Knowledge Test for Nursing Assistants

Development and evaluation of training programs for new nurses and nursing assistants

To prevent upper airway obstruction (UAO) in patients with head and neck cancer.

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Question 1 : A 70 -year- old female patient has been diagnosed with throat cancer. After surgery, it was noted that the patient was becoming slightly restless and appeared to be breathing slightly faster. What should the nursing assistant do first ?

A. Wait and observe the symptoms for a while because they may be normal after surgery.

B. Report to the nurse immediately so that the nurse can assess the symptoms in detail.

C. Go to check the patient's blood pressure and body temperature only.

D. Position the patient flat to help them breathe more easily.

Explanation : B. Correct : Restlessness and rapid breathing are the initial signs of abnormal breathing. Immediately reporting to the nurse for a detailed assessment of the symptoms is the most important thing because the nurse can assess and decide on the next care plan.

- False Reason (a): Waiting to observe symptoms may miss the opportunity for timely help if symptoms worsen.

- False Reason (C): Monitoring other vital signs is important, but addressing the breathing problem is the first priority.

- False Reason (d): Lying the patient flat may make breathing more difficult in patients with UAO. The head of the bed should be elevated 30-45 degrees .

Question 2 : Which of the following is the earliest warning sign of UAO that a nursing assistant should most easily recognize in a patient with HNC?

A. Skin turns dark green ( Cyanosis)

B. Patients stop breathing ( Apnea)

C. The voice is hoarseer than usual or sounds like something hot is in the mouth ( Hot Potato Voice)

D. Blood pressure drops below 90/60 mmHg .

Explanation : C. Correct: A hoarse voice or a hot potato voice is an early sign that a nursing assistant can easily observe in their communication with the patient.

- Wrong reason (a) , ( b) , ( d): Cyanosis , apnea , or low blood pressure are late /severe signs, which often occur when UAO is already severe and the patient may be in critical condition.

Question 3 : A male patient who underwent a tracheostomy produced a large amount of sputum and the patient had difficulty coughing up sputum. What should the nursing assistant do to support care and prevent tracheostomy tube obstruction ?

A. Advise patients to refrain from drinking water to help dry up phlegm.

B. Clean the tracheostomy tube as trained and report to the nurse if the patient cannot cough up sputum on his/her own.

C. Use a cloth to cover the patient's mouth and nose to prevent sputum from splashing.

D. Inform the nurse to come and change the tracheostomy tube immediately.

Explanation: B. Correct: The nursing assistant is responsible for supporting primary care, including cleaning the tracheostomy tube as trained and reporting to the nurse if the patient is unable or ineffective at coughing up sputum.

- Wrong reason (a): Not drinking water makes mucus thicker, making it harder to expel.

- Wrong reason (c): Using a cloth to cover the mouth and nose may obstruct the breathing of the patient with a tracheostomy.

- Wrong reason (d): Changing the tracheostomy tube is a medical procedure that must be performed by a specialist and is not a first-line management in this situation.

Question 4 : While caring for a patient with HNC who had a tracheostomy, the nursing assistant noticed that the ropes holding the patient's tracheostomy tube were loose and old. What action should the nursing assistant take to prevent the tracheostomy tube from dislodging ?

A. Tie the rope tighter by yourself immediately.

B. Don't do anything. Wait for the next nurse to come and check.

C. Use scissors to cut off the loose parts of the rope.

D. Report to the nurse for consideration of changing the tracheostomy tube ligation rope.

Explanation: D. Correct: When the tracheostomy rope is found to be loose or old, the nursing assistant should immediately report to the nurse so that the nurse can assess and replace the rope correctly and safely according to the practice.

- Wrong reason (a): Tightening the rope on your own without proper training can cause problems such as tying it too tight or not tying it securely.

- False Reason (b): Doing nothing greatly increases the risk of the tracheostomy tube dislodging.

- False Reason (C): Unsupervised cutting of the rope may cause immediate dislocation of the tracheostomy tube, which is a dangerous emergency.

Question 5 : An HNC patient who has undergone a tracheostomy and is about to be discharged from the hospital is assigned to teach the patient and family about what to do at home. What are the important instructions regarding the care of the tracheostomy wound to prevent infection ?

A. Clean the tracheostomy wound at least twice a day or when the wound has discharge. If the wound is swollen, red, more painful, or has a fever, see a doctor immediately before the appointment date.

B. Clean the throat wound once a day and if you have a fever, take medicine to reduce the fever yourself.

C. It is recommended to use a toothbrush to clean around the throat puncture wound.

D. It is recommended to use a plaster to cover the tracheostomy wound at all times to prevent infection.

Explanation : A. Correct: It is correct practice to clean the tracheostomy wound at least twice a day or when the wound has discharge. Seeing a doctor immediately before the appointment date if there are any abnormal symptoms such as swelling, redness, increased pain, or fever is important to prevent complications at home.

