CNA Preventing Patient Falls and Injuries 2 — Questions and Answers
Question 1: A resident with orthostatic hypotension who has been dizzy upon standing is starting a new blood pressure medication. What is the MOST appropriate action for the CNA to take before assisting the resident to ambulate for the first time after receiving the new medication?
- Ask the resident to sit on the edge of the bed for a few minutes before standing. (Correct answer)
- Take the resident's blood pressure while they are lying down.
- Encourage the resident to walk quickly to a nearby chair.
- Have the resident drink a full glass of water immediately before getting up.
Correct answer: Ask the resident to sit on the edge of the bed for a few minutes before standing.
Orthostatic hypotension is a drop in blood pressure upon standing, which can be worsened by new medications. Having the resident dangle their legs at the bedside for a few minutes allows their body to adjust to the change in position, reducing dizziness and the risk of falling.
Question 2: You are caring for a resident with advanced dementia who becomes increasingly agitated and restless in the late afternoon, a behavior known as 'sundowning'. Which of the following interventions is most likely to decrease their risk of falling during this time?
- Increasing the lighting in the room and playing loud, upbeat music.
- Asking the resident to stay in their room alone to reduce stimulation.
- Engaging the resident in a calm, familiar activity, such as folding laundry. (Correct answer)
- Administering a new sedative medication ordered by the physician.
Correct answer: Engaging the resident in a calm, familiar activity, such as folding laundry.
Engaging a resident with dementia in a simple, familiar, and calming activity can redirect their focus and reduce agitation and restlessness associated with sundowning. This structured activity provides a sense of purpose and can prevent aimless wandering, which increases fall risk. Increasing stimulation can worsen agitation, and isolation may increase anxiety.
Question 3: A patient is consistently trying to slide down in their wheelchair, increasing their risk of falling out. The CNA has already ensured the patient is comfortable and has no unmet needs. What is the best immediate action?
- Apply a lap belt to keep the patient in the chair and report it to the nurse.
- Place a wedge cushion in the wheelchair and reposition the patient. (Correct answer)
- Inform the patient that they must sit up straight to be safe.
- Remove the patient from the wheelchair and place them in bed with all side rails up.
Correct answer: Place a wedge cushion in the wheelchair and reposition the patient.
A wedge cushion is designed to be higher in the front, which helps to prevent a patient from sliding forward and out of the chair. After placing the cushion, the CNA should properly reposition the patient to ensure they are seated safely and comfortably. This is a specific intervention to address the sliding issue without using a restraint.
Question 4: A facility has placed thick, cushioned floor mats next to the beds of high-risk residents to reduce injury from a fall. When is this floor mat MOST likely to become a hazard itself?
- When the resident is sleeping soundly in the bed.
- When a staff member is assisting the resident out of bed to a standing position. (Correct answer)
- When the resident is using the call light to ask for assistance.
- When the mat is placed on a carpeted surface instead of a hard floor.
Correct answer: When a staff member is assisting the resident out of bed to a standing position.
While floor mats can cushion a fall from bed, their thickness can create an uneven surface and a significant trip hazard for both residents and staff, especially during transfers when a stable footing is crucial. The mat should be moved aside during assisted transfers.
Question 5: A resident expresses a significant fear of falling after a recent near-miss event and is now refusing to participate in their prescribed physical therapy. Which action by the CNA is most appropriate?
- Insist that the resident must attend therapy because the doctor ordered it.
- Tell the resident their fear is irrational and they will be fine.
- Ask the nurse or physical therapist to discuss alternative, less intimidating exercises with the resident. (Correct answer)
- Document the refusal and take no further action.
Correct answer: Ask the nurse or physical therapist to discuss alternative, less intimidating exercises with the resident.
Fear of falling is a legitimate concern that can impede recovery and increase fall risk. The CNA should report this to the nurse or therapist. They can then work with the resident to find alternative exercises, perhaps starting with chair-based exercises, to build confidence and strength without causing distress, which is a key part of patient-centered care.
Question 6: Which of the following is an often-overlooked environmental factor that a CNA can modify to help prevent falls in residents with visual impairments?
- Ensuring the television volume is at an appropriate level.
- Administering prescribed eye drops exactly on schedule.
- Reducing glare by adjusting blinds and using soft, indirect lighting. (Correct answer)
- Making sure the resident's hearing aids are working properly.
Correct answer: Reducing glare by adjusting blinds and using soft, indirect lighting.
For individuals with visual impairments, glare from windows or bright overhead lights can be disorienting and obscure hazards on the floor. A CNA can proactively manage the environment by adjusting blinds and using lamps or nightlights to create consistent, glare-free illumination, which enhances visibility and safety.
CNA Preventing Patient Falls and Injuries 2
A resident with orthostatic hypotension who has been dizzy upon standing is starting a new blood pressure medication.
What is the MOST appropriate action for the CNA to take before assisting the resident to ambulate for the first time after receiving the new medication?