CNA (Certified Nursing Assistant) practice questions and exam guide

A resident with dysphagia is on a thickened-liquid diet. Which liquid is APPROPRIATE?

1. Iced water, since cold triggers a stronger swallow
2. Warm black coffee sipped slowly through a straw
3. Nectar-thick juice thickened as ordered in the care plan
4. Plain milk, which coats the throat and moves slowly

Answer: C — Nectar-thick juice thickened as ordered in the care plan

C) Correct - the care plan specifies the consistency the speech therapist found safe for this resident, and nectar-thick liquid moves slowly enough for the resident to control the swallow. A) iced water is a thin liquid; cold may heighten sensation but does not make a thin liquid safe in dysphagia. B) coffee is thin, and a straw delivers a fast bolus to the back of the throat, which increases aspiration risk. D) milk is also a thin liquid, and coating the throat does not slow it enough to protect the airway.

A resident repeatedly wakes during the night and says she cannot fall back asleep. Which nursing assistant action is MOST likely to promote rest?

1. Turn on the overhead light and visit with her at the bedside until she becomes tired enough to sleep
2. Offer her a cup of coffee and let her stay awake in the dayroom until morning
3. Reduce noise and light, offer toileting and a warm blanket, and reposition her comfortably
4. Leave the television on at a good volume so the sound distracts her from wakefulness

Answer: C — Reduce noise and light, offer toileting and a warm blanket, and reposition her comfortably

C) Correct — addressing environmental and physical causes such as noise, light, a full bladder, cold or an uncomfortable position is the person-centered first approach to sleeplessness. A) floods the room with stimulating light and conversation. B) supplies a stimulant, worsening the problem. D) adds noise and light, the very barriers to sleep.

A resident with severe arthritis in both hands becomes frustrated trying to button her blouse each morning. The BEST suggestion for the nurse aide to bring to the nurse is:

1. That staff dress her completely from now on so she is not frustrated each morning
2. That she wear a hospital gown instead of her own clothing while her hands are painful
3. That she be offered adaptive clothing such as tops with hook-and-loop closures
4. That she stay in her nightgown until the arthritis in her hands improves

Answer: C — That she be offered adaptive clothing such as tops with hook-and-loop closures

C) Correct — adaptive clothing preserves independence and dignity while removing the task the resident cannot manage. A) is doing FOR rather than WITH and erodes remaining ability. B) strips personal identity and is not a substitute for street clothes in long-term care. D) is a plausible-sounding delay but leaves her undressed and less engaged, and chronic arthritis will not simply resolve.

A resident has Clostridioides difficile diarrhea. Which hand hygiene method is BEST after care?

1. An alcohol-based hand rub, because it acts faster than soap
2. A sanitizing wipe used on the palms and the backs of the hands
3. An alcohol rub followed by a moisturizing lotion for dry skin
4. Washing with soap and water and friction for at least 20 seconds

Answer: D — Washing with soap and water and friction for at least 20 seconds

D) Correct — C. difficile forms spores that alcohol does not kill; mechanical friction with soap and running water physically removes them. A) is the common misconception that alcohol is always preferred; speed does not help against spores. B) wipes miss the fingertips, nails and webs where organisms concentrate, and again do not remove spores. C) adds lotion but still relies on an agent that is ineffective against spores.

A resident tells the nurse aide, "My chest feels tight and I can't catch my breath." The aide should FIRST:

1. Tell the resident it is probably indigestion from lunch
2. Stay with the resident and get the nurse right away
3. Take a full set of vital signs and chart them before saying anything
4. Have the resident lie flat and rest

Answer: B — Stay with the resident and get the nurse right away

B) Correct — chest tightness with shortness of breath is a potential emergency, and the aide's role is to stay with the resident and get the nurse immediately. A) interprets and diagnoses, which is outside the aide's scope and may delay life-saving care. C) tempts because vital signs are useful, but obtaining and charting them before alerting anyone wastes critical time. D) is wrong for a resident struggling to breathe, who is usually more comfortable upright.

A nurse aide notices a spray bottle of cleaning chemical with no label in the shower room. What should the aide do?

1. Pour the contents into the drain and rinse the bottle
2. Use it only for surfaces, not for resident skin
3. Label it with the product she thinks it is
4. Leave it untouched and report it to the nurse

Answer: D — Leave it untouched and report it to the nurse

D) Correct — an unlabeled chemical cannot be identified, so it is left alone and reported so it can be handled according to the safety data sheet. A) may cause a dangerous reaction in the drain and exposes the aide to unknown fumes. B) still means using a substance nobody can identify. C) guesses at the contents, and a wrong label is more dangerous than no label because it invites confident misuse.

