Sorrentino: Mosby's Textbook for Nursing Assistants, 8th Edition

Scenarios in Practice

Critical Thinking Scenarios With Suggested Answers

Chapter 2: The Person’s Rights

You are assisting a person with range of motion (ROM) exercises. The person does not want to
participate and tells you to leave the room. Does the person have the right to refuse? What will
you do? Does the nursing center have to take action?

The person has the right to refuse. You should reintroduce the action at a later time. Report the
refusal to the nurse. The nursing center may have to take action if the person is there to receive
rehabilitation care. If a person will not perform certain tasks to assist in maintaining or
improving his or her health status, the nursing center could become liable. The physician may
need to become involved to reevaluate goals of care for the person.

Chapter 4: Ethics and Laws

During morning care, a coworker is heard telling a resident, “If you wet your pants again, I will
not lay you down after lunch.” What type of abuse does this statement represent? What should
you do?

This is mental abuse. You should tell your coworker that this is not something he or she should
say to the resident. Confirm that the person is okay. Reassure the person that you will help. You
should report this to the nurse immediately. The nurse will follow up and interview the person
and communicate this with his or her supervisor.

Chapter 4: Ethics and Laws

You and a coworker are assisting a resident in the shower. You go to the resident’s room to get
her sweater. When you return, you enter the shower room and see your coworker spraying the
resident in the face with the water nozzle. Is this a type of abuse? What will you do next?

Yes, this is physical abuse. Go into the shower room and immediately stop the coworker’s
actions, turn the call light on, get help finding the nurse, and report what has occurred. Do not
leave the resident alone with the coworker.

Chapter 5: Work Ethics

The nursing center has four scheduled CNAs assigned to the wing in which you are working.
You are assigned to a resident who is combative and a fall risk. One of your coworkers walks
past your combative resident’s room and sees the resident trying to get out of bed. What should
your coworker do first? What safety concerns must be monitored? How could the coworker
display teamwork in this situation?a

Your coworker should go to the resident’s bedside and attempt to meet his or her needs. Safety
of the resident and employee is important. Protecting the resident from a fall or skin tears is a
priority. The employee avoiding harm is important as well. Even though the coworker is not
assigned to the resident, he or she still worked as part of the team to care for and ensure the
safety and satisfaction of the resident. The CNA could sit with the resident and assist with
toileting or other personal care needs.

Chapter 5: Work Ethics

At a local nursing center, your coworker reports negative information about your work
performance. The nurse approaches you about this information. How will you explain your
performance to the nurse?

You should answer in an honest approach that is factual and describes your interpretation of your
performance, including an ethical description of your care. You could suggest that the nurse
speak to the residents to help support the fact that these are false allegations.

Chapter 6: Communicating With the Health Team

You are working at a nursing center and performing perineal care. You observe moderately sized
red discoloration located on your resident’s inner thigh. When will you report this finding? To
whom will you report this? How will you describe the discolored areas?

You should report the finding of discolored skin as soon as you have completed the task and the
resident is safe and comfortable. You should inform the nurse first, then anyone caring for the
resident. Use common items, such as a quarter, to describe the size. The location in this case is
the medial upper aspect of the inner thigh.

Chapter 15: Preventing Infection

You are caring for a person with an upper respiratory infection. You have been in the room
assisting the person numerous times during the shift. As you leave the room, you cannot
remember if you have performed hand hygiene. What action will you take? How could forgetting
this skill harm the person and others?

Immediately perform hand hygiene. Forgetting the basic skill of hand hygiene could be lethal.
The infection could be spread to people with lower immune systems and make them ill. This
carelessness could also infect other people who are providing care. Understanding the chain of
infection and methods of transmitting microbes is mandatory.

Chapter 15: Preventing Infection

You are assigned to care for a person being treated for a methicillin-resistant Staphylococcus
aureus (MRSA) infection in a wound. The nurse has provided you with little information as to
what type of precautions you should take. What questions will you ask to learn the proper way to
assist this person?

What type of personal protective equipment (PPE) is necessary to care for this person? Is the
wound the only source of infection? The nurse will explain that it is a contact isolation needing
glove and gown application with proper hand hygiene. The source is located in a wound.

Chapter 16: Body Mechanics

A person for whom you are caring reports being uncomfortable as she rests in bed. She is in the
supine position. What will you do to make her more comfortable?

Reposition the person so she is not on her back (e.g., lateral, Sims’, or Fowler’s position). Lateral
is side lying, Sims’ is on the stomach with one knee pulled up toward the chest, and Fowler’s is a
position with the head of the bed at a 45- to 60-degree angle. Place pillows near bony areas, such
as between her knees and behind her back.

Chapter 17: Safely Moving and Transferring the Person

You are assisting a person with a transfer from the wheelchair to the bed. During the transfer the
person starts to fall. What equipment must be in place to ensure the person’s safety? What should
you do?

Nonslip shoes, a gait belt or safety belt, and locks on the wheelchair are all important pieces of
safety equipment. While holding onto the gait belt, gently lower the person to the floor if unable
to balance the person and put him or her back into the wheelchair. If you lowered the person to
the floor, turn on the call light to get assistance. You may need to use a mechanical lift to assist
the person off the floor. If you placed the person back into wheelchair, reassure him or her.

Chapter 17: Safely Moving and Transferring the Person

A totally dependent person can only be transferred using a mechanical lift. It is time to get the
person up to go to the dining room. What safety checks will you perform to ensure that the lift is
ready? How will you prepare the person?

The mechanical lift’s battery strength should be sufficient to perform the lift. Use the proper size
of sling. Place the sling straps securely into the sling hooks and equally on both sides. The proper
number of people to operate the lift should be present. Two people may be required to position
the person on the sling. Position the person comfortably into the sling and centered. With the lift
placed over the person, attach the sling to the sling hooks. Two people performing the transfer
will ensure the safety of the person. One person directs the lift, and the other ensures that the
person does not have problems while in the lift.
Chapter 17: Safely Moving and Transferring the Person

You are caring for a person with weakness on the left side. You are to assist the person into a
wheelchair in preparation for lunch. What steps will you take to ensure a safe transfer to the
wheelchair?

Position the wheelchair to the person’s strong side, or the right side in this case. Use a gait belt,
wear nonslip shoes, and lock the wheels on the wheelchair. Good communication between you
and the person will help you move him or her safely.

Chapter 19: Bedmaking

A totally dependent person is scheduled for a complete bed linen change this morning. You are
the CNA assigned to perform this task. What items should you bring to the room to complete this
task? What safety concerns should you consider while performing this task?

You need a complete set of bedding and a bath blanket. A complete set of bedding consists of a
bottom sheet, top sheet, blanket, bedspread, and pillow case. You can use a mattress pad,
waterproof pad, and cotton draw sheet if necessary. For safety, log-roll the person while
changing the sheet. Use side rails or have another person help to make the task as safe as
possible.

Chapter 20: Personal Hygiene

You are caring for a person with dentures. The person is not able to remove the dentures for you.
How will you remove the dentures? After you remove the dentures, where will you put them?

Using a piece of gauze, rock the dentures out of the roof of the mouth and then from the bottom
of the mouth. Place the dentures in a denture cup or kidney basin.

Chapter 20: Personal Hygiene

The person living at the nursing center is to be bathed this evening. The person is not allowed to
shower and is totally dependent. How will you provide a complete bed bath? How will you
ensure privacy during this process?

You can bathe the person in bed. The complete bathing process uses a head-to-toe process and
involves washing the face (paying close attention to the eyes), neck, arms, armpits, chest, legs,
feet, back, buttocks, and perineal area. You can shave, provide oral care, and comb the person’s
hair during this process. Close the curtains or door, and use towels and bath blankets to cover the
body parts not being washed. Providing warmth to the person you are bathing is also important.

Chapter 20: Personal Hygiene

During a shower, the person living in a nursing center depends on the CNA to perform most
aspects of the task. How do you allow the person to help care for himself or herself? How do you
do this and maintain safety?

Communicate before the shower about getting the person involved. While the person is in the
shower, ask him or her about the water temperature. Help him or her with the wash cloth, and
use the hand-over-hand technique if needed to help the person wash his or her face. Many times
the person can do a lot of the upper body care but need more assistance with the legs and
perineal area. The person may not do the most efficient cleaning, and it may take good
communication to let him or her try and then let you finish the task. Constant assistance as
necessary will help ensure safety. The person cannot be allowed to stand.

Chapter 20: Personal Hygiene

As you check one of the persons to whom you are assigned in the nursing center, you observe
that the person has had an incontinent stool. How will you explain to the person what needs to be
done to care for the incontinence?

You must make the person aware that he or she has had an accident in the incontinent pad, the
undergarments need to be removed, and you will need to help him or her clean up the accident.
Many times this is a dignity issue. The way you express the steps of care is important. The
person must not feel bad about the need for help. It is a delicate situation.

Chapter 21: Grooming

You are caring for a person who needs to be dressed after a bath. This person has arm weakness
on the right side. How will this affect dressing this person?

Place the weak arm into the garment first and the strong arm last. This will create confidence in
the person and make it less challenging to get the person dressed.

Chapter 24: Nutrition and Fluids

The person for whom you are caring had the following for breakfast: 4 fl oz of milk, 6 fl oz of
coffee, scrambled eggs, and one piece of toast. The person voided 4 fl oz of urine this morning.
What is the person’s fluid intake in milliliters? What is the fluid output in milliliters?

Intake = 4 fl oz + 6 fl oz = 10 fl oz × 30 = 300 ml

Output = 4 fl oz × 30 = 120 ml

Chapter 26: Measuring Vital Signs

The nurse asks you to obtain a complete set of vital signs for one of the persons to whom you are
assigned. The measurements are as follows: temperature 101.5º F, heart rate 104 beats/min,
respiratory rate 22 breaths/min, and blood pressure 90/60 mm Hg. Which of these vital signs are
of concern? What subjective data could be stated? What is your first action after collecting these
vital signs?

All of these vital sign measurements are abnormal. Ask the person about pain or any other
unusual feelings. Report the vital signs and any other abnormal subjective data (e.g., feeling of
dizziness or sweatiness) to the nurse immediately.

Chapter 27: Exercise and Activity

A person living at the nursing center needs passive range of motion (ROM) exercise. You are the
CNA assigned to the person. The nurse communicates to you that the person has restricted
movement to the right hip. How will the restriction change the ROM exercise for this person?

ROM exercise is performed with from head to toe. The neck, arms, and legs are exercised. All
joints are moved with support and never to the point of pain. Each ROM repetition is 3 to 5
cycles. ROM exercise includes all areas of the body, but with this person, do not perform flexion,
extension, abduction, and adduction of the right hip.

Chapter 27: Exercise and Activity

A dependent resident is to ambulate four times a day. The resident is resting in bed. You are to
walk with the person for the first time. What steps will you perform to ensure safety during
ambulation?

Discuss with the nurse any significant activity restrictions. You should dangle the person from
the bed, apply a gait belt, wear nonslip shoes, and use a walker. Having another person walk
behind you and the person with a wheelchair may help ensure safety; if the person becomes tired,
he or she can sit down immediately.

Chapter 29: Admissions, Transfers, and Discharges

During the admission of a new person to the nursing center, you are asked to obtain her height
and weight. The person is unable to stand. How will you measure and weigh this person?

You can use a measuring tape to measure height and a wheelchair scale to measure weight. Zero
out the wheelchair scale and then weigh the wheelchair separately. Subtract the wheelchair
weight from the total weight calculated on the scale.

Chapter 46: Confusion and Dementia

As you approach a person who suffers from memory loss, the person becomes more anxious
around 4 PM. The person appears to be extremely tired and afraid. What behavior is the person
displaying? What will you do to help the person?
This behavior is known as sundowning. Validation therapy, one-on-one care, reassurance,
distraction, and recollection of past memories from a memory box are several helpful strategies.

Chapter 52: End-of-Life Care

A person is exhibiting signs of physical failure. The family and the person may not understand
the dying process. The person states, “Let me live to see my grandson graduate.” What stage
does this statement represent? What does this statement represent to the family?

This statement represents bargaining. The person wants to see one more significant event. The
family feels that their loved one has hope but also that he or she is considering that the end is
near.