Answers to Practice Exam III

Answers at a Glance

  1. A

  2. A

  3. C

  4. A

  5. B

  6. C

  7. D

  8. B

  9. D

10. B

11. A

12. C

13. B

14. A

15. A

16. A

17. B

18. B

19. B

20. D

21. D

22. C

23. C

24. B

25. D

26. B

27. A

28. C

29. C

30. A

31. B

32. C

33. A

34. B

35. B

36. C

37. C

38. B

39. A

40. D

41. C

42. A

43. B

44. D

45. C

46. C

47. B

48. A

49. B

50. A

51. C

52. C

53. D

54. D

55. A

56. B

57. C

58. D

59. A

60. B

61. B

62. C

63. B

64. C

65. A

66. B

67. C

68. A

69. B

70. C

71. A

72. D

73. C

74. A, B, C, D

75. D

Rationales for Answers to Practice Exam III

  1. A. The CNA is licensed and has the potential to be charged with negligence for not providing care to a resident. Malpractice (B), slander (C), and assault (D) are legal terms that do not apply to this situation.

  2. A. Stage one of a pressure sore is redness. Open area with redness is indicative of stage two (B). Black area is indicative of stage three (C), and open area with visible bone is indicative of stage four (D).

  3. C. It is unethical to accept money from a resident when employed to take care of that person. Facilities have policies regarding gifts and tips, so answer A is incorrect. Choices B and D are forms of accepting money, which make them incorrect.

  4. A. The chart is a legal document. Entries into the chart are written with pen (B) and are not erased. If a factual or typographical error is made (D), a single line is made through the error, and then it is initialed (C).

  5. B. Listening to the resident when he or she is talking demonstrates caring, showing value to the resident as a person. Timely completion of an assignment (A) and obtaining vital signs for the unit before lunch (C) are tasks and are not forms of caring. Not changing the resident when soiled (D) is considered neglect.

  6. C. A professional should introduce himself or herself by surname and title and show respect to the resident by referring to the resident by his or her surname. The options in answers A, B, and D are incorrect because they either do not show respect to the resident or are not professional.

  7. D. The resident has the right to refuse care. The nurse does not need to be informed of the refusal is incorrect. The nurse should be informed of the resident's refusal, but this can be done as soon as the nursing assistant is able (B). Informing the resident that everyone must take a bath when it is scheduled (A) or simply proceeding to bathe the resident anyway (C) does not respect the rights of the resident.

  8. B. Residents have the right to privacy at all times, including when family is visiting. Providing snacks for the resident and family members (A), although hospitable, is not a responsibility of the nursing assistant. Remaining close enough to hear the conversation (C) and leaving the intercom on (D) do not provide privacy.

  9. D. Nursing home residents have the right to know the costs for services rendered, but not to demand free or reduced medical care. (A) Residents have the right to information, including the regulations of the home. (B) The resident has the right to participate in decisions about his or her roommate, and he or she also has (C) the right to file complaints and grievances without fear of reprisal.

10. B. Quadriplegia is the result of all four limbs being paralyzed. Flaccid lower extremities (A) refers to both lower extremities being paralyzed. Inability to move the left side (C) refers to someone who is hemiplegic. The loss of feeling in both feet (D) is numbness, not paralysis.

11. A. The nursing assistant demonstrates caring by sitting and listening to the resident. Ignoring (B), laughing (C), or demanding (D) the resident stop talking is inappropriate and demonstrates a lack of care for the resident and her condition.

12. C. Visual aids need to be within reach of the resident in order for the resident to be able to use them when needed. Making sure the light in the room is not too bright (A) is wrong because the light might need to be brighter for someone who is visually impaired. Placing rugs on the floor so the resident will not be too shocked by the cold floor (B) is wrong because a visually impaired resident can easily trip and fall on loose rugs. Turning up the volume on the television so the resident can hear because he or she has trouble seeing (D) is wrong because the other senses might heighten, not lessen.

13. B. The facility should provide the resident privacy for sexual expression. Many residents in long-term care facilities have an active sex life. Leaving the door open (A) or telling the resident to ask the husband to come at a later time (C) is a violation of the resident’s rights. Calling the physician is not included under the nursing assistant’s scope of practice (D).

14. A. The first step in emptying the urinary drainage bag is to release the clamp and allow the urine to flow into a graduate. Then reclamp the tubing and cleanse the end with alcohol. (B) Soap and water, (C) air-drying, and (D) peroxide do not cleanse the tip of tubing appropriately to prevent infection.