- Wrong reason (b): Dressing the wound once a day may not be enough, and taking fever-reducing medication without consulting a doctor may not be appropriate.

- Wrong reason (c): Using a toothbrush to clean around the tracheal incision is inappropriate and may cause irritation or infection.

- Wrong reason (d): Keeping the tracheostomy wound closed all the time can cause the wound to become moist and infected.

Question 6 : Nursing assistants play a key role in being the frontline caregiver for HNC patients at risk for UAO. What is the most important reason for the role of nursing assistants ?

A. Nursing assistants have the broadest medical experience.

B. Nursing assistants spend the most time in close contact with patients, so they are more likely to notice the first warning signs.

C. Nursing assistants can quickly diagnose UAO.

D. The nursing assistant is the primary responsible person for managing respiratory emergencies.

Explanation : B. Correct: Nursing assistants often spend the most time in close contact with patients, and are therefore more likely to be the first to notice the first warning signs of UAO , which is the most important reason for their frontline role .

- False Reason (a): Although nursing assistants are experienced, nurses often have more extensive medical experience.

- False Reason (C): Diagnosis of UAO is the role of nurses and physicians.

- False Reason (d): Management of respiratory emergencies is the role of nurses and the medical team.

Question 7: If the nursing assistant notices that the HNC patient is having more difficulty breathing and has a clear “wheezing” (or Stridor) breathing sound , which is a more serious sign, what should the nursing assistant do first ?

A. Try to position the patient in a lying position.

B. Call the doctor directly immediately.

C. Immediately report to the nurse using clear words describing the symptoms observed.

D. Check the patient's body temperature only.

Explanation : C. Correct: When more serious signs are found, such as Stridor , the nursing assistant must immediately report to the nurse, using clear language about the symptoms observed, so that the nurse can make a decision and call for immediate assistance.

- Wrong reason (a): Positioning the patient supine may worsen UAO . The head of the patient should be elevated at 30-45 degrees .

- Wrong reason (b): The nursing assistant should report to the nurse first so that the nurse can coordinate with the doctor.

- False Reason (d): Checking body temperature is important, but not the first line of action in a respiratory emergency.

Question 8 : When preparing a HNC patient who has undergone a tracheostomy and is about to go home, what advice should the nursing assistant give regarding fluid intake to help prevent tracheostomy tube obstruction ?

A. It is recommended to avoid drinking water after 6:00 p.m.

B. There is no need to advise on drinking water because it is not related to the tracheostomy tube.

C. It is recommended to drink only fruit juices.

D. It is recommended to drink at least 2-3 liters of clean water per day, if there are no contraindications.

Explanation : D. Correct: Drinking at least 2-3 liters of clean water per day (if there are no contraindications) is an important recommendation to help reduce the viscosity of sputum, making it easier to expel sputum and preventing blockage of the tracheostomy tube.

- Wrong reason (a): Abstaining from drinking water without indication may cause thicker sputum.

- False Reason (C): Drinking clean water is more important than juice in this context.

- Wrong reason (b): Drinking water is directly related to mucus management and preventing tracheostomy tube obstruction.

Question 9 : While caring for a patient with HNC who has a tracheostomy, the nursing assistant notices that the patient has difficulty swallowing and frequently chokes while eating. What should the nursing assistant do ?

A. Change food into solid and dry food.

B. Stop giving the patient food immediately and report to the nurse.

C. Let the patient drink plenty of water to help swallow.

D. Tell the patient to try to swallow faster.

Explanation : B. Correct: When a patient frequently chokes while eating, the patient should stop eating immediately to prevent recurrence of choking or lung aspiration, and the nurse should be notified immediately to assess the cause and plan appropriate management.

- Wrong reason (a): Changing the diet to hard, dry food will further increase the risk of choking.

- False Reason (C): Drinking a lot of water may increase choking, especially in patients with swallowing problems.

- False Reason (d): Telling the patient to try to swallow faster does not solve the choking problem and may cause harm.

Question 10 : Which is one of the Late/Severe Signs of UAO that the nursing assistant must immediately report to the nurse ?

A. The patient becomes lethargic or unconscious.

B. Breathing faster than 30 times/minute

C. Wide nostrils

D. I have a low fever.

Explanation : A. Correct: The patient has symptoms of drowsiness or loss of consciousness, which is a Late/Severe Signs of UAO , indicating lack of oxygen in the brain and must be reported to the nurse immediately.

- False Reason (b): Respiratory tachycardia (> 30 breaths/min) is also a more serious sign, but the change in level of consciousness is more indicative of severe hypoxia to the brain than the first.

- Wrong reason (c): Flared nostrils are an early warning sign.

