CNA Bathing and Dressing 2 — Questions and Answers
Question 1: A resident with severe dementia becomes highly agitated and combative during shower time. Which of the following is the MOST appropriate initial action for the CNA to take?
- Firmly hold the resident and continue the shower quickly to get it over with.
- Stop the shower, cover the resident for warmth and privacy, and speak in a calm, reassuring voice. (Correct answer)
- Leave the resident in the shower to calm down alone for a few minutes.
- Offer the resident a favorite snack as a bribe to complete the shower.
Correct answer: Stop the shower, cover the resident for warmth and privacy, and speak in a calm, reassuring voice.
When a resident with dementia becomes agitated, the priority is to de-escalate the situation and ensure their safety and comfort. Stopping the immediate cause of distress (the shower), providing warmth and privacy, and using a calm voice are key de-escalation techniques. Continuing the shower by force can increase agitation and is unsafe. Leaving the resident alone is a safety risk, and bribery is not a therapeutic or effective long-term strategy.
Question 2: When applying anti-embolism stockings (TED hose) to a resident who has been sitting in a chair for an hour, what is the correct first step?
- Apply the stockings immediately while the resident is seated.
- Ask the resident to stand up and march in place for two minutes.
- Have the resident lie down with their legs elevated for at least 15 minutes before application. (Correct answer)
- Soak the resident's feet in warm water to improve circulation before application.
Correct answer: Have the resident lie down with their legs elevated for at least 15 minutes before application.
Anti-embolism stockings are designed to prevent blood from pooling in the legs. If a resident has been sitting or standing, blood will have already pooled due to gravity. To ensure the stockings are effective, the resident should lie down (supine) with their legs elevated for at least 15 minutes to allow the blood to drain from the leg veins before the stockings are applied. Applying them while the resident is sitting would trap the pooled blood and defeat the purpose.
Question 3: A CNA is assisting a resident with a right-sided weakness from a stroke to dress. Which of the following describes the correct technique?
- Undress the right arm first, then the left; Dress the left arm first, then the right.
- Undress the left arm first, then the right; Dress the right arm first, then the left. (Correct answer)
- Always start with the right side for both dressing and undressing for consistency.
- Allow the resident to choose which side to start with to promote independence.
Correct answer: Undress the left arm first, then the right; Dress the right arm first, then the left.
The guiding principle for dressing a resident with one-sided weakness is 'dress the weak side first, undress the strong side first'. This method minimizes the need to move the affected limb and reduces strain. Therefore, the CNA should undress the unaffected (strong) left arm first, and when dressing, start with the affected (weak) right arm.
Question 4: While giving a bed bath, a CNA notices a small, intact blister on the resident's heel, with red and irritated skin around it. This finding should be documented and reported as which stage of pressure injury?
- Stage III
- Unstageable
- Stage I
- Stage II (Correct answer)
Correct answer: Stage II
A Stage II pressure injury is defined as partial-thickness skin loss presenting as a shallow open ulcer with a red-pink wound bed, or as an intact or open/ruptured serum-filled blister. A Stage I injury is non-blanchable redness on intact skin. A Stage III involves full-thickness tissue loss where fat may be visible. An unstageable ulcer has its depth obscured by slough or eschar.
Question 5: A resident has a PICC line in their left arm for long-term antibiotic therapy. What is the most critical precaution the CNA must take when preparing this resident for a shower?
- Ensure the resident's left arm is kept below the level of the heart.
- Apply a tight elastic bandage over the PICC line dressing to hold it in place.
- Cover the entire PICC line dressing and exit site with a waterproof, occlusive cover. (Correct answer)
- Have the resident use their right arm exclusively for washing to avoid dislodging the line.
Correct answer: Cover the entire PICC line dressing and exit site with a waterproof, occlusive cover.
The primary risk associated with a PICC line during bathing is infection, which can occur if the insertion site gets wet. It is crucial to cover the entire dressing and the catheter's exit site with a waterproof cover to keep it completely dry. Submerging the line or allowing water to seep under the dressing can introduce bacteria and lead to a serious bloodstream infection. While being careful with the arm is important, preventing water exposure is the most critical safety measure.
Question 6: When dressing a resident with severe, painful arthritis in their hands and shoulders, which type of clothing would be the most appropriate for the CNA to select?
- A pullover sweater and pants with a button fly.
- A shirt with many small, decorative buttons and zippered pants.
- A wrap-around skirt and a blouse with snaps or Velcro closures. (Correct answer)
- A tight-fitting cotton t-shirt and elastic-waist pants.
Correct answer: A wrap-around skirt and a blouse with snaps or Velcro closures.
For a resident with severe arthritis, the goal is to choose clothing that is easy to put on and take off, minimizing painful movements. A wrap-around skirt avoids the difficulty of pulling pants over the legs and hips. Shirts with large snaps or Velcro closures are much easier to manipulate than small buttons or zippers for someone with limited hand dexterity and shoulder mobility. This choice promotes the resident's independence and reduces discomfort.
CNA Bathing and Dressing 2
A resident with severe dementia becomes highly agitated and combative during shower time.
Which of the following is the MOST appropriate initial action for the CNA to take?