CNA FINAL EXAM LATEST (3 DIFFERENT VERSIONS) 2022-2025 /CERTIFIED NURSING ASSISTANT / (CNA, Exams of Differential Equations and Transforms

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CNA FINAL EXAM LATEST (3 DIFFERENT

VERSIONS) 2022-2025 /CERTIFIED

NURSING ASSISTANT / (CNA) EXAM EACH

VERSION CONTAINS 100 REAL EXAM

QUESTIONS AND ANSWERS

VERSION 1

When getting ready to make a bed, the nurse aide SHOULD place the clean linens on: (Basic Nursing Skills) (A) Clean linens should be placed on a chair or table beside the bed. The only purpose for using a restraint is to: (Legal and Ethical Behavior) (A) The only purpose for using a restraint is to ensure the safety of the client or others. Articles contaminated with blood or body fluids SHOULD be disposed of in the: Basic Nursing Skills (B) Bloody or bodily fluid contaminated articles SHOULD be placed in the biohazard container. To avoid pulling the indwelling urethral catheter when turning a client, the catheter tubing SHOULD be secured to the client’s: (Basic Nursing Skills)

B. The tubing should be secured to the patient's upper thigh. When collecting a 24-hour urine sample for a client, the nurse aide SHOULD request that the client: (Basic Nursing Skills) (D) The nurse aide should discard the first voided urine. When ambulating the client, the nurse aide SHOULD : (Basic Nursing Skills) (B) When ambulating the patient, be sure the patient is wearing non-skid footwear. Which of the following is the BEST personal protective equipment item for the nurse aide to wear when handling infectious waste that could splash or spray? (D) The best PPE item a nurse aide can use for is a face shield Which of the following would be an appropriate response for the nurse aide to make if a client expresses anger during care? (D) “You seem upset. Would you like to talk about it?” The nurse aide has raised the height of the client’s bed to provide care to the client, but the nurse aide forgot to bring the supplies needed. What should the nurse aide do NEXT? (C) The nurse aide should lower the bed and place the call light within reach. A client requests that the nurse aide call the client’s spiritual advisor. The nurse aide SHOULD : C) tell the client that the nurse aide will inform the nurse of the client’s request. A client wakes up during the night and asks for something to eat. The nurse aide SHOULD : (A) check client’s diet before offering

nourishment. The nurse aide is preparing to bathe a client. What should the nurse aide do FIRST? (C) Tell the client what the nurse aide is going to do When making a bed that is occupied by a client, the nurse aide SHOULD: (B) make the toe pleat. Frequent turning and repositioning of the client helps prevent: (D) pressure injuries. When applying elastic stockings to the client, it would be BEST for the nurse aide to position the client: (A) lying down in bed. The nurse aide is in the employee dining room. A group of nurse aides are eating lunch together and begin discussing how rude a certain client was acting. The nurse aide SHOULD : (Legal and Ethical Behavior) (B) suggest that this is not the place to discuss the client. The client’s signaling device SHOULD be placed: (B) within the client’s reach. When helping a client who is recovering from a stroke to walk, the nurse aide SHOULD assist: (B) on the client’s weak side. A client who is confused begins to cry and scream out for the client’s parent. What should the nurse aide do NEXT? (Emotional and Mental Health Needs) (C) Talk to the client in a calm voice about familiar things. Which of the following actions would be BEST for the nurse aide to take to show respect to the spiritual needs of a client? (C) Assisting the client to read the client’s religious materials

While the nurse aide is providing care to the client, the client calls the nurse aide by the name of the client’s child, who died several years ago. The nurse aide’s BEST response would be to: (D) ask the client about the client’s favorite memories of the client’s child. When providing care for a client receiving oxygen therapy, the nurse aide SHOULD : (Basic Nursing Skills) (A) check ears for pressure points. A client falls and suffers a deep cut on the forehead. What should the nurse aide do NEXT? (D) Stay with the client and call for help The client has been sad and depressed since being admitted to the facility yesterday. What would be the BEST thing for the nurse aide to do for the client? (D) Introduce the client to other clients and staff members The nurse aide is asked by a client who is confused “what day it is?” The nurse aide SHOULD: (C) point to the date on a calendar and say the date. Which of the following is MOST important for the prevention of skin breakdown in the client? (D) Repositioning the client every 2 hours When caring for a client who is dying, the nurse aide SHOULD : (C) pay special attention to fluid intake and mouth care. To BEST communicate with a client who has total hearing loss, the nurse aide should: (D) write out the information. When a client who is weak and unable to move without assistance is positioned in a chair, the nurse aide SHOULD : (D) place the signaling device within the client's reach.

