CNA Basic Nursing Skills 3 2 — Questions and Answers
Question 1: What does the term 'eschar' refer to in wound care?
- New granulation tissue forming in the wound bed
- Thick, dry, leathery necrotic tissue covering a wound (Correct answer)
- Clear fluid seeping from a wound
- A wound that has fully epithelialized
Correct answer: Thick, dry, leathery necrotic tissue covering a wound
Eschar is thick, dry, leathery necrotic (dead) tissue that can cover a wound and must be assessed by a nurse or wound care specialist.
Eschar is a type of necrotic tissue that forms a hard, black or dark brown covering over a wound. It must not be removed by the CNA; debridement decisions are made by licensed clinical staff. CNAs should document and report the presence of eschar as part of wound observation. Slough (soft, yellow-white necrotic tissue) is another type of necrotic tissue that also warrants reporting.
Question 2: How should a CNA handle soiled wound dressings after removal?
- Place them in the regular trash immediately
- Roll them inward and dispose of them in a biohazard or covered waste container (Correct answer)
- Leave them on the overbed table for the nurse to inspect
- Flush them down the toilet
Correct answer: Roll them inward and dispose of them in a biohazard or covered waste container
Soiled dressings contain potentially infectious material and must be disposed of in a covered or biohazard waste container after rolling them inward to contain the contaminated surface.
Rolling soiled dressings inward prevents the contaminated surface from touching other surfaces or the CNA's hands, reducing cross-contamination. Proper disposal in a covered or biohazard waste container follows standard precautions. After disposing of the dressing, the CNA performs hand hygiene before proceeding with wound care. Proper disposal also protects other staff who handle waste.
Question 3: Which sign indicates that a wound is healing properly?
- Increasing redness and warmth around the wound
- Green purulent drainage from the wound
- Pink granulation tissue visible in the wound bed (Correct answer)
- Wound edges pulling apart
Correct answer: Pink granulation tissue visible in the wound bed
Pink granulation tissue in the wound bed is a positive sign of healing, indicating new tissue formation.
Granulation tissue is a rich, vascular, pink or red tissue that forms in the wound bed during the proliferative phase of healing. Its presence indicates the wound is progressing toward closure. In contrast, purulent drainage, increasing redness, dehiscence (wound edges pulling apart), and warmth are signs of infection or delayed healing that should be reported promptly.
Question 4: A resident has a wound on the heel. Which action best helps prevent worsening of the wound?
- Massage the heel vigorously to increase circulation
- Apply a tight bandage to reduce swelling
- Use a heel protector or float the heels off the mattress (Correct answer)
- Keep the resident lying on their back at all times
Correct answer: Use a heel protector or float the heels off the mattress
Floating heels off the mattress or using heel protectors eliminates pressure on this bony prominence, preventing further tissue damage.
Heels are one of the most common sites for pressure injuries due to their bony prominence and limited tissue padding. Floating the heels by placing a pillow beneath the calf (not under the knee) or using approved heel protection devices removes pressure entirely. Massaging over reddened or injured bony prominences is contraindicated as it can worsen tissue damage.
Question 5: What information should the CNA document after a wound dressing change?
- Only the time the dressing was changed
- Location of the wound, type of dressing, wound appearance, and drainage amount and color (Correct answer)
- The brand of dressing used only
- No documentation is required for routine dressing changes
Correct answer: Location of the wound, type of dressing, wound appearance, and drainage amount and color
Thorough documentation includes wound location, dressing type used, wound appearance (size, color, odor), and drainage characteristics to provide an accurate record for the care team.
Proper wound care documentation serves as a legal record and communication tool for the healthcare team. It should capture wound location, size if measured, wound bed appearance, surrounding skin condition, drainage type, amount and color, odor, and the type of dressing applied. Any changes from prior assessments must also be noted. Complete records enable early detection of complications.
Question 6: Which action by the CNA violates principles of aseptic technique during wound care?
- Washing hands before and after the procedure
- Using sterile gloves when touching the wound
- Reaching across the sterile field to obtain supplies (Correct answer)
- Changing gloves if they become contaminated
Correct answer: Reaching across the sterile field to obtain supplies
Reaching across a sterile field contaminates it because the unsterile arm passes over the sterile area, compromising the aseptic environment.
Aseptic technique requires that the sterile field remain uncontaminated throughout the procedure. Reaching across a sterile field introduces non-sterile surfaces into the environment. CNAs should organize supplies before beginning and position themselves to access the field without crossing over it. Sterile items that are contaminated must be replaced before continuing the procedure.
CNA Basic Nursing Skills 3 2
What does the term 'eschar' refer to in wound care?