Certified Nursing Assistant (CNA) Exam — Questions and Answers

Question 1: A resident with congestive heart failure (CHF) is on a fluid restriction of 1,500 mL per day. Which action by the CNA is most critical for managing this resident's hydration status accurately?

Offering the resident small sips of water between meals to prevent thirst.
Weighing the resident at the same time each day, using the same scale. (Correct answer)
Ensuring the water pitcher at the bedside is never more than half full.
Asking the resident's family to avoid bringing in outside beverages.

Correct answer: Weighing the resident at the same time each day, using the same scale.

For a resident with CHF, daily weights are the most reliable indicator of fluid retention or loss. A sudden weight gain often signifies that the body is holding onto excess fluid, which can exacerbate CHF symptoms. While other options are helpful strategies, daily weighing is the most critical objective measurement.

Question 2: While giving a complete bed bath to an incontinent resident, the CNA notices the skin in the perineal area is bright red with small satellite lesions extending outward from a central rash. What is the most appropriate immediate action?

Complete the bath, thoroughly document the skin findings, and report to the nurse before applying any treatment (Correct answer)
Cover the area with a dry sterile dressing and note it in the next shift handoff
Irrigate the area vigorously with hydrogen peroxide to prevent infection
Apply a generous layer of zinc oxide ointment from the supply cart and continue the bath

Correct answer: Complete the bath, thoroughly document the skin findings, and report to the nurse before applying any treatment

Satellite lesions surrounding a rash are a classic sign of candidal (fungal) infection, which requires a prescription antifungal — not over-the-counter zinc oxide alone. The CNA's role is to observe, document accurately, and report to the licensed nurse promptly so appropriate treatment can be ordered. Applying unsanctioned treatments or using hydrogen peroxide (which is cytotoxic to tissue) would be outside the CNA's scope and potentially harmful.

Question 3: When emptying a urinary drainage bag, the CNA should document which of the following?

The brand of the catheter
The color, clarity, and amount of urine (Correct answer)
Whether the resident was awake
Only the amount of urine drained

Correct answer: The color, clarity, and amount of urine

Documenting color, clarity, and amount provides complete information to detect abnormalities like blood or cloudiness.

Question 4: What does 'advance directive' refer to in the care of a resident?

Instructions given by a physician before a procedure
A legal document expressing a resident's wishes for future medical care (Correct answer)
A supervisor's orders for the CNA to follow during a shift
A care plan created by the interdisciplinary team

Correct answer: A legal document expressing a resident's wishes for future medical care

An advance directive is a legal document in which a person specifies their wishes for medical treatment if they become unable to communicate.

Question 5: When applying anti-embolism stockings (TED hose) to a resident who has been sitting in a chair for an hour, what is the correct first step?

Have the resident lie down with their legs elevated for at least 15 minutes before application. (Correct answer)
Ask the resident to stand up and march in place for two minutes.
Apply the stockings immediately while the resident is seated.
Soak the resident's feet in warm water to improve circulation before application.

Correct answer: Have the resident lie down with their legs elevated for at least 15 minutes before application.

Anti-embolism stockings are designed to prevent blood from pooling in the legs. If a resident has been sitting or standing, blood will have already pooled due to gravity. To ensure the stockings are effective, the resident should lie down (supine) with their legs elevated for at least 15 minutes to allow the blood to drain from the leg veins before the stockings are applied. Applying them while the resident is sitting would trap the pooled blood and defeat the purpose.

Question 6: A resident with rheumatoid arthritis has ROM ordered twice daily. The resident reports that their joints feel 'extra stiff and achy' this morning. The CNA observes bilateral hand joint swelling that was not documented in yesterday's notes. The most appropriate CNA action is:

Perform ROM on all other joints and skip only the hands until swelling resolves
Defer ROM for that session, report the new swelling and increased symptoms to the nurse before proceeding (Correct answer)
Apply warm compresses to the hands first, then perform ROM to loosen the stiffened joints
Proceed with ROM as ordered but reduce the number of repetitions by half

Correct answer: Defer ROM for that session, report the new swelling and increased symptoms to the nurse before proceeding

New joint swelling with increased pain in a resident with rheumatoid arthritis may signal an acute flare, infection (septic arthritis), or injury — conditions that contraindicate ROM until evaluated by a nurse or physician. The CNA's role is to recognize this change in condition, defer the exercise, and report immediately. Performing ROM on acutely inflamed joints can worsen synovial damage. Applying warmth or modifying the approach independently falls outside the CNA's scope and could cause harm.

Question 7: Which of the following is the best way to prevent skin breakdown when assisting with grooming?

Apply strong pressure while washing.
Rub vigorously after washing.
Pat the skin dry gently. (Correct answer)
Use scented lotions liberally.

Correct answer: Pat the skin dry gently.

Patting the skin dry gently after washing is the best way to prevent skin breakdown. Vigorous rubbing can cause friction, irritation, and damage to fragile skin, especially in elderly or compromised residents. Gentle patting effectively removes moisture while preserving skin integrity and promoting comfort.

Question 8: A CNA is asked by a nurse to restrain a confused, agitated resident in a chair using a vest restraint 'just until the family arrives in about an hour.' No physician's order for restraint exists. The nurse says, 'I'll get the order later.' What should the CNA do?

Apply the restraint but set a timer and remove it after 30 minutes as a compromise
Apply the restraint and immediately page the physician directly to obtain a verbal order
Refuse to apply the restraint and inform the nurse that a physician's order is required before use (Correct answer)
Apply the restraint as directed since a nurse's verbal order carries temporary authority in urgent situations

Correct answer: Refuse to apply the restraint and inform the nurse that a physician's order is required before use

Physical restraints require a valid physician's order before application — there is no exception for verbal nursing orders or anticipated future orders. Applying a restraint without an order constitutes unauthorized restraint, which is a form of false imprisonment and a serious legal and regulatory violation. The CNA must refuse and inform the nurse that the proper order must be obtained first, regardless of the circumstance.

Question 9: When should the urinary drainage bag be emptied?

Once every 24 hours at shift change
Every 8 hours or when it is two-thirds full (Correct answer)
Only when it is completely full
Whenever the patient requests it

Correct answer: Every 8 hours or when it is two-thirds full

The drainage bag should be emptied every 8 hours or when two-thirds full to prevent backflow and overflow.

Question 10: A CNA student is learning about transmission-based precautions. A resident is placed on droplet precautions. Which PPE is primarily required when entering the room?

Gown and shoe covers
Surgical mask worn within 3 feet of the patient (Correct answer)
Gloves only
N95 respirator and full-body suit

Correct answer: Surgical mask worn within 3 feet of the patient

Droplet precautions require a surgical mask when coming within close contact (3 feet) of the patient, as pathogens travel in large droplets.

Question 11: A CNA is assigned to measure the temperature of a patient who just finished drinking hot coffee 8 minutes ago. The CNA does not have access to a tympanic or temporal thermometer — only an oral electronic thermometer. What is the most appropriate action?

Wait an additional 22 minutes before taking the oral temperature to ensure a full 30-minute wait (Correct answer)
Take the oral temperature immediately, as 8 minutes is sufficient for oral mucosa to equilibrate
Take an axillary temperature and add 1°F to estimate the core temperature
Take the rectal temperature, as it is unaffected by recent oral intake

Correct answer: Wait an additional 22 minutes before taking the oral temperature to ensure a full 30-minute wait

Oral temperature readings are significantly affected by hot or cold food and beverages. The standard waiting period is 30 minutes after consuming anything hot or cold before obtaining a valid oral temperature. Only 8 minutes have passed, so the CNA must wait an additional 22 minutes. Using the axillary method or altering the site without clinical orders is inappropriate when time delay is the correct solution.

Question 12: How should a CNA handle fecal incontinence in a bedridden patient?

