WA CNA written exam

what is the normal systolic blood pressure range for adults?

100-120

For most residents, the range of normal respiration is

12-20 inspirations per minute

if a resident drinks four ounces of water with a meal, how many milliliters (mL) of water has he consumed?

120 mL

which blood pressure reading would you report to the nurse?

144/92

A patient has just finished consuming a cold beverage. How long should you wait before taking the patients oral temp?

15-20 minutes

Mr. Burns just smoked a cigarette. How long should you wait to take his oral temperature?

15-20 minutes

Mr. greens water pitcher holds 1000 mL. it was full when you came on shift. You refill it once during your shift. At the end of the shift, it is half full. How much water has Mr. Green had to drink?

1500 mL

Mr. Martin drank 6 ounces of coffee and 3 ounces of orange juice during breakfast. How many milliliters (mL) did he drink?

270 mL

if a patient has not had a bowel movement in more than _____, the patient is at an increased risk for developing constipation and the nurse should be notified.

3 days

To convert four ounces (oz) of liquid to milliliters (mL), the nurse aide should multiply 4 by

30 mL

Three fluid ounces equals how many milliliters?

90

To lift an object using good body mechanics, the nurse aide SHOULD

bend the knees and keep the back straight

when a new client is admitted, which of the following should a nurse aide observe and record?

bruises

which of the following best helps reduce pressure on the bony prominences?

floatation mattress

when a patient is dying, the last sensation that is lost is

hearing

Signs of poor circulation include

paleness; cold skin, and edema

what is the term for a device used to take the place of a missing body part?

posthesis

clean bed linen placed in a clients room but NOT used should be

put in the dirty linen container

when cleaning a males genitals area during perineal care, the nurse aide should do which of the following?

replace the foreskin after pushing it back to wash an uncircumcised penis

What does R.A.C.E stand for?

rescue/remove, alarm, confine/ contain, extinguish

a patient visits a care facility for only a short period to give his or her usual caregivers a "break". What is this called?

respite care

Physical restraints are used MOST often

to prevent client injury

Mrs. Hernandez had a hip replacement and is admitted to the long-term care facility for rehab. Her condition is considered

Acute

Mrs. Sparks is an 83 year old female patient who suffers from the late effects of a CVA. She has {L} sided hemiplegia. This is...

Paralysis on the left side of the body

how often should restraints be unfastened or released?

Q1-2 hours

who can order a warm or cold application?

a doctor

which of the following is the most comfortable position for a client with a respiratory problem?

fowlers (90 degrees sitting up)

when wearing gloves, you should remember that

gloves are worn when using disinfectants

on which side should the patient lie for an enema?

left

which type of fire can be put out with water?

paper

which of the following people provide treatment for persons who have difficulty talking due to disorders such as a stroke or physical defects?

speech therapists

which of the following are the parts that make up the whole person?

spiritual, physical, emotional, cognitive, social

which state of a pressure sore or ulcer involves breakdown of the subcutaneous layer of the skin?

stage 3

infection control practices that prevent the transmission of disease are called

standard precautions

what is rigor mortis?

stiffening and locking of the joints after death

you are instructed to strain Mr. Powers urine. The purpose of straining the urine is to detect

stones

Towards the end of the day, residents with dementia commonly experience which of the following?

sundown syndrome

post partum refers to

the period of time after the delivery of a baby

which of the following is a correct measurement of urinary output?

300 mL

how many tips does a quad-cane base have?

4

Mrs. Shumway has an order for I&O. You have picked up her breakfast and note that she drank half of a 6 oz. glass of juice, 4oz. of milk, and 8 oz. of coffee. Therefore, you document

450 mL (1 oz = 30 mL)

which of the following measurements is an example of the proper way to record urinary output?

480 ml

your resident consumed a bowl of soup that was 180 cc of liquid. How many ounces was that?

6 oz

In long-term care facilities, which shift usually gets the residents ready for their appointments, X-rays, and other procedures?

7 am - 3:30 pm

There are two kinds of restraints

Physical and chemical

when lifting, the nurse aide should have his or her feet separated in the standing position to

Provide a wide base of support

A resident is NPO for tests. The nurse aide should

Remove the water pitcher and glass from the room

You are caring for Mr. Brown, who has a diagnosis of COPD. His SpO2 is 82%. He is currently receiving O2 via Nasal Cannula @ 2 liters/min. What do you do?

