CNA Assisting with Daily Living 2 — Questions and Answers
Question 1: A resident with severe rheumatoid arthritis has significant pain and stiffness in their hands in the morning. Which of the following is the most appropriate technique for assisting this resident with dressing?
- Encourage the resident to wear loose-fitting clothing with Velcro fasteners instead of buttons or zippers. (Correct answer)
- Complete the entire dressing process for the resident quickly to minimize their time in pain.
- Insist the resident work through the pain to maintain their fine motor skills.
- Schedule dressing for later in the afternoon when their stiffness has typically subsided.
Correct answer: Encourage the resident to wear loose-fitting clothing with Velcro fasteners instead of buttons or zippers.
Adaptive clothing, like items with Velcro fasteners, can greatly increase the independence and reduce the pain for a resident with severe arthritis in their hands. This approach promotes dignity and self-care while accommodating their physical limitations. Completing the task for them removes their independence, insisting they work through pain is inappropriate and potentially harmful, and while rescheduling might help, it's not always practical and doesn't address the immediate need to get dressed for the day.
Question 2: You are assisting a resident with dysphagia (difficulty swallowing) during breakfast. The care plan specifies a nectar-thick liquid consistency. You notice the resident is repeatedly coughing and clearing their throat after taking sips of their thickened juice. What is your immediate priority?
- Offer the resident a sip of water to clear their throat.
- Continue feeding the resident, but at a much slower pace.
- Stop feeding immediately and report the signs of potential aspiration to the nurse. (Correct answer)
- Mix the juice with more thickener to make it honey-thick.
Correct answer: Stop feeding immediately and report the signs of potential aspiration to the nurse.
Coughing and throat clearing are key signs of aspiration, which is when food or liquid enters the airway. The immediate priority is to stop the feeding to prevent further aspiration and report the observation to the nurse. The nurse needs to assess the resident, and a speech therapist may need to re-evaluate the prescribed liquid consistency. Offering water (a thin liquid) would increase aspiration risk, continuing feeding is unsafe, and changing the consistency without an order is outside the CNA's scope of practice.
Question 3: A resident who has a glass prosthetic eye needs assistance with their morning care. The resident is capable of removing and inserting it but has poor vision in their remaining eye. What is the most important step for the CNA to take when preparing the supplies for this task?
- Use an alcohol-based wipe to sterilize the prosthetic before insertion.
- Line the sink basin with a washcloth or soft towel before the resident handles the prosthesis. (Correct answer)
- Instruct the resident to store the prosthesis in a dry cup overnight.
- Apply a thick layer of petroleum jelly to the prosthesis for lubrication.
Correct answer: Line the sink basin with a washcloth or soft towel before the resident handles the prosthesis.
A glass prosthesis is fragile and expensive. Lining the sink with a soft towel provides a cushion and prevents the prosthesis from breaking if it is accidentally dropped during cleaning or handling. Alcohol-based products can damage the prosthesis and should not be used. Prosthetics are typically stored in a case with saline or a recommended solution, not a dry cup. While lubricants may be used, they are specific for ocular prostheses, and applying a thick layer of a non-approved substance is not appropriate.
Question 4: A resident with moderate dementia insists on wearing a heavy sweater on a very hot day. Which of the following actions best respects the resident's autonomy while ensuring their safety?
- Tell the resident they are mistaken and firmly insist they wear a t-shirt.
- Allow the resident to wear the sweater but monitor them closely for signs of overheating. (Correct answer)
- Hide the sweater and provide two other appropriate shirts for them to choose from.
- Explain the concept of heat stroke and why their choice is dangerous.
Correct answer: Allow the resident to wear the sweater but monitor them closely for signs of overheating.
This approach balances respect for the resident's choice with the CNA's responsibility for safety. Allowing the resident to wear the sweater avoids a power struggle and agitation, which can be common in dementia care. However, the CNA must remain vigilant and monitor for signs of overheating (e.g., flushing, excessive sweating, confusion), and be prepared to intervene by guiding the resident to a cooler area or gently suggesting removing the sweater later. The other options are confrontational, deceptive, or rely on complex reasoning that a person with moderate dementia may not be able to follow.
Question 5: When assisting a resident with one-sided weakness from a stroke to put on a button-up shirt, which principle should the CNA follow?
- Dress the unaffected (strong) side first to anchor the shirt in place.
- Slide both sleeves on simultaneously to save time and reduce movement.
- Undress the affected (weak) side first when removing the shirt.
- Dress the affected (weak) side first when putting the shirt on. (Correct answer)
Correct answer: Dress the affected (weak) side first when putting the shirt on.
The correct and standard procedure is to dress the weak or affected side first (D.O.W. - Dress On Weak). This method minimizes the need to move and manipulate the weak limb, reducing strain and discomfort. The strong arm can then be easily placed into its sleeve. The reverse is true for undressing: undress the strong side first (U.O.S. - Undress On Strong).
Question 6: A resident consistently refuses their morning shower, stating, "I don't need one." The resident is alert and oriented. After re-approaching later with the same result, what is the CNA's most appropriate next step?
- Insist on the shower because it is part of the facility's required routine.
- Document the refusal and report it to the charge nurse. (Correct answer)
- Ask a different CNA to try to convince the resident to shower.
- Explain that refusing care can lead to skin infections and odor.
Correct answer: Document the refusal and report it to the charge nurse.
Alert and oriented residents have the right to refuse care. After respectfully attempting to provide care and being refused, the CNA's duty is to document the refusal accurately in the resident's chart and inform the charge nurse. The nurse may then assess the situation further, explore the reasons for refusal, and develop a new strategy. While asking another CNA or explaining the risks might be part of a larger team strategy, the immediate required action is to document and report the refusal to the licensed professional.
CNA Assisting with Daily Living 2
A resident with severe rheumatoid arthritis has significant pain and stiffness in their hands in the morning.
Which of the following is the most appropriate technique for assisting this resident with dressing?