GNA Written Examination (NNAAP) — Questions and Answers

Question 1: A GNA has just finished a task that involved contact with a resident's body fluids and has removed their gloves. According to Standard Precautions, what is the immediate next step?

Apply a new pair of gloves for the next task.
Document the care provided to the resident.
Perform hand hygiene with soap and water or an alcohol-based rub. (Correct answer)
Use a paper towel to wipe off any residual moisture.

Correct answer: Perform hand hygiene with soap and water or an alcohol-based rub.

Standard Precautions mandate that hand hygiene be performed immediately after removing gloves. Gloves are not a perfect barrier and can have microscopic tears, and hands can become contaminated during the removal process. Performing hand hygiene is a critical step to prevent cross-contamination.

Question 2: Why is it important for the GNA to keep a resident's skin clean and dry in the perineal area?

To prevent irritant dermatitis and pressure injuries caused by prolonged moisture from urine or stool (Correct answer)
To make catheter insertion easier
To comply with OSHA infection control rules only
To reduce odors only

Correct answer: To prevent irritant dermatitis and pressure injuries caused by prolonged moisture from urine or stool

Urine and stool are caustic to skin; prompt cleansing and drying of the perineal area prevents chemical burns, dermatitis, and secondary pressure injuries.

Question 3: Which food texture is appropriate for a resident on a minced-and-moist diet?

Raw carrots
Whole-grain crackers
Ground turkey in gravy (Correct answer)
A fresh apple

Correct answer: Ground turkey in gravy

Minced-and-moist diets require foods that are finely cut and moistened, such as ground meat in gravy, to ease safe swallowing.

Question 4: The nurse visits the home of an older person recovering from an exacerbation of a chronic illness. which observation indicates to the nurse that the person has dispelled the myth that older people cannot learn new things?

Planning to meet friends for lunch
Preparing a shopping list
Scheduling an ophthalmologic
Researching medications on the internet (Correct answer)

Correct answer: Researching medications on the internet

Researching medications on the internet demonstrates initiative in learning new technology and seeking health information, directly countering the myth that older adults cannot learn new things. Planning lunch, scheduling appointments, and writing shopping lists are routine tasks that do not require acquiring new knowledge or skills.

Question 5: A resident is unable to move his own arm due to a recent stroke. The nursing assistant is instructed to perform passive range of motion (PROM) exercises. This means the nursing assistant will:

assist the resident in moving the arm, with the resident doing most of the work.
ask the resident to lift the arm as high as they can.
have the resident squeeze a stress ball to build strength.
move the resident's arm through the exercises without assistance from the resident. (Correct answer)

Correct answer: move the resident's arm through the exercises without assistance from the resident.

Passive range of motion (PROM) involves the caregiver moving the resident's joints through their range of motion without any active participation from the resident. This is done when the resident is unable to move the limb on their own.

Question 6: Which of the following is considered a basic Activity of Daily Living (ADL)?

Dressing oneself (Correct answer)
Preparing a meal
Managing personal finances
Shopping for groceries

Correct answer: Dressing oneself

Activities of Daily Living (ADLs) are fundamental self-care tasks. The six basic ADLs are bathing, dressing, eating, transferring (mobility), toileting, and continence. Managing finances, shopping, and preparing meals are considered Instrumental Activities of Daily Living (IADLs), which are more complex tasks required for independent living.

Question 7: Why should a GNA avoid massaging bony prominences that are reddened?

Massage can further damage fragile tissues and worsen injury (Correct answer)
It increases the risk of infection
Regulations prohibit it
It wastes time during care

Correct answer: Massage can further damage fragile tissues and worsen injury

Massaging reddened bony areas can cause additional damage to already compromised tissues, increasing the severity of the pressure injury.

Question 8: Which of the following beverages counts toward a resident's daily fluid intake?

Water, juice, milk, and soup broth (Correct answer)
Only beverages served at meals
Only non-caffeinated beverages
Only water

Correct answer: Water, juice, milk, and soup broth

All liquids consumed — including water, juice, milk, soups, gelatin, and ice cream — count toward a resident's fluid intake record.

Question 9: A GNA is caring for a resident with advanced dementia who is pacing the halls and appears distressed, repeatedly saying, "I need to go home! I need to go home!" Which communication technique is most therapeutic?

Gently reminding the resident that this is their home now.
Asking the resident to describe what their home is like. (Correct answer)
Offering to walk them to their room to rest.
Administering their prescribed PRN medication for anxiety.

Correct answer: Asking the resident to describe what their home is like.

This response uses validation therapy by acknowledging the resident's feelings and reality without directly correcting them. Asking about their home focuses on the emotion behind the words and allows the GNA to connect with the resident's experience. Reminding them that the facility is their home (reality orientation) can increase agitation in advanced dementia. While rest may be needed, it doesn't address the underlying emotional distress. Administering medication is not within the GNA's scope of practice without a nurse's direction.

Question 10: A GNA is positioning a resident in a side-lying (lateral) position to prevent pressure ulcers. Which of the following actions is essential for proper body alignment and pressure relief?