Report it STAT to the nurse

for safety, when leaving a client alone in a room, the nurse aide SHOULD

place the signaling device within the clients reach

to take an oral temperature the nurse aide should

place the thermometer under the tongue

which does NOT prevent or reduce odors?

placing fresh flowers in the room

A resident who is incontinent of urine is at increased risk of developing

pressure sores

the purpose of padding side rails on the clients bed is to

protect the client from injury

The goal of the health care team is to

provide quality care

restorative nursing care is the process of

providing care for the needs of the whole person

A nurse aide is pushing a resident in a wheelchair down the hall when a call light lights up. What should the aide do?

push the patient to a safe place, apply the wheel locks, then answer the call light

when you empathize with residents, you are

putting yourself in their place

drainage bags from urinary catheters should always

be kept below the level of the bladder

a resident is on a bladder training program. The nurse aide can expect the resident to

be on a scheduling for toileting

During dinner, an HIV-positive client accidentally breaks a glass and cuts himself. What is the proper procedure?

block off the area until it can be cleaned

when caring for a client who uses a protective device (restraint), the nurse aide SHOULD

check the clients body alignment

which of these actions helps prevent skin breakdown around a stoma if the resident has had a colostomy?

clean the stoma with water and mild soap

which is the most accurate way to measure a residents temperature?

rectal

A client who is on a low-cholesterol diet should not eat

red meat

Personal protective equipment (PPE) is used to

reduce exposure for health care workers

which of the following diets has not food restrictions?

regular

if the nurse aide discovers fire in a clients room, the FIRST thing to do is

remove the client

while making an empty bed, the nurse aide sees that the side rail is broken. The nurse aide SHOULD

report the broken side rail immediately

The nurse aide notices on the flow sheet that a resident has not had a bowel movement for 5 days. The nurse aide should

report this to the charge nurse

You have taken Ms. Clarks resting pulse and it is 106 beats per minute, which is significantly higher than her normal pulse. You should

report this to the charge nurse

Mr. Brown has an ankle brace. When you remove the brace, you notice a reddened area on the ankle. You should

report your observations to the nurse

considering the residents level of activity, which of the following sets of vital signs should be reported to the charge nurse immediately?

resting: 98.6-98-32

the nurse aide sees a client spill water on the floor in the hall. Another client is walking down the hall. The burse aide SHOULD...

clean up the spill

a professional and safe working appearance would include which of the following?

clean, wrinkle free uniforms, and short fingernails, and off the shoulder hair

what is the main purpose of continuing education for the nurse aide?

client safety

which of the following signs indicates a problem with a diabetic patient

cold, clammy skin

The nurse aide is walking with a client confined to a wheel chair when the facility fire alarm system is activated. The client becomes excited from the noise. The burse aide SHOULD

comfort the client while moving the person to a safe place

Food moves more slowly through the digestive tract of older people. What is a common consequence?

constipation

The learnings and behaviors of a group that are passed down from one generation to the next are known as

culture

Mrs. Shumway's nursing care plan lists CHF (congestive Heart Failure) as her primary dx. (Diagnosis). You would expect her ADL routine to include which of the following?

daily am weight measurement

which of the following is considered a normal age-related change?

decreased bladder capacity

Wrinkles in the bed linens can lead to problems for residents. Which is the most serious problem that they can cause?

decubitus ulcer

if a resident exhibits paranoid behavior, what should the nurse aide know?

delusions are a normal part of the progression of the dementia process

All of the following are signs of aggressive behavior EXCEPT

depressed mood

incidents reports are written in order to

determine patterns and trends

The thinning of the fatty layer under the skin could cause a resident to

develop pressure sores

which of the following methods is the correct way to remove a dirty isolation gown?

roll it dirty side in and away from the body

To encourage blood circulation in a resident who must remain in bed, you can do all of the following EXCEPT

rub the skin vigorously during a bed bath

the nurse aide is going to help the client walk from the bed to a chair. What should the nurse aide put on the clients feet?

rubber-soled slippers or shoes

In Maslow's hierarchy of needs, which of the following basic needs are most essential?

safety and secruity

Which one of these conditions require Contact isolation precautions?

scabies

The nurse aide notices that the clients radio cord is draped across a chair to reach the nearest outlet. The FIRST thing the nurse aide should do is...

