A New Jersey CNA is dressing a resident who had a left-side stroke and has left arm weakness. The resident is putting on a button-up shirt. Which arm should the CNA place into the sleeve first?

The left (weak) arm first, then the right arm. The affected-side rule states that clothing goes ONTO the weak side first and comes OFF the strong side first. Dressing the weak left arm first reduces strain on the impaired limb and avoids forcing the affected joint through a stretched sleeve. The memory aid is 'weak goes in first, strong comes out first.'

A resident with diabetes asks the CNA to trim his thickened, overgrown toenails. What is the correct response?

Explain that cutting a diabetic resident's toenails is outside the CNA scope and report it to the nurse for podiatry referral. Cutting the toenails of a resident with diabetes or poor circulation is outside the New Jersey CNA scope of practice because a small injury can become a serious, slow-healing wound or infection. The correct action is to refuse the task kindly and report the need to the nurse, who arranges a podiatry referral.

While giving mouth care to an unconscious resident, which action BEST protects the resident from aspiration?

Turn the resident's head to the side and use only a small amount of solution. Turning the head to the side lets fluid drain out of the mouth instead of down the airway, and using only a small amount of solution limits the liquid that could be aspirated. A padded tongue blade (never a finger) holds the mouth open safely. Unconscious residents still need oral care every 2 hours because the mouth dries out.

Activities of Daily Living & Personal Care | Free Guide 2026

Key Takeaways

Wash from cleanest to dirtiest: eyes first (inner to outer canthus, no soap, new cloth area per eye), perineal area last during a complete bed bath
Dressing rule: put clothing onto the weak (affected) side first, remove from the strong (unaffected) side first ('weak goes in first, strong comes out first')
Perineal care for females is always front to back (clean to dirty) to prevent urinary tract infection; for males clean from the tip outward and return a retracted foreskin
For an unconscious resident, give oral care every 2 hours with the head turned to the side, a padded tongue blade, and a small amount of solution to prevent aspiration
Reposition at least every 2 hours in bed (every 1 hour in a chair); the earliest pressure-injury sign is a reddened area that does not fade (Stage 1) — report it

What ADLs Are and Why They Matter

Activities of daily living (ADLs) are the routine self-care tasks a person normally performs without help: bathing, dressing, grooming, oral care, toileting, and eating (transferring and mobility are sometimes added). New Jersey CNAs assist with ADLs while protecting the resident's dignity, privacy, and independence — the federal Nursing Home Reform Act and NJ's resident-rights rules require that residents do as much for themselves as they safely can. The CNA's job is to assist, not take over.

ADLs matter clinically and on the exam. Several of the 23 skills on the NNAAP (National Nurse Aide Assessment Program) skills list come directly from this section — for example, mouth care, denture care, perineal care, dressing a resident with a weak arm, and a partial bed bath. On test day the candidate performs five randomly chosen skills (handwashing always included) within 30 minutes, and any step printed in bold is a Critical Element Step that must be done correctly or the whole skill fails. Technique and order are therefore not optional details.

Bathing

Bathing cleans the skin, improves circulation, and gives the CNA a chance to observe the whole body for bruising, rashes, or breakdown. The two common methods are the complete bed bath (for fully dependent residents) and the partial bath (face, hands, axillae, and perineal area).

The Clean-to-Dirty Rule

Always wash from the cleanest area to the dirtiest. This prevents spreading microorganisms.

Order	Body Area	Key Point
1	Eyes	Inner to outer corner, no soap, new section of cloth per eye
2	Face, neck, ears	Ask whether the resident wants soap on the face
3	Arms, hands, axillae	Wash the farthest part first; support the joint
4	Chest and abdomen	Keep the resident covered with a bath blanket
5	Legs and feet	Check between the toes; do not massage the calves
6	Back and buttocks	A good time to inspect for skin breakdown
7	Perineal area	Always last — cleanest to dirtiest

Keep water at about 105°F (40.5°C), test it before use, change it when it becomes cool or soapy, and dry the skin thoroughly, especially in skin folds where moisture causes breakdown. Do not massage the legs — this can dislodge a blood clot (thrombus).

