CNA Basic Nursing Skills 5 2 — Questions and Answers
Question 1: When providing perineal care to a female resident, which direction should the CNA wipe?
- Back to front
- Front to back (Correct answer)
- In a circular motion
- Side to side
Correct answer: Front to back
Wiping front to back (urethra toward anus) prevents fecal bacteria from contaminating the urethra and vagina, reducing urinary tract infection risk.
The principle of front-to-back wiping during perineal care follows the clean-to-dirty principle of infection control. The urethra is clean and the rectum is contaminated. Wiping back to front can drag E. coli and other fecal organisms toward the urethra, significantly increasing the risk of UTI. A fresh wipe or washcloth section should be used for each stroke.
Question 2: What is a common sign that a resident's urinary catheter may be blocked?
- The urine is pale yellow and clear
- The drainage bag is nearly full and the resident is comfortable
- The resident complains of lower abdominal pressure and no urine is draining (Correct answer)
- The tubing is looped on the bed
Correct answer: The resident complains of lower abdominal pressure and no urine is draining
Complaints of bladder pressure with no urine draining into the catheter bag indicate possible obstruction and must be reported to the nurse.
A blocked catheter prevents urine from draining, causing the bladder to distend. Signs include absent or greatly reduced drainage despite adequate fluid intake, lower abdominal distension, discomfort, or the resident's urge to void. The CNA should check for kinks in the tubing, ensure the bag is below bladder level, and report the situation to the nurse promptly.
Question 3: How should the urinary drainage bag be positioned relative to the resident's bladder?
- At the same level as the bladder
- Above the level of the bladder
- Below the level of the bladder (Correct answer)
- Position does not matter
Correct answer: Below the level of the bladder
The drainage bag must always be below the level of the bladder so that gravity assists urine flow and prevents backflow, which could cause infection.
Urinary drainage bags must never be raised above the bladder because this allows urine to flow back into the bladder (reflux), introducing bacteria and increasing infection risk. The bag should not touch the floor either, as this contaminates the bag and tubing. During transfers and ambulation, the bag should be kept at a lower level than the bladder at all times.
Question 4: What is the most important action a CNA can take to prevent urinary tract infections in catheterized residents?
- Change the catheter daily
- Keep the catheter tubing free of kinks and maintain a closed drainage system (Correct answer)
- Open the drainage system regularly to flush the tubing
- Keep the resident on bed rest
Correct answer: Keep the catheter tubing free of kinks and maintain a closed drainage system
Maintaining a closed drainage system prevents bacteria from entering the catheter and is the most important infection-prevention strategy for catheterized residents.
Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Maintaining a closed drainage system means never disconnecting the catheter from the drainage tubing except when explicitly ordered, avoiding opening the system unnecessarily, preventing tubing kinks, and maintaining the bag below bladder level. Hand hygiene and perineal care also contribute to prevention.
Question 5: When emptying a urinary drainage bag, the CNA should:
- Pour urine directly into the toilet without measuring
- Wear gloves, use a clean measuring container, avoid touching the drain spout to the container, and document output (Correct answer)
- Remove and discard the entire drainage bag after emptying
- Empty the bag into the same container used for other residents to save time
Correct answer: Wear gloves, use a clean measuring container, avoid touching the drain spout to the container, and document output
Proper technique includes wearing gloves, measuring output in a dedicated container, not contaminating the drain spout, and accurately documenting the output.
Each step serves a critical purpose: gloves protect the CNA from body fluids; a clean individual container prevents cross-contamination between residents; not touching the spout to the container maintains catheter system sterility; and accurate measurement and documentation of urinary output provides essential data for assessing kidney function, hydration status, and fluid balance.
Question 6: A resident with a urinary catheter reports burning at the catheter insertion site. The CNA should:
- Reassure the resident that this is normal with catheters
- Apply ice to the area
- Report this finding to the nurse promptly (Correct answer)
- Reposition the catheter tubing
Correct answer: Report this finding to the nurse promptly
Burning at the catheter insertion site may indicate irritation or infection and requires nursing assessment.
Burning or discomfort at the urethral meatus can indicate a urinary tract infection, catheter irritation, or improper catheter positioning. While some mild discomfort can be normal initially with catheter placement, persistent or new-onset burning requires evaluation. The nurse will assess the resident, check for other signs of CAUTI (cloudy or foul-smelling urine, fever), and determine whether intervention is needed.
CNA Basic Nursing Skills 5 2
When providing perineal care to a female resident, which direction should the CNA wipe?