CNA Nutrition and Hydration Management 2 — Questions and Answers
Question 1: A resident with congestive heart failure (CHF) is on a fluid restriction of 1500 mL per day. During your shift, you observe their family brought a large cup of what appears to be a smoothie. The resident has already consumed their lunch fluids. What is the MOST appropriate initial action?
- Take the smoothie away and explain that it violates the fluid restriction.
- Politely explain the fluid restriction to the family and resident, and offer to put the smoothie in the refrigerator for later. (Correct answer)
- Allow the resident to have a few sips and then document the approximate amount consumed.
- Ignore the situation as it is a gift from the family and does not involve facility-provided fluids.
Correct answer: Politely explain the fluid restriction to the family and resident, and offer to put the smoothie in the refrigerator for later.
Educating the resident and family about the importance of the fluid restriction is crucial for their health and safety. Offering to save the item for another time respects the family's gesture while still adhering to the care plan. Taking it away can be confrontational, and allowing consumption violates the prescribed medical order. All intake, regardless of source, must be counted.
Question 2: You are assisting a resident with severe rheumatoid arthritis during mealtime. They have difficulty holding standard utensils due to joint pain and stiffness. Which of the following adaptive devices would be MOST beneficial to promote their independence?
- A plate guard
- A nosey cup
- Utensils with built-up, weighted handles (Correct answer)
- A bib-style clothing protector
Correct answer: Utensils with built-up, weighted handles
Utensils with built-up handles are easier to grip for individuals with limited finger function, such as those with severe arthritis. Weighted handles help to stabilize hand tremors. This combination directly addresses the resident's specific physical challenges, promoting self-feeding and dignity.
Question 3: A resident with dementia often becomes agitated and refuses to eat, stating they believe the food is poisoned. Which strategy is most likely to be effective in encouraging nutritional intake?
- Insisting they eat because it is required for their health.
- Offering to taste the food first in front of the resident.
- Serving meals in the original packaging, such as a yogurt container or pre-packaged sandwich. (Correct answer)
- Asking a different staff member to attempt feeding the resident.
Correct answer: Serving meals in the original packaging, such as a yogurt container or pre-packaged sandwich.
For a resident with paranoia or delusions about food, seeing it come from a sealed, unopened container can provide reassurance that it has not been tampered with. This approach addresses their specific fear directly and non-confrontationally. Tasting the food might sometimes work but can also be incorporated into the delusion. Insisting they eat will likely increase agitation.
Question 4: Which of the following is considered a 'honey-thick' liquid consistency according to the National Dysphagia Diet (NDD)?
- A liquid that is slightly thicker than water and flows like apricot nectar.
- A liquid that is very thick, holds its shape, and must be eaten with a spoon.
- A liquid that pours very slowly, like molasses, and drizzles off a spoon. (Correct answer)
- A thin liquid, like water or clear juice, with no modifications.
Correct answer: A liquid that pours very slowly, like molasses, and drizzles off a spoon.
Honey-thick liquids are moderately thick and flow off a spoon slowly in a drizzle, similar to the consistency of honey or molasses. Nectar-thick is thinner, and pudding-thick is the thickest consistency, requiring a spoon.
Question 5: You are caring for a resident who is receiving end-of-life care. Their appetite has significantly decreased, and they often refuse meals. The family is very distressed, believing the resident is 'starving.' What is the CNA's most appropriate response?
- Encourage the family to bring in the resident's favorite high-calorie foods to tempt them.
- Explain that loss of appetite is a natural part of the dying process and forcing food can cause discomfort. (Correct answer)
- Suggest the family speak with the doctor about getting a feeding tube placed.
- Document the refusal and say nothing to the family to avoid upsetting them further.
Correct answer: Explain that loss of appetite is a natural part of the dying process and forcing food can cause discomfort.
A key part of end-of-life care is educating the family. It's important to gently explain that as the body's systems slow down, the need and desire for food decrease. Forcing nutrition can cause nausea, bloating, and other distress. The focus shifts from caloric intake to comfort.
Question 6: A resident who had a stroke has dysphagia and is at high risk for aspiration. Which of the following observations, if made during or after a meal, would require IMMEDIATE reporting to the nurse as a possible sign of silent aspiration?
- The resident complains that the pureed food is bland.
- The resident develops a frequent, wet-sounding cough or gurgly voice. (Correct answer)
- The resident pockets food in one side of their mouth.
- The resident eats only half of the meal provided.
Correct answer: The resident develops a frequent, wet-sounding cough or gurgly voice.
A wet or gurgly-sounding voice after eating or drinking is a key indicator that fluid or food may have passed the vocal cords and entered the airway, which is a sign of aspiration. While food pocketing is a concern to be addressed, a wet cough suggests a more immediate risk to the resident's respiratory system.
CNA Nutrition and Hydration Management 2
A resident with congestive heart failure (CHF) is on a fluid restriction of 1500 mL per day.
During your shift, you observe their family brought a large cup of what appears to be a smoothie.
The resident has already consumed their lunch fluids.
What is the MOST appropriate initial action?