C.N.A.

Final Exam
Review
Updated for Spring 2015
 Role of the Nursing Assistant
Delegation
List tasks which are typically not in the scope of practice for
nursing assistants.
Administering medication
Procedures requiring sterile technique
Diagnosing illness or prescribing treatments or meds
Informing resident or family of diagnosis or medical plans
 Role of the Nursing Assistant
Delegation
What are the 5 rights of delegation?
Right Task
Right Circumstance
Right Person
Right Direction/communication
Right Supervision/Evaluation
 Role of the Nursing Assistant
Delegation
When a C.N.A. is asked to perform a task not in his scope
of practice or that he has not been trained to do, how
should he respond to the request?
Do not accept the delegation
Communicate to nurse why refused(respectfully)
For example: I have not been trained and or it is
not within my scope of practice.
 Role of the Nursing Assistant
Communication
What type of question encourages residents to
communicate?
Open Ended Questions
 Role of the Nursing Assistant
Communication
When working with a resident who does not speak English,
what can be done to improve communication?
Ask if there is an interpreter to help
Enhance communication with nonverbal cues
Use pictures for to illustrate basic needs such as
toilet, bed, eating, drink
 Basic Nursing Skills
Vital Signs
What measures should be taken to assure a measurement
of weight accurately indicates a change in the residents
body weight?
Start with the scale balanced at zero
Make sure the resident is not holding onto the scale
Make sure the resident is not holding onto a walker
or cane while being weighed.
Weigh the resident on the same scale each time
 Psychosocial Care Skills
Emotional
According to Maslow’s Hierarchy of needs, which need
might a resident have difficulty meeting due to his
dependence on others for assistance with ADLs?
Need for Self – Esteem
 Role of the Nursing Assistant
Communication
A resident has the right to refuse cares.
How should a nursing assistant respond to a resident who
refuses cares?
Try to be persuasive and give options. If that
doesn’t work:
Respect refusal
Notify the nurse of any refusal of cares
Aging and Reproduction
Menopause is the time in a woman’s life when she has decreased blood
levels of estrogen and progesterone. What are some normal changes of
aging that result from this decrease?
Loss of calcium which leads to brittle bones
Menstrual periods stop
Vaginal walls get drier and thinner
 Physical Care Skills
Elimination & Basic Nursing Skills
List 5 guidelines for urinary catheter care:
1. Make sure the drainage bag is below the bladder or
hips. (prevents urine flowing back into bladder)
2. Keep drainage bag off floor
3. Keep tubing straight, free from kinks. ( if not straight urine
may be prevented from draining)

4. Keep genital area clean. (catheter goes all the way to the bladder
and makes it easier for bacteria to enter the body)
 Role of the Nursing Assistant
Communication
Which of the following is an open ended question that
would be most helpful in encouraging the resident to
communicate?
How do you prefer to have your breakfast?
Are you hungry for breakfast?
Do you want to eat breakfast?
I will take you to breakfast now.
How do you prefer to have your breakfast?
 Physical Care Skills
Elimination & Basic Nursing Skills
What daily cares for someone with a catheter are the
responsibility of the nursing assistant?

Cleaning the area around the urethral opening

Emptying the drainage bag
 Role of the Nursing Assistant
Communication
List nursing assistant documentation Guidelines:
Document cares only after they have been done
Use facts, not opinions
Use black ink (not pencil)
Be concise (brief & accurate)
 Physical Care Skills
ADLs Nutrition & Hydration
What is the most appropriate way for a nursing assistant
to determine which item on a resident’s tray to feed them
first?
Ask the resident which food he prefers to eat first.
Allow him to make the choice.
 Physical Care Skills
Basic Nursing Skills
What is the nursing assistant responsibility when
providing foot care for a resident with diabetes?
Do not cut toe nails
Always dry thoroughly (especially between toes)
Use only mild soap to prevent irritation
Report any calluses or reddened areas to the nurse
 Role of the Nursing Assistant
Professionalism
A nursing assistant is informed by her supervisor that she
needs to improve a particular aspect of her job
performance. What immediate action on the part of the
nursing assistant would demonstrate a willingness to
improve her job performance?
Asking her supervisor for tips on how to improve in
that particular area is a positive and assertive way
to respond to constructive criticism.
Do not make excuses or blame others
 Role of the Nursing Assistant
Legal & Ethical Behavior

What type of abuse is occurring if a nursing assistant

provides “special” care to a resident for additional
payment?
Financial Abuse
 Role of the Nursing Assistant
Legal & Ethical Behavior
What type of abuse is occurring when a caregiver says
things to a resident that are insulting?
Psychological Abuse
 Role of the Nursing Assistant
Legal & Ethical Behavior
What term is used to describe the legal violation occurring
when a dependent resident does not receive the basic cares
needed to maintain adequate personal hygiene?
Neglect
Aging and Reproduction
As the male reproductive system ages, what are some of
the typical changes that will occur?