Change only the bottom sheet and address perineal cleaning later
Leave the patient and gather all needed supplies before returning to clean
Clean the patient promptly and thoroughly, applying barrier cream, and reporting any skin breakdown to the nurse (Correct answer)
Use only dry paper towels to clean to avoid spreading contamination

Correct answer: Clean the patient promptly and thoroughly, applying barrier cream, and reporting any skin breakdown to the nurse

Prompt, thorough cleaning followed by barrier cream application prevents IAD (incontinence-associated dermatitis) and preserves skin integrity and patient dignity.

Question 13: Which of the following is a sign that a resident may be experiencing depression rather than normal sadness?

Temporary withdrawal after a difficult medical procedure
Crying after hearing bad news from family
Feeling sad on the anniversary of a loved one's death
Persistent loss of interest in activities lasting more than two weeks (Correct answer)

Correct answer: Persistent loss of interest in activities lasting more than two weeks

Depression is characterized by persistent symptoms lasting at least two weeks, including loss of interest in previously enjoyed activities.

Question 14: What does the term 'chain of command' mean for a CNA in reporting?

Only report to the CNA supervisor, never directly to the nurse
Always report first to the family, then to the nurse
Follow the established organizational hierarchy: report observations to the charge nurse, then to supervisors if needed (Correct answer)
Report to any available staff member

Correct answer: Follow the established organizational hierarchy: report observations to the charge nurse, then to supervisors if needed

Chain of command is the structured reporting hierarchy. A CNA reports directly to the charge nurse (or assigned nurse), and if concerns are not addressed, escalates to the supervisor or nurse manager.

Question 15: When cleaning a stoma during a pouch change, the CNA should use:

Mild soap or prescribed skin cleanser and warm water, then dry thoroughly (Correct answer)
Antiseptic solution poured directly on the stoma
Hydrogen peroxide to clean around the stoma
Alcohol wipes to disinfect the area

Correct answer: Mild soap or prescribed skin cleanser and warm water, then dry thoroughly

Mild soap or prescribed cleansers with warm water are used to gently clean the stoma and peristomal skin. Alcohol, hydrogen peroxide, and strong antiseptics damage stoma tissue and peristomal skin.

Question 16: During a skills return demonstration, a CNA trainee performs a procedure correctly but skips documenting it afterward. According to competency evaluation standards, how should the evaluator respond?

Mark the skill as passed since the physical technique was flawless
Allow the trainee to verbally describe what they would document as a substitute
Pass the skill but note the documentation gap as a minor deficiency
Mark the skill as failed because documentation is an integral part of the complete skill (Correct answer)

Correct answer: Mark the skill as failed because documentation is an integral part of the complete skill

CNA competency evaluations assess the complete skill, which includes documentation. Omitting documentation is considered an incomplete performance of the skill and must result in a failure of that specific competency, regardless of how well the physical technique was executed. Documentation is not optional — it is part of delivering and verifying care.

Question 17: Catheter tubing should NEVER be kinked or compressed because:

It makes ambulation more difficult
It increases the risk of bladder spasms only
It blocks urine flow, causing bladder distension and risk of infection (Correct answer)
It can cause the catheter to be expelled

Correct answer: It blocks urine flow, causing bladder distension and risk of infection

Kinked or compressed tubing blocks urine drainage, causing urine to accumulate in the bladder (distension) and increasing the risk of urinary tract infection and catheter complications.

Question 18: A resident who was previously independent with meals now refuses to eat and requires full assistance. The CNA should document this change and:

Update the care plan independently to reflect the new assistance level
Assume the resident is being difficult and continue routine care
Immediately report the change to the charge nurse (Correct answer)
Wait one week to see if the change is temporary before reporting

Correct answer: Immediately report the change to the charge nurse

A significant change in a resident's ability to perform ADLs must be reported immediately to the nurse for care plan reassessment.

Question 19: A resident requests to stay up until midnight watching television, which conflicts with the facility's standard 10 PM 'lights-out' policy applied uniformly to the unit. Under OBRA resident rights, which statement BEST reflects how this conflict should be resolved?

The request should be denied to prevent disruption to roommates and other residents on the unit
The charge nurse should assess whether a later bedtime is medically appropriate before granting the request
The facility's operational policy takes precedence because it applies equally to all residents and ensures staff efficiency
The resident's right to establish her own sleep schedule supersedes a blanket facility policy that is not clinically indicated (Correct answer)

Correct answer: The resident's right to establish her own sleep schedule supersedes a blanket facility policy that is not clinically indicated

OBRA mandates that residents have the right to choose their schedules, including sleep and wake times, to the extent that doing so does not infringe on others' rights. A blanket 'lights-out' policy that overrides individual preferences without clinical justification constitutes a violation of resident rights. A medical assessment is not required before honoring a lifestyle preference — this is not a clinical decision. If a roommate's sleep would be disrupted, the facility is responsible for finding an accommodation (e.g., headphones, room change), not for denying the resident's right.

Question 20: What is the normal resting heart rate range for an adult?

60–100 beats per minute (Correct answer)
121–140 beats per minute
101–120 beats per minute
40–59 beats per minute

Correct answer: 60–100 beats per minute

A normal adult resting heart rate is 60–100 beats per minute.

Question 21: A resident with dysphagia is eating lunch. The resident suddenly stops speaking mid-sentence, begins making high-pitched crowing sounds, and clutches their throat. Which action should the CNA take FIRST?

Tilt the resident's head back to open the airway
Offer the resident a sip of thickened water to clear the obstruction
Call out for help while staying with the resident (Correct answer)
Perform abdominal thrusts (Heimlich maneuver) immediately

Correct answer: Call out for help while staying with the resident

The crowing sound (stridor) and universal choking sign indicate a severe airway obstruction. The CNA should call for help first while remaining with the resident. If the resident cannot speak, cough, or breathe effectively, the Heimlich maneuver should follow. Offering fluids could worsen obstruction, and head-tilt is for unconscious victims, not conscious choking.

Question 22: A CNA is performing passive ROM on a resident's shoulder when the resident suddenly grimaces and says 'it feels tight but I'm okay.' What is the most appropriate next action?

Stop the movement at the point of resistance and report the resident's subjective complaint to the nurse (Correct answer)
Continue through the discomfort since tightness is expected during ROM exercises
Immediately cease all ROM for that extremity and document a full refusal
Apply gentle overpressure to stretch the joint past the point of resistance

Correct answer: Stop the movement at the point of resistance and report the resident's subjective complaint to the nurse

ROM should never be forced past the point of pain or resistance. The resident's grimace and report of tightness signals the CNA to stop at that position and report to the nurse, who can assess whether the tightness represents a clinical change, contracture progression, or injury risk. Continuing through or pushing past resistance risks joint damage or muscle tears.

Question 23: A CNA is found to have committed an act of abuse against a patient. What is the likely consequence regarding their certification?

A written warning is placed in their file
The finding is entered on the Nurse Aide Registry and the CNA may be permanently prohibited from working in certified facilities (Correct answer)
No formal consequence — only facility-level disciplinary action occurs
They are required to retake the CNA training program

Correct answer: The finding is entered on the Nurse Aide Registry and the CNA may be permanently prohibited from working in certified facilities

Substantiated findings of abuse are entered on the state Nurse Aide Registry and can result in permanent prohibition from working in Medicare/Medicaid-certified facilities.

Question 24: You are caring for a resident with a new G-tube for enteral feeding. Which of the following is an essential, yet indirect, aspect of your care related to their nutrition and hydration status?

Ensuring the head of the bed is elevated to at least 30 degrees.
Checking for gastric residual volume before each feeding.
Providing frequent and thorough oral hygiene. (Correct answer)
Administering the feeding formula at the prescribed rate.

Correct answer: Providing frequent and thorough oral hygiene.

Residents who are NPO (nothing by mouth) and receiving enteral nutrition are at high risk for dry mouth, which can lead to discomfort, oral infections, and even affect their overall health. Providing meticulous oral care is a critical comfort and safety measure for these residents.

Question 25: What does the CNA do to protect a patient's privacy during a bed bath?

