chapter 1: answers to workbook pages 1.a matching...

Chapter 1: Answers to Workbook Pages

1.A Matching Definitions

1. K 5. E 8. F 11. D

2. C 6. B 9. M 12. J

3. G 7. I 10. H 13. L

4. A

1.B Reflective Short-Answer Exercises

1. Florence Nightingale felt that the caregiver’s role was to help the individual make the fullest recovery possible. When giving care, she considered not only the person but also the environment. She felt that a healthy environment was important to help a patient regain his health.

2. Factors preventing her from seeking medical care include limited finances and inability to pay the insurance deductible.

3. No, illnesses such as asthma are best managed through regular doctor visits and medications.

4. No, it is not cost effective because urgent care is more costly than office visits.

1.C Fill in the blanks using terms found in the word bank.

1. sick, injured, poor 7. home care

2. infectious illness 8. assisted-living facilities

3. arthritis, heart disease 9. respectful

4. managed health care organizations 10. Medicare

5. inflation 11. quality of life

6. competition

1.D Multiple-Choice Exercises

1. c 5. c 9. b

2. d 6. d 10. d

3. b 7. a 11. b

4. a 8. d

1.E Choose the best response to the following scenarios.

1. a 2. c 3. a 4. b 5. d 6. c



1. D 5. H 8. B 11. C

2. F 6. L 9. A 12. G

3. J 7. M 10. I 13. K

4. E


1. An assisted-living facility helps residents or clients with basic needs such as bathing, cooking, and cleaning, as well as providing social activity. A nurse may be on staff but is not present 24/7. It bridges the gap between independent living and the need for skilled nursing care. A long-term care facility offers skilled nursing care 24/7 and provides basic needs. Each type of facility also follows different regulations.

2. Steve is struggling due to the difference in nursing assistant responsibilities. Assistants working in a nursing home assist with daily tasks such as bathing, ambulation, and feeding. In an assisted-living facility, they help with basic care, as well as meal preparation and servicing, light housekeeping, and possibly medication administration.

3. In various settings, the client may have different abilities and require different levels of care. The duties and responsibilities of the nursing assistant may also vary depending on the type of facility.

4. Yes, bodies such as OBRA regulate resident care and rights, as well as training requirements. This, in turn, determines what duties need to be performed by the nursing assistant.

5. Steve could have discussed expectations during the hiring process, or he could have spoken with his supervisor or nurse to clarify questions regarding duties for his shift.

2.C Fill in the blank using terms found in the word bank.

1. Provide personal care 8. Document

2. Scope of practice 9. Chain of command

3. Assisted-living facilities 10. Hospice, dying

4. Home health aides 11. Reinforce

5. Acute care 12. Refuse

6. Omnibus Reconciliation Act

7. Medicare


1. d 5. b 9. a

2. b 6. a 10. b

3. b 7. b 11. c

4. a 8. d 12. b


1. b 2. a 3. c 4. b 5. d 6. a



1. D 5. J 9. H 13. M

2. K 6. F 10. G 14. N

3. C 7. L 11. I

4. B 8. E 12. A


1. NPO stands for “nothing by mouth.” This includes providing the client with ice chips.

2. The error could have been avoided by ensuring that the nursing assistant or visitors do not offer ice chips, food, or fluids to the client. A sign can be placed in the client’s room above the bed or other prominent place. The nursing assistant must be aware of the meaning of NPO.

3. It is the nursing assistant’s responsibility to understand commonly used abbreviations. She can ask for clarification if she is unsure of the meaning of NPO. She can also look up the meaning in the facility’s list of approved abbreviations.

4. The nursing assistant should have informed the nurse that she is unsure what NPO means and asked for clarification of the NPO order. Margaret could also have informed the nurse of Mrs. Grey’s complaints of dry mouth and asked what interventions could be done to decrease the discomfort.

5. The objective data includes the client’s emesis, her statement regarding stomach pain, and the vital signs the nursing assistant obtained.

6. Margaret could have reminded the client of her NPO status, reinforced any teaching that the nurse had done, reminded Mrs. Grey of the possible consequences of not adhering to the prescribed diet, offered oral care, and placed a sign in the client’s room. She should be clear and direct while remaining respectful.

7. Margaret needs to clearly state who she is, and what she will be doing to care for her client. She should remain respectful and allow Mrs. Grey an opportunity to express her feelings.