- False Reason (d): Low-grade fever is an early sign that may indicate infection, but it is not as severe a sign of life-threatening UAO as neurological symptoms.

Question 11 : In an HNC patient with a history of risk for UAO, the nursing assistant notices an Airway precaution / difficult airway sign attached to the head of the bed and on the patient's file. What is the primary purpose of this sign for the nursing assistant ?

A. Inform that the patient requires special water and food.

B. Indicates that the patient has a problem in communication.

C. This indicates that the patient needs special mental care.

D. Warn to be extra careful in observing the patient's respiratory symptoms and be a warning signal for the team.

Explanation : D. Correct: The Airway precaution / difficult airway symbol is primarily intended to remind all levels of personnel, especially nursing assistants, to closely monitor and observe the patient's airway condition, as this patient group is at high risk for UAO .

- Wrong reasons (a) , ( b) , ( c): This symbol does not directly indicate the patient's dietary needs , mental state , or communication problems.

Question 12 : A nursing assistant is caring for an HNC patient with a persistent cough and notices that the patient's voice has become hoarse and his speech sounds like he has something hot in his mouth ( Hot Potato Voice). What should the nursing assistant do next ?

A. Give the patient plenty of warm water to drink to relieve the sore throat.

B. Record symptoms in the nursing record and continue to observe symptoms.

C. Immediately report any changes in voice to the nurse.

D. Advise the patient to refrain from speaking to rest the voice.

Explanation: C. Correct: Hoarseness and Hot Potato Voice are early warning signs of UAO. The nursing assistant is responsible for observing and reporting these changes to the nurse promptly and accurately so that further assessment and care can be provided.

- False Reason (a): Drinking warm water may provide some relief from a sore throat, but it does not address any potential airway obstruction.

- False Reason (b): Simply recording symptoms and continuing observation may delay intervention too long in a potentially more severe condition.

- False Reason (d): Abstaining from talking does not address the airway obstruction and may make it more difficult to recognize other symptoms.

Question 13 : A male HNC patient is sleeping. A nursing assistant walks past the bed and notices that the patient has slight retractions in his chest. As a nursing assistant, what should be the first immediate action ?

A. Check if the patient is in deep sleep.

B. Perform a preliminary assessment of vital signs and report to the nurse any observed symptoms.

C. Try to position the patient in a side-lying position.

D. Prepare oral cleaning equipment for the patient.

Explanation : B. Correct: Retractions are the first warning sign of UAO. The nursing assistant should assess the vital signs (e.g., respiratory rate) and promptly report the observed symptoms to the nurse so that further evaluation and treatment can be initiated.

- False Reason (a): Deep sleep is not directly related to Retractions , which are abnormal respiratory signals.

- Wrong reason (c): Positioning the patient in lateral recumbency may be inappropriate and does not address the underlying airway problem.

- False Reason (d): Preparation of oral hygiene equipment is not related to an airway emergency.

Question 14 : When reporting abnormal symptoms of HNC patients to the nurse, which information should the nursing assistant emphasize as the most important initially ?

A. Details of the patient's complete medical history.

B. Recommendations on medications that patients should receive

C. Questions about the patient's long-term treatment plan

D. Observed information regarding changes in the patient's symptoms and breathing patterns.

Explanation : D. Correct: The nursing assistant has the primary responsibility of observing and reporting symptoms that indicate an increase in severity. Therefore, the observed information about changes in the patient's symptoms and breathing pattern is the most important thing to initially report to the nurse so that the nurse can assess and make a decision quickly.

- False Reason (a): Medical history is important, but the nurse can access it from the medical record, and it is not the most urgent information that the assistant nurse needs to report in an emergency.

- False Reason ( b) , (c): Questions about treatment plans or medication recommendations are the role of nurses and physicians, not nursing assistants.

Question 15 : Which of the following is the main reason why the competence of nurses and nursing assistants (with less than 3 years of service) is an important factor in the safety of HNC patients with UAO?

A. Because HNC patients have complex communication needs.

B. Because this group of personnel is the largest in the ward.

C. Because the lack of skills and ability to assess and manage high-risk patients may lead to a crisis.

D. Because HNC patients often have nutritional problems that require special care.

Explanation : C. Correct: The majority of the ward's personnel, more than 50-60 percent, have less than 3 years of experience and lack the skills and ability to manage high-risk patients. Therefore, improving the level of personnel's ability to assess and detect warning signs from the beginning is the most important thing to prevent crises and reduce the rate of adverse events.

- False Reason (a): Although HNC patients may have complex communication needs, this is not the primary reason why new staff competency is a direct factor in UAO safety.

- False Reason (b): Having a large number of these personnel is the current situation, but it does not make their performance directly important to safety. The main reason is the lack of skills in this group.

