GNA Written Examination (NNAAP) — Questions and Answers

Question 1: Which action is CORRECT when drying a resident's skin after bathing?

Use a hair dryer on high heat for efficiency
Rub briskly with the towel for maximum dryness
Leave moisture on the skin to prevent dryness
Pat skin gently dry, especially in skin folds (Correct answer)

Correct answer: Pat skin gently dry, especially in skin folds

Gentle patting prevents friction and skin trauma, while thorough drying of skin folds prevents moisture-related breakdown.

Question 2: When handling soiled linens contaminated with blood or body fluids, which action by the GNA demonstrates correct procedure?

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

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

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

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 4: Which of the following is an early sign of hypoxia (low blood oxygen) that the nursing assistant should report?

Restlessness and confusion (Correct answer)
Increased urine output
Flushed, warm skin
Bradycardia (slow pulse)

Correct answer: Restlessness and confusion

Restlessness and confusion are early signs of hypoxia because the brain is highly sensitive to decreased oxygen levels; these changes must be reported immediately.

Question 5: 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?

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

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

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

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 7: 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?

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

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 8: 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.
Wrap the frayed part with electrical tape and plug it back in.
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.

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 9: A nursing assistant is preparing to take a resident's blood pressure. What is the correct placement of the blood pressure cuff?

Around the wrist, over the pulse point
Around the forearm, below the elbow
Around the upper arm, above the shoulder
Around the upper arm, about 1 inch above the elbow crease (Correct answer)

Correct answer: Around the upper arm, about 1 inch above the elbow crease

The blood pressure cuff should be placed around the upper arm approximately 1 inch (2–3 cm) above the antecubital crease (elbow crease) for accurate readings.

Question 10: The right to be treated with dignity and respect includes which of the following?

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

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 11: Which thermometer route is most appropriate for a resident who is confused and cannot follow instructions to hold the thermometer under the tongue?

Oral
Tympanic (ear)
Axillary (armpit) (Correct answer)
Rectal

Correct answer: Axillary (armpit)

The axillary route is the safest alternative for confused or uncooperative residents because it poses no risk of injury and requires no resident cooperation.

Question 12: 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.
Wearing a gown, gloves, and a surgical mask.
Placing used linens in a standard laundry bag.
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 13: 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?

Explain to the resident that the doctor ordered it, so they must take it.
Tell them you will come back later when they are in a better mood.
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 14: A resident with diabetes has not eaten their meal. The GNA should:

Notify the nurse right away (Correct answer)
Document and ignore unless the resident complains
Offer a high-sugar snack immediately
Wait until the next meal to address it

Correct answer: Notify the nurse right away

Diabetic residents who skip meals are at risk for hypoglycemia, so the nurse must be notified immediately.

Question 15: 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?

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

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

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

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 17: A GNA is caring for an unconscious resident who is near death and has a dry mouth with crusted lips. Which comfort measure is most appropriate for the GNA to perform?

Use a hard-bristled toothbrush to scrub the resident's teeth and gums.
Ignore the dry mouth since the resident is unconscious.
Gently apply a moisturizing swab to the resident's lips and inside of the mouth. (Correct answer)
Attempt to give the resident small sips of water from a cup.

Correct answer: Gently apply a moisturizing swab to the resident's lips and inside of the mouth.

Frequent oral care is a critical comfort measure for a dying resident, as a dry mouth can cause significant discomfort. [29, 35] Using a soft, moisturizing swab is the safest and most effective way to provide this care. [24] Giving fluids by mouth to an unconscious person creates a high risk of aspiration, and it is wrong to assume an unconscious person feels no discomfort. [29]

Question 18: The nurse is preparing to discharge an older client with instructions on smoking cessation. The nurse states to a colleague, "This client has been smoking for years and isn't going to stop now." Which negative stereotype of aging does the nurse's statement most reflect?

3. Old people do not value health promotion education (Correct answer)
2. Old people are set in their ways.
1. Old people are expected to be sick
4. Old people are a drain on societal resources

Correct answer: 3. Old people do not value health promotion education

1. Many older adults have chronic disease but function well. 2. Often people characterize the elderly in a negative way, believing that after a certain age, things cannot be changed. Older people can learn new things and take up new hobbies they can enjoy and give life meaning and pleasure. 3. Although it may not be possible to reverse all the damage, it is never too late to stop smoking cigarettes. People who quit smoking at an older age enjoy better health outcomes. 4. Older people contribute greatly to society by volunteering, helping with grandchildren, mentoring others, and continue working.

