- When helping a client who is recovering from a stroke to walk, the nurse aide should assist
- From behind the client
- On the client’s strong side
- On the client’s weak side
- With a wheelchair
Correct answer: On the client’s weak side
When helping a client walk who is recovering from a stroke, the nurse aide should stay on the client’s weak side. Walk next to, and slightly behind, the client in order to be ready to suddenly support the weak side. If the client is using a walker or cane, allow space for the device. While walking, be alert to avoid possible fall hazards. The client should wear slippers or shoes with rubber soles for traction.
- The Heimlich maneuver (abdominal thrusts) is used for a client who has
- Impaired eyesight
- Fallen out of bed
- A bloody nose
- A blocked airway
Correct answer: A blocked airway
The Heimlich maneuver (abdominal thrusts) is the first aid method for helping people who have food or an object caught in their upper airway. When a client appears to be choking, the nurse aide must act quickly to clear the airway. Call for help. To perform abdominal thrusts, stand behind the client. Make a fist with your dominant hand. Place this fist just above the client’s navel. Wrap your other hand firmly around the fist. Pull inward and upward, pressing into the client’s abdomen with quick and forceful upward thrusts, as if you are trying to lift the client off his or her feet from this position. Continue the abdominal thrusts in quick succession until the object is expelled.
- The equipment you need for oral care of an unconscious client includes
- Toothpaste
- Toothette/mouth swab
- Toothbrush
- All of the above
Correct answer: Toothette/mouth swab
Because an unconscious client is not able to assist with oral care, the nurse aide must take extra precautions to prevent choking or aspirating while giving oral care. The client’s head should be turned to the side. If possible, lower the head of the bed. Gently clean the teeth and gums with a separate moist toothette or mouth swab for each area of the mouth. Wipe the client’s mouth when finished and raise the head of the bed to its prior position.
- A nursing assistant is caring for a patient with MRSA and is wearing a gown and gloves whenever she provides the patient care. When she needs to go care for another patient, she should dispose of her gown and gloves:
- In the dirty utility room
- In the hallway.
- In the current patients room.
- In the next patients room before touching that patient.
Correct answer: In the current patients room.
Taking the gown and gloves off in the patients room before leaving to care for another patient helps reduce the spread of infection to staff and other patients.
- When transferring a resident from a wheelchair to stationary chair, the nursing assistant should stand ____.
- In front of the wheelchair.
- To the right side of the wheelchair.
- Behind the wheelchair.
- To the left of the side of the wheelchair.
Correct answer: In front of the wheelchair.
Standing in front of the wheelchair is the most ergonomic way for the nursing assistant to pivot a resident into a stationary chair. The other options are not as effective for allowing this.
- The nurse aide is walking with a client confined to a wheelchair when the facility fire alarm system is activated. The client becomes excited from the noise. The nurse aide SHOULD
- Comfort the client while moving the person to a safe place
- Leave the client to search for help
- Lock the client’s wheelchair and check the surrounding area for smoke
- Push the wheelchair out of the hallway and carry the client out of the facility
Correct answer: Comfort the client while moving the person to a safe place
The nurse aide should be familiar with all fire safety policies and protocols. When a fire alarm sounds, all staff must respond to keep clients safe. Remember “R.A.C.E.” to quickly act. R = Rescue/Remove all people who can not take care of themselves. A = Alarm, if it has not already been done. Pulling the alarm can be done at the same time as rescue. C = Confine/Contain the fire or smoke by closing doors to prevent or slow the spread. Smoke is especially dangerous for everyone. E = Extinguish the fire if possible, using a handheld fire extinguisher. Attempt to extinguish only small fires, as long as you can remain safe and have an escape route.
- A nursing assistant is instructed to take the oral temperature of a patient who just had a cold drink. The patient’s temperature should be taken ____.
- 3-5 minutes after the drink was finished.
- 15 minutes after the drink was finished.
- Immediately; a cold drink should not affect the reading of most oral thermometers
- 20-30 minutes after the drink was finished.
Correct answer: 15 minutes after the drink was finished.
A delay of 15 minutes should be enough time for the oral cavity to return to a more accurate body temperature.
- To obtain the most accurate patient weight, the nursing assistant should weigh the patient ____.
- Directly after a meal.
- With two different scales
- 3-4 hours after eating.
- At the same time every day.
Correct answer: At the same time every day.
Weighing the patient at the same time every day will yield the most accurate results, as the patient is likely in similar circumstances.
- Which of these could be considered neglectful when assisting a resident with showering?
- Respecting the fact that bathing and showering can be a scary activity for residents and assuring them you will help them through the process.
- Being patient and calm and explaining what you are going to do before you do it.
- Leaving the resident alone so they are motivated to care for themselves.
- Being sensitive to water temperature and testing it before beginning the procedure.
Correct answer: Leaving the resident alone so they are motivated to care for themselves.
Residents left alone in the shower could slip and fall; leaving a resident alone is considered neglect. All of the other options show care for the patient and his/her rights.
- A resident in your care is suffering chest pains. Which of these is not a direction to follow?
- Offer support and reassurance.
- Talk and act in a calm manner.
- Have the resident take small sips of water and place them in a prone position.
- Call for help immediately.
Correct answer: Have the resident take small sips of water and place them in a prone position.
Patients suffering chest pains should not have water or foods until they can be assessed by other members of the healthcare team. A prone position is not appropriate for chest pains. All of the other options are important in the treatment of your resident.
- Another term for decubitus ulcer is ____.
- Pressure sore
- Perforation
- Ulcerated cyst
- Ulcerated tumor
Correct answer: Pressure sore
The term pressure sore is actually a more accurate term to use than decubitus ulcer. The other options are incorrect.
- All of these are ways to prevent pressures sores except:
- Changing soiled sheets quickly.
- Changing positions regularly.
- Providing extra blankets.
- Avoiding wrinkles in sheets.
Correct answer: Providing extra blankets.
Providing extra blankets will not necessarily help with pressure sores. The other options all assist in pressure sore prevention.
- Making a bed, whether occupied or unoccupied, should end with ____.
- Adjusting the height of the bed.
- Mitering the corners.
- Moving the call light.
- Washing your hands.
Correct answer: Washing your hands.
Hands should be washed after making the bed. The other options are part of the process but not the last step.
- Which medical term is often used for “burping, belching and passing gas”?
- Flank
- Flatus
- Fascia
- Familial
Correct answer: Flatus
The medical term for intestinal gas is flatus. Familial refers to a condition more common in certain families than in the general population. Fascia is the medical term for a tissue lining under the skin. Flank is used for a side of the back.
- Which of these describes stage 4 of a decubitus ulcer?
- Superficial ulcer that looks blackened or like a deep crater.
- Open area with redness.
- Open area with damage reaching to the bone, joint, or tendons.
- Redness on the skin.
Correct answer: Open area with damage reaching to the bone, joint, or tendons.
Damage to the bone, joint, or tendons signals stage D: Stage 1 is redness, stage 2 is both redness and an open sore, and stage 3 may indicate a blackened or crater-like appearance.
- Which of these treatments would be best to decrease swelling?
- Heat compression.
- Cold compression.
- Dry bandage pressure.
- Moist bandages.
Correct answer: Cold compression.
Cold packs are applied to reduce swelling. Heat compressions are common treatments for back pain. Dry bandage pressure is used to stop bleeding and moist bandages are used on burns.
- Which medical position can be described as, “The patients head is elevated with legs either bent or straight”?
- Fowlers position
- Roses position
- Sims position
- Trendelenbergs position
Correct answer: Fowlers position
In Fowlers position the head is elevated. In Trendelenbergs position the head is lower than the feet. In Sims position the resident is lying on one side. In Roses position the head is over the end of a table.
- Which of these is least likely to contribute to skin tears?
- Length of hair
- Equipment
- Resident falls
- Length of nails
Correct answer: Length of hair
The length of a resident or caregivers hair is the least likely element to cause a skin tear. The other options are all considered common causes of skin tears for both the elderly and the very young.
- Which of these examples demonstrates using proper body mechanics when helping to lift a resident in bed?
- Bending at the waist, knees locked, using arm muscles to lift.
- Bending at the waist, knees unlocked, using arm muscles to lift.
- Bending at the waist, knees partially flexed, using leg muscles to lift .
- Bending at the waist, knees unlocked, using back muscles to lift.
Correct answer: Bending at the waist, knees partially flexed, using leg muscles to lift .
Keeping knees flexed and using leg muscles to lift are the best options to avoid injury. The other options are not using body mechanics properly and increase the likelihood for injury.
- If you smell smoke and discover a resident smoking in his room, it is best to ____.
- Have him stop and remind him of the facility policies because of the hazards it creates to every resident
- Tell the resident you will allow him to finish his cigarette but you are obligated to report it if it happens again
- Call the family contact and ask them to deal with their loved one on this issue
- Ignore the first incident but report it if it happens again with the same resident.
Correct answer: Have him stop and remind him of the facility policies because of the hazards it creates to every resident
The resident needs to stop and to know you will not allow his behavior to continue. He also may need to be reminded of the policies and hazards. The other options are not the proper way to immediately deal with the situation.
- The best use of alcohol-based sanitizer is:
- When helping with catheterization.
- When hands are not visibly soiled.
- When hands have blood from a cut.
- When hands are visibly soiled.
Correct answer: When hands are not visibly soiled.
Alcohol-based sanitizers are best used for hands that are not visibly soiled. Soap and water are used when soiling is visible. The other options are not appropriate times to use alcohol-based sanitizer.
- Which of these is incorrect in reference to wearing gloves?
- Always wear latex gloves because they are the most impermeable option.
- Wash your hands before putting on, and after removing, gloves.
- Upon removal, avoid letting the outer layer of the gloves contact your skin.
- Peel the glove away from you so it comes off inside out.
Correct answer: Always wear latex gloves because they are the most impermeable option.
Latex gloves may not necessarily be the best choice because of latex allergies. The other options are all necessary precautions that should be used.
- If you are walking with a resident and they fall, which of these is not an action you should take?
- Supply information for the nurse so proper documentation can be made.
- Inform the nurse.
- Help the resident off the floor and in to the nearest chair.
- Keep the resident from moving until you can assess if they have injuries.
Correct answer: Help the resident off the floor and in to the nearest chair.
Helping the resident off the floor and in to the nearest chair is not an immediate action to take. A serious injury might become worse if the resident is moved. The other actions are all necessary in the process of dealing with a resident who has fallen.
- Which of these is the least likely to signal impending death?
- Unstable blood pressure.
- Cooled extremities.
- Labored breathing
- Increase in appetite.
Correct answer: Increase in appetite.
Impending death will often lead to a decreased appetite rather than an increase in appetite. The other answer options are all common signs of a body shutting down.
- A resident is supposed to have 240 milliliters of juice every 2 hours. Which of these choices would be the most convenient to meet this requirement?
- 12 oz. can of juice.
- 8 oz. can of juice.
- 5 oz. can of juice.
- 4 oz. can of juice.
Correct answer: 8 oz. can of juice.
There is approximately 30 milliliters for every ounce, so an 8 oz. can of juice is the exact requirement. The other options could be used but are not the most convenient.
- A resident in your care has called you for help. He claims he can’t find his dentures. As a nursing assistant, it is your responsibility to ____.
- Notify the supervising nurse.
- Document the loss in the patients medical record.
- Tell the resident that you will notify the family contact member
- Ask the resident to refrain from eating until the dentures are located.
Correct answer: Notify the supervising nurse.
The supervising nurse should be notified. He or she will determine the appropriate documentation of the incident. It is not a nursing assistants role to contact the family members or make a decision that the resident should stop eating.
- All of these might be used in dealing with contractures except ____.
- Hand roll
- Repositioning every shift
- Bandaging
- Physical therapy
Correct answer: Bandaging
Contractures involve the degeneration and stiffening of joints. Bandaging is not used as a method of prevention or treatment. The other options are all possible ways of preventing contractures from happening or loosening joints after contraction has occurred.
- Hypertension is a medical term for:
- High blood pressure.
- High anxiety.
- Hyperactivity.
- Tense muscles.
Correct answer: High blood pressure.
The medical term for high blood pressure is hypertension. The other options are incorrect.
- Applying friction in the handwashing process is very important. According to CDC recommendations, the scrubbing portion of hand washing should take ____.
- 60 seconds
- 10 seconds
- 20 seconds
- Any amount of time, as long as you scrub until hands feel clean.
Correct answer: 20 seconds
20 seconds is the suggested recommendation for proper friction. To make sure you are scrubbing for the correct amount of time, it is often suggested you sing or hum “Happy Birthday” to yourself twice while washing.
- Which of these should not be part of the process for cleaning a residents dentures?
- Rinsing thoroughly.
- Placing clean dentures on top of a tissue on the residents table.
- Padding the sink.
- Washing your hands.
Correct answer: Placing clean dentures on top of a tissue on the residents table.
Placing dentures on a tissue could lead to dentures being knocked off and damaged or a housekeeper removing the tissue and, inadvertently, throwing the dentures in the trash. The other options are extremely important to the washing process.
- The medical term tetraplegia—meaning paralysis of all four extremities—is often used interchangeably with the term ____.
- Quadriplegia
- Hemiplegia
- Paraplegia
- Cardioplegia
Correct answer: Quadriplegia
Quadriplegia is another word used for tetraplegia—both of which mean paralysis of all four extremities. Hemiplegia is paralysis of one side, cardioplegia is paralysis of the heart, and paraplegia is paralysis of just the legs.
- To minimize the spread of bacteria, further infection and contamination, which procedure should be used for washing the perineum of a resident with a catheter?
- Wash from the meatus out.
- Wash from the rectum to the scrotum.
- Wash with peroxide.
- Wash from the rectum to the meatus.
Correct answer: Wash from the meatus out.
Washing from the meatus out is correct because it avoids further spread of contamination. Peroxide is not a cleanser and the other two options are in the opposite direction they should be in.
- All of these precautions should be followed when using a transfer-gait belt, except ____.
- Never using a frayed or worn transfer-gait belt.
- Placing transfer belts around the residents waist.
- Not worrying about proper body mechanics.
- Slightly rocking and pulling when using a gait belt on a resident in a sitting position.
Correct answer: Not worrying about proper body mechanics.
Proper body mechanics are always used to avoid injury and should never be ignored. The other options are all useful precautions.
- Which of these is considered an accurate method for counting respiration rate?
- The resident counts to 30 while the nursing assistant counts respirations.
- The nursing assistant watches the abdomen while the nurse looks at her watch to time 30 seconds.
- The resident counts to 30 while the nursing assistant counts respirations.
- The nursing assistant looks at the residents abdomen and a watch at the same time.
Correct answer: The nursing assistant looks at the residents abdomen and a watch at the same time.
The nursing assistant monitors a watch for a 30 second interval while observing the residents abdomen. The other options could produce an inaccurate result.
- A resident has the following symptoms: dizziness, feeling faint, blood pressure below 90/60 and cold, sweaty skin. The resident is most likely suffering from ____.
- Hypertension
- Hypodermia
- Hypoglottis
- Hypotension
Correct answer: Hypotension
Hypotension is low blood pressure and all these symptoms are associated with it. Hypodermia is the medical term for tissue under the epidermis, hypoglottis is the underside of the tongue, and hypertension is high blood pressure.
- Alcohol-based hand cleanser is appropriate for all of these situations except ____.
- When soap and water are not available.
- After walking a resident down the hall.
- When hands have observable dirt.
- After handling a residents clothes.
Correct answer: When hands have observable dirt.
Observable dirt that is visible on hands requires soap and water. The other options are all considered times that alcohol-based hand cleanser could be used.
- Convulsions are associated with ____.
- A spasm
- A tear
- A seizure
- A sprain
Correct answer: A seizure
Convulsion is a term often used interchangeably with seizures. The other options are all incorrect.
- Which of these is not true about the proper procedure for taking a tympanic membrane temperature with an electric thermometer?
- Use a speculum cover that is twisted securely in place.
- Be sure the ear is free of cerumen (earwax) before inserting the unit.
- Wait for the unit to signal before removing the speculum.
- Be sure that the speculum fits snugly by pulling gently on the ear pinna.
Correct answer: Be sure the ear is free of cerumen (earwax) before inserting the unit.
Do not attempt to remove cerumen from the ear canal before taking a tympanic membrane temperature. All of the other answer choices are procedures that should be followed.
- If you are helping a resident put on a clean night shirt and it falls to the ground before you get started, it is best to ____.
- Ask the resident if they want to go ahead and use the dropped shirt.
- Place the shirt on the chair and go to get a clean garment.
- Tell the resident to wear the shirt until you can go and get a clean one.
- Put the shirt in the hamper for cleaning and get another clean garment.
Correct answer: Put the shirt in the hamper for cleaning and get another clean garment.
Picking up something that has dropped to the floor and then using it on a resident can cause contamination and infection. The resident may not make the best decision and should not choose. Placing the shirt on a chair can be easily forgotten and the resident could pick it up at a later time and put it on.
- When muscle tissues shorten and then a joint becomes hard to move it is called _____.
- A perforation
- A contracture
- A twitch
- A rupture
Correct answer: A contracture
Contracture is the shortening of muscle tissue making stretching difficult. A rupture is when something bursts open. A twitch is a sudden, jerking movement. A perforation is an opening.
- Which of these is not true when taking a blood pressure reading?
- The optimum position for the resident is sitting with both feet on the floor.
- It is best if the resident does not talk while his or her blood pressure reading is being taken.
- Blood pressure readings can be a little higher in the mornings.
- The optimum position for the resident is lying down with his or her feet elevated.
Correct answer: The optimum position for the resident is lying down with his or her feet elevated.
It is not optimum to have a resident lying down for a blood pressure reading. All of the other options are true considerations for optimum results.
- A resident is ill with the following symptoms: fever, swelling, redness, and chills. The resident most likely has ____.
- Arthritis.
- An infection.
- An allergy.
- Food poisoning.
Correct answer: An infection.
Given all of these symptoms combined, infection is the correct answer. The swelling and redness, coupled with the fever, indicate a local infection. The other options do not commonly have all of these symptoms combined.
- Which of these tasks related to intravenous therapy is in the scope of responsibilities for a nursing assistant?
- Get the intravenous feed into the patient and then call the supervising nurse to assess.
- Nursing assistants are not allowed to be involved in the intravenous process.
- Prepare the proper solution.
- Watch the drip and report any problems
Correct answer: Watch the drip and report any problems
A nursing assistant can watch the flow of solution and then report any problems to the charge nurse. The nursing assistant cannot start the feed nor prepare the solution.
- Which of these applies to proper hand washing procedures?
- Use friction for 15 seconds.
- Use only antibacterial soap when washing hands.
- If the soap doesn't lather, it is important to use longer friction time.
- Use a paper towel to turn off the faucet.
Correct answer: Use a paper towel to turn off the faucet.
Using a paper towel to turn off the faucet prevents transferring germs from the faucet to your hands. The other options are incorrect because friction needs to be longer than 15 seconds, using only antibacterial soap may not be an option, and some soaps can be effective even if they do not produce a lot of lather.
- Why is an axillary reading generally lower than the other forms of taking a temperature?
- It is placed deeper in the body.
- It is taken for a shorter period of time.
- It is not inside the body.
- It is taken at the back of the body.
Correct answer: It is not inside the body.
Axillary temperatures are taken in the armpit. They are not actually inside the body such as in the mouth, rectum, or ear. The other answers are incorrect.
- Which of these would most likely be used to protect a resident from inflicting immediate harm to themselves in a care facility setting?
- Isolation.
- A watch schedule 24/7.
- Additional staff.
- Restraints.
Correct answer: Restraints.
Restraints are only used with an order from the physician and only when the resident is in danger of harm to themselves or others. Isolation increases the chance for harm and additional staff or a 24/7 watch schedule are likely unmanageable with the number of residents and staff in a care facility. This is the correct answer, given the answer choices, however, please check the regulations in your state concerning the use of restraints. There is at least one state that does not permit their use.
- Which of these is the correct step in taking a radial pulse?
- Press lightly on the side of the neck with the pads of two fingers.
- Press lightly against the radial bone with your fingers.
- If the pulse rate is erratic, count an extra 90 seconds.
- Count the number of beats in 30 seconds and then triple it.
Correct answer: Press lightly against the radial bone with your fingers.
Taking a radial pulse requires fingers placed on the inside of the wrist against the radial bone. The count is for 60 seconds. The other options are incorrect.
- A pulse can be taken in all of these areas except ____.
- Behind the knee.
- The back of the head.
- The inner wrist.
- The side of the neck.
Correct answer: The back of the head.
A pulse is not taken at the back of the head, but can be taken at any of the other options.
- Which statement is false with regard to taking a rectal temperature?
- The thermometer should be inserted 1.5 inches in an adult.
- A rectal temperature reading may be slightly higher than an oral temperature reading.
- Mercury thermometers are preferred for accuracy.
- Wipe the residents rectum when finished, if needed.
Correct answer: Mercury thermometers are preferred for accuracy.
Mercury thermometers are no longer used in medical facilities due to the dangers of mercury. The other answers are all correct pertaining to rectal temperatures. The insertion depth would be less in a child or infant.
- The normal pulse rate for an adult is 60-100 beats per minute. The normal pulse rate for children is ____.
- 70 to 120 beats per minute.
- 60 to 100 beats per minute.
- 55 to 105 beats per minute.
- 40 to 60 beats per minute.
Correct answer: 70 to 120 beats per minute.
A range of 70 to 120 is normal for young children. Babies up to 1 year old can have even higher pulse rates. The other options could apply to adults or conditioned athletes but are incorrect for children.
- Which statement is incorrect regarding the Heimlich maneuver?
- If the resident is coughing violently, proceed with the Heimlich maneuver immediately.
- Place your hands around the resident between the xiphoid and the umbilicus.
- To properly apply the Heimlich maneuver, make a fist with your hands.
- If you are alone and choking, you can perform the Heimlich maneuver on yourself using the back of a chair.
Correct answer: If the resident is coughing violently, proceed with the Heimlich maneuver immediately.
If the resident can cough, there is a good chance the object will be dislodged. If the resident cannot speak or cough it is a sign you need to do the maneuver. All of the other options are correct.
- A nursing assistant may help in alleviating the use of restraints on a resident using all of these suggestions except ____.
- Bringing out a restraint so the resident is reminded they will be used if the behavior continues.
- Redirect or distract a resident.
- Becoming aware of the triggers that make a resident agitated.
- Learning what activities calm a resident down.
Correct answer: Bringing out a restraint so the resident is reminded they will be used if the behavior continues.
Threatening the use of restraints makes it a punishment and is not the appropriate action. Restraints are only used when a physician has prescribed them and is not determined by a nursing assistant. The other options can be used to help diffuse the use of restraints and may or may not work depending on the situation.
- Transmission-based precautions are ____.
- Part of the standard-based precautions for all residents.
- Added to standard-based precautions when a resident is known or suspected of having a communicable disease
- Only used during times when an epidemic is declared.
- Not as stringent as other precautions.
Correct answer: Added to standard-based precautions when a resident is known or suspected of having a communicable disease
When a resident is suspected or confirmed of having a disease that can be transmitted to others, transmission-based precautions are added to standard-based precautions and are designed to interrupt the spread of disease. The other options are not true as transmission-based precautions are not applicable for all residents, can be more stringent than other precautions and are used more than just during an epidemic.
- Which of these is not true about condom catheters?
- They are a treatment used to avoid urinary tract infections.
- They are internal catheters and not as effective as external catheters.
- They are more effectively used if pubic hair is removed around the area.
- They should be changed frequently.
Correct answer: They are internal catheters and not as effective as external catheters.
Condom catheters are external catheters and often described as more convenient than internal catheters. All of the other options are facts about their use.
- After assisting a resident onto a bedpan, it will help to make the patient more comfortable if you
- Turn on the television for distraction.
- Raise the head of the bed.
- Lower the head of the bed.
- Have a trusted loved one assist with the procedure.
Correct answer: Raise the head of the bed.
Raising the head of the bed once a resident is set on a bedpan will make them more comfortable. Turning on the television may actually interfere with the process and the other options may make the resident more uncomfortable.
- The medical term for a device with two soft plastic prongs that attach to a plastic tube delivering oxygen is:
- An oxygen diffuser.
- A nasal shunt.
- A nasal antihistamine.
- A nasal cannula.
Correct answer: A nasal cannula.
A nasal cannula is the device that goes into the nose and helps deliver oxygen. The other options are all incorrect.
- A resident has the following symptoms: expelled brown fluid from the rectum, excessive amounts of flatus, and light abdominal cramping. Which of these is most likely the cause of these symptoms?
- A blood clot.
- A stroke.
- A heart attack.
- An enema.
Correct answer: An enema.
These are common symptoms following an enema procedure. If the cramps become severe, contact the charge nurse. These are not primary symptoms indicating a heart attack, blood clot, or stroke.
- A resident with venous stasis has developed pressure sores under elastic stockings. What is the most likely cause?
- The resident is allergic to the elastic.
- The elastic stockings are the wrong treatment and should be remove.
- There are wrinkles in the elastic stockings.
- The resident has been scratching his or her legs.
Correct answer: There are wrinkles in the elastic stockings.
Wrinkles in stockings or bed sheets are a common cause of pressure sores. While the other options may cause different symptoms, pressure sores develop when there is an article pressing against the body for a period of time.
- To avoid pulling the catheter when turning a patient, the catheter tube should be taped to the patients ____.
- Knee.
- Outer thigh.
- Bed frame.
- Upper thigh.
Correct answer: Upper thigh.
Taping the catheter to the upper thigh can help prevent inadvertent removal and physical trauma. Taping it to the outer thigh, bed frame, or knee can cause pulling and removal when you are turning a patient.
- Which of these is not a signal for notifying the charge nurse regarding a residents ostomy bag?
- Pus draining out of a stoma.
- A sudden increase in the amount of stool in the pouch.
- Skin around the stoma is bulging.
- A temperature of 98.8.
Correct answer: A temperature of 98.8.
A temperature of 98.8 is considered within a normal range. Pus or bulging around the stoma or a sudden increase in stool should all be reported to the charge nurse immediately.
- Which is the standard for measuring urinary output?
- Milliliters.
- Cups.
- Ounces.
- Liters.
Correct answer: Milliliters.
Urinary output is measured in milliliters (ml). Some facilities may still use cubic centimeters (cc), which are volumetrically equivalent to milliliters. However, the use of cubic centimeters is not considered best practice due to the abbreviation “cc” often being confused for the abbreviation “u” (meaning units). The other answers are not the correct standard of measure for this type of output.
- Which is the best advice if you are uncertain you are able to move an obese patient on your own when it is time for their scheduled re-positioning?
- Try to move the client alone.
- Ask the family members to assist you.
- Give the patient something sturdy to grab onto and encourage him or her to move to himself or herself.
- Ask another nursing aide to help.
Correct answer: Ask another nursing aide to help.
Which is the best advice if you are uncertain you are able to move an obese patient on your own when it is time for their scheduled re-positioning?
- When having a conversation with a dysphasic patient (someone who has trouble speaking), it is important not to ____.
- Finish what you believe they are trying to say for them.
- Encourage them to use all of their senses to convey their needs.
- Praise their efforts.
- Use visual aids and other devices such as a whiteboard.
Correct answer: Finish what you believe they are trying to say for them.
Dysphasia may occur as the result of a neurological problem (stroke or Alzheimers disease) or a past surgery to remove a cancer from the mouth, tongue, oral cavity, or larynx (voice box). It is important to remember that although the patients ability to communicate has been affected, their intelligence has not. Be patient and do not hurry them. Do not try to finish what you believe they are trying to say. Use visual aids and devices to help them communicate, encourage them to use all of their senses to convey their needs, and always praise their efforts to communicate.
- Which of the following is a correct measurement of urinary output?
Correct answer: 300 cc
300 cc is a metric measurement meaning 300 cubic centimeters. In medicine around the world, the metric system is used for all length, weight, volume, and temperature measurements. The metric system is based on units of ten, and is more precise than other methods of measurement.
- Normal urine color is
- Red.
- Colorless.
- Brown.
- Yellow.
Correct answer: Yellow.
Normal urine has a yellow color that ranges from dark yellow to light straw color. Urine that is amber-colored indicates dehydration; more fluids need to be taken. Brown urine can mean severe dehydration or liver disease, and should be checked. Urine that is red-tinted can happen after the client eats some foods, such as beets or blueberries. Red urine can also be a sign of kidney disease, urinary tract infections, or prostrate problems. If urine is colorless, it can mean that the client is over-hydrated and should reduce fluid intake.
- A patient who was given insulin in the morning is pale and sweaty and appears confused two hours later. It would be helpful to find out whether the patient
- Ate too much sugar
- Had breakfast
- Had visitors that day
- Has diabetes
Correct answer: Had breakfast
A diabetic client who received insulin and is now pale, sweaty, and confused is showing signs of hypoglycemia (low blood sugar). Insulin lowers blood sugar, so if the client did not eat after the injection, the blood sugar drops dangerously. It is important to find out whether the client had breakfast. Quickly check the client's blood sugar and report to the nurse; the client will need 15 grams of a simple carbohydrate, such as 1/2 cup of orange juice.
