CNA SKILLS TEST WITH COMPLETE SOLUTIONS.

Beginning Procedure Actions 1.*Wash hands thoroughly prior to entering room or when in room 2. Assemble needed equipment 3.Go to resident's room, knock and pause before entering. 4. *Introduce self by name and title 5. *Identify the resident by facility policies and address them by name. 6. Ask visitors to leave the room and inform them where they may wait. 7.*Provide privacy throughout procedure; pull curtains, shut door, properly cover patient as needed. 8.*Explain procedure to resident; speak clearly, slowly and directly to resident, maintaining face to face contact whenever possible. 9. Answer resident's questions about the procedure. 10. Allow resident to assist as much as possible. 11. Raise the bed to a comfortable working height. Ending Procedure Actions 1.*Position resident comfortably. 2.*Return bed to lowest position. 3.*Leave signal cord, telephone and water within reach. 4.*Perform a general safety check. 5. Open curtain. 6. Care for equipment following policy. 7.*Wash hands. 8. Let visitors know they may return. 9.*Report completion of task and observation of any abnormalities and record actions and observations. Vital Signs: Blood Pressure 1.Clean ear pieces and diaphragm with antiseptic wipe. 2. Position residents arm resting on firm surface with palm up. 3.Wrap cuff around arm with bladder over artery 1" above antecubital space-cuff even and snug. 4. Place ear pieces in ears and place diaphragm over artery. 5. Inflate cuff to no more than 180mm/Hg or may use pulse obliteration method, candidate choice 6. Deflate cuff, note systolic reading, and note point of diastolic reading. 7. Accurate reading within 4mm/Hg window on both systolic and diastolic 8.*Accurately record blood pressure. Vital Signs: Temperature (Tympanic) 1. Place tympanic thermometer cover on. 2. Ask person to turn head so ear is in front of you, put new probe cover on. 3. Pull back on the ear (gentle, firm) to straighten the ear canal and insert probe gently into ear canal directed toward nose. 4. Start the thermometer. 5. Wait until you hear a beep or flashing light and remove. 6.*Read the temperature and record accurately. Vital Signs: Temperature (Oral/Axillary) 1. *Ask the person if they have eaten or consumed a beverage, cold or hot or smoked within the last 15 minutes. 2. Place a sheath on the probe. 3. Correct placement for obtaining oral reading or axillary reading. 4. If necessary, hold the probe in place for oral 5. Leave the probe in place until the instrument beeps. 6. Remove the probe sheath from the probe and dispose of properly. 7. Replace the probe. 8.*Red the temperature and record accurately. Vital Signs: Pulse (Radial/Apical) 1. Locate pulse at the correct site. 2. Count pulse for 30 seconds and double or count for 1 full minute. Accuracy within + or -4 beats per minute. 3.*Document Accurately Vital Signs: Respiratory Rate 1. Count respirations for 1 full minute. Accuracy within + or -2 breaths. 2.*Document Accurately Handwashing 1. Don't touch the sink with your uniform. 2. Turn water to warm 3. Wet and soap hands 4.*Wash hands with fingers down for 15-30 seconds, including wrist, nails and between fingers. 5. Rinse with fingertips down. 6. Use dry paper towel to dry hands. 7.*Use a paper towel to turn off faucets. 8.*Immediately discard paper towels in trash without touching to your other hand. Skill 1: Pressure Ulcer Prevention *Equipment: Pillows, Elbow/Heel Protectors 1.*Demonstrate 2 ways to prevent pressure ulcers: -Proper use of bed cradle -Elbow/heel protector* -Using pillows to reduce skin to skin contact* -Making sure sheets are wrinkle free 2.*Explain 2 other ways to prevent pressure ulcers: -Changing position frequently -Good nutrition and hydration -Provide good perineal care (keep resident clean and dry) -Be careful of the resident's skin (no shearing or friction) -Check resident's skin carefully-provide good skin care -Assist your resident to the bathroom frequently -Encourage mobility -Use pressure reducing devices Skill 2: Position Foley Catheter/Bag/Tubing *Equipment: Catheter Bag (Could already be on patient) 1.Secure tubing to resident's inner thigh or abdomen. 