Restorative Care Practice Test

Answer: D — Range of motion exercises move each joint through its full natural arc of movement to maintain flexibility, prevent stiffness, and avoid contractures - the permanent and painful shortening and tightening of muscles, tendons, and joint capsules that occurs when joints are not moved regularly. Contractures can develop in as little as a few days of immobility and once fully formed are often irreversible. ROM exercises are especially critical for immobile or bed-bound residents and are a core component of restorative care provided by CNAs.

Answer: D — In passive ROM, the CNA performs all the movement for the resident because the resident is unable to move the joint on their own due to paralysis, unconsciousness, extreme weakness, or medical restriction. The CNA gently moves each joint through its complete range while supporting the limb above and below the joint. Passive ROM prevents contractures and maintains joint mobility but does not build muscle strength since the resident muscles are not actively contracting during the exercise.

Answer: A — In active-assistive ROM, the resident actively participates by moving the joint as far as they can using their own muscle strength, and the CNA provides gentle assistance to complete the remaining range that the resident cannot achieve independently. This type of ROM is ideal for residents who have some ability to move but lack the full strength or range to complete the motion. It promotes independence, maintains muscle function, and encourages the resident to do as much as possible on their own.

Answer: A — ROM exercises must always be performed slowly, gently, and smoothly - supporting the limb both above and below the joint being moved. The CNA should move each joint through its full comfortable range but must NEVER force a joint past its natural point of resistance or continue if the resident reports pain. Forcing movement can cause muscle tears, ligament damage, joint dislocation, or fractures - especially in elderly residents with osteoporosis or fragile tissues. Pain is a signal to stop immediately and report to the nurse.

Answer: C — ROM exercises should be performed at least twice daily (often during morning care and bathing) or as frequently as specified in the individual resident care plan. Consistency is critical because joints can begin to stiffen and contractures can start forming within just a few days of immobility. Each exercise session typically involves moving each joint through its full range 3 to 5 repetitions. The CNA should coordinate with the nursing and therapy team to ensure the exercise program is followed consistently.

Answer: C — A complete ROM program addresses ALL joints in the body - neck, shoulders, elbows, wrists, fingers and thumbs, hips, knees, ankles, and toes. Even small joints like fingers and toes can develop contractures that significantly impact function (inability to grip utensils, difficulty wearing shoes). Exercising only large joints or only the affected side leaves other joints vulnerable to stiffness and contracture formation. The care plan will specify which joints to exercise and any restrictions or precautions for specific joints.

Answer: A — Occasional cracking or popping sounds (called crepitus) in joints during movement are common, especially in elderly residents, and are often caused by gas bubbles in the joint fluid or ligaments shifting over bony surfaces. If the resident reports no pain, the CNA can continue the exercises gently. However, the observation should be reported to the nurse because persistent crepitus can sometimes indicate cartilage damage, arthritis progression, or other joint pathology that the care team should be aware of.

Answer: C — The correct ambulation sequence with a standard walker is: (1) the resident lifts and advances the walker about one arm length forward and sets it down firmly on all four legs, (2) steps forward with the weaker leg first into the walker, then (3) follows with the stronger leg. The resident should stand upright inside the walker - not lean forward over it - and should look ahead rather than down at their feet. The CNA walks slightly behind and to the side of the resident weaker side, using a gait belt for safety.

Answer: B — The cane must always be held on the OPPOSITE side of the weak or injured leg. If the right leg is weak, the cane goes in the left hand. This biomechanical principle creates a wider and more stable base of support by distributing the resident weight across both sides. The cane and the weak leg move forward together, then the strong leg follows. Holding the cane on the same side as the weak leg actually reduces stability and increases fall risk because the support is not counterbalanced.

Answer: D — Before any ambulation, the CNA must: check the care plan for specific activity orders and weight-bearing restrictions, assess the resident current condition (vital signs, pain level, dizziness, medication effects), apply non-skid footwear (never barefoot or in socks alone on smooth floors), apply a gait belt for safety, clear the walking path of obstacles, and ensure the mobility aid is the correct height and in good condition. Skipping any of these steps significantly increases fall risk. A resident condition can change daily, so assessment before each ambulation is essential.

Answer: C — When a resident shows signs of distress during ambulation - dizziness, pallor, sweating, weakness, or feeling faint - the CNA must stop walking immediately, support the resident using the gait belt, and safely lower them into the nearest chair or wheelchair. If no chair is available, gently ease them to the floor using proper body mechanics. Stay with the resident, call for help using the call system or by asking a passerby, monitor their condition, and do not attempt to resume ambulation until the nurse has assessed and cleared them.

Answer: B — Proper wheelchair positioning includes: feet supported on footrests (feet dragging on the floor can catch and cause injury or tip the chair), brakes locked whenever the wheelchair is stationary (unlocked brakes cause the chair to roll during transfers leading to falls), a seat belt or positioning device applied only if specifically ordered in the care plan, the resident sitting upright with hips back in the seat, and the wheelchair cushion in place to prevent pressure on the coccyx. The CNA should check wheelchair safety and positioning regularly.

Answer: B — The CNA role with orthotic devices (braces, splints, AFOs) is to follow the care plan instructions for when and how to apply and remove the device, ensure it is positioned correctly as taught by the therapist, check the skin underneath regularly for redness, irritation, pressure marks, or skin breakdown, keep the device clean, and report any problems (skin issues, poor fit, resident complaints) to the nurse and therapy team. The CNA should NEVER modify, adjust the fit of, or discontinue use of an orthotic device - these decisions belong to the physical therapist and physician.

