NH LNA Exam Flashcards

Q: Why does New Hampshire call this exam the LNA exam instead of the CNA exam?

New Hampshire licenses nursing assistants under RSA 326-B (the state Nurse Practice Act), using the title Licensed Nursing Assistant (LNA) instead of Certified Nursing Assistant (CNA). The written-exam content outline and scope of practice are functionally the same as a standard CNA exam in other states.

Q: How many questions are on the New Hampshire LNA written exam, and what is the passing score?

The written exam has 60 multiple-choice questions, administered in 90 minutes. You need a score of 70% or higher to pass, per Excel Testing's official NH Nurse Aide Competency Test Guide.

Q: What happens during the New Hampshire LNA skills exam?

You fully perform (not simulate) 4 randomly selected clinical skills for a test observer within 30 minutes, with another candidate playing the resident. Missing a bolded critical step is an automatic fail, and 4 or more non-critical skill errors will also fail the exam.

Q: How soon can I retake the New Hampshire LNA exam if I fail a section?

You must wait at least 2 days after your previous test date before retesting, per Excel Testing's official policy. You only need to retake the portion (written or skills) you failed, not both.

Q: What happens if I fail the New Hampshire LNA exam three times?

After repeated failures, candidates are required to complete a new NH Board of Nursing-approved nursing assistant training program before attempting the exam again. This is not a simple additional waiting period but a full retraining requirement, consistent with federal nurse aide competency evaluation rules.

Q: How do I renew a New Hampshire LNA license?

NH LNA licenses must be renewed every 2 years. Renewal requires both 24 hours of continuing education AND 200 hours of work as a nursing assistant during the renewal period — both requirements apply, not just one.

Question 1

A resident's family member asks you to explain their loved one's diagnosis and lab results. What should you do?

Accepted Answer

Politely explain that discussing diagnoses, treatment plans, or lab results is outside a nursing assistant's scope of practice. Refer the family member to the nurse, who can share information appropriately.

Question 2

What is 'delegation' in the context of the nursing assistant's role?

Accepted Answer

Delegation is when a licensed nurse assigns a specific nursing task to the aide after determining the aide is competent to perform it. The nurse remains accountable for the outcome; the aide may only perform delegated tasks within their training and the care plan.

Question 3

You notice a resident's skin looks different and they seem more short of breath than usual. What is your responsibility?

Accepted Answer

Report the observation to the nurse immediately using objective, factual language, then document it. Nursing assistants observe and report — they do not diagnose or decide on treatment independently.

Question 4

A resident refuses to take a shower today. What must you do?

Accepted Answer

Respect the resident's right to refuse care — under OBRA, care cannot be forced. Document the refusal, notify the nurse, and offer to try again later or provide an alternative such as a bed bath, without coercion.

Question 5

Before entering a resident's room or beginning personal care, what two rights must you actively protect?

Accepted Answer

Privacy and dignity. Knock and wait before entering, close the door or pull the privacy curtain, and keep the resident covered except for the body part being cared for.

Question 6

A resident wants to file a complaint about their care. What is their right, and what is your role?

Accepted Answer

Residents have the right to voice grievances without fear of retaliation or reprisal. Your role is to listen respectfully, never dismiss the concern, and report it to the nurse or supervisor so it is formally addressed.

Question 7

Distinguish physical abuse from neglect.

Accepted Answer

Physical abuse is an intentional act that causes bodily harm or pain. Neglect is the failure to provide necessary care (food, hygiene, safety, supervision), whether intentional or not. Both must be reported immediately.

Question 8

You notice unexplained bruising on a resident's arm during care. What must you do?

Accepted Answer

Report it to the nurse immediately and document your objective observation (location, size, appearance). As a mandatory reporter, you cannot decide the finding is nothing — any suspicion of abuse or neglect must be reported.

Question 9

What is financial exploitation of a resident, and who must report it?

Accepted Answer

Financial exploitation is the illegal or improper use of a resident's funds, property, or assets. Every nursing assistant is a mandatory reporter and must report suspected exploitation to the nurse or supervisor.

Question 10

Why is New Hampshire's nursing assistant credential called an 'LNA' instead of a 'CNA'?

Accepted Answer

New Hampshire licenses nursing assistants rather than certifying them. LNA stands for Licensed Nursing Assistant, governed by RSA 326-B (the NH Nurse Practice Act); the scope of practice and exam content are essentially the same as a CNA in other states.

Question 11

How often must a New Hampshire LNA license be renewed, and what does renewal require?

Accepted Answer

Every 2 years. Renewal requires 24 hours of continuing education AND 200 hours of work as a nursing assistant during the renewal period — both requirements must be met, not just one.

Question 12

What is the New Hampshire MNA credential, and how does an LNA obtain it?

Accepted Answer

MNA stands for Medication Nursing Assistant, an add-on certification letting an experienced LNA administer medications in long-term care settings under specific conditions. It requires completing an additional 80-hour course beyond the base LNA training.

Question 13

What is the correct way to lift a heavy object to protect your back?

