Question 1: You are providing post-mortem care for a resident from a culture you are unfamiliar with. The family is present and requests to perform a specific ritual that involves placing herbs on the body. Facility policy does not address this specific ritual. What should you do?

• Ask the family to wait, and immediately consult with the charge nurse for guidance. (Correct answer)
• Document the request and your refusal to participate in non-standard procedures.
• Politely inform the family that only facility-approved procedures are allowed.
• Allow the family to perform their ritual while you continue with the standard post-mortem care procedures.

Correct answer: Ask the family to wait, and immediately consult with the charge nurse for guidance.

When faced with unfamiliar cultural or religious requests during end-of-life care, the CNA's role is to be respectful and seek guidance from the supervising nurse. The nurse can assess the request for any safety or policy conflicts and make an informed decision that respects the family's beliefs while ensuring facility protocols are appropriately followed. This approach ensures culturally competent and sensitive care.

Question 2: Signs of wound infection include:

• Gradual closure with granulation tissue
• Increased redness, warmth, swelling, purulent drainage, and odor (Correct answer)
• Pink edges, minimal exudate, no odor
• Decreased pain over time

Correct answer: Increased redness, warmth, swelling, purulent drainage, and odor

Classic signs of wound infection are redness, warmth, swelling, pain, purulent (pus-like) drainage, and malodor. These must be reported to the nurse immediately.

Question 3: A resident has an indwelling urinary catheter. The drainage bag should be positioned:

• On the resident's bed
• Below the level of the bladder (Correct answer)
• At the level of the bladder
• Above the level of the bladder

Correct answer: Below the level of the bladder

The drainage bag must always remain below bladder level to allow gravity-assisted urine flow and prevent backflow that could cause infection.

Question 4: What type of fire extinguisher should be used on an electrical fire?

• Any class of extinguisher is equally safe for electrical fires
• Class B extinguisher designed for flammable liquids
• Class C extinguisher, which is designed for electrical fires (Correct answer)
• Class A (water) extinguisher

Correct answer: Class C extinguisher, which is designed for electrical fires

Class C fire extinguishers use non-conductive agents safe for electrical fires. Water (Class A) extinguishers conduct electricity and can cause electrocution if used on electrical fires.

Question 5: A CNA witnesses a coworker treating a patient roughly. What should they do?

• Intervene to protect the patient and report the incident to the supervisor immediately (Correct answer)
• Report it anonymously only if it happens again
• Confront the coworker privately after the shift
• Ignore it to avoid conflict with the coworker

Correct answer: Intervene to protect the patient and report the incident to the supervisor immediately

CNAs have a legal and ethical obligation to protect patients from abuse. They must intervene when safe and report immediately to a supervisor.

Question 6: A CNA is taking an apical pulse on a patient with an irregular heartbeat. After counting for 30 seconds, the CNA counts 38 beats. What should the CNA do next?

• Average the 30-second count with a second 30-second count
• Notify the nurse immediately that the pulse is dangerously low
• Count for a full 60 seconds and record that number (Correct answer)
• Record the pulse as 76 beats per minute

Correct answer: Count for a full 60 seconds and record that number

When a patient has an irregular pulse (arrhythmia), the apical pulse must be counted for a full 60 seconds — not multiplied from a 30-second count. Irregular rhythms can vary significantly within a minute, and doubling a 30-second count can introduce significant error. Only after a full 60-second count should the CNA record and report findings.

Question 7: A CNA notices that a resident's adult daughter regularly takes small amounts of money from her mother's purse during visits without the resident's knowledge. The resident has mild dementia. What is the CNA's primary obligation?

• Avoid involvement since it is a family matter outside the CNA's scope of practice
• Report the observation to the charge nurse as a suspected case of financial exploitation (Correct answer)
• Confront the daughter directly and ask her to stop taking the money
• Document the behavior privately and wait to see if it continues before reporting

Correct answer: Report the observation to the charge nurse as a suspected case of financial exploitation

CNAs are mandated reporters and have a legal and ethical duty to report all forms of suspected abuse, neglect, and exploitation — including financial exploitation by family members. A resident with dementia cannot protect herself, making reporting to the charge nurse immediately the correct action. Confronting the daughter could be unsafe and is outside the CNA's authority; waiting delays protection; and family relationships do not exempt individuals from abuse reporting requirements.

Question 8: All are types of pathogens EXCEPT

• fungus
• bacteria
• virus
• Ebola

Pathogens are microorganisms that can cause disease, and common types include bacteria, viruses, and fungi. Ebola, however, is not a type of pathogen itself, but rather a severe and often fatal disease caused by the Ebola virus. Therefore, fungus, virus, and bacteria represent broad categories of infectious agents, while Ebola is an example of a specific illness resulting from a viral infection.

Question 9: A CNA overhears two nurses at the medication cart discussing a resident's new HIV diagnosis by name in a busy hallway. The CNA's most appropriate first action is to:

• Report the nurses to the charge nurse for disciplinary action
• Politely suggest that sensitive information be discussed in a private area (Correct answer)
• Ignore it, since nurses outrank CNAs and it is not the CNA's responsibility
• File a formal HIPAA complaint with the facility's privacy officer immediately

Correct answer: Politely suggest that sensitive information be discussed in a private area

The CNA has a professional obligation to protect resident privacy and confidentiality. The most appropriate immediate action is a professional, low-escalation intervention — suggesting a private space — which may resolve the issue without formal complaint. Jumping directly to a formal complaint or disciplinary report bypasses the least-invasive ethical step. Doing nothing violates the CNA's own professional standards.

Question 10: When giving a partial bath, which body areas are typically included?

• Entire body except the feet
• Only the face and hands
• Face, hands, axillae (underarms), back, and perineum (Correct answer)
• Arms and legs only

Correct answer: Face, hands, axillae (underarms), back, and perineum

A partial bath focuses on areas most prone to odor and skin breakdown: face, hands, axillae (underarms), back, and perineum. These areas require daily cleansing even when a full bath is not given.

Question 11: You don't answer a call light because the patient is always hitting it accidentally. No responding is considered to be

• breaking confidentiality.
• unethical.
• false imprisonment.
• neglect or abuse. (Correct answer)

Correct answer: neglect or abuse.

Failing to respond to a patient's call light, regardless of perceived frequency or reason, is considered neglect. Patients rely on call lights for essential needs, safety, and comfort. Deliberately ignoring a call light deprives the patient of necessary care and attention, which can lead to harm, distress, or injury, thus constituting neglect or a form of abuse.

Question 12: A CNA is caring for a resident who refuses a scheduled medication. After informing the nurse, which documentation entry BEST reflects proper reporting of this event?

• Resident stated 'I don't want my pills today.' Nurse Smith notified at 0812. Resident alert and oriented, no distress noted. (Correct answer)
• Resident refused medications. Nurse told. Resident seems fine.
• Medications refused by resident at breakfast. Family will be informed later.
• Resident refused 0800 medications; nurse notified at 0812; no further intervention taken by CNA

Correct answer: Resident stated 'I don't want my pills today.' Nurse Smith notified at 0812. Resident alert and oriented, no distress noted.

Proper documentation must include the resident's exact words (direct quote when possible), the specific time the nurse was notified, the nurse's name, and the resident's current status. Option B contains all these elements. Option A omits the resident's statement and nurse's name. Option C is vague and unprofessional. Option D defers notification to family without documenting nurse notification or resident status.

Question 13: When documenting a resident's fall, the CNA should include:

• A brief note that a fall occurred
• The CNA's opinion about why the fall happened
• Time, location, what the resident was doing, injuries observed, and who was notified (Correct answer)
• Only the time and location of the fall

Correct answer: Time, location, what the resident was doing, injuries observed, and who was notified

Complete incident documentation includes specific details—time, location, circumstances, observed injuries, and notifications—to support follow-up care and legal protection.

