Assisting with Daily Living Flashcards

A CNA is assisting a resident with dysphagia who requires a minced-and-moist diet. The resident requests their favorite food—a whole apple. What is the most appropriate action?

Answer: Explain the diet restriction and offer a pureed apple or applesauce as an alternative

A minced-and-moist diet is prescribed for residents with swallowing difficulties to reduce aspiration risk. A whole apple or even small cut pieces are unsafe and violate the diet order. Blending into a thin liquid is also incorrect because it creates the wrong texture level. The CNA must honor the diet restriction while supporting the resident's dignity by offering an appropriate alternative that aligns with their preference.

While providing oral care to an unconscious resident, the CNA notices secretions pooling in the back of the mouth. What is the priority intervention?

Answer: Turn the resident's head to one side and use a suction toothbrush or swab to clear secretions before proceeding

For unconscious residents, pooling secretions create a significant aspiration risk. Turning the head to the side uses gravity to prevent secretions from flowing toward the airway. Tilting the head backward is dangerous because it opens the airway to aspiration. Continuing oral care without repositioning ignores the immediate hazard. Postponing care is not appropriate since oral hygiene is essential for preventing aspiration pneumonia in this population.

A resident with left-sided hemiplegia needs to be dressed. Which sequence reflects correct technique for applying a pullover shirt?

Answer: Start with the weak left arm, pull the shirt over the head, then thread the strong right arm through

The principle for hemiplegic dressing is 'weak side first, strong side last' for application and 'strong side first, weak side last' for removal. Starting with the affected (left) arm ensures the sleeve is properly positioned before the shirt must be pulled over the head, preventing unnecessary manipulation of the weak limb. Dressing both arms simultaneously is not feasible for a patient with hemiplegia, and asking the resident to raise both arms ignores the functional deficit.

A resident with moderate Alzheimer's disease becomes agitated and resistive during morning bathing. Which advanced technique is most appropriate to de-escalate the situation?

Answer: Stop the task, allow the resident to calm down, use simple one-step commands, and try again offering a warm washcloth to self-hold

Forcing a cognitively impaired resident through a task they are resisting can escalate agitation and risks injury to both resident and caregiver. Stopping, allowing a calm interval, using simple one-step commands, and offering sensory engagement (e.g., holding a warm washcloth) are evidence-based person-centered strategies that reduce resistance. Proceeding rapidly increases distress. Physical restraint to continue bathing violates rights and may constitute abuse. Skipping documentation without a skilled attempt and nurse notification is a care omission.

A CNA is assisting a bariatric resident who requires a two-person transfer to a shower chair. The second caregiver is not immediately available. What should the CNA do?

Answer: Wait for the second caregiver, explain the delay to the resident, and do not attempt the transfer alone

Safe patient handling protocols for bariatric residents require a minimum number of caregivers to prevent injury to both the resident and staff. Attempting a one-person transfer violates safety policy and poses high injury risk. Enlisting an untrained visitor is dangerous and a liability. Falsely documenting a refusal is fraudulent documentation. The correct action is to wait for qualified assistance, keep the resident informed, and proceed safely when the second caregiver is available.

A resident using a hearing aid complains that it produces a high-pitched whistling sound. Before notifying the nurse, which action should the CNA take first?

Answer: Check that the hearing aid is properly seated in the ear canal and that the earmold is free of cerumen blockage

A whistling sound (acoustic feedback) from a hearing aid is most commonly caused by an improper fit—the device is not fully inserted—or by cerumen (earwax) blocking the earmold and causing sound to escape around it. The CNA should first ensure the device is properly seated and inspect for visible wax blockage. Soaking a hearing aid in water destroys the electronics. Increasing volume worsens feedback. While a low battery can cause some issues, whistling is not its classic presentation; the fit and blockage check is the appropriate first step.