Certified Nursing Assistant (CNA) Exam — Questions and Answers

Question 1: A CNA is considering specialization to increase earning potential and career distinction. Which specialty certification area has seen the MOST consistent demand growth driven by demographic shifts in the U.S. population, making it the most strategically sound long-term investment?

Pediatric care assistance certification
Geriatric care and dementia/Alzheimer's specialty certification (Correct answer)
Surgical technician cross-training
Behavioral health aide certification

Correct answer: Geriatric care and dementia/Alzheimer's specialty certification

The aging Baby Boomer population is driving sustained, decades-long growth in demand for geriatric and dementia care specialists. The U.S. Census projects the 65+ population to nearly double by 2060, creating long-term structural demand. Pediatric CNA roles are comparatively limited, surgical tech is a distinct career path, and behavioral health aide roles, while growing, are not driven by the same demographic inevitability.

Question 2: When lifting a heavy object, the CNA should:

Use a wide base of support and bend at the knees (Correct answer)
Twist the body to position the object
Keep legs straight and arms extended
Bend at the waist

Correct answer: Use a wide base of support and bend at the knees

Proper body mechanics: wide base, bend knees, keep back straight, hold object close.

Question 3: A CNA is ambulating a post-surgical resident using a gait belt when the resident suddenly becomes pale, diaphoretic, and states 'I feel like I'm going to faint.' The hallway has no chairs immediately available. What is the correct technique to protect the resident?

Widen the CNA's stance, slide the resident down the CNA's leg to the floor in a controlled descent, and call for help (Correct answer)
Lower the resident's head between the knees while both remain standing to restore blood pressure
Tighten the gait belt, lean the resident against the wall, and run to get a wheelchair
Ask the resident to take slow deep breaths and continue walking to the nearest room

Correct answer: Widen the CNA's stance, slide the resident down the CNA's leg to the floor in a controlled descent, and call for help

When a resident is about to faint during ambulation, the priority is preventing an uncontrolled fall. The CNA should widen their base of support, use the gait belt to guide the resident in a controlled slide down the CNA's leg to the floor, then call for help. Leaving the resident alone to get a wheelchair risks an unprotected fall. Lowering the head while standing is impractical and dangerous. Continuing ambulation ignores a medical emergency.

Question 4: A resident tells the CNA they want to file a complaint against the facility. The CNA should:

Inform the resident of their right to contact the ombudsman and assist them (Correct answer)
Explain that complaints rarely result in changes
Tell the nurse so the situation can be handled internally
Discourage the complaint by explaining how hard the staff works

Correct answer: Inform the resident of their right to contact the ombudsman and assist them

Residents have the right to voice grievances without retaliation, and CNAs must support access to the ombudsman.

Question 5: A facility's nurse call system generates an automated alert showing a resident has not triggered their bed sensor for an unusually long time — atypical for that resident's pattern. No alarm is audible. What should the CNA do FIRST?

Wait 15 minutes to see if the pattern normalizes before taking action
Report the sensor as malfunctioning to maintenance and document it
Reset the sensor from the monitoring station, since no audible alarm means no emergency
Immediately perform a welfare check on the resident in person (Correct answer)

Correct answer: Immediately perform a welfare check on the resident in person

An absence of expected movement data is a passive alert that can indicate a fall, loss of consciousness, or other emergent event. The absence of an audible alarm does not mean there is no emergency — the sensor may itself be malfunctioning or the resident may be incapacitated. The priority is always direct resident safety verification. A welfare check must happen immediately before any device troubleshooting.

Question 6: A resident's family member, who is also a registered nurse but is visiting in a personal capacity, tells the CNA to change the dressing on the resident's Stage 3 pressure injury. The family member says she has 'permission' from the resident. What should the CNA do?

Allow the family member (as a nurse) to perform the dressing change while the CNA assists
Change the outer dressing layer only, leaving the wound contact layer intact
Perform the dressing change since a licensed nurse has authorized it
Decline to perform the dressing change and notify the charge nurse (Correct answer)

Correct answer: Decline to perform the dressing change and notify the charge nurse

Dressing changes on Stage 3 pressure injuries involve wound assessment and sterile technique and are outside the CNA scope of practice. Authorization can only come through the facility's chain of command—a visiting family member, even if credentialed, has no authority to delegate clinical tasks to facility staff. The CNA must decline and notify the charge nurse, who can assess the wound and determine the appropriate intervention.

Question 7: Once a nurse aide’s name is placed on the abuse registry for neglect they may

continue to work as long as they abuse no one else.
work only as a home health aide.
petition the state nursing board for reinstatement. (Correct answer)
never be employed as a nurse aide again.

Correct answer: petition the state nursing board for reinstatement.

If a nurse aide's name is placed on the abuse registry for neglect, it typically means they are barred from working as a CNA. However, most states have a process where an individual can petition the state nursing board or equivalent regulatory body for reinstatement after a certain period, provided they meet specific criteria, such as demonstrating rehabilitation or completing additional training. This process allows for potential re-entry into the profession under strict conditions.

Question 8: Which communication technique is most effective when speaking with a hearing-impaired resident?

Shout loudly so they can hear across the room
Face the resident, speak clearly at a normal pitch, and check for comprehension (Correct answer)
Speak very rapidly to keep the resident engaged
Write all communications instead of speaking

Correct answer: Face the resident, speak clearly at a normal pitch, and check for comprehension

When communicating with a hearing-impaired resident, the CNA should face the resident directly, speak clearly at a normal or slightly lower pitch (not shouting), use short sentences, check for understanding, and ensure hearing aids are in and working if prescribed.

Question 9: A CNA is providing oral care to an unconscious resident and notices the resident begins to gag. What is the PRIORITY action?

Elevate the head of the bed to 90 degrees and continue oral care slowly
Turn the resident's head to the side and pause suctioning to allow the gag reflex to subside (Correct answer)
Stop oral care immediately and document that it could not be completed
Call the nurse immediately and do not attempt any further oral care

Correct answer: Turn the resident's head to the side and pause suctioning to allow the gag reflex to subside

When an unconscious resident gags during oral care, the priority is to turn their head to the side to prevent aspiration and allow secretions to drain, then pause to let the gag reflex subside before carefully continuing. Stopping entirely or escalating unnecessarily denies the resident essential hygiene; elevating to 90 degrees is appropriate positioning before starting but does not address an active gag reflex.

Question 10: A resident who had a stroke has left-sided weakness and is receiving range-of-motion exercises. While performing passive ROM on the affected shoulder, you feel sudden resistance and the resident grimaces. What is the MOST appropriate immediate action?

Apply gentle but firm pressure to push through the resistance to prevent contracture
Stop the exercise immediately and report the resistance and pain response to the nurse (Correct answer)
Skip the shoulder and continue ROM on other joints, documenting the resistance later
Ask another CNA to hold the resident still while you complete the full shoulder ROM

Correct answer: Stop the exercise immediately and report the resistance and pain response to the nurse

Sudden resistance combined with a pain response (grimacing) indicates possible injury, spasm, or a musculoskeletal complication. The CNA must stop immediately to prevent further harm and report to the nurse, who can assess for fracture, dislocation, or increased spasticity. Pushing through resistance risks serious injury. Continuing elsewhere without reporting delays necessary evaluation.

Question 11: An older adult's total body water percentage has declined from approximately 60% in young adulthood to roughly 50%. Which clinical consequence is most directly attributable to this specific compositional change?

Decreased red blood cell production from bone marrow adipose replacement
Reduced volume of distribution for water-soluble drugs, raising peak serum concentrations (Correct answer)
Increased risk of hyponatremia due to impaired sodium reabsorption
Elevated serum potassium from reduced aldosterone-mediated excretion

Correct answer: Reduced volume of distribution for water-soluble drugs, raising peak serum concentrations

Total body water (TBW) serves as the volume of distribution (Vd) for hydrophilic (water-soluble) drugs. When TBW decreases with aging, the same dose of a water-soluble drug is dissolved in less fluid, producing higher peak serum concentrations and potentially toxic effects. This is distinct from changes in renal clearance. The other options involve mechanisms not directly linked to TBW reduction: hyponatremia relates to ADH and renal function; RBC production decline relates to marrow changes; potassium regulation relates to aldosterone.

