CNA fm new - augustlearningsolutions.com · Workbook%Answers%to%accompany%CNA:%NursingAssistant%Certification,FirstEdition% Lisa!Whitley,!RN,!ADN;!Candace!Barth,RN,!BSN;!and!Dr.!Carrie!Engelbright,RN,CNE,CWP!

Workbook Answers to accompany CNA: Nursing Assistant Certification

Lisa Rae Whitley, RN, ADN Candace S. Barth, RN, BSN

Dr. Carrie Engelbright, RN, CNE, CWP

Workbook Answers to accompany CNA: Nursing Assistant Certification, First Edition Lisa Whitley, RN, ADN; Candace Barth, RN, BSN; and Dr. Carrie Engelbright, RN, CNE, CWP © 2017, August Learning Solutions

Published by August Learning Solutions Cleveland, OH

August Learning Solutions concentrates instructor’s efforts to create products that provide the best learning experience, streamlining your workload and delivering optimal value for the end user, the student. www.augustlearningsolutions.com Cover image credits: Row 1 (left to right): August Learning Solutions, August Learning Solutions, ElenaMedvedeva/iStock/Thinkstock; Row 2 (left to right): August Learning Solutions, ElenaMedvedeva/iStock/Thinkstock; Row 3 (left to right): August Learning Solutions, ElenaMedvedeva/iStock/Thinkstock, ElenaMedvedeva/iStock/Thinkstock; Row 4 (left to right): August Learning Solutions, August Learning Solutions, ElenaMedvedeva/iStock/Thinkstock

Chapter 1: Answers to Workbook Pages

1.A Matching Definitions

1. B 4. A 7. I

2. C 5. E 8. H

3. G 6. F 9. D

1.B Reflective Short Answer Exercises

1. She would have ensured a stable and healthy environment.

2. Risk of exposure is decreased by sanitizing hard surfaces, limiting time with other clients, and ensuring appropriate hand washing is done by staff.

3. Factors preventing her from seeking medical care include: limited finances, high insurance deductible, and inability to miss work days.

4. No, illnesses such as asthma are best managed through regular doctor visits and medications.

5. No, it is not cost effective because urgent care is more costly than office visits.

1.C Fill in the blanks using terms found in the word bank.

1. sick, injured, poor 6. heart disease, asthma, arthritis

2. quality of life 7. Medicare

3. almshouses 8. Medicaid

4. 1800s 9. managed care organizations, healthcare providers

5. infectious illness 10. flexible

11. inflation

1.D Multiple Choice Exercises

1. c 5. c 9. d

2. d 6. d 10. b

3. b 7. c

4. a 8. a

1.E Choose the best response to the following scenarios.

1. b 2. d



1. B 2. D 3. A 4. C


1. They are likely an older couple, since CHF is more common in the older adults.

2. No, age should not matter.

3. It is an herbal supplement that could either help or hurt a client depending on his medical condition and other medications he may be taking.

4. No, it is not the nursing assistant’s responsibility to know how an herbal supplement impacts the client. It is her responsibility to alert her immediate supervisor or the nurse in charge.

5. No, they should not be accepted by the nursing assistant. The wife should be informed to give them directly to the nurse.

6. If the pills are accepted by the nursing assistant, they should be given to the nurse in charge or the assistant’s immediate supervisor.

7. The nursing assistant should state that she will give the supplement directly to the nurse and will also inform the nurse of the wife’s request.

8. Customer service skills include: listening, explaining actions, allowing time for conversation, being respectful of the client’s choices, and addressing client needs promptly.

2.C Fill in the blank with terms found in the word bank.

1. Client 6. Online

2. Basics 7. Assisted-‐living facilities

3. Consumer 8. Alternative therapies

4. Competition 9. Western medicine

5. Home care 10. Respectful


1. c 5. c 9. d

2. d 6. c 10. c

3. b 7. b

4. a 8. a


1. a 2. c 3. a 4. c 5. d



1. D 4. E 7. A 10. G

2. F 5. H 8. I

3. J 6. B 9. C


1. An assisted-‐living facility helps residents or clients with basic needs like bathing, cooking, and cleaning, as well as providing social activity. A nurse may be on staff but is not present 24/7. It bridges the gap between independent living and the need for skilled nursing care. A long-‐term care facility offers skilled nursing care 24/7, as well as providing assistance with basic needs. Each type of facility also follows different regulations.

2. Steve is struggling due to the difference in nursing assistant responsibilities. Assistants working in a nursing home assist with daily tasks such as bathing, ambulation, and feeding. In an assisted-‐living facility, they help with basic care, as well as meal preparation and servicing, light housekeeping, and possibly medication administration.

3. In various settings, the same client may have different abilities and require different levels of care. The duties and responsibilities of the nursing assistant may also vary depending on the type of facility.

4. Yes, bodies such as OBRA regulate resident care and rights, as well as training requirements. This, in turn, determines what duties need to be performed by the nursing assistant.

5. Steve could have discussed expectations during the interview process, or he could have spoken with his supervisor or nurse to clarify questions regarding duties for his shift.

3.C Fill in the blank using terms found in the word bank.

1. Assisted-‐living 7. Omnibus Reconciliation Act, 1987

2. Home health aide 8. Medicare

3. Joint Commission 9. Medicaid

4. Respite care 10. Hospice, dying

5. Acute care 11. Train

6. JCAHO


1. c 5. a 9. a

2. d 6. c 10. c

3. b 7. d

4. b 8. b


1. b 2. a 3. b 4. c



1. B 2. C 3. A


1. Yes, the nursing assistant is responsible for the bad reaction since he took on a task that is not within his scope of practice.

2. The nursing assistant may be reprimanded, suspended, or dismissed from his job. He might be held legally responsible.

3. Administering the insulin was not in the scope of practice for the nursing assistant. The nursing

assistant had not been supplied with additional training by a facility that had been approved by its regulating agency.

4. The request cannot be ignored. Unless informed otherwise, the supervisor will assume that the task has been completed. The nursing assistant must tell the supervisor, “I am not able to complete that task;

it is not in my scope of practice.”

5. The nursing assistant needs to be matter-‐of-‐fact and avoid becoming confrontational. The nursing assistant also must follow the chain of command when communicating this information. The refusal needs to be documented.

4.C Fill in the blank using the words from the word bank.

1. Reinforce 7. Instruction and support

2. Provide personal care 8. Doctor

3. Chain of command 9. Refuse

4. Registered nurse 10. Time management

5. 17% 11. Organization

6. Scope of practice 12. Document


1. b 4. a 7. c 10. b

2. d 5. b 8. d 11. c

3. d 6. b 9. a 12. a


1. b 4. a

2. b 5. a

3. d 6. c



1. D 4. B 7. E 10. I

2. K 5. J 8. H 11. A

3. C 6. F 9. G


1. NPO stands for “nothing by mouth.” Margaret was wrong in giving the client ice chips.

2. Ice chips were offered to the client, which is contrary to the provider’s orders of NPO.

3. Yes, the error could have been avoided by ensuring that the nursing assistant or visitors do not offer ice chips, food, or fluids to the client. A sign can be placed in the client’s room above the bed or other prominent place.

