skills for CNA state exam

Washes Hands

1. address client by name and introduces self to client by name

2. turns on water at sink

3. Wet hands and wrists thoroughly

4. Applies soap to hands

5. LATHER ALL SURFACES OF WRISTS, HANDS, AND FINGERS, PRODUCING FRICTION FOR AT LEAST 15 SECONDS

6. Cleans fingernails by rubbing fingertips against palms of the opposite hand

7. After lathering for about 15 seconds, rinses all surfaces, keeping hands lowed than the elbows and the fingertips down

8. Uses clean, dry paper towel to dry off and then dispose paper towel into waste container

9. Uses new paper towel to turn off faucet then dispose of

10. does not touch inside of sink at any time

Cleans Upper or Lower Denture

1. puts on clean gloves before handling dentures

2. put water basin in the sink and fill with water

3. Rinses denture in tepid/moderate temperature running water before brushing them

4. Applies toothpaste to both sides of denture brush. (cup denture in hand)

5. Brushes surfaces of denture

6. Rinses surface of denture under tepid/moderate temperature running water

7. Before placing denture into cup, rinses denture cup and lid.

8.Places denture in denture cup with tepid/moderate temperature water and places lid on cup

9. Rinses toothbrush and places in designated toothbrush basin/container

10. Maintains clean technique with placement of toothbrush and denture. (put toothbrush on paper towel)

11. Sink basin is removed and disposed of appropriately and sink is drained

12. After rinsing and drying equipment, dispose of gloves into waste container and washes hands

Counts and Records Radial Pulse

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. Place finger tips on thumb side of client's wrist to locate radial pulse

3. Count beats for one full minute. (say "start" and "stop")

4. put call light within reach, lower bed

5. Washes hands

6. AFTER OBTAINING PULSE BY PALPATING THE RADIAL ARTERY POSITION, RECORDS PULSE RATE WITHIN PLUS OR MINUS 4 BEATS OF THE EVALUATOR'S READING... (LAST)

Counts and Records Respirations

1. explains procedure (for testing purpose), speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. Count respirations for one full minute (say "start" and "stop")

3. call light is within reach and bed is lowered

4. washes hands

5. RECORDS RESPIRATION RATE WITHIN PLUS OR MINUS 2 BREATHS OF EVALUATOR'S READING

Donning and Removing PPE (Gown and Gloves)

1. picks up gown and unfolds

2. facing the back opening of the gown places arms through each sleeve

3. fastens the neck opening

4. secures gown at waist making sure that back of clothing is covered by gown

5. puts on gloves

6. cuffs of gloves overlaps cuffs of gown

7.8.9. remove and dispose of gloves properly and wash hands

10. unfasten gown at neck and then the waist

11. remove gown without touching the outside of gown

12. while removing gown, holds gown away from body, turns gown inward and keeps it inside out as rolling it up

13. dispose of gown in designated container without contaminating self

14. washes hands!

Dresses Client With Affected Weak Right Arm

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. asks which top the client would like to wear

4. while avoiding overexposure of client, removes gown from the unaffected (left) side first, then removes gown from the affected (right) side

5.ASSISTS TO PUT THE RIGHT (AFFECTED/WEAK) ARM THROUGH THE RIGHT SLEEVE OF THE TOP BEFORE PLACING GARMENT ON LEFT (UNAFFECTED) ARM

6. while putting on items, moves body gently and naturally, avoiding force and over-extension of limbs and joints

7. finishes with clothing in place

8. dispose of gown into dirty linen container

9. call light is in reach and bed is in low position

10. washes hands

Gives Modified Bed Bath (Face, and one Arm, Hand, and Underarm)

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Remove gown while keeping client covered (with a bath blanket or sheet)

4. Before washing, check water temperature for safety and comfort and asks client to verify comfort of water

5. puts on clean gloves before washing client

6. Beginning with the eyes, washes eyes with wet washcloth (no soap), using a different area of the wash cloth for each eye, washing inner to outer, then proceed to wash the whole face

7. blot dry face with towel

8. exposes one arm and then places towel underneath arm

9. applies soap to wet washcloth

10. washes arm, hand, and underarm, keeping rest of body covered

11. rinses and blot dries arm, hand, and underarm

12. moves body gently and naturally, avoiding force and over-extension of limbs and joints

13. puts clean gown on client

14. empties, rinses, and dries basin

15. after dying basin, place in designated dirty area

16. disposes of used gown and linen into soiled linen container

17. avoids contact between candidate clothing and used linen

18. remove and dispose of gloves and washes hands

19. call light is in reach and bed is in low position

Makes and Occupied Bed (Client does not need assistance to turn)