1. Lives 6. Medical abbreviations 11. Acquired

2. Subjective data 7. Incident report 12. Training

3. Objective data 8. Hearing loss 13. Aphasia

4. Oral report 9. Nonverbal communication

5. Verbal communication 10. Language


1. c 5. a 9. b 13. a

2. c 6. d 10. c 14. c

3. b 7. b 11. b

4. d 8. c 12. a


1. c 2. b 3. a 4. b 5. a 6. b



1. K 6. C 11. H 16. I

2. D 7. A 12. L 17. S

3. E 8. M 13. Q 18. P

4. G 9. O 14. F 19. N

5. B 10. J 15. T 20. R


1. Confidential information protected by HIPAA includes the method used to transfer the client, the fall, the transfer to the emergency room, the diagnosis, and the admission to the hospital for corrective surgery.

2. No, it is not informed consent, since it is the nurse’s or physician’s role to inform the client about the options and consequences of her choices.

3. No, the nursing assistant was not abiding by her responsibilities, since she was not following the care plan. This means she didn’t maintain client safety and didn’t follow the plan developed by the nurse.

4. She refused to complete a delegated task.

5. She should have asked for assistance from either another nursing assistant or from the nurse.

6. The negligent action was not following the care plan.

7. She is at risk for suspension or loss of her job. She might be flagged on the registry or lose her certification.

4.C Fill in the blanks with terms from the word bank.

1. Abuse 6. Neglect 11. Nurse aid registry

2. Work Ethic 7. Leave of absence

3. Assault 8. Mandatory reporter

4. Cultural competence 9. Informed consent

5. Touching 10. Privacy


1. c 6. c 11. a

2. b 7. c 12. c

3. c 8. a 13. d

4. d 9. b

5. b 10. d


1. b 2. c 3. a 4. d 5. b 6. c



1. L 6. M 11. O 16. A

2. J 7. D 12. F 17. T

3. S 8. P 13. C 18. R

4. B 9. H 14. G 19. E

5. K 10. N 15. I 20. Q


1. Possible injuries include head injury, bone fractures, muscle sprains, skin tears, and bruising.

2. Inability to put weight on the leg and muscle weakness might interfere with getting up from the floor.

3. Decreased sight may cause tripping on objects, bumping into obstacles, or miscalculating distances. Changes in the inner ear may cause decreased balance. Sensation of touch decreases as nerve fibers that send and receive messages slow down with age, resulting in slower responses to stimuli.

4. Yes, heart medications may have caused him to become dizzy. Lung and kidney function slows, leading to poor absorption and metabolism of drugs.

5. Integumentary: Layers of the skin become thinner and lose elasticity. Underlying blood vessels are more visible, and bruising more apparent. Musculoskeletal: Decreased muscle mass and slower contraction of muscles lead to increased weakness and fatigue. Bone mass declines, becoming more brittle and breaking more easily. Respiratory: Lungs do not expand and contract as efficiently due to overall muscle weakness, leading to a decrease in air exchange and a decreased tolerance to exercise. Cardiovascular: Fewer red blood cells means less oxygen is delivered to the body tissue, which can cause increased fatigue. Nervous: Speed decreases, leading to older people taking more time to process and act on information. Endocrine: Decreased metabolism may lead to drug toxicity. Urinary: Kidneys are less effective at removing wastes from the blood, resulting in possible drug toxicity. Bladder is less responsive to stretch receptors and less elastic, which leads to the elderly client needing to void more

often. Urethral sphincter may lose ability to expand and contract voluntarily, resulting in incontinence.

5.C Fill in the blanks using terms from the word bank.

1. Smallest 6. Alimentary canal

2. Hormone 7. Melanin

3. Contracts, relaxes 8. Muscle

4. Organ system 9. Body, brain

5. Middle layer 10. Integumentary system


1. c 4. d

2. a 5. b

3. c 6. a


1. b 2. a 3. b



1. E 4. D 7. O 10. H 13. C 16. N

2. A 5. I 8. F 11. P 14. K

3. J 6. G 9. L 12. B 15. M


1. Frank may be experiencing a cardiovascular accident, or stroke.

2. Symptoms include atypical behavior, facial drooping on one side of the mouth, one-sided weakness, inability to understand speech, confusion, inability to form words, and increased difficulty in transferring.