see if any changes can be made so that the radio can be plugged in safely

a resident has diabetes. Which is a common sign of a low blood sugar level?

shakiness

which of the following is NOT a sleep aid?

drinking alcohol

when starting a job, when is HIPAA training mandatory?

during initial orientation

which device does NOT make toileting easier?

egg crate toilet cover

what is the best way to keep a skilled nursing facility from having an unpleasant odor?

empty bedpans and change linens in a timely manner

What type of isolation precautions are necessary for a patient with a gastrointestinal infection?

enteric precautions

if you see a fire, what should you do first?

evacuate patients in the area

mouth care should be given to an unconscious person

every two hours

various factors will change pulse rate. An increased pulse rate can be caused by

exercise

before performing any procedure, a nurse aide must

explain the procedure, wash his or her hands, identify the patient

which of the following is true regarding the use of side rails on a bed?

side rails should not be raised unless stated in the care plan

what position is Fowlers position?

sitting up

A patient chokes while eating and is unable to cough or speak. What is the first thing the nurse aide should do?

slap the patient between the shoulder blades

Constipation and indigestion can result from

slowed peristalsis

A Nurse aide is going to take Mr. Heath's vital signs. What should the nurse aide do to reduce Mr. Heath's anxiety and get him to cooperate?

explain the procedures to Mr. Heath

You are assigned to give Mr. Brown a partial bath. Which parts of his body should you wash?

face, hands,, underarms, back, perineum

Mrs. Harvey complains of abdominal discomfort. Watery stool has been leaking from her rectum. This could be a sign on

fecal impaction

Used disposable supplies and equipment should be discarded

in a designated receptacle

The exchange of oxygen and carbon dioxide takes place

in the lungs

A bed sore or decubitus ulcer is caused by

inadequate turning

Residents who are bedridden face all of the following risks EXCEPT

increased muscle strength

Diabetes mellitus makes a resident more prone to develop

infections

when a new ambulatory patient is admitted, the nurse aide should always

instruct the patient on how to use the call light

Besides hearing, what other function does the ear have?

it controls balance and equilibrium

to help prevent resident falls, the nurse aide should do which of the following?

leave residents beds at the lowest level when care is complete

which of the following is the recommended position for giving an enema

left sims

when transferring a client, MOST of the clients weight should be supported by the nurse aide's

legs

The nurse aide reports directly to the

licensed nurse

Intake and output deal with

liquids

signs and symptoms of shock may include

low blood pressure; tachycardia; and clammy, pale skin

how should the nurse aide position the patient to apply elastic stockings?

lying down in bed

supine position is

lying on the back

which of the following is a way to care for residents suffering from depression

make sure the residents wear their glasses and hearing aids

A resident who has stress incontinence

may leak urine when laughing or coughing

You notice that a patient has passed a black, tarry stool. This is called

melena

proper use of a waist restraint requires that the nurse aide

monitor for skin irritation

when interacting with clients, the nurse aide should remember that

more than half of all communication is nonverbal

which of the following statements about blindness are false?

most legally blind or visually limited people have no sight at all

charting is an accurate record of all medical care while the patient is in the hospital, including therapies given, treatments performed, and the patients progress. Information typically found in the chart includes all of the following EXCEPT

names of visitors

continuing education is

necessary for recertification in many states, important for keeping abreast of new development, a professional standard

the brain is part of the

nervous system

what does "afebrile" mean?

no fever

what can the nurse aide give a resident who has an order for NPO?

no foods or liquids

The normal aging process is BEST defined as the time when

normal body functions and senses decline

NPO means

nothing by mouth

Once a nurse aides name is placed on the abuse registry for neglect, the nurse aide may

petition the state nursing board for reinstatement

what is the branch of medicine that deals with physical medicine and rehab called?

physiatry

a client is to be assisted out of bed to sit in a wheelchair. How can this procedure be made safe?

place the bed in the lowest position

The nervous system changes as people get older. Which change is considered normal?

slower response time

the term atrophy refers to an organ or tissue becoming

smaller because of underuse

which of the following human needs are considered basic?

social, spiritual, sexual

Communication with a resident who has late stage dementia or Alzheimer's includes

speaking in one or two word sentences

a patient is nearing death. What should the nurse aide focus on?