Question 12: A CNA discovers that a co-worker has been documenting vital signs before actually measuring them to save time. The CNA has not yet reported this. Under HIPAA and professional ethics standards, what is the CNA's PRIMARY obligation?

Document personal observations in a private journal before deciding whether to report
Speak privately with the co-worker first and give them 24 hours to self-report
Report the behavior to the charge nurse or supervisor immediately, regardless of workplace relationships (Correct answer)
Report only if a patient is demonstrably harmed by the falsified documentation

Correct answer: Report the behavior to the charge nurse or supervisor immediately, regardless of workplace relationships

CNAs have an immediate and non-negotiable duty to report unsafe or unethical practices that could harm residents, regardless of personal relationships or whether harm has already occurred. Falsifying medical records is both illegal and a patient safety issue — waiting for harm to occur, allowing self-reporting windows, or simply journaling observations are all ethically insufficient and may make the CNA complicit. The charge nurse or supervisor must be notified immediately.

Question 13: A CNA is assisting a resident with dysphagia to eat. The resident has a dietary order for nectar-thick liquids. The family member at the bedside insists on giving the resident regular water because 'they always loved water.' What is the MOST appropriate CNA response?

Thicken the water to nectar consistency before allowing the family to give it
Explain that only the nurse or physician can modify the thickened-liquid order, and offer to contact the nurse (Correct answer)
Allow the family to give a small amount of regular water since family preferences should be respected
Document the family's request and allow it once per visit as a quality-of-life measure

Correct answer: Explain that only the nurse or physician can modify the thickened-liquid order, and offer to contact the nurse

A thickened-liquid order is a physician/speech-language pathologist directive based on aspiration risk assessment. The CNA has no authority to override or modify this order. The correct response is to respectfully explain this limitation and facilitate communication with the nurse, who can involve the care team if the family wants to revisit the order.

Question 14: SBAR is a communication tool used during handoff reporting. What does it stand for?

Situation, Background, Assessment, Recommendation (Correct answer)
Signs, Body, Activity, Response
Symptoms, Baseline, Assessment, Reporting
Status, Background, Assessment, Resolution

Correct answer: Situation, Background, Assessment, Recommendation

SBAR (Situation, Background, Assessment, Recommendation) is a standardized communication framework that promotes clear, concise, structured reporting during care transitions and urgent communications.

Question 15: Which abbreviation correctly means 'nothing by mouth'?

PRN
BID
NPO (Correct answer)
SOB

Correct answer: NPO

NPO stands for 'nil per os,' a Latin phrase meaning nothing by mouth, used when a resident must not eat or drink.

Question 16: A CNA is performing passive range-of-motion exercises on a resident's shoulder when the resident suddenly grimaces and says nothing but grips the bedrail tightly. What is the MOST appropriate immediate action?

Ask the family member present whether to continue
Reduce the range of motion slightly and continue the exercise
Complete the exercise quickly to minimize prolonged discomfort
Stop the exercise immediately and assess the resident for pain (Correct answer)

Correct answer: Stop the exercise immediately and assess the resident for pain

Nonverbal signs of pain — such as grimacing or gripping the bedrail — are valid pain indicators, especially in residents who cannot or choose not to verbalize discomfort. The CNA must stop immediately, assess, and report. Continuing in any form risks injury and violates the resident's right to pain-free care.

Question 17: When counting a resident's pulse, the CNA notices it is bounding and strong. This finding most likely indicates:

The resident needs more fluids
Normal cardiac function
The resident is relaxed and sleeping
A potentially elevated blood pressure or fluid overload (Correct answer)

Correct answer: A potentially elevated blood pressure or fluid overload

A bounding pulse can indicate elevated blood pressure, fluid overload, or other cardiovascular changes that warrant reporting.

Question 18: What information should ALWAYS be included in a resident's fluid intake and output (I&O) record?

The exact volume in milliliters, type of fluid, and time consumed or measured (Correct answer)
Only fluid intake — output is tracked separately by the nurse
The type of beverage only
An estimated amount based on the container size

Correct answer: The exact volume in milliliters, type of fluid, and time consumed or measured

Accurate I&O records require the exact measured volume (mL), type of fluid (water, juice, broth), and time of intake or output to allow the care team to assess fluid balance precisely.

Question 19: How long should a CNA scrub hands with soap and water to meet standard hand hygiene guidelines?

At least 10 seconds
At least 20 seconds (Correct answer)
At least 45 seconds
At least 5 seconds

Correct answer: At least 20 seconds

The CDC recommends scrubbing all hand surfaces with soap and water for at least 20 seconds before rinsing.

Question 20: When is it appropriate for a CNA to apply a physical restraint?

Only when a physician has written an order and consent is obtained (Correct answer)
When the family requests it for safety
When the CNA feels it is necessary during a busy shift
Whenever the patient is agitated

Correct answer: Only when a physician has written an order and consent is obtained

Physical restraints require a physician's order and informed consent before application.

Question 21: When documenting a resident's report of pain, the CNA should record:

The resident's exact words, pain location, scale rating, and time (Correct answer)
Only the CNA's own assessment of whether the pain seems real
A brief summary like 'resident seemed uncomfortable'
Nothing, since pain assessment is the nurse's responsibility

Correct answer: The resident's exact words, pain location, scale rating, and time

Accurate documentation uses the resident's own words and includes objective details like location, severity rating, and timing.

Question 22: Which of the following should be reported when monitoring a catheterized resident?

Clear yellow urine with a volume of 50 mL/hour
Cloudy brown urine with sediment and strong odor (Correct answer)
Urine that smells slightly of what the resident ate
Pale urine with no visible sediment

Correct answer: Cloudy brown urine with sediment and strong odor

Cloudy, brown, or foul-smelling urine with sediment is abnormal and may indicate infection, dehydration, or other pathology. This must be reported to the nurse promptly.

Question 23: A CNA is caring for a resident with a court-appointed legal guardian. The resident, who has mild dementia, verbally consents to a non-emergency procedure. The legal guardian, however, has not been contacted and has not provided consent. How should the CNA proceed?

Obtain written consent from the resident as this supersedes the guardian's authority for mild dementia cases
Hold the procedure and notify the nurse so the legal guardian can be contacted for proper consent (Correct answer)
Proceed with the procedure since the resident's verbal consent is sufficient for non-emergency interventions
Ask a family member present to provide substitute consent since the guardian is unavailable

Correct answer: Hold the procedure and notify the nurse so the legal guardian can be contacted for proper consent

When a resident has a court-appointed legal guardian, that guardian holds decision-making authority for the resident — even if the resident can verbally express preferences. A legal guardian's authority is established by a court and supersedes the resident's own consent capacity (the court determined the resident lacked full decision-making capacity). For non-emergency procedures, the guardian must be contacted and provide informed consent. Another family member cannot substitute for a legally appointed guardian. The CNA's role is to hold the procedure and notify the nurse to facilitate the proper consent process.

Question 24: An AED is brought to the scene of a cardiac arrest. What is the CNA's responsibility when an AED is present?

Wait to use the AED until two nurses are present
Continue CPR until the nurse arrives and ignore the AED
Attach and use the AED as soon as possible and follow its voice prompts (Correct answer)
Only allow physicians to use the AED

Correct answer: Attach and use the AED as soon as possible and follow its voice prompts

AEDs are designed for use by bystanders and first responders. Their rapid application significantly improves cardiac arrest survival rates and CNAs trained in CPR are expected to use them.

Question 25: A resident grimaces and says 'ouch' during a ROM exercise. What is the FIRST action the CNA should take?