- When taking a client’s radial pulse, the nurse aide’s fingertips should be placed on the client’s
Correct answer: Wrist
A radial pulse is found at the client’s wrist. To locate it, place your index and middle fingers on the hollow area below the thumb. Apply light pressure to feel the pulse. Count each beat for 30 seconds and multiply by 2 to get the pulse rate. If the client has an irregular heartbeat, count for 60 seconds. Record the pulse rate in the client’s chart.
- Which of the following best helps reduce pressure on the bony prominences?
- Several pillows
- Repositioning every shift
- Sheepskin
- Flotation mattress
Correct answer: Flotation mattress
A bedridden client can quickly develop pressure sores if allowed to remain in one position. To prevent the skin from breaking down, reposition the client at least every two hours. Use pillows to support the client and to relieve places where skin can rub, such as between the legs or at the tailbone. Always keep the skin clean and dry. A sheepskin on the bed or wheelchair provides extra padding, but does not replace repositioning. Observe the skin for reddened areas and report them to the nurse. Special beds and flotation mattresses are helpful in preventing pressure sores.
- Which of the following people provide treatment for persons who have difficulty talking due to disorders such as a stroke or physical defects?
- Physical therapist
- Speech therapist
- Registered nurse
- Occupational therapist
Correct answer: Speech therapist
When a client is unable to speak clearly or has trouble forming words, a speech therapist can help improve problems from strokes, physical defects, and swallowing disorders. Speech therapists work with both adults and children. They are qualified to evaluate, diagnose, and treat clients.
- A client is to be assisted out of bed to sit in a wheelchair. Which action would make this procedure safe?
- Place a pillow on the wheelchair seat
- Lower both footrest pedals
- Release the wheel brakes
- Place the bed in the low position
Correct answer: Place the bed in the low position
Client safety during transfer begins with the bed in the lowest position. This allows the client to easily reach the floor when standing and pivoting to sit in the wheelchair. The brakes of the wheelchair should be locked and the footrests completely out of the way.
- While making an empty bed, the nurse aide sees that the side rail is broken. The nurse aide SHOULD
- Tie the side rail in the raised position until it is fixed
- Warn the client to be careful when she gets back into bed
- Report the broken side rail immediately
- Wait for the next safety check to report the broken side rail
Correct answer: Report the broken side rail immediately
Every staff member is responsible for keeping clients safe at all times. This includes monitoring all equipment and reporting when anything needs repair. Never use broken equipment or try to create a temporary solution if equipment is not working properly. Tag the broken bed and move it so that another client can’t use it. Replace it immediately with one that has functioning side rails.
- The equipment you need to gather to do unconscious oral care would include
- Toothpaste.
- Toothette/mouth swab
- Toothbrush.
- All of the above
Correct answer: Toothette/mouth swab
Because an unconscious client is not able to assist with oral care, the nurse aide must take extra precautions to prevent choking or aspirating while giving oral care. The client’s head should be turned to the side. If possible, lower the head of the bed. Gently clean the teeth and gums with a separate moist toothette or mouth swab for each area of the mouth. Wipe the client’s mouth when finished and raise the head of the bed to its prior position.
- While eating dinner a client starts to choke and turn blue. The nurse aide SHOULD
- Immediately remove the client’s food tray and go find the nurse in charge
- Slap the client on the back until the food dislodges
- Call for assistance and perform the Heimlich maneuver (abdominal thrusts)
- Give the client a drink of water
Correct answer: Call for assistance and perform the Heimlich maneuver (abdominal thrusts)
Abdominal thrusts (the Heimlich maneuver) is the best response to choking. Calling for assistance as you prepare to do abdominal thrusts will alert others of the emergency. A quick back slap can be tried, but if the food does not immediately dislodge, the nurse aide must quickly move to start abdominal thrusts. Performing abdominal thrusts involves standing behind the client and using hands to exert upward pressure on the bottom of the diaphragm.
- The purpose for padding side rails on the client’s bed is to
- Have a place to connect the call signal
- Protect the client from injury
- Use them as a restraint
- Keep the client warm
Correct answer: Protect the client from injury
Side rails are important for keeping clients from falling out of bed. They also allow a way for clients to grab on to the railing to reposition themselves. However, if the client is agitated, confused, has a head injury or history of seizures, padding the side rails can prevent injuries or entrapment. Some facilities have bed rail pads or bumpers in stock. Use a mattress pad to make a side rail pad. Make sure the bed is always in the lowest position.
- As a CNA, you become an advocate for the resident(s) that you care for. This means that you ____.
- Help them make difficult decisions regarding their care.
- Ask questions regarding their care.
- Complain when something that they don't like is done.
- Communicate their needs when they might not be able to.
Correct answer: Communicate their needs when they might not be able to.
Because you will likely spend more time with your resident(s) than any other member of the healthcare team, you will have very close interactions with them. This will lead to you befriending them and becoming their advocate, which is communicating their needs when they might not be able to.
- Which of these best describes the purpose of padded side rails?
- To protect a resident from injury.
- To prevent skin breakdown.
- To keep a resident in the proper temperature.
- To use as a restraint.
Correct answer: To prevent skin breakdown.
Padded side rails are to protect the resident from injury. The other answers are incorrect
- A resident drinks 8 ounces of milk during lunch, but the standard measurement of documentation in the facility is cubic centimeters (cc). What value would the nursing assistant record?
Correct answer: 240 cc
There are approximately 30 cc in every ounce, so 8 ounces is equal to approximately 240 cc of fluid.
- A CNA is recording the 24-hour urine output of a patient with kidney issues. What 24-hour urine value would warrant a report to the nurse?
- 800 cc
- 1400 cc
- 1900 cc
- 600 cc
Correct answer: 600 cc
The normal 24-hour urine output for a patient should between 800 and 2000 cc. 600 cc of urine in 24 hours could indicate a complication and should be reported
- There is a sign that says “NPO” on your patients door. You know this means ____.
- The patient is at risk for falls.
- The patient is under isolation precautions.
- The patient can only have liquids.
- The patient can not have anything by mouth.
Correct answer: The patient can not have anything by mouth.
If patients are “NPO,” they are not allowed to have any food or fluids by mouth
- Which of these would be inappropriate when caring for a diabetic patient?
- Keeping the patients feet clean and dry.
- Carefully monitoring and reporting the patients food consumption.
- Ensuring the patient has plenty of snacks to eat throughout the day.
- Offering the patient a thermal foot soak once a day to relax.
Correct answer: Carefully monitoring and reporting the patients food consumption.
Patients with diabetes can have diabetic neuropathy, which means they have a decreased sensation in their extremities. If the patient soaks his or her feet in hot water, he or she could sustain tissue damage as he or she may not be able to tell if the water is too hot. Keeping the feet clean and dry is an appropriate care tactic for diabetic patients. Diabetic patients should eat several snacks throughout the day to keep their blood sugar stable, and their overall intake should be monitored and reported to prevent large blood sugar swings.
- Your patient has a low pulse, seems slightly confused, and has sweet, fruity-smelling breath. You suspect ____.
- Hypertension
- Hypoglycemia
- Hypotension
- Hyperglycemia
Correct answer: Hypertension
Hyperglycemia, or high blood sugar, is marked by slurred speech, low pulse, warm skin, sluggish or confused demeanor, deep respirations, and fruity or sweet-smelling breath.
- You are caring for a patient with a strict dysphagia diet. Which item on the patients tray would you question?
- Peanut butter.
- Chocolate pudding.
- Applesauce.
- Mashed potatoes and gravy.
Correct answer: Peanut butter.
A dysphagia (difficulty-swallowing) diet avoids thick, sticky, or hard-to-swallow foods that increase aspiration risk. Peanut butter is thick and sticky and can be very hard to swallow safely, so the nurse aide should question it on the tray. Smooth, soft items like chocolate pudding, applesauce, and mashed potatoes and gravy are appropriate for a dysphagia diet.
- You should be careful when changing, as this is a common site for unintentionally discarded needles.
- A residents bed linens.
- A residents clothing.
- A residents bath towels and washcloths.
- A residents trash bag.
Correct answer: A residents bed linens.
As many procedures requiring the use of needles and other “sharps” are done at the bedside, the bed linens may be a place where extra precaution is needed when changing as they may be a common site for unintentionally discarded needles.
- The circulatory system consists of the
- Blood vessels, arteries, veins and capillaries
- Heart, aorta, pulmonary vessels, lungs
- Heart, arteries, veins and capillaries
- Blood vessels, lymph nodes, spleen
Correct answer: Heart, arteries, veins and capillaries
The circulatory system is made up of the heart, arteries, veins, and capillaries. They are connected to make a complete circuit in the body. The heart pumps oxygenated blood from the lungs, as well as nutrients, through the arteries to the capillaries. The capillaries then deliver carbon dioxide and waste to the veins. The veins take the waste products to the liver and kidneys for disposal, and the carbon dioxide goes to the lungs to be exhaled.
- A fractured hip is ____.
- The most difficult injury from which to recover.
- The most frequent injury when a resident falls.
- The most expensive injury for rehabilitation.
- The injury that generates the most complaints from residents.
Correct answer: The most frequent injury when a resident falls.
A fractured hip is the most frequent of all injuries when a resident falls. The other options are varied depending on the residents age, the overall health of the resident, or how fractured the hip may be.
- If the nurse aide discovers fire in a client’s room, the FIRST thing to do is
- Call the nurse in charge
- Try to put out the fire
- Open a window
- Remove the client
Correct answer: Remove the client
The nurse aide should be familiar with all fire safety policies and protocols. When a fire alarm sounds, all staff must respond to keep clients safe. Remember “R.A.C.E.” to quickly act. R = Rescue/Remove all people who can not take care of themselves. A = Alarm, if it has not already been done. Pulling the alarm can be done at the same time as rescue. C = Confine/Contain the fire or smoke by closing doors to prevent or slow the spread. Smoke is especially dangerous for everyone. E = Extinguish the fire if possible, using a handheld fire extinguisher. Attempt to extinguish only small fires, as long as you can remain safe and have an escape route.
- On what side should the patient lie for an enema?
- The side closer to the restroom
- Right
- Left
- Whichever side is more comfortable
Correct answer: Left
The left Sim’s position is used for rectal examinations and administering enemas. The client lies on the left side, with the right knee and hip bent. It is also called the lateral recumbent or semiprone side position.
- Which of the following is NOT considered to be a way to restrain a client?
- A hand mitt
- Lap buddy/tray
- A sedative
- Pain management
Correct answer: Pain management
A restraint may be either physical or chemical. Its purpose is to protect the client from harming himself or others. Only a physician may order a restraint, and guidelines are strict. A pain medication may help calm a client or relieve behavior associated with severe pain, but it is not in the restraint category.
- The electric shaver that the nurse aide is using to shave a client begins to spark and smoke. What should the nurse aide do FIRST?
- Use the roommate’s shaver to finish the shave
- Finish shaving the client as quickly as possible
- Unplug the shaver
- Call the nurse in charge
Correct answer: Unplug the shaver
The electric shaver that the nurse aide is using to shave a client begins to spark and smoke. What should the nurse aide do FIRST?
- When taking an oral temperature, it is important to
- Place the thermometer under the tongue
- Put lubricant on the thermometer
- Place the thermometer in the rectum
- Place the thermometer under the arm
Correct answer: Place the thermometer under the tongue
To take an oral temperature, make sure the client has not had anything hot or cold to eat or drink for 15 minutes. Place the thermometer under the client’s tongue. A digital thermometer will beep when it registers the client’s temperature. A glass thermometer will have a line that stops moving when it gives the reading. In an adult, a fever is considered to be greater than 38 degrees C (100.4 degrees F). For children, a fever is 37.5 degrees C (99.5 degrees F).
- To lift an object using good body mechanics, the nurse aide SHOULD
- Hold the object away from the body
- Bend knees and keep back straight
- Keep both feet close together.
- Lift with abdominal muscles
Correct answer: Bend knees and keep back straight
It is important to maintain proper spinal position with lifting. The risk of injury to the low back increases when using the back muscles, bending at the waist, twisting, or trying to lift when the load is too heavy. Common injuries associated with lifting are strains, sprains and herniated discs. For heavy loads, always find another person to help.
- When operating a manual bed, the nurse aide should remember to
- Lock the wheels when the cranks are folded
- Fold cranks under bed
- Keep the bed in the neutral position
- Elevate the client’s head at all times
Correct answer: Fold cranks under bed
When working a manual bed, be sure to first lock the bed by pressing down the levers on the wheels at the head and foot of the bed. At the end of the bed there are three cranks which control the bed height, as well as raising and lowering the head and feet. Cranks are turned clockwise (left to right) to raise each section, and counter-clockwise to lower them. After positioning the client, always fold the cranks under the bed to prevent others from tripping or falling.
- The most comfortable position for a resident with a respiratory problem is
- Fowler's.
- Prone.
- Lateral.
- Supine.
Correct answer: Fowler's.
When a client is having difficulty breathing, Fowler’s position can provide relief. When sitting in Fowler’s position, the client is upright at 90 degrees, allowing the chest to expand as much as possible. Prone (on the abdomen), supine (on the back), and lateral (on the side) are all flat positions, which can make respiratory distress worse.
- Which one of these behaviors is NOT a signal of possible combativeness?
- Clenched mouth and teeth.
- Saying "I am angry."
- Fists in a ball.
- Rapid eye movement.
Correct answer: Saying "I am angry."
Non-verbal signs can tell you more about a person’s mood than their words. Non-verbal cues often come from instinct. Observe the signals that tell you a person is angry and ready to strike. If words and behavior do not match, always believe the behaviors or actions.
- The primary reason for combative behavior in a resident is
- Confusion
- Resentment
- Stubbornness
- Hunger
Correct answer: Confusion
The most common cause for combative behavior in clients with dementia is confusion about their care. Because of memory loss, clients become confused when staff members try to help them. Clients may not recognize their caregivers, or may not want to do what the caregiver is telling them, such as getting up, eating, or taking a shower. The clients’ automatic reaction will be to say “No” and push, hit, or kick. Always allow plenty of time when dealing with the clients. Speak softly and explain what is happening. Don’t argue. Remain calm and be prepared to try again in a few minutes.
- When caring for a confused resident what should a nursing assistant do?
- Say nothing to avoid more confusion.
- Give simple directions.
- Allow the resident to plan daily activities.
- Give the resident activities.
Correct answer: Give simple directions.
When speaking to a client who is confused or agitated, use a calm voice. Talk directly to the client, saying their name. Use short sentences and allow time for the client to respond. Be respectful and always treat the client like an adult.
- Reality orientation should include
- Calling the resident by his name.
- Using nicknames like "Granny".
- Talking about your interests.
- Telling imaginative stories to the resident.
Correct answer: Calling the resident by his name.
Reality orientation involves repeating information to help clients understand their surroundings. To keep a client oriented, their name is used frequently. Information such as date and time are reinforced with calendars and clocks
- What is an important way to help the resident feel comfortable in a long-term facility?
- Discourage visitors until the resident has settled in.
- Allow the resident to establish their own schedule.
- Bring the resident to all activities.
- Provide space for personal possessions.
Correct answer: Provide space for personal possessions.
During any change or transition, it is important to have familiar objects nearby. Special possessions, such as small pieces of furniture, blankets, photos, or mementos are important. Even personal items like soaps and shampoo can make a new environment more comfortable. If the resident has family, encourage them to visit so that the resident does not feel abandoned.
- When preparing to give peri-care to an incontinent female resident with dementia, the CNA knows
- The resident may become tearful
- The resident may feel sexually assaulted
- The resident may become combative
- All of the above
Correct answer: All of the above
Even under the best situations, giving peri-care can be awkward or embarrassing for a resident. For a resident with dementia, cleaning the genital area can cause various reactions. If the resident feels threatened or fearful, they may strike back. If they have a history of unwanted sexual actions, they may cry or complain of being assaulted. Always tell the resident what you are going to do and why. Describe each step before you do it. Speak in a calm manner.
- Which of the following is NOT true of dementia?
- People with dementia are often frightened and anxious.
- Grooming is difficult for patients with dementia.
- People with dementia act uncooperative in order to be spiteful.
- Patients can have vivid hallucinations.
Correct answer: People with dementia act uncooperative in order to be spiteful.
As dementia progresses, a client can exhibit any of the “Four A’s” of agitation, anxiety, anger, or aggression. These behaviors are not intentional, but signs of the disease. Remain calm and reassuring during these episodes. Redirecting the client is often a good way to end the behavior.
- A resident with Alzheimer’s disease tells the nurse aide that she smells smoke. The nurse aide should
- Put the patient to bed because she is clearly tired
- Tell her that no one is allowed to smoke in the building
- Reassure the patient that there is no fire
- Look around for a fire
Correct answer: Look around for a fire
Often the first symptom of Alzheimer’s disease is a loss of short-term memory. The client can still recall events and information about the past until the disease progresses to complete loss of brain function. Depending on the stage of Alzheimer’s, a client could certainly detect the smell of a fire.
- Some patients may exhibit some “false beliefs” not supported by facts or reality. This is known as
- Deliberation
- Digression
- Duration
- Delusion
Correct answer: Delusion
Delusions are false beliefs that involve a misinterpretation of experiences. A person may believe that they are being followed, tricked, or spied on. They may also be convinced that songs or books contain special information meant for them. Attempts to show the person that their belief is wrong or irrational are not accepted by the person.
- In a reality orientation program you would do all of the following EXCEPT
- Ask them to identify the smells of their meal.
- Show them the weather outside their window.
- Ask the resident about their childhood.
- Tell them the date and time each morning.
Correct answer: Ask the resident about their childhood.
Reality orientation is a formal program that involves repeating information to help residents understand their surroundings. To keep a residents oriented, their name is used frequently. Information such as date and time are reinforced with calendars and clocks. Show residents the weather, and ask them to identify smells and tastes.
- The end of the day can bring a common behavior for residents with dementia, called
- Sundown Syndrome.
- Overstimulation Fatigue.
- Depressive Disorder.
- Evening Paranoia.
Correct answer: Sundown Syndrome.
Caregivers can notice a big change in late afternoon or evening with clients who have dementia. Fading daylight seems to trigger confusion and agitation. It is also connected to hunger, poor vision, and less natural light. Take time to recognize the response of each resident who displays different behaviors. Does the twilight seem to cause confusion? Are lamps or other lights on? Could the residents be hungry? Does poor vision make it difficult to see?
- All of the following are clues to aggressive behavior EXCEPT
- Pacing
- Clenched jaw
- Rocking
- Depressed mood
Correct answer: Depressed mood
Knowing the signs of aggressive behavior can help you prevent a situation from escalating. An aggressive episode can develop unexpectedly. If the client has a clenched jaw or fist, or suddenly begins to pace or rock, act quickly. Assess the situation to find a possible cause. Is the client in pain? Tired or hungry? Overstimulated? Confused? Use a calm manner to deal with the client. Eliminate distractions and try to focus on a new activity.
- Which of the following can be a cause of intellectual disability?
- Down syndrome.
- Childhood illness.
- Birth complications.
- All of the above.
Correct answer: All of the above.
Intellectual disability (ID) is a below-normal intelligence and ability to perform basic tasks. ID can be caused by something that happens before birth, such as exposure to alcohol or drugs, or an infection. An example of a chromosomal disorder is Down syndrome. ID can be caused by an inherited condition such as Tay-Sachs disease or PKU. Problems with the birth, such as oxygen deprivation or premature delivery are two more reasons. Even infections such as meningitis or Whooping cough can result in ID.
- Residents with cognitive impairments often have difficulty sleeping. What can be helpful?
- Keep residents up as late as possible, so they will fall asleep more quickly.
- Turn on the television and allow the residents to watch until they fall asleep on their own.
- Establish a bedtime schedule and make sure the residents go to bed within 15 minutes of that time.
- Avoid physical activity during the day because it can overstimulate the residents.
Correct answer: Establish a bedtime schedule and make sure the residents go to bed within 15 minutes of that time.
Confusion and other symptoms can become exaggerated with fatigue. Causes of sleep problems for all residents can include the natural aging process, medication side effects, pain, and nightly urination. For residents with dementia, there is also a disrupted circadian rhythm, as well as fewer deep sleep cycles. Establishing a bedtime routine can reset the internal clock and make it easier for residents to fall asleep. Increasing physical activity during the day can improve the quality of sleep.
- If a resident becomes confused, you should
- Place him in his room so he won't wander.
- Put him in restraints so he won’t fall.
- Help the resident recognize familiar items.
- Sit him down until you have time to assist him.
Correct answer: Help the resident recognize familiar items.
When a resident seems confused, start by offering basic information. “Hello, Mr. Roberts. I’m Sally, your nurse aide. Do you remember me?” From there, offer other ways to help him regain his sense of time and place. “It’s Tuesday, August 26. You had chicken for lunch and watched the movie.” Returning the resident to his room to look at familiar objects and photos can also be helpful. Always remain calm and friendly.
- A resident with dementia has wandered to another unit. What should the nurse aide say after finding the resident?
- "Let's go. Don't you know I have work to do?"
- "Let's walk back together, okay?."
- “Do you think you're Christopher Columbus?"
- "How on Earth did you get here?"
Correct answer: "Let's walk back together, okay?."
6 out of 10 patients with dementia will wander. Even in the early stages, a resident can become confused for a short time. They may be restless or trying to do former activities, such as going to work or “go home.”
- A 90 year-old resident tells you that his mother is coming to visit on Sunday. What is your most appropriate response?
- "That is impossible! Your mother is dead."
- "Okay, let's figure out how old your mother could be."
- "How nice! What are you going to do when she gets here?"
- "Are you wishing you could see your mother?"
Correct answer: "Are you wishing you could see your mother?"
When residents who are confused about the past, do not contradict them or try to convince them they have no such thing. Do not play along with their misunderstanding. Look for the meaning behind their words and behavior. You can say, “Tell me what your mother was like. What are your best memories?”
- While the nurse aide tries to dress a resident who is confused, the resident keeps trying to grab a hairbrush. The nurse aide should _.
- Try to dress the resident more quickly
- Give the resident the hairbrush to hold
- Restrain the resident’s hand
- Put the hairbrush away and out of sight
Correct answer: Give the resident the hairbrush to hold
Offering a resident something to hold while performing a task can make the resident feel secure and allow the nurse aide to proceed more easily. For example, let them hold a washcloth during a bed bath. If they have a favorite small object, that can also be a good source of comfort.
- A client with dementia has developed a fear of taking a shower. What can a nurse aide do?
- Remind the client of the importance of being clean.
- Ask the client's family to convince the client.
- Give a bed bath and try a shower on another day.
- Offer a reward if the client takes a shower.
Correct answer: Give a bed bath and try a shower on another day.
A shower or bath can become a frightening experience for a client with dementia. Be patient and plan ahead. Gather everything needed and make sure the room is warm. In a gentle voice, tell the client what is going to happen throughout the process. Encourage the client to do as much as possible. Don’t rush and never leave the client alone. If the client refuses to shower, give a bed bath and try a shower another day.
- A confused resident tells you there is a monster in the closet. The nurse aide should
- Tell the resident there are no such things as monsters
- Pretend to kill the monster in the closet
- Tell the resident you will take the monster home with you
- Open the closet and show the resident nothing is there
Correct answer: Open the closet and show the resident nothing is there
If a client is confused, do not play along. This only adds to the client’s fear if you support the confusion or hallucination. Sensible explanations will not be helpful, because the client absolutely believes the fantasy. The best approach is to calmly address the situation directly. Accompany the client to the closet, reinforcing reality. Remain with the client, reminding them of their surroundings.
- A resident with Alzheimer’s disease has a baby doll that she carries with her and cares for. When she misplaces the doll, she begins to cry. What should the nurse aide do?
- Quickly find a new doll to replace the lost one.
- Tell the resident that it was only a doll.
- Comfort the resident as if the doll were real.
- Allow the resident to cry until she stops.
Correct answer: Comfort the resident as if the doll were real.
Dolls therapy can be useful for people with Alzheimer’s disease. Studies show that dolls can calm and soothe residents, as well as decrease wandering. A doll can also improve speech and communication. Because the doll is “real” to the resident, the loss is treated accordingly. After a short time, a new doll can be introduced to the resident. It is important to note that males can enjoy dolls, too.
- The Global Deterioration Scale (GDS) helps caregivers understand how people decline when they have dementia. Of the seven stages, which stage has no sign of dementia?
- Stage 2
- Stage 6
- Stage 7
- Stage 4
Correct answer: Stage 2
CNAs who work in a facility with residents who have dementia or Alzheimer’s disease will become familiar with the GDS. Stages 1-3 are pre-dementia, with none for few signs of decline. Stage 4 has signs of inability to concentrate, finishing tasks, and social withdrawal. Stage 5 includes some assistance with ADL and inability to recall current information, such as date or where they are. Stage 6 requires extensive help with ADL, incontinence, and inability to recognize family members. Stage 7 requires complete care, as well as inability to speak or walk.
- While the nurse aide is giving care to Mr. T., he calls the nurse aide by the name of his son who died several years ago. The nurse aide’s BEST response is to
- Ignore Mr. T. because he is confused.
- Ask Mr. T about his favorite memories of his son.
- Pretend to be Mr. T’s son.
- Quickly finish the care and leave Mr. T alone.
Correct answer: Ask Mr. T about his favorite memories of his son.
Because of their memory loss, it is common for clients with dementia to mix up names of others. They may even be aware that they are confused, but can’t figure out why. When they refer to someone who is no longer living, they may have been thinking about the person. Help them remember by asking about the person. If there is a photo or memento of the person, show it to them and help them reminisce about happy memories.
- Reality orientation therapy should include
- Telling the resident that they will be going home soon.
- Creating imaginative stories to amuse the resident.
- Calling the resident by a name such as "Gramps."
- Addressing the resident by their proper name.
Correct answer: Addressing the resident by their proper name.
Reality orientation involves repeating information to help clients understand their surroundings. To keep a client oriented, their name is used frequently. Information such as date and time are reinforced with calendars and clocks.
- When you approach a resident with dementia, how should you behave?
- With an "I'm busy, let's get this done" behavior.
- With a meek, submissive demeanor.
- With a cold, professional attitude.
- With a relaxed and cheerful manner.
Correct answer: With a relaxed and cheerful manner.
Patients with dementia can detect moods and attitudes, and act in a similar manner. If you are not involved, distant, or busy, the resident can detect this and react in a fearful way. If you are meek, they may try to take advantage of you. With a positive attitude, they can sense your nonjudgmental and relaxed demeanor and will respond accordingly.
- A resident is standing in the hallway holding a bag, and asks the nurse aide when the train is due. The aide should tell her
- That she is being ridiculous
- Where she is, in a matter-of-fact tone of voice
- That it should be here any time now
- To go back to her room
Correct answer: Where she is, in a matter-of-fact tone of voice
If a client is confused, do not play along. This only adds to the client’s confusion and frustration. Gently tell the client where she is and guide her back to her room. Use her name, remind her of her surroundings, and stay with her until she feels calm and reassured.
- Which of the following is the most appropriate time to use a soft toothette?
- When a resident is complaining of a toothache
- When a resident is having a seizure
- When a resident has dentures
- When giving an unconscious resident mouth care
Correct answer: When giving an unconscious resident mouth care
An unconscious resident is in danger of aspirating fluid or toothpaste and soft toothettes are generally untreated. The other options are incorrect.
- Which of the following would be an inappropriate action when providing nail care to a resident?
- Use lots of lotion on the hands and feet and between fingers and toes to help prevent dryness.
- Use extra caution if you trim the nails of diabetic residents.
- Thoroughly dry the fingers and toes to prevent skin breakdown.
- Soak the residents hands or feet in warm water before trimming to make the process easier.
Correct answer: Use extra caution if you trim the nails of diabetic residents.
While lotion can be an appropriate and needed part of nail care, you should avoid putting lotion between the fingers and toes, as it may serve as a medium to promote bacterial growth. Always check your facilitys guidelines for regulations about the nail-trimming of diabetic residents.
- A resident is recovering from a stroke and has weakness on their left side. They call you to help them put on a sweater. Assistance should be given ____.
- Behind the resident
- In front of the resident
- On the residents left side
- On the residents right side
Correct answer: On the residents left side
Assisting on the side that is the weakest offers support and helps the resident to keep their balance. The other options are not the best means of support.
- It is time to bathe an Alzheimers patient who has had visitors in the room for most of the shift. Which of the following is the most appropriate action for the nursing assistant to take?
- Ask the charge nurse to speak with the visitors.
- Ask the visitors to step out until the bath is complete.
- Ask the patient when you should come back.
- Perform the bath as your first task the next day.
Correct answer: Ask the visitors to step out until the bath is complete.
It is crucial, and within the scope of duties, for a nursing assistant to take charge of a patients privacy. It is also important to see that ADLs are accomplished within a reasonable time span and the question indicates that visitors have been present “most of the shift,” giving no opportunity for ADLs to be completed. Visitors can wait in another area. A patient with Alzheimers may not make the best decision as to when their bath should occur.
- A resident is often late to physical therapy because she is very slow at feeding herself during breakfast. What is the best action for the nursing assistant to take?
