PSW Basic 2 — Questions and Answers

Question 1: A PSW is assisting a client with a bed bath. Which area should be washed first?

Face and eyes (Correct answer)
Arms and hands
Chest and abdomen
Perineal area

Correct answer: Face and eyes

When performing a bed bath, you always start with the cleanest area first — the face and eyes — and work toward the more soiled areas to prevent cross-contamination.

The standard procedure for a bed bath follows the principle of washing from the cleanest to the dirtiest area. The face and eyes are washed first using a separate section of the washcloth for each eye, wiping from the inner to outer corner. The bath then proceeds downward: neck, arms, chest, abdomen, legs, back, and finally the perineal area. This sequence is a fundamental personal care skill taught in all Ontario PSW programs and prevents the spread of microorganisms from contaminated areas to cleaner ones.

Question 2: What is the most important reason for a PSW to encourage a client to do as much self-care as possible?

It reduces the PSW's workload
It promotes the client's independence and dignity (Correct answer)
It saves time during the shift
It is required by the employer

Correct answer: It promotes the client's independence and dignity

Encouraging self-care promotes independence, maintains the client's sense of dignity and self-worth, and supports their physical and cognitive abilities.

A core principle of person-centred care in the PSW scope of practice is promoting client independence. When clients perform tasks they are capable of — even if it takes longer — they maintain muscle strength, cognitive function, and a sense of control over their lives. This approach respects their dignity and autonomy, which are fundamental rights outlined in Ontario's Long-Term Care Homes Act and Home Care and Community Services Act. While it may also reduce workload, the primary rationale is always the client's well-being.

Question 3: A client with diabetes asks the PSW to cut their toenails. What is the correct response?

Cut the toenails carefully using clean nail clippers
Refuse and explain that toenail care for diabetic clients must be done by a regulated health professional (Correct answer)
Soak the feet first, then trim the nails
File the nails instead of cutting them

Correct answer: Refuse and explain that toenail care for diabetic clients must be done by a regulated health professional

Clients with diabetes are at high risk for foot complications. Toenail cutting for diabetic clients is outside the PSW's scope of practice and must be performed by a nurse or foot care specialist.

Diabetes causes peripheral neuropathy (reduced sensation) and peripheral vascular disease (reduced blood flow), which means even a small nick from nail cutting can lead to serious infection, ulceration, or even amputation. For this reason, foot and toenail care for diabetic clients falls outside the PSW scope of practice in Ontario. PSWs should report the need for foot care to the supervisor or nurse so a regulated professional — such as an RN, RPN, or chiropodist — can safely perform the task. PSWs can still assist with daily foot inspections and washing.

Question 4: When repositioning a client in bed, how often should they be turned to prevent pressure injuries?

Every 4 hours
Every 2 hours or as directed in the care plan (Correct answer)
Once per shift
Only when the client requests it

Correct answer: Every 2 hours or as directed in the care plan

The standard guideline is to reposition immobile clients at least every 2 hours, or more frequently as specified in the individual care plan, to prevent pressure injuries.

Pressure injuries (formerly called pressure ulcers or bedsores) develop when sustained pressure reduces blood flow to skin and underlying tissues. The widely accepted clinical guideline, endorsed by the National Pressure Injury Advisory Panel (NPIAP), recommends repositioning immobile clients at least every 2 hours. However, some clients may need more frequent repositioning based on their individual risk factors — skin condition, nutrition, moisture, and mobility level. The care plan should specify the exact schedule. PSWs must document each repositioning and report any skin changes immediately.

Question 5: A PSW notices that a client's skin is red and non-blanchable over the sacrum. What should the PSW do?

Apply lotion to the area and continue with care
Massage the reddened area to improve circulation
Report the finding to the supervisor or nurse immediately (Correct answer)
Place a bandage over the area

Correct answer: Report the finding to the supervisor or nurse immediately

Non-blanchable redness is a sign of a Stage 1 pressure injury. The PSW must report this immediately so the healthcare team can assess and implement a treatment plan.

Non-blanchable erythema — redness that does not turn white when pressed — over a bony prominence like the sacrum is classified as a Stage 1 pressure injury according to the NPIAP staging system. This is a significant finding that indicates tissue damage has begun. The PSW must never massage the area (this can cause further tissue damage), and applying lotion or a bandage does not address the underlying problem. The correct action is to report immediately to the nurse or supervisor, document the finding, and continue to reposition the client as directed. Early detection and reporting by PSWs is critical for preventing progression to more severe stages.

Question 6: Which of the following is an example of passive range of motion (PROM) exercise?

The client lifts their own arm above their head
The PSW moves the client's leg through its full range of movement (Correct answer)
The client walks to the dining room with a walker
The client squeezes a stress ball independently

Correct answer: The PSW moves the client's leg through its full range of movement

Passive range of motion means the PSW moves the client's limb through its range — the client does not use their own muscle effort. This is used when clients cannot move the joint independently.

Range of motion (ROM) exercises are classified into three types: passive (PROM), active-assistive (AAROM), and active (AROM). In passive ROM, the PSW or therapist moves the client's joint through its full range without any effort from the client. This is prescribed for clients who are paralyzed, unconscious, or too weak to move the joint themselves. The purpose is to maintain joint flexibility, prevent contractures, and promote circulation. PSWs perform PROM exercises only as delegated by a physiotherapist or nurse and must follow the care plan for specific joints, repetitions, and precautions.

PSW Basic 2

A PSW is assisting a client with a bed bath.
Which area should be washed first?