Sorrentino: Mosbys Textbook for Nursing Assistants, 9th Edition

Critical Thinking Scenarios

Chapter 1: Introduction to Health Care Agencies
You are working in a long-term care center and a surveyor asks you a question. You are
unsure of the answer. You worry your response may cause your facility to get in trouble
or you could get in trouble for answering incorrectly. How will you respond?
Chapter 2: The Persons Rights
You are assisting a person with range-of-motion (ROM) exercises. The person does not
want to participate and tells you to leave the room. Does the person have the right to
refuse? What will you do? Does the nursing center have to take action?
Chapter 3: The Nursing Assistant
You are working on a memory care unit and answer the phone. It is a physician who tells
you he has just left town for vacation and is about to lose cell service. He forgot to order
critically important monitoring labs for a resident. He requires you to take the order
before the cell signal is lost. What would you do?
Chapter 4: Delegation
You are working in a private home care setting. The nurse has delegated to you to give
the patient a bath and perform ROM exercises. She calls you and states she is running
behind today and asks you to perform an assessment and notify her of the results so she
can include them in her notes and plan of care. What do you do?
Chapter 5: Ethics and Laws
During morning care, a co-worker is heard telling a resident, If you wet your pants
again, I will not lay you down after lunch. What type of abuse does this statement
represent? What should you do?
Chapter 5: Ethics and Laws
You and a co-worker are assisting a resident in the shower. You go to the residents room
to get her sweater. When you return, you enter the shower room and see your co-worker
spraying the resident in the face with the water nozzle. Is this a type of abuse? What will
you do next?
Chapter 6: Student and Work Ethics
The nursing center has four scheduled CNAs assigned to the wing in which you are
working. You are assigned to a resident who is combative and a fall risk. One of your coworkers walks past your combative residents room and sees the resident trying to get out
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Critical Thinking Scenarios with Suggested Answers

of bed. What should your co-worker do first? What safety concerns must be monitored?
How could the co-worker display teamwork in this situation?
Chapter 6: Student and Work Ethics
At a local nursing center, your co-worker reports negative information about your work
performance. The nurse approaches you about this information. How will you explain
your performance to the nurse?
Chapter 7: Communicating with the Health Team
You are working at a nursing center and performing perineal care. You observe
moderately sized red discoloration located on your residents inner thigh. When will you
report this finding? To whom will you report this? How will you describe the discolored
areas?
Chapter 8: Assisting with the Nursing Process
Your care is important and communicating changes in patient condition is critical for the
best outcome for the patient. When assisting a patient to the dining room you observe the
following: the patient enjoys chatting with friends on the way and is pleasant and
cooperative. The patient becomes flushed and appears to have increasingly difficult time
breathing; he then reports pain whenever he tries to take a deep breath and heaviness in
his chest. What would you do?
Chapter 9: Understanding the Person
You are caring for a person who is usually very social, participates in every activity, and
appears happy, but you have noticed over the last couple of days she is hardly
participating in any activities, she did not go to church service, which she never misses,
and she is not talking to her friends. What would you do?
Chapter 10: Body Structure and Function
A patient you are caring for refuses to eat. What do you do?
Chapter 11: Growth and Development
You are caring for a 13-year-old girl. The mother is consulting with the physician in her
office. Upon returning to the exam room you find the girl and her boyfriend in a heated
discussion. You heard him calling her names, holding her by the wrist, and threatening
her. What do you do?
Chapter 12: Care of the Older Person
You are caring for a patient when another nurse assistant approaches you and wants you
to come and see something. As you follow her, she gets to a patients room and starts to
open the door without knocking. She then tells you a resident married couple of the

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Critical Thinking Scenarios with Suggested Answers

