Tag: texas cna state test

Prometric CNA State Exam: Opening Steps

The opening steps, also called pre-steps, opening procedures and beginning steps, are the steps a nursing assistant takes before starting a direct patient care skill at the CNA state exam. Even though a solid knowledge of the opening steps is needed to pass the hands-on skills evaluation portion of nursing assistant certification examinations in most states, these measures also have usefulness in real-world healthcare settings when giving direct patient care.

The opening steps must be the very first steps the nursing assistant performs before moving into the actual part of any patient care procedural skill (Tanner, 2020). Prior to starting a procedural skill at the state certification exam to become a certified nurse aide, the test taker must take eight specific actions as part of the opening steps. These steps include knocking, introducing oneself, identifying the patient, describing the skill, obtaining consent, providing privacy measures, washing one’s hands, and gathering clean supplies.

The opening steps are tightly related to the four connected concepts of safety, privacy, comfort and infection control. Nursing assistants are entrusted with the important duty of keeping their patients and residents safe, comfortable and cleanly while upholding their privacy at all times. To quickly recall the four concepts, it is extremely useful to use the acronym P.I.C.S., which stands for Privacy + Infection Control + Comfort + Safety. 

Repeated in a somewhat different way, the certified nursing assistant’s role revolves around keeping all of their patients safe, ensuring their comfort, upholding their privacy, and protecting them from preventable healthcare-acquired infections whenever patient care tasks are completed. The individual measures that comprise the opening steps are listed below.

  • Knock
  • Introduce Oneself
  • Identify the Patient
  • Describe the Skill
  • Obtain Consent
  • Provide Privacy
  • Wash Hands
  • Gather Clean Supplies

Always be very mindful that the opening steps require outstanding communication skills on the part of the nursing assistant. A normal opening steps announcement sounds really similar to this: “Knock, knock. Good morning, Mrs. Taylor! My name is Ronald and I will be your nursing assistant today. I am going to assist you with using the bedpan. Is that okay? Alright! I will provide you with some privacy, wash my hands, gather supplies and start in just a moment.”

Texas CNA Skills (Part Eighteen): Skills That Are Not Performed on Other Live People at the CNA State Test

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Candidates and test takers who have completed a nurse aide training program must attain a passing score on the National Nurse Aide Assessment Program exam, more commonly known as the CNA state test, in order to receive state certification as a certified nursing assistant (CNA) in Texas. The CNA state test consists of two parts: a written section with 70 multiple choice questions as well as a skills evaluation.

Both the written section and skills evaluation of the CNA state test must be passed in order to receive state certification. The skills evaluation requires the test taker to demonstrate five testable skills in the presence of a nurse aide evaluator (NAE) who is scoring them as he or she observes the performance of each skill. There are exactly 22 testable skills that could appear on the CNA state test in Texas, and five of them will be selected at random for the test taker to perform.

Out of the 22 testable skills, 15 of them are to be performed on a live person at the CNA state test. In other words, the vast majority of skills will be performed on a random student with whom the test taker will be partnered at the Pearson Vue testing center. This is a reciprocal process because the two partners will be performing their five skills on each other as the NAE observes the skills demonstrations for scoring purposes.

Only seven of the 22 hands-on skills are not performed on a live person at the Pearson Vue testing center during the skills evaluation portion of the CNA state test. The first skill is hand hygiene (a.k.a. hand-washing); of course, test takers will demonstrate how to wash their own hands in front of the NAE. Thus, hand hygiene is not done on another live person. Keep in mind that all test takers will be required to complete the hand hygiene skill due to the emphasis on infection prevention.

Moreover, the personal protective equipment (PPE) skill, which requires the test taker to don and doff a gown and a pair of gloves properly, is not performed on another live person. The test taker will be dressing oneself in the PPE items before demonstrating how to appropriately remove and dispose of them. Another skill that will not be performed on a live person at the CNA state test is denture care. Rather, the test taker will demonstrate how to correctly provide care for an upper or lower denture.

Measurement and recording of urinary output is yet another skill that the test taker will never perform on a live person at the testing center. The test taker will be called upon to accurately measure the amount of simulated urine in front of the NAE before recording the numeric result. Measuring and recording urinary output is considered one of the five measurement skills that requires correct documentation at the Pearson Vue testing center in order to achieve a passing score.