A resident in rehab keeps saying 'I can't do this.' The best response is:

1. 'Let's break it into smaller steps. You did this part well yesterday.'
2. 'You're right, this one is too hard for you today — let me just do it for you.'
3. 'Stop complaining; other residents manage this without any trouble.'
4. 'Just try harder and you'll be back to normal before you know it.'

Answer: A — 'Let's break it into smaller steps. You did this part well yesterday.'

B) Promotes dependence. A) Correct — encouragement + chunking. C/D) Disrespectful.

A resident uses a cane. The cane should be held on:

1. The strong side
2. The weak side
3. Either side
4. In front of the body

Answer: A — The strong side

B) Provides no support on falling side. A) Correct — cane on strong side, moved with weak leg. C/D) Wrong.

When walking a resident with a gait belt, the CNA should:

1. Walk slightly behind and to the weak side, grasping the gait belt from behind
2. Walk in front of the resident holding the belt and pulling gently to set the pace
3. Walk several steps away to give the resident room to move independently and build confidence
4. Hold the resident's hand on the strong side rather than using the belt, which is less restrictive

Answer: A — Walk slightly behind and to the weak side, grasping the gait belt from behind

A) Correct — support the weak side and stay ready to ease a fall. B) Pulling from in front can pull the resident off balance. C) Distance leaves you unable to reach the resident in time. D) A hand hold gives no control of the trunk if the resident's knees buckle.

Which intervention helps a sundowning resident?

1. Turn on bright overhead lights and the television to keep the resident alert and oriented
2. Keep familiar routines, soft lighting, a calm voice, and less noise in the evening
3. Arrange for several family members to visit together in the evening for reassurance
4. Settle the resident alone in a darkened quiet room until the agitation passes on its own

Answer: B — Keep familiar routines, soft lighting, a calm voice, and less noise in the evening

A) Bright overhead light and a blaring television add stimulation at the exact time the resident is least able to process it. B) Correct — sundowning eases when the evening is predictable and low-stimulation, so routine, soft light, a calm voice, and quiet reduce agitation. C) Several visitors at once overstimulates a resident who is already overloaded. D) A dark room alone increases fear, misperception, and fall risk.

A resident with known moderate dementia has been alert and stable for months. Today she is suddenly much more confused than usual, drowsy, and cannot be redirected. The nurse aide should:

1. Report the sudden change to the nurse right away
2. Assume the dementia has progressed and document it at the end of the shift
3. Use validation therapy and continue with routine care
4. Let her sleep and recheck her tomorrow

Answer: A — Report the sudden change to the nurse right away

A) Correct — an abrupt change from baseline suggests delirium, which often has a treatable cause such as infection or dehydration and requires prompt reporting. B) is the common misconception that all worsening confusion is dementia; dementia changes gradually, not overnight. C) applies a valid technique but delays reporting a possible acute illness. D) postpones care for a potentially urgent condition.

A resident's spouse died last week and the resident cries while the nurse aide helps with morning care. The BEST response is to:

1. Change the subject to the day's activity calendar so she has something pleasant to look forward to
2. Sit quietly beside her, offer a tissue, and let the resident talk about her spouse if she wishes
3. Tell her that her spouse is in a better place now and is no longer suffering from his illness
4. Finish the morning care quickly and step out of the room so she can have time alone to cry

Answer: B — Sit quietly beside her, offer a tissue, and let the resident talk about her spouse if she wishes

B) Correct - staying present without hurrying, and letting her lead the conversation, supports grieving rather than steering her toward a feeling she does not have. A) avoids the emotion and signals that grief is unwelcome. C) imposes the aide's own beliefs about death, which may not match the resident's. D) confuses privacy with abandonment at a moment when support is wanted; leaving is right only if she asks to be alone.

Spiritual care for a resident with a different faith from yours means:

1. Sharing your own beliefs so the resident has a chance to consider a different faith
2. Explaining respectfully where you think their beliefs are mistaken if they ask you directly
3. Respecting their beliefs and offering to arrange chaplain or clergy contact when asked
4. Keeping conversation strictly to physical care and leaving spiritual matters entirely alone

Answer: C — Respecting their beliefs and offering to arrange chaplain or clergy contact when asked

A) Sharing your own faith to give the resident “a chance to consider” it is proselytizing, and attempting to influence a resident's beliefs violates their rights. B) Judging a resident's beliefs as mistaken is never the aide's role, even when invited. C) Correct — supporting the resident's own practice and arranging clergy or chaplain contact when she asks meets a spiritual need without imposing your views. D) Confining care to physical tasks ignores spirituality, which is part of whole-person care.

