CNA State Skill exam

Question 1

SKILL 1: HAND HYGIENE (HAND WASHING)

Answer 1

1. Address client by name and introduce self by name.
2. Turn on water at sink.
3. Wet hands and wrists thoroughly.
4. Apply soap to hands.
5. Lather all surfaces of wrists, hands, and fingers for at least 20 seconds. Keep hands lower than elbows and fingertips down.
6. Clean fingernails by rubbing fingertips against palms of the opposite hand.
7. Rinse all surfaces of wrists, hands, and fingers, keeping hands lower than elbows and fingertips down.
8. Use a clean, dry paper towel/towels to dry all surfaces of fingers, hands, and wrists starting at fingertips, then dispose of the paper towel/towels in a waste container.
9. Use a clean, dry paper towel/towels to turn off faucet, then dispose of the paper towel/towels in a waste container or use knee/foot control to turn off faucet.
10. Do not touch the inside of the sink at any time.

Question 2

SKILL 2 — APPLIES ONE KNEE-HIGH ELASTIC STOCKING

Answer 2

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Ensure the client is in a supine position (lying down in bed) while stocking is applied.
4. Turn the stocking inside-out, at least to the heel.
5. Place the foot of the stocking over the toes, foot, and heel.
6. Pull the top of the stocking over the foot, heel, and leg.
7. Move the foot and leg gently and naturally, avoiding force and over-extension of the limb and joints.
8. Finish the procedure with no twists or wrinkles, ensuring the heel of the stocking (if present) is over the heel and the opening in the toe area (if present) is either over or under the toe area. If using a mannequin, state that the stocking needs to be wrinkle-free.
9. Ensure the signaling device is within reach and the bed is in a low position.
10. After completing the skill, wash hands.

Question 3

SKILL 3 — ASSISTS TO AMBULATE USING TRANSFER
BELT

Answer 3

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Ensure the client is wearing non-skid shoes/footwear before assisting to stand.
4. Ensure the bed is at a safe level before assisting to stand.
5. Check and/or lock bed wheels before assisting to stand.
6. Assist the client to a sitting position with feet flat on the floor before assisting to stand.
7. Apply the transfer belt securely at the waist over clothing/gown before assisting to stand.
8. Provide instructions to enable the client to assist in standing, including a prearranged signal to begin standing.
9. Stand facing the client, positioning yourself to ensure the safety of both the candidate and the client during the transfer. Count to three (or use another prearranged signal) to alert the client to begin standing.
10. On the signal, gradually assist the client to stand by grasping the transfer belt on both sides with an upward grasp (your hands should be in an upward position), and maintain the stability of the client’s legs by standing knee to knee or toe to toe with the client.
11. Walk slightly behind and to one side of the client for a distance of ten (10) feet, while holding onto the belt.
12. Assist the client back to bed and remove the transfer belt.
13. Ensure the signaling device is within reach and the bed is in a low position.
14. After completing the skill, wash hands.

Question 4

SKILL 4 — ASSISTS WITH USE OF BEDPAN

Answer 4

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Lower the head of the bed before placing the bedpan.
4. Put on clean gloves before placing the bedpan under the client.
5. Place the bedpan correctly under the client’s buttocks.
6. Remove and dispose of gloves (without contaminating yourself) into a waste container and wash hands.
7. After positioning the client on the bedpan and removing gloves, raise the head of the bed.
8. Ensure toilet tissue is within reach.
9. Ensure a hand wipe is within reach and instruct the client to clean their hands with the hand wipe when finished.
10. Ensure the signaling device is within reach, and ask the client to signal when finished.
11. Put on clean gloves before removing the bedpan.
12. Lower the head of the bed before removing the bedpan.
13. Ensure the client is covered except when placing and removing the bedpan.
14. Empty and rinse the bedpan, pouring the rinse into the toilet.
15. Place the bedpan in the designated dirty supply area.
16. Remove and dispose of gloves (without contaminating yourself) into a waste container and wash hands.
17. Ensure the signaling device is within reach, and the bed is in a low position.