3. Providing emergency care in a timely fashion can potentially minimize side effects and decrease the chance of death.


1. Pressure injury 4. Smell, sound 7. Shortness of breath

2. Physical 5. Evidence 8. Urinate

3. Atrophy 6. Hunched 9. Dysrhythmia


1. d 2. b 3. a 4. c


1. b 2. a 3. c



1. D 4. A

2. B 5. C

3. E


1. Healthcare workers could become ill after exposure to germs. They could also potentially carry those microbes home, making family members ill.

2. Other clients in the facility would be at risk of exposure if staff did not wash hands between client contacts or if the appropriate PPE was not utilized.

3. Handwashing

4. No, staff must wash hands. C. Diff is not killed by hand sanitizers.

5. The nursing assistant should disinfect any equipment, including the wheelchair if used; wash the client’s hands; ensure the client is wearing a clean gown; toilet the client; have the client wear a brief if he is still experiencing explosive diarrhea.

6. The nursing assistant should also alert the radiology staff of the client’s contact isolation status so that they may be prepared.


1. Vaccine 6. Chain of infection

2. Primary prevention 7. Infection control

3. Antibody 8. Healthcare workers

4. Barrier 9. VRE, MRSA

5. Immunity


1. b 5. c 9. b 13. a

2. d 6. b 10. d 14. c

3. d 7. a 11. c

4. c 8. a 12. b


1. b 2. a 3. b 4. c 5. b 6. d



1. B 2. C 3. E 4. D 5. A


1. Working the 3:00 p.m. to 11:00 p.m. shift may have contributed to the incident. It is common for the evening shift to have fewer staff members present. Clients may also be more tired as the night progresses, resulting in more difficulty in transfers. Other factors contributing to injuries include not following the care plan, possible attempt to “catch” the client instead of lowering the client to the ground, and poor body mechanics.

2. Prevention of injuries includes waiting for assistance from another staff member, discussing the transfer and asking about a possible change in care plan with the nurse, using a sit-to-stand device if approved by nurse, using good body mechanics, making healthy lifestyle choices to reduce the chance of back injury, and ensuring that the floor is not wet and is free of obstacles.

3. Consistently use good body mechanics, get help when lifting or moving heavy objects, do not store large or heavy objects on top shelves, exercise regularly, maintain a healthy weight, and wear appropriate shoes with good support.

4. Yes, she might be subject to disciplinary action, or even forfeiture of her certification as a nursing assistant, since she did not follow the care plan.

5. She must report to the nurse or her immediate supervisor.

6. She needs to fill out an incident report.

8.C Fill in the blanks with terms found in the word bank.

1. Employer, insurance company 5. RACE 9. Physically

2. Ergonomics 6. OSHA 10. Walkways

3. Workplace violence 7. PASS 11. Chemical

4. Blood-borne pathogens 8. Dangerous 12. Emergency plans


1. d 5. c 9. b

2. b 6. a 10. c

3. b 7. b

4. d 8. d


1. c 2. a 3. c 4. d 5. b 6. a


9.A Definitions

1. Ambulatory: The ability to get up out of bed and walk

2. Gait: A person’s pattern of walking


1. It is likely her husband will need to be admitted to a nursing home or assisted-living facility. A caregiver in the home may be an option but can be costly.

2. Sally may feel guilty for not taking care of her husband, concerned for his welfare, or worried about the hospital and nursing home costs.

3. The nursing assistant could help Sally by doing the following: (a) Ensure the client does not suffer a second fall. (b) Assist with daily care such as dressing, eating, and hygiene. (c) Use active listening skills and allow the client to express her feelings. (d) Assist the client in visiting her spouse if he is admitted to the same facility. (e) Notify the nurse if there are signs of pain or changes in Sally’s condition. (f) Encourage client independence in order to assist Sally in reaching her therapeutic goals.

4. Factors that may have contributed to Sally’s fall include (a) a throw rug on the floor; (b) dim lighting at night; (c) using the bathroom in the night, especially if it is far from the bedroom or located up a set of stairs; (d) age-related changes such as loss of balance, frequent voiding, fatigue and generalized weakness, poor activity tolerance, or decreased sense of touch; and (e) inadequate or no footwear.

5. Steps to take to prevent a fall include (a) removing obstacles from the floor, including rugs; (b) keeping rooms and hallways well lit; (c) installing grab bars in the bathroom; (d) keeping assistive devices such as canes or walkers nearby; (e) maintaining muscle strength by participating in exercise classes or walking; (f) wearing nonskid footwear; and (g) having regular vision and hearing checks.


