CNA Oregon State Exam (copy)

Which of the following healthcare settings is generally for people who will die in six months or less?

A. Hospice care

B. Long-term care

C. Outpatient care

D. Acute care

A. Hospice care

Which of the following statements is true of long-term care?

A. People with terminal illnesses do not live in long-term care facilities.

B. Most conditions in long-term care facilities are chronic.

C. People who live in long-term facilities are never able to return home.

D. Long-term care takes place in a person's home.

B. Most conditions in long-term care facilities are chronic.

Where is long-term care offered?

A. In adult day services facilities

B. In hospitals

C. In skilled nursing facilities

D. In ambulatory surgical centers

C. In skilled nursing facilities

_____________ is care given by specialists to help restore or improve function after an illness or injury.

A. Subacute care

B. Acute care

C. Adult day services

D. Rehabilitation

D. Rehabilitation

A resident has purchased a special gift for her NA. What would be the best response by the NA?

A. The NA should refuse the gift but thank the residents for thinking of her.

B. The NA should accept the gift because she is unsure about her facility's policy on gifts.

C. The NA should accept the gift if the resident will keep it confidential.

D. The NA should refuse the gift and tell the resident that her employer is very unfair about the employees accepting gifts from the residents

A. The NA should refuse the gift but thank the residents for thinking of her.

The abbreviation HMO means

A. Home maintenance organization

B. Health management organization

C. Health maintenance organization

D. Home medical organization

C. Health maintenance organization

The group with the longest average stay in long-term care facilities is

A. Men

B. Developmentally disabled

C. Caregivers

D. Residents with heart disease

B. Developmentally disabled

Which of the following statements is true of acute care?

A. Acute care is normally given in adult day services facilities

B. One advantage of acute care is people do not have to leave their homes to receive it.

C. Acute care is given to people who do not have a serious illness.

D. Acute care is given in hospitals for people who require immediate care.

D. Acute care is given in hospitals for people who require immediate care.

A _______ is a method or way of doing something.

A. Policy

B. Procedure

C. Survey

D. Cite

B. Procedure

Medicare will pay for

A. All care requested by the recipient

B. All care requested by the doctor

C. All care requested by the long-term care facility

D. Only care that it determines to be medically necessary

D. Only care that it determines to be medically necessary

______________ is a medical assistance program for low-income people.

A. Medicare

B. Medicaid

C. CMS

D. OSHA

B. Medicaid

Regular inspections performed in facilities to make sure they are following state and federal regulations are called

A. Surveys

B. Citations

C. Procedures

D. Licenses

A. Surveys

Which of the following is a core value associated with culture change?

A. Doing everything for residents

B. Treating all residents the same way

C. Promoting self-determination and personal choice

D. Making sure all residents participate in the same activities

C. Promoting self-determination and personal choice

Which member of the care team diagnoses disease and prescribes treatment?

A. Nursing assistant (NA)

B. Resident

C. Physician (MD)

D. Dietitian (RDT)

C. Physician (MD)

Which of the following care team members are licensed professionals who delegate jobs to nursing assistants?

A. NAs, nurses

B. Resident's family

C. Nurses, PTs, OTs

D. NAs, physicians

C. Nurses, PTs, OTs

Which of the following statements is true of residents as a part of the care team?

A. Residents cannot make their own decisions

B. Residents are not care team members

C. Residents should not try to make choices about the care they want to receive

D. The care team revolves around the resident and his or her condition, treatment, and progress

D. The care team revolves around the resident and his or her condition, treatment, and progress

Which of the following statements is true of a nursing assistant's responsibilities if an activity is not listed in the care plan?

A. The NA should not perform the activity if it is not listed on the care plan

B. The NA should perform the activity if he or she believes it is best for the resident

C. The NA should only perform the activity if the resident says he wants it performed

D. The NA should consult other NAs to see if they would perform the activity

A. The NA should not perform the activity if it is not listed on the care plan

What is one reason why reporting a resident's changes and problems to the supervisor is a very important role of the nursing assistant?

A. The care plan must be updated as the resident's condition changes.

B. Reporting changes is not a task that the NA performs.

C. Depending on the resident's changes, the NA can decide if she wants to work that day or not.

D. The NA can decide what medication to prescribe for the resident's current condition.

A. The care plan must be updated as the resident's condition changes.

Which of the following is a typical task that an NA performs?

