Arkansas Certified Nursing Assistant (CNA) Mock Skills Study Guide

General Preparation and Infection Control Procedures

Initial Hand Hygiene Protocol: * Apply hand sanitizer to cover all surfaces of the hands. * Rub hands together vigorously until they are completely dry.
Procedural Standards: * Always explain the procedure to the resident before beginning. * Provide for privacy by closing curtains or doors as required. * Maintain respectful and courteous interpersonal interactions at all times. * The resident must be left within reach of their call light or signaling device at the conclusion of every skill. * Perform a final hand hygiene sequence after completing the task.

Ambulation Procedures Using a Gait Belt

Ambulation from Bed to Wheelchair

Pre-Transfer Verbalization: The candidate must explicitly verbalize acknowledgment that this is a one-person transfer per the resident’s care plan. The RN Test Observer must reply "yes."
Safety Preparation: * Lock the bed brakes. * Adjust the bed height so the resident’s feet will be flat on the floor. * Bring the resident to a sitting position. * Assist the resident with putting on non-skid footwear PRIOR to standing.
Gait Belt Application: * Place the belt around the resident's waist to stabilize the trunk. * Tighten the belt and verify tightness by slipping fingers between the belt and the resident.
Ambulation Execution: * Grasp the gait belt and bring the resident to a standing position using proper body mechanics. * Stabilize the resident and ambulate them for at least $10\,steps$ to the wheelchair.
Wheelchair Placement: * Ensure wheelchair brakes are locked. * Assist the resident to pivot and sit in a controlled, safe manner. * Remove the gait belt upon completion.

Ambulation from Wheelchair to Bed

Setup: * Verify the one-person transfer acknowledgment with the RN Test Observer. * Lock both the bed brakes and the wheelchair brakes. * Adjust the bed height for flat foot placement on the floor.
Movement: * Apply the gait belt and check tightness (fingers between belt and resident). * Grasp the belt with both hands and stand the resident using proper body mechanics. * Ambulate at least $10\,steps$ to the bed.
Post-Ambulation: * Pivot and sit the resident on the bed safely. * Remove the gait belt and the non-skid footwear. * Assist the resident to lie down in the center of the bed with good body alignment. * Lower the bed to its lowest position.

Hygiene and Personal Care: Bed Bath and Perineal Care

Partial Bed Bath (Face, Arm, Hand, and Underarm)

Preparation: Provide privacy, fill a basin with warm water, and raise the bed height.
Coverage: Cover the resident with a bath blanket and fanfold linens down to the waist or move them to the opposite side.
Sequence of Washing: * Face: Wash WITHOUT soap. Pat dry. * Arm, Hand, and Underarm: Place a towel under the arm to protect the bed. Wash with soap, rinse, and pat dry for the arm, hand, and underarm (axilla).
Post-Bath Care: Assist the resident into a clean gown. Empty, rinse, and dry all equipment before returning it to storage. Dispose of soiled linen in the designated laundry hamper. Lower the bed.

Perineal Care for a Female (Mandatory First Task)

Safety and Privacy: Raise the bed height and provide privacy. Direct the RN Test Observer to stand on the opposite side of the bed or raise the opposite side rail for safety.
Preparation: Put on gloves. Turn the resident or raise hips to place a barrier (towel or waterproof pad) under the buttocks. Expose ONLY the perineum.
Cleaning Process (Frontal): * Candidate must verbalize the separation of the labia. * Clean one side of the labia from top to bottom (front to back). * Using a clean portion of the washcloth, clean the other side of the labia from top to bottom. * Using another clean portion, clean the vaginal area from top to bottom. * Rinse using the same sequence (side, side, center) with a clean cloth/portion. * Pat dry and cover the area with a bath blanket.
Cleaning Process (Rear): * Assist the resident to turn onto their side. (RN may help hold the manikin ONLY after the candidate has initiated the turn). * Clean from the vagina toward the rectal area using a clean soapy washcloth. * Rinse from the vagina to the rectal area. * Pat dry, remove the barrier, and return the resident to their back.
Conclusion: Dispose of linen, clean equipment, and remove gloves (inside out) before proceeding to the mandatory Hand Washing section.

Hand Washing Protocols (Mandatory Component)

Initiation: Begin by wetting hands and applying soap.
Friction and Duration: Rub hands together using friction for at least $20\,seconds$ with soap.
Coverage: Wash all surfaces of the hands, including the wrists and interlacing the fingers while pointing them downward.
Rinsing: Rinse thoroughly under running water with fingers pointed downward.
Drying and Faucet Control: * Dry hands with clean paper towels. * Turn off the faucet using a clean, dry paper towel (or knee/foot control/sensor). * Avoid re-contaminating hands by touching the sink or faucet at any point during or after the procedure.

Elimination and Output Measurement

Bedpan Usage and Output Measurement (Mandatory First Task)

Procedure: Put on gloves. Position the resident correctly (pan not upside down, centered) using proper body mechanics. Raise the head of the bed. Leave tissue and call light within reach. Step away from the resident.
Resident Hygiene: Provide or assist the resident with hand hygiene (using wipes, washcloth, or sanitizer). Ensure the resident’s hands are dry.
Measurement: * Remove the bedpan. Hold it while the RN pours an unknown quantity of liquid into it. * Place a graduate cylinder on a level, flat surface. * Read the output at eye level. * Tolerance: The candidate's recording must be within $25\,mls$ of the RN Test Observer’s reading.
Sanitization: Empty and rinse equipment into the toilet. Remove gloves and wash hands.

