CNA Personal Care Skills 2 — Questions and Answers
Question 1: When assisting a resident with oral hygiene, what should the nurse aide do if the resident is unconscious or unable to swallow?
- Use a bulb syringe to rinse the mouth thoroughly
- Position the resident on their side and use a small amount of liquid with oral swabs (Correct answer)
- Skip oral care until the resident becomes conscious
- Apply toothpaste generously and suction immediately
Correct answer: Position the resident on their side and use a small amount of liquid with oral swabs
For unconscious or dysphagic residents, the nurse aide should position them on their side to prevent aspiration and use oral swabs with minimal liquid. This maintains oral hygiene while protecting the airway.
Unconscious residents cannot protect their own airway, making aspiration a serious risk during oral care. Positioning the resident on their side uses gravity to keep fluids from entering the airway. Oral swabs (foam-tip applicators) moistened with a small amount of water or mouthwash allow the nurse aide to clean teeth, gums, and tongue without flooding the mouth. Bulb syringes introduce too much fluid, and skipping oral care leads to infection risk. This skill falls under Physical Care Skills in the NNAAP framework.
Question 2: A resident's fingernails need to be trimmed. Which residents should have their nail care referred to a nurse or podiatrist rather than performed by the nurse aide?
- Residents who are over 80 years old
- Residents who are ambulatory and independent
- Residents with diabetes or circulatory conditions (Correct answer)
- Residents who request nail trimming themselves
Correct answer: Residents with diabetes or circulatory conditions
Residents with diabetes or circulatory problems have reduced sensation and healing capacity in their extremities. Cutting their nails poses a risk of injury and infection, so nail care must be delegated to a licensed nurse or podiatrist.
Diabetes causes peripheral neuropathy (reduced sensation) and poor circulation, meaning a small nick from nail trimming can go unnoticed and progress to a serious infection or ulcer. Similarly, vascular diseases reduce blood flow to the feet, impairing wound healing. NNAAP guidelines specifically require nurse aides to refer nail care for residents with these conditions to a licensed professional. This protects residents from preventable complications and is part of the Physical Care Skills domain.
Question 3: When giving a complete bed bath to a resident, which area should the nurse aide wash LAST?
- Face and neck
- Chest and abdomen
- Legs and feet
- Perineal area (Correct answer)
Correct answer: Perineal area
The perineal area (genitals and anal region) is washed last during a bed bath because it is the most contaminated area. Washing it last prevents spreading microorganisms to cleaner areas of the body.
Standard bed bath procedure follows a clean-to-dirty principle. The nurse aide begins with the face (cleanest) and proceeds down the body, finishing with the perineal area, which harbors the highest concentration of microorganisms. Washing the perineum last — and using a clean washcloth or fresh side of the cloth for each stroke — prevents the transfer of fecal bacteria to other body parts or to the caregiver. This is a fundamental infection control practice within the Physical Care Skills domain of the NNAAP exam.
Question 4: A resident tells the nurse aide they prefer to wear their own clothing rather than a hospital gown. What is the most appropriate response?
- Explain that hospital gowns are required for safety and infection control
- Inform the charge nurse and document that the resident refused the gown
- Honor the resident's preference and assist them with their own clothing (Correct answer)
- Allow personal clothing only on days when no medical procedures are scheduled
Correct answer: Honor the resident's preference and assist them with their own clothing
Respecting residents' personal preferences in clothing is an expression of their dignity and individual rights. The nurse aide should honor this preference as long as it does not create a safety concern.
Resident rights are a core NNAAP domain under Psychosocial Care Skills and Role of the Nurse Aide. Residents have the legal right to wear their own clothing and express their individual identity. Forcing residents to wear hospital gowns when they have expressed a preference for personal clothing violates their dignity and autonomy. The nurse aide should assist the resident in dressing in their preferred attire, ensuring it is clean, safe (no tripping hazards), and appropriate for the weather. This empowers residents and supports their psychological well-being.
Question 5: Which technique should the nurse aide use when shampooing the hair of a resident who must remain in bed?
- Tilt the bed to a 90-degree angle so water drains to the floor
- Use a specially designed shampoo basin or inflatable trough to catch water (Correct answer)
- Perform a dry shampoo only — wet shampooing is not allowed in bed
- Wrap the head tightly in towels before applying shampoo to absorb excess water
Correct answer: Use a specially designed shampoo basin or inflatable trough to catch water
A shampoo basin or inflatable hair-washing trough is placed under the resident's head to collect water and prevent it from soaking the bed. This allows safe and thorough hair washing for bed-bound residents.
Bed-bound residents still require hair washing for hygiene, comfort, and dignity. A plastic shampoo basin or inflatable trough is positioned beneath the head and neck to channel water away from the bed linens and into a bucket. The nurse aide uses warm water and mild shampoo, rinses thoroughly, and dries the hair promptly to prevent chilling. Tilting the bed 90 degrees is not safe; dry shampoo is an alternative but does not replace wet washing; and towels alone cannot absorb enough water to prevent soaking. This procedure falls under Physical Care Skills in the NNAAP framework.
Question 6: When applying anti-embolism (compression) stockings to a resident, the nurse aide should:
- Apply the stockings immediately after the resident gets out of bed and walks around
- Apply the stockings while the resident is lying down before they get out of bed (Correct answer)
- Leave the stockings on continuously for 72 hours without removal
- Apply the stockings only when the resident reports leg pain or swelling
Correct answer: Apply the stockings while the resident is lying down before they get out of bed
Anti-embolism stockings should be applied while the resident is lying down, before they stand or ambulate. This prevents blood from pooling in the leg veins before the stockings are in place, maximizing their effectiveness in preventing deep vein thrombosis (DVT).
Anti-embolism stockings (TED hose or compression stockings) work by applying graduated pressure to the legs, improving venous return and reducing the risk of deep vein thrombosis and pulmonary embolism. When a person stands or sits, gravity causes blood to pool in the lower extremities. By applying the stockings while the resident is supine (before rising), the veins are at their smallest and the stockings fit most effectively. Waiting until after ambulation allows pooling to occur first, reducing the stockings' therapeutic benefit. Stockings should be removed at least once per shift to assess skin integrity. This is a Restorative Care and Physical Care Skills topic on the NNAAP exam.
CNA Personal Care Skills 2
When assisting a resident with oral hygiene, what should the nurse aide do if the resident is unconscious or unable to swallow?