Question 14: What is the primary goal of range of motion (ROM) exercises?

• To increase muscle size.
• To improve digestion.
• To reduce body fat.
• To maintain joint flexibility and prevent stiffness. (Correct answer)

Correct answer: To maintain joint flexibility and prevent stiffness.

The primary goal of range of motion (ROM) exercises is to move a joint through its full extent of movement to maintain flexibility and prevent stiffness. These exercises are crucial for preventing contractures, improving circulation, and preserving joint function, especially in individuals with limited mobility. They do not primarily aim to increase muscle size or improve digestion.

Question 15: The back-lying position is the

• Prone position
• Semi fowler position
• Sims position
• Supine position (Correct answer)

Correct answer: Supine position

The supine position specifically refers to lying flat on the back with the face upward. This is a common position used for various medical examinations, procedures, and for rest. Other positions like prone (lying on the stomach), Sims (semi-prone on the side), and semi-Fowler's (semi-sitting) describe different body orientations.

Question 16: An important rule of communication is to always use "register." This means

• a method of helping clients to recall events.
• the way we talk to different people. (Correct answer)
• a list of words to look up in the dictionary.
• the records of all the clients at the facility.

Correct answer: the way we talk to different people.

In communication, 'register' refers to adapting one's language, tone, and formality based on the audience, context, and purpose. For CNAs, this means adjusting how they speak to a resident, a family member, a doctor, or a colleague to ensure clarity, respect, and effectiveness. Using the appropriate register helps build rapport and convey professionalism.

Question 17: Which of the following is generally NOT an acceptable abbreviation in medical documentation?

• HR (heart rate)
• BP (blood pressure)
• U (units) (Correct answer)
• O2 (oxygen)

Correct answer: U (units)

The abbreviation 'U' for units is on the Joint Commission's 'Do Not Use' list because it can be misread as '0' (zero), potentially causing a ten-fold medication error.

Question 18: Which of the following is a culturally sensitive approach to pain assessment?

• Recognizing that pain expression varies across cultures and asking open-ended questions about comfort (Correct answer)
• Ignoring behavioral cues in stoic residents
• Assuming all residents from a particular culture have high pain tolerance
• Using only English pain rating scales regardless of language

Correct answer: Recognizing that pain expression varies across cultures and asking open-ended questions about comfort

Cultural competence in pain assessment means recognizing diverse pain expression norms, using appropriate tools, and asking open-ended questions to elicit accurate pain reports.

Question 19: If there are concerns about abuse in an facility

• The incident must be reported immediately to the supervisor or administrator. (Correct answer)
• Corrective action is taken against the reporter if the claim is found false.
• Only serious claims of abuse must be reported and investigated.
• 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.

Any concern or suspicion of abuse in a facility must be reported immediately to the supervisor or administrator. This is a legal and ethical obligation for all healthcare professionals, including CNAs, to protect residents from harm. Prompt reporting ensures that an investigation can be initiated quickly to ensure resident safety and well-being.

Question 20: The term 'extension' as used in ROM exercises means:

• Straightening a joint to increase the angle between body parts (Correct answer)
• Rotating a limb inward toward the body midline
• Bending a joint to decrease the angle between body parts
• Moving a joint in a circular pattern

Correct answer: Straightening a joint to increase the angle between body parts

Extension straightens or opens a joint, increasing the angle, which is the opposite of flexion.

Question 21: A resident's nasogastric tube feeding bag is empty and the pump alarms. The CNA should:

• Notify the nurse immediately so the feeding can be restarted or discontinued (Correct answer)
• Disconnect the tube and allow a 30-minute break
• Silence the alarm and resume care without notifying anyone
• Refill the bag with water from the resident's pitcher

Correct answer: Notify the nurse immediately so the feeding can be restarted or discontinued

CNA scope does not include managing tube feedings; an empty bag must be reported to the nurse for appropriate clinical management.

Question 22: Which of the following is MOST appropriate when a resident has an ostomy?

• Provide emotional support and maintain the resident's dignity during ostomy care (Correct answer)
• Avoid discussing the ostomy with the resident to prevent embarrassment
• Ignore complaints about odor, as it is expected with an ostomy
• Perform ostomy care only when the resident is asleep to avoid embarrassment

Correct answer: Provide emotional support and maintain the resident's dignity during ostomy care

Ostomy care has a significant emotional and psychological impact. CNAs should perform care matter-of-factly, provide privacy, and offer emotional support while maintaining the resident's dignity.

Question 23: When inserting a rectal suppository is delegated to a CNA (where permitted by state), the resident should be positioned in which position?

• Prone with a pillow under the abdomen
• High Fowler's position with knees bent
• Left lateral (Sims') position with the upper knee flexed (Correct answer)
• Supine with legs extended flat

Correct answer: Left lateral (Sims') position with the upper knee flexed

The left lateral (Sims') position aligns the sigmoid colon for easier suppository insertion and takes advantage of gravity to retain the medication.

Question 24: Typical impairments that may make it more difficult for you and your patient to communicate effectively include

• Insomnia
• Apoplexia
• Bulimia
• Aphasia (Correct answer)

Correct answer: Aphasia

Aphasia is a neurological condition that impairs a person's ability to communicate, affecting their speech, understanding, reading, and writing. This makes it a significant barrier to effective communication between a CNA and a patient, requiring patience and adapted communication techniques. Unlike the other options, aphasia directly impacts the communication process itself.

Question 25: The nurse aide is caring for a client whose religious beliefs do not allow the client to eat certain foods. The nurse aide should report this information to the

• client’s family.
• other nurse aides.
• charge nurse. (Correct answer)
• dietician

Correct answer: charge nurse.

The charge nurse is the central point of contact for important client information and care planning. Religious dietary restrictions are crucial for a client's well-being and must be communicated to the charge nurse, who will then ensure the information is properly documented and relayed to the dietician and other staff. This ensures the client's cultural and religious needs are respected and integrated into their care plan.

Question 26: A CNA is caring for a resident with a court-appointed legal guardian. The resident, who has mild dementia, verbally consents to a non-emergency procedure. The legal guardian, however, has not been contacted and has not provided consent. How should the CNA proceed?

• Ask a family member present to provide substitute consent since the guardian is unavailable
• Obtain written consent from the resident as this supersedes the guardian's authority for mild dementia cases
• Hold the procedure and notify the nurse so the legal guardian can be contacted for proper consent (Correct answer)
• Proceed with the procedure since the resident's verbal consent is sufficient for non-emergency interventions

Correct answer: Hold the procedure and notify the nurse so the legal guardian can be contacted for proper consent

When a resident has a court-appointed legal guardian, that guardian holds decision-making authority for the resident — even if the resident can verbally express preferences. A legal guardian's authority is established by a court and supersedes the resident's own consent capacity (the court determined the resident lacked full decision-making capacity). For non-emergency procedures, the guardian must be contacted and provide informed consent. Another family member cannot substitute for a legally appointed guardian. The CNA's role is to hold the procedure and notify the nurse to facilitate the proper consent process.

Question 27: Under HIPAA, a CNA may share a resident's health information with:

• Any staff member who asks
• Local media if a public health issue is suspected
• Members of the care team directly involved in the resident's treatment (Correct answer)
• The resident's neighbors if they express concern

Correct answer: Members of the care team directly involved in the resident's treatment

HIPAA permits sharing protected health information only with those directly involved in the patient's care on a need-to-know basis.

Question 28: During a 12-hour shift, a CNA notices that a resident who normally drinks 240 mL of fluid per meal has only consumed approximately 80 mL across all meals and refuses repeated offers of fluids. The resident also voided only once during the shift. What is the MOST critical documentation and reporting action?