facility are being intimate. She is snickering and says, I didnt think it was possible at
their age. What do you do?
Chapter 13: Safety
You are assisting the nurse in caring for a new mother and baby in their home. You
observe the mother has put the baby on her queen-size bed and used pillows to prevent
the baby from falling. The baby is covered with a lovely soft blue blanket. The baby is
supine. She has propped a bottle with additional pillows for feeding and left the baby in
this manner unattended.
Chapter 14: Fall Prevention
You are caring for a 66-year-old patient and you notice he is not wearing his glasses, his
pants are so loose they are barely staying on, and his socks are at least two sizes too big,
which he is wearing without shoes. Additionally, the family has brought him a new gift
of an exotic multicolor throw rug for his room. His room is cluttered with so much piled
around the floor there is barely a visible path to walk. What needs to be addressed?
Chapter 15: Restraint Alternatives and Safe Restraint Use
A person you are caring for is in wrist restraints. Teaching has been done with the patient.
He has been instructed to notify staff for any numbness, tingling, or decreased sensation.
During your shift, every 15 minutes you check the patient and he reports numbness in his
right hand. What do you do?
Chapter 16: Preventing Infection
You are caring for a person with an upper respiratory infection. You have been in the
room assisting the person numerous times during the shift. As you leave the room, you
cannot remember if you have performed hand hygiene. What action will you take? How
could forgetting this skill harm the person and others?
Chapter 16: Preventing Infection
You are assigned to care for a person being treated for a methicillin-resistant
Staphylococcus aureus (MRSA) infection in a wound. The nurse has provided you with
little information as to what type of precautions you should take. What questions will you
ask to learn the proper way to assist this person?
Chapter 17: Body Mechanics
A patient reports being uncomfortable as she rests in bed. She is in the supine position.
What will you do to make her more comfortable?
Chapter 18: Safely Moving the Person

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Critical Thinking Scenarios with Suggested Answers

You are asked by another nursing assistant to help move a person up in bed and reposition her. She has reported all pertinent information to you about the patient and you
proceed to the room to perform the move. You follow proper procedures including
knocking before entering, providing privacy, properly introducing yourself to the patient,
and explaining what you are going to do. Then you note the only pad under the patient is
a disposable single-use under-pad. What should you do?
Chapter 19: Safely Transferring the Person
You are assisting a person with a transfer from the wheelchair to the bed. During the
transfer, the person starts to fall. What equipment must be in place to ensure the persons
safety? What should you do?
Chapter 19: Safely Transferring the Person
A totally dependent person can only be transferred using a mechanical lift. It is time to
get the person up to go to the dining room. What safety checks will you perform to ensure
that the lift is ready? How will you prepare the person?
Chapter 19: Safely Transferring the Person
You are caring for a person with weakness on the left side. You are to assist the person
into a wheelchair in preparation for lunch. What steps will you take to ensure a safe
transfer to the wheelchair?
Chapter 20: The Persons Unit
You are caring for a patient who cannot use the call system. How will you assure his
needs are met?
Chapter 21: Bedmaking
A totally dependent person is scheduled for a complete bed linen change this morning.
You are the CNA assigned to perform this task. What items should you bring to the room
to complete this task? What safety concerns should you consider while performing this
task?
Chapter 22: Personal Hygiene
You are caring for a person with dentures. The person is not able to remove the dentures
for you. How will you remove the dentures? After you remove the dentures, where will
you put them?
Chapter 22: Personal Hygiene
The person living at the nursing center is to be bathed this evening. The person is not
allowed to shower and is totally dependent. How will you provide a complete bed bath?
How will you ensure privacy during this process?

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Critical Thinking Scenarios with Suggested Answers

Chapter 22: Personal Hygiene
During a shower, the person living in a nursing center depends on the CNA to perform
most aspects of the task. How do you allow the person to help care for himself or herself?
How do you do this and maintain safety?
Chapter 22: Personal Hygiene
As you check one of the persons to whom you are assigned in the nursing center, you
observe that the person has had an incontinent stool. How will you explain to the person
what needs to be done to care for the incontinence?
Chapter 23: Grooming
You are caring for a person who needs to be dressed after a bath. This person has arm
weakness on the right side. How will this affect dressing this person?
Chapter 24: Urinary Elimination
You are assisting in the care of an infant that has not had a wet diaper for 6 hours. Is this
acceptable? What should you do?
Chapter 25: Urinary Catheters
You are caring for a patient with an indwelling catheter. As the patient returns from the
radiology department you note the collection bag is on the side rail. After assuring the
patient is comfortably back in his bed you also note the securing device is gone. What
should you do?
Chapter 26: Bowel Elimination
You are assisting with the care of a newborn infant. Your 12-hour shift is almost over and
the infant has not had a bowel movement. What is the correct course of action?
Chapter 26: Bowel Elimination
You are caring for a patient with C. difficile. What precautions should you follow?
Chapter 27: Nutrition and Fluids
The person for whom you are caring had the following for breakfast: 4 fluid ounces of
milk, 6 fluid ounces of coffee, scrambled eggs, and one piece of toast. The person voided
4 fluid ounces of urine this morning. What is the persons fluid intake in milliliters? What
is the fluid output in milliliters?
Chapter 28: Nutritional Support and IV Therapy

