CNA Skills and Competencies 2 — Questions and Answers
Question 1: A resident with advanced dementia is non-verbal and frequently groans and grimaces, especially during repositioning. The nurse has instructed the CNA to monitor for signs of pain. Which of the following is the MOST reliable way for the CNA to assess this resident's pain level?
- Ask the resident's family if this is their typical behavior when uncomfortable.
- Use a standardized pain assessment tool for non-verbal patients, such as observing for restlessness, facial expressions, and body language. (Correct answer)
- Assume the resident is in pain and immediately request PRN pain medication from the nurse.
- Check if the resident's vital signs are elevated, as this is the primary indicator of pain.
Correct answer: Use a standardized pain assessment tool for non-verbal patients, such as observing for restlessness, facial expressions, and body language.
Pain is a subjective experience, and in non-verbal patients, self-report is not possible. While family input is helpful, the most reliable and systematic approach is to use a standardized observational tool that assesses specific behaviors known to indicate pain, such as facial expressions (grimacing), body movements (restlessness, guarding), and vocalizations (groaning). This provides a more objective basis for reporting to the nurse than relying solely on vital signs, which can be affected by many other factors, or assumptions.
Question 2: During post-mortem care, the family of the deceased resident, who practiced a specific religion, requests to perform a ritual washing of the body. The facility's standard procedure is for staff to perform all aspects of body preparation. What is the CNA's most appropriate initial action?
- Politely inform the family that only trained staff can handle the body due to infection control policies.
- Allow the family to proceed with the ritual, as long as they wear appropriate personal protective equipment (PPE).
- Immediately notify the supervising nurse of the family's specific cultural and religious request. (Correct answer)
- Explain that while you understand, all post-mortem procedures must wait until the funeral home arrives.
Correct answer: Immediately notify the supervising nurse of the family's specific cultural and religious request.
A CNA's primary responsibility in this sensitive situation is to communicate the family's needs to the nurse. While accommodating cultural and religious preferences is crucial, the nurse must first assess the situation to ensure the request can be met safely and in accordance with facility policy, possibly making an exception or modification. The CNA should not independently approve or deny the request, as this falls outside their scope of practice.
Question 3: A nurse gives a CNA a verbal order to apply a sterile dressing to a resident's small, open wound. The CNA has not been trained in sterile technique. Which of the following is the CNA's correct response?
- Attempt to apply the dressing using clean technique instead of sterile technique.
- Ask another, more experienced CNA to perform the task.
- Politely refuse the task and inform the nurse that performing sterile procedures is outside a CNA's scope of practice. (Correct answer)
- Find the supplies and wait for the nurse to return to supervise the procedure.
Correct answer: Politely refuse the task and inform the nurse that performing sterile procedures is outside a CNA's scope of practice.
Applying a sterile dressing is generally considered outside the scope of practice for a CNA, as it requires knowledge of sterile technique to prevent infection. CNAs are responsible for knowing their legal and professional boundaries. The correct action is to refuse the task respectfully and clearly state the reason, ensuring patient safety and adherence to professional standards.
Question 4: While assisting a resident, a CNA receives a written order from a physician that seems ambiguous and potentially unsafe. The order reads: 'Increase fluid intake.' The resident has a history of congestive heart failure (CHF) and is on a fluid restriction. What should the CNA do first?
- Follow the physician's order as written, assuming the doctor has a reason for changing the plan.
- Ask the resident's family if they are aware of any changes to the care plan.
- Ignore the new order and continue with the previously established fluid restriction.
- Do not act on the order and immediately report the discrepancy to the supervising nurse for clarification. (Correct answer)
Correct answer: Do not act on the order and immediately report the discrepancy to the supervising nurse for clarification.
A CNA's responsibility includes recognizing and reporting potential safety risks or contradictions in care. Given the resident's history of CHF and fluid restriction, the order to 'Increase fluid intake' is ambiguous and potentially harmful. The CNA must not act on this order. The first and most critical step is to bring the concern to the supervising nurse, who can then clarify the order with the physician.
Question 5: During a family visit, a CNA observes a resident's adult child speaking to them in a demeaning manner and handling their arm roughly. The resident appears fearful and tearful. This is the first time the CNA has witnessed such behavior. What is the CNA's immediate legal and ethical responsibility?
- Confront the family member directly and tell them to stop.
- Wait until the visit is over and then ask the resident if they feel safe.
- Document the observation in the resident's chart and monitor future visits closely.
- Ensure the resident's immediate safety and report the suspicion of abuse to the charge nurse according to facility protocol. (Correct answer)
Correct answer: Ensure the resident's immediate safety and report the suspicion of abuse to the charge nurse according to facility protocol.
CNAs are mandated reporters. When they suspect any form of abuse (physical, verbal, emotional), their immediate duty is to protect the resident and report their observations to their supervisor. This initiates the facility's protocol for investigating and addressing potential abuse. Confronting the family member could escalate the situation, and waiting to report could leave the resident in a dangerous situation.
Question 6: A CNA is assigned to provide care for a resident who has just been admitted from another country and speaks a language the CNA does not understand. When attempting to provide personal care, the resident becomes agitated and pushes the CNA away. Which action demonstrates the highest level of competency?
- Use loud, simple English words and hand gestures to explain the task.
- Leave the room and come back later when the resident has calmed down.
- Notify the nurse that a facility-approved interpreter is needed to communicate effectively.
- Ask a fellow CNA who knows a few words in that language to try and assist. (Correct answer)
Correct answer: Ask a fellow CNA who knows a few words in that language to try and assist.
Effective communication is key to providing safe and compassionate care. When a language barrier exists, using professional interpreter services is the best practice to ensure clear and accurate communication, respect the resident's rights, and prevent misunderstandings that could lead to agitation or refusal of care. Using gestures, loud speech, or untrained individuals can lead to misinterpretation and is not a substitute for professional interpretation.
CNA Skills and Competencies 2
A resident with advanced dementia is non-verbal and frequently groans and grimaces, especially during repositioning.
The nurse has instructed the CNA to monitor for signs of pain.
Which of the following is the MOST reliable way for the CNA to assess this resident's pain level?