- False Reason (d): Nutritional issues are part of the care of HNC patients but are not directly related to the importance of competency in UAO management .

Question 16 : A patient with HNC undergoing radiation therapy has a slight increase in neck and facial swelling. What additional signs should the nursing assistant closely monitor for to report to the registered nurse when suspecting UAO due to radiation - induced edema ?

A. Changes in the skin in the irradiated area.

B. Headache and nausea

C. Having a hoarse voice or Hot Potato Voice

D. Changes in blood sugar levels

Explanation : C. Correct: Radiation-induced edema can result in airway obstruction. An important sign that the nursing assistant should watch for and report is hoarseness or hot potato voice , which indicates edema or pathology in the vocal cords or throat.

- Wrong reason (a): Skin changes in the irradiated area are a side effect of radiation therapy, but are not directly related to UAO.

- False Reason (b): Headache and nausea may be common symptoms of treatment, but are not specific signs of UAO.

- False Reason (d): Changes in blood sugar levels are not directly related to UAO.

Question 17 : A male HNC patient has a history of tracheostomy. The nursing assistant notices that the patient has obvious difficulty breathing, shortness of breath, and respiratory muscle use. What should the nursing assistant do first in this situation ?

A. Immediately report to the nurse any difficulty breathing and observed breathing patterns.

B. Check the cleanliness of the bed sheets.

C. Give the patient liquid food to relieve symptoms.

D. Position the patient in a lying position to reduce muscle use.

Explanation : A. Correct: When a patient has obvious symptoms of difficulty breathing, shortness of breath, and using respiratory muscles, the nursing assistant should immediately report the observed symptoms to the nurse for urgent assessment and further care, as these are serious signs of UAO.

- Wrong reason (b): Not related to a respiratory emergency.

- False Reason (C): Feeding may increase the risk of aspiration in patients with respiratory problems.

- Wrong reason (d): Lying flat may make breathing more difficult. The head of the bed should be elevated.

Question 18 : An adult HNC patient has a respiratory rate ( RR) of 32 breaths per minute, which is considered tachypnea . What part of the UAO warning signal should the nursing assistant consider this to be and what action should be taken ?

A. Late/Severe Signs; Prepare emergency life-saving equipment immediately.

B. Early Warning Signs in general symptoms ; Nurse report

For further assessment

C. Normal conditions found in cancer patients; recorded in nursing records only.

D. Side effects from drug use ; patients are advised to temporarily stop taking the drug.

Explanation: B. Correct: Tachypnea is an increased respiratory rate, which is one of the early warning signs. The nursing assistant should report it to the nurse for further assessment.

- Incorrect reason (a): Despite rapid breathing, it does not meet the criteria of Late/Severe Signs that require immediate emergency life support equipment, unless there are other severe symptoms as well.

- False Reason (C): Although some conditions can cause rapid breathing, in the context of HNC patients, caution must be exercised and reported for assessment.

- Wrong reason (d): Stopping medication without a doctor's order is not advisable.

Question 19 : A male HNC patient presents with dysphagia and limited mouth opening ( trismus) , which are early warning signs of UAO. How should the nursing assistant provide this information to the professional nurse when reporting ?

A. Send a short message via Line Group to inform the nurse.

B. Write all details in the nursing record and then inform the nurse on the next shift.

C. Wait until the nurse comes to visit the patient as usual.

D. Report to the nurse immediately, emphasizing the main symptoms observed.

Explanation : D. Correct: Difficulty swallowing and limited mouth opening are the initial signs of UAO. The nursing assistant should report to the nurse immediately, emphasizing the main symptoms observed, to facilitate rapid assessment.

- Wrong reason (a): Sending a message may not receive an immediate response in an urgent reporting situation.

- Wrong reason (C): Waiting may delay treatment too much.

- Wrong reason (b): Next shift report is too late for UAO alarm.

Question 20 : Which of the following is one of the communication systems in the ward team that helps the nursing assistants to be informed about patients at risk for UAO , especially the Difficult Airway group?

A. Shift transfer from OPD, ER, OR and posting of Airway precaution / difficult airway symbols at the head of the bed.

B. Joint meeting with the PCT team, Department of Otolaryngology, every 1-2 months.

C. System for anesthesiologists to assist in tube insertion

D. Presentation of research results in the department's Grand Round

Explanation : A. Correct: Shift handover from OPD, ER, OR and posting of Airway precaution / difficult airway symbols at the head of the bed and on the patient file is a team communication system that helps nursing assistants know about patients at risk of UAO and monitor them appropriately.

- False Reasons (b) , ( c) , ( d): The PCT meeting , anesthesiologist team system, or Grand Round is a higher level or ad hoc communication mechanism for physician/nurse management, not the primary channel through which NPs obtain information about individual patients on a daily basis.