questions

•You find your patient unresponsive and not breathing. You should immediately:
Yell for help

Rationale: An unresponsive patient should never be left alone. Yell for help immediately and the nurse will respond to the patient and begin CPR if the patient’s living will allows him/her to do so.

•You notice your patient is having trouble speaking and they aren’t able to use their left arm very well. You notify the nurse immediately because your patient may be having:
A stroke

Rationale: Signs of a stroke including trouble speaking, weakness on one side of the body, facial drooping, confusion and trouble seeing. Any of these signs should be reported to the nurse immediately for evaluation. The longer a stroke goes untreated, the more damage there is. If a stroke can be treated within 90 minutes, the patient has a very good chance of not having any permanent deficits.

•You would immediately notify the nurse of:
A pulse of 41

Rationale: A pulse of 41 is low. Normal pulse rate should be between 60 and 100 beats per minute. The lower the pulse, the less the heart is perfusing blood to the rest of the body. Because oxygen is in your blood, your body is also not getting enough oxygen. Although this low heart rate may be normal for some patients, it is for the nurse to decide if it normal so he/she should be notified immediately.

•CNA's should renew their CPR card every:
2 years

Rationale: Because a CNA may play a part in performing CPR on a patient that is in cardiac arrest, he/she must renew their CPR card every 2 years. The quicker CPR is performed on a dying patient, the better chance that patient has of living without any permanent damage. Many facilities require that you have your CPR card and will pay for you to take the class and keep your card up to date.

•The following is considered a medical emergency:
Blood in stool

Rationale: Blood in the stool signifies that the patient is bleeding somewhere. Although the bleeding could just be from a hemorrhoid, the patient should be checked by a physician to make sure they are not bleeding somewhere internally, like the intestines or stomach. If you find a patient with blood in their stool, notify the nurse immediately. Make sure not to flush or dispose of the stool because the nurse will need to assess it.

•Your patient rings his call light and tells you that his chest hurts. Your first action is to:
Notify the nurse immediately

Rationale: Chest pain is a sign of a something serious, like a heart attack. The CNA should notify the nurse of the patient's complaint so he/she can access him and take further action. The CNA is not allowed to assess the patient or begin treatment themselves. Even if the CNA thinks it is nothing, they must notify the nurse to investigate.

•You notice that your patient's urine has been darker and has a foul odor. You notify the nurse of this change because it is a sign of:
Urinary tract infection

Rationale: Sign of a UTI are burning during urination, dark urine, frequent urges to urinate and foul smelling urine. If left untreated, a UTI can turn into a kidney infection, or even kidney failure. In older patients, UTI's often make them confused and disoriented. If you have an older patient that is confused or disoriented, check their urine for any changes and report them to the nurse.

•You enter a patient's room to find them not breathing. They are a DNR. This means that you should now do which of the following:
Yell for the nurse, but do not start CPR

Rationale: When a patient signs a DNR, this means they do not want extraordinary measures taken to save them in case of severe illness or death. It is the nurse's ultimate decision and knowledge to decide whether or not CPR is to be performed, but if there is a signed and legal DNR, CPR is not performed. Yell for the nurse immediately and let him or her decide the next course of action.

•If you discover a fire, you should R.A.C.E. R.A.C.E. stands for:
Rescue, alarm, contain, evacuate

Rationale: According to OSHA fire safety, R.A.C.E. is the acronym that should be following in case of a fire. Rescue any patients in the vicinity of the fire that it could immediately danger (without injuring yourself), alarm the building, contain the fire by closing doors and windows and evacuate the building of all patients, employees and visitors.

•You are assigned to a patient that is prone to having seizures. As a nursing assistant, you are most concerned about the patient's:
Safety

Rationale: The nursing assistant should be constantly aware of the safety of any patient, but especially for one with a history of seizures. Look around the room for anything that could be dangerous if a patient begins to seize, and make sure the siderails of the bed are padded if this is allowed at your facility. It is the responsibility of all employees to make sure every patient is safe, but as a nursing assistant, this will be your priority with this type of patient.

•You are assigned to a patient who has lost a lot of blood due to a tear in his intestine. He is receiving blood for the first time. When changing him, you notice he has a new rash. You notify the nurse immediately because he:
Could be having a reaction to the blood he is receiving

Rationale: Although most patients don't have reactions to receiving blood, it does occur. The nurse will stay with the patient and monitor him/her for several minutes initially to make sure nothing negative occurs. A rash is one of the first signs that the body is having a reaction to something, and if the patient is reacting to the blood, this could have deadly results.

•Your patient is a diabetic and tells you that they think their sugar is getting low. You should:
Notify the nurse

Rationale: Diabetic patients often can sense when their blood sugar isn't right. The nursing assistant should immediately notify the nurse and she can delegate a further course of action. Some nursing assistants are allowed to check a patient's blood sugar. This will be the first step. The nurse may then ask you to get the patient some orange juice to raise their blood sugar if it is low. No steps should be taken by the nursing assistant without the approval by the nurse.

•While bathing a patient, she tells you she is going to take all of her medication today because she just wants to die. You react by:
Having someone else notify the nurse while you stay with the patient

Rationale: Whenever a patient threatens to harm themselves, they should never be left alone. The nurse should be notified immediately so he/she can further assess the patient. No matter how small the threat may be, it should always be taken seriously. The nursing assistant isn't allowed to remove the patient's medications or dispose of them, so just stay with the patient until you are given further instructions by the nurse.

•While you are taking vital signs on a patient, you notice the patient's pulse is jumping from 90 to 120 beats per minute on the machine you're using. Your next action should be:
To manually check the patient's pulse

Rationale: Because machines can always dysfunction, the nursing assistant should manually check the pulse before reporting it to the nurse. There are certain heart conditions where the pulse can jump like what was mentioned, but these can only be determined by a physician. If the manual re-check is similar to what the machine said, notify the nurse immediately.

•You are taking care of a patient that hasn't voided at all during your 12 hour shift. You notify the nurse knowing that the next step is:
Insert a catheter

Rationale: Urinating is the body ways of removing toxins. If these toxins aren't removed, they are harmful to the patient. An average of 30ml per hour is normal urine output, and no output for 12 hours is something that should be dealt with immediately. CNA's generally aren't allowed to insert catheter, but often must assist the nurse with the procedure. Inserting a catheter will show whether the patient just can't begin the urination process, or if they are not making any urine. Both should be treated urgently.