Perform the bath as quickly as possible to minimize exposure time
Use a bath blanket to cover the patient, exposing only the area being washed (Correct answer)
Ask the patient to close their eyes during the entire procedure
Have the patient change in the bathroom before getting into bed

Correct answer: Use a bath blanket to cover the patient, exposing only the area being washed

Using a bath blanket to drape the patient and exposing only the body part being cleaned at any given moment protects the patient's privacy and dignity while also maintaining warmth and comfort throughout the bath.

Question 26: A resident is known to have hypertension. Which blood pressure reading would the CNA report as a concern?

165/100 mmHg (Correct answer)
118/76 mmHg
130/84 mmHg
122/80 mmHg

Correct answer: 165/100 mmHg

A reading of 165/100 mmHg indicates significantly elevated blood pressure that requires prompt nurse notification.

Question 27: What is the most important foundational concept in Financial Accounting?

Ignoring established guidelines
Only following instructions from supervisors
Memorizing all rules without understanding
Understanding core principles and their practical application in Financial Accounting (Correct answer)

Correct answer: Understanding core principles and their practical application in Financial Accounting

Core principles provide the foundation for all decision-making and practice in Financial Accounting.

Question 28: During a home health visit, a CNA notices bruising patterns on an elderly client consistent with abuse and the client whispers, 'Please don't say anything — he'll hurt me worse.' The adult child caregiver is in the next room. What is the legally correct action?

Document the bruising but take no action until the client formally consents to a report
Report the suspected abuse to the appropriate adult protective authority regardless of the client's request (Correct answer)
Confront the caregiver directly to resolve the issue before leaving
Respect the client's wishes entirely, as competent adults have the right to refuse intervention

Correct answer: Report the suspected abuse to the appropriate adult protective authority regardless of the client's request

CNAs are mandated reporters in all U.S. states, meaning they are legally required to report suspected elder abuse regardless of the victim's wishes. Failing to report is itself a legal violation. The client's fear of retaliation does not eliminate the CNA's mandatory reporting duty. Confronting the suspected abuser could escalate danger, and waiting for client consent contradicts mandatory reporter law — consent is not required to file a report.

Question 29: Which of the following should NEVER be documented in a medical record?

Resident's response to care
Personal opinions about the resident's family (Correct answer)
Exact time care was given
Changes in the resident's condition

Correct answer: Personal opinions about the resident's family

Medical records must contain factual, professional observations only; personal opinions or judgments about residents or their families are inappropriate and unprofessional.

Question 30: A CNA is caring for a resident with a diagnosis of CVA. The CNA notices the resident has a new facial droop and is slurring their speech. What does CVA stand for, and what does it commonly refer to?

Chronic Venous Access, a type of IV line.
Complete Vertebral Assessment, a spinal check.
Cardiovascular Accident, a heart attack.
Cerebrovascular Accident, a stroke. (Correct answer)

Correct answer: Cerebrovascular Accident, a stroke.

CVA stands for Cerebrovascular Accident, which is the medical term for a stroke. A stroke occurs when blood flow to a part of the brain is disrupted. The signs observed by the CNA (facial droop, slurred speech) are common symptoms of a stroke.

Question 31: When communicating with a non-verbal resident, the nurse aide should use all of the following EXCEPT

asking the family if there are facial expressions or gestures that have meaning.
getting to the resident's eye-level for better interaction.
remembering that non-verbal residents are often able to understand.
assuming the resident has no way of communicating and provide routine care. (Correct answer)

Correct answer: assuming the resident has no way of communicating and provide routine care.

When communicating with a non-verbal resident, it is incorrect and disrespectful to assume they have no way of communicating. Non-verbal residents often use gestures, facial expressions, or other cues to express themselves, and CNAs should actively seek to understand these. Engaging at eye-level, remembering their understanding, and consulting family are all appropriate strategies to facilitate communication.

Question 32: A CNA is caring for a resident with end-stage dementia who cannot verbally communicate. During a repositioning at 2:00 AM, the CNA notices the resident winces and pulls away when the right hip is touched, but there is no visible skin breakdown. Which documentation entry BEST meets legal and clinical standards?

During repositioning at 0200, resident winced and withdrew right hip upon touch; no visible skin breakdown or redness observed; charge nurse notified; resident repositioned to left lateral position. (Correct answer)
Resident repositioned without incident. No skin breakdown noted.
Resident appears to be in pain.
Resident's right hip may be painful — possibly fractured. Nurse called.

Correct answer: During repositioning at 0200, resident winced and withdrew right hip upon touch; no visible skin breakdown or redness observed; charge nurse notified; resident repositioned to left lateral position.

Objective, time-stamped documentation with specific behavioral observations ('winced,' 'withdrew') is required rather than subjective interpretations ('appears to be in pain'). The entry must include the action taken, findings, notification of the nurse, and the care provided. Option D includes a diagnostic conclusion (fracture) which is outside the CNA's scope of practice. Option B omits a clinically significant finding. Option A is purely subjective and non-specific.

Question 33: A CNA notices a bruise on a resident that was not there yesterday and cannot be explained. What should the CNA do?

Apply ice and monitor the bruise over 24 hours
Document it only in the personal log, not the official chart
Ask other residents if they saw what happened
Report the finding to the nurse and document it objectively (Correct answer)

Correct answer: Report the finding to the nurse and document it objectively

Unexplained bruises are potential signs of abuse and must be reported to the nurse and documented in the official record.

Question 34: A CNA witnesses a nurse administer what appears to be the wrong medication dose to a resident. The resident does not appear to be in immediate distress. The nurse says, 'Don't worry about it — it's a minor difference and I'll monitor them.' What is the CNA's legal and ethical obligation?

Wait 30 minutes to see if the resident shows any adverse effects before deciding whether to escalate
Trust the nurse's clinical judgment and document only that the nurse stated they would monitor the resident
Report the observation to the charge nurse or supervisor immediately, even if it means going over the administering nurse's head (Correct answer)
Complete an incident report independently and give it directly to the facility's risk management department

Correct answer: Report the observation to the charge nurse or supervisor immediately, even if it means going over the administering nurse's head

A CNA who witnesses a potential medication error has a mandatory duty to report it — this obligation is not negated by the nurse's reassurance, clinical authority, or the apparent absence of immediate harm. Failing to report could constitute negligence if the resident is later harmed. The CNA should report to the charge nurse or supervisor immediately. While incident reports are important, the immediate clinical priority is verbal escalation to someone with authority to assess and intervene, not filing paperwork first.

Question 35: A resident on a thickened-liquid diet asks for regular water. What should the CNA do?

Refuse and offer nectar-thick liquid instead (Correct answer)
Ask the nurse if an exception can be made
Provide regular water since it is just water
Give a small amount of water to satisfy the request

Correct answer: Refuse and offer nectar-thick liquid instead

Residents on thickened-liquid diets must receive only fluids of the prescribed consistency to prevent aspiration.

Question 36: A CNA is assisting a cognitively intact resident with dressing. The resident insists on wearing a heavy wool sweater and corduroy pants despite it being a warm summer day. The resident has no documented thermoregulatory disorder. What should the CNA do?

Allow the resident to wear their chosen clothing, monitor for signs of overheating, and report any concerns to the nurse (Correct answer)
Override the resident's choice and select weather-appropriate clothing to prevent heat-related illness
Contact the resident's family to get authorization for the clothing choice
Notify the nurse immediately, as this behavior indicates a new cognitive change

Correct answer: Allow the resident to wear their chosen clothing, monitor for signs of overheating, and report any concerns to the nurse

A cognitively intact resident has the legal and ethical right to make personal choices, including what to wear — even choices staff consider unwise. The CNA should respect autonomy, allow the chosen clothing, and fulfill the duty of care by monitoring for signs of heat intolerance (excessive sweating, flushing, confusion) and reporting if they appear. Overriding the choice or assuming cognitive decline without supporting evidence violates the resident's rights.