Due to concerns that revolve around privacy, safety and infection control, the skills of catheter care, perineal care and applying an elastic stocking to one leg will always be performed on a mannequin at the CNA state test. In essence, these three skills are not done on a live person at the Pearson Vue testing center. This bit of knowledge often relieves test takers since they would feel uncomfortable if a random student wiped their most private areas in front of a NAE during a perineal care skill demonstration.

Do you want to become a nursing assistant in two weeks in the DFW area? Call Legacy Healthcare Careers at (682)626-5266 where you will be trained to pass the Texas CNA state examination on your first attempt.

Texas CNA Skills (Part Seventeen): Do Not Forfeit Your CNA State Examination Fees!

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Graduates of certified nursing assistant (CNA) training programs most likely put forth a whole lot of effort in a diligent manner to complete their coursework and practice their skills to perfection. The next logical step is passing the CNA state exam. Achieving a passing score on the CNA state exam is like icing on a cake because it is a rewarding culmination of the student’s perseverance and efforts throughout the previous weeks or months.

Nevertheless, there are a number of ways students can mess up on their efforts to take the CNA state test before they ever even get the opportunity to set foot in the the Pearson Vue testing center. In other words, some students make one or more silly mistakes that result in forfeiture of their testing appointments in addition to loss of the exam monies they paid.

The following is a list of actions that could potentially cause students to not be admitted into the Pearson Vue testing center and lead to forfeiture of CNA state exam fees.

  1. Test takers will need to arrive at the Pearson Vue testing center approximately 30 minutes prior to their scheduled test appointment times. A failure to arrive at the testing center on time will result in forfeiture of the CNA state exam appointment as well as any testing fees that had been previously paid.
  2. Test takers who want to change or cancel their testing appointment times will need to provide proper notice to Pearson Vue. Test takers who opt to change or cancel their state test appointment times without providing sufficient advance notice will forfeit the exam fee.
  3. Test takers will need to present two forms of unexpired identification in order to be admitted into the Pearson Vue testing center. For instance, a valid drivers license and a social security card would be acceptable forms of identification. Test takers who do not present two forms of unexpired identification will forfeit their testing appointments and lose the exam fees they previously paid.

Texas CNA Skills (Part Sixteen): Facts About the CNA State Examination

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The National Nurse Aide Assessment Program, or NNAAP for short, is also known as the CNA state examination. In essence, this is the two-part exam that nurse aide candidates must pass in order to obtain state certification as a certified nursing assistant (CNA) in the state of Texas. In addition, Pearson Vue is the corporation entrusted with administering the CNA state examination in Texas, as well as many other states.

The CNA state examination consists of two sections. The first section is the written examination, which consists of 70 multiple choice questions. Of these 70 questions, only 60 will be graded. However, the test taker is not made aware regarding which questions will be graded, so it is important to answer all questions correctly and to the best of one’s ability. Test takers have approximately two hours to take the written examination.

Test takers who either cannot read well or simply feel uncomfortable with a written test can choose to have the written examination administered orally in their choice of either English or Spanish. When the written examination is administered orally, the test taker receives earphones in order to listen in as the exam questions are transmitted by way of an mp3 player. Each test question can be repeated via mp3 player up to two times.

The second section of the CNA state examination consists of a comprehensive hands-on skills evaluation. During the skills evaluation, the test taker is given 30 minutes to demonstrate five random procedural skills in the presence of a nurse aide evaluator (NAE) who observes and grades them as they are performed. The test taker will receive a laminated card with a listing of the five skills that he or she must perform.

All test takers will be called upon to perform the hand-washing skill in Texas as part of the skills evaluation section of the CNA state examination. This is because hand hygiene is the single most effective action nurse aides can take to prevent the spread of infections. Moreover, all test takers can expect to receive a minimum of one random measurement skill to perform in front of the nurse aide evaluator.

The five testable measurement skills include the following: weighing an ambulatory resident, measuring and recording blood pressure, measuring and recording respiration rate, measuring and recording urinary output, and measuring and recording pulse. The results of measurement skills must be properly documented on a sheet of paper provided by the Pearson Vue testing center. When recording a weight, the test taker must indicate whether the result is in pounds (lbs) or kilograms (kgs).

The other skills are selected completely at random based on the laminated card that the test taker is given. Most skills will be demonstrated on another test taker. At the Pearson Vue testing center, each test taker is paired with another test taker. The pair must perform skills on each other. For instance, a test taker who is asked to perform foot care and a partial bed bath will be performing these skills on their partner.