Oral Care

Oral hygiene prevents tooth decay, gum disease, and aspiration pneumonia. Provide it at least twice daily and after meals.

Dentures: Hold them over a towel or a water-filled basin while cleaning so they do not break if dropped, use cool water, and store them in a labeled cup of cool water or denture solution — never hot water, which warps them.
Unconscious resident: Turn the head to the side so fluid drains out, use only a small amount of solution on swabs, and use a padded tongue blade — never your fingers — to keep the mouth open. Because the mouth dries out, provide care every 2 hours.

Grooming and Dressing

Grooming includes hair care, shaving, and nail care. Shave in the direction of hair growth with a safety razor; an electric razor is required for a resident on blood thinners (anticoagulants) because of bleeding risk. Never use an electric razor near oxygen.

The Affected-Side Rule

For a resident with weakness or paralysis on one side (for example, hemiplegia after a stroke):

Dressing: put clothing on the weak (affected) side first.
Undressing: remove clothing from the strong (unaffected) side first.

Memory aid: "weak goes in first, strong comes out first." This reduces strain on the impaired limb and protects the joint, and dressing a resident with a weak arm is itself an NNAAP skill.

Perineal Care

Perineal (peri) care cleans the genital and anal area and reduces infection. For females, always wipe front to back (urethra toward anus), using a clean section of cloth with each stroke, to prevent a urinary tract infection (UTI). For males, clean in a circular motion from the tip of the penis outward; on an uncircumcised resident retract the foreskin, clean, then return it to prevent swelling. Peri care is given daily, after every incontinence episode, and as part of catheter care.

Nail and Foot Care

Clean under the nails and file straight across to prevent ingrown nails. A New Jersey CNA does NOT cut the toenails of a resident with diabetes or poor circulation — a small nick can become a serious, slow-healing wound. Report long nails to the nurse for a podiatry referral; this is outside the CNA scope of practice.

Skin Care and Pressure-Injury Prevention

A pressure injury (pressure ulcer, decubitus ulcer, or bedsore) forms over a bony prominence — sacrum, heels, hips, elbows, shoulder blades, back of the head — when prolonged pressure cuts off blood flow. Prevention is a core CNA duty and a frequent exam topic:

Reposition at least every 2 hours in bed and at least every 1 hour in a chair; follow the posted turning schedule.
Keep skin clean and dry; change wet or soiled linens promptly.
Reduce friction and shearing — lift the resident with a draw sheet, never drag.
Use pillows, heel protectors, and padding to keep bony areas off the bed; keep linens wrinkle-free.
Encourage fluids and good nutrition, which keep skin healthy.
Report the earliest sign immediately: a reddened area that does not fade (blanch) after pressure is relieved — this is a Stage 1 pressure injury. Catching it early prevents an open Stage 2-4 wound.

AM and PM Care

Routine care is grouped by time of day:

Early AM care (before breakfast): toileting, washing the face and hands, oral care.
AM (morning) care: a bath or partial bath, grooming, dressing, and bed-making.
PM (HS / evening) care (bedtime): oral care, washing, a back rub for circulation and comfort, fresh linens, and a comfortable, safe position with the call light within reach.

Throughout all care, knock, address the resident by their preferred name, explain each step, keep the body covered except the area being washed, and let the resident make choices — these dignity steps are also graded Critical Elements on the skills exam.

Test Your Knowledge

During a complete bed bath for a New Jersey nursing home resident, the CNA notices the water has become cool and slightly soapy halfway through. The resident's perineal area has not yet been washed. What is the BEST action?

Finish quickly with the same water so the resident does not get chilled

Skip the perineal area and let the next shift complete it

Change the water before continuing, then wash the perineal area last

Use the cool water only for the perineal area to save time

New Jersey CNA

1Becoming a CNA in New Jersey

2Role, Resident Rights, Legal & Ethical Practice

3Communication & Psychosocial / Mental Health Care

4Personal Care & Basic Nursing Skills

5Infection Control, Safety, Emergencies & The Skills Test