CNA Exam: Nurse Aide Basics

What is dysphagia?

Difficulty swallowing

The North Carolina curriculum defines dysphagia as difficulty in swallowing and says it poses a danger of aspiration.

A resident has a dry mouth, cracked lips, sunken eyes and small amounts of dark urine. What condition do these signs suggest?

Dehydration

The North Carolina curriculum lists these among the signs of dehydration and says the aide observes and reports them.

Where must a urinary catheter drainage bag be kept in relation to the resident's bladder?

Below the bladder

The North Carolina curriculum says the catheter bag should always be kept below the bladder to prevent urine from flowing back into the bladder.

During catheter care, in which direction do you clean the catheter?

Away from the meatus, in one direction only

The NNAAP skills list says to clean at least four inches of the catheter from the meatus, moving in one direction away from the meatus and using a clean area of the cloth for each stroke.

Who assesses a resident's pain and gives medication if it is appropriate?

The nurse

The North Carolina curriculum says the aide reports complaints of pain to the nurse, and the nurse assesses the pain and medicates if appropriate.

Hand washing breaks which link in the chain of infection?

The mode of transmission

The North Carolina curriculum gives washing your hands as the example of breaking the mode of transmission link.

For which residents should Standard Precautions be used?

All residents, during all care

CDC says Standard Precautions are used for all patient care. The North Carolina curriculum explains that a resident may have an infection and show no signs.

Which condition of the hands calls for soap and water rather than an alcohol-based hand rub?

Hands are visibly soiled

CDC's clinical guidance for health care workers calls for soap and water when hands are visibly soiled. The North Carolina curriculum says the same.

Can wearing gloves take the place of hand hygiene?

No, clean hands after removing gloves

CDC says gloves are not a substitute for hand hygiene and tells staff to always clean their hands after removing gloves.

What PPE does CDC direct staff to wear for interactions under Contact Precautions?

Gown and gloves

CDC says to wear a gown and gloves for all interactions that may involve contact with the patient or the patient's environment.

What does CDC say staff should put on upon entering a room under Droplet Precautions?

A mask

CDC tells staff to put on a mask upon entry into the patient room or space for droplet precautions.

What respiratory protection does CDC list for health care personnel under Airborne Precautions?

A fit-tested N95 or higher level respirator

CDC's airborne precautions include a fit-tested NIOSH-approved N95 or higher level respirator for health care personnel.

Under CDC Enhanced Barrier Precautions in nursing homes, what PPE is used during high-contact resident care?

Gown and gloves

CDC says Enhanced Barrier Precautions use gown and gloves during high-contact care such as dressing, bathing, transferring and device care. Face protection may also be needed if there is a risk of splash or spray.

In CDC's sequence for putting on full PPE, which item goes on last?

Gloves

CDC's sequence is gown, then mask or respirator, then goggles or face shield, then gloves, with gloves extending over the gown wrists. CDC says to tailor the procedure to the PPE in use.

In CDC's first example for removing PPE, which item comes off first?

Gloves

CDC's Example 1 removes gloves first, then goggles or face shield, gown, and mask, followed by hand hygiene. CDC notes there is more than one safe way, and the NNAAP skills list also starts with gloves.

Where should a used sharp, such as a razor blade or needle, always be placed?

In a sharps container

The North Carolina curriculum says anything sharp used on a resident always goes in a sharps container and never in a regular trash can.

When a nurse aide finishes care, where should the call signal and the bed be?

Signal within reach, bed in low position

Steps across the NNAAP skills list end with the signaling device within reach and the bed in low position. The North Carolina curriculum says the same.

Before a resident moves between a bed and a wheelchair, what must be done with the wheelchair wheels?

Lock them

The NNAAP skills list requires locking the wheelchair wheels before assisting a resident to stand. The North Carolina curriculum says to lock the wheelchair before moving a resident into or out of it.

Where is a transfer belt applied on a resident?

Securely at the waist, over clothing

The NNAAP skills list says the transfer belt is applied securely at the waist over clothing or a gown before assisting the client to stand.

What does a Stage 1 pressure injury look like?

Intact skin with redness that does not fade when pressed, usually over a bony prominence

CMS describes Stage 1 as intact skin with non-blanchable redness, usually over a bony prominence. In dark skin tones blanching may not be visible and the area may look persistently blue or purple. A nurse aide does not stage the injury, but reports new reddened or discolored areas to the nurse.

With a resident lying on their back, how can the heels be floated off the bed?

Place a pillow under the calves

The North Carolina curriculum says that to create floating or elevated heels, place a pillow under the calves.

A resident reports pain during range of motion exercises. What should the nurse aide do?

Stop the exercise and notify the nurse

The North Carolina curriculum says to stop the exercises at once and notify the nurse. The NNAAP skills list also has the aide discontinue exercise if the client verbalizes pain.

Where on the wrist does a nurse aide feel for the radial pulse?

On the thumb side

The NNAAP skills list says to place fingertips on the thumb side of the client's wrist to locate the radial pulse.

On the NNAAP skills list, how long are respirations counted?

One full minute

The NNAAP skills list says to count respirations for one full minute, and it uses the same time for radial pulse.

What three things should stay consistent when weighing a resident over time?

Scale, type of clothing and time of day

The North Carolina curriculum says to weigh a resident in similar clothing, at about the same time of day (preferably before breakfast), and on the same scale.

A resident's urine is cloudy and has a strong smell. What should the nurse aide do?

Document it and report to the nurse

The North Carolina curriculum says to document abnormal findings such as cloudy or dark urine, blood or mucus, or a strong or fruity smell, and to report them to the nurse.

How much of their own care should a resident be encouraged to do?

As much as they can

The North Carolina curriculum says restorative care encourages residents to do as much as they can, as long as they can, as often as they can.

