CNA Basic Nursing Skills 19 2 — Questions and Answers
Question 1: What is the recommended schedule for repositioning a patient who is chair-bound (sitting in a wheelchair) to prevent pressure injuries?
- Every 2 hours, same as bed-bound patients
- Every 15–30 minutes using weight shifts or position changes (Correct answer)
- Once every 4 hours since sitting exerts less pressure than lying
- Only when the patient specifically requests a change
Correct answer: Every 15–30 minutes using weight shifts or position changes
Chair-bound patients should perform or be assisted with weight shifts every 15–30 minutes because the ischial tuberosities bear concentrated pressure in a seated position, making pressure injuries develop more rapidly than in bed.
Seated pressure on the ischial tuberosities (sitting bones) is substantially higher per unit area than lying-down pressure distributed over a larger surface. This is why chair-bound patients can develop ischial pressure ulcers more rapidly than bed-bound patients develop sacral ulcers with the same 2-hour schedule. Recommended chair repositioning: (1) perform seated weight shifts every 15–30 minutes by leaning forward, leaning to each side, or pressing up from the armrests for 60 seconds, (2) for patients who cannot perform weight shifts independently, the CNA must assist with position changes at this interval, (3) ensure adequate wheelchair cushioning (gel, air, or foam pressure-redistribution cushion), (4) assess ischial area during personal care for redness or skin changes.
Question 2: A resident in a nursing home is found lying on their back with their head flat. The CNA is preparing to reposition them on their side. Which step should be done FIRST?
- Raise the side rail on the opposite side and roll the patient toward themselves
- Wash hands and put on gloves if needed, explain the procedure to the patient, and lower the bed to a safe working height (Correct answer)
- Move the patient immediately without explanation to avoid waking them
- Call for a second caregiver before explaining anything to the patient
Correct answer: Wash hands and put on gloves if needed, explain the procedure to the patient, and lower the bed to a safe working height
Before repositioning, the CNA must perform hand hygiene, don gloves if needed, explain the procedure, and set the bed to the correct working height — patient communication and safety preparation come first.
The standard pre-procedure steps for any patient care task: (1) hand hygiene, (2) personal protective equipment as needed, (3) introduction and explanation of what will happen ('I'm going to turn you onto your side to make you more comfortable'), (4) raise the bed to working height (waist level) to protect the CNA's back, (5) lower the side rail only on the working side (keep far side rail up for safety). These steps apply even for sleeping patients — repositioning without explanation can startle a patient, leading to defensive reactions or unsafe movement. Proper preparation is the foundation of safe and dignified patient care.
Question 3: Which of the following is a sign that a repositioning schedule may need to be INCREASED in frequency?
- The patient asks to be repositioned more often than scheduled (Correct answer)
- The patient's skin remains intact with no redness between repositioning intervals
- The current schedule is working and the patient is comfortable
- The patient gained 2 pounds in the past week
Correct answer: The patient asks to be repositioned more often than scheduled
If a patient requests more frequent repositioning, it may indicate they are experiencing discomfort or that the current interval is allowing excessive pressure to develop — this should be reported to the nurse.
The 2-hour repositioning standard is a minimum guideline, not a maximum — individual patients may require more frequent turning based on: skin condition (any redness between turns indicates the interval is too long), pain or discomfort, moisture from incontinence, nutritional deficits affecting skin integrity, high spasticity or involuntary movement, and the firmness of the mattress surface. When a patient repeatedly requests repositioning or shows redness at any scheduled inspection, the CNA should report to the nurse for reassessment of the turning schedule. The care plan may be revised to turn every hour or more frequently, and a pressure-relieving mattress overlay may be ordered.
Question 4: What is the 30-degree lateral tilt position used for?
- To help patients with dysphagia swallow more easily during meals
- To provide a lateral position that avoids placing body weight directly on the trochanter, reducing pressure ulcer risk (Correct answer)
- To assist with chest drainage in patients with pneumonia
- To prevent patients from rolling out of bed at night
Correct answer: To provide a lateral position that avoids placing body weight directly on the trochanter, reducing pressure ulcer risk
The 30-degree lateral tilt places the patient on their side at 30 degrees rather than full 90-degree lateral, keeping weight off the trochanter and reducing pressure injury risk at the hip.
Full 90-degree lateral (side-lying) positioning places the full body weight on the trochanter (lateral hip), which is a common pressure injury site. The 30-degree lateral tilt positions the patient on a 30-degree angle (tilted from supine using a wedge or folded pillows behind the back) so body weight is distributed across the back, buttock, and partially the hip — avoiding the concentrated pressure point of the trochanter. Studies show significantly lower pressure at the trochanteric area in the 30-degree tilt compared to full lateral positioning, making it the preferred preventive position when available. Heels must still be elevated (floated) regardless of position.
Question 5: A night-shift CNA finds a resident in the same position as when checked 3 hours ago. No documentation of repositioning during that time exists. What should the CNA do?
- Reposition the patient, document the current turn, and continue the scheduled routine
- Reposition the patient, document the finding and action, and report it to the charge nurse (Correct answer)
- Complete a full skin assessment and document that the missed turns were not their responsibility
- Change the repositioning schedule to every 3 hours to match what was actually done
Correct answer: Reposition the patient, document the finding and action, and report it to the charge nurse
A missed repositioning schedule is a care error that must be reported to the charge nurse; the patient should be repositioned immediately, the skin assessed, and the incident documented accurately.
A 3-hour repositioning gap is a significant care gap that may have caused early pressure injury. The correct actions: (1) immediately reposition the patient, (2) perform a thorough skin assessment at all pressure points — look for Stage 1 pressure injury (non-blanchable redness), (3) document the current time, repositioning action taken, and skin assessment findings honestly in the chart, (4) verbally report the gap in care and skin findings to the charge nurse, who will complete an incident report and monitor the patient's skin over the next 24–48 hours. Altering the documented schedule to cover a missed turn is falsification of medical records — a serious legal violation. Accountability is essential in nursing home care.
Question 6: What information should the CNA communicate to the oncoming shift during a handoff report related to repositioning?
- Only if a pressure ulcer was found during the shift
- Last position, time of last turn, skin condition at pressure points, and scheduled next turn time (Correct answer)
- General comments about whether the patient was cooperative
- That the patient was turned on schedule without specific details
Correct answer: Last position, time of last turn, skin condition at pressure points, and scheduled next turn time
Handoff reports for repositioning must include the patient's last position, last turn time, skin condition findings, and next scheduled turn — this ensures care continuity across shifts without gaps.
Safe handoff communication is critical for repositioning continuity. A patient who is turned every 2 hours needs the oncoming staff to know exactly when the last turn occurred to avoid an extended gap at shift change (shift-change gaps are a known pressure injury risk). Required handoff information: (1) the patient's current position (left side, right side, supine), (2) the exact time of the last position change, (3) any skin findings from the shift (redness, breakdown, blistering), (4) the time the next repositioning is due, (5) any patient concerns about pain or discomfort during turns. Vague statements like 'patient was turned' are insufficient — specific documentation and verbal report ensure the schedule continues without interruption.
CNA Basic Nursing Skills 19 2
What is the recommended schedule for repositioning a patient who is chair-bound (sitting in a wheelchair) to prevent pressure injuries?