Ensuring the resident's back is perfectly straight at a 90-degree angle to the mattress.
Tucking the resident's bottom arm straight underneath their body.
Positioning the resident directly on their hip bone.
Placing a pillow between the resident's knees and ankles. (Correct answer)

Correct answer: Placing a pillow between the resident's knees and ankles.

Placing pillows between the knees and ankles prevents direct pressure between these bony prominences, which are high-risk areas for skin breakdown. This also helps maintain proper hip and spine alignment.

Question 11: What does the diastolic blood pressure number represent?

The total amount of blood pumped per minute
The pressure in arteries when the heart is at rest between beats (Correct answer)
The pressure in arteries when the heart beats
The resistance in the capillaries

Correct answer: The pressure in arteries when the heart is at rest between beats

The diastolic pressure is the lower number and reflects the pressure in the arteries when the heart muscle is relaxed between contractions.

Question 12: A GNA is caring for a resident on droplet precautions due to influenza. When entering the resident's room, what is the minimum Personal Protective Equipment (PPE) the GNA must wear?

A surgical mask. (Correct answer)
Gloves and a gown.
An N95 respirator.
Goggles and a gown.

Correct answer: A surgical mask.

Droplet precautions are used for diseases spread by large droplets from coughing, sneezing, or talking. Standard infection control guidelines require a surgical mask to be worn when working within three to six feet of a resident on droplet precautions to protect the mucous membranes of the nose and mouth.

Question 13: A GNA is with a resident who suddenly loses consciousness, falls to the floor, and begins to convulse with rigid, jerking motions. Which action is most appropriate for the GNA to take to ensure the resident's safety?

C. Firmly hold the resident's arms and legs to stop the jerking movements.
D. Immediately begin chest compressions and rescue breaths.
B. Attempt to insert a padded tongue blade into the resident's mouth.
A. Loosen any tight clothing around the neck and place a soft item under the head. (Correct answer)

Correct answer: A. Loosen any tight clothing around the neck and place a soft item under the head.

During a tonic-clonic (grand mal) seizure, the priority is to protect the person from injury. Loosening restrictive clothing and cushioning the head are essential safety measures. Nothing should ever be placed in the mouth, and restraining the person can cause musculoskeletal injury. CPR is not indicated unless the person stops breathing after the seizure has ended.

Question 14: A GNA is caring for a resident who is normally alert and oriented. During morning care, the GNA notes the resident is suddenly quiet, confused about where they are, and unable to state the correct month. What is the GNA's MOST important immediate action?

Try to reorient the resident by showing them a calendar and a clock.
Ask the resident's family during their next visit if this is normal behavior.
Document the changes in the resident's chart at the end of the shift.
Report the sudden change in mental status to the nurse immediately. (Correct answer)

Correct answer: Report the sudden change in mental status to the nurse immediately.

A sudden change in mental status, such as acute confusion, is a significant finding that could indicate a serious underlying medical issue like a urinary tract infection (UTI), stroke, or adverse medication reaction. This requires immediate reporting to the nurse for prompt assessment and intervention to ensure the resident's safety and well-being.

Question 15: Which statement would be most appropriate to ask when assessing an aging adult for cognitive function?

Can you count to 10 for me?
Who is the president of the United States?
Have you noticed anything different about your memory or thinking in the past few months? (Correct answer)
What is today's date?

Correct answer: Have you noticed anything different about your memory or thinking in the past few months?

Open-ended questions invite the patient to self-report subjective changes in memory or thinking, which is more sensitive and respectful when screening for cognitive decline. Questions like 'What is today's date?' or 'Who is the president?' are formal cognitive tests, not conversational screening tools, and can feel demeaning rather than inviting honest disclosure.

Question 16: The nursing assistant notices a resident's skin is pale, cool, and clammy. Which vital sign change is most consistent with these findings?

Elevated temperature and increased blood pressure
Slow pulse and elevated temperature
Low blood pressure and rapid pulse (Correct answer)
Normal blood pressure and slow respiratory rate

Correct answer: Low blood pressure and rapid pulse

Pale, cool, and clammy skin combined with low blood pressure and a rapid pulse are classic signs of shock or cardiovascular compromise, requiring immediate reporting.

Question 17: A GNA is caring for a resident who has a designated legal representative for healthcare decisions. The physician is explaining a new treatment plan. According to the principles of informed consent, who must be involved in this decision-making process?

Only the resident, as they are the one receiving care.
Only the resident's legal representative.
Only the physician and the GNA.
The resident, to the extent practicable, and their legal representative. (Correct answer)

Correct answer: The resident, to the extent practicable, and their legal representative.

The informed consent process should involve the resident as much as they are able to participate. Federal law requires that the resident's care plan is prepared with the participation of the resident and/or their family or legal representative. Even if a legal representative is designated, the resident's involvement, preferences, and understanding should be sought and respected to the greatest extent possible.

Question 18: While assisting in the dining room, a GNA observes a resident who is conscious, clutching their throat with both hands, and unable to cough or speak. Which of the following is the GNA's immediate priority?

