Basic Nursing Skills Flashcards

Which of the following statements is TRUE in regards to administering a cleansing enema?

Answer: The enema bag should be hung on the IV pole with the tubing at the bottom

When administering a cleansing enema, the enema bag is typically hung on an IV pole to utilize gravity for a controlled flow of the solution into the rectum. The tubing should be positioned at the bottom of the bag to allow the fluid to drain effectively. The height of the bag, usually 12-18 inches above the patient's anus, is crucial for regulating the flow rate and preventing discomfort.

A person drinks 1 cup of apple juice with their breakfast. How many milliliters should be recorded?

Answer: 240 mL

In healthcare, a standard conversion for fluid measurement is that 1 cup is approximately equivalent to 8 fluid ounces. Since 1 fluid ounce is roughly 30 milliliters (mL), multiplying 8 ounces by 30 mL/ounce yields 240 mL. Therefore, 1 cup of apple juice should be recorded as 240 mL for accurate intake tracking.

If you have a patient who cannot independently perform range of motion, your job is to help them by performing passive range of motion (PROM). PROM will help the patient with all of the following EXCEPT:

Answer: Increase his or her nutrition

Passive Range of Motion (PROM) exercises involve a caregiver moving a patient's joints through their full range of motion when the patient cannot do so independently. PROM is beneficial for preventing muscle atrophy, improving circulation, and maintaining joint flexibility. However, these exercises do not directly influence or increase a patient's nutritional intake or status, which is primarily determined by diet.

Which of the following demonstrates a barrier to effective communication?

Answer: Responding to the patient by saying “Don’t worry your doctor always knows best”

Responding to a patient with phrases like 'Don’t worry your doctor always knows best' is a barrier to effective communication because it dismisses their feelings and concerns. This type of response can make the patient feel unheard, invalidate their anxieties, and discourage them from expressing further questions or fears. Effective communication requires active listening, empathy, and encouraging open dialogue.

Which of the following statements is FALSE in regard to indwelling catheter care for a male patient?

Answer: Leave the perineal area moist after cleaning it

After performing indwelling catheter care, it is essential to thoroughly dry the perineal area. Leaving the area moist can create a favorable environment for bacterial or fungal growth, increasing the risk of skin irritation, breakdown, and infection. Proper drying helps maintain skin integrity and reduces the potential for complications.

Which of the following statements BEST describes abduction?

Answer: When you move the extremity away from the body

In anatomical terminology, abduction refers to the movement of a limb or body part away from the midline of the body. For example, lifting your arm out to the side is abduction of the shoulder. Conversely, adduction is the movement towards the midline of the body.

An important way to reduce the incidence of decubitus ulcers is to:

Answer: Change position every 2 hours

Decubitus ulcers, or pressure sores, are caused by prolonged pressure on the skin, which restricts blood flow and leads to tissue damage. The most effective preventative measure, especially for immobile clients, is to regularly change their position, typically every two hours. This relieves pressure on vulnerable areas, allowing blood flow to resume and preventing skin breakdown.

You are told to put a client in Fowler's position. Before changing the position of the client's bed you should:

Answer: Explain the procedure to the client

Before performing any procedure, including changing a client's position, it is a fundamental principle of patient care to explain what you are going to do. This practice respects the client's autonomy, helps them understand the procedure, reduces anxiety, and encourages cooperation. It ensures informed consent and builds trust between the caregiver and the client.

When giving mouth care to an unconscious patient, the safest position to prevent aspiration is:

Answer: With the head turned to the side.

When providing mouth care to an unconscious patient, the primary concern is preventing aspiration, where fluids or debris enter the lungs. Turning the patient's head to the side allows gravity to facilitate the drainage of any liquids or secretions out of the mouth, significantly reducing the risk of them being inhaled into the airway and causing complications like pneumonia.

Mr. Roark, a newly admitted conscious client, has been put to bed. Before leaving him alone, the FIRST action would be to:

Answer: Make sure he knows how to use the call light

For a newly admitted conscious client, ensuring their safety and ability to call for help is the absolute first priority before leaving them alone. The call light is their primary means of communication for needs or emergencies. Explaining its use and placing it within easy reach empowers the client and prevents potential distress or harm.

A patient has a new cast on his right arm. While caring for him, it is important to FIRST observe for:

Answer: Warmth and color of fingers.

When a patient has a new cast, it is crucial to monitor for signs of impaired circulation, which can occur if swelling develops under the cast. Observing the warmth and color of the fingers (or toes, if a leg cast) distal to the cast provides immediate indicators of blood flow. Coldness, pallor, or a bluish discoloration (cyanosis) would signal a circulatory compromise requiring urgent attention.