Question 5

SKILL 5 — CLEANS UPPER OR LOWER DENTURE

Answer 5

1. Put on clean gloves before handling the denture.
2. Line the bottom of the sink and/or partially fill the sink with water before holding the denture over the sink.
3. Rinse the denture under moderate temperature running water before brushing.
4. Apply denture toothpaste to the toothbrush.
5. Brush all surfaces of the denture.
6. Rinse all surfaces of the denture under moderate temperature running water.
7. Rinse the denture cup and lid.
8. Place the denture in the denture cup with moderate temperature water/solution and place the lid on the cup.
9. Rinse the toothbrush and place it in the designated toothbrush basin/container.
10. Maintain clean technique when placing the toothbrush and denture.
11. Remove and dispose of the sink liner appropriately and/or drain the sink.
12. Remove and dispose of gloves (without contaminating yourself) into a waste container and wash hands.

Question 6

SKILL 6 — COUNTS AND RECORDS RADIAL PULSE

Answer 6

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Place fingertips on the thumb side of the client’s wrist to locate the radial pulse.
3. Count the beats for one full minute.
4. Ensure the signaling device is within reach.
5. Wash hands before recording.
6. Record the pulse rate within plus or minus 4 beats of the evaluator’s reading.

Question 7

SKILL 7 — COUNTS AND RECORDS RESPIRATIONS

Answer 7

1. Explain the procedure (for testing purposes), speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Count respirations for one full minute.
3. Ensure the signaling device is within reach.
4. Wash hands before recording.
5. Record the respiration rate within plus or minus 2 breaths of the evaluator’s reading.

Question 8

SKILL 8 — DONNING AND REMOVING PPE (GOWN
AND GLOVES)

Answer 8

1. Pick up the gown and unfold it.
2. Facing the back opening of the gown, place arms through each sleeve.
3. Fasten the neck opening.
4. Secure the gown at the waist, making sure the back of the clothing is covered by the gown (as much as possible).
5. Put on gloves.
6. Ensure the cuffs of the gloves overlap the cuffs of the gown.
7. Before removing the gown, with one gloved hand, grasp the other glove at the palm and remove the glove.
8. Slip fingers from the ungloved hand underneath the cuff of the remaining glove at the wrist, and remove the glove, turning it inside out as it is removed.
9. Dispose of gloves into the designated waste container without contaminating yourself.
10. After removing gloves, unfasten the gown at the waist and neck.
11. After removing gloves, remove the gown without touching the outside of the gown.
12. While removing the gown, hold it away from your body without touching the floor, turn the gown inward, and keep it inside out.
13. Dispose of the gown in the designated container without contaminating yourself.
14. After completing the skill, wash hands.

Question 9

SKILL 9 — DRESSES CLIENT WITH AFFECTED (WEAK)
RIGHT ARM

Answer 9

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Ask the client which shirt they would like to wear and dress them in the shirt of their choice.
4. Avoid overexposure of the client by ensuring their chest is covered.
5. Remove the gown from the left (unaffected) side first, then remove the gown from the right (affected/weak) side.
6. Before dressing the client, dispose of the gown into the soiled linen container.
7. Assist the client in putting the right (affected/weak) arm through the right sleeve of the shirt before placing the garment on the left (unaffected) arm.
8. While putting on the shirt, move the body gently and naturally, avoiding force and overextension of limbs and joints.
9. Finish with clothing in place.
10. Ensure the signaling device is within reach, and the bed is in a low position.
11. After completing the skill, wash hands.

Question 10

SKILL 10 — FEEDS CLIENT WHO CANNOT FEED
SELF

Answer 10

1. Explain the procedure to the client, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Before feeding, look at the name card on the tray and ask the client to state their name.
3. Ensure the client is in an upright sitting position (75-90 degrees) before feeding.
4. Place the tray where the food can be easily seen by the client.
5. Clean the client’s hands before beginning feeding.
6. Sit in a chair facing the client during feeding.
7. Tell the client what foods and beverages are on the tray.
8. Ask the client what they would like to eat first.
9. Using a spoon, offer the client one bite of each type of food on the tray, telling the client the content of each spoonful.
10. Offer a beverage at least once during the meal.
11. Ask the client if they are ready for the next bite of food or sip of beverage.
12. At the end of the meal, clean the client’s mouth and hands.
13. Remove the food tray.
14. Leave the client in an upright sitting position (75-90 degrees) with the signaling device within reach.
15. After completing the skill, wash hands.