Question 19: 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)
Asking the resident for permission before closing their room door.
Reporting a change in a resident's condition to the charge nurse during report.

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 20: The nurse plans an educational wellness program for a group of older adults residing in the community. on which topic should the nurse focus the majority of the information?

benefits of remaining socially active
Managing Alzheimer's disease symptoms
benefits of treating depression with medications
managing heart failure symptoms (Correct answer)

Correct answer: managing heart failure symptoms

Heart failure is one of the most common and serious chronic conditions in older adults, requiring ongoing symptom management to prevent hospitalizations and maintain quality of life, making it the priority focus for a wellness program. While depression, Alzheimer's, and social activity are all important, heart failure management has the highest prevalence and acute risk impact in this population.

Question 21: When recording vital signs, the nursing assistant should:

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

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

Try to catch the resident to prevent the fall completely.
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)
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 23: Dementia and depression are strongly related to:

A decreased quality of life and functional deficits (Correct answer)
Past economic status and job performance
Clients over the age of 60
Clients over the age of 65

Correct answer: A decreased quality of life and functional deficits

Dementia and depression both directly impair a person's ability to perform daily activities, maintain independence, and experience satisfaction in life, resulting in decreased quality of life and functional deficits. Age thresholds and past economic status do not define the relationship; these conditions affect people across various ages and socioeconomic backgrounds.

Question 24: 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)
Waiting for the resident to ask before offering to take them to the toilet.
Restricting the resident's fluid intake in the evening.
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 25: 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.
Directly behind the resident to catch them if they fall.
On the resident's right side, slightly behind them. (Correct answer)
On the resident's left side, slightly behind them.

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

Constipation
Hypoglycemia
Pressure ulcers
Aspiration pneumonia (Correct answer)

Correct answer: Aspiration pneumonia

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

Question 27: Which of the following blood pressure readings would be considered hypotensive (abnormally low) for most adults?

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

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

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

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

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

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 30: 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?

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

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

Take the measurement immediately upon entering the room
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
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 32: Moisture from incontinence increases the risk of skin breakdown primarily because it:

Softens and weakens the skin, making it more vulnerable to injury (Correct answer)
Makes the skin too dry and flaky
Prevents pressure injuries from forming
Reduces the need for repositioning

Correct answer: Softens and weakens the skin, making it more vulnerable to injury

Prolonged moisture from urine or feces softens skin (maceration), making it more susceptible to friction, shear, and pressure injuries.

Question 33: Which position is safest for a resident while eating to prevent aspiration?

High Fowler's (sitting upright at 90 degrees) (Correct answer)
Side-lying
Semi-Fowler's at 30 degrees
Supine (flat on back)

Correct answer: High Fowler's (sitting upright at 90 degrees)

Sitting upright at 90 degrees (High Fowler's) keeps the airway open and reduces the risk of food or liquid entering the lungs.

Question 34: What is the normal resting pulse rate range for an adult?

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

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 35: A resident's blood pressure is 148/92 mmHg. How should the nursing assistant respond?

Recheck immediately and report to the nurse (Correct answer)
Ask the resident to exercise to lower it
Administer an antihypertensive medication
Document it as normal and continue care

Correct answer: Recheck immediately and report to the nurse

148/92 mmHg is elevated; the nursing assistant should recheck and promptly report this finding to the nurse for further evaluation.

Question 36: A GNA is caring for a resident who is actively dying. Which of the following are common physical signs that death is approaching?

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

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 37: While ambulating a resident with a gait belt, the resident begins to feel faint and their knees start to buckle. What is the GNA's most appropriate immediate action?

Attempt to hold the resident in a standing position until help arrives.
Quickly grab a nearby chair to sit the resident down.
Let go of the gait belt and step away to avoid being pulled down.
Widen their stance and gently slide the resident down their leg to the floor. (Correct answer)

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

The safest procedure when a resident is falling is to control their descent to the floor. By widening their stance and sliding the resident down their leg, the GNA protects both the resident from a hard fall and themselves from a back injury.

Question 38: To break the 'Mode of Transmission' link in the chain of infection, a GNA should prioritize which of the following actions?

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

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

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

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

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

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 41: An older person states that "it's just a matter of time" before a knee and hip replacement will be needed. which theory of aging is this older person describing to the nurse?

endocrine
immunological
wear and tear (Correct answer)
programmed longevity

Correct answer: wear and tear

The wear and tear theory proposes that the body deteriorates over time from repeated use and accumulated stress, much like mechanical parts wearing out—exactly what the person is describing with joint replacement needs. Endocrine, programmed longevity, and immunological theories attribute aging to hormonal changes, genetic programming, or immune system decline, not physical mechanical deterioration.