1. Ambulatory 6. Upright

2. Gait 7. EMS

3. Fall 8. Programs

4. Death rates 9. Strengthening

5. Nursing assistant 10. Alarm systems


1. d 4. c 7. d 10. b

2. b 5. a 8. a 11. d

3. b 6. c 9. c


1. c 2. b 3. a 4. d 5. c 6. d


10.A Definitions

1. Restraint: any physical or chemical limitation that limits or prevents a client from moving freely about his environment


1. No, restraining the client does not decrease aggressive behaviors or prevent physical outbursts. Clients may become anxious, scared, or angry.

2. Physical risks include increased dependence, agitation, behavioral problems, pressure injuries, bowel and bladder incontinence, fecal impaction, muscle cramps and atrophy, falls, and death. Emotional risks include loss of dignity, depression, and decreased self-worth.

3. No, a chemical restraint has several side effects, and not all medications have been studied in clients with dementia.

4. Risks of using medication include increased drowsiness and fatigue, decreased independence, increased risk of falls, potential interactions with other medications, and limiting the client’s ability to function at his normal capacity.

5. Restraint alternatives include using therapeutic communication, decreasing stimuli, avoiding known triggers, tending to needs like toileting on a consistent basis, offering food and liquids frequently, encouraging exercise and activity, providing one-on-one care, encouraging the client to be close to staff, having familiar objects nearby, using a calm and slow approach, checking on the client frequently, reducing or eliminating the use of alarms, and reapproaching as needed.


1. Restraint 5. Physical, emotional 9. Bedframe

2. Medicare, Medicaid 6. 15 minutes 10. Safety

3. Two 7. 2 hours 11. Chemical

4. Safety 8. Range-of-motion


1. d 5. c 9. b

2. c 6. c 10. d

3. b 7. a 11. b

4. b 8. c 12. d


1. d 2. a 3. d 4. b 5. d 6. c



1. M 5. D 9. J 13. G

2. F 6. I 10. E 14. A

3. K 7. L 11. H

4. N 8. C 12. B


1. It is likely that he walked away due to being embarrassed.

2. No, the nursing assistant should remain with the client until his airway has cleared. A partial obstruction can worsen and become a complete obstruction.

3. No, abdominal thrusts should not be done, since the client has not given consent. If he does give consent, abdominal thrusts can be done at that time.

4. He originally had a partial obstruction.

5. Symptoms of a partial obstruction include choking or coughing.

6. He had a complete airway obstruction by the end of the scenario.

7. Symptoms of a complete airway obstruction include a high-pitched wheeze or no sound at all; a red, gray, or bluish color to the skin; and possibly one or two hands to the throat.

8. The nursing assistant should have activated the EMS when she noted the wheezing and the cough becoming weaker.


1. Anaphylactic shock 7. Sitting

2. Epidermis 8. Blood

3. Cardiac arrest 9. Brain

4. Seizure 10. Life-threatening

5. Cardiogenic shock 11. Consciousness

6. Complete airway obstruction 12. Emergencies


1. c 5. b 9. b 13. d

2. a 6. a 10. b 14. a

3. b 7. d 11. a 15. b

4. c 8. c 12. c 16. c


1. c 2. b 3. b 4. c 5. a 6. d



1. D 2. E 3. A 4. C 5. B


1. (a) Physiological needs: offer food and fluids frequently, meet elimination needs promptly, reposition frequently, and ambulate. (b) Safety: ensure alarm systems are in place, reduce fall risks, lock up chemicals, and keep sharp or dangerous objects out of clients’ reach. (c) Love and belonging: offer choices, treat clients with dignity and respect, promote independence, and encourage clients’ participation in forming plan of care. (d) Esteem: let the client know that he is valued by offering choices. (e) Self-actualization: encourage the client’s participation in arts and crafts activities, social gatherings, and outings; provide mind-stimulating games and activities.

2. Gene is in the infancy stage: nonverbal and distrustful of primary caregivers.

3. Quality of life is diminished, as evidenced by his apparent inability to enjoy life.

4. The nursing assistant should care for the client holistically by addressing emotional health, physical comfort, spiritual wellness, and social activity.

5. Look for signs of stable emotional health: contentment, smiling, healthy interactions with others, finding joy in life, participation in activities, a positive outlook, having fun, laughing, demonstrating respect for others, solid self-esteem, resilience against stressors, and maintaining healthy relationships.