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. lowers head of bed before moving client

4. client is covered while linens are changed, with bath blanket

5. loosens top linen from end of bed

6. raises side rails on side to which client will move and client moves towards raised side rail

7. loosens bottom used linen on working side and moves bottom used linen toward center of bed

8. places and tucks in clean bottom linen/fitted bottom sheet on working side and tucks under client (half bed dirty, half bed clean)

9. Before going to other side, client moves back onto clean bottom linen

10. Raises side rail then goes to other side of bed

11. removes used bottom linen

12. pulls and tucks in clean bottom linen, finishing with bottom sheet free of wrinkles

13. Client is covered with clean top sheet and bath blanket/used top sheet has been removed

14. changes pillowcase

15. linen is centered and tucked at foot of bed and miter corners!

16. avoid contact between candidates clothing and used linen

17. disposes of used linen into soiled linen container and avoids putting linen on floor

18. call light is within reach, bed is in low position, take down privacy

19. washes hands

Measures and Recored Weight of Ambulatory (walking) Client

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. candidate ensures client has shoes on before walking to the scale

3. sets scale to zero, before weighing the client (could do this first)

4. While client steps onto scale, candidate stands next to scale and assists client, if needed, onto center of scale, then determines client's weight (say "here, let me assist you")

5. While client steps off scale, candidate stands next to scale and assists client, if needed, off scale before recording weight. (WALK CLIENT TO BED, GIVE CALL LIGHT, COME BACK)

6. RECORDS WEIGHT BASED ON INDICATOR OF SCALE. WEIGHT IS WITHIN PLUS OR MINUS 2 LBS. OF EVALUATOR'S READING) ((.25 OR .5 OR .75))

7. washes hands

Provides Finger Care on One Hand

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible (get resident ready before you get the water)

2. Check water temperature for safety and comfort and asks client to verify comfort of water

3. basin is in a comfortable position for the client

4. put on gloves before cleaning finger nails

5. fingernails are immersed in basin of water (leave for a while) ((take out and place hand on towel))

6. Cleans under each fingernail with orangewood stick

7. wipes orangewood stick on towel after each nail

8. blot dries fingernail area

9. candidate feels each nail and files as needed

10. disposed of orangewood stick and emery board into waste container

11. empties, rinses, and dries basin

12. place basin into designated dirty area

13. disposes of used linen into soiled linen container - with gloves on still

14. remove and dispose of gloves and washes hands

15. call light is within reach and bed is in low position

Provides Foot Care on One Foot

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door (get person ready before you go get the water)

3. Before washing, check water temperature for safety and comfort and asks client to verify comfort of water

4. basin is in a comfortable position for the client and on protective barrier (plastic bag)

5. put on gloves before washing foot

6. clients barefoot is placed into the water

7. apply soap to wet washcloth (wet, ring, soap, ready)

8. lifts foot from water and washes foot, including between the toes (sit soapy rag on towel outside of basin)

9. foot is rinsed, including between the toes

10. dries foot, including between the toes

11. applies lotion to bottom and top of foot. NOT between the toes. remove excess with towel if necessary

12. supports foot and ankle during procedure (under foot/heel)

13. empties, rinses and dries basin

14. place basin in designated dirty area

15. dispose of used linen into soiled linen container with gloves on still

16. remove and dispose of gloves and wash hands

17. call light is within reach, take down privacy, lower bed

Provides Mouth Care

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Before providing mouth care, client is upright sitting position (45-90 degrees) - ((all the way up))

4. puts on gloves

5. places clothing protector (Towel) across chest before providing mouthcare

6. moistens toothbrush

7. applies toothpaste to toothbrush

8. CLEANS MOUTH (INCLUDING TONGUE AND SURFACES OF TEETH) USING GENTLY MOTIONS

9. maintains clean technique with placement of toothbrush (put on paper towel on the table)

10. holds emesin basin to chin while client rinses mouth

11. wipes mouth and removes clothing protector

12. empties, rinses, and dries basin

13. place used toothbrush in basin

14. place basin/toothbrush together in designated dirty area

15. disposes of clothing protector appropriately

16. removes and disposes gloves and washes hands

17. call light is within reach, lower bed, and take down privacy

Applies One Knee-High Elastic Stocking

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Client is supine position (lying down in bed) while stocking is applied

4. Turns stocking inside out

5. Places foot of stocking over toes, foot, and heel

6. Pulls top of stocking over foot, heel and leg

7. Moves foot and leg gently and naturally, avoiding force and over-extension of limbs and joints

8. FINISHES PROCEDURE WITH NO TWISTS OR WRINKLES AND HEEL OF STOCKING (IF PRESENT) IS OVER HEEL AND OPENING IN TOE AREA (IF PRESENT) IS EITHER OVER OR UNDER TOE AREA.