Answer: C — Built-up handles (also called padded handles or ergonomic grips) are thicker, cushioned handles added to forks, spoons, knives, toothbrushes, and pens to make them easier to grasp for residents with weak grip strength, limited finger dexterity, arthritis, or conditions that affect hand function such as stroke or Parkinson disease. The larger diameter requires less finger strength to hold securely. These adaptive devices promote independence in eating and grooming rather than requiring the resident to be fed or assisted with every task.

Answer: A — A plate guard is a curved plastic or metal rim that clips onto the edge of a standard plate, creating a raised wall that prevents food from being pushed off the plate during self-feeding. It is especially useful for residents who eat with one hand (such as after a stroke), residents with limited coordination, or those with tremors. The resident can push food against the guard to load it onto the utensil independently. This simple device significantly increases self-feeding independence and preserves the resident dignity during meals.

Answer: D — Grab bars are safety devices mounted on bathroom walls near the toilet, shower, and bathtub to provide stable handholds that residents can grasp for support during transfers (sitting down and standing up from the toilet), entering and exiting the shower or tub, and maintaining balance on wet slippery surfaces. They significantly reduce fall risk in the bathroom - one of the most dangerous areas in any healthcare facility or home. Grab bars must be securely anchored to wall studs and should be checked regularly for looseness.

Answer: C — A long-handled reacher (also called a grabber or reaching aid) is a lightweight tool with a trigger grip and a grasping claw at the end that extends the resident reach by 2 to 3 feet. It helps residents with limited range of motion, back or hip restrictions (such as after hip replacement surgery where bending past 90 degrees is prohibited), wheelchair users, or anyone who cannot safely bend down or reach overhead. Common uses include picking up dropped items, retrieving clothes from closets, and pulling objects from high shelves.

Answer: D — Bladder retraining is a structured program that establishes a regular toileting schedule - initially offering the resident the opportunity to use the toilet at frequent fixed intervals (such as every 1 to 2 hours). As the resident regains bladder control, the intervals are gradually lengthened to retrain the bladder to hold larger volumes for longer periods. The CNA plays a critical role by ensuring the resident is offered toileting assistance on schedule, encouraging participation, and documenting the results. This program avoids unnecessary catheter use which increases infection risk.

Answer: A — Prompted voiding is a behavioral technique specifically designed for residents with cognitive impairment who may not recognize or communicate the need to urinate. The CNA approaches the resident at regular intervals (typically every 2 hours), asks if they need to use the bathroom, encourages them to try even if they say no, praises successful toileting, and documents the results. This approach respects the resident dignity, promotes continence, reduces incontinence episodes, and avoids the physical and psychological harm of unnecessary catheterization or adult briefs.

Answer: B — Bowel training programs establish a consistent daily toileting schedule that takes advantage of the gastrocolic reflex - a natural increase in intestinal activity that occurs 20 to 30 minutes after eating, especially after breakfast. By positioning the resident on the toilet or commode at this optimal time each day, the body is trained to expect and produce a bowel movement on a regular predictable schedule. The CNA should also ensure adequate fluid intake, encourage fiber-rich foods as approved in the diet, and promote physical activity to support healthy bowel function.

Answer: A — Proper fluid management is essential for both bladder and bowel health. The CNA should encourage adequate fluid intake distributed throughout the day (typically offering fluids every 1 to 2 hours), follow the care plan for any specific fluid requirements or restrictions, track intake and output when ordered, and reduce (but not eliminate) fluid intake in the evening hours to minimize nighttime incontinence. Restricting fluids without orders causes dehydration, concentrated urine, constipation, and urinary tract infections. Thirst is an unreliable indicator of hydration in elderly residents.

Answer: D — The CNA is a vital member of the rehabilitation team who supports and reinforces the work done by physical and occupational therapists. This includes encouraging the resident to practice prescribed exercises as instructed, using proper techniques during ADLs that align with therapy goals (such as maintaining hip precautions), promoting independence in daily tasks, providing positive reinforcement and motivation, and reporting the resident progress, difficulties, or complaints to the nurse and therapy team. The CNA should never design or modify exercise programs independently.

Answer: B — The physical therapist (PT) specializes in evaluating and treating problems with movement, mobility, strength, balance, endurance, and physical function. PTs design individualized exercise programs, teach safe transfer and ambulation techniques, use therapeutic modalities (heat, cold, electrical stimulation, ultrasound), and work to restore the resident maximum physical independence. The CNA supports the PT by reinforcing prescribed exercises, following mobility and weight-bearing instructions in the care plan, and reporting the resident response to activity.

Answer: B — The occupational therapist (OT) specializes in helping residents regain or maintain the ability to perform activities of daily living (ADLs) such as eating, dressing, bathing, grooming, and toileting. OTs evaluate functional abilities, recommend and train residents on adaptive devices (built-up utensils, button hooks, reachers, shower chairs), teach energy conservation techniques, modify the environment for accessibility, and develop strategies to compensate for physical or cognitive limitations. The CNA reinforces OT recommendations during daily care routines.

Answer: C — Frustration during rehabilitation is extremely common - recovery is often slow, painful, and emotionally exhausting. The CNA should validate the resident feelings (I understand this is really hard and frustrating), offer genuine encouragement (You walked five more feet today than yesterday - that is real progress), remind them of their goals, celebrate every small achievement, and maintain a positive supportive attitude. The frustration should be reported to the nurse and therapy team so they can reassess the program, adjust goals, or provide additional support such as counseling or pain management.