15. A. Removing any items might be considered a violation of the resident’s rights. Asking the resident’s permission to give him or her a bath (B), gently waking the resident for breakfast (C), and offering to wash his or her face and brush his or her teeth before serving breakfast (D) show respect for the resident and his or her rights.

16. A. An ombudsman is the person who represents a resident and investigates complaints. A nurse representative who assures quality care (B) is the quality care manager. A person appointed by the court to handle an estate (C) is a guardian. A union representative (D) helps the employees, not the residents.

17. B. Withholding medication as a form of punishment is considered abuse. A daughter discussing changes in care with her mother (A) or a son who does not return his father for several hours whenever they go out to lunch (C) is not demonstrating physical or verbal abuse. Giving the wrong medication to a resident (D) is an example of malpractice if the resident is harmed by the error.

18. B. The resident has the right to confidentiality. Unless the CNA is assigned to the care of the resident, the CNA should not seek (A) or share (D) information about the resident. All persons who are using the chart must protect the information properly and place the chart in a secure area after using it (C).

19. B. All health-care persons have a moral and legal responsibility to report suspected elder abuse to the authorities. A and C—assessing the bruises and inquiring—are documented by the nurse (D). The CNA should not be confrontational with the family or the resident.

20. D. Rectal temperatures reflect closely the body’s core temperature (A). B and C may not provide an accurate temperature.

21. D. This choice lists all the correct steps to prevent injury to the CNA and the resident in a transfer from a chair. Choices A, B, and C may put the CNA and/or the resident at risk for harm.

22. C. Adjusting the bed to an appropriate height prevents having to bend the back while bathing the resident. Positions A, B, and D will not prevent bending, reaching, and twisting the body, and all may lead to back injury.

23. C. When the CNA provides oral care, he or she is likely to come in contact with body fluids. The care detailed in answers A, B, and C does not put the CNA at risk for exposure to body fluids.

24. B. The side-lying position is the position of choice to help the fluids to flow out of the mouth to prevent aspiration. All other positions are inappropriate for an unconscious patient.

25. D. Handwashing is the most important action to prevent infections. A and B are correct actions, but not the most important. Answer C does not prevent infection, and if the resident’s skin becomes too dry, the skin can crack and provide an entry for infections.

26. B. Facilities designate a particular dress code that includes a particular color of loose-fitting scrubs that are clean and neat. T-shirts (A), jeans (C), or tight shirts (C) are generally not a part of the CNA’s dress code for duty.

27. A. Every member of the health-care team should treat the residents with respect and knock every time before entering a room. Even if the door is standing wide open, knock and wait to be bade entrance before going into a resident’s room. That room is his or her personal space. Options B, C, and D do not demonstrate respect of the resident’s private space.

28. C. Sexual harassment or making unwelcome sexually explicit or implied statements to residents is abusive and can be grounds for resident grievance or legal action. Option A, helping a resident at his or her request, is part of the CNA’s responsibility. Options B and D are wrong, but are not grounds for legal actions.

29. C. When a sharps container is full, the container should be closed, sealed, and disposed of according to the facility’s safety policy. The actions of A, B, and D increase the chance of someone being exposed to contaminated sharps.

30. A. When the CNA assists with sterile procedures (catheter insertions, applying a dressing), the CNA is to avoid touching equipment or other objects in the sterile field. B, C, and D are the responsibility of the nurse.

31. B. Only a podiatrist should trim the toenails of geriatric patients because older persons have decreased circulation and small cuts could become infected.

32. C. When a change is noticed in the resident, it needs to be reported to the nurse as soon as possible. Choices A and D can be done, but reporting a change to the nurse is the most important response of the CNA. Choice B is incorrect because a doctor is to prescribe compression stocking.

33. A. Residents need social interaction for psychological health. The best way to encourage social interaction is speak to all residents even when they are unable to be a part of the interaction. Choices B, C, and D are actions that do not encourage socialization.

34. B. The CNA should observe the resident’s body language for signs of pain. If the resident is smiling, he or she is probably not in pain. Choices A, C, and D are nonverbal indications that the resident may be in pain.

35. B. When the CNA is assisting the resident with toileting, it is important for the CNA to wash his or her hands. Choices A, C, and D are steps in assisting the resident, but not the final step.

36. C. Caffeinated beverages should be limited to earlier in the day and restricted closer to bedtime to promote sleep.

37. C. Due to the possibility of a false reading or injuring the arm, a resident’s blood pressure should be taken in an arm that does not have an IV (D), that is not on the side of a mastectomy (B), or that is not paralyzed (A).

38. B. The sign of an infiltrated IV site is a swollen, red, painful area that may ooze fluid from the insertion site. Choices A, C, and D are signs of a healthy skin and IV site.

