage bag on the floor allows bacteria to travel up the tubing into the bladder, significantly increasing CAUTI risk.

A confused resident tries to climb out of bed at night. The most appropriate nursing assistant action is to:

Answer: Lower the bed to its lowest position and place the call light within reach

Lowering the bed and ensuring call-light access are safe, non-restraint interventions that reduce fall injury risk.

Which vital sign finding should the nursing assistant report to the nurse immediately?

Answer: Respiratory rate of 26 breaths per minute

A respiratory rate of 26 breaths per minute is above the normal adult range of 12–20 and indicates potential respiratory distress.

A resident's advance directive states 'Do Not Resuscitate' (DNR). The nursing assistant finds the resident unresponsive and not breathing. The correct action is to:

Answer: Call for the nurse immediately without beginning CPR

A valid DNR order means CPR should not be initiated; the nursing assistant must notify the nurse immediately and follow the documented care plan.

The purpose of using a draw sheet (lift sheet) when moving a resident up in bed is to:

Answer: Reduce friction and shear forces on the resident's skin

A draw sheet allows caregivers to slide the resident smoothly, reducing friction and shear that can damage fragile skin.

When providing oral care to an unconscious resident, the nursing assistant should position the resident:

Answer: On their side with the head slightly lowered (lateral Sims' position)

Lateral positioning with the head slightly lowered prevents aspiration of fluids into the airway during oral care.