Activities of Daily Living Practice Test

Answer: C — The first step before any care procedure is hand hygiene, followed by gathering all supplies (basin, washcloths, towels, clean gown, bath blanket, soap, lotion) BEFORE approaching the resident. Having everything ready prevents leaving the resident alone, exposed, or cold during the bath. Water temperature should be checked and kept at approximately 105°F-110°F (not above 120°F which can scald), and the door should be closed for privacy — never left open.

Answer: D — The correct order for a bed bath is always from cleanest to dirtiest: start with the face and eyes (using water only, no soap, wiping from inner to outer corner), then neck, arms, hands, chest, abdomen, legs, feet, back, and finally the perineal area last. This sequence prevents spreading bacteria from contaminated areas (like the perineum) to cleaner areas (like the face). A fresh washcloth area or a new cloth should be used for each body section.

Answer: A — A partial bath focuses on the areas that produce the most odor, perspiration, and bacteria, and that are most important for skin health and comfort: face, hands, axillae (underarms), back, and the perineal area. These areas are washed daily even when a full bath is not given. A partial bath is appropriate on non-full-bath days, for residents who fatigue easily, or when a full bath is refused — it maintains hygiene while respecting the resident's energy level and preferences.

Answer: C — The CNA should immediately address the resident's comfort by slightly increasing the water temperature (keeping it within the safe range of 105°F-110°F), draping a warm bath blanket or towel over body parts not being actively washed, minimizing the amount of skin exposed at any time, and ensuring there are no cold drafts in the room. Resident comfort and dignity during bathing are priorities — ignoring the complaint or using dangerously hot water are both unacceptable responses.

Answer: B — A shower chair is essential for residents with weakness or balance problems to prevent falls on the wet, slippery surface. Positioning the resident's strong (unaffected) side nearest the faucet controls allows them to adjust water independently, promoting autonomy and safety. The bathroom door should be closed for privacy (the CNA remains inside to assist), and water temperature must be warm and comfortable (105°F-110°F). Standing throughout a shower with one-sided weakness creates an extreme fall risk.

Answer: C — An unconscious resident must be positioned on their SIDE with the head turned slightly downward toward the mattress during oral care. This critical positioning allows any liquid or secretions to drain OUT of the mouth by gravity rather than pooling in the back of the throat and being aspirated (inhaled) into the lungs. Aspiration pneumonia is a life-threatening risk for unconscious residents. The CNA should use a padded tongue depressor to gently hold the mouth open, use only small amounts of fluid, and apply suctioning if available.

Answer: A — Dentures are extremely fragile and expensive — dropping them on a hard surface can crack or break them. The standard safety precaution is to line the sink with a washcloth or towel, or partially fill the sink with water, to cushion the dentures if they slip from the CNA's wet hands. Dentures should be removed from the mouth for proper cleaning, rinsed under cool or lukewarm running water (never hot, which warps the acrylic), and scrubbed with a denture brush and denture cleanser — not regular toothpaste, which is too abrasive.

Answer: A — Grooming — including hair care — is an important part of preserving a resident's dignity, self-image, and emotional well-being. The CNA should always ask the resident their preference for hairstyle, part placement, and any products they like. Even with left-sided paralysis, the resident may be able to brush with their right hand if given the brush and encouragement. Promoting independence in grooming tasks supports both physical rehabilitation and psychological health.

Answer: D — Oral care should be provided at least twice daily (morning and bedtime) and ideally after meals to remove food particles, prevent plaque buildup, reduce bacterial growth, and maintain healthy gums. For unconscious residents or those on ventilators, oral care may be needed every 2 hours. Poor oral hygiene in elderly residents has been directly linked to aspiration pneumonia, tooth decay, gum disease, malnutrition (due to mouth pain making eating difficult), and systemic infections. The CNA should always report any mouth sores, bleeding gums, loose teeth, or unusual odor to the nurse.

Answer: A — The golden rule of dressing is: affected (weak) side goes IN first, and when undressing, the strong side comes OUT first — often remembered as 'dress the worst first.' Sliding the sleeve over the weak left arm first requires less range of motion and causes less pain or strain on the affected limb. Then the shirt is brought around the back and the strong right arm slides through easily. This technique minimizes discomfort while promoting as much resident participation as possible.

Answer: A — An electric razor is the safest choice for residents with tremors, limited mobility, or who are on blood-thinning medications because it significantly reduces the risk of nicks and cuts compared to blade razors. The CNA should always ask the resident's preference — some residents prefer to shave themselves with assistance, while others want the CNA to do it. The CNA should also ask about preferred shaving direction, whether the resident wants a mustache or beard maintained, and apply aftershave or moisturizer per the resident's wishes.

Answer: D — Fingernails should be trimmed and filed in a gently rounded (oval) shape following the natural curve of the fingertip to prevent sharp edges that could scratch the skin. Toenails should be cut straight across to prevent ingrown toenails, which can cause pain and infection. Important: CNAs should NEVER cut the nails of diabetic residents or residents with poor circulation — this must be done by a nurse or podiatrist due to the high risk of wound complications. Nails should be soaked briefly in warm (not hot) water to soften them before trimming.

Answer: D — The bedpan should be positioned with the wider, flatter end (the open end) toward the resident's buttocks/back and the narrow handle end toward the front/feet. The CNA raises the head of bed slightly for comfort, asks the resident to bend their knees and press their feet flat to lift their hips (if able), then gently slides the bedpan into position. For residents who cannot lift their hips, the CNA rolls them to the side, positions the bedpan against the buttocks, and rolls them back onto it. Privacy must be provided throughout.

