GNA Written Examination (NNAAP) — Questions and Answers

Question 1: A GNA is caring for a resident who has a designated legal representative for healthcare decisions. The physician is explaining a new treatment plan. According to the principles of informed consent, who must be involved in this decision-making process?

Only the resident, as they are the one receiving care.
The resident, to the extent practicable, and their legal representative. (Correct answer)
Only the resident's legal representative.
Only the physician and the GNA.

Correct answer: The resident, to the extent practicable, and their legal representative.

The informed consent process should involve the resident as much as they are able to participate. Federal law requires that the resident's care plan is prepared with the participation of the resident and/or their family or legal representative. Even if a legal representative is designated, the resident's involvement, preferences, and understanding should be sought and respected to the greatest extent possible.

Question 2: A resident's family member is very grateful for the care you have provided and offers you a $50 bill as a 'thank you.' What is the most professional response?

Politely refuse the gift, explaining that it is against facility policy. (Correct answer)
Take the money and give it to your supervising nurse.
Suggest they use the money to buy a gift for the entire unit.
Accept the money but do not tell anyone.

Correct answer: Politely refuse the gift, explaining that it is against facility policy.

Accepting personal cash gifts from residents or their families creates a conflict of interest, violates professional boundaries, and is against the policy of nearly all healthcare facilities. The most professional action is to politely decline and explain that you are happy to provide care as part of your job.

Question 3: A GNA is caring for a resident with advanced dementia who is pacing the halls and appears distressed, repeatedly saying, "I need to go home! I need to go home!" Which communication technique is most therapeutic?

Offering to walk them to their room to rest.
Asking the resident to describe what their home is like. (Correct answer)
Administering their prescribed PRN medication for anxiety.
Gently reminding the resident that this is their home now.

Correct answer: Asking the resident to describe what their home is like.

This response uses validation therapy by acknowledging the resident's feelings and reality without directly correcting them. Asking about their home focuses on the emotion behind the words and allows the GNA to connect with the resident's experience. Reminding them that the facility is their home (reality orientation) can increase agitation in advanced dementia. While rest may be needed, it doesn't address the underlying emotional distress. Administering medication is not within the GNA's scope of practice without a nurse's direction.

Question 4: A resident with moderate dementia frequently wanders into other residents' rooms. Which of the following is the best initial approach for the GNA to manage this behavior?

Redirect the resident by inviting them to a scheduled activity. (Correct answer)
Lock the resident's door from the outside.
Scold the resident for not respecting others' privacy.
Apply a restraining device to keep the resident in their chair.

Correct answer: Redirect the resident by inviting them to a scheduled activity.

Redirecting a wandering resident to a purposeful and engaging activity is a recommended strategy. This approach addresses potential underlying causes like boredom without using restraints or punitive measures. Restraints and locking doors are illegal and unethical, and scolding is not a therapeutic response and can increase agitation.

Question 5: Medications, slower mobility, lack of proper fluid intake, and poor diet can lead into what common symptom in the elder population?

Mental changes
Skin changes
Depression
Urinary incontinences (Correct answer)

Correct answer: Urinary incontinences

Medications (some cause urinary retention or urgency), reduced mobility (difficulty reaching the bathroom in time), inadequate fluid intake (concentrated urine irritates the bladder), and poor diet collectively impair bladder control, leading to urinary incontinence. The other options—skin changes, mental changes, and depression—are not the primary combined result of these specific factors.

Question 6: In assisting aging client, it is important for the nurse to recognize?

The financial status of the client
The job that the client held prior to aging
All components of well-being including biological function, psychological function and social function. (Correct answer)
The client's ability to perform ADLs

Correct answer: All components of well-being including biological function, psychological function and social function.

Holistic nursing care requires addressing all dimensions of well-being—biological (physical health), psychological (mental and emotional health), and social (relationships and community). Focusing only on ADLs, finances, or prior employment misses critical aspects that affect an older adult's overall health and quality of life.

Question 7: The nurse notes that an older person has difficulty removing clothes in preparation for a physical assessment. on which area should the nurse focus when determining this person's ability to perform activities of daily living?

Bathing (Correct answer)
Laundry
Walking
Housekeeping

Correct answer: Bathing

Difficulty removing clothes directly relates to dressing, which is a core Activity of Daily Living (ADL) alongside bathing, toileting, transferring, continence, and feeding. Bathing also involves manipulating clothing and garments, making it the most relevant ADL to assess given this observation. Housekeeping, laundry, and walking are either instrumental ADLs or a separate functional domain.

Question 8: A resident begins to fall while you are assisting them with ambulation. What is the correct action for the nursing assistant to take?

Quickly grab the resident's arm to pull them back up.
Widen their stance and gently slide the resident down their leg to the floor. (Correct answer)
Try to catch the resident to prevent the fall completely.
Step away to avoid being injured by the falling resident.

Correct answer: Widen their stance and gently slide the resident down their leg to the floor.

Attempting to stop a fall can cause serious injury to both the resident and the nursing assistant. The safest procedure is to use proper body mechanics to guide the resident gently to the floor, protecting their head and body from injury as much as possible.