- Bring the resident to breakfast earlier.
- Encourage her to eat faster by taking her plate away when its time for her physical therapy.
- Withhold breakfast until after physical therapy.
- Begin feeding the resident breakfast.
Correct answer: Bring the resident to breakfast earlier.
Bringing the resident to breakfast earlier allows the resident to continue independently feeding herself and still make her physical therapy on time. The other options either encourage dependence or could border on neglect.
- A resident on the DASH diet reduces his food intake and shows little interest in eating. What is the best way for a nursing assistant to handle the situation?
- Call the staff nutritionist.
- Discuss the problem with the resident and try to persuade him to eat more.
- Check the residents prescribed dietary supplements and provide them to the resident.
- Talk with the family to see if they can coordinate bringing the residents favorite foods from outside the facility.
Correct answer: Check the residents prescribed dietary supplements and provide them to the resident.
The most appropriate action for a nursing assistant to take would be to provide the resident with his prescribed daily supplements. Discussing the problem with the resident may be helpful, but it is unlikely to make him eat more. Food the family brings in may be more appealing to the resident but likely would not comply with the DASH diet. While the nutritionist may need to be involved at some point, the RN or physician on duty would make that consult.
- Which of these may depend on facility rules when performing nail care on a resident?
- Nails are easier to trim if the feet or hands soak for 10 minutes before starting.
- When providing nail care, report blue or pale nail beds to the nurse.
- Nail care is best provided if the resident can sit in a chair, although it can be done with the resident in bed.
- The policy on cutting toenails.
Correct answer: The policy on cutting toenails.
Many care giving facilities only allow nurses and physicians to cut a residents toenails. The other options are all within the scope of a nursing assistants role for nail care given to residents.
- Which of these is an incorrect procedure for shaving a resident?
- Use a towel around the residents chest when shaving his face.
- Shave upward on the neck.
- When shaving the face, start from the chin and shave upwards towards the sideburns.
- Before shaving a resident check on their records and with the nurse to be sure they do not have a bleeding problem.
Correct answer: When shaving the face, start from the chin and shave upwards towards the sideburns.
Shaving the face from the chin upwards to the sideburns is incorrect technique for shaving a resident. You need to start at the sideburns and shave downward. All of the other options are part of the correct procedures when shaving a resident.
- Which of these is not a common mealtime and eating challenge that residents often face?
- Chewing or swallowing problems
- Loss of ability to manipulate eating utensils
- Being reminded when it is time to eat
- Decreased recognition of hunger or thirst
Correct answer: Being reminded when it is time to eat
If a care facility is doing its job, residents will be reminded of when it is time to eat, will feed the resident using caregivers or have nourishment given intravenously. This is the only option that should not be a problem for proper care of residents. The other answers are frequent and common challenges residents face.
- All of these are proper precautions for residents who are unable to move by themselves, except:
- The resident should be left clean and dry from incontinence.
- The resident should be routinely checked for pressure sores.
- The resident should be turned every 2 hours.
- The resident should be turned on once every nursing assistant shift.
Correct answer: The resident should be turned on once every nursing assistant shift.
Turning a resident once for every nursing assistant shift is not often enough to prevent circulation-related problems. All of the other options are critical when handling a resident that cannot move themselves.
- Which of these statements is false for the care of a resident’s dentures?
- Dentures break easily and are expensive to replace.
- Denture care is left to the resident so a care facility cannot be charged with negligence if something goes wrong.
- Dentures are very slippery when wet.
- Dentures should be stored in cool water.
Correct answer: Denture care is left to the resident so a care facility cannot be charged with negligence if something goes wrong.
This statement is not true because many of the residents are incapable of taking care of their dentures properly. All of the other options need to be taken into consideration for the proper care of dentures.
- Morning care (sometimes referred to AM care) before the resident eats breakfast is important for which of these reasons?
- It provides a pleasant appearance.
- It adds to a residents sense of well-being.
- All of these are correct.
- It helps to decrease harmful bacteria.
Correct answer: All of these are correct.
Morning care decreases harmful bacteria, adds to a residents sense of well-being and provides a more pleasant appearance to the resident and to others.Therefore, all of these answers are correct.
- A Hoyer Lift is primarily used for ____.
- Helping to move a resident on to a stretcher.
- Helping to move a resident to a chair.
- Helping to move a resident into a bathtub.
- Helping to move a resident into a vehicle.
Correct answer: Helping to move a resident to a chair.
A Hoyer Lift is a safety device that is used to help move an immobile resident from a bed to a chair and back. The other options are not the primary purpose of the Hoyer Lift.
- Key considerations for bathing residents include safety, privacy, and which of these?
- Quiet surroundings.
- Providing security.
- Swiftness in procedure.
- Dim lighting.
Correct answer: Providing security.
When a resident is undressed and in a vulnerable state, the most important consideration beyond safety and privacy is providing security. Bathing and showering are common activities that produce anxiety. While the resident may want the procedure rushed, too much swiftness could cause injury. The surroundings vary from resident to resident and some may prefer quiet, while others are soothed by conversation or music. Dim lighting is another personal preference, but safety must be the utmost concern.
- Which of these is an important fact that is easily overlooked or forgotten by caregivers and facilities in reference to resident bathing needs?
- The resident should be rinsed and dried thoroughly.
- Beliefs about bathing frequency differs among cultures.
- The caregiver needs to use proper body mechanics to avoid injury when bathing a resident.
- The water needs to be at a safe temperature for bathing.
Correct answer: Beliefs about bathing frequency differs among cultures.
Cultural differences in the frequency and types of bathing should be taken into consideration although it is not often thought of when setting a residents care schedule. All of the other answers are part of standard operating procedures for bathing.
- Bad breath, tooth decay, and skin breakdown in the mouth are all symptoms of ____.
- Dry mucous membrane in the mouth.
- Overly moist mouth.
- Dehydration
- Inadequate amounts of toothpaste used when brushing the teeth.
Correct answer: Dry mucous membrane in the mouth.
These symptoms could occur because of dehydration, but the primary reason is dry mucous membranes in the mouth. An overly moist mouth is incorrect. A resident can have dry mucous membranes without being actually dehydrated. Inadequate toothpaste could lead to tooth decay, which in turn can cause bad breath, but the best answer is a dry mucous membrane.
- An important, but frequently forgotten, consideration when providing hair care to residents is _____.
- Race and culture
- Age
- Length of stay.
- Environmental conditions.
Correct answer: Race and culture
Race and culture are often overlooked when discussing hair care with residents. Listen and be conscientious of how other’s culture or race may differ from your own opinions on hair care. While age, environmental conditions, and length of stay can all play a role in the resident’s appearance and hair, they are not major contributors.
- A small, watery leakage of stool could indicate which of these conditions?
- A GI infection.
- A medication reaction.
- A fecal impaction.
- Pelvic muscle weakness.
Correct answer: A fecal impaction.
A fecal impaction occurs when a hard feces is trapped in the large intestine and/or rectum and cannot be pushed out by the resident. It should be suspected when only a small amount of watery stool is leaked onto the clothing or after the resident has reported defecation. It is a condition that requires immediate reporting to the licensed nurse, as further intervention is necessary to prevent complications.
- Behaviors that may signal pain in the elderly may include all of these except _____.
- Not participating in social activities.
- Insomnia
- Not eating or drinking.
- Excessive talking.
Correct answer: Excessive talking.
The elderly may have an increased pain tolerance (it doesn’t affect their activities or rest) or the inability to perceive pain. They may deny pain but demonstrate behaviors that indicate discomfort, such as insomnia, decreased appetite, or withdrawal from recreational or social activities. Physical signs of pain include tachycardia (increased pulse), tachypnea (increased respirations), dyspnea (difficulty breathing), and hypertension (high blood pressure).
- Which of these is not a way to assist a resident to rest more comfortably and effectively?
- Remove all positioning devices so they don't interfere with sleep.
- Create a quiet environment.
- Pacing their ADLs, recreational activities, and visiting times to allow for proper rest.
- Offer diversion activities such as reading, listening to music, and meditation.
Correct answer: Remove all positioning devices so they don't interfere with sleep.
Positioning devices should be used to promote comfort and rest when needed. The pacing of activities is important so that the resident does not become overtired and anxious, which can prevent relaxation.The provision of quiet, calming activities and a calm environment are also important in inducing rest. In addition to these answer choices, you may provide a massage to help relax the resident or you may give emotional support during times of discomfort. These options would be in addition to generally maintaining the individuals routine and physical environment to promote safety and security, which encourage rest and sleep.
- As dementia progresses, incontinence can become an issue. How can the nurse aide assist?
- Avoid outings to minimize accidents and possible embarrassment.
- Remind the resident to let you know when they need to use the bathroom.
- Start to use an adult diaper to keep clothing and linens clean.
- Watch for signs of discomfort so you can take the resident to the bathroom.
Correct answer: Watch for signs of discomfort so you can take the resident to the bathroom.
As dementia progresses, the resident may have episodes of incontinence. Do not immediately begin the use of adult diapers. Establish a toileting schedule and take the resident to the bathroom at regular times. Do not wait for them to let you know. Begin to watch for signs of need to go to the bathroom. Is the resident restless? Crossing legs? Pulling at clothing? Don’t wait for the next scheduled time, and take them immediately. When going out, prepare by bringing a change of clothing and watching for restrooms. If an accident happens, stay positive to reduce the resident’s embarrassment.
- When getting dressed, a client always wants to wear her favorite outfit. What is a good solution?
- Hide the favorite outfit for a few days so she forgets.
- Tell the resident that the outfit is dirty and she will have to choose another.
- Ask the family to get several identical outfits.
- Explain the benefits of variety and offer several other outfits.
Correct answer: Ask the family to get several identical outfits.
Getting dressed can be a source of confusion for a client with dementia. Simplify the process by limiting choices of clothing. If the client has a favorite outfit, try to get several identical sets. Clothing should be comfortable and easy to get on or off. Help the client by placing clothes in the order they are put on.
- A nurse aide finds a resident looking in the refrigerator at the nurses’ station at 5 a.m. The resident, who is confused, explains that he needs breakfast before he leaves for work. The best response by the nurse aide is to ____.
- Tell him that residents are not allowed in the nurses’ station
- Remind him that he is retired from his job and in a nursing home
- Ask the resident about his job and if he is hungry
- Help the resident back to his room and into bed
Correct answer: Ask the resident about his job and if he is hungry
When residents who are confused think they still have a job, or are excited about a new job, do not contradict them or try to convince them they have no such thing. Do not play along with their misunderstanding. Simply ask them about the job and redirect them. You can say, “That sounds important. Let’s have breakfast first, okay?” Give them a task, take a walk, or take them to another activity.
- A resident who has not been discharged insists she is going home. What should the nurse aide do?
- Notify the charge nurse immediately.
- Put her in physical restraints until she calms down.
- Tell her she cannot leave without a doctor’s order.
- Advise her that she can leave if she wants to.
Correct answer: Notify the charge nurse immediately.
It is beyond the scope of practice for a nurse aide to deal with some client situations, such as leaving against medical advice (AMA). Immediately inform the nurse or a supervisor. Stay with the client and reassure her that the nurse will help her. Try to redirect her focus or offer a new activity.
- If a client has hand tremors, the nurse aide SHOULD
- Do everything for the patient to avoid embarrassment.
- Tell patient to stop shaking and control the tremors.
- Restrain the hand that has the tremor.
- Assist the patient with the activity of daily living as needed.
Correct answer: Assist the patient with the activity of daily living as needed.
Hand tremors are the most common type of involuntary movement. There is no cure for tremors. Treatment includes physical therapy, occupational therapy, and medications. Therapy can help clients learn to do many tasks for themselves. Adaptive devices, such as special eating utensils, can support their efforts to be independent.
- The role of the ombudsman is to
- Work with the nursing home to protect patient rights.
- Control the nursing home budget.
- Prepare the classes which nurse aides take to learn about patient hygiene.
- Run a group of nursing homes.
Correct answer: Work with the nursing home to protect patient rights.
An ombudsman is a trained advocate for clients’ rights in a long-term care facility. They assist clients and their families with any issues or disagreements that occur at the facility. Examples are inadequate services, lack of privacy, poor food quality, or problems with other residents. If the client or family is unable to resolve a problem with the staff, an ombudsman can negotiate on their behalf, as well as find other resources to help them.
- Equipment used to help the resident maintain correct body alignment includes all of the following EXCEPT
- Cones
- Splints
- Bed cradles
- Foot supports
Correct answer: Cones
Proper body positions maintain good body alignment, which is necessary to help the client feel comfortable, as well as avoid complications. Foot supports prevent foot drop by keeping feet in their natural position. Splints can stabilize a limb or joint. A bed cradle protects a part of the body by keeping the weight of sheets and blankets from touching the client.
- After assisting with evening care, the nurse aide notices the client has bilateral hearing aids. The nurse aide understands that if a hearing aid is not in use, it should
- Be left on the patient's bedside table.
- Have the battery disengaged.
- Be placed in the patients pocket.
- Be left turned on.
Correct answer: Have the battery disengaged.
When hearing aids are not going to be in use for several hours or overnight, disengage the battery to make it last longer. The battery can be removed, but it is easier to open the door of the hearing aid and leave the battery inside. Clients with limited vision or poor motor skills will be able to close the door and insert the hearing aid easily. Never leave hearing aids where they can get lost, misplaced, or damaged. A drawer or container are safe storage places.
- The primary goal of restorative care is
- Take care of patients personal business.
- Keep the patient comfortable in nursing home.
- Do everything for the patient.
- Return patient to a normal life at home.
Correct answer: Return patient to a normal life at home.
Restorative care provides specialized services to help a client regain the highest possible health and function and to prevent decline. The goal is to assist the client to return to a home setting and live independently. Rehabilitation methods are used to teach clients activities of daily living, speech, and safety.
- What is the process of restoring a disabled client to the highest level of functioning possible?
- Rehabilitation
- Retention
- Reincarnation
- Responsibility
Correct answer: Rehabilitation
Rehabilitation is the specialized care that helps a client get the best possible level of function and independence possible. The rehabilitation process is used to restore physical strength and movement after surgery, illness, or trauma. It cannot reverse the damage, but can assist the client to attain a better quality of life.
- The nurse aide is making an occupied bed. Which of the following is the most restorative approach?
- Encourage the resident to help.
- Do everything for the resident.
- Lower both side rails.
- Tell the resident to get out of bed.
Correct answer: Encourage the resident to help.
Even clients who must remain in bed can often still participate in their care. They can move and turn in bed during the linen change. They can assist with their bed bath and perform their own oral care. The nurse aide should encourage the client to do as much as possible.
- The most basic rule of body mechanics is to
- Twist as your lift.
- Never use a lift belt.
- Bend from the knees and hip.
- Keep the arms flexed.
Correct answer: Bend from the knees and hip.
Proper body mechanics uses the legs to do most of the work. Keep your back straight and locked; do not turn or twist. If you bend, do so at the knees and hips, not the waist. Before lifting or moving a client, assess how much the client is able to do. If you have any doubts, always ask for assistance from a co-worker.
- A patient is leaving the hospital. The family has been told to give her medications bid. The wife asks what that means. The nurse aide tells her to give the medication
- Three times a day
- Once a day
- Twice a day
- Only when needed
Correct answer: Twice a day
BID is an abbreviation used in medicine and pharmacy to indicate “two times each day.” The medication should be taken every 12 hours. BID is also written as b.i.d. or bid.
- A nursing assistant is helping a resident to walk. If the resident becomes faint and begins to fall, the assistant should
- Carry the resident back to bed then go for help.
- Hold the resident up and call for help.
- Ease resident to the floor and call for help.
- Hold resident up and continue walking.
Correct answer: Ease resident to the floor and call for help.
Before helping any resident walk, take time to assess how much assistance will be needed. Allow the resident to sit at the edge of the bed and dangle their legs before standing. When walking, if the resident becomes weak or dizzy, protect them and yourself by easing the resident to the floor. Do this by holding them under the arms while putting one of your legs forward to support the resident while lowering them to the floor. Keep your knees bent to avoid a back injury.
- A contracture (tightening, or shortening of a muscle) is caused by
- Pressure on the muscle
- Too much exercise
- Lack of movement of muscle
- Old age
Correct answer: Lack of movement of muscle
When a muscle is not moved or exercised, it can shorten and become stiff. Range of motion (ROM)becomes limited and movement can be painful. Prevention is important when a client is immobile or has a disorder that can lead to contractures, such as cerebral palsy or muscular dystrophy. Stretching, performing ROM exercises and using splints can help maintain function.
- Goals of arthritis care include
- Decreasing inflammation and preserving joints.
- Strengthening bones and muscles.
- Preventing contractures.
- All of the above
Correct answer: All of the above
Arthritis is a common chronic disorder of the joints. It involves pain, swelling, and stiffness that can limit movement. Care of a client with arthritis includes a wide range of ongoing treatments to decrease inflammation and maintain the joints. Stretching, exercise, heat and cold, and anti-inflammatory medications can be helpful.
- A button hook and a sock assist are all part of what kind of nursing care?
- Disability and reactivity
- Activities of daily living
- Prosthetic mobility
- Restorative and rehabilitation
Correct answer: Restorative and rehabilitation
When clients are recovering from illnesses or accidents, or learning to live with a disorder, special items can be used to help the clients adapt to the situation and be as independent as possible. Two types of healthcare professionals assist clients with these goals. Restorative medicine is a new branch of medicine that works to restore a client’s health, not just treat symptoms. Rehabilitative medicine specializes in treating clients with painful or limiting physical conditions.
- ROM exercises will help prevent
- Obesity
- Depression
- Contractures
- Pressure sores
Correct answer: Contractures
A contracture is a shortening of muscles, tissues, tendons, and skin at the joints, due to lack of movement and exercise. When joints remain bent over time, they can no longer be straightened. Range of motion (ROM) exercises provide a way to maintain joint flexibility. In passive ROM, someone moves the joints with no assistance from the client. In active ROM, the client does the exercises alone or with the help of devices, such as a strap.
- A patient has had hip surgery. Her legs should be
- In the most comfortable position for the patient.
- Abducted
- Adducted
- Elevated
Correct answer: Abducted
Following hip surgery, the client should be positioned to maintain natural alignment of the leg. A pillow (“abductor pillow”) or wedge is placed between the legs keeps the legs in the correct position. Ankles and legs cannot be crossed, and toes should point toward the ceiling. The hip should not be rotated inwards or outwards. The client can never lie on the non-operative side.
- The most common cause of accidents in the home results from
- Falls
- Lacerations
- Abrasions
- Burns
Correct answer: Falls
According to the National Safety Council, falls are the number one cause of home accidents. For age 65 and older, falls are the first cause of injury-related deaths, including broken hips. Many falls can be prevented with simple measures, such as removing small rugs and clutter, and wiping up spills.
- Mrs. Jones has been throwing up for several days, unable to eat or drink. You find her in bed. She is pale, lethargic, and her eyes are dull. She is likely suffering from
- Congestive heart failure
- Hypovolemic shock
- Fecal impaction
- Multiple sclerosis
Correct answer: Hypovolemic shock
Water makes up about 90% of blood. During an illness, replacing fluids lost by vomiting and diarrhea is extremely important to prevent dehydration. Severe dehydration can cause a drop in the blood volume, causing very low blood pressure.. The result is hypovolemic (low volume) shock, a medical emergency.
- While helping an 86 year-old male resident get ready for bed, he tells you that he is tired of living and has been saving his pain pills. What should you do?
- Go through his belongings to search for the pills.
- Notify the nurse and stay with the resident.
- Make him give you the pills so you can flush them.
- Ask him why he feels his life is so worthless.
Correct answer: Notify the nurse and stay with the resident.
Studies show that depression is a common cause for suicide in the elderly. White males, age 85 years and older, are at the highest risk for suicide. Never dismiss a threat of suicide. Always notify your supervisor, so the resident can be evaluated and treated.
- A patient chokes while eating and is unable to cough or speak. The first thing the nurse aide should do is
- Call for the nurse and Code Team
- Attempt to remove the obstruction
- Tilt the victim’s head back and give two quick breaths
- Slap the patient between the shoulder blades
Correct answer: Slap the patient between the shoulder blades
A quick back slap can be tried, but if the food does not immediately dislodge, the nurse aide must quickly move to start abdominal thrusts. Abdominal thrusts (the Heimlich maneuver) is the best response to choking. Calling for assistance as you prepare to do abdominal thrusts will alert others of the emergency. Performing abdominal thrusts involves standing behind the client and using hands to exert upward pressure on the bottom of the diaphragm.
- The fire alarm has sounded. The nurse aide should FIRST
- Report to the charge nurse for direction
- Make sure all the residents are out of the hallway and close all doors
- Take the nearest fire extinguisher to the nurse's station
- Notify the fire department in case no one else has
Correct answer: Make sure all the residents are out of the hallway and close all doors
The nurse aide should be familiar with all fire safety policies and protocols. When a fire alarm sounds, all staff must respond to keep clients safe. Remember “R.A.C.E.” to quickly act. R = Rescue/Remove all people who can not take care of themselves. A = Alarm, if it has not already been done. Pulling the alarm can be done at the same time as rescue. C = Confine/Contain the fire or smoke by closing doors to prevent or slow the spread. Smoke is especially dangerous for everyone. E = Extinguish the fire if possible, using a handheld fire extinguisher. Attempt to extinguish only small fires, as long as you can remain safe and have an escape route.
- Factors that increase a resident’s risk of falling include
- Sensory problems.
- Medication use.
- Muscle weakness.
- All of the above.
Correct answer: All of the above.
As people age, their physical and medical conditions can lead to increased risks for falling. Muscle weakness, especially in the legs, is one of the most important risk factors. Medications, and the side effects, can cause dizziness or confusion. Sensory problems, such as numbness in the feet or foot pain increase the risk of falls. Other risk factors include poor vision, balance problems, and slow reflexes.
- If you see a fire, your first action should be to
- Call the operator.
- Pull the fire alarm.
- Get a fire extinguisher.
- Evacuate patients in the area.
Correct answer: Evacuate patients in the area.
The nurse aide should be familiar with all fire safety policies and protocols. When a fire alarm sounds, all staff must respond to keep patients safe.
- If a diabetic resident develops symptoms of increased thirst and urination, blurred vision, weakness, and a fruity-smelling breath, what should the CNA do?
- Offer the resident orange juice.
- Report it immediately to the nurse.
- Wait for 15 minutes the re-check the resident.
- Report the incident at the end of the shift.
Correct answer: Report it immediately to the nurse.
When a resident with diabetes exhibits signs and symptoms of high blood sugar (hyperglygemia), do not give additional sugar, such as orange juice or candy. Notify the nurse immediately, because the resident needs insulin. If the blood sugar is not lowered, ketoacidois—a serious complication of diabetes—can result. The CNA should be aware of which residents have diabetes, and what to look for regarding reactions.
- You must be especially careful about fire if the resident is receiving _______.
- Heat treatments
- Intravenous fluids
- Sleeping medications
- Oxygen
Correct answer: Oxygen
Oxygen “feeds” fires, because fire needs oxygen to continue burning. Normal air has 21% oxygen which can be serious in health care facilities. Areas where residents are on supplemental oxygen have 23.5% oxygen, which increases the intensity of the flames. If possible, turn off the oxygen supply, close windows and doors when evacuating residents.
- Safety measures to prevent accidental poisoning from medications include
- Call medication "candy" so patients will be more likely to take it.
- Transfer medications to other containers.
- Give medication in the dark to avoid waking the patient.
- Never leave medicine out where it can be swallowed.
Correct answer: Never leave medicine out where it can be swallowed.
Accidental poisoning from medications can be prevented, especially among children, who are at the highest risk. Medications are the leading reason for poisoning in children. About 95% of medication-related poisoning among children happens when medication is available and children are unsupervised. All adults are responsible for storing and dispensing medication safely. Always use childproof tops and keep medications in their original containers. Don’t take medications in front of children, who like to mimic adults. Never call medicine “candy.” When taking medications during the night, turn on the light to ensure the proper drug and dosage is being taken.
- You’ve been asked to increase a residents muscle strength and joint mobility with “passive range of motion” exercises. The best example of this type of treatment would be ____.
- Having the resident move the arm in a circular direction while you time short intervals.
- Using resistance exercises on a residents arm.
- Gently holding the residents arm and smoothly moving it in a circular motion.
- Having the resident lift small objects in short intervals.
Correct answer: Gently holding the residents arm and smoothly moving it in a circular motion.
“Passive range of motion” exercises are those performed on someone unable to voluntarily move limbs on their own. The other options assume the resident can move on their own.
- Which of these is the best example of restorative care skills?
- Use of a heating pad for a stiff neck.
- Use of pads or adult briefs for incontinence.
- Use of a denture soaking dish.
- Use of adaptive, assistive, and therapeutic equipment.
Correct answer: Use of adaptive, assistive, and therapeutic equipment.
The best answer is adaptive, assistive, and therapeutic equipment because the ultimate goal of restorative care is to promote or main optimal independence. The other items may be used routinely for care but would not be the best answer for restorative care.
- When a resident has a rehabilitation plan of care, your role may be to ____.
- Do more tasks for the resident than usual.
- Assist with retraining.
- Administer pain medications.
- Give the resident shorter times to complete tasks to speed up recovery.
Correct answer: Assist with retraining.
Rehabilitation plans are to help residents regain the ability to do tasks they were able to do before being disabled. This may involve retraining old skills or introducing new ways of doing things to return functioning to normal as much as possible. Administering pain medications, decreasing what a resident does, or pressuring them to hurry on a task are not appropriate responses.
- A button hook and a sock assist are part of what kind of nursing care?
- Restorative and rehabilitative
- Prosthetic mobility
- Disability and reactivity
- Activities of daily living
Correct answer: Restorative and rehabilitative
When clients are recovering from illnesses or accidents, or learning to live with a disorder, special items can be used to help the clients adapt to the situation and be as independent as possible. Two types of healthcare professionals assist clients with these goals. Restorative medicine is a new branch of medicine that works to restore a client’s health, not just treat symptoms. Rehabilitative medicine specializes in treating clients with painful or limiting physical conditions.
- When ambulating an unsteady client, it is BEST for the nurse aide to use a
- Quad cane
- Gait belt
- Wheelchair
- Walker
Correct answer: Gait belt
When a nurse aide is helping a client ambulate, a gait belt allows the client to walk with support and will prevent a fall if the client becomes weak. It also reduces back strain for the nurse aide. A gait belt is also used to help a client stand from a sitting position and transfer to a chair.
- The best way to encourage a residents independence is to ____.
- Let a resident begin the morning care routine and then assist if they need it.
- Provide the items necessary for the morning care routine and then leave the room so the resident is motivated to begin on his or her own.
- Wait until a resident is soiled and then clean it up so he or she might be more motivated to try to make it to the bathroom independently.
- Let resident roommates help one another do their morning care routine.
Correct answer: Let a resident begin the morning care routine and then assist if they need it.
The nursing assistant needs to let the resident have some duties on his or her own, but still be ready to assist with some of the more difficult tasks. The other options could be considered neglect.
- According to the principles of proper body mechanics, a nurse aide who is lifting an object should place his or her feet
- 12–18 inches apart.
- Anywhere desired
- 6–12 inches apart.
- 3–5 feet apart.
Correct answer: 12–18 inches apart.
When lifting any heavy object, start by placing your feet shoulder width apart (about 12–18 inches apart), with one foot slightly in front of the other. Squat down, bending only your hips and knees. Keep your back straight and your shoulders back as you slowly stand. Never twist or turn as you lift. Hold the object close to your body, near your navel.
- Using proper body mechanics is essential to avoiding injuries. The muscles most prone to injury are those in the ____.
Correct answer: Back
Lower back muscles are the most susceptible to injury from improper body mechanics. The other options are additional areas of injury, but the back is the most frequent area.
- The definition: “Nursing interventions that promote the residents ability to adapt and adjust to living as independently and safely as possible,” best describes ____.
- Proactive Nursing
- Therapeutic Nursing
- Restorative Nursing
- Occupational Nursing
Correct answer: Restorative Nursing
Restorative Nursing is a defined area of nursing that goes beyond rehabilitation. Some normal function may never be recoverable and the patient may need behavioral or cognitive activities that help him or her learn how to deal with an issue that is unrecoverable. The other choices are not defined areas of nursing like Restorative Nursing, but they may be involved in the process of restoration.
- Why is the knowledge of common disease processes and conditions important to restorative care?
- All of these are correct.
- Disease processes and conditions may impede progress.
- Knowledge of disease processes and conditions can affect what kind of care management is appropriate.
- Disease processes and conditions affect body system functions and it relates to the residents aptitude for success with restorative care.
Correct answer: All of these are correct.
All of these statements are correct and are important reasons for knowing disease processes and conditions.
- You are a nursing assistant and a resident you are assisting with ambulation has pain while using splints. The best response is to ____.
- Tell the resident that the pain is normal until they adjust to the splint.
- Tell the resident that this is a sign that he or she overdid the therapy and should shorten his or her time on the floor.
- Notify the charge nurse promptly.
- Administer topical pain medication to the area that is sore.
