CNA Basic Nursing Skills 10 2 — Questions and Answers
Question 1: While making an occupied bed, the CNA notices the mattress has a visible stain and odor. What is the PRIORITY action?
- Cover the mattress with extra blankets
- Complete bed-making and report the issue after the shift
- Report the mattress condition to the charge nurse before continuing (Correct answer)
- Place a plastic bag over the mattress
Correct answer: Report the mattress condition to the charge nurse before continuing
A stained, malodorous mattress may harbor pathogens and requires nursing or environmental services attention before bedding is changed; the nurse should be notified promptly.
A mattress with visible soiling or odor is a potential infection control hazard. The CNA should notify the charge nurse, who will arrange for the mattress to be cleaned or replaced by housekeeping or environmental services before the bed is made up with fresh linens. Covering the problem with blankets does not eliminate the pathogen risk and delays proper cleaning. The CNA works within the scope of practice — maintenance and equipment decisions are made with nurse oversight.
Question 2: When changing bed linens for a patient with limited mobility, the CNA should:
- Remove all linens at once before repositioning the patient
- Fan-fold linens to the center of the bed and roll the patient to work side-by-side (Correct answer)
- Have the patient stand at the bedside while the entire bed is changed
- Always change linens only when the patient is out of the room
Correct answer: Fan-fold linens to the center of the bed and roll the patient to work side-by-side
Fan-folding linens to the center and making one side of the bed before rolling the patient allows the bed to be changed safely with minimal patient movement.
Making an occupied bed requires organization and cooperation. The CNA lowers the side rail on the working side, loosens the soiled linens, and rolls them toward the center of the bed. Clean linens are fan-folded and tucked under the soiled linens on the center of the bed. The patient is log-rolled to the made side, the soiled linens are removed and discarded, and the clean linens are unfolded and secured. This technique changes the entire bed with only one patient roll, minimizing discomfort, exertion, and fall risk.
Question 3: A patient reports that the side rail was not raised after the CNA left the room. What is the SIGNIFICANCE of this?
- Side rails are only for patient comfort, so it is not important
- A lowered side rail increases the risk of the patient falling out of bed (Correct answer)
- Side rails are always raised for all patients regardless of orders
- The patient can raise side rails independently, so it is the patient's responsibility
Correct answer: A lowered side rail increases the risk of the patient falling out of bed
Side rails are a fall prevention device; leaving them lowered without clinical justification exposes an at-risk patient to serious injury from an unassisted fall.
Side rails are considered a restraint-related device and must be used according to the patient's care plan and physician or nurse orders. For patients with fall risk (most elderly and post-surgical patients), side rails should be raised when the CNA leaves the bedside, except when the patient is getting in or out of bed. Failure to raise ordered side rails can result in a preventable fall with serious injury. If a patient has a physician order for side rails to remain down (e.g., claustrophobia), that order must be followed and documented.
Question 4: What is the correct method for handling soiled bed linens to prevent infection?
- Shake linens briskly to remove debris before placing in hamper
- Hold linens close to the uniform while carrying to the hamper
- Roll soiled linens inward (soiled side in) and carry away from the body (Correct answer)
- Stack soiled linens neatly on a chair until the end of the shift
Correct answer: Roll soiled linens inward (soiled side in) and carry away from the body
Rolling soiled linens inward contains pathogens within the fold, and carrying them away from the uniform prevents cross-contamination of the CNA's clothing.
Standard linen handling precautions require that soiled linens never be shaken (which aerosolizes particles), never held against the uniform (which contaminates the CNA's clothing), and never left on furniture or the floor. The correct technique is to roll linens into a bundle with the contaminated surfaces facing inward, then carry the bundle at arm's length from the body directly to the linen hamper. Gloves should be worn. Linen hampers should never be overfilled. Each patient should have a separate hamper or bag.
Question 5: Which bed position is MOST appropriate when a patient is not eating, receiving care, or being transferred?
- High Fowler's with the side rails down
- Lowest position with the bed in a flat, locked position and call light within reach (Correct answer)
- Trendelenburg position with foot of bed elevated
- Semi-Fowler's with the overbed table raised
Correct answer: Lowest position with the bed in a flat, locked position and call light within reach
When a patient is at rest and no care is being provided, the bed should be in its lowest position to minimize fall injury risk, flat, locked, and with the call light accessible.
Bed safety protocols specify that when a patient is resting or sleeping and the CNA has finished care, the bed should be: (1) lowered to its lowest position — so a potential fall is from a minimal height, (2) flat or in the patient's preferred position per care plan, (3) wheels locked, (4) side rails raised according to care plan, and (5) call light placed within easy reach. High or Trendelenburg positions are used only for specific clinical indications. Leaving the bed elevated when leaving the room is a common and preventable cause of fall injuries.
Question 6: When a side rail is found broken or non-functional, the CNA should:
- Tie the side rail in place with a strip of sheet
- Document the issue and report it to the charge nurse immediately so maintenance can be called (Correct answer)
- Continue care and report it at the end of the shift
- Have the patient keep one hand on the rail at all times
Correct answer: Document the issue and report it to the charge nurse immediately so maintenance can be called
A broken side rail is a safety hazard that must be immediately reported to the charge nurse so maintenance can repair or replace it before the patient is left unattended.
Broken or non-functional side rails pose serious fall and entrapment hazards. The CNA does not repair equipment — that is the role of biomedical engineering or maintenance staff. The immediate steps are: (1) report to the charge nurse verbally right away, (2) document the observation and report in the patient's chart or incident report, and (3) take necessary interim safety precautions (e.g., closer monitoring, lower bed position) as instructed by the nurse until the equipment is repaired. Improvised repairs with sheets are unsafe and violate safety standards.
CNA Basic Nursing Skills 10 2
While making an occupied bed, the CNA notices the mattress has a visible stain and odor.
What is the PRIORITY action?