Question 42: A GNA enters a room and finds a resident unresponsive, without a pulse, and not breathing. The GNA is aware the resident has a valid "Do Not Resuscitate" (DNR) order. What is the GNA's most appropriate action?

A. Begin chest compressions immediately and call for help.
B. Position the resident comfortably and wait for a family member to arrive.
C. Immediately notify the charge nurse of the findings without initiating CPR. (Correct answer)
D. Leave the room to find the resident's chart to re-verify the DNR order.

Correct answer: C. Immediately notify the charge nurse of the findings without initiating CPR.

A Do Not Resuscitate (DNR) order is a legal medical directive that must be honored. The GNA's responsibility is to confirm the absence of vital signs and immediately alert the licensed nurse. Initiating CPR would violate the resident's end-of-life wishes. The GNA should act on their knowledge of the code status and notify the nurse, who will then follow facility protocol.

Question 43: 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?

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

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 44: Why should a GNA avoid massaging bony prominences that are reddened?

Regulations prohibit it
It wastes time during care
Massage can further damage fragile tissues and worsen injury (Correct answer)
It increases the risk of infection

Correct answer: Massage can further damage fragile tissues and worsen injury

Massaging reddened bony areas can cause additional damage to already compromised tissues, increasing the severity of the pressure injury.

Question 45: Which of the following is a sign of poor nutritional status the GNA should report?

Resident drinks 6 glasses of water daily
Resident eats 75% of meals
Unintentional weight loss over several weeks (Correct answer)
Resident prefers soft foods

Correct answer: Unintentional weight loss over several weeks

Unintentional weight loss is a key indicator of malnutrition and must be reported to the nurse for further evaluation.

Question 46: 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 47: 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?

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

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

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 49: A resident of an assisted-living facility enjoys her new apartment but is disappointed that so many females reside there alone. what does this resident's observation suggest about older men?

they are healthy enough to live in their own homes
They tend to live with family when they age
They do not like to live in assisted ling facilities
They do not live as long as women (Correct answer)

Correct answer: They do not live as long as women

Men have a shorter average life expectancy than women, so by advanced age more women survive and often live alone or in assisted-living facilities. The observation that few men reside there reflects this longevity gap, not preferences about living arrangements or ability to live independently.

Question 50: Which of the following BEST demonstrates proper body mechanics for a GNA preparing to assist with lifting a resident?

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

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 51: 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.
Ask a coworker for help and use a draw sheet or slide sheet. (Correct answer)
Instruct the resident to grab onto the side rails and pull themselves up.
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 52: Which of the following statements is the BEST example of proper, factual documentation by a GNA in a resident's chart?

"Resident consumed 50% of breakfast and drank 240 mL of orange juice." (Correct answer)
"Resident seems to be in a bad mood today."
"Resident consumed a small amount of their breakfast."
"Resident was uncooperative during care this morning."

Correct answer: "Resident consumed 50% of breakfast and drank 240 mL of orange juice."

Good documentation is objective, specific, and uses measurable data whenever possible. Stating the exact percentage of food eaten and the specific volume of fluid consumed provides clear, factual information that is useful for the care team. Terms like "uncooperative," "bad mood," and "small amount" are subjective opinions or vague estimates.

Question 53: How often should a bedridden resident be repositioned to prevent pressure injuries?

Every 8 hours
Every 4 hours
Every 2 hours (Correct answer)
Once per shift

Correct answer: Every 2 hours

Standard practice requires repositioning immobile residents at least every 2 hours to relieve pressure on bony prominences and restore blood flow.

Question 54: How many full seconds should the nursing assistant count a regular pulse before multiplying to obtain the rate per minute?

20 seconds, then multiply by 3
15 seconds, then multiply by 4
30 seconds, then multiply by 2 (Correct answer)
60 seconds with no multiplication needed

Correct answer: 30 seconds, then multiply by 2

Counting a regular pulse for 30 seconds and multiplying by 2 is an accepted shortcut method; a full 60-second count is required for irregular pulses.

Question 55: 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 physician and the GNA.
The resident, to the extent practicable, and their legal representative. (Correct answer)
Only the resident's legal representative.
Only the resident, as they are the one receiving care.

