GNA Written Examination (NNAAP) — Questions and Answers

Question 1: What is the normal resting pulse rate range for an adult?

60–100 beats per minute (Correct answer)
40–60 beats per minute
100–120 beats per minute
120–140 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 2: To break the 'Mode of Transmission' link in the chain of infection, a GNA should prioritize which of the following actions?

Ensuring residents receive their prescribed antibiotics on time.
Encouraging residents to eat a well-balanced diet.
Practicing frequent and thorough hand hygiene. (Correct answer)
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 3: A GNA is trying to communicate with a resident who has a significant hearing impairment and dementia. Which action is most effective?

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

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

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

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

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

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

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 7: 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?

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

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 8: The GNA notices that a resident's bed sheet has wrinkles under the resident's back. This is a concern because:

Wrinkles indicate the sheet is too small
It is harder to change wrinkled sheets
Sheet wrinkles create pressure points that can damage skin (Correct answer)
It makes the bed look untidy

Correct answer: Sheet wrinkles create pressure points that can damage skin

Sheet wrinkles create uneven pressure points against the skin, which can accelerate tissue breakdown in immobile residents.

Question 9: 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.
It is best to frequently change the daily routine to provide stimulation.
Correcting all of the resident's misstatements will help their memory.
Maintaining a consistent and predictable routine provides a sense of security. (Correct answer)

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 10: 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)
Use a paper towel to wipe off any residual moisture.
Apply a new pair of gloves for the next task.
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 11: 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.
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.

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 12: 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?

Managing Alzheimer's disease symptoms
benefits of remaining socially active
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 13: Why should a GNA avoid massaging bony prominences that are reddened?

It wastes time during care
Regulations prohibit it
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 14: 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.
Try to catch the resident to prevent the fall completely.
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 15: 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?

Crush the pill and mix it in their applesauce to ensure they take it.
Respect the resident's decision, document the refusal, and report it to the nurse immediately. (Correct answer)
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.

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 16: 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.
Administering their prescribed PRN medication for anxiety.
Offering to walk them to their room to rest.
Asking the resident to describe what their home is like. (Correct answer)

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 17: Which of the following is considered a basic Activity of Daily Living (ADL)?

Managing personal finances
Preparing a meal
Dressing oneself (Correct answer)
Shopping for groceries

Correct answer: Dressing oneself

Activities of Daily Living (ADLs) are fundamental self-care tasks. The six basic ADLs are bathing, dressing, eating, transferring (mobility), toileting, and continence. Managing finances, shopping, and preparing meals are considered Instrumental Activities of Daily Living (IADLs), which are more complex tasks required for independent living.

Question 18: A resident has a legal document that outlines their wishes for medical treatment, such as the use of life-sustaining measures, in case they become unable to make decisions for themselves. This document is known as:

An advance directive. (Correct answer)
A facility incident report.
A last will and testament.
An informed consent form.

Correct answer: An advance directive.

An advance directive is a legal document, such as a living will or a durable power of attorney for health care, that allows a person to state their preferences for end-of-life medical care. [27, 34, 36] A last will and testament deals with property after death, while informed consent is for specific procedures, and an incident report documents unexpected events.

Question 19: 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 manage or treat a specific medical condition (Correct answer)
To reduce food costs for the facility

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

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.
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 21: The absorption of medication in the geriatric client is most often affected by:

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

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 22: 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:

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

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

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)
A resident with mild arthritis who walks with a cane

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 24: 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?

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

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 25: A resident's care plan states 'fluid restriction of 1,500 mL/day.' The GNA should:

Offer fluids freely since dehydration is dangerous
Monitor and limit fluid intake to the ordered amount per shift (Correct answer)
Only apply the restriction during nighttime hours
Refuse to give the resident any fluids

Correct answer: Monitor and limit fluid intake to the ordered amount per shift

Fluid restrictions are medical orders that must be followed precisely, with intake distributed across shifts and documented accurately.

Question 26: A resident has a stage 2 pressure injury with a shallow open wound. The GNA's role is to:

Follow the nurse's instructions for wound care and report any changes (Correct answer)
Select and apply the appropriate dressing independently
Clean the wound and apply any available bandage
Irrigate the wound with hydrogen peroxide twice daily

Correct answer: Follow the nurse's instructions for wound care and report any changes

Wound care for a Stage 2 or higher pressure injury is directed by the nurse; the GNA assists as instructed and reports any changes in wound appearance.

