Transfers, gait belts, canes and walkers for HHAs

Safe transfer techniques and ambulation are on the federal list of skills a nurse must watch an aide perform, and the written questions test the same decisions. Which side does the chair go on? Which hand holds the cane? Where does the aide walk? Nearly every answer follows from one rule: the client's strong side does the work, and the aide guards the weak side.

Questions and answers, explained

All 11 questions above, with the correct answer and why it is correct. Everything here is on transfers, gait belts, canes and walkers for hhas.

1. Before transferring a client from the bed to a wheelchair, what must the aide do with the wheelchair?

   • ALeave the brakes off so it can roll closer as the client sits down
   • BPlace it behind the aide, out of the client's view
   • CLock the brakes and move the footrests out of the wayCorrect
   • DFold it partly so it takes up less floor space

   Why: Locked brakes keep the chair from rolling away as the client sits, and swinging the footrests aside keeps the client from tripping. The chair goes close to the bed on the client's strong side.

   Reference 42 CFR 484.80(b)(3)(x); NNAAP transfer skill

2. A small kitchen fire starts while the aide is with a client who uses a wheelchair. What comes first?

   • AGrab the fire extinguisher before anything else and try to put the fire out
   • BGet the client out of the homeCorrect
   • COpen all the windows to let the smoke out
   • DCall the agency to ask what to do

   Why: RACE puts Rescue first: get the client out to safety, then Alarm (call 911 from outside), Contain the fire by closing doors, and Extinguish only if it is small and safe. Opening windows feeds a fire with oxygen.

   Reference NFPA fire safety; RACE

3. A client with left-sided weakness is moving from the bed to a wheelchair. Where should the wheelchair be placed?

   • AOn the client's right, strong sideCorrect
   • BOn the client's left, weak side
   • CAt the foot of the bed, facing the wall
   • DAcross the room, so the client walks to it

   Why: The client leads with and pivots on the strong leg, so the chair goes on the strong side, close to the bed and at a slight angle. That way the strong side carries the weight through the turn.

   Reference NNAAP transfer skill

4. Which change makes a client's home safer from falls?

   • AAdding throw rugs in the hallway for warmth
   • BTurning off all the lights at night so the client sleeps better
   • CWaxing the floors until they shine
   • DClearing clutter and cords from walkwaysCorrect

   Why: Clear walkways, secured or removed throw rugs, night lights, grab bars, nonslip footwear and frequently used items within reach all reduce falls. Loose rugs, darkness and slick waxed floors are common causes of falls at home.

   Reference CDC STEADI home fall prevention checklist

5. How tight should a gait (transfer) belt be?

   • ALoose enough to slide down over the client's hips
   • BSo tight that the aide's fingers cannot fit anywhere under the belt
   • CDirectly on bare skin under the client's clothes
   • DSnug over clothing, with room to slip flat fingers underCorrect

   Why: The belt goes around the waist over clothing, snug enough to hold but with room to slide flat fingers underneath for comfort and breathing. Too loose and it slides up under the arms or down over the hips during a transfer.

   Reference NNAAP transfer and ambulation skills

6. A client with a weak right leg uses a cane. In which hand should the cane be held?

   • AThe left hand, on the strong sideCorrect
   • BThe right hand, on the weak side
   • CEither hand, switching every few steps
   • DBoth hands together in front of the body

   Why: The cane is held on the strong side so it can share weight with the weak leg as they move forward together. Holding it on the weak side makes the client lean toward that side and throws off balance.

   Reference Assistive device training; physical therapy guidance

7. A client with a weak leg uses a cane on stairs. Which leg leads going up?

   • AThe weak leg, with the cane following behind
   • BWhichever leg is closer to the railing
   • CThe cane alone, then both legs together
   • DThe strong leg, then the cane and weak legCorrect

   Why: The rule is up with the good, down with the bad. Going up, the strong leg lifts the body first, then the cane and weak leg follow. Going down, the cane and weak leg step down first while the strong leg holds the weight.

   Reference Physical therapy stair training guidance

8. How should a client walk with a standard (non-wheeled) walker?

   • APush it quickly ahead and hurry to catch up
   • BLift it a short step ahead, then step in, weak leg firstCorrect
   • CCarry it in one hand while walking normally
   • DLean on it with the back bent far forward and the walker held well ahead

   Why: The client lifts the walker and sets it down a short step ahead with all four legs on the floor, then steps into it with the weak leg first, followed by the strong leg, while standing upright. Placing it too far forward makes the client lean and fall.

   Reference Assistive device training; physical therapy guidance

9. A client starts to fall while walking with the aide. What should the aide do?

   • AGrab the client's arm and pull hard to hold them upright until they recover
   • BStep away quickly so the aide is not hurt too
   • CWiden the stance and ease the client to the floor, protecting the headCorrect
   • DLet go of the belt and run to call for help

   Why: Trying to stop a fall by pulling usually injures both people. The aide keeps a wide base, holds the gait belt, pulls the client close and slides them gently down along the aide's leg to the floor, protecting the head. The client stays down until checked.

   Reference Safe patient handling; fall management

10. The aide finds a client on the floor after a fall. What should the aide do first?

    • ALift the client back into bed right away so they are comfortable
    • BGive the client something to drink
    • CLeave and finish the other tasks first
    • DKeep the client still, check responsiveness, and get helpCorrect

    Why: Moving a client who may have a broken hip or head or spine injury can worsen it. The aide stays with the client, checks whether they respond and are breathing, calls 911 if needed per agency policy, and notifies the nurse, who decides how the client is moved.

    Reference Fall management; agency emergency policy

11. What is the safest way to take a client in a wheelchair down a steep ramp?

    • AGo forward quickly so the chair does not roll back
    • BLet the client roll down alone using the brakes
    • CTip the chair forward onto its front wheels so it rolls more slowly downhill
    • DGo down backward, with the aide below and looking behindCorrect

    Why: Backing down a steep ramp lets the aide control the chair's speed with their body below it and keeps the client from sliding forward out of the seat. The aide looks over a shoulder to check the path.

    Reference Wheelchair safety guidance

Drill the whole domain

• Mobility, Transfers and Positioning (9%)
• Safety and Emergencies (7%)

Other topics

• HHA vital signs: normal ranges and how to measure them
• Perineal and catheter care: the steps HHAs get tested on
• Pressure injuries and skin tears: what HHAs check and report
• Food safety for home health aides: the temperatures to know
• HHA scope of practice: what a home health aide can and cannot do
• Dementia care for home health aides: communication that works
• Hand hygiene, gloves and PPE order for home health aides
• Fire, oxygen and electrical safety in a client's home
• Positioning and range of motion: Fowler's, Sims' and ROM terms
• Client rights, abuse and neglect: what HHAs must report
• Emergencies for home health aides: choking, stroke, seizures
• Assisting with medications: an HHA's role and limits

See all topics · Study Guides · Full practice exam