39. A. The needle stick site needs to be washed thoroughly immediately, and then the incident should be reported to the nurse in order to follow facility protocol for needle sticks (B). Choices C and D are the responsibility of the nurse on duty.

40. D. When a resident’s chart states that he or she has a paralyzed side, it means that his or her arm and leg on one side of the body is flaccid. A stroke or spinal cord injury can cause paralysis of the body below the injury site.

41. C. When a resident is using an oxygen device, the CNA should check the skin around the device frequently for any skin breakdown, and then reposition the device. Many oxygen delivery methods use tubing or edges that put pressure on the nares, top of the nose, cheeks, or ears when in use.

42. A. First thing in the morning is the time of day to acquire the most accurate weight. The actions in B, C, and D change the weight with the activity.

43. B. The proper procedure when a charting mistake occurs is to put one line through the mistake and initial it. Choices A, C, and D are actions that appear something is being covered up instead of corrected.

44. D. Increased thirst is a sign of increase sugar levels or dehydration, not a UTI. A sign that an elderly resident may have a urinary tract infection include all options A, B, and C.

45. C. To diffuse aggressive behavior, the CNA should leave the situation if he or she can and return later. Option A is considered threatening to the resident and may be considered assault. Option B is opposite of what is needed to calm the resident. The best course is to have a calm demeanor and be understanding. Option D would escalate an aggressive resident.

46. C. If time permits, the CNA is responsible to clean the body, comb the hair, and remove visible blood or other body fluids before the family visits. Option A and D are incorrect because the CNA does not remove any tubes or dressings connected to the body. Option B—the dentures are to be cleaned, placed in the mouth, and sent to the funeral home with the resident.

47. B. A, C, and D are steps for obtaining an oral temperature using an electronic thermometer. The steps are as follows:

a. Wash hands.

b. Remove the thermometer from the charger.

c. Place probe on the thermometer.

d. Gently place in resident’s mouth under the side of the tongue at the back of the mouth.

e. Ask resident to close mouth around probe with lips closed.

f. Remove probe when beep sounds and see temperature display on the thermometer.

g. Eject probe into proper receptacle.

h. Clean thermometer and replace on charger.

i. Record temperature and mode used to access according to agency policy.

Option B is incorrect because offering fluids would cause a false reading for an oral temperature. If resident has just finished having a drink, then the CNA should wait 15 minutes before taking the oral temperature.

48. A. A resident with a new leg brace will need frequent skin care. The brace will need to be examined to ensure that the edges are not putting pressure on the skin that may lead to skin breakdown and skin ulcers. Options B, C, and D are essential for most residents.

49. B. A radial pulse is taken for a full 60 seconds, and the number is recorded on the resident’s chart. Many residents have irregular, fast, or slow heartbeats, and to obtain an accurate reading, the pulse should be counted for a full 60 seconds; the number is recorded on the resident’s chart. Options A, C, and D have been used, but they are not best practices.

50. A. Research findings support option A, the arm at heart level, and further states that feet should be uncrossed (B) and flat on the floor, and no talking (C) or drinking (D) while the blood pressure is being taken for the most accurate reading.

51. C. Perineal care is the cleansing of the genital and rectal areas. Option A is night time facial and tooth cleansing. Option B is morning time facial cleansing and tooth brushing. Option D is not a term that is used in care.

52. C. Bed alarms are to alert the staff to the resident’s getting out of bed so that the staff can respond to assist as needed. Options A, B, and C are incorrect and increase chances of the resident’s falling (A). When side rails are elevated, the resident may attempt to climb out of bed (B). The bedside table should be close to the resident in case he or she is looking for an item on the table when he or she wakes up, and (D) having all the lights off may cause the resident to become disoriented.

53. D. The term STAT means to accomplish the task immediately. Options A, B, and C do not reflect the definition for STAT.

54. D. An ostomy pouch should be changed every shift so that the amount of output for the shift can be added to the 24-hour Intake and Output record. Options A, B, and C are incorrect and may cause leaking. The pouch is difficult to change when full.

55. A. When the CNA recognizes that he or she may be becoming impatient with the resident, to prevent escalating the situation it is best for the CNA to leave the room and come back when he or she feels less impatient. Option B and D may escalate the situation. Option C will help the CNA, but it is not the first option.

56. B. The CNA should tell the nurse the resident’s request, and he or she will evaluate and call the appropriate pastor. Option A is incorrect because the local church might not be the same denomination as the resident provided. Option C is incorrect because calling the doctor is not part of the CNA's scope of practice. Option D is incorrect because telling the resident that you are a pastor may make the resident uncomfortable and should be avoided.