Correct answer: Notify the charge nurse promptly.
If the resident is experiencing pain using a splint, the charge nurse should be told promptly because there may be a more serious issue that needs attention. A nursing assistant should not encourage working through the pain, changing the prescribed amount of time on the floor, or administer any medications without consulting with the charge nurse and other members of the residents health care team.
- “To turn upward” defines which of these terms?
- Lateral
- Supination
- Eversion
- Extension
Correct answer: Supination
Supination is the proper term for turning upward. Lateral is incorrect because it means “to the side.” Extension is defined as straightening and eversion is turning outward.
- What does the term PROM stand for?
- Positive range of motivation.
- Passive range of motion.
- Position reversing motion.
- Positioning references on machines.
Correct answer: Passive range of motion.
Passive range of motion is used for motion that is “assisted,” which helps to prevent atrophy, increase circulation, and create mobility. The other answers are incorrect.
- One of the residents you care for is seeing a physical therapist. You’ve been asked to follow up with some “range of motion” activities. Which of these is the best term for this type of care?
- Emotional and mental care.
- Spiritual and cultural care
- Hygiene care.
- Restorative care.
Correct answer: Restorative care.
Range of motion activities are used as a therapy to restore or maintain mobility and flexibility and are an important component of restorative care. The other answers are incorrect.
- What is the difference between abduction and adduction?
- Abduction moves the extremity toward the body and adduction moves it away from the body.
- Abduction is moving the extremity away from the body and adduction is moving it toward the body.
- Abduction requires two or more persons and adduction can be done with one person.
- Abduction involves moving the entire body and adduction involves moving an extremity.
Correct answer: Abduction is moving the extremity away from the body and adduction is moving it toward the body.
Abduction is moving an extremity away from the body; adduction is moving it toward the body. The other answers are incorrect.
- Restorative care can help prevent complications that develop due to immobility, such as constipation, contractures, pressure sores, and ____.
- Low blood pressure.
- Blood clots.
- Dry skin.
- Labored breathing.
Correct answer: Blood clots.
Blood clots are a serious complication of immobility that restorative nursing helps to prevent. The other symptoms are all incorrect, as related to immobility.
- The nurse aide just admitted a new resident. Which of the following is the most restorative approach?
- Encourage a family member to unpack for him.
- Encourage the resident to participate in unpacking.
- Tell him he'll need to unpack for himself.
- Unpack all of their clothes and put them away for him.
Correct answer: Encourage the resident to participate in unpacking.
Helping clients return to their previous state of health includes having them do as much for themselves as possible. Engaging them in activities encourages them to be independent throughout the restorative process. Also, clients who are involved in decision making are more likely to be compliant with treatment.
- An assisting device does not help with ____.
- Moving around.
- Eating
- Dressing
- Restraining
Correct answer: Restraining
Assisting devices such as canes, reaching rods, braces, and splints are products that make tasks and activities easier to perform. Restraining does the opposite and impedes movement.
- Proper body mechanics dictates that when lifting an object, the nurse aide place his feet
- 12 inches to 18 inches apart.
- 6 inches to 12 inches apart.
- 3 feet to 5 feet apart.
- It doesn't matter.
Correct answer: 12 inches to 18 inches apart.
When lifting any heavy object, start by placing your feet shoulder width apart, about 12 to 18 inches, with one foot slightly in front of the other. Squat down, bending only your hips and knees. Keep your back straight and shoulders back as you slowly stand. Never twist or turn as you lift. Hold the object close to your body, near your navel.
- What is the correct medical term for muscle wasting?
- Anorexia
- Atrophy
- Shrivel
- Hypoxia
Correct answer: Atrophy
While muscles that waste away do shrivel, the correct medical term is “atrophy.” Anorexia is an abnormal loss of appetite and hypoxia is a deficiency of oxygen reaching the tissues.
- You are delegated to provide passive R.O.M. to L lower and upper extremities. This means you
- Watch how many times she moves left lower and upper extremities in 15 minutes.
- Have patient raise left arm and leg 10 times.
- Support each joint and provide extension and flexion movements on the left side of the body.
- Extend right arm over left side of the body.
Correct answer: Support each joint and provide extension and flexion movements on the left side of the body.
In passive range-of-motion (PROM), the client’s joints are supported and moved by someone else. The client does not participate in the exercises. PROM keeps joints flexible, but does not build muscle. Active ROM is necessary to increase strength.
- When the nurse aide moves a joint during ROM (range of motion) exercises, and the resident complains of pain, the nurse aide should
- Push past the point where the pain is to see if pain still occurs.
- Ask nurse to give pain medication so exercises can continue.
- Stop giving resident any ROM exercises.
- Stop the movement at the point where pain occurs and report to the nurse.
Correct answer: Stop the movement at the point where pain occurs and report to the nurse.
Range of motion (ROM) exercises provide a way to maintain joint flexibility. Each joint is moved as far as it can comfortably go. The client may feel slight discomfort as the muscles are stretched, but never push beyond the point of pain. If the client reports pain, stop immediately and report to the nurse or therapist.
- Exercises that move each muscle and joint are called
- Range of motion
- Abduction
- Rotation
- Adduction
Correct answer: Range of motion
Range of motion (ROM) exercises provide a way to maintain joint flexibility. In passive ROM, someone moves the joints with no assistance from the client. In active ROM, the client does the exercises alone or with the help of devices, such as a strap. ROM is important to prevent contractures. A contracture is a shortening of muscles, tissues, tendons, and skin at the joints, due to lack of movement and exercise. When joints remain bent over time, they can no longer be straightened.
- You notice a change in a resident’s mental condition. The best course of action is to ____.
- Try to use a sense of humor to lighten the mood of the resident.
- Report the change immediately to the charge nurse.
- Ask the resident if he or she has noticed a change in his or her personality.
- Plan to spend extra time with this resident as he or she may need more assistance than normal.
Correct answer: Report the change immediately to the charge nurse.
If a resident’s mental condition has changed, it is extremely important to report it immediately. Something more serious could have happened or could be prevented from happening by “cuing in” to subtle or overt changes. A resident may not notice the change, so asking him or her is not the correct choice. A sense of humor and increased patience is important and can help residents adjust to change; however, it should never be a substitute for reporting mental condition occurrences that deviate from normal behavior.
- There are a number of common causes for constipation. Which of the following is NOT a common cause?
- If the patient has a diet that is low in fibre.
- If the patient is not ingesting enough water.
- If there is an increase in the patient’s intestinal mobility.
- If the patient is ignoring their urges to go to the bathroom.
Correct answer: If there is an increase in the patient’s intestinal mobility.
When a person’s intestinal mobility slows down, they have a higher chance of becoming constipated. Therefore and increase in intestinal mobility would be an incorrect answer. Ignoring the urge to go, a lack of fibre in the diet and not drinking enough water, are all common causes of constipation.
- In Elizabeth Kübler-Ross’s description of the grieving process, she states that a person goes through various stages when they lose someone close to them. She believes that the first stage of the grieving process is:
- Anger
- Denial
- Depression
- Acceptance
Correct answer: Denial
Kübler-Ross’s believes that denial is a person’s first natural reaction in the grieving process. People then move on to the other stages that are listed above, but usually, denial would be the first stage.
- Encouraging your patients to take part in their care and in activities within the facility helps with their emotional and mental health needs by
- Keeping them in control of completing tasks.
- Allowing them to feel a sense of independence and improving their outlook.
- Allowing for more physical mobility.
- Giving yourself a break since you already have too many tasks to complete.
Correct answer: Allowing them to feel a sense of independence and improving their outlook.
A predominant struggle which patients who have to rely on others for assistance tend to have, is dealing with the loss of independence. This loss affects their personality and overall outlook. By participating in their own care and activities, your patients will feel a great improvement in their mood. You don’t want to add pressure on the patient, so do not make them full accountable for everything. They definitely need your support. Therefore, allow them to participate but not for the reason to create less tasks for the nursing assistant.
- One of your patients is pacing around, yelling and screaming. He is even blurting out profanities. What is the FIRST action that a nursing assistant should take in this type of situation?
- Call your patient’s family members to help in this situation.
- Try to restrain your patient so that they do not cause themselves, or you any harm.
- Call the supervising nurse for assistance and direction.
- Ask your patient to calm down and relax.
Correct answer: Call the supervising nurse for assistance and direction.
The best thing to do in this kind of situation would be to call your charge nurse. The nurse may have to medicate your patient to calm him down or even call another member of the medical team to assist with the situation. The other options given could aggravate the patient and trying to restrain the patient may actually put the nursing assistant in harms way if the patient tries to resist.
- Your patient catches you off guard with a sexual comment. Your best response to them should be:
- Walk away from your patient and pretend that you didn’t hear the vulgar comment.
- Let your patient know that the comment is absolutely unacceptable to you.
- Make a funny comment in response to their words to treat the incident like a joke.
- Change the subject and steer the conversation in another direction.
Correct answer: Let your patient know that the comment is absolutely unacceptable to you.
The resident must know that you will not allow any further comments of this nature. This will establish a boundary for their future behavior with you. You must also inform your supervising nurse immediately so that the incident can be documented.
- Your patient’s family member is upset that their loved one is unhappy at the facility. As the patient’s nursing assistant, the best way for you to handle this situation is:
- Listen to their concerns politely and tell them that you will share these concerns with the nurse.
- Tell the family member that you are stepping away until they calm down.
- Request that the patient’s family member put their complaints in writing.
- Explain to the patient’s family member calmly but firmly, that it is not your responsibility to discuss the patient’s care.
Correct answer: Listen to their concerns politely and tell them that you will share these concerns with the nurse.
The best response to any issue is always to listen politely and then share any concerns with your charge nurse. Any other options do not suggest a resolution therefore removing hope of any positive outcome for the family member. You don’t want to sound dismissive or block any further communication by suggesting that the family member put their complaints in writing or by telling them that you cannot discuss the issue. You don’t want to insult them by telling them that you will walk away until they calm down as this implies that they are unjustified in being upset.
- Out of the four choices below, which could be a primary contributing factor to a patient’s resentment towards their family members?
- The patient is missing the togetherness at family meals.
- The patient is feeling abandoned due to having been placed in other’s care.
- The patient is missing church attendance with their family members.
- The patient is missing annual family birthday parties.
Correct answer: The patient is feeling abandoned due to having been placed in other’s care.
The above issues definitely can all contribute to resentment, however it is mostly felt – and extremely normal and common for your patients to feel abandoned if family members can no longer handle caring for them at home. Being placed in a stranger’s care can be scary and wouldn’t necessarily be a choice that the patient would make for himself or herself.
- From time-to-time, nursing assistants will encounter residents who are feeling anxious or unsettled about their surroundings or circumstances. The best way that you can help them deal with their anxiety is:
- You can distract your patient from their immediate thoughts by turning on the radio or T.V.
- You can open the curtains in order to let in more sunlight and brighten the patient’s surroundings.
- Allow them to re-group and re-focus in private by leaving the room.
- Comfort your patient by speaking to them in a calm manner. Your demeanor can affect their mental state.
Correct answer: Comfort your patient by speaking to them in a calm manner. Your demeanor can affect their mental state.
Reducing any stimulation around your patient during times where they are feeling anxious can bring relief to their anxiety. The other options will create additional stimulation and add to an already tense environment. This can cause your patient to feel even more anxious and confused.
- Which of the following is an absolutely inappropriate way to deal with the stress of being a caregiver?
- Take up a new hobby.
- Join a club to take your mind off your work.
- Exercise and get outside daily for some fresh air.
- Talk to your co-workers and discuss your patients during lunch so you can vent all your frustrations.
Correct answer: Talk to your co-workers and discuss your patients during lunch so you can vent all your frustrations.
It can definitely be therapeutic to share similar issues with your co-workers and get advice from your peers; it is inappropriate to talk about your patients, as it is a violation of their privacy. The best way to release your work stresses, is to do something positive and healthy, such as exercising, getting outside for some fresh air, learning something new or joining a new club.
- Empathy is a characteristic that helps a nursing assistant care for their patients. Which of the following is the best example of a definition of this term?
- Maintaining awareness of the things you say and how those things can affect others.
- Putting yourself in your patient’s position or situation, without pitying them.
- Understanding the cause of your patient’s misbehaviors.
- All of the above.
Correct answer: All of the above.
All of the statements above are factors, which define empathy. Empathy towards your patients is one of the most important qualities that a nursing assistant can possess.
- One of your patients just found out that one of their family members has passed away. What is the best way that you can assist them with their grieving process?
- Remind your patient that death is inevitable and they shouldn’t worry too much.
- Suggest to your patient that they get their mind off this difficult time by thinking happy thoughts.
- Spend some time with your patient and offer your support, especially if they feel like talking to you about the situation.
- Tell the patient to calm down.
Correct answer: Spend some time with your patient and offer your support, especially if they feel like talking to you about the situation.
When you sit and listen to your patient, they are apt to feeling more comfortable to talk to you about what they are feeling. The other options would more than likely make your patient feel like you are discounting their feelings of sadness and despair.
- When a patient is dying, which of the five senses do they lose last?
Correct answer: Hearing
A patient’s family members and visitors must know that even if a patient cannot communicate anymore, they may still be able to hear what is being said to them. While the other senses may have diminished, the hearing is the last sense to be lost for most dying patients.
- If your patient regularly becomes increasingly confused during dusk, early evening or during the night, they are most likely suffering from:
- Sundowner’s Syndrome
- Alzheimer’s Disease
- Dementia
- Psychosis
Correct answer: Sundowner’s Syndrome
Sundowner’s Syndrome is the term that medical professionals use to describe when a patient becomes primarily disoriented at night. The other options indicate disorientation, but are not specifically consistent with a specific time of day.
- Your patient is showing signs of a change in their mental health. The best course of action for you as their nursing assistant to take would be:
- You must immediately report the change to your head nurse
- You can try and brighten your patient’s mood by using your sense of humor.
- In this instance, your patient may need nor assistance than usual, so you can plan to spend extra time with them.
- You can speak with your patient, to see if they themselves believe that there has been a change in their personality.
Correct answer: You must immediately report the change to your head nurse
Should you notice a change in one of your patient’s mental state, you must immediately report it. If you do not report these subtle or even overt changes, a more serious situation could arise. This type of situation could be prevented if the nursing assistant is more aware of the changes in their patients’ behaviors. Your patient may not notice a change in their own behavior or they may not admit to any changes, so asking him or her would not be a wise decision. Increasing your level of patience or using your sense of humor, can of course assist in the adjustment to change that your patients have to face, but these should never be a substitution for reporting mental health condition situations. Always report to your supervisors, anything that a patient does which deviates from normal behavior.
- Your patient is progressively getting frustrated. He is upset and begins to raise his voice. Which of the following would be the best way to respond to his behavior?
- You can offer your care and support in order to comfort him and calm him dow
- You must report his behavior to your supervising nurse.
- You must request that your patient lower his voice so that the other patients do not get upset.
- You must always walk away from an irate patient so that they understand that you will not tolerate that kind of behavior.
Correct answer: You can offer your care and support in order to comfort him and calm him dow
It shows concern for your patient’s needs when you show them genuine care and support. You will receive a more positive response if you use a calming and comforting manner with your patients. The other options are more negative and this could escalate the patient’s frustration. They may even avoid dealing with the issue.
- Which of the symptoms below is NOT a sign of depression?
- If your patient has a decrease in their appetite.
- If your patient increases the amount that they sleep.
- If your patient becomes withdrawn.
- If your patient’s interest in joining the facility’s social activities increases.
Correct answer: If your patient’s interest in joining the facility’s social activities increases.
If a patient is suffering from depression, their desire to become involved in social activities, would not increase. In fact that desire would decrease. An increase in time sleeping, a decrease in appetite and withdrawing from social situations are all signs of depression.
- Your patient is upset because he has learned that his roommate has passed away. He would like to discuss this with you. What is the best course of action for you to take?
- You can remind your patient that death is a natural part of life and reassure him that his roommate had a full life but is now in a better place.
- Tell your patient a personal story about a time that you had lost someone that you loved and how you dealt with it.
- Allow your patient to express their feelings about his roommate’s death.
- You can try distracting your patient by changing the subject and bringing up a more pleasant subject.
Correct answer: Allow your patient to express their feelings about his roommate’s death.
Patients need to be able to express their feelings in these types of situations. Allowing them to do so will help them cope better and alert you if further counselling may be necessary. The other options discredit your patient’s feelings and do not actually help him in any way.
- Our bodies naturally change due to the aging process. Which of the following is NOT a normal biological change?
- The digestive process slows down.
- The joints become less flexible and stiffer.
- The bones become weaker and thinner.
- The ability to make decisions weakens.
Correct answer: The ability to make decisions weakens.
A patient’s inability to make decisions would be linked to disease rather than to a normal biological change. Biologically, during the aging process, bones become thinner and weaker. Joints become stiffer and less flexible and the movement of food through our digestive system slows down. These are all normal biological changes.
- There are a number of ways that a nursing assistant may help their patient who is dealing with their impending death. All of the following are correct methods EXCEPT:
- Giving the patient their privacy, should they request it.
- Spending a decreased amount of time with the patient, so that the patient doesn’t feel the pressure to be sociable.
- Being available to show your patient the support that they need, by spending an increased amount of time with them.
- Sitting with your patient and listening to them when they want to talk about it.
Correct answer: Spending a decreased amount of time with the patient, so that the patient doesn’t feel the pressure to be sociable.
Sometimes your patient may want you to just sit quietly with them, so that they don’t feel alone in dealing with their thoughts. They may also want someone to listen as they talk about their fears and emotions. Leaving a patient alone may add to a patient’s feelings of isolation while dealing with this difficult time.
- Your patient recently learned that her spouse had passed away. What is the best way for the nursing assistant to deal with the patient?
- You can sit with your patient and offer support in case they wish to talk about what they’re feeling.
- You can introduce humor into your conversation to lighten the mood.
- You can bring in other patients throughout the day so that is occupies your patient’s time.
- You can completely ignore the topic and switch the conversation if your patient becomes emotional so that it takes his or her mind off of the loss.
Correct answer: You can sit with your patient and offer support in case they wish to talk about what they’re feeling.
If your patient has lost a loved one, they may need to talk about their feelings of memories of the loss of their loved one. Sometimes, just sitting with your patient and providing them comfort is all they really need. If you were to ignore the subject or change the conversation, use humor or even bring other people into the room when they may not feel like talking to anyone, could prevent your patient from actually dealing with their grief.
- While helping a resident, the resident hits you. What should you do?
- Leave the room immediately.
- Report the incident to the charge nurse.
- Firmly tell the resident never to hit you again.
- Pretend it did not happen.
Correct answer: Report the incident to the charge nurse.
If you are hit by a resident while giving care, notify the nurse. You may be asked to complete an Incident Report. If you are injured, get treatment. Always remove yourself from harm by stepping out of the way of the resident’s reach. Remain calm and explain that hitting is not acceptable.
- If an alert and oriented client touches a nurse aide inappropriately, the nurse aide’s BEST response is to
- Step back and ask the client not to do it again
- Slap the client’s hand
- Warn the client that the behavior may be punished
- Refuse to care for the client
Correct answer: Step back and ask the client not to do it again
Intimacy is a lifelong need for humans, and clients can be sexually active into their 80s and 90s. However, inappropriate sexual behavior is never acceptable. It can include suggestive comments, deliberate touching, or exposure of genitals. Do not ignore the behavior. The nurse aide should immediately step back and give the patient immediate and firm feedback about the inappropriate. Say, “If you do this again, I will not be able to continue to care for you.”
- Mrs. Melvin is a demanding patient who is difficult to please. Which of the following would be appropriate for you to do when caring for Mrs. Melvin?
- Avoid Mrs. Melvin’s room once you have finished her care, so she won’t keep asking for things.
- Before leaving the room, ask Mrs. Melvin if you have done everything she needs.
- Require Mrs. Melvin to bathe and dress when you are available, not when she wishes to.
- Tell Mrs. Melvin you have other residents who need your help more than she does.
Correct answer: Before leaving the room, ask Mrs. Melvin if you have done everything she needs.
If a client is demanding, show them that you care by asking what they need or what will make them feel better. Their behavior is not directed at you, but can be a sign of anxiety, loneliness, or fear. Take time to learn more about the client; this may help you understand what is behind the behavior. Stay positive and focus on giving excellent care.
- Whenever a patient visits the care facility for a short period of time only, to give their usual caregivers a ‘break,’ this is called
- Respite care
- Hospice care
- Therapeutic care
- Constant care
Correct answer: Therapeutic care
Caregiving is demanding, both physically and mentally. Respite care gives family and caregivers a chance to temporarily rest while the patient is cared for in a facility. Respite care can be during the day, for a weekend, or for a few days. It can also take place in the patient’s home.
- Which of these is not a sign of depression?
- Increased amount of time sleeping.
- A decrease in appetite.
- Withdrawal
- Increased interest in participating in social activities.
Correct answer: Increased interest in participating in social activities.
When people are suffering from depression, their desire to be involved in activities does not increase, so this is the correct answer. A persons interest in activity actually decreases when he or she is suffering from depression. The other options are common signs of depression: an increase in the amount of time sleeping, a decrease in appetite, and withdrawal from socializing.
- Elizabeth Kübler-Ross describes the stages of grief a person goes through when they lose someone close to them. She believes the first stage of the grieving process is ____.
- Acceptance
- Anger
- Depression
- Denial
Correct answer: Denial
Kübler-Ross believes a persons first reaction when facing a death is denial. People normally move on to experience the other stages listed, but denial is typically the first.
- A resident who consistently becomes more confused during dusk, early evening, or during the night is most likely suffering from ____.
- Psychosis
- Alzheimer's disease
- Sundowners Syndrome
- Dementia
Correct answer: Sundowners Syndrome
Sundowners Syndrome is a term used when disorientation occurs primarily at night. The other options indicate disorientation but are not specifically consistent to a certain time of day.
- A resident died and his roommate is upset and wants to discuss it with you. What is the best action to take?
- Remind the patient that death is a natural part of life and reassure him his roommate had a great life and is in a better place.
- Talk to the patient about a time you lost someone you loved and how you dealt with it.
- Try and distract the patient by changing the subject and bringing up something happy.
- Talk with the roommate and allow him to express his feelings.
Correct answer: Talk with the roommate and allow him to express his feelings.
Allowing the resident to talk about his roommates death will help him deal with his feelings and help alert you if further counseling or follow-up is needed. The other options discredit the patients feelings and are not therapeutic.
- Which of these is not a common cause of constipation?
- An increase in intestinal motility.
- A low fiber diet.
- Ignoring the urge to go.
- Not drinking enough water.
Correct answer: An increase in intestinal motility.
When intestinal motility slows down, constipation can occur. So an increase in motility is the correct answer because it would not cause constipation. Lack of fiber in a diet, ignoring the urge to go, and not drinking enough water are all common causes of constipation.
- A resident in your care is frustrated, upset, and raising his voice in complaint. Which of these is the best response to his actions?
- Report the incident to the supervising nurse.
- Walk away from the patient in an effort to show you won't tolerate the behavior.
- Offer support and care using a comforting and calming manner.
- Ask the resident to lower his voice in courtesy to other residents who are getting upset.
Correct answer: Offer support and care using a comforting and calming manner.
Offering support and care to an unruly resident shows concern for his or her needs. A comforting and calming manner is a positive response. The other options are either negative and could escalate the residents agitation or they avoid dealing with the problem.
- A resident is pacing around his room, yelling and swearing. What is the first action the nursing assistant should take?
- Tell the resident to calm down.
- Call the residents family to assist with the situation.
- Call the charge nurse.
- Attempt to apply restraints.
Correct answer: Call the charge nurse.
Calling the charge nurse is the best option in this situation. The nurse may have to give the patient medication to calm him down or involve another member of the team to assist with the situation. The other options may aggravate the resident more and attempting to put restraints on the resident may place the nursing assistant in harms way.
- All of these are ways that a nursing assistant can help a resident who is dealing with his or her impending death, except ____.
- Spending more time with the resident than you normally would so you are available to offer support.
- Sitting and listening if the resident wants to talk about it.
- Giving the resident privacy if they ask for it.
- Spending less time with the resident so there is no pressure to be sociable.
Correct answer: Spending less time with the resident so there is no pressure to be sociable.
Residents often want someone to just sit quietly so that they are not alone in dealing with their thoughts. They may want someone to sit and listen as they talk through their feelings and fears. Spending less time with a resident may add to feelings of isolation while dealing with the situation. The other options provide support, as needed, and respect the wishes of the resident.
- A resident catches you off guard with a comment that is sexual. Your best response would be to ____.
- Change the conversation to a different subject.
- Walk away and pretend you did not hear it.
- Make a humorous comment in return.
- Let the resident know that the comment is not acceptable to you.
Correct answer: Make a humorous comment in return.
It is important for the resident to know you will not accept further comments of this nature. It establishes a boundary for his or her behavior with you in the future. It is also important you inform the supervising nurse.
- Mrs. Lee is showing signs of anxiety by repeatedly using the call signal and is sharp with you when you respond. What is your best course of action?
- Tell the nurse that Mrs. Lee doesn’t like you and request to be reassigned.
- Tell Mrs. Lee that you have sick people to take care of.
- Take Mrs. Lee’s call signal away or unplug it.
- Give Mrs. Lee some choices and control over her care.
Correct answer: Give Mrs. Lee some choices and control over her care.
Anxiety can cause a client to seem demanding and rude. Don't get angry or impatient, and pay attention to your body language. Don't ignore an anxious client; work directly with the person. In this case, offering choices can help Mrs. Lee feel less dependent. Ask her opinion of her schedule. You can even address her behavior: "Mrs. Lee, you seem anxious. What can we do to make you feel better?"
- A client looks forward to playing Bingo each morning. The best action for the nurse aide is to
- Tell the client that the nurse aide may not have time to get the client ready for Bingo
- Tell the client that the nurse aide forgot about Bingo, but they will go the next day
- Plan the client’s schedule so the client will be bathed and dressed in time for Bingo
- Encourage the client to bathe and dress himself or herself to be ready for Bingo
Correct answer: Plan the client’s schedule so the client will be bathed and dressed in time for Bingo
Helping clients maintain their interests is important to their self-esteem. Clients who can make decisions about their activities have a greater sense of independence and social connection. This can help prevent depression and withdrawal. Arrange the client's schedule to accommodate the person's interests.
- If a resident refuses to eat a certain food because of a religious preference, the CNA should
- Make a meal from other clients' food trays
- Tell the resident that all meals are the same
- Notify the dietitian of the dietary restriction
- Ask the family to bring in special foods
Correct answer: Notify the dietitian of the dietary restriction
Cultural diversity includes diets for religious reasons. There may be foods that are not allowed, strict rules for preparation, or fasting on certain days. Diets may be important in the healing process for these clients. Not getting what they need can feel like a sin or violation of their faith. Health care professionals must make sure their client’s dietary needs are met and their religious beliefs are supported.
- Nurse aides can provide a client with a sense of security by
- Turning on the television when giving care
- Talking to another nurse aide while providing care
- Explaining all routines and procedures
- Leaving the room without speaking
Correct answer: Explaining all routines and procedures
An important standard of client care is to always explain what you are going to do before proceeding. Ask the client if he or she has any questions. Rushing a client or doing something without warning creates anxiety. If the client refuses, he or she may be fearful. Don't argue or use force. Tell the person that you will return again in a few minutes.
- As a nursing assistant, you may encounter residents who are anxious or feeling unsettled about either their circumstances or surroundings. The best response in dealing with this anxiety is to ____.
- Open the shades to let in more light and brighten the surroundings.
- Leave the room so the resident can re-group and re-focus in private.
- Speak in a calm voice and exhibit a calm and comforting demeanor.
- Turn on the radio or television to distract the resident from their immediate thought.
Correct answer: Speak in a calm voice and exhibit a calm and comforting demeanor.
Reducing stimuli during anxious times brings relief to anxiety. The other options bring additional stimuli into an environment that is already tense or may make the patient feel more anxious and confused.
- A resident in your care has just received news of a death in the family. What is the best way to assist them with the grieving process?
- Tell the resident about an experience you had with death and what helped you cope with it.
- Remind the resident that death is inevitable.
- Spend some time with the resident, particularly offering support if he or she wishes to talk about it.
- Suggest that the resident get his or her mind off of things by thinking of something pleasant.
Correct answer: Spend some time with the resident, particularly offering support if he or she wishes to talk about it.
Sitting quietly and listening makes the resident feel comfortable enough to talk through his or her feelings. The other options tend to discount the residents immediate feelings of despair.
- One of the caring characteristics that helps a nursing assistant care for residents is empathy. Which of these is the best definition of this term?
- Being aware of what you say and what effect it has on others.
- All of these.
- Seeing yourself in others situations without pitying them.
- Taking time to try to understand the cause of misbehavior.
Correct answer: All of these.
All of these are part of the definition of empathy. It is one of the best qualities a caregiver can possess.
- A good listening approach to use when communicating with residents is to
- Sit beside the resident
- Avoid direct eye contact
- Always offer some advice
- Stand about 6 feet away from the resident
Correct answer: Sit beside the resident
For the best communication, place yourself at the resident's eye level. This helps the resident feel reassured and engaged in the interaction. Studies show that when staff members sit next to clients, the clients perceive a higher quality of care. They also feel more connected to the staff.