Continue the exercise since some discomfort is expected
Apply a warm compress to the area
Stop the exercise immediately and notify the nurse (Correct answer)
Document the complaint and finish the session

Correct answer: Stop the exercise immediately and notify the nurse

Pain during ROM is a signal to stop immediately and report to the nurse before continuing.

Question 26: Restorative care documentation should be completed:

Only when a resident makes significant progress
Once per shift regardless of session timing
Immediately after each session while details are accurate (Correct answer)
At the end of the week in a summary

Correct answer: Immediately after each session while details are accurate

Documenting immediately after each session ensures accuracy and provides the care team with current information about the resident's progress.

Question 27: What should a nurse aide do when a resident comes out their room wearing mismatched slippers?

Make the resident go back and fix their mistake.
Tell the resident to get help next time.
Quietly ask if the resident notices the slippers. (Correct answer)
Tease the resident about their fashion sense.

Correct answer: Quietly ask if the resident notices the slippers.

When a resident wears mismatched slippers, the most respectful and appropriate action is to quietly and privately ask if they've noticed. This approach allows the resident to maintain dignity and control, giving them the opportunity to correct the situation themselves if they wish. It avoids embarrassment and respects their autonomy, while still addressing a potential safety or comfort issue discreetly.

Question 28: A CNA documents that a resident's wound dressing was changed at 1400, but the charge nurse later reviews the MAR and discovers the dressing was actually changed at 1600. What is the legally and ethically correct action the CNA should take?

Add the correct time in parentheses above the original entry without crossing anything out
Draw a single line through the incorrect time, write the correct time and initials beside it, and document the reason for the correction (Correct answer)
Discard the original documentation page and rewrite the entire entry with the correct time
Use correction fluid to cover the error and rewrite the correct time over it

Correct answer: Draw a single line through the incorrect time, write the correct time and initials beside it, and document the reason for the correction

The correct method for correcting a charting error is to draw a single line through the incorrect entry (never obliterate it), write the correct information, initial and date the correction, and document the reason. Using correction fluid, discarding records, or rewriting charts are forms of falsification that can result in license revocation and legal consequences.

Question 29: A resident in a restorative walking program begins to complain of chest pain during ambulation. The CNA should:

Encourage the resident to push through the discomfort
Continue walking at a slower pace
Have the resident sit down and call for the nurse immediately (Correct answer)
Document the complaint and report at end of shift

Correct answer: Have the resident sit down and call for the nurse immediately

Chest pain during activity is a serious symptom requiring the resident to stop immediately and the nurse to be notified right away.

Question 30: Why is it important to encourage residents to perform as much of their own grooming as possible?

To help them save energy for other activities.
To promote independence and self-esteem. (Correct answer)
To reduce the workload for staff.
To speed up the grooming process.

Correct answer: To promote independence and self-esteem.

Encouraging residents to participate in their own grooming tasks promotes independence and enhances their self-esteem. Allowing them to perform as much as they can fosters a sense of control and dignity, which is vital for their overall well-being. This approach supports their remaining abilities and prevents learned helplessness.

Question 31: Which statement is false?

Religious and cultural practices are not allowed in the health care agency. (Correct answer)
A person's culture influences health and illness practices.
A person may not follow the beliefs and practices of their religion or culture.
Culture and religion influence food practices.

Correct answer: Religious and cultural practices are not allowed in the health care agency.

The statement that "Religious and cultural practices are not allowed in the health care agency" is false. Healthcare facilities are legally and ethically obligated to respect and accommodate residents' diverse religious and cultural beliefs and practices, provided they do not pose a direct threat to health or safety. Providing culturally competent care is essential for holistic patient well-being and satisfaction.

Question 32: What is the first step a CNA should take to prevent the spread of infection?

Use hand sanitizer after patient contact
Perform hand hygiene (Correct answer)
Wear a gown when entering a patient’s room
Wear gloves when touching patients

Correct answer: Perform hand hygiene

Hand hygiene (washing hands with soap and water or using an alcohol-based hand rub) is the first and most important step to prevent the spread of infection. It should be done before and after contact with patients, after using the restroom, before eating, and after touching any potentially contaminated surfaces. Gloves, gowns, and hand sanitizers are additional measures but do not replace proper hand hygiene.

Question 33: What is dysphagia?

Inability to digest fat
Loss of appetite
Difficulty swallowing (Correct answer)
Excessive hunger

Correct answer: Difficulty swallowing

Dysphagia refers to difficulty or discomfort in swallowing, which increases aspiration risk and may require diet texture modifications.

Question 34: When emptying a urinary catheter drainage bag, the CNA should:

Leave the drainage port open briefly to air-dry after emptying
Drain directly into the toilet without measuring if the patient is stable
Empty into a measuring container, record the output, and clean the drainage port with an alcohol wipe before recapping (Correct answer)
Allow the drainage port to contact the measuring container

Correct answer: Empty into a measuring container, record the output, and clean the drainage port with an alcohol wipe before recapping

Emptying into a measuring container allows accurate intake/output documentation; cleaning the drainage port with alcohol and recapping maintains the closed sterile system.

Question 35: A resident with advanced dementia has become increasingly confused, irritable, and drowsy over the past 24 hours. They have also had a decreased urinary output. Which condition should the CNA suspect and report to the nurse immediately?

Progression of their dementia.
Dehydration. (Correct answer)
A urinary tract infection.
A reaction to a new medication.

Correct answer: Dehydration.

While the other options are possible, the acute onset of increased confusion, lethargy, and decreased urination are classic signs of dehydration in the elderly. These symptoms can often be mistaken for dementia progression, but their sudden appearance warrants immediate investigation for dehydration.

Question 36: A normal pulse oximetry (SpO2) reading for a healthy adult is:

85% to 90%
80% to 85%
95% to 100% (Correct answer)
90% to 94%

Correct answer: 95% to 100%

A normal SpO2 reading is 95% to 100%; readings below 90% indicate hypoxia and must be reported immediately.

Question 37: A CNA is caring for a patient on Contact Precautions for C. difficile (C. diff). After removing gloves, the CNA performs hand hygiene. Which statement is correct regarding hand hygiene for C. diff specifically?

Either soap and water or ABHR is equally effective against C. diff spores
ABHR with at least 70% ethanol is sufficient to eliminate C. diff spores
Soap and water must be used because ABHR does not kill C. diff spores (Correct answer)
ABHR is preferred because it kills C. diff spores faster than soap and water

Correct answer: Soap and water must be used because ABHR does not kill C. diff spores

C. difficile produces spores that are resistant to alcohol-based hand rubs regardless of concentration. Soap and water physically removes spores from the skin through mechanical action; it does not kill them but washes them down the drain. For this reason, CDC guidelines mandate soap and water — not ABHR — after caring for patients with C. diff infections.

Question 38: How can the nurse's assistant convey interest and attentiveness to a client?

Change the subject frequently.
Respond when appropriate. (Correct answer)
Direct the conversation.
Correct the client’s mistakes.

Correct answer: Respond when appropriate.

Conveying interest and attentiveness involves active listening and appropriate responses. Responding thoughtfully and relevantly shows the client that their words are being heard and valued. This builds trust and encourages open communication, which is vital for effective care.

Question 39: A CNA is caring for a resident using a mechanical lift for transfers. The sling was laundered by the laundry department and returned to the room. Before using it, the CNA should FIRST:

Inspect the sling for any tears, frayed edges, or damaged attachment loops before each use (Correct answer)
Check that the sling is the correct size by attempting to position it under the resident
Confirm with the nurse that the sling has been cleared for reuse after laundering
Attach the sling to the lift and test it with a lighter resident before using it with this resident

Correct answer: Inspect the sling for any tears, frayed edges, or damaged attachment loops before each use

Mechanical lift slings must be inspected before every use for structural integrity — including tears, fraying, stretched fabric, or damaged D-rings/loops — regardless of whether they were recently laundered. Laundering can weaken stitching or reveal pre-existing damage. Attempting to size-check by positioning first, testing on another resident, or waiting for nurse clearance are not standard pre-use protocols. Sling failure during a lift can cause a resident to fall and sustain serious injury.