• Report to the charge nurse immediately and document the pattern of refusal, amounts, and voiding frequency as an ongoing shift observation (Correct answer)
• Encourage the resident more aggressively and re-document if intake improves before shift end
• Document the fluid intake and output totals at the end of the shift in the designated I&O section
• Note the low intake on the meal tray documentation form only, since nutrition tracking is dietary's responsibility

Correct answer: Report to the charge nurse immediately and document the pattern of refusal, amounts, and voiding frequency as an ongoing shift observation

A significant reduction in fluid intake combined with decreased urinary output is a pattern that could indicate dehydration, acute illness, or altered mental status — all conditions requiring prompt clinical evaluation. The CNA must report this pattern to the charge nurse during the shift, not wait until end-of-shift documentation. Thorough documentation should capture specific amounts, times of offers and refusals, and the single voiding event. Waiting until shift end delays necessary intervention. Encouraging the resident more aggressively without reporting bypasses the clinical escalation protocol. Restricting documentation to only meal trays omits critical fluid balance data.

Question 29: While bathing a resident with late-stage dementia, the resident becomes agitated and starts hitting the CNA. What is the most appropriate nursing assistant response?

• Firmly but calmly tell the resident the bath must be completed today and continue working
• Document that the resident refused care and do not attempt bathing again until the next scheduled day
• Restrain the resident's arms briefly to complete the bath quickly and minimize distress
• Stop the bath, ensure the resident's safety, allow a calm-down period, and then attempt to resume using a different approach or timing (Correct answer)

Correct answer: Stop the bath, ensure the resident's safety, allow a calm-down period, and then attempt to resume using a different approach or timing

Residents with dementia who become agitated during care should never be restrained (which is both a rights violation and can escalate aggression). The correct response is to immediately stop, ensure safety, allow the resident to calm, and then try again — possibly at a different time of day, using distraction, simplified instructions, or partial care. Forcing completion violates resident dignity and rights. Documenting as a full refusal without attempting alternative approaches fails the resident's hygiene needs.

Question 30: When caring for a home health client, all team members need to

• Ask another team member to do the charting.
• Put all the responsibility on the case worker.
• Work individually on their assigned tasks.
• Communicate frequently with each other. (Correct answer)

Correct answer: Communicate frequently with each other.

Effective communication among all team members is vital for providing coordinated and comprehensive care, especially in home health settings where team members may not be physically together. Frequent communication ensures everyone is aware of the client's changing needs, care plan updates, and any concerns. This leads to better outcomes and continuity of care for the client.

Question 31: Which of the following is an example of an 'activities of daily living' (ADL) document the CNA is responsible for completing?

• Dietary assessment forms
• Nursing care plans
• Physician progress notes
• Daily resident care flow sheet recording bathing, dressing, and mobility assistance provided (Correct answer)

Correct answer: Daily resident care flow sheet recording bathing, dressing, and mobility assistance provided

CNAs routinely document ADL care flow sheets, which record the type and amount of assistance provided with bathing, dressing, grooming, toileting, and mobility during each shift.

Question 32: If your home health client refuses to take their medication, you should

• Tell them you will get into trouble if they don't cooperate.
• Remove the medication so the client can't save it.
• Sneak the medication into some pudding.
• Notify your supervisor about their refusal. (Correct answer)

Correct answer: Notify your supervisor about their refusal.

If a home health client refuses to take their medication, the CNA's responsibility is to notify their supervisor about the refusal. CNAs cannot force medication, hide it, or coerce clients, as this violates their rights and professional boundaries. Reporting ensures that the nursing staff or physician can assess the situation, understand the reason for refusal, and adjust the care plan as needed.

Question 33: How should a CNA care for a resident's dentures that have been left dry overnight?

• Apply lubricant to the dry dentures and insert them directly
• Soak them in cool water or denture cleaning solution before reinserting (Correct answer)
• Insert them immediately without soaking — they will soften in the mouth
• Soak them in hot water to quickly rehydrate and sanitize

Correct answer: Soak them in cool water or denture cleaning solution before reinserting

Dentures that have been left dry should be soaked in cool water or denture solution to rehydrate them before reinsertion. Dry dentures can be uncomfortable, warped, or damaged, and may not fit properly.

Question 34: When a resident is being transferred to another facility, the CNA's responsibility regarding their rights includes:

• Packing the resident's belongings without their input to save time
• Notifying the family before telling the resident
• Completing the transfer quickly to minimize disruption
• Informing the resident of their right to refuse transfer and to be informed about the new facility (Correct answer)

Correct answer: Informing the resident of their right to refuse transfer and to be informed about the new facility

Residents must be informed about planned transfers, have their questions answered, and be told of their right to appeal or refuse the transfer.

Question 35: Which of the following CNA specialty certifications is specifically designed for those working in long-term care facilities who want to demonstrate advanced competency in restorative nursing practices?

• Certified Rehabilitation Nursing Assistant (CRNA)
• Certified Long-Term Care Nursing Assistant (CLTCNA)
• Certified Geriatric Nursing Assistant (CGNA)
• Certified Restorative Nursing Assistant (CRNA) (Correct answer)

Correct answer: Certified Restorative Nursing Assistant (CRNA)

The Certified Restorative Nursing Assistant (CRNA) credential is a recognized specialty for CNAs in long-term care who focus on restorative care — helping residents maintain or regain functional abilities. It is distinct from the anesthesia CRNA credential. The other options either don't exist as standardized credentials or are not specific to restorative nursing practice.

Question 36: What is the correct technique for emptying a urinary drainage bag?

• Drain by opening the drainage port into a graduated measuring container, avoiding touching the port to the container (Correct answer)
• Use a syringe to withdraw urine from the bag's outlet port
• Pour the urine directly into the toilet without measuring
• Squeeze the bag from the top down into a collection container

Correct answer: Drain by opening the drainage port into a graduated measuring container, avoiding touching the port to the container

The drainage port should be opened carefully to drain urine into a graduated container without touching the port to the container, maintaining sterility and allowing accurate measurement.

Question 37: A resident with a new ostomy refuses to participate in any self-care. The CNA's BEST approach is to:

• Document refusal and skip all teaching until the resident asks
• Contact family to convince the resident to participate immediately
• Provide care without pressure while involving the resident in small steps as tolerated (Correct answer)
• Firmly tell the resident they must learn or they cannot go home

Correct answer: Provide care without pressure while involving the resident in small steps as tolerated

Gradual involvement respects the resident's adjustment timeline while building confidence toward independence in ostomy self-care.

Question 38: While measuring a patient's respiratory rate, the CNA notices the patient becomes aware of being observed and begins breathing differently. What is the best technique to obtain an accurate measurement?

• Tell the patient to breathe normally and then count respirations
• Ask the patient to hold still and count only visible chest movements
• Wait 5 minutes for the patient to relax, then count
• Count respirations immediately after completing the pulse measurement without releasing the wrist (Correct answer)

Correct answer: Count respirations immediately after completing the pulse measurement without releasing the wrist

Respirations are unique among vital signs because patients can consciously alter their breathing pattern when they know it is being measured. The standard technique is to transition directly from pulse measurement — keeping fingers on the wrist — so the patient believes the CNA is still counting the pulse. This allows an unobserved, and therefore more accurate, respiratory rate.

Question 39: When suddenly they hear a scream coming from the adjacent room, the nurse's assistant is giving the patient a bed bath. What ought to the nurse assistant do?

• Focus on the patient and ignore anything else.
• Shout for help from the nurses nearby and continue the bath.
• Finish the bed bath before checking on what happened.
• Secure the safety of the patient first before leaving the room. (Correct answer)

Correct answer: Secure the safety of the patient first before leaving the room.