Question 11

SKILL 11 — GIVES MODIFIED BED BATH (FACE AND
ONE ARM, HAND AND UNDERARM)

Answer 11

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Remove the gown and place it directly in the soiled linen container while ensuring the client’s chest and lower body are covered.
4. Before washing, check the water temperature for safety and comfort, and ask the client to verify the comfort of the water.
5. Put on clean gloves before washing the client.
6. Begin with the eyes: wash eyes with a wet washcloth (no soap), using a different area of the washcloth for each stroke, washing from the inner aspect to the outer aspect, then proceed to wash the face.
7. Dry the face with a dry cloth towel/washcloth.
8. Expose one arm and place a cloth towel underneath the arm.
9. Apply soap to the wet washcloth.
10. Wash fingers (including fingernails), hand, arm, and underarm, keeping the rest of the body covered.
11. Rinse and dry fingers, hand, arm, and underarm.
12. Move the body gently and naturally, avoiding force and over-extension of limbs and joints.
13. Put a clean gown on the client.
14. Empty, rinse, and dry the basin.
15. Place the basin in the designated dirty supply area.
16. Dispose of linen in the soiled linen container.
17. Avoid contact between your clothing and used linens.
18. Remove and dispose of gloves (without contaminating yourself) into the waste container and wash hands.
19. Ensure the signaling device is within reach and the bed is in a low position.

Question 12

SKILL 13 — MEASURES AND RECORDS URINARY
OUTPUT

Answer 12

1. Put on clean gloves before handling the bedpan.
2. Pour the contents of the bedpan into the measuring container without spilling or splashing urine outside the container.
3. Rinse the bedpan and pour the rinse into the toilet.
4. Measure the amount of urine at eye level with the container on a flat surface (if between measurement lines, round up to the nearest 25 ml/cc).
5. After measuring the urine, empty the contents of the measuring container into the toilet.
6. Rinse the measuring container and pour the rinse into the toilet.
7. Before recording output, remove and dispose of gloves (without contaminating yourself) into the waste container and wash hands.
8. Record the contents of the container within plus or minus 25 ml/cc of the evaluator’s reading.
   !

Question 13

SKILL 14 — MEASURES AND RECORDS WEIGHT OF
AMBULATORY CLIENT

Answer 13

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Ensure the client has non-skid shoes/footwear on before walking to the scale.
3. Before the client steps on the scale, set the scale to zero.
4. Ask the client to step on the center of the scale and obtain their weight.
5. Ask the client to step off the scale.
6. Wash hands before recording.
7. Record the weight based on the indicator on the scale. Ensure the weight is within plus or minus 2 lbs of the evaluator’s reading (or within plus or minus 0.9 kg if recording in kg).

Question 14

SKILL 15 — PERFORMS MODIFIED PASSIVE RANGE OF
MOTION (PROM) FOR ONE KNEE AND ONE ANKLE

Answer 14

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Ensure the client is supine in bed and instruct the client to inform you if pain is experienced during the exercise.
4. While supporting the leg at the knee and ankle, bend the knee and then return the leg to the client’s normal position (flexion/extension). Repeat at least 3 times unless pain is verbalized. Move joints gently, slowly, and smoothly through the range of motion, discontinuing exercise if the client verbalizes pain.
5. While supporting the foot and ankle close to the bed, push/pull the foot toward the head (dorsiflexion), and push/pull the foot down, so the toes point down (plantar flexion). Repeat at least 3 times unless pain is verbalized. Move joints gently, slowly, and smoothly through the range of motion, discontinuing exercise if the client verbalizes pain.
6. Ensure the signaling device is within reach, and the bed is in a low position.
7. After completing the skill, wash hands.

Question 15

SKILL 16 — PERFORMS MODIFIED PASSIVE RANGE OF
MOTION (PROM) FOR ONE SHOULDER

Answer 15

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Instruct the client to inform you if pain is experienced during the exercise.
4. While supporting the arm at the elbow and wrist, raise the client’s straightened arm from the side position upward toward head to ear level and return the arm down to the side of the body (flexion/extension). Repeat at least 3 times unless pain is verbalized. Move the joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if the client verbalizes pain.
5. While supporting the arm at the elbow and wrist, move the client’s straightened arm away from the side of the body to shoulder level and return it to the side of the body (abduction/adduction). Repeat at least 3 times unless pain is verbalized. Move the joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if the client verbalizes pain.
6. Ensure the signaling device is within reach, and the bed is in a low position.
7. After completing the skill, wash hands.