Question 9: When counting a resident's pulse, the nursing assistant notices the rhythm is irregular. What is the best action?

Ignore it since irregular pulses are common in the elderly
Count for only 15 seconds and multiply by four for speed
Count the pulse for a full minute and report the finding to the nurse (Correct answer)
Ask the resident if they feel the irregularity

Correct answer: Count the pulse for a full minute and report the finding to the nurse

An irregular pulse must be counted for a full 60 seconds and reported to the nurse immediately, as it may indicate a cardiac arrhythmia.

Question 10: A GNA is assigned to assist a resident with bathing. Which action best ensures the resident's dignity and safety during this ADL?

Letting the resident bathe completely alone, regardless of their fall risk.
Ensuring the resident is properly covered and the water temperature is safe. (Correct answer)
Rushing through the bath to minimize exposure.
Leaving the door open to call for help if needed.

Correct answer: Ensuring the resident is properly covered and the water temperature is safe.

A key responsibility during any ADL is to ensure the resident's safety, dignity, and privacy. For bathing, this includes preventing falls by using safety measures, checking that the water is a comfortable and safe temperature, and keeping the resident covered as much as possible to protect their privacy and warmth.

Question 11: While assisting in the dining room, a GNA observes a resident who is conscious, clutching their throat with both hands, and unable to cough or speak. Which of the following is the GNA's immediate priority?

A. Offer the resident a glass of water.
C. Leave the resident to immediately find the charge nurse.
B. Begin performing abdominal thrusts (Heimlich maneuver). (Correct answer)
D. Perform a blind finger sweep of the resident's mouth.

Correct answer: B. Begin performing abdominal thrusts (Heimlich maneuver).

The resident is displaying the universal sign for a severe airway obstruction. The correct and immediate response is to perform abdominal thrusts to dislodge the object. Giving water could worsen the situation, leaving the resident is dangerous, and a blind finger sweep could push the object further down.

Question 12: A resident with significant hearing impairment is trying to understand the GNA's instructions for an upcoming procedure. Which of the following is the most effective communication strategy for the GNA to use?

Facing the resident, speaking clearly at a normal pace, and using facial expressions. (Correct answer)
Speaking very loudly and slowly directly into the resident's ear.
Asking a family member to explain the procedure to the resident later.
Writing down the entire conversation on a notepad.

Correct answer: Facing the resident, speaking clearly at a normal pace, and using facial expressions.

Effective communication with a hearing-impaired individual involves multiple senses. Facing the person allows them to read lips and see facial expressions, which provide important context. Speaking clearly at a normal pace, without shouting, prevents sound distortion. While writing can be a useful aid, it's not the primary method for dynamic conversation. Shouting can distort sounds and be perceived as anger. Relying on a family member removes the direct communication and relationship-building between the GNA and the resident.

Question 13: A GNA has just finished a task that involved contact with a resident's body fluids and has removed their gloves. According to Standard Precautions, what is the immediate next step?

Document the care provided to the resident.
Use a paper towel to wipe off any residual moisture.
Apply a new pair of gloves for the next task.
Perform hand hygiene with soap and water or an alcohol-based rub. (Correct answer)

Correct answer: Perform hand hygiene with soap and water or an alcohol-based rub.

Standard Precautions mandate that hand hygiene be performed immediately after removing gloves. Gloves are not a perfect barrier and can have microscopic tears, and hands can become contaminated during the removal process. Performing hand hygiene is a critical step to prevent cross-contamination.

Question 14: When providing postmortem care for a resident who has just passed away, what is a primary responsibility of the GNA?

Removing all intravenous lines and medical tubing from the body.
Informing the resident's family members of the death.
Completing the official death certificate for the facility's records.
Treating the body with dignity while performing a final bath and positioning. (Correct answer)

Correct answer: Treating the body with dignity while performing a final bath and positioning.

The GNA's role in postmortem care is to treat the deceased with respect and dignity. [1, 2] This includes gently bathing the body, dressing it in a clean gown, and placing it in a natural, dignified position before family viewing or transport. [5, 23] Notifying the family, completing the death certificate, and removing medical tubing are tasks performed by the licensed nurse or physician. [1, 5]

Question 15: When operating a fire extinguisher to combat a small fire, the GNA should follow the PASS acronym. The 'A' in PASS stands for:

A. Activate the building's main fire alarm.
D. Aim the nozzle at the top of the flames.
B. Aim the nozzle at the base of the fire. (Correct answer)
C. Assess the situation before acting.

Correct answer: B. Aim the nozzle at the base of the fire.

The PASS acronym for using a fire extinguisher stands for: Pull the pin, Aim the nozzle at the base of the fire, Squeeze the handle, and Sweep from side to side. Aiming at the base is crucial to extinguish the fuel source.

Question 16: Mr. Jones is a resident who can feed himself but has difficulty getting out of his bed and moving to a chair. Which ADL does he need assistance with?

Eating
Continence
Dressing
Transferring (Correct answer)

Correct answer: Transferring

Transferring is the ADL that refers to the ability to move from one position to another, such as moving from a bed to a chair or standing up from a seated position. Since Mr. Jones can feed himself but struggles with moving from the bed to a chair, he requires help with transferring.