C. Leave the resident to immediately find the charge nurse.
A. Offer the resident a glass of water.
D. Perform a blind finger sweep of the resident's mouth.
B. Begin performing abdominal thrusts (Heimlich maneuver). (Correct answer)

Correct answer: B. Begin performing abdominal thrusts (Heimlich maneuver).

The resident is displaying the universal sign for a severe airway obstruction. The correct and immediate response is to perform abdominal thrusts to dislodge the object. Giving water could worsen the situation, leaving the resident is dangerous, and a blind finger sweep could push the object further down.

Question 19: A resident with dementia becomes increasingly agitated and confused in the late afternoon. The GNA recognizes this behavior as sundowning. Which of the following interventions is most appropriate?

Turn on the television to a lively program for distraction.
Increase the lighting in the resident's room before dusk. (Correct answer)
Ask the resident to explain why they are feeling so upset.
Encourage a long nap after lunch to ensure they are well-rested.

Correct answer: Increase the lighting in the resident's room before dusk.

Closing curtains and increasing light before dusk can help minimize shadows and the confusion they may cause for a person with dementia experiencing sundowning. A full schedule or too much daytime napping can interfere with nighttime sleep and worsen sundowning, while loud distractions like television can increase agitation. Trying to reason with a resident who is confused is often ineffective.

Question 20: A GNA accidentally sustains a needlestick injury from a used lancet while performing a blood glucose check. What is the GNA's first priority?

Immediately report the injury to the charge nurse.
Find the resident to ask about their health history.
Wash the area thoroughly with soap and water. (Correct answer)
Fill out an incident report form.

Correct answer: Wash the area thoroughly with soap and water.

In the event of an exposure to bloodborne pathogens, such as through a needlestick, the immediate first action is to wash the affected area thoroughly with soap and water. This helps to remove as much of the potentially infectious material as possible. Reporting the incident and follow-up care are also critical but come immediately after initial decontamination of the site.

Question 21: A resident begins to fall while you are assisting them with ambulation. What is the correct action for the nursing assistant to take?

Step away to avoid being injured by the falling resident.
Widen their stance and gently slide the resident down their leg to the floor. (Correct answer)
Quickly grab the resident's arm to pull them back up.
Try to catch the resident to prevent the fall completely.

Correct answer: Widen their stance and gently slide the resident down their leg to the floor.

Attempting to stop a fall can cause serious injury to both the resident and the nursing assistant. The safest procedure is to use proper body mechanics to guide the resident gently to the floor, protecting their head and body from injury as much as possible.

Question 22: When providing postmortem care for a resident who has just passed away, what is a primary responsibility of the GNA?

Treating the body with dignity while performing a final bath and positioning. (Correct answer)
Removing all intravenous lines and medical tubing from the body.
Completing the official death certificate for the facility's records.
Informing the resident's family members of the death.

Correct answer: Treating the body with dignity while performing a final bath and positioning.

The GNA's role in postmortem care is to treat the deceased with respect and dignity. [1, 2] This includes gently bathing the body, dressing it in a clean gown, and placing it in a natural, dignified position before family viewing or transport. [5, 23] Notifying the family, completing the death certificate, and removing medical tubing are tasks performed by the licensed nurse or physician. [1, 5]

Question 23: Which action by the GNA helps prevent skin breakdown during repositioning?

Tucking sheets tightly around the resident
Dragging the resident across the sheet
Repositioning only when the resident asks
Using a lift sheet to move the resident (Correct answer)

Correct answer: Using a lift sheet to move the resident

Using a lift or draw sheet reduces friction and shear forces on the skin, which are major contributors to pressure injuries.

Question 24: A resident on a sodium-restricted diet should avoid which food?

Boiled chicken breast
Plain oatmeal
Canned soup (Correct answer)
Fresh fruit

Correct answer: Canned soup

Canned soups are typically very high in sodium and are not appropriate for residents on sodium-restricted diets.

Question 25: Which of the following is an early sign of hypoxia (low blood oxygen) that the nursing assistant should report?

Bradycardia (slow pulse)
Flushed, warm skin
Increased urine output
Restlessness and confusion (Correct answer)

Correct answer: Restlessness and confusion

Restlessness and confusion are early signs of hypoxia because the brain is highly sensitive to decreased oxygen levels; these changes must be reported immediately.

Question 26: Which site is most commonly used to count the pulse rate in a nursing assistant's routine assessment?

Carotid artery
Radial artery at the wrist (Correct answer)
Brachial artery at the elbow
Femoral artery

Correct answer: Radial artery at the wrist

The radial artery at the wrist is the most accessible and commonly used site for routine pulse measurement by nursing assistants.

Question 27: A nursing assistant is assisting a resident with ambulation. The resident has a cane because of weakness on their right side. On which side should the nursing assistant stand to provide the BEST support?

On the resident's left side, slightly behind them.
In front of the resident to guide their path.
On the resident's right side, slightly behind them. (Correct answer)
Directly behind the resident to catch them if they fall.

Correct answer: On the resident's right side, slightly behind them.

To provide the most effective support and maintain balance, the nursing assistant should stand on the resident's weaker side. This positioning allows the assistant to quickly provide stability if the resident begins to lose balance on their affected side.