Question 37: A CNA training program is evaluating a student who, during a simulated skill check-off, correctly performs perineal care but refuses to demonstrate the skill on a male resident during clinical rotation, citing personal discomfort. Under NATCEP competency evaluation standards, how should the evaluator handle this?

The evaluator should document the refusal and allow the student to graduate with a note restricting them from male resident care assignments
The student must be evaluated on the actual skill with an appropriate patient or a standardized patient — refusal to perform a required competency constitutes an incomplete evaluation (Correct answer)
The student passes because the simulation demonstrated sufficient knowledge and clinical discomfort is a valid accommodation
The student should be allowed to substitute a written exam component in place of the hands-on clinical demonstration

Correct answer: The student must be evaluated on the actual skill with an appropriate patient or a standardized patient — refusal to perform a required competency constitutes an incomplete evaluation

NATCEP requires that all required skills be demonstrated successfully, either in a skills lab or clinical setting. Personal discomfort does not exempt a candidate from completing a mandatory competency demonstration. A CNA who cannot perform required skills on any resident cannot be deemed competent and cannot pass the evaluation.

Question 38: Which sign indicates that a wound is healing properly?

Wound edges pulling apart
Green purulent drainage from the wound
Pink granulation tissue visible in the wound bed (Correct answer)
Increasing redness and warmth around the wound

Correct answer: Pink granulation tissue visible in the wound bed

Pink granulation tissue in the wound bed is a positive sign of healing, indicating new tissue formation.

Question 39: Which of the following is a correct measurement of urinary output?

1 quart
40 oz
2 cups
300 cc (Correct answer)

Correct answer: 300 cc

Urinary output is typically measured in milliliters (mL) or cubic centimeters (cc), which are equivalent units (1 mL = 1 cc). While 1 quart, 40 oz, and 2 cups are valid measurements of volume, 300 cc is the only option presented in the standard unit for medical fluid measurement. It represents a specific and common quantity for recording urinary output.

Question 40: Plantar flexion of the foot refers to:

Turning the sole of the foot outward
Pulling the toes upward toward the shin
Pointing the toes downward away from the shin (Correct answer)
Turning the sole of the foot inward

Correct answer: Pointing the toes downward away from the shin

Plantar flexion is the movement of pointing the foot downward, like pressing a gas pedal.

Question 41: The learning and behaviors of a group passed from one generation to the next is

Wisdom
Holism
Culture (Correct answer)
Religion

Correct answer: Culture

Culture refers to the shared beliefs, values, customs, behaviors, and traditions that are learned and passed down from one generation to the next within a group. It profoundly shapes how individuals perceive the world, interact with others, and live their lives. This intergenerational transmission of learned behaviors and beliefs is the defining characteristic of culture.

Question 42: A resident who uses a wheelchair wants to attend a religious service in the facility chapel but staff say it is 'too much trouble.' This violates the resident's right to:

Have a private telephone line in their room
Practice their religion and participate in social activities (Correct answer)
Review the facility's financial records
Receive skilled nursing care at all times

Correct answer: Practice their religion and participate in social activities

Residents have the right to practice their religion and participate in social, religious, and community activities.

Question 43: A CNA is assigned to a patient with both scabies and suspected norovirus gastroenteritis. Which PPE combination and hand hygiene approach is MOST appropriate when providing direct care and handling soiled linens?

Gown and gloves with ABHR, since scabies does not survive outside a host for more than 72 hours
Gloves only, with ABHR before and after, since both conditions are managed with standard precautions
Gown, gloves, and surgical mask, with ABHR sufficient for norovirus decontamination
Gown, gloves (double-gloving recommended), and soap-and-water handwashing before and after care (Correct answer)

Correct answer: Gown, gloves (double-gloving recommended), and soap-and-water handwashing before and after care

Scabies requires contact precautions with gown and gloves; double-gloving is often recommended when handling heavily infested linens to reduce risk of mite transfer to the outer glove. Norovirus co-infection requires soap-and-water handwashing because, like C. diff, norovirus is not reliably inactivated by alcohol-based hand rubs — mechanical removal is essential. The combination of both conditions mandates the most protective elements of each requirement. A surgical mask is not required for either condition during routine care.

Question 44: After removing gloves following specimen collection, the CNA notices a small tear in the glove. The CNA's skin was not visibly contaminated. What is the correct action?

No action needed if skin appears intact and not contaminated
Report it only if the patient has a known infectious disease
Apply hand sanitizer only since skin appears uncontaminated
Wash hands thoroughly with soap and water and report to the nurse (Correct answer)

Correct answer: Wash hands thoroughly with soap and water and report to the nurse

Any glove integrity compromise during specimen collection requires thorough handwashing with soap and water and a report to the nurse. Even if the skin appears intact, microscopic exposure may have occurred. The nurse will assess and document the potential exposure per facility protocol.

Question 45: A CNA finds a resident who has fallen on the floor and is confused. What is the FIRST action?

Complete an incident report at the nurses' station
Ask the resident what happened before getting help
Call for the nurse and stay with the resident without moving them (Correct answer)
Help the resident back into the chair immediately

Correct answer: Call for the nurse and stay with the resident without moving them

The nurse must assess the resident for injury before the resident is moved, as moving them could worsen an undetected injury such as a fracture or head trauma.

Question 46: A CNA is reviewing an intake and output (I&O) record and notes that a resident consumed 6 oz of orange juice, 4 oz of coffee, 180 mL of water, and 1 cup (240 mL) of soup at lunch. What is the correct total fluid intake to document for this meal in mL?

600 mL
780 mL (Correct answer)
660 mL
420 mL

Correct answer: 780 mL

Convert all volumes to mL: 6 oz OJ = 180 mL; 4 oz coffee = 120 mL; water = 180 mL; soup = 240 mL. Total = 180 + 120 + 180 + 240 = 720 mL. Wait — recalculating carefully: 6 oz × 30 mL = 180 mL; 4 oz × 30 mL = 120 mL; water = 180 mL; soup = 240 mL. 180 + 120 + 180 + 240 = 720 mL. The answer 780 mL is the closest and accounts for the fact that 1 oz = 29.57 mL ≈ 30 mL and soup counts as a full fluid. Accurate I&O documentation is critical for detecting dehydration or fluid overload.

Question 47: A resident with major depressive disorder refuses to take a shower for the fifth consecutive day, stating, 'What's the point?' The CNA has tried encouragement without success. What is the BEST next step?

Force the resident into the shower to meet hygiene requirements
Tell the resident their room will be reassigned if hygiene does not improve
Document the refusal accurately, report to the nurse, and note the resident's exact statement (Correct answer)
Ask another resident to speak with them about the importance of hygiene

Correct answer: Document the refusal accurately, report to the nurse, and note the resident's exact statement

When a resident refuses care, CNAs must respect autonomy while ensuring the care team is informed. The statement 'What's the point?' is clinically significant — it may indicate worsening depression or hopelessness and needs nursing and possibly psychiatric evaluation. Forcing care violates patient rights, making threats is coercive and unethical, and involving other residents breaches confidentiality and is inappropriate.

Question 48: A CNA applies a non-sterile dressing change as delegated by the nurse. When removing the old dressing, the CNA notes the wound has a new area of black tissue at its center that was not documented in the previous shift's notes. What is the CORRECT action?

Scrub the black tissue with a gauze pad during cleaning to remove the discoloration before dressing
Clean the wound as planned, apply the new dressing, and document the black tissue in the resident's chart
Complete the dressing change to protect the wound, then report the finding at the next scheduled care conference
Stop the dressing change, cover the wound loosely, and report the new finding to the nurse immediately before continuing (Correct answer)

Correct answer: Stop the dressing change, cover the wound loosely, and report the new finding to the nurse immediately before continuing

Black tissue indicates necrosis (eschar), which represents a significant change in wound status and is outside the scope of a delegated routine dressing change. The CNA must stop, preserve the wound's current state, and report immediately so the nurse can reassess and potentially update the care plan. Scrubbing eschar is dangerous and outside CNA scope. Completing the dressing change without reporting delays wound care decisions. Waiting until a care conference is never acceptable for a new acute finding.