What would be the BEST way for the nurse aide to promote client independence when bathing a client who had a stroke? (B) Encourage the client to do as much as possible and assist as needed Which of the following methods is the correct way to remove a dirty isolation gown? (C) Roll the gown dirty side in and away from the body The health care team member who assists the client with the performance of activities of daily living is the: (B) occupational therapist. What does “ambulate with assistance” mean? (D) The client can walk with the nurse aide providing help When transferring a client, MOST of the client’s weight should be supported by the nurse aide’s: (C) legs. When changing a soiled dressing, the nurse aide SHOULD wash the nurse aide’s hands: (D) before, during, and after the procedure. The nurse aide MUST wear gloves when: (B) providing mouth care. When assisting a client who has right-sided weakness to transfer from a wheelchair, the nurse aide SHOULD support the client’s: (B) right side. The nurse aide can help prevent pressure injuries in the client by: (C) keeping linens clean, dry, and wrinkle free. If a nurse aide discovers a small fire in a client’s room, the nurse aide should FIRST (C) remove the client from any danger.

When a client has memory loss or confusion, the nurse aide SHOULD: (D) give the client simple step-by-step instructions. What does the abbreviation ADL mean? (C) Activities of Daily Living Which of the following actions SHOULD the nurse aide take to communicate with a client who has a hearing loss? (A) Face the client when speaking What is the FIRST area of a client’s body that the nurse aide should wash when providing a bed bath? (B) Face When a nurse provides the nurse aide confidential information about a client, the nurse aide SHOULD : (B) keep the information private. Before entering a client’s room, the nurse aide should FIRST : (C) knock on the door. Mouth care for a client who is unconscious MUST be done every: (A) 2 hours. The nurse aide SHOULD place the client’s soiled bedsheets: (D) in the soiled linen container. Before taking the oral temperature of a client who has just finished a cold drink, the nurse aide SHOULD wait: (A) 20 minutes. To prevent dehydration of the client, the nurse aide SHOULD : (A) offer fluids frequently while the client is awake. When preparing to take a meal tray into the client’s room, what is the MOST important action for the nurse aide to take?

(A) Check that the client’s name is displayed on the tray card Which of the following equipment should the nurse aide have available when caring for a client’s beard? (B) Towel, gloves, razor and shaving cream To find out what type of diet the client should be receiving, it would be BEST for the nurse aide to check: (C) in the client’s care plan. What SHOULD the nurse aide do when a client with Alzheimer’s disease seems depressed and quiet? (B) Observe the client for non-verbal cues Which of the following actions by the nurse aide can BEST demonstrate active listening skills? (B) Responding when appropriate The nurse aide SHOULD understand that a back massage: (C) promotes circulation. When assisting with dressing a client who has left-sided weakness, what part of a sweater should be put on FIRST? (B) Left sleeve A client with arthritis reports difficulty when cutting the food. What SHOULD the nurse aide do to encourage the client’s independence in eating? (C) Assist the client in cutting the food and encourage the client to use the special eating utensils The nurse aide is assisting a coworker in obtaining a quad cane for a client. How many legs SHOULD the nurse aide understand that a quad cane has? (D) 4 Once a client has been pronounced dead, the responsibility of the nurse aide is to: (A) make sure the body is clean.

A client drinks 240 mL of soup, 120 mL of coffee, and 90 mL of juice for lunch. The client’s total liquid intake for lunch is: (B) 450 mL. VERSION 2 this pattern of nursing focuses on TASKS and JOBS. Each person has a separate task to do. What pattern would this be? A. functional nursing B. team nursing C. primary nursing D. patient-focused nursing - ANSWER- A T/F An acute illness is controlled but the patient will always have it? - ANSWER- F Asthma is an example of what type of illness? A. acute B. chronic C. terminal - ANSWER- B A resident goes to cast there vote for the president of the United States. they are exercising what right? a. right to information b. right to citizenship c. quality of life c. right to work - ANSWER- b T/F an NA can give medication and take doctors orders? - ANSWER- F T/F a resident's neighbor comes in and asks you about the residents condition. you, as a CNA, can tell them this Information? - ANSWER- F (this is against HIPPA)

