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CNA exam topic: nutrition and hydration

24 exam-style questions with the answer and the exact rule from federal regulations or CDC guidance.

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1. A resident is receiving enteral feeding via a gastrostomy tube. According to the regulations, what specific complications must the nurse aide help prevent?Aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers. The regulation lists these specific medical complications as the targets for prevention in residents receiving enteral feeding.
   42 CFR § 483.25(g): “A resident who is fed by enteral means receives the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers.”
2. When a nurse aide is assisting a resident with transfers, ambulation, eating, and dressing, which specific method is required by the training curriculum?Using assistive devices. The regulation lists the use of assistive devices as a required component of personal care skills training.
   42 CFR § 483.152(b): “Use of assistive devices in transferring, ambulation, eating, and dressing;”
3. How should a nurse aide handle a resident's specific dietary preferences, such as religious or cultural needs?Reflect them based on reasonable efforts and input from residents. Menus must reflect religious, cultural, and ethnic needs based on reasonable efforts and resident input, ensuring personal dietary choices are respected.
   42 CFR § 483.60(c): “Reflect, based on a facility's reasonable efforts, the religious, cultural, and ethnic needs of the resident population, as well as input received from residents and resident groups”
4. A resident requests a snack at 9:00 PM, which is outside the facility's scheduled meal times. What is the correct action for the nurse aide?Provide a suitable, nourishing alternative meal or snack consistent with the resident plan of care. The regulation mandates that facilities must provide suitable nourishing alternatives for residents eating outside traditional times, ensuring the resident's dietary needs and preferences are met.
   42 CFR § 483.60(f): “Suitable, nourishing alternative meals and snacks must be provided to residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident plan of care.”
5. What is the maximum time allowed between a substantial evening meal and breakfast if no nourishing snack is served at bedtime?14 hours. The standard limit is 14 hours; the extension to 16 hours is conditional upon serving a bedtime snack and resident agreement, so without those conditions, the limit remains 14 hours.
   42 CFR § 483.60(f): “There must be no more than 14 hours between a substantial evening meal and breakfast the following day, except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span.”
6. When administering parenteral fluids to a resident, which factors must guide the nurse aide's actions?Professional standards of practice, physician orders, the care plan, and resident preferences. The regulation requires that parenteral fluid administration follows professional standards, physician orders, the care plan, and the resident's preferences.
   42 CFR § 483.25(h): “Parenteral fluids must be administered consistent with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences.”
7. A resident group submits a written recommendation to the facility regarding a change in meal times. What is the required response from the facility regarding this recommendation?The facility must consider the views and act promptly upon the grievance or recommendation. The facility is obligated to consider the group's views and act promptly, though it is not required to implement every request exactly as recommended.
   42 CFR § 483.10(f): “The facility must consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility.”
8. A resident tells you they are unhappy with the food served at lunch and wants to complain. According to the regulations, how must the facility ensure the resident can voice this grievance?The resident has the right to file grievances orally (spoken) or in writing. The regulation states that residents have the right to file grievances either orally or in writing, ensuring accessibility for all residents.
   42 CFR § 483.10(j): “Notifying resident individually or through postings in prominent locations throughout the facility of the right to file grievances orally (meaning spoken) or in writing; the right to file grievances anonymously;”
9. During a meal service, a resident asks for water because they feel thirsty. What is the requirement regarding drinks provided to residents?Drinks, including water and other liquids, must be consistent with resident needs and preferences and sufficient to maintain hydration. The regulation requires that drinks be provided based on the resident's needs and preferences to ensure adequate hydration.
   42 CFR § 483.60(d): “(6) Drinks, including water and other liquids consistent with resident needs and preferences and sufficient to maintain resident hydration.”
10. A nurse aide is serving lunch to a resident who has specific dietary restrictions due to allergies and intolerances. According to the regulations, how must the facility provide food for this resident?The facility must provide food that accommodates the resident's allergies, intolerances, and preferences. The regulation mandates that food provided must accommodate the specific allergies, intolerances, and preferences of the resident.
    42 CFR § 483.60(d): “(4) Food that accommodates resident allergies, intolerances, and preferences;”
11. A nurse aide is assigned to assist residents with meals. Which resident condition is listed as a 'complicated feeding problem' that requires the aide to call a supervisory nurse rather than providing independent feeding assistance?The resident has difficulty swallowing. The regulation specifies that feeding assistants should only assist residents without complicated feeding problems, and difficulty swallowing is listed as such a problem requiring supervisory nurse involvement.
    42 CFR § 483.60(h): “Complicated feeding problems include, but are not limited to, difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings.”
12. When a feeding assistant is working, who must supervise their activities?A registered nurse (RN) or licensed practical nurse (LPN). The regulation mandates that feeding assistants operate under the direct supervision of an RN or LPN to ensure proper care standards.
    42 CFR § 483.60(h): “A feeding assistant must work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN).”
