Certified Nursing Assistant (CNA) Exam — Questions and Answers

Question 1: When repositioning a resident in a wheelchair, the CNA should first:

Lower the footrests
Tighten the gait belt
Ask the resident to slide forward independently
Lock the wheelchair brakes (Correct answer)

Correct answer: Lock the wheelchair brakes

Locking the brakes is the very first step to prevent the wheelchair from rolling during repositioning.

Question 2: A resident who is known to receive social services support suddenly refuses to allow the social worker into their room and tells the CNA, 'I don't need anyone poking into my business.' The resident shows no signs of cognitive impairment. What is the CNA's MOST appropriate course of action?

Respect the refusal, document the interaction, and notify the social worker and charge nurse so the care team can assess the change and determine next steps (Correct answer)
Agree to act as an intermediary by relaying the social worker's questions to the resident during routine care visits
Immediately flag the refusal to the charge nurse as a potential sign of abuse, neglect, or undue influence
Encourage the resident to reconsider by explaining the legal obligation to accept social services in a licensed facility

Correct answer: Respect the refusal, document the interaction, and notify the social worker and charge nurse so the care team can assess the change and determine next steps

A cognitively intact resident has the legal right to refuse any service, including social work visits. The CNA's role is to respect autonomy, document the refusal accurately, and notify the charge nurse and social worker so the team can monitor for any underlying concerns and update the care plan accordingly. Claiming legal obligation to accept services is false and coercive. Acting as an informal intermediary for the social worker exceeds CNA scope and could compromise the professional relationship. While the change in behavior should be noted, immediately flagging it as abuse without other indicators is premature and inappropriate.

Question 3: A resident has right-sided weakness from a stroke. When performing ROM on the right arm, the CNA should:

Have the resident do all the work independently to rebuild strength
Use forceful stretching to overcome the weakness
Move each joint slowly through its full range, supporting the limb throughout (Correct answer)
Skip the right arm because it is paralyzed and ROM is not needed

Correct answer: Move each joint slowly through its full range, supporting the limb throughout

A weakened or paralyzed limb needs passive ROM to prevent contractures, maintain circulation, and preserve joint integrity. The CNA moves the limb carefully through its full range.

Question 4: What is the CNA's responsibility after calling a Code Blue?

Assume responsibility for the Code Blue.
Be available for any necessary tasks. (Correct answer)
Leave as soon as the Code Blue team arrives.
Participate as a full team member.

Correct answer: Be available for any necessary tasks.

After calling a Code Blue, the CNA's primary responsibility is to support the advanced medical team that arrives. They should remain available to assist with any necessary tasks, such as gathering supplies, positioning the patient, or providing information, as directed by the lead healthcare professionals. This ensures efficient team response without overstepping their scope of practice.

Question 5: Which of the following sequences correctly describes the anatomical positions used when performing circumduction of the shoulder joint?

Protraction → retraction → elevation → depression of the shoulder girdle
Flexion → abduction → extension → adduction, tracing a cone-shaped arc (Correct answer)
Horizontal adduction → horizontal abduction → diagonal flexion → diagonal extension
Internal rotation → external rotation → pronation → supination in sequence

Correct answer: Flexion → abduction → extension → adduction, tracing a cone-shaped arc

Circumduction combines four cardinal movements in sequence — flexion (forward), abduction (lateral), extension (backward), and adduction (return toward midline) — creating a cone-shaped arc at the joint. It is a compound movement unique to ball-and-socket joints like the shoulder and hip. The other options describe different movement combinations: option B includes forearm movements, option C describes scapular movements, and option D describes horizontal plane movements only.

Question 6: After completing foot care, the CNA notices a small blister on the resident's heel. The correct action is to:

Apply lotion to the blister and continue care as normal
Leave the foot unwrapped and document the blister
Report the blister to the nurse and do not pop it (Correct answer)
Pop the blister and cover it with a bandage

Correct answer: Report the blister to the nurse and do not pop it

Blisters are skin integrity issues that must be reported to the nurse; popping them can introduce infection.

Question 7: A CNA with a latex allergy is assigned to care for a patient who is also latex-sensitive. The facility's PPE supply room has latex gloves, latex-free nitrile gloves, and vinyl gloves. Which glove selection is most appropriate, and why?

Vinyl gloves, because they provide the strongest barrier protection for latex-sensitive individuals
Latex gloves with double-gloving to prevent allergen transmission to the patient
Nitrile gloves, because they provide superior barrier protection and are safe for both the CNA and the latex-sensitive patient (Correct answer)
Either nitrile or vinyl; both offer identical barrier protection so the choice is irrelevant

Correct answer: Nitrile gloves, because they provide superior barrier protection and are safe for both the CNA and the latex-sensitive patient

Nitrile gloves are the correct choice for both a latex-allergic CNA and a latex-sensitive patient. Nitrile offers superior puncture resistance and barrier integrity compared to vinyl, making it the standard alternative in clinical settings. Vinyl gloves have higher rates of micro-perforations and are adequate only for low-risk tasks. Double-gloving with latex does not prevent allergen exposure — latex proteins can transfer through outer gloves and through airborne powder particles.

Question 8: A resident is recovering from a stroke and has been making good progress in regaining mobility. Today, you notice they seem unusually lethargic, their speech is slightly more slurred than yesterday, and they have a new facial droop. These signs are subtle. The resident's vital signs are within their normal range. What should the CNA do?

Document the observations and check on the resident again in an hour.
Immediately and clearly report the specific, subtle changes to the nurse. (Correct answer)
Ask the resident if they are feeling tired and offer them a chance to rest.
Encourage the resident to participate in their scheduled physical therapy.

Correct answer: Immediately and clearly report the specific, subtle changes to the nurse.

Subtle neurological changes can be early signs of a worsening condition or a new event, like a transient ischemic attack (TIA) or another stroke. Even with normal vital signs, these observations are critical. The CNA's primary role is to observe and report changes promptly to the nurse, who can then perform a full assessment. Delaying the report could have serious consequences.

Question 9: Which of the following is a violation of documentation standards?

Documenting care immediately after it is performed
Using only approved abbreviations
Using the resident's exact words in quotation marks
Leaving blank lines or spaces in chart entries (Correct answer)

Correct answer: Leaving blank lines or spaces in chart entries

Blank lines or spaces in chart entries are a documentation violation because they could allow unauthorized additions to be inserted later. Draw a line through blank spaces to prevent alterations.

Question 10: A resident with dementia accuses the CNA of stealing her jewelry. The CNA should:

Ignore the accusation and continue working
Ask the resident's roommate to validate the accusation
Report the accusation to the charge nurse and document the incident (Correct answer)
Argue with the resident to clarify the misunderstanding

Correct answer: Report the accusation to the charge nurse and document the incident

All accusations, regardless of the resident's cognitive status, must be reported to the charge nurse and documented to protect both the resident and the CNA.

Question 11: What is the purpose of a flow sheet in a resident's chart?

To summarize the resident's entire medical history
To track staff scheduling
To document physician orders only
To record routine, repeated observations and care tasks efficiently (Correct answer)

Correct answer: To record routine, repeated observations and care tasks efficiently

Flow sheets allow CNAs to quickly document repetitive tasks like vital signs, ADLs, and repositioning in a structured, time-efficient format.

Question 12: A resident's family member, who is not the legal power of attorney, corners a CNA in the hallway and demands to know the results of the resident's recent blood tests. Which of the following is the CNA's correct response?

Tell the family member they will have to wait for the doctor's next visit.
Look up the results in the chart to confirm before sharing them.
Politely state that you cannot share that information and refer them to the charge nurse. (Correct answer)
Provide a general summary of the results without giving specific numbers.

Correct answer: Politely state that you cannot share that information and refer them to the charge nurse.