OBRA does all BUT WHICH of the following items? a. sets training and competency hours b. sets regulations for hospitals c. looks after resident quality of life d. makes sure resident rights are being followed - ANSWER- b T/F Negligence is hitting a resident on purpose? - ANSWER- F When does the CNA NOT report to the nurse? a. when there is a change from normal on a resident b. when they leave the unit c. what ADL's another CNA on your unit did to their resident d. the ADL's you did on your patient - ANSWER- c how is 2:32pm written in military time? a. 232 b. 232pm c. 14: d. 1432 - ANSWER- d T/F flow sheets are uses for frequent measurements like V/S? - ANSWER- T what quadrant is MOST of the stomach located in? a. LUQ b.RUQ c. LLQ d. RLQ - ANSWER- a T/F the toes are distal to the knee compared to the ankle - ANSWER- T which observations does not need to be reported immediately? a. bleeding b. dry skin c. reddened skin d. abnormal vitals - ANSWER- b which of the following is considered a sign? a. headache

b. nausea c. pain d. dark colored urine - ANSWER- d (you can see the patients urine but can not see a,b,c) According to Maslow's Hierarchy of Needs which of the following needs must be taken care of first? a. food b.shelt er c. having friends d. feeling secure as a person - ANSWER- a T/F a resident suddenly has FBAO (foreign body airway obstruction) they are not speaking, breathing, or making noise. you should immediately encourage coughing? - ANSWER- F (perform the Heimlich maneuver) Medicated shampoo should be kept where? a. in the residents bathroom b. in the residents bedside table c.locked up at the nurses station d. with the CNA at all times - ANSWER- c T/F you should unlock the brakes of a W/C before attempting a transfer? - ANSWER- F how many people do you need for a stretcher transfer? a. 2 b. 4 c. 3 d. 1 - ANSWER- c which of the following is NOT on a MSDS? a. health hazards b. how to clean up a spill c. chemical name of the product d. what age you should be to use the product - ANSWER- d all of the following help prevent fires EXCEPT... a. residents wear cotton pajamas b. no open flames in the rooms

c. keeping residents on oxygen out of their room d. no smoking in rooms - ANSWER- c T/F race stands for- Rescue, alarm confine, and extinguish - ANSWER- T the last sentence of the acronym PASS is a. squeeze the lever b. sweep back and forth c. sweep up and down d. none of the above - ANSWER- b which of the following does NOT help prevent falls? a. ANSWER the call lights promptly b. meet basic needs c. non-skid footwear d. call lights by the door so the resident doesn't trip - ANSWER- d T/F gait belts should be buckled over the spine - ANSWER- F T/F bedrails are considered a restraint? - ANSWER- T T/F you should always try to stop a resident fall? - ANSWER- F What restraint is considered least restrictive to a resident a. a mitt b. wrist restraint c. vest restraint d. belt restraint - ANSWER- a restrained residents should be observed every... a. 10 mins b. 5 mins c. 20 mins d. 15 mins - ANSWER- d which is not considered a HAI? a. HIV b. influenza c. a broken arm

d. hepatitis A - ANSWER- c as a CNA when should you not use Alcohol-based hand rub? a. after contact with a resident b. before contact with a resident c. before eating d. after removing gloves - ANSWER- c TB, chicken pox, severe acute respiratory are all examples of? a. droplet precautions b. airborne precautions c. contact precautions d. all of the above - ANSWER- b which of these isolation precautions required N95 mask? a. droplet b. airborne c. contact d. all of these above - ANSWER- b T/F trendelenburg position is used the resident's comfort and is often re- questioned? - ANSWER- F fowlers bed position is often used for our residents. which one of these is not a fowlers position? a. 15-30 degrees b. 30-45 degrees c. 45-60 degrees d. 60-90 degrees - ANSWER- a T/F logrolling is done with 2 people and a resident - ANSWER- T T/F lateral and dorsal recumbent are the same position - ANSWER- F (supine and dorsal recumbent) as a CNA transferring a resident which of these are not recommended? a. transfer on the strong side b. transfer belt applied correctly c. allow the resident to hold around your neck d. bend at your knees when lifting - ANSWER- c