The only hands-on skills that are not performed on another live person include hand-washing, perineal care, urinary catheter care, denture care, PPE and applying a stocking to one leg. The test taker will wash his or her own hands, of course. On the other hand, perineal care and urinary catheter care will be performed on a female mannequin. The stocking skill will also be performed on a mannequin.

Test takers should arrive at the Pearson Vue testing center approximately 30 minutes prior to the scheduled testing time. This is crucial because people who arrive late are sent home, automatically forfeit their testing fees and must reschedule. Also, they should plan to remain at the Pearson Vue testing center all day. Test takers are made aware of their passing or failing results later that evening by logging into the Pearson Vue portal.

REFERENCES

Pearson Education. (2018). Texas Nurse Aide Candidate Handbook. Retrieved May 21, 2019, from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas%20Nurse%20Aide%20Candidate%20Handbook-064400.aspx

 

Texas CNA Skills (Part Fifteen): Providing Foot Care

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The following list is a sequence of steps on the proper way to provide foot care to a client during the skills demonstration section of the CNA state examination. Keep in mind that test takers and candidates will be performing the foot care procedural skill on an actual person, not a mannequin.

  1. The candidate knocks on the door.
  2. The candidate identifies the resident.
  3. The candidate introduces himself or herself.
  4. The candidate explains that he or she is there to perform foot care.
  5. The candidate provides for privacy using a door, privacy screen or curtain.
  6. The candidate washes his or her hands.
  7. The candidate gathers the supplies needed to complete foot care.
  8. The candidate places the supplies on the over-bed table.
  9. The candidate places a barrier such as a bed protector or chuck pad on the floor.
  10. The candidate dons gloves.
  11. The candidate removes a sock from one foot and places it on the over-bed table.
  12. The candidate adds warm water to a bath basin.
  13. The candidate checks the water’s temperature with his or her wrist.
  14. The candidate directs the resident to check the water’s temperature with his/her finger or wrist before placing one entire foot in the bath basin.
  15. The candidate applies soap to one wash cloth and gets it lathered up and soapy.
  16. The candidate washes the entire foot, making sure to scrub between the toes.
  17. The candidate rinses the entire foot using another wash cloth with the rinse water from the bath basin, making sure to submerge the resident’s foot in the water.
  18. The candidate removes the resident’s foot.
  19. The candidate pats the foot dry, including the areas between the toes.
  20. The candidate applies a quarter-sized amount of lotion to his or gloved hands and warms it up by rubbing between both hands.
  21. The candidate applies lotion to the resident’s feet, making sure to avoid rubbing any lotion between the toes.
  22. The candidate must wipe away any excess lotion.
  23. The candidate cleans the resident’s area and removes the supplies.
  24. The candidate rinses the bath basin and dries it with a clean paper towel.
  25. The candidate places the bath basin and supplies in the appropriate area.
  26. The candidate places all dirty linens in the hamper and and throws away any trash that may have accumulated.
  27. The candidate removes his or her gloves and discards them.
  28. The candidate places the bed in the lowest position.
  29. The candidate places the call light or signaling device within reach.
  30. The candidate opens the door or privacy screen.
  31. The candidate asks the resident if anything else is needed before he or she leaves the room.
  32. The candidate washes his or her hands.
  33. The candidate documents the procedure and announces that the skill is complete.

Texas CNA Skills (Part Fourteen): the Five-Surface Wash Cloth Method for Perineal Care

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Perineal care, commonly referred to as peri-care, is the routine care that nurses, nursing assistants and caregivers perform on clients’ genital areas and buttocks to maintain cleanliness, eliminate unpleasant odors, and reduce the microorganism count on this part of the body. Perineal care is a state-testable skill that might randomly appear on a candidate’s CNA state exam, so knowing how to do all steps properly is important.

It is crucial that nurse aides know how to perform perineal care correctly since the client’s perineal area has the potential of becoming infected if this skill is not done the right way. Proper perineal care promotes comfort, infection control, safety and privacy. When performing this skill, always provide for the client’s privacy and wipe from front to back to avoid introducing germs from the anus and buttocks into the urinary tract.

Since the client’s comfort should be kept in mind throughout the procedure, be very gentle and careful when performing perineal care because this part of the body can be extremely sensitive to extremes in touch and temperature. The necessary supplies to perform this skill include a pair of gloves, a wash basin, lukewarm water, soap, six wash cloths, two bath towels, and two bed protectors (also known as ‘chucks’).