Question 16

SKILL 17 — POSITIONS ON SIDE

Answer 16

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before turning, lower the head of the bed.
4. Raise the side rail on the side to which the body will be turned.
5. Assist the client to slowly roll onto their side toward the raised side rail.
6. Place or adjust the pillow under the head for support.
7. Reposition the arm and shoulder so that the client is not lying on the arm.
8. Support the top arm with a supportive device.
9. Place a supportive device behind the client’s back.
10. Place a supportive device between the legs with the top knee flexed, ensuring the knee and ankle are supported.
11. Ensure the signaling device is within reach, and the bed is in a low position.
12. After completing the skill, wash hands.

Question 17

SKILL 18 — PROVIDES CATHETER CARE FOR
FEMALE

Answer 17

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before washing, check the water temperature for safety and comfort, and ask the client to verify the comfort of the water.
4. Put on clean gloves before washing.
5. Place a linen protector under the perineal area, including the buttocks, before washing.
6. Expose the area surrounding the catheter (only expose the client between the hip and knee).
7. Apply soap to a wet washcloth.
8. While holding the catheter at the meatus without tugging, clean at least four inches of the catheter from the meatus, moving in only one direction, away from the meatus, using a clean area of the washcloth for each stroke.
9. While holding the catheter at the meatus without tugging, use a clean washcloth to rinse at least four inches of the catheter from the meatus, moving in only one direction, away from the meatus, using a clean area of the washcloth for each stroke.
10. While holding the catheter at the meatus without tugging, dry at least four inches of the catheter, moving away from the meatus, using a dry cloth towel/washcloth.
11. Empty, rinse, and dry the basin.
12. Place the basin in the designated dirty supply area.
13. Dispose of used linen into the soiled linen container and dispose of the linen protector appropriately.
14. Avoid contact between your clothing and used linen.
15. Remove and dispose of gloves (without contaminating yourself) into the waste container and wash hands.
16. Ensure the signaling device is within reach, and the bed is in a low position.

Question 18

SKILL 19 — PROVIDES FOOT CARE ON ONE FOOT

Answer 18

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before washing, check the water temperature for safety and comfort, and ask the client to verify the comfort of the water.
4. Ensure the basin is in a comfortable position for the client and placed on a protective barrier.
5. Put on clean gloves before washing the foot.
6. Place the client’s bare foot into the water.
7. Apply soap to a wet washcloth.
8. Lift the foot from the water and wash the foot (including between the toes).
9. Rinse the foot (including between the toes).
10. Dry the foot (including between the toes) with a dry cloth towel/washcloth.
11. Apply lotion to the top and bottom of the foot (excluding between the toes), removing excess with a towel/washcloth.
12. Support the foot and ankle during the procedure.
13. Empty, rinse, and dry the basin.
14. Place the basin in the designated dirty supply area.
15. Dispose of used linen into the soiled linen container.
16. Remove and dispose of gloves (without contaminating yourself) into the waste container and wash hands.
17. Ensure the signaling device is within reach.

Question 19

SKILL 20 — PROVIDES MOUTH CARE

Answer 19

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before providing mouth care, ensure the client is in an upright sitting position (75-90 degrees).
4. Put on clean gloves before cleaning the mouth.
5. Place a cloth towel across the client’s chest before providing mouth care.
6. Secure a cup of water and moisten the toothbrush.
7. Before cleaning the mouth, apply toothpaste to the moistened toothbrush.
8. Clean the mouth (including the tongue and all surfaces of the teeth), using gentle motions.
9. Maintain clean technique with the placement of the toothbrush.
10. Hold the emesis basin to the client’s chin while they rinse their mouth.
11. Wipe the client’s mouth and remove the clothing protector.
12. Dispose of used linen into the soiled linen container.
13. Rinse the toothbrush and empty, rinse, and dry the basin.
14. Remove and dispose of gloves (without contaminating yourself) into the waste container and wash hands.
15. Ensure the signaling device is within reach, and the bed is in a low position.