supporting the patient and keeping the person comfortable

All body fluids are considered infectious except

sweat

Headaches, nausea, and pain are considered

symptoms

in a report, the nurse aide is told that one of her patients has been ordered NPO after midnight. The aide should

take away the water pitcher at midnight

when taking a blood pressure reading, you should do all of the following EXCEPT?

take the blood pressure reading in an arm with an IV

the nurse aide is responsible for the following fire prevention measures EXCEPT

taking cigarettes and matches away from all clients and visitors

why must the Foley bag be kept lower than the patients bladder?

to prevent urine returning to the bladder

when you're documenting in a patients record, which statement is FLASE?

to save time, chart a procedure before doing it

The equipment you need for oral care of an unconscious client includes

toothette /mouth swab

a patient has a diagnosis of psoriasis. her nurse aide should

treat her the same way as any other patient with a non-infectious disease

when taking a clients radial pulse, the nurse aides fingertips should be placed on the clients

wrist

Normal urine color is

yellow

Long term care facilities can provide which of the following types of service?

Home care

a nurse aide notices blood in a patients IV tubing. The aide should

notify the IV nurse

a complains that her hand hurts where the IV is running. The nurse assistant notices that the hand is puffy. The nurse aide assistance should

notify the IV nurse that the infusion appears to have infiltrated

you observe that a patient is bleeding from an IV site. You should

notify the RN immediately

The preferred way to remove a bedpan from a client who is unable to lift their buttocks is to

turn the client on their side while holding the bedpan

The normal heart rate or pulse rate for an adult human is 60-100 bpm. An elevated heart rate can be expected with

uncontrolled bleeding

The electric shaver that the nurse aide is using to shave a client begins to spark and smoke. what should the nurse aide do FIRST?

unplug the shaver

to avoid pulling on the catheter while you're turning a male client, the catheter tube must be taped to his

upper thigh

what is the condition when patients are unable to control their bladder?

urinary incontinence

hypothermia is a

very low body temperature

If the resident is smoking and the nurse aide needs to take an oral temperature, what should the nurse aide do?

wait 15 minutes to take their temperatures

which conditions promote the growth of bacteria?

warm, dark, moist

which of the following symptoms is most associated with rheumatoid arthritis?

warm, red, painful, and swollen joints

while emptying the trash in a clients room, you get stuck by a needle that should have been placed in the sharps container. What is the first thing you should do?

wash the site for several minutes

when assisting a resident with a weak left side from a wheelchair, the nurse aide should support the clients

weak side

As dementia progresses, incontinence can become an issue. How can the nurse aide assist?

what for signs of discomfort so you can take the resident to the bathroom

A sitting or semi-sitting position with the head of bed elevated is called

Fowler's

Mrs. Allen has had a gastrostomy, and the nurse just put Ensure through the feeding tube. The CNA needs to put her in which position for the next one to two hours?

Fowler's

a client who requires a high-fiber diet should eat

Fruits, vegetables, and whole grains

When lifting a heavy object, which muscle groups should you use?

Muscles of the legs

The nurse aide knows to wear which of the following when performing care for clients?

Name badge with job title, clean uniform or scrubs, shows with non-skid soles

when caring for a patient with MRSA, a nurse aide should wear

a gown and gloves

An elderly resident who is inactive is at risk of constipation. In addition to increased activity and exercise, which of the following actions helps prevent constipation?

adequate fluid intake

A sit bath is helpful

after rectal surgery

when calculating total fluid intake over a 24 hour period, all of the following should be included EXCEPT

all eye or skin ointments that are absorbed

which statement about gait belts is FALSE?

all gait belts have reversible buckles

when assisting a blind resident to walk, you should

allow the resident to hold your arm

The medical term for hair loss is called

alopecia

A restraint attached to a patients body and to a stationary object is

an active physical restraint

The type of bed used for a patient arriving by stretcher or wheelchair is

an open bed

in what position should the nurse aide place the unconscious person when giving oral care?

Lateral

Which vegetable is not allowed on a low-sodium diet?

Sauerkraut

What is a pulse oximeter used to measure?

