CNA Scope of Practice 2 — Questions and Answers
Question 1: A registered nurse is busy with a critical patient and asks the CNA to apply a prescribed medicated cream to a resident's pressure injury that has broken the skin. The CNA has previously applied barrier creams for this resident. What is the CNA's most appropriate action?
- Apply the medicated cream as requested and document it.
- Refuse the task and report the nurse to the supervisor for inappropriate delegation.
- Inform the nurse that applying medication to non-intact skin is outside the CNA scope of practice. (Correct answer)
- Ask another CNA to witness the application of the cream.
Correct answer: Inform the nurse that applying medication to non-intact skin is outside the CNA scope of practice.
While CNAs may apply over-the-counter barrier creams to intact skin, applying any substance, especially a prescribed medicated one, to non-intact skin is considered a medication administration and wound care task. This requires a nurse's assessment and is outside the typical scope of practice for a CNA. The most appropriate action is to professionally and clearly state why the task cannot be performed.
Question 2: A resident with a well-established ostomy asks the CNA for advice on how to manage skin irritation around the stoma. The CNA has received facility-approved training in basic ostomy care. Which of the following responses is within the CNA's scope of practice?
- "You should try using a different type of ostomy appliance; I can show you some options online."
- "I can clean the area and apply the barrier powder as the care plan directs. I will also report the irritation to the nurse right away." (Correct answer)
- "It looks like you might have a fungal infection. I'll get you some antifungal cream to apply to the area."
- "Let's cut the opening on your wafer a little larger to give the skin some air."
Correct answer: "I can clean the area and apply the barrier powder as the care plan directs. I will also report the irritation to the nurse right away."
A CNA with specialized training can perform routine, established ostomy care, which includes emptying the bag, cleaning the skin, and applying barrier creams or powders as directed by the care plan. However, assessing the skin, diagnosing a condition (like an infection), recommending new products, or altering the ostomy appliance are all outside the CNA scope of practice. The correct action is to perform the allowed task and immediately report the observation to the nurse for assessment.
Question 3: During a medical emergency, a resident becomes unresponsive and stops breathing. Which of the following actions falls outside the CNA's scope of practice, even in this emergency?
- Initiating chest compressions as part of CPR.
- Activating the emergency response system and calling for a nurse.
- Administering a family member's nitroglycerin tablet to the resident. (Correct answer)
- Bringing the emergency crash cart to the room.
Correct answer: Administering a family member's nitroglycerin tablet to the resident.
Administering medication, especially a prescription medication like nitroglycerin that does not belong to the resident, is strictly outside the CNA scope of practice, even in an emergency. CNAs are trained and expected to perform CPR, call for help, and assist the team by bringing equipment. However, medication administration requires a licensed nurse's order and assessment.
Question 4: A CNA is working in a state where, with additional certification and under specific circumstances, they are permitted to perform certain advanced tasks. Which of these tasks would most likely require this type of special certification?
- Performing range-of-motion exercises on a post-stroke resident.
- Discontinuing a resident's indwelling urinary catheter. (Correct answer)
- Assisting a resident with using a metered-dose inhaler.
- Documenting a resident's fluid intake and output.
Correct answer: Discontinuing a resident's indwelling urinary catheter.
While specific regulations vary by state, discontinuing (removing) an indwelling urinary catheter is an invasive procedure that is generally outside the standard CNA scope. Some states or facilities may allow a specially trained CNA to perform this task. The other tasks, such as assisting with inhalers (but not administering the medication independently), performing restorative exercises, and documenting I&O, are more commonly within the standard CNA role.
Question 5: A resident's family member asks the CNA to explain the side effects of the resident's new blood pressure medication. The most appropriate response for the CNA is to:
- Read the side effects from the medication information sheet to the family.
- Explain that CNAs cannot provide medical education and offer to get the nurse. (Correct answer)
- Share a personal experience with a similar medication.
- Advise the family to look up the information on the internet.
Correct answer: Explain that CNAs cannot provide medical education and offer to get the nurse.
Patient education, including explaining medication actions and side effects, is the responsibility of licensed nurses. A CNA's scope is to reinforce information already provided by the nurse, not to provide new education. Reading from a handout could lead to misinterpretation, and the other options are unprofessional and inappropriate. The correct action is to defer to the nurse.
Question 6: A nurse delegates several tasks for a stable resident. Which of the following delegated tasks should the CNA question or refuse to perform?
- Performing a routine, clean intermittent catheterization for a resident with a long-term spinal cord injury.
- Emptying and measuring the output from a Jackson-Pratt (JP) surgical drain. (Correct answer)
- Applying compression stockings (TED hose) to the resident's legs.
- Reinforcing the nurse's instructions on how to use the call light.
Correct answer: Emptying and measuring the output from a Jackson-Pratt (JP) surgical drain.
Managing surgical drains, including a Jackson-Pratt drain, requires sterile technique, assessment of the drainage, and monitoring of the insertion site, which are all nursing responsibilities outside the CNA scope of practice. In some states/facilities, a specially trained CNA may perform clean intermittent catheterization. Applying compression stockings and reinforcing teaching are standard CNA tasks.
CNA Scope of Practice 2
A registered nurse is busy with a critical patient and asks the CNA to apply a prescribed medicated cream to a resident's pressure injury that has broken the skin.
The CNA has previously applied barrier creams for this resident.
What is the CNA's most appropriate action?