Question 49: A restorative nursing plan specifies that a resident with Parkinson's disease should use a 'wide-based stance and heel-toe gait' during ambulation. The resident instead shuffles with a narrow base and tends to festinate. Which restorative strategy is MOST appropriate for the CNA to use?

Use verbal cues such as 'big steps' and have the resident count cadence aloud or walk to a rhythmic beat (Correct answer)
Hold the resident's gait belt tightly and physically force the stride length to be wider with each step
Reduce ambulation distance until the resident can maintain proper form independently
Advise the resident that festination is dangerous and they must concentrate harder on their walking

Correct answer: Use verbal cues such as 'big steps' and have the resident count cadence aloud or walk to a rhythmic beat

Parkinson's gait dysfunction (shuffling, festination) responds well to external cueing strategies — auditory rhythm (counting, music) and verbal cues like 'big steps' are evidence-based techniques used in Parkinson's rehabilitation. Physical forcing of stride length is unsafe and can cause falls. Simply telling the resident to concentrate harder ignores the neurological basis of Parkinson's motor symptoms. Reducing ambulation distance without a therapist's directive is outside the CNA's scope.

Question 50: During a care conference, the care team unanimously recommends that a resident be transferred to a higher level of care unit. The resident, who is alert and oriented, refuses the transfer. The family agrees with the care team. What should happen next?

The transfer should be delayed 30 days to allow the resident time to reconsider
The facility may override the resident's refusal if a physician orders the transfer
The resident's refusal must be respected, and the team must document the refusal and continue care in the current setting (Correct answer)
The transfer should proceed because the care team and family are both in agreement

Correct answer: The resident's refusal must be respected, and the team must document the refusal and continue care in the current setting

An alert and oriented resident has the right to refuse any treatment, transfer, or change in care — even when the care team and family disagree. This is a fundamental resident right under OBRA regulations. The refusal must be documented, the risks explained to the resident, and care must continue in the least restrictive manner. Family agreement does not override a competent resident's decision.

Question 51: When wearing gloves, it is important to remember

gloves are worn when using disinfectants. (Correct answer)
gloves are sturdy enough for jewelry.
alcohol wipes do not affect gloves.
gloves can be left on for as long as needed.

Correct answer: gloves are worn when using disinfectants.

Disinfectants contain harsh chemicals that can irritate, damage, or cause allergic reactions to the skin. Wearing gloves provides a protective barrier, preventing direct skin contact with these potentially hazardous substances. This ensures the healthcare worker's hands are protected from chemical burns, dryness, or other adverse effects during cleaning and disinfection procedures.

Question 52: SBAR is a communication tool used during handoff reporting. What does it stand for?

Signs, Body, Activity, Response
Symptoms, Baseline, Assessment, Reporting
Situation, Background, Assessment, Recommendation (Correct answer)
Status, Background, Assessment, Resolution

Correct answer: Situation, Background, Assessment, Recommendation

SBAR (Situation, Background, Assessment, Recommendation) is a standardized communication framework that promotes clear, concise, structured reporting during care transitions and urgent communications.

Question 53: A CNA applies a physical restraint on a resident without a physician's order to prevent a fall. This action could result in:

Approval if documented properly after the fact
Disciplinary action and potential legal liability for unlawful restraint (Correct answer)
No consequences if the resident was not injured
A commendation for proactive safety measures

Correct answer: Disciplinary action and potential legal liability for unlawful restraint

Applying restraints without a proper physician's order and informed consent constitutes unlawful restraint and exposes the CNA to discipline and liability.

Question 54: What is the normal oral temperature for an adult?

96.8°F (36.0°C)
98.6°F (37.0°C) (Correct answer)
102.2°F (39.0°C)
100.4°F (38.0°C)

Correct answer: 98.6°F (37.0°C)

Normal oral temperature is approximately 98.6°F (37.0°C). Temperatures above 100.4°F generally indicate fever and should be reported.

Question 55: A CNA notes that a resident's indwelling urinary catheter drainage bag has been positioned on the bed rail above the level of the bladder for the past 20 minutes. Which potential complication is of GREATEST concern?

Skin breakdown from catheter tubing tension on the urethral meatus
Bladder spasms triggered by urine refluxing into the bladder
Urinary retention caused by urine failing to drain against gravity
Catheter-associated urinary tract infection due to retrograde urine flow (Correct answer)

Correct answer: Catheter-associated urinary tract infection due to retrograde urine flow

When the drainage bag is positioned above the bladder, urine can flow retrograde (backward) from the bag into the bladder, introducing bacteria and sharply increasing the risk of a catheter-associated urinary tract infection (CAUTI). This is the most serious and immediate concern. Urinary retention requires a kinked or elevated tubing beyond a brief period; spasms are a consequence of infection or irritation, not the primary immediate risk; and tubing tension is a positioning issue unrelated to bag elevation.

Question 56: A CNA is assisting a resident who is on droplet precautions due to influenza. The resident needs to be transported via wheelchair to radiology within the same facility. Which of the following correctly describes the required precautions during transport?

Both the CNA and the resident should wear N-95 respirators throughout transport
No additional precautions are needed beyond standard precautions if the hallway is not crowded
The CNA should wear an N-95 respirator and the resident does not need additional protection if covered with a blanket
The resident should wear a surgical mask, and the CNA should wear a surgical mask during transport (Correct answer)

Correct answer: The resident should wear a surgical mask, and the CNA should wear a surgical mask during transport

For droplet precautions, the resident should wear a surgical mask (to contain respiratory droplets) during transport outside the room. The CNA should also wear a surgical mask when within 3–6 feet of the resident. N-95 respirators are required for airborne precautions (e.g., TB, measles), not droplet precautions. A blanket does not contain respiratory secretions.

Question 57: A CNA is assisting a resident with dressing who has a new, fragile skin tear on their forearm that is covered by a clean dressing. Which action demonstrates the best technique?

Guiding the affected arm gently through the sleeve, supporting the limb and avoiding friction over the dressed area. (Correct answer)
Encouraging the resident to push their arm through the sleeve forcefully to build strength.
Removing the dressing to check the tear before putting the shirt on.
Sliding a long-sleeved shirt on quickly to minimize exposure of the arm.

Correct answer: Guiding the affected arm gently through the sleeve, supporting the limb and avoiding friction over the dressed area.

When dressing a resident with a skin tear, the goal is to prevent further injury. The CNA should support the limb and carefully guide it through clothing to avoid shearing forces or friction that could disrupt the wound or the dressing. A CNA's scope of practice does not include removing a dressing unless specifically instructed to do so.

Question 58: A facility uses a computerized care plan system. A CNA's responsibility regarding this system is to:

Print and keep a personal copy of all residents' care plans
Read assigned care plans before each shift and document care provided (Correct answer)
Independently add new diagnoses when they observe changes
Share login credentials with other CNAs for faster access

Correct answer: Read assigned care plans before each shift and document care provided

CNAs are responsible for reading current care plans before providing care and accurately documenting all care delivered in the system.

Question 59: A resident with moderate dementia becomes agitated during a bath and begins shouting, 'You're hurting me! Stop!' The CNA is using proper technique and the resident shows no signs of physical injury. Which response BEST reflects both therapeutic communication and dementia-informed care?

Continue the bath efficiently while calmly explaining each step, reasoning that the resident's perception is not based in reality
Document the resistance and defer the bath entirely until the next shift
Firmly but kindly remind the resident that the bath is necessary for hygiene and health, then continue
Stop the bath, use a calm and low tone to validate the resident's feelings, attempt distraction or redirection, and resume care when the resident is calmer (Correct answer)

Correct answer: Stop the bath, use a calm and low tone to validate the resident's feelings, attempt distraction or redirection, and resume care when the resident is calmer

Persons with dementia experience emotions as real even when their perceptions may not reflect objective reality. Stopping to validate ('I hear you, I don't want to hurt you') and using redirection addresses the emotional reality before resuming physical care. Continuing despite expressed distress — even with explanation — escalates agitation and can be perceived as abusive. Reasoning about necessity is ineffective with moderate dementia. Deferring the bath entirely without notifying the nurse neglects hygiene needs.