Question 40: Which factor can cause a falsely LOW pulse oximetry reading?

Poor peripheral circulation or cold extremities (Correct answer)
High altitude
Resting quietly in a warm room
Recent physical activity

Correct answer: Poor peripheral circulation or cold extremities

Poor peripheral circulation reduces blood flow to the probe site, causing the pulse oximeter to produce a falsely low SpO2 reading.

Question 41: When using nonverbal communication with residents, a CNA should be aware that:

Nonverbal cues are less important than spoken words
Crossing arms shows a resident you are focused on listening
Nonverbal communication is only relevant with non-English speakers
Body language, eye contact, and facial expressions convey powerful messages (Correct answer)

Correct answer: Body language, eye contact, and facial expressions convey powerful messages

Nonverbal communication including posture, facial expression, and eye contact significantly affects how residents feel and whether they feel respected.

Question 42: When should a CNA perform hand hygiene during isolation precautions?

Only after removing PPE.
Once per shift while in isolation care.
Before entering the patient’s room only.
Before and after entering the room. (Correct answer)

Correct answer: Before and after entering the room.

Performing hand hygiene both before and after entering an isolation room is a critical infection control measure. Washing hands before entry protects the patient from any pathogens the CNA might carry. Washing hands again after exiting removes any microorganisms acquired in the room, preventing their spread to other areas or individuals.

Question 43: A CNA discovers a patient is not breathing and has no pulse. The facility has an AED nearby. What is the correct sequence?

Start CPR only and wait for the nurse to use the AED
Use AED first, then start CPR after the first shock
Call for help, start CPR, use AED as soon as available (Correct answer)
Call 911, wait for paramedics, then start CPR

Correct answer: Call for help, start CPR, use AED as soon as available

The chain of survival requires calling for help, starting CPR immediately, and attaching the AED as soon as it arrives.

Question 44: During a care task, a resident makes a sexually inappropriate comment toward the CNA. What is the MOST appropriate initial response?

Immediately leave the room and document the incident without addressing the resident
Laugh it off to avoid escalating the situation and complete care as quickly as possible
Calmly and professionally set a limit by stating the behavior is inappropriate, then continue care if safe (Correct answer)
Threaten to report the resident to the charge nurse if the behavior continues

Correct answer: Calmly and professionally set a limit by stating the behavior is inappropriate, then continue care if safe

The CNA should calmly and professionally address the inappropriate behavior in the moment by clearly stating it is unacceptable, which maintains boundaries without escalating. Ignoring or laughing it off signals tacit acceptance; leaving without addressing it abandons the resident's care; threatening is unprofessional and confrontational. Documentation and reporting to a supervisor should still follow after care is completed.

Question 45: The purpose of using a draw sheet (pull sheet) when repositioning a patient in bed is to:

Restrain the patient during the procedure
Keep the patient warm during repositioning
Absorb incontinence between linen changes
Reduce friction and shear on the patient's skin (Correct answer)

Correct answer: Reduce friction and shear on the patient's skin

A draw sheet reduces friction and shear forces on fragile skin when sliding or turning a patient.

Question 46: Which of the following behaviors in an elderly resident most likely indicates depression?

Excitement about upcoming family visits
Increased participation in social activities
Improved appetite and energy levels
Persistent sadness, withdrawal, and loss of interest in activities (Correct answer)

Correct answer: Persistent sadness, withdrawal, and loss of interest in activities

Depression in the elderly commonly presents as persistent sadness, social withdrawal, loss of interest in previously enjoyed activities, and changes in appetite or sleep.

Question 47: A family member corners a CNA in the hallway and demands to know the full details of another resident's medical diagnosis. The CNA should PRIMARILY:

Remind them that medical diagnoses are confidential and suggest they speak with their own family's care team
Provide a brief summary to maintain family trust and facility relationships
Tell them you do not know the other resident's diagnosis to avoid conflict
Explain that you can only discuss a resident's information with authorized individuals and refer them to the nurse (Correct answer)

Correct answer: Explain that you can only discuss a resident's information with authorized individuals and refer them to the nurse

HIPAA strictly prohibits disclosing any resident's protected health information to unauthorized parties, including other families. The correct response is to acknowledge the limitation honestly (without being dismissive) and refer the individual to the appropriate team member. Fabricating ignorance is dishonest; discussing any detail — even minimal — is a privacy violation; suggesting they talk to their own family's team doesn't address this situation correctly.

Question 48: During morning care, a CNA notices that a resident's gastrostomy tube (G-tube) site has a small amount of dried, brownish drainage around the stoma that was present on the previous shift as well and is documented as 'baseline.' The tube is patent and the resident has no complaints. What should the CNA do?

Gently clean the site with warm water and a washcloth per care plan, then document the unchanged appearance (Correct answer)
Leave the site untouched since any disturbance may dislodge the tube
Apply hydrogen peroxide to dissolve the dried drainage and report a change in condition
Report the drainage to the nurse as a new finding requiring wound care orders

Correct answer: Gently clean the site with warm water and a washcloth per care plan, then document the unchanged appearance

Documented baseline drainage that is unchanged does not constitute a new finding. The CNA should perform routine stoma skin care per the care plan (typically cleaning with warm water) and document that the site appears at baseline. Leaving dried secretions in place risks skin breakdown. Hydrogen peroxide is not appropriate for routine stoma care. Reporting as 'new' when it is documented as baseline creates unnecessary alarm.

Question 49: When measuring weight, the CNA should:

Weigh at the same time of day, in similar clothing, and on the same scale (Correct answer)
Weigh the resident with shoes on for accuracy
Weigh at different times of day for comparison
Estimate weight from appearance if the scale is unavailable

Correct answer: Weigh at the same time of day, in similar clothing, and on the same scale

Consistent technique — same time of day (usually morning after toileting), similar clothing, and the same scale — ensures accurate weight comparisons over time.

Question 50: Which action by a CNA would constitute abuse?

Threatening to withhold a meal unless a resident completes an activity (Correct answer)
Assisting a resident with ambulation using a gait belt
Reporting a fall incident to the charge nurse
Documenting a resident's refusal of care

Correct answer: Threatening to withhold a meal unless a resident completes an activity

Threatening to withhold meals is a form of psychological and physical abuse involving coercion and potential neglect of a basic need.

Question 51: A patient on contact precautions requires a bed bath. Halfway through the procedure, the CNA realizes there are not enough clean washcloths to complete the bath. What is the correct action?

Ask a passing staff member to hand supplies through the door without the CNA leaving
Leave the patient uncovered, exit the room to get supplies, then re-gown and re-glove before re-entering
Use paper towels to finish the remaining areas
Cover the patient, remove PPE, get supplies, perform hand hygiene, re-don PPE before re-entering the room (Correct answer)

Correct answer: Cover the patient, remove PPE, get supplies, perform hand hygiene, re-don PPE before re-entering the room

Contact precautions require full PPE compliance at every entry into the room. The CNA must leave the patient in a safe, covered position, remove and discard PPE outside the room, perform hand hygiene, retrieve supplies, then perform hand hygiene and re-don fresh PPE before re-entering. Leaving the patient uncovered is a dignity and safety violation; using paper towels is not an approved skin care method.

Question 52: A resident with MRSA is on contact precautions. Which statement about their room placement is CORRECT?

A private room or cohorting with same-organism patients is preferred (Correct answer)
They must share a room only with other MRSA patients
They must always be in a negative-pressure room
Room placement does not matter with contact precautions

Correct answer: A private room or cohorting with same-organism patients is preferred

Contact precautions ideally use a private room, or cohorting (placing patients with the same organism together) when a private room is unavailable.