In an emergency, a CNA's immediate priority is to ensure the safety of the patient they are currently with. This means making sure the patient is not in immediate danger (e.g., covering them, ensuring they won't fall) before quickly leaving to investigate the scream. Abandoning a patient mid-procedure or ignoring a potential emergency are unacceptable actions, as the current patient's safety must be secured first.

Question 40: A nurse verbally instructs a CNA to apply a new topical antifungal cream to a resident's skin fold area and says 'I'll write the order later.' The CNA should:

• Politely decline to apply the medication until a written or electronic order is visible in the chart, and inform the nurse of this (Correct answer)
• Apply the cream and document it as a 'nurse-directed intervention' in the ADL record
• Apply the cream immediately since a licensed nurse gave the verbal instruction
• Ask another CNA to observe the application to provide verification of the verbal order

Correct answer: Politely decline to apply the medication until a written or electronic order is visible in the chart, and inform the nurse of this

CNAs do not administer medications, including topical prescription or medicated preparations, regardless of who gives the verbal instruction. Applying antifungal cream prescribed by a physician is medication administration, which falls outside CNA scope of practice in virtually all U.S. states. A verbal instruction from a nurse does not expand CNA scope. The CNA should politely but firmly communicate this scope limitation. Having a witness or documenting it as a 'nurse-directed intervention' does not make the action legal or within scope.

Question 41: What is the most important action a CNA can take to prevent urinary tract infections in catheterized residents?

• Keep the resident on bed rest
• Keep the catheter tubing free of kinks and maintain a closed drainage system (Correct answer)
• Open the drainage system regularly to flush the tubing
• Change the catheter daily

Correct answer: Keep the catheter tubing free of kinks and maintain a closed drainage system

Maintaining a closed drainage system prevents bacteria from entering the catheter and is the most important infection-prevention strategy for catheterized residents.

Question 42: A resident with advanced dementia who is non-verbal suddenly begins resisting care, grimacing, and moaning during repositioning. These behaviors are new. The CNA should first suspect:

• The resident is experiencing undiagnosed pain. (Correct answer)
• The resident is having a catastrophic reaction to being touched.
• This is a typical progression of the resident's dementia.
• The resident is attempting to be manipulative to avoid care.

Correct answer: The resident is experiencing undiagnosed pain.

Sudden changes in behavior, especially in non-verbal residents, are often indicators of an underlying physical issue. Resisting care, grimacing, and moaning are classic non-verbal cues for pain. While other causes are possible, pain should be the first consideration to rule out, as it is a common and treatable cause of distress.

Question 43: A CNA documents that a resident's wound dressing was changed at 1400 and notes the wound appears "much better." The charge nurse asks the CNA to correct the entry. What is the primary problem with this documentation?

• The term 'much better' is subjective and lacks measurable, objective description (Correct answer)
• Only licensed nurses are permitted to document wound assessments
• The time should be written in AM/PM format rather than military time
• The documentation should have been completed before the procedure, not after

Correct answer: The term 'much better' is subjective and lacks measurable, objective description

Accurate documentation requires objective, measurable language. 'Much better' is a subjective judgment that means different things to different observers and cannot be quantified or compared over time. Proper documentation would include specific measurements (e.g., wound size in centimeters), wound characteristics (color, drainage type and amount, odor), and surrounding tissue condition. Military time is actually the preferred format in healthcare settings, documentation is always done after care is provided, and CNAs can document observations of wound appearance.

Question 44: Which of the following is an example of active range of motion exercise?

• The CNA stretches the patient's leg muscles while the patient sleeps
• The patient moves their own arm through the full range of motion without CNA assistance (Correct answer)
• The CNA moves the patient's arm through its full range of motion while the patient relaxes
• The CNA and patient both apply force to move a stiff joint

Correct answer: The patient moves their own arm through the full range of motion without CNA assistance

Active ROM exercises are performed entirely by the patient using their own muscle strength, without assistance from the CNA or any external force, making option B the correct example.

Question 45: When performing passive range-of-motion (ROM) exercises, the CNA should move each joint to the point of:

• Full range without stopping
• Resistance or pain, then stop (Correct answer)
• Slight discomfort
• Maximum resistance

Correct answer: Resistance or pain, then stop

ROM exercises should be stopped when resistance or pain is felt to prevent injury to the patient's joints.

Question 46: A resident on a bladder retraining schedule urgently requests the bedpan 45 minutes before their scheduled toileting time. The resident is cognitively intact and appears distressed. What should the CNA do?

• Redirect the resident with a conversation to suppress the urge until the scheduled time
• Remind the resident of the schedule and encourage them to wait the remaining 45 minutes
• Provide the bedpan immediately without documentation, as deviations from schedules are expected
• Provide the bedpan immediately, then adjust and document the toileting interval for the nurse to reassess (Correct answer)

Correct answer: Provide the bedpan immediately, then adjust and document the toileting interval for the nurse to reassess

A cognitively intact resident experiencing genuine urgency must never be denied toileting — doing so risks incontinence, loss of dignity, or injury from attempting to toilet unassisted. The CNA should respond to the resident's immediate need, then document the deviation and actual void time so the nurse can refine the retraining interval. Bladder retraining schedules are clinical tools that require adjustment based on observed patterns — not rigid rules that override resident rights or safety. Redirecting a resident with true urgency to suppress the urge is inappropriate and can cause discomfort or incontinence.

Question 47: When recording a resident's fluid intake, 8 oz of consumed soup counts as:

• Fluid only if it was a broth-type soup
• Solid food and is not recorded
• Half the amount compared to beverages
• 240 mL of fluid intake (Correct answer)

Correct answer: 240 mL of fluid intake

Soups and other liquid foods count as fluid intake; 8 oz equals approximately 240 mL and must be recorded on the intake record.

Question 48: A resident with moderate dementia refuses to bathe, becoming agitated and combative whenever approached with a washcloth. Which nursing assistant intervention is MOST appropriate as an initial strategy?

• Document the refusal and inform the charge nurse, then attempt the bath again in exactly one hour
• Offer a towel bath instead, using warm, soapy towels to cleanse the resident without requiring them to enter the tub or shower (Correct answer)
• Restrain the resident briefly to complete essential perineal care, then stop to minimize distress
• Ask family members to be present to persuade the resident to cooperate with the bath

Correct answer: Offer a towel bath instead, using warm, soapy towels to cleanse the resident without requiring them to enter the tub or shower

A towel bath is an evidence-based alternative that significantly reduces agitation in dementia patients during hygiene care. It provides effective cleansing without the sensory disruption of a traditional bath, respecting the resident's dignity while meeting care needs. Restraint is never appropriate for bathing and violates resident rights. Waiting one hour without a plan change is not proactive care. Family persuasion may help long-term but is not the immediate clinical intervention.

Question 49: What is the first action a CNA should take if they find an unresponsive patient?

• Call for help and check for breathing (Correct answer)
• Administer oxygen if available
• Shake the patient to wake them
• Begin chest compressions immediately

Correct answer: Call for help and check for breathing

If a patient is unresponsive, the CNA should immediately call for help and check for signs of breathing and a pulse. After assessing the situation, if the patient is not breathing, the CNA should initiate CPR following the facility's emergency protocols. Shaking the patient or delaying the assessment could worsen the situation.

Question 50: The role of the CNA in supporting a resident's social needs BEST includes:

• Making decisions about which social activities the resident should attend
• Reporting residents who decline activities as noncompliant
• Limiting social contact to prevent overstimulation
• Encouraging participation in activities based on the resident's own preferences (Correct answer)

Correct answer: Encouraging participation in activities based on the resident's own preferences

Respecting resident autonomy means encouraging social activities that align with the resident's own interests and preferences.