To maintain cleanliness and prevent infections, take the extra time to use a new part of the wash cloth with each wipe to ensure that a clean area of the cloth is always being used. Legacy Healthcare Careers recommends the five-surface method for using wash cloths while providing perineal care at the CNA state test. If executed the right way, the five-surface method enables nurse aides to use five different parts of one wash cloth.

The five-surface method has a couple of benefits. First of all, it provides a clean part of the wash cloth for each wipe, and this is important for achieving a passing score on the perineal care skill at the CNA state exam. Second of all, it keeps the nurse aide from going through too many wash cloths, and this can be immensely helpful when working at a healthcare facility that experiences ongoing shortages of clean linens.

To use the five-surface method, get a wash cloth and fold it in half, then fold it in half a second time to end up with a smaller wash cloth. Thereafter, hold the wash cloth with the four corners pointed upward. Use the first corner of the wash cloth to wipe one area. Then fold the first corner downward and wipe another area with the second corner. Continue to fold each corner until the back of the wash cloth, which will be used as the fifth wiping surface, is reached.

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In essence, the five-surface method purposely involves use of five different parts of the wash cloth for wiping the client while performing perineal care:

  • the first corner
  • the second corner
  • the third corner
  • the fourth corner
  • The back of the wash cloth

REFERENCES

Tanner, D. (2019). How to Give Perineal Care. Retrieved April 28, 2019, from https://www.caregiverology.com/perineal-care.html

Texas CNA Skills (Part Thirteen): Resources to Help Prepare for the CNA State Test

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The National Nurse Aide Assessment Program (NNAAP), also known as the CNA state test, must be passed by any nurse aide who wants to attain state certification as a CNA. In addition, nurse aides who plan to pass the CNA state test on the very first attempt would be wise to utilize all of the resources they can possibly get their hands on. It also helps that many of the existing resources are completely free!

Fortunately, there are numerous resources out there to help students conquer the state test successfully. Preparation is the key, so the following resources will prove useful only if the student uses them and does not wait until the last minute to cram them in and study during the final hour. In fact, studying for the CNA state test should really be an ongoing process in which small amounts of material are covered each day.

Even though a mountain of testing information exists throughout the deepest crevices of the world wide web, a few of the resources might be terribly outdated or not all that informative. Therefore, a list of more relevant resources have been compiled and listed below to help nurse aide students prepare for the CNA state test. Take a deep breath, relax, prepare, and enjoy your future nursing assistant career!

  • Other Schools’ CNA Program Websites: Many CNA programs publish their lecture notes, study guides, PowerPoint presentations, online lessons and other learning materials for free. Click here to get to a series of excellent PowerPoint presentations on CNA lessons from the Kings County Office of Education.
  • Texas Curriculum for Nurse Aides in Long Term Care Facilities: This is the official nurse aide curriculum that has been approved for use by the state of Texas. In fact, the theory and skills contained within this curricula are used to formulate the questions and skills scenarios on the Texas CNA state test. Click here to get to the Texas curriculum.
  • Illinois State Nursing Exam Practice Test: This is a sample CNA state test that is being offered completely online through the Southern Illinois University website. This exam enables the user to select the number of questions; moreover, it automatically checks the submitted answers for correctness. Unlike the real CNA state test, no time limit have been imposed on this practice test.
  • Study Guide Books: There happens to be a myriad of CNA study guides for sale on websites such as Amazon, Ebay and Barnes & Noble that are designed to help test takers prepare for the written portion of the CNA state test. Purchasing one of these study guides might be a wise investment.
  • National Nurse Aide Assessment Program (NNAAP) Practice Exam: This practice test contains a number of questions that are extremely similar to ones that will be seen on the written section of the CNA state test. Therefore, it would be a good idea to take this practice exam, review the answers, and study the rationales for all the answers. Click here to get to the NNAAP Practice Exam.
  • Bureau of Labor Statistics (BLS): The BLS website, which happens to be updated and maintained by the United States Department of Labor on a regular basis, contains the most up-to-date statistics on the nursing assistant role. The BLS site has info such as routine nurse aide duties, work environment, average pay rates, and projected job outlook. Click here to get to the BLS nursing assistant web page.
  • Your CNA School: Do not forget to utilize the CNA school that you attended because the instructors can serve as knowledgeable resources. A reputable CNA program will be staffed with instructors who want students to succeed, so it is in the best interests of the school’s staff to assist graduates in preparing for the state test.

