Elimination and Catheter Care on the CNA Exam: Bedpans, Catheters, and Output

Where elimination fits on the exam

Elimination is one of the Activities of Daily Living topics on the 2024 NNAAP written outline, and toileting is a personal care skill in the federal training curriculum. Three NNAAP skills sit in this area: catheter care for a female resident, measuring and recording urinary output, and assisting with a bedpan, which some states, such as Pennsylvania, don't test.

Written questions in this area are usually about one of three things: preventing infection, protecting privacy, or reporting what you measure and notice. After the rules below, practice CNA elimination and catheter-care questions with explanations →.

Keeping a urinary catheter system safe

CDC's guideline for preventing catheter-associated urinary tract infections gives clear maintenance rules, and they map directly onto exam answers:

The "below the bladder" rule exists because urine flowing back from the bag toward the bladder can carry bacteria. That's why the bag position is one of the most tested facts in this topic.

Original practice question. A nurse aide is helping a resident with a urinary catheter move from the bed to a wheelchair. Where should the drainage bag be during and after the transfer?

• A. On the resident's lap, so it doesn't get caught
• B. On the floor next to the wheelchair
• C. Below the level of the bladder, attached to the wheelchair frame and off the floor
• D. Hooked over the wheelchair's armrest, level with the resident's chest

Answer: C. The bag must stay below the bladder and off the floor. A lap (A) or chest-high armrest (D) puts it at or above bladder level, and the floor (B) contaminates it.

Catheter care: the direction matters

The NNAAP catheter-care skill reinforces two habits. First, hold the catheter steady where it enters the body so you don't pull on it. Second, clean, rinse, and dry along the catheter in one direction only, away from the entry point, using a clean area of the washcloth for each stroke. The idea is to move germs away from the opening, never toward it. Expose only the area you are cleaning and protect the bed with a pad.

Measuring and recording urinary output

Accurate intake and output records help the nurse spot problems early. The skills checklist for measuring urinary output shows the habits that matter:

• wear gloves and pour carefully to avoid spills
• set the measuring container on a flat surface and read it at eye level
• record the amount accurately; Pennsylvania's checklist says to round up to the next 25 mL when the level falls between marks
• empty the container into the toilet, rinse it, then remove gloves and clean your hands

Measurement questions on the written exam often ask what to do with a reading: record it and report anything unusual, such as a much smaller amount than usual or a change in appearance, to the nurse. Interpreting it is the nurse's job. The vital signs and measurements guide covers the other measurements on the exam.

Bedpans and toileting with dignity

Toileting is one of the most private moments of care, so privacy and dignity answers usually win:

• close the curtain or door and keep the resident covered except while placing or removing the bedpan
• lower the head of the bed before placing and before removing the bedpan, as the skills checklist does
• give toilet tissue and a hand wipe, put the call light in reach, and ask the resident to signal when finished
• answer call lights promptly; waiting for help to use the bathroom is a dignity issue as well as a comfort one

Common traps

• Placing the catheter bag on the bed rail that gets raised, on the lap, or on the floor.
• Disconnecting tubing to make a transfer easier.
• Cleaning toward the catheter's entry point.
• Guessing an output amount instead of measuring at eye level.
• Leaving a resident on a bedpan without a call light.

Infection-control habits, like gloves and hand hygiene, run through every elimination task. The infection control guide covers them in detail.