1. A family member of a resident who died says calmly, 'I know she is at peace now, and I'm grateful I got to say goodbye.' This statement reflects which stage of grief?
Communication and Psychosocial Needs
A.Depression
B.Anger
C.Acceptance
D.Bargaining
Show answerAnswer
C. Acceptance
Acceptance is the final stage of grief, marked by a sense of peace and coming to terms with the loss. The calm, grateful tone in this statement reflects resolution rather than active grieving.
2. A nurse aide is caring for a resident with moderate dementia who becomes agitated when asked multiple questions at once. What is the best approach when giving instructions?
Communication and Psychosocial Needs
A.Explain all steps of care in detail before starting
B.Ask the resident to repeat instructions back word for word
C.Give one simple instruction at a time
D.Speak loudly so the resident pays closer attention
Show answerAnswer
C. Give one simple instruction at a time
Residents with dementia often have difficulty processing multiple pieces of information at once. Giving one simple, clear instruction at a time reduces confusion and agitation.
3. A nurse aide needs to collect a stool specimen from a resident who also needs to urinate. What is the correct action?
Basic Nursing Skills
A.Have the resident urinate into the same container as the stool specimen to save time
B.Mix a small amount of urine with the stool sample intentionally for volume
C.Collect the stool specimen directly from the toilet bowl after the resident flushes
D.Ask the resident to urinate first, then use a separate container such as a bedpan or specimen hat to collect the stool
Show answerAnswer
D. Ask the resident to urinate first, then use a separate container such as a bedpan or specimen hat to collect the stool
Stool specimens should not be contaminated with urine, as this can affect test results. The resident should urinate first into the toilet or a separate container, then have a bowel movement into a clean specimen container such as a bedpan or specimen hat.
4. A physician needs to perform a new procedure on a resident that was not previously explained. Who is responsible for obtaining informed consent from the resident before the procedure?
Resident Rights and Legal/Ethical
A.Whichever staff member is available at the time
B.The resident's family, regardless of the resident's own wishes
C.The nurse aide, since they spend the most time with the resident
D.The physician or licensed practitioner performing or ordering the procedure
Show answerAnswer
D. The physician or licensed practitioner performing or ordering the procedure
Informed consent must be obtained by the physician or licensed practitioner who will perform or order the procedure, as it requires explaining risks, benefits, and alternatives, which is outside the nurse aide's scope of practice. The aide's role is to report concerns, not to obtain consent.
5. A nurse aide is asked to check a resident's apical pulse. Where should the stethoscope be placed?
Basic Nursing Skills
A.On the wrist at the base of the thumb
B.At the fifth intercostal space, left of the sternum, at the midclavicular line
C.On the top of the foot near the ankle
D.On the neck beside the trachea
Show answerAnswer
B. At the fifth intercostal space, left of the sternum, at the midclavicular line
The apical pulse is measured by listening directly over the apex of the heart with a stethoscope, located at the fifth intercostal space at the midclavicular line on the left side of the chest.
6. A nurse aide is teaching a new coworker about proper hand hygiene. What is the minimum amount of time hands should be scrubbed with soap and water to effectively remove germs?
Infection Control and Safety
A.60 seconds
B.20 seconds
C.5 seconds
D.10 seconds
Show answerAnswer
B. 20 seconds
The CDC recommends scrubbing hands with soap and water for at least 20 seconds to effectively remove germs, about the time it takes to hum 'Happy Birthday' twice. Shorter durations do not adequately reduce microorganisms.
7. After finishing wound care on a resident with a known infection, a nurse aide removes PPE. Which item should be removed FIRST?
Infection Control and Safety
A.Goggles
B.Gloves
C.Gown
D.Mask
Show answerAnswer
B. Gloves
Gloves are typically the most contaminated item and are removed first to prevent spreading pathogens to other PPE or skin. After gloves, hand hygiene is performed before removing goggles, gown, and finally the mask.
8. When weighing a resident on a standing scale to track weight changes over time, which practice ensures the most accurate comparison between readings?
Basic Nursing Skills
A.Alternate between different scales located on different units
B.Weigh the resident wearing different amounts of clothing each time for comfort
C.Weigh the resident at a different time each day depending on staffing availability
D.Weigh the resident at the same time of day, on the same scale, wearing similar clothing
Show answerAnswer
D. Weigh the resident at the same time of day, on the same scale, wearing similar clothing
To obtain accurate, comparable weight measurements over time, the resident should be weighed under the same conditions each time: same scale, same time of day, and similar clothing, minimizing variables that could cause false weight changes.
9. A resident with dementia becomes increasingly confused, restless, and agitated every day around 4:00–5:00 PM. This pattern is best known as:
Communication and Psychosocial Needs
A.Sundowning, and the nurse aide should maintain good lighting and a calm, consistent routine
B.Normal aging, and no action is needed
C.A behavior that requires physical restraints for safety
D.A sign of severe pain requiring immediate unauthorized medication
Show answerAnswer
A. Sundowning, and the nurse aide should maintain good lighting and a calm, consistent routine
Sundowning refers to increased confusion and agitation in the late afternoon or evening common in dementia residents. Maintaining a calm environment, adequate lighting, and consistent routines can help reduce symptoms.
