CNA Basic Nursing Skills 16 2 — Questions and Answers
Question 1: Which of the following is a KEY component of a patient's discharge plan that the CNA might help facilitate?
- Prescribing follow-up medications for the patient to take home
- Providing information about patient's ability to perform ADLs and care needs observed during the stay (Correct answer)
- Calling insurance companies to arrange coverage for home services
- Deciding which home care agency the patient will use after discharge
Correct answer: Providing information about patient's ability to perform ADLs and care needs observed during the stay
CNAs contribute essential observations about a patient's ADL capabilities and functional level to the discharge planning team, which determines the level of home or facility care needed.
Discharge planning begins at admission and involves a multidisciplinary team: physician, nurse, social worker, physical/occupational therapists, and case managers. The CNA's unique contribution is their direct observation of the patient's functional abilities during daily care: How much assistance does the patient need to bathe, dress, ambulate, eat, and toilet? Has functional level improved, plateaued, or declined during the stay? These observations inform whether the patient can return home safely (with or without home health aide support) or requires placement in a skilled nursing or long-term care facility. Prescribing medications and making insurance calls are outside the CNA scope of practice.
Question 2: A patient is being discharged home. The CNA notes that the patient cannot safely transfer from the bed to the wheelchair without maximum assistance. What should the CNA do?
- Reassure the patient they will figure it out at home
- Document the observation and report it to the charge nurse and discharge planning team before discharge (Correct answer)
- Teach the patient's family member to perform the transfer immediately before discharge
- Tell the patient to rest more at home so strength will return
Correct answer: Document the observation and report it to the charge nurse and discharge planning team before discharge
Reporting a functional safety concern before discharge allows the team to arrange appropriate resources (home health aide, equipment) or reassess the discharge plan to prevent a home fall.
A patient's inability to safely transfer independently at discharge is a significant safety concern that could lead to a fall injury at home if not addressed. The CNA's responsibility is to report this observation to the charge nurse immediately so the discharge team can: determine whether a home health aide is needed for transfers, arrange durable medical equipment (hospital bed, patient lift), consider recommending continued inpatient rehabilitation, or consult physical therapy for a functional mobility reassessment before discharge. Teaching a family member a complex lift in the minutes before discharge without proper training is not a safe substitute for a proper care plan and equipment.
Question 3: The CNA notices a new admission patient is anxious about leaving the nursing home to go home. The BEST response is to:
- Tell the patient they should be happy to go home and stop worrying
- Listen to the patient's concerns and notify the nurse so social work can address discharge anxiety (Correct answer)
- Ask the patient why they don't want to leave
- Assure the patient that everything at home will be fine without knowing the actual situation
Correct answer: Listen to the patient's concerns and notify the nurse so social work can address discharge anxiety
Discharge anxiety is common — the CNA's role is to validate the patient's feelings and involve the appropriate team member (nurse, social worker) to address specific fears and arrange support.
Patients may experience anxiety about discharge for many valid reasons: fear of managing medications or wound care at home, fear of falling without nearby help, concerns about returning to an unsafe living situation, financial worries about home care costs, or social isolation. The CNA should listen attentively and without judgment, acknowledge the patient's concerns ('It sounds like you have some worries about going home — can you tell me more?'), and promptly report the anxiety to the charge nurse. Social workers specialize in discharge planning support and can connect patients with community resources, home health services, meal delivery programs, and mental health support.
Question 4: When a patient is ready for discharge, what is the CNA's role in the discharge process?
- Write the patient's discharge instructions
- Assist with packing personal belongings, ensure the patient has all personal items, and assist with transport to the exit as assigned (Correct answer)
- Decide the discharge time based on bed availability
- Administer the patient's take-home medications before they leave
Correct answer: Assist with packing personal belongings, ensure the patient has all personal items, and assist with transport to the exit as assigned
The CNA assists with the practical aspects of discharge — packing belongings, checking that the patient has all personal items, and physically assisting with transport — under nursing direction.
Discharge is a team process with defined roles. The physician writes the discharge order, the nurse provides discharge teaching and medication reconciliation, the social worker arranges community services, and the CNA assists with: (1) gathering and packing all personal belongings (including items in the room, bedside table, and closet), (2) checking that the patient has their glasses, dentures, hearing aids, and all personal valuables, (3) transporting the patient to the car or transport vehicle in a wheelchair per policy, (4) ensuring the patient's family/transport is present and ready. Discharge instructions and medications are exclusively the nurse's and physician's responsibility.
Question 5: A patient's family asks the CNA what medications the patient will be taking after discharge. The CNA should:
- Tell the family the medication names they have observed the patient take
- Refer the family to the nurse, who is responsible for medication education and discharge instructions (Correct answer)
- Write down the medications from the patient's chart for the family
- Tell the family all medications will be explained in the discharge paperwork without further elaboration
Correct answer: Refer the family to the nurse, who is responsible for medication education and discharge instructions
Medication information and discharge teaching are exclusively the nurse's responsibility — the CNA directs families to the nurse to ensure accurate, safe, and legally appropriate information is given.
Medication reconciliation, patient and family education about medications (purpose, dose, timing, side effects, interactions), and discharge medication teaching are within the nurse's scope of practice, not the CNA's. If a CNA provides medication information — even casually from memory — errors can occur that compromise patient safety. The appropriate CNA response is: 'That's a great question for the nurse — let me get them for you.' The CNA can facilitate the conversation by summoning the nurse promptly. Family members often ask CNAs because they see them most frequently, but medication counseling always requires the nurse.
Question 6: Which item should the CNA ALWAYS check the patient has with them at the time of discharge?
- A printed copy of their nursing notes from the stay
- Glasses, hearing aids, dentures, and other personal medical devices (Correct answer)
- A list of all diagnoses from the entire stay
- Their insurance cards and billing statements
Correct answer: Glasses, hearing aids, dentures, and other personal medical devices
Personal medical devices like glasses, hearing aids, and dentures are essential for the patient's function and safety after discharge — loss of these items at discharge is a common and preventable error.
Personal assistive devices are frequently removed during care and misplaced during a hospital or nursing home stay. A CNA-discharge checklist should include: (1) eyeglasses (check the bedside table, bathroom), (2) hearing aids and batteries, (3) dentures/partial plates (check the bathroom cup and any labeled containers), (4) cane, walker, or wheelchair if patient's own property, (5) orthotic devices and prosthetics, (6) personal clothing, and (7) personal valuables (jewelry, wallet, phone) stored in the patient's name. The CNA should ask the patient directly: 'Do you have everything you came in with?' before completing the discharge process.
CNA Basic Nursing Skills 16 2
Which of the following is a KEY component of a patient's discharge plan that the CNA might help facilitate?