CNA Test Practice 3

In diabetes, some sugar appears in the urine (glucosuria or glycosuria). The diabetic person may also have acetone (ketone bodies, ketones) in the urine. To determine the presence of these substances in the urine, these tests are usually done four times a day – 30 minutes before meals and at bedtime. The doctor uses the test to make drug and diet decisions. Double-voided specimens are best for these tests.

The ideal temperature of the water for a hot Sitz bath is between 95°F and 110°F. Water that is too hot will burn the client, and water that is too cold will cause the muscles to tighten up rather than relax. A hot Sitz bath will provide relaxation and relieve muscle spasms, soften exudates, hasten the suppuration process, hasten healing (in cases of perianal surgeries), reduce congestion, and provide comfort in the perineal area.

Cauliflower is gas-forming. Other examples of gas-forming foods are beans, cabbage, radishes, and cucumbers.

The bag hangs from the bed frame, chair, or wheel chair. It must not touch the floor. The bag is always kept lower than the client’s bladder. If the drainage bag is higher than the bladder, urine can flow back into the bladder and an infection can occur. Therefore, do not hang the drainage bag on a bed rail. When the bed rail is raised, the bag is higher than the bladder level. When the person walks, the bag is held lower than the bladder. Emptying of the drainage should be done every 6-8 hours to prevent proliferation of microbes which can develop into infection. The tubing should not have dependent loops to prevent stasis of urine in the tubes which can promote backflow to the bladder.

The restraint straps should be secured to the bed frame and never to the side rail to avoid accidental injury in the event that the side rail is released. A half-bow or safety knot should be used for applying a restraint because it does not tighten when force is applied against it and allows quick and easy removal of the restraint in case of emergency. The jacket restraint should be secured, and one to two fingers should slide easily between the restraint and the client’s skin.

The job of the nursing assistant is to make sure there are no kinks in the tubing and to secure the connecting tubing in place. The other choices are all responsibilities of a physician.

Elastic stockings exert pressure on the veins. The pressure promotes venous blood flow to the heart. By doing so, the stockings prevent blood clots.

Elastic stockings or anti-embolic stockings are applied before the client gets out of bed. Otherwise the legs can swell from sitting or standing. Stockings are hard to put on when the legs are swollen. The client lies in bed while they are off. This prevents the legs from swelling.

Ostomy care is done aseptically (rules of cleanliness). It does not require a doctor’s order for changing the ostomy pouch. The collection bag must be changed when it is full or when the adhering seal is broken. A client with ostomy will have a change in the normal bowel movement. The fecal matter will be collected through an appliance that is held over the stoma by a special adhesive or paste.

Clients with difficulty breathing often prefer sitting up and leaning over a table to breathe. This is called orthopneic position. Place a pillow on the table to increase the client’s comfort.

Hypoxia means that the cells do not have enough oxygen. It is a life-threatening condition. The brain is very sensitive to inadequate oxygen. Restlessness is an early sign, as are dizziness and disorientation. Hypoxia will have increased respiratory rate, increased pulse rate, but not increased temperature. Cyanosis, or bluish discoloration of the skin, is a late sign of hypoxia.

A rubber sheet protects the client from soiled linens and excess drainage. It can even predispose the client to develop skin breakdown and pressure ulcers because it creates moisture and friction to the skin. Trochanter rolls are applied to prevent the hips and legs from turning outward and aids in proper positioning of the client. A bed cradle is placed on bed and over the person. Top linens are brought over the cradle to prevent pressure on the legs and feet.

T-binders secure dressings in place after rectal and perianal surgeries. The double T-binder is for men, while the single T-binder is for women. A breast binder is specifically used to support the breasts after breast surgery; not by breastfeeding mothers. Straight abdominal binders are applied with the person supine. It is secured in front of the body by safety pins, Velcro, zippers, hooks, or other closures. The top part is at the person’s waist. The lower part is over the hips.