Question 27: 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?

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

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

Every 2 hours (Correct answer)
Every 4 hours
Every 8 hours
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 29: 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 30: Mr. Smith, a resident with a history of congestive heart failure (CHF), had a recorded weight of 182 lbs yesterday. Today, his weight is 185 lbs and he has increased swelling in his ankles. What is the GNA's priority action?

Encourage Mr. Smith to drink more fluids to stay hydrated.
Document the weight and continue with routine care.
Re-weigh Mr. Smith after lunch to see if the number changes.
Report the 3-pound weight gain and increased ankle swelling to the nurse. (Correct answer)

Correct answer: Report the 3-pound weight gain and increased ankle swelling to the nurse.

Sudden weight gain of 2-3 pounds in a day and increased edema (swelling) are key signs of fluid retention, which can indicate a worsening of congestive heart failure. This condition requires prompt reporting to the nurse for immediate assessment and potential intervention to prevent serious complications.

Question 31: 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?

Ask the resident to explain why they are feeling so upset.
Encourage a long nap after lunch to ensure they are well-rested.
Turn on the television to a lively program for distraction.
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 32: A GNA is speaking with a resident who suddenly develops a facial droop on one side, slurred speech, and weakness in their right arm. The GNA should recognize these as signs of what potential medical emergency?

B. A seizure
C. Hypoglycemia (low blood sugar)
D. A stroke (CVA) (Correct answer)
A. A heart attack

Correct answer: D. A stroke (CVA)

Facial drooping, Arm weakness, and Speech difficulty are classic signs of a stroke, often remembered by the acronym FAST. Recognizing these signs and immediately notifying the nurse is critical for the resident to receive timely, life-saving treatment.

Question 33: Which of the following is a sign of poor nutritional status the GNA should report?

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

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 34: 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?

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

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 35: A GNA is with a resident who suddenly loses consciousness, falls to the floor, and begins to convulse with rigid, jerking motions. Which action is most appropriate for the GNA to take to ensure the resident's safety?

D. Immediately begin chest compressions and rescue breaths.
C. Firmly hold the resident's arms and legs to stop the jerking movements.
A. Loosen any tight clothing around the neck and place a soft item under the head. (Correct answer)
B. Attempt to insert a padded tongue blade into the resident's mouth.

Correct answer: A. Loosen any tight clothing around the neck and place a soft item under the head.

During a tonic-clonic (grand mal) seizure, the priority is to protect the person from injury. Loosening restrictive clothing and cushioning the head are essential safety measures. Nothing should ever be placed in the mouth, and restraining the person can cause musculoskeletal injury. CPR is not indicated unless the person stops breathing after the seizure has ended.

Question 36: A resident on a sodium-restricted diet should avoid which food?

Boiled chicken breast
Fresh fruit
Plain oatmeal
Canned soup (Correct answer)

Correct answer: Canned soup

Canned soups are typically very high in sodium and are not appropriate for residents on sodium-restricted diets.

Question 37: Which site is most commonly used to count the pulse rate in a nursing assistant's routine assessment?

Carotid artery
Femoral artery
Radial artery at the wrist (Correct answer)
Brachial artery at the elbow

Correct answer: Radial artery at the wrist

The radial artery at the wrist is the most accessible and commonly used site for routine pulse measurement by nursing assistants.

Question 38: 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?

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

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 39: A GNA is preparing to transfer a resident with left-sided weakness from the bed to a wheelchair. What is the MOST important action for the GNA to take immediately before moving the resident?

Put a pillow in the wheelchair for comfort before the transfer.
Ask the resident to place their arms around the GNA's neck for support.
Place the wheelchair on the resident's weak (left) side.
Ensure the wheels of the bed and the wheelchair are locked. (Correct answer)

Correct answer: Ensure the wheels of the bed and the wheelchair are locked.

Locking the wheels on both the bed and the wheelchair is a critical safety step to prevent the surfaces from moving during the transfer, which could cause a fall.

Question 40: Which product is typically used to protect a resident's skin from incontinence-related moisture?

Moisture barrier cream or ointment (Correct answer)
Petroleum-based shampoo
Rubbing alcohol
Hydrogen peroxide

Correct answer: Moisture barrier cream or ointment

Moisture barrier creams and ointments create a protective layer between the skin and moisture from incontinence, preventing skin breakdown.