A decrease in sperm production

Enlargement of the prostate gland which may make
urination difficult.
 Physical Care Skills
Elimination
Give the term for each of the following types of urinary incontinence:
Loss of urine due to an increase in intra-abdominal pressure such as
when sneezing
Stress incontinence
Voiding involuntarily from a sudden urge to void
Urge Incontinence
Incontinence by things outside the urinary tract
Functional Incontinence
Incontinence with over distention of bladder
Overflow incontinence
 Basic Nursing Skills
Therapeutic / Developmental Dis.
For residents who have conditions such as Cerebral Palsy
which affect their muscle movement and coordination, how
should a nursing assistant go about physical cares?
Allow the resident to move slowly, be patient
Keep the resident’s body in as normal alignment as
possible
 Basic Nursing Skills
Data Collection/Reporting/Disease
People with heart or kidney disease often cannot handle
the amount of fluid consumed. This is called Fluid
Overload. What are signs this could be occurring?
Edema of extremities
Daily weight gain of 1-2 pounds
Decreased urine output
Shortness of breath
Increased heart rate
 Psychosocial Care Skills
Emotional & Mental Health Needs
In each of the following scenarios, what stage of grief is the resident likely to
be experiencing?

Refusing to believe they or a loved one is dying

Denial

Expressing rage or frustration to self or others

Anger

Making promises to god or somehow trying to negotiate for their recovery.

Bargaining

Crying or withdrawing from activities previously enjoyed

Depression

Making arrangements for loved ones or possessions for after they have died

Acceptance
 Role of the Nursing Assistant
Legal & Ethical Behavior
List injuries that are considered suspicious for physical
abuse that should be reported.
Teeth marks
belt buckle or strap marks
bruises, contusions, welts,
scars
scratches or puncture marks
swelling in the face, broken teeth,
unexplained fractures or dislocations
 Basic Nursing
Disease
Which chronic disease is characterized by excessive
urination, excessive hunger and excessive thirst?
Diabetes
 Role of the Nurse Aide
Client Rights
Which resident right is being violated in the following
situations?
Resident is not informed of treatment options or cost
The right to be fully informed about rights & services
Residents health condition is discussed in front of visitors.
The right to privacy & confidentiality
Resident is not given access to their own money
The right to security of possessions
 Physical Care Skills
Restorative Skills
List the guidelines for safe use of a cane
The resident should hold the cane on the resident’s
stronger side
 Basic Nursing
Disease
What actions should a nursing assistant take when a
resident has a sudden onset of dyspnea and shortness of
breath?
1 Assist them to a sitting position or elevate the
head of the bed
2 Notify the nurse immediately
 Physical Care Skills
Restorative Skills
Give the correct term for the following exercises:
Exercises performed by the caregiver, without the resident’s
help
Passive Range of Motion (PROM)
Exercises are done by the resident with some help & support
from the nursing assistant or other caregiver
Active Assisted Range of Motion (AAROM)
Exercises are performed by a resident without help
Active Range of Motion (AROM)
 Basic Nursing
What do you call any intervention used in place of a restraint or that reduces
the need for a restraint?
Restraint Alternative
Give some examples:
Prevent falls by improving safety measures such as lighting
Call lights within reach & responded to quickly, keep bed low,
place a mat next to bed for those at fall risk.
Provide activities for those who wander
Distract or redirect behaviors
Decrease stimulation such as loud noises
Use chair or bed alarms, wander guards, coded doors
 Basic Nursing
Safety
What are physical problems associated with the use of restraints?
Pressure Ulcers
Pneumonia
Risk of Suffocation
Reduced Circulation
Constipation
Incontinence
Muscle Atrophy
 Basic Nursing
First Aid & Safety
What are common signs of a stroke?
One sided arm weakness or numbness
Slurred speech or difficulty communicating
Facial numbness, weakness or drooping on one side
Paralysis on one side of the body
Loss of consciousness
 Basic Nursing
Disease
What disease is chronic and progressive with trouble
breathing, especially with getting air out of the lungs?
COPD –Chronic Obstructive Pulmonary Disease
What symptoms are common for those with COPD?
Chronic cough or wheeze, SOB,
Cyanosis, confusion,
difficulty completing meals due to SOB,
Fear & Anxiety related to inability to breath
 Basic Nursing
Disease
How can a caregiver comfort a resident with dementia who
is experiencing a delusion, believing her baby is missing
(referring to a doll she believes is her real baby)?
Reassure the resident and assist her to look for the
doll.
The best response to disruptive behaviors related to
dementia is to acknowledge the person’s reality, be
non-confrontational.
 Basic Nursing
Comfort
What is the appropriate action for a nursing assistant to
take when a resident or patient complains of pain?
Notify the nurse
What are basic comfort measures a nursing assistant can
do for someone in pain?
Positioning with supportive devices
Back massage
Warm or cold compress as ordered
 Basic Nursing
Safety
What safety measures should a nursing assistant take for
a resident who is a fall risk?
Keep the bed in the low position
Use a gait belt during ambulation
Assure good lighting during ambulation
Keep call light within reach and answer promptly
Keep walk ways clear
Check on them frequently to anticipate needs
 Basic Nursing
Comfort
What is the goal of hospice or end of live care?
Provide for physical and emotional comfort
Care focuses on quality of life rather than extending
life or curing an illness.
 Basic Nursing
End of Life Care
What are common signs of approaching death?
Diminished sense of touch
Loss of movement, muscle tone & feeling
Weak pulse that is abnormally slow or rapid
Cheyne-Stoke respirations
Rattling or gurgling breathing
Incontinence
Mottling, spotting or blotched skin caused by poor
circulation
 Role of the Nursing Assistant
Legal & Ethical Behavior
What is the term used for the unlawful restraint of
someone which affects the person’s freedom of movement?