Question 51: A CNA overhears two coworkers gossiping about a resident. The appropriate response is to:

• Report the resident's behavior to the supervisor
• Ignore it since it does not involve patient care
• Join the conversation to learn more details
• Remind coworkers that resident information is confidential (Correct answer)

Correct answer: Remind coworkers that resident information is confidential

Gossiping about residents violates confidentiality and professional standards; CNAs should address it directly.

Question 52: Which statement is true about residents who are restrained?

• They are not at risk for falling out of their beds or wheelchairs.
• They are at lower risk of developing pneumonia.
• They are at greater risk for developing pressure sores. (Correct answer)
• They have improved posture and alignment.

Correct answer: They are at greater risk for developing pressure sores.

Restraints severely restrict a resident's movement, making it difficult for them to reposition themselves independently. This prolonged pressure on certain body areas, combined with potential friction and shearing, significantly increases their risk of developing pressure sores (decubitus ulcers). These are serious complications that can lead to infection and other health issues.

Question 53: Which of the following is the correct sequence for donning (putting on) PPE?

• Mask, gown, gloves, eye protection
• Gown, mask/respirator, eye protection, gloves (Correct answer)
• Gloves, gown, mask, eye protection
• Eye protection, gloves, gown, mask

Correct answer: Gown, mask/respirator, eye protection, gloves

CDC guidelines specify gown first, then mask/respirator, eye protection, and gloves last.

Question 54: While feeding an elderly resident who has had a recent stroke, you notice the resident pockets food in the left cheek and has a weak cough after swallowing. Which action should the CNA take FIRST?

• Gently remove the pocketed food with a gloved finger and resume feeding
• Offer thin liquids to help wash the pocketed food down
• Continue feeding slowly and remind the resident to chew thoroughly on each bite
• Stop feeding, keep the resident upright, and immediately notify the nurse (Correct answer)

Correct answer: Stop feeding, keep the resident upright, and immediately notify the nurse

Pocketing food and a weak or absent cough are serious signs of dysphagia and high aspiration risk. The CNA must stop feeding immediately to prevent aspiration, keep the resident in an upright position to reduce aspiration risk, and notify the nurse right away. Continuing feeding, offering thin liquids, or manually removing pocketed food could trigger aspiration or injury.

Question 55: A resident has a small cut that is bleeding moderately. The CNA should FIRST:

• Leave the wound open to air dry
• Apply direct pressure with a clean cloth or gloved hand (Correct answer)
• Apply a tourniquet above the wound
• Irrigate vigorously with hydrogen peroxide

Correct answer: Apply direct pressure with a clean cloth or gloved hand

Direct pressure is the first-line intervention to control moderate bleeding from a wound.

Question 56: While assisting a resident with active-assistive ROM, the resident, who has severe arthritis, can only move their shoulder part of the way through abduction before reporting pain. Which action should the CNA take?

• Switch to passive ROM and complete the full range of motion for the resident.
• Encourage the resident to push through the pain to increase their range of motion.
• Stop the exercise for that joint and document the resident's refusal to participate.
• Support the joint and move it only to the point of resistance or pain, then stop. (Correct answer)

Correct answer: Support the joint and move it only to the point of resistance or pain, then stop.

The guiding principle for ROM exercises is to move the joint only to the point of resistance or pain, and never force it beyond that limit. For a resident with arthritis, this is especially important to prevent further inflammation and injury. Pushing through pain is contraindicated. The resident is not refusing, but reporting a limitation. Forcing the joint through a full passive range would be painful and potentially harmful.

Question 57: Which statement BEST describes validation therapy when used with dementia residents?

• Keeping the resident focused only on present-day tasks
• Using distraction to redirect all confused statements
• Acknowledging and respecting the resident's feelings and perceived reality (Correct answer)
• Correcting the resident's false beliefs with facts

Correct answer: Acknowledging and respecting the resident's feelings and perceived reality

Validation therapy acknowledges the resident's emotional reality rather than correcting factual errors, reducing distress.

Question 58: During a home care visit, a nursing assistant notices that an elderly client has unexplained bruising in various stages of healing and flinches when her adult son, who lives with her, enters the room. The client says, 'I fall a lot — please don't make trouble.' The nursing assistant should:

• Ask the son directly whether he has ever harmed his mother
• Wait until the next visit to see if more signs emerge before reporting
• Report the observations to the supervising nurse as potential elder abuse (Correct answer)
• Respect the client's wishes and document only the falls mentioned

Correct answer: Report the observations to the supervising nurse as potential elder abuse

Nursing assistants are mandated reporters in virtually all U.S. jurisdictions and are legally required to report suspected abuse, neglect, or exploitation regardless of the client's wishes or instructions. The combination of patterned bruising, fear response to a household member, and a dismissive explanation constitutes reasonable suspicion of elder abuse. Confronting the alleged abuser or delaying the report would be inappropriate and potentially dangerous.

Question 59: When a CNA witnesses a resident fall, what additional documentation must be completed beyond routine charting?

• A diet change request
• A discharge form
• An incident/occurrence report (Correct answer)
• A transfer summary

Correct answer: An incident/occurrence report

An incident report must be completed for any unexpected event like a fall to document the circumstances, injuries, and response for quality improvement and legal purposes.

Question 60: The nurse assistant should follow these tips to communicate with a client who is completely deaf:

• allow them to initiate communication.
• write information for the client to read. (Correct answer)
• smile frequently and speak loudly.
• avoid eye contact with the client

Correct answer: write information for the client to read.

For a client who is completely deaf, verbal communication is ineffective. Writing information down allows the client to read and fully comprehend the message, ensuring clear and accurate communication. This method respects their communication needs and prevents misunderstandings.

Question 61: A resident who was previously cheerful begins refusing meals, staying in bed, and crying frequently. The CNA should:

• Report the behavioral changes to the charge nurse promptly (Correct answer)
• Allow the resident privacy and assume this is a normal phase
• Ask other residents to cheer the resident up
• Encourage the resident to exercise willpower and improve mood

Correct answer: Report the behavioral changes to the charge nurse promptly

Significant behavioral changes such as refusal to eat, withdrawal, and crying are clinical signs that require reporting for professional assessment.

Question 62: An elderly resident with a history of cardiovascular disease is in a facility without air conditioning during a heatwave. Which age-related physiological change puts them at the GREATEST risk for hyperthermia?

• A blunted thirst mechanism, leading to severe dehydration.
• Increased metabolic rate leading to excess heat production.
• Thickening of the subcutaneous fat layer, trapping heat.
• Reduced sweat gland function and decreased skin blood flow. (Correct answer)

Correct answer: Reduced sweat gland function and decreased skin blood flow.

Aging impairs thermoregulation by reducing the efficiency of sweat glands and decreasing cutaneous vasodilation (skin blood flow). These are the body's primary mechanisms for dissipating heat. A blunted thirst mechanism contributes to dehydration, which worsens the situation, but the core problem is the reduced ability to cool down through sweating and increased skin blood flow.

Question 63: The RN, LPN, and CNA are members of the

• Primary team
• Nursing team (Correct answer)
• Medical team
• Ancillary team

Correct answer: Nursing team

Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs) all work collaboratively to provide direct patient care and support nursing functions. They form the core of the nursing team, each with distinct roles but united in their goal of patient well-being.

Question 64: A resident's family member asks the CNA why their loved one seems so confused after a urinary tract infection. The CNA's best response is:

• 'This is a normal part of aging.'
• 'He is probably just tired from the infection.'
• 'Confusion can be a sign of infection in older adults — the nurse can explain more.' (Correct answer)
• 'The infection must have spread to the brain.'

Correct answer: 'Confusion can be a sign of infection in older adults — the nurse can explain more.'