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 56: A resident receiving end-of-life care tells the GNA, "I'm so scared of dying." What is the MOST therapeutic response from the GNA?

"I will let the nurse know so they can talk to you about it."
"Don't be scared, we will take great care of you."
"Would you like to talk about what is making you feel scared?" (Correct answer)
"We all have to go sometime. You should try not to think about it."

Correct answer: "Would you like to talk about what is making you feel scared?"

The most therapeutic response is one that acknowledges the resident's feelings and provides an open-ended invitation for them to express themselves further. [3, 19] This demonstrates active listening and empathy. Providing false reassurance (A), dismissing their feelings (C), or immediately deferring to the nurse (D) closes off communication and fails to provide immediate emotional support. [19, 20]

Question 57: What is the primary purpose of a therapeutic diet prescribed to a nursing home resident?

To make meal preparation easier for dietary staff
To match the resident's personal food preferences
To reduce food costs for the facility
To manage or treat a specific medical condition (Correct answer)

Correct answer: To manage or treat a specific medical condition

Therapeutic diets are medically ordered to manage conditions such as diabetes, heart disease, or swallowing disorders.

Question 58: 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)
Can you count to 10 for me?
Who is the president of the United States?
What is today's date?

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 59: A GNA notices a resident has lost 5 pounds since last week without any diet change. This finding should be:

Ignored unless the resident reports feeling unwell
Documented and reported to the nurse immediately (Correct answer)
Considered normal for elderly residents
Mentioned only at the next care conference

Correct answer: Documented and reported to the nurse immediately

Sudden unexplained weight loss may indicate illness, depression, or a medication side effect and must be reported to the nurse promptly.

Question 60: Which of the following is an example of an objective observation that a GNA should report?

The resident's urine is noted to be cloudy and has a strong odor. (Correct answer)
The resident reports feeling anxious about an upcoming doctor's appointment.
The resident states, "I have a sharp pain in my stomach."
The resident's wife says he seemed sad all morning.

Correct answer: The resident's urine is noted to be cloudy and has a strong odor.

Objective data consists of facts that are observed through the senses (sight, smell, touch, hearing) and can be measured. Cloudy, strong-smelling urine is a direct observation made by the GNA. The other options are subjective reports of feelings or symptoms from the resident or their family.

Question 61: The GNA's role in providing direct care and assisting with activities of daily living (ADLs) is performed under the direct supervision of which healthcare team member?

The medical doctor
The licensed nurse (RN/LPN) (Correct answer)
The physical therapist
The facility administrator

Correct answer: The licensed nurse (RN/LPN)

Geriatric Nursing Assistants work as part of the nursing team and are supervised by licensed nurses (Registered Nurses or Licensed Practical Nurses). The nurse delegates tasks to the GNA and is ultimately responsible for the resident's overall nursing care plan.

Question 62: When a GNA promotes a resident's independence in performing ADLs, what is the primary goal?

To ensure the resident can be discharged quickly.
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.

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

Shouting the information so the resident can hear.
Approaching the resident from behind to avoid startling them.
Using simple sentences and gesturing or pointing. (Correct answer)
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 64: 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?

Encourage the resident to drink more cranberry juice and re-check in the morning.
Ask the resident's family if this is a normal occurrence for them.
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).

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 65: Which resident is at GREATEST risk for a pressure injury based on risk factors?

A resident with mild arthritis who walks with a cane
An ambulatory resident who is well nourished
A resident who sits in a wheelchair 2 hours per day
A bedridden, incontinent resident with poor nutrition (Correct answer)

Correct answer: A bedridden, incontinent resident with poor nutrition

Immobility, incontinence, and malnutrition are three of the strongest risk factors for pressure injuries, making this resident the highest risk.

Question 66: Which bony prominence is at HIGHEST risk for a pressure injury in a resident who spends most of the day in bed?

Sacrum/coccyx (Correct answer)
Knuckles
Sternum
Forehead

Correct answer: Sacrum/coccyx

The sacrum and coccyx bear significant weight when a resident lies flat and are the most common sites for pressure injuries in bedridden patients.

Question 67: 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?

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

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 68: 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?

Speaking very loudly and slowly directly into the resident's ear.
Facing the resident, speaking clearly at a normal pace, and using facial expressions. (Correct answer)
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 69: 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)
Tucking the resident's bottom arm straight underneath their body.
Ensuring the resident's back is perfectly straight at a 90-degree angle to the mattress.
Positioning the resident directly on their hip bone.

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.

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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