A. Changing a sterile dressing on an open wound

B. Helping residents with elimination needs

C. Administering medication

D. Prescribing treatments

B. Helping residents with elimination needs

Which of the following tasks is outside the scope of practice for an NA?

A. Giving a resident a bath

B. Inserting tubes into a resident's body

C. Helping a resident eat dinner

D. Transferring a resident from the bed to a chair

B. Inserting tubes into a resident's body

A professional relationship between an NA and a resident includes

A. Telling the resident about problems with the supervisor

B. Calling the resident Dearie and Sweetie

C. Letting a resident know if the NA is in a bad mood

D. Keeping resident information confidential

D. Keeping resident information confidential

Proper personal grooming for an NA means

A. Wearing artificial nails and large rings

B. Keeping hair clean and neatly brushed

C. Wearing nose rings

D. Keeping tattoos visible by wearing a low-cut blouse

B. Keeping hair clean and neatly brushed

What does the term empathy mean?

A. Empathy means being alert

B. Empathy means being able to document honestly

C. Empathy means able to identify with the feelings of others

D. Empathy means taking responsibility for one's own actions

C. Empathy means able to identify with the feelings of others

Which of the following is an example of a professional relationship with an employer?

A. Documenting carefully

B. Never bothering the nurses with questions

C. Trying not to be late more than twice a week

D. Talking about management behind their backs

A. Documenting carefully

What does the chain of command do?

A. It determines which residents go in which rooms.

B. It determines which shift an NA work.

C. It describes the care plan for each resident.

D. It helps protect nursing assistants and their employees from liability.

D. It helps protect nursing assistants and their employees from liability.

The correct order of the nursing process is

A. Planning, evaluation, assessment, implementation, nursing diagnoses

B. Evaluation, implementation, nursing diagnosis, assessment, planning

C. Assessment, nursing diagnosis, planning, implementation, evaluation

D. Evaluation, assessment, nursing diagnoses, planning, implementation

C. Assessment, nursing diagnosis, planning, implementation, evaluation

What is the single best way for an NA to manage his or her time efficiently?

A. See the NAs favorite residents first

B. Let other care team members answer call lights so that the NA can finish assignments

C. Plan ahead by making a list of tasks to do

D. Save time by washing hands only after caring for residents who are obviously sick

C. Plan ahead by making a list of tasks to do

______ have to so with the knowledge of right and wrong.

A. Laws

B. Ethics

C. Advance directives

D. Living wills

B. Ethics

An example of ethical behavior by a nursing assistant is

A. Protecting a resident's privacy

B. Changing the care plan if the NA believes it is inappropriate for a resident

C. Performing a task outside her scope of practice when a resident requests that she do so

D. Accepting a gift from a resident for a job well done

A. Protecting a resident's privacy

OBRA was passed as a response to

A. Lack of funding for long-term care facilities

B. Reports of poor care and abuse in long-term care facilities

C. Nursing assistants being unable to pass competency exams

D. Staff members not reporting to work on time

B. Reports of poor care and abuse in long-term care facilities

How many hours of training does OBRA require for nursing assistants?

A. At least 50 hours

B. At least 75 hours

C. At least 100 hours

D. At least 120 hours

B. At least 75 hours

How many hours of in-service education does OBRA require for nursing assistants every year?

A. At least 34 hours

B. At least 28 hours

C. At least 18 hours

D. At least 12 hours

D. At least 12 hours

A nursing assistant tells a resident that her grandchildren are noisy and disrupt the facility and suggests that next time her daughter visits, she should leave the kids at home. Which Resident's Right might this behavior violate?

A. The right to voice complaints without fear of punishment

B. The right to refuse medication and treatment

C. The right to have visitors

D. The right to confidentiality

C. The right to have visitors

Which of the following terms means harming a person physically, mentally, or emotionally by failing to provide needed care?

A. Neglect

B. Assault

C. Battery

D. Abuse

A. Neglect

Which of the following terms means the improper or illegal use of person's money, possessions, property, or other assets?

A. Substance abuse

B. Financial abuse

C. Verbal abuse

D. Sexual abuse

B. Financial abuse

Which of the following is an example of sexual abuse?

