Certified Nursing Assistant (CNA) Exam: Activities of Daily Living Concepts
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Overview
This chapter covers the everyday personal care a nurse aide gives: bathing, mouth and denture care, grooming, dressing, eating, toileting, and rest. Questions often ask what to do first, how to keep the resident safe, and how to protect dignity while helping.
Safety comes first in personal care. Check bath water temperature before the resident gets in, because older skin burns easily. Give mouth care to an unconscious resident with the resident on the side so fluid drains out of the mouth. Clean dentures over a sink lined with a towel or a little water, and store them wet in a labeled cup. Use an electric razor for residents who take blood thinners.
When dressing a resident with a weak side, dress the weak arm first and undress it last. For meals, sit the resident upright, offer small bites, and let the resident choose the order of foods. NPO means nothing by mouth, and thickened liquids are ordered for residents who have trouble swallowing.
For elimination, wipe from front to back and keep a urinary drainage bag below the bladder and off the floor. Clean catheter tubing from the body outward. Report unusual output such as black, tarry stool. To help prevent pressure injuries, reposition as the care plan says, keep skin clean and dry, and never rub reddened bony areas.
Key concepts
Weak side first
When dressing a resident with weakness on one side, put clothing on the weak arm or leg first and take it off the strong side first.
Memory tipDress weak first, undress strong first.
Unconscious mouth care
Mouth care for a resident who cannot swallow, done with the resident on the side and only a small amount of liquid so nothing runs into the airway.
Memory tipSide-lying so fluid drains out.
Denture care
Clean dentures over a sink lined with a towel or water, using cool or lukewarm water, and store them wet in a labeled denture cup.
Memory tipSoft landing, never hot water, always labeled.
NPO
A care order meaning nothing by mouth: no food and no drinks.
Memory tipNPO = nothing by mouth.
Thickened liquids
Liquids made thicker for residents with dysphagia (trouble swallowing), because they move more slowly and are less likely to enter the airway.
Memory tipDysphagia → thickened liquids, sit upright.
Urinary drainage bag
The bag on a urinary catheter, kept below the level of the bladder and off the floor so urine cannot flow back and the bag stays clean.
Memory tipBelow the bladder, off the floor.
Pressure injury
Skin and tissue damage caused by pressure, often over bony areas such as the tailbone, hips, and heels.
Memory tipTurn, keep dry, smooth sheets; never rub red spots.
Often tested
- Check bath water temperature before the resident gets in.
- Perineal care: wipe front to back, clean to dirty.
- Feed with the resident upright, in small bites, at eye level.
- Do not cut the toenails of residents with diabetes; tell the nurse.
- Report black, tarry stool to the nurse.
3 sample questions
Verified practice questions from this unit.
Question 1. A resident has weakness on the right side. When you help her put on a shirt, which arm should go into a sleeve first?
- ① Whichever arm the aide finds easier
- ② The left (strong) arm
- ③ The right (weak) arm
- ④ Both arms at the same time
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Answer: ③ The right (weak) arm
Key point: Dress the weak side first; undress the strong side first
Dress the weak (affected) arm first and undress it last. The weak arm cannot bend or reach well, so it goes into the sleeve while the shirt is loose. The strong arm can then move into its sleeve easily.
Wrong choices
- Whichever arm the aide finds easier: The rule is based on the resident's weak side, not the aide's preference.
- The left (strong) arm: The strong arm can bend and reach, so it goes in last and comes out first.
- Both arms at the same time: Putting both arms in at once pulls on the weak arm and is hard to control.
Question 2. Before helping a resident into a tub bath, what should the aide do first?
- ① Add bath oil to the water
- ② Leave the resident to undress alone
- ③ Fill the tub to the very top
- ④ Check the water temperature
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Answer: ④ Check the water temperature
Key point: Check water temperature before any bath
Older skin burns easily and some residents cannot feel heat well. Always check the water temperature with a bath thermometer or the inside of your wrist before the resident gets in. Many programs also let the resident test the water to make sure it is comfortable.
Wrong choices
- Add bath oil to the water: Bath oil makes the tub slippery and is not a safety step.
- Leave the resident to undress alone: Staying close keeps the resident safe from falls.
- Fill the tub to the very top: A very full tub can overflow and is not needed for a safe bath.
Question 3. When giving perineal care to a female resident, in which direction should the aide wipe?
- ① From back to front
- ② Back and forth with the same part of the washcloth
- ③ From front to back
- ④ In circles starting at the anus
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Answer: ③ From front to back
Key point: Perineal care: front to back, clean to dirty
Wipe from front to back (from the urinary opening toward the anus) and use a clean part of the washcloth for each stroke. This moves from the cleanest area to the dirtiest area and helps prevent urinary tract infections.
Wrong choices
- From back to front: Wiping back to front carries germs from the anal area toward the urinary opening.
- Back and forth with the same part of the washcloth: Reusing the same part of the cloth spreads germs.
- In circles starting at the anus: Starting at the anus spreads germs to cleaner areas.
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