CNA Basic Nursing Skills 1 2 — Questions and Answers

Question 1: A bed-bound patient is at risk for pressure ulcers. What is the MOST important nursing intervention to prevent skin breakdown?

Apply lotion to all bony prominences every hour
Reposition the patient at least every 2 hours (Correct answer)
Keep the patient in the same position for comfort
Place a thick pillow under the patient's heels

Correct answer: Reposition the patient at least every 2 hours

Repositioning every 2 hours relieves prolonged pressure on bony prominences, which is the primary cause of pressure ulcers in immobile patients.

Pressure ulcers (also called pressure injuries or bedsores) develop when sustained pressure reduces blood flow to tissues overlying bony prominences such as the sacrum, heels, and hips. CNAs are responsible for turning and repositioning bed-bound residents at minimum every 2 hours to restore circulation. A written turning schedule is typically posted at the bedside. Lotion can help keep skin supple but does not replace repositioning. Pillows under heels can float them but are a supplement, not a substitute for regular position changes.

Question 2: When repositioning a patient from their back to their side, the CNA should place a pillow:

Under the patient's head only
Between the patient's knees and under the upper arm (Correct answer)
Behind the patient's back only
Under both feet

Correct answer: Between the patient's knees and under the upper arm

Pillows between the knees and under the upper arm prevent bony prominences from pressing against each other and maintain spinal alignment in the side-lying position.

When placing a patient in a lateral (side-lying) position, proper body alignment requires support at several points. A pillow placed between the knees prevents the top knee from pressing down on the bottom knee, which can cause skin breakdown and discomfort. A pillow under the upper arm prevents shoulder strain and maintains chest expansion for breathing. The head is supported by the regular bed pillow. A pillow or wedge behind the back helps maintain the side-lying position safely.

Question 3: A resident's skin appears reddened over the sacrum but the skin is intact. The CNA should FIRST:

Apply a bandage over the area
Continue the normal care routine
Report the observation to the nurse immediately (Correct answer)
Massage the reddened area vigorously

Correct answer: Report the observation to the nurse immediately

Persistent redness over a bony prominence is a Stage 1 pressure injury warning sign and must be reported to the nurse right away for assessment and intervention.

Redness over the sacrum that does not blanch (turn white) with fingertip pressure is classified as a Stage 1 pressure injury. This is the earliest and most reversible stage, but prompt action is critical. The CNA must report immediately so the nurse can document the finding, adjust the care plan, and possibly order a pressure-relieving mattress or wound care consult. Massaging reddened areas is contraindicated because it can further damage fragile capillaries beneath the skin. Bandaging an intact area is unnecessary and can trap moisture.

Question 4: Which position places a patient at the HIGHEST risk for developing a pressure ulcer?

Sitting in a recliner chair for 20 minutes
Lying in the semi-Fowler's position for 4 hours without repositioning (Correct answer)
Ambulating with a walker twice a day
Sitting upright at 90 degrees at mealtime

Correct answer: Lying in the semi-Fowler's position for 4 hours without repositioning

Remaining in any one position for 4 hours without repositioning severely restricts blood flow to compressed tissues, greatly increasing pressure ulcer risk.

The duration and intensity of pressure are the two key factors in pressure ulcer development. Lying in semi-Fowler's for 4 hours without repositioning exposes the sacrum and heels to prolonged, unrelieved pressure. Additionally, semi-Fowler's creates shearing forces as gravity pulls the body downward while the skin stays in contact with the bed surface. Sitting briefly in a recliner or chair with regular position changes is far safer. Ambulation actively prevents pressure ulcers by eliminating sustained contact. Upright mealtime positioning is recommended for safe swallowing and typically lasts only 20–30 minutes.

Question 5: When performing a skin inspection during repositioning, the CNA should pay SPECIAL attention to:

The patient's hair and scalp only
Bony prominences such as heels, sacrum, and hips (Correct answer)
Only areas covered by clothing
The patient's abdomen and chest

Correct answer: Bony prominences such as heels, sacrum, and hips

Bony prominences like the heels, sacrum, coccyx, and hips bear the most pressure when a patient is immobile and are the most common sites for pressure injuries.

Pressure ulcers almost always form over bony prominences because there is little soft tissue between the bone and the skin surface. Key sites to assess in bed-bound patients include: occiput (back of head), shoulder blades, elbows, sacrum/coccyx, trochanters (outer hips), knees (medial and lateral), malleoli (ankles), and heels. For chair-bound patients, the ischial tuberosities (sitting bones) are most vulnerable. CNAs should look for redness, warmth, swelling, or open areas and report any changes immediately.

Question 6: A patient who weighs 200 lbs needs to be repositioned. The CNA cannot safely move the patient alone. What should the CNA do?

Ask the patient to assist and attempt the move alone
Skip the repositioning and document it as completed
Ask another staff member for assistance before repositioning (Correct answer)
Wait until the next scheduled repositioning time

Correct answer: Ask another staff member for assistance before repositioning

CNAs must request assistance when a patient's weight or condition makes safe repositioning impossible alone, to protect both the patient and the CNA from injury.

Safe patient handling requires that the CNA assess the patient's weight, mobility, and ability to assist before any repositioning. When a patient exceeds safe single-caregiver limits, the CNA must call for a second caregiver or use a mechanical lift. Attempting an unsafe move risks muscle strain or injury to the CNA, and can cause the patient to fall or sustain friction/shear injuries. Skipping repositioning and falsifying documentation is illegal and an abuse of the resident. The patient cannot be left in a pressure-producing position simply because help is inconvenient to find.

CNA Basic Nursing Skills 1 2

A bed-bound patient is at risk for pressure ulcers.
What is the MOST important nursing intervention to prevent skin breakdown?