CNA Basic Nursing Skills 6 2 — Questions and Answers
Question 1: What position should a resident be in during mealtime to prevent aspiration?
- Lying flat on their back
- Head of bed elevated to 30 degrees
- Sitting upright at 90 degrees or as close as possible (Correct answer)
- On their left side
Correct answer: Sitting upright at 90 degrees or as close as possible
An upright position of 90 degrees uses gravity to assist swallowing and reduces the risk of food or liquid entering the airway.
Aspiration occurs when food or liquid enters the airway rather than the esophagus. An upright position (90 degrees) allows gravity to direct food toward the stomach. Residents with dysphagia (swallowing difficulties) are particularly at risk. The CNA should ensure residents are fully awake, positioned upright, and use any prescribed adaptive equipment or modified diet textures per the care plan.
Question 2: If a resident on a thickened-liquid diet receives a regular glass of water, what should the CNA do?
- Let the resident drink it since water is always safe
- Remove the regular water and offer a thickened beverage per the care plan (Correct answer)
- Thicken it at the bedside with whatever is available
- Document it and report it at the end of the shift
Correct answer: Remove the regular water and offer a thickened beverage per the care plan
Diet modifications such as thickened liquids are medically ordered to prevent aspiration. The CNA must follow the diet order and remove incorrect items promptly.
Thickened-liquid diets are prescribed by a physician or speech-language pathologist for residents with dysphagia to prevent aspiration pneumonia. Thin liquids (including water) flow too quickly for these residents to swallow safely. The CNA must remove regular water, provide an approved thickened beverage, and notify the nurse that an incorrect item was served so the dietary department can be alerted.
Question 3: When assisting a resident who is partially dependent during feeding, what should the CNA do?
- Feed the resident quickly to complete care tasks efficiently
- Offer small bites or sips, allow adequate time for chewing and swallowing, and check for pocketing (Correct answer)
- Feed the resident while they are lying on their back to prevent spilling
- Alternate between solids and liquids with every bite regardless of the care plan
Correct answer: Offer small bites or sips, allow adequate time for chewing and swallowing, and check for pocketing
Safe feeding requires small bites, adequate time, and monitoring for pocketing (food held in the cheek), which can indicate swallowing difficulty.
Pocketing (collecting food in the cheek) can indicate dysphagia or denture problems and poses an aspiration risk when the resident lies down. Small bites and adequate chewing/swallowing time reduce choking risk. Rushing feeding is a safety hazard. Feeding should be a calm, dignified interaction that respects the resident's pace. The CNA should observe and document intake, including any refusal or difficulty.
Question 4: A resident refuses to eat at mealtime. What should the CNA do?
- Document the refusal, encourage the resident gently, and report it to the nurse (Correct answer)
- Force-feed the resident to ensure adequate nutrition
- Remove the tray without offering an alternative
- Tell the resident they must eat or they will become ill
Correct answer: Document the refusal, encourage the resident gently, and report it to the nurse
Residents have the right to refuse food. The CNA should gently encourage without coercing, document the refusal, and report to the nurse so the care team can address any underlying issues.
Forced feeding violates resident rights and can cause physical harm. When a resident refuses meals, the CNA should explore reasons (nausea, discomfort, food preference), offer alternatives if available, and report the refusal to the nurse. The nurse may consult dietary or a physician. Ongoing refusals can lead to malnutrition, so monitoring and reporting are essential for timely intervention.
Question 5: What does the abbreviation 'I&O' stand for in nursing documentation?
- Input and Output
- Intake and Output (Correct answer)
- Internal and Oral
- Intake and Outflow
Correct answer: Intake and Output
I&O stands for Intake and Output, which refers to the measurement and recording of all fluids a resident consumes and all fluids excreted.
Intake and Output monitoring is ordered for residents with conditions such as congestive heart failure, renal failure, or dehydration, or post-surgery. Intake includes all oral fluids, tube feedings, and IV fluids. Output includes urine, wound drainage, emesis, and stool (if liquid). Accurate I&O documentation helps the healthcare team assess fluid balance, kidney function, and the effectiveness of diuretic therapy.
Question 6: Which action is correct when a resident shows signs of choking while eating?
- Give the resident water to wash the food down
- Perform abdominal thrusts (Heimlich maneuver) if the resident cannot cough, speak, or breathe (Correct answer)
- Pat the resident gently on the back while they are sitting
- Tilt the resident's head back and open the airway
Correct answer: Perform abdominal thrusts (Heimlich maneuver) if the resident cannot cough, speak, or breathe
If a resident cannot cough, speak, or breathe due to a complete airway obstruction, the Heimlich maneuver should be performed immediately.
A resident who can cough forcefully should be encouraged to cough. If they cannot cough, speak, or breathe (complete obstruction), the CNA immediately activates the emergency response system and performs abdominal thrusts. For the abdominal thrust, the CNA stands behind the resident, places a fist above the navel and below the breastbone, grasps the fist with the other hand, and delivers firm upward thrusts until the object is expelled or the resident becomes unresponsive.
CNA Basic Nursing Skills 6 2
What position should a resident be in during mealtime to prevent aspiration?