6. The nursing assistant should meet the client’s needs starting with survival needs: allow for healthy interactions with others, offer opportunities for him to express himself, develop the client–caregiver relationship, and finally assist the client in meeting self-actualization.

7. (a) Emotional: ensure safety, use therapeutic communication, allow time for the client to express his feelings, develop rapport with the use of activities, encourage brain-stimulating games, encourage visits from family and friends, offer choices, and offer time to participate in hobbies. (b) Physical: offer food and fluids frequently, ambulate, reposition frequently, address elimination needs, and utilize nonpharmacological interventions to decrease discomfort or pain. (c) Spiritual: offer opportunities to attend religious meetings or services, yoga, meditation, and relaxation breathing exercises;

provide privacy; decorate room with spiritual artifacts or religious icons if the client desires.

8. He can watch television, listen to stories read aloud, attend church, participate in group exercises, make crafts, look through photographs, attend activities such as ice cream socials, or go for walks with a caregiver.

9. The nursing assistant can develop a bond with the spouse, offer opportunities for privacy, suggest that she volunteer at the facility, or suggest group activities or classes.


1. Physical, emotional 6. Enhances

2. Internal 7. Measure

3. Quality of life 8. Pain

4. Abraham Maslow 9. Nonverbal

5. Milestones 10. Religious beliefs


1. d 6. d

2. a 7. b

3. c 8. a

4. b 9. c

5. d 10. d


1. b 2. a 3. c 4. a 5. b



No definitions listed for this chapter.


1. Basic human needs include food, water, breathing, elimination, sleep, homeostasis, and sex. The facility must also meet his safety needs.

2. In a LTC facility, each room must have no more than four people in a room, at least 80 sq. ft. per client in a shared room or 100 sq. ft. per client in a private room, at least one window facing outside, a closet with shelves and clothing racks, direct access to an exit corridor, privacy curtains in a shared room, an appropriate bed with clean and comfortable mattress and linens, access to toileting facilities, and a call-light system for each client. An assisted-living facility should have a way for each client to call for assistance, equipment needed for care appropriate for the client, and the means to provide comfort and privacy.

3. She should look for low noise levels, safety systems in place, clean and tidy rooms, and clean equipment.

4. Poor quality of care may be indicated by multiple alarms sounding, dirty and untidy rooms, unpleasant odors, or unkempt clients.

5. Each facility should be clean with a homelike atmosphere.

6. Facilities should be free of fecal and urine odors.

7. They can bring in items from home such as comforters, recliners, small pieces of furniture, or artwork.

8. In an assisted-living facility, the family can bring in the client’s own furniture, linens, towels, photographs, and small personal items.

9. The daughter needs to choose a facility that best addresses her father’s physical, safety, and emotional needs.


1. Rights 7. Bathroom

2. Privacy 8. Call-light system

3. Welcoming 9. Alarms

4. Safety 10. Smelling

5. Minimum 11. Clients

6. Water 12. Assisted-living


1. c 4. a 7. c 10. d

2. b 5. d 8. a 11. a

3. d 6. c 9. b


1. b 2. a 3. b 4. c 5. d



1. D 5. F

2. B 6. C

3. A 7. E

4. H 8. G


1. She may have an altered perception of discomfort due to dementia. Diabetic clients may have decreased sensation.

2. The client has signs of a stage-one pressure injury.

3. Yes, this must be reported to the nurse immediately.

4. She is incontinent of feces and urine, requires assistance with mobility, has poor intake, has dementia, does not follow her diabetic diet, has increased fragility of skin due to age, and is wheelchair bound.

5. Incontinence affects the skin by increasing the moisture on the surface of the skin, leading to maceration; changing the pH of the skin; increasing the temperature of the skin with the use of an incontinence garment; and causing excoriation.

6. She should be repositioned every 2 hours while in bed and every hour when up in a chair.

7. Incontinence care should be completed at least every 2 hours and as needed.

8. The best product to use for providing peri-care is one specifically designed for that purpose.

9. The nursing assistant can encourage toileting, avoid vigorous drying when performing peri-care, reposition the client frequently, use an approved barrier cream on the area, provide adequate nutrition and hydration, discourage intake of sweets, avoid the use of too many blankets, avoid the use of incontinence garments while the client is in bed, place a pressure-relieving device in the wheelchair and bed as ordered, and use a lift sheet for positioning to reduce shearing.

10. No, alternative desserts should be offered instead of additional sweets. If the client insists on eating the additional sweets, she has that right. The nurse should be updated regarding the client’s wish.


1. Bone 6. Heat, humidity

2. Eschar 7. Shear

3. Debridement 8. Prevention

4. Movement 9. Rashes

5. Immobility 10. Hydration


1. d 6. d

2. b 7. c

3. c 8. a

4. a 9. d

5. b 10. b


1. a 2. b 3. b 4. c 5. d



1. F 4. B

2. A 5. D

3. E 6. C


1. An incontinence pad should be used.

2. The nursing assistant should perform hand hygiene, carry linens away from the body and uniform, and place clean linens on a clean surface. Linens that fall to the floor should be placed in the dirty laundry hamper and replaced with clean linens.

3. Items to assemble include gloves, personal hygiene items, fitted sheet, incontinence pad, lift sheet if needed, top sheet, bed blanket or bedspread if needed, pillowcase, bath blanket (if available), and clean clothes or gown for the client.

4. A complete bed change needs to be done using a bath blanket (if available) or some other type of covering for comfort and privacy.

5. The linens need to be placed in a hamper. If there is no hamper nearby, they should be bagged prior to walking in the hallways. If there is not a laundry facility in the building, the linens should be laundered promptly by the nursing assistant.


1. Warmth, privacy 6. Clean, dry

2. Linens 7. Lift sheet

3. Occupied bed change 8. Bath

4. Open bed 9. Housekeeping staff

5. Contamination


1. c 6. d

2. a 7. b

3. b 8. c

4. c 9. a

5. a 10. b


1. b 2. a 3. c 4. d 5. b


16.A Definitions

1. Gait belt: a device that is placed around the client’s waist when assisting the client with a transfer or ambulation

2. Trapeze: a device attached to the client’s bed frame and extending out overhead; allows the client to assist in repositioning herself


1. It helps prevent the complications associated with immobility and decreases the risk of choking or aspiration.

2. Devices to use may include trapeze, side rails, or draw sheet. A top sheet, bath blanket, or bed blanket can be substituted for a regular draw sheet.

3. The movement should be broken up into smaller steps. Raise the side rail, and ask the client to grasp the rail and roll onto her side. Use the substitute draw sheet to assist her to her side. Then help her to a sitting position; raise the head of the bed if necessary.

4. A sit-to-stand device could be used if the client’s weight is not greater than the device’s capacity. If the client is unable to stand or bear weight, a bariatric lift may be used.


1. Repositioned 6. Ligament 11. Tripod

2. Flat 7. Safety 12. Waist

3. Sims’s 8. Semi-Fowler’s 13. Bed frame

4. Sleeping 9. Fowler’s 14. Transferring

5. Muscles 10. Shearing


1. d 5. d 9. c 13. b

2. a 6. a 10. b 14. c

3. b 7. c 11. d

4. b 8. b 12. d


1. a 2. d 3. a 4. c 5. b 6. a 7. b



1. B 4. D 7. G

2. C 5. H 8. A

3. F 6. E


1. Ambulation decreases risk of constipation, prevents or eases bloating and gas, encourages circulation, improves muscle and bone health, decreases risk of contractures and pressure injuries, improves cardiovascular function, improves balance, increases or maintains range of motion in the joints, decreases edema in the lower extremities, and improves blood flow to the skin.

2. The client needs an assist of at least one, and two with weakness.

3. Yes, nursing assistants can use more assistance than stated in the care plan, but never less.

4. Safety interventions include ensuring the care plan is followed; locking the brakes of a wheelchair before the client stands; pulling the wheelchair behind the client; using a gait belt with an underhand grasp; ensuring that assistive devices are near and working properly; ensuring that the client has appropriate footwear; anticipating the distance the client may ambulate; communicating to the client during transfers and ambulation; and may have one nursing assistant on each side of the client for stability.

5. Assistive devices include a gait belt and wheeled walker. If the client is steady, a cane can be placed in the client’s unaffected hand before beginning to walk.

6. The nursing assistant can perform range-of-motion exercises and encourage the client’s participation in ADLs.


1. Family members 7. Digestive system

2. Skin 8. Physical therapist

3. Cardiovascular 9. Rubber-tipped spoon

4. Safety 10. Moving, ambulation

5. Nursing assistant 11. Occupational therapist

6. Maximize


1. d 5. b 9. b 13. c

2. b 6. a 10. c 14. c

3. a 7. c 11. a

4. c 8. b 12. a


1.c 2. c 3. b 4. a 5. b 6. d



1. H 5. A

2. B 6. C

3. G 7. D

4. E 8. F


1. Yes, it was an appropriate time, since the client was experiencing a change in his medical status. The information can then be given to the emergency team upon their arrival.

