CNA Basic Nursing Skills 8 2 — Questions and Answers
Question 1: A resident tells the CNA their pain level is 7 out of 10. What is the appropriate response?
- Tell the resident to try to relax and that the pain will pass
- Report the pain level and description to the nurse promptly (Correct answer)
- Give the resident a pain medication from the medication cart
- Document the pain and wait until the next nursing assessment
Correct answer: Report the pain level and description to the nurse promptly
Pain is the fifth vital sign. A rating of 7/10 is significant and must be reported to the nurse immediately for evaluation and pain management intervention.
CNAs cannot administer medications but play a critical role in pain management by identifying and promptly reporting pain. A score of 7/10 indicates severe pain requiring nursing action. The CNA should report the pain rating, location, quality (sharp, dull, burning), onset, and any aggravating or relieving factors. Non-pharmacological comfort measures (repositioning, warm blankets) may be used while awaiting the nurse.
Question 2: What non-pharmacological comfort measure is appropriate for a resident with mild joint pain?
- Applying cold compresses to a joint with known inflammation unless ordered
- Repositioning the resident to a more comfortable position (Correct answer)
- Encouraging the resident to avoid all movement
- Administering a non-prescription analgesic
Correct answer: Repositioning the resident to a more comfortable position
Repositioning is a safe, non-pharmacological comfort measure within the CNA's scope of practice that can reduce positional pain and pressure.
Non-pharmacological comfort measures include repositioning, pillows for support, gentle range of motion if ordered, distraction, warm or cold applications (when ordered), and providing a calm environment. These measures are within the CNA's scope and can be applied immediately. They complement — but do not replace — pharmacological pain management when needed.
Question 3: Why is documenting the location and quality of a resident's pain important?
- It is only necessary if the pain is 8 or higher on the scale
- It helps the nurse and physician identify possible causes and choose appropriate treatment (Correct answer)
- It is done to satisfy billing requirements only
- It replaces the need for nursing assessment
Correct answer: It helps the nurse and physician identify possible causes and choose appropriate treatment
Detailed pain documentation — location, quality, onset, and scale rating — provides diagnostic information that enables appropriate clinical decision-making.
Pain characteristics are essential clinical data. Chest pain with radiation to the arm suggests cardiac origin; burning epigastric pain after meals suggests GI issues; sharp sudden back pain in a fall patient may indicate a fracture. The more detailed and specific the CNA's report, the more effectively the nurse can triage and respond. Standardized pain assessment tools (numeric, facial expression, PAINAD for dementia) are used based on the resident's ability to self-report.
Question 4: A cognitively impaired resident is unable to verbally report pain. Which behavioral signs may indicate pain?
- Sleeping more than usual and being very calm
- Grimacing, guarding a body part, restlessness, crying, or changes in usual behavior (Correct answer)
- Asking for extra blankets
- Eating more food than normal
Correct answer: Grimacing, guarding a body part, restlessness, crying, or changes in usual behavior
Behavioral indicators such as facial grimacing, guarding, moaning, restlessness, and behavioral changes are used to assess pain in non-verbal residents.
Residents with dementia or other cognitive impairments may not be able to use standard pain scales. The PAINAD (Pain Assessment in Advanced Dementia) scale and similar tools use behavioral indicators: breathing, vocalization, facial expression, body language, and consolability. The CNA should know the resident's baseline behavior and report deviations that may indicate pain or discomfort to the nurse for further evaluation.
Question 5: Which comfort measure should ONLY be performed after a specific nursing or physician order?
- Raising the head of the bed for comfort
- Offering a warm blanket
- Applying a heating pad to an injured area (Correct answer)
- Repositioning to relieve pressure
Correct answer: Applying a heating pad to an injured area
Applying a heating pad requires a physician's or nurse's order because improper heat application can cause burns, particularly in residents with reduced sensation or circulation problems.
Heat therapy increases blood flow and can relieve muscle pain, but it carries significant risks — particularly burns from excessive heat or prolonged application. Residents with diabetes, peripheral vascular disease, or reduced sensation are especially vulnerable. CNAs should never apply heating pads, hot water bottles, or hot packs without an explicit order and should follow all temperature and duration guidelines specified in the order.
Question 6: What should the CNA do if a resident's prescribed pain medication does not appear to be working after administration?
- Give the resident an additional dose from the medication cart
- Reassess the resident and report the inadequate pain relief to the nurse (Correct answer)
- Tell the resident to wait another hour before mentioning it again
- Assume the medication requires more time and do nothing
Correct answer: Reassess the resident and report the inadequate pain relief to the nurse
Reassessing and reporting inadequate pain control enables the nurse to contact the prescriber for medication adjustment or alternative interventions.
The CNA's role after pain medication administration (by nursing staff) is to reassess comfort and report outcomes. If pain persists or worsens, this information is essential for the nurse to escalate to the prescribing physician. Adjusting doses or adding medications is not within the CNA's scope. Timely reporting prevents unnecessary suffering and facilitates appropriate pain management plan revisions.
CNA Basic Nursing Skills 8 2
A resident tells the CNA their pain level is 7 out of 10.
What is the appropriate response?