Question 28: A resident complains of dizziness. The GNA takes their radial pulse and counts 48 beats in one minute. When reporting to the nurse, which information is most essential for the GNA to communicate?

The resident's subjective complaint of dizziness and the objective pulse rate of 48. (Correct answer)
That the resident did not finish their breakfast this morning.
The GNA's opinion that the resident's medication dose is too high.
That the resident's roommate also felt dizzy earlier in the day.

Correct answer: The resident's subjective complaint of dizziness and the objective pulse rate of 48.

The GNA's role is to report factual observations accurately. This includes both the subjective information (what the resident says, i.e., "I feel dizzy") and the objective data (what the GNA measures, i.e., a pulse of 48). This combination gives the nurse critical information for their assessment. Offering opinions, irrelevant information about other residents, or other less critical data is inappropriate.

Question 29: Mr. Smith, a resident with a history of congestive heart failure (CHF), had a recorded weight of 182 lbs yesterday. Today, his weight is 185 lbs and he has increased swelling in his ankles. What is the GNA's priority action?

Encourage Mr. Smith to drink more fluids to stay hydrated.
Re-weigh Mr. Smith after lunch to see if the number changes.
Document the weight and continue with routine care.
Report the 3-pound weight gain and increased ankle swelling to the nurse. (Correct answer)

Correct answer: Report the 3-pound weight gain and increased ankle swelling to the nurse.

Sudden weight gain of 2-3 pounds in a day and increased edema (swelling) are key signs of fluid retention, which can indicate a worsening of congestive heart failure. This condition requires prompt reporting to the nurse for immediate assessment and potential intervention to prevent serious complications.

Question 30: Which of the following BEST describes the primary goal of restorative nursing care?

To ensure the resident is completely dependent on staff for all care.
To help residents attain and maintain their highest possible level of function and independence. (Correct answer)
To provide care as quickly as possible to save time.
To focus only on the resident's acute medical conditions.

Correct answer: To help residents attain and maintain their highest possible level of function and independence.

The fundamental goal of restorative care is to maximize a resident's independence and prevent further decline in their physical and functional abilities. This involves helping them perform daily activities as independently as possible.

Question 31: Which thermometer route is most appropriate for a resident who is confused and cannot follow instructions to hold the thermometer under the tongue?

Oral
Axillary (armpit) (Correct answer)
Rectal
Tympanic (ear)

Correct answer: Axillary (armpit)

The axillary route is the safest alternative for confused or uncooperative residents because it poses no risk of injury and requires no resident cooperation.

Question 32: When handling soiled linens contaminated with blood or body fluids, which action by the GNA demonstrates correct procedure?

Placing the linens on the floor outside the resident's room before bagging.
Shaking the linens vigorously to remove any solid waste before bagging.
Carrying the soiled linens tightly against their uniform to prevent dropping them.
Rolling the linens inward to contain the soiled area and placing them in a leak-proof bag. (Correct answer)

Correct answer: Rolling the linens inward to contain the soiled area and placing them in a leak-proof bag.

Soiled linens should be handled with minimal agitation to prevent contaminating the air, surfaces, and uniforms. Rolling the linens inward contains the contamination, and placing them directly into a designated leak-proof bag at the point of use prevents the spread of microorganisms.

Question 33: A resident is on a bladder retraining program. What is a key responsibility of the Geriatric Nursing Assistant (GNA) in this program?

Following the toileting schedule consistently and recording intake and output. (Correct answer)
Restricting the resident's fluid intake in the evening.
Waiting for the resident to ask before offering to take them to the toilet.
Deciding independently to change the toileting schedule.

Correct answer: Following the toileting schedule consistently and recording intake and output.

Consistency is crucial for success in a bladder retraining program. The GNA's role includes adhering strictly to the scheduled toileting times, encouraging fluids, and accurately documenting incontinence and voiding patterns to help the nurse evaluate the plan's effectiveness.

Question 34: A resident with dysphagia is at highest risk for which complication during meals?

Hypoglycemia
Constipation
Aspiration pneumonia (Correct answer)
Pressure ulcers

Correct answer: Aspiration pneumonia

Dysphagia (difficulty swallowing) increases the risk of food or liquid entering the airway, which can lead to aspiration pneumonia.

Question 35: A resident's care plan states 'fluid restriction of 1,500 mL/day.' The GNA should:

Refuse to give the resident any fluids
Offer fluids freely since dehydration is dangerous
Monitor and limit fluid intake to the ordered amount per shift (Correct answer)
Only apply the restriction during nighttime hours

Correct answer: Monitor and limit fluid intake to the ordered amount per shift

Fluid restrictions are medical orders that must be followed precisely, with intake distributed across shifts and documented accurately.

Question 36: Which of the following is a key principle of providing care for a person with dementia?

It is best to frequently change the daily routine to provide stimulation.
Maintaining a consistent and predictable routine provides a sense of security. (Correct answer)
Correcting all of the resident's misstatements will help their memory.
Communicating primarily with the family to avoid confusing the resident.

Correct answer: Maintaining a consistent and predictable routine provides a sense of security.