Sharing a resident's protected health information (PHI) with anyone not legally authorized is a violation of HIPAA. The CNA's scope of practice does not include interpreting or sharing lab results. The correct action is to protect the resident's privacy by politely refusing to share the information and directing the family member to the licensed nurse, who can verify legal authorization and communicate appropriately.

Question 13: The nurse assistant must be able to converse adequately with a client who has hearing loss.

speak in a high pitched tone of voice.
look directly at the client when speaking. (Correct answer)
stand behind the client when speaking.
speak in a loud and slow manner.

Correct answer: look directly at the client when speaking.

When communicating with a client who has hearing loss, looking directly at them is crucial. This allows them to see your face, read lips, and observe your facial expressions and body language, which are vital for understanding the message. Speaking clearly and at a moderate pace, without shouting, also aids comprehension.

Question 14: Under OBRA 1987, how often must a long-term care facility conduct a comprehensive assessment of each resident?

Annually and after significant change (Correct answer)
Every 6 months
Every 30 days
Every 90 days

Correct answer: Annually and after significant change

OBRA requires a comprehensive MDS assessment annually and whenever a significant change in the resident's condition occurs.

Question 15: A resident with severe rheumatoid arthritis in both hands refuses a bath, stating, 'My joints are too stiff and painful in the morning. I never bathe in the morning at home.' What is the CNA's best response?

Skip the bath entirely and document that the resident refused
Proceed with the bath as scheduled since the care plan must be followed exactly
Offer a partial bed bath limited to the face and hands to fulfill the hygiene requirement
Consult with the charge nurse about adjusting the bath schedule to later in the day to accommodate the resident's pain pattern and preferences (Correct answer)

Correct answer: Consult with the charge nurse about adjusting the bath schedule to later in the day to accommodate the resident's pain pattern and preferences

Person-centered care requires honoring residents' preferences and accommodating their medical realities. Morning stiffness and pain are hallmark symptoms of rheumatoid arthritis. Forcing care violates the resident's rights, while simply documenting a refusal without problem-solving fails to meet care needs. The appropriate action is to advocate for the resident by communicating with the charge nurse to update the care plan to a time when the resident is more comfortable.

Question 16: A CNA is caring for a resident with schizophrenia who begins whispering to someone who isn't there and becomes increasingly agitated. The resident grabs the CNA's arm and says, 'They're trying to poison my food.' What is the MOST therapeutic response?

Say 'No one is poisoning your food. I prepared it myself and it's completely safe.'
Immediately leave the room and call for the charge nurse without saying anything to the resident.
Acknowledge the resident's fear without reinforcing the delusion, then notify the nurse. (Correct answer)
Distract the resident by turning on the television and offering a different activity.

Correct answer: Acknowledge the resident's fear without reinforcing the delusion, then notify the nurse.

The most therapeutic approach is to acknowledge the resident's emotional experience ('I can see you're frightened') without agreeing with or arguing against the delusion. Arguing or insisting the food is safe can escalate agitation in psychosis. The CNA must also report this behavioral change to the nurse, as it may indicate a medication issue or worsening condition. Simply leaving without acknowledging the resident is abandonment-adjacent behavior, and distraction alone ignores a reportable change in mental status.

Question 17: A CNA is alone in a room with a resident who begins choking on food and cannot cough, speak, or breathe. The resident is morbidly obese and the CNA cannot wrap her arms fully around the resident's abdomen to perform standard abdominal thrusts. What is the MOST appropriate alternative intervention?

Lay the resident supine and attempt abdominal thrusts from above
Administer back blows only and wait for the resident to cough it out
Perform chest thrusts instead of abdominal thrusts (Correct answer)
Perform blind finger sweeps of the mouth to dislodge the object

Correct answer: Perform chest thrusts instead of abdominal thrusts

For a conscious choking victim who is obese or pregnant, chest thrusts are the recommended alternative when abdominal thrusts cannot be effectively delivered. The rescuer places hands on the center of the chest (same position as CPR compressions) and delivers firm inward thrusts. Blind finger sweeps are contraindicated in conscious adults as they can push the object deeper. Back blows alone are insufficient. Laying the patient supine and attempting abdominal thrusts is not the established protocol for conscious choking victims.

Question 18: When a resident accuses a CNA of stealing, the most appropriate first action is to:

Argue that you did not take anything
Ask the family to speak with the resident
Ignore the comment and continue working
Report the accusation to the charge nurse immediately (Correct answer)

Correct answer: Report the accusation to the charge nurse immediately

Accusations must be reported to the charge nurse so the situation can be investigated and documented appropriately.

Question 19: A CNA documents that a resident's wound dressing was changed at 1400, but the charge nurse later reviews the MAR and discovers the dressing was actually changed at 1600. What is the legally and ethically correct action the CNA should take?

Discard the original documentation page and rewrite the entire entry with the correct time
Use correction fluid to cover the error and rewrite the correct time over it
Add the correct time in parentheses above the original entry without crossing anything out
Draw a single line through the incorrect time, write the correct time and initials beside it, and document the reason for the correction (Correct answer)

Correct answer: Draw a single line through the incorrect time, write the correct time and initials beside it, and document the reason for the correction

The correct method for correcting a charting error is to draw a single line through the incorrect entry (never obliterate it), write the correct information, initial and date the correction, and document the reason. Using correction fluid, discarding records, or rewriting charts are forms of falsification that can result in license revocation and legal consequences.

Question 20: The most common sensory change in elderly residents is:

Decreased hearing and vision (Correct answer)
Loss of touch sensation
Loss of taste
Enhanced smell

Correct answer: Decreased hearing and vision

Hearing loss (presbycusis) and vision changes are the most common age-related sensory changes.

Question 21: The term 'reality orientation' refers to:

Teaching residents about their diagnoses
Orienting new staff to the facility
Reviewing a resident's care plan goals
Helping confused residents remain aware of person, place, and time (Correct answer)

Correct answer: Helping confused residents remain aware of person, place, and time

Reality orientation involves repeated cues about person, place, and time to help reduce confusion in residents with cognitive impairment.

Question 22: A resident tells the CNA, 'My daughter hit me last night.' What should the CNA do?

Talk to the daughter directly about the accusation
Document the statement in the resident's own words and report it to the charge nurse immediately (Correct answer)
Wait to report until more evidence is available
Dismiss the statement as confusion from dementia

Correct answer: Document the statement in the resident's own words and report it to the charge nurse immediately

Any statement suggesting abuse must be reported immediately to the charge nurse. Document the exact words the resident used in quotation marks. This is a mandatory reporting obligation under abuse prevention laws.

Question 23: Which technology allows a CNA to quickly look up a patient's allergy list before providing care?

The electronic health record (EHR) (Correct answer)
The dietary software module
The facility's HR portal
A personal health app on a smartphone

Correct answer: The electronic health record (EHR)

The EHR contains the patient's full medical history, including allergy information, accessible at point of care.

Question 24: A resident who is disoriented

is over 70 years old.
probably will become violent.
likely has developmental delays.
is confused as to time and place. (Correct answer)

Correct answer: is confused as to time and place.

Disorientation specifically refers to a state of confusion regarding person, place, or time. A disoriented resident may not know where they are, what day it is, or even who they are. This indicates a cognitive impairment that requires careful observation, clear communication, and a supportive environment to help them feel secure.

Question 25: A patient is on a fluid restriction of 1,000 mL per day. The CNA's shift responsibility is to offer how much fluid across an 8-hour shift if divided equally?

250 mL
333 mL (Correct answer)
125 mL
500 mL

Correct answer: 333 mL

1,000 mL divided over 3 shifts of 8 hours each equals approximately 333 mL per shift.

Question 26: A resident tells you they want to refuse their scheduled bath today. What is the most appropriate action?