Texas CNA Skills (Part Twelve): Understand the Patient Care Scenario!

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The CNA state test consists of  a written section as well as a hands-on clinical skills portion. The clinical skills section of the CNA state exam test is comprised of multiple procedural skills interwoven into a simulated patient care scenario that has been formulated to resemble situations nursing assistants aides normally encounter during the course of a shift at the workplace.

The clinical skills section of the CNA state test is administered in a simulated caregiving situation that will look almost exactly like the patient care environment in which most nursing assistants are expected to function. Unless specified otherwise, all the equipment and supplies a test taker needs during the clinical skills section of the CNA state test will be supplied by the testing site.

The skills section of the CNA state test will be designed to seem as realistic as possible. Also, the test taker will perform the hand-washing skill the on first instance it is needed in the test. However, after the first hand-washing demonstration, all other moments that require hand hygiene will only need to be verbalized. For instance, after performing foot care, the test taker would verbalize, “Now I would wash my hands.”

The patient care scenario will be typed on a sheet of paper or index card and handed to the test taker by the testing site evaluator. In most cases the testing site evaluator will read the scenario instructions to the test taker before the clinical skills section of the CNA state test is slated to begin.

The ‘patient’ who participates in the simulated patient care scenario is usually another test taker who has graciously volunteered to step into that role. In other words, test takers will perform hands-on skills on each other during the CNA state test. Test takers who volunteer to pose as a patient must adhere to a predetermined dress code.

However, instances do arise where performance of a procedural skill on a mannequin would be far more appropriate. For instance, if the scenario card involves an intimate skill such as perineal care or urinary catheter care, the test taker will demonstrate it on a mannequin rather than another person.

The following is an example of a simulated patient care scenario that is similar to what one would receive during the skills section of the CNA state test.

Sample Scenario 

Ms. Hernandez: Hand-washing / Manual Blood Pressure / Give Modified Bed Bath / Mouth Care / Position on Side

Ms. Hernandez is a 65-year-old long term resident of Curry Hills Nursing & Rehab Center who has hypertension and major depressive disorder. She has refused showers for the third day in a row due to her depressed mood. When you enter Ms. Hernandez’s room, you find her laying in bed. She is wearing a hospital gown, bra and underwear.

You will wash your hands and check Ms. Hernandez’s blood pressure manually before giving her a modified bed bath. You will perform oral care prior to positioning her on her side. You will leave Ms. Hernandez in a position of safety and comfort. You will document as needed while providing the care.

 

CNA State Examination Practice Questions (Part Four)

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QUESTION: The resident has returned to the nursing home this afternoon after having undergone a minor same-day surgery at a freestanding surgical center earlier this morning. The resident has a doctor’s order to receive a full liquid diet for the rest of the day. The resident is now telling the nursing assistant, “I am getting really hungry right now.” Which food items and fluids would be appropriate on the meal tray of a resident who has been prescribed a full liquid diet?

A. Cream soup, broth, vanilla ice cream, water, and orange juice

B. Chicken noodle soup, sliced apples, side salad, and hot tea

C. Turkey bacon sandwich, corn on the cob, pudding, and milk

D. Spaghetti with meatballs, green beans, chocolate cake, and cola

ANSWER: A (The full liquid diet consists of fluids and food items that are usually in liquid form, as well as food items that will melt into liquid form when they are at room temperature, such as ice cream, ice cubes and popsicles. The full liquid diet allows the resident’s body to heal from the recent surgical procedure).

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QUESTION: The charge nurse has told the nursing assistant, “The patient in room 209 is in shock.” The nursing assistant knows to place the patient in which of the following positions in bed if any signs and symptoms of shock are noted:

A. The high Fowler’s position

B. The Trendelenberg position

C. The Sims’ position

D. The low Fowler’s position

ANSWER: B (The nursing assistant would place the patient in the Trendelenberg position when the signs and symptoms of shock are being experienced by the patient. This position places the legs of the patient in an elevated position that is higher than the head. This position also promotes return of the blood in the extremities (arms and legs) back into the circulating blood, therefore increasing the patient’s blood volume and blood pressure. The Sims and Fowler’s positions cannot produce these effects).