Individuals with dementia thrive on consistency and predictability, which helps to reduce cognitive demands and anxiety. Establishing and maintaining a daily routine can provide a sense of security and stability. Frequent changes can be confusing and distressing. Constantly correcting a person with dementia is a form of reality orientation that can cause agitation, and direct communication with the resident should be maintained as much as possible.

Question 37: A resident informs the GNA that they wish to file a formal complaint about the care they are receiving. What is the GNA's primary responsibility in this situation?

To ask the resident's family to handle the complaint.
To inform the resident of the facility's grievance procedure and notify the charge nurse. (Correct answer)
To resolve the issue themselves to avoid formal paperwork.
To tell the resident that complaining could cause problems with the staff.

Correct answer: To inform the resident of the facility's grievance procedure and notify the charge nurse.

Residents have the right to voice grievances without fear of retaliation. The GNA's role is to facilitate this right by informing the resident of the proper procedure and reporting the complaint to the appropriate licensed staff, such as the charge nurse, who can initiate the formal process. Attempting to resolve it alone may be inappropriate for the scope of the issue, and discouraging a complaint infringes on the resident's rights.

Question 38: A GNA is trying to communicate with a resident who has a significant hearing impairment and dementia. Which action is most effective?

Shouting the information so the resident can hear.
Using simple sentences and gesturing or pointing. (Correct answer)
Approaching the resident from behind to avoid startling them.
Writing down complex instructions for them to read.

Correct answer: Using simple sentences and gesturing or pointing.

When communicating with a resident with both hearing impairment and dementia, using clear, simple sentences combined with non-verbal cues like gesturing is most effective. Shouting distorts sound and can be frightening. Approaching from the front is crucial to avoid startling the resident. Complex written instructions may be difficult for a person with dementia to process.

Question 39: The nurse plans an educational wellness program for a group of older adults residing in the community. on which topic should the nurse focus the majority of the information?

Managing Alzheimer's disease symptoms
benefits of remaining socially active
benefits of treating depression with medications
managing heart failure symptoms (Correct answer)

Correct answer: managing heart failure symptoms

Heart failure is one of the most common and serious chronic conditions in older adults, requiring ongoing symptom management to prevent hospitalizations and maintain quality of life, making it the priority focus for a wellness program. While depression, Alzheimer's, and social activity are all important, heart failure management has the highest prevalence and acute risk impact in this population.

Question 40: A GNA enters a room and finds a resident unresponsive, without a pulse, and not breathing. The GNA is aware the resident has a valid "Do Not Resuscitate" (DNR) order. What is the GNA's most appropriate action?

B. Position the resident comfortably and wait for a family member to arrive.
C. Immediately notify the charge nurse of the findings without initiating CPR. (Correct answer)
A. Begin chest compressions immediately and call for help.
D. Leave the room to find the resident's chart to re-verify the DNR order.

Correct answer: C. Immediately notify the charge nurse of the findings without initiating CPR.

A Do Not Resuscitate (DNR) order is a legal medical directive that must be honored. The GNA's responsibility is to confirm the absence of vital signs and immediately alert the licensed nurse. Initiating CPR would violate the resident's end-of-life wishes. The GNA should act on their knowledge of the code status and notify the nurse, who will then follow facility protocol.

Question 41: When should a GNA encourage a resident to drink fluids unless otherwise ordered?

Only when the resident asks
Only during scheduled meal times
Only before bedtime
Throughout the day at regular intervals (Correct answer)

Correct answer: Throughout the day at regular intervals

Encouraging fluids regularly throughout the day helps prevent dehydration, constipation, and urinary tract infections in elderly residents.

Question 42: To break the 'Mode of Transmission' link in the chain of infection, a GNA should prioritize which of the following actions?

Assisting residents with bathing and personal hygiene.
Practicing frequent and thorough hand hygiene. (Correct answer)
Ensuring residents receive their prescribed antibiotics on time.
Encouraging residents to eat a well-balanced diet.

Correct answer: Practicing frequent and thorough hand hygiene.

The 'Mode of Transmission' refers to how a pathogen travels from a reservoir to a susceptible host. Frequent and thorough hand hygiene is the single most effective way to break this link by removing pathogens from the hands, which are a primary vehicle for transmission in healthcare settings.

Question 43: What is the primary purpose of a therapeutic diet prescribed to a nursing home resident?

To manage or treat a specific medical condition (Correct answer)
To make meal preparation easier for dietary staff
To match the resident's personal food preferences
To reduce food costs for the facility

Correct answer: To manage or treat a specific medical condition

Therapeutic diets are medically ordered to manage conditions such as diabetes, heart disease, or swallowing disorders.

Question 44: While ambulating a resident with a gait belt, the resident begins to feel faint and their knees start to buckle. What is the GNA's most appropriate immediate action?

Quickly grab a nearby chair to sit the resident down.
Let go of the gait belt and step away to avoid being pulled down.
Widen their stance and gently slide the resident down their leg to the floor. (Correct answer)
Attempt to hold the resident in a standing position until help arrives.

Correct answer: Widen their stance and gently slide the resident down their leg to the floor.