Honor the refusal, document it, and notify the nurse (Correct answer)
Insist the bath must happen for infection control
Tell the family so they can convince the resident
Skip documenting since the resident is alert and oriented

Correct answer: Honor the refusal, document it, and notify the nurse

Competent residents have the legal right to refuse any care, and CNAs must document and report refusals to the nurse.

Question 27: A CNA is assigned to a resident on contact precautions for C. difficile (C. diff). Which PPE and hand hygiene combination is required upon leaving the room?

Remove gown in the hallway, discard gloves at the nurses' station, use alcohol-based hand rub
Remove gloves and gown inside the room, perform alcohol-based hand rub outside the room
Remove gloves inside the room, keep gown on until reaching the hallway, then use alcohol-based hand rub
Remove gloves and gown inside the room, then perform soap-and-water handwashing (Correct answer)

Correct answer: Remove gloves and gown inside the room, then perform soap-and-water handwashing

C. difficile spores are NOT killed by alcohol-based hand sanitizers. The CDC specifically mandates soap-and-water handwashing for C. diff contact precautions. Both gloves and gown must be removed before exiting the room (inside the room) to prevent environmental contamination of the hallway. Alcohol-based hand rubs are insufficient and represent a critical infection control error in C. diff isolation.

Question 28: A newly admitted resident's preliminary care plan lists 'assistance with ambulation × 2 staff.' While executing morning care, the CNA's usual partner is occupied with an emergency. A nursing student on the unit volunteers to be the second person for the transfer. What should the CNA do?

Ask the resident if they feel comfortable transferring with a student and proceed if the resident consents
Proceed with the nursing student as the second person, since two people are present and safety is maintained
Wait until another certified staff member or licensed nurse is available, as the care plan specifies trained staff assistance (Correct answer)
Attempt the transfer alone using a gait belt, documenting that no second staff member was available

Correct answer: Wait until another certified staff member or licensed nurse is available, as the care plan specifies trained staff assistance

A 'two-staff assist' designation on a care plan implies qualified personnel trained in safe patient handling. A nursing student's competency and legal accountability are not equivalent to certified/licensed staff; using them as the designated second person circumvents the safety intent of the plan. The CNA must wait or notify the charge nurse to arrange appropriate assistance—resident consent does not change the staffing requirement.

Question 29: A resident with left-sided hemiplegia requires a gown change. The CNA should remove the soiled gown from the strong side first and dress the weak side first. Which of the following scenarios represents the CORRECT sequence when changing this resident's gown?

Remove from right (strong) arm first, then left; dress right (strong) arm first, then left
Remove from left (weak) arm first, then right; dress right (strong) arm first, then left
Remove from right (strong) arm first, then left; dress left (weak) arm first, then right (Correct answer)
Remove from left (weak) arm first, then right; dress left (weak) arm first, then right

Correct answer: Remove from right (strong) arm first, then left; dress left (weak) arm first, then right

The correct technique is 'strong off first, weak on first.' Remove the gown from the unaffected (strong/right) side first because it has greater range of motion, making removal easier. Then dress the affected (weak/left) side first because it is less mobile and threading it through the sleeve is more difficult — leaving the stronger arm free to assist.

Question 30: A CNA notices a bruise on a resident that was not there yesterday. The resident says 'please don't tell anyone.' What should the CNA do?

Ask other residents if they witnessed anything before reporting
Wait to see if more bruises appear before taking action
Honor the resident's privacy request and say nothing
Document and report the finding to the charge nurse immediately (Correct answer)

Correct answer: Document and report the finding to the charge nurse immediately

CNAs are mandated reporters and must report unexplained injuries immediately regardless of the resident's request for secrecy.

Question 31: After performing a blood glucose check with a glucometer, what should the CNA do with the lancet?

Place it immediately into the sharps container without recapping (Correct answer)
Recap it and dispose of in regular trash
Bend it before disposal to prevent reuse
Recap it and place in the sharps container

Correct answer: Place it immediately into the sharps container without recapping

Lancets must be placed directly into an approved sharps container immediately after use, without recapping. Recapping is a leading cause of needle-stick injuries. Bending needles is also prohibited. Sharps containers prevent injuries to healthcare workers and housekeeping staff.

Question 32: How should the CNA perform catheter care to prevent infection?

Wash the catheter from the insertion site outward with mild soap and water in a single stroke (Correct answer)
Apply antibacterial powder around the urethral meatus daily
Scrub the catheter vigorously with a circular motion moving toward the body
Clean only the exposed part of the catheter once weekly

Correct answer: Wash the catheter from the insertion site outward with mild soap and water in a single stroke

Catheter care involves cleaning from the urethral meatus outward (away from the body) to prevent drawing bacteria toward the insertion site.

Question 33: When caring for a patient in contact precautions, the CNA must wear:

Full PPE including PAPR at all times
N95 respirator and face shield only
Gloves and gown upon entering the room (Correct answer)
Gloves only when touching the patient directly

Correct answer: Gloves and gown upon entering the room

Contact precautions require gloves and gown to be donned upon entering the room to prevent contact transmission.

Question 34: A CNA is preparing to use a blood pressure cuff that was previously used by a resident on contact precautions. What should the CNA do before using it on another resident?

Rinse the cuff under warm running water
Disinfect the cuff with a facility-approved disinfectant wipe and allow it to dry (Correct answer)
Wipe the cuff with a dry cloth to remove visible debris
Ask the charge nurse if the cuff can be shared between residents

Correct answer: Disinfect the cuff with a facility-approved disinfectant wipe and allow it to dry

Equipment used on a resident in contact precautions must be thoroughly disinfected with an approved disinfectant before use on another resident. Allowing drying time ensures the disinfectant has adequate contact time to kill pathogens.

Question 35: The phrase 'If it wasn't documented, it wasn't done' means:

Verbal reports are sufficient and replace written documentation
CNAs only need to document extraordinary events
Documentation is optional if the care was routine
Undocumented care is legally considered as not having occurred (Correct answer)

Correct answer: Undocumented care is legally considered as not having occurred

In healthcare and law, care that is not documented cannot be proven to have occurred, making thorough documentation essential for legal protection and continuity of care.

Question 36: A nurse aide is caring for a resident with dementia who becomes combative during a bath and strikes the aide. The nurse aide should:

Restrain the resident's hands to complete the bath safely and efficiently
Stop the task, ensure the resident's safety, and report the behavior to the nurse (Correct answer)
Complete the bath quickly before the resident becomes more agitated
Firmly tell the resident that hitting is unacceptable behavior

Correct answer: Stop the task, ensure the resident's safety, and report the behavior to the nurse

Combative behavior in a resident with dementia is often a response to fear, pain, or confusion — not intentional aggression. The nurse aide must prioritize safety for both the resident and themselves by stopping the task, ensuring the resident is in a safe position, and reporting the behavior to the nurse. Applying restraints without a physician's order is illegal and a form of abuse. Reprimanding a resident with dementia for behavior they cannot control is inappropriate. Rushing through care while a resident is in distress increases the risk of injury and trauma.

Question 37: During morning care, a CNA notes that a resident's surgical wound dressing is saturated with serosanguineous drainage. The wound was dressed by a nurse two hours ago. The CNA's scope of practice does NOT include changing the dressing. What is the MOST appropriate action?

Apply gentle pressure over the dressing to slow drainage while waiting for the nurse
Reinforce the dressing with additional gauze, document the drainage amount and color, and notify the nurse (Correct answer)
Leave the dressing undisturbed and notify the nurse immediately without touching it
Remove the saturated dressing, cover the wound with a clean towel, and call for the nurse

Correct answer: Reinforce the dressing with additional gauze, document the drainage amount and color, and notify the nurse

Reinforcing a saturated dressing (adding gauze on top without removing the original) is within CNA scope and keeps the wound covered while the CNA notifies the nurse. Leaving it saturated risks skin maceration and infection. Removing the dressing or applying pressure exceeds CNA scope and could harm the wound. Documentation of the drainage type, amount, and time is essential before notifying the nurse.

