The New Admission, the Daughter, and the LPN's Request
You are a certified nurse aide three months into your first job at a 60-bed long-term care facility. At 1900 the charge nurse is pulled to another unit for a code, leaving you and one LPN for 28 residents. A new admission arrived two hours ago: Mr. H, 78, admitted after hip fracture repair, with a saline IV, a Foley catheter, and an as-needed oxycodone order. At 1930 Mr. H's daughter stops you in the hallway and asks, 'What did the doctor say his kidney labs showed? Are they giving him too much pain medicine?' Before you answer, the LPN calls down the hall that she needs you to 'just hand Mr. H his 2000 oxycodone, he's due' - she is in another room with a resident complaining of chest pain.
1. The daughter asks about Mr. H's kidney labs and whether his pain medication dose is too high. What do you say in the hallway, and what do you do afterward?
Read the worked answer
In the moment
- Acknowledge the concern without interpreting anything: 'I can't read or explain lab results or judge his medication dose - that's the nurse's call. What I can tell you is what I'm seeing: he's resting, his catheter is draining, and he's due for pain medicine at 2000.'
- Share only direct observations and the care plan (comfort, how he's moving, how he's eating). Do not guess at numbers, do not say 'his kidneys are failing,' and do not comment on whether the dose is too high.
- Offer a route: 'I'll tell the nurse you want to talk about his labs and his pain plan, and she'll come find you or call you.'
- Before sharing anything about his condition, confirm she is authorized to receive it - proxy, or on the facility's approved contact list. If you are unsure, share nothing and route her to the nurse.
Afterward
- Give the nurse the exact question as soon as she is free.
- Document objectively: time, who asked, what was requested, that it was referred to the nurse.
Reasoning: the CNA's scope covers direct care and observation, not interpreting diagnostic results or judging whether a prescribed dose is appropriate. Answering would be both a scope problem and a privacy problem, and a wrong guess could frighten the family or undercut the plan of care. Referral is not refusal - it is the correct handoff.
2. The LPN asks you to hand Mr. H his 2000 oxycodone because she is tied up. What do you do?
Read the worked answer
Answer: decline, and offer a workable alternative.
- 'I can't pass medication - that's outside what I'm certified to do. I can keep an eye on him, answer his light, or get vitals on your chest-pain resident, but I can't hand him that pill.'
- Do not accept it even though a nurse asked. A task outside your scope does not become in-scope because a licensed person requested it.
- Offer real help so the resident's pain still gets addressed: check on Mr. H and report his pain level, ask the charge nurse for coverage, page the on-call nurse, or ask the LPN to come as soon as the chest-pain resident is settled.
- If the LPN insists, escalate to the charge nurse. That is a patient-safety issue, not insubordination.
- Document the request and your response.
Reasoning: five separate things go wrong with an aide handing over a controlled substance - you cannot verify the order, dose, or time; you cannot assess for sedation and respiratory depression afterward; you cannot take a verbal order to change it; and you would be the last person to see the resident before the error. The resident's pain is a real need, but the fix is escalation, not a shortcut.
3. At 2010 the LPN is still occupied and Mr. H is calling out. What do you observe, what do you report, and how do you frame it?
Read the worked answer
Observe (post-op hip, day of admission)
- Pain: location, what he says, whether he can move the unaffected leg, whether he guards the incision.
- Circulation and sensation in the operative leg: color, temperature, swelling, whether he can wiggle toes, any numbness or tingling.
- Urine in the Foley bag: amount, color, clarity - he has a pending kidney-labs question, so output matters.
- Breathing and alertness: rate, effort, how easily he rouses, whether he is overly drowsy.
- Positioning, incision intactness, and whether the dressing is dry.
Report to the charge nurse using SBAR
- Situation: 'Mr. H, 78, post-op hip, calling out with pain, last pain medicine not yet given because the LPN is with a chest-pain resident.'
- Background: surgery today, Foley in place, as-needed oxycodone due at 2000.
- Assessment: what you see and measure - not a diagnosis.
- Recommendation: 'He needs the nurse to assess him and give the ordered dose; his daughter also wants to talk about labs and the pain plan.'
Documentation: time-stamped, factual, no blame language. 'At 2010 resident verbalized pain 7/10, nurse notified' beats 'LPN never gave meds.'
Reasoning: you cannot fix the staffing gap, but untreated pain plus an unassessed post-op hip is exactly the situation an aide is positioned to catch first. Reporting the pattern (not just the single complaint) is what prompts the nurse to reprioritize.