UTIs frequently cause sudden confusion (delirium) in older adults, and the CNA should acknowledge this and refer detailed explanation to the nurse.

Question 65: When helping a resident select clothing for the day, the CNA should PRIMARILY consider:

• The easiest garment for the CNA to put on quickly
• The resident's personal preferences and the weather or room temperature (Correct answer)
• The color that best matches the facility's décor
• What the family dropped off most recently

Correct answer: The resident's personal preferences and the weather or room temperature

Respecting personal choice and ensuring comfort based on temperature are the top priorities in resident-centered care.

Question 66: What does the acronym 'SDS' (Safety Data Sheet) refer to, and why is it important?

• A document that provides information about chemical hazards, safe handling, storage, first aid, and emergency procedures for chemical products (Correct answer)
• A summary of a resident's daily functional status
• A schedule of daily safety checks for equipment
• A form documenting a resident's social history and discharge summary

Correct answer: A document that provides information about chemical hazards, safe handling, storage, first aid, and emergency procedures for chemical products

An SDS (Safety Data Sheet) is required by OSHA for all hazardous chemical products and provides essential information on safe handling, exposure risks, and emergency procedures.

Question 67: A CNA is providing end-of-life care to a resident. The resident says, 'I just want someone to sit with me — I don't want to talk.' Which response BEST demonstrates therapeutic communication?

• Tell the resident you need to keep busy but will check back soon
• Encourage the resident to share their feelings, as expressing emotions is important for coping
• Inform the resident that silence can feel awkward and suggest listening to music together instead
• Sit quietly with the resident, offering a gentle touch on the hand if appropriate, without prompting conversation (Correct answer)

Correct answer: Sit quietly with the resident, offering a gentle touch on the hand if appropriate, without prompting conversation

Therapeutic presence — the ability to 'be with' a patient in silence without the need to fill space with words — is a highly advanced communication skill critical in palliative and end-of-life care. The resident has explicitly expressed a preference for presence over conversation. Honoring this request, using therapeutic touch appropriately, is the most respectful and therapeutically valid response. Pushing for verbal expression overrides the resident's stated wishes and autonomy.

Question 68: A CNA is donning PPE to enter an airborne infection isolation room for a patient with active pulmonary tuberculosis. Which sequence reflects the CORRECT donning order?

• Gloves → gown → N95 respirator → eye protection
• Gown → N95 respirator → eye protection → gloves (Correct answer)
• N95 respirator → gown → gloves → eye protection
• Eye protection → N95 respirator → gown → gloves

Correct answer: Gown → N95 respirator → eye protection → gloves

CDC's recommended donning order for full PPE is: (1) gown to protect clothing and skin, (2) mask/respirator to protect the respiratory tract before the face is potentially exposed, (3) eye protection placed over the already-secured respirator, and (4) gloves last, extending over the gown cuffs. For TB, an N95 or higher respirator is required (surgical masks are insufficient). Gloving last prevents contaminating already-donned PPE with hand contact.

Question 69: When caring for a resident whose religion is different from your own, you should

• Accept and respect their religious beliefs. (Correct answer)
• Try to convert the resident to your religion
• Show the resident the faults in their religion
• Ensure they follow all religious requirements.

Correct answer: Accept and respect their religious beliefs.

When caring for a resident with different religious beliefs, it is paramount to accept and respect their practices and traditions. CNAs must provide care that is culturally and spiritually sensitive, ensuring the resident's comfort and dignity without imposing personal views. Attempting to convert or criticize their religion is highly unprofessional and unethical.

Question 70: When should a CNA measure and record a resident's intake and output (I&O)?

• Once per day at the end of the night shift
• Only when the resident complains of thirst
• Only when the resident has a urinary catheter
• Every shift, when ordered by the nurse or care plan (Correct answer)

Correct answer: Every shift, when ordered by the nurse or care plan

I&O measurements are recorded every shift when ordered, to monitor fluid balance and kidney function.

Question 71: A CNA is assigned to care for four patients. Patient A is in Airborne Precautions (TB), Patient B is in Droplet Precautions (influenza), Patient C is in Contact Precautions (MRSA wound), and Patient D has no isolation precautions. In which order should the CNA ideally provide care to minimize infection transmission risk?

• Patient C first to allow wound care dressing time, then A, then B, then D
• Patient D first, then Patient C, then Patient B, then Patient A (Correct answer)
• Patient A first (most restrictive precautions), then B, then C, then D
• Any order is acceptable as long as PPE is changed between patients

Correct answer: Patient D first, then Patient C, then Patient B, then Patient A

The standard principle is to care for the least infectious (or most vulnerable) patients first and the most infectious last, to reduce the risk of carrying organisms from infected patients to susceptible ones. Patient D (no precautions) should be seen first. Among precaution patients, Contact (MRSA) is typically visited before Droplet and Airborne patients in this workflow. While PPE changes between patients are always required, sequencing provides an additional safety layer — especially because PPE can fail or be imperfectly removed.

Question 72: A CNA has four residents to bathe this morning. Which resident should be bathed LAST to best manage time and patient safety?

• The resident with a stage 3 pressure ulcer requiring wound care after bathing
• The resident who is ambulatory and can assist with their own care (Correct answer)
• The resident who requested a bath first thing in the morning
• The resident who has a scheduled physical therapy session at 10 AM

Correct answer: The resident who is ambulatory and can assist with their own care

Residents who are more independent should generally be scheduled last so that limited CNA time is prioritized for those with greater care needs.

Question 73: An AED is brought to the scene of a cardiac arrest. What is the CNA's responsibility when an AED is present?

• Continue CPR until the nurse arrives and ignore the AED
• Wait to use the AED until two nurses are present
• Only allow physicians to use the AED
• Attach and use the AED as soon as possible and follow its voice prompts (Correct answer)

Correct answer: Attach and use the AED as soon as possible and follow its voice prompts

AEDs are designed for use by bystanders and first responders. Their rapid application significantly improves cardiac arrest survival rates and CNAs trained in CPR are expected to use them.

Question 74: A resident with end-stage dementia is no longer able to swallow safely and the family has requested that the care team 'do everything possible' to maintain nutrition. The physician has documented that the resident is not a candidate for tube feeding per the advance directive. The family insists the CNA force-feed the resident pureed food orally. What is the correct response?

• Decline to force-feed, explain the aspiration risk and the advance directive, and involve the nurse and social worker (Correct answer)
• Follow the family's instructions since next-of-kin hold final decision-making authority over the care team
• Contact the facility administrator to override the physician's order based on the family's request
• Attempt small bites of pureed food very slowly since the family's wishes must be respected

Correct answer: Decline to force-feed, explain the aspiration risk and the advance directive, and involve the nurse and social worker

Force-feeding a resident with unsafe swallowing places them at serious risk of aspiration pneumonia and violates their documented advance directive. The CNA must refuse to force-feed, explain the medical and legal reasons calmly and compassionately, and escalate immediately to the nurse and social worker who can facilitate a family care conference. Families do not have the authority to override valid advance directives, and next-of-kin authority does not supersede a legally documented directive.

Question 75: A patient rated as high fall risk needs to use the restroom. What is the safest approach?

• Leave the bathroom door open so you can hear them
• Provide a bedside commode and assist the patient to it (Correct answer)
• Hand them a urinal and check back in five minutes
• Allow the patient to walk slowly with the call light nearby

Correct answer: Provide a bedside commode and assist the patient to it

A bedside commode minimizes ambulation distance for high-risk patients and keeps the CNA close for hands-on assistance.