Question 38: A contracture is best described as:

Temporary joint stiffness that resolves with rest
A type of muscle spasm that occurs during exercise
A shortening and hardening of muscles and connective tissue causing limited joint movement (Correct answer)
Inflammation of a joint due to overuse

Correct answer: A shortening and hardening of muscles and connective tissue causing limited joint movement

A contracture is the permanent or semi-permanent shortening of muscles, tendons, and connective tissue around a joint, resulting in limited and often painful range of motion that can cause deformity.

Question 39: Why is maintaining personal hygiene important for a resident's overall health?

It only matters for ambulatory (walking) residents
It is required only for residents who have infections
It prevents infections, skin breakdown, and promotes psychological well-being (Correct answer)
It is only important for preventing social embarrassment

Correct answer: It prevents infections, skin breakdown, and promotes psychological well-being

Good personal hygiene prevents skin breakdown, infection, and odor, while also promoting psychological well-being and self-esteem. For residents who cannot care for themselves, CNAs play a central role in preserving dignity and preventing hygiene-related health complications.

Question 40: A CNA is disposing of waste items from a resident's room. Which of the following items must be placed in a designated biohazard bag?

A disposable gown worn during routine care
A wound dressing saturated with blood (Correct answer)
A used tissue from a resident with a cold
An empty urine collection bag

Correct answer: A wound dressing saturated with blood

Biohazard bags are used for waste contaminated with blood or other potentially infectious materials (OPIM) that can release these substances in a liquid or semi-liquid state if compressed. A dressing saturated with blood fits this description and must be disposed of as regulated medical waste. Items like used tissues or gowns from routine care without significant contamination are typically considered regular waste.

Question 41: A CNA notices that a cognitively intact resident is consistently agreeing with everything the CNA says during care interactions, even when the CNA suspects the resident has a different preference. This pattern is MOST likely an example of:

The CNA using leading questions without realizing it. (Correct answer)
The resident exhibiting signs of early cognitive decline.
The resident demonstrating passive communication due to fear of being seen as difficult.
The resident having fully adapted to the facility routine.

Correct answer: The CNA using leading questions without realizing it.

When a cognitively intact resident consistently agrees with the CNA, the most likely professional cause is that the CNA is inadvertently using leading or closed questions (e.g., 'You'd prefer the blue gown, right?') rather than open-ended ones. This suppresses authentic resident input. While passive communication is possible, the CNA should first examine their own questioning technique before attributing the pattern to the resident.

Question 42: A resident who is cognitively intact refuses a scheduled bath. The CNA should:

Report the refusal and offer an alternative time (Correct answer)
Ask another CNA to convince the resident
Insist on the bath for infection control purposes
Document nothing since baths are optional

Correct answer: Report the refusal and offer an alternative time

Competent residents have the right to refuse care; the CNA must report the refusal and offer alternatives per the care plan.

Question 43: The term 'extension' as used in ROM exercises means:

Straightening a joint to increase the angle between body parts (Correct answer)
Rotating a limb inward toward the body midline
Bending a joint to decrease the angle between body parts
Moving a joint in a circular pattern

Correct answer: Straightening a joint to increase the angle between body parts

Extension straightens or opens a joint, increasing the angle, which is the opposite of flexion.

Question 44: While caring for a resident, your gloves become visibly soiled with stool. The resident also needs their pillows repositioned. What is the correct sequence of actions?

Remove the soiled gloves, perform hand hygiene, don new gloves, and then reposition the pillows. (Correct answer)
Reposition the pillows quickly, then remove gloves and perform hand hygiene.
Wipe the gloves on a disposable towel before repositioning the pillows.
Finish repositioning the pillows, then remove gloves and use alcohol-based hand sanitizer.

Correct answer: Remove the soiled gloves, perform hand hygiene, don new gloves, and then reposition the pillows.

When gloves become soiled or when moving from a contaminated body site to a clean one (or to the patient's environment), the CNA must change them. The correct procedure is to remove the soiled gloves, perform hand hygiene, and then put on a new, clean pair before touching another surface or continuing care. This prevents cross-contamination.

Question 45: A resident tells the CNA they are cold during a bed bath. The best response is to:

Speed up the bath to finish faster
Cover unexposed body parts with a bath blanket and adjust room temperature (Correct answer)
Stop the bath and reschedule for later in the day
Use hotter water to compensate for the cold room

Correct answer: Cover unexposed body parts with a bath blanket and adjust room temperature

Using a bath blanket to cover the resident and adjusting room temperature maintains warmth, dignity, and comfort during bathing.

Question 46: A CNA is assisting with care in a unit when a Code Gray (combative person/security threat) is announced for a different hallway. Shortly after, an agitated, confused resident from that hallway walks into the CNA's resident's room and begins shouting and attempting to grab objects. The CNA's current resident is frail and bed-bound. What is the most appropriate response by the CNA?

Calmly attempt to redirect the agitated resident using a low, non-threatening voice while positioning yourself between the agitated resident and the bed-bound resident, and activating the call system for help (Correct answer)
Leave both residents immediately to alert security and the charge nurse from the hallway
Close and lock the room door to contain the agitated resident while you call for help from within the room
Physically restrain the agitated resident to prevent harm to the bed-bound resident

Correct answer: Calmly attempt to redirect the agitated resident using a low, non-threatening voice while positioning yourself between the agitated resident and the bed-bound resident, and activating the call system for help

CNAs are not trained for physical restraint of combative individuals and must not use unauthorized restraints, which is both a safety risk and a legal violation. Leaving the frail, bed-bound resident unprotected is also inappropriate. The correct approach uses de-escalation techniques (calm voice, non-threatening body language, redirection) while the CNA positions themselves protectively between the two residents and simultaneously activates the call bell to summon trained help. This balances immediate protection of the vulnerable resident with safe, non-escalating interaction until security arrives.

Question 47: When applying anti-embolism stockings (TED hose) to a resident who has been sitting in a chair for an hour, what is the correct first step?

Have the resident lie down with their legs elevated for at least 15 minutes before application. (Correct answer)
Soak the resident's feet in warm water to improve circulation before application.
Ask the resident to stand up and march in place for two minutes.
Apply the stockings immediately while the resident is seated.

Correct answer: Have the resident lie down with their legs elevated for at least 15 minutes before application.

Anti-embolism stockings are designed to prevent blood from pooling in the legs. If a resident has been sitting or standing, blood will have already pooled due to gravity. To ensure the stockings are effective, the resident should lie down (supine) with their legs elevated for at least 15 minutes to allow the blood to drain from the leg veins before the stockings are applied. Applying them while the resident is sitting would trap the pooled blood and defeat the purpose.

Question 48: A nurse aide is repositioning a resident who has a Stage 3 pressure injury on the sacrum and a left hip replacement performed two weeks ago. Which positioning approach is correct?

Position the resident supine with the head of bed at 45 degrees to relieve sacral pressure
Position the resident on the right side with the left leg adducted across the midline for comfort
Position the resident on the right side at about 30 degrees with an abduction pillow between the legs (Correct answer)
Position the resident on the left side at 90 degrees to keep pressure off the sacrum

Correct answer: Position the resident on the right side at about 30 degrees with an abduction pillow between the legs

This resident has two competing needs: keeping pressure off the sacral wound and protecting the new hip. A 30-degree lateral (side-lying) position offloads the sacrum without placing full pressure on the trochanter, and lying on the unaffected right side with an abduction pillow keeps the operated left hip in safe alignment. Lying on the operative left side is contraindicated, adduction past midline risks hip dislocation, and semi-Fowler's at 45 degrees increases shearing and pressure directly on the sacrum.

Question 49: What is multi-factor authentication in CNA security?

A firewall type
A data encryption method
Requiring two or more verification factors for access (Correct answer)
Same password for multiple accounts

Correct answer: Requiring two or more verification factors for access

MFA requires multiple verification factors (knowledge, possession, biometrics), significantly reducing unauthorized access.

Question 50: The recommended daily fluid intake for most adults to maintain adequate hydration is approximately:

8 cups (64 oz) (Correct answer)
4 cups (32 oz)
16 cups (128 oz)
1 cup (8 oz)

Correct answer: 8 cups (64 oz)

Most adults need approximately 8 cups (64 oz) of fluid per day to maintain normal hydration and body functions.

Question 51: A CNA is assigned to measure the oral temperature of a resident who just finished a hot cup of coffee 8 minutes ago. The CNA is running behind schedule. What is the correct action?

Wait the full 15–20 minutes after eating or drinking before measuring oral temperature, or use an alternative site such as tympanic or axillary (Correct answer)
Proceed with the oral measurement and add a notation that the resident had coffee, then subtract 1°F from the reading
Measure oral temperature now since 8 minutes is close enough to the recommended wait time
Skip the temperature measurement entirely and document it as 'unable to obtain' due to timing

Correct answer: Wait the full 15–20 minutes after eating or drinking before measuring oral temperature, or use an alternative site such as tympanic or axillary

Hot or cold substances in the mouth affect oral temperature readings for 15–20 minutes. Taking a reading at 8 minutes would yield an inaccurate (falsely elevated) result. The correct approach is to wait the full recommended time or use an alternative measurement site. Estimating a correction factor is not an acceptable nursing practice for CNAs.

Question 52: When assisting a resident with severe depression, which approach is MOST appropriate?

Encourage the resident to 'snap out of it'
Leave the resident alone to rest as much as possible
Tell the resident to think of happy memories
Maintain a calm, consistent presence and provide simple activities (Correct answer)

Correct answer: Maintain a calm, consistent presence and provide simple activities

A calm, consistent presence and simple, achievable activities help provide structure and gentle stimulation for residents with depression.

Question 53: While assisting with ADLs, a CNA notices that a resident who previously performed her own perineal care has stopped initiating this task and now waits passively for the CNA to do it. The resident has no new documented cognitive or physical changes. What is the MOST appropriate initial response?

Perform the perineal care for the resident to maintain hygiene standards
Encourage the resident to resume performing her own care by offering verbal prompts and setup assistance (Correct answer)
Update the care plan to reflect that the resident now requires full CNA assistance with perineal care
Report the change in functional behavior to the charge nurse as a potential sign of depression or other underlying change

Correct answer: Encourage the resident to resume performing her own care by offering verbal prompts and setup assistance

A sudden decline in self-initiated ADL performance without a documented physical or cognitive cause warrants a restorative approach first. The CNA's role in promoting independence includes providing the least restrictive level of assistance — verbal cues and setup — before assuming dependency. Immediately providing full care or updating the care plan to reflect greater dependence could institutionalize unnecessary reliance. If prompting fails or behavior persists, then reporting to the charge nurse is appropriate.

Question 54: Which of the following is an acceptable way for the CNA to cope with feelings of anger and frustration?

Tell several staff members over lunch.
Call your best friend on the way home and vent.
Ask your supervisor for time to talk about your feelings. (Correct answer)
Refuse to care for a difficult resident until your mood improves.

Correct answer: Ask your supervisor for time to talk about your feelings.

Discussing feelings of anger and frustration with a supervisor is a professional and constructive way to cope. Supervisors can offer guidance, support, and solutions, and it ensures that any issues affecting job performance or resident care are addressed appropriately within the facility's structure. This maintains professionalism and protects resident privacy.

Question 55: When speaking with a person who has Alzheimer's or late-stage dementia,

eliminating all conversation.
speaking one- or two-word sentences. (Correct answer)
encouraging them to be more expressive.
hiring a speech therapist.

Correct answer: speaking one- or two-word sentences.

Individuals with Alzheimer's or late-stage dementia often have significant cognitive impairment, making it difficult to process complex information. Using short, simple one- or two-word sentences helps to reduce confusion and allows the resident to better understand and respond to communication. This approach minimizes frustration for both the resident and the caregiver.

Question 56: A CNA finds a sharps container that is three-quarters full. What should the CNA do?

Push the sharps down to make more room
Notify the appropriate staff to have it replaced (Correct answer)
Continue using it until it is completely full
Transfer the sharps to a trash bag

Correct answer: Notify the appropriate staff to have it replaced

Sharps containers should be replaced when three-quarters (75%) full to prevent overfilling, which increases the risk of needlestick injuries during disposal.

Question 57: Under the Patient Self-Determination Act (PSDA), facilities must:

Require all residents to have an advance directive upon admission
Only discuss advance directives with residents who are terminally ill
Create advance directives on behalf of residents who cannot do so
Inform residents of their rights to make decisions about their care, including the right to refuse treatment and create advance directives (Correct answer)

Correct answer: Inform residents of their rights to make decisions about their care, including the right to refuse treatment and create advance directives

The PSDA requires healthcare facilities to provide written information to patients and residents about their rights to make their own healthcare decisions, including completing advance directives.

Question 58: Using the phones in the nursing station for personal calls, except in an emergency is

Allowed once per shift.
Determined by the nurse.
Appropriate.
Unacceptable. (Correct answer)

Correct answer: Unacceptable.

Using phones in the nursing station for personal calls, except in an emergency, is unacceptable. Nursing stations are professional environments where staff need to be focused on patient care and readily available for urgent communications. Personal calls can be distracting, tie up essential lines, and potentially violate patient privacy if conversations are overheard.

Question 59: A resident with a valid Do-Not-Resuscitate (DNR) order begins showing signs of respiratory distress during your shift. The resident's spouse rushes in and demands that you 'do everything possible.' What is the legally and ethically correct action for the CNA?

Provide comfort measures, notify the nurse immediately, and do not initiate CPR (Correct answer)
Follow the spouse's wishes, as family consent supersedes advance directives in emergencies
Attempt CPR until a nurse arrives to clarify the order
Ask the spouse to sign a form temporarily overriding the DNR before taking action

Correct answer: Provide comfort measures, notify the nurse immediately, and do not initiate CPR

A legally executed DNR order reflects the resident's own autonomous wishes and remains legally binding even when family members object. The CNA must honor the DNR by providing comfort measures (positioning, reassurance) and immediately notifying the nurse. Neither a family member's emotional request nor the urgency of the moment authorizes the CNA to override a legal advance directive.

Question 60: A CNA notices that a resident's PEG tube feeding bag is nearly empty. The resident's nurse is off the unit and a second nurse is busy with an emergency. What should the CNA do?

Disconnect the feeding tube from the pump to stop the flow until the nurse returns
Increase the infusion rate on the pump to compensate before the bag empties
Refill the bag using the same formula stored in the resident's room to prevent interruption
Clamp the tube and locate the nurse as quickly as possible to report the status (Correct answer)

Correct answer: Clamp the tube and locate the nurse as quickly as possible to report the status

CNAs are not permitted to manage enteral feeding bags, adjust pump settings, or manipulate tube connections — those are nursing tasks. The correct action is to clamp the line (a safety step to prevent air entry, within CNA scope in many facilities) and promptly locate a nurse. Refilling the bag, adjusting the pump rate, or disconnecting the tube all exceed CNA scope and could harm the resident.

Question 61: When providing denture care for an unconscious resident, which of the following steps is essential for safety?

Use hot water to effectively sterilize the dentures.
Brush the resident's gums and tongue vigorously with a firm toothbrush.
Leave the clean dentures out to air dry on the bedside table.
Position the resident on their side before cleaning their mouth. (Correct answer)

Correct answer: Position the resident on their side before cleaning their mouth.

The greatest risk when providing oral care to an unconscious resident is aspiration. Positioning the resident on their side allows fluids to drain out of the mouth instead of into the airway, which could cause a serious lung infection. Hot water can warp dentures, and vigorous brushing can injure delicate oral tissues. Dentures should be stored in a labeled cup with cool water.

Question 62: Which action demonstrates respect for a resident's autonomy?

Bathing the resident while they sleep to avoid disturbing them
Asking the resident to choose between two meal options (Correct answer)
Skipping a resident's preferred activity because the CNA is busy
Deciding which clothes the resident will wear to save time

Correct answer: Asking the resident to choose between two meal options

Offering choices respects the resident's right to self-determination, which is central to autonomy.

Question 63: Which sequence CORRECTLY describes the principle of 'moving from proximal to distal' when performing ROM on an upper extremity?

Elbow → shoulder → wrist → fingers
Shoulder → elbow → wrist → fingers (Correct answer)
Fingers → wrist → elbow → shoulder
Wrist → elbow → fingers → shoulder

Correct answer: Shoulder → elbow → wrist → fingers

Proximal-to-distal means starting closest to the body's center and working outward: shoulder (most proximal), then elbow, wrist, and finally fingers (most distal). This sequence promotes circulation and ensures large joints are stabilized before smaller, more delicate joints are moved.

Question 64: A CNA is assigned to shave a male resident who is on warfarin (Coumadin) anticoagulation therapy. Which type of razor should be used, and why?

A straight razor, because it provides cleaner strokes and reduces tugging on fragile skin
A disposable safety razor, because it is cost-effective and widely available
No razor — facial shaving is contraindicated for patients on anticoagulant therapy
An electric razor, because anticoagulants significantly increase bleeding risk from skin nicks (Correct answer)

Correct answer: An electric razor, because anticoagulants significantly increase bleeding risk from skin nicks

Patients on anticoagulants such as warfarin have impaired clotting, meaning even a small nick from a blade razor can cause prolonged or significant bleeding. An electric razor minimizes the risk of skin cuts while still providing effective shaving. Shaving is not contraindicated, but the choice of tool must account for bleeding risk.

Question 65: What is the purpose of perineal care during ADLs?

To improve mobility.
To keep the skin moisturized.
To prevent skin breakdown and infections. (Correct answer)
To reduce pain during movement.

Correct answer: To prevent skin breakdown and infections.

Perineal care is essential for maintaining hygiene and preventing complications in the genital and anal areas. Regular cleaning removes urine, feces, and sweat, which can irritate the skin and promote bacterial growth. This practice helps prevent skin breakdown, discomfort, and the development of infections like urinary tract infections (UTIs).

Question 66: During a care routine, a cognitively intact resident tells the CNA, 'I haven't signed any advance directive and I don't want one — if something happens, I want everything done to keep me alive.' Later that shift, a family member tells the CNA that the family has agreed the resident should be a DNR. What is the CNA's correct response?

Follow the family's wishes, as next-of-kin typically have authority over treatment decisions
Contact the physician to determine whether the resident's cognitive status allows them to make their own decisions
Document both statements and split the difference by alerting the charge nurse without taking any position
Honor the resident's expressed wishes and immediately report the family's statement to the charge nurse (Correct answer)

Correct answer: Honor the resident's expressed wishes and immediately report the family's statement to the charge nurse

A cognitively intact resident has the absolute legal and ethical right to make their own healthcare decisions, including refusing a DNR. The family has no authority to override a competent resident's stated wishes. The CNA's duty is to honor those wishes and escalate the family's conflicting statement to the charge nurse so the care team can address the situation and protect the resident's autonomy.

Question 67: How should the CNA position themselves when performing ROM exercises to protect their own body?

Sit on the edge of the resident's bed for easier reach
Stand on the far side of the bed and reach across
Use proper body mechanics with feet apart and back straight (Correct answer)
Bend at the waist to get closer to the limb being exercised

Correct answer: Use proper body mechanics with feet apart and back straight

Using proper body mechanics — stable base, straight back — protects the CNA from back and muscle injuries.

Question 68: A CNA notices their gown has become wet while caring for a patient with C. difficile. What should they do?

Continue care and change at the end of the shift
Apply gloves over the wet area
Reinforce the gown with a second one over it
Remove and replace the gown immediately (Correct answer)

Correct answer: Remove and replace the gown immediately

A saturated or wet gown is no longer an effective barrier and must be changed immediately to prevent pathogen transmission.

Question 69: A resident with a DNR order stops breathing. What action should the CNA take?

Notify the nurse immediately and do not initiate CPR (Correct answer)
Wait to see if the resident resumes breathing on their own
Call 911 before notifying the nurse
Begin CPR immediately while calling for help

Correct answer: Notify the nurse immediately and do not initiate CPR

A DNR order means CPR is not to be performed; the CNA should immediately notify the nurse.

Question 70: You are caring for a resident when the physical therapist (PT) arrives to conduct a session. The resident tells you privately that he is in significant pain and does not want to do therapy today. What should you do?

Tell the PT to reschedule since the resident refused and return to your other duties
Encourage the resident to try therapy anyway since missing sessions delays recovery
Inform the PT of the resident's pain and refusal so the team can reassess before proceeding (Correct answer)
Administer a PRN pain medication from the resident's chart to prepare him for therapy

Correct answer: Inform the PT of the resident's pain and refusal so the team can reassess before proceeding

Resident pain and refusal of treatment are clinical data that must be communicated to the appropriate team members. The PT needs this information to determine whether to proceed, modify, or postpone the session. CNAs cannot administer medications, and overriding a resident's refusal without reassessment violates resident rights.

Question 71: Which behavior is a recognized sign of pain in a nonverbal resident with advanced dementia?

Requesting extra blankets
Facial grimacing, guarding, or increased agitation during movement (Correct answer)
Sleeping more than usual
Refusing to watch television

Correct answer: Facial grimacing, guarding, or increased agitation during movement

Nonverbal pain indicators in dementia include facial grimacing, body guarding, and agitation especially during repositioning or care activities.

Question 72: When transferring a heavy resident from the bed to a wheelchair for the first time

teach the resident to do the transfer alone.
tell the resident they are too heavy for you to transfer.
the aide should review the care plan or check with the nurse. (Correct answer)
one person should be enough to transfer the resident.

Correct answer: the aide should review the care plan or check with the nurse.

Before transferring a heavy resident for the first time, especially if the aide is unsure of the best approach or the resident's specific needs, it is crucial to consult the care plan or check with the nurse. This ensures that the appropriate transfer technique, necessary equipment (like a lift), and adequate staffing are utilized, prioritizing the safety of both the resident and the aide and preventing injury.

Question 73: Which of the following would cause a CNA to be removed from the Nurse Aide Registry?

Failing to renew certification on time
A substantiated finding of resident abuse or neglect (Correct answer)
Transferring to a different state
Taking a leave of absence from work

Correct answer: A substantiated finding of resident abuse or neglect

A substantiated finding of abuse, neglect, or misappropriation of resident property can result in a CNA being placed on the abuse registry and removed from the Nurse Aide Registry, making them ineligible for employment in certified facilities.

Question 74: When communicating with a resident who has severe dementia, the CNA should use:

Medical terminology to maintain professionalism
Short, simple sentences with a calm tone and direct eye contact (Correct answer)
Long, detailed instructions given all at once
Written notes since verbal communication is ineffective

Correct answer: Short, simple sentences with a calm tone and direct eye contact

Simple sentences, calm tone, and eye contact optimize understanding and connection for residents with severe cognitive impairment.

Question 75: A resident who is on a bowel training program is incontinent of stool between scheduled toileting times. The CNA observes that the stool is liquid and seeping around what appears to be a large, hard stool mass. This presentation MOST likely indicates:

A normal variation in bowel habit for this resident
Fecal impaction with overflow incontinence (Correct answer)
Infectious diarrhea requiring contact precautions
Malabsorption syndrome requiring dietary consultation

Correct answer: Fecal impaction with overflow incontinence

Liquid stool seeping around a hard mass is a classic sign of fecal impaction with overflow (paradoxical) incontinence. The impacted mass blocks normal passage, but liquid stool from higher in the colon seeps around it, mimicking diarrhea. This must be reported to the nurse immediately for assessment and intervention, as impaction can lead to serious complications. Treating it as infectious diarrhea or a normal variation would cause significant harm.

Question 76: A CNA is caring for a resident who tells her that her roommate has been taking her personal belongings. The CNA verifies this is true after observation. What is the CNA's PRIMARY responsibility in this situation?

Document the observation and report it to the charge nurse immediately (Correct answer)
Move the resident's belongings to a locked storage area without notifying anyone
Advise the resident to speak with the roommate personally to resolve the conflict
Confront the roommate directly and demand the items be returned

Correct answer: Document the observation and report it to the charge nurse immediately

CNAs are mandatory reporters and are responsible for documenting and reporting suspected theft or misappropriation of a resident's property to the charge nurse or supervisor. Taking unilateral action (confronting the roommate, moving belongings without authorization) falls outside the CNA's scope, and advising the resident to handle it alone neglects the CNA's duty to protect resident rights.

Question 77: When providing oral care for an unconscious patient, what should you do first?

Check for dental issues.
Use a toothbrush only.
Position the patient on their side. (Correct answer)
Ask if they prefer mint toothpaste.

Correct answer: Position the patient on their side.

Before providing oral care for an unconscious patient, it is crucial to position them on their side, typically in a lateral or semi-Fowler's position with the head turned to the side. This prevents aspiration of fluids or debris into the lungs, as the patient cannot swallow or protect their airway. Patient safety is the top priority.

Question 78: A patient who has been constipated reports the urge to have a bowel movement. What should the CNA do immediately?

Remind the patient to drink more water for the next movement
Respond promptly, assist the patient to the toilet or commode, and provide privacy (Correct answer)
Tell the patient to wait until the scheduled toileting time
Place the patient on the bedpan and leave the room for 30 minutes

Correct answer: Respond promptly, assist the patient to the toilet or commode, and provide privacy

Responding promptly to a patient's toileting request respects dignity, prevents incontinence, and takes advantage of the natural defecation reflex.

Question 79: A CNA is assisting a post-operative resident to ambulate for the first time after hip replacement surgery. The resident uses a walker and becomes slightly pale and diaphoretic after walking 10 feet. What should the CNA do FIRST?

Help the resident sit down in the nearest safe chair immediately (Correct answer)
Call for the nurse while keeping the resident standing
Return the resident to bed using a wheelchair
Encourage the resident to take slow deep breaths and continue walking

Correct answer: Help the resident sit down in the nearest safe chair immediately

Pallor and diaphoresis during ambulation are signs of orthostatic hypotension or cardiac compromise. The priority is to prevent a fall by getting the resident seated safely and immediately — not returning to bed first (which requires continued ambulation) and not keeping them standing. Once seated and stable, the CNA calls the nurse. Encouraging continued ambulation when the resident shows these signs risks syncope and falling.

Question 80: A resident with end-stage renal disease (ESRD) on dialysis is served a meal tray that includes a banana, a glass of orange juice, and tomato soup. The CNA recognizes that this tray is problematic. Which nutrient in these foods is the PRIMARY concern for this resident?

Phosphorus, which accumulates and causes renal osteodystrophy in dialysis patients
Protein, which increases nitrogenous waste and accelerates uremic syndrome
Sodium, which causes fluid retention and worsens hypertension in ESRD
Potassium, which cannot be adequately excreted by failing kidneys and can cause fatal cardiac arrhythmias (Correct answer)

Correct answer: Potassium, which cannot be adequately excreted by failing kidneys and can cause fatal cardiac arrhythmias

Bananas, orange juice, and tomatoes are all high-potassium foods. In ESRD, the kidneys cannot excrete potassium adequately, leading to hyperkalemia, which can cause life-threatening cardiac arrhythmias including ventricular fibrillation. While sodium, phosphorus, and protein are all legitimately restricted in ESRD, the three foods listed are specifically recognized as high-potassium foods, making potassium the primary concern with this particular tray. The CNA should not serve this tray and must notify the nurse immediately.

Question 81: An Advanced Directive for her end-of-life care is provided to you by a 22-year-old with terminal brain cancer. You are aware that this might signify any of the things below, BUT

She can choose to be a DNR patient
Her Living Will can indicate her wishes
She can designate who can make her medical decisions
Her family can direct the staff to keep her alive (Correct answer)

Correct answer: Her family can direct the staff to keep her alive

An Advanced Directive, such as a Living Will, allows an individual to express their wishes regarding medical treatment, including end-of-life care. Once a valid Advanced Directive is in place, the patient's stated wishes take precedence and cannot be overridden by family members. Therefore, her family cannot direct staff to keep her alive if she has specified otherwise in her directive.

Question 82: A resident with capacity wants to refuse a prescribed medication. The correct response is to:

Contact the resident's family to obtain permission to give the medication
Respect the refusal, document it, and report to the charge nurse (Correct answer)
Administer the medication anyway to ensure health
Mix the medication into food without the resident's knowledge

Correct answer: Respect the refusal, document it, and report to the charge nurse

Residents with decision-making capacity have the right to refuse any medication, and the refusal must be respected, documented, and reported.

Question 83: Under federal nursing home regulations, residents must be free from chemical restraints. A chemical restraint is defined as:

Any medication given to treat a diagnosed psychiatric condition
Pain medication administered on a scheduled basis
A medication used for discipline or staff convenience rather than to treat a medical condition (Correct answer)
Antibiotics given to control infection

Correct answer: A medication used for discipline or staff convenience rather than to treat a medical condition

Chemical restraints are drugs used to control behavior for staff convenience or discipline rather than to treat a legitimate medical or psychiatric condition.

Question 84: When is it appropriate for a CNA to apply a physical restraint to a resident?

When a family member requests it verbally
Any time the resident is confused or agitated
Whenever the CNA feels it is needed for safety
When a licensed nurse orders it and proper protocol is followed (Correct answer)

Correct answer: When a licensed nurse orders it and proper protocol is followed

Physical restraints require a physician's order, nursing assessment, and adherence to facility protocol — CNAs cannot apply them independently.

Question 85: Which restraint alternative should a CNA try FIRST for a confused resident who keeps trying to get out of bed?

Apply a soft vest restraint
Raise all four side rails
Use bilateral soft wrist restraints
Lower the bed and place mats on the floor (Correct answer)

Correct answer: Lower the bed and place mats on the floor

Lowering the bed and placing floor mats reduces fall injury risk without restricting movement.

Question 86: A long-term care facility is implementing a new unit-level budget where CNAs are asked to track and report daily supply usage using a tally sheet. A CNA notices her tally consistently shows 20% more glove usage than the unit budget anticipates. The MOST constructive action is:

Ignore the discrepancy since infection control takes priority over budget concerns
Document the pattern accurately and bring it to the charge nurse with a possible explanation, such as acuity changes or supply waste (Correct answer)
Reduce glove use to meet the budget target, changing gloves only between residents rather than tasks
Adjust the tally retroactively to reflect the budgeted amount to avoid drawing attention to the unit

Correct answer: Document the pattern accurately and bring it to the charge nurse with a possible explanation, such as acuity changes or supply waste

Accurate reporting is essential even when data reveals a budget variance. CNAs should document honestly and proactively communicate discrepancies with possible clinical explanations (e.g., increased isolation precautions, higher acuity). Reducing glove use to fit budget targets violates infection control standards and endangers residents and staff. Falsifying records is a serious ethical and legal violation.