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QUESTION: The instructor is teaching a group of nurse aide students about the various roles of the different members of the multidisciplinary team within a typical nursing home setting. The instructor knows that her teaching has been effective if the nurse aide student is able to correctly pair the following healthcare worker with the associated duties and functions:

A. Dietitian: meal preparation

B. Speech language pathologist: instruction of new languages

C. Physical therapist: ambulation and balance/gait exercises

D. Certified nursing assistant: ordering medications

ANSWER: C (Physical therapists deliver rehabilitative and restorative care techniques, including assistance with ambulation and balance/gait exercises. Speech language pathologists, also known as speech therapists, assess and treat residents who are afflicted with swallowing disorders; in addition, they assess and treat residents with speech disorders and communicative problems that sometimes happen after a stroke. Speech language pathologists do not teach people new languages.

The primary role of a dietitian in the nursing home setting is to formulate nutritional programs designed to improve or maintain the health statuses of the residents who reside there; conversely, they do not prepare meals in the nursing home setting. Ordering medications is not within the scope of practice for certified nursing assistants).

 

CNA State Examination Practice Questions (Part Two)

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QUESTION: The nursing assistant observes a very small fire in the outdoor smoking area of the skilled nursing facility where he works. He has been trained to extinguish small fires through nurse aide training and annual fire safety in-service training at his place of employment. This nursing assistant is following the proper sequence for using a fire extinguisher if he:

A. Pulls the fire extinguisher’s pin, aims at the base of the fire, squeezes the fire extinguisher’s handle, and sweeps in a back and forth motion.

B. Aims at the base of the fire, pulls the pin, squeezes the handle of the fire extinguisher, and sweeps in a back and forth sweeping motion.

C. Pulls the pin of the fire extinguisher, gently shakes the fire extinguisher, aims at the base, squeezes the handle of the fire extinguisher, and sweeps in a back and forth sweeping motion.

D. Aims at the middle of the fire, pulls the pin, squeezes the fire extinguisher’s handle, ans sweeps in a back and forth sweeping motion.

ANSWER: A (the proper sequence of steps to use a fire extinguisher can be readily recalled by remembering the PASS acronym, which stands for PULL-AIM-SQUEEZE-SWEEP. P = pull the pin out to activate the fire extinguisher. A = aim the fire extinguisher toward fire’s base. S = squeeze the fire extinguisher’s handle to facilitate expulsion of the container’s contents. S = sweep in a back and forth motion across the fire’s base as the contents of the fire extinguisher are expelled).

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QUESTION: The nursing assistant has strong suspicions that a CNA coworker might be verbally abusing an elderly patient at the post-acute rehabilitation center where they both work. What is the first action that the nursing assistant must take?

A. Place a telephone call to the local sheriffs department to report the suspicions of abuse. Ensure the names of the resident and suspected abuser are available just in case more information is requested.

B. Report the suspected abuse to the charge nurse or facility administrator.

C. Privately confront the suspected abuser and demand that she immediately stop verbally abusing the elderly patient.

D. Do nothing at the moment since the nursing assistant only has suspicions of possible verbal abuse without any substantiated proof.

ANSWER: B (nursing assistants are mandated reporters who are legally mandated to report all instances of witnessed abuse, as well as any suspected abuse and neglect. The nursing assistant does not need proof of suspected abuse in order to report it; rather, a designated person will investigate the allegation of abuse. The nursing assistant should not call the sheriffs department since the administrator and/or charge nurse knows to adhere to facility procedures for initiation of investigations of alleged abuse).

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QUESTION: The nursing assistant student is currently learning about principles of infection control during this evening’s nurse aide lessons at school. The instructor has made all students in the classroom aware that some questions regarding infection control might be included on the written section of the CNA state test. The student answers the instructor’s question correctly if she responds that the following entity is a host of infection:

A. A wadded piece of toilet paper contaminated with stool

B. A stethoscope contaminated with the microbe that causes whopping cough

C. A sick patient who is currently infected with tuberculosis

D. A sick dog who is currently infected with rabies

ANSWER: C (according to the chain of infection, an infected human being is a host of infection. A vector is a living nonhuman, such as an infectious dog, mice, tick or mosquito, that can transmit infections to humans. A fomite is an inanimate object, such as used toilet paper, contaminated equipment, and unclean door knobs, that can potentially spread infection via direct contact).