4. It is the nursing assistant’s responsibility to understand commonly used abbreviations. She can ask for clarification if she is unsure of the meaning of NPO. She can also look up the meaning in the facility’s list of approved abbreviations.

5. The nursing assistant should inform the nurse that she is unsure what NPO means. She could also ask if ice chips are allowed or what might be available to ease oral discomfort.

6. The objective data includes the client’s emesis, her statement regarding stomach pain, and the vital signs the nursing assistant obtained.

7. The information should be reported right away, since it is not within normal limits.

8. Margaret should have asked the nurse for clarification of the NPO order. She could also have informed the nurse of Mrs. Grey’s complaints of dry mouth and asked what interventions could be done to decrease the discomfort.

9. Margaret could have reminded the client of her NPO status, reinforced any teaching that the nurse had done, reminded Mrs. Grey of the possible consequences of not adhering to the prescribed diet, offered oral care, and placed a sign in the client’s room. She should be clear and direct while remaining respectful.

10. Margaret should watch for nonverbal indications of being upset, open the lines of communication with the use of therapeutic communication, demonstrate empathy, and allow Mrs. Grey to express her feelings.

11. Margaret needs to clearly state who she is, what her expectations are of Mrs. Grey, and what she will be doing to care for her client. She should allow Mrs. Grey to feel in control of her care, while remaining in compliance with the provider’s orders.

12. Nonverbal cues that enhance therapeutic communication include making eye contact with the client; nodding at appropriate times; and avoiding crossing arms, rolling eyes, or looking at a clock while the client is talking.

5.C Fill in the blank using the terms found in the word bank.

1. Medical abbreviations 8. Documented

2. Lives 9. Computer, paper

3. Plan of care 10. Incident report

4. Subjective data 11. Occurrence of an accident or exposure

5. Measurable 12. Nonverbal communication

6. Oral report 13. Verbal communication

7. Professional 14. Safe


1. c 5. d 9. b 13. a

2. c 6. a 10. b 14. d

3. b 7. b 11. b

4. b 8. a 12. c


1. c 2. b 3. a 4. b 5. d 6. c



1. C 2. A 3. D 4. B


1. Errors made include writing in purple ink, sending in a resume greater than one page, providing details of her personality and family, mailing in a letter-‐sized envelope, and writing “application” on the envelope.

2. Applications should be clearly printed using black ink; either physically dropped off, mailed in a large envelope, or electronically submitted; unfolded and free of creases; and be error free.

3. The application should have been filled out appropriately and either sent in a large envelope, delivered personally, or submitted electronically. She also could have made a follow-‐up phone call, asked when interviews would be held, and inquired about the anticipated hiring date for the positions.

4. The application and resume should include academic and work history, personal and academic accomplishments relevant to the job, references, and contact information.

5. Personal information such as marital status, height, weight, or children should be left out. Details regarding personality traits or family should also be omitted.

6. No, she should have filled out the application using professional standards, sent in a resume to show serious interest, made a follow-‐up call, and maintained a positive attitude.

6.C Fill in the blanks using terms from the word bank.

1. Professional accomplishments 5. Nurse aide registry 9. Work ethic

2. State 6. Professionalism 10. Team leadership

3. Clinical 7. Application

4. Certified nursing assistant 8. Reference list


1. c 5. d 9. c

2. b 6. c 10. c

3. b 7. b

4. a 8. a


1. d 2. c 3. d 4. d 5. b



1. K 6. C 11. H 16. I

2. D 7. A 12. L 17. S

3. E 8. M 13. Q 18. P

4. G 9. O 14. F 19. N

5. B 10. J 15. T 20. R


1. Confidential information protected by HIPAA includes method of transfer, fall, injuries resulting from fall, the transfer and admission to the hospital, and cause of death.

2. No, it is not informed consent, since it is the nurse’s or physician’s role to inform the client about the options and consequences of her choices.

3. No, the nursing assistant was not abiding by her responsibilities, since she was not following the care plan. This means she didn’t maintain client safety, didn’t follow the plan developed by the nurse, and refused a delegated task.

4. She refused to complete a delegated task.

5. She should have asked for assistance from either another nursing assistant or from the nurse.

6. The negligent action was not following the care plan.

7. No, it is not abuse, since the nursing assistant did not mean to inflict harm.

8. She is at risk for suspension or loss of her job.

9. She might be flagged on the registry or lose her certification.


1. Assault 5. Ethics 9. Privacy

2. Abuse 6. Caregiver strain 10. Informed consent

3. Touching 7. Traditions, attitudes 11. Leave of absence

4. Abandonment 8. Cultural competence 12. Mandatory reporter


1. d 4. c 7. b 10. a

2. b 5. a 8. d 11. c

3. c 6. c 9. d 12. d


1. c 2. a 3. b 4. d 5. b 6. c



1. L 6. M 11. O 16. A

2. J 7. D 12. F 17. T

3. S 8. P 13. C 18. R

4. B 9. H 14. G 19. E

5. K 10. N 15. I 20. Q


1. Possible injuries include head injury, muscle sprains, skin tears, and bruising.

2. Inability to put weight on the leg and muscle weakness might interfere with getting up from the floor.

3. Decreased sight may cause tripping on objects, bumping into obstacles, or miscalculating distances. Changes in the inner ear may cause decreased balance. Sensation of touch decreases as nerve fibers that send and receive messages slow down with age, resulting in slower responses to stimuli.

4. Yes, heart medications may have caused him to become dizzy. Lung and kidney function slows, leading to poor absorption and metabolism of drugs.

5. A light appetite may have contributed to his fall due to low blood sugar.

6. Musculoskeletal: Decreased muscle mass and slower contraction of muscles leads to increased weakness and fatigue. Respiratory: Lungs do not expand and contract as efficiently due to overall muscle weakness, leading to a decrease in air exchange and a decreased tolerance to exercise. Cardiovascular: Fewer red blood cells means less oxygen is delivered to the body tissue, which can cause increased fatigue. Nervous: Speed decreases, leading to older people taking more time to process and act on information. Endocrine: Decreased metabolism may lead to drug toxicity. Urinary: Kidneys are less effective at removing wastes from the blood, resulting in possible drug toxicity. Bladder is less responsive to stretch receptors and less

elastic, which leads to the older adult client needing to void more often. Urethral sphincter may lose ability to expand and contract voluntarily, resulting in incontinence.

7. Preventative measures may include use of commode or urinal at bedside, sleeping in a bedroom close to the bathroom, increased lighting in the hallway and bathroom, removal of scatter rugs or obstacles, eating a light snack at bedtime, having a healthcare provider review his medications, and nonskid footwear. It may also be appropriate to have a lifeline installed.


1. Smallest 6. Alimentary canal

2. Hormone 7. Melanin

3. Contracts, relaxes 8. Muscle

4. Organ system 9. Body, brain

5. Middle layer 10. Integumentary system


1. c 4. d

2. a 5. b

3. c 6. a


1. b 2. a 3. b



1. G 8. R 15. S

2. A 9. E 16. L

3. M 10. D 17. P

4. F 11. H 18. N

5. K 12. O 19. C

6. B 13. J 20. U

7. I 14. T 21. Q


1. When working in home health, EMS is activated by dialing 911.

2. Frank may be experiencing a cardiovascular accident, or stroke.

3. Symptoms include atypical behavior, facial drooping on one side of the mouth, one-‐sided weakness, inability to understand speech, confusion, inability to form words, and increased difficulty in transferring.