The amount of O2 in the blood

who supervises the work of a nurse aide?

a nurse

what are the main components of successful communication?

a sender, a message, and a reciever

The loss of the ability to express oneself is known as

aphasia

A client needs to be repositioned but is heavy, and the nurse aide is not sure that she can move the client alone. The nurse aide should

ask another nurse aide to help

The nurse asks you to change the urine drainage bag for a patient with an indwelling catheter. If you aren't sure how to change it, what should you do?

ask the nurse to show you

Breathing liquids or solids into the airway or lungs is called

aspirations

As nurses aides begin their assignments, which should they do first?

assist a resident that needs assistance to get off the toilet

to be sure that a clients weight is measured accurately, the client should be weighed

at the same time of the day

wasting or a decrease in the size of a muscle is called

atrophy

while eating dinner, a client starts to choke and turn blue. The nurse aide SHOULD

call for assistance and perform the Heimlich maneuver (abdominal thrusts)

A resident has an indwelling urinary catheter. While making the rounds, the nurse aide notices that there is no urine in the drainage bag. What should the nurse aide do first?

check for kinks in the tubing

which of the following is the safest way to confirm a residents identity?

check the ID bracelet or tag attached to the resident

when caring for a resident with an indwelling Foley catheter, you should

check the bag and tubing frequently for adequate urinary flow

what is the FIRST thing a nurse aide should do when finding an unresponsive client?

call for help

you arrive at a clients home for care. She shows you a burn on her arm. It is blistered and the client is complaining of severe pain. You should

call the Home Health manager

Most of our calories should come from

carbohydrates

The earliest identifying sign for a developing pressure sore is a local

change in color

if your patient is in traction, you should NOT

change the position of the weights

A patient suffering from pneumonia might exhibit symptoms such as

chest pains and discomfort, persistent coughing, thick sputum

using touch as a way to communicate with a clinet

depends on the clients culture

when a patient is receiving a nasogastric (NG) tube feeding, what should the nursing assistant do?

immediately report any signs of choking or vomitting

a patient appears paler than usual. The nurse aide should

Ask the patient how he feels and take his vital signs immediately

in a reality orientation program, which of the following should you NOT do?

Ask the residents about their childhood

Mrs. Andrews has an indwelling urinary catheter. Which of the following statements is INCORRECT?

Attach the drainage bag to the bed rail

which of the following measurements that you obtained from Mrs. Shumway should be reported immediately to the charge nurse?

B/P 190/114

meal trays have arrived. Before serving each tray, the nurse aide should

Check each armband, even on familiar pateints

swollen ankles and legs may be signs of

Congestive heart failure

When operating a manual bed, the nurse aide should remember to...

Fold the cranks under the bed (This prevents others from tripping or falling)

Many elderly residents lose their appetite because of

Depression, decrease in number of taste buds, social isolation

why should heat NOT be applied to a diabetic residents feet?

Diabetics have decreased sensitivity to heat

Which of following is a proper way to correct an error in charting?

Draw a single line through it

A diabetic resident asks the nurse aide to cut her toenails. The burse aide should

Tell the resident that the nurse aide cannot do it but will report it to the charge nurse

The RN assigns you a task that is in your job description. Which of the following statements is FALSE?

The RN should delegate every non-RN task to you

A person with dementia is being admitted to your facility. Which of the following statements are correct?

The admission process will be completed as quickly as possible, the persons confusion may increase in these new surroundings, and family members will be asked to leave to help the person adjust

Who is responsible for the entire nursing staff and the activities involved in providing safe care?

The director of nursing

A hepatitis B vaccination protects the person receiving it against a disease that affects

The liver

which of the following is a major reason for urinary incontinence in elderly?

The muscle that keeps urine in the bladder weakens

A nursing aide has four patients to assist. Whom should she address first?

The patient who needs to be taken to the bathroom

objective data is any information that is fact. This means that the info is unbiased and multiple people should be able to interpret the info in the same way. Which f the following is NOT an example of objective data?

The patients pain level is 3 out of 10

who is in charge of delegating the work assignment?

The registered nurse on duty

When dry, hard stool fills the rectum and will not pass, it is called

impaction

To secure a restraint, a slipknot is used so that

The restraint can be removed quickly when needed

What is a CNA's scope of practice?

The skills that the CNA is legally allowed to perform

The opening of the colostomy to the outside of the body is called

The stoma

The safety device used to transfer a weak or dependent patient from a bed to a chair is called a

Transfer/ gait belt

what does the acronym "BID" stand for?

