ALF Core Competency Exam 2 Questions
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1. A resident with a known history of chronic obstructive pulmonary disease
(COPD) presents with increased shortness of breath, a productive cough
with thick green sputum, and a low-grade fever. The resident's oxygen
saturation is 88% on room air. Which of the following actions should the
direct care staff member take first?
A. Administer a PRN bronchodilator inhaler as prescribed.
B. Place the resident in a high-Fowler's position and notify the supervising
nurse.
C. Increase the resident's fluid intake to thin secretions.
D. Apply a non-rebreather mask at 15 liters per minute.
Answer: B
Rationale: The immediate priority is to position the resident to maximize
ventilation and then escalate care. High-Fowler's position facilitates
diaphragmatic descent and lung expansion. While bronchodilators and
fluids are important, the first step in a decompensating respiratory
situation is to ensure proper positioning and assessment by a licensed
nurse, as the staff member is acting within their scope of practice to
recognize and report acute changes.
2. When applying a gait belt to a resident who is unsteady on their feet, where
should the belt be positioned to ensure both safety and effectiveness?
A. Directly over the xiphoid process to provide upper body support.
B. Around the resident's waist, just above the iliac crests, over their
clothing.
C. Snugly around the lower ribcage to prevent upward slippage.
, D. Over the abdomen, below the umbilicus, to facilitate a natural stance.
Answer: B
Rationale: The gait belt must be placed around the resident's natural
waist, just above the iliac crests. This bony landmark provides a stable
base that prevents the belt from riding up into the ribcage or abdomen,
which could cause injury or discomfort. It ensures the caregiver can
provide effective counterbalance without compromising the resident's
breathing or safety.
3. A resident with dysphagia is placed on a nectar-thick liquid diet. Which of
the following beverages is considered appropriate for this diet consistency?
A. Buttermilk.
B. Unthickened tomato juice.
C. A milkshake.
D. Chilled gelatin.
Answer: A
Rationale: Buttermilk, by its nature, has a thicker consistency that coats
the spoon and is appropriate for a nectar-thick diet. Unthickened tomato
juice is thin, milkshakes (while thick) are often considered a different
consistency class, and chilled gelatin is a solid food requiring further
breakdown. Nectar-thick liquids should be thick enough to fall slowly from
a spoon.
4. In the event of a fire in a resident's room, the immediate action sequence is
"RACE." What is the most appropriate third step in this protocol?
A. Rescue any residents in immediate danger.
B. Pull the fire alarm and call the emergency number.
C. Contain the fire by closing all doors and windows.
D. Extinguish the fire if it is small and contained.
Answer: C
Rationale: The RACE acronym stands for Rescue, Alarm, Contain, and
Extinguish/Evacuate. After rescuing those in immediate danger and
activating the alarm, the third step is to contain the fire by closing doors
, and windows to limit the oxygen supply and prevent the fire from
spreading to other areas of the facility.
5. A resident's care plan specifies the use of a mechanical lift for all transfers.
The resident is found sitting on the edge of the bed, insisting they can
stand. What is the most appropriate response from the staff member?
A. Assist the resident to stand using a stand-pivot technique to respect their
autonomy.
B. Remind the resident of the care plan and explain the safety reasons for
using the lift.
C. Call for a second staff member to assist with a two-person stand-pivot
transfer.
D. Leave the resident seated while you retrieve the mechanical lift from the
storage room.
Answer: B
Rationale: The staff member must adhere to the care plan to prevent
injury. Reminding the resident of the plan and explaining the rationale
respects their autonomy while maintaining safety protocols. Deviating
from the plan, even if the resident insists, places the resident and staff at
risk for a fall or musculoskeletal injury.
6. A resident with a diagnosis of diabetes mellitus is exhibiting signs of
hypoglycemia. Which of the following is an early clinical manifestation of
this condition?
A. Polyuria and polydipsia.
B. Fruity odor on the breath.
C. Diaphoresis and pallor.
D. Kussmaul respirations.
Answer: C
Rationale: Diaphoresis (sweating) and pallor are classic early signs of
hypoglycemia, driven by the sympathetic nervous system's response to
low blood glucose. Polyuria, polydipsia, fruity breath, and Kussmaul
respirations are associated with hyperglycemia and diabetic ketoacidosis.
, 7. When administering a topical medication to a resident's skin, which of the
following principles is essential for proper application?
A. Apply a thick layer of the medication and cover it with an occlusive
dressing.
B. Apply the medication in a circular, rubbing motion to enhance
absorption.
C. Apply the medication in a thin, even layer in the direction of hair growth.
D. Apply the medication immediately after a warm bath to open the pores.
Answer: C
Rationale: Topical medications should be applied in a thin, even layer in
the direction of hair growth to prevent folliculitis and ensure even
distribution. Rubbing vigorously or applying thick layers can lead to
irritation or systemic absorption, and applying after a bath may increase
absorption but is not a standard principle for all topicals.
8. A resident is on a fluid restriction of 1500 mL per day. The resident has
consumed 500 mL of fluids during the day shift. How many mL of fluids are
allowed for the evening and night shifts combined?
A. 500 mL.
B. 1000 mL.
C. 1500 mL.
D. 750 mL.
Answer: B
Rationale: The calculation is simple subtraction. The total daily restriction
is 1500 mL. Subtracting the 500 mL consumed during the day shift (1500 -
500 = 1000) leaves 1000 mL for the remainder of the day.
9. A resident is exhibiting signs of a urinary tract infection (UTI), including
confusion, frequency, and urgency. Which of the following observations is
most critical to report immediately to the supervising nurse?
A. The resident's fluid intake for the past 8 hours.
B. The color and clarity of the resident's urine.
C. The resident's temperature and change in mental status.
D. The resident's complaints of mild suprapubic discomfort.
And Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A | Instant
Download Pdf
1. A resident with a known history of chronic obstructive pulmonary disease
(COPD) presents with increased shortness of breath, a productive cough
with thick green sputum, and a low-grade fever. The resident's oxygen
saturation is 88% on room air. Which of the following actions should the
direct care staff member take first?
A. Administer a PRN bronchodilator inhaler as prescribed.
B. Place the resident in a high-Fowler's position and notify the supervising
nurse.
C. Increase the resident's fluid intake to thin secretions.
D. Apply a non-rebreather mask at 15 liters per minute.
Answer: B
Rationale: The immediate priority is to position the resident to maximize
ventilation and then escalate care. High-Fowler's position facilitates
diaphragmatic descent and lung expansion. While bronchodilators and
fluids are important, the first step in a decompensating respiratory
situation is to ensure proper positioning and assessment by a licensed
nurse, as the staff member is acting within their scope of practice to
recognize and report acute changes.
2. When applying a gait belt to a resident who is unsteady on their feet, where
should the belt be positioned to ensure both safety and effectiveness?
A. Directly over the xiphoid process to provide upper body support.
B. Around the resident's waist, just above the iliac crests, over their
clothing.
C. Snugly around the lower ribcage to prevent upward slippage.
, D. Over the abdomen, below the umbilicus, to facilitate a natural stance.
Answer: B
Rationale: The gait belt must be placed around the resident's natural
waist, just above the iliac crests. This bony landmark provides a stable
base that prevents the belt from riding up into the ribcage or abdomen,
which could cause injury or discomfort. It ensures the caregiver can
provide effective counterbalance without compromising the resident's
breathing or safety.
3. A resident with dysphagia is placed on a nectar-thick liquid diet. Which of
the following beverages is considered appropriate for this diet consistency?