Question 17: A resident informs the GNA that they wish to file a formal complaint about the care they are receiving. What is the GNA's primary responsibility in this situation?

To resolve the issue themselves to avoid formal paperwork.
To inform the resident of the facility's grievance procedure and notify the charge nurse. (Correct answer)
To ask the resident's family to handle the complaint.
To tell the resident that complaining could cause problems with the staff.

Correct answer: To inform the resident of the facility's grievance procedure and notify the charge nurse.

Residents have the right to voice grievances without fear of retaliation. The GNA's role is to facilitate this right by informing the resident of the proper procedure and reporting the complaint to the appropriate licensed staff, such as the charge nurse, who can initiate the formal process. Attempting to resolve it alone may be inappropriate for the scope of the issue, and discouraging a complaint infringes on the resident's rights.

Question 18: A nursing assistant is assisting a resident with ambulation. The resident has a cane because of weakness on their right side. On which side should the nursing assistant stand to provide the BEST support?

In front of the resident to guide their path.
On the resident's right side, slightly behind them. (Correct answer)
On the resident's left side, slightly behind them.
Directly behind the resident to catch them if they fall.

Correct answer: On the resident's right side, slightly behind them.

To provide the most effective support and maintain balance, the nursing assistant should stand on the resident's weaker side. This positioning allows the assistant to quickly provide stability if the resident begins to lose balance on their affected side.

Question 19: When handling soiled linens contaminated with blood or body fluids, which action by the GNA demonstrates correct procedure?

Shaking the linens vigorously to remove any solid waste before bagging.
Rolling the linens inward to contain the soiled area and placing them in a leak-proof bag. (Correct answer)
Carrying the soiled linens tightly against their uniform to prevent dropping them.
Placing the linens on the floor outside the resident's room before bagging.

Correct answer: Rolling the linens inward to contain the soiled area and placing them in a leak-proof bag.

Soiled linens should be handled with minimal agitation to prevent contaminating the air, surfaces, and uniforms. Rolling the linens inward contains the contamination, and placing them directly into a designated leak-proof bag at the point of use prevents the spread of microorganisms.

Question 20: Which of the following actions by a GNA would be a violation of a resident's right to privacy and confidentiality under HIPAA?

Using a computer with a privacy screen to access a resident's electronic health record.
Discussing a resident's medical condition with the physical therapist in the hallway. (Correct answer)
Reporting a change in a resident's condition to the charge nurse during report.
Asking the resident for permission before closing their room door.

Correct answer: Discussing a resident's medical condition with the physical therapist in the hallway.

Discussing a resident's protected health information (PHI) in a public area where it can be overheard by unauthorized individuals is a violation of HIPAA. Communications about residents should occur in private settings. Reporting to the nurse, asking for privacy preferences, and using secure electronic systems are all appropriate actions that protect resident rights.

Question 21: The nurse learns that an older person takes several vitamin and nutritional supplements everyday. which theory of aging is supported by this older person's behavior?

wear and tear
cross link
somatic DNA damage
free radical (Correct answer)

Correct answer: free radical

The free radical theory of aging holds that unstable oxygen molecules (free radicals) cause cumulative cellular damage over time, and antioxidant supplements are believed to neutralize these free radicals—explaining why this person takes vitamins and nutritional supplements. Somatic DNA damage, cross-link, and wear and tear theories do not specifically support antioxidant supplementation as a countermeasure.

Question 22: When measuring vital signs in an elderly resident, which change is considered a normal part of aging that the nursing assistant should be aware of?

Resting pulse above 100 beats per minute
Blood pressure that tends to be slightly higher than in younger adults (Correct answer)
Respiratory rate that decreases to below 8 breaths per minute
Temperature that is routinely above 99.5°F at rest

Correct answer: Blood pressure that tends to be slightly higher than in younger adults

Blood pressure tends to be slightly higher in older adults due to decreased arterial elasticity, which is a normal aging change, though significantly elevated readings still require reporting.

Question 23: Which statement would be most appropriate to ask when assessing an aging adult for cognitive function?

Have you noticed anything different about your memory or thinking in the past few months? (Correct answer)
What is today's date?
Who is the president of the United States?
Can you count to 10 for me?

Correct answer: Have you noticed anything different about your memory or thinking in the past few months?

Open-ended questions invite the patient to self-report subjective changes in memory or thinking, which is more sensitive and respectful when screening for cognitive decline. Questions like 'What is today's date?' or 'Who is the president?' are formal cognitive tests, not conversational screening tools, and can feel demeaning rather than inviting honest disclosure.

Question 24: A GNA and a nurse are using a mechanical (Hoyer) lift to transfer a resident from the bed. After the sling is positioned under the resident, what is the most critical safety check before lifting the resident off the bed?

Ensure all sling loops or clips are securely attached to the lift cradle. (Correct answer)
Raise the head of the bed to a 90-degree angle.
Ask the resident if they are comfortable in the sling.
Make sure the wheels of the lift are locked in place.