A. Rubbing up against a resident inappropriately

B. Confining a resident in a separate physical space without the resident's consent

C. Using alcohol in a harmful way

D. Failing to provide needed care for a resident

A. Rubbing up against a resident inappropriately

Which of the following is an example of physical abuse?

A. Stealing from a resident

B. Showing a resident a pornographic material

C. Shoving a resident

D. Threatening a resident

C. Shoving a resident

Threatening to harm a resident if he tells another caregiver about a problem is an example of which type of abuse?

A. Physical abuse

B. Psychological abuse

C. Financial abuse

D. Substance abuse

B. Psychological abuse

What is required of a nursing assistant if he suspects that a resident is being abused?

A. The NA should call the police and let them know that the resident is being abused.

B. The NA should discuss the issue with the resident to find out if it is OK for him to report what he suspects.

C. The NA should report it to the charge nurse immediately.

D. The NA should immediately confront the abuser about what he suspects.

C. The NA should report it to the charge nurse immediately.

Which is the following behaviors promotes Residents' Rights?

A. Keeping a change in the care plan confidential so as not to upset the resident

B. Treating a resident badly if he has made a complaint about an NA

C. Encouraging a resident to participate in care planning

D. Borrowing money from a resident if it helps the NA continue to work

C. Encouraging a resident to participate in care planning

Which organization typically investigates charges of abuse against nursing assistants?

A. Centers for Medicare and Medicaid Services (CMS)

B. The Resident's Council (RC)

C. The Federal Bureau of Investigation (FBI)

D. The relevant state agency

D. The relevant state agency

What are typical duties of an ombudsman?

A. An ombudsman advocates for staff members involved in disputes with management

B. An ombudsman advocates for residents and helps settle disputes

C. An ombudsman teaches nursing assistant training classes

D. An ombudsman organizes activities and outings for residents

B. An ombudsman advocates for residents and helps settle disputes

For nursing students, confidentiality means

A. Not telling the nurse about possible abuse of a resident

B. Not documenting resident problems

C. Keeping resident information private

D. Sharing resident information with the NAs family

C. Keeping resident information private

With whom may an NA share a resident's medical information?

A. With the resident's brother and sister

B. With the NAs parents

C. With other members of the care team

D. With the resident's children

C. With other members of the care team

One reason that the Health Insurance Portability and Accountability Act (HIPAA) was created is to

A. Help keep health information private and secure

B. Help ombudsman monitor care in facilities

C. Ensure that nursing assistants receive adequate health insurance coverage

D. Prevent abuse and neglect of residents

A. Help keep health information private and secure

Which of the following is the best way for a nursing assistant to keep residents' health information confidential?

A. Discuss residents' information in public areas away from care facilities so that residents cannot hear it

B. Bring friends to the facility to meet residents

C. Store, file, or shred documents according to facility policy

D. Post updates about favorite residents on her Facebook page to avoid being overheard

C. Store, file, or shred documents according to facility policy

What is the purpose of the Patient Self-Determination Act (PSDA)?

A. To offer in-service training for nursing assistants

B. To keep protected health information (PHI) private

C. To give adults information about their rights related to advance directives

D. To detail how abuse should be reported

C. To give adults information about their rights related to advance directives

Which of the following is an example of an advance directive?

A. Last Will and Testament

B. Power of Attorney

C. Divorce Decree

D. Durable Power of Attorney for Health Care

D. Durable Power of Attorney for Health Care

Which of the following types of advance directives instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest?

A. Legal proxy

B. Do-not-resuscitate order

C. Protected health information

D. Minimum data assessment

B. Do-not-resuscitate order

What is the correct order of the three-step communication process?

A. Sender sends message. Receiver receives message. Receiver provides feedback.

B. Receiver sends message. Receiver receives message. Sender provides feedback.

C. Senders sends message. Sender receives message. Receiver provides feedback.

D. Receiver sends message. Receiver receives message. Receiver provides feedback.

A. Sender sends message. Receiver receives message. Receiver provides feedback.

Which of the following is an example of non-verbal communication?

A. Asking for a cookie

B. Pointing to a cookie

C. Writing a note requesting a cookie

D. Shouting for a cookie

B. Pointing to a cookie

Types of verbal communication include

A. Reading

B. Nodding one's head

C. Crossing one's arms

D. Writing

D. Writing

Which of the following is an example of a barrier to communication?

