CNA Skills

Question 1

Opening Procedure

Answer 1

1. Wash /Sanitize hands
2. Knock; pause for a response; enter the room
3. Greet the resident
4. Introduce yourself with name/title
5. Ask for permission to check the ID band
6. Respectfully greet the resident by name
7. Explain procedure and ask permission to perform skill
8. Gather supplies
9. Provide privacy

Question 2

Closing Procedure

Answer 2

1. Re-verify that your resident is positioned comfortably and is correctly aligned
2. Place resident’s bed in lowest position
3. Raise side rail or rails (if necessary
4. Place and secure the call light within reach of the resident’s hands
5. Place over-bed table within reach
6. Open privacy curtains
7. Wash / Sanitize hands
8. Say “goodbye” and Exit room
9. Report and record

Question 3

Gown and gloves

Answer 3

1. Wash hands
2. Choose appropriately sized gown and gloves
3. Examine gown and gloves for any damage
4. Put on the gown (with opening in the back).
5. Overlap gown to fully cover uniform in the back.
6. Tie gown (securely) at the neck then the waist
7. Put on gloves
8. Pull gloves up (over) the gown cuff. (OK to make thumb-hole in gown cuff)
9. Knock; enter, and proceed with “opening procedure”.
10. Perform some form of patient care
11. Perform “closing procedure”.
12. Remove PPE (at the appropriate time and place), without contaminating yourself.
13. Dispose of PPE properly (in the appropriate container and location).
14. Wash hands; exit room
15. Report and record.

Question 4

Position in fowler’s

Answer 4

1. Perform “opening procedure”
2. Verbally acknowledge resident’s complaint of “having difficulty breathing”.
3. Adjust HOB to appropriate level as quickly as possible.
4. Re-check patient’s breathing.
5. Perform comfort measures (pillows, raising FOB to prevent sliding, etc
6. Perform “closing procedure
7. Report and record (resident’s complaint, what you did to help, and the results of your actions).

Question 5

Position in side laying lateral position

Answer 5

1. Perform “opening procedure”
2. Use good body mechanics: raise level of bed, bend knees, spread feet apart
3. Safely move the supine resident to the side (edge) of bed in 3-segments
4. Cross resident’s arms over chest or prepare correct arm in “stop-sign” position
5. Cross ankles or bend the knee of the upper (top) leg.
6. Be sure side rail is up on the side resident is turned toward
7. Place one hand on shoulder, the other on hip, and “log-roll” the resident.
8. Support resident’s back by tucking a pillow, folded lengthwise, behind back.
9. Support resident’s top arm with a pillow in front of chest; use hand roll if needed.
10. Place resident’s top leg slightly forward, with knee bent; support top leg with a pillow.
11. Be sure that the top leg/foot does not rest on (or rub) the lower leg/foot.
12. Stand at FOB to see if resident’s body is properly aligned.
13. Resident should not be lying on his/her arm or shoulder.
14. Adjust pillow to cradle/support resident’s head/face comfortably
15. Perform “closing procedure”.

Question 6

Transfer from bed to chair

Answer 6

1. Perform “opening procedure”
2. Place chair or wheelchair near the bed.
3. Remove/fold back wheelchair footrest and lock bed/wheelchair brakes (if used).
4. Raise HOB fully to assist resident to a sitting position.
5. Lower side rail nearest to chair.
6. To Dangle: place one arm behind resident’s back and the other arm under the thighs.
7. Encourage resident to assist in turning to a sitting position, placing feet flat on the floor.
8. Assist resident with robe and non-skid shoes (may do prior to dangle).
9. Stand in front of resident to apply gait belt snugly around resident’s waist, with room between resident’s body and belt to grasp belt (with two hands) at each side of waist.
10. Place your knee, (furthest from wheelchair), between resident’s knees.
11. Use a secure, underhand (palms-up) grasp to hold belt at each side of resident’s waist.
12. May instruct resident to assist (to stand) by having resident pressing hands on mattress
13. On the count of “three”, assist resident to stand up, maintaining palms-up grasp on belt.
14. If belt loosens upon standing, assist resident to sit on the bed for all belt adjustments.
15. Turn, taking steps along with the resident, until resident is right in front of chair.
16. Lower resident into chair, then release your 2-handed grasp and remove gait belt. Remove belt carefully, lifting it away from resident’s body (to avoid injury from friction).
17. Position wheelchair footrest and provide a lap blanket.
18. Perform “closing procedure”

