A New Jersey CNA is walking a resident with a gait belt when the resident's knees suddenly buckle and the resident begins to fall. What is the SAFEST action?

Ease the resident down to the floor while protecting the head, then call the nurse. A CNA should never try to stop a fall in progress, because catching the full weight injures both people. Holding the gait belt and easing the resident down to the floor while protecting the head and your own back is safest. The resident stays on the floor until the nurse assesses for injury — lifting before assessment can worsen a fracture.

A CNA is performing passive range-of-motion exercises on a New Jersey resident's shoulder. When the arm reaches a certain point, the resident grimaces and the joint resists. What should the CNA do?

Stop at the point of resistance, do not force the joint, and report the response. During passive range of motion the CNA moves the joint only to the point of resistance or pain and never forces it, because forcing can tear tissue or dislocate the joint. Stopping and reporting the new pain or stiffness to the nurse is correct, since it may indicate a change in the resident's condition that needs assessment.

Before transferring a resident from the bed to a wheelchair using a gait belt, which preparation step is essential for safety?

Lock the wheels on both the bed and the wheelchair and lower the bed. Locking the wheels on both the bed and the wheelchair and lowering the bed keeps both surfaces from moving during the transfer, which prevents falls. An unlocked wheelchair can roll away, a raised bed increases fall distance, and bare feet are a slipping hazard — non-skid footwear should be applied, not removed.

A CNA needs to reposition a fully dependent, bedbound resident up in bed. What technique BEST prevents skin damage and CNA back injury?

Use a draw sheet with a second caregiver to lift, not drag, the resident. Using a draw sheet with a partner lets the team lift rather than drag the resident, which prevents the friction and shearing forces that tear fragile skin, and it distributes the weight to protect both caregivers' backs. Dragging by the arms or wrists causes shearing and can injure the resident's shoulders.

Mobility, Positioning, Transfers & ROM — Free Study Guide 2026

Key Takeaways

Use good body mechanics: feet shoulder-width apart, bend the knees not the back, keep the load close, pivot the feet (never twist the spine), and push or pull rather than lift
Reposition bedbound residents at least every 2 hours to prevent pressure injuries and contractures; use a draw sheet to avoid friction and shearing
Apply a gait (transfer) belt over clothing, snug enough to fit a flat hand underneath, grip it underhand, and transfer toward the resident's strong side
Lock all wheelchair and bed wheels and lower the bed to its lowest position before any transfer; apply non-skid footwear
Passive ROM is done by the CNA for a resident who cannot move; never push a joint past the point of resistance or pain. If a resident falls, ease them to the floor — do not catch them or lift them before the nurse assesses

Why Safe Movement Matters

Moving and positioning residents safely protects them from falls, pressure injuries, and contractures (permanent shortening and stiffening of a muscle or joint), and protects the New Jersey CNA from disabling back injury. Transferring a resident, ambulating with a gait belt, and positioning are all on the NNAAP skills list, and back injuries are the leading reason CNAs leave the field — so technique is both a safety and a career issue.

Body Mechanics

Body mechanics is the safe, efficient use of the body to prevent injury by using the strong leg muscles instead of the back. Key rules:

Keep a wide, stable base of support — feet about shoulder-width apart, one foot slightly forward.
Bend at the knees and hips, not the waist; keep your back straight and your center of gravity low.
Hold the load close to your body and lift with your legs, not your back.
Push, pull, slide, or roll rather than lift whenever possible.
Face the direction of movement and pivot your feet — never twist your spine.
Use a wide stance and the count of three so the resident knows when to move.
Get help or a mechanical lift for heavy or fully dependent residents; do not try to move them alone.

Positioning

Residents who cannot move themselves must be repositioned at least every 2 hours in bed and every 1 hour in a chair. Use a draw sheet (turning/lift sheet) with a partner to lift rather than drag, which prevents friction and shearing that damage skin. Support the body with pillows and keep good body alignment.

Position	Description	Common Use
Fowler's	Head of bed raised 45-60°	Eating, breathing difficulty
Semi-Fowler's	Head of bed raised 30-45°	Rest, tube feeding
High-Fowler's	Head of bed near 90°	Eating, severe shortness of breath
Supine	Flat on the back	Resting, exams
Lateral	Lying on the side	Pressure relief, sleeping
Prone	Lying on the stomach	Used briefly; uncommon in the elderly
Sims'	Left side, upper knee bent forward	Enemas, rectal procedures

A turning schedule posted at the bedside (for example, left side → back → right side) ensures no area bears pressure too long. Keep the head, spine, hips, and limbs aligned and use supports to prevent footdrop and external hip rotation.

Transfers

Before any transfer, prepare the environment:

Lock the wheels on the bed and the wheelchair.
Lower the bed to its lowest position and lock it.
Apply non-skid footwear to the resident.
Position the wheelchair on the resident's strong side, at a slight angle.
Explain each step and let the resident help as much as possible.

Gait (Transfer) Belt

A gait belt (transfer belt) is placed snugly over the resident's clothing, around the waist, snug enough that a flat hand fits underneath — too loose and it can slip up to the chest. Grasp the belt with an underhand grip at the sides; never pull on the resident's arms or under the armpits. Transfer toward the resident's strong (unaffected) side and block the resident's weak knee with your knee for stability. Count to three and have the resident push up from the armrests or bed.

Mechanical (Hoyer) Lift

A mechanical lift (Hoyer or sit-to-stand) is used for residents who cannot bear weight or are too heavy to lift safely. Two staff are required: one operates the lift, one guides the resident. Check the sling, hooks, and straps before lifting, keep the resident centered, and never leave the resident suspended. Using a lift instead of a manual lift protects both the resident and the CNA.

Fall Prevention

Falls are a leading cause of injury and death in long-term care. Prevent them by keeping the bed low and locked, the call light within reach, the floor dry and clutter-free, adequate lighting, non-skid footwear on, and brakes locked. Answer call lights promptly. If a resident starts to fall, do NOT try to stop or catch the fall — widen your stance, hold the gait belt, and ease the resident down to the floor while protecting the head (you can bend your knees and let them slide down your leg). Stay with the resident and call the nurse.

Never lift a fallen resident until the nurse assesses for injury such as a fracture.

Range of Motion

Range-of-motion (ROM) exercises move joints through their full normal movement to prevent contractures, maintain mobility, and improve circulation. They are usually done during the bath or care routine, with each joint exercised 3-5 repetitions per the care plan.

Active ROM (AROM): the resident performs the movement independently.
Active-assisted ROM: the resident moves with some CNA help.
Passive ROM (PROM): the CNA moves the joint because the resident cannot move it themselves.

During PROM, support the joint above and below, move slowly and gently, and stop at the point of resistance or pain — never force a joint, which can tear tissue or dislocate the joint. Begin at the head/neck (if ordered) and work downward, supporting each limb fully.

Common ROM Movements

Movement	Meaning
Flexion	Bending a joint
Extension	Straightening a joint
Abduction	Moving a limb away from the body
Adduction	Moving a limb toward the body
Rotation	Turning a joint
Dorsiflexion / Plantar flexion	Foot up toward shin / foot down

Report any new pain, swelling, stiffness, or resistance to the nurse, since it may indicate an injury or a change in the resident's condition that needs assessment. Encouraging residents to do as much active movement as possible preserves their independence.

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