there are 4 different types if bedmaking for a medical facility. which one is done for a resident returning on a stretcher? a. closed linens b. surgical c. open- top d. occupied - ANSWER- b which of these is not an OBRA requirement? a. space for W/C b. 1 window c. no more than 2 residents per room d. room temperature 71-81 degrees - ANSWER- c performing oral care for a resident in their bed you should not? a. use a kidney basin b. brush teeth at 45 degrees angle c. sit the resident up right d. only use hot water for denture care - ANSWER- d mr. jones is unconscious and needs mouth care as a CNA you should gather all supplies then? a. brush his teeth with a toothbrush b. use a clamp to hold his mouth open c. position Mr. Jones in a supine position d. turn head to the side to prevent aspiration - ANSWER- d T/F when providing a bed bath you should wash from the dirtiest to the cleanest - ANSWER- F T/F a complete bed bath should be in the order of: eyes face/ neck arm chest/ abd leg back peri - ANSWER- T T/F when removing PPE it should be done in this order:

mask, gown, and gloves - ANSWER- F what should you not do when giving a resident a bath a. keep water at 100 degrees b. cover body parts for privacy c. disinfect tub d. report/record bathing procedures and residents response - ANSWER- a T/F you are giving mrs. jones a back massage you notice a reddened area you should massage the bony red spots and apply lotion - ANSWER- F T/F you should change the basin water when giving a bath before cleaning the perennial area - ANSWER- T when assisting a resident with a tub bath what should you not do? a. stay with the resident if weak b. assist the resident out of the bath before draining the water c. turn on the cold water first d. clean the tub before and after use - ANSWER- b when providing male perineal care always start at? a. shaft b. abd c. meatus d. rectum - ANSWER- c T/F female perineal care should have the water temp at 105-109 - ANSWER- t T/F you should be using a safety razor (disposable razor) on a person that is on blood thinners (anticoagulants) - ANSWER- F (an electric razor should be used on a person that is confused or on anticoagulants) when shaving the face with a disposable razor, which direction should you shave? a. from chin to cheek b. side to side c. against the direction the hair growth d. with the direction the hair growth - ANSWER- d

this is used to clean under the nails and to push back the cuticles a. emery board b. nail file c. orange stick d,. tongue depressor - ANSWER- c mr. smith is paralyzed on his right side. when dressing, which arm would you put in first? a. right arm b. left arm - ANSWER- a (POW) mr. smith needs to get undressed. he has paralysis on his right side. which arm should come out of his shirt first a. right arm b. left arm - ANSWER- b (TOSS) fracture pans are used for persons for all of the following reasons except.. a.l hip fracture b. traction c. arm fracture d. limited movement in back - ANSWER- c T/F a urinal can only be used while sitting - ANSWER- f (men can use a tribal while sitting, lying down, or standing) T/F when hanging the drainage bag of a catheter, the drainage bag should be attached to the bed frame - ANSWER- T the catheter should be secured to a. the bottom sheet b. the bed frame c. the bed rail d. the inner thigh - ANSWER- D ostomy pouches are changed a. every 3-7 days b. when full of air c. everyday d. when half full or stool stool - ANSWER- a

which nutrient is excellent for tissue growth and wound healing? a. carbohydrates b. minerals c. proteins d. vitamins - ANSWER- c you are serving.a meal try to mr. smith. you notch coffee, apple juice, beef broth, and jello on his tray. you would check to make sure that he is on what type of diet? a. Regular b. clear liquid c. full liquid d. soft diet - ANSWER- b your patient has dysphagia. you know this means that your patient has a. difficulty swallowing b. difficulty speaking c. difficulty breathing d. difficulty chewing - ANSWER- a T/F the male is considered uncircumcised when foreskin must be retracted during perineal care - ANSWER- T your resident is on a full liquid diet. you know that he can have the flooring food/drink items a. only water, broth, jello, coke, and coffee b. only liquids that have been thickened c. catered, milk, ice cream and jello d. all pureed foods or drinks - ANSWER- c T/F Your patient is NPO, you know your patient can only have water to drink - ANSWER- F T/F when measuring output the CNA can measure the following: urine, vomiting, diarrhea, and wound drainage - ANSWER- T your patient drank at of a 6 oz glass of milk. the drank how many milliners of milk a.240 ml b.24ml