Question 20

SKILL 21 — PROVIDES PERINEAL CARE (Female)

Answer 20

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before washing, check the water temperature for safety and comfort, and ask the client to verify the comfort of the water.
4. Put on clean gloves before washing the perineal area.
5. Place a pad/linen protector under the perineal area, including the buttocks, before washing.
6. Expose the perineal area (only expose between hips and knees).
7. Apply soap to a wet washcloth.
8. Wash the genital area, moving from front to back, while using a clean area of the washcloth for each stroke.
9. Using a clean washcloth, rinse soap from the genital area, moving from front to back, while using a clean area of the washcloth for each stroke.
10. Dry the genital area, moving from front to back, with a dry cloth towel/washcloth.
11. After washing the genital area, turn the client to the side, then wash the rectal area, moving from front to back, using a clean area of the washcloth for each stroke.
12. Using a clean washcloth, rinse soap from the rectal area, moving from front to back, while using a clean area of the washcloth for each stroke.
13. Dry the rectal area, moving from front to back, with a dry cloth towel/washcloth.
14. Reposition the client.
15. Empty, rinse, and dry the basin.
16. Place the basin in the designated dirty supply area.
17. Dispose of used linen into the soiled linen container and dispose of the linen protector appropriately.
18. Avoid contact between your clothing and used linen.
19. Remove and dispose of gloves (without contaminating yourself) into the waste container and wash hands.
20. Ensure the signaling device is within reach, and the bed is in a low position.

Question 21

SKILL 22 — TRANSFERS FROM BED TO WHEELCHAIR
USING TRANSFER BELT

Answer 21

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before assisting to stand, position the wheelchair alongside the bed, either at the head of the bed facing the foot or at the foot of the bed facing the head.
4. Before assisting to stand, fold up or remove the footrests.
5. Before assisting to stand, lock the wheels on the wheelchair.
6. Ensure the bed is at a safe level before assisting to stand.
7. Check and/or lock the bed wheels before assisting to stand.
8. Assist the client to a sitting position with their feet flat on the floor before assisting to stand.
9. Ensure the client is wearing shoes before assisting to stand.
10. Apply the transfer belt securely at the waist over the clothing/gown before assisting to stand.
11. Provide instructions to enable the client to assist in the transfer, including a prearranged signal to alert when to begin standing.
12. Stand facing the client, positioning yourself to ensure safety during the transfer. Count to three (or use another prearranged signal) to alert the client to begin standing.
13. On the signal, gradually assist the client to stand by grasping the transfer belt on both sides with an upward grasp (your hands should be in an upward position) and maintaining the stability of the client’s legs by standing knee to knee or toe to toe with the client.
14. Assist the client to turn and stand in front of the wheelchair with the back of the client’s legs against the wheelchair.
15. Lower the client into the wheelchair.
16. Position the client with hips touching the back of the wheelchair and remove the transfer belt.
17. Position the feet on the footrests.
18. Ensure the signaling device is within reach.

Question 22

SKILL 23* — MEASURES AND RECORDS MANUAL
BLOOD PRESSURE

Answer 22

1. Explain the procedure, speaking clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
2. Before using the stethoscope, wipe the bell/diaphragm and earpieces with alcohol.
3. Position the client’s arm with the palm up and the upper arm exposed.
4. Feel for the brachial artery on the inner aspect of the arm, at the bend of the elbow.
5. Place the blood pressure cuff snugly on the client’s upper arm, with the sensor/arrow over the brachial artery site.
6. Place the earpieces of the stethoscope in your ears and the bell/diaphragm over the brachial artery site.
7. Inflate the cuff between 160 mm Hg to 180 mm Hg. If a beat is heard immediately upon cuff deflation, completely deflate the cuff and reinflate to no more than 200 mm Hg. Deflate the cuff slowly and note the first sound (systolic reading) and the last sound (diastolic reading). If rounding is needed, round UP to the nearest 2 mm of mercury.
8. Remove the cuff.
9. Ensure the signaling device is within reach.
10. Wash hands before recording.
11. After obtaining the reading using the BP cuff and stethoscope, record both systolic and diastolic pressures, ensuring they are within plus or minus 8 mm of the evaluator’s readings.