2. The equipment needs to be cleaned with alcohol and probe covers discarded.

3. No, his temperature is 99.9°F. Normal for an axillary temperature is 97.6°F.

4. No, his pulse is 108. Normal pulse for an adult is 60–100 bpm.

5. Yes, his respirations are 14 per min. Normal is 12–20 per minute.

6. No, his BP is elevated at 190/98. Normal is below 120/80.


1. Sixty 5. Painful

2. Bradypnea 6. Tachypnea

3. Hypertension 7. Stethoscope

4. Hypotension 8. Tachycardia


1. a 4. b

2. b 5. d

3. a 6. c


1. b 2. a 3. a 4. b



1. Peri-care: Washing the perineal area

2. Paraphimosis: The swelling that prevents the retraction of the foreskin back over the glans, or head, of the penis


1. The client has a UTI, which can lead to confusion in an older client.

2. No, the nursing assistant should stop the bath. Continuing with the bath may lead to an escalation in behavior.

3. Alternatives include a towel bath, a partial or complete bed bath, rinseless products, covering the client with a towel or bath blanket while washing, or shampooing while the client is dressed.

4. Interventions include shampooing the hair while the client is in bed, using a rinseless system such as a prepared shower cap, or using the beauty shop.

5. Duties may include obtaining the client’s weight, changing bed linens, performing hair care, doing a skin check, taking vital signs, and performing nail care.


1. Supplies 6. Challenge 11. Room

2. Perineal 7. Empathetic 12. Showers or tub baths

3. Client 8. Privacy 13. Urethra

4. Partially bathed 9. Alternatives

5. Skin 10. Rinseless


1. d 5. b 9. b 13. d

2. c 6. c 10. c 14. d

3. a 7. a 11. a

4. d 8. d 12. c


1. d 2. a 3. b 4. c 5. a



1. B 2. C 3. A


1. Allow the client to make choices regarding grooming and dressing, allow the client time to perform tasks, offer choices, promote independence by encouraging the client to perform tasks within her abilities, and acknowledge completed tasks and the client’s progress.

2. The nursing assistant should support the right arm and guide it through the sleeve of the shirt until the shirt is as far up the arm as possible. Then, bring the left arm through the left sleeve.

3. Encourage the client to wear her glasses as prescribed and ensure that the glasses are comfortable.

4. Ensure that the glasses are clean and that all pieces are intact. The nursing assistant also needs to check the skin behind the client’s ears.


1. Oral swabs 4. Two 7. Hearing aid

2. Nails 5. Affected 8. Direction

3. Independent 6. Soft cloth 9. Every night


1. d 4. b 7. b 10. a

2. b 5. a 8. d 11. c

3. a 6. c 9. c


1. b 2. c 3. d 4. c 5. d 6. c



1. B 4. D

2. C 5. A

3. E 6. F


1. Yes, it is a client’s right to make choices regarding the foods he wishes to eat.

2. The client can be encouraged to follow a healthy diet by reinforcing education the nurse has already provided. The nursing assistant can ask the client what foods would be acceptable as an alternative to the pizza.

3. If the client continues to refuse the supper offered, the nursing assistant needs to update the nurse and watch the client closely for signs of abnormal glucose levels.

4. He is ingesting simple carbohydrates.

5. He is eating pepperoni, which is a highly processed meat high in saturated fats.

6. Saturated fats can lead to atherosclerosis and high cholesterol.

7. Pepperoni and cheese are both protein sources.

8. They are not good protein sources, since both are high in sodium and fat.

9. The client might benefit from a diabetic or consistent carbohydrate diet to help control blood glucose levels, a low-fat or low-cholesterol diet due to his history of heart disease, and a low-sodium diet to control blood pressure.


1. Blood sugar 6. Dairy 11. Dialysis

2. Calories 7. Encourages 12. Grains

3. Vegetables 8. MyPlate

4. Hypervitaminosis 9. Starches

5. Enzyme 10. Water-soluble


1. d 5. a 9. a 13. c

2. c 6. b 10. b 14. c

3. b 7. d 11. d 15. a

4. c 8. c 12. a


1. c 2. c 3. d 4. a 5. b 6. d 7. b 8. b



1. F 5. H

2. C 6. G

3. E 7. D

4. A 8. B


1. Yes, he is at risk for skin breakdown due to his colostomy, catheter, and immobility.

2. A catheter is placed when a client has urinary retention. This may have been caused by damage to the brain or spinal cord.