Correct answer: Ensure all sling loops or clips are securely attached to the lift cradle.

Verifying that the sling is securely attached to the lift is the most critical safety check. A detached or improperly attached sling can lead to a catastrophic fall and serious injury for the resident.

Question 25: Which of the following BEST describes the primary goal of restorative nursing care?

To focus only on the resident's acute medical conditions.
To help residents attain and maintain their highest possible level of function and independence. (Correct answer)
To ensure the resident is completely dependent on staff for all care.
To provide care as quickly as possible to save time.

Correct answer: To help residents attain and maintain their highest possible level of function and independence.

The fundamental goal of restorative care is to maximize a resident's independence and prevent further decline in their physical and functional abilities. This involves helping them perform daily activities as independently as possible.

Question 26: A GNA is preparing to assist a resident with perineal care. The resident is known to have a C. difficile infection. Which of the following infection control actions is MOST critical?

Using an alcohol-based hand rub before and after care.
Placing used linens in a standard laundry bag.
Wearing a gown, gloves, and a surgical mask.
Washing hands with soap and water after removing gloves. (Correct answer)

Correct answer: Washing hands with soap and water after removing gloves.

Clostridioides difficile (C. difficile) produces spores that are not effectively killed by alcohol-based hand sanitizers. The Centers for Disease Control and Prevention (CDC) specifically recommends washing hands with soap and water after caring for a patient with C. difficile to physically remove the spores.

Question 27: A resident has weakness on their left side from a stroke. When assisting the resident to put on a button-up shirt, the GNA should first put the shirt on:

whichever arm the resident prefers.
both arms at the same time.
the left arm, then the right arm. (Correct answer)
the right arm, then the left arm.

Correct answer: the left arm, then the right arm.

When assisting a resident with one-sided weakness, the clothing should be put on the weaker (affected) side first. This technique minimizes strain and makes the process easier and safer for the resident. When undressing, the process is reversed: remove clothing from the stronger side first.

Question 28: What is the normal oral body temperature range for an adult?

102°F–104°F (38.9°C–40°C)
95.0°F–97.0°F (35°C–36.1°C)
97.6°F–99.6°F (36.4°C–37.6°C) (Correct answer)
100.0°F–101.5°F (37.8°C–38.6°C)

Correct answer: 97.6°F–99.6°F (36.4°C–37.6°C)

Normal oral body temperature for an adult is approximately 97.6°F–99.6°F (36.4°C–37.6°C), with 98.6°F (37°C) as the classic average.

Question 29: The nurse visits the home of an older person with chronic lung disease. which observation indicates that the person is engaged in health improvement activities?

Sleeps in a recliner
Prepares pasta for dinner
Talks with family once a week
Walks a pet twice a day (Correct answer)

Correct answer: Walks a pet twice a day

Walking a pet twice daily provides regular, moderate physical activity, which improves lung function, circulation, and overall endurance in someone with chronic lung disease. Preparing pasta, talking with family once a week, and sleeping in a recliner do not represent active health improvement behaviors and the recliner position can actually worsen respiratory function.

Question 30: The absorption of medication in the geriatric client is most often affected by:

An increase in serum albumin
An increase in body water
A decrease if body fat
A decrease in body water and lean body weight (Correct answer)

Correct answer: A decrease in body water and lean body weight

With aging, body water and lean muscle mass decrease while body fat increases; since many drugs distribute into body water or lean tissue, these changes reduce the volume of distribution and alter drug absorption and distribution. Body fat actually increases with age, serum albumin decreases (not increases), and increased body water is the opposite of what occurs.

Question 31: A resident with dysphagia is at highest risk for which complication during meals?

Hypoglycemia
Pressure ulcers
Aspiration pneumonia (Correct answer)
Constipation

Correct answer: Aspiration pneumonia

Dysphagia (difficulty swallowing) increases the risk of food or liquid entering the airway, which can lead to aspiration pneumonia.

Question 32: A resident refuses to eat their meal. What is the FIRST action the GNA should take?

Force the resident to eat
Remove the tray without comment
Give the resident a snack instead
Document refusal and notify the nurse (Correct answer)

Correct answer: Document refusal and notify the nurse

Refusing meals must be documented and reported to the nurse so the care team can assess the resident's nutritional status.

Question 33: Which of the following is a key principle of providing care for a person with dementia?

Correcting all of the resident's misstatements will help their memory.
Maintaining a consistent and predictable routine provides a sense of security. (Correct answer)
Communicating primarily with the family to avoid confusing the resident.
It is best to frequently change the daily routine to provide stimulation.

Correct answer: Maintaining a consistent and predictable routine provides a sense of security.

Individuals with dementia thrive on consistency and predictability, which helps to reduce cognitive demands and anxiety. Establishing and maintaining a daily routine can provide a sense of security and stability. Frequent changes can be confusing and distressing. Constantly correcting a person with dementia is a form of reality orientation that can cause agitation, and direct communication with the resident should be maintained as much as possible.

Question 34: The right to be treated with dignity and respect includes which of the following?