Question 7

Denture care

Answer 7

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Take dirty dentures (already in denture cup) and supplies to sink area.
4. Line bottom of sink with a washcloth or small towel. Turn on water without splash.
5. Place dirty dentures in emesis basin. Clean denture cup and fill will cool water.
6. Apply toothpaste (or denture cleanser) to toothbrush (or denture brush).
7. Brush all areas of dentures (on both sides of each plate) within sink area.
8. Handle dentures carefully by holding/brushing one plate at a time.
9. Rinse dentures under cool, running water.
10. Place dentures back in denture cup that is (filled with clean, cool water.)
11. Offer mouthwash solution/sponge-tipped swabs, emesis basin for oral hygiene.
12. Clean and store equipment. Dispose of linens and trash appropriately.
13. Remove gloves and wash hands.
14. Perform “closing procedure”.

Question 8

Occupied bed

Answer 8

1. Perform “opening procedure”
2. Remove and fold any reusable linen (blanket/spread) and place over a clean chair.
3. Raise side rail, roll resident away from you, towards opposite side.
4. Only rail down is on the side where you’ll be working.
5. For resident’s comfort, leave pillow under head and top sheet in place.
6. Wear gloves while handling soiled linens, then discard gloves and wash hands.
7. Loosen and roll all dirty bottom linens toward resident and tuck against back.
8. Secure ½ of clean (fitted) bottom sheet on the bare mattress, with minimal wrinkles.
9. Roll other ½ of clean (fitted) bottom sheet towards resident, tucking it under old sheets.
10. Flatten the rolled sheets and help the resident roll over the linen, towards you.
11. Raise the side rail; go to the opposite side; lower the side rail.
12. Remove dirty linens; place in linen bag (on FOB or on chair with barrier).
13. Pull clean bottom linens towards you and secure onto mattress with minimal wrinkles.
14. Center resident on back and comfortably aligned; raise both side rails.
15. Cover resident with clean top sheet. Resident can hold it as you remove the old one.
16. Place blanket/spread over top sheet and miter together at FOB; make a toe pleat.
17. Neatly fold hem of top sheet down over the blanket/spread.
18. Wear gloves (as necessary) to dispose of linens. Remove gloves and wash hands.
19. Perform “closing procedure”.

Question 9

Mouth care for unconscious

Answer 9

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Gently position resident’s head towards you. (Entire body may be turned to side)
4. Place a towel or waterproof barrier under head and over chest.
5. Place emesis basin under the chin, at side of resident’s face, if resident is fully lateral.
6. Open packages of sponge-tipped swabs and/or lemon glycerin swabs.
7. Prepare a small cup of mouthwash/water solution to dip sponge-tipped swabs.
8. Gently open mouth and separate teeth with a padded tongue blade.
9. Clean entire mouth (roof, tongue, cheeks, teeth, gums, lips) –use sponge-tipped swabs for
   cleaning and glycerin swabs for stimulating moisture and refreshing.
10. Place used swabs directly into trash bag.
11. Dry resident’s face. Remove basin, towels, and waterproof barriers.
12. Apply lip lubricant.
13. Clean and store equipment. Dispose of linens and trash appropriately.
14. Remove gloves and wash hands.
15. Perform “closing procedure”.

Question 10

Bed bath: upper body

Answer 10

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Drape resident for warmth and privacy with a bath blanket.
4. Keep linens dry by placing a towel/waterproof barrier under limbs while washing.
5. Gently wash (with soap), rinse and pat-dry entire upper body, starting with face*.
6. Only uncover one area at a time to ensure warmth, dignity, and privacy.
7. Leave resident draped and comfortable when bath is completed.
8. Clean and store equipment. Dispose of linens and trash appropriately.
9. Remove gloves and wash hands.
10. Perform “closing procedure”.

Question 11

Bed bath: lower body

Answer 11

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Drape resident for warmth and privacy with a bath blanket.
4. Keep linens dry by placing a towel/waterproof barrier under limbs while washing.
5. Gently wash (with soap), rinse and pat-dry entire lower body, starting with hips.
6. Only uncover one area at a time to ensure warmth, dignity, and privacy.
7. Leave resident draped and comfortable when bath is completed.
8. Clean and store equipment. Dispose of linens and trash appropriately.
9. Remove gloves and wash hands.
10. Perform “closing procedure”.