Accepted Answer

Keep a wide base of support (feet shoulder-width apart), bend at the knees rather than the waist, hold the load close to your body, and never twist your spine while lifting — pivot your feet instead.

Question 14

What are the two most basic room setup steps for preventing a fall for a resident who gets up unassisted?

Accepted Answer

Keep the call light within easy reach at all times, and keep the bed in its lowest position with the wheels locked. Also clear pathways of clutter and ensure non-slip footwear is worn.

Question 15

A family member asks you to tie a confused resident's wrist to the bed rail because they keep pulling at their IV. Can you do this?

Accepted Answer

No. A physical restraint requires a physician's order and must be a last resort after alternatives, like a wanderguard alarm or closer supervision, have failed. If a restraint is in use, it must be released and the resident checked at least every 2 hours.

Question 16

A resident from a different cultural background declines a meal that conflicts with their dietary beliefs. What should you do?

Accepted Answer

Respect their cultural and religious dietary preferences, do not pressure them to eat it, and notify the nurse or dietary staff so an appropriate substitute can be arranged.

Question 17

What is Maslow's hierarchy of needs, and why does it matter for nursing assistants?

Accepted Answer

It ranks human needs from most to least basic: physical needs (food, warmth, safety) first, then love/belonging, self-esteem, and self-actualization. Physical needs generally must be addressed before a resident can focus on emotional or social needs.

Question 18

How do dementia and delirium differ in onset?

Accepted Answer

Dementia develops gradually and is generally a progressive, irreversible decline in memory and thinking. Delirium has a sudden, rapid onset and is often reversible once the underlying cause (infection, medication, dehydration) is treated.

Question 19

A resident with dementia becomes more confused and agitated every evening. What is this pattern called, and how should you respond?

Accepted Answer

This is called sundowning. Keep the environment calm and consistently lit, maintain a predictable routine, and avoid arguing with the resident's confusion — use validation and gentle redirection instead.

Question 20

A resident with dementia insists their deceased spouse is coming to visit today. What approach should you use?

Accepted Answer

Use validation therapy: acknowledge the resident's feelings and reality rather than correcting or arguing with them, then gently redirect them to a comforting activity.

Question 21

What is the normal oral temperature range for an adult, and what temperature is generally considered a fever?

Accepted Answer

Normal oral temperature averages about 97.8-99.1°F. A temperature at or above 100.4°F (38°C) is generally considered a fever and should be reported to the nurse.

Question 22

What is the normal pulse rate range for a resting adult?

Accepted Answer

60 to 100 beats per minute. A resting pulse below 60 (bradycardia) or above 100 (tachycardia) should be reported to the nurse.

Question 23

What is the normal respiratory rate range for an adult, and how should you count it?

Accepted Answer

12 to 20 breaths per minute. Count respirations without telling the resident, since awareness of being watched can change breathing patterns; count for a full minute or per facility policy.

Question 24

What blood pressure reading should be reported to the nurse?

Accepted Answer

A normal adult blood pressure is generally below 120/80. Significantly elevated readings (such as 140/90 or higher) or unusually low readings should be reported promptly, along with any symptoms like dizziness or headache.

Question 25

What pulse oximetry (SpO2) reading requires you to notify the nurse immediately?

Accepted Answer

Normal oxygen saturation is 95-100%. A reading below 90% is a warning sign of inadequate oxygenation and must be reported to the nurse right away.

Question 26

In what order should you put on (don) PPE before entering an isolation room?

Accepted Answer

Gown first, then mask, then goggles or face shield, and gloves last. Gloves go on last so they cover the gown's cuffs and stay clean until you touch the resident.

Question 27

In what order should you remove (doff) PPE when leaving an isolation room?

Accepted Answer

Gloves first (the most contaminated item), then goggles or face shield, then gown, and mask last — followed immediately by hand hygiene. This reverse order minimizes the risk of self-contamination.

Question 28

When should you perform hand hygiene during resident care?

Accepted Answer

Before and after every resident contact, before and after gloving, after touching body fluids or contaminated surfaces, and after removing PPE. Hand hygiene is the single most effective way to prevent the spread of infection.

Question 29

What are 'standard precautions,' and when do they apply?

Accepted Answer

Standard precautions are basic infection-control practices, such as hand hygiene and gloves when contact with body fluids is likely, used with every resident regardless of known infection status, because any resident could be carrying an infectious organism.

Question 30

A resident has a known MRSA infection requiring contact precautions. What PPE is required to enter the room?

Accepted Answer

Gown and gloves, in addition to standard precautions. Contact precautions are used for organisms spread by direct or indirect touch (like MRSA or C. diff) and are added on top of, not instead of, standard precautions.

Question 31

A resident has suspected tuberculosis. What type of precautions and PPE are required?

Accepted Answer

Airborne precautions, requiring an N95 (or higher) respirator mask before entering the room, ideally a negative-pressure room. Airborne precautions apply to diseases spread by tiny particles that travel through air, such as TB, measles, and chickenpox.