Addressing a resident by their first name without asking their preference.
Requiring all residents to wake up at the same time for breakfast.
Leaving a resident's door open during personal care without their permission.
Allowing a resident to choose their own clothing and hairstyle. (Correct answer)

Correct answer: Allowing a resident to choose their own clothing and hairstyle.

Treating a resident with dignity and respect means recognizing their individuality and promoting self-determination. Allowing residents to make personal choices, such as what to wear and how to style their hair, upholds this right. Imposing a rigid schedule, using familiar terms without permission, and violating personal privacy are all contrary to this fundamental right.

Question 35: A resident is unable to move his own arm due to a recent stroke. The nursing assistant is instructed to perform passive range of motion (PROM) exercises. This means the nursing assistant will:

move the resident's arm through the exercises without assistance from the resident. (Correct answer)
have the resident squeeze a stress ball to build strength.
assist the resident in moving the arm, with the resident doing most of the work.
ask the resident to lift the arm as high as they can.

Correct answer: move the resident's arm through the exercises without assistance from the resident.

Passive range of motion (PROM) involves the caregiver moving the resident's joints through their range of motion without any active participation from the resident. This is done when the resident is unable to move the limb on their own.

Question 36: A GNA is positioning a resident in a side-lying (lateral) position to prevent pressure ulcers. Which of the following actions is essential for proper body alignment and pressure relief?

Placing a pillow between the resident's knees and ankles. (Correct answer)
Positioning the resident directly on their hip bone.
Ensuring the resident's back is perfectly straight at a 90-degree angle to the mattress.
Tucking the resident's bottom arm straight underneath their body.

Correct answer: Placing a pillow between the resident's knees and ankles.

Placing pillows between the knees and ankles prevents direct pressure between these bony prominences, which are high-risk areas for skin breakdown. This also helps maintain proper hip and spine alignment.

Question 37: A resident with dementia becomes increasingly agitated and confused in the late afternoon. The GNA recognizes this behavior as sundowning. Which of the following interventions is most appropriate?

Increase the lighting in the resident's room before dusk. (Correct answer)
Turn on the television to a lively program for distraction.
Ask the resident to explain why they are feeling so upset.
Encourage a long nap after lunch to ensure they are well-rested.

Correct answer: Increase the lighting in the resident's room before dusk.

Closing curtains and increasing light before dusk can help minimize shadows and the confusion they may cause for a person with dementia experiencing sundowning. A full schedule or too much daytime napping can interfere with nighttime sleep and worsen sundowning, while loud distractions like television can increase agitation. Trying to reason with a resident who is confused is often ineffective.

Question 38: When a GNA promotes a resident's independence in performing ADLs, what is the primary goal?

To fulfill the facility's documentation requirements.
To enhance the resident's self-esteem and functional ability. (Correct answer)
To make the GNA's job easier and faster.
To ensure the resident can be discharged quickly.

Correct answer: To enhance the resident's self-esteem and functional ability.

Encouraging residents to participate in their own ADLs as much as they are safely able to is crucial for rehabilitation and maintaining their quality of life. This practice helps preserve their physical function, independence, and sense of self-worth.

Question 39: A resident is on a bladder retraining program. What is a key responsibility of the Geriatric Nursing Assistant (GNA) in this program?

Following the toileting schedule consistently and recording intake and output. (Correct answer)
Restricting the resident's fluid intake in the evening.
Waiting for the resident to ask before offering to take them to the toilet.
Deciding independently to change the toileting schedule.

Correct answer: Following the toileting schedule consistently and recording intake and output.

Consistency is crucial for success in a bladder retraining program. The GNA's role includes adhering strictly to the scheduled toileting times, encouraging fluids, and accurately documenting incontinence and voiding patterns to help the nurse evaluate the plan's effectiveness.

Question 40: When inspecting a resident's skin, redness that does not turn white (blanch) when pressed indicates:

An allergic reaction
A stage 1 pressure injury (Correct answer)
Healthy skin aging
Normal circulation

Correct answer: A stage 1 pressure injury

Non-blanchable redness is a hallmark sign of a Stage 1 pressure injury, indicating tissue damage from prolonged pressure.

Question 41: A GNA accidentally sustains a needlestick injury from a used lancet while performing a blood glucose check. What is the GNA's first priority?

Find the resident to ask about their health history.
Immediately report the injury to the charge nurse.
Wash the area thoroughly with soap and water. (Correct answer)
Fill out an incident report form.

Correct answer: Wash the area thoroughly with soap and water.

In the event of an exposure to bloodborne pathogens, such as through a needlestick, the immediate first action is to wash the affected area thoroughly with soap and water. This helps to remove as much of the potentially infectious material as possible. Reporting the incident and follow-up care are also critical but come immediately after initial decontamination of the site.

Question 42: A GNA notices that a resident's urine is dark, cloudy, and has a strong odor. Which statement best describes the GNA's role in this situation?

Report the objective observations to the nurse for further assessment. (Correct answer)
Document the observation and diagnose the resident with a urinary tract infection (UTI).
Ask the resident's family if this is a normal occurrence for them.
Encourage the resident to drink more cranberry juice and re-check in the morning.