10. A nurse aide notices that a resident from a different cultural background avoids direct eye contact during conversations. The aide should understand that this behavior:
Communication and Psychosocial Needs
A.Means the resident is angry with the staff
B.May be a normal cultural sign of respect
C.Indicates the resident is being dishonest
D.Suggests the resident has a cognitive impairment
Show answerAnswer
B. May be a normal cultural sign of respect
In many cultures, avoiding direct eye contact is a sign of respect, particularly toward authority figures or elders, rather than a sign of dishonesty, anger, or cognitive problems.
11. A nurse aide observes that a resident's respirations are 32 breaths per minute and shallow. What should the nurse aide do first?
Basic Nursing Skills
A.Document the finding in the chart at the end of the shift without further action
B.Encourage the resident to hold their breath to slow the respiratory rate
C.Wait one hour and recheck respirations to see if the rate changes
D.Report the finding to the nurse promptly, as this is above the normal range
Show answerAnswer
D. Report the finding to the nurse promptly, as this is above the normal range
Normal adult respiratory rate is 12-20 breaths per minute. A rate of 32 breaths per minute is significantly elevated (tachypnea) and shallow breathing may indicate respiratory distress, requiring prompt reporting to the nurse.
12. A resident's hearing aid is not working properly, and she says she cannot hear well today. What should the nurse aide check first?
Communication and Psychosocial Needs
A.Whether the resident's roommate is speaking too loudly
B.Whether the hearing aid battery needs replacing
C.Whether the resident is pretending not to hear
D.Whether the resident needs a hospital referral
Show answerAnswer
B. Whether the hearing aid battery needs replacing
A common and simple cause of hearing aid malfunction is a dead or weak battery. Checking this first is a quick, appropriate nurse aide action before assuming other causes.
13. While riding the elevator at the facility, two nurse aides discuss a resident's recent diagnosis where other visitors can overhear. This is an example of a violation of:
Resident Rights and Legal/Ethical
A.Informed consent
B.HIPAA confidentiality
C.Scope of practice
D.Advance directive rights
Show answerAnswer
B. HIPAA confidentiality
Discussing a resident's protected health information in a public area where others can overhear violates HIPAA confidentiality rules, which require protected health information to be shared only with those directly involved in care and in private settings.
14. A resident begins coughing forcefully into the open air during a group activity. According to respiratory hygiene/cough etiquette, what should the nurse aide teach the resident to do?
Infection Control and Safety
A.Hold their breath until the urge to cough passes
B.Cough into a closed fist to contain droplets
C.Turn away from others but continue coughing into the open air
D.Cough or sneeze into the upper sleeve or a tissue, then discard the tissue and perform hand hygiene
Show answerAnswer
D. Cough or sneeze into the upper sleeve or a tissue, then discard the tissue and perform hand hygiene
Respiratory hygiene/cough etiquette requires covering the mouth and nose with a tissue or the upper sleeve (not the hand) to reduce droplet spread, followed by proper disposal and hand hygiene.
15. A nurse aide is preparing to count a resident's respirations. Which technique is correct?
Basic Nursing Skills
A.Count respirations only while the resident is talking
B.Tell the resident to breathe deeply and count out loud
C.Count respirations immediately after taking the pulse, without telling the resident
D.Ask the resident to hold their breath for 10 seconds first
Show answerAnswer
C. Count respirations immediately after taking the pulse, without telling the resident
Respirations should be counted discreetly, often right after taking the pulse while still holding the wrist, because people tend to breathe differently if they know they are being observed.
16. A nurse aide is assisting a resident who has no known infections with routine bathing. Under standard precautions, how should the aide treat the resident's blood and body fluids?
D.As non-infectious since the resident has no diagnosed illness
Show answerAnswer
B. As potentially infectious, requiring appropriate precautions
Standard precautions require that all blood, body fluids, secretions, and excretions be treated as potentially infectious regardless of a resident's diagnosis, since infection status may be unknown. This protects both the aide and resident from transmission of disease.
17. A nurse aide notices a resident's room floor is wet from a recently mopped area. What is the priority action to prevent a fall?
Infection Control and Safety
A.Place a 'wet floor' caution sign and block access until dry
B.Leave the floor as is since it will dry quickly
C.Mop the floor again to dry it faster
D.Tell the resident verbally to be careful when walking
Show answerAnswer
A. Place a 'wet floor' caution sign and block access until dry
Placing a visible wet floor sign and restricting access until the floor is dry is the standard safety measure to prevent slips and falls. A verbal warning alone or leaving the area unmarked does not adequately protect residents, especially those with cognitive or mobility impairments.
18. A nurse aide is transferring a weak resident from the bed to a wheelchair. Which action best helps prevent a fall during this transfer?