9. call light is within reach, bed in low position, privacy down

10. washes hands

Assists to Ambulate Using Transfer Belt

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. BEFORE ASSISTING TO STAND, CANDIDATE ENSURES CLIENT IS WEARING SHOES

3. before assisting to stand, bed is at a safe level

4. before assisting to stand, checks and/or locks bed wheels

5. before assisting to stand, client is assisted to sitting position (put head of bed up) with feet flat on the floor

6. before assisting to stand, applies transfer belt securely over clothing/gown

7. before assisting to stand, provides instructions to enable client to assist in standing including prearranged signal to alert client to begin standing. (say "on the count of 3, were going to stand")

8. stands facing client positioning self to ensure safety of candidate and client during transfer (put your leg between theirs). Counts to 3 to alert client to begin standing

9. On, signal, gradually assists client to stand by grasping transfer belt on both sides with an upward grasp ( keep thumbs out), and maintaining stability of clients legs

10. Walks slightly behind and to one side of client for a distance of 10 feet, while holding onto the belt

11. After ambulation, assists client to bed (put client on bed side before you get to the bed) and removes transfer belt

12. Call light is within reach, bed is in low position

13. Washes hands

Performs Passive Range of Motion (PROM) For One Knee and One Ankle

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Instructs client to inform nurse aide if pain is experienced during exercise. (say " If this hurts, please tell me")

4. Supports leg at knee and ankle while performing range of motion for knee

5. Bends the knee and then returns leg to clients normal position (extension/flexion) (AT LEAST 3 TIMES) unless they tell you of pain

6. Supports foot and ankle close to the bed while performing range of motion for ankle (grab middle of foot)

7. Pushes/pulls foot toward head (dorsiflexion/back) and pushes/pulls foot down, toes point down (plantar flexion) AT LEAST 3 TIMES unless pain is verbalized

8. WHILE SUPPORTING THE LIMB, MOVES JOINTS GENTLY, SLOWLY, AND SMOOTHLY THROUGH THE RANGE OF MOTION, DISCONTINUING EXERCISE IF CLIENT VERBALIZES PAIN.

9. call light is within reach, privacy down, bed down

10. washes hands

Performs Passive Range of Motion (PROM) for One Shoulder

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Instructs client to inform nurse aide if pain is experienced during exercise. (say " If this hurts, please tell me")

4. supports client's arm at elbow and wrist while performing range of motion for shoulder

5. raises client's straightened arm from side position upward toward head to ear level and returns arm down to side of body (extension.flexion) AT LEASAT 3 TIMES unless pain is verbalized

6. move's client straightened arm away from the side of the body to should level and returns to side of body (abduction/adduction) AT LEAST 3 TIMES unless pain is verbalized

7.WHILE SUPPORTING THE LIMB, MOVES JOINTS GENTLY, SLOWLY, AND SMOOTHLY THROUGH THE RANGE OF MOTION, DISCONTINUING EXERCISE IF CLIENT VERBALIZES PAIN.

8. call light is within reach, privacy down, bed is low position

9. washes hands

Assists with use of Bedpan

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Before placing bedpan, lowers head of bed

4. Puts on gloves before handling bedpan

5. PLACES BEDPAN CORRECTLY UNDER CLIENT'S BUTTOCKS

6. removes and disposes gloves and washes hands

7. After positioning client on bedpan and removing gloves, raise head of bed

8. Toilet tissue is within reach

9. Hand wipes are within reach and client is instructed to clean hands with wipes when finished. (say "please wipe your hands when you are done")

10. Give call light and say "call me when you're done"

11. Puts on clean gloves before removing bedpan

12. Head of bed is flat before removing bedpan

13. avoid overexposure of client

14. Removes, empties, and rinses bedpan and pour into toilet

15. after rinsing bedpan, place in designated dirty area

16. removes and disposes gloves and wash hands

17. call light is within reach, bed in low and take down privacy

Feeds Client Who Cannot Feed Self

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. Before feeding, candidate picks up names card from tray and ask client to state name. (say " can you tell me your name?")

3. BEFORE FEEDING CLIENT, CLIENT IS IN AN UPRIGHT SITTING POSITION (ALL THE WAY UP)

4. places tray where it can be easily seen by client

5. Clients hands are cleaned with hand wipe before feeding

6. Candidate sits facing client during feeding. (say " may i sit on your bed?")

7. Tells client what foods are on tray and asks what client would like to eat first. (say " today we have...., what would you like to start with?"

