Basic Nursing Skills 14 Flashcards

A CNA is caring for a resident who has a nasogastric (NG) tube in place. Before assisting with oral hygiene, which action is MOST important?

Answer: Verify the tube is clamped or disconnected from suction before beginning

Before performing oral hygiene on a resident with an NG tube, the CNA must confirm the tube is clamped or removed from active suction. This prevents accidental aspiration of oral care products or water through the tube. The tube should never be removed by the CNA, petroleum jelly does not replace proper oral care, and flat supine positioning increases aspiration risk.

While performing passive range-of-motion (PROM) exercises on a resident's shoulder, the resident suddenly grimaces and says 'that pinches.' What is the CORRECT next action?

Answer: Stop the movement immediately and hold the joint still at that position

PROM exercises should be painless. When a resident expresses pain, the CNA must stop immediately and hold the joint in its current position — not push through or speed up. Continuing can cause injury such as muscle tears or joint damage. The nurse must be informed, as pain during ROM may indicate injury, inflammation, or contracture development.

A CNA is assisting a resident with a percutaneous endoscopic gastrostomy (PEG) tube during bathing. When cleaning around the tube insertion site, which finding should be reported to the nurse IMMEDIATELY?

Answer: Bright red granulation tissue with a small amount of serosanguineous drainage

Bright red granulation tissue (hypergranulation) combined with serosanguineous drainage indicates an abnormal tissue response that requires prompt nursing assessment and possible medical intervention. Dried crusting is common and expected. A PEG tube rotating freely indicates it is properly mobile — tubes that cannot rotate are at risk of buried bumper syndrome. Slight pinkness under the bumper from pressure is normal and does not require immediate reporting.

When using a mechanical lift (Hoyer lift) to transfer a bariatric resident, a CNA notices one of the sling loops appears slightly frayed. What should the CNA do?

Answer: Stop the transfer, report the damaged sling, and obtain a replacement before proceeding

A frayed sling loop is a serious safety hazard that could snap during transfer, causing the resident to fall and sustain severe injury. The transfer must be halted immediately regardless of the resident's weight or urgency, the damaged equipment reported and tagged out of service, and a safe replacement sling obtained. Taping or proceeding with damaged equipment violates facility safety policy and endangers both the resident and the CNA.

A CNA is assigned to collect a clean-catch midstream urine specimen from a female resident with limited mobility and mild cognitive impairment. Which approach BEST ensures specimen integrity?

Answer: Perform the perineal cleanse personally and assist the resident to void mid-stream into the container, since her impairment makes self-collection unreliable

A resident with cognitive impairment and limited mobility cannot reliably perform the multi-step clean-catch process independently. The CNA must assist directly — performing the perineal cleanse and guiding mid-stream collection — to avoid contamination that would invalidate the specimen. Collecting from an incontinence brief yields a contaminated sample. Inserting a catheter requires a nurse and physician order and is not appropriate simply for specimen collection when clean-catch is feasible with assistance.

During a bed bath, a CNA observes that a non-ambulatory resident's sacral area has intact skin that is non-blanchable and dark red. The area was documented as 'normal' in the previous shift's notes. What is the PRIORITY action?

Answer: Report the finding to the nurse immediately without repositioning the area onto the pressure

Non-blanchable erythema at the sacrum is the hallmark of a Stage 1 pressure injury (or deep tissue injury if the color is dark/purple). This is a new finding compared to the previous shift and requires immediate nurse notification. The CNA should not massage over bony prominences or reddened areas — this destroys fragile capillaries and worsens injury. Donut rings actually create a ring of pressure that worsens injury at the margins. Repositioning intervals may need to increase, but the nurse must first assess and update the care plan.