4. The nursing assistant should ensure the client’s safety by placing him in bed, positioning him on his side due to drooling or difficulty in swallowing, reassuring him that help is coming, and remaining with him until emergency personnel arrive.

5. Emergency care would not be given in a timely fashion, which would reduce the chance to minimize side effects. Death may occur.

6. Yes, a high level of responsibility is required of nursing assistants.

7. Answers may vary among students.

9.C Fill in the blanks with terms from the word bank.

1. Pressure injury 6. Hunched

2. Cystocele 7. Shortness of breath

3. Physical 8. Urinate

4. Smell, sound 9. Dysrhythmia

5. Evidence 10. Germ, parasite


1. d 5. a

2. c 6. b

3. b 7. a

4. c 8. c


1. b 2. a 3. c



1. E 4. A

2. C 5. D

3. F 6. B


1. Jordan may experience an increased amount of infections.

2. Healthcare workers could become ill after exposure to germs. They could also potentially carry those microbes home, making family members ill.

3. Other clients in the facility would be at risk of exposure if staff did not wash hands between client contacts.

4. Hand washing

5. PPE required includes gloves, gown, and goggles. Goggles are worn if splashing may occur.

6. He was on antibiotics for 5 days, decreasing the natural bacteria in his GI tract and allowing the C. Diff bacteria to grow.

7. No, staff must wash hands. C. Diff is not killed by hand sanitizers.

8. Yes, housekeeping should be made aware so that they use a bleach and water solution to clean the room.

9. The nursing assistant should disinfect any equipment, including the wheelchair if used; wash the client’s hands; ensure the client is wearing a clean gown; toilet the client; have the client wear a brief if he is still experiencing explosive diarrhea.

10. The nursing assistant should also alert the radiology staff of the client’s contact isolation status so that they may be prepared.

11. The nursing assistant should double bag the soiled product. The bag should be placed in the appropriate receptacle.


1. Vaccine 7. Microorganisms

2. Primary prevention 8. 1800s

3. Antibody 9. Chain of infection

4. Preventing, limiting 10. Infection control

5. Barrier 11. Healthcare workers

6. Immunity 12. MRSA, VRE


1. c 5. d 9. b 13. d

2. d 6. d 10. a 14. c

3. b 7. c 11. a 15. b

4. a 8. c 12. b 16. a


1. b 5. a

2. a 6. b

3. b 7. d

4. c



1. B 2. C 3. E 4. D 5. A


1. She should formulate a “game plan” at the beginning of the shift with her coworkers and use whatever devices the facility uses to communicate with each other during the shift.

2. Working the 3:00 p.m. to 11:00 p.m. shift may have contributed to the incident. It is common for the evening shift to have fewer staff members present. Clients may also be more tired as the night progresses, resulting in more difficulty in transfers.

3. Other factors contributing to injuries include not following the care plan, possible attempt to “catch” the client instead of lowering the client to the ground, and poor body mechanics.

4. Prevention of injuries include waiting for assistance from another staff member, discussing the transfer and asking about a possible change in care plan with the nurse, using a sit-‐to-‐stand device if approved by nurse, using good body mechanics, making healthy lifestyle choices to reduce the chance of back injury, and ensuring that the floor is not wet and is free of obstacles.

5. She could have lowered the client to the floor.

6. She might be subject to disciplinary action, or even forfeiture of her certification as a nursing assistant, since she did not follow the care plan.

7. She must report to the nurse or her immediate supervisor.

8. She needs to fill out an incident report.

11.C Fill in the blanks with terms found in the word bank.

1. Employer, insurance company 7. PASS

2. Ergonomics 8. Dangerous

3. Chemical 9. Physically

4. RACE 10. Walkways

5. Blood-‐borne pathogens 11. Emergency plans

6. OSHA 12. Workplace violence

11.D Multiple Choice

1. d 5. b 9. b 13. b

2. b 6. d 10. d 14. c

3. c 7. c 11. c

4. a 8. a 12. a

11.E Choose the best response for the following scenarios.

1. c 2. a 3. c 4. d 5. b 6. a



1. C 2. A 3. B


1. It is likely her husband will need to be admitted to a nursing home or assisted-‐living facility. A caregiver in the home may be an option, but that can be costly.

2. Sally may feel guilty for not taking care of her husband, concerned for his welfare, or worried about the hospital and nursing home costs.

3. The nursing assistant could help Sally by doing the following: a) Ensure the client does not suffer a second fall. b) Assist with daily care such as dressing, eating, and hygiene. c) Use active listening skills and allow the client to express her feelings. d) Assist the client in visiting her spouse if he is admitted to the same facility. e) Notify the nurse if there are signs of pain or changes in Sally’s condition. f) Encourage client independence in order to assist Sally in reaching her therapeutic goals.

4. Factors that may have contributed to Sally’s fall include a) throw rug on the floor; b) dim lighting at night; c) using the bathroom in the night, especially if it is far from the bedroom or located up a set of stairs; d) age-‐related changes such as loss of balance, frequent voiding, fatigue and generalized weakness, poor activity tolerance, or decreased sense of touch; and e) inadequate or no footwear.

5. Steps to take to prevent a fall include: a) Remove obstacles from the floor, including rugs; b) keep rooms and hallways well lit; c) install grab bars in the bathroom; d) keep assistive devices such as canes or walkers nearby; e) maintain muscle strength by participating in exercise classes or walking; f) wear nonskid footwear; and g) have regular vision and hearing checks.


1. Ambulatory 7. Upright

2. Lying, sitting 8. EMS

3. Gait 9. Programs

4. Fall 10. Orthostatic hypotension

5. Death rates 11. Strengthening

6. Nursing assistant 12. Alarm systems


1. d 4. c 7. d 10. a 13. c

2. b 5. a 8. c 11. c 14. d

3. b 6. c 9. a 12. b


1. c 2. b 3. a 4. d 5. c 6. d


13.A Definitions

1. A restraint is any physical or chemical limitation that limits or prevents a client from moving freely about his environment.


1. No, restraining the client does not decrease aggressive behaviors or prevent physical outbursts. Clients may become anxious, scared, or angry.

2. Risks include increased dependence, agitation, behavioral problems, pressure sores, bowel and bladder incontinence, fecal impaction, muscle cramps and atrophy, falls, and death. Emotional risks include loss of dignity, depression, and decreased self-‐worth.

3. No, a chemical restraint has several side effects, and not all medications have been studied in clients with dementia.

4. Risks of using medication include increased drowsiness and fatigue, decreased independence, increased risk of falls, potential interactions with other medications, and limiting the client’s ability to function at his normal capacity.

5. Restraint alternatives include using therapeutic communication, decreasing stimuli, avoiding known triggers, tending to needs like toileting on a consistent basis, offering food and liquids frequently, encouraging exercise and activity, providing one-‐on-‐one care, encouraging the client to be close to staff, having familiar objects nearby, using a calm and slow approach, checking on the client frequently, reducing or eliminating the use of alarms, and reapproaching as needed.