Answer: B — Perineal care for female residents ALWAYS requires wiping from front to back — from the urethra toward the rectum — to prevent bacteria from the rectal area from being introduced into the urethra and vaginal area, which is the leading cause of urinary tract infections (UTIs) in women. Each stroke should use a clean area of the washcloth to avoid recontamination. The CNA should also observe for any abnormalities such as redness, swelling, unusual discharge, skin breakdown, or foul odor during perineal care.

Answer: B — Observing urine characteristics (color, clarity, odor, amount) is an important part of the CNA's role during toileting and elimination care. Dark amber urine with a strong odor can indicate dehydration, urinary tract infection, or other medical conditions that require nursing assessment. The CNA should never diagnose or advise the resident — instead, they should document the exact observation (color, odor, approximate amount) and report it to the nurse promptly so appropriate evaluation and intervention can be initiated.

Answer: B — Residents have the right to choose their preferred method of toileting whenever it is safe and consistent with their care plan. Using a bedside commode promotes more natural positioning (which aids elimination), preserves dignity better than a bedpan, and supports independence. The CNA should ensure the commode is placed near the bed on the resident's strong side, lock the wheels, provide privacy with curtains, place toilet tissue within reach, and ALWAYS offer hand hygiene after toileting is complete.

Answer: A — Before any transfer, the CNA must first explain what will happen (so the resident can assist and is not startled), then position the wheelchair parallel to the bed on the resident's strong side at a slight angle, LOCK the wheelchair brakes (unlocked brakes cause the chair to roll away during transfer, leading to serious falls), swing footrests out of the way, and lower the bed to its lowest position. Preparation and communication prevent injuries — rushing through transfers is the leading cause of transfer-related falls and injuries.

Answer: C — When a resident begins to fall, the CNA should never try to catch or hold them fully upright — this can injure both the resident and the CNA. Instead, the CNA should hold the resident close to their body using the gait belt, widen their own base of support, bend at the knees, and gently ease the resident down to the floor in a slow, controlled manner. Once the resident is safely on the floor, the CNA should stay with them, call for help, check for injuries, and NOT move the resident until the nurse assesses them.

Answer: B — The correct gait pattern with a cane is: the cane and the weak (affected) leg move forward together at the same time, then the strong (unaffected) leg steps forward to meet or pass them. The cane is always held on the OPPOSITE side of the weak leg to create a wider base of support and shift body weight effectively. This pattern ensures that the cane is always providing support when the weaker leg is bearing weight, maximizing stability and reducing fall risk.

Answer: A — Mechanical lifts ALWAYS require a minimum of two trained staff members for safe operation — one operates the lift controls while the other guides the resident's body and monitors for safety. Operating alone is a serious safety violation that puts the resident at risk for falls, skin tears, and entrapment injuries. The resident should never hold the metal frame (hands should rest in their lap or across their chest). The lift should only be raised high enough to clear the surface — lifting higher creates a dangerous swing and increases fall risk.

Answer: C — A gait (transfer) belt is placed snugly around the resident's waist directly over their clothing — never on bare skin, which causes friction burns during transfers. The belt should be tight enough to be secure but loose enough to fit two flat fingers between the belt and the resident's body. The CNA grips the belt from underneath (not on top) to provide upward support during the transfer. Gait belts are never placed around the neck (strangulation risk), chest (restricts breathing), or hips (provides no trunk support).

Answer: C — Before making an occupied bed, the CNA should explain what they will do (to reduce anxiety and gain cooperation), close the door and pull the privacy curtain, and raise the bed to a comfortable working height to protect the CNA's back from strain. The resident stays in bed throughout the procedure. The pillow remains under the head for comfort unless it needs to be changed. Pulling all linens at once would leave the resident completely exposed and cold — linens are changed one side at a time.

Answer: D — Wrinkled linens create uneven pressure points and friction against the resident's skin, which can directly contribute to the development of pressure ulcers (bedsores), skin tears, and irritation — especially in residents who are immobile, have thin fragile skin, or who spend prolonged periods in bed. Smooth, taut linens distribute pressure evenly and reduce friction during repositioning. This is a critical standard of care, not merely an aesthetic concern — wrinkled bedding under an immobile resident is considered a preventable risk factor for skin breakdown.

Answer: B — Mitered (hospital) corners are a specific folding technique that tucks the sheet securely under the mattress at a 45-degree angle, creating a tight, smooth, and anchor-like hold that prevents the bottom sheet from pulling loose, bunching up, or wrinkling during resident movement and repositioning. This technique is essential for maintaining wrinkle-free linens that reduce friction and pressure on the skin. Loose or bunched sheets increase the risk of skin breakdown and are uncomfortable for the resident.

Answer: D — The correct technique for changing a bottom sheet on an occupied bed involves rolling the resident gently to one side (raising the side rail on that side for safety), loosening the soiled sheet and rolling/fan-folding it snugly against the resident's back, placing the clean sheet on the exposed mattress half and tucking it in tightly, then gently rolling the resident over the folded linen onto the clean side, removing the dirty sheet from the other half, pulling the clean sheet taut, and tucking it in. This method keeps the resident safe, warm, covered, and minimizes disruption throughout.