Correct answer: Report the objective observations to the nurse for further assessment.

The GNA's role is to be an observer and reporter of facts. Noting the color, clarity, and smell of the urine are objective observations. The GNA must report these findings to the licensed nurse, who will then use their clinical judgment to assess the resident and determine the cause. Diagnosing a condition like a UTI is outside the GNA's scope of practice.

Question 43: To break the 'Mode of Transmission' link in the chain of infection, a GNA should prioritize which of the following actions?

Practicing frequent and thorough hand hygiene. (Correct answer)
Encouraging residents to eat a well-balanced diet.
Assisting residents with bathing and personal hygiene.
Ensuring residents receive their prescribed antibiotics on time.

Correct answer: Practicing frequent and thorough hand hygiene.

The 'Mode of Transmission' refers to how a pathogen travels from a reservoir to a susceptible host. Frequent and thorough hand hygiene is the single most effective way to break this link by removing pathogens from the hands, which are a primary vehicle for transmission in healthcare settings.

Question 44: When transferring a resident from the bed to a wheelchair, which action demonstrates proper body mechanics by the nursing assistant?

Keeping their feet close together for better balance.
Bending their knees and keeping their back straight. (Correct answer)
Twisting their back to pivot the resident to the chair.
Bending at the waist to lift the resident.

Correct answer: Bending their knees and keeping their back straight.

Proper body mechanics require using the strong muscles of the legs to lift, not the weaker back muscles. Bending at the knees, keeping the back straight, and maintaining a wide base of support prevents injury to the caregiver.

Question 45: Which action by the GNA helps prevent skin breakdown during repositioning?

Repositioning only when the resident asks
Dragging the resident across the sheet
Using a lift sheet to move the resident (Correct answer)
Tucking sheets tightly around the resident

Correct answer: Using a lift sheet to move the resident

Using a lift or draw sheet reduces friction and shear forces on the skin, which are major contributors to pressure injuries.

Question 46: A resident's temperature is 101.8°F (38.8°C). This finding indicates:

An error in measurement and should be retaken only
Hypothermia and should be reported immediately
A normal variant for elderly residents
Fever (pyrexia), which must be reported to the nurse (Correct answer)

Correct answer: Fever (pyrexia), which must be reported to the nurse

A temperature of 101.8°F is classified as a fever (pyrexia) and must be reported to the nurse promptly so appropriate interventions can be initiated.

Question 47: A GNA is caring for a resident who is actively dying. Which of the following are common physical signs that death is approaching?

Clear, loud speech and increased interest in social activities.
Increased appetite and high energy levels.
Warm, pink skin and a strong, regular pulse.
Irregular breathing patterns (like Cheyne-Stokes) and mottling of the skin. (Correct answer)

Correct answer: Irregular breathing patterns (like Cheyne-Stokes) and mottling of the skin.

As the body's systems begin to shut down, circulation slows, causing a blotchy, purplish discoloration of the skin called mottling, particularly in the extremities. [6, 11] Breathing patterns often become irregular, with periods of rapid breathing followed by periods of no breathing (apnea), a pattern known as Cheyne-Stokes respirations. [10, 15] The other options describe signs of health and vitality.

Question 48: Which statement reflects the state of drug absorption in the geriatric patient?

There is a decreased in gastric pH as we age
The rate of absorption is slowed (Correct answer)
The rate of absorption is faster due to thinning of the mucosa
The percentage of the medication that is absorbed is decreased

Correct answer: The rate of absorption is slowed

Aging causes decreased gastric motility, reduced blood flow to the GI tract, and lower gastric acid production, all of which slow the rate at which drugs are absorbed into the bloodstream. The mucosa does not cause faster absorption when it thins, the percentage absorbed is generally unchanged, and gastric pH actually increases (becomes less acidic) with age.

Question 49: Heel protectors or heel-lift devices are used for residents who are bedridden primarily to:

Keep the feet warm
Support proper ankle alignment for walking
Prevent foot drop only
Offload pressure from the heels to prevent pressure injuries (Correct answer)

Correct answer: Offload pressure from the heels to prevent pressure injuries

Heels are extremely vulnerable to pressure injuries because of minimal soft tissue padding, and heel protectors relieve this pressure entirely.

Question 50: When assisting a resident with dementia who has become combative during morning care, which of the following actions should the GNA take first?

Continue with the care task quickly to finish.
Firmly tell the resident to stop the behavior.
Stop the care task and step back to ensure safety. (Correct answer)
Leave the resident alone to calm down.

Correct answer: Stop the care task and step back to ensure safety.

The immediate priority in any situation involving aggression or combativeness is the safety of both the resident and the caregiver. The GNA should stop the task that is causing the agitation and create a safe distance. Continuing the task or using a firm tone can escalate the behavior. Leaving a distressed resident entirely alone may not be safe or therapeutic.

Question 51: When recording a resident's fluid intake, 1 cup (8 oz) of juice equals how many milliliters (mL)?

300 mL
120 mL
180 mL
240 mL (Correct answer)

Correct answer: 240 mL

8 fluid ounces equals 240 mL, which is the standard conversion used in healthcare settings for fluid intake documentation.

