Assisting with Daily Living Flashcards

A resident with moderate dementia refuses to bathe, becoming agitated and combative whenever approached with a washcloth. Which nursing assistant intervention is MOST appropriate as an initial strategy?

Answer: Offer a towel bath instead, using warm, soapy towels to cleanse the resident without requiring them to enter the tub or shower

A towel bath is an evidence-based alternative that significantly reduces agitation in dementia patients during hygiene care. It provides effective cleansing without the sensory disruption of a traditional bath, respecting the resident's dignity while meeting care needs. Restraint is never appropriate for bathing and violates resident rights. Waiting one hour without a plan change is not proactive care. Family persuasion may help long-term but is not the immediate clinical intervention.

When assisting a hemiplegic resident to dress, which sequence correctly follows proper technique?

Answer: Dress the affected (weak) side first, then the unaffected (strong) side; undress the unaffected side first, then the affected side

The correct principle is 'weak side on first, off last.' The affected limb has limited range of motion, so putting clothing on it first prevents overstretching the joint. During undressing, removing the garment from the stronger side first allows it to slide off the weaker side with less manipulation. This sequence minimizes pain, prevents injury, and respects the biomechanical limitations of the affected extremity.

A CNA is assisting a resident who uses a mechanical lift for transfers. Midway through the transfer, the resident reports feeling the sling shifting under their thighs. What is the CORRECT immediate action?

Answer: Lower the resident back to the bed, check sling positioning per manufacturer guidelines, and re-initiate the transfer only when the sling is properly placed

A shifting sling mid-transfer is a serious safety risk that can result in the resident falling from the lift. The only safe course of action is to immediately lower the resident back to the starting surface, recheck that the sling is correctly positioned according to the manufacturer's guidelines and care plan, and restart the transfer. Continuing a transfer with a compromised sling risks a fall. Having staff hold limbs or asking the resident to grip straps are unsafe improvisations that do not address the root problem.

A resident with dysphagia has a care plan specifying nectar-thick liquids. During a meal, the resident insists on drinking thin water and states, 'I've been drinking water my whole life — I know how to swallow.' How should the CNA respond?

Answer: Explain the aspiration risk, document the refusal, notify the nurse, and offer the thickened liquid again without forcing

The CNA must explain the medical reason for the thickening order (aspiration risk, which can cause pneumonia), respect that the resident has the right to refuse, document the refusal accurately, and immediately report to the nurse so the care team can address it — potentially involving the speech-language pathologist for re-education or care plan revision. Secretly adding thickener is a form of deception and violates the resident's rights. Thin water sips do not eliminate aspiration risk. Unilaterally overriding a physician/SLP order is outside the CNA's scope.

A resident who is blind and newly admitted asks the CNA to help orient them to their room. Which sighted-guide technique is MOST appropriate during the initial orientation walk?

Answer: Allow the resident to grasp the CNA's arm just above the elbow and walk a half-step behind while the CNA narrates the environment

The correct sighted-guide technique has the visually impaired person grip the guide's arm just above the elbow (not the hand), allowing them to feel body movement and direction changes naturally. The guide walks a half-step ahead, and the person follows. The CNA narrates the environment to build a mental map. Holding the hand and walking ahead reverses the control dynamic and can disorient the person. Wheelchair transport bypasses the walking orientation entirely. Clock descriptions alone, while useful for object placement, are insufficient as a mobility orientation without a physical guide.

A CNA notices that a resident with Parkinson's disease is taking considerably longer than usual to button their shirt and seems frustrated. The resident has not asked for help. What is the BEST course of action?

Answer: Ask the resident if they would like assistance, and if they decline, allow them to continue while remaining nearby and available

Promoting independence and allowing the resident to complete tasks at their own pace is a core principle of person-centered care. For Parkinson's patients, self-directed movement is also therapeutically important. The CNA should ask first — taking over without consent undermines dignity and autonomy. While an OT referral may be appropriate eventually, initiating it without the resident's input or the nurse's assessment is premature in this moment. Recommending adaptive clothing unilaterally oversteps the CNA's role; that suggestion belongs in an interdisciplinary care conference after assessment.