57. C. The CNA should stop passive range of motion (PROM) when the resident complains of pain. Option A (stiffness) and B (weakness) are reasons for PROM to be performed. Use of passive range of motion increases flexibility and prevents stiffness. PROM is used for residents who are weak and may not be able to do active ROM. Option D is incorrect because PROM is not an exercise and will not increase muscle size.

58. D. Droplet precautions call for a mask to prevent transmission. Option A requires the use of gloves and possibly eye protection because there is a chance of splashing. Standard precautions (option B) is the term used for a set of infection control practices to prevent the transmission of diseases. Option C, contact precautions, require gloves and a gown.

59. A. A fracture is the cracking or breaking of bone. Option B is incorrect because a sprain is the twisting of ligaments. Option C is incorrect because a strain is the over-stretching or tearing of ligaments, and option D, laceration, is a disruption of skin.

60. B. When assisting a resident to ambulate, it is important for the CNA to continually ask if he or she has pain, is having any difficulty breathing, or if he or she is dizzy. Option A is incorrect because the CNA should stand beside the resident for safety if the resident begins to fall. Options C and D increase the likelihood of the resident or the CNA being distracted and introduces the possibility of falling or injury.

61. B. The CNA prevents spreading germs from one person to another by washing his or her hands when entering a room and leaving the room. Option A is correct when there is a possibility of respiratory contamination. Option C, bathing, can help to prevent infection by helping to keep the skin intact and moist. Option D does not prevent contamination.

62. C. The CNA is not to share the resident’s information with anyone but the health-care worker who is taking care of him or her. The information provided in options A, B, and C is given to those who are responsible to help care for the resident.

63. B. The CNA should report the finding to the nurse and then follow through with applying lotion and gently massaging the area if directed by the nurse. If the resident is not changing positions often, the CNA will need to turn the resident more often, (D) but at least every 2 hours.

64. C. The resident has a right to religious beliefs and practices. The CNA should give the resident and his wife the privacy and time to pray. Options A, B, and D do not show the resident respect for his beliefs or privacy to practice those beliefs.

65. A. Kosher meals are prepared by special vendors who deliver kosher meals to the facility to be served to residents. Option B is incorrect because a kosher diet is a daily diet. Option C is incorrect because the meals have strict preparation requirements, and option D is incorrect because the rabbi does not prepare the meals.

66. B. A resident who is conscious needs to be sitting up (Fowler's position) when oral care is provided in order to prevent aspiration. Option A is used when the resident is unconscious; options C and D would risk the resident’s aspirating while oral care is being provided.

67. C. The safest way to dress a resident is to begin with the weak side to lessen the risk of the resident’s falling. Options A, B, and D would increase the risk of the resident’s falling or not being able to complete the task.

68. A. Mild cognitive impairment is manifested by memory loss. As the impairment worsens, the resident will have trouble remembering how to dress (B), eat (C), and walk (D).

69. B. A barrier between the cold compress and skin is needed to prevent skin breakdown. Option A will increase the risk of skin damage. The cold pack should be left in place for only 20 minutes at time. Option C, putting on a heating pad after a cold pack, would decrease the effect of the cold pack. Option D should be performed only if the area is soiled.

70. C. Aspiration precautions include providing small amounts of food to the resident. Option A suggests the resident can be in any position to eat, but the resident should be in a high-Fowler's position to eat to prevent aspiration (B). The resident should be provided thickened liquids (A), not just liquids, and the resident should be provided oral care before and after eating (D), not at bedtime only.

71. A. The team member responsible for developing a discharge plan for a resident is the social worker. Option A is incorrect because the dietitian develops the resident’s nutritional plan. Option C is incorrect because the CNA carries out the resident’s plan of care. Option D is incorrect because the physical therapist assesses and develops plans to increases the resident’s ROM and strength.

72. D. All the devices listed are examples of assistive devices. Canes, walkers, and wheelchairs assist the individual in mobility.

73. C. The goal of restorative care is to promote independence in activities of daily living. Options A and D will increase the resident’s negative feelings about not being able to care for himself or herself and make him or her not want to continue in the process. Option B is incorrect because members of the team should encourage the resident in each small goal that is accomplished so that the resident knows that he or she is improving.

74. A, B, C, and D. The goals of restorative care include decreasing falls and injuries, promoting activity and mobility, and increasing muscle strength.

75. D. New residents may have difficulty adjusting to their loss of their independence, home, health, and belongings. The CNA can help by letting the resident make his or her own choices as much as possible, not make the choices for him or her. Encourage the resident to be involved and to get to know the other residents, rather than to stay isolated (B). Bringing personal items from home will make the resident feel more at home (C).