Basic Nursing Skills 19 Flashcards

A CNA is performing passive range of motion on a resident's shoulder when the resident suddenly grimaces and the joint offers unexpected resistance. What is the most appropriate immediate action?

Answer: Stop the movement immediately, document the response, and report to the nurse before continuing

Unexpected resistance combined with pain (grimacing) during ROM can indicate a joint injury, heterotopic ossification, or acute pathology. The CNA must stop immediately to prevent further injury, document findings accurately, and report to the nurse for clinical assessment before any further ROM is attempted. Pushing through resistance risks fracture, dislocation, or soft tissue damage.

A resident on fall precautions with a history of orthostatic hypotension is being transferred from bed to wheelchair. The CNA assists the resident to a sitting position at the edge of the bed. After 2 minutes, the resident reports feeling fine. What should the CNA do NEXT before completing the transfer?

Answer: Have the resident dangle legs for an additional 3–5 minutes and reassess blood pressure before standing

Orthostatic hypotension can be delayed — subjective 'feeling fine' after 2 minutes is insufficient assurance. The standard protocol is to dangle the legs for at least 3–5 minutes and, when possible, verify blood pressure. Rising too quickly or prematurely significantly increases fall risk in residents with this diagnosis. The resident's self-report alone does not clear them for standing.

While providing peri-care to an uncircumcised male resident who is cognitively intact but physically dependent, the resident asks the CNA to skip retracting the foreskin because it is uncomfortable. How should the CNA respond?

Answer: Acknowledge the discomfort, explain the infection risk of skipping this step, and explore ways to minimize discomfort while honoring his right to refuse

A cognitively intact resident retains the right to refuse or modify care. The CNA should not override this right, but also has a duty to educate about the risk (smegma accumulation, infection, UTI). The correct approach is therapeutic communication — explain risks, explore alternatives (gentler technique, warm water), and document both the education provided and the resident's decision. Coercion violates patient rights; silent omission violates care standards.

A CNA notices that a resident's urinary drainage bag has been positioned on the side rail of the raised bed for the past hour during repositioning tasks. Which complication is the PRIMARY concern with this placement?

Answer: Urine may flow backward from the bag into the bladder, introducing bacteria and increasing UTI risk

The cardinal rule of catheter care is that the drainage bag must always remain below the level of the bladder. When the bag is elevated above bladder level — such as when hung on a raised side rail — gravity-assisted retrograde flow can carry bacteria-laden urine back into the bladder, directly causing a catheter-associated urinary tract infection (CAUTI). This is among the most preventable healthcare-associated infections.

A CNA is assisting with oral care for a resident with dysphagia who is at high aspiration risk. The resident is currently semi-conscious following a change in medication. Which oral care method is most appropriate?

Answer: Foam swabs moistened with water or oral rinse, with the head of bed elevated and oral suction immediately available

For a semi-conscious, dysphagic resident, foam swabs minimize fluid volume introduced into the oral cavity while maintaining hygiene and mucous membrane moisture. Elevating the HOB (30–45°) uses gravity to reduce pooling in the posterior pharynx. Suction must be immediately available. Postponing oral care is not appropriate — secretion pooling increases aspiration pneumonia risk. Flat positioning and glycerin swabs (which can draw fluid) are contraindicated.

A resident has a new order for a warm soak of the right foot at 105°F (40.6°C). When the CNA checks the water with a bath thermometer, it reads exactly 105°F. Before placing the foot in the basin, what additional assessment step is MOST critical for this resident, who has type 2 diabetes?

Answer: Assess the resident's baseline foot skin color, temperature, and sensation before immersion

Diabetic residents frequently have peripheral neuropathy, meaning they cannot reliably detect water temperature with their feet. Even a correctly measured 105°F soak can cause burns if the resident has compromised sensation or circulation. The CNA must perform a baseline neurovascular assessment (skin color, capillary refill, temperature differential, sensation) before immersion. This also establishes a comparison point to detect adverse reactions during or after the soak. A second thermometer reading is good practice but is secondary to this patient-safety assessment.