8. Using spoon offers client one bite of each type of food on tray, telling the client the content of each spoonful. (say " here is a bite of......")

9. Offers beverage at least once during meal

10. Makes sure client's mouth is empty before offering next bite of food or sip of beverage

11. At end of meal, client's mouth is wiped (with napkin) and hands are cleaned (with hand wipes)

12. Removes food tray and places tray in designated dirty area

13. call light is within reach and bed is in low

14. washes hands

Measures and Records Urinary Output

1. Puts on clean gloves before handling bedpan

2. Pours the contents of the bedpan into measuring container without spilling or splashing urine outside of container (put toilet seat in boy position - all the way out)

3. Measures the amount of urine at eye level with container on flat surface (on top of a paper towel)

4. After measuring urine, empties contents into toilet

5. Rinses measuring container and pour into toilet

6. Rinses bedpan and pour into toilet

7. after rinsing equipment and before recording output, remove and dispose gloves and wash hands

8. RECORDS CONTENTS OF CONTAINER WITHIN PLUS OR MINUS 25 CC OF EVALUATOR'S READING

Positions on Side

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. before turing, lowers head of bed - flat (move client to one side, ask "can you move to one side")

4. Raises side rail on side to which body will be turned

5. slowly rolls onto side as one unit toward raised side rail

6. Places or adjusts pillow under head for support

7. client is positioned so that client is not lying on arm, (pull out shoulder)

8. supports top arm with pillow

9. places pillow behind client's back

10. places pillow between legs with top knee flexed; knee and ankle supported

11. call light is within reach, rail is down, bed is in low, privacy down

12. wash hands

Provides Perineal Care (Peri-Care) For Female

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. before washing checks water temperature for safety and comfort and asks client to verify comfort of water

4. puts on clean gloves before washing perineal area

5. Places pad/linen protector under perineal area before washing

6. Exposes perineal area while avoiding overexposure of client

7. Applies soap to wet washcloth

8. WASHES GENITAL AREA, MOVING FROM FRONT TO BACK, WHILE USING CLEAN AREA OF THE WASHCLOTH FOR EACH STROKE

9. USING CLEAN WASHCLOTH, RINSES SOAP FROM GENITAL AREA, MOVING FROM FRONT TO BACK, WHILE USING A CLEAN AREA OF THE WASHCLOTH FOR EACH STROKE.

10. pat dries genital area moving from front to back with towel

11. After washing genital area, turns to side, then washes and rinses rectal area moving from front to back using a clean area of washcloth for each stroke. Dries with towel

12. Repositions client

13. Empties, Rinses, and Dries basin

14. After rinsing basin, place basin in designated dirty area

15. Disposes of used linen into soiled linen container and disposes of linen protector appropriately

16. Avoids contact between candidate clothing and used linen

17. After disposing of used linen, and placing used equipment in designated dirty area, removes and disposes gloves and washes hands

18. Call light is within reach, bed is in low, privacy removed.

Transfers From Bed to Wheelchair Using Transfer Belt

1. explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2. privacy is provided with a curtain, screen, or door

3. Before assisting to stand, wheelchair is positioned along side of bed, at head of bed, and facing the foot of the bed.

4. Before assisting to stand, footrests are folded up or removed - (place on bed)

5. Before assisting to stand, bed is at a safe level (low position)

6. BEFORE ASSISTING TO STAND, LOCKS WHEELS ON WHEELCHAIR

7. Before assisting to stand, checks and/or locks bed wheels

8. Before assisting to stand, client is assisted to a sitting position with feet flat on the floor

9. Before assisting to stand, candidate ensures client is wearing shoes.

10. Before assisting to stand, applies transfer belt securely over clothing/gown

11. Before assisting to stand, provides instructions to enable client to assist in transfer including prearranged signal to alert when to begin standing (say "on the count of 3 we're going to stand")

12. Stands facing clients positioning self to ensure safety of candidate and client during transfer. Counts to 3 to alert client to begin standing

13. On signal, gradually assists client to stand by grasping transfer belt on both sides with an upward grasp (keep thumbs out) and maintaining stability of client's legs (with your leg between theirs)

14. Assists client to turn to stand in front of wheelchair with back of client's legs against wheelchair

15. Lowers client into wheelchair (with you being in front of them)

16. Positions client with hips touching back of wheelchair and transfer belt is removed - (say " can you scoot back?")

17. positions feet on footrest

18. call light is within reach, privacy down

19. washes hands