Chapter 17_ Personal Hygiene and Bed Making _ Nursing School Test Banks

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Chapter 17: Personal Hygiene and Bed Making MULTIPLE CHOICE 1. The nurse is aware that normal flora that does not cause disease but does prevent disease­causing microorganisms from reproducing is ... known as: a. sebum. b. the epidermis. c. resident bacteria. d. the dermis. ANS: C Bacteria reside on the skin’s outer surface. Resident bacteria constitute normal flora that does not cause disease but does prevent disease­causing microorganisms from reproducing. Sebum, secreted from hair follicles from sebaceous glands, provides an acidic coating. This acid coating protects the epidermis against penetration from chemicals and microorganisms. It also minimizes loss of water and plasma proteins. It is not alive, however, and is not considered flora. The epidermis, or outer skin layer, is the first line of defense from external injury and infection. It contains several thin layers of cells undergoing different stages of maturation. Resident bacteria live on its surface and protect it. Three primary layers make up the skin: the epidermis, the dermis, and subcutaneous tissue. The dermis lies underneath the epidermis and is not considered “flora.” Students Chat Room 19 2/20/2017 Chapter 17: Personal Hygiene and Bed Making | Nursing School Test Banks https://nursingtestbank.info/chapter­17­personal­hygiene­and­bed­making/ 2/28 DIF: Cognitive Level: Comprehension REF: Text reference: p. 392 OBJ: Discuss guidelines used to provide personal hygiene to patients. TOP: Resident Bacteria KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. In relation to hygiene and the acute care setting, the nurse knows that which of the following statements is true? a. The disposable bath is a less desirable form of bathing than the traditional basin bath. b. The disposable bath is a more desirable form of bathing than the traditional basin bath. c. The disposable bath is more desirable for patients who can bathe independently. d. The disposable bath is not an acceptable form of bathing in the acute care setting. ANS: B Prepackaged disposable bath products have been shown to decrease the spread of infection. The disposable bath is a desirable form of bathing for patients who are unable to bathe themselves in critical care and longterm care settings; it is even preferable to the traditional basin bath. DIF: Cognitive Level: Analysis REF: Text reference: pp. 394­395 OBJ: Discuss guidelines used to provide personal hygiene to patients. TOP: The Disposable Bath KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 3. The nurse is caring for a ventilated patient in the ICU who has just undergone coronary artery bypass. The nurse is concerned that the patient may be at risk for ventilator­acquired pneumonia (VAP). What step will she take to minimize this risk? Students Chat Room 19 2/20/2017 Chapter 17: Personal Hygiene and Bed Making | Nursing School Test Banks https://nursingtestbank.info/chapter­17­personal­hygiene­and­bed­making/ 3/28 a. Not provide oral hygiene because this may cause bacterial contamination of the airway. b. Be careful not to use chlorhexidine in oral care because it provides a medium for bacterial growth. c. Not use chlorhexidine in oral care because it enhances the rate at which VAP develops. d. Include the use of a chlorhexidine rinse as part of oral hygiene to delay the development of VAP. ANS: D Guidelines for oral care in ventilator patients and those who need assistance with oral hygiene often include the use of a chlorhexidine rinse as a part of oral hygiene. Chlorhexidine early in the postintubation period may help delay the onset or development of VAP. Presently, chlorhexidine is recommended during the postoperative period for patients undergoing cardiac surgery. Ventilator­associated pneumonia results from the colonization of bacteria in the oral pharynx. These microorganisms then migrate from the mouth into the lungs. Dental plaque is also a reservoir for microorganisms causing VAP. Because of this evidence, guidelines for oral care in ventilator patients and those who need assistance with oral hygiene often include the use of a chlorhexidine rinse as a part of oral hygiene. DIF: Cognitive Level: Application REF: Text reference: p. 411 OBJ: Discuss guidelines used to provide personal hygiene to patients. TOP: Chlorhexidine KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 4. The nurse plans to give the patient a therapeutic bath. Which of the following is considered therapeutic? a. Bed bath b. Sponge bath at the sink c. Sitz bath Students Chat Room 19 2/20/2017 Chapter 17: Personal Hygiene and Bed Making | Nursing School Test Banks https://nursingtestbank.info/chapter­17­personal­hygiene­and­bed­making/ 4/28 d. Bag bath ANS: C The Sitz bath cleanses and reduces pain and inflammation in perineal and anal areas. It is used for a patient who has undergone rectal or perineal surgery or childbirth or has local irritation from hemorrhoids or fissures. There are two categories of baths: cleansing and therapeutic. Cleansing baths include the bed bath, tub bath, sponge bath at the sink, shower, and bag bath. DIF: Cognitive Level: Analysis REF: Text reference: p. 395 OBJ: Discuss guidelines used to provide personal hygiene to patients. TOP: Therapeutic Baths KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 5. What should the nurse do before starting a patient’s bed bath? a. Lower the bed. b. Offer the bedpan or urinal. c. Partially undress the patient. d. Place the head of the bed in high­Fowler’s position. [Show More]

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