Question 12

Back rub

Answer 12

1. Perform “opening procedure”
2. Apply gloves (if necessary).
3. Place resident in a comfortable side-lying position with side rail up.
4. Keep resident draped for warmth and privacy with a bath blanket.
5. Place towel on bed (behind back) to protect linens.
6. Only uncover back/partial buttocks area to ensure warmth, dignity, and privacy.
7. Squeeze lotion into palms and rub hands together to “warm” lotion.
8. Starting at the coccyx, gently rub resident’s back in large, long, circular motions.
9. Work your way up to the shoulders, massage them and continue back down to coccyx.
10. Continue back rub using circular and/or long strokes for 3-5 minutes.
11. Assist resident into position of choice.
12. Cover resident with sheet (bed linens) and remove bath blanket.
13. Clean and store equipment. Dispose of linens and trash appropriately.
14. Remove gloves (if worn) and wash hands.
15. Perform “closing procedure”.

Question 13

Peri care

Answer 13

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Gently assist resident into a supine position with knees bent and legs apart.
4. Place a linen protector under resident’s buttocks.
5. Keep resident warm and completely draped with a bath blanket.
6. Only uncover perineal area/buttocks area to ensure warmth, dignity, and privacy.
7. Wash (using soap/peri-wash), rinse, and pat dry genital area from front to back (while resident is in supine position).
8. Wash (using soap/peri-wash), rinse, and pat dry rectal area from front to back (resident is in a side-lying position with side-rail up).
9. Use a different part of the washcloth/mitt for each wipe/stroke.
10. Remove gloves, wash, re-glove to assist resident into position of choice.
11. Cover resident with sheet (bed linens) and remove bath blanket.
12. Wear gloves to clean and store equipment. Dispose of linens and trash appropriately.
13. Remove gloves and wash hands.
14. Perform “closing procedure”.

Question 14

Shaving

Answer 14

1. Perform “opening procedure”
2. Place barrier for supplies to maintain clean set-up.
3. Place clothing protector to resident’s chest area prior to shave.
4. Assess skin for abrasions, moles, and/or direction of hair growth.
5. Check razor for rust, chips, or breaks.
6. Soften beard with warm, moist cloth before applying shaving cream.
7. Apply shaving cream to resident’s face.
8. Apply gloves before shaving. (Remove gloves, sanitize hands, and re-glove as needed)
9. Hold skin taut to prevent nicks.
10. Shave face using downward strokes, in direction of hair growth.
11. Rinse razor often during procedure to remove hair/excess shaving cream.
12. Wipe/rinse resident’s face of remaining lather after the shave.
13. Dry resident’s face.
14. Offer resident a mirror.
15. Offer resident choice of aftershave or shaving lotion.
16. Remove towel from resident, clean equipment and return to proper area.
17. Dispose of razor in sharps container.
18. Dispose of linens and trash appropriately.
19. Remove gloves and wash hands.
20. Perform “closing procedure”.

Question 15

Clean finger nails

Answer 15

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Soak resident’s hands/fingernails in a basin of warm water. Use soap to clean them.
4. Place towel under resident’s hands for comfort and hygiene.
5. Push back cuticles gently with a washcloth and/or orange stick padded with cotton.
6. Use orange stick to clean under dirty fingernails.
7. Change water and rinse resident’s hands.
8. Dry resident’s hands thoroughly.
9. Use clippers to trim fingernails straight across.
10. Use nail file/emery board to smooth rough and sharp edges.
11. Offer lotion and gently massage resident’s hands.
12. Dispose of linens and trash appropriately.
13. Return clippers to facility designated dirty area (or to resident’s personal grooming kit).
14. Remove gloves and wash hands.
15. Perform “closing procedure”.

Question 16

Dressing with affected arm

Answer 16

1. Perform “opening procedure”
2. Allow resident choice of clothing/gown.
3. Pull the curtain and/or shut the door to maintain resident’s privacy.
4. Keep resident covered with a bath blanket until fully dressed.
5. Dress the resident’s paralyzed (weak) arm first, with the entire arm completely through the
   sleeve before dressing the other arm.
6. Move resident’s arms gently and naturally without force.
7. Encourage resident to assist with non-paralyzed arm as able.
8. Dispose of linens and trash appropriately.
9. Perform “closing procedure”.