Question 76: Using a resident's nickname is acceptable if

• The nickname is appropriate
• The family uses that name
• Everyone else calls them that
• The resident requests it (Correct answer)

Correct answer: The resident requests it

Using a resident's nickname is acceptable only if the resident explicitly requests or consents to it. Respecting a resident's personal preferences, including how they wish to be addressed, is a fundamental aspect of person-centered care and promotes dignity. Otherwise, staff should use their formal name.

Question 77: A facility is budgeting for a new call-light system. The director of nursing explains that this capital expenditure will be depreciated over 7 years. From a facility financial management perspective, why is depreciation relevant to the annual operating budget?

• It spreads the cost of the asset across its useful life, reducing the budget impact in any single year (Correct answer)
• It allows the facility to deduct the full purchase price from resident billing in the first year
• It prevents the asset from appearing on the facility's balance sheet
• It means the facility must set aside cash equal to the depreciation amount each month

Correct answer: It spreads the cost of the asset across its useful life, reducing the budget impact in any single year

Depreciation is an accounting method that allocates the cost of a long-lived asset (like a call-light system) across the years it will be used, rather than expensing it all at once. This smooths the budget impact and more accurately reflects the asset's contribution to operations over time. It does not require a matching cash reserve, nor does it remove the asset from the balance sheet — the asset remains listed at cost minus accumulated depreciation.

Question 78: What are record retention policies in CNA practice?

• Keeping everything forever
• Destroying records yearly
• Paper storage only
• Rules defining how long records must be kept and when destroyed (Correct answer)

Correct answer: Rules defining how long records must be kept and when destroyed

Retention policies establish consistent guidelines based on legal requirements and business needs.

Question 79: A resident who is on a bowel training program is incontinent of stool between scheduled toileting times. The CNA observes that the stool is liquid and seeping around what appears to be a large, hard stool mass. This presentation MOST likely indicates:

• Infectious diarrhea requiring contact precautions
• Fecal impaction with overflow incontinence (Correct answer)
• Malabsorption syndrome requiring dietary consultation
• A normal variation in bowel habit for this resident

Correct answer: Fecal impaction with overflow incontinence

Liquid stool seeping around a hard mass is a classic sign of fecal impaction with overflow (paradoxical) incontinence. The impacted mass blocks normal passage, but liquid stool from higher in the colon seeps around it, mimicking diarrhea. This must be reported to the nurse immediately for assessment and intervention, as impaction can lead to serious complications. Treating it as infectious diarrhea or a normal variation would cause significant harm.

Question 80: The most important way to prevent the spread of infection is

• Vaccinations
• Hand washing (Correct answer)
• Antibiotics
• Sanitizer

Correct answer: Hand washing

Hand washing, or hand hygiene, is universally recognized as the single most effective and fundamental method to prevent the spread of infection in all settings, especially healthcare. It physically removes transient microorganisms from the hands, effectively breaking the chain of infection. While other measures like antibiotics and vaccinations are important, consistent and proper hand washing has the broadest impact on preventing pathogen transmission and saving lives.

Question 81: While providing perineal care to a female resident with an indwelling urinary catheter, the nursing assistant should clean the catheter tubing in which direction?

• From the insertion site outward, using circular strokes
• Any direction is acceptable as long as a fresh cloth is used for each stroke
• From the insertion site downward along the catheter for several inches (Correct answer)
• From the tubing end toward the insertion site to push debris away from the body

Correct answer: From the insertion site downward along the catheter for several inches

When cleaning around an indwelling catheter, the nursing assistant should use a clean cloth and wipe from the meatus (insertion site) downward along the catheter tubing for several inches. This direction moves microorganisms away from the urethral opening, reducing the risk of catheter-associated urinary tract infection (CAUTI). Cleaning toward the insertion site or in circular patterns can introduce pathogens toward the sterile catheter-bladder interface.

Question 82: A urine specimen must be sent to the lab but will not be transported for 30 minutes. The CNA should:

• Discard and collect a fresh specimen at transport time
• Add a preservative from the supply closet
• Refrigerate the specimen until transport (Correct answer)
• Leave the specimen at room temperature

Correct answer: Refrigerate the specimen until transport

Urine specimens not transported immediately should be refrigerated to prevent bacterial growth and specimen degradation.

Question 83: A resident from a traditionally collectivist cultural background has been receiving mental health counseling but refuses to continue, stating: 'In my culture, family decides what is best for me — my daughter says therapy is shameful and I must stop.' The resident appears ambivalent. Which action by the CNA BEST balances cultural sensitivity with the resident's individual rights?

• Respect the family's cultural authority by discontinuing encouragement of therapy and informing the social worker the family has declined on the resident's behalf
• Encourage the resident to defy their family's wishes, explaining that individual autonomy supersedes cultural norms in a healthcare setting
• Contact the daughter directly to educate her about the benefits of mental health therapy and request she reverse her position
• Listen non-judgmentally to the resident's ambivalence, avoid imposing personal views, and report the situation to the charge nurse or social worker so the care team can address both the cultural context and the resident's own expressed wishes (Correct answer)

Correct answer: Listen non-judgmentally to the resident's ambivalence, avoid imposing personal views, and report the situation to the charge nurse or social worker so the care team can address both the cultural context and the resident's own expressed wishes

This scenario involves a tension between individual autonomy and cultural/family dynamics. The CNA should not make unilateral decisions about deferring to the family or pressuring the resident to defy cultural values. The appropriate role is to listen empathetically, acknowledge the resident's ambivalence, and escalate to the charge nurse or social worker — who have the training and authority to navigate this ethically complex situation, potentially involving a cultural mediator or family meeting. CNAs do not independently contact family members about clinical decisions.

Question 84: When pushing a wheelchair up a ramp, the CNA should:

• Walk backward pulling the wheelchair
• Push forward, leaning slightly forward (Correct answer)
• Let the resident push themselves
• Go as fast as possible

Correct answer: Push forward, leaning slightly forward

Push forward up the ramp, using leg muscles and leaning slightly forward for momentum.

Question 85: While performing perineal care on a female resident, the CNA notices an unusual odor and a thick, yellow vaginal discharge. The MOST appropriate immediate action is to:

• Continue the perineal care using standard technique, then report and document the finding immediately after
• Use an antiseptic wipe instead of soap and water to clean the area more thoroughly
• Stop the perineal care, cover the resident, and report the finding to the nurse before continuing (Correct answer)
• Ask the resident if she has noticed the discharge and document her response as the only required action

Correct answer: Stop the perineal care, cover the resident, and report the finding to the nurse before continuing

Unusual discharge may indicate infection and is a significant change in condition requiring immediate nurse notification. The CNA should stop, maintain the resident's dignity by covering her, and report before continuing. Substituting antiseptic wipes is outside the CNA's scope, and relying solely on the resident's report without notifying the nurse is insufficient.

Question 86: An elderly resident has a advance health directive that includes a DNR (Do Not Resuscitate) order. You enter their room and find them not breathing. What do you do?

• Close the door and notify the nurse. (Correct answer)
• Call for help and begin CPR.
• Start the resident on oxygen at 2L/minute.
• Call the family to see if they agree with the DNR.

Correct answer: Close the door and notify the nurse.

A Do Not Resuscitate (DNR) order is a legal document instructing healthcare providers not to perform CPR or other life-sustaining measures. If a resident with a DNR order is found not breathing, the CNA's role is to respect this directive. The correct action is to ensure privacy by closing the door and immediately notify the nurse, who will verify the DNR status and follow the facility's protocol for end-of-life care.

Question 87: A resident asks the nurse aide to mail a personal letter for her. When the aide goes to help, she notices the envelope is addressed to the state's long-term care ombudsman with a note saying 'COMPLAINT.' What must the nurse aide do?