False Imprisonment
 Psychosocial Care Skills
Emotional and Mental Health Needs
Withdrawal from previously enjoyed activities, avoiding
social situations, loss of appetite, altered sleep habits and
crying are symptoms of what mental health condition?

Depression
 Psychosocial Care Skills
Emotional and Mental Health Needs
When caring for a resident who is showing signs of
depression, what action is always appropriate?
Listening.
Give the person opportunities to talk about their
feelings if they want to.
 Role of the Nursing Assistant
Legal and Ethical Behavior
Is it appropriate for nursing assistant to accept gifts from
residents or their family members?
No

How should a nursing assistant respond when a resident

or family member attempts to give them a gift?
Be polite but refuse, it is against the policy of long
term care agencies for employees to accept personal
gifts.
 Physical Care Skills, Basic Nursing
Infection Control
Why is it important to use a paper towel to turn off the
faucet after washing hands?

To prevent pathogens from the faucet from getting

on to your clean hands.
 Basic Nursing Skills
Safety
How should a caregiver respond when a resident with
dementia becomes aggressive?
The caregiver should call for assistance, assure all
residents are safe (including the aggressive
resident) and notify the nurse immediately.
 Basic Nursing
Disease
What disease affects the muscles, causing them to become
stiff and causes stooped posture ad a shuffling gait?

Parkinson’s Disease
 Physical Care Skills
Nutrition & Elimination
What can a nursing assistant do to promote regular bowel
movements and prevent constipation for the long term care
resident?
Encourage fluids & a high fiber, low fat diet
Assist with regular exercise
Allow plenty of time for elimination
 Activities of Daily Living
Nutrition & Hygiene
What safety measure should a nursing assistant take to
minimize the risk of aspiration when a resident is
receiving a tube feeding.
Assure the resident is place in a low fowlers position
during and immediately after the feeding.
 Basic Nursing Skills
Infection Control
Under what condition is it acceptable for a nursing
assistant to re-use gloves between residents?
It is never acceptable to re-use contaminated gloves

When must gloves be used?