1. Restraint 7. 2 hours

2. Medicare, Medicaid 8. Range-‐of-‐motion

3. Two 9. Bed frame

4. Safety 10. Side rails

5. Physical, emotional 11. Safety

6. 15 minutes 12. Chemical


1. d 5. a 9. a 13. b

2. c 6. c 10. c 14. d

3. b 7. d 11. b

4. b 8. c 12. d


1. d 2. a 3. d 4. b 5. d 6. c



1. M 5. D 9. J 13. G

2. F 6. I 10. E 14. L

3. K 7. A 11. H

4. N 8. C 12. B


1. It is likely that he walked away due to being embarrassed.

2. His body language is a reflection of his embarrassment.

3. No, the nursing assistant should remain with the client until his airway has cleared. A partial obstruction can worsen and become a complete obstruction.

4. No, abdominal thrusts should not be done since the client has not given consent. If he does give consent, abdominal thrusts can be done at that time.

5. He originally had a partial obstruction.

6. Symptoms of a partial obstruction include choking or coughing.

7. He had a complete airway obstruction by the end of the scenario.

8. Symptoms of a complete airway obstruction include a high-‐pitched wheeze or no sound at all; a red, grey, or bluish color to the skin; and possibly one or two hands to the throat.

9. The nursing assistant should have activated the EMS when she noted the wheezing and the cough becoming weaker.


1. Anaphylactic shock 7. Sitting

2. Epidermis 8. Blood, fluid

3. Cardiac arrest 9. Brain

4. Seizure 10. Life-‐threatening

5. Cardiogenic shock 11. Consciousness

6. Complete airway obstruction 12. Emergencies


1. c 5. b 9. b 13. d

2. a 6. a 10. b 14. a

3. b 7. d 11. a 15. b

4. c 8. c 12. c 16. c


1. c 5. c

2. b 6. a

3. b 7. d

4. b



1. B 2. A 3. C


1. She is experiencing job burnout, as evidenced by increased stress and calling in sick to avoid going to work. She seems anxious and mentally tired.

2. Contributing factors include conflicts with clients, conflict with her supervising nurse, children at home, and possibly choosing the wrong place of employment.

3. The level of stress may determine whether staying at home was an appropriate choice. If Janet is in danger of harming a client, she should not work.

4. Janet could reduce stress by getting enough sleep, eating right, exercising, maintaining healthy relationships, using humor, keeping a journal, and doing stress-‐relieving techniques such as yoga or meditation.

5. Job satisfaction can be increased by remembering why you chose to work in healthcare and what makes you happy about it, identifying and working toward goals, finding a positive mentor, and using the EAP when necessary. Job satisfaction is increased by taking care of one’s self.

6. By managing time effectively, Janet can reduce stress and increase the quality and quantity of her work.

7. Time management steps include get enough sleep, arrive at work on time, make a list of tasks to be done, communicate effectively with coworkers, divide work among coworkers if needed, take breaks, and ensure that tasks are completed correctly.

8. Janet can better help her clients by reducing her stress. Once she has reduced her own stress, she can use those techniques to assist clients.

9. Ways to decrease stress include staying physically healthy, meditation, humor, journaling, visualization, and breathing exercises.

10. Janet can coach her clients on techniques that she uses to remain calm and in control of herself. She should be empathetic and understanding of clients who may experience stress because of pain, illness, sleep deprivation, anxiety, depression, or grief.


1. Endorphins 6. Healthy balance

2. Exhaustion 7. Paycheck

3. Nonpharmacological pain management 8. Employee assistance program

4. Helping 9. Maintain

5. Communicate 10. Many


1. a 5. c 9. a

2. b 6. b 10. d

3. d 7. a

4. c 8. b


1. c 2. c 3. a 4. d 5. b



1. D 2. E 3. A 4. C 5. B


1. a) Physiological needs: offer food and fluids frequently, meet elimination needs promptly, reposition frequently, and ambulate. b) Safety: ensure alarm systems are in place, reduce fall risks, lock up chemicals, and keep sharp or dangerous objects out of clients’ reach. c) Love and belonging: offer choices, treat clients with dignity and respect, promote independence, and encourage clients’ participation in forming plan of care. d) Esteem: let the client know that he is valued by offering choices. e) Self-‐actualization: encourage the client’s participation in arts and crafts activities, social gatherings, and outings; provide mind-‐stimulating games and activities.

2. Gene is in the infancy stage: nonverbal and distrustful of primary caregivers.

3. Quality of life is diminished, as evidenced by his apparent inability to enjoy life.

4. The nursing assistant should care for the client holistically by addressing emotional health, physical comfort, spiritual wellness, and social activity.

5. He seems emotionally unwell.

6. The nursing assistant should meet the client’s needs starting with survival needs: allow for healthy interactions with others, offer opportunities for him to express himself, develop the client–caregiver relationship, and finally assist the client in meeting self-‐actualization.

7. Look for signs of stable emotional health: contentment, smiling, healthy interactions with others, finding joy in life, participation in activities, a positive outlook, having fun, laughing, demonstrating respect for others, solid self-‐esteem, resilience against stressors, and maintaining healthy relationships.

8. a) Emotional: ensure safety, use therapeutic communication, allow time for client to express her feelings, develop rapport with the use of activities, encourage brain-‐stimulating games, encourage visits from family and friends, offer choices, and offer time to participate in hobbies. b) Physical: offer food and fluids frequently, ambulate, reposition frequently, address elimination needs, and utilize nonpharmacological interventions to decrease discomfort or

pain. c) Spiritual: offer opportunities to attend religious meetings or services, yoga, meditation, and relaxation breathing exercises; provide privacy; decorate room with spiritual artifacts or religious icons if client desires.

9. He can watch television, listen to stories read aloud, attend church, participate in group exercises, make crafts, look through photographs, or go for walks with a caregiver.

10. The nursing assistant can develop a bond with the spouse, offer opportunities for privacy, suggest that she volunteer at the facility, or suggest group activities or classes.


1. Physical, emotional 6. Enhances

2. Internal 7. Measure

3. Quality of life 8. Pain

4. Abraham Maslow 9. Nonverbal

5. Milestones 10. Religious beliefs


1. d 6. d

2. a 7. b

3. c 8. a

4. b 9. c

5. d 10. d


1. b 2. a 3. c 4. a 5. b



No definitions listed for this chapter


1. Basic human needs include food, water, breathing, elimination, sleep, homeostasis, and sex. The facility must also meet his safety needs.

2. In a LTC facility each room must have no more than four people in a room, at least 80 sq. ft. per client in a shared room or 100 sq. ft. per client in a private room, at least one window facing outside, a closet with shelves and clothing racks, direct access to an exit corridor, privacy curtains in shared room, an appropriate bed with clean and comfortable mattress and linens, access to toileting facilities, and a call-‐light system for each client.

An assisted-‐living facility should have a way for each client to call for assistance, equipment needed for care appropriate for the client, and the means to provide comfort and privacy.

3. She should look for low noise levels, safety systems in place, clean and tidy rooms, and clean equipment.

4. Poor quality of care may be indicated by multiple alarms sounding, dirty and untidy rooms, unpleasant odors, or unkempt clients.