Question 53: A urine specimen collected via clean-catch midstream must be transported to the lab but will not arrive for 90 minutes. The CNA has no ice available. Which action best preserves specimen integrity?

Add a boric acid preservative tube and document the additive used
Refrigerate the specimen at 2–8°C and transport within the 2-hour window (Correct answer)
Collect a new specimen immediately before transport to ensure freshness
Pour the specimen into a sterile container with a tight-fitting lid to slow evaporation

Correct answer: Refrigerate the specimen at 2–8°C and transport within the 2-hour window

Refrigeration at 2–8°C is the standard method to preserve urine specimens when immediate delivery is not possible, inhibiting bacterial overgrowth and cellular degradation for up to 24 hours. Boric acid is a valid chemical preservative but requires specific tubes that a CNA may not independently add without an order. Simply resealing does not prevent degradation, and collecting a new specimen without resolving the transport delay repeats the same problem.

Question 54: A patient who is visually impaired and uses bifocal glasses is being transferred to a new room. Which environmental modification is MOST critical to implement BEFORE leaving the patient alone?

Ensure the television remote is within reach on the bedside table
Dim the room lighting to reduce glare that worsens bifocal distortion at close range
Place a non-slip mat at the bathroom threshold and orient the patient verbally to the new room layout (Correct answer)
Raise all four side rails to the highest position to prevent the patient from getting up unsupervised

Correct answer: Place a non-slip mat at the bathroom threshold and orient the patient verbally to the new room layout

Visually impaired patients are at high risk for falls in unfamiliar environments. Non-slip surfaces address the most common fall mechanism (slipping), and verbal orientation builds the patient's mental map of the new space, reducing the likelihood they will misjudge distances or miss obstacles. Raising all four rails is a restraint requiring a physician's order and is inappropriate without one. Dimming lights reduces visibility and worsens orientation. The remote control is comfort-oriented, not safety-critical.

Question 55: A nurse delegates a task to a CNA. Which element is required for the delegation to be valid?

The CNA must have completed at least five years of experience
The task must be listed in the state nursing practice act as a physician task
The nurse must complete the task first as a demonstration
The task must be one the CNA has been trained and is competent to perform (Correct answer)

Correct answer: The task must be one the CNA has been trained and is competent to perform

Valid delegation requires that the task is within the CNA's training and competency, and is appropriate for delegation under state law.

Question 56: A CNA documents that a resident's wound dressing was changed at 2:15 PM, but realizes at 3:00 PM that she accidentally recorded it in the wrong resident's chart. What is the correct way to handle this documentation error?

Use correction fluid to cover the error, then write the correct information
Shred the page and start a new documentation sheet
Draw a single line through the error, write 'error,' add initials and date/time, then document correctly (Correct answer)
Erase the incorrect entry and rewrite it in the correct chart

Correct answer: Draw a single line through the error, write 'error,' add initials and date/time, then document correctly

The correct method for handling a documentation error is to draw a single line through the mistake so the original entry remains legible, write 'error' above or beside it, initial and date/time stamp the correction, then document the accurate information. Using correction fluid, erasing, or destroying records are all violations of legal medical record standards because they obscure what was originally written.

Question 57: A CNA is caring for a resident with moderate Alzheimer's disease who becomes agitated every afternoon around 3 PM, pacing the hallways and calling out. This pattern has occurred for several weeks. Which intervention best addresses the underlying cause of this behavior?

Assess for unmet physiological needs and implement a structured pre-afternoon activity to reduce sundowning triggers (Correct answer)
Document the behavior and wait for the next scheduled care conference to develop a plan
Redirect the resident to their room and close the door to prevent wandering
Administer a PRN anxiolytic medication as ordered to calm the resident

Correct answer: Assess for unmet physiological needs and implement a structured pre-afternoon activity to reduce sundowning triggers

Sundowning is a recognized pattern of increased confusion and agitation in the late afternoon/evening in cognitively impaired residents. The best approach is proactive: assess for unmet needs (hunger, pain, fatigue, toileting) and implement structured, calming activities before the predictable onset. Medications should not be the first-line response to behavioral symptoms. Isolating the resident increases distress, and waiting for a care conference fails to address an ongoing pattern.

Question 58: A CNA discovers that a colleague has been documenting vital signs as 'completed' in the electronic health record without actually performing them. The CNA does not report this because she does not want to cause trouble. Which ethical principle is the CNA violating by staying silent?

Veracity, because silence implies agreement with the falsified records
Justice, because the colleague is receiving equal workload unfairly
Fidelity, because she is failing to keep her promise to perform her duties
Nonmaleficence, because inaction in the face of foreseeable harm constitutes doing harm by omission (Correct answer)

Correct answer: Nonmaleficence, because inaction in the face of foreseeable harm constitutes doing harm by omission

Nonmaleficence means 'do no harm.' When a CNA knowingly allows falsified documentation to continue unchallenged, she permits foreseeable patient harm through missed clinical data—violating nonmaleficence by omission. Mandatory reporting laws in most states also require CNAs to report suspected abuse or neglect, including fraudulent documentation that endangers residents. Fidelity relates to keeping promises; veracity relates to truthfulness in one's own statements.

Question 59: A resident with an obstructed airway

Can speak
Is always unconscious
Can breathe
Cannot speak (Correct answer)

Correct answer: Cannot speak

A complete airway obstruction prevents air from passing through the vocal cords, making it impossible for a person to speak or make any sounds. While they might try to cough or gasp, no vocalizations will occur. This inability to speak is a critical sign indicating a severe choking emergency that requires immediate intervention.

Question 60: During a bed bath, a CNA notes that the patient's left arm is significantly weaker than the right due to a recent stroke. When changing the patient's gown, which sequence is correct?

Remove from the strong arm first, then the weak arm; dress the strong arm first, then the weak arm
Remove from the weak arm first, then the strong arm; dress the weak arm first, then the strong arm
Remove from the strong arm first, then the weak arm; dress the weak arm first, then the strong arm (Correct answer)
Remove from the weak arm first, then the strong arm; dress the strong arm first, then the weak arm

Correct answer: Remove from the strong arm first, then the weak arm; dress the weak arm first, then the strong arm

The correct technique follows the principle 'undress the strong side first, dress the weak side first.' This is because removing the gown from the strong arm first gives the maximum range of motion to maneuver the garment over and off the weak arm. Conversely, when dressing, the weak arm is placed into the sleeve first so that the remaining, more flexible strong arm can be guided in with less risk of pain or injury. This minimizes strain on the affected limb throughout the process.

Question 61: A resident's intake and output (I&O) record shows output far exceeding intake over 24 hours. The CNA should:

Report the imbalance to the nurse immediately (Correct answer)
Encourage fluids independently without notifying the nurse
Restrict fluids to reduce output
Document the finding and do nothing further

Correct answer: Report the imbalance to the nurse immediately

A significant I&O imbalance can indicate dehydration and must be reported promptly to the nurse.

Question 62: A resident with severe rheumatoid arthritis in both hands uses a button hook and built-up-handle utensils. The occupational therapist's care plan specifies 'allow maximum time for self-care with adaptive devices.' During a morning care session running behind schedule, the charge nurse asks the CNA to just dress the resident quickly. What should the CNA do?

Allow the resident to attempt one task with the adaptive device, then complete the rest for them.
Skip the adaptive devices for that morning and document that the resident refused to use them.
Explain to the nurse that the care plan specifies independent ADL use with adaptive devices and ask for guidance on how to proceed. (Correct answer)
Dress the resident quickly to keep the unit schedule on track, then document the deviation.

Correct answer: Explain to the nurse that the care plan specifies independent ADL use with adaptive devices and ask for guidance on how to proceed.

The care plan — developed by the occupational therapist and interdisciplinary team — is a legally binding directive for care. Bypassing it without documented clinical rationale violates the resident's right to rehabilitation-focused care and may constitute neglect. The CNA must escalate the conflict to the nurse rather than unilaterally override the plan or falsify documentation.

Question 63: A resident recovering from surgery reports incision pain rated 4/10 when repositioning. What is the best initial CNA response?

Tell the resident to avoid moving until the pain is gone
Administer the resident's scheduled pain medication early
Ask the resident to describe the pain fully, assist with slow repositioning, use a pillow to splint the incision, and notify the nurse (Correct answer)
Document the pain but wait for the nurse's next routine check

Correct answer: Ask the resident to describe the pain fully, assist with slow repositioning, use a pillow to splint the incision, and notify the nurse

Thorough pain assessment, gentle repositioning with splinting support, and nurse notification represent best practice for managing expected post-operative discomfort.

Question 64: When a CNA performs a task they were not trained to do and a resident is harmed, this may be considered:

Only the nurse's responsibility
Standard practice in emergencies
A scope of practice violation and potential negligence (Correct answer)
Acceptable if no one was watching

Correct answer: A scope of practice violation and potential negligence

Performing tasks outside one's training or scope of practice can result in legal liability for negligence and harm to the resident.

Question 65: A resident's care plan specifies 'thickened liquids—honey consistency' for dysphagia management. The resident asks for a glass of water. The CNA should:

Ask a family member to decide whether the resident can have water
Give the water since the resident is an adult who can make their own choices
Withhold all fluids until the nurse can be reached
Provide thickened water at honey consistency as specified in the care plan (Correct answer)

Correct answer: Provide thickened water at honey consistency as specified in the care plan

Thickened liquid orders are swallowing safety interventions that must be followed precisely to prevent aspiration, even when residents request otherwise.

Question 66: A resident asks to see their own medical records. Under HIPAA, the CNA should:

Tell the resident only the physician can discuss records
Refuse because residents cannot access their records
Show the chart immediately without notifying anyone
Explain that residents have the right to their records and direct them to the nurse or appropriate staff (Correct answer)

Correct answer: Explain that residents have the right to their records and direct them to the nurse or appropriate staff

HIPAA grants residents the right to access their medical records; the CNA should acknowledge this right and direct the request to the appropriate staff member.

Question 67: Which of the following actions by a CNA could be considered 'abuse'?

Firmly asking a resident to cooperate with care
Threatening to withhold a resident's meal if they do not cooperate (Correct answer)
Reporting a resident's refusal of care to the charge nurse
Using a lift device for heavy transfers

Correct answer: Threatening to withhold a resident's meal if they do not cooperate

Threatening to withhold food as a means of controlling behavior is a form of psychological abuse and a violation of the resident's rights.

Question 68: During passive range of motion exercises, a patient suddenly says "Ouch, that hurts!" when the CNA moves their knee. What should the CNA do?

Stop the exercise immediately and report the pain to the nurse (Correct answer)
Continue the exercise but move more slowly
Apply ice to the knee and continue with other joints
Tell the patient that some discomfort is normal and encourage them to tolerate it

Correct answer: Stop the exercise immediately and report the pain to the nurse

Pain during ROM exercises is a warning sign that should never be ignored. The CNA must stop immediately to prevent potential injury and report the pain to the nurse for further assessment.

Question 69: If you see a fire, your first action should be to

Evacuate patients in the area (Correct answer)
Pull the fire alarm
Get a fire extinguisher
Call the operator

Correct answer: Evacuate patients in the area

When a fire is discovered, the immediate priority is to ensure the safety of patients and staff. Following the "RACE" acronym, "R" stands for Rescue, meaning to remove anyone in immediate danger. Evacuating patients in the affected area is the critical first step before activating alarms or attempting to fight the fire.

Question 70: When performing a bed bath for a cognitively intact resident who refuses to have their perineal area cleaned, what is the nurse aide's best response?

Document the refusal, respect the resident's right, and report to the nurse (Correct answer)
Notify the charge nurse immediately so they can obtain consent from the family
Explain the importance of perineal care and proceed if the resident does not respond
Ask a same-gender staff member to complete the care instead

Correct answer: Document the refusal, respect the resident's right, and report to the nurse

A cognitively intact resident has the legal and ethical right to refuse any care. The CNA must honor this refusal, document it thoroughly, and report to the nurse so the care team is aware. Proceeding without consent is a violation of resident rights, and family consent is not needed for a competent adult.

Question 71: How should a CNA remove a soiled gown after patient care?

Shake it to remove debris before discarding.
Reuse the gown if it looks clean.
Fold it inward and dispose of it. (Correct answer)
Pull it off quickly to save time.

Correct answer: Fold it inward and dispose of it.

When removing a soiled gown, it should be carefully folded inward so that the contaminated outer surface is contained. This minimizes the spread of pathogens to the environment or the healthcare worker's hands and clothing. The gown should then be immediately disposed of in the appropriate waste receptacle to maintain infection control.

Question 72: Negligence in nursing assistant practice occurs when:

A CNA fails to provide the standard of care, resulting in harm to a resident (Correct answer)
A CNA makes a correct clinical decision with an unforeseen outcome
A CNA reports concerns about a resident to the charge nurse
A CNA performs a task beyond their scope of practice intentionally to harm a resident

Correct answer: A CNA fails to provide the standard of care, resulting in harm to a resident

Negligence is the failure to provide the expected standard of care that a competent CNA would provide, resulting in harm to the resident.

Question 73: A resident with dysphagia is receiving mouth care after a meal. The CNA notices pooled secretions in the right side of the resident's cheek. Which technique is MOST appropriate?

Have the resident gargle with mouthwash to mobilize and clear the pooled secretions
Use a bulb syringe to flush the cheek with water to clear the pooled secretions
Turn the resident's head toward the affected side and use a suction toothbrush or swab to clear secretions (Correct answer)
Suction the secretions with the wall suction device before continuing mouth care

Correct answer: Turn the resident's head toward the affected side and use a suction toothbrush or swab to clear secretions

Turning the resident's head toward the affected (right) side uses gravity to help keep secretions localized and accessible while preventing them from sliding toward the larynx. A suction toothbrush or swab allows controlled, gentle removal. Flushing with a bulb syringe in a dysphagia patient risks aspiration. Wall suction is a nursing/respiratory therapy skill and exceeds CNA scope unless specifically trained and delegated. Gargling requires voluntary pharyngeal control that a dysphagic resident may lack and poses a high aspiration risk.

Question 74: A resident with rheumatoid arthritis has ROM ordered twice daily. The resident reports that their joints feel 'extra stiff and achy' this morning. The CNA observes bilateral hand joint swelling that was not documented in yesterday's notes. The most appropriate CNA action is:

Perform ROM on all other joints and skip only the hands until swelling resolves
Apply warm compresses to the hands first, then perform ROM to loosen the stiffened joints
Proceed with ROM as ordered but reduce the number of repetitions by half
Defer ROM for that session, report the new swelling and increased symptoms to the nurse before proceeding (Correct answer)

Correct answer: Defer ROM for that session, report the new swelling and increased symptoms to the nurse before proceeding

New joint swelling with increased pain in a resident with rheumatoid arthritis may signal an acute flare, infection (septic arthritis), or injury — conditions that contraindicate ROM until evaluated by a nurse or physician. The CNA's role is to recognize this change in condition, defer the exercise, and report immediately. Performing ROM on acutely inflamed joints can worsen synovial damage. Applying warmth or modifying the approach independently falls outside the CNA's scope and could cause harm.

Question 75: To ensure maximum effectiveness, when is the ideal time for a CNA to apply a resident's anti-embolism stockings (TED hose)?

In the evening, just before the resident goes to sleep for the night.
After the resident has ambulated to the dining room for breakfast.
After the resident has been sitting in their chair for about 30 minutes.
In the morning, before the resident gets out of bed. (Correct answer)

Correct answer: In the morning, before the resident gets out of bed.