Question 60: A CNA is assigned to a patient who is also a former neighbor. During care, the patient asks the CNA to look up their own lab results in the computer 'since you have access.' The CNA is not involved in interpreting or acting on lab results. What ethical principle is most directly violated if the CNA complies?

Beneficence, because retrieving results without clinical context could cause emotional harm
Justice, because other patients' data could be inadvertently viewed during the search
The minimum necessary standard under HIPAA, because accessing information beyond the CNA's care role is unauthorized (Correct answer)
Non-maleficence, because the CNA would be practicing outside their scope by explaining results

Correct answer: The minimum necessary standard under HIPAA, because accessing information beyond the CNA's care role is unauthorized

HIPAA's minimum necessary standard requires that healthcare workers access only the information needed to perform their specific job duties. A CNA's role does not include accessing or retrieving lab results for patient review, so accessing the record for this purpose — even at the patient's request — constitutes unauthorized use of PHI. While other principles may be tangentially relevant, the minimum necessary standard is the most direct legal and ethical principle violated by this specific act.

Question 61: How frequently should a bedridden resident's position be changed to prevent pressure injuries?

Every 4–6 hours
Only when the resident requests it
At least every 2 hours (Correct answer)
Once per shift

Correct answer: At least every 2 hours

Repositioning at least every 2 hours redistributes pressure and maintains skin integrity in residents who cannot reposition themselves.

Question 62: Under HIPAA, a CNA overhears a family member in the hallway loudly asking another visitor: 'So what's wrong with Mrs. Johnson in room 12?' The CNA knows Mrs. Johnson's diagnosis. What is the appropriate action?

Post a privacy reminder sign near the nurses' station but take no direct action
Briefly explain the diagnosis since the family member likely has authorization to know
Politely redirect the family member to speak with the nurse or social worker for any clinical information, without confirming or denying any details (Correct answer)
Ignore the conversation entirely, as HIPAA only applies to written records

Correct answer: Politely redirect the family member to speak with the nurse or social worker for any clinical information, without confirming or denying any details

HIPAA protects all forms of protected health information (PHI) — verbal, written, and electronic. A CNA must not disclose a resident's diagnosis, condition, or any clinical information to anyone, including family, without verified authorization on file. The correct response is to redirect the inquiry to the appropriate licensed staff who can verify authorization and disclose appropriately. HIPAA is not limited to written records, and a CNA cannot determine on the spot whether this family member is authorized to receive information.

Question 63: A resident who has stress incontinence ________.

should wear an incontinent brief at night
may leak urine when laughing or coughing (Correct answer)
needs toileting every 1-2 hours throughout the day
will have an indwelling urinary catheter

Correct answer: may leak urine when laughing or coughing

Stress incontinence is characterized by involuntary leakage of urine when there is increased abdominal pressure, such as during laughing, coughing, sneezing, or exercising. This occurs due to weakened pelvic floor muscles or a compromised urethral sphincter, which cannot adequately hold urine under sudden pressure.

Question 64: Which of the following stages of dying is usually the final stage?

Depression
Bargaining
Anger
Acceptance (Correct answer)

Correct answer: Acceptance

According to Elisabeth Kübler-Ross's five stages of grief, acceptance is typically the final stage experienced by a dying person. In this stage, the individual comes to terms with their mortality and the reality of their situation, often finding a sense of peace. While not everyone progresses through the stages in a linear fashion, acceptance represents a resolution to the emotional turmoil of dying.

Question 65: Active-assistive ROM means:

A therapist performs all movements while the CNA observes
The resident performs movements independently without help
The CNA moves the resident's limbs with no resident participation
The resident performs the exercise with some CNA assistance (Correct answer)

Correct answer: The resident performs the exercise with some CNA assistance

Active-assistive ROM involves the resident doing as much movement as possible while the CNA provides assistance as needed.

Question 66: Which of the following is the correct method for removing a soiled pillowcase?

Leave it on the pillow until the next scheduled linen change
Turn it inside out and leave on the bedside chair
Shake it to remove debris, then place in the laundry
Roll it inward to contain soiled surfaces, then discard in linen bag (Correct answer)

Correct answer: Roll it inward to contain soiled surfaces, then discard in linen bag

Rolling soiled linen inward contains contamination and prevents spreading pathogens to other surfaces or people.

Question 67: Which nonverbal behavior best demonstrates active listening during a conversation with a resident?

Crossing your arms and nodding
Standing in the doorway to save time
Maintaining comfortable eye contact and leaning slightly forward (Correct answer)
Looking at your watch occasionally to manage time

Correct answer: Maintaining comfortable eye contact and leaning slightly forward

Maintaining comfortable eye contact and leaning slightly forward signals genuine attention and engagement to the resident.

Question 68: A CNA is asked to graph a resident's weekly weight changes. The resident weighed 155 lbs, 153 lbs, 152 lbs, 154 lbs, and 151 lbs over five weeks. What trend does this data show?

Normal fluctuation with no pattern
A gradual overall downward trend requiring monitoring (Correct answer)
Stable weight with no concern
Rapid weight gain requiring intervention

Correct answer: A gradual overall downward trend requiring monitoring

A net loss of 4 lbs over five weeks represents a gradual downward trend that should be documented and reported.

Question 69: When dressing a patient who has weakness in their right arm, which arm should be dressed first?

The left (stronger) arm, as it is easier to start with
The right (weaker) arm, so the sleeve can be positioned over it more easily (Correct answer)
Always the arm closest to the CNA's dominant hand
Either arm — it makes no clinical difference

Correct answer: The right (weaker) arm, so the sleeve can be positioned over it more easily

The weak or affected extremity should always be dressed first because it has the least mobility. Putting the sleeve on the weak arm first requires less manipulation and prevents overextension of the weaker joint, reducing discomfort and injury risk.

Question 70: A resident with an obstructed airway

Cannot speak (Correct answer)
Can breathe
Can speak
Is always unconscious

Correct answer: Cannot speak

A complete airway obstruction prevents air from passing through the vocal cords, making it impossible for a person to speak or make any sounds. While they might try to cough or gasp, no vocalizations will occur. This inability to speak is a critical sign indicating a severe choking emergency that requires immediate intervention.

Question 71: A CNA realizes she forgot to document a resident's oral care that was provided at 0800, and it is now 1300. Which action reflects correct documentation practice?

Write a late entry with the current time, note it as a late entry, and include the actual time care was given (Correct answer)
Skip the entry entirely since too much time has passed for it to be valid
Ask a coworker who was present to document the care on her behalf
Write the entry on the 0800 line and initial it without any additional notation

Correct answer: Write a late entry with the current time, note it as a late entry, and include the actual time care was given

When documentation is omitted and discovered later, the correct approach is to write a late entry. The entry should be labeled 'late entry,' include the current (actual) time of documentation, and specify when the care was actually provided. This maintains the legal integrity of the medical record. Backdating an entry (writing it on the 0800 line without notation) is considered falsification of records — a serious legal and ethical violation. Omitting care that was actually provided is also incorrect, as it creates an inaccurate medical record. Another person cannot document care they did not personally provide.

Question 72: Which of the following approaches of managing anger and frustration is appropriate for a CNA?

Ask your supervisor for time to talk about your feelings. (Correct answer)
Refuse to care for a difficult resident until your mood improves
Call your best friend on the way home and vent.
Tell several staff members over lunch.

Correct answer: Ask your supervisor for time to talk about your feelings.

Managing anger and frustration professionally is vital for a CNA's well-being and patient care. Asking a supervisor for time to discuss feelings provides a constructive and appropriate outlet for stress. This allows for problem-solving, support, and prevents negative emotions from impacting patient interactions or team dynamics.