c.180 ml d. 30 ml - ANSWER- c T/F 1 oz = 8 milliliters - ANSWER- F `a normal oral temperature range is a.96.6-99. b.97.6-99. c.98.6-99. d.97.0-100.0 - ANSWER- b T/F an elderly person with a temperature of 98.6 may signal a fever - ANSWER- T when taking a rectal temperature, you will need to use which color thermometer a. red b. blue c. green d. brown - ANSWER- a T/F the brachial pulse is located on the thumb side of wrist - ANSWER- F this pulse site on the neck is used to asses a pulse during CPR a. apical b. brachial c. carotid d. radical - ANSWER- c A normal pulse range for an adult is a. 10- 20 b. 12- 24 c. 60- 80 d. 60-100 - ANSWER- d T/F inhalation and exhalation is considered one breath - ANSWER- T your patient's blood pressure is 130/54. you know that: a. the systolic is abnormal b. the diastolic is abnormal

c. both systolic and diastolic are abnormal d. neither systolic or diastolic is abnormal - ANSWER- d this type of positioning device is used to prevent plantar flexion a. foot board b. trochanter roll c. hip abnormal wedge d. orthostatic - ANSWER- a the best was to prevent orthostatic hypotension is a. drink plenty of water b. exercise daily c. change position slowly d. stop smoking - ANSWER- c hip abductor wedge is commonly used after a. abnormal surgery b. hip replacement surgery c. knee replacement surgery d. total hysterectomy - ANSWER- b temperature - ANSWER- 97.6-99. BP - ANSWER- 90-120/60- 90 address the resident by - ANSWER- the name of his/her choice what should you do if a visitor asks to access the residents records - ANSWER- refer them to the nurse T/F you can't help residents write letters, only verify an address - ANSWER- T the 3 S's for Acute - ANSWER- short, suden, severe Nursing assistants Nevers - ANSWER- - give meds of any king -take orders from the doctor -perform sertile procedures -tell the person/family the dx or medical or surgical plans -insert or remove tubes or objects from the person's body

-dx or proscribe treatments or meds -supervise other nursing assistants -ignore an order What is assault? - ANSWER- threat what is battery - ANSWER- touch admission record - ANSWER- Identifying information (name, DOB, address, nearest relative and legal rep, allergies, dx, Dr.) health record - ANSWER- (nursing hx)- chief complaint, illness hx, past health hx, meds, allergies, assistive devices what should you record - ANSWER- -what you observed -what you did -the person's response lateral - ANSWER- away from the midline medial - ANSWER- toward the midline proximal - ANSWER- Closer to the point of attachment distal - ANSWER- away from the point of attachment Posterior - ANSWER- toward the back anterior - ANSWER- toward the front what are objective - ANSWER- signs what are signs - ANSWER- seen, heard, felt or smelled (ex: v/s, color of urine, or smell of drainage) what are subjective? - ANSWER- Symptoms what are symptoms - ANSWER- what the person tells you (ex: pain, nauseas or headache)

what is the prioritize order of care? - ANSWER- -when your shift begins, get report -read over chart or chair plan to find out what has changed -assess what had happened during pervious shift -find out what needs to happen on your shift what is on a person's ID bracelet - ANSWER- person's name room bed number birth date age doctor agencys name what should you do if you notice poison in a person's room - ANSWER- remove it and tell the nurse after you remove it what does FBAO stand for - ANSWER- foreign body airway obstruction what is a MSDS - ANSWER- Material Safety Data Sheet what does RACE stand for - ANSWER- rescue, alarm, confine, extinguish What does PASS stand for? - ANSWER- Pull (the safety pin), Aim (low), Squeeze (the lever), Sweep (back and forth) what is the most common reason for falls? - ANSWER- urgency to use the bathroom S/S of infection - ANSWER- • fever

• chills
• increased pulse
• increased respirations
• fatigue
• N/V/D (diarrhea)
• redness/swelling
• heat/warmth at site
• headache
• aches