5. Each facility should be clean with a homelike atmosphere.

6. Facilities should be free of fecal and urine odors.

7. They can bring in items from home such as comforters, recliners, small pieces of furniture, or artwork.

8. The daughter needs to choose a facility that best addresses her father’s physical, safety, and emotional needs.

9. In an assisted-‐living facility, the family can bring in the client’s own furniture, linens, towels, photographs, and small personal items.


1. Rights 7. Bathroom

2. Privacy 8. Call-‐light system

3. Welcoming 9. Alarms

4. Safety 10. Smelling

5. Minimum 11. Clients

6. Water 12. Assisted-‐living


1. c 4. a 7. c 10. b

2. b 5. d 8. b 11. a

3. d 6. c 9. a 12. d


1. b 2. a 3. b 4. c 5. d 6. a



1. D 6. F

2. B 7. C

3. A 8. E

4. H 9. G

5. I


1. She may have an altered perception of discomfort due to dementia. Diabetic clients may have decreased sensation.

2. The client has signs of a stage-‐one pressure injury.

3. Yes, this must be reported to the nurse immediately.

4. She is incontinent of feces and urine, requires assistance with mobility, has poor intake, has dementia, does not follow her diabetic diet, has increased fragility of skin due to age, and is wheelchair bound.

5. Incontinence affects the skin by increasing the moisture on the surface of the skin, leading to maceration; changing the pH of the skin; increasing the temperature of the skin with the use of an incontinence garment; and causing excoriation.

6. She should be repositioned every 2 hours while in bed and every hour when up in a chair.

7. Incontinence care should be completed at least every 2 hours and as needed.

8. The best product to use for providing peri-‐care is one specifically designed for that purpose.

9. The nursing assistant can encourage toileting, avoid vigorous drying when performing peri-‐care, reposition the client frequently, use an approved barrier cream on the area, provide adequate nutrition and hydration, discourage intake of sweets, avoid the use of too many blankets, avoid the use of incontinence garments while the client is in bed, place a pressure-‐

relieving device in the wheelchair and bed as ordered, and use a lift sheet for positioning to reduce shearing.

10. No, alternative desserts should be offered instead of additional sweets. If the client insists on eating the additional sweets, she has that right. The nurse should be updated regarding the client’s wish.

11. Interventions may include offering desserts made with an artificial sweetener, offering alternative desserts, starting with a dessert and then progressing to other food items, reinforcing teaching that the nurse has already done regarding diet, and encouraging adequate fluid intake.


1. Bone 6. Heat, humidity

2. Eschar 7. Shear

3. Debridement 8. Prevention

4. Movement 9. Rashes

5. Immobility 10. Hydration


1. d 6. d

2. b 7. c

3. c 8. a

4. a 9. d

5. b 10. b


1. a 2. b 3. b 4. c 5. d



1. F 4. B

2. A 5. D

3. E 6. C


1. An incontinence pad or bed protector should be used.

2. The nursing assistant should perform hand hygiene, carry linens away from the body and uniform, place clean linens on a clean surface, and place linens that fall to the floor in the dirty laundry hamper and replace with clean linens.

3. Items to assemble include gloves, personal hygiene items, fitted sheet, incontinence pad, lift sheet if needed, top sheet, bed blanket or bedspread if needed, pillowcase, bath blanket (if available), and clean clothes or gown for the client.

4. The nursing assistant can help by providing a bed bath, completing an occupied bed change, and reassuring the client that accidents do occur, especially when one is ill.

5. A complete bed change needs to be done using a bath blanket (if available) or some other type of covering for comfort and privacy.

6. The linens need to be placed in a hamper. If there is no hamper nearby, they should be bagged prior to walking in the hallways. If there is not a laundry facility in the building, the linens should be laundered promptly by the nursing assistant.


1. Warmth, privacy 6. Clean, dry

2. Linens 7. Lift sheet

3. Occupied bed change 8. Bath

4. Open bed 9. Housekeeping staff

5. Bed protector 10. Contamination


1. c 6. d

2. a 7. b

3. b 8. c

4. c 9. a

5. a 10. b


1. b 2. a 3. c 4. d 5. b



There are no definitions listed for this chapter


1. Yes, Fowler’s position would be a good choice for Alden. It would make breathing easier.

2. He would be at a greater risk of friction and shearing injuries.

3. Fowler’s and tripod positions would keep him most comfortable because they both ease breathing in clients with COPD. The tripod position allows more air to enter the chest cavity.


1. Repositioned 6. Ligament

2. Physical abuse 7. Semi-‐Fowler’s

3. Sims’s 8. Fowler’s

4. Side-‐lying 9. Tripod

5. Sleeping 10. Wheelchair


1. d 5. d

2. a 6. c

3. b 7. a

4. b 8. c


1. b 2. a 3. d 4. a



1. B 2. A 3. D 4. C


1. It helps prevent the complications associated with immobility as well as decreasing the risk of choking or aspiration.

2. Devices to use include trapeze, side rails, and friction/shearing prevention device. A top sheet, bath blanket, or bed blanket can be substituted for a regular draw sheet.

3. Six people would be needed to move the client from bed to a stretcher due to her size.

4. Two regular gait belts can be connected or a sit-‐to-‐stand device could be used if the client’s weight is not greater than the device’s capacity.

5. A friction/shearing prevention device could be used. The nursing assistant could also raise the head of the bed to help the client to a sitting position.

6. A bariatric lift may be used to transfer the client into a wheelchair.


1. Shearing prevention device 7. Shearing

2. Waist 8. Three

3. Bed frame 9. Stretcher

4. Moving 10. Safety

5. Flat 11. Dangling

6. Muscles 12. Transferring


1. b 5. a 9. b 13. b

2. c 6. b 10. d 14. c

3. d 7. a 11. d

4. d 8. c 12. a


1. c 2. c 3. a 4. d 5. b 6. a 7. b

Chapter 22: Answers to Workbook Questions

22.A Definitions

1. Passive range of motion (PROM): the nursing assistant physically moves the client’s joints through the exercise. The client does not assist in the movement, or assists very little.

2. Active range of motion (AROM): the client independently moves a specific joint and actively participates in the exercise.


1. Ambulation decreases risk of constipation, prevents or eases bloating and gas, encourages circulation, improves muscle and bone health, decreases risk of pressure injuries and contractures, improves cardiovascular function, improves balance, increases or maintains range of motion in the joints, decreases edema in the lower extremities, and improves blood flow to the skin.

2. The client needs an assist of two due to weakness.

3. Yes, nursing assistants can use more assistance than stated in the care plan, but never less.

4. Yes, ambulating with an assist of two is a better solution than wheeling her to the dining room because she is able to receive the benefits of exercise while remaining safe.

5. Safety interventions include locking the brakes of a wheelchair before the client stands; pulling the wheelchair behind the client; using a gait belt with an underhand grasp; ensuring that assistive devices are near and working properly; ensuring that the client has appropriate footwear; anticipating the distance the client may ambulate; communicating to the client during transfers and ambulation; and having one assistant on either side of the client, while keeping an underhand grasp on the gait belt.