In applying elastic bandage, expose fingers or toes to allow circulation checks. Check the color and temperature of the extremity every hour. If the person complains of pain, itching, tingling, or numbness, remove the bandage and tell the nurse at once.

If the client is incontinent (cannot control bowels and/or urine), record this on the output side of the I&O sheet each time the bed is wet. Even though the urine cannot be measured, it will be obvious that the client’s kidneys are functioning.

The hearing aid should be adjusted to an audible level that the client can tolerate. A hearing aid helps the person hear more in both quiet and noisy environments.

A 24-hour urine specimen is a collection of all urine by a client over a 24-hour period. All urine is collected for 24 hours, usually from 7 A.M. on the first day to 7 A.M. the following day. It is necessary to ask the client to void, and then discard this voided urine. This is done because this urine has been in the bladder an unknown length of time. The test should begin with the bladder empty. For the next 24 hours, save all the urine voided by the client in one collection bottle. Recording the amount of urine and the time voided is not important in this procedure.

It is unnecessary to use a new piece of floss for each tooth. Break off an 18-inch piece of floss from the dispenser; this will do for all the teeth. Just move to a new section of floss after every second tooth is flossed. The other choices are correct steps in flossing.

The nurse aide should report to the nurse any abnormal stools. Carefully observe the color, amount, consistency, odor, shape, size, frequency of defecation, and complaints of pain.

Clients with a pacemaker can use electrical appliances. Microwaves are allowed, but caution must be used in airports to avoid the magnetic wands used for detection. Some clients have difficulties being around lawn mowers and cellular phones.

A client who is in oxygen therapy should have safety measures implemented in order to prevent explosion. Use of electric razors or hair dryers while the oxygen is running is not allowed. Combing a client’s hair can also create a spark of electricity from his hair that could set off an explosion. The face mask can be removed if the client wishes to eat and converse with visitors. Use of cotton bedclothes is also encouraged to decrease static electricity.

Fluid output is the sum total of liquids that come out of the body. Most fluid is discharged from the body as urine. Output also includes emesis (vomitus), drainage from a wound, loss of blood, and excessive perspiration. Every time the client uses the urinal, emesis basin, or bedpan, the urine and other fluids must be measured. For perspiration, wound discharges, or bleeding, indicate what was wet, how wet, the size of the wet area, and the time it occurred.

Careful drying is essential to avoid maceration of the penis. To decrease the risk for infection, wash the penis from the tip the base to reduce the risk for introducing microorganisms into the urethral meatus. Effective cleaning requires soap and thorough rinsing. It’s also essential to remove secretions that accumulate under the foreskin because they can lead to inflammation and are associated with the development of penile cancer. The foreskin of uncircumcised men must be retracted for cleaning, then replaced to prevent paraphimosis (capistration).

Catching urine midstream reduces the amount of contamination by microorganisms at the meatus. Voiding in a urinal doesn’t allow for an uncontaminated specimen because the urinal is not sterile. When cleaning an uncircumcised male, the foreskin should be retracted, and the glans penis should be cleaned to prevent specimen contamination. Voiding in a clean container is done for a random specimen, not a clean-catch specimen for urine culture.

The system is no longer a closed system and bacteria might have been introduced; the nursing assistant should report to the nurse immediately for the removal of the catheter and inserting a new one using sterile technique. Placing a towel under the bag and taping up the hole leave the system open, which increases the risk for infection. Replacing the drainage bag is not recommended due to the limitations of the duties of the nursing assistant and the increased risk of infection.

Clean gloves protect the hands and wrists from microorganisms in the linens. Sterile gloves allow one to touch a sterile object or area without contaminating it. A mask protects the wearer and client from droplet nuclei and large particle aerosols. Shoe protectors prevent static and microorganism transmission from the floor of one room to another.

Collecting the specimen at the convenience of the nursing assistant is not a rule to follow. It should be collected at the correct time. Specimens are collected and tested to prevent, detect, and treat disease. The doctor orders what specimen to collect and the test needed.