A. NA uses medical terminology with the resident.

B. NA asks the resident to repeat a sentence.

C. NA speaks the same language as the resident.

D. NA speaks clearly using a professional tone of voice.

A. NA uses medical terminology with the resident.

Which of the following are ways for NAs to avoid barriers to communication?

A. The NA should use slang so that the resident understands more easily.

B. The NA should respond with "Why?" when resident makes a statement.

C. The NA should use medical terminology when talking with the resident so the resident will more easily understand his condition.

D. The NA should ask open-ended questions that require more than yes or no responses.

D. The NA should ask open-ended questions that require more than yes or no responses.

An example of active listening is

A. NA looking around the room while the resident is speaking

B. NA finishing the resident's sentences to make communication faster

C. NA focusing on the resident and providing feedback

D. NA talking constantly so that there are no pauses in the conversation

C. NA focusing on the resident and providing feedback

Which of the following statements is an example of a fact?

A. Mrs. Silva needed help to get to the bathroom today.

B. Mrs. Silva needs more friends.

C. Mrs. Silva looks happy when her daughter visits.

D. Mrs. Silva is too thin.

A. Mrs. Silva needed help to get to the bathroom today.

Which of the following is an example of objective information?

A. "Mrs. Johnson says she has a rash on her torso."

B. "There are raised, red marks the size of pinpricks on Mrs. Johnson's torso."

C. "Mrs. Johnson must have a rash because she looks uncomfortable."

D. "Mrs. Johnson needs some lotion."

B. "There are raised, red marks the size of pinpricks on Mrs. Johnson's torso."

Why is it important for an NA to consider a resident's cultural background when communicating with him?

A. It is not important to consider cultural background.

B. Because the resident will certainly want to tell stories about his culture.

C. Because the NA might know somebody with the same background and she can tell the resident about that person.

D. Because cultural background helps determine how much people communicate and can help the NA communicate better with the resident.

D. Because cultural background helps determine how much people communicate and can help the NA communicate better with the resident.

What is a proper way for an NA to respond if a resident does not hear her or does not understand her?

A. The NA should speak more quickly.

B. The NA should speak more softly or whisper.

C. The NA should speak slowly and clearly.

D. The NA should shout.

C. The NA should speak slowly and clearly.

Which of the following statements is true of touch?

A. All people like to be touched.

B. Nursing assistants do not need to touch residents.

C. Nursing assistants can softly pat residents' shoulders to communicate caring.

D. All residents will feel more comfortable when there is little physical contact.

C. Nursing assistants can softly pat residents' shoulders to communicate caring.

Positive responses to cultural diversity include

A. Valuing and respecting each person as an individual

B. Seeing all people from a certain culture as being the same

C. Preferring people of one culture over those of other cultures

D. Making assumptions about a person based on stereotypes about their culture

A. Valuing and respecting each person as an individual

Which of the following senses is not used in making observations?

A. Sight

B. Touch

C. Smell

D. Taste

D. Taste

With whom should nursing assistants use medical terms and abbreviations?

A. Residents

B. Nurses

C. Residents' friends

D. Visitors

B. Nurses

Which of the following should an NA report about a resident to the nurse immediately?

A. Family fighting

B. Chest pain. high fever

C. Watching too much TV

D. Acting lonely

B. Chest pain. high fever

The part of the word that is added to the end of a root to form a new word is called a(n)

A. Root

B. Prefix

C. Suffix

D. Abbreviation

C. Suffix

When should documentation be recorded?

A. Immediately after care is given

B. At the end of the shift

C. Whenever there is time

D. Before the care is given

A. Immediately after care is given

Careful charting is important because

A. The NA does not want to get in trouble.

B. The resident must be able to read the chart.

C. The family will want to take the chart home regularly to study it.

D. It is the only way to guarantee clear and complete communication among the care team.

D. It is the only way to guarantee clear and complete communication among the care team.

Which of the following shows the correct conversion of 0530 to regular time?

A. 12:30 a.m.

B. 12:30 p.m.

C. 5:30 a.m.

D. 5:30 p.m.

C. 5:30 a.m.

Which of the following shows the correct conversion of 2:35 p.m. to military time?

A. 2435 hours

B. 1435 hours

C. 2235 hours

D. 1235 hours

B. 1435 hours

Which of the following occurrences is considered an incident and requires a report to be completed?

