CNA Basic Nursing Skills 11 2 — Questions and Answers
Question 1: Before serving a meal tray, a CNA should FIRST:
- Arrange the room furniture for best appearance
- Check the patient's name band and tray card to confirm identity and diet order (Correct answer)
- Ask the patient what they would like to eat from the menu
- Set up the tray while the patient is in the bathroom
Correct answer: Check the patient's name band and tray card to confirm identity and diet order
Verifying patient identity against the tray card ensures the correct diet (regular, pureed, diabetic, etc.) is served to the correct patient, preventing diet-related harm.
Serving the wrong diet can cause serious harm — for example, a choking incident if a dysphagia patient receives regular-texture food, or a blood sugar crisis if a diabetic patient receives an incorrect carbohydrate load. CNAs verify the patient's identity using two identifiers (name and date of birth or wristband) and check that the tray card matches the prescribed diet (regular, mechanical soft, pureed, thickened liquids, low-sodium, diabetic, etc.). If there is any discrepancy, the tray is withheld and the charge nurse is notified.
Question 2: A patient who has dysphagia should be assisted to eat in which position?
- Lying flat on their back with the head turned to the side
- Upright at 90 degrees (sitting straight up) with the chin slightly tucked (Correct answer)
- Semi-reclined at 30 degrees with the head tilted back
- Lying on their side with a rolled towel under the neck
Correct answer: Upright at 90 degrees (sitting straight up) with the chin slightly tucked
Sitting fully upright with the chin slightly tucked uses gravity and proper airway mechanics to direct food into the esophagus and away from the airway in patients with swallowing difficulty.
Dysphagia (swallowing difficulty) puts patients at high risk for aspiration — food or liquid entering the airway instead of the esophagus. The safest eating position is fully upright (90 degrees) with a slight chin tuck, which narrows the entrance to the trachea and widens the esophagus. Patients should remain upright for at least 30–60 minutes after eating. Reclined or flat positions allow food to flow back toward the airway. Head tilted back is particularly dangerous as it opens the trachea more. The CNA must follow the speech-language pathologist's positioning orders exactly.
Question 3: A patient with poor appetite eats only 25% of their meal. The CNA should:
- Remove the tray and document nothing since it was not a full meal
- Encourage the patient to finish the tray, remove it when done, and document the intake percentage (Correct answer)
- Force the patient to eat the remainder of the meal for nutritional adequacy
- Give the patient supplemental nutrition without notifying the nurse
Correct answer: Encourage the patient to finish the tray, remove it when done, and document the intake percentage
Documenting actual intake percentage (even if low) and reporting poor appetite to the nurse ensures proper nutritional monitoring and possible dietary intervention.
Accurate intake documentation — recorded as a percentage of the meal eaten — is essential for tracking nutritional status in long-term care and hospital settings. A consistent pattern of low intake (under 50–75%) triggers nursing assessment and possible dietitian consult, supplements, or appetite stimulants. The CNA should gently encourage eating without coercion (forcing is abuse), document the actual intake percentage, and report the low intake to the charge nurse. Giving unauthorized supplements could cause drug-nutrient interactions or allergic reactions and is outside CNA scope of practice.
Question 4: When assisting a patient with feeding, the CNA should offer bites of food that are:
- As large as possible to reduce feeding time
- About the size of a teaspoon (small) and at a pace set by the patient (Correct answer)
- Mixed together on one spoon for efficiency
- Served only when the patient asks for another bite
Correct answer: About the size of a teaspoon (small) and at a pace set by the patient
Small teaspoon-sized bites at the patient's preferred pace allow sufficient time for swallowing and reduce the risk of choking or aspiration.
When assisting with feeding, the CNA controls the bite size and pace entirely. Standard safe feeding technique includes: offering small bites (approximately 5 mL or one teaspoon), waiting until the patient has completely swallowed the previous bite before offering the next, watching for coughing, throat clearing, or wet voice (signs of aspiration), and allowing rest breaks. Large bites overwhelm the swallowing mechanism. Mixing foods on one spoon can obscure whether the patient can handle the texture combinations. The patient's pace — which is often slower than the CNA would prefer — must be respected.
Question 5: A resident has an order for thickened liquids. The CNA offers them a thin glass of water. What could RESULT?
- The patient will be better hydrated because thin liquids are more effective
- The patient may aspirate the thin liquid because their swallow reflex cannot manage it safely (Correct answer)
- No harm will occur since water is not a food substance
- The physician order is optional and the patient can choose their own texture
Correct answer: The patient may aspirate the thin liquid because their swallow reflex cannot manage it safely
Thickened liquid orders are prescribed by a speech-language pathologist to prevent aspiration; offering thin liquids violates the order and puts the patient at immediate risk for aspiration pneumonia.
A thickened liquid diet order is a medical intervention designed to slow the flow of liquids through the oral cavity, giving a weakened or poorly coordinated swallow mechanism time to protect the airway. Thin liquids flow rapidly and can easily slip past an incompletely closed epiglottis into the trachea. Aspiration of even small amounts of liquid causes aspiration pneumonia, which is a serious and potentially fatal complication in elderly patients. The order is not optional — the CNA must follow it precisely and should report if the patient refuses thickened liquids so the nurse can address the issue.
Question 6: Which observation during feeding should the CNA report to the nurse IMMEDIATELY?
- The patient eats slowly and takes frequent sips of liquid
- The patient states they are not very hungry today
- The patient coughs repeatedly during eating and has a wet, gurgling voice (Correct answer)
- The patient prefers a different flavor of supplement drink
Correct answer: The patient coughs repeatedly during eating and has a wet, gurgling voice
Repeated coughing and a wet, gurgling voice during eating are signs of aspiration and require immediate cessation of feeding and nursing notification.
Signs of aspiration during feeding include: coughing or choking, a wet or gurgling voice after swallowing (indicating liquid pooling around the vocal cords), color changes (cyanosis around the lips), difficulty breathing, drooling, or food falling out of the mouth. The CNA must immediately stop feeding, sit the patient upright, and notify the nurse. The patient should not eat or drink anything further until assessed by the nurse and possibly re-evaluated by the speech-language pathologist. Aspiration can lead to pneumonia, respiratory failure, and death if not caught early.
CNA Basic Nursing Skills 11 2
Before serving a meal tray, a CNA should FIRST: