Basic Nursing Skills 16 Flashcards

A CNA is performing passive range-of-motion exercises on a resident's shoulder joint. The resident suddenly reports sharp, localized pain at approximately 90 degrees of abduction. What is the most appropriate immediate action?

Answer: Stop the movement, support the extremity in a comfortable position, and report the pain to the nurse

Sharp, localized pain during ROM exercises is a warning sign of potential tissue damage, joint injury, or an underlying condition. The CNA must immediately stop the movement, support the extremity to prevent further injury, and notify the nurse. Continuing through sharp pain—even with reduced force—risks serious harm, and completing the sequence before reporting is a dangerous delay.

When applying a transfer belt to a resident with a recent colostomy, which consideration takes priority over standard belt placement technique?

Answer: The belt should be placed above the stoma site to avoid pressure on the appliance and surrounding skin

The transfer belt must be positioned to avoid placing pressure on the colostomy appliance or stoma, which could dislodge the appliance, cause skin breakdown around the stoma, or cause the resident pain. Placing the belt above the stoma site achieves both safe transfer mechanics and protection of the ostomy. Placement below the waist compromises leverage and safety. The belt is not categorically contraindicated—just adapted.

A CNA is performing perineal care on a female resident who is incontinent and has an indwelling urinary catheter. In what order should the following areas be cleaned: (1) the perineal area from front to back, (2) the catheter tubing from the meatus outward approximately 4 inches, (3) the anal area?

Answer: 1, 2, 3 — perineal area first, then catheter tubing, then anal area last

Proper technique follows clean-to-dirty progression. The perineal area is cleaned front to back first, followed by the catheter tubing moving away from the meatus to prevent introducing pathogens toward the urinary tract. The anal area, being the most contaminated, is always last. Cleaning the catheter after the anal area risks contaminating gloves and then touching a urinary device. Cleaning the anus first and then the catheter tubing is a major infection-control error.

A CNA notes that a resident's gastrostomy tube (G-tube) feeding bag still has 150 mL of formula remaining when the next scheduled feeding is due. The resident is alert and denies discomfort. What is the CNA's most appropriate action?

Answer: Inform the nurse before proceeding, as G-tube feeding management is outside CNA scope of practice

Assessing residual feeding volume, adjusting feeding schedules, and making decisions about tube feedings fall outside CNA scope of practice. The CNA's role is to observe and report. Adding formula on top of old formula risks bacterial contamination from mixing. Independently discarding or holding a scheduled feeding without nurse direction also exceeds CNA authority. The nurse must assess the situation and determine the appropriate course of action.

During morning care, a CNA observes that a resident's dependent lower extremity is mottled, cool to the touch, and the resident reports it feels 'numb.' The resident has a history of peripheral vascular disease. Which action reflects the highest priority application of basic nursing skills?

Answer: Withhold massage of the extremity, position it no higher than heart level, and immediately report findings to the nurse

Mottling, coolness, and numbness in a resident with PVD suggest critically compromised arterial perfusion—a medical emergency requiring immediate nurse notification. Massage is contraindicated as it can dislodge emboli or further injure ischemic tissue. Elevation above heart level worsens arterial flow to an already compromised limb (elevation is appropriate for venous problems, not arterial). Delaying report until end of shift in a potential acute ischemia scenario could result in limb loss or death.

A CNA is assisting with postmortem care and notices rigor mortis has not yet set in. The family has requested that the resident be positioned with hands folded across the chest and eyes closed. Which additional postmortem care action is most clinically important to perform before rigor mortis develops?

Answer: Place a small pillow or rolled towel under the chin to keep the mouth closed

Supporting the jaw to keep the mouth closed must be done before rigor mortis sets in, as once rigor develops (typically within 2–6 hours), the jaw cannot be repositioned without force. This is both a dignity measure and a practical one for family viewing. Lotion application, while appropriate, is less time-sensitive. Removal of IV lines and dressings requires nursing or facility protocol approval—not an independent CNA decision. Turning a body after death does not prevent livor mortis (hypostasis), which is a gravity-driven process in fixed tissues.