Chapter 31 Hygiene
A client with psoriasis tells the nurse, "I finally found a remedy online that will cure my psoriasis." What is the appropriate nursing response?
"Advertised remedies that promise a cure may be a scam."
The nurse is caring for a client that has multiple dental caries and wants to understand the cause. Which statement by the client indicates that additional teaching is warranted?
"I will brush once every day and floss every other day."
The parents of 3 young children have discussed the dental health needs of their children with the nurse. Which statement indicates the need for further instruction?
"If my children do not have cavities by the age of 10, fluoride treatments can be discontinued."
When an adult client from Indonesia refuses a complete bath on the day after abdominal surgery, the nurse should:
understand that his culture may influence his hygiene and ask him his preference.
An older adult client has been admitted to the hospital and the nurse is preparing to provide hygiene to the client. The nurse brings a soft toothbrush and toothpaste to the bedside and the client's daughter begins to laugh, stating, "She doesn't actually have a single tooth left!" What should the nurse do?
Use the toothbrush as planned, despite the client having no teeth.
Which nursing action is appropriate when providing foot care for a client?
Rinse the feet, dry thoroughly, and apply moisturizer on the tops and bottoms.
A parent reports that their home water is not fluoridated and questions the nurse whether it would be benefitial to start giving fluoride supplements to the 9-year-old child. Which response by the nurse is most appropriate?
"In the absence of fluoridated water supplies, supplementation is often recommended."
A client who has been reluctant to have his or her hair shampooed for a week tells the nurse, "I do not want you to shampoo my hair. It does not need washing." The client's hair is very greasy, the scalp is irritated, and it has begun to smell. What is the appropriate nursing response?
"Let's talk about what might be bothering you about your hair."
Which statement made by the client, regarding flat patches of brown skin on the face, demonstrates understanding?
"These brown spots are senile lentigines and are common when you get older."
A nurse providing hygiene and bathing for older adult clients knows that additional safety measures may be necessary in their care. The nurse delegates some aspects of care to an unlicensed assistive personnel (UAP). Which of the following are true regarding safety of the older adult while bathing?
-Use of a tub/shower seat may be necessary if balance problems are present. -Water temperature should be monitored carefully due to decreased temperature sensation. -Use a long-handled shower brush or attachment to help with limited mobility.
A nurse is assisting an older, continent client with dry skin who is hospitalized. Which approach to hygiene should the nurse take with this client?
Alternate between a full bed bath on one day and use of skin lotion or bath oil on the next.
A nurse caring for the skin of clients of different age groups should consider which accurately described condition?
An adolescent's skin ordinarily has enlarged sebaceous glands and increased glandular secretions.
A nurse is preparing to help a client with a skin infection have a tub bath. In which way can the nurse ensure the client's safety?
Check that the bathroom has a nonskid floor.
The nurse is preparing to provide hygiene for a client who has a leg cast and activity restrictions. Which is the priority nursing intervention that will be performed to prepare for hygiene care?
Check the nursing care plan for hygiene directives.
The nurse is caring for a client who has been diagnosed with pediculosis. What intervention will the nurse provide?
Launder gowns, linens, and towels separate from other clients' items
A client has a diagnosis of Bathing/Hygiene Self-care Deficit due to recent surgery and decreased strength. An outcome goal is for the client to participate in self-care measures by the end of the week. Which documentation by the nurse shows the outcome was met?
Client demonstrated bathing independently while seated in the bathroom. Client experienced no difficulty with the procedure and experienced no pain.
The nurse is caring for a client with diabetes who has thick toenails. What is the appropriate nursing intervention?
Contact a podiatrist to care for toenails.
A client with diabetes has been admitted to a long-term care facility. Upon assessment, the nurse noticed that the client's toenails are very thick, and pedal pulses are diminished. What nursing interventions are appropriate?
Contact health care provider regarding diminished pedal pulses. Contact a podiatrist.
he nurse is planning hygiene care for a client with self-care bathing deficit related to weakness. Which nursing intervention is appropriate?
Encourage the client to wash own face and hands.
The nurse is discussing hygiene with a client. The client states that not understanding the importance of daily bathing or the use of antiperspirants. What information should be provided by the nurse?
