CNA Basic Nursing Skills 18 2 — Questions and Answers

Question 1: Which technique is MOST important to prevent injury to the CNA when assisting a patient to stand?

Using only arm strength to lift the patient upward
Using proper body mechanics: bending at the knees, keeping the back straight, and staying close to the patient (Correct answer)
Standing behind the patient and pushing up from under the arms
Pulling the patient up by the wrists to distribute force evenly

Correct answer: Using proper body mechanics: bending at the knees, keeping the back straight, and staying close to the patient

Proper body mechanics — wide base of support, bending at knees (not waist), keeping back straight, and staying close — protect the CNA's spine and transfer the workload to larger leg muscles.

Back injuries are the most common occupational injury among CNAs. Proper body mechanics prevent injury by: (1) establishing a wide base of support (feet shoulder-width apart), (2) bending at the hips and knees (not the waist), (3) keeping the spine in neutral alignment (no twisting or bending sideways), (4) keeping the patient close to the body during transfers, (5) tightening core muscles, (6) using leg muscles (the body's strongest) to generate lift, (7) never twisting the spine while bearing load — pivot the feet instead. These principles apply during all patient handling tasks: transfers, repositioning, and lifts.

Question 2: When assisting a patient to transfer from bed to wheelchair, the wheelchair should be positioned:

At a 90-degree angle directly in front of the bed
At a 45-degree angle on the patient's stronger side with the brakes locked (Correct answer)
Behind the patient against the wall to prevent rolling
On the patient's weaker side to challenge and strengthen that side

Correct answer: At a 45-degree angle on the patient's stronger side with the brakes locked

Positioning the wheelchair at 45 degrees on the patient's stronger side minimizes the arc of rotation and allows the patient to lead the pivot step with their stronger leg.

The standard bed-to-wheelchair transfer technique positions the wheelchair: (1) at 45 degrees to the bed — this shortens the rotational distance compared to 90 degrees, reducing fall risk and patient effort, (2) on the patient's stronger side — allows the patient to use their stronger leg to push to stand and lead the pivot, (3) brakes locked before the transfer begins, (4) footrests swung out of the way to provide a clear step landing area. The CNA applies a gait belt before beginning, ensures the patient's feet are flat on the floor before standing, and uses a pivot-step technique. After transfer, the CNA lowers and replaces footrests and applies seatbelt if indicated.

Question 3: A patient uses a quad cane for ambulation assistance. On which side should the CNA walk when guiding this patient?

On the side with the cane, between the patient and the cane
On the patient's weaker side, slightly behind them (Correct answer)
Directly in front, walking backward to monitor the patient's face
On the patient's stronger side to prevent over-reliance on the cane

Correct answer: On the patient's weaker side, slightly behind them

The CNA walks on the patient's weaker side during ambulation, where the greatest fall risk exists, while the cane is used on the stronger side for weight-bearing support.

During assisted ambulation with a cane: the patient holds the cane in the hand on the stronger side (the cane acts as a functional substitute for the weaker leg), and the CNA stands on the patient's weaker side and slightly behind, gripping the gait belt at the back. This arrangement means the CNA is positioned to prevent a fall toward the unprotected weaker side. The CNA should match the patient's pace and not rush them. For a quad cane, the flat base goes on the floor first, all four tips make contact, then the patient steps forward. The CNA communicates reassuringly and monitors the patient's color, breathing, and steadiness throughout.

Question 4: How should a gait belt be applied before assisting a patient to stand?

Around the patient's neck for maximum security
Around the patient's waist over clothing with enough room to fit two fingers under the belt (Correct answer)
Around the patient's thighs to guide their legs during standing
Over the patient's hospital gown at the chest level

Correct answer: Around the patient's waist over clothing with enough room to fit two fingers under the belt

A gait belt is applied around the waist over clothing, snug enough to be secure (CNA can fit only 1–2 fingers under it) but not so tight it restricts breathing or causes pain.

The gait belt (also called a transfer belt) is a safety device used during assisted standing, transfer, and ambulation. Correct application: (1) wrap the belt around the patient's waist over clothing (never directly on skin, over wounds, colostomy appliances, or G-tubes — check for contraindications first), (2) thread the buckle end through the frame and back over — never through the smooth back side, (3) tighten so you can fit only 1–2 fingers underneath — too loose provides no security, too tight restricts breathing, (4) ensure the belt is not over the patient's abdomen if there are wounds or tubes, (5) instruct the patient on the belt's purpose. The CNA grips the belt from underneath for lifting assistance — never grip the patient's clothing, which tears and provides poor control.

Question 5: During ambulation, a patient suddenly becomes dizzy and starts to lose balance. The CNA should:

Support the patient and attempt to walk them quickly to the nearest chair
Ease the patient to the floor in a controlled manner to prevent an uncontrolled fall (Correct answer)
Hold the patient upright by pulling their arms until help arrives
Call for help loudly while releasing the patient to run for assistance

Correct answer: Ease the patient to the floor in a controlled manner to prevent an uncontrolled fall

When a patient begins to fall, the CNA's priority is a controlled descent to the floor — this is safer than trying to hold up the patient's full weight, which risks injuring both the patient and the CNA.

When a patient begins to fall and cannot be safely supported upright, the correct response is a controlled lowering to the floor: (1) widen your stance for stability, (2) bend your knees (not your waist) to lower your center of gravity, (3) use the gait belt to guide the patient to the floor while supporting their head, (4) ease the patient to the side, guiding them to a seated position then lowering to the floor, (5) do not try to stop the fall by pulling up — this can dislocate joints and strain your back. After the patient is on the floor: stay with them, call for help, perform a brief assessment (ask about pain, assess for injury), wait for nursing staff before attempting to get the patient up.

Question 6: What is the CORRECT method for assisting a patient from a seated position to standing?

Pull the patient up by clasping both their hands and leaning back
Have the patient scoot to the chair edge, place feet flat, lean forward, and assist to stand using the gait belt (Correct answer)
Lift the patient under the arms from behind in a quick single motion
Hold the patient by one arm and pull upward while they push from the chair

Correct answer: Have the patient scoot to the chair edge, place feet flat, lean forward, and assist to stand using the gait belt

The correct sit-to-stand technique has the patient scoot forward, plant feet, lean forward (nose over toes), and use leg muscles to stand — the CNA supports using the gait belt, never pulling by the arms.

The sit-to-stand transfer sequence: (1) have the patient scoot forward to the front edge of the chair/bed, (2) feet flat on the floor, hip-width apart, (3) lean forward so the nose is over the toes (shifts center of mass over the feet), (4) rock forward and push up from the armrests or the mattress using arm strength plus leg muscles, (5) the CNA stands beside the patient holding the gait belt from underneath and guides the movement without pulling up — lifting a patient by pulling arms risks shoulder dislocation and the CNA risks back injury. Counting to three together coordinates the effort. Allow the patient to stand fully before taking the first step.

CNA Basic Nursing Skills 18 2

Which technique is MOST important to prevent injury to the CNA when assisting a patient to stand?