Anti-embolism stockings are designed to prevent venous stasis and blood clots. They are most effective when applied before gravity causes blood and fluid to pool in the lower legs. Applying them while the resident is still lying down in the morning ensures minimal swelling (edema) is present.

Question 76: A resident's chart contains information about a positive HIV status. A CNA shares this with a coworker who is not involved in the resident's care. This violates:

The resident's care plan only
The facility dress code
HIPAA privacy regulations (Correct answer)
No rules, since they work at the same facility

Correct answer: HIPAA privacy regulations

Sharing any protected health information with unauthorized individuals, regardless of workplace setting, is a direct HIPAA violation.

Question 77: A nurse aide working in a long-term care facility is assigned to a resident placed on droplet precautions for influenza. The resident asks to be walked to the common dining room for lunch. What is the MOST appropriate action?

Allow the resident to go if they wear a surgical mask and the aide wears an N95 respirator
Bring the meal to the resident's room and have the resident eat in their room with the door closed (Correct answer)
Allow the resident to go if the aide wears a surgical mask and the resident wears an N95 respirator
Walk the resident to the dining room but seat them 6 feet away from other residents

Correct answer: Bring the meal to the resident's room and have the resident eat in their room with the door closed

Residents on droplet precautions should remain in their rooms to prevent transmission to other vulnerable individuals. A shared dining room — even with 6 feet of distance — poses unacceptable transmission risk in a congregate care setting with elderly, immunocompromised residents. If the resident must be transported, they should wear a surgical mask during transport, but eating in the common area is not appropriate while on active droplet precautions. The meal should be brought to the resident's room.

Question 78: 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.
Protecting the peristomal skin from the liquid stool. (Correct answer)
Ensuring the pouch is no more than one-quarter full before emptying.
Applying a thick layer of barrier cream to the peristomal skin.

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 79: A resident with dysphagia is eating lunch. Which observation should be reported immediately to the nurse?

Resident needs encouragement to eat
Resident coughs repeatedly while eating (Correct answer)
Resident eats slowly
Resident prefers soft foods

Correct answer: Resident coughs repeatedly while eating

Repeated coughing during meals is a sign of aspiration risk and must be reported to the nurse immediately.

Question 80: A family member asks to read their adult parent's medical chart. The CNA should:

Allow access only if the resident is asleep
Decline and explain no one can see the chart
Tell them to speak with the charge nurse (Correct answer)
Hand them the chart since they are family

Correct answer: Tell them to speak with the charge nurse

Medical record access decisions are made by licensed staff and administration in accordance with HIPAA; the CNA should redirect the family to the charge nurse.

Question 81: When using a fire extinguisher, the CNA should aim the nozzle at which part of the fire?

The top of the flames
The middle of the flames
The base of the fire (Correct answer)
The smoke rising from the fire

Correct answer: The base of the fire

The PASS technique (Pull, Aim, Squeeze, Sweep) directs the extinguishing agent at the base of the fire to cut off its fuel source.

Question 82: When providing perineal care to a female resident, the correct wiping direction is:

Circular motion
Side to side
Back to front
Front to back (Correct answer)

Correct answer: Front to back

Wiping front to back prevents introducing rectal bacteria into the urethra and vaginal area.

Question 83: While providing perineal care to a female resident with an indwelling urinary catheter, the CNA should cleanse in which sequence?

Catheter tubing from the insertion site outward, then the perineum in a back-to-front direction to avoid contaminating the catheter
Perineum with soap and water in any direction, followed by an antiseptic wipe at the meatus, as sequence does not affect infection rates
Labia majora first, then labia minora, then from the urethral meatus distally along the catheter using a single downward stroke per wipe (Correct answer)
From the urethral meatus outward along the catheter tubing for at least 4 inches, then the labia minora, then the labia majora

Correct answer: Labia majora first, then labia minora, then from the urethral meatus distally along the catheter using a single downward stroke per wipe

Correct catheter perineal care begins with the labia majora (outer to inner), then the labia minora, and finally a single clean stroke from the meatus distally along the catheter tubing. This progression moves from less contaminated to most critical areas last, minimizing the risk of introducing microorganisms into the urinary tract. Back-to-front direction or reusing wipes introduces fecal flora near the urethra.

Question 84: To prevent musculoskeletal injuries, a CNA should use a gait belt when:

Assisting a resident who needs help with ambulation or transfers (Correct answer)
Changing a resident's bed linens
Measuring a resident's vital signs
Administering oral hygiene care

Correct answer: Assisting a resident who needs help with ambulation or transfers

A gait belt provides a secure grip during ambulation and transfers, reducing injury risk for both the resident and the CNA.

Question 85: When communicating with a resident who speaks limited English, the CNA should:

Speak loudly and slowly, assuming volume will help them understand
Refuse to provide care until a family member translates
Use an approved interpreter, gestures, picture boards, or bilingual staff as available (Correct answer)
Ask other residents to help translate for privacy reasons

Correct answer: Use an approved interpreter, gestures, picture boards, or bilingual staff as available

Using approved interpreters, visual aids, gestures, or bilingual staff provides safe, effective communication while preserving the resident's dignity and privacy.

Question 86: When performing passive range-of-motion exercises on a patient's shoulder, the patient suddenly reports sharp pain and you feel resistance during abduction. What should the CNA do FIRST?

Switch to a different joint and return to the shoulder at the end of the session
Apply gentle steady pressure to push through the resistance to improve flexibility
Reduce the range slightly and continue the exercise more slowly
Stop the movement immediately, support the joint, and report to the nurse (Correct answer)

Correct answer: Stop the movement immediately, support the joint, and report to the nurse

Pain and resistance during ROM exercises are warning signs of possible injury, joint pathology, or muscle spasm. Continuing movement — even reduced or slow — risks causing serious harm such as dislocation or fracture. The CNA must stop immediately, stabilize the joint in a neutral position, and report to the nurse for further assessment.

Question 87: A resident with dementia repeatedly says 'I want to go home' even though they have lived in the facility for two years. The CNA's best response is:

Call the resident's family every time they say this
Explore the feeling behind the statement and respond with empathy and redirection (Correct answer)
Tell the resident firmly they cannot go home and walk away
Ignore the statement as it is just a symptom of dementia

Correct answer: Explore the feeling behind the statement and respond with empathy and redirection

Exploring the emotional meaning behind 'I want to go home' and responding with empathy and redirection is more effective than denial or ignoring the behavior.

Question 88: Which of the following is an example of an 'activities of daily living' (ADL) document the CNA is responsible for completing?

Dietary assessment forms
Physician progress notes
Nursing care plans
Daily resident care flow sheet recording bathing, dressing, and mobility assistance provided (Correct answer)

Correct answer: Daily resident care flow sheet recording bathing, dressing, and mobility assistance provided

CNAs routinely document ADL care flow sheets, which record the type and amount of assistance provided with bathing, dressing, grooming, toileting, and mobility during each shift.

Question 89: While shampooing a resident's hair in bed using a trough, the CNA notices the water draining from the trough has become very cold. The resident has not complained. What should the CNA do?

Stop the shampoo immediately as cold water poses a hypothermia risk in all residents
Reduce the amount of water used and complete shampooing quickly
Continue shampooing since the resident has not expressed discomfort
Check the resident's comfort level and warm the water before continuing (Correct answer)

Correct answer: Check the resident's comfort level and warm the water before continuing

Cold water during a bed shampoo poses a risk for chilling and discomfort, particularly for elderly residents who may have diminished temperature sensation and impaired thermoregulation. The CNA must proactively check comfort and adjust water temperature — not wait for the resident to report discomfort. While cold water is a concern, it is not an automatic hypothermia emergency requiring immediate cessation; warming the water and continuing is appropriate. Reducing water does not address temperature.

Question 90: A resident's family member asks the CNA to share the resident's latest lab results and diagnosis, stating they have power of attorney. How should the CNA respond?