• Notify the director of nursing before mailing so the facility can respond proactively
• Delay mailing until the resident's family can review the contents
• Mail the letter promptly without opening it, reading it, or informing facility management (Correct answer)
• Open the letter to verify it does not contain false information before mailing

Correct answer: Mail the letter promptly without opening it, reading it, or informing facility management

Residents have an explicit right under federal law (OBRA) to communicate privately with the ombudsman and to send and receive mail without interference. Staff are strictly prohibited from opening, reading, delaying, or intercepting resident mail — including complaint letters. Notifying management, opening the letter, or involving family without the resident's consent would all violate this protected right and potentially constitute retaliation.

Question 88: 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

• had breakfast. (Correct answer)
• had visitors that day.
• ate too much sugar.
• has diabetes.

Correct answer: had breakfast.

A patient who received insulin and then becomes pale, sweaty, and confused two hours later is exhibiting classic signs of hypoglycemia (low blood sugar). Insulin lowers blood sugar, and if the patient did not eat breakfast after receiving insulin, their blood sugar could drop dangerously low. Knowing if they ate is critical for understanding and addressing the situation.

Question 89: A CNA is asked to graph a resident's weekly weight changes. The resident weighed 155 lbs, 153 lbs, 152 lbs, 154 lbs, and 151 lbs over five weeks. What trend does this data show?

• A gradual overall downward trend requiring monitoring (Correct answer)
• Stable weight with no concern
• Normal fluctuation with no pattern
• Rapid weight gain requiring intervention

Correct answer: A gradual overall downward trend requiring monitoring

A net loss of 4 lbs over five weeks represents a gradual downward trend that should be documented and reported.

Question 90: Which behavior demonstrates a CNA maintaining professional appearance standards?

• Keeping nails short and clean without nail polish (Correct answer)
• Wearing loose-fitting jewelry to appear approachable
• Wearing open-toed shoes for comfort during long shifts
• Wearing strong cologne to mask clinical odors

Correct answer: Keeping nails short and clean without nail polish

Short, clean nails without polish reduce the risk of harboring and transmitting pathogens to residents.

Question 91: Which of the following actions by a CNA during sputum collection demonstrates correct technique?

• Asking the resident to cough while lying flat on their back
• Having the resident spit saliva into the cup to fill it halfway first
• Encouraging the resident to take several deep breaths before coughing deeply (Correct answer)
• Collecting the specimen immediately after the resident eats a meal

Correct answer: Encouraging the resident to take several deep breaths before coughing deeply

Deep breathing before coughing loosens secretions from the lower airways, improving the quality and quantity of the sputum specimen.

Question 92: An agency relationship in business law requires which of the following elements?

• Registration with a state licensing board
• A written contract and notarization
• Consent, control, and action on behalf of another party (Correct answer)
• Payment of consideration to the agent

Correct answer: Consent, control, and action on behalf of another party

An agency relationship exists when one party (agent) consents to act on behalf of another (principal) subject to the principal's control.

Question 93: A resident keeps refusing restorative exercises, saying they are too tired. The CNA's best response is to:

• Force the exercises since they are medically necessary
• Ask what time of day the resident feels most energetic and report to the nurse (Correct answer)
• Tell the resident the exercises will be discontinued if they keep refusing
• Document refusal and skip the session

Correct answer: Ask what time of day the resident feels most energetic and report to the nurse

Scheduling exercises when the resident has the most energy promotes participation and respects their preferences while supporting the care goal.

Question 94: During perineal care (peri-care) for a female resident, the CNA should wipe:

• In a circular motion around the perineal area
• From back to front for more thorough cleaning
• From front to back (urethra toward the anus) to prevent urinary tract infections (Correct answer)
• In whichever direction is most comfortable for the resident

Correct answer: From front to back (urethra toward the anus) to prevent urinary tract infections

Perineal care for females must always be performed front to back (urethral area to anal area) to prevent introducing fecal bacteria (including E. coli) into the urethra, which can cause urinary tract infections.

Question 95: How far should a CNA move a resident's joint during passive ROM exercises?

• To the point of mild pain to stretch the joint
• Only halfway through the normal range
• Only to the point of resistance or slight discomfort (Correct answer)
• As far as possible to maximize flexibility

Correct answer: Only to the point of resistance or slight discomfort

ROM exercises should only be performed to the point of resistance or slight discomfort — never to the point of pain. Forcing a joint beyond its comfortable range can cause injury.

Question 96: The following are all aspects of sexuality. EXCEPT

• How you speak and smile.
• Cultural and religious expectations.
• Caring about your appearance.
• Holding hands when in pain. (Correct answer)

Correct answer: Holding hands when in pain.

Sexuality encompasses a broad range of human expression, including self-perception, appearance, communication styles, and cultural/religious influences on intimacy and relationships. Holding hands when in pain is an act of comfort and support, which is a general human need, but it is not inherently an aspect of sexuality. It's a response to physical distress, not an expression of sexual identity or desire.

Question 97: What should you do for a person who has stopped breathing and has no heartbeat?

• Do mouth to mouth resuscitation.
• Call the ambulance.
• Perform abdominal thrusts.
• Start chest compressions. (Correct answer)

Correct answer: Start chest compressions.

When a person has stopped breathing and has no heartbeat, they are in cardiac arrest. The immediate and most critical intervention is to begin chest compressions, which are the foundation of cardiopulmonary resuscitation (CPR). Chest compressions manually circulate blood to the brain and other vital organs, buying time until advanced medical help arrives or a defibrillator can be used.

Question 98: A resident participating in a restorative feeding program has dysphagia and is on a IDDSI Level 5 (minced and moist) diet with mildly thick liquids. During a meal, the resident requests to drink the thin water on the tray that was placed by mistake. The CNA should:

• Allow the resident to drink the thin water since it is their right to refuse dietary restrictions
• Remove the thin water, explain the aspiration risk calmly, and offer the correct thickened liquid (Correct answer)
• Thicken the water at the bedside using available thickener packets without notifying anyone
• Tell the resident they must wait until the speech therapist approves any change

Correct answer: Remove the thin water, explain the aspiration risk calmly, and offer the correct thickened liquid

Dysphagia diets are prescribed to prevent aspiration pneumonia, a life-threatening complication. The CNA must remove the contraindicated food/liquid and substitute the correct consistency while explaining the reason respectfully. Allowing thin liquids violates the care plan and creates serious aspiration risk. Thickening liquids independently at the bedside without a protocol or training risks incorrect consistency levels. Telling the resident to wait without addressing the immediate situation (the thin water remains on the tray) is also unsafe.

Question 99: A resident who is three days post-colostomy surgery is on the CNA's assignment. While performing peristomal skin care, the CNA notices the stoma appears dark purple rather than its usual pink-red color. What should the CNA do FIRST?

• Apply a warm compress to restore blood flow to the stoma
• Document the color change in the chart and continue with routine care
• Report the observation to the nurse before completing the pouch change (Correct answer)
• Gently massage the stoma to stimulate circulation and check for responsiveness

Correct answer: Report the observation to the nurse before completing the pouch change

A healthy stoma should appear beefy red or pink and moist. A dark purple or dusky color indicates compromised blood supply — a potentially life-threatening complication called stomal necrosis or ischemia that requires immediate medical attention. The CNA must stop and report to the nurse before proceeding. Applying compresses or massaging the stoma could worsen tissue damage. Documenting without reporting delays critical intervention.

Question 100: A patient's chart is a legal document. If something is mistakenly written on the chart, the correct action is to

• 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.
• 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)
• 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.
• 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.

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.

A patient's chart is a legal document, and any corrections must be made in a way that preserves the original entry for legal and auditing purposes. Drawing a single line through the error makes it legible, while initialing and dating the correction ensures accountability. Using correction fluid or completely obscuring the mistake is unacceptable as it can be seen as an attempt to falsify records.