Question 17

Serving and feeding paralyzed resident

Answer 17

1. Perform “opening procedure”
2. Validate/check for the correct resident by reading name printed on ID band.
3. Offer resident a washcloth for hands before meal.
4. Clean over bed table before serving the meal.
5. Select correct meal tray from meal cart by checking the diet card located on tray.
6. Compare dietary card with resident’s name; check for correct diet; be alert for allergies.
7. Verify that the food items on tray match diet (lift the plate cover “lid” to see the food).
8. Drape resident with a towel/clothing protector prior to feeding.
9. Open containers, cut meat, offer condiments, remove items NOT allowed, etc.
10. Check temperature of hot liquids/food items.
11. Allow the resident time to chew food; feed resident slowly, without rushing.
12. Offer liquids between swallows as needed.
13. Offer the resident choices during meal; encourage use of unaffected hand.
14. Offer the resident a washcloth for hands after meal.
15. Clean over-bed table after meal.
16. Dispose of linens and trash appropriately.
17. Remove tray and note % of meal eaten and cc’s or ml’s of fluids taken.
18. Perform “closing procedure”.

Question 18

Record height on upright scale

Answer 18

1. Perform “opening procedure”
2. Place chair at side of scale.
3. Gather paper towel (to place on scale platform).
4. Assist resident to put on non-skid shoes.
5. Drape resident with a robe.
6. Keep one hand behind/near resident while walking to the scale.
7. Place paper towel on scale platform.
8. Assist the resident to sit in the chair to remove shoes.
9. Assist the resident to step on the scale from the side, facing away from scale.
10. Raise height bar safely.
11. Lower height bar until it touches top of resident’s head and is level with resident’s head.
12. Read resident’s height at correct location.
13. Record resident’s height, using words, abbreviations, or symbols: FEET (feet, ft, or ‘) INCHES (inches, in, or “) CENTIMETERS (centimeters or cm)
14. Assist resident to step safely off of the scale.
15. Assist resident to sit in the chair and to put non-skid shoes back on.
16. Remove paper towel from scale platform and discard (gloves may be worn).
17. Assist resident back to room, keeping one hand behind/near resident while walking.
18. Perform “closing procedure”.

Question 19

Measure and record weight

Answer 19

1. Perform “opening procedure”
2. Place chair at the side of the scale.
3. Gather paper towel (to place on scale platform).
4. Assist resident to put on non-skid shoes.
5. Drape resident with a robe.
6. Keep one hand behind/near resident while walking to the scale.
7. Place paper towel on the scale platform.
8. Assist the resident to sit in the chair to remove shoes/robe.
9. “Zero” (balance) scale prior to the resident standing on the scale platform.
10. Assist the resident to stand on the scale platform.
11. Measure the resident’s weight correctly by sliding weights to appropriate areas until scale

indicator balances. (Begin with “large weight” clicked in place)

12. Adjust smaller weight indicator to balance.
13. Read scale and record the resident’s weight in pounds (lb.) or kilograms (kg).
14. Assist the resident to step safely off the scale.
15. Assist resident to sit in the chair and to put non-skid shoes/robe back on.
16. Remove paper towel from scale platform and discard (gloves may be worn).
17. Assist resident back to room, keeping one hand behind/near resident while walking.
18. Perform “closing procedure”.

Question 20

Bedpan

Answer 20

1. Perform “opening procedure”
2. Apply gloves. (Remove gloves, sanitize hands, and re-glove as needed)
3. Assist resident to lift hips, slide linen protector and bedpan under buttocks.
4. Place the resident on the bedpan correctly with resident’s buttocks well-centered over the
   opening of the bedpan. (Note the direction of the bedpan)
5. Drape the resident with a bath blanket/sheet while on the bedpan.
6. Remove gloves and sanitize hands.
7. Raise HOB for resident’s comfort during bowel movement.
8. Leave call light within resident’s reach, before leaving room–to allow privacy.
9. Return to room when resident signals or after no more than 5 minutes.
10. Lower HOB for resident’s comfort during bedpan removal.
11. Wash hands and reapply gloves.
12. Turn resident to the side and remove the bedpan. Cover it and properly place it out of the way (on FOB or on chair with barrier).
13. While resident is on the side, wipe the resident from front to back.
14. Place soiled toilet paper into a prepared (cuffed) plastic trash bag.
15. Assist resident to lift hips; remove linen protector and discard it in the trash bag.
16. Discard gloves, sanitize hands, then raise side rail.
17. Reapply gloves – take bedpan to the bathroom.
18. Observe any abnormalities in bowel movement (for reporting and recording).
19. Empty bedpan into toilet.
20. Clean and rinse bedpan and store in proper area.
21. Dispose of linens and trash appropriately.
22. Remove gloves and wash hands.
23. Perform “closing procedure”.