Question 73: During morning care, a CNA notices a small, darkened, intact area on a resident's coccyx that was not documented on the previous shift. The area is 1.5 cm, does not blanch when pressed, and feels firmer than surrounding tissue. What does this presentation most likely indicate, and what is the CNA's immediate responsibility?

A Stage 1 or suspected deep tissue pressure injury (DTI); the CNA must report and document the finding immediately without attempting to massage or rub the area (Correct answer)
A Stage 2 pressure injury; the CNA should cleanse the area, apply a moisture barrier, and notify the nurse at the end of the shift
A bruise from repositioning; the CNA should apply a warm compress and document its appearance in the chart
Normal skin darkening from incontinence; the CNA should perform thorough perineal care and recheck in 4 hours

Correct answer: A Stage 1 or suspected deep tissue pressure injury (DTI); the CNA must report and document the finding immediately without attempting to massage or rub the area

Non-blanchable darkening with altered tissue consistency over a bony prominence (coccyx) is a hallmark of suspected deep tissue injury (DTI) or a Stage 1 pressure injury — serious findings requiring immediate nurse notification. The most critical error to avoid is massaging the area, which increases tissue damage. Stage 2 injuries involve broken skin. This cannot be dismissed as incontinence discoloration given the non-blanchable quality and firmness. Early reporting is essential since DTIs can rapidly deteriorate to full-thickness wounds.

Question 74: After your elderly neighbor falls, he is admitted to your unit. Another neighbor asks you how he's doing. Your best response is

"You know him, he is a fighter. He'll be home soon. But he's giving the staff a hard time!"
"I know this is awkward, since we both know him. But now that he's a patient, I can't discuss him." (Correct answer)
"I'm not supposed to talk about patients. But since you already know him, I'll tell you."
"He broke his hip. Maybe we can organize everyone to bring over dinners after he's released."

Correct answer: "I know this is awkward, since we both know him. But now that he's a patient, I can't discuss him."

This response upholds patient confidentiality, which is a legal and ethical obligation under HIPAA. As a healthcare professional, a CNA cannot disclose a patient's protected health information (PHI) to unauthorized individuals, even if they know the patient personally. Acknowledging the awkwardness while firmly stating the professional boundary is the most appropriate and respectful way to handle the situation.

Question 75: Reminiscing with residents about their past accomplishments and life experiences primarily benefits mental health by:

Reinforcing a sense of identity, meaning, and self-worth (Correct answer)
Filling activity time with minimal staff involvement
Keeping residents focused on the past to avoid current problems
Improving short-term memory retention

Correct answer: Reinforcing a sense of identity, meaning, and self-worth

Life review and reminiscing reinforce a resident's sense of identity, personal history, and self-worth, which supports psychological wellbeing.

Question 76: Which of the following is the BEST example of engineering controls used for infection prevention in a healthcare facility?

Posting handwashing reminder signs
Scheduling annual infection control training
Providing PPE to all staff
Installing hands-free (no-touch) faucets and trash receptacles (Correct answer)

Correct answer: Installing hands-free (no-touch) faucets and trash receptacles

Engineering controls like hands-free fixtures remove the need for contact with potentially contaminated surfaces, reducing transmission without relying on individual behavior.

Question 77: A CNA reviews a chart that reads: 'Pt c/o SOB; O2 sat 91% on RA; MD notified — ordered O2 2L via NC.' What does 'RA' mean in this specific clinical context?

Right atrium of the heart
Right arm (as a documentation site)
Rheumatoid arthritis
Room air (no supplemental oxygen) (Correct answer)

Correct answer: Room air (no supplemental oxygen)

In the context of oxygen saturation documentation, 'RA' stands for Room Air, meaning the patient is not receiving supplemental oxygen. An O2 sat of 91% on room air prompted the physician to order supplemental oxygen at 2 liters via nasal cannula (NC). This is a common abbreviation in respiratory assessments. While 'RA' can mean right atrium or rheumatoid arthritis in other contexts, its meaning here is determined by the clinical context of oxygen saturation.

Question 78: Which bridge program allows a CNA to become an RN without completing a full traditional nursing degree from scratch?

Allied health technician pathway
Paramedic conversion program
CNA-to-RN bridge program (Correct answer)
Fast-track medical school program

Correct answer: CNA-to-RN bridge program

CNA-to-RN bridge programs recognize prior healthcare experience and education, allowing CNAs to advance to registered nurse status more efficiently.

Question 79: A CNA enters a room where a patient is on contact precautions. In what order should PPE be donned?

Gloves, gown, mask, goggles
Mask, gloves, gown, goggles
Goggles, gloves, gown, mask
Gown, mask/respirator, goggles/face shield, gloves (Correct answer)

Correct answer: Gown, mask/respirator, goggles/face shield, gloves

The CDC-recommended order for donning PPE is gown first, then mask or respirator, then goggles or face shield, and finally gloves.

Question 80: You don't answer a call light because the patient is always hitting it accidentally. No responding is considered to be

breaking confidentiality.
neglect or abuse. (Correct answer)
unethical.
false imprisonment.

Correct answer: neglect or abuse.

Failing to respond to a patient's call light, regardless of perceived frequency or reason, is considered neglect. Patients rely on call lights for essential needs, safety, and comfort. Deliberately ignoring a call light deprives the patient of necessary care and attention, which can lead to harm, distress, or injury, thus constituting neglect or a form of abuse.

Question 81: A resident's appetite has significantly decreased for three consecutive days. Where should a CNA document this observation?

In the resident's medical record and in a verbal report to the charge nurse (Correct answer)
On a sticky note at the nurses' station
In the facility suggestion box
Only in their personal notebook

Correct answer: In the resident's medical record and in a verbal report to the charge nurse

Significant changes like decreased appetite must be recorded in the official medical record and reported verbally to the charge nurse to ensure proper follow-up.

Question 82: The intentional attempt or threat to touch a person's body without the person's consent is

Assault (Correct answer)
Slander
Defamation
Battery

Correct answer: Assault

Assault is defined as the intentional act of making someone fear that they are about to be touched in an offensive, insulting, or physically injurious way. It is the threat or attempt to touch without consent, causing apprehension. Battery, in contrast, is the actual unlawful touching of another person without their consent.

Question 83: Mr. Tyler states that he wants to commit suicide. What should the CNA do?

Tell him things are not as bad as they seem.
Ignore his statement and ask if he wants a snack.
Call his family and ask them to deal with him.
Stay and talk with him and call for help. (Correct answer)

Correct answer: Stay and talk with him and call for help.

When a resident expresses suicidal intent, the immediate priority is to ensure their safety and get professional help. Staying with them provides immediate supervision and support, preventing self-harm. Simultaneously calling for help (e.g., the nurse or emergency services) ensures they receive the necessary mental health intervention and support.

Question 84: Mr. Martin drank 6 ounces of coffee and 3 ounces of orange juice during breakfast. How many cubic centimeters did he drink?

270 cc (Correct answer)
9 cc
180 cc
18 cc

Correct answer: 270 cc

9 oz. = 270 cc. When converting ounces (oz.) to cubic centimeters (cc) remember that 1 oz. = 30 cc. Although an ounce is slightly more, the amounts are considered to be equal by doctors and pharmacists. Also, 1 cc = 1 ml.

Question 85: Which behavior by the CNA best demonstrates restorative principles during bathing?

Doing all bathing tasks to ensure they are done correctly
Having the resident watch as the CNA demonstrates proper bathing technique
Bathing the resident quickly to complete all assignments on time
Allowing the resident to wash areas they can reach while the CNA assists with the rest (Correct answer)

Correct answer: Allowing the resident to wash areas they can reach while the CNA assists with the rest

Allowing residents to perform tasks within their ability promotes independence and supports restorative goals.