6. Assistive devices include a gait belt and wheeled walker.

7. The nursing assistant can perform range-‐of-‐motion exercises and encourage the client’s participation in ADLs.


1. Independently 5. Digestive system

2. Nursing assistant 6. Cardiovascular

3. Ambulation, moving 7. One-‐assist

4. Self-‐esteem 8. Safety


1. d 5. c 9. a

2. c 6. c 10. a

3. b 7. d 11. b

4. a 8. b 12. d


1. c 2. a 3. c 4. b 5. d



1. D 2. C 3. B 4. A


1. Yes, he would benefit from physical therapy.

2. Physical therapy might work on balance, gait, transfer training, and fall prevention techniques. It would include ambulation, transfers, and strengthening exercises.

3. PT could help the client recover from the fractured femur and right hand injury.

4. Yes, he could benefit from occupational therapy.

5. OT might include ADL and IADL training in order for the client to return to his previous level of functioning. OT would work with the client to perform bathing, dressing, and grooming as well as strategies to perform tasks done at home like cooking or laundry.

6. OT could help the client recover from the right hand and brain injuries.

7. Yes, he could benefit from speech therapy.

8. ST could provide evaluation and treatment of clients who have cognitive disorders such as memory impairment. Deficits can be improved with sequencing and other memory exercises.

9. ST could help the client recover from the brain injury.

10. He might be interested in hunting, fishing, sports, reading, or carpentry work.

11. The nursing assistant can ask the client his interests and then encourage him to attend scheduled activities that involve those interests, find reading material pertaining to his interests, introduce him to other clients, and find games he can participate in with one hand.

12. Levels include love and belonging, self-‐esteem, and self-‐actualization.

13. The nursing assistant can perform range-‐of-‐motion exercises, ambulate the client, provide restorative care, and encourage independence.


1. Apraxia 5. Maximize

2. Neurologic damage 6. Physical therapist

3. IADLs 7. Occupational therapist

4. Laryngectomy 8. Family members


1. d 5. b

2. a 6. d

3. b 7. a

4. c 8. c


1. a 2. a 3. a 4. b



1. C 2. A 3. B


1. The nursing assistant should help the client with ADLs and grooming, provide nonpharmacological pain-‐relieving interventions, use active listening techniques, allow the client to express her feelings and concerns.

2. Yes, it needs to be reported.

3. The nurse should be informed of the client’s concerns and upset feelings. The nursing assistant needs to relay statements that the client has made and report the client’s demeanor and mood.

4. No, the prosthetic is normally fitted to the client about 6 weeks after the surgery to allow healing.


1. Mastectomy 5. Skin

2. Orthotic 6. Sock

3. Artificial 7. Hygiene

4. Daily living 8. Rubber-‐tipped spoon


1. d 5. b

2. c 6. a

3. a 7. c

4. c 8. d


1. d 2. a 3. b 4. d



1. H 5. A

2. B 6. C

3. G 7. D

4. E 8. F


1. Yes, it was an appropriate time, since the client was experiencing a change in his medical status. The information can then be given to the emergency team upon their arrival.

2. A full set of vital signs were taken.

3. The equipment needs to be cleaned with alcohol and probe covers discarded.

4. No, his temperature is 99.9 F. Normal for an axillary temperature is 97.6 F.

5. No, his pulse is 108. Normal pulse for an adult is 60–100 bpm.

6. Yes, his respirations are 14 per min. Normal is 12–20 per minute.

7. Yes, his O2 sat is within normal limits at 95%. Normal is 95%–100%.

8. No, his BP is elevated at 190/98. Normal is below 120/80.


1. Sixty 5. Painful

2. Bradypnea 6. Tachypnea

3. Hypertension 7. Stethoscope

4. Hypotension 8. Tachycardia


1. d 5. a

2. c 6. b

3. a 7. d

4. b 8. c


1. b 2. a 3. a 4. b



1. Peri-‐care: Washing the perineal area

2. Paraphimosis: The swelling that prevents the retraction of the foreskin back over the glans, or head, of the penis


1. The client has a UTI, which can lead to confusion in older adults.

2. No, the nursing assistant should stop the bath. Continuing with the bath may lead to an escalation in behavior.

3. Alternatives include a towel bath, a partial or complete bed bath, rinseless products, covering the client with a towel or bath blanket while washing, or shampooing while the client is dressed.

4. Interventions include shampooing the hair while the client is in bed, using a rinseless system such as a prepared shower cap, or using the beauty shop.

5. Duties may include obtaining the client’s weight, changing bed linens, hair care, doing a skin check, taking vital signs, and nail care.


1. Paraphimosis 6. Challenge 11. Room

2. Perineal 7. Empathetic 12. Showers or tub baths

3. Client 8. Privacy 13. Urethra

4. Partially bathed 9. Alternatives 14. Supplies

5. Skin 10. Rinseless


1. d 5. b 9. b 13. d

2. c 6. c 10. c 14. d

3. a 7. a 11. a

4. d 8. d 12. c


1. d 2. a 3. b 4. c 5. a



1. C 4. A

2. D 5. F

3. E 6. B


1. Allow the client to make choices regarding grooming and dressing, allow the client time to perform tasks, offer choices, promote independence by encouraging the client to perform tasks within her abilities, and acknowledge completed tasks and the client’s progress.

2. The nursing assistant should support the right arm and guide it through the sleeve of the shirt until the shirt is as far up the arm as possible. Then, bring the left arm through the left sleeve.

3. Help the client maintain her dignity and independence by asking how she would like her hair styled, offer to help with grooming, and acknowledge the client’s progress.

4. Encourage the client to wear her glasses as prescribed and ensure that the glasses are comfortable.

5. Ensure that the glasses are clean and that all pieces are intact. The nursing assistant also needs to check the skin behind the client’s ears.


1. Alopecia 6. Athlete’s foot 11. Hearing aid

2. Teeth 7. Independent 12. Surgical prep

3. Oral swabs 8. Two 13. Direction

4. Nails 9. Affected 14. Every night

5. Podiatrist 10. Soft cloth


1. d 6. b 11. d

2. c 7. d 12. c

3. d 8. c 13. a

4. a 9. a 14. c

5. b 10. b


1. b 2. c 3. d 4. c 5. d 6. c



1. C 6. E

2. D 7. A

3. G 8. F

4. B 9. H

5. I 10. J


1. Yes, it is a client’s right to make choices regarding the foods he wishes to eat.

2. The client can be encouraged to follow a healthy diet by reinforcing education the nurse has already provided. The nursing assistant can ask the client what foods would be acceptable as an alternative to the pizza.

3. If the client continues to refuse the supper offered, the nursing assistant needs to update the nurse and watch the client closely for signs of abnormal glucose levels.

4. He is ingesting simple carbohydrates.

5. He is eating pepperoni, which is a highly processed meat high in saturated fats.

6. Saturated fats can lead to atherosclerosis and high cholesterol.

7. Pepperoni and cheese are both protein sources.

8. They are not good protein sources, since both are high in sodium and fat.

9. The client might benefit from a diabetic or consistent carbohydrate diet to help control blood glucose levels, a low-‐fat or low-‐cholesterol diet due to his history of heart disease, and a low-‐sodium diet to control blood pressure.


1. Blood sugar 9. Encourages

2. Calories 10. MyPlate

3. Less 11. Starches

4. Hypervitaminosis 12. Water-‐soluble

5. Enzyme 13. Water

6. Dairy 14. Dialysis

7. Fat molecules 15. Grains

8. Malnutrition 16. Vegetables


1. d 5. c 9. c 13. a

2. a 6. a 10. a 14. c

3. c 7. b 11. b 15. c

4. b 8. d 12. d 16. a


1. c 2. c 3. d 4. a 5. b 6. d 7. b 8. b



1. C 4. B 7. I

2. E 5. A 8. F

3. G 6. H 9. D


1. The client is totally dependent for his daily care.

2. Yes, he is at risk for skin breakdown due to his colostomy, catheter, and immobility.

3. A catheter is placed when a client has urinary retention. This may have been caused by damage to the brain or spinal cord.

4. The catheter holder needs to be attached to either the client’s thigh or abdomen.

5. The nursing assistant can use medical tape to secure the catheter.

6. No, a leg bag is for clients who are ambulatory. The leg bag must be lower than the level of the bladder.

7. The nursing assistant needs paper towels, alcohol wipes, and a graduate.

8. Yes, the bowel movement still needs to be documented. If it is not, the client may receive unnecessary medication.

9. Colostomy care may be done with mild soap, water, and a washcloth.


1. Colostomy 9. Outside

2. Red 10. Elimination

3. Ileostomy 11. Incontinence garment

4. Hidden 12. Indwelling catheter

5. Abdomen 13. Males

6. Suppository 14. Catheter holder

7. Bladder 15. Times

8. Urinary retention 16. Hemorrhoids


1. d 5. c 9. c 13. a

2. a 6. b 10. c 14. b

3. b 7. d 11. b 15. d

4. a 8. a 12. d 16. c


1. c 2. a 3. d 4. c 5. b 6. c 7. d 8. a


30.A Definition

1. Urinary analysis: A test that looks for bacteria in the urine


1. The client might have a urinary tract infection. Symptoms include urgency, frequency, weakness, changes in urinary pattern, and hallucinations.

2. Directives include what the sample should be stored in, how to collect the sample, how much urine is needed, the appropriate time to collect the sample, and where the sample should be stored after collection.

3. A clean catch urine specimen is needed in order to test for bacteria present in the urine.

4. The client should sit on the toilet or commode. Then, cleanse the peri-‐area. The nursing assistant collects the urine after the client has started to void, stops, and then starts voiding again.

5. To prevent contamination, use a sample from the client and not the bedpan, urinal, or commode. The specimen cup should not touch any surface, including the client’s skin.


1. Urinary analysis 6. Contamination

2. Clean 7. Strain

3. Samples 8. Fecal samples

4. Biohazard 9. Special

5. Bedpan 10. Needs


1. d 6. a

2. a 7. d

3. d 8. a

4. c 9. b

5. b 10. d


1. a 2. b 3. c 4. b 5. d



1. B 2. C 3. A


1. Pneumonia is an acute respiratory illness.

2. Limited mobility and remaining in bed may lead to pneumonia.

3. The nursing assistant is responsible for a) changing the client from a portable cylinder to a concentrator and back again as needed; b) making sure that the oxygen is at the correct rate per care plan and alerting the nurse if it is not; c) ensuring that the cylinders and concentrator are in working order; d) monitoring for nosebleeds and dryness; e) alerting the nurse if the client has respiratory distress; f) checking behind the client’s ears for skin breakdown; and g) ensuring that cylinders have an adequate amount of O2 for activities.

4. The nursing assistant must ensure that there is adequate O2 in the cylinders for the time the client is away from the facility.

5. The nursing assistant needs to a) keep the concentrator away from curtains or linens; b) keep the concentrator at least 12 inches away from the wall and 5 feet away from heat sources; c) only use distilled water in humidification bottles; and d) remove the filter from back of concentrator, rinse with cool water, and dry thoroughly before replacing.

6. The nursing assistant can ensure that O2 is running at the ordered rate, use relaxation exercises, encourage positioning that eases breathing, answer the call light promptly, assure the client that assistance is available when needed, and anticipate client needs.

7. Exercises include cough and deep breathing and use of an incentive spirometer.

8. The nursing assistant is responsible for reinforcing any instruction already done by the nurse and reminding the client to do exercises as stated in the care plan or ISP.


1. Acute condition 7. Anxious

2. Long 8. Deep breathing

3. Incentive spirometer 9. Physician

4. Oxygen 10. Face mask

5. Drug 11. Continuous

6. Nasal cannula 12. Cylinders


1. c 4. d 7. b 10. a

2. b 5. d 8. a 11. b

3. a 6. c 9. c 12. d

31.E. Choose the best response to the following scenarios.

1. b 2. c 3. a 4. c 5. c 6. b



1. D 2. C 3. A 4. B


1. She is a surgical client.

2. Clients are placed on NPO status before surgery and remain NPO until the doctor or surgeon gives the order to advance the diet.

3. Clients typically remain NPO until they are able to pass flatus or bowel sounds are heard. She will be able to advance after the doctor or surgeon gives the order to do so.

4. Her activity level is limited to being repositioned every 2 hours.

5. She is at risk for pneumonia due to limited mobility and a possible reluctance to take deep breaths following surgeries to chest and abdomen.

6. She is at risk of developing blood clots due to limited mobility.

7. Sequential stockings force fluid and blood from the lower legs back to the heart, reducing the risk of blood clots.

8. The nursing assistant needs to avoid pulling or tugging on the IV and catheter.


1. Atelectasis 8. Doctor

2. Ambulatory surgery 9. Walking

3. Supports 10. Immobility

4. Blood clots 11. Cardiac

5. Acute care 12. Intravenous

6. Ears 13. Assesses

7. Medical 14. Resist


1. b 5. a 9. d 13. a

2. c 6. c 10. b 14. b

3. a 7. a 11. d 15. a

4. b 8. b 12. c 16. c


1. b 2. a 3. a 4. d 5. c 6. a 7. b


33.A Definitions

1. Communication disorder: A speech or language problem that results in impaired interactions with others

2. Autism: A neurological disorder that impairs communication and social interaction


1. Autism is a neurological disorder, not a communication disorder. Autism does impair communication and social interaction, however.

2. Interventions include using a picture board, asking the client to write down what he needs or wants on paper or a white board, or using a personal computer.

3. Autism is a neurological disorder. He also has a communication disorder, since he has a speech problem that results in impaired interactions with others.

4. The nursing assistant can help the client by being literal, speaking clearly and concisely, maintaining consistency, telling the client what to expect and when, and going slowly with tasks.


1. Autism 5. Training

2. Language 6. Hearing loss

3. Nursing assistant 7. Aphasia

4. Acquired 8. Misunderstood


1. c 2. b 3. a 4. a 5. c 6. d 7. b 8. b


1. a 2. c 3. b 4. d



1. D 4. B

2. F 5. A

3. E 6. C

34.B Reflective Short Answers

1. No, testicular cancer is not one of the most common cancers in the United States.

2. The tumor is malignant.

3. Indicators include a palpable growth in the testes or weight loss.

4. Zach’s cancer is a stage II. It is still confined to the area where the cancer originated.

5. Zach is suffering from nausea, vomiting, lack of appetite, risk of infection, and depression.

6. Yes, he could benefit from palliative care to relieve the symptoms and stress of dealing with cancer.


1. Cancerous 8. Genetics

2. Cancer 9. Catch

3. Substances 10. Inactivity

4. Spread 11. Biopsy

5. Palliative care 12. Individualized

6. Malignant 13. Chemotherapy

7. Region


1. c 6. a 11. c

2. d 7. c 12. d

3. a 8. b 13. a

4. b 9. d 14. b

5. c 10. a


1. c 2. b 3. d 4. a 5. c 6. a 7. c



1. A 2. C 3. B


1. HIV is the human immunodeficiency virus. AIDS is the end stage of an HIV infection. The body’s immune system is severely damaged and can no longer fight off infections and diseases. Symptoms become more pronounced.

2. The likeliest ways of contracting HIV are by having unprotected sex with an infected partner, having multiple sex partners, or sharing injectable drug paraphernalia.

3. The method of transmission should not matter to the healthcare professional.



6. She might experience diarrhea, fatigue, yeast infections, night sweats, fever, skin lesions, rashes, visual disturbances, cough, dementia, extreme weight loss, and possibly cancer.

7. She needs to use standard precautions, which is a routine aspect of healthcare practice.

8. No, she does not need to tell clients of her HIV-‐positive status.


1. End 5. T cells 9. Needlestick

2. HIV 6. AIDS 10. CDC

3. Purplish 7. Chimpanzees 11. Yourself

4. 1 million 8. Infected 12. Blood


1. d 4. a 7. b 10. d

2. a 5. c 8. b 11. c

3. c 6. d 9. a 12. a


1. c 2. c 3. b 4. d 5. a 6. d



1. B 2. A 3. C


1. She has Alzheimer’s disease.

2. No, the disease worsens over time and there is no cure.

3. A diagnosis of Alzheimer’s is only confirmed upon autopsy, which is when the plaques and tangles are identified.

4. She is likely in stage three: severe or late stage which includes severe mental decline and loss of physical functioning.

5. Symptoms include agitation, wandering, sleep disturbances, emotional upset, and impaired communication.

6. Unmet needs might include toileting, hunger, thirst, sensory activities, sleep or rest, or uncomfortable or wet clothing.

7. Interventions may include reminiscence, activity, or pet therapy.

8. Approach with a smiling face; a positive, respectful, and kind attitude; slow pace; and quiet temperament.

9. The nursing assistant can place a small nightlight in the client’s room, tend to sounding alarms promptly, and keep the client with her if the client wakes.

10. The client can be kept safe through the use of wander alert systems at each exit, special locked units, and gated courtyards or patios.

11. Stress may come from sleeplessness, financial strain, guilt, grief, and emotional pain. It is distressing to see a loved one change. He may doubt the decision because of Olga’s behavior in a new environment or may feel guilty about being unable to care for her.

12. Symptoms of caregiver strain include anxiety, depression, and exhaustion.


1. Memory 6. Healthy 11. Obsessed

2. Elopement 7. Autopsy 12. Sexual

3. Restlessness 8. Dementia 13. Memories

4. Alzheimer’s 9. Behaviors 14. Managed

5. Plaques, tangles 10. Unmet


1. d 5. d 9. d 13. c

2. b 6. c 10. c 14. a

3. c 7. b 11. d

4. b 8. a 12. b


1. c 2. b 3. a 4. b 5. d 6. c 7. b


37.A Definitions

1. Mottling: an appearance of purplish marbling on the skin as a result of poor blood flow to the extremities

2. Cheyne-‐Stokes breathing: a pattern of fast, shallow breathing followed by slow, deep breathing, with periods of apnea


1. The nursing assistant must be strong, supportive, and caring of both the client and the client’s family. The nursing assistant may use the privacy curtain or ask the family to step outside of the room while completing personal care.

2. He is experiencing Cheyne-‐Stokes breathing. The nursing assistant can explain that it is a pattern of fast, shallow breathing followed by slow, deep breathing, with periods of apnea. The nursing assistant can reassure the family that this is a normal stage in the dying process and that the healthcare team is keeping the client comfortable.

3. Yes, he likely is able to hear the chanting because hearing is the last of the senses to fade.

4. The chanting may provide him comfort as part of his religion and as a reassurance that family is near.

5. The chanting should be encouraged as long as it is not upsetting or harmful to the client and does not infringe on the rights of others in the building.

6. Yes, this may occur as digestion slows and the client is unable to take in food.

7. Yes, voiding may completely cease, as the urinary system slows and eventually stops.

8. The nursing assistant may apply oxygen as directed by the nurse, provide oral care and reposition the client frequently, and apply small amounts of K-‐Y Jelly® in the nares for comfort and to decrease the risk of nosebleeds.

9. He may find comfort in pictures or statues of Hindu gods.

10. The nursing assistant should accommodate the family’s vigil as long as it is not upsetting or harmful to the client and does not infringe on the rights of other clients in the building.

11. Answers among students may vary; the nursing assistant should be flexible, respectful, and not be judgmental of the client’s religion or lack thereof. She should not impose her religious beliefs on others.

12. They may be physically and emotionally exhausted or may feel upset, angry, guilty, depressed, or sad.

13. They may be angry at each other over past events. They might also be angry at the situation.


15. The nursing assistant should accommodate the family’s request. For a request such as placing the client on the floor after death, the nursing assistant should ask the nurse for directives.

16. Caregiving should be flexible in order to accommodate the client, the family, and his religion as long as it causes the client no harm and does not infringe on the rights of other clients.


1. Apnea 6. Cardiovascular

2. Mottling 7. Hearing

3. Physical 8. Decrease

4. Death 9. Religion

5. Honored 10. Doctor


1. b 5. d 9. b

2. c 6. c 10. c

3. a 7. a

4. b 8. d


1. b 2. a 3. c 4. a 5. d



1. B 2. D 3. C 4. A


1. He has a number of unexplained bruises and blood in the stool, which are signs of abnormal bleeding.

2. Yes, this could be from an anticoagulant. The most common oral anticoagulant is warfarin (Coumadin).

3. He may be straining with bowel movements. He should increase fluid intake and dietary fiber. He may also be eating foods high in vitamin K, so might need to reduce foods such as green leafy vegetables or broccoli.

4. All signs and symptoms of abnormal bleeding must be reported to the nurse promptly.


1. Adverse drug reaction 5. Nurse

2. Severe 6. Generic, trade

3. Two 7. Side effect

4. High 8. Anaphylaxis


1. a 5. d

2. c 6. a

3. c 7. c

4. b 8. b


1. b 2. a 3. c 4. d

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CNA fm new - augustlearningsolutions.com · Workbook%Answers%to%accompany%CNA:%NursingAssistant%Certification,FirstEdition% Lisa!Whitley,!RN,!ADN;!Candace!Barth,RN,!BSN;!and!Dr.!Carrie!Engelbright,RN,CNE,CWP!