Actively portray resident from card. Speak up if the CNA causes pain or ignores clinical safety checks.
Role C: Observer
Use assessment rubric checklist. Record any missed steps, compromised safety, or loss of resident dignity.
Ready? Switch roles after each 8-minute scenario is completed. SLIDE 7/7
Is the scrambled egg fluid? _________
Calculate Total Intake (mL/cc):
Case Study 2: Afternoon Intake and Output Comparison BALANCE SHEET
During your afternoon shift, Resident James Cooper drinks two 8 oz glasses of water and eats 3 oz of ice cream. You measure his indwelling urinary drainage bag twice: at 14:00, you empty 240 mL of urine, and at 18:00, you empty 310 mL of urine.
Total Intake (mL):
Total Output (mL):
Net Balance (mL):
Clinical Alert Critical Question
If a resident consumes 1200 mL of fluid over 24 hours, but their total catheter output is only 250 mL for the entire day, what immediate physical checks must the CNA conduct on the tubing before alerting the supervising nurse?
CNA Clinical Essentials Study Guide Page 2 of 3
STUDENT CLASSROOM WORKBOOK
SKILL SEQUENCE CHECKLISTS
CNA Skill: ROM & Catheter
Skill Checklist 1: Passive ROM (Elbow and Shoulder)
Evaluate your peer during the clinical simulation. Check off the circles upon successful clinical completion.
Identify: Introduce self, identify the resident, and state the exact movements to be executed.
Joint Support: Support joint above and below (under wrist and under elbow) before raising arm.
Flexion/Extension: Move joint slowly and rhythmically 3 times per joint.
Pain Assessment: Verbally ask the resident about pain or discomfort during exercise cycles.
Dignity & Comfort: Keep resident covered with a bath blanket, exposing only the active arm.
Safety: Return arm safely to side, adjust bed level, and hand call light directly back to resident.
Skill Checklist 2: Indwelling Catheter Principles
Identify the core infection prevention actions required during catheter care.
Anatomical Cleansing: Always clean the perineal area from cleanest area to dirtiest (front to back).
Tubing Wipe Direction: Wipe at least 4 inches of catheter tubing outward away from urethra.
One-Way Motion: Use a clean section of the washcloth for every wipe of the tubing.
Secure Placement: Verify tube securing clip (STATLOCK) is firmly placed on resident thigh.
No floor contact: Maintain clear distance between the drainage bag and the patient's floor.
Below Bladder: Hang the drainage bag exclusively from the static bed framework.
Reflective Skill Evaluation:
During your peer-simulation practice, what was the most difficult physical care action to perform while simultaneously maintaining the resident's dignity? What strategy did your partner use that you found effective?
CNA Clinical Essentials Study Guide Page 3 of 3
CNA
Resident
Observer
SCENARIO CARD 3: FLUID RESTRICTION & INTAKE
Resident Profile Mr. Marcus Reynolds (Age 68)
Diagnosed with stage-4 Chronic Kidney Disease on hemodialysis. He is on a strict fluid restriction protocol of 1000 mL per 24 hours.
The Clinical Twist
Mr. Reynolds complains of intense thirst, saying "My mouth feels like cardboard." He asks you to fill a large 16 oz insulated mug with ice water.
CNA Objectives
Refuse fluid request while maintaining compassionate care.
Explain clinical reasons behind fluid restriction in plain language.
▢ Reassured the resident without being defensive or curt?
▢ Offered safe alternative care solutions for dry mouth?
Cut Along Dotted Line
SCENARIO CARD 4: CATHETER CARE & POSITIONING
Resident Profile Mrs. Clara Higgins (Age 79)
Recovering from hip surgery and has an indwelling urinary catheter in place. She is in bed and needs assistance adjusting her posture.
The Clinical Twist
When you fold back her sheets, you discover her urinary drainage bag is currently hooked to the movable bed rail, and the tubing is kinked beneath her hip.
CNA Objectives
Identify and immediately correct the dangerous bag positioning.
Reposition the drainage bag to the static frame below the bladder.
Carefully uncoil and inspect the tubing for blocks or sediment.
Wash hands, explain the positioning change, and preserve dignity.
Observer Verification
▢ Moved the bag off the side rail immediately?
▢ Unkinked the tube without pulling on the insertion site?
▢ Ensured the bag was placed lower than bladder level?