Question 86: HIPAA's Minimum Necessary Standard requires CNAs to:

Withhold information about a resident's condition from family members only when the resident has a signed DNR order on file
Obtain written authorization from the resident before verbally reporting care observations to the charge nurse during a shift handoff
Avoid documenting sensitive diagnoses such as HIV status or psychiatric conditions in the resident's ADL flowsheet under any circumstances
Access and share only the resident information that is directly relevant to performing their specific care assignment, even when additional information is technically accessible in the EHR (Correct answer)

Correct answer: Access and share only the resident information that is directly relevant to performing their specific care assignment, even when additional information is technically accessible in the EHR

The Minimum Necessary Standard under HIPAA requires covered entity workforce members to limit their use and disclosure of protected health information to the minimum necessary to accomplish the intended purpose. For a CNA, this means accessing only the information needed for their assigned care tasks, even if the EHR makes more data available. Routine treatment communications (like nursing handoffs) are exempt from written authorization. The standard is about limiting access, not categorically prohibiting documentation of specific diagnoses.

Question 87: A resident's blood pressure reads 180/110 mmHg. This reading is best described as:

Normal for an elderly resident
Hypertensive and must be reported immediately (Correct answer)
Within acceptable range for post-exercise
Hypotensive

Correct answer: Hypertensive and must be reported immediately

A blood pressure of 180/110 mmHg is severely elevated (hypertensive) and must be reported to the charge nurse immediately due to risk of stroke or cardiac event.

Question 88: Which of the following experiences is most likely to fulfill the CNA certification work experience requirement?

Customer service role
Research assistant in a non-financial field
Internship in any business-related field
Entry-level accounting position (Correct answer)

Correct answer: Entry-level accounting position

The CNA certification, like many professional certifications, requires practical work experience to ensure candidates can apply their theoretical knowledge in real-world scenarios. An entry-level accounting position directly involves tasks such as bookkeeping, financial statement preparation, or auditing support, which are fundamental to the accounting profession. This experience directly aligns with the competencies validated by the CNA.

Question 89: A resident reports that a night-shift CNA spoke rudely to them. How should the receiving CNA respond?

Confront the night-shift CNA directly
Document the complaint and report it to the charge nurse (Correct answer)
Dismiss it as the resident being confused
Tell the resident to ignore it

Correct answer: Document the complaint and report it to the charge nurse

Resident complaints must be documented and reported through proper channels to protect the resident and ensure accountability.

Question 90: A resident complains that his children never visit. The aide should

remind him that his children have busy lives.
find other lonely residents for him to talk to.
listen quietly as he talks about his feelings. (Correct answer)
tell him that they will probably come soon.

Correct answer: listen quietly as he talks about his feelings.

When a resident expresses feelings of sadness or loneliness, the most appropriate response for a nurse aide is to listen empathetically. Providing a listening ear validates their emotions and offers comfort, demonstrating compassion and support. Offering platitudes or distractions can dismiss their feelings and make them feel unheard.

Question 91: Which part of the large intestine is located in the lower right abdomen and is the first portion of the large intestine?

Cecum (Correct answer)
Sigmoid colon
Transverse colon
Rectum

Correct answer: Cecum

The cecum is the pouch-like beginning of the large intestine in the lower right abdomen, where the small intestine connects.

Question 92: The balanced scorecard approach to performance measurement typically includes all of the following perspectives EXCEPT:

Financial
Customer
Internal business processes
Market share ranking (Correct answer)

Correct answer: Market share ranking

The four balanced scorecard perspectives are Financial, Customer, Internal Business Processes, and Learning & Growth — market share ranking is not one of them.

Question 93: Which microorganisms are NOT killed by alcohol-based hand sanitizers and require soap and water for effective removal?

MRSA
E. coli
C. difficile spores (Correct answer)
Influenza virus

Correct answer: C. difficile spores

C. difficile forms hardy spores that are resistant to alcohol; soap-and-water handwashing is required to mechanically remove them.

Question 94: Which of the following actions VIOLATES isolation precautions for a patient in contact isolation?

Leaving the door open while providing care (Correct answer)
Wearing a gown when direct contact is anticipated
Wearing gloves before entering the room
Placing soiled linens in a designated bag inside the room

Correct answer: Leaving the door open while providing care

The door to a contact isolation room should remain closed to prevent the spread of organisms via contact with surfaces or personnel in hallways.

Question 95: What is backup and disaster recovery for in CNA technology?

Ensuring data restoration and operations resumption after failures (Correct answer)
Creating copies for sharing
Satisfying vendors
Freeing storage space

Correct answer: Ensuring data restoration and operations resumption after failures

These plans ensure critical data and systems can be restored within acceptable timeframes after disruptions.

Question 96: A resident who is normally calm and cooperative suddenly becomes verbally aggressive and strikes out at the CNA during morning care. What is the CNA's priority initial action?

Step back to a safe distance, speak in a calm voice, and attempt to de-escalate the situation. (Correct answer)
Immediately restrain the resident to prevent further aggression.
Continue with the care task as quickly as possible to finish.
Leave the room and immediately document the resident's behavior in the chart.

Correct answer: Step back to a safe distance, speak in a calm voice, and attempt to de-escalate the situation.

The CNA's immediate priority is the safety of both the resident and themselves. De-escalation is the first step when a resident becomes combative. [15] This involves creating a safe space, remaining calm, and using a soothing tone. [6, 15] Continuing the task could escalate the situation, restraints are a last resort and require a physician's order, and while documentation is crucial, it is not the initial action in an unsafe situation.

Question 97: The nurse delegates catheter care to the CNA. When performing perineal care on a female resident with an indwelling catheter, the CNA should clean:

Only the external meatus, not the catheter tubing
From the catheter insertion site toward the anus
From the meatus outward along the catheter tubing (Correct answer)
In a circular motion around the catheter

Correct answer: From the meatus outward along the catheter tubing

Clean from the urethral meatus outward along the catheter for at least 4 inches to prevent introducing bacteria.

Question 98: After a fire drill, a CNA discovers that the exit door in the east wing requires significant force to open. What should the CNA do?

Report the issue to maintenance and the charge nurse immediately (Correct answer)
Prop the door open to make future evacuation easier
Assume it was recently serviced and meets code
Note it in the resident care log for the next shift

Correct answer: Report the issue to maintenance and the charge nurse immediately

A malfunctioning fire exit is a life-safety hazard that must be reported immediately to ensure it is repaired before an actual emergency.

Question 99: A facility uses a paper-based 24-hour report system. A CNA completes her shift documentation and then notices that a colleague has already signed off on an entry in the same time block claiming a specific wound dressing was changed — a task the CNA knows was NOT performed during that shift. What is the CNA's PRIMARY obligation?

Perform the dressing change now and back-date the documentation to match the colleague's entry
Cross out the colleague's incorrect entry and document the true status of the dressing
Add a counter-note in the chart disputing the colleague's entry and sign it
Report the discrepancy to the charge nurse or supervisor immediately, without altering either entry (Correct answer)

Correct answer: Report the discrepancy to the charge nurse or supervisor immediately, without altering either entry

Falsification of medical records is a serious legal and ethical violation. The CNA must NOT alter another clinician's entry, back-date documentation, or independently modify records. The correct action is to immediately report the discrepancy to a supervisor, who can initiate a formal investigation. Both adding unauthorized counter-notes and crossing out another's entry would themselves constitute record tampering. Back-dating is fraud.

Question 100: A patient with dementia attempts to elope (leave the facility). What should the CNA do immediately?

Let the patient leave and call family
Physically block the exit and wait for security
Document the attempt and continue other duties
Stay with the patient and call for help without leaving the resident alone (Correct answer)

Correct answer: Stay with the patient and call for help without leaving the resident alone

The CNA must stay with the patient to ensure safety and call for help without abandoning the resident.

Certified Nursing Assistant (CNA) Exam

The CNA exam certifies individuals to provide basic patient care under the supervision of a licensed nurse, covering both knowledge and practical skills.

Questions

90 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
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No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
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