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Critical Thinking Scenarios with Suggested Answers

A patient you are caring for is receiving a bolus tube feeding through a nasogastric (NG)
tube. You observe the patient is comfortable and resting in the supine position. Should
you take any action?
Chapter 29: Measuring Vital Signs
The nurse asks you to obtain a complete set of vital signs for one of the persons to whom
you are assigned. The measurements are as follows: temperature 101.5 F, heart rate 104
beats/min, respiratory rate 22 breaths/min, and blood pressure 90/60 mm Hg. Which of
these vital signs are of concern? What subjective data could be stated? What is your first
action after collecting these vital signs?
Chapter 30: Exercise and Activity
A person living at the nursing center needs passive range-of-motion (ROM) exercise.
You are the CNA assigned to the person. The nurse communicates to you that the person
has restricted movement to the right hip. How will the restriction change the ROM
exercise for this person?
Chapter 30: Exercise and Activity
A dependent resident is to ambulate four times a day. The resident is resting in bed. You
are to walk with the person for the first time. What steps will you perform to ensure
safety during ambulation?
Chapter 31: Comfort, Rest, and Sleep
You are caring for a patient from China. He denies a complaint of pain. You notice he is
splinting and guarding his right side when he moves. He is grimacing and his jaw is
clenched. You note he is frequently repositioning himself in the chair and you
occasionally hear him grunt with the effort. What could you derive from your
observations and what should you do?
Chapter 32: Admissions, Transfers, and Discharges
During the admission of a new person to the nursing center, you are asked to obtain her
height and weight. The person is unable to stand. How will you measure and weigh this
person?
Chapter 33: Assisting with the Physical Examination
You are preparing a person for an exam. The person tells you she has to go to the
bathroom and asks if it is alright to go. How do you respond?
Chapter 34: Collecting and Testing Specimens
You are assisting a patient obtain a clean-voided urine specimen. The patient accidentally
puts tissue in the collection container. What do you do?

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Critical Thinking Scenarios with Suggested Answers

Chapter 34: Collecting and Testing Specimens
You are assisting with a 24-hour urine collection on a patient assigned to your care. The
patient is in the dining room and chooses not to return to his room to collect the
specimen; instead he voids in the nearest bathroom. Is it okay to just collect one extra
sample and continue the collection?
Chapter 35: The Person Having Surgery
You are caring for a patient that has had surgery and now has an order for elastic
stockings. The patient was alert and oriented before surgery but is a little confused at this
time. She keeps rolling her stockings down and twisting them. Is this an issue?
Chapter 36: Wound Care
You are caring for a patient with diabetes. You notice the person is forcing his shoes on
over very swollen feet and the shoes are extremely tight. He denies any discomfort. Is
this a problem?
Chapter 37: Pressure Ulcers
You are assisting in the care of a hospice patient. While giving the patient a bath you note
an area on the sacrum that appears to be dried stool. You gently wash it over and over but
it does not come off. It is about the size of a quarter and you are sure it was not there
yesterday. What are the implications and what do you do?
Chapter 38: Heat and Cold Applications
You are caring for a patient who has a history of Crohns disease. She gets severe
abdominal cramps and uses a heating pad at home for the pain. She is very fair with
freckles and red hair; she is also 11 weeks pregnant. Your facility often uses a heating
pack that is self-contained and temperature regulated to avoid burns. There is no order for
this, nor is it in her care plan. You tell her you will speak to the nurse. The patient tells
you the facility system is not good enough; it does not get hot enough anyway. She will
have her husband bring in her own. Is this acceptable?
Chapter 39: Oxygen Needs
You take the vital signs for a patient who does not appear to be in any distress and denies
complaints of pain or shortness of breath. His oxygen saturation is 87% on room air. You
see in his previously charted vitals the saturation was 86%. You have two other patients
that have requested your attention including one who has been waiting for a shower.
What will you do next?
Chapter 40: Respiratory Support and Therapies
You are caring for a person with a tracheostomy. The person wishes to take a shower.
What are the implications?

