CNA Roles and Responsibilities 3 — Questions and Answers
Question 1: A resident's family member, who states she is a Registered Nurse, tells the CNA that her mother's IV fluid bag is empty and asks the CNA to hang a new bag that is on the bedside table. What is the CNA's MOST appropriate response?
- Tell the family member that since she is an RN, she can hang the new bag herself.
- Hang the new IV bag as requested to be helpful and responsive to the family.
- Politely state that this task is not within a CNA's scope of practice and immediately find the supervising nurse to report the situation. (Correct answer)
- Make a note to inform the nurse about the empty IV bag when she makes her next rounds.
Correct answer: Politely state that this task is not within a CNA's scope of practice and immediately find the supervising nurse to report the situation.
Managing intravenous (IV) therapy, including changing fluid bags, is a complex task that falls outside the scope of practice for a CNA. [2, 23] It requires the clinical judgment of a licensed nurse. The CNA's correct action is to refuse the request politely, explain why, and immediately alert the supervising nurse who is responsible for IV management.
Question 2: A CNA is assigned to provide postmortem care. Which of the following actions represents an advanced application of this responsibility?
- Notifying the physician that the resident has passed away.
- Gently closing the resident's eyes and mouth and placing a rolled towel under the chin.
- Asking the family about any specific cultural or religious customs they wish to have observed during the care. (Correct answer)
- Completing the legal paperwork for the death certificate.
Correct answer: Asking the family about any specific cultural or religious customs they wish to have observed during the care.
While all CNAs are trained in the physical tasks of postmortem care, such as bathing the body and positioning it respectfully, an advanced application involves demonstrating cultural competence and sensitivity. [3] Asking the family about their specific customs shows respect and provides holistic, family-centered care during a difficult time. Notifying the physician and handling legal paperwork are outside the CNA's scope, while closing the eyes/mouth is a standard procedural step. [3, 25]
Question 3: During a care planning meeting, a CNA who has a strong rapport with a resident with dementia is asked for input. Which contribution would be most appropriate and valuable for the CNA to provide?
- A suggestion for a new medication to manage the resident's anxiety.
- An opinion that the current physical therapy plan is not effective.
- Observations about daily routines and activities that seem to calm or agitate the resident. (Correct answer)
- A diagnosis of the stage of the resident's dementia based on behavior.
Correct answer: Observations about daily routines and activities that seem to calm or agitate the resident.
CNAs spend the most time with residents and are uniquely positioned to observe their daily habits, preferences, and behaviors. [21, 22] Providing specific observations about what triggers agitation or promotes calm is invaluable information for the interdisciplinary team to create an effective, individualized care plan. [22] Suggesting medications, diagnosing, or critiquing other professionals' plans are outside the CNA's scope of practice.
Question 4: A resident who is normally calm and cooperative suddenly becomes verbally aggressive and strikes out at the CNA during morning care. What is the CNA's priority initial action?
- Continue with the care task as quickly as possible to finish.
- Immediately restrain the resident to prevent further aggression.
- Step back to a safe distance, speak in a calm voice, and attempt to de-escalate the situation. (Correct answer)
- Leave the room and immediately document the resident's behavior in the chart.
Correct answer: Step back to a safe distance, speak in a calm voice, and attempt to de-escalate the situation.
The CNA's immediate priority is the safety of both the resident and themselves. De-escalation is the first step when a resident becomes combative. [15] This involves creating a safe space, remaining calm, and using a soothing tone. [6, 15] Continuing the task could escalate the situation, restraints are a last resort and require a physician's order, and while documentation is crucial, it is not the initial action in an unsafe situation.
Question 5: A CNA is asked by the facility's activities director to apply a complex, sterile dressing to a small abrasion on a resident's arm before an outdoor event. The supervising nurse is busy in another wing. The CNA should:
- Apply a simple adhesive bandage instead of the complex dressing.
- Refuse the task, stating it is outside the CNA's scope of practice, and inform the activities director to find the nurse. (Correct answer)
- Attempt to apply the sterile dressing carefully as requested.
- Apply a non-sterile gauze pad and report it to the nurse later.
Correct answer: Refuse the task, stating it is outside the CNA's scope of practice, and inform the activities director to find the nurse.
Applying a sterile dressing is a nursing task that falls outside the CNA's scope of practice. [9, 10, 18] It requires sterile technique and wound assessment skills. The correct action is to recognize this boundary, refuse to perform the task, and ensure the person who made the request understands they need to find a licensed nurse to perform it. Applying any other dressing would be inappropriate and documentation alone is not sufficient.
Question 6: Which of the following is a key responsibility of a CNA regarding a resident's nutritional intake, beyond simply assisting with feeding?
- Developing a new dietary plan if the resident is losing weight.
- Calculating the resident's specific daily caloric needs.
- Independently ordering a change to the texture of the resident's food (e.g., pureed).
- Observing and documenting the percentage of meals consumed and reporting any significant changes or difficulties to the nurse. (Correct answer)
Correct answer: Observing and documenting the percentage of meals consumed and reporting any significant changes or difficulties to the nurse.
While CNAs assist with feeding, a crucial and advanced responsibility is to be the 'eyes and ears' for the nurse. This includes carefully observing how much the resident eats, noting any difficulties with chewing or swallowing, and documenting this information accurately. [14] Reporting these observations promptly is vital for the nurse and dietitian to assess the resident's condition. Developing plans, calculating caloric needs, and ordering diet changes are outside the CNA's scope of practice.
CNA Roles and Responsibilities 3
A resident's family member, who states she is a Registered Nurse, tells the CNA that her mother's IV fluid bag is empty and asks the CNA to hang a new bag that is on the bedside table.
What is the CNA's MOST appropriate response?