On which side of the body is a cane held?

The stronger side

The North Carolina curriculum says a cane should be positioned on the resident's stronger side.

When walking with a resident, where should the nurse aide stay?

On the weaker side and slightly behind

The North Carolina curriculum says the aide stays on the weaker side and slightly behind the resident. The NNAAP skills list has the aide walk slightly behind and to one side.

How can a nurse aide tell a visually impaired resident where food is on the plate?

Use an imaginary clock face

The North Carolina curriculum says to use an imaginary clock face to explain the position of food on the plate.

What is the ultimate goal of bladder or bowel training?

Continence

The North Carolina curriculum defines bladder and bowel training as measures to restore the function of voiding and defecating, with the ultimate goal of continence.

What kind of instructions work best for a resident with Alzheimer's disease?

Simple, one-step instructions

The North Carolina curriculum says to use simple, one-step instructions and positive phrases, and to avoid complicated questions.

Should a nurse aide argue with a resident who has dementia?

No, speak softly and calmly

The North Carolina curriculum says not to argue or treat the resident like a child, and to speak softly and calmly. It also warns against using force or commands.

What is sundowning?

Increased agitation and confusion starting in late afternoon

The North Carolina curriculum describes sundowning as increased agitation, confusion and hyperactivity beginning in the late afternoon and building through the evening.

What should a nurse aide do on noticing a change in a resident's mental health?

Observe, report to the nurse and document

The North Carolina curriculum lists observing changes, reporting observations to the nurse and documenting them as the aide's role.

Should a nurse aide keep talking to a dying resident who no longer responds?

Yes, identify yourself and explain tasks

The North Carolina curriculum says to communicate with the resident even if non-responsive, identify yourself, explain tasks, and be aware of the ability to hear when other senses diminish.

An aide is unsure about a resident's cultural or religious customs. What is the best approach?

Ask the resident or family about their practices

The North Carolina curriculum says people from different cultures appreciate being asked about practices and suggests asking about customs, including who may provide personal care.

Should a nurse aide use medical terms and abbreviations when talking with residents?

No, avoid them

The North Carolina curriculum says to avoid medical terms and abbreviations when communicating with residents.

What is expressive aphasia?

Trouble communicating thoughts by speech or writing

The North Carolina curriculum defines expressive aphasia as trouble communicating thoughts by speech or writing, and receptive aphasia as difficulty understanding words. Both can follow a stroke.

Before giving personal care, what must the nurse aide provide for the resident?

Privacy, with a curtain, screen or door

The NNAAP skills list has the aide provide privacy with a curtain, screen or door. Under 42 CFR 483.10(h), residents have a right to personal privacy, including during personal care.

What should a nurse aide do before entering a resident's room?

Knock and ask permission to enter

The North Carolina curriculum lists knocking on doors and requesting permission to enter as part of protecting dignity.

May a physical or chemical restraint be used for staff convenience?

No

42 CFR 483.10(e)(1) gives residents the right to be free from restraints imposed for discipline or convenience and not required to treat medical symptoms.

Under federal rules, what must a nursing home resident be free from when voicing a grievance?

Discrimination or reprisal

42 CFR 483.10(j)(1) says a resident has the right to voice grievances without discrimination or reprisal and without fear of it.

Does a nursing home resident have the right to refuse treatment?

Yes

42 CFR 483.10(c)(6) gives residents the right to request, refuse or discontinue treatment.

May a nursing home resident keep and use personal clothing and furnishings?

Yes, as space permits

42 CFR 483.10(e)(2) gives residents the right to retain and use personal possessions, including furnishings and clothing, as space permits, unless it infringes on the rights or safety of others.

May staff attend a resident group meeting if they are not invited?

No, only at the group's invitation

42 CFR 483.10(f)(5) says staff, visitors or other guests may attend resident group or family group meetings only at the group's invitation.

Who decides when a nursing home resident goes to bed, gets up and eats?

The resident

CMS's resident rights summary says residents have the right to decide when they go to bed, rise in the morning and eat their meals.

Under federal nursing home rules, what is the term for the willful infliction of injury, unreasonable confinement, intimidation or punishment that causes harm?

Abuse

42 CFR 483.5 defines abuse this way, with resulting physical harm, pain or mental anguish. Willful means the person acted deliberately, not that they meant to cause harm.

Under federal nursing home rules, what is the failure to provide goods and services necessary to avoid harm, pain or distress called?

Neglect

42 CFR 483.5 defines neglect as the failure of a facility, its employees or service providers to provide those goods and services.

A staff member uses a resident's money without the resident's consent. What is the federal term for this?

Misappropriation of resident property

42 CFR 483.5 defines misappropriation as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without consent.

Under federal rules, how long does a finding of abuse stay on a nurse aide's state registry record?

Permanently, with limited exceptions

42 CFR 483.156(c)(1) says the information must remain in the registry permanently unless the finding was made in error, the person was found not guilty in court, or the state is notified of the person's death.

What must a nurse aide's charting be based on?

Facts, not opinions

The North Carolina curriculum says recorded information must be based on facts, not opinions, and to use simple, descriptive terms.

What is objective data?

Observations made using the senses, based on facts

The North Carolina curriculum defines objective data as observations using the senses and based on facts. Subjective data is what a person tells you and you cannot observe.

Which document guides the care a nurse aide gives each resident?

The care plan

The North Carolina curriculum tells aides to follow the plan of care as outlined and to follow the nursing care plan that reflects a resident's cultural and religious beliefs.

Under federal rules, may a nurse aide student perform a service they have not been trained in and found proficient at?

No

42 CFR 483.152(a)(4) says students do not perform any services for which they have not trained and been found proficient by the instructor.