CNA Skills Exam Practice

Opening

1. Identify patient

2. Introduce self

3. Explain procedure

4. Close privacy curtain

5. Wash hands

6. Gather supplies/Set on barrier

Closing

1. Open privacy curtain

2. Place call light in reach

3. Ask patient if they need anything and are comfortable

4. Make sure work area is neat

5.Wash hands

6. Make any necessary corrections (tell evaluator you are making them)

7. Tell evaluator "My skill is done."

Wash Hands

Supplies: Soap and Water, Paper Towels

1. Wet hands, apply soap, lather for 20 seconds over all surfaces (including wrists)

2. Clean nails by rubbing them into palm of other hand.

3. Rinse off all surfaces

4. Dry with paper towels, being sure not to touch clean hands on other surfaces.

5. Use clean paper towel to shut off water.

Measure and Record Pulse

Supplies: Watch/Clock with second hand, pen, documentation sheet

1. Opening

2. Locate pulse on thumb side of patient's wrist. Support forearm while elbow is on the bed.

3. Count beats for one FULL MINUTE. Say start and stop to indicate what you are doing.

4. Closing

5. Document (Ex: 72/minute)

Measure and Record Respiration

Supplies: Watch/Clock with second hand, pen, documentation sheet.

1. Opening

2. Holding wrist so they do not know you are counting respirations, say start and count respirations for one FULL MINUTE. Say stop.

3. Closing.

4. Document (Ex: 16/minute)

Ambulate Resident Using a Gait Belt

Supplies: Non-skid footwear, gait belt.

1. Opening and assure nonskid footwear is on.

2. Place gait belt around patient's waist.

3. Ensure a 4 finger space between patient and belt.

4. Have patient place hands on your shoulders while gripping the gait belt with both arms around patient.

5. Assist patient with standing by counting to three. Let them stand still for a few seconds and ask if they are dizzy.

6. Walk 10 steps and then 10 back while holding the gait belt with one hand on farthest side.

7. Frequently ask about comfort, dizziness, or weakness

8. In same position as helping stand, lower patient into chair on count of three.

9. Remove gait belt.

10. Closing

Dress Resident Who Has a Weak Arm

Supplies: Barrier for table, Clean clothes of resident's choice, bath blanket.

1. Opening + Place bath blanket over patient.

2. Give options of clothing and gather garments required.

3. Place socks and pants on resident.

4. Undress STRONG arm first ("USA" FIRST)

5. Remove shirt from weak arm.

6. Maintain privacy and support weak arm.

7. Dress WEAK arm first, then strong arm.

8. Ensure clothing is appropriately fastened and neat.

9. Dispose of soiled linens.

10. Closing

Provide Mouth Care: With Teeth

Supplies: Barrier for table, towel, toothbrush, toothpaste, emesis basin, cup of water, gloves.

1. Opening

2. Put the head of the bed ALL THE WAY UP (90 degrees) to prevent aspiration. Adjust pillow for comfort.

3. Place towel on patient's chest.

4. Wet toothbrush and put small amount of toothpaste on it. Place in emesis basin.

5. Apply gloves.

6. Brush all surfaces of teeth and gums gently and thoroughly. (Up/down and side to side motions) Brush tip of tongue.

7. Offer water to rinse and spit into emesis basin more than once, drying mouth with towel each time.

8. Throw away toothbrush, place linen inappropriate place, empty, rinse, and disinfect emesis basin.

9. Use clean paper towel to pick up all supplies and to open drawer to store them.

10. Remove gloves.

11. Closing

Provide Mouth Care: With Dentures

Supplies: Barrier for table, toothpaste, thoothette, denture brush, towel, emesis basin, cup of water, washcloth, 2 pairs of gloves

1. Opening

2. Put the head of the bed ALL THE WAY UP (90 degrees) to prevent aspiration. Adjust pillow for comfort.

3. Prepare denture brush like a toothbrush. Place in emesis basin.

4. Take emesis basin with brush, denture cup, washcloth, and one set of gloves to sink.

5. Place washcloth in sink. Turn cool water on with paper towel.

6. Apply gloves.

7. Rinse dentures in cool water and brush all surfaces. Rinse denture cup and fill with cool water. Place clean dentures in cup and close cup.

