CNA Toileting and Elimination 2 — Questions and Answers
Question 1: A resident with a spinal cord injury at the T5 level suddenly complains of a pounding headache and is sweating profusely on his face and neck. His blood pressure is significantly elevated. What is the CNA's most immediate and critical action?
- Check for a kink in the urinary catheter tubing. (Correct answer)
- Lower the head of the bed immediately.
- Offer the resident a drink of water.
- Cover the resident with a warm blanket.
Correct answer: Check for a kink in the urinary catheter tubing.
These are classic signs of autonomic dysreflexia, a medical emergency common in residents with spinal cord injuries at T6 or above. It is often triggered by a noxious stimulus below the level of injury, with a distended bladder being the most common cause. Checking for and relieving any obstruction in the urinary catheter is the first and most critical action to remove the stimulus and lower the blood pressure.
Question 2: When applying a condom catheter (urinary sheath) to an uncircumcised resident, which step is essential for preventing injury?
- Retracting the foreskin before applying the catheter.
- Ensuring the foreskin is in its natural, returned position before rolling on the catheter. (Correct answer)
- Applying adhesive tape in a tight, overlapping spiral.
- Leaving less than a half-inch of space between the penis tip and the catheter end.
Correct answer: Ensuring the foreskin is in its natural, returned position before rolling on the catheter.
For an uncircumcised male, the foreskin must be returned to its natural position after cleaning and before the condom catheter is applied. If the foreskin is left retracted, it can cause swelling and constriction, leading to a serious condition called paraphimosis.
Question 3: A resident with a new ileostomy has very liquid, continuous stool. Which of the following is the most important consideration for the CNA during pouch changes?
- Measuring the stoma at each pouch change.
- Ensuring the pouch is no more than one-quarter full before emptying.
- Applying a thick layer of barrier cream to the peristomal skin.
- Protecting the peristomal skin from the liquid stool. (Correct answer)
Correct answer: Protecting the peristomal skin from the liquid stool.
The drainage from an ileostomy is rich in digestive enzymes and is very irritating to the skin. The most critical aspect of care is to ensure the skin barrier is cut to the correct size and a good seal is achieved to protect the peristomal skin from contact with the effluent. While measuring the stoma is important initially, protecting the skin is paramount with this type of output.
Question 4: A CNA is assisting a nurse with a resident who has continuous bladder irrigation (CBI) post-surgery. The CNA's primary responsibility in this situation is to:
- Adjust the flow rate of the irrigation solution.
- Flush the catheter manually if clots are seen.
- Report when the irrigation bag is nearly empty. (Correct answer)
- Assess the color and clarity of the urine.
Correct answer: Report when the irrigation bag is nearly empty.
Continuous bladder irrigation must not be interrupted. The CNA's role is to monitor the system and report to the nurse when the irrigation bag is getting low so a new one can be hung promptly, preventing the system from running dry. Adjusting flow rates and manual flushing are tasks performed by the licensed nurse.
Question 5: A resident with a neurogenic bladder is on a timed voiding schedule. The resident has not voided for 4 hours and reports feeling full. What should the CNA do first?
- Encourage the resident to drink more fluids to stimulate urination.
- Apply firm pressure to the lower abdomen (Credé method).
- Notify the nurse of the situation. (Correct answer)
- Wait another hour and then re-check on the resident.
Correct answer: Notify the nurse of the situation.
A neurogenic bladder means the resident may not be able to empty their bladder effectively, leading to urinary retention. The CNA's observation of the resident not voiding on schedule and the resident's report of fullness are important findings that must be reported to the nurse immediately. The nurse will then assess the resident and determine the appropriate intervention, which may include intermittent catheterization. Applying pressure (Credé method) should only be done if specifically ordered and trained.
Question 6: When a CNA is assigned to administer a rectal suppository for constipation, which action is performed to ensure proper placement and retention?
- Insert the suppository about 1/2 inch into the rectum.
- Encourage the resident to ambulate immediately after insertion.
- Insert the suppository alongside the rectal wall. (Correct answer)
- Position the resident on their right side with their left leg flexed.
Correct answer: Insert the suppository alongside the rectal wall.
The suppository should be inserted about 3-4 inches for an adult and placed against the rectal wall (mucosa) for proper absorption, not into a mass of feces. The resident should be positioned on their left side (Sims' position) and asked to remain in that position for 5-10 minutes to help retain the suppository.
CNA Toileting and Elimination 2
A resident with a spinal cord injury at the T5 level suddenly complains of a pounding headache and is sweating profusely on his face and neck.
His blood pressure is significantly elevated.
What is the CNA's most immediate and critical action?