Two times a day

All of the following statements about type 2 diabetes are true EXCEPT

Type 2 diabetes is very rare in adults

which symptoms best indicate an instance of urinary tract infection?

Urine that appears cloudy, the need to urinate more frequently, burning or stinging sensation when urinating

which is INCORRECT when your recording on a patients chart?

Use a pencil in case you make a mistake

The Heimlich maneuver (abdominal thrusts) is performed on a patient who has

a blocked airway

The Heimlich maneuver (abdominal thrusts) is used on a client who has

a blocked airway

what is an embolism?

a blood clot that moves through the bloodstream and causes obstruction

which of the following should be reported immediately

a blood pressure of 90/40

A common eye disorder involving a cloudy condition of the lends that impairs eyesight is known as

a cataract

On admission to a nursing home or a long-term care facility, a resident must be given

a copy of the Residents Bill of Rights

the nursing care plan states, "Transfer with mechanical lift". However, the client is very agitated. To transfer the client, the nurse aide SHOULD

get assistance to move the client

to help ensure adequate circulation to prevent patient skin breakdown, you should

give back massages, perform active or passive range of motion exercises, change the patients position frequently

a patient who was given insulin in the morning is pale and sweaty and appears confused two hours later. It would be helpful to find out whether the patinet

had breakfast

which of the following are associated with smoking

heart attacks, vitamin C deficiency, pneumonia

The circulatory system consists of the

heart, arteries, veins, and capillaries

Paralysis on one side of the body is called

hemiplegia

to take a rectal temperature, the nurse aide should insert the thermometer and

hold on to the thermometer until is can be removed

A health care agency or program for patients who are dying is

hospice

settings where a CNA can work includes

hospitals, hospices, home care

a patient with a persistent blood pressure measurement above 140/90 has

hypertension

the charge nurse has asked you to take Mrs. Shumway's vital signs. Before doing so, you must

identify the patient and introduce yourself, gather all appropriate equipment, wash your hands

a resident with an ileostomy evacuates feces through the

ileum

The residents weight is measured routinely as a way to check the persons

nutrition and health

The best way for a nurse aid to gather information about the safety and well-being of a resident is

observation

Which specialist is responsible for assisting residents to perform everyday activities?

occupational therapist

when helping a client who is recovering from a stroke to walk, the nurse aide should assist

on the clients weak side

a client is paralyzed on the right side. The nurse aide should place the signaling device

on the left side of the bed near the clients hand

To count respirations, one respiration includes

one inhalation and one exhalation

Elderly residents sometimes appear stooped over and seem to have lost height. This is due to

osteoporosis in the spinal column

which of the following is NOT considered a way to restrain a client

pain managment

which of the following is an appropriate task for the nurse aide?

participating in resident care plan conferences

you patient is on bed rest. You can help percent development of contractures by

performing ROM exercises, positioning in a good body alignment, and using supportive devices

repeating a phrase or action over and over is called

perseveration

all behavior has meaning to the

person doing the behavior

a hospice specializes in the care of people who are

terminally ill

Insulin, a hormone, regulates

the amount of sugar in the blood

strokes are seen in the elderly. A stroke occurs when

the brain is deprived of oxygen

The plan that starts on the residents admission and assists when the resident goes home is called

the discharge plan

what is aphasia?

the inability to speak or articulate words

if your patient has bradycardia, what does that mean?

the patients heart rate is abnormally slow (below 60 bpm)

who should manage the residents finances?

the resident

A nurse aide is assigned to a stroke patient with a diagnosis of aphasia. The nurse aide knows that

the resident cannot talk

in the nursing care plan, you note that it is written, "02 per N/C @3L, Orthopnea pos. as needed". As a CNA, you know that this means which of following?

the resident is an oxygen with a nasal cannula of three liters. Assist to sit in Fowlers postion

a nurse assistant notices red marks on a residents back and buttocks. The aide acts in the knowledge that

the skin can break down if nothing is done

a patient who is lying on his or her back is in

the supine position

An important rule of communication is to always use the proper "register". This means

the way we talk to different people

why do residents with Parkinson's disease require assistance when walking?

they have a shuffling gait and often get tremors

a Foley catheter is used

to drain urine from the bladder

what is the purpose of the chain of command in a long-term care facility?

to keep communication about a problem flowing smoothly