The safest procedure when a resident is falling is to control their descent to the floor. By widening their stance and sliding the resident down their leg, the GNA protects both the resident from a hard fall and themselves from a back injury.

Question 45: Which of the following actions by a GNA would be a violation of a resident's right to privacy and confidentiality under HIPAA?

Using a computer with a privacy screen to access a resident's electronic health record.
Asking the resident for permission before closing their room door.
Discussing a resident's medical condition with the physical therapist in the hallway. (Correct answer)
Reporting a change in a resident's condition to the charge nurse during report.

Correct answer: Discussing a resident's medical condition with the physical therapist in the hallway.

Discussing a resident's protected health information (PHI) in a public area where it can be overheard by unauthorized individuals is a violation of HIPAA. Communications about residents should occur in private settings. Reporting to the nurse, asking for privacy preferences, and using secure electronic systems are all appropriate actions that protect resident rights.

Question 46: When assisting a resident with dementia who has become combative during morning care, which of the following actions should the GNA take first?

Firmly tell the resident to stop the behavior.
Stop the care task and step back to ensure safety. (Correct answer)
Continue with the care task quickly to finish.
Leave the resident alone to calm down.

Correct answer: Stop the care task and step back to ensure safety.

The immediate priority in any situation involving aggression or combativeness is the safety of both the resident and the caregiver. The GNA should stop the task that is causing the agitation and create a safe distance. Continuing the task or using a firm tone can escalate the behavior. Leaving a distressed resident entirely alone may not be safe or therapeutic.

Question 47: When operating a fire extinguisher to combat a small fire, the GNA should follow the PASS acronym. The 'A' in PASS stands for:

C. Assess the situation before acting.
B. Aim the nozzle at the base of the fire. (Correct answer)
D. Aim the nozzle at the top of the flames.
A. Activate the building's main fire alarm.

Correct answer: B. Aim the nozzle at the base of the fire.

The PASS acronym for using a fire extinguisher stands for: Pull the pin, Aim the nozzle at the base of the fire, Squeeze the handle, and Sweep from side to side. Aiming at the base is crucial to extinguish the fuel source.

Question 48: Dementia and depression are strongly related to:

Clients over the age of 65
A decreased quality of life and functional deficits (Correct answer)
Past economic status and job performance
Clients over the age of 60

Correct answer: A decreased quality of life and functional deficits

Dementia and depression both directly impair a person's ability to perform daily activities, maintain independence, and experience satisfaction in life, resulting in decreased quality of life and functional deficits. Age thresholds and past economic status do not define the relationship; these conditions affect people across various ages and socioeconomic backgrounds.

Question 49: A resident on a thickened-liquid diet asks for a glass of water. The GNA should:

Give water since hydration is important
Add thickener to the water before offering it
Report to the nurse and follow the care plan (Correct answer)
Tell the resident they cannot have any fluids

Correct answer: Report to the nurse and follow the care plan

Thickened liquids are prescribed to prevent aspiration, so the GNA must follow the care plan and consult the nurse before offering any fluids.

Question 50: Which of the following blood pressure readings would be considered hypotensive (abnormally low) for most adults?

130/84 mmHg
118/76 mmHg
140/90 mmHg
88/52 mmHg (Correct answer)

Correct answer: 88/52 mmHg

A blood pressure of 88/52 mmHg is below the normal threshold and indicates hypotension, which can cause dizziness, falls, and inadequate organ perfusion.

Question 51: A resident with moderate dementia frequently wanders into other residents' rooms. Which of the following is the best initial approach for the GNA to manage this behavior?

Apply a restraining device to keep the resident in their chair.
Scold the resident for not respecting others' privacy.
Lock the resident's door from the outside.
Redirect the resident by inviting them to a scheduled activity. (Correct answer)

Correct answer: Redirect the resident by inviting them to a scheduled activity.

Redirecting a wandering resident to a purposeful and engaging activity is a recommended strategy. This approach addresses potential underlying causes like boredom without using restraints or punitive measures. Restraints and locking doors are illegal and unethical, and scolding is not a therapeutic response and can increase agitation.

Question 52: A resident has a stage 2 pressure injury with a shallow open wound. The GNA's role is to:

Irrigate the wound with hydrogen peroxide twice daily
Clean the wound and apply any available bandage
Follow the nurse's instructions for wound care and report any changes (Correct answer)
Select and apply the appropriate dressing independently

Correct answer: Follow the nurse's instructions for wound care and report any changes

Wound care for a Stage 2 or higher pressure injury is directed by the nurse; the GNA assists as instructed and reports any changes in wound appearance.

Question 53: What is the normal oral body temperature range for an adult?

97.6°F–99.6°F (36.4°C–37.6°C) (Correct answer)
102°F–104°F (38.9°C–40°C)
100.0°F–101.5°F (37.8°C–38.6°C)
95.0°F–97.0°F (35°C–36.1°C)

Correct answer: 97.6°F–99.6°F (36.4°C–37.6°C)

Normal oral body temperature for an adult is approximately 97.6°F–99.6°F (36.4°C–37.6°C), with 98.6°F (37°C) as the classic average.