Question 87: What is considered a normal minimum urine output for an adult patient?

60 mL/hour
10–15 mL/hour
100 mL/hour
30 mL/hour (Correct answer)

Correct answer: 30 mL/hour

A minimum urine output of 30 mL/hour indicates adequate renal perfusion in adults; output below this is considered oliguria.

Question 88: When assisting a patient who begins to fall, what technique protects both the patient and the CNA?

Control the descent by bending your knees, widening your stance, and guiding the patient to the floor (Correct answer)
Grab the patient's arm tightly and call out for help before doing anything else
Try to hold the patient upright at all costs to prevent them from reaching the floor
Step aside quickly to avoid being pulled down with the patient

Correct answer: Control the descent by bending your knees, widening your stance, and guiding the patient to the floor

A controlled descent using proper body mechanics prevents injury to both the patient and the CNA — trying to catch a full fall can injure both parties.

Question 89: What is the purpose of inspecting the skin during personal care?

To determine if the resident needs a change in diet
To identify early signs of pressure injuries, skin breakdown, rashes, or other changes that need to be reported to the nurse (Correct answer)
To determine if the resident needs additional exercise
To assess the resident's cardiovascular health

Correct answer: To identify early signs of pressure injuries, skin breakdown, rashes, or other changes that need to be reported to the nurse

Skin inspection during personal care allows the CNA to identify early pressure injuries, rashes, or skin changes that, when reported promptly, can be treated before progressing.

Question 90: In electronic health records (EHR), what should a CNA do if they accidentally log in with another employee's credentials?

Use the credentials to chart until they receive their own login
Continue charting since it is a minor issue
Ask the other employee to fix the error at shift change
Log out immediately, access the EHR with their own credentials, and report the error to their supervisor (Correct answer)

Correct answer: Log out immediately, access the EHR with their own credentials, and report the error to their supervisor

Each caregiver must use only their own login credentials. Using another's login is a HIPAA violation and falsification of records. Log out immediately, use correct credentials, and report the incident.

Question 91: Normal SpO2 (oxygen saturation) for a healthy adult is typically:

95–100% (Correct answer)
90–94%
100% only
85–90%

Correct answer: 95–100%

A normal pulse oximetry reading for a healthy adult is 95–100%.

Question 92: A hearing-impaired resident uses a hearing aid. Before speaking, the CNA should FIRST:

Speak loudly directly into the resident's ear
Write all communication on a notepad
Ensure the hearing aid is in place and turned on (Correct answer)
Ask the charge nurse to handle all communication

Correct answer: Ensure the hearing aid is in place and turned on

Verifying the hearing aid is properly placed and functioning ensures the resident can hear before communication begins.

Question 93: Which action best prevents patient identification errors when providing care?

Read the name written on the whiteboard in the room
Ask a coworker to confirm the patient's identity
Ask the patient to state their name and birth date (Correct answer)
Check the room number against the assignment sheet

Correct answer: Ask the patient to state their name and birth date

Using two patient identifiers — name and date of birth — is the standard safe practice to prevent errors.

Question 94: What is the primary goal of regulatory compliance in CNA practice?

Increasing operational costs
Limiting professional innovation
Ensuring adherence to laws and standards governing professional practice (Correct answer)
Creating bureaucratic processes

Correct answer: Ensuring adherence to laws and standards governing professional practice

Regulatory compliance ensures professionals follow applicable laws and standards to protect public safety and maintain quality.

Question 95: During a routine morning care visit, a CNA discovers that a cognitively intact resident has been secretly stockpiling their prescribed medications in a bedside drawer. The resident tells the CNA, 'Please don't tell anyone — I just want to have control over something in my life.' What is the MOST appropriate action for the CNA to take?

Counsel the resident about the dangers of medication hoarding and encourage them to speak with the charge nurse themselves within 24 hours
Remove the medications, return them to the nurse, and explain to the resident that you are required to report this finding for their safety (Correct answer)
Honor the resident's request for confidentiality, as cognitively intact residents have the right to autonomous decision-making
Document the finding in the care plan notes and inform the social worker at the next interdisciplinary team meeting

Correct answer: Remove the medications, return them to the nurse, and explain to the resident that you are required to report this finding for their safety

Medication stockpiling is a serious safety concern often associated with suicidal intent. Even when a resident is cognitively intact and requests confidentiality, the CNA has a mandatory duty to report safety threats — confidentiality does not supersede safety. The CNA must immediately remove the medications, return them to the nurse, and report the incident. Allowing a 24-hour window or waiting for the next team meeting creates unacceptable risk. The CNA should explain transparently why they cannot honor the confidentiality request.

Question 96: What does 'negligence' mean in the context of CNA practice?

Failing to provide the standard of care, resulting in harm (Correct answer)
Spreading false information about a resident
Threatening a resident with punishment to gain compliance
Intentionally harming a resident through physical force

Correct answer: Failing to provide the standard of care, resulting in harm

Negligence is the failure to perform care at the accepted standard, which results in harm or risk of harm to the resident.

Question 97: A CNA is feeding a resident with dysphagia who is on a nectar-thick liquid diet. The resident becomes upset and insists on drinking thin water, saying 'I've been drinking water my whole life.' What is the CNA's most appropriate response?

Explain the aspiration risk, offer thickened water as an alternative, and report the resident's request to the nurse (Correct answer)
Provide a small sip of thin water to satisfy the request, then resume thickened liquids
Allow the resident to drink thin water since autonomy must be respected above all clinical orders
Distract the resident with a different activity and document nothing unless an incident occurs

Correct answer: Explain the aspiration risk, offer thickened water as an alternative, and report the resident's request to the nurse

The CNA must honor the care plan (nectar-thick liquids) while also respecting the resident's right to understand their care. Explaining the risk of aspiration and offering thickened water as a compliant alternative addresses both safety and dignity. The nurse must be informed so that the care team can reassess or document an informed refusal. Providing thin water without clinical authorization — even 'just a sip' — violates the care plan and creates an aspiration risk.

Question 98: When observing a resident's skin during morning care, which finding must be reported immediately?

Dry skin on the lower legs
A reddened area over the coccyx that does not blanch when pressed (Correct answer)
Mild scalp flakiness
A small bruise from a known bump yesterday

Correct answer: A reddened area over the coccyx that does not blanch when pressed

Non-blanchable redness over a bony prominence indicates a Stage 1 pressure injury requiring immediate nursing assessment.

Question 99: The CNA should understand that grieving in elderly residents:

Can occur from multiple losses including health, independence, and friends (Correct answer)
Only happens when someone dies
Should be discouraged
Is a sign of depression that needs medication

Correct answer: Can occur from multiple losses including health, independence, and friends

Elderly people experience grief from many losses — not just death.

Question 100: During a fire emergency, what does the acronym RACE stand for?

Respond, Alert, Close, Exit
Run, Alert, Check, Evacuate
Rescue, Announce, Contain, Extinguish (Correct answer)
Remove, Assess, Call, Evacuate

Correct answer: Rescue, Announce, Contain, Extinguish

RACE — Rescue (move residents from immediate danger), Announce/Alarm (activate the fire alarm), Contain (close doors and windows), Extinguish (use fire extinguisher if safe) — is the standard fire response protocol.

Certified Nursing Assistant (CNA) Exam

The CNA exam certifies individuals to provide basic patient care under the supervision of a licensed nurse, covering both knowledge and practical skills.

Questions

90 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds