Certified Nursing Assistant (CNA) Exam Activities of Daily Living Summary

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.

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.

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.

Sitting upright helps food and fluids go down the throat to the stomach instead of into the airway. Raise the head of the bed so the resident sits up as straight as possible, or help the resident sit in a chair, as the care plan allows.

Wrong choices

• Flat: Eating while lying flat greatly raises the risk of choking.
• Lower than the feet: Having the head lower than the feet is unsafe for eating.
• Raised only a few inches: A small raise still leaves the resident almost lying down, which makes choking more likely.

Urine must drain downhill. Keep the bag below the bladder so urine cannot flow back, and keep it off the floor to keep it clean. Hang it on the bed frame, not on a side rail that moves.

Wrong choices

• On the bed above the resident's hip: Above the bladder, urine can flow back into the bladder and cause infection.
• On the resident's stomach: This is above the bladder and lets urine flow back.
• On the floor next to the bed: The floor is dirty, and germs can get onto the bag.

Pressure injuries form when pressure cuts off blood flow, often over bony areas such as the hips, tailbone, and heels. Do not massage reddened bony areas, because rubbing can damage the tissue more. Report redness to the nurse. Turning, clean and dry skin, and smooth linens all help.

Wrong choices

• Keeping sheets smooth and free of wrinkles: Wrinkles press into the skin, so smooth sheets are correct.
• Keeping the skin clean and dry: Moisture damages skin, so keeping it clean and dry is correct.
• Repositioning the resident as often as the care plan says: Regular turning relieves pressure and is correct.

An unconscious resident cannot swallow or cough well. Turning the resident on the side with the head turned lets fluid run out of the mouth instead of into the airway. Use only a small amount of liquid on a swab, and never put your fingers in the resident's mouth.

Wrong choices

• Face down on the stomach: Face down makes it hard to see the mouth and can block breathing.
• Sitting straight up in a chair: An unconscious resident cannot sit safely in a chair.
• Flat on the back with no pillow: Lying flat on the back lets fluid run into the throat and airway.

NPO comes from Latin words meaning nothing by mouth: no food and no drinks, often before a test or surgery. Remove the water pitcher if instructed, and tell the nurse if the resident asks for something.

Wrong choices

• Clear liquids only: Clear liquids are a different diet order.
• Push fluids: 'Push fluids' means encourage extra drinking, the opposite of NPO.
• Soft foods only: A soft diet is a separate diet order.

Dentures are expensive and break easily if they hit a hard sink. A towel or a little water in the sink gives a soft landing if they slip. Clean them with cool or lukewarm water, because hot water can warp them.

Wrong choices

• To make the dentures whiter: Lining the sink has nothing to do with color.
• To soften the denture adhesive: The towel or water does not soften adhesive.
• To keep the cleaning water warm longer: Warm water is not the goal; hot water can actually warp dentures.

People with diabetes often have poor circulation and less feeling in their feet. A small cut can become a serious infection. Nurse aides do not cut the toenails of residents with diabetes or poor circulation; report the request to the nurse.

Wrong choices

• File them down with a sharp metal tool: A sharp tool can injure the skin and is not the aide's task here.
• Soak her feet in very hot water first: People with diabetes may not feel heat well, so hot water can burn them.
• Cut them straight across with clippers: Even careful cutting can cause a small cut that heals poorly in a person with diabetes.