A resident speaks little English and her family offers to interpret during care instructions from the nurse. The nurse aide should:

1. Ask the family to interpret, since they know her best and can explain things in a way she trusts
2. Speak English more loudly and slowly, repeating each instruction until the resident nods that she understands
3. Use gestures and pointing only, avoiding speech so the resident is not confused by unfamiliar words
4. Tell the nurse so a qualified interpreter or the facility's language service can be arranged

Answer: D — Tell the nurse so a qualified interpreter or the facility's language service can be arranged

D) Correct — a qualified interpreter protects accuracy and confidentiality, and arranging one is the nurse's responsibility once the aide reports the need. A) is common but risks filtered or inaccurate information and breaches confidentiality. B) is a misconception; volume does not overcome a language barrier. C) abandons verbal communication and leaves the resident uninformed.

When working with a resident from a culture different from yours, you should:

1. Assume your own customs are correct, since facility routines apply to everyone
2. Ignore cultural differences and treat every resident identically to avoid favoritism
3. Ask the resident about preferences and respect food, dress, and religious practices
4. Ask to be reassigned to a resident whose customs and language you understand better

Answer: C — Ask the resident about preferences and respect food, dress, and religious practices

A) Cultural imposition. C) Correct. B) Insensitive. D) Abandons the resident.

Communicating with a hearing-impaired resident:

1. Raise your voice from across the room so the resident hears you before you get there
2. Face them, speak clearly and at a normal volume, and be sure hearing aids are in and on
3. Speak at a normal pace but use short, rapid phrases so less has to be heard at once
4. Skip speaking and write out everything you need to say to avoid any misunderstanding

Answer: B — Face them, speak clearly and at a normal volume, and be sure hearing aids are in and on

A) Shouting from across the room distorts speech sounds, removes the resident's view of your face, and is undignified. B) Correct - facing the resident with good light lets them use lip movement and expression, a clear normal voice keeps the sounds undistorted, and a working hearing aid does more than any change in your voice. C) Rapid speech is harder to follow and to lip-read. D) Writing everything is patronizing and slow when speech works with the aid in place.

An aphasic resident (post-stroke) struggles to find words. You should:

1. Supply the word as soon as they hesitate so the conversation keeps moving comfortably
2. Speak louder and more slowly, since stroke often dulls the resident's hearing as well
3. Allow extra time without rushing, and use yes/no questions or a picture board as needed
4. Wait quietly without responding until the resident works the word out entirely on their own

Answer: C — Allow extra time without rushing, and use yes/no questions or a picture board as needed

A) Finishing sentences for the resident is frustrating and discourages further attempts to speak. B) Aphasia is a language problem, not a hearing problem, so raising your voice does not help. C) Correct - unhurried time lets the resident retrieve words, and yes/no questions or a picture board give a way to communicate the message when words will not come. D) Offering no support at all leaves the resident struggling and isolated.

To correct a paper-chart error:

1. Erase the entry neatly and rewrite it so the chart stays legible for the next shift
2. Draw a single line through it, write 'error,' then initial and date the correction
3. Cover the entry with correction fluid and write the accurate information over it
4. Remove the page and start a fresh one, copying the accurate entries onto it

Answer: B — Draw a single line through it, write 'error,' then initial and date the correction

A/C/D) Falsification. B) Correct.

A resident asks you not to discuss her care in front of her roommate. You should:

1. Explain that privacy cannot be guaranteed in a shared room, but keep it brief
2. Honor the request — close the curtain, lower your voice, or move the conversation to a private area
3. Ignore the request, since discussing care at the bedside is a normal part of routine practice
4. Ask the roommate to step out whenever this resident's care is being discussed

Answer: B — Honor the request — close the curtain, lower your voice, or move the conversation to a private area

A/C) Violates privacy. B) Correct. D) Roommate has rights too.

Which is the LEAST restrictive alternative to physical restraint?