Question 54: Which of the following is a sign of poor nutritional status the GNA should report?

Resident prefers soft foods
Resident drinks 6 glasses of water daily
Unintentional weight loss over several weeks (Correct answer)
Resident eats 75% of meals

Correct answer: Unintentional weight loss over several weeks

Unintentional weight loss is a key indicator of malnutrition and must be reported to the nurse for further evaluation.

Question 55: A resident with significant hearing impairment is trying to understand the GNA's instructions for an upcoming procedure. Which of the following is the most effective communication strategy for the GNA to use?

Speaking very loudly and slowly directly into the resident's ear.
Facing the resident, speaking clearly at a normal pace, and using facial expressions. (Correct answer)
Writing down the entire conversation on a notepad.
Asking a family member to explain the procedure to the resident later.

Correct answer: Facing the resident, speaking clearly at a normal pace, and using facial expressions.

Effective communication with a hearing-impaired individual involves multiple senses. Facing the person allows them to read lips and see facial expressions, which provide important context. Speaking clearly at a normal pace, without shouting, prevents sound distortion. While writing can be a useful aid, it's not the primary method for dynamic conversation. Shouting can distort sounds and be perceived as anger. Relying on a family member removes the direct communication and relationship-building between the GNA and the resident.

Question 56: A GNA is preparing to transfer a resident with left-sided weakness from the bed to a wheelchair. What is the MOST important action for the GNA to take immediately before moving the resident?

Place the wheelchair on the resident's weak (left) side.
Put a pillow in the wheelchair for comfort before the transfer.
Ensure the wheels of the bed and the wheelchair are locked. (Correct answer)
Ask the resident to place their arms around the GNA's neck for support.

Correct answer: Ensure the wheels of the bed and the wheelchair are locked.

Locking the wheels on both the bed and the wheelchair is a critical safety step to prevent the surfaces from moving during the transfer, which could cause a fall.

Question 57: When bathing a resident, the GNA should inspect the skin for:

Only visible wounds or cuts
Evidence of self-harm only
Redness, blisters, open areas, bruising, or changes since last assessment (Correct answer)
Changes in skin color only on the face

Correct answer: Redness, blisters, open areas, bruising, or changes since last assessment

During bathing, the GNA has the opportunity to assess the entire body for any new or worsening skin changes that must be reported.

Question 58: A GNA notices that a resident's urine is dark, cloudy, and has a strong odor. Which statement best describes the GNA's role in this situation?

Report the objective observations to the nurse for further assessment. (Correct answer)
Ask the resident's family if this is a normal occurrence for them.
Encourage the resident to drink more cranberry juice and re-check in the morning.
Document the observation and diagnose the resident with a urinary tract infection (UTI).

Correct answer: Report the objective observations to the nurse for further assessment.

The GNA's role is to be an observer and reporter of facts. Noting the color, clarity, and smell of the urine are objective observations. The GNA must report these findings to the licensed nurse, who will then use their clinical judgment to assess the resident and determine the cause. Diagnosing a condition like a UTI is outside the GNA's scope of practice.

Question 59: A resident receiving end-of-life care tells the GNA, "I'm so scared of dying." What is the MOST therapeutic response from the GNA?

"Would you like to talk about what is making you feel scared?" (Correct answer)
"Don't be scared, we will take great care of you."
"We all have to go sometime. You should try not to think about it."
"I will let the nurse know so they can talk to you about it."

Correct answer: "Would you like to talk about what is making you feel scared?"

The most therapeutic response is one that acknowledges the resident's feelings and provides an open-ended invitation for them to express themselves further. [3, 19] This demonstrates active listening and empathy. Providing false reassurance (A), dismissing their feelings (C), or immediately deferring to the nurse (D) closes off communication and fails to provide immediate emotional support. [19, 20]

Question 60: The nurse learns that an older person takes several vitamin and nutritional supplements everyday. which theory of aging is supported by this older person's behavior?

free radical (Correct answer)
wear and tear
somatic DNA damage
cross link

Correct answer: free radical

The free radical theory of aging holds that unstable oxygen molecules (free radicals) cause cumulative cellular damage over time, and antioxidant supplements are believed to neutralize these free radicals—explaining why this person takes vitamins and nutritional supplements. Somatic DNA damage, cross-link, and wear and tear theories do not specifically support antioxidant supplementation as a countermeasure.

Question 61: When transferring a resident from the bed to a wheelchair, which action demonstrates proper body mechanics by the nursing assistant?

Twisting their back to pivot the resident to the chair.
Keeping their feet close together for better balance.
Bending at the waist to lift the resident.
Bending their knees and keeping their back straight. (Correct answer)

Correct answer: Bending their knees and keeping their back straight.

Proper body mechanics require using the strong muscles of the legs to lift, not the weaker back muscles. Bending at the knees, keeping the back straight, and maintaining a wide base of support prevents injury to the caregiver.

Question 62: A GNA and a nurse are using a mechanical (Hoyer) lift to transfer a resident from the bed. After the sling is positioned under the resident, what is the most critical safety check before lifting the resident off the bed?