A. A resident uses the call light frequently.

B. A resident yells at a family member.

C. A resident accuses an NA of abusing her.

D. The NA arrives 10 minutes late to work.

C. A resident accuses an NA of abusing her.

Which of the following is an example of proper telephone communication at work?

A. "Good morning, Linda Manor Care Facility, Susan Jones speaking."

B. "We're all really busy right now. You'll have to call back later."

C. "Sandra is not working today. Her cell phone number is 555-1212."

D. "Jeanie no longer works here. She was fired two months ago."

A. "Good morning, Linda Manor Care Facility, Susan Jones speaking."

A nursing assistant may ignore a resident's call light when

A. The resident uses it too often for unimportant reasons

B. The nursing assistant has had conflict with the resident in the past

C. The nursing assistant just finished giving care to that resident

D. Never

D. Never

Why must an NA be concerned about privacy if documentation is done on a computer?

A. Because it is common for computer hackers to target long-term care facilities

B. Because the federal government is monitoring all computers in LTC facilities to ensure that HIPAA is followed

C. Because residents will probably try to sneak a look at other resident's information

D. Because the information is confidential and somebody who is not part of the care team see the screen

D. Because the information is confidential and somebody who is not part of the care team see the screen

If a resident has a hearing impairment, the NA should

A. Face away from the resident when speaking

B. Face the resident with the light on the NA's face

C. Shout so that the resident can hear the NA

D. Exaggerate the words so that the resident can read the NAs lips

B. Face the resident with the light on the NA's face

One way that an NA can help a resident who is visually impaired is to

A. Move the furniture to make it easier for the resident to get around

B. Keep the lights very low

C. Use the face of an imaginary clock to explain the position of objects

D. Walk behind the resident, lightly pushing the client forward

C. Use the face of an imaginary clock to explain the position of objects

What can a nursing assistant do to help with communication with a resident who has had a stroke?

A. The NA should ask questions that require longer answers to help keep the resident mentally active.

B. The NA should refuse to use pictures to communicate so that the resident will be motivated to speak more.

C. The NA should talk constantly so the resident wont feel uncomfortable If speaking is difficult for him.

D. The NA should use smiles or gestures to convey information.

D. The NA should use smiles or gestures to convey information.

What is the best way a nursing assistant can respond to a combative resident?

A. The NA should tell the resident that he will be discharged from the facility if he does not stop what he is doing.

B. The NA should let the resident know that other NAs will refuse to care for him if she continues the behavior.

C. The NA should remain calm and lower the tone of her voice.

D. The NA should stand as close as possible to the resident.

C. The NA should remain calm and lower the tone of her voice.

Why is it important for a nursing assistant not to overreact when a resident behaves inappropriately?

A. It may actually reinforce the behavior.

B. Other residents may then copy the behavior.

C. The NA's supervisor will be angry with him.

D. The NA might surprise the resident.

A. It may actually reinforce the behavior.

Infection prevention is

A. The way in which infections occur

B. An Infection that is prevented from traveling from one part of the body to another

C. A set of methods used to prevent the spread of disease

D. An object that has been prevented from being contaminated with pathogens

C. A set of methods used to prevent the spread of disease

The following are necessary links in the chain of infection. When an NA wears gloves, which link is broken, thus preventing the spread of disease?

A. Reservoir (place where the pathogen lives and grows)

B. Mode of transmission (a way for the disease to spread)

C. Susceptible host (person who is likely to get the disease)

D. Portal of entry (body opening that allows pathogens to enter

C. Susceptible host (person who is likely to get the disease)

The following are necessary links in the chain of infection. When an NA gets a vaccination shot for hepatitis B, which link will be affected and thus prevent hepatitis B infection?

A. Reservoir (Place where the pathogen lives and grows)

B. Mode of transmission (a way for the disease to spread)

C. Susceptible host (person who is likely to get the disease)

D. Portal of entry (body opening that allows pathogens to enter)

C. Susceptible host (person who is likely to get the disease)

A nursing assistant will come into contact with microorganisms

A. Only in high-traffic areas of the facility

B. Only during direct contact with the residents

C. Only during personal care procedures

D. Every time the NA touches something

D. Every time the NA touches something

The single most important thing the NA can do to prevent the spread of disease is to

A. Carry dirty linen close to her uniform so as not to spread contaminants

B. Wash and dry her disposable gloves before reusing them

C. Remove gloves before cleaning spills

D. Wash her hands

D. Wash her hands

The elderly are at a higher risk of infection because

A. They have strong immune systems

B. They are rarely hospitalized

C. They are always well-nourished

D. They may have limited mobility

D. They may have limited mobility

With whom should an NA use Standard Precautions?