Politely explain that sharing clinical information is outside the CNA's role and direct the family member to the nurse (Correct answer)
Ask the resident if it is acceptable before sharing the information with the family member
Share the information since the power of attorney legally authorizes the family member to receive it
Retrieve the chart and read the relevant entries to the family member at the nursing station

Correct answer: Politely explain that sharing clinical information is outside the CNA's role and direct the family member to the nurse

Communicating clinical information such as diagnoses and lab results is outside the CNA's scope of practice, regardless of the family member's legal authority. Even if the power of attorney is valid, the CNA is not the appropriate person to interpret or relay clinical findings. The CNA should acknowledge the request respectfully and refer the family member to the nurse or charge nurse who can properly address it.

Question 91: A family member asks the nurse aide what medication the client is receiving. The nurse aide should

give the family member the client’s chart.
refer the family member to the nurse. (Correct answer)
allow the family member to read the client’s medication list.
tell the family member what medications are given.

Correct answer: refer the family member to the nurse.

CNAs are not authorized to discuss a client's medical information, including medications, with family members due to privacy regulations (HIPAA) and their scope of practice. The nurse is the appropriate healthcare professional to provide such information, as they have the comprehensive knowledge and authority to do so.

Question 92: A CNA is caring for a resident who is legally incompetent and has a court-appointed guardian. The resident's adult daughter, who is not the guardian, insists on seeing her mother's medical records. What is the CNA's most appropriate response?

Refer the daughter to the nurse or administrator, as only the legal guardian has authority to access records (Correct answer)
Show the daughter the records since she is immediate family
Allow access only if the daughter signs a confidentiality agreement
Call the physician to obtain permission before showing the records

Correct answer: Refer the daughter to the nurse or administrator, as only the legal guardian has authority to access records

When a resident is legally incompetent, a court-appointed guardian holds the legal authority to make decisions and access records — not family members who lack that legal designation. The CNA must defer this boundary-setting to the nurse or administrator, who can properly explain HIPAA rights and legal guardianship to the daughter.

Question 93: A resident on a fluid restriction of 1,000 mL/day has already consumed 800 mL by noon. What should the CNA do?

Give normal fluids for the rest of the day since the limit seems too strict
Stop all fluids immediately for the rest of the day without informing anyone
Offer extra fluids to keep the resident comfortable
Notify the nurse and document the intake so the team can plan remaining fluids (Correct answer)

Correct answer: Notify the nurse and document the intake so the team can plan remaining fluids

The CNA must notify the nurse and document the intake so the care team can manage the remaining fluid allowance safely.

Question 94: A patient uses a speech-generating device (SGD) to communicate. How should the CNA respond when the patient uses it?

Speak faster to save time since communication is slower
Complete care tasks while the patient types to multitask efficiently
Wait patiently and address the patient's message as you would any spoken communication (Correct answer)
Ask the family to interpret instead to save time

Correct answer: Wait patiently and address the patient's message as you would any spoken communication

Patients using SGDs deserve the same respectful, attentive communication as verbal patients; wait and respond directly.

Question 95: Before bathing a resident, a CNA should check the water temperature using which method?

Check with fingertips only
Use a thermometer or test on the inner wrist; ideal temperature is 105 to 110 degrees F (Correct answer)
Ask the resident to test it
Run the water until it feels comfortable on the back of the hand only

Correct answer: Use a thermometer or test on the inner wrist; ideal temperature is 105 to 110 degrees F

Water temperature should be tested with a bath thermometer or on the inner wrist. The safe range is approximately 105 to 110 degrees F (40 to 43 degrees C) to prevent burns, especially for residents with reduced sensation.

Question 96: A resident recovering from a right hip replacement (posterior approach) is on hip precautions. During a restorative dressing session, the resident attempts to put on pants by crossing the right leg over the left knee to reach the foot. What is the MOST critical concern and correct CNA response?

Intervene immediately, as crossing the legs violates hip flexion/adduction/internal rotation precautions and risks dislocation (Correct answer)
Remind the resident to keep movements slow and controlled, then allow the crossed-leg position briefly
Allow the procedure since dressing is an ADL that supersedes hip precautions during the restorative phase
Contact the surgeon before intervening, since only the surgical team can enforce hip precautions

Correct answer: Intervene immediately, as crossing the legs violates hip flexion/adduction/internal rotation precautions and risks dislocation

Posterior hip replacement precautions strictly prohibit hip flexion beyond 90°, adduction past midline, and internal rotation — crossing the leg over the opposite knee violates all three simultaneously and is a primary mechanism of prosthetic dislocation. The CNA must intervene immediately and redirect the resident to use adaptive equipment (long-handled reacher, sock aid, dressing stick) or a safer technique. These precautions apply to all activities regardless of context and do not require surgeon contact to enforce.

Question 97: A resident who has a valid Do-Not-Resuscitate (DNR) order stops breathing during the CNA's shift. A family member present in the room shouts at the CNA to 'do something — call a code!' The CNA's CORRECT action is to:

Suspend the DNR temporarily until the attending physician can be reached to verbally confirm it
Defer to the family's request since next-of-kin have authority to override advance directives in emergency situations
Begin CPR immediately to honor the family's wishes until a nurse or physician can take over
Follow the DNR order, notify the nurse immediately, provide comfort measures, and calmly explain the DNR to the family (Correct answer)

Correct answer: Follow the DNR order, notify the nurse immediately, provide comfort measures, and calmly explain the DNR to the family

A valid DNR is a legally binding medical order that must be followed regardless of family demands in the moment. The CNA's role is to notify the nurse immediately, provide comfort measures per scope of practice, and compassionately explain to the family that the resident made this decision in advance and it must be honored. Family members cannot override a legally executed advance directive in an emergency, and a DNR cannot be suspended without a physician order rescinding it. Initiating CPR against a DNR order violates both the law and the resident's autonomy.

Question 98: A resident with scabies has been treated. When changing their bed linens, what is the MOST critical additional precaution a CNA must take beyond standard precautions?

Wear an N95 respirator while handling the linens.
Double-bag the linens in special hazardous waste bags.
Leave the linens in a sealed bag for 24 hours before laundering.
Ensure linens are washed in hot water and dried on a high heat setting. (Correct answer)

Correct answer: Ensure linens are washed in hot water and dried on a high heat setting.

Scabies mites and eggs are killed by exposure to high heat. Therefore, the most critical step is to launder the infested linens in hot water and dry them on a high heat setting to ensure decontamination and prevent re-infestation or spread. While careful handling is important, specialized bagging or respirators are not standard protocol for scabies linen.

Question 99: A resident with aphasia after a stroke struggles to find words. The CNA should:

Give the resident time and use simple yes/no questions (Correct answer)
Avoid speaking with the resident to prevent frustration
Speak for the resident in all situations
Refer all communication to the speech therapist only

Correct answer: Give the resident time and use simple yes/no questions

Allowing extra time and using simple questions helps residents with aphasia communicate more effectively.

Question 100: When providing oral care for an unconscious resident, which technique is most important for preventing aspiration?

Using a standard toothbrush with a small amount of toothpaste.
Positioning the resident on their side with their head turned to the side. (Correct answer)
Positioning the resident flat on their back to access the mouth easily.
Using a large amount of water to thoroughly rinse the mouth.

Correct answer: Positioning the resident on their side with their head turned to the side.

Positioning an unconscious resident on their side allows fluids and secretions to drain out of the mouth instead of into the airway, which is the most effective way to prevent aspiration pneumonia. Using excess water increases the risk of aspiration. The resident should never be flat on their back during oral care. A toothette or moistened swab is often used, and toothpaste is generally avoided due to the risk of choking.

Certified Nursing Assistant (CNA) Exam

The CNA exam certifies individuals to provide basic patient care under the supervision of a licensed nurse, covering both knowledge and practical skills.

Questions

90 min

Time Limit

70%

To Pass

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