1. Soft wrist restraints applied loosely enough for the resident to shift position
2. A vest restraint worn only while the resident is seated in the day room
3. Bed alarm plus frequent observation, repositioning, and meaningful activities
4. A chair with a locked lap tray that the resident cannot release independently

Answer: C — Bed alarm plus frequent observation, repositioning, and meaningful activities

A) Wrist restraints are a physical restraint even when applied loosely. B) A vest restraint is still a restraint, and limiting it to the day room does not change that. C) Correct — none of these limits the resident's free movement, so together they are the least restrictive approach: the alarm and rounds catch risk while activity addresses the reason the resident gets up. D) A lap tray the resident cannot remove is a restraint.

OBRA stands for:

1. Omnibus Budget Reconciliation Act of 1987
2. Office of Beneficiary Rights Administration
3. Older Beneficiaries' Rights Act of 1990
4. Omnibus Budget Recovery Amendment of 1990

Answer: A — Omnibus Budget Reconciliation Act of 1987

A) Correct — OBRA is the Omnibus Budget Reconciliation Act of 1987, the federal law that created nursing assistant training and competency requirements, the resident rights protections, and the standardized resident assessment used in long-term care. B) tempts because it sounds like a real federal office concerned with resident rights, but no such agency is the source of the nursing home reform requirements. C) uses the familiar words 'rights' and 'older' and a plausible year, yet OBRA is budget legislation, not a stand-alone rights act, and 1990 is the wrong year. D) recycles 'Omnibus Budget' correctly but substitutes 'Recovery Amendment' and 1990 for the actual title and year.

You see a coworker take a resident's watch. You should:

1. Speak to the coworker privately and ask her to put it back
2. Report what you saw to your supervisor immediately
3. Say nothing, since you did not see it clearly
4. Retrieve the watch later and return it to the room

Answer: B — Report what you saw to your supervisor immediately

A) Inadequate. B) Correct — financial abuse is reportable. C) Failure to report. D) Not your role.

You note thick, yellow toenails on a diabetic resident. You should:

1. Report to the nurse - CNAs do NOT cut or file diabetic toenails
2. Trim them yourself with clippers, cutting straight across
3. File them down with an emery board until they are thin and smooth
4. Soak the feet in warm water to soften the nails, then trim them

Answer: A — Report to the nurse - CNAs do NOT cut or file diabetic toenails

A) Correct - thick, discolored nails on a resident with diabetes suggest a fungal infection, and nail care on a diabetic foot is reserved for the nurse or podiatrist because reduced sensation and poor circulation turn a small nick into a non-healing ulcer. B) trimming is outside the aide's scope for a diabetic resident no matter how careful the technique. C) filing still abrades the nail and surrounding skin and can break the skin barrier. D) soaking softens tissue and macerates diabetic skin, and the trimming that follows is still out of scope.

A resident who requires a two-person transfer needs to move from bed to wheelchair, and no other staff member is free. The nurse aide should:

1. Perform the transfer alone using a gait belt and careful body mechanics
2. Ask the resident's visiting son to help with the lift
3. Wait and tell the nurse that help is needed for the transfer
4. Transfer the resident with a mechanical lift alone to save time

Answer: C — Wait and tell the nurse that help is needed for the transfer

C) Correct — the aide follows the care plan and asks for help through the nurse rather than attempting an unsafe transfer; teamwork and speaking up are expected. A) is the most common cause of injury to residents and aides; a gait belt does not convert a two-person transfer into a one-person transfer. B) family members are not trained staff and must not be used as the second person. D) most mechanical lifts also require two trained staff, so this is still unsafe and against the plan.

Perineal care?

Female: front to back, top to bottom, never reuse cloth side. Male: clean meatus first, then shaft + scrotum. Retract foreskin if uncircumcised; replace after.

Bathing principles?

Provide privacy. Wash from clean to dirty (face → torso → arms → legs → perineum last). Use warm (not hot) water. Pat skin dry. Inspect for skin breakdown.

What is the difference between delirium and dementia?

Delirium is a sudden, often reversible confusion from causes such as infection or dehydration. Dementia is a gradual, progressive, irreversible loss of mental function.

How should an aide communicate with a resident who is hearing impaired?

Face the resident at eye level in good light, reduce background noise, speak clearly at a normal or slightly slower pace, and use short sentences and gestures.

Apical pulse?

Listen at apex of heart (5th ICS, midclavicular line, left) for 1 full minute. Used for cardiac residents + before cardiac meds + infant pulse.

Dressing principles?

Dress weak/affected side FIRST. Undress weak side LAST. Allow resident to do what they can.