A. Buttermilk.
B. Unthickened tomato juice.
C. A milkshake.
D. Chilled gelatin.
Answer: A
Rationale: Buttermilk, by its nature, has a thicker consistency that coats
the spoon and is appropriate for a nectar-thick diet. Unthickened tomato
juice is thin, milkshakes (while thick) are often considered a different
consistency class, and chilled gelatin is a solid food requiring further
breakdown. Nectar-thick liquids should be thick enough to fall slowly from
a spoon.
4. In the event of a fire in a resident's room, the immediate action sequence is
"RACE." What is the most appropriate third step in this protocol?
A. Rescue any residents in immediate danger.
B. Pull the fire alarm and call the emergency number.
C. Contain the fire by closing all doors and windows.
D. Extinguish the fire if it is small and contained.
Answer: C
Rationale: The RACE acronym stands for Rescue, Alarm, Contain, and
Extinguish/Evacuate. After rescuing those in immediate danger and
activating the alarm, the third step is to contain the fire by closing doors
, and windows to limit the oxygen supply and prevent the fire from
spreading to other areas of the facility.
5. A resident's care plan specifies the use of a mechanical lift for all transfers.
The resident is found sitting on the edge of the bed, insisting they can
stand. What is the most appropriate response from the staff member?
A. Assist the resident to stand using a stand-pivot technique to respect their
autonomy.
B. Remind the resident of the care plan and explain the safety reasons for
using the lift.
C. Call for a second staff member to assist with a two-person stand-pivot
transfer.
D. Leave the resident seated while you retrieve the mechanical lift from the
storage room.
Answer: B
Rationale: The staff member must adhere to the care plan to prevent
injury. Reminding the resident of the plan and explaining the rationale
respects their autonomy while maintaining safety protocols. Deviating
from the plan, even if the resident insists, places the resident and staff at
risk for a fall or musculoskeletal injury.
6. A resident with a diagnosis of diabetes mellitus is exhibiting signs of
hypoglycemia. Which of the following is an early clinical manifestation of
this condition?
A. Polyuria and polydipsia.
B. Fruity odor on the breath.
C. Diaphoresis and pallor.
D. Kussmaul respirations.
Answer: C
Rationale: Diaphoresis (sweating) and pallor are classic early signs of
hypoglycemia, driven by the sympathetic nervous system's response to
low blood glucose. Polyuria, polydipsia, fruity breath, and Kussmaul
respirations are associated with hyperglycemia and diabetic ketoacidosis.
, 7. When administering a topical medication to a resident's skin, which of the
following principles is essential for proper application?
A. Apply a thick layer of the medication and cover it with an occlusive
dressing.
B. Apply the medication in a circular, rubbing motion to enhance
absorption.
C. Apply the medication in a thin, even layer in the direction of hair growth.
D. Apply the medication immediately after a warm bath to open the pores.
Answer: C
Rationale: Topical medications should be applied in a thin, even layer in
the direction of hair growth to prevent folliculitis and ensure even
distribution. Rubbing vigorously or applying thick layers can lead to
irritation or systemic absorption, and applying after a bath may increase
absorption but is not a standard principle for all topicals.
8. A resident is on a fluid restriction of 1500 mL per day. The resident has
consumed 500 mL of fluids during the day shift. How many mL of fluids are
allowed for the evening and night shifts combined?
A. 500 mL.
B. 1000 mL.
C. 1500 mL.
D. 750 mL.
Answer: B
Rationale: The calculation is simple subtraction. The total daily restriction
is 1500 mL. Subtracting the 500 mL consumed during the day shift (1500 -
500 = 1000) leaves 1000 mL for the remainder of the day.
9. A resident is exhibiting signs of a urinary tract infection (UTI), including
confusion, frequency, and urgency. Which of the following observations is
most critical to report immediately to the supervising nurse?
A. The resident's fluid intake for the past 8 hours.
B. The color and clarity of the resident's urine.
C. The resident's temperature and change in mental status.
D. The resident's complaints of mild suprapubic discomfort.