Question 52: A GNA is caring for a resident who is normally alert and oriented. During morning care, the GNA notes the resident is suddenly quiet, confused about where they are, and unable to state the correct month. What is the GNA's MOST important immediate action?

Try to reorient the resident by showing them a calendar and a clock.
Ask the resident's family during their next visit if this is normal behavior.
Report the sudden change in mental status to the nurse immediately. (Correct answer)
Document the changes in the resident's chart at the end of the shift.

Correct answer: Report the sudden change in mental status to the nurse immediately.

A sudden change in mental status, such as acute confusion, is a significant finding that could indicate a serious underlying medical issue like a urinary tract infection (UTI), stroke, or adverse medication reaction. This requires immediate reporting to the nurse for prompt assessment and intervention to ensure the resident's safety and well-being.

Question 53: Which of the following BEST demonstrates proper body mechanics for a GNA preparing to assist with lifting a resident?

Keeping feet close together to concentrate strength.
Twisting the back to pivot the resident smoothly.
Standing with feet shoulder-width apart and bending at the knees. (Correct answer)
Bending at the waist with straight legs.

Correct answer: Standing with feet shoulder-width apart and bending at the knees.

A wide base of support (feet shoulder-width apart) and using the strong muscles of the legs by bending at the knees are fundamental principles of good body mechanics that protect the GNA from back injury.

Question 54: A GNA is trying to communicate with a resident who has a significant hearing impairment and dementia. Which action is most effective?

Approaching the resident from behind to avoid startling them.
Using simple sentences and gesturing or pointing. (Correct answer)
Shouting the information so the resident can hear.
Writing down complex instructions for them to read.

Correct answer: Using simple sentences and gesturing or pointing.

When communicating with a resident with both hearing impairment and dementia, using clear, simple sentences combined with non-verbal cues like gesturing is most effective. Shouting distorts sound and can be frightening. Approaching from the front is crucial to avoid startling the resident. Complex written instructions may be difficult for a person with dementia to process.

Question 55: What is the normal resting pulse rate range for an adult?

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

Correct answer: 60–100 beats per minute

A normal adult resting pulse rate is 60–100 beats per minute; values outside this range should be reported.

Question 56: When bathing a resident, the GNA should inspect the skin for:

Evidence of self-harm only
Only visible wounds or cuts
Redness, blisters, open areas, bruising, or changes since last assessment (Correct answer)
Changes in skin color only on the face

Correct answer: Redness, blisters, open areas, bruising, or changes since last assessment

During bathing, the GNA has the opportunity to assess the entire body for any new or worsening skin changes that must be reported.

Question 57: Which of the following actions should the nursing assistant take BEFORE measuring a resident's blood pressure?

Ensure the resident has rested for at least 5 minutes in a seated position (Correct answer)
Apply the cuff over thick clothing for resident comfort
Take the measurement immediately upon entering the room
Have the resident walk briskly for two minutes to stabilize circulation

Correct answer: Ensure the resident has rested for at least 5 minutes in a seated position

The resident should rest quietly for at least 5 minutes before blood pressure measurement to avoid falsely elevated readings caused by recent activity.

Question 58: Which of the following blood pressure readings would be considered hypotensive (abnormally low) for most adults?

140/90 mmHg
130/84 mmHg
118/76 mmHg
88/52 mmHg (Correct answer)

Correct answer: 88/52 mmHg

A blood pressure of 88/52 mmHg is below the normal threshold and indicates hypotension, which can cause dizziness, falls, and inadequate organ perfusion.

Question 59: The nurse assessing the older population needs to have a basic understanding of which of the following?

The signs of Cardiac Disease
The signs of sexual dysfunction
The economic status of the area
The difference between normal and abnormal for the older age group (Correct answer)

Correct answer: The difference between normal and abnormal for the older age group

Effective geriatric assessment requires knowing what changes are normal with aging (e.g., slower reflexes, mild forgetfulness) versus abnormal findings that signal disease. Without this distinction, nurses may either over-pathologize normal aging or miss true illness. Economic status, sexual dysfunction signs, and cardiac disease signs are narrower concerns that don't form the foundational knowledge base needed.

Question 60: A GNA is caring for a resident on droplet precautions due to influenza. When entering the resident's room, what is the minimum Personal Protective Equipment (PPE) the GNA must wear?

Gloves and a gown.
A surgical mask. (Correct answer)
An N95 respirator.
Goggles and a gown.

Correct answer: A surgical mask.

Droplet precautions are used for diseases spread by large droplets from coughing, sneezing, or talking. Standard infection control guidelines require a surgical mask to be worn when working within three to six feet of a resident on droplet precautions to protect the mucous membranes of the nose and mouth.

Question 61: When recording vital signs, the nursing assistant should:

Wait until the end of the shift to document all findings at once
Round all numbers to the nearest 10 for simplicity
Only record values that are outside the normal range
Record findings immediately and accurately in the resident's chart (Correct answer)

Correct answer: Record findings immediately and accurately in the resident's chart

Vital signs must be recorded immediately and accurately after measurement to ensure the care team has up-to-date information for clinical decision-making.