Make sure the wheels of the lift are locked in place.
Ensure all sling loops or clips are securely attached to the lift cradle. (Correct answer)
Ask the resident if they are comfortable in the sling.
Raise the head of the bed to a 90-degree angle.

Correct answer: Ensure all sling loops or clips are securely attached to the lift cradle.

Verifying that the sling is securely attached to the lift is the most critical safety check. A detached or improperly attached sling can lead to a catastrophic fall and serious injury for the resident.

Question 63: A new resident, who is alert and oriented, refuses to take a prescribed medication, stating, "I don't want that pill." What is the GNA's most appropriate initial action?

Tell them you will come back later when they are in a better mood.
Crush the pill and mix it in their applesauce to ensure they take it.
Explain to the resident that the doctor ordered it, so they must take it.
Respect the resident's decision, document the refusal, and report it to the nurse immediately. (Correct answer)

Correct answer: Respect the resident's decision, document the refusal, and report it to the nurse immediately.

Residents have the right to be informed about their care and to refuse treatment, including medications. The GNA must respect this right. The correct procedure is to not force the medication, to document the refusal accurately, and to report it promptly to the licensed nurse, who can then follow up with the resident and physician.

Question 64: A GNA is caring for an unconscious resident who is near death and has a dry mouth with crusted lips. Which comfort measure is most appropriate for the GNA to perform?

Ignore the dry mouth since the resident is unconscious.
Gently apply a moisturizing swab to the resident's lips and inside of the mouth. (Correct answer)
Attempt to give the resident small sips of water from a cup.
Use a hard-bristled toothbrush to scrub the resident's teeth and gums.

Correct answer: Gently apply a moisturizing swab to the resident's lips and inside of the mouth.

Frequent oral care is a critical comfort measure for a dying resident, as a dry mouth can cause significant discomfort. [29, 35] Using a soft, moisturizing swab is the safest and most effective way to provide this care. [24] Giving fluids by mouth to an unconscious person creates a high risk of aspiration, and it is wrong to assume an unconscious person feels no discomfort. [29]

Question 65: A GNA is caring for a resident who is actively dying. Which of the following are common physical signs that death is approaching?

Increased appetite and high energy levels.
Warm, pink skin and a strong, regular pulse.
Clear, loud speech and increased interest in social activities.
Irregular breathing patterns (like Cheyne-Stokes) and mottling of the skin. (Correct answer)

Correct answer: Irregular breathing patterns (like Cheyne-Stokes) and mottling of the skin.

As the body's systems begin to shut down, circulation slows, causing a blotchy, purplish discoloration of the skin called mottling, particularly in the extremities. [6, 11] Breathing patterns often become irregular, with periods of rapid breathing followed by periods of no breathing (apnea), a pattern known as Cheyne-Stokes respirations. [10, 15] The other options describe signs of health and vitality.

Question 66: What is the normal resting pulse rate range for an adult?

120–140 beats per minute
100–120 beats per minute
60–100 beats per minute (Correct answer)
40–60 beats per minute

Correct answer: 60–100 beats per minute

A normal adult resting pulse rate is 60–100 beats per minute; values outside this range should be reported.

Question 67: A GNA is preparing to assist a resident with perineal care. The resident is known to have a C. difficile infection. Which of the following infection control actions is MOST critical?

Placing used linens in a standard laundry bag.
Using an alcohol-based hand rub before and after care.
Washing hands with soap and water after removing gloves. (Correct answer)
Wearing a gown, gloves, and a surgical mask.

Correct answer: Washing hands with soap and water after removing gloves.

Clostridioides difficile (C. difficile) produces spores that are not effectively killed by alcohol-based hand sanitizers. The Centers for Disease Control and Prevention (CDC) specifically recommends washing hands with soap and water after caring for a patient with C. difficile to physically remove the spores.

Question 68: The right to be treated with dignity and respect includes which of the following?

Requiring all residents to wake up at the same time for breakfast.
Allowing a resident to choose their own clothing and hairstyle. (Correct answer)
Leaving a resident's door open during personal care without their permission.
Addressing a resident by their first name without asking their preference.

Correct answer: Allowing a resident to choose their own clothing and hairstyle.

Treating a resident with dignity and respect means recognizing their individuality and promoting self-determination. Allowing residents to make personal choices, such as what to wear and how to style their hair, upholds this right. Imposing a rigid schedule, using familiar terms without permission, and violating personal privacy are all contrary to this fundamental right.

Question 69: Which sign indicates that a resident may be dehydrated?

Skin that springs back when pinched
Dark yellow urine with strong odor (Correct answer)
Blood pressure within normal range
Pink, moist mucous membranes

Correct answer: Dark yellow urine with strong odor

Dark yellow, concentrated urine with a strong odor is a common sign of dehydration and should be reported to the nurse.

GNA Written Examination (NNAAP)

The Maryland Geriatric Nursing Assistant (GNA) written examination, administered through the National Nurse Aide Assessment Program (NNAAP), certifies individuals to provide specialized care for elderly residents in long-term care facilities.

Questions

120 min

Time Limit

70%

To Pass

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