- Which of these is not an appropriate way to deal with the stress of being a caregiver?
- Join a new club.
- Talk to your co-workers about your patients during lunch to vent frustrations.
- Exercise and get outside for fresh air.
- Learn something new.
Correct answer: Talk to your co-workers about your patients during lunch to vent frustrations.
While it can be therapeutic to share similar problems and get advice from your peers, talking about the residents is a violation of their privacy. Exercise, getting outside for fresh air, learning something new, or joining a new club are all positive and healthy ways of dealing with something stressful.
- Which of these could be a major contributing factor to a resident’s resentment of family members?
- A feeling of abandonment because of being placed in others care.
- Missing annual birthday parties.
- A feeling of spiritual unrest by missing church attendance with family.
- Missing family meals together.
Correct answer: A feeling of abandonment because of being placed in others care.
While all of these cases can contribute to resentment, it is extremely normal and common for residents to feel abandoned if family members can no longer assist them in the home or live with them. Having their care placed in strangers hands is both scary and not necessarily a choice they would make.
- When a patient is dying, the last of the five senses the patient loses is ____?
Correct answer: Hearing
Family members and visitors need to know that even if a patient cannot communicate, they may still hear what is being said to them. While the other senses may be lost, in most cases hearing is the last sense to be lost for a dying patient.
- Encouraging residents to participate in their care and in activities helps with emotional and mental health needs by ____.
- Improving their sense of independence and outlook.
- Making them more mobile.
- Relieving the burden on the caregiver, who already has too many tasks to complete.
- Holding them accountable for completing tasks.
Correct answer: Improving their sense of independence and outlook.
One of the biggest struggles with residents who must rely on others for assistance is a loss of independence. This loss affects their personality and outlook. By having the residents participate in their care and in activities, even minimally, can cause a vast improvement in mood. Accountability should not be a primary motivator as it can add undue pressure. Mobility can contribute, but should not cause the participation to exceed what the resident is safe trying. Participation should not be encouraged solely to create fewer tasks for a caregiver.
- A nurse aide who is active in her church is assigned to care for a client who is not a member of any religious group. The nurse aide SHOULD
- Arrange to have his or her clergyman visit the client
- Explain how religion has helped her during difficult times
- Respect the client’s beliefs and not try to change them
- Tell the client that it is important to have some type of spiritual belief
Correct answer: Respect the client’s beliefs and not try to change them
Respecting a client's spiritual beliefs can be a challenge if they are not understood or are different from yours. Compassionate care means having an open mind and not promoting any religion or spiritual practice. A client may be deeply spiritual but not part of a formal religion. Ask if the client has any spiritual needs, then comply with the person's wishes.
- A family member is angry that her loved one is unhappy. As a nursing assistant, the best way to handle the situation is to ____.
- Ask her to put the complaints in writing.
- Tell her you will leave for a few minutes so she can calm down.
- Calmly explain it is not your responsibility to discuss the residents care.
- Listen politely and tell her you will share her concerns with the nurse.
Correct answer: Listen politely and tell her you will share her concerns with the nurse.
The best response is to listen politely and share any concerns with the nurse. The other options do nothing to give the family member hope of resolution. Asking her to put her complaint in writing or telling her that you cannot discuss it is dismissive and blocks further communication. Telling her you will leave until she calms down implies she is unjustified in being upset.
- A resident recently learned that her spouse has died. The best response the nursing assistant can give is to ____.
- Sit and offer support if the resident wants to talk about it.
- Introduce humor to lighten the mood.
- Bring in other residents frequently so it occupies the residents time.
- Ignore the topic and switch the conversation if the resident gets emotional so it takes his or her mind off of it.
Correct answer: Sit and offer support if the resident wants to talk about it.
A resident who has lost a loved one may need to talk about his or her feelings or memories of the lost loved one. Often, just sitting and holding the resident’s hand provides the comfort needed. Ignoring the topic, switching the conversation, using humor, or introducing others into the room when they may not know what to say prevents the resident from dealing with his or her grief.
- Which of these is not a normal biological change to the body from the aging process?
- The ability to make decisions is weakened.
- Joints become stiffer and less flexible.
- Bones become thinner and less strong.
- The movement of food from the digestive system becomes slower.
Correct answer: The ability to make decisions is weakened.
The inability to make decisions is a process that would be linked to disease as opposed to a normal biological change that occurs during the aging process. Biologically, bones become thinner and less strong, joints become stiffer and less flexible, and the movement of food through our digestive system slows down.
- When encountering residents with culturally or linguistically diverse backgrounds, one of the actions that can help caregivers provide effective care is to ____.
- Avoid interactions with diverse residents until you feel totally comfortable.
- Recognize when stereotyping occurs and work to correct it.
- Ask a coworker to take over care for diverse residents who make you feel uncomfortable.
- Talk slowly and loudly so that you are understood.
Correct answer: Recognize when stereotyping occurs and work to correct it.
It is inappropriate for a caregiver to ignore or avoid interaction because of the diversity of their patients. Talking slowly and loudly can be offensive to some cultures. A coworker should not take over care to alleviate your discomfort. Understanding cultural differences takes time and practice. Therefore, recognize when you are engaging in avoidance or stereotyping and work to improve it.
- A residents family is visiting and it is time to perform a procedure. The family asks for time to pray with the resident. Which of these is not an acceptable response?
- Ask the family to leave so the procedure can start as scheduled, but offer to let the resident pray to themselves during the process.
- Ask the family and resident if they have any questions about the procedure that might ease their worry before you give them privacy to pray.
- Give the family and resident privacy.
- Tell the family you will return shortly.
Correct answer: Ask the family to leave so the procedure can start as scheduled, but offer to let the resident pray to themselves during the process.
It is important residents and family members have freedom and privacy to express their religious beliefs. Denying their request to do so violates those rights. The other choices provide them with some options.
- Talking to residents about spiritual beliefs can have an effect on ____.
- A residents mental health.
- A residents physical health.
- All of these.
- A residents feeling of “connectedness” with their caregiver.
Correct answer: All of these.
Letting a resident talk about his or her spiritual beliefs, whether you agree with them or not, lends comfort and empathy and shows you care. All of these answers are correct.
- As a nursing assistant there are ways you can help a resident meet his or her spiritual needs. Which of these would discourage, rather than encourage them?
- You tell the resident you are not allowed to engage with residents about their beliefs.
- You sit and listen when a resident wants to tell you about a religious experience.
- You respond positively when a residents visitor asks for privacy to pray with the resident.
- You assist when a resident asks you to see if the visiting pastor has time to stop and see him or her.
Correct answer: You tell the resident you are not allowed to engage with residents about their beliefs.
As a nursing assistant, you are allowed to let a resident talk about his or her beliefs. All of the other options honor their freedom to express spiritual values.
- Which of these is true about spirituality in a care facility?
- It is important for nursing assistants who have religious beliefs to share their ideas with the residents under their care so those who are dying have reassurance.
- Employees are morally and ethically obligated to share religious beliefs if they have them so a resident is not without hope.
- It is a residents right to practice his or her own religious beliefs, even if those beliefs are different from any other resident or staff member in the building.
- Family members need to take charge of the residents spiritual needs and are responsible for bringing in members of a church so the resident doesn’t have to worry about it.
Correct answer: It is a residents right to practice his or her own religious beliefs, even if those beliefs are different from any other resident or staff member in the building.
It is a residents right to be able to practice his or her own, self-chosen beliefs. The other options involve others trying to make the decision for the resident, or persuading them to rely on others decisions concerning his or her belief system.
- Which of these is true about cultural awareness in a care facility?
- Cultural awareness is ideal but not always practical because there may not be enough staff to meet these needs.
- Cultural awareness is ideal but is sometimes sacrificed when it costs too much to implement.
- If a facility is interested in treating the “whole” person, cultural awareness has to be a part of the staffs training.
- Cultural awareness is not practical in a large facility handling too many residents.
Correct answer: If a facility is interested in treating the “whole” person, cultural awareness has to be a part of the staffs training.
Working in a care facility involves treating residents who may be diverse in beliefs and customs. A staff needs to be aware of these differences so each individual is treated in a manner that respects his or her beliefs and provides the same level of treatment for all residents.
- Participation in religious activities can provide all of these important patient benefits, except ____.
- Allowing more time for the CNA to get a break from their duties.
- Reducing a residents isolation.
- Increasing a residents sense of belonging.
- Promoting social contact with others.
Correct answer: Allowing more time for the CNA to get a break from their duties.
Any activity a resident participates in is designed primarily as a benefit to increase the residents well being, not to make the CNAs role easier. Therefore, the only answer that is incorrect is that a religious activity is to give the CNA a break.
- How is family an important part of cultural awareness?
- Different cultures may interpret the role of caregivers quite differently than the way the care plan is written.
- Different cultures may have different expectations of gender roles.
- All of these are correct.
- Different spiritual beliefs may affect how much care the family allows.
Correct answer: All of these are correct.
All of these are important considerations when working with both a resident and his or her family members who are from a different cultural background.
- All of these could be described as positive benefits of the role religion can play, except ____.
- Helping to facilitate a sense of meaning and comfort.
- As a means for increasing tolerance to cope with difficulties.
- Serving as a way for the resident to gain independence and separate from his or her family.
- Helping to facilitate a more positive and hopeful attitude about the residents care that in turn can improve health outcomes.
Correct answer: Serving as a way for the resident to gain independence and separate from his or her family.
The use of religion is not aimed at separating a resident from his or her family. If anything, it can be a means for bringing a family together. All of the other options are goals of religion in anyones life, no matter what denomination or belief is practiced.
- Which of these is a positive way of dealing with cultural differences?
- Choose a coworker who is the most similar in cultural beliefs to work with the resident.
- Ask family members to take over the difficult, culturally-specific parts of care.
- Realize that cultural differences can be related to intellectual deficiencies.
- Learn and use key words in the persons own language, visual aids, gestures, and prompts.
Correct answer: Learn and use key words in the persons own language, visual aids, gestures, and prompts.
All of these options are negative ways of dealing with cultural differences except learning key words in the residents language, or using visual aids, gestures, or prompts.
- A patient has been diagnosed with a terminal illness. On a spiritual front, the most appropriate action for the nursing assistant to take is to ____.
- Share your religious beliefs and understanding of the afterlife with the patient to give them hope.
- Pray for the patient aloud so they can see how much you care.
- Offer to contact a pastor or spiritual leader if the patient desires it.
- Avoid discussing the diagnosis unless the patient brings it up.
Correct answer: Offer to contact a pastor or spiritual leader if the patient desires it.
Offering to contact a pastor or spiritual leader is the most appropriate action to take. Avoidance of the issue does not help the patient, and opportunities should be made to discuss the diagnosis if the patient desires to talk about it. Sharing your own beliefs and prayers, while well-intentioned, are not helpful and does not put the patients needs first.
- What is the implied meaning of this statement by Killian and Waite from the article, “Cultural Diversity Best Practices” as it applies to caregivers? “Another reason for increasing cultural proficiency is the growing number of healthcare providers and workers from other countries who have become colleagues within the healthcare delivery system.”
- Diversity in the workforce will require the healthcare team to be able to work cohesively among team members with different belief systems.
- Diversity in the workforce will have little effect upon healthcare workers.
- Diversity in the workforce will make it much easier for colleagues to work together.
- Diversity in the workforce will change job roles for members of the healthcare team.
Correct answer: Diversity in the workforce will require the healthcare team to be able to work cohesively among team members with different belief systems.
The statement implies that with more workers from other countries, the healthcare team will need to work together with people who may have different belief systems and values. This does not alter job roles, but may change the approach the team takes to accomplish tasks.
- When working with residents who may have cultural differences, it is important to respect personal space. Which of these is the best way for a CNA to honor personal space?
- The CNA avoids the use of touch as much as is possible.
- The CNA explains care and procedures in terms that the patient understands.
- The CNA only talks to the patient when no one else is present.
- The CNA has the patients family provide as much personal care as possible.
Correct answer: The CNA explains care and procedures in terms that the patient understands.
Since many care procedures require touch and physical closeness, a CNA needs to explain care and procedures so the resident understands them and knows what to expect. While it is important to guard a patients private information, only talking with the patient when no one else is present is not realistic and would unnecessarily exclude family members from routine or friendly conversation. While it is important to include family as much as the patient wishes, patient care is part of the CNAs responsibility and should not be offloaded to others.
- Which of these is the most important factor when providing care to people from specific ethnic groups?
- Learning everything about the patients culture.
- Physical distance away from the patient.
- Communication.
- Talking with a higher volume so the patient clearly hears what is being said.
Correct answer: Communication.
Talking in a loud volume is not necessary and only separates the patient from the way others are treated. Physical distance from the patient is not possible with many care procedures and would create a distancing in the rapport you are trying to establish with the patient. Learning about the patients culture is appropriate, but learning everything about the patients culture is not realistic, given the nuances and many types of cultures in the world. Good communication aids understanding and acceptance of differences.
- One of the most basic ways a caregiver can provide spiritual and emotional care to a patient is by?
- Asking if he or she needs more family visits.
- Asking if he or she is getting adequate food.
- Asking if he or she needs a counselor.
- Asking if he or she has any questions.
Correct answer: Asking if he or she has any questions.
Simply asking if the patient has questions can open the door to communication and foster empathy. Asking if the patient needs a counselor is not the best way to start as it might imply you do not want to help or you feel they are beyond your level of care. Asking about food intake does not focus on the spiritual and emotional needs. Asking about more family visits may require you to impose upon the family more than they are willing to give and end up disappointing the patient.
- You are caring for a Japanese man who just had bilateral knee surgery. When you try and put his anti-embolism stockings on, he winces and then looks away and stares off into the corner. Your best response is to ____.
- Tell the patient that he was very brave while you were putting on the stockings and that you are proud of him for his cooperation.
- Assume that the patient is no longer in pain as he is no longer wincing.
- Acknowledge that putting on the stockings can be painful and ask if he is in any pain currently.
- Tell the nurse that the patient is in pain and needs pain meds.
Correct answer: Acknowledge that putting on the stockings can be painful and ask if he is in any pain currently.
Those from Asian cultures can be stoic about pain, so it is important to assess their non-verbals. Although nursing assistants cannot perform official pain assessments, it is important that they report patient pain complaints to the nurse so the nurse can administer meds as appropriate. Telling the patient you are proud of him, while well-intentioned, may come off as condescending and may discourage him from reporting future pain. Telling the nurse that the patient needs pain meds and assuming the patient is no longer in pain both make assumptions about the patient without talking directly to him.
- Caring for a residents psychosocial needs as a CNA is just as important as caring for his or her physiological needs. The term psychosocial needs generally refers to ____.
- Emotional and recreational well-being.
- Intellectual and spiritual well-being.
- Physical and intellectual well-being.
- Emotional and mental well-being.
Correct answer: Emotional and mental well-being.
Caring for the psychosocial needs of a resident generally refers to caring for his or her emotional and mental well-being. These are basic needs of all people that contribute to the quality of their overall health and welfare.
- Which of these is the most significant reason that adjusting to aging might be difficult for a resident?
- He or she may resist physical help with activities of daily living such as dressing and bathing.
- He or she has too much free time and choice in recreational activities.
- He or she must depend on daily medications to maintain health.
- He or she may have lost a spouse or significant other.
Correct answer: He or she may have lost a spouse or significant other.
Being mentally and emotionally healthy helps a resident better cope with the effects of aging. Although a resident may have to cope with many changes as he or she ages, the loss of a spouse or significant other is one of the most significant. Facing the future alone and living in a strange environment may produce depression or loss of hope for the future. Residents in this position will need extra attention to meet their psychosocial needs.
- Which of these descriptions represents a Western cultural view of health and wellness?
- Illness is due to supernatural, religious, or magical causes.
- Responsibility for ones own health and wellness lays with ones cultural group and relies on care provided by others.
- Treatment of illness relies on herbal remedies dispensed by practitioners trained through apprenticeships.
- Illness is caused by biological and medical sources (i.e., bacteria, viruses, germs, and cancer).
Correct answer: Illness is caused by biological and medical sources (i.e., bacteria, viruses, germs, and cancer).
The Western cultural view of health and wellness is based on illness caused by biological and medical sources; illness due to supernatural, religious, or magical causes is a non-Western cultural view. Western views base treatment of illness on medicine and surgery provided by practitioners trained through programs with established standards and qualifications. The responsibility for ones own health, in the Western cultural view, belongs to oneself.
- The term spiritual distress means ____.
- The feeling that there is no God.
- The feeling that you regret the choices you've made in life.
- The feeling of loss of hope for the future.
- The feeling of not being sure which religious group to belong to
Correct answer: The feeling of loss of hope for the future.
Spiritual distress is the feeling of loss of hope for the future. It is the opposite of spiritual health, and it is a negative outlook that can have serious consequences on both physical and emotional health. Research has shown that spiritual distress in the elderly—even with intervention or help from others—can lead to death soon after the feeling of hopelessness occurs.
- When the valves in the legs weaken it can result in
- Cerebral vascular accident.
- Varicose veins.
- Heart failure.
- Myocardial infarction.
Correct answer: Varicose veins.
Varicose veins are large, swollen veins in the legs that result from weakened valves. Veins have one-way valves to prevent blood from backflowing as it returns to the heart. If they are damaged, the blood pools in the veins, causing swelling, pain, and possibly blood clots. Varicose veins can be treated with compression stockings, or if they are serious, surgery.
- The medical abbreviation for “before meals” is
Correct answer: Ac
The Latin term for before meals is “ac” which means “ante cibum.” Many medical abbreviations come from Latin or Greek. The abbreviation for after meals is “pc” which means “post cibum.”
- What type of isolation precautions are necessary for a patient with a gastrointestinal infection?
- Secretion Precautions
- Enteric Precautions
- Drainage Precautions
- Respiratory Precautions
Correct answer: Enteric Precautions
Enteric precautions are used for infections such as C. difficile, rotavirus, or norovirus, as well as severe diarrhea of an unknown cause. Precautions for staff include proper hand washing and putting on gown and gloves before entering the patient’s room. All linen is bagged in the patient’s room. Visitors may not eat in the room and must wash their hands with soap and water when leaving the room.
- If a nurse aide needs to wear a gown to care for a patient in isolation, the nurse aide should
- Remove the gown in the dirty utility room
- Leave the gown untied to take it off quickly
- Take the gown off before leaving the patient’s room
- Wear the same gown to care for the next patient
Correct answer: Take the gown off before leaving the patient’s room
All items used for a patient in isolation must remain in the room. This includes personal protective equipment (PPE) such as gowns, gloves, and masks. Every facility has strict isolation protocols to prevent spread of infection and disease.
- Rheumatoid arthritis may
- Cause pain and muscle spasms.
- Cause deformities.
- Have periods of remission.
- All of the above.
Correct answer: All of the above.
Rheumatoid Arthritis (RA) is an autoimmune disease. The patient’s immune system attacks the lining of the membranes that surround the joints, causing severe pain, swelling, redness, and muscle spasms. Over time, the joints become deformed. There can be periods of remission, but there is no cure for RA.
- Which of these practices is not part of good verbal communication with a resident?
- Asking open-ended questions.
- Using medical jargon.
- Speaking clearly.
- Clarifying the message that you receive.
Correct answer: Using medical jargon.
You should avoid using medical jargon when speaking to a patient. Speak clearly, using words and phrases that your resident can understand, and ask open-ended questions that discourage yes or no answers but encourage further exploration of the resident’s thoughts and feelings instead. Always make sure to clarify the message you receive by repeating what you’re told back to the resident. These steps ensure good verbal communication.
- It is important to report which of these conversations between a CNA and a resident to ensure his or her safety and well-being?
- His or her likes and dislikes.
- His or her favorite activities.
- His or her specific requests.
- His or her favorite foods.
Correct answer: His or her specific requests.
Developing a good interpersonal relationship with your resident will facilitate effective communication. While you should get to know him or her as well as you can, certain conversations should be reported to ensure the well-being and safety of your resident. Reporting specific requests, evaluations, concerns about care, or safety considerations, as well as a change in condition, are examples of such conversations.
- Which of these is not considered to be a good communication skill of a CNA?
- Delegating
- Listening
- Responding
- Documenting
Correct answer: Delegating
Good, effective communication skills of a CNA include listening, responding, and documenting what residents tell you about themselves and their unique needs. While you may need to develop or use the skill of delegating as a CNA, it is not considered an essential skill for good communication.
- A resident tells you that he feels like he’s “got a lump in his chest.” An example of clarifying the message he’s communicated to you would be to ask him ____.
- “Do you feel pain?”
- “Tell me more about that?”
- “Are you having any palpitations or radiation of your symptoms?”
- “Let me see if I understand what you mean. You feel like you have fullness in your chest?”
Correct answer: “Let me see if I understand what you mean. You feel like you have fullness in your chest?”
Part of effective communication is to clarify the message that has been communicated to you by your resident. This involves repeating back to him or her the information that you believe was communicated to ensure that everyone is on the same page. These questions usually start with, “Let me see if I understand what you mean…?” or “Is this what I am hearing you say…?”.
- Which option is the most important for effective communication with a completely deaf patient?
- A phone system with amplifiers.
- A loud voice that projects over noise.
- A laptop or pen and paper.
- An alarm that rings louder than in non-hearing impaired rooms.
Correct answer: A laptop or pen and paper.
Although some of the options may be acceptable for someone who has even a slight percentage of hearing; it is important, when dealing with a patient who cannot hear any sound, to have an easy alternative method of communication.
- Which of the following should a nursing assistant do if a patient becomes upset and frustrated?
- Ask the patient to give you all the details that led up to their frustration.
- Try to explain to the patient that their frustration is an overreaction.
- Offer your support to the patient by listening and telling them that you will share their concerns with the healthcare team members.
- Try and reason with the patient and make them understand that it is normal for things to upset them from time to time.
Correct answer: Offer your support to the patient by listening and telling them that you will share their concerns with the healthcare team members.
Aggravating a resident by trying to reason with them, can cause agitation. Saying that everyone gets upset over some things from time-to-time does not validate the patient’s feelings that they have the right to be upset. Offering to listen and tell the health care team will allow them to vent their frustrations and to know that you care enough about their well being to try and get them additional help.
- Which of the following options best describes the most likely reaction that a patient would have after overhearing a nursing assistant criticize their fellow co-workers?
- Hearing this would make the patient feel uncomfortable.
- Hearing this would make the patient feel like they can confide in you.
- Hearing this would make the patient feel like their own feelings about the staff are validated.
- Hearing this would make the patient feel like you really care about them.
Correct answer: Hearing this would make the patient feel uncomfortable.
If a patient were to hear a nursing assistant criticize their fellow co-workers, it makes the patient feel uncomfortable. The patient might worry that you are also doing the same thing to them whenever they are not around. Speaking in this manner shows a lack of empathy for others and will make your patient feel less likely to open up to you or that your care is insincere.
- Your patient tells you that he is frustrated and plans on leaving the building without having received medical approval. They say they have already called their relatives. What should your first line of communication be?
- Call the relatives and request that they wait before coming to the facility.
- Report this incident to the facility administrator.
- Report this incident to the patient’s treating physician.
- Report this incident to the nurse.
Correct answer: Report this incident to the nurse.
The nurse is the one who should report these types of incidents to other staff members who are part of the healthcare team, including the patient’s physician.
- If your patient is unable to smell smoke, they increase their use of salt and sugar on foods, they ask for a magnifying glass to read and they ask for the volume to be turned up while they are watching television; what would the most likely diagnoses be?
- They have sensory deprivation.
- They have sensory stimulation.
- They have sensory impairment.
- They have sensory overload.
Correct answer: They have sensory impairment.
When a patient loses or feels a reduction in the use of their taste, smell, hearing or sight senses, this is usually a sign of sensory impairment. Sensory overload and sensory stimulation are an increase to the patient’s senses and sensory deprivation is when there is a deliberate reduction or elimination of stimuli to the senses.
- One of the following is extremely important when a patient is being admitted to a new care facility. Which is the best choice?
- The patient must have the opportunity to provide his or her own information.
- N order to decrease the stress levels of an already difficult adjustment for the patient, the family members should keep the patient from being too involved in the admitting process
- It is required that a senior member of the patient’s religious congregation be present in order to ensure that their spiritual needs will be met; should this patient have strong religious beliefs.
- In order to avoid inaccuracies or misrepresented information given by the patient, it is better for the family to provide all the admitting information.
Correct answer: The patient must have the opportunity to provide his or her own information.
The patient must always have input regarding their needs and wishes. Family members may always add or correct the information, should the patient confuse any details. It is the care facility’s duty to build a rapport with the patient and the patient needs to feel like they have been a part of the entire process. More often than not, family members have just as much difficulty accepting the placement in the facility as the patient. Therefore it is comforting for both parties to have facility staff to take a personal interest in their patients.
- When beginning a procedure on a patient, there are certain steps to follow from start to finish. As a nursing assistant, it is extremely important to do which of the following tasks FIRST in the process:
- Enter the date in the patient’s medical file.
- Document what you did.
- Verify the resident’s identification.
- Provide privacy in the immediate area.
Correct answer: Verify the resident’s identification.
While all the options are correct steps in patient procedures; the first step should always be checking the patient’s identification.
- Which of the following must be reported to the charge nurse “STAT?”
- A patient with loose stools.
- A patient’s radial pulse of 135.
- A patient’s respiratory rate of 18.
- A patient with cloudy urine.
Correct answer: A patient’s radial pulse of 135.
A normal adult’s radial pulse is 60-100 beats per minute, depending on their activity level. 135 beats per minute is above normal and should be addressed immediately. The respiratory rate of 18 falls in a “normal” category and cloudy urine or loose stools may be a problem but not something that necessitates the label “STAT.”
- Assuring your patient that you are listening is usually the best response to give. Which of the options below would be the best method of exhibiting good listening skills?
- Continuing to work while speaking with your patient.
- Directing the conversation further by asking the patient questions.
- Directing the conversation by speaking about your own experiences on the topic.
- Facing your patient while they are speaking and responding when you deem it to be appropriate.
Correct answer: Facing your patient while they are speaking and responding when you deem it to be appropriate.
Stopping what you are doing, facing your patient and making eye contact are all ways to signal that you are listening and to show them that what they are saying is important. The other options may dissuade future conversations.
- A patient who has difficulties with their memory, needs a nursing assistant who will:
- Leave them alone to minimize their level of agitation.
- Make jokes and laugh with the patient in order to lighten their mood.
- Remind the patient when they have forgot important information.
- Make eye contact, sit with them and listen.
Correct answer: Make eye contact, sit with them and listen.
A patient who has difficulties with their memory may feel worse if they are reminded of their forgetfulness. Joking and laughing may often cause embarrassment and could show disrespect towards the patient. Difficulties with memory may require more of your time when dealing with your patient, so time spent actively listening and showing care is definitely the best answer in this case.
- You are asked to ambulate a patient BID during your shift. That means you will ambulate the patient how often?
- One time
- Two times
- Three times
- Four times
Correct answer: Two times
BID is a medical abbreviation, which derives from the original Latin term “Bis in die” which means twice a day. QD is once a day, TID is three times a day, and QID is four times a day.
- Which of the following options is not at all helpful when dealing with a patient who has a speech impairment?
- You should try and complete your patient’s sentence whenever they are having trouble.
- You should use an assistive device such as a whiteboard or laptop so that the patient can write out the words that he is having difficulty communicating.
- You must be patient as the patient is trying to communicate his needs.
- You should encourage the patient to use gestures and non-verbal communication if words are too difficult.
Correct answer: You should try and complete your patient’s sentence whenever they are having trouble.
It will only further frustrate your patient if you try and complete his sentences. It will also make him feel like you are rushing him through the conversation. The other options are all appropriate actions to take while you’re dealing with a patient who has a speech impairment.
- Some non-verbal communication could send a negative message to your patient. Which of the following is an example of this?
- Using a curt voice when answering their questions.
- Keeping your hands on your hips and pursing your lips.
- Facing your patient and speaking to them slowly.
- Using an overtly loud voice while explaining yourself to your patient.
Correct answer: Keeping your hands on your hips and pursing your lips.
This question was created to test your understanding of unspoken actions or behaviour that could provide a negative message to your patient. Keeping your hands on your hips with pursed lips sends a poor message, whether you have said anything or not. All of the other choices are also poor communication techniques but they are verbal.
- Of the following options, which one contributes to bad communication between a nursing assistant and a resident?
- Not listening to what your patient is saying.
- The patient does not seem to understand what they are being told.
- A nursing assistant who does not explain what they are doing while performing a procedure on their patient.
- All of these
Correct answer: All of these
Each of the above options can individually interfere with the communication between a nursing assistant and their patient. All of them combined could make communication even more difficult. By listening to your patient carefully and observing their behaviour, an NA can sometimes notice small nuances and ‘read between the lines.’ This can enable them to be even more understanding of what type of response is needed. As their caregiver, you must take the time to explain procedures and ask if your patient has any questions.
- Which of the following is not a part of the process for documenting in a patient’s medical record?
- Identifying the author of the notes.
- Using correct spelling.
- Dating your entries.
- Documenting your entries in pencil so erasures keep the medical records clean.
Correct answer: Documenting your entries in pencil so erasures keep the medical records clean.
A medical record is a legal document. Entries are never to be erased. The other options are all part of the process for documenting in a patient’s medical record.
- There is a process that an NA must follow upon entering a patient’s room for the first time. Which of the following is NOT a part of that process?
- Telling the patient your name
- Showing the patient your licensing card
- Speaking to the patient by using their name
- Knocking and waiting a few seconds before entering the patient’s room
Correct answer: Showing the patient your licensing card
It is not necessary for the patient to see your licensing cards. The other options establish a level of courtesy, respect for privacy and personal engagement with your patient.
- A patient’s input and output must be documented:
- In the early morning, afternoon and late evening.
- Every two hours.
- At the end of your shift.
- By the nurse. The CNA does not record this information.
Correct answer: At the end of your shift.
As a CNA, you record the totals throughout your shift and they are always documented before you leave for the day. The other options are incorrect.
- Each of the following are symptoms of a possible visual impairment, except:
- The patient may find it difficult to navigate on a set of stairs.
- You notice your patient squinting or tilting their head to one side in order to focus on an object.
- Your patient has not been sleeping well.
- Your patient spills or knocks over their food.
Correct answer: Your patient has not been sleeping well.
Not sleeping well can be caused by a number of reasons. However, visual impairment would not be one of them. Each of the other options, are common indicators that your patient has a visual impairment.
- You have been told that you left something important off the patient’s daily input chart. All of the following must always be included except:
- A cup of tea.
- Toast with their breakfast.
- Lactated Ringers being given intravenously.
- A protein bar for snack.
Correct answer: Lactated Ringers being given intravenously.
The nurse will always chart a patient’s intravenous fluids. All of the other choices would be required documentation on the patient’s intake records.
- Which of the following options would NOT be a primary reason for an indwelling catheter to be taped down?
- Which of the following options would NOT be a primary reason for an indwelling catheter to be taped down?
- In order to reduce a patient’s inflammation of urinary issues.
- In order to let the patient’s family members and visitors know that it is not intended to be removed.
- In order to stabilize and secure it so that it is not accidentally removed.
Correct answer: In order to let the patient’s family members and visitors know that it is not intended to be removed.
Although taping a patient’s catheter down may inadvertently let family members and visitors know that the indwelling catheter is not to be removed, this is not the primary reason why it is done. All of the other choices are correct.
- Which of the following is an acceptable way for the CNA to cope with feelings of anger and frustration?
- Tell several staff members over lunch.
- Ask your supervisor for time to talk about your feelings.
- Refuse to care for a difficult resident until your mood improves.
- Call your best friend on the way home and vent.
Correct answer: Ask your supervisor for time to talk about your feelings.
At some point in time, every health care professional becomes frustrated over a challenging client or situation. Do not dismiss your feelings. It is important to find a safe outlet for expressing your concerns. Remember the laws about client confidentiality and avoid comments with co-workers and friends. Supervisors are experienced and can offer perspectives and suggestions. Remember that working with clients can be challenging, but also rewarding.
- There are certain steps to follow from start to finish when beginning a procedure on a patient. As a nursing assistant, it is extremely important to start with which of these tasks?
- Enter the date in the patients medical record.
- Document what you did.
- Provide privacy in the immediate area.
- Verify the residents identification.
Correct answer: Verify the residents identification.
While the other options are correct steps, the first step is to check the residents identification.
- If a client says, “God is punishing me,” or asks, “Why me?” how should the nurse aide respond?
- Talk about a time you felt the same way.
- Reply, “God doesn’t punish people.”
- Listen and ask questions to learn more.
- Make humorous remarks to relieve tension.
Correct answer: Listen and ask questions to learn more.
Good communication includes active listening. This means giving a client your undivided attention and discerning the meaning of the person's message. It is safe to respond, "I don't know. How can we help you?" Do not discourage conversation. Engage the client by asking more questions such as "Why do you think that?" or "Tell me more." The client is in an active thought process. Do not offer solutions. Just be available to listen and reflect.
- A patient is having surgery the following day. Which of these notations in the orders indicates the patient should have nothing by mouth?
Correct answer: NPO
NPO is the medical abbreviation for “nothing by mouth”. It is from the Latin “nil per os”. NOC stands for night, NKA stands for no known allergies, and MN stands for midnight.
- A resident calls his relatives and then tells you he is frustrated and plans on leaving the building without medical approval. Your first line of communication should be ____.
- Reporting it to the physician.
- Reporting it to the facility administrator.
- Reporting it to the nurse.
- Calling the relatives and asking them to wait.
Correct answer: Reporting it to the nurse.
The nurse is the person who should report the incident to other staff who are part of the healthcare team, including the physician.
- Which of these should be reported to the charge nurse “STAT”?
- Urine that is cloudy.
- A respiratory rate of 18.
- Loose stools.
- A radial pulse of 135.
Correct answer: A radial pulse of 135.
A normal adults radial pulse is 60-100, depending on activity level. 135 is above normal and should be addressed. The respiratory rate falls in a “normal” category and cloudy urine or loose stools may be a problem but not something necessitating the label “STAT.”
- What is the most likely diagnosis for a resident who cannot smell smoke, increases their use of sugar or salt on foods, asks for a magnifying glass to read, and asks for the volume to be turned up while watching television?
- Sensory impairment.
- Sensory stimulation.
- Sensory deprivation.
- Sensory overload.
Correct answer: Sensory impairment.
Sensory impairment is when a resident loses or has a reduction in the use of the sight, hearing, smell, or taste senses. Sensory overload and sensory stimulation is an increase to the senses and sensory deprivation is a deliberate reduction or elimination of stimuli to the senses.
- A resident’s input and output must be documented in a patient’s record ____.
- At the end of your shift.
- By the nurse; the nursing assistant does not record this.
- Every two hours.
- In the early morning, noon, and late evening.
Correct answer: At the end of your shift.
As a nursing assistant, you record the amounts occurring throughout your shift, as they occur. Then, the intake and output totals must be documented in the patient’s record before you leave for the day. The other options are incorrect because it is your job to do this and there is no way to predict how often or when there will be intake or output.
- Which of these is not part of the process upon entering a residents room for the first time?
- Showing the resident your licensing card.
- Knocking and waiting a few seconds before entering.
- Speaking to the resident using his or her name.
- Telling the resident your name.
Correct answer: Showing the resident your licensing card.
The resident doesn’t need to see your licensing. The other options establish courtesy, respect for privacy, and personal engagement with the resident.
- If you have a resident who is completely deaf, which of these would be the most important for effective communication?
- A laptop or pen and paper.
- A loud voice that projects over noise.
- An alarm that rings louder than in non-hearing impaired rooms.
- A phone system with amplifiers.
Correct answer: A laptop or pen and paper.
It is important when dealing with a resident who hears no sound to have an easy, alternative form of communication. The other options might be acceptable for someone who still has some percentage of hearing.
- Sometimes the best response for a nursing assistant is to assure the resident you are listening. Which of these behaviors is the best way to exhibit good listening skills?
- Speaking about your own experiences on the topic to direct the conversation.
- Asking questions that direct the conversation further.
- Talking to the resident while you continue to work.
- Turning in the residents direction and responding when it is appropriate.
Correct answer: Turning in the residents direction and responding when it is appropriate.
Stopping, facing the resident, and making eye contact are all ways to signal that you are listening and that what they are saying is important. The other options may dissuade future conversations.
- When you are documenting in a medical record, which of these is not part of the process?
- Author identification.
- Using correct spelling.
- Dating your entries.
- Writing in pencil so erasures can make the record clean.
Correct answer: Writing in pencil so erasures can make the record clean.
You must consider that a medical record is a legal document. Entries are not erased. The other options are part of the process.
- If you are unsure of the steps of a task that the nurse told you to do, you should
- Ask another CNA to do the job so you won't get in trouble
- Ask the nurse to clarify the instructions
- Do the best possible job and hope it is adequate
- Ask the patient how the task is usually done
Correct answer: Ask the nurse to clarify the instructions
Clarification is an important part of communication. If you receive a message that you don't understand, ask the speaker to explain. Simply say, "I'm not sure what you said about…" or "I don't feel clear about..." It is always good to repeat back the instructions so the speaker knows you understand them. It can be dangerous to give any client care if you're uncertain about how to perform a task.
- The nurse aide finds a resident sobbing. What is the best thing for the nurse aide to say to the person?
- “Crying doesn't solve anything."
- “You seem sad. Can you tell me about it?”
- “Cheer up. Let's go to the activity room.”
- “Please stop crying. It upsets the others.”
Correct answer: “You seem sad. Can you tell me about it?”
Emotions are a natural part of life. They must be acknowledged before they can be understood. Do not ignore or minimize how another person feels. Let the person talk about what happened and why the person feels the way he or she does. By sitting quietly and listening, you validate the person's emotions and allow him or her to find solutions or meanings. Don't offer a quick solution to avoid your own discomfort.
- An example of negative body language is
- Leaning toward the resident to communicate
- Putting your hands on your hips
- Smiling and maintaining eye contact
- Touching the resident’s shoulder as you're talking
Correct answer: Putting your hands on your hips
Negative body language can be powerful and cancel the meaning of your words. Putting your hands on your hips, crossing your arms, or making a "steeple" with your fingers can each create a communication barrier between you and others. Remember that over half of all communication is nonverbal. Use gestures to offer support, not to push others away.
- All of these are indications of visual impairment except ____.
- The resident squints or tilts his or her head to one side to focus on an object.
- The resident spills or knocks over food.
- The resident withdraws from social activities he or she once enjoyed.
- The resident has difficulty navigating on stairs.
Correct answer: The resident withdraws from social activities he or she once enjoyed.
While a resident may withdraw from social activities that require visual acuity, withdrawing from social interaction is not a classic sign of visual impairment and may be caused from a variety of other unrelated factors. All of the other choices are common indicators that visual impairment exists.
- The nurse asks you to ambulate a patient BID during your shift. This means you will ambulate the patient ____ times.
Correct answer: Two
BID is a common medical abbreviation that originates from the Latin “Bis in die” and means twice a day. QD is once a day, TID is three times a day, and QID is four times a day.
- The nurse has just told you that you left something important off the charting of a resident’s input for the day. All of these should be included except ____.
- Toast with breakfast
- A protein bar snack
- Lactated ringers being given intravenously
- Afternoon tea
Correct answer: Lactated ringers being given intravenously
A nurse charts intravenous fluids. All of the other options would be required documentation on the residents intake record.
- Which of these is most important when a resident is being initially admitted to a care facility?
- The resident should have the opportunity to provide his or her own information.
- The family should give all of the admitting information to avoid inaccuracies or misrepresented information given by the resident.
- If the resident has strong religious beliefs it is required that a member of his or her spiritual community be present to ensure these needs will be met.
- The family members should keep the resident from being involved in the admitting process to lessen the stress of an already difficult adjustment.
Correct answer: The resident should have the opportunity to provide his or her own information.
The resident needs to have input about his or her needs and wishes. Family members can supplement with additional or corrected information if the resident confuses details. The care facility needs to build a rapport with the resident and the resident needs to feel that he or she is part of the process. Oftentimes, family members have as much difficulty accepting the placement as the resident. Therefore, it is comforting for both to have facility members take a personal interest in the residents.
- When a resident is upset and frustrated, a nursing assistant should ____.
- Try to make the resident understand that it is normal to have things that make a person upset.
- Try to reason with the resident about why his or her frustration is an overreaction.
- Offer support by listening and telling the resident you will share his or her concerns with the health care team members.
- Ask the resident to remember all of the details that led up to the frustration.
Correct answer: Offer support by listening and telling the resident you will share his or her concerns with the health care team members.
Trying to reason with a resident or asking the resident to remember details can aggravate his or her agitation. Telling the resident there are circumstances everyone gets upset over does not give validation that he or she has a right to be upset. Offering to listen and to tell the health care team allows the resident to vent frustrations and to know you care enough to try to get additional help.
- A resident with memory difficulties often needs a nursing assistant who will ____.
- Remind the resident of the forgotten information.
- Make jokes and laugh to lighten the residents mood.
- Make eye contact, sit with the resident, and listen.
- Leave the resident alone to minimize his or her agitation.
Correct answer: Make eye contact, sit with the resident, and listen.
A resident with memory difficulties can feel worse if he or she is constantly reminded of his or her forgetfulness. Joking and laughing can cause embarrassment and shows disrespect. Memory difficulties may require more of your time rather than less. Time spent actively listening and showing care is the best answer.
- Which of these is not a primary reason for an indwelling catheter to be taped down?
- To secure and stabilize it to prevent accidental removal.
- To provide psychological security to the resident.
- To reduce inflammation of urinary tissues.
- To signal to family members or visitors that it is not intended for removal.
Correct answer: To signal to family members or visitors that it is not intended for removal.
While the taping may inadvertently signal to family members and visitors that the indwelling catheter is not to be removed, it is not a primary reason it is done. All of the other options are correct.
- Which of these contributes to bad communication between a nursing assistant and a resident?
- The resident not understanding what is being told to them.
- Not listening to what the resident says.
- A caregiver who does not explain what he or she is doing when performing a procedure on a resident.
- All of these.
Correct answer: All of these.
Each of these individually can interfere with communication between a health worker and a resident. All of them combined make matters even more difficult. By listening carefully to a resident and observing behavior, a nursing assistant can sometimes “read between the lines” and be even more understanding of what type of response is needed. Take time to explain procedures and ask if the resident has any questions.
- Which of these is a form of nonverbal communication that might send a poor message to a resident?
- A curt voice when answering questions.
- Hands on the hips and pursed lips.
- Facing the resident and talking slowly.
- Using an overtly loud voice when explaining yourself.
Correct answer: Hands on the hips and pursed lips.
This question is to test understanding of unsaid actions or behavior that signal a negative message. Having your hands on your hips with lips pursed sends a poor message whether a word is uttered or not. All of the other choices are poor communication techniques that are verbal.
- Which of these describes the most likely reaction a resident has upon hearing a nursing assistant criticize fellow co-workers?
- It makes the resident feel uncomfortable.
- It makes the resident feel like he or she can confide in you.
- It makes the resident feel you really care about him or her.
- It makes the resident feel validated in his or her feelings.
Correct answer: It makes the resident feel uncomfortable.
When a nursing assistant criticizes fellow co-workers, it makes residents feel uncomfortable. The resident might fear you doing the same thing to them when they are not present. It shows a lack of empathy for others and tends to make a resident feel less likely to open up or feel your care may be insincere.
- Which of these would not be helpful when dealing with a patient with a speech impairment?
- Be patient as the resident tries to communicate his or her needs
- Use an assistive device, such as a whiteboard, so the resident can write down words he or she is having difficulty communicating.
- Encourage the resident to use gestures and non-verbal communication when words are too difficult.
- Try and complete the residents sentence when he or she is having trouble.
Correct answer: Try and complete the residents sentence when he or she is having trouble.
Completing the residents sentence will only frustrate him or her and make him or her feel like you are rushing through the conversation. The other options are all appropriate actions to take when dealing with a patient with a speech impairment.
- Restraints are used for all of the following EXCEPT
- To prevent the patient from pulling out tubes or lines.
- To protect the person from harming themselves or others.
- To allow staff to take care of other patients.
- To prevent falls from a bed or wheelchair.
Correct answer: To allow staff to take care of other patients.
Restraints can be useful for preventive reasons, such as keeping a patient from falling from a bed or wheelchair and to keep lines and tubes intact. Many surgical and intensive care units use restraints in this manner. Restraints may also be used for behavior issues, such as possible physical harm to themselves or others.
- A resident refuses lunch, but about two hours later decides she would like a snack. What is the nurse aide’s best response?
- "Do you think you can wait a few more hours? Dinner will be ready then."
- "Residents are not allowed to eat between meals. Besides, you had your chance."
- "Sure. Let me just check your diet and then I'll bring something to you."
- "Sure. Let me just check your diet and then I'll bring something to you."
Correct answer: "Sure. Let me just check your diet and then I'll bring something to you."
According to Medicare, residents have the right to make decisions regarding their schedule, including when to eat meals. Remember that for residents, the facility is their home now. They are able to choose their own schedule and activities. The nurse aide should check the diet orders, then bring a snack to the resident.
- It is appropriate for a nurse aide to share the information regarding a client’s status with
- The staff on the next shift
- The client’s roommate
- Social media friends
- The client’s family members
Correct answer: The staff on the next shift
HIPAA (Health Insurance Portability and Privacy Act) is the Federal law that protects a client’s privacy about their medical information. This can even include the client’s family, if the client wishes. Medical information includes documentation, records, and communications. There are severe penalties for sharing information, even if it is unintentional, such as being overheard in the hospital cafeteria.
- When getting ready to dress a client, the nurse aide SHOULD
- See if the clothes the client wore the day before are still clean
- Choose clothes that the nurse aide personally likes
- Give the client a choice of which outfit to wear
- Get the first clothes the nurse aide can reach in the closet
Correct answer: Give the client a choice of which outfit to wear
By giving clients choices throughout the day, you are encouraging them to be independent. They have the right to be treated with dignity and respect, which includes being involved in making decisions about clothing, schedule, and activities.
- A nurse aide closes the door, pulls curtains between beds, and covers the resident with a bath sheet when giving a bath. This is an example of maintaining a resident’s
- Facility
- Privacy
- Sexuality
- Confidentiality
Correct answer: Privacy
Physical privacy is the right to do something without having someone witness. This includes personal functions, such as bathing, toileting, or grooming. The nurse aide can be an advocate for patients to help them meet their needs. For example, if a patient needs to use the bedpan, the nurse aide should ask visitors to leave the room so the patient can use the bedpan and get cleaned up. The nurse aide can inform the visitors when they can return.
- On admission to a nursing home or a long-term care facility, a resident must be given
- The facility's monthly menu
- An Informed Consent document
- A copy of the Resident Bill of Rights
- The activity and worship schedules
Correct answer: A copy of the Resident Bill of Rights
Nursing homes and long-term care facilities must give every new resident a copy of the Resident Bill of Rights in a language they understand. The document must also be posted in a visible place. While each facility may have different wording, the rights protect and assure the resident of respectful treatment.
- Respect is demonstrated by the nurse aide for the resident by
- Agreeing with the resident on everything
- Always listening to what the resident has to say
- Keeping the resident’s room free of clutter
- Correcting the resident’s grammar mistakes
Correct answer: Always listening to what the resident has to say
When a nurse aide uses active listening to communicate with a resident, the resident feels respected and appreciated. By giving the resident undivided attention, without interrupting, the aide-resident relationship can develop. Listening also helps avoid misunderstandings.
- Who should manage the resident’s finances?
- The resident
- The administrator
- The family
- The attorney
Correct answer: The resident
The resident has the right to manage their money or to designate someone else to do it. Sometimes a resident will ask the facility to hold their money. If so, the facility must give the resident full access to their account and protect the funds.
- Mr. Smith, a 72-year-old male Alzheimer’s patient, has been stopped several times today while wandering from unit. He is ambulatory, but confused and combative. The CNA would first
- Call the physician for a restraint order
- Redirect the resident or provide alternative activity
- Immediately notify the charge nurse
- Place the resident in a wheelchair with a soft waist restraint
Correct answer: Redirect the resident or provide alternative activity
Always assess a resident’s mental status before asking about restraints. The resident may feel restless, but still be able to be redirected to another activity. Restraint orders are only used when residents are a threat to themselves or others.
- A patient tells a nurse aide that the foods on her tray conflict with her religious beliefs. The nurse aide should
- Tell the patient's family to bring in food
- Leave the tray there in case she changes her mind
- Tell the patient that nothing else is available
- Take the tray away and notify the charge nurse
Correct answer: Take the tray away and notify the charge nurse
Cultural diversity includes diets for religious reasons. There may be foods that are not allowed, strict rules for preparation, or fasting on certain days. Diets may be important in the healing process for these clients. Not getting what they need can feel like a sin or violation of their faith. Health care professionals must make sure their client’s dietary needs are met and their religious beliefs are supported.
- A nurse aide reclines a resident in a geri-chair so the resident cannot attempt to stand. This is a violation of
- The nurse aide to practice safety for the resident
- The resident’s right to cooperation
- The resident’s right to be free from restraints
- The resident’s right to walk without assistance
Correct answer: The resident’s right to be free from restraints
One of the basic rights of a resident is to be free from restraints. Restraints can never be used as a means of discipline or punishment. Nor can they be used for staff convenience. Physical restraints are anything that restricts movement. This includes positioning a resident so they are unable to get up or stand.
- All of the following situations are examples of abuse or neglect EXCEPT
- Restraining a client according to a physician’s order
- Leaving a client alone in a bathtub to get a towel
- Threatening to withhold a client’s meals
- Leaving a client in a wet and soiled bed
Correct answer: Restraining a client according to a physician’s order
Neglect is failure to provide appropriate care of a client. Leaving a client in an unsafe situation or in need of physical care are two examples. Verbal abuse (also called bullying) is a form of emotional abuse that can be as harmful as physical abuse. It includes yelling, criticism, blaming, insulting, belittling, or threatening. Restraints may only be applied with a physician’s order.
- Which of the following is a right of residents in a nursing facility?
- Making as much noise as they want.
- Taking a sleeping pill at night.
- Refusing treatment ordered by the doctor.
- Smoking in their room.
Correct answer: Refusing treatment ordered by the doctor.
Residents have the right to be informed about their medical status, to choose their doctor, and make decisions about their care. They may refuse treatment and medication. These rights have been in place since 1987 when the Nursing Home Reform Law was put into place.
- To help residents, the CNA opens their mail before bringing it to their rooms. This is an example of:
- Making mail easier to access and read.
- Assisting residents with their favorite activities.
- Violating residents' right to privacy.
- Ignoring policies in order to be more efficient.
Correct answer: Violating residents' right to privacy.
Among Resident Rights is the right to send and receive unopened mail. Residents also have the right to have assistance reading or writing their own correspondence. Opening mail without permission is a violation of privacy, even if the CNA means no harm.
- Mr. Brown has been a resident in your facility for two years. His wife has broken her hip and will soon be a resident, too. What is the policy for married couples?
- The administrator determines room assignments.
- Roommates are matched by gender.
- Couples can be together for meals and activities.
- Residents with a spouse or partner can share a room.
Correct answer: Residents with a spouse or partner can share a room.
Residents have the right to share a room with their spouse, even if they have different needs. Their room is considered private, and staff must knock before entering. The spouse who needs the most care can determine the type of facility where the couple lives. Studies have shown that when couples are able to remain together, they experience overall greater health and happiness.
- What happens to the resident’s personal possessions in a long-term facility?
- Possessions are put into the facility's storage.
- The resident may bring items for the bedside table.
- Residents may keep and use personal possessions.
- Possessions are not permitted because of liability.
Correct answer: Residents may keep and use personal possessions.
One of the resident’s rights is being able to keep personal possessions and to make their room comfortable and homelike. They may furnish their room as long as it does not interfere with their safety and health or that of others. The facility must provide reasonable security for the possessions.
- Restraints should be unfastened or released
- 3-5 hours
- Never
- Daily
- 1-2 hours
Correct answer: 1-2 hours
Restraints are used to keep a resident safe in special circumstances. They may only be applied with a physician’s order and must be removed as soon as possible. If a restraint is used, the resident must be checked every 1-2 hours to make sure there is no skin damage or pain, that alignment is maintained, and that the resident physical needs are met.
- An aide puts a resident in a reclining position in a geri-chair, so he cannot stand up while the aide takes care of other residents. This is a violation of resident’s right to .
- Watch his favorite TV show
- Be free from restraints
- Visit with other residents
- Be able to get a snack
Correct answer: Be free from restraints
One of the basic rights of a resident is to be free from restraints. Restraints can never be used as a means of discipline or punishment. Nor can they be used for staff convenience. Physical restraints are anything that restrict movement. This includes positioning a resident so they are unable to get up or stand.
- All of the following are in the Resident Bill of Rights except
- The right to be free from sexual, verbal, physical or mental abuse.
- The right to use another resident's possessions.
- The right to choose which activities to participate in.
- The right to be free of corporal punishment and involuntary seclusion.
Correct answer: The right to use another resident's possessions.
While every resident has rights that apply to their care and privacy, they do not have the right to complete freedom in regard to their surroundings and other residents. Their rights are personal and physical, pertaining only to their own care.
- In giving care according to the 1987 Nursing Home Reform Law, the nurse aide SHOULD
- Allow others to borrow the client's possessions
- Open the client’s mail without permission
- Provide privacy during the client’s personal care
- Prevent the client from complaining about care
Correct answer: Provide privacy during the client’s personal care
Residents have rights which include privacy, property, and the grievance process. When a resident enters a facility, it becomes their home and they have many of the same rights that they would have had in their private residences.
- You observe two adult residents sharing the same bed after lunch. You know these residents are capable of exercising their own rights. This means
- They have the right to privacy
- They are probably seeking intimacy
- They are free to make decisions
- All of the above
Correct answer: All of the above
Humans can remain sexual throughout their lives. If residents are mentally competent, they can decide to seek intimacy. Residents have a right to express their sexuality as long as it is not public and does not harm the resident or others. Assure privacy for residents and avoid commenting to co-workers. Always treat residents with respect and dignity.
- Which statement is TRUE concerning sexuality in the elderly?
- Elderly women are not interested in sex.
- Elderly people are only focused on their health.
- Elderly people can be attracted to each other.
- Sex and intimacy are not important.
Correct answer: Elderly people can be attracted to each other.
Humans can remain sexual throughout their lives. They also can enjoy intimacy and touch at any age. Sexual expression may change as people age, but does not end. Residents have a right to express their sexuality as long as it is not public and does not harm the resident or others. Assure privacy for residents and avoid commenting to co-workers. Always treat residents with respect and dignity.
- Which of the following statements about nursing home admissions is false?
- Half of elderly people are unsafe at their relatives' home.
- Family members may be unable to care for elderly relatives at home.
- Most families prefer to care for elderly relatives at home.
- Most people prefer to put elderly relatives in a long term care facility.
Correct answer: Most people prefer to put elderly relatives in a long term care facility.
Studies show that 90% of people want to get older “in place,” near their families. Home care offers many benefits for both the elderly and their families. The decision to place a family member in a facility is difficult and often happens when there are no other options.
- A new resident brings family photos and her favorite lamp with her. What should you say to her?
- "The photos can stay, but this lamp looks expensive. It might not be safe here."
- "Sorry, but we aren't allowed to let residents decorate their rooms."
- "There is a limit to how many personal items a resident can bring."
- "How nice! Where shall we hang the photos? Do you want your lamp by your bed?"
Correct answer: "How nice! Where shall we hang the photos? Do you want your lamp by your bed?"
One of the resident’s rights is being able to keep personal possessions and to make their room comfortable and homelike. They may furnish their room as long as it does not interfere with their safety and health or that of others. The facility must provide reasonable security for the possessions.
- If a resident refuses a bed bath, which is the best response?
- "Whatever. This gives me more time to help someone else."
- "Why don't you think about it? I'll check back with you later."
- "I really think you need to be cleaned up. You smell."
- "Sorry, but our policy is that everyone gets a daily bath."
Correct answer: "Why don't you think about it? I'll check back with you later."
Every resident has the right to make decisions regarding their care, including refusing care or treatment. The nurse aide can explain the benefits of a bed bath and give the resident time to reconsider. Do not proceed to bathe them. A resident could file a grievance after being bathed against his will, and the nurse aide could be disciplined.
- As you finish your shift, a patient with a history of bowel incontinence has a strong odor. Your responsibility is to
- Shout to the oncoming shift that they have a “Code Brown."
- Help the oncoming nurse aide change the patient
- Make sure the patient's room has plenty of supplies
- Ignore the situation because your shift is over
Correct answer: Help the oncoming nurse aide change the patient
Residents have a right to physical care and comfort, regardless of the time. As long as a nurse aide is on duty, he or she is responsible for providing excellent care. As a team member, the nurse aide should cooperate with other shifts to keep the resident's care a priority.
- When you walk in to begin your shift, a resident is being put in restraints by the charge nurse. This means ____.
- You need to call the family and notify them at once that restraints are being used.
- You need to leave all of this residents care in the hands of the charge nurse until the restraints have been removed
- You need to avoid the patient so as not to escalate his or her agitation.
- You need to check the resident at least every two hours to assess basic needs, circulation, and bathroom necessities.
Correct answer: You need to check the resident at least every two hours to assess basic needs, circulation, and bathroom necessities.
:It is important that restraints are recognized as a way to keep a resident from harming themselves and not as a form of punishment. Nursing assistants can still care for a resident in restraints.
- A family member asks the nurse aide what medications the client is receiving. The nurse aide should
- Refer the family member to the nurse
- Give the family member the client’s chart
- Allow the family member to read the client’s medication list
- Tell the family member what medications the client is being given
Correct answer: Refer the family member to the nurse
A nurse aide is not allowed to provide medical information to the client's family or friends. Instead, the nurse aide should refer them to the nurse. The nurse can verify if the family member is on a list approved by the client. The nurse can also provide information if the family member is involved in the care or paying for it. If not, the nurse will explain the HIPAA Privacy Rule.
- It would not be appropriate to share health care information about a resident with ____.
- The physical therapist who is doing rehabilitation with the resident.
- The physician who cares for the resident.
- The charge nurse who supervises you.
- The residents best friend who visits weekly to play games with him.
Correct answer: The residents best friend who visits weekly to play games with him.
The members of the resident’s healthcare team need access to the resident’s health information in order to provide the best treatment. Friends are not allowed to have access to the resident’s records.
- Which of the following statements about aging is true?
- Most older people are sick and helpless.
- Most older people live in nursing homes.
- Most older people are confused.
- Most older people are alert and oriented.
Correct answer: Most older people are alert and oriented.
Normal aging is a gradual process that is different for each individual. Body functions slow, but most people stay healthy. About 90% of the elderly live in their homes. Less than 5% of elderly people live in nursing homes. Similarly, about 5% have dementia.
- A resident in your care tells you that he does not like his current physician and wishes to be seen by another doctor. Your response to this should be ____.
- To gently tell the resident that the doctor has been assigned to him and he cannot change physicians without a legal procedure.
- To reassure the resident that his doctor is qualified and capable and encourage the resident to respect the docto
- To acknowledge the residents concerns and suggest a different medical provider.
- To help the resident contact the social worker or RN for assistance in this matter.
Correct answer: To help the resident contact the social worker or RN for assistance in this matter.
Each resident has the right to choose his or her own physician and pharmacy. Your opinion of a physician is not relevant to that decision and should not be shared with the resident, whether it is positive or negative. The assistance of the facility social worker or an RN should be sought in this case.
- The family members of a resident ask you to check what the resident’s record says about resuscitation wishes in the event the resident was to expire. Upon looking at the records, you see that the resident has given permission to share all medical information with these family members. You also see the initials DNR in the resident’s advance directive. You tell the family ____.
- The residents file has a notation indicating, Decision not recorded which means no decision has been made.”
- “The residents file has a notation indicating, Do necessary resuscitation.”
- “The residents file has a notation indicating, Do not resuscitate.”
- “The residents file has a notation indicating, Do not record so that the decision is left up to the family.”
Correct answer: “The residents file has a notation indicating, Do not resuscitate.”
DNR is an universal term abbreviation for “DO NOT RESUSCITATE”.Note: You would not release any information to the family unless permission to do so was found in the resident’s files. To do so would be in violation of HIPAA regulations, which should be known, understood, and followed at all times.
- Which of these is a violation of a residents right to privacy?
- A charge nurse discussing a residents medical condition with a nurse who is getting ready to take over her shift.
- A nurse sharing medical information about a resident with the EMT who is transporting the resident to a hospital.
- Two nursing assistants discussing a residents medical condition in the lunchroom.
- A physical therapist, charge nurse, and nursing assistant discussing a residents rehabilitation needs with the resident.
Correct answer: Two nursing assistants discussing a residents medical condition in the lunchroom.
A residents right to privacy allows members of the immediate healthcare team who are treating him or her to discuss his or her condition. All of the other options involve members of that team. Talking to a fellow nursing assistant, who may or may not be part of the team, in a lunchroom where conversations could be overheard by others, is a violation.
- A residents right to information involves all of these except ____.
- The resident seeing and discussing his or her medical record.
- The resident receiving information about the complete medical history of his or her roommate.
- The resident seeing in detail and discussing his or her medical bill.
- The resident receiving information about possible unanticipated outcomes of a procedure.
Correct answer: The resident receiving information about the complete medical history of his or her roommate.
The staff divulging the complete medical history of the residents roommate is a violation of the roommates privacy. All of the other options are part of a residents right to information.
- When a resident has visitors, it is important for a nursing assistant to ____.
- Leave the patients intercom on so you can monitor conversations that might agitate the resident.
- Restrict the visitors time spent with the resident.
- Give the resident and the guests privacy.
- Offer one of the empty rooms reserved for visitors to spend the night.
Correct answer: Give the resident and the guests privacy.
A resident has the right to visitors and privacy. The other options are not appropriate actions for the nursing assistant to take.
- You have two residents in your care who belong to your church. Both have been asking you questions about the medical condition of the other. They are both worried and know you care. What is your best response?
- Tell both residents that you would be violating facility policies and violating their own rights by sharing information.
- Tell them you have to wait until your supervisor returns from vacation to ask her permission.
- Ask to be reassigned to a different area so you will not be around these two residents.
- Share the information because you know both of them and they are active in your church.
Correct answer: Tell both residents that you would be violating facility policies and violating their own rights by sharing information.
The other options either disregard your code of conduct about keeping patient information amongst the members of the residents healthcare team, or only avoid the problem.
- Which of these statements is true for “restorative nursing”?
- Restorative nursing helps a resident gain and then maintain functionality and well-being.
- Restorative nursing returns the duties of the residents exercise plan back into the hands of the family.
- Restorative nursing is out of the scope of duties for a nursing assistant.
- Restorative nursing allows the resident to return home and do self-care.
Correct answer: Restorative nursing helps a resident gain and then maintain functionality and well-being.
The other options do not provide restorative care.
- Residents have a right to telephone privileges. Which of these correctly describes these rights?
- Telephones can be used only under a caregivers supervision.
- Privacy and phone access are provided to each resident.
- Residents have the right to use phones during certain scheduled times.
- Residents may use phones, but they must provide their own.
Correct answer: Privacy and phone access are provided to each resident.
Residents have the right to have access to a phone and privacy to use it. Supervised phone calls violate the resident’s privacy and scheduled hours only restricts rights. A resident does not have to bring their own phone to be able to use one.
- “Any threat to the psychological well-being of a resident that results in psychological or emotional distress” is the definition of ____.
- Mental abuse
- Verbal assault
- Harassment
- Physical abuse
Correct answer: Mental abuse
This is the definition of mental abuse. Depriving a resident of any of the rights listed in the “Residents Bill of Rights” constitutes mental abuse. Financial exploitation and verbal assault are other examples of mental abuse.
- It is appropriate for the nursing assistant to share personal client information with ____.
- The clients wife.
- The clients children.
- The clients roommate.
- The nursing assistant on the next shift.
Correct answer: The nursing assistant on the next shift.
HIPAA privacy laws dictate that healthcare professionals only share relevant client information with those directly involved in caring for the patient.
- In giving care according to the 1987 Nursing Home Reform Act, the nurse aide SHOULD
- Provide privacy during the client’s personal care
- Prevent the client from complaining about care
- Open the client’s mail without permission
- Allow others to borrow the client's possessions
Correct answer: Provide privacy during the client’s personal care
Residents of nursing homes have rights, which include rights to privacy, property, and the grievance process. When residents enter a facility, it becomes their home. There they have many of the same rights that they would have had in their private residences.
- Which of these does not show caring behavior?
- Making extra stops during the week to talk with a resident who gets no visitors.
- Stopping to ask a co-worker to finish up your duties so you are not late to lunch.
- Stopping to listen to a resident who is concerned about an upcoming procedure.
- Stopping to see if there is anything you can do to help a resident who is crying.
Correct answer: Stopping to ask a co-worker to finish up your duties so you are not late to lunch.
This is the only option that does not show that resident care is your primary concern.
- As a nursing assistant, when a resident refuses a bath it is your responsibility to ____.
- Call the family and request that they try to persuade the resident to change his or her mind.
- Give the resident a bath anyway, but make it shorter than usual.
- Respect the residents wishes.
- Tell the resident he or she cannot have visitors until he or she allows bathing.
Correct answer: Respect the residents wishes.
Respecting the resident’s rights includes the right to refusal of care. However, the supervising nurse should be notified as early as is convenient.
- Which of these is included in the “Residents Bill of Rights”?
- The right to have your family determine your plan of care.
- The right to have transportation to and from the facility whenever it is necessary.
- The right to be informed about the facilitys services and charges.
- The right to have the social and recreational activities of your choice.
Correct answer: The right to be informed about the facilitys services and charges.
The “Residents Bill of Rights” is a policy that expands upon the “Patients Bill of Rights”, formulated by the American Hospital Association (AHA). It serves as a guide for those who are living in long-term care facilities. The right to be informed about the facilitys services and charges is an issue addressed in this bill of rights.
- Which resident right is being violated if a nursing assistant enters the hospital cafeteria and hears another assistant talking about a resident with co-workers?
- The residents right to privacy.
- The residents right to know who is involved in their medical care.
- The residents right to make decisions regarding their own care.
- The residents right to be present when their care is discussed.
Correct answer: The residents right to privacy.
All of these are resident rights; however, the only one that applies to this particular situation is the right to privacy. The other rights are incorrect for this situation.
- You have taken care of the same pleasant female resident daily for the past 6 months. Very suddenly, she demonstrates a drastic personality change. She exhibits frequent crying and withdrawal from activities. She refuses her ADLs and becomes fearful of physical contact with you and other caregivers. She seems very anxious and nervous when she is around others. As her CNA, your most appropriate course of action would be to ____.
- Ask the resident if someone is abusing her.
- Wait until you notice physical signs of abuse to report your suspicions.
- Discuss your concerns of resident abuse with the patients family when they visit.
- Report your suspicion of resident abuse in accordance with the guidelines of your facility.
Correct answer: Report your suspicion of resident abuse in accordance with the guidelines of your facility.
This scenario includes many clues that suggest this resident is being abused. In this case, it is your moral, ethical, and legal duty to report your suspicion of resident abuse. You should do so following the policies of your facility and avoid any personal opinions or assumptions as you do. Always be as factual as possible about your observations. Do not worry about whether your suspicion is correct; your duty to protect your resident outweighs all else.
- Beneficence is defined as ____.
- Doing good for others.
- Not doing harm to others.
- Keeping the matters of others private.
- Speaking the truth consistently and dependably.
Correct answer: Doing good for others.
Beneficence is defined as doing good for others. It is one of the ethical principles that should always guide you in your daily work as a CNA.
- Which of these describes the job of an Ombudsman Committee?
- To set the fees for the services of a long-term care facility provides.
- To investigate breaches of resident confidentiality.
- To investigate all complaints of resident abuse.
- To determine appropriate punishment for medical providers convicted of resident abuse.
Correct answer: To investigate all complaints of resident abuse.
An Ombudsman Committee is a group of concerned citizens usually appointed by the state governor to investigate all complaints of resident abuse. The committee members are not affiliated with a healthcare facility.
- A resident is to be discharged from your facility for failure to pay for his care. According to the “Residents Bill of Rights,” what is the proper amount of notice that he must be given?
- 30 days
- 60 days
- 7 days
- No notice is required.
Correct answer: 30 days
The “Residents Bill of Rights” states that in the case of a transfer or discharge for medical reasons, the welfare of the resident or that of other residents, and for non-payment (excluding becoming Medicaid-eligible), the resident or representative must be given written notice 30 days prior to the change.
- Mrs. Featherhat is a Native American who has been diagnosed as near death. Her family wishes to perform a ceremony with candles and incense. The facility should
- Allow the ceremony with proper safety measures
- Inform the family that the ceremony will not help her terminal condition
- Transfer Mrs. Featherhat to a private facility for Native Americans.
- Not allow the ceremony because of safety precautions
Correct answer: Allow the ceremony with proper safety measures
Every culture and religion celebrates the end of life in a different way. As a healthcare professional, the nurse aide should support the resident and family in a positive and safe manner.
- A resident's call light
- May be kept out of the resident's reach so they can rest
- May be answered when you have time
- Should be answered as quickly as possible
- Should only be answered by the nurse aide assigned to that client
Correct answer: Should be answered as quickly as possible
All clients have a right to have access to their caregivers. For clients who are confined to bed or have limited mobility, their safety could be at stake. A client who needs something might be in distress, or try to get out of bed alone. When they use their call light, a quick response is a clinical standard.
- You observed a coworker being physically abusive to a resident. You did not report the incident to the Nurse Supervisor. You can be charged with
- Negligence
- Aiding and abetting
- Malpractice
- False witness
Correct answer: Aiding and abetting
Aiding and abetting is a legal term that means you have knowledge of a crime, even if you weren’t present. If you do not report it, you are considered to be an accomplice, or that you assisted. Always immediately report any type of abuse, neglect, or malpractice to your supervisor.
- When caring for a resident whose religion is different from your own, you should
- Show the resident the faults in their religion.
- Try to convert the resident to your religion.
- Accept and respect their religious beliefs.
- Ensure they follow all religious requirements.
Correct answer: Accept and respect their religious beliefs.
Cultural diversity includes acceptance and respect of other religions and their practices. Religions may be different regarding which day of the week is set aside for worship. Jewish, Muslim, and Seventh-Day Adventists worship on Fridays and Saturdays. There may also be dietary restrictions and days of fasting. Within a religion, individuals may participate in some, but not all, aspects. Allow residents to observe their religion without interference or discrimination.
- The intentional attempt or threat to touch a person’s body without the person’s consent is
- Assault
- Slander
- Defamation
- Battery
Correct answer: Assault
Assault is an intentional attempt or threat to touch someone without their consent. There does not need to be actual touching. If the person feels afraid of being harmed, assault can be charged, even if there was no possibility of being touched. A simple assault is when no harm is done. It is a misdemeanor. Aggravated assault happens when a child, elderly person, patient, or someone in a protected class is threatened. It is a serious felony charge.
- You hear another nurse aide tell a confused resident, “If you don’t eat, I’ll lock you in your room.” You should
- Tell the charge nurse what you have observed
- Tell the other aides, so they can observe this aide with alert residents
- Tell the aide if she does it again, you will report her
- Do nothing, since the resident is too confused to understand
Correct answer: Tell the charge nurse what you have observed
Whether or not a resident seems confused, verbal abuse is inappropriate and must be reported. It is a form of emotional abuse that can be as harmful as physical abuse. It includes yelling, criticism, blaming, insulting, belittling, or threatening. Confused clients can perceive emotional abuse, even if they are unable to respond. All abuse must be immediately reported.
- You observe your charge nurse holding a resident’s nose to get him to take his medications. You should
- Discuss the incident with other CNAs
- Make an anonymous call to the family
- Do nothing. She is your supervisor.
- Report the incident immediately to the D.O.N
Correct answer: Report the incident immediately to the D.O.N
All abuse or suspected abuse must be reported. Every health care facility has a procedure for handling concerns about client care. If the issue cannot be resolved, it moves to the next level of authority. If an incident involves a supervisor, proceed to the next level. In this case, if a nurse aide observes the charge nurse in situation that could be dangerous or neglectful for the client, the nurse aide can go directly to the Nursing or Administrative Supervisor.
- If the nurse aide is concerned about client care, who should the nurse aide speak to FIRST?
- The director of nursing.
- The nurse in charge.
- The administrator.
- Another nurse aide.
Correct answer: The nurse in charge.
Every health care facility has a procedure for handling concerns about client care. If the issue cannot be resolved, it moves to the next level of authority. For example, if a nurse aide observes a situation that could be dangerous or neglectful, the nurse aide should notify the charge nurse. The charge nurse will attempt to resolve the issue before calling the Nursing or Administrative Supervisor. At the top of the chain are the Chief Medical Officer and the Hospital Administrator. Each level has increasing authority and responsibility to address the situation.
- Keeping information confidential about a client is
- Dependent on the situation
- Somewhat important
- Applicable only to medical records
- A legal responsibility
Correct answer: A legal responsibility
HIPAA (Health Insurance Portability and Privacy Act) is the Federal law that protects a client’s privacy about their medical information. This includes documentation, records, and communications. There are severe penalties for sharing information, even if it is unintentional.
- After you have visited a home health client, learned some new information about them, and want to talk about it, you should
- Discuss it at lunch with your co-workers.
- Call your supervisor to share the information.
- Call the client's sister and give her an update.
- Discuss it only with your mother.
Correct answer: Call your supervisor to share the information.
HIPAA privacy laws strictly protect a client’s medical information. Only those who need the information to give care can have access. Discussing the client with your supervisor is acceptable. HIPAA also gives patients the right to restrict who can have access to their health information, even with family members. It is illegal to discuss clients with anyone not involved in client care.
- The client offers a nurse aide a twenty dollar bill as a thank you for all that the nurse aide has done. The nurse aide SHOULD
- Ask the nurse in charge what to do
- Take the money not to offend the client
- Politely refuse the money
- Take the money and buy something for the floor
Correct answer: Politely refuse the money
When a client is grateful for the care they have received, they may wish to acknowledge the nurse aide with a money. The nurse aide’s response can be, “I’m sorry, but I can’t accept.” Gifts or money compromise the client-nurse boundary. It can also destroy the trust that clients have in nurses. In some facilities, it can result in disciplinary action.
- A nurse aide forgets to raise the side-rails on a bed and the resident is injured from a fall. This is termed as
- Incidental
- Abuse
- Accidental
- Neglect
Correct answer: Neglect
Neglect occurs when a resident does not receive the proper level of care they need. It can be intentional or unintentional, but the effect is the same: the resident can be harmed both physically and psychologically. Putting residents in unsafe situations is neglect. Other examples of neglect include poor hygiene or nutrition, and leaving residents to try to take care of themselves. Both the employee and the facility are liable for neglect.
- A standard of care is a way of ensuring that patients always are cared for by professionals who are everything EXCEPT
Correct answer: Fast
A standard of care is what a reasonable and competent professional, with the same level of training, would do in the same situation. It means that you should be properly trained for the tasks your job. If you are not, then you can refuse to do a task until you are trained. This ensures that patients always received the highest quality of care. Being fast does not always equal being competent.
- A famous athlete has been admitted into your facility. He is in a different unit. If you want to find out why he is there, what should you do?
- Avoid temptation and just keep working.
- Log on and quickly read his electronic health record.
- Drop by the other unit to learn whatever you can.
- Ask a co-worker on the unit to give you an update.
Correct answer: Avoid temptation and just keep working.
All health care professionals must be trained in HIPAA regulations before beginning client care. Facilities are responsible for protecting client privacy at every level. It can be tempting to want to learn more about a certain client, and possible to do because you are an employee. But even basic information or a conversation violate HIPAA. You could lose your job for seeking information.
- While you are at lunch with other nurse aides, they start to discuss how rude a resident was behaving. What should you do?
- Join in the conversation so they know the truth.
- Tell them that this is not the place to discuss the client.
- Be quiet and do not say anything to the other nurse aides.
- Return to the unit after lunch and tell the client what was said.
Correct answer: Tell them that this is not the place to discuss the client.
HIPAA (Health Insurance Portability and Privacy Act) is the Federal law that protects a resident’s privacy. This includes documentation, records, and communications. Information can only be shared with those who need it to provide treatment. There are severe penalties for sharing information, even if it is unintentional.
- After the end of the shift, some nurse aides go to a restaurant. Acceptable topics of conversation would include
- Their patients
- The weather
- Hospital politics
- Surgical procedures
Correct answer: The weather
The HIPAA Privacy Act regarding protecting a client’s confidential information is clear: Absolutely no information can be shared outside those who need it in order to care for the client. Even a discussion in a hallway or the cafeteria, where others can overhear, is a violation. Discussing other workplace issues in a public place is rude and inappropriate; these can be disturbing or misunderstood by other restaurant patrons.
- Which of the following would affect a nurse aide’s status on the State Registry and possibly cause the nurse aide to be ineligible to work in a nursing home?
- Failure to show for work without calling to tell the supervisor.
- Being charged of resident neglect in a legal court case.
- Missing the annual mandatory infection control training.
- Termination from another facility for repeated tardiness.
Correct answer: Being charged of resident neglect in a legal court case.
If the CNA has a neglect charge, their license will be revoked for at least a year. Each state licensing board has regulations regarding reinstatement after claims of abuse or neglect. If the state allows reinstatement, they will provide information about the process. An attorney may be useful in reviewing the case and helping dispute or reinstate the license.
- Proper use of a waist restraint requires that the nurse aide
- Monitor for skin irritation
- Tie restraints to the side rail
- Apply the restraint tightly to prevent movement
- Release the restraint every four hours
Correct answer: Monitor for skin irritation
Physical restraints are devices or equipment that prevent normal movement. Examples are waist,arm, or leg restraints, hand mitts, or vests. It is against the law to use restraints unless necessary to treat a client’s medical symptoms, or if there is a risk of harming self or others. Restraints are not used for punishment, convenience, or a method of control. Either a physician’s order or the client’s consent is required before a restraint can be applied. If a restraint is in place, monitor closely for, and report, signs of injury.
- A 22-year old with terminal brain cancer tells you that she has an Advanced Directive for her end-of-life care. You know this can mean any of the following EXCEPT
- She can choose to be a DNR patient.
- Her Living Will can indicate her wishes.
- She can designate who can make her medical decisions.
- Her family can direct the staff to keep her alive.
Correct answer: Her family can direct the staff to keep her alive.
Advanced directives describe the kind of medical treatment you want for yourself if you are in serious health condition or unable to speak for yourself. Anyone over age 18 can have an Advanced directive. Once in place, it is a legal document that cannot be revoked. A person can choose to have a Living Will, which lists the person’s wishes regarding end-of-life care. The person can also designate someone who can make medical decisions if the person is unable to; this is called the Medical Power of Attorney. A person can also indicate they wish to be a DNR, or Do Not Resuscitate, patient if their heart stops beating or they stop breathing.
- If abuse is suspected within a facility
- Only serious claims of abuse must be reported and investigated.
- The incident must be reported immediately to the supervisor or administrator.
- Corrective action is taken against the reporter if the claim is found false.
- If two co-workers agree that there is no abuse, a report is not necessary.
Correct answer: The incident must be reported immediately to the supervisor or administrator.
All abuse or suspected abuse must be reported. Every health care facility has a procedure for handling concerns about client care. If an incident involves a co-worker, notify the charge nurse. If a nurse aide observes the charge nurse in a situation that could be dangerous or neglectful for a resident, the nurse aide can go directly to the Nursing or Administrative Supervisor.
- The nurse aide reports directly to the
- Staff development nurse
- Physician
- Administrator
- Licensed nurse
Correct answer: Licensed nurse
Every staff member has a role in providing excellent client care. Each person can work within their scope of practice and allow others with different authority to handle appropriate tasks. The nurse aide reports to the RN or LVN, who reports to the Director of Nursing. The facility’s Administrator and Medical Director may be the people with the most responsibility. A staff development nurse oversees training and education.
- It is okay to call a resident by a nickname if
- The nickname is appropriate.
- The resident requests it.
- Everyone else calls them that.
- The family uses that name.
Correct answer: The resident requests it.
“Register” is the formality of speech, depending on the circumstances. It always applies to how you address someone. For example, you may first address a new client as “Mr. Smith” until he asks you to call him “Bob.” Do not assume that because his family calls him “Bubba” that you can, too. All languages have register, and usually we know exactly how to switch from formal to informal.
- What is the main purpose of continuing education for the nurse aide?
- Facility compliance
- Review of skills
- Promotes teamwork
- Client safety
Correct answer: Client safety
Learning does not end with certification. New methods and advancements are constantly being discovered. Staying current makes sure that clients are getting the safest care and best treatment. Also, hospitals and facilities must show training records to maintain accreditation, so continuing education must be current.
- A patient’s chart is a legal document. If something is mistakenly written on the chart, the correct action is to
- Use a black or blue marker to cover the mistake completely. Then follow with the correct information. Add your name and title, date, and time.
- Get a new chart page and copy everything, including all the correct information in blue or black ink. Write your name and title, date, and time.
- Use correction ink to block out the mistake. Then write the correct information over it in blue or black ink. Add your initials, date, and time.
- Draw a single line through the mistake with blue or black ink. Write your initials, date, and time. Then write the correct information.
Correct answer: Draw a single line through the mistake with blue or black ink. Write your initials, date, and time. Then write the correct information.
If you make a mistake, follow your facility’s policy for correction. Many times a single line through the mistake, with date, time, and your initials is acceptable. Never erase, black out, or use correction fluid.
- Mr. Joseph overhears the nurse aide speaking to the nurse about his roommate’s diagnosis and demands to know more about the roommate’s condition. The nurse aide should
- Tell Mr. Joseph that if his roommate wants him to know, the roommate can tell Mr. Joseph.
- Firmly but politely explain she cannot discuss another resident’s condition
- Tell Mr. Joseph it is not his concern, he should only worry about himself.
- Tell Mr. Joseph to ask the roommate’s family during their next visit.
Correct answer: Firmly but politely explain she cannot discuss another resident’s condition
Absolutely no medical information can be shared with others without the client’s consent. This can even include the client’s family, if the client wishes. Remember that client information can only be shared with health care workers. Be aware that If information is overheard by anyone other than the health care workers involved in the client’s direct care, a breach of privacy has occurred.
- On Monday, Mrs. Green and her family requested and received a “Do Not Resuscitate” order from her doctor. While bathing her on Thursday, she stops breathing and dies. Her son is not home. You should
- Call 911 to ask for emergency help.
- Notify the case manager of the death.
- Leave a sympathy note for her son.
- Call her doctor to verify the order.
Correct answer: Notify the case manager of the death.
When a client (or the client’s Power of Attorney for Healthcare) obtains a “Do Not Resuscitate” (DNR) order, they do not want any measures taken if their breathing or heart stops. When a DNR order is in place, do not do CPR or call Emergency Services. Notify your supervisor and provide post-mortem care.
- There is a contained fire in the residents room. What is the first action a nursing assistant should take?
- Pull the fire alarm.
- Yell for help.
- Move the resident to safety.
- Grab the fire extinguisher.
Correct answer: Move the resident to safety.
Safety of the resident is always the number one priority.
- The nurse aide gave a client the wrong diet. What should the nurse aide do after realizing this error?
- Report the error immediately to the nurse.
- Ask the client to stop eating.
- Blame another nurse aide for the error.
- Remove evidence of the error.
Correct answer: Report the error immediately to the nurse.
All health care professionals make mistakes. Common errors include failing to check the patient's ID before giving a meal tray, giving care, or giving medications. The very first thing to do after making a mistake is to admit that it happened. Never disregard a mistake that you've made. Immediately tell a nurse. If you are asked to complete an Incident Report, provide all details.
- The charge nurse has administered a prescribed medication to the wrong patient. This is an example of ____.
- Malpractice
- Neglect
- Battery
- Assault
Correct answer: Malpractice
Nursing malpractice is when a nurse fails to perform medical duties and that failure results in harm to the patient. The other options are legal terms, but do not apply to this situation.
- A nursing assistant threatens to slap a resident if he doesn’t stop yelling. This is classified as:
- Battery
- Assault
- Slander
- Libel
Correct answer: Assault
Assault is a threat of harm, whereas battery is actual infliction of harm. Libel and slander are verbal assaults against someone’s character.
- Mr. Joseph overhears the nurse aide speaking to the nurse about his roommate's diagnosis and demands to know more about his roommate’s condition. The nurse aide should
- Tell Mr. Joseph to ask the roommate’s family during their next visit.
- Firmly but politely explain she cannot discuss another resident’s condition
- Tell Mr. Joseph it is not his concern and he should only worry about himself.
- Tell Mr. Joseph that his roommate can tell him if his roommate wants him to know.
Correct answer: Firmly but politely explain she cannot discuss another resident’s condition
Absolutely no medical information can be shared with others without the client's consent. This can even include the client's family if the client wishes. Remember that client information can only be shared with health care workers. Be aware that If information is overheard by anyone other than the health care workers involved in the client's direct care, it constitutes a breach of privacy.
- Which of these could cause a nursing assistant to be charged with battery?
- Raising a hand to threaten a slap.
- Using restraints on a resident without a physicians order.
- Administering medications.
- Ignoring or delaying a response to a residents call for help.
Correct answer: Using restraints on a resident without a physicians order.
Restraining a resident without a physicians order is battery. Raising a hand in a threat is considered assault. Ignoring a residents call for help is negligence, and administering medications as a nursing assistant is considered malpractice.
- A resident’s family is visiting when you arrive on duty and one of them hands you an envelope that contains a thank you card and a monetary gift in appreciation for your care of their loved one. The best response is to ____.
- Accept the gift and be sure this resident gets extra attention so he or she knows you are appreciative.
- Accept the gift and then check with your fellow colleagues about how they handled similar situations.
- Thank the family and use the money to purchase a gift for the residents birthday.
- Thank the family and resident but tell them you must decline until you can check with your supervisor and facility policies regarding the acceptance of gifts.
Correct answer: Thank the family and resident but tell them you must decline until you can check with your supervisor and facility policies regarding the acceptance of gifts.
As a paid employee for the care of the resident, it is a violation of professional ethics to accept money or gifts from a resident or their family. Some facilities allow gifted money to be donated to a fund that purchases items for the benefit of all the residents, but you need to know your company or facility policy. A particular problem can be caused accepting gifts from patients with dementia.
- Which of these examples would not be considered neglect?
- Forgetting to provide your resident with enough water in a timely manner.
- Leaving clutter on the floor where a resident walks.
- Not staying on the floor once you've clocked in.
- Forgetting to move an immobile resident enough to keep them from getting bed sores.
Correct answer: Not staying on the floor once you've clocked in.
An assistant may need to leave the floor for various reasons during his or her shift. The other options are necessary responsibilities to ensure a residents safety or to meet basic needs. Failure in any of those areas is considered neglect.
- All of these could result in a nursing assistant being charged with negligence except ____.
- Not turning a patient every two hours as prescribed to prevent pressure sores.
- Not checking on a resident at a prescribed time.
- Nicking the forehead of a resident while trimming their bangs.
- Deliberately harming a resident with extreme force.
Correct answer: Deliberately harming a resident with extreme force.
Deliberately harming a resident is considered both battery and physical abuse. All of the other options are considered negligence.
- Your fellow nursing assistant is angry at you and lies to the charge nurse. He claims you stole money from a resident’s purse. This is an example of ____.
- Malpractice
- Accolades
- Defamation
- Assault
Correct answer: Defamation
Making false, offensive statements about someone is considered defamation. Accolades are giving praise and compliments to someone. Assault is threatening harm to someone else. Malpractice is illegal or unethical behavior resulting in a failure to fulfill the duties and responsibilities of your position.
- You hear a charge nurse telling a resident that the LPN is not performing as well as she should be. The legal term for this is ____.
- Slander
- Gossip
- Insubordination
- Discrimination
Correct answer: Slander
Saying something malicious that destroys someones reputation is considered slander. Discrimination is unfair treatment of someone because of prejudice. Insubordination is refusal to obey orders. While the charge nurse is engaging in gossip, it is not considered a legal term.
- Which of these is the legal term for “being responsible for providing care according to an accepted standard”?
- Liability
- Aiding and abetting
- Slander
- Legality
Correct answer: Liability
The correct answer is liability. Legality, slander, aiding and abetting all have different legal meanings.
- You observe a co-worker sexually harassing a resident and choose to ignore it. This is an example of ____.
- Libel
- Cease and desist
- Passive aggression
- Aiding and abetting
Correct answer: Aiding and abetting
When a caregiver is aware of a violation of patient rights inflicted by a co-worker and does nothing to assist, it is considered aiding and abetting, or contributing to the offense. While this could be interpreted as a form of passive aggression if the caregiver who ignores the action is angry with the resident, this is not the legal term given to this type of behavior. Libel is a term used against a person who is performing the act of defamation. Cease and desist is a demand to stop doing an allegedly illegal activity and to not start doing it again in the future.
- When a nursing assistant restricts a residents movements or actions without proper authorization, it can be interpreted as ____.
- False imprisonment.
- Liability
- Aiding and abetting.
- Slander
Correct answer: False imprisonment.
Nursing assistants need to understand that the use of restraints without proper authorization is not the only action that can be interpreted as false imprisonment and a violation of a patients rights. Even threatening to use restraints without a doctors permission can result in false imprisonment charges.
- Another word for forcing a patient to do something against his or her will is ____.
- Conspiracy
- Collusion
- Coercion
- Consequences
Correct answer: Coercion
Conspiracy is a plot or secret plan by two or more people. Consequences are what follows as a result of a behavior. Collusion is secret cooperation between people to do something illegal.
- Which of these is a form of involuntary seclusion?
- Leaving a patient alone without a means of communicating, such as removing a call bell.
- Leaving the room when the resident wants to have private time with family.
- Putting a patient in a wheelchair and rolling him or her away from others when he or she asks to be moved.
- Closing the patients door when he or she asks for time to be alone.
Correct answer: Leaving a patient alone without a means of communicating, such as removing a call bell.
Removing a patients mean of communication and then leaving him or her alone is considered involuntary seclusion because the patient is not choosing for this to happen. The other options are all requested by the resident and are not considered involuntary.
- If a resident went on a day trip with family members and returns complaining of hunger and thirst, the nursing assistant should ____.
- Tell the resident the family who was in charge assured you they had strictly followed mealtime schedules.
- Talk to the family about the importance of the resident getting proper snacks when on an outing.
- Tell the resident when the next snack and beverage time is scheduled and get him or her a glass of water.
- Report this to the charge nurse.
Correct answer: Report this to the charge nurse.
The nursing assistant is required to report any suspected abuse—even if you suspect friends or family members of the resident. The other options do not alleviate the problem or prevent it from happening again.
- Which of these scenarios would most likely be considered a violation of patient rights?
- The nursing assistant changes the patient to a hospital gown after others complain that the patients “lucky shirt” is soiled and beginning to smell.
- Restraints are applied to a patient who has been trying to punch the nurses who are caring for him.
- A patient is receiving care from a physician that he or she has requested to be dismissed.
- A patient is transferred from a nice facility to one that is further away and slightly less nice because of non-payment.
Correct answer: A patient is receiving care from a physician that he or she has requested to be dismissed.
The Patients Bill of Rights states that patients have the right choose their own physician. Although patients have a right to remain free of restraints, restraints may be used with a doctors order if the patient is harming himself or others. Patients may not be transferred without reason, but non-payment is considered a valid reason. A patient has a right to their own clothes, unless they are hazardous or infringing on the rights of others.
- Which of these would be an example of invasion of a patients privacy?
- Not knocking on the residents door when entering the room.
- Not shutting the residents door when exiting the room.
- Exposing the residents body unnecessarily when performing his or her care.
- Discussing the residents dislikes with a co-worker during report.
Correct answer: Exposing the residents body unnecessarily when performing his or her care.
Examples of invasion of privacy include instances of failing to keep the residents affairs confidential or exposing the residents body unnecessarily, or to others, during care. It is always advisable to knock before entering a residents room, but failing to do so is not an invasion of privacy. Unless asked to do so by the resident, it is not necessary to shut the door when exiting the room. Lastly, sharing confidential information during report is necessary for patient care, but should be done in an area in which this information cannot be overheard by nonessential medical staff or other residents.
- The definition of liability is ____.
- Being responsible for providing care according to an accepted standard.
- Lack of care according to an accepted standard.
- Having insufficient knowledge to properly perform your duties.
- Participating in an unlawful act.
Correct answer: Being responsible for providing care according to an accepted standard.
Liability is defined as being responsible for providing care according to an accepted standard. Performing duties outside of your job description or performing appropriate duties incorrectly, which causes harm to a resident, may result in you being charged since you are liable for abiding by the standards of care.
- Which of these is not an example of abuse?
- Threatening to hit a resident.
- Hitting a resident.
- Startling a resident.
- Kicking a resident.
Correct answer: Startling a resident.
Abuse is defined as the threat of or actual physical or mental harm to a resident. While startling someone may cause them some anxiety, it is temporary and not an act or threat of abuse.
- Which of these is not a liable act?
- Voluntary seclusion.
- Invasion of privacy.
- Theft
- Abuse
Correct answer: Voluntary seclusion.
Liable acts include all of the following: abuse, aiding and abetting, assault, battery, false imprisonment, invasion of privacy, neglect, negligence, theft, and involuntary (not voluntary) seclusion. Involuntary seclusion is when you keep a resident isolated from others as a form of punishment while voluntary seclusion is a residents choice.
- What are your legal and ethical responsibilities if you have access to medical records?
- To keep all information confidential.
- To share information with anyone who asks.
- To write everything down accurately.
- To only tell your family about a patient.
Correct answer: To keep all information confidential.
HIPAA (Health Insurance Portability and Privacy Act) is the Federal law that protects a resident’s privacy. This includes documentation, records, and communications. Information can only be shared with those who need it to provide treatment. There are severe penalties for sharing information, even if it is unintentional.
- A client with metastatic cancer has an Do-Not-Resuscitate (DNR) advance directive. If the client’s heart rate begins to slow, what should you do?
- Call a code and initiate CPR.
- Call the family because they can reverse the DNR.
- Ask the client to verify the DNR and document their response.
- Notify the nurse, in case supportive measures are in place.
Correct answer: Notify the nurse, in case supportive measures are in place.
When a client has a DNR in place, it is legal and final. Do not try to change or interfere with the outcome. Notify the nurse, in case other measures, such as morphine, are in place. Support and care for a dying client.
- Forgetting to raise the side rails as ordered causes a resident to fall and be injured. This could be called
- Neglect to keep the resident safe
- An unreported incident
- An accidental fall, because it wasn't intended
- A faulty safety standard
Correct answer: Neglect to keep the resident safe
Neglect is considered mistreatment that results from lack of attention or carelessness. Neglect can be physical, emotional, or financial. Failing to put up a client’s side rails is physical neglect, because basic safety was disregarded.
- Documentation of a residents fluid intake and output is part of your role as a nursing assistant. The standard unit of measure for doing this is ____.
- Milligrams
- Meters
- Ounces
- Milliliters
Correct answer: Milliliters
Milliliters is the correct answer. Ounces are also used to measure fluids, but are not considered the standard unit of measurement for intake and output. Meters are used for measuring distance, and milligrams are used primarily for measuring solids.
- If you are unable to clean up a large spill on the floor yourself, what is the best alternative, once you have notified someone to help?
- Do not let any residents exit their rooms.
- Ask a resident walking by to help you stop traffic.
- Block off the area from traffic.
- Throw towels over the spill until it can be cleaned more completely.
Correct answer: Block off the area from traffic.
If the spill is large enough you are not able to clean it immediately without further equipment, the area should be blocked to traffic. Not allowing residents to exit their rooms is not practical and throwing towels can make it slippery and more dangerous. Involving a resident is not a safe option.
- When performing care activities, gloves should be worn ____.
- When performing peri-care.
- When you are changing a residents clothing.
- When you are feeding a resident.
- When you are helping with ambulation of a resident.
Correct answer: When performing peri-care.
Activities such as peri-care increase the likelihood of exposure to blood or bodily fluids. The other options have less risk for contamination.
- The best source of Vitamin D is found in which of these foods?
Correct answer: Milk
The best source of Vitamin D is in the dairy food group.
- A nurse asks you to perform something “stat”. This means do it ____.
- As soon as possible.
- Before your shift ends.
- Performing a “stat” action is out of the CNAs scope of practice and only should be done by a licensed nurse.
- Immediately.
Correct answer: Immediately.
“STAT” is a term used for emergencies and when a residents safety is threatened. The other options are not quick enough to deal with immediate safety.
- A resident has suffered a stroke. As a nursing assistant, you’ve been asked to help with ambulation. The best position for doing this would be ____.
- On the residents side that is unaffected.
- On the residents side that has been affected by the stroke.
- In back of the resident.
- In front of the resident.
Correct answer: On the residents side that has been affected by the stroke.
Ambulation for a resident that has suffered a stroke requires optimum support to the side that has been affected and is weak.
- Part of your role as a nursing assistant is to be delegated tasks throughout your shift. In which of these examples would refusal to do a task be acceptable?
- Task that you don't feel needs to be done.
- A task that you have already done numerous times throughout your shift.
- A task that should not be done by a nursing assistant.
- A task that is not normally assigned to your shift.
Correct answer: A task that should not be done by a nursing assistant.
The only time it is appropriate to refuse to do a task is when it is something which you have a legal obligation to uphold. One case might be refusing to administer medications for a nurse.
- At the end of your shift, your fellow nursing assistant comes in to relieve you. While giving report, you discover your colleague is under the influence of alcohol. The best course of action, as a member of a healthcare team, is to ____.
- Tell the nursing assistant to go home and that you'll cover her shift.
- Tell the nurse in charge immediately.
- Suggest your colleague seek professional help through Alcoholics Anonymous or another alcohol-related support group.
- Get coffee or another caffeinated drink and stay with your colleague until she sobers up.
Correct answer: Tell the nurse in charge immediately.
This situation poses an immediate threat to the safety of the residents under the care of your colleague. If you do not report it you could be held responsible for any negligence that occurs. The other options conceal the problem and the immediate possible threat to safety.
- You enter a resident’s room and notice he is having difficulty breathing. Your proper response should be to ____.
- Call the family contact member immediately.
- Notify the nurse immediately.
- Wait in the room for a period of time to see if it improves.
- Check back in a few minutes to see if the problem still exists.
Correct answer: Notify the nurse immediately.
Any problems with breathing need to be reported to the nurse in case a serious problem is developing. The other responses delay immediate help.
- Which of these statements is incorrect regarding cleaning a urinary drainage bag?
- The bag should be kept below the level of the bladder (hip level) to prevent urine from flowing back.
- Avoid touching the tube or catheter ends as you disconnect them to clean the bag.
- Wash your hands both before and after cleaning a urinary drainage bag.
- Use peroxide to cleanse the drain on the urinary bag.
Correct answer: Use peroxide to cleanse the drain on the urinary bag.
Peroxide should not be used as it may not be readily available nor is it adequate for cleansing. Alcohol is used for cleaning and all of the other options are important precautions for doing this process.
- The primary role of the CNA in patient assessment is to ____.
- Provide a weekly assessment to the patients physician.
- Give the family members and friends an assessment of the patient when they come for their next visit.
- Give the patient a physical exam and assess the patients condition in a report for the nurse.
- Assist the nurse with physical data such as height, weight, vital signs, food/fluid intake and output.
Correct answer: Assist the nurse with physical data such as height, weight, vital signs, food/fluid intake and output.
The CNAs role in patient assessment is to report physical data and observations to the nurse. The nurse is the member of the healthcare team who makes the assessment and advises the physician. The other answers are incorrect.
- Which of these are conditions requiring extra care regarding the residents nail care?
- Incontinence issues.
- Obesity and irritable bowel syndrome.
- Dementia and insomnia.
- Anticoagulation therapy and diabetes.
Correct answer: Anticoagulation therapy and diabetes.
Anticoagulation therapy can cause excessive bleeding and diabetes patients are at risk of ulceration from cuts or abrasions. These two conditions require extreme caution when administering nail care. The other conditions are incorrect because they pose little or no threat if proper nail care procedures are used.
- Which of these best describes how accurate documentation assists the entire healthcare team?
- Accurate documentation is important, but it is more important to initiate conversations with residents under your care.
- Accurate documentation is a precautionary action to serve primarily as a means for defending a CNAs behavior should a problem arise.
- Accurate documentation is emphasized throughout a CNA and nurses training; however, realistically, it does not happen as often as it should.
- Accurate documentation is crucial for determining if interventions listed in the care plan are effective.
Correct answer: Accurate documentation is crucial for determining if interventions listed in the care plan are effective.
Accurate documentation is for the patient. It is crucial for assessing if the care plan is working or needs adjustment. While accurate documentation can serve as a record of CNA behavior, that is not the reason for it. Accurate documentation is vital, even if it means a little less time for conversation.
- Which of these best describes an advantage to being a CNA when considering future career options?
- You have an opportunity to practice many different types of care roles to see which you like best.
- You have an opportunity to see several healthcare occupations and witness the role each plays in patient care.
- You have an opportunity to work with many different types of patients from varying backgrounds.
- You have an opportunity to work with many cultures and different family members of the residents you care for.
Correct answer: You have an opportunity to see several healthcare occupations and witness the role each plays in patient care.
While all of these choices provide a CNA many different experiences, the opportunity to witness nurses, physicians, and medical technicians provides the best advantage for considering future career options.
- The nursing assistant walks in on a patient who is having a seizure. Which of these actions should the nursing assistant take first?
- Place a padded tongue blade in the patients mouth to keep the airway open.
- Call for the doctor immediately.
- Support the patients head and move anything that could injure the patient.
- Restrain the patient so the patient does not harm himself/herself.
Correct answer: Support the patients head and move anything that could injure the patient.
The nursing assistant should stay with the patient and try and prevent him or her from getting hurt while seizing. Restraining the patient or putting a tongue blade in their mouth could injure the patient. The doctor should be notified that the patient had a seizure, but it is not the nursing assistants responsibility to do so, nor is it the first action that should be taken.
- Which of these members of the healthcare team is responsible for supervising UAP (unlicensed assistive personnel)?
- MD or DO (physician).
- Certified nursing assistant (CNA).
- Patient care assistant/technician (PCA/PCT).
- Registered Nurse (RN).
Correct answer: Registered Nurse (RN).
The registered nurse (RN) is responsible for supervising all UAP. The RN will also typically assign an unlicensed assistive staff members duties regarding the residents personal care activities each day. A licensed practical nurse (LPN) may assign duties and supervise UAP as well.
- Which of these statements about “active listening” is false?
- Active listening is listening to a resident without being distracted by your own thoughts.
- Active listening is sometimes referred to as “listening with a third ear”.
- Active listening is a skill that can cue you in on a residents unexpressed needs.
- Active listening is listening to a resident while doing another activity.
Correct answer: Active listening is listening to a resident while doing another activity.
Active listening is an important skill that you must learn to do. It is tempting to continue to work while not giving your full attention to a resident, in order to save time. But, being able to stop, listen, fully observe and hear what your resident is communicating to you (both verbally and nonverbally) not only acknowledges the residents worth as a human being who is worthy of your attention, but it also allows you to better understand his or her unique needs as your patient.
- Which member of the residents health care team is responsible for determining socialization and communication skills of residents and then finding the resources to match them?
- LPN
- Chaplain
- Physician
- Social worker
Correct answer: Social worker
A social worker is the member of the health care team tasked with matching resident social and emotional needs to resources and treatments available. The physician and nurse execute the medical plan and a chaplain may assist with spiritual needs.
- Which of these is true about the term care plan?
- A care plan promises care will be delivered as written.
- All of these are true.
- A nurse can face strict penalties for not following the written care plan.
- A care plan is a legal document.
Correct answer: All of these are true.
All of these are true statements about a care plan.
- There is an order to give a female patient a shower, but she refuses. The nurse aide should
- Threaten to use restraints if she does not cooperate
- Take the patient to the shower anyway
- Tell her that she must do what is ordered
- Document in the chart that the patient refused to shower
Correct answer: Document in the chart that the patient refused to shower
If a patient is competent, they can refuse care or treatment. A patient who has dementia may simply need a different approach to bathing that day. In either case, try to reschedule the shower or offer a bed bath. If the patient continues to refuse, document what was offered. If the patient gave a reason, include their statement. The nurse aide should show that care was offered and refused, not that the care was skipped.
- You discover a fire in a residents room. You have gotten the resident out of harms way. What is the next step you should execute?
- Evacuate.
- Use the fire extinguisher to start putting out the fire.
- Call the residents family to notify them.
- Pull the fire alarm.
Correct answer: Pull the fire alarm.
The first step in dealing with a fire is getting any residents in close proximity out of harms way. The second step is to pull the alarm so remaining occupants can evacuate. Calling the residents family is not a step to ensure immediate safety. The other options are part of the process.
- If you have a concern about an assignment, you should ____.
- Discuss it immediately with your supervisor, regardless of who else is present.
- Tell your resident that you don't feel that you can properly take care of him or her.
- Complain to a co-worker and ask him or her to do it for you.
- Discuss it privately with your immediate supervisor.
Correct answer: Discuss it privately with your immediate supervisor.
There will be times when you may have concerns about being able to carry out a specific assignment as a CNA. The appropriate course of action is to discuss it privately with your immediate supervisor. This allows for little disruption and is respectful not only to your supervisor, but also to your co-workers and the residents.
- As a CNA, you work as a “team player” to take care of all of your residents needs. Which of these is a reason you should take this approach when you need to ambulate a resident?
- You can move the resident yourself while your helper explains what you are doing.
- You don't have to work as hard if you have someone else there to help you lift a resident.
- The resident will feel and be safer when two or more staff members help with ambulation.
- The resident can be ambulated more quickly if you work together.
Correct answer: The resident will feel and be safer when two or more staff members help with ambulation.
Your residents safety and well-being is your top priority when working as a CNA. Ambulation of a resident can be dangerous for both you and the resident if done alone. Always ask for help when you need it.
- Which of these is not true about a patients care plan?
- A good care plan is designed to assist team members in delivering high-quality, consistent care.
- A care plan is not necessary for every single resident in a care facility.
- A good nurse will solicit input from the CNA for the patients care plan to make it more effective.
- Effective care plans take the patients wishes into consideration.
Correct answer: A care plan is not necessary for every single resident in a care facility.
Every single resident needs a plan of care established to document what it is being done. This is the only incorrect statement. All of the other statements are true about a care plan.
- Which member of the healthcare team is responsible for carrying out the patients medical plan?
- The doctor.
- Every member of the healthcare team.
- The nursing assistant.
- The registered nurse.
Correct answer: The registered nurse.
The doctor is responsible for creating the patients medical plan, and the registered nurse is responsible for seeing that is executed. The nursing assistant assists in the delivery of care that supports the medical plan, but is not ultimately responsible for carrying the plan out.
- Your resident consumed a bowl of soup that was 180cc of liquid. How many ounces was that?
Correct answer: 6 oz
180cc = 6 oz. When converting cubic centimeters (cc) to ounces (oz) remember that 30cc = 1 ounce. Although an ounce is slightly more, the amounts are considered to be equal by doctors and pharmacists. Also, 1cc = 1 ml.
- Why is taking a residents oral temperature the most common means of obtaining a reading?
- It is the only method residents will accept.
- It is the most cost effective means of taking a temperature.
- It offers the most ease of access and least inconvenience to the resident
- It is more accurate than other methods.
Correct answer: It offers the most ease of access and least inconvenience to the resident
Ease of using this method makes it the most preferable. The other answer options are not necessarily true.
- To avoid pulling on the catheter while you're turning a male client, the catheter tube must be taped to his
- Hip
- Bed frame
- Upper thigh
- Bedsheet
Correct answer: Upper thigh
An indwelling urinary catheter is used to drain the bladder into a bag outside the body. A catheter for males is a long tube with a balloon that is inflated after being inserted. The tube that drains the urine must not be tugged on or become kinked. In males, it is attached to the client's inner thigh by tape or a special fastening device. Never attach the tube to anything except the client's inner thigh. The drainage bag should remain lower than the client's bladder to prevent a backflow of urine.
- Which of the following is NOT considered a way to restrain a client?
- A sedative
- Lap buddy/tray
- Pain management
- A hand mitt
Correct answer: Pain management
A restraint may be either physical or chemical. Its purpose is to protect the client from harming himself or others. Only a physician may order a restraint, and guidelines are strict. A pain medication may help calm a client or relieve behavior associated with severe pain, but it is not in the restraint category.
- The nurse aide sees a client spill water on the floor in the hall. Another client is walking down the hall. The nurse aide SHOULD
- Clean up the spill
- Call housekeeping
- Call the nurse
- Leave the spill
Correct answer: Call housekeeping
Falls can lead to serious injury and complications, especially among elderly or very ill clients. Every staff member should be constantly alert for potential hazards such as spills and immediately take care of the situation. Never ignore a potential cause of a fall. If the spill is caused by blood or body fluid, follow the protocol for decontamination and wear Personal Protective Equipment (PPE).
- While eating dinner, a client starts to choke and turn blue. The nurse aide SHOULD
- Immediately remove the client’s food tray and go find the nurse in charge
- Call for assistance and perform the Heimlich maneuver (abdominal thrusts)
- Give the client a drink of water
- Slap the client on the back until the food dislodges
Correct answer: Call for assistance and perform the Heimlich maneuver (abdominal thrusts)
Abdominal thrusts (the Heimlich maneuver) is the best response to choking. Calling for assistance as you prepare to do abdominal thrusts will alert others to the emergency. You can try a quick back slap, but if the food is not immediately dislodged, quickly start abdominal thrusts. To perform abdominal thrusts, stand behind the client and use your hands to exert upward pressure on the bottom of the diaphragm.
- A client needs to be repositioned but is heavy, and the nurse aide is not sure that she can move the client alone. The nurse aide should
- Go on to another task
- Have the family do it
- Try to move the client alone
- Ask another nurse aide to help
Correct answer: Ask another nurse aide to help
Clients or objects that are heavy should never be moved or lifted by one person. The risk of falls or injuries to both the client and the nurse aide increases with heavy loads. Ask for assistance before attempting to pull or roll a heavy patient. Use good body mechanics by using your leg muscles to avoid back injury.
- When transferring a client, MOST of the client’s weight should be supported by the nurse aide’s
Correct answer: Legs
When transferring a client, position yourself to support the client by using your legs. Keep your back straight and locked; do not turn or twist. If you bend, do so at the hips, not the waist. Before beginning the transfer, assess how much the client is able to do. If you have any doubts, always ask for assistance from a co-worker.
- To take an oral temperature, the nurse aide should
- Place the thermometer under the arm
- Place the thermometer under the tongue
- Put lubricant on the thermometer
- Place the thermometer in the rectum
Correct answer: Place the thermometer under the tongue
To take an oral temperature, make sure the client has not had anything hot or cold to eat or drink for 15 minutes. Place the thermometer under the client's tongue. A digital thermometer will beep when it registers the client's temperature. A glass thermometer will have a line that stops moving when it gives the reading. Note: The normal body temperature ranges for very young children, older children, and adults are different. For children aged 2 – 5 years, the normal body temperature range is 37.0°C - 37.2°C (98.6°F – 99.0°F). For children aged 5 – 10 years, the normal range is 35.5°C – 37.5°C (95.9°F – 99.5°F). For persons age 11 and up, fever is considered a temperature higher than 38 degrees C (100.4°F).
- What is the FIRST thing a nurse aide should do when finding an unresponsive client?
- Start compressions.
- Close the door.
- Call the client's family.
- Call for help.
Correct answer: Call for help.
When encountering any type of emergency situation such as an unconscious client, always call for help first. Others can clear the area, phone for an ambulance, assist with CPR, help move or transfer the client, or document the events.
- Which type of fire can be put out with water?
- Paper
- Chemical
- Electrical
- Grease
Correct answer: Paper
Fire extinguishers are classified by the materials they can snuff out. Think "ABC." Class A fire extinguishers are used for paper, wood, textiles, and some plastics. Class B extinguishers are used for flammable liquids such as oil or gasoline. Class C extinguishers are for electrical fires. All fire extinguishers have labels on them to identify which type of fire they can be used on. Never use water on an electrical fire because of the risk of electric shock.
- Physical restraints are used MOST often
- At the roommate’s request
- When staff is short
- To prevent client injury
- At the family’s request
Correct answer: To prevent client injury
Physical restraints are devices or equipment that prevent normal movement. Examples are arm or leg restraints, hand mitts, and vests. It is against the law to use restraints unless they are necessary to treat a client's medical symptoms or there is a risk of harming oneself or others. Restraints may not be used for punishment, convenience, or control. Either a physician's order or the client's consent is required before a restraint can be applied.
- The nursing care plan states, “Transfer with mechanical lift.” However, the client is very agitated. To transfer the client, the nurse aide SHOULD
- Lift the client without the mechanical device
- Keep the wheels unlocked so the lift can move with the client
- Get assistance to move the client
- Place the client in the lift
Correct answer: Get assistance to move the client
Client safety is always your highest priority. Do not try to accomplish a task alone if a patient is unable to cooperate for any reason. It is important to follow the nursing care plan, including all the steps for operating any equipment being used to move or transfer the client. Ask a co-worker to help if you have any concerns about keeping the client safe. If the client remains agitated, notify the nurse before proceeding.
- The nurse aide is going to help the client walk from the bed to a chair. What should the nurse aide put on the client’s feet?
- Socks or stockings only
- Rubber-soled slippers or shoes
- Cloth-soled slippers
- Nothing
Correct answer: Rubber-soled slippers or shoes
When helping a client ambulate, you must prevent the client from falling. Proper footwear should always be worn for any type of walking, even a short distance. Rubber-soled slippers or shoes provide traction to prevent falls. Socks, stockings, or slippers made from fabric can make the client slip or lose his or her balance. Walking in bare feet can lead to foot injuries, which is especially dangerous for diabetic clients.
- Clean bed linen placed in a client’s room but NOT used should be
- Put in the dirty linen container
- Taken to the nurse in charge
- Used for a client in the next room
- Returned to the linen closet
Correct answer: Put in the dirty linen container
Once linen has been in a client's room, it is no longer considered clean. Each client's room may have pathogens or sources of possible infection that can be spread by objects from that room. Opened supplies or items with sterile packaging that has been opened should also be discarded, even if they have not been used.
- The Heimlich maneuver (abdominal thrusts) is used on a client who has
- Impaired eyesight
- Fallen out of bed
- A bloody nose
- A blocked airway
Correct answer: A blocked airway
The Heimlich maneuver (abdominal thrusts) is a first aid technique for helping someone who has food or an object caught in his or her upper airway. When a client appears to be choking, you must act quickly to clear the airway. First, call for help. Next, to perform abdominal thrusts, stand behind the client. Make a fist with your dominant hand. Place this fist just above the client's navel. Wrap your other hand firmly around the fist. Pull inward and upward, pressing into the client's abdomen with quick and forceful upward thrusts as if you were trying to lift the client off his or her feet from this position. Continue the abdominal thrusts in quick succession until the object is expelled.
- A client is to be assisted out of bed to sit in a wheelchair. How can this procedure be made safe?
- Place a pillow on the wheelchair seat.
- Lower both footrest pedals.
- Release the wheel brakes.
- Place the bed in the lowest position.
Correct answer: Place the bed in the lowest position.
Client safety during transfer begins with the bed in the lowest position. This allows the client to easily reach the floor when standing and pivoting to sit in the wheelchair. The brakes of the wheelchair should be locked and the footrests completely out of the way.