8. Rinse denture brush and place in basin. Place denture brush and basin on barrier. Place wet washcloth in soiled linens

9. Use paper towel to carry denture cup back to beside table.

10. Remove gloves.

11. Perform mouth care with toothette instead of toothbrush.

12. Clean up supplies and remove gloves.

13. Closing

Provide Foot Care to Resident

Supplies: Barrier, FOOT basin, gloves, 2 washcloths, soap, towel, lotion, socks and shoes.

1. Opening + Barrier on floor

2. Fill basin with warm water and allow patient to test water. Place basin on barrier.

3. Apply gloves and place one foot in basin to soak.

4. Soak foot for 5-10 minutes (ON TEST JUST SAY THIS, DO NOT WAIT THIS LONG)

5. Remove foot. Wash by placing soap on one wet washcloth.

6. Place in basin to rinse with other washcloth.

7. Dry entire foot with towel, including between toes.

(In real world: Repeat above for other foot)

8. Observe skin surfaces (Verbalize you are doing so)

9. With small amount of lotion, warm in hands and apply to entire foot, excluding between toes.

10. Remove excess lotion with towel put socks and shoes on.

11. Dispose of soiled linens. Empty, rinse, and disinfect basin. Use paper towel to collect supplies and store them.

12. Remove gloves.

13. Closing

Provide Hand Care to Resident

Supplies: Barrier, basin, towel, 2 washcloths, soap, gloves, orangewood stick, emery board, lotion

1. Opening

2. Fill basin with warm water, let patient check water.

3. Place basin at comfortable level for patient and soak one hand for 2-4 minutes.

4. Apply gloves.

5. Apply soak to washcloth, wash hand.

6. Place hand back in basin and use other washcloth to rinse hand.

(In real life-do other hand as well)

7. Pat hand dry, including between fingers.

8. Remove dirt with slanted end of orange stick, wiping it off between each nail.

9. Use emery board to file nails toward center making them smooth, rounded, an free of rough edges.

10. Warm and apply lotion from wrist to fingertips, removing excess with towel.

11. Dispose of soiled linens. Empty, rinse, and disinfect basin. Use paper towel to collect supplies and store them.

12. Remove gloves

13. Closing

Feed Resident Who is in a Chair

Supplies: Meal tray, towelette, clothing protector/towel

1. Opening

2. Ask resident if they would like a clothing protector and apply it.

3. Assist with washing resident's hands with towelette. Throw it away with a paper towel.

4. Sit facing resident and offer a drink before the meal. Offer a drink every 3-4 bites.

5. Feed slowly, filling the spoons no more than half way. Talk to resident during meal. If they stop or refuse, make two attempts to get them to eat more before stopping.

6. Wipe face off with towel after meal and place it in soiled linens. Throw away disposable food items.

7. Closing

8. Document (Check appropriate boxes on document)

Making an Occupied Bed

Supplies: Barrier, bath blanket, fitted bottom sheet, flat sheet, pillow case

1. Opening + flatten and raise bed for working

2. Cover resident with bath blanket, pulling down covers underneath.

3. Have patient move toward you and roll away toward center. Be sure they stay covered in bath blanket.

4. Roll dirty bottom sheet towards patient and tuck it under them.

5. Place clean sheet on mattress, roll towards you and tuck it tightly under dirty sheet. (NOT ON TEST: If draw sheet/chucks are needed, they would be placed and treated like the top sheet in terms of pulling to other side)

6. Have patient move to other side of the bed, on the clean side. Be sure they stayed covered in bath blanket.

7. Pull dirty sheet roll from under patient, roll it into a ball and remove it from the bed. Place it in dirty linen.

8. Pull clean sheet from under patient, securing it tightly and smoothly on other side.

9. Cover patient with top sheet, removing bath blanket from underneath.

10. Secure bottom of top sheet with mitered/hospital corners. (Tuck under, pull hanging side up, tuck excess under, let side fall.) Loosen foot area for comfort.

11. Replace pillow case with open part facing away from door.

12. Closing

Change Position to Supported Side Lying

Supplies: Barrier, 3 additional pillows (if desired: bath blanket)

1. Opening + Raise bed

2. Move patient to side closest to you, opposite side they will be turned onto. (Ex: If turning on left side, move to right of bed.)

3. Move farthest are up and closest arm across chest.

4. Bend closest knee so foot is flat on mattress.

5. Roll patient onto side away from you.

6. Place one long side of pillow under patient, tuck other long side under them to create a roll.

7. Place pillow between knee and ankles.

8. Place pillow under top arm, being sure not to block face.

9. Adjust pillow under head and ask about comfort.

10. Make sure patient is not lying on arm and shoulders are not on head pillow.

11. Closing + Lower bed

Assist Resident with Bedpan

Supplies: Bath blanket, chucks, bedpan, toilet paper, 2 pairs of gloves, towelette

1. Opening

2. Cover patient with bath blanket and apply gloves.

3. Place clean chucks under patient

4. Place bedpan under patient, either by them raising hips with knees or be rolling them away and back. Wider end should be toward the back.

5. Remove gloves, raise head of bed, give call light and toilet paper.

6. Wait outside for patient to finish.

7. Lower head of bed and apply gloves.

8. Apply gloves and remove bedpan and chucks.

9. Empty bedpan into toilet. Rinse and pour rinse water in there. Note any inconsistencies.

10. Clean and return to storage.

11. Give towelette to patient to wash hands. Remove bath blanket.

12. Dispose of gloves.

13. Closing

Provide Partial Bed Bath

Supplies: Barrier, bath blanket, bath basin, 4 washcloths, soap, 2 towels, lotion, gloves, clean gown

1. Opening + Raise bed

2. Fill bath basin with warm water and allow patient to check temperature. Place washcloths in basin.

3. Place bath blanket over patient. Keep towel under areas you wash.

4. Apply gloves

5. Remove gown from side nearest you, rolling it to the other side.

6. Use washcloth #1 to wash face from middle out with no soap and place washcloth #1 on barrier.

7. Apply soap to washcloth #2 and wash neck, ears, and front of torso, lifting breast with back of hand. Wash arm and underarm nearest you. Rinse and dry above areas.

8. Dress clean arm in clean gown. Dress other arm in gown.

(In real life: Wash other arm before dressing)

9. Roll patient onto side. Using #3 and #4 washcloths wash and rinse back. Then dry back.

10. Warm lotion and give backrub. (Up middle of back, circles down, three times) Remove excess lotion. Fasten back of gown.

11. Lower bed using paper towel barrier

12. Clean basin and store all supplies appropriately using a paper towel as a barrier.

13. Remove gloves.

14. Replace top sheets and remove bath blanket.

15. Closing

Provide Perineal Care (Female)

Supplies: Barrier, bath blanket, bath basin, gloves, soap, 2 protective pads, 4 washcloth, towel, paper towel

1. Opening + Raise bed

2. Fill basin and allow patient to check water temperature

3. Place bath blanket over patient

4. Apply gloves

5. Replace soiled chucks with clean ones. (Roll over, tuck chucks, etc)

6. Expose perineum, place towel over legs.

7. Wash, rinse, and dry perineum using five strokes (middle, side and side, skin folds) Wipe front to back. Place both washcloths on barrier (wash and rinse ones)

8. Have patient roll over and wash anal area front to back.

9. Replace chucks under patient and remove bath blanket.

10. Lower bed with paper towel barrier.

11. Rinse, clean, disinfect and store basin and other supplies

12. Closing

Provide Catheter Care (Female)

Supplies: Bath blanket, protective pad (chucks), bath basin, gloves, soap, 4 washcloths, towel, barrier, paper towel