A. With residents who have infectious diseases

B. With residents he suspects might have infectious diseases

C. With every resident in his care

D. With residents who request that they be used

C. With every resident in his care

Under Standard Precautions, the term bodily fluids includes

A. Sweat

B. Water

C. Juice

D. Urine

D. Urine

Hand hygiene is

A. Washing hands with either plain or antiseptic soap and water or using alcohol-based hand rubs only

B. Washing hands with soap and water only

C. Using alcohol-based hand rubs only

D. Wearing gloves when performing care procedures

A. Washing hands with either plain or antiseptic soap and water or using alcohol-based hand rubs only

When washing hands, an NA should use friction for

A. At least 25 seconds

B. At least 20 seconds

C. At least 15 seconds

D. At least 5 seconds

B. At least 20 seconds

Which of the following is true of wearing gloves?

A. Disposable gloved can be washed and reused.

B. Gloves should be changed before contact with mucous membranes

C. After giving care, gloves are not contaminated

D. Gloves can continue to be worn if they are torn as long as the hole is covered

B. Gloves should be changed before contact with mucous membranes

Which of the following is the proper order to don PPE?

A. Put on mask and goggles, gown, and gloves

B. Put on gloves, gown, and mask and goggles

C. Put on mask and goggles, gloves, and gown

D. Put on gown, mask and goggles, and gloves

D. Put on gown, mask and goggles, and gloves

Which of the following statements is true of disinfection?

A. Disinfecting an item means that all pathogens on the item are destroyed

B. Disinfection is carried out with an autoclave

C. Disinfection kills some pathogens but does not destroy all of them

D. Disinfection can be accomplished with regular soap and cold water

C. Disinfection kills some pathogens but does not destroy all of them

If an NA needs to clean up a spill, what is the first step that she should take?

A. Put the waste directly into the nearest trash can

B. Spray bleach solution on the spill

C. Put on gloves

D. Vacuum the spill

C. Put on gloves

Which of the following is true of Transmission-Based Precautions?

A. An NA does not need to practice Standard Based Precautions if he practices Transmission Based Precaution

B. They are exactly the same as Standard Precautions

C. They are practiced in addition to Standard Precautions

D. They will not be listed in the care plan so as not to alarm anyone

C. They are practiced in addition to Standard Precautions

What is one way that bloodborne pathogens can be transmitted?

A. By hugging an infected person

B. By infected blood entering the bloodstream

C. By standing too close to an infected person when he coughs

D. By touching something an infected person has touched

B. By infected blood entering the bloodstream

Which of the following is true of hepatitis B (HBV)?

A. HBV is a relatively minor disease and poses no real threat to healthcare workers

B. The vaccine for HBV helps prevent the disease

C. More people in the U.S. have HIV than HBV

D. HBV cause some unpleasant symptoms but cannot cause death

B. The vaccine for HBV helps prevent the disease

The Bloodborne Pathogens Standard requires that

A. Employers educate a select group of employees who will be in contact with residents with bloodborne disease

B. Employers provide hepatitis B vaccinations to employees at reduced cost

C. Employers keep one set of personal protective equipment on hand for visitors to use

D. Employers have an exposure control plan

D. Employers have an exposure control plan

Tuberculosis may be transmitted

A. Through a protective mask

B. By dancing

C. By wearing gloves

D. By coughing

D. By coughing

Tuberculosis is

A. A bloodborne disease

B. A sexually transmitted disease

C. An airborne disease

D. Completely eradicated (no longer exists)

C. An airborne disease

A person with TB disease

A. Can spread it to others

B. Does not show any symptoms

C. Cannot infect others

D. Has what is called latent TB

A. Can spread it to others

How is MRSA most often spread?

(A) By direct physical contact

(B) By indirect contact

(C) By being in enclosed spaces

(D) Through the air

(A) By direct physical contact