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Critical Thinking Scenarios with Suggested Answers

Chapter 41: Rehabilitation and Restorative Nursing Care
You are assisting a patient with his range-of-motion exercises; he says he does not feel
like doing them today and asks you to finish the exercises for him. What is your
response?
Chapter 42: Hearing, Speech, and Vision Problems
You are assisting in the care of an infant that is fussy, irritable, cries a lot, and has been
pulling at his ear. He feels warm. What are the implications?
Chapter 42: Hearing, Speech, and Vision Problems
You are assisting in the care of a person with vertigo. What are the implications?
Chapter 43: Cancer, Immune System, and Skin Disorders
You are caring for a patient with AIDS, and the patient wants to visit with a friend of his,
another patient, who you know has an active case of the flu. What are the implications?
Chapter 44: Nervous System and Musculoskeletal Disorders
You are caring for a paraplegic who suddenly becomes nauseous, dizzy, and restless. He
reports a headache and appears to be sweating and flushed. What is the major concern?
Chapter 45: Cardiovascular, Respiratory, and Lymphatic Disorders
You are caring for a patient on a cardiac rehab unit. After exercising he reports chest
tightness and pain in his jaw, he appears pale, and he says he feels like he is going to
throw up. You are aware the patient has a diagnosis of angina. What do you do?
Chapter 46: Digestive and Endocrine Disorders
You are caring for a confused patient with poor hygiene and hepatitis A. He has been
incontinent of stool. What are the implications?
Chapter 47: Urinary and Reproductive Disorders
You are caring for a patient with an ileal conduit. You notice there is tape around the
drain pouch. When you ask the patient about it, he tells you it was leaking and the
previous PCT taped the area that was leaking. What actions should you take?
Chapter 47: Urinary and Reproductive Disorders
You are caring for a patient and he has not made any urine for the last 8 hours. What
should you do?
Chapter 48: Mental Health Disorders

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Critical Thinking Scenarios with Suggested Answers

You are caring for a patient with schizophrenia. The person has become agitated. What
do you do to protect yourself?
Chapter 49: Confusion and Dementia
As you approach a person who suffers from memory loss, the person becomes more
anxious around 4 PM. The person appears to be extremely tired and afraid. What behavior
is the person displaying? What will you do to help the person?
Chapter 50: Intellectual and Developmental Disabilities
You are caring for a patient with an intellectual disability. This patient is normally very
happy and cooperative and participates in activities. You have noticed recently he is
withdrawn and does not want to participate in any activities, not even his favorite event,
time in the model train room. You have seen a few scattered bruises within different
stages of healing and have noticed he has a decreased appetite. Simple noises make him
flinch. When someone closed a door just now he ran to the corner and started rocking and
crying softly. What are the implications?
Chapter 51: Sexuality
You are caring for a 58-year-old man who is to have abdominal surgery. Part of his care
is a special bath with chlorahexidine to reduce infection. You are helping with his bath
and as you scrub his lower abdomen he becomes aroused. What do you do?
Chapter 52: Caring for Mothers and Babies
You are assisting in the care of a newborn. He is only 72 hours old. He has become fussy
and feels warm, and you note his umbilical stump is producing a small amount of foulsmelling drainage. What should you do?
Chapter 53: Assisted Living
You are caring for a person in an assisted living residence. The nurse has reviewed with
you the persons service plan and your responsibilities. You are to assist with bathing,
laundry, light housekeeping, and medication reminders. When you remind the person it is
time for his medication, he asks you to assist with taking the medication. How do you
respond?
Chapter 54: Basic Emergency Care
You are caring for a patient in the hospital that has a deep vein thrombosis (DVT). You
have just helped him to the bathroom when the patient reports having numbness on his
right side. He stumbles as you get him back in the bed and his speech is starting to sound
garbled. What are the implications?
Chapter 55: End-of-Life Care

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Critical Thinking Scenarios with Suggested Answers

A person is exhibiting signs of physical failure. The family and the person may not
understand the dying process. The person states, Let me live to see my grandson
graduate. What stage does this statement represent? What does this statement represent
to the family?
Chapter 56: Getting a Job
During a job interview you are asked what made you interested in this particular position,
what are your strengths, what areas do you feel you need to improve on, and how many
sick days you took last year. What are the implications of these questions and how will
you answer?

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