Excessive perspiration will result in potentially offensive odor. Bacteria can flourish in the presence of excessive perspiration. Perspiration promotes skin breakdown.
A nurse is making the bed of a client whose limited mobility prevents her from leaving the bed. What should the nurse do when performing this procedure?
Fan-fold soiled linens as close to the client as possible.
Foot care is an essential part of routine hygiene. What is an important nursing consideration when planning foot care for clients with diabetes?
Foot care should not include soaking the feet.
A nurse assisting a client with contact lens removal finds that the hard contact is not over the cornea. What would be the appropriate intervention in this situation?
Gently slide the hard lens over the cornea and remove it with gloved fingers.
The nurse is preparing to bathe a client using a self-contained bathing system that has premoistened, disposable washcloths. Which method for warming the premoistened cloths is correct?
Heat the entire package in the microwave, following the manufacturer's recommendation.
Which nursing actions are recommended guidelines when performing oral care?
Ideally, brush teeth immediately after eating or drinking. If desired, use an automatic toothbrush to remove debris and plaque from teeth. If desired, use salt and sodium bicarbonate as cleaning agents for short-term use.
The nurse is educating an adolescent on how to treat acne. What would the nurse include as an education point?
Keep hair off the face and wash hair daily.
When caring for a client with dentures, what should the nurse teach the client?
Keeping dentures out for long periods of time permits the gum line to change, affecting denture fit
A nurse is going to bathe a client who is confined to bed. What does the nurse do first?
Perform hand hygiene.
A nurse has finished providing morning care for the client. Which safety measures should the nurse employ prior to leaving the client's room?
Place the bed in the lowest position. Test the functioning of the bed and bed controls. Place the call light near the client within reach. Ensure the bed is locked.
A nurse is caring for a client who cannot swallow or expectorate. What interventions to keep the mouth and throat free of accumulating secretions should the nurse perform when caring for this client?
Provide frequent mouth care. Arrange for suctioning to remove mucus. Assist the client to a lateral position.
A nurse is washing a client's hair using a shampoo cap. Which step should the nurse use?
Remove and discard the cap after one use and dry the client's hair with a towel.
A nurse is educating a client on how to care for dentures. What is a recommended teaching guideline?
Store dentures in cold water when not in use.
Which documentation note regarding an assessment of eroding tooth enamel is most appropriate?
The client is at risk for caries due to eroding tooth enamel.
The nurse is caring for a client who is on warfarin therapy. Which teaching will the nurse provide?
Use an electric razor for shaving purposes.
The nursing student is providing hygiene education for a family who will soon take an older adult client home from the hospital. Which teaching provided by the nursing student requires nursing instructor intervention?
Use bath oil in the tub to decrease dry skin.
The nursing student is providing hygiene education for a family who will soon take an older adult client home from the hospital. Which teaching provided by the nursing student requires nursing instructor intervention?
Use soap daily when bathing to remove debris and keep skin moist.
A nurse is providing oral care to children on a pediatric unit. Which guideline should the nurse follow for providing care in special situations?
Water should be used to clean an infant's teeth.
In which situation would it be appropriate to shave the beard of an unconscious client without his permission?
When inserting an endotracheal tube
A nurse is taking care of a client who needs a bed bath. Which action can the nurse delegate to an unlicensed assistive personnel (UAP)?
back massage
A nurse is selecting a product to provide a complete bed bath to a client who is on bed rest. Which product would be best to use in this manner?
body foam
An older adult client is reporting dry, itching skin. The nurse should assess:
how often the client is bathing.
The nurse is caring for a client who has had multiple dental caries. Which food will the nurse encourage the client to avoid that is on the dietary tray?
jelly to go on the toast
A 55-year-old client has just undergone surgery for a knee replacement. He asks the nurse if he can shave because his face is itching from the stubble. What information is a priority for the nurse to verify prior to shaving the client?
medications listed on the client's medication administration record (MAR)
The nurse notices multiple caries upon inspecting a client's mouth. When asked if the client has dental pain, the client responds, "No, my teeth and gums never hurt." Which structural damage does the nurse anticipate?
nerve
The nurse is observing a student who is using a safety razor to shave a client. Which action would require intervention by the nurse?
pulling the razor against the direction of hair growth