Question 41: 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 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.

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 42: 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.
C. Assess the situation before acting.
B. Aim the nozzle at the base of the fire. (Correct answer)

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

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

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

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

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 45: 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 facility administrator
The licensed nurse (RN/LPN) (Correct answer)
The physical therapist

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 46: 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)
Placing the linens on the floor outside the resident's room 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 47: When should a GNA encourage a resident to drink fluids unless otherwise ordered?

Only when the resident asks
Only before bedtime
Only during scheduled meal times
Throughout the day at regular intervals (Correct answer)

Correct answer: Throughout the day at regular intervals

Encouraging fluids regularly throughout the day helps prevent dehydration, constipation, and urinary tract infections in elderly residents.

Question 48: 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
Talks with family once a week
Prepares pasta for dinner
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 49: 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?

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

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

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

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 51: 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.
Asking the resident for permission before closing their room door.
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.

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 52: The nurse prepares an educational program on healthy aging for a community group. which segment of the population should the nurse explain as bring the fastest growing in the US?

Young-old
Middle-age
B Middle-old
Old-old (Correct answer)

Correct answer: Old-old

The 'old-old' population (typically age 85 and older) is the fastest-growing demographic segment in the US due to advances in medicine and increased longevity. Middle-aged and young-old groups are growing more slowly, and 'middle-old' is not a standard demographic classification.

Question 53: Which of the following beverages counts toward a resident's daily fluid intake?

Only beverages served at meals
Only water
Water, juice, milk, and soup broth (Correct answer)
Only non-caffeinated beverages

Correct answer: Water, juice, milk, and soup broth

All liquids consumed — including water, juice, milk, soups, gelatin, and ice cream — count toward a resident's fluid intake record.

Question 54: A resident is on a bladder retraining program. What is a key responsibility of the Geriatric Nursing Assistant (GNA) in this program?

Waiting for the resident to ask before offering to take them to the toilet.
Restricting the resident's fluid intake in the evening.
Following the toileting schedule consistently and recording intake and output. (Correct answer)
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 55: 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
programmed longevity
immunological
wear and tear (Correct answer)

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 56: Which of the following statements is the BEST example of proper, factual documentation by a GNA in a resident's chart?

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

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

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

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 58: 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.
An N95 respirator.
A surgical mask. (Correct answer)
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 59: 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
30 seconds, then multiply by 2 (Correct answer)
15 seconds, then multiply by 4
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 60: 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.
Wash the area thoroughly with soap and water. (Correct answer)
Immediately report the injury to the charge nurse.
Find the resident to ask about their health history.

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 61: 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)
Leave the resident alone to calm down.
Continue with the care task quickly to finish.
Firmly tell the resident to stop the behavior.

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 62: 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 did not finish their breakfast this morning.
That the resident's roommate also felt dizzy earlier in the day.
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 63: Which statement would be most appropriate to ask when assessing an aging adult for cognitive function?

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

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 64: 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.
the right arm, then the left arm.
both arms at the same time.
the left arm, then the right arm. (Correct answer)

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

Lower the bed as much as possible to get better leverage.
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)

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

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

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 67: 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.
Widen their stance and gently slide the resident down their leg to the floor. (Correct answer)
Let go of the gait belt and step away to avoid being pulled down.

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 68: 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?

The resident, to the extent practicable, and their legal representative. (Correct answer)
Only the resident, as they are the one receiving care.
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 69: The nurse visits the home of an older person recovering from an exacerbation of a chronic illness. which observation indicates to the nurse that the person has dispelled the myth that older people cannot learn new things?

Preparing a shopping list
Scheduling an ophthalmologic
Planning to meet friends for lunch
Researching medications on the internet (Correct answer)

Correct answer: Researching medications on the internet

Researching medications on the internet demonstrates initiative in learning new technology and seeking health information, directly countering the myth that older adults cannot learn new things. Planning lunch, scheduling appointments, and writing shopping lists are routine tasks that do not require acquiring new knowledge or skills.

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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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

health.maryland.gov — Exam information · verified Oct 2026
regs.maryland.gov — Renewal · verified Oct 2026
hdmaster.com — Test delivery, fees, time limit · verified Oct 2026
kb-maryland.credentia.com — Eligibility, registration deadline, passing score, score release, exam format, time limit · verified Oct 2026