• confusion

• loss of appetite
• rash What does HAI stand for? - ANSWER- healthcare associated infections What is medical asepsis? - ANSWER- Clean technique; remove or destroys pathogens What is surgical asepsis? - ANSWER- sterile technique- keeps items free from all microbes, destroys all microbes when do you use soap and water - ANSWER- When hands are visibly soiled or contaminated with blood or body fluids -before eating or after using the restroom -if alcohol based hand rub is not available when do you use alcohol based hand rub - ANSWER- -before hand after contact with person -after contact (if not visibly soiled) -moving from contaminated body site to clean -after contact with objects -after removing gloves when does one perform hand hygiene - ANSWER- before and after every resident contact hand washing tips - ANSWER- -friction is key -1st step in preventing the spread of germs and most effective percussion used to control spread -the medical asepsis communicable disease - ANSWER- contagious disease types of communicable disease - ANSWER- -contact (touch)
• droplet (yelling, coughing, or sneezing) (droplets large so they fall) -airborne (in air) (floats in the air) T/F you don't need to wear gloves when handling contaminated items - ANSWER- f- always wear gloves when handling contaminated items

how should one serve and remove tray from an isolation room - ANSWER-

• wash hands, place meal tray on isolation cart, put on PPE, helper holds tray while you transfer food to isolation tray
• uneaten food is flushed and disposable dishes, bones, etc. are discarded or transfer dishes to tray held by another CNA -cover dishes and return to kitchen -clean isolation try and store in room
• DOUBLE BAG TRASH What is donning? - ANSWER- Putting on PPE Donning order of PPE - ANSWER- gown, mask, goggles, gloves removing order of PPE - ANSWER- gloves, gown, mask how should one remove their PPE gown - ANSWER- untie waist strings first, then untie neck strings. remove gown from shoulders and roll it up inside out away from body when is double-bagging needed? - ANSWER- if the outside of the bag is wet, soiled, or may be contaminated how are specimens transported to the lab? - ANSWER- in a biohazard specimen bag with good body alignment how wide apart should you feet be for support - ANSWER- 18" apart (shoulder width0 Fowler's position - ANSWER- 45-60 degrees Semi-Fowler's Position - ANSWER- 30-45 degrees High Fowler's Position - ANSWER- 60-90 degrees supine position - ANSWER- lying on back, facing upward what is supine also called? - ANSWER- dorsal recumbent prone position - ANSWER- lying face down

lateral position - ANSWER- side lying position Sims position - ANSWER- lying on left side with right knee drawn up and with left arm drawn behind, parallel to the back T/F place a pillow at the head board to prevent the person from hitting head on the headboard as you are moving them up in bed - ANSWER- T how many people is needed for logrolling - ANSWER- at least 2 T/F transfer on the person's weak side - ANSWER- f (transfers on the strong side, strong side moves first) What is the Trenelenberg bed position? - ANSWER- feet are higher than the head, used when BP drops what is the OBRA requirements for beds - ANSWER- proper bed with clean, comfortable mattress OBRA requirement on room temperature - ANSWER- 71- 81 closed bed making - ANSWER- lines not folded back (the sheets go full length foot to head) open bed making - ANSWER- top lines folded back and is ready for the resident occupied bed making - ANSWER- a bed with a person in it surgical bed making - ANSWER- lines folded to one side what are 3 important rules for bed making - ANSWER- -keep bottom linen wrinkled-free -make as much of one side of bed as possible -roll dirty lines away from you what degree should you brush their teeth at - ANSWER- 45 how to help a confused person brush teeth - ANSWER- provide step- by- step assistance

when to should you assist brush teeth - ANSWER- in AM and after each meal unconscious mouth care - ANSWER- -prevent aspiration by turning head to side -use a padded tongue blade to hold mouth open -use a sponge tipped applicator to clean mouth (make sure it is tight on the stick) -done every 2 hours What is aspiration? - ANSWER- chock and fluid goes into lungs T/f pat the patient dry after bathing - ANSWER- T how full should the bath basin be - ANSWER- 2/3 what temperature should the bath basin be at - ANSWER- 110-115 degrees what order should you wash the patient - ANSWER- -start at inner cannula of eye

• face/neck far arm and hand then nearest arm and hand -chest then abdomen -far leg then the nearest leg what is the general goal for bathing - ANSWER- remove pathogens and promote comfort when changing water for perineal care what should the water temperature be at - ANSWER- 105-109 T/F massage reddened bony areas - ANSWER- F T/F side-lying position for elderly is more comfortable - ANSWER- T how should you keep the bath blanket on the resident during perineal care - ANSWER- diamond shape