Restorative Skills — CNA practice questions

To prevent heel pressure injuries in a bedridden resident, you should:

1. Float (suspend) the heels off the mattress using a pillow under the calves
2. Massage the heels firmly at each turn to bring circulation back into the reddened skin
3. Place a doughnut-shaped ring under each heel so pressure is spread around the sore spot
4. Apply a warm heating pad to the heels to improve circulation to the area at night

Answer: A — Float (suspend) the heels off the mattress using a pillow under the calves

A) Correct — heel suspension is the standard measure. B) Vigorous massage over a bony prominence increases tissue breakdown. C) Ring cushions cut off circulation in the tissue they encircle. D) Heat risks burns and does not relieve pressure.

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.

A resident who uses a walker is observed placing all body weight through the arms rather than using it for balance, and is walking noticeably slower than usual today. What should the aide do?

1. Assume nothing is wrong, since walker technique varies day to day
2. Report the change in weight-bearing and gait to the nurse, since it may indicate pain, weakness, or a new problem
3. Take the walker away until the resident 'walks correctly'
4. Correct the resident's technique herself without telling anyone

Answer: B — Report the change in weight-bearing and gait to the nurse, since it may indicate pain, weakness, or a new problem

B) Correct - a noticeable change from a resident's usual pattern of device use, such as increased weight through the arms and slower gait, can signal pain, weakness, or a new medical issue, and should be reported to the nurse for assessment. A) dismissing a clear change risks missing a developing problem. C) removing the walker increases fall risk and does not address the underlying cause. D) an aide should report changes rather than attempt to independently correct gait technique, which is outside the aide's scope.

A resident with limited mobility should be repositioned at minimum every:

1. 30 minutes
2. 1 hour
3. 2 hours
4. 4 hours

Answer: C — 2 hours

A) Excessive. B) Frequent but not the standard. C) Correct — q2hr standard. D) Too long.

While bathing, you note a reddened area over the sacrum that does NOT fade when pressed. This is most consistent with:

1. Normal skin redness that fades once the resident is repositioned
2. Stage 1 pressure injury — non-blanchable redness that must be reported to the nurse
3. A bruise from a minor bump, with purple discoloration
4. An allergic reaction to detergent, with a raised itchy rash

Answer: B — Stage 1 pressure injury — non-blanchable redness that must be reported to the nurse

A) Normal redness blanches, or fades, when pressed and disappears after repositioning; this area does neither. B) Correct — intact skin with redness that does not blanch is a Stage 1 pressure injury, and over the sacrum it means pressure relief and a nurse report are needed now. C) A bruise follows a bump and shows purple or blue discoloration rather than persistent redness over a bony point. D) A detergent reaction is typically raised, itchy, and spread over contact areas, not confined to the sacrum.

When using a walker, the resident should:

1. Walk into the walker: walker first, then the weak leg, then the strong leg
2. Lift the walker clear of the floor with each step so it never catches on the carpet
3. Keep the walker just behind the body and pull it along while stepping forward
4. Push the walker well out ahead and then take two steps to catch up to it

Answer: A — Walk into the walker: walker first, then the weak leg, then the strong leg

A) Correct — advancing the walker, then the weak leg, then the strong leg keeps the resident's weight over the support at every step. B) Lifting the walker clear of the floor removes the support just when the resident needs it. C) A walker trailed behind gives no support in the direction of travel. D) Pushing it far ahead pulls the resident's weight forward and causes falls.

During passive ROM, if the resident reports pain you should:

1. Stop at the point of pain and report it to the nurse
2. Continue slowly through the full range, since some discomfort is expected with stiff joints
3. Move the joint more quickly through the arc so the painful part is over sooner
4. Apply steady extra pressure at the end of the range to gradually stretch the tight joint

Answer: A — Stop at the point of pain and report it to the nurse

A) Correct - pain is the signal to stop, because the joint is being moved past what it tolerates; the aide stops, supports the limb, and reports the pain and which joint it involved. B) Pain is a stop signal, not discomfort to work through. C) Faster movement increases the risk of injury. D) Forcing a joint past resistance can tear tissue or dislocate it.

You are assisting with eating. A resident says she can feed herself but is slow. You should:

1. Allow her to do what she can; sit with her, encourage her, and assist only as needed
2. Take over the feeding so her food does not get cold before she finishes it
3. Leave the room and come back at the end of the meal to record how much she ate
4. Feed her quickly so you can help the next resident who needs tray assistance

Answer: A — Allow her to do what she can; sit with her, encourage her, and assist only as needed

A) Correct — letting a resident feed herself at her own pace maintains function, dignity, and appetite, while you stay seated beside her to encourage and step in only where she cannot manage. B) Taking over because food is cooling removes independence for the aide's convenience; food can be rewarmed. C) Leaving the room means no one is watching for choking. D) Feeding quickly to get to the next resident is unsafe and undignified.

Which is a core principle of restorative care that the nurse aide should apply when a resident uses an assistive device such as a cane or walker?

1. Do the task for the resident to save time, since assistive devices slow down care
2. Discourage device use so the resident builds strength faster without it
3. Remove the device once the resident reaches the dining room so it does not get in the way
4. Encourage and allow the resident to do as much as possible independently with the device, providing only the help that is needed

Answer: D — Encourage and allow the resident to do as much as possible independently with the device, providing only the help that is needed

A) doing the task for the resident undermines independence and function, the opposite of restorative care. B) discouraging use of a prescribed device without the care team's direction is unsafe and outside the aide's role. C) removing a prescribed device increases fall risk and is not the aide's decision. D) Correct - the core restorative principle is to promote the resident's highest level of independence, so the aide encourages self-performance with the prescribed device and assists only as needed, never doing for the resident what the resident can do for self.

When transferring a resident to a wheelchair, you should:

1. Place the wheelchair on the resident's strong side, lock both brakes, and apply a gait belt before standing
2. Place the wheelchair on the weak side so the resident can lean toward it while pivoting
3. Lock the brakes and transfer without a gait belt if the resident can bear weight on both legs
4. Lower the footrests into place first so the resident's feet land on them during the pivot

Answer: A — Place the wheelchair on the resident's strong side, lock both brakes, and apply a gait belt before standing

A) Correct - positioning the chair on the strong side lets the resident pivot toward the side that bears weight, locked brakes keep the chair from rolling away, and the gait belt gives the aide a safe hold. B) The resident should turn toward the strong side, not the weak one. C) A gait belt is used regardless of weight-bearing status. D) Footrests should be raised or removed so they are not a tripping or bruising hazard during the pivot.

Range of motion (ROM)?

Active = resident does it themselves. Passive = CNA moves the joints for them. Support proximal + distal joints. Move slowly through full range without forcing.

What is the goal of restorative care?

To help residents regain or maintain the highest possible level of independence and function, and to prevent decline and complications.

What is the nurse aide's role with a resident's prosthetic limb?

Assist the resident with application/removal as trained and per the care plan, check the residual limb skin for redness or breakdown, and report any fit problems or skin changes to the nurse — fitting and adjustment are not within the aide's scope.

Pressure injury prevention?

Reposition every 2 hours. Inspect skin daily. Keep skin clean + dry. Use pressure-relieving devices. Adequate nutrition + hydration. Float heels.