Basic Nursing Skills 21 Flashcards

A resident with dysphagia is most at risk for which complication?

Answer: Aspiration pneumonia

Dysphagia (difficulty swallowing) increases the risk of aspirating food or liquid into the lungs, which can cause aspiration pneumonia.

When ambulating a resident with a cane, the cane should be held on the:

Answer: Opposite side from the weak leg

Holding the cane on the stronger side allows weight to be transferred through the cane when the weaker leg steps forward, providing proper support.

A resident develops a reddened area over the coccyx that does not blanch when pressed. This indicates:

Answer: A Stage I pressure injury

Non-blanchable redness over a bony prominence is the hallmark of a Stage I pressure injury, indicating deep tissue damage has begun.

Which action by the CNA demonstrates correct hand hygiene technique?

Answer: Scrubbing all surfaces of hands and wrists for at least 20 seconds

Effective handwashing requires scrubbing all surfaces including between fingers and wrists for a minimum of 20 seconds with soap and water.

When feeding a resident who is at risk for aspiration, the CNA should position the head of the bed at:

Answer: 45 to 90 degrees

Elevating the head of the bed to 45–90 degrees (high Fowler's or seated) uses gravity to direct food toward the stomach and away from the airway.

A resident has an indwelling urinary catheter. The drainage bag should be positioned:

Answer: Below the level of the bladder

The drainage bag must always remain below bladder level to allow gravity-assisted urine flow and prevent backflow that could cause infection.

Which observation about a resident's surgical wound should the CNA report to the nurse IMMEDIATELY?

Answer: Separation of wound edges with purulent drainage

Wound dehiscence (separation of edges) with purulent discharge indicates serious infection requiring immediate medical intervention.