Question 62: Which food texture is appropriate for a resident on a minced-and-moist diet?

Raw carrots
Whole-grain crackers
A fresh apple
Ground turkey in gravy (Correct answer)

Correct answer: Ground turkey in gravy

Minced-and-moist diets require foods that are finely cut and moistened, such as ground meat in gravy, to ease safe swallowing.

Question 63: When assisting a dependent resident to move up in bed, what is the safest and most effective method for the GNA to use?

Grasp the resident under their arms and pull them up toward the headboard.
Instruct the resident to grab onto the side rails and pull themselves up.
Ask a coworker for help and use a draw sheet or slide sheet. (Correct answer)
Lower the bed as much as possible to get better leverage.

Correct answer: Ask a coworker for help and use a draw sheet or slide sheet.

Using two people and a friction-reducing device like a draw sheet is the standard of care. This method prevents shearing injury to the resident's skin and protects both caregivers from musculoskeletal injury by distributing the weight and reducing the force needed.

Question 64: A resident's care plan lists an 'I&O' (intake and output) order. The GNA should:

Only record what the resident drinks during meals
Record only output, as intake is the nurse's responsibility
Estimate amounts to save time
Measure and record all fluids consumed and all urine produced (Correct answer)

Correct answer: Measure and record all fluids consumed and all urine produced

An I&O order requires precise measurement and documentation of all fluids the resident consumes and all urine or other output produced.

Question 65: During rounds, a GNA discovers a frayed electrical cord on a resident's personal lamp. Which of the following is the most appropriate immediate action?

Inform the resident not to use the lamp and check on it later.
Unplug the lamp, remove it from the resident's room, and report the hazard. (Correct answer)
Wait until the end of the shift to report it to the maintenance department.
Wrap the frayed part with electrical tape and plug it back in.

Correct answer: Unplug the lamp, remove it from the resident's room, and report the hazard.

A frayed electrical cord is a significant fire and electrical shock hazard that must be dealt with immediately. The proper procedure is to eliminate the immediate danger by unplugging and removing the device, and then reporting it to the nurse or appropriate department for repair or disposal.

Question 66: A resident on a thickened-liquid diet asks for a glass of water. The GNA should:

Give water since hydration is important
Add thickener to the water before offering it
Tell the resident they cannot have any fluids
Report to the nurse and follow the care plan (Correct answer)

Correct answer: Report to the nurse and follow the care plan

Thickened liquids are prescribed to prevent aspiration, so the GNA must follow the care plan and consult the nurse before offering any fluids.

Question 67: A new resident, who is alert and oriented, refuses to take a prescribed medication, stating, "I don't want that pill." What is the GNA's most appropriate initial action?

Tell them you will come back later when they are in a better mood.
Explain to the resident that the doctor ordered it, so they must take it.
Respect the resident's decision, document the refusal, and report it to the nurse immediately. (Correct answer)
Crush the pill and mix it in their applesauce to ensure they take it.

Correct answer: Respect the resident's decision, document the refusal, and report it to the nurse immediately.

Residents have the right to be informed about their care and to refuse treatment, including medications. The GNA must respect this right. The correct procedure is to not force the medication, to document the refusal accurately, and to report it promptly to the licensed nurse, who can then follow up with the resident and physician.

Question 68: A resident complains of dizziness. The GNA takes their radial pulse and counts 48 beats in one minute. When reporting to the nurse, which information is most essential for the GNA to communicate?

The GNA's opinion that the resident's medication dose is too high.
That the resident's roommate also felt dizzy earlier in the day.
That the resident did not finish their breakfast this morning.
The resident's subjective complaint of dizziness and the objective pulse rate of 48. (Correct answer)

Correct answer: The resident's subjective complaint of dizziness and the objective pulse rate of 48.

The GNA's role is to report factual observations accurately. This includes both the subjective information (what the resident says, i.e., "I feel dizzy") and the objective data (what the GNA measures, i.e., a pulse of 48). This combination gives the nurse critical information for their assessment. Offering opinions, irrelevant information about other residents, or other less critical data is inappropriate.

Question 69: A GNA discovers a small fire contained in a trash can in a resident's empty bathroom. After rescuing the resident from the room and activating the alarm, what is the next step according to the RACE fire safety protocol?

C. Confine the fire by closing the bathroom and room doors. (Correct answer)
B. Search for other residents to rescue.
A. Evacuate the entire wing immediately.
D. Yell 'fire' repeatedly in the hallway.

Correct answer: C. Confine the fire by closing the bathroom and room doors.

The acronym RACE stands for Rescue, Alarm, Confine, and Extinguish/Evacuate. After ensuring the resident is safe (Rescue) and activating the alarm (Alarm), the next critical step is to Confine the fire by closing doors to prevent it from spreading.

GNA Written Examination (NNAAP)

The Maryland Geriatric Nursing Assistant (GNA) written examination, administered through the National Nurse Aide Assessment Program (NNAAP), certifies individuals to provide specialized care for elderly residents in long-term care facilities.

Questions

120 min

Time Limit

70%

To Pass

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