Question 32

Differentiate objective data from subjective data in resident observation.

Accepted Answer

Objective data is what you directly observe or measure, such as a wound being red and swollen. Subjective data is what the resident tells you, such as 'my stomach hurts.' Both should be documented, but keep them separate and factual.

Question 33

Name three situations that require you to report to the nurse urgently, without delay.

Accepted Answer

Chest pain, uncontrolled bleeding, and a resident fall or sudden change in consciousness/breathing all require immediate reporting. Do not wait until the end of your shift to communicate urgent findings.

Question 34

What is I&O tracking, and why does it matter?

Accepted Answer

I&O stands for intake and output — recording all fluids a resident consumes and all fluid output (urine, vomit, drainage). It helps the care team monitor hydration, kidney function, and fluid balance, especially for residents on fluid restrictions.

Question 35

You catch a resident before a near-fall and no injury occurs. What must you still do?

Accepted Answer

Complete an incident report documenting exactly what happened, even without injury. Unusual or unexpected events must always be documented and reported to the nurse, since patterns of near-misses can signal a bigger safety problem.

Question 36

During a bed bath, what part of the body should you wash first, and what should you wash last?

Accepted Answer

Wash the face first, since it is the cleanest area, and the perineal area last, since it is the most likely to be contaminated — always working from clean to dirty to avoid spreading microorganisms.

Question 37

What is the correct direction for cleansing during perineal care, and why?

Accepted Answer

Always clean front to back, from the urethral area toward the anal area, never the reverse. This prevents moving bacteria from the rectal area toward the urinary opening, reducing the risk of urinary tract infections.

Question 38

How should you position an unconscious resident for oral care, and why?

Accepted Answer

Position them side-lying with the head turned slightly down. This lets fluids and secretions drain out of the mouth by gravity, reducing the risk of aspiration.

Question 39

How should dentures be stored when not in the resident's mouth?

Accepted Answer

In a labeled, covered container filled with cool (not hot) water or a denture-cleaning solution. Hot water can warp dentures, and an unlabeled container risks mix-ups between residents.

Question 40

A diabetic resident asks you to trim their toenails. What should you do?

Accepted Answer

Do not trim a diabetic resident's toenails yourself — refer this to the nurse or a podiatrist. Diabetic residents have a higher risk of poor circulation and slow-healing wounds, so even a small nick can lead to serious complications.

Question 41

A resident has right-sided hemiplegia and needs help getting dressed. Which side should you dress first?

Accepted Answer

Dress the weak (affected) side first, then the strong side. When undressing, do the reverse — remove clothing from the strong side first, then the weak side. This rule minimizes strain on the weaker limb.

Question 42

How should a gait belt be applied before assisting a resident to stand or walk?

Accepted Answer

Snugly around the resident's waist, over their clothing (never bare skin), with enough room to slide two fingers underneath. Use the belt handles to guide and steady the resident, not to lift their full body weight.

Question 43

What must you always do to a wheelchair before transferring a resident into or out of it?

Accepted Answer

Lock both wheels. An unlocked wheelchair can roll away during the transfer and cause a fall — always check that the brakes are engaged before the resident moves.

Question 44

Distinguish active range of motion (AROM) from passive range of motion (PROM).

Accepted Answer

In active ROM, the resident moves their own joints independently, helping maintain strength and mobility. In passive ROM, the aide moves the resident's joints for them because the resident cannot move that body part alone, which helps prevent joint contractures.

Question 45

When ambulating with a resident who has one-sided weakness, where should you walk?

Accepted Answer

Walk slightly behind and to the side of the resident's weak side, ready to provide support if they start to fall. Never pull on a weak arm or shoulder.

Question 46

A resident begins to fall while you are assisting them to walk. What should you do?

Accepted Answer

Do not try to catch or hold them fully upright, since this risks injury to both of you. Widen your stance, support their body, and gently guide or lower them to the floor while protecting their head, then call for help.

Question 47

A resident is on a fluid restriction but keeps asking for more water than allowed. What should you do?

Accepted Answer

Offer only the permitted amount, track it as part of I&O, and notify the nurse if the resident is exceeding or requesting more than their restriction allows — do not give extra fluids on your own.

Question 48

How should you position a resident who is at risk of aspiration during feeding?

Accepted Answer

Keep the resident sitting as upright as possible during and for at least 30 minutes after eating, to reduce the risk of food or liquid entering the airway.

Question 49

What is bowel and bladder training, and how is it typically implemented?

Accepted Answer

A structured program using a regular, scheduled toileting routine (for example, every 2 hours) to help a resident regain or maintain continence, rather than waiting for accidents to happen.

Question 50

How should a urinary catheter drainage bag be positioned, and what should you focus on for a dying resident's comfort?

Accepted Answer

The catheter bag must always be kept below the level of the bladder to prevent backflow and infection. For a dying resident, focus on comfort measures — pain relief, mouth care, positioning, and treating the body with dignity during post-mortem care.

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