Infection Control and Safety
A.Have the resident hold onto the aide's neck for support
B.Allow the resident to transfer alone while the aide watches from the doorway
C.Use a properly applied gait belt around the resident's waist
D.Transfer the resident quickly to reduce time spent standing
Show answerAnswer
C. Use a properly applied gait belt around the resident's waist
A gait belt applied snugly around the resident's waist gives the aide a secure handhold to support and control the resident's movement during transfer, reducing fall risk. Grabbing the aide's neck, rushing, or leaving the resident unsupervised all increase the chance of injury.
20. A fire breaks out in a resident's room, and the nurse aide is the first to discover it. Following the RACE protocol, what is the FIRST action the aide should take?
Infection Control and Safety
A.Extinguish the fire with a nearby extinguisher
B.Rescue anyone in immediate danger
C.Confine the fire by closing the door
D.Activate the fire alarm
Show answerAnswer
B. Rescue anyone in immediate danger
RACE stands for Rescue, Alarm, Confine, Extinguish. The first priority is always to rescue anyone in immediate danger from the fire before doing anything else.
21. A facility wants to discharge a resident because her family stopped paying privately and she is transitioning to Medicaid. Under resident rights regulations, this type of involuntary discharge is:
Resident Rights and Legal/Ethical
A.Legal, as long as 30 days' notice is given
B.Legal only if the resident's physician approves
C.Illegal, because payment source change is not a valid reason for involuntary discharge
D.Legal, since facilities can discharge residents for any financial reason
Show answerAnswer
C. Illegal, because payment source change is not a valid reason for involuntary discharge
Federal regulations prohibit involuntary discharge or transfer based solely on a change in payment source, such as transitioning from private pay to Medicaid. Valid reasons for discharge are limited to specific criteria like medical necessity, danger to others, or nonpayment when the resident has the means but refuses to pay—not simply switching payer types.
22. A nurse aide finds a small trash can fire in the resident's room and decides it is safe to use a fire extinguisher. Using the PASS technique, what should the aide do immediately after pulling the pin?
Infection Control and Safety
A.Sweep the nozzle side to side
B.Stand as close to the fire as possible
C.Aim at the base of the fire
D.Squeeze the handle
Show answerAnswer
C. Aim at the base of the fire
PASS stands for Pull, Aim, Squeeze, Sweep. After pulling the pin, the next step is to aim the nozzle at the base of the fire, not the flames, before squeezing the handle and sweeping side to side.
23. A nurse aide enters a resident's room and finds them unresponsive and not breathing. The resident's chart clearly states a valid Do Not Resuscitate (DNR) order. What should the aide do?
Resident Rights and Legal/Ethical
A.Follow the DNR order and do not perform CPR, then notify the nurse
B.Wait for the nurse to arrive before doing anything
C.Call the family first to ask permission before acting
D.Begin CPR immediately since the resident is not breathing
Show answerAnswer
A. Follow the DNR order and do not perform CPR, then notify the nurse
A valid DNR order is a legal directive that must be honored; performing CPR against a documented DNR would violate the resident's legal right to refuse resuscitative treatment. The aide should follow the order and immediately notify the nurse.
24. A nurse aide is assigned to care for a resident with confirmed active tuberculosis. Before entering the room wearing an N95 respirator, what must the aide do to ensure the mask is providing adequate protection?
Infection Control and Safety
A.Check the expiration date printed on the box only
B.Perform a seal check by inhaling and exhaling to detect air leaks
C.Wear the mask loosely to allow easier breathing
D.Spray the mask with disinfectant before each use
Show answerAnswer
B. Perform a seal check by inhaling and exhaling to detect air leaks
A seal check (also called a fit check) involves inhaling and exhaling sharply while wearing the N95 to detect air leaking around the edges, ensuring a proper seal against airborne pathogens like TB. This step is essential every time the respirator is worn.
25. A nurse aide takes a resident's oral temperature and obtains a reading of 98.6°F. How should this finding be interpreted?
Basic Nursing Skills
A.This reading is invalid because oral temperatures are never accurate
B.This is above normal and should be reported immediately
C.This is below normal and indicates hypothermia
D.This is within the normal range for oral temperature
Show answerAnswer
D. This is within the normal range for oral temperature
Normal oral body temperature averages 98.6°F (37°C), with an acceptable range of about 97.6°F to 99.6°F. This reading falls within the normal expected range and requires no special action beyond routine documentation.
A stool specimen must be collected without urine contamination, typically by having the resident urinate first, then collecting stool in a clean container like a specimen hat.
Urine contamination can alter stool test results
Use a specimen hat or clean bedpan, not the toilet directly
Label and transport specimens promptly per facility policy
Total fluid intake is calculated by adding all liquids and liquid foods (like soup, ice cream, gelatin) consumed during a given period, usually recorded in milliliters (mL).
Add all liquid amounts consumed to get total intake
Federal law prohibits discharging or transferring a resident simply because they change from private pay to Medicaid; discharge must meet specific legal criteria.
Payment source change is not valid grounds for discharge
Valid reasons include medical necessity, danger, or nonpayment when able to pay
Proper notice alone does not legalize an improper discharge
A seal check involves inhaling and exhaling to detect air leaks, confirming the N95 respirator fits properly before entering an airborne precaution room.
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