1. Opening

2. Fill basin and allow patient to check water temperature.

3. Apply gloves and place chucks under patient (roll to side, push under, etc) Place bath blanket like in peri-care.

4. Place towel under catheter tubing.

5. Wash, rinse, and dry catheter tubing by holding it near the meatus and cleaning four inches away four times.

6. Perform peri-care.

7. Make sure patient is not laying on tubing and bag is not touching floor.

8. Remove chucks and dispose of linens.

9. Use paper towel to lower bed.

10. Empty, rinse, disinfect and store basin and other supplies.

11. Replace sheet and remove bath blanket.

12. Closing

Measure and Record Contents of Urinary Drainage Bag

Supplies: Barrier, gloves, alcohol wipes, graduate container

1. Opening

2. Place barrier on floor and open alcohol pad.

3. Apply gloves

4. Empty urine into graduate carefully.

5. Close clamp and clean tube opening with alcohol pad.

6. Place graduate on flat surface on the barrier and measure contents at eye level.

7. Empty contents into toilet, fill with water, empty that into toilet. Disinfect and store graduate.

8. Remove gloves

9. Make sure bag is not touching the floor and tubing is not kinked.

10. Closing

11. Document (Time, type, amount (cc's) and initials)

Transfer Resident from Bed to Wheelchair

Supplies: Wheelchair, gait belt, non-skid footwear

1. Opening

2. Assist resident to sitting at side of bed in sitting position (Hand under shoulders and under legs)

3. Hold position for 5-10 seconds asking about dizzy, lightheaded, and weakness.

4. Place footwear on patient and have feet flat on floor.

5. Place gait belt on patient, assuring four finger space.

6. Place wheelchair close to bed on patient's strong side with arm of wheelchair almost touching bed footrests should be out.

7. LOCK wheelchair wheels.

8. Place one foot in front of patients and the other parallel to their feet

9. Grasp gait belt with their hands on your shoulders and on the count of three, assist with smooth controlled stand. Pivot patient to wheelchair and place them as far back in it as possible in smooth motion. There should be no stops in this.

10. Reposition patient in chair for comfort. Ask about dizziness, lightheadedness, and weakness.

11. Remove gait belt and swing footrests back. Place patient's feet on them.

12. LOCK Wheelchair

13. Closing

Perform Passive ROM to Shoulder

Supplies: N/A

1. Opening

2. Position patient flat on back and check side of body you will be working on.

3. Repeat exercises 3 times, asking about comfort. Support extremity.

4. Remember: USA (Up/Down, Side/Side, Around)

5. Flexion/Extension (Up/Down) "Asking a question"

6. Add/Abd-duction (Side/Side) "Snow Angel"

7. Rotation (Around) "Rolling cookie dough" (Roll the arm itself)

8. Closing

Perform Passive ROM to Elbow and Wrist

Supplies: N/A

1. Opening

2. Position patient flat on back and check side of body you will be working on.

3. Repeat exercises 3 times, asking about comfort. Support extremity.

4. Remember: USA (Up/Down, Side/Side, Around) for wrist

5. Flexion/Extension (Up/Down) of Elbow "Make a muscle"

6. Flexion/Extension (Up/Down) of Wrist "Rev a motorcycle"

7. Add/Abd-duction (Side/Side) of Wrist "Beauty Pageant Wave"

8. Rotation (Around) of Wrist "Wave a Magic Wand"

9. Closing

Perform Passive ROM to Hip, Knee, and Ankle

Supplies: N/A

1. Opening

2. Position patient flat on back and check side of body you will be working on. Support extremity.

3. Repeat exercises 3 times, asking about comfort.

4. Remember: USA (Up/Down, Side/Side, Around)

5. Flexion/Extension (Up/Down) of Hip "Climbing stairs"

6. Add/Abd-duction (Side/Side) of Hip "Snow Angel"

7. Rotation (Around) of Hip "Rolling cookie dough" (roll leg itself)

8. Flexion/Extension (Up/Down) of Ankle "Pressing gas"

9. Add/Abd-duction (Side/Side) of Ankle "Beauty Pageant Wave"

10. Rotation (Around) of Ankle "Circles"

11. Closing