Urinary Drainage Bag and Isolation Gown (Mandatory First Task)

Donning Isolation Gown: Unfold the gown, place arms through sleeves, and secure the neck and waist. Back flaps must cover clothing completely. Put on gloves and ensure the glove cuff overlaps the gown sleeve at the wrist.
Emptying the Bag: * Place a barrier on the floor under the drainage bag and place the graduate on it. * Open the drain and allow urine to flow. Avoid touching the graduate with the tubing tip. * Wipe the drain with an alcohol wipe AFTER emptying. Close the drain.
Recording: Measure on a flat surface at eye level. Record output (within $25\,mls$ of the observer).
Doffing: * Remove gloves (inside out) BEFORE removing the gown. * Unfasten the gown at the neck and waist. Remove by folding soiled area to soiled area and dispose. * Proceed to the mandatory Hand Washing protocol.

Specialized Care Tasks

Catheter Care for a Female (Mandatory First Task)

Initial Check: Verbalize checking that urine flows unrestricted (checking for kinks in tubing).
Washing Strategy: Use soap and water. Hold the catheter where it exits the urethra with one hand. Clean $3-4\,inches$ down the tube moving ONLY away from the urethra.
Repetition: Use a clean portion of the washcloth for at least $2\,strokes$ . Rinse and pat dry using the same "away from urethra" motion.
Safety: Do not allow the tube to be pulled at any time. Replace gown and covers.

Denture Care

Setup: Line the sink with a protective lining (towel or paper towel) to prevent damage. Put on gloves.
Cleaning: Apply cleanser and brush all inner, outer, and chewing surfaces thoroughly. Rinse the denture and cup with cool, clean water.
Storage: Place the denture in the cup and add cool, clean water.

Foot Care (One Foot)

Soaking: Immerse one foot in warm water. Verbalize soaking for $5\,to\,20\,minutes$ .
Washing: Wash the entire foot and between the toes with soap. Rinse and dry thoroughly, including between the toes.
Moisturizing: Warm lotion between hands and massage over the foot. DO NOT get lotion between the toes. Wipe off any excess.

Nail Care (One Hand)

Soaking: Immerse nails in warm water. Verbalize soaking for at least $5\,minutes$ .
Cleaning: Dry the hand and between fingers. Use an orange stick to gently clean under the nails. Push back cuticles with a towel/washcloth and file each nail.

Resident Support: Feeding, Dressing, and Bed Making

Feeding a Dependent Resident

Verification: Ask the resident to state their name and verify it against the diet card.
Preparation: Protect clothing with a napkin/towel. Provide hand hygiene for the resident and ensure hands are dry before feeding.
Technique: Sit at eye level facing the resident. Describe the foods. Offer fluids frequently. Offer small amounts of food and allow time for chewing/swallowing. Wipe the resident’s face at least once.
Volume Tracking: * Solid Food: Record intake as a percentage. Tolerance: within $25\%$ of observer. * Fluids: Record total consumed fluid in mls. Tolerance: within $60\,mls$ of observer.

Dressing a Bedridden Resident

Gown Removal: Keep the resident covered. Remove the gown from the UNAFFECTED side first.
Applying Clothes: * Shirt: Always dress the AFFECTED (weak) side first. Insert your hand through the sleeve to grasp the resident's hand. * Pants: Dress the AFFECTED (weak) side leg first. Draw pants up to the waist. * Socks: Draw socks up until smooth.

Making an Occupied Bed

Guidelines: The resident must remain covered at all times. Do not shake linen and avoid touching linen to your uniform.
Process: Roll the resident to one side. Fanfold soiled linen toward the center. Place clean bottom linen and secure two fitted corners. Roll the resident over the linen bundle. Remove soiled linen to the hamper. Pull through clean linen and secure the remaining two corners.
Finishing: Place clean top linen and blanket/spread. Tuck at the foot while providing room for feet to move. Replace the pillowcase while gently lifting the resident's head.

Mobility and Mechanics

Pivot Transfers (Bed to Wheelchair / Wheelchair to Bed)

Acknowledgment: Verbalize the one-person transfer care plan status.
Device Placement: Position the wheelchair at the head or foot of the bed so the arm/wheel touches the bed side. Lock wheelchair brakes.
Sequence: Apply non-skid footwear. Ensure feet are flat on the floor before standing. Apply and check the gait belt. Use proper body mechanics to stand, pivot, and sit the resident.

Positioning Resident on Side

Safety: Move the resident in three segments (upper body, hips, then legs) toward yourself to create room for the turn. Direct the RN to stand on the opposite side or raise the side rail.
Support Devices: Place support devices under the head, under the upside arm, behind the back, and between the knees. Ensure the face is not obstructed and the resident is not lying on the downside arm.

Range of Motion (ROM)

General Rules: Position the resident supine (flat). Ask at least once if there is any discomfort/pain. Do not force joints beyond free movement. Complete each movement at least $3\,times$ .
Hip and Knee: * Abduction/Adduction: Move the entire leg away from and toward the body. * Flexion/Extension: Bend and straighten the knee and hip simultaneously while supporting the joints (hand under knee, hand under ankle).
Shoulder: * Flexion/Extension: Raise the arm up over the head and back to the side. * Abduction/Adduction: Move the entire arm away from and back to the side while supporting the elbow and wrist.

Vital Signs Monitoring

Radial Pulse and Respirations

Pulse: Locate at the thumb side of the wrist. Count for $60\,seconds$ or $30\,seconds \times 2$ . Explicitly tell the observer when you start and stop counting. Tolerance: within $4\,beats$ of the observer.
Respirations: Count for $60\,seconds$ or $30\,seconds \times 2$ . Tell the observer when you start and stop. Tolerance: within $2\,breaths$ of the observer.