CNA Supporting Rehabilitation Activities 2 — Questions and Answers
Question 1: A resident is using a continuous passive motion (CPM) machine after a total knee replacement. The resident reports a new, sharp pain in the knee. What is the CNA's most appropriate immediate action?
- Stop the machine and notify the nurse at once. (Correct answer)
- Adjust the machine's range of motion to a more comfortable setting.
- Offer the resident pain medication that is ordered as needed (PRN).
- Reassure the resident that some pain is normal and continue the therapy.
Correct answer: Stop the machine and notify the nurse at once.
A new, sharp pain during CPM therapy is a significant finding that could indicate a complication. The CNA's primary role is observation and reporting. The safest and most appropriate action is to stop the machine to prevent further injury and immediately inform the nurse, who can then assess the resident and determine the cause. Adjusting the machine or administering medication is outside the CNA's scope of practice.
Question 2: A CNA is assisting a resident who is relearning to eat after a stroke. The speech therapist has been working with the resident on swallowing techniques. Which of the following is the most subtle but critical sign of possible aspiration that the CNA must report immediately?
- A new, wet or gurgly-sounding voice after swallowing. (Correct answer)
- The resident eating very slowly.
- Occasional drooling of saliva from the corner of the mouth.
- The resident stating they do not like the pureed food.
Correct answer: A new, wet or gurgly-sounding voice after swallowing.
While coughing or choking are obvious signs of aspiration, a wet, gurgly voice (dysphonia) after swallowing is a more subtle but critical indicator that fluid or food may have entered the airway. Slow eating, some drooling, or food dislike are common but less urgent issues. A gurgly voice requires immediate reporting to the nurse for further assessment to prevent aspiration pneumonia.
Question 3: While performing passive range-of-motion (PROM) exercises on a resident with severe joint contractures, the resident, who is non-verbal, grimaces and tenses their body when you attempt to extend their arm. What is the CNA's correct action?
- Move the joint only to the point of resistance or pain, without forcing it. (Correct answer)
- Apply gentle, steady pressure to try and slowly increase the extension.
- Stop the exercises for that limb and move on to a different one.
- Document the resident's refusal and skip PROM for the rest of the shift.
Correct answer: Move the joint only to the point of resistance or pain, without forcing it.
The primary rule for PROM is to move the joint gently and to stop at the point of resistance or pain. Forcing the movement can cause injury. The CNA should respect the non-verbal cues of pain, move the joint only within its pain-free range, and report the resident's reaction and the limited range of motion to the nurse. It is not appropriate to force the joint or to abandon the exercises entirely without reporting.
Question 4: A resident recovering from a spinal cord injury requires assistance with lower body dressing. Which of the following techniques is most important for the CNA to use to prevent complications?
- Rolling the resident side-to-side to pull up pants and checking the skin for redness with each turn. (Correct answer)
- Encouraging the resident to sit up at the edge of the bed unsupported to build core strength.
- Choosing tight-fitting clothing to provide extra support to the lower limbs.
- Completing the dressing task as quickly as possible to minimize the resident's fatigue.
Correct answer: Rolling the resident side-to-side to pull up pants and checking the skin for redness with each turn.
Residents with spinal cord injuries have a very high risk of developing pressure injuries due to impaired sensation and mobility. The log-rolling technique allows for dressing while minimizing spinal movement and provides a crucial opportunity to inspect the skin, especially over bony prominences like the sacrum and hips, for any signs of pressure. Loose clothing is recommended, and safety is more important than speed or unsupported sitting.
Question 5: A resident is working with occupational therapy to use a weighted spoon to manage tremors. The resident becomes extremely frustrated, shouts, "I can't do this!" and throws the spoon. What is the CNA's most therapeutic response?
- Acknowledge their frustration calmly and offer to take a short break. (Correct answer)
- Insist they pick up the spoon and try again to stay on schedule.
- Tell the resident that everyone struggles at first and they shouldn't give up.
- Immediately report the behavior to the nurse as uncooperative.
Correct answer: Acknowledge their frustration calmly and offer to take a short break.
Rehabilitation can be a long and frustrating process. The CNA's role includes providing emotional support. Acknowledging the resident's feelings validates their experience, and suggesting a brief pause can help de-escalate the situation and allow the resident to regain composure. This response is empathetic and supportive, fostering a better therapeutic relationship than insisting, minimizing their feelings, or immediately labeling them as uncooperative.
Question 6: A CNA observes a resident, who has weakness on their left side, ambulating with a quad cane. The resident is holding the cane with their left hand and moving it with their left foot. The CNA knows this is incorrect. What is the CNA's best course of action?
- Gently remind the resident that the cane should be on their strong side and assist them in correcting its use. (Correct answer)
- Take the cane away immediately as it is a safety hazard.
- Allow the resident to continue, as they may have a different method taught by the therapist.
- Report the observation to the nurse and the physical therapist at the next opportunity.
Correct answer: Gently remind the resident that the cane should be on their strong side and assist them in correcting its use.
Assistive devices like canes should be used on the strong (unaffected) side to provide a wide base of support and unload weight from the weaker side. Using it on the weak side is unsafe. The CNA's role includes reinforcing training provided by therapy. The best action is to provide immediate, gentle correction and assistance to ensure safety, and then report the need for re-education to the nurse/therapist. Simply taking the cane away could cause a fall, and ignoring the incorrect use is unsafe.
CNA Supporting Rehabilitation Activities 2
A resident is using a continuous passive motion (CPM) machine after a total knee replacement.
The resident reports a new, sharp pain in the knee.
What is the CNA's most appropriate immediate action?