13. A resident refuses the initial meal choice offered at breakfast and requests a different option. What must the facility provide in this situation?The facility must offer appealing options of similar nutritive value to the resident. If a resident declines the initial food choice, the facility is required to provide alternative options that are appealing and nutritionally equivalent.
    42 CFR § 483.60(d): “(5) Appealing options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice;”
14. When serving food to residents, from which sources must the facility procure its food?Sources approved or considered satisfactory by federal, state, or local authorities. The regulation states that food must be procured from sources that have been approved or deemed satisfactory by relevant governmental authorities to ensure safety and quality.
    42 CFR § 483.60(i): “Procure food from sources approved or considered satisfactory by federal, state, or local authorities;”
15. A resident requests a specific dietary supplement prescribed by their physician. According to federal regulations, how should the facility handle the cost of this item?The facility must include the cost of the medically prescribed dietary supplement in the general meal service without extra charge. The regulation states that medically prescribed dietary supplements ordered by qualified providers are included in the standard meal service and cannot incur additional charges.
    42 CFR § 483.10(f): “The facility may not charge for special foods and meals, including medically prescribed dietary supplements, ordered by the resident's physician, physician assistant, nurse practitioner, or clinical nurse specialist, as these are included in accordance with § 483.60.”
16. Regarding the frequency of meals, what is the minimum requirement for a nursing facility?Three meals daily, at regular times comparable to normal mealtimes. The regulation specifies that facilities must provide at least three meals daily at regular times comparable to normal community mealtimes.
    42 CFR § 483.60(f): “Each resident must receive and the facility must provide at least three meals daily, at regular times comparable to normal mealtimes in the community or in accordance with resident needs, preferences, requests, and plan of care.”
17. How should food be prepared to meet the standards outlined for nursing facility residents?Food should be prepared by methods that conserve nutritive value, flavor, and appearance. The regulation specifies that food preparation methods must preserve the nutritional content, taste, and visual appeal of the meal.
    42 CFR § 483.60(d): “(1) Food prepared by methods that conserve nutritive value, flavor, and appearance;”
18. A resident in a nursing facility declines the standard tray served at lunch and asks for a different meal choice. According to federal regulations, what is the facility's obligation regarding this request?The aide must provide appealing options of similar nutritive value to the resident. The regulation requires facilities to provide appealing alternatives of similar nutritional value when residents request different meal choices.
    42 CFR § 483.60(d): “Appealing options of similar nutritive value to residents who choose not to eat food that is initially served or who request a different meal choice”
19. What is the requirement for an individual to work as a paid feeding assistant in a facility?They must successfully complete a State-approved training program for feeding assistants. The regulation requires successful completion of a State-approved training program specifically for feeding assistants.
    42 CFR § 483.95(h): “A facility must not use any individual working in the facility as a paid feeding assistant unless that individual has successfully completed a State-approved training program for feeding assistants, as specified in § 483.160.”
20. A nurse aide is placing regulated waste into a container. What condition must the container meet regarding its construction?It must be constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping. Regulated waste containers must be leak-proof to ensure containment during all stages of handling.
    29 CFR § 1910.1030(d): “Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping;”
21. Which individual is excluded from the definition of a 'nurse aide' in this context?An individual who furnishes services to residents only as a paid feeding assistant. The regulation states that paid feeding assistants are not considered nurse aides, distinguishing them from other non-licensed service providers.
    42 CFR § 483.5: “Nurse aides do not include those individuals who furnish services to residents only as paid feeding assistants as defined in § 488.301 of this chapter.”
22. Which of the following is NOT considered a 'resident representative' according to the listed definitions?A nurse aide assigned to provide daily hygiene care. The rule defines a nurse aide separately from resident representatives, who are defined as individuals chosen by the resident, authorized by law, legal representatives, or court-appointed guardians.
    42 CFR § 483.5: “Nurse aide. A nurse aide is any individual providing nursing or nursing-related services to residents in a facility. This term may also include an individual who provides these services through an agency or under a contract with the facility, but is not a licensed health professional, a registered dietitian, or someone who volunteers to provide such services without pay.”
23. Under what specific condition may the time between a substantial evening meal and breakfast extend up to 16 hours?If a nourishing snack is served at bedtime. The standard limit is 14 hours, but it extends to 16 hours only if a nourishing snack is provided at bedtime and the resident group agrees to this schedule.
    42 CFR § 483.60(f): “except when a nourishing snack is served at bedtime, up to 16 hours may elapse between a substantial evening meal and breakfast the following day if a resident group agrees to this meal span.”
24. A resident with a gastrostomy tube is currently able to eat enough food alone or with minimal assistance. According to the regulations, how should the nurse aide approach feeding this resident?Offer oral food and fluids, reserving enteral feeding only if clinically indicated and consented to. The regulation mandates that residents capable of eating orally should not be fed via enteral methods unless specific clinical conditions and consent requirements are met.
    42 CFR § 483.25(g): “A resident who has been able to eat enough alone or with assistance is not fed by enteral methods unless the resident's clinical condition demonstrates that enteral feeding was clinically indicated and consented to by the resident”

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