Any time there is a risk of contact with body fluids
 Basic Nursing Skills
Infection Control
What are the 6 links in the chain of infection?
1 Causative Agent (Pathogen is present)
2 Reservoir
3 Portal of Exit
4 Mode of Transmission
5 Portal of Entry
6 Susceptible Host
 Basic Nursing Skills
Infection Control
What can be done to break the chain of infection and
prevent it’s spread?
Wash hands (removes pathogens)
Cover wounds (cover portal of exit or entry)
Wear gloves (barrier to prevent transmission)
Use tissue for cough/sneeze (cover portal of exit)
Get immunizations (makes a less susceptible host)
 Basic Nursing
Vital Signs - Terms
What is the term for elevated blood pressure readings?
Hypertension (greater than 140/90)
What is the term for the hardening and loss of elasticity of the
walls of the arteries?
Arteriosclerosis
What is the term for paralysis on one side of the body?
Hemiplegia
What is the common term for a Cerebral Vascular Accident?
Stroke
 Activities of Daily Living
Hygiene
What surfaces of the mouth should be cleaned during
mouth care?
All surfaces of the teeth and the tongue
What position must a conscious resident be in during
mouth care?
High Fowlers
What position should an unconscious resident be in during
mouth care?
Prone position with their head to the side
 Activities of Daily Living
Hygiene
Why should a nursing assistant make sure the toothette is
only slightly damp (minimal water) when providing mouth
care to an unconscious person?
To prevent aspiration during care
Physical Care Skills
Postmortem Care
What is involved in postmortem care for the nursing
assistant?
Washing & positioning the body
Put on clean clothes
Make sure the room is presentable for family
Role of the Nursing Assistant
Communication & Health Care Team
How should a nursing assistant answer the phone at a
health care agency?
Identify the agency, their name and position & ask
how they can help. Give no personal information
about any of the residents at the facility.
Can a nursing assistant take a telephone order from a
physician?
No, that is not within their scope of practice. Only
the nurse can accept a verbal order from the
physician.
 Physical Care Skills
Elimination
Why should a nursing assistant avoid rubbing areas of the
skin that are pale or red?
This could cause pain and further tissue damage if
the discoloration is caused from prolonged pressure.
Disease
List some common problems a patient with AIDs may
experience:
Fatigue
Appetite Loss
Diarrhea
Stomach upset
Night Sweats
Skin Rash
Low Resistance to infection
 Basic Nursing Skills
Safety
What common safety device is used to transfer residents
who are weak, unsteady, or uncoordinated?
Transfer or gait belt
Where on the resident is a gait belt placed?
It is placed around the resident’s waist outside the
clothing.
 Basic Nursing Skills
Infection Control
What is the most significant thing a nursing assistant can
do to prevent the spread of infection?
Wash their hands

How long should CNAs scrub their hands with lather

during the hand washing procedure?
A minimum of 20 seconds
 Role of the Nurse Aide
Client Rights
What legal act protects the confidentiality rights of
individuals in the health care system?
HIPPA
 Restorative Skills
Prevention
At a minimum, how often must an immobile resident be
repositioned to prevent pressure ulcers?
Every 2 hours
What should a nursing assistant avoid doing to prevent
sheering and friction?
Do not pull the resident across sheets during
transfers or repositioning.
 Physical Care Skills
Elimination
What normal age-related condition occurs to the digestive
system as a result of slower peristalsis & decreased
mobility?
Constipation
 Basic Nursing Procedures
Technical Skills
When should hearing aides be removed?
Before a shower or bath to prevent them from
getting wet.
At bed time unless the resident prefers to leave
them in.
When changing the battery
 Role of the Nurse Aide
Communication
How can a nurse aide improve communication with a
resident who is hearing impaired?
Do not speak until you are in front of the resident
where they can see your face
Make sure there is adequate lighting so the resident
can see your nonverbal communication
Do not shout, rather avoid rushing and pronounce
words clearly
 Restorative Skills

When bladder retraining programs are used, why is it

important to keep a record of the residents pattern of
elimination?
To predict when a resident will need a bedpan or a
trip to the bathroom and thus prevent incontinent
episodes.
 Restorative Skills
Prevention
What is the purpose of Range of Motion Exercises?
To prevent joint contractures, muscle atrophy and
loss of function due to immobility.
 Restorative Care
Prevention
What commonly delegated care is done by a nurse aide
after peri care for an incontinent resident to prevent skin
breakdown?
Application of barrier cream
 Basic Nursing Skills
Technical Procedures
What is the normal temperature range for the following
sites?
Oral
97.6-99.6 degrees F.
Rectal
98.6 to 100.6 degrees F
Axillary
96.6-98.6 degrees F
 Role of the Nurse Aid
Legal
How can a potential employer learn if a nurse aide was
found guilty of abusing residents?
The state nurse aide registry
 Role of the Nurse Aide
Legal and Ethical Behavior
What is the nurse aide’s legal responsibility when she
suspects or witnesses abuse of a resident?
She must report the abuse immediately to the
nurse.
 Basic Nursing Skills
Infection Control
What peri care guidelines are designed to prevent
infection?
Wear gloves
Wash front to back
Use a clean area of the wash cloth for each stroke