3. The catheter holder needs to be attached to either the client’s thigh or abdomen.

4. The nursing assistant can use medical tape to secure the catheter.

5. The nursing assistant needs paper towels, alcohol wipes, and a graduate. If a graduate is not available, a urinal can be used to measure the urinary output.

6. Yes, the bowel movement still needs to be documented. If it is not, the client may receive unnecessary medication.


1. Colostomy 6. Urinary retention 11. Indwelling catheter

2. Suppository 7. Elimination 12. Catheter holder

3. Hemorrhoids 8. Incontinence garment 13. Bedpan

4. Bladder 9. Hidden

5. Contamination 10. Abdomen


1. c 6. d 11. d

2. d 7. a 12. d

3. b 8. c 13. a

4. c 9. d

5. c 10. b


1. c 2. d 3. c 4. b 5. c 6. b



1. B 2. A 3. C


1. No, the disease worsens over time, and there is no cure.

2. She is likely in stage three: severe or late stage, which includes severe mental decline and loss of physical functioning.

3. Symptoms include agitation, wandering, sleep disturbances, emotional upset, and impaired communication.

4. Unmet needs might include toileting, hunger, thirst, sensory activities, sleep or rest, or uncomfortable or wet clothing.

5. Interventions may include reminiscence, activity, or pet therapy. The nursing assistant also must ensure that basic needs are met.

6. Approach with a smiling face; a positive, respectful, and kind attitude; slow pace; and quiet temperament.

7. The nursing assistant can place a small nightlight in the client’s room, tend to sounding alarms promptly, and keep the client with her if the client wakes.

8. The client can be kept safe through the use of wander alert systems at each exit, special locked units, and gated courtyards or patios.

9. Stress may come from sleeplessness, financial strain, guilt, grief, and emotional pain. It is distressing to see a loved one change. Harry may doubt the decision because of Olga’s behavior in a new environment or may feel guilty about being unable to care for her.


1. Memory 5. Plaques, tangles 9. Obsessed

2. Elopement 6. Dementia 10. Sexual

3. Restlessness 7. Behaviors 11. Memories

4. Alzheimer’s 8. Unmet 12. Managed


1. d 5. d 9. d

2. b 6. a 10. b

3. d 7. d 11. c

4. c 8. c 12. a


1. c 2. b 3. a 4. b 5. d 6. c 7. b


24.A Definitions

1. Mottling: an appearance of purplish marbling on the skin as a result of poor blood flow to the extremities

2. Cheyne-Stokes breathing: a pattern of fast, shallow breathing followed by slow, deep breathing, with periods of apnea


1. The nursing assistant must be strong, supportive, and caring of both the client and the client’s family. Caregiving should be flexible in order to accommodate the client, the family, and his religion as long as it causes the client no harm and does not infringe on the rights of other clients. The nursing assistant may use the privacy curtain or ask the family to step outside of the room while completing personal care.

2. He is experiencing Cheyne-Stokes breathing. The nursing assistant can explain that it is a pattern of fast, shallow breathing followed by slow, deep breathing, with periods of apnea. The nursing assistant can reassure the family that this is a normal stage in the dying process and that the healthcare team is keeping the client comfortable.

3. Yes, he likely is able to hear the chanting because hearing is the last of the senses to fade.

4. The chanting may provide him comfort as part of his religion and as a reassurance that family is near.

5. Yes, this may occur as digestion slows and the client is unable to take in food.

6. Yes, voiding may completely cease, as the urinary system slows and eventually stops.

7. The nursing assistant may apply oxygen as directed by the nurse, provide oral care and reposition the client frequently, and apply small amounts of K-Y Jelly® in the nares for comfort and to decrease the risk of nosebleeds.

8. The nursing assistant should accommodate the family’s vigil as long as it is not upsetting or harmful to the client, and does not infringe on the rights of other clients in the building.


1. Apnea 6. Cardiovascular

2. Mottling 7. Hearing

3. Physical 8. Decrease

4. Death 9. Religion

5. Honored 10. Doctor


1. b 5. c

2. a 6. d

3. b 7. b

4. c 8. c


1. b 2. a 3. c 4. a 5. d

chapter 1: answers to workbook pages 1.a matching...

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