Question 21

Radial pulse

Answer 21

1. Perform “opening procedure”
2. Place resident’s hand in comfortable resting position prior to counting pulse.
3. Place your fingertips correctly on the radial artery (thumb side of wrist).
4. Count the resident’s radial pulse using a second-hand watch for one (1) minute.
5. Record the resident’s radial pulse within (plus or minus) 5 beats of Evaluator’s result.
6. Perform “closing procedure”.

Question 22

Respirations

Answer 22

1. Perform “opening procedure”
2. Avoid telling resident that respirations are being counted; you can say you are “taking vital signs” while pretending to take resident’s pulse).
3. Count resident’s respirations using a second-hand watch for one (1) minute.
4. Record resident’s respirations within (plus or minus) 2 breaths of the Evaluator’s recording.
5. Perform “closing procedure”.

Question 23

BP

Answer 23

1. Perform “opening procedure”
2. Place resident’s arm, with the palm up, in a comfortable resting position.
3. Clean the stethoscope’s diaphragm/bell and earpieces with alcohol before use.
4. Feel for the resident’s brachial artery on the inner aspect of the resident’s arm.
5. Wrap the blood pressure cuff snugly around the resident’s arm, approximately 1-2 inches
   above the antecubital area.
6. Correctly place the stethoscope earpieces in your ears.
7. Safely and correctly place the diaphragm of the stethoscope over the brachial artery.
8. Inflate the cuff.
9. Let the air out smoothly, at a safe rate (2-4 mm Hg per second), and listen for the first sound (the systolic reading).
10. Continue steady deflation as you listen for the last sound– becomes quiet/almost silent (the diastolic reading).
11. Remember the readings to be able to record them.
12. Quickly let all air out of the cuff (completely deflate).
13. Record the blood pressure reading correctly within (plus or minus) 8mm Hg of the Evaluator’s recording (systolic and/or diastolic).
14. Remove the blood pressure cuff from resident’s arm.
15. Perform “closing procedure”

Question 24

ROM: upper body

Answer 24

1. Perform “opening procedure”
2. Adjust bed to a safe and comfortable working height.
3. Lower side rail on the side you will be working on.
4. Ask resident to inform you if any pain or discomfort is experienced during the exercises.
5. Safely and gently exercise the resident’s shoulder, elbow, wrist, and fingers, supporting and
   moving each joint gently and naturally (without force to limbs or joints).
6. Exercise each joint in as many patterns as are appropriate and safe for the joint. Examples of Patterns: Flexion, Extension, Abduction, Adduction, and Rotation
7. Each pattern must be demonstrated at least 3 times for each joint.
8. Ask frequently during the exercises if the resident is having any pain.
9. Repeat exercises on the other arm.
10. Perform “closing procedure”

Question 25

ROM: lower body

Answer 25

1. Perform “opening procedure”
2. Adjust bed to a safe and comfortable working height.
3. Lower side rail on the side you will be working on.
4. Ask resident to inform you if any pain or discomfort is experienced during the exercises.
5. Safely and gently exercise the resident’s hip, knee, ankle, and toes, supporting and moving
   each joint gently and naturally (without force to limbs or joints).
6. Exercise each joint in as many patterns as are appropriate and safe for the joint. Examples of Patterns: Flexion, Extension, Abduction, Adduction, and Rotation
7. Each pattern must be demonstrated at least 3 times for each joint.
8. Ask frequently during the exercises if the resident is having any pain.
9. Repeat exercises on the other leg.
10. Perform “closing procedure”

Question 26

Assist with ambulation

Answer 26

1. Perform “opening procedure”
2. Apply resident’s non-skid shoes and robe.
3. Stand in front of resident to apply gait belt snugly around resident’s waist, with room between
   resident’s body and belt to grasp belt, with hands at each side of waist.
4. Ask resident if he/she is dizzy before assisting resident to stand.
5. Use a secure, underhand (palms-upward) grasp to hold belt at each side of resident’s waist.
6. May instruct resident to assist (to stand) by pressing hands on mattress.
7. On the count of “three”, assist resident to a standing position, maintaining palms-up grasp on each side of belt.
8. If belt loosens upon standing, assist resident to sit on the bed for all belt adjustments.
9. Maintain an upward grasp (one hand grasping belt is OK) while walking the resident.
10. Remain slightly behind and to the side of the resident while walking.
11. Ask resident if he/she is dizzy, tired, in pain, or short of breath while walking.
12. Return resident back to the room.
13. Hold belt (with two hands) at each side of the resident’s waist, with an upward grasp, when seating the resident on the bed.
14. Remove belt carefully, lifting it away from resident’s body (to avoid injury from friction).
15. Perform “closing procedure”