BP question for CNA job

DanainOrlando · Nov 17, 2009

Anyone can call the MD's office. What's outside the CNA scope of practice is to take physician's orders or messages.

You know, that's an excellent point - as a CNA there isn't any treatment that I'm allowed to give other than CPR - so what good does it do me to call a doctor's office?

KateRN1 · Nov 17, 2009

I'm applying for a job at a CNA agency, and they have a multiple choice test that I have to take. I appreciate any assistance that anyone here can give me.
One of the questions is:
1.) If a person has a b/p of 60/40, you should:
a.) call the nursing agency
b.) call a physician
c.) Dial 911
d.) Nothing.
I would say call a physician; is that right?

The best answer for the test is (A). Yes, the B/P is low, but without further assessment information, it is outside of the CNA's scope of practice to notify the physician. Calling 911 may or may not be necessary, there is not enough information given in the stem to make a judgment. The CNA *always* reports abnormal vital signs to the licensed nurse and/or agency. It is not within the CNA's scope of practice to assess the patient or to take physician's orders, that falls to the licensed nurse. The CNA reports the abnormal vital signs to the licensed nurse who can take into consideration all aspects of the patient's care, including medications, medical conditions, recent procedures, and overall health. It is up to the licensed nurse to then relay the information to the physician and be prepared for new orders (or not).

Another question is:
The potential for splashing and soiling with blood and bodily fluids exists in caring for certain patients. What precautions should be considered in addition to gloves?
a.) Disposable plastic gown
b.) Disposable plastic gown, and goggles
c.) Disposable plastic gown, goggles and mask
I took a short CNA course - nobody mentioned anything about goggles! Which is the best answer?

The best answer is ©. The key word in this stem is "splashing." Any time there's a possibility of splashing, goggles and mask should be used. That doesn't always happen in real life, but it is the correct answer for the exam.

DanainOrlando · Nov 17, 2009

The best answer for the test is (A). Yes, the B/P is low, but without further assessment information, it is outside of the CNA's scope of practice to notify the physician. Calling 911 may or may not be necessary, there is not enough information given in the stem to make a judgment. The CNA *always* reports abnormal vital signs to the licensed nurse and/or agency. It is not within the CNA's scope of practice to assess the patient or to take physician's orders, that falls to the licensed nurse. The CNA reports the abnormal vital signs to the licensed nurse who can take into consideration all aspects of the patient's care, including medications, medical conditions, recent procedures, and overall health. It is up to the licensed nurse to then relay the information to the physician and be prepared for new orders (or not).
The best answer is ©. The key word in this stem is "splashing." Any time there's a possibility of splashing, goggles and mask should be used. That doesn't always happen in real life, but it is the correct answer for the exam.

Thank you SO much! That is extremely helpful. I still feel that the questions could be phrased a little better, but both of your answers make perfect sense.

Otessa, BSN, RN · Nov 17, 2009

I would call the nursing agency since a CNA is unable to take MD orders.

otessa

noahsmama · Nov 17, 2009

I'm with the people who say call 911 for a BP of 60/40 -- that's a life threatening BP (assuming the pt is an adult and not a newborn baby) and the pt needs to go to an ER. The other steps are a waste of time in a life-threatening situation.

If you find out what the agency considers to be the "right" answers, please let us know!

nialloh, RN · Nov 17, 2009

I work on a cardiac unit. For a B/P of 60/40 we would call a rapid responce. As the last poster said, this is a life threatening level, and time is of the essence. Call 911.

KateRN1 · Nov 18, 2009

I respectfully disagree for the B/P of 60/40. For a patient who is alert and oriented, whose other vital signs are within normal parameters, and who is otherwise hemodynamically stable, a low blood pressure warrants careful monitoring, not a call to EMS. However, the scope of practice of the CNA is not one to make that series of assessments and requires the judgment of a licensed nurse, therefore the best answer *for the test* is to call the licensed nurse or nursing agency and allow someone with that scope of practice to make the judgment. For a patient who is unconscious with a B/P of 60/40, absolutely call 911 (for any patient who is unconscious for that matter), but that is not indicated in the question.

This is a *test* item, not necessarily designed to test the taker's medical/nursing knowledge but rather designed to test whether the cadidate knows his/her chain of command--which is to report to the licensed nurse.

DanainOrlando · Nov 18, 2009

Yes, that is it exactly; it's a test question, not reality. Sort of like in the CNA class when they taught you to pass the CNA test, not how to really work as a CNA.

Anyway, I got the job and am meeting my first patient tonight, so I assume I got the question right; I put down "Call the agency".

systoly · Nov 18, 2009

Congratulations

DanainOrlando · Nov 19, 2009

Congratulations

Thank you! I met my first patient and she is absolutely lovely.