2.*Place tubing over leg 3. Position tubing to facilitate gravitational flow, no kinks. 4.*Attach to bed frame (not over or on side rail) always-below level of bladder. 5. Keep catheter bag from touching floor. Skill 3: Oxygen *Equipment: Nasal Cannula (Could already be on patient) 1.*Demonstrate correct placement of O2 nasal cannula (place prongs following the contour of the nasal passage, tubing around ears and under chin (not behind head)) 2.*When asked by nurse-demonstrate how to check the oxygen flow meter and verbalize actions needed if flow rate is not accurate. Do not adjust the flow of oxygen-if incorrect, alert the nurse immediately. 3.*Verbalize 3 oxygen use guidelines. -Avoid lighting matches or smoking around oxygen use -Ensure that all electrical equipment is in good repair -No kinks in the tubing -Make sure the device is placed correctly on the resident -Do not remove the mask or nasal cannula, unless you are specifically told to do so by a nurse. -Make sure the water level in the humidity bottle does not get too low -Provide oral care frequently -Watch for signs of skin irritation behind the person's ears, over their cheeks, or around their ears and nose -Check to make sure oxygen is flowing Skill 4: Occupied Draw Sheet Change *Equipment: Clean Draw Sheet 1. Place clean draw sheet on clean surface within reach (chair, over-the-bed table) 2. Provide privacy throughout procedure 3. Lower head of bed, placing resident in supine position 4.*After raising side rail, assist resident to turn onto side, moving toward raised side rail. 5. Loosen draw sheet, roll soiled draw sheet toward resident 6.*Place and tuck in clean draw sheet on working side (this must be done before turning resident) 7.*Raise side rail and assist resident to turn onto clean draw sheet 8.*Remove soiled linens/draw sheet, avoiding contact with clothes, and place in appropriate location within room-never on floor 9. Pull and tuck in clean draw sheet, finishing with sheet free of wrinkles Skill 5: Apply Cold Compress *Equipment: Ice pack, Towel 1.*Cover cold compress with towel or other protective cover (compress should not be placed on bare skin without covering) 2.*Properly place on correct site as directed by skill examiner 3.*When asked by examiner, verbalize frequency of checks and how long you would leave compress on resident (initially check after 5 minutes/do not leave on resident for more than 20 minutes) 4. Assess for redness, swelling, irritation and or pain if this occurs remove compress and report to nurse immediately Skill 6: Measure and Record Fluid Intake *Equipment: Graduate Container 1.*Calculate intake in mL 2.*Measure on a flat, level surface 3.*Record intake accurately within +/-25 mL's of nurses reading Skill 7: Converting Ounces To mL's-30 mL's=1 ounce 1.*Convert ounces to mL 2.*Record amount accurately within +/-25 mL's of nurses reading Skill 8: Measure/Record Urine Output *Equipment: Graduate Container 1.*Place container on flat surface, measure accurately in mL's 2. Dispose of properly into toilet 3. Rinse and dry container 4. Remove gloves, wash hands 5.*Record output accurately with +/-25 mL's or nurses reading Skill 9: Conscious Choking 1.*Candidate is able to identify symptoms of choking (grabbing throat), asks resident "Are you choking?" 2. Call for help 3. Stands behind resident and wraps arms around resident's waist 4. Places the thumb side of the fist against the resident's abdomen 5.*Positions fist slightly above naval 6. Grasp fist with other hand, press fist and hand into the resident's abdomen *with an inward, upward thrust 7. Candidate should indicate that they would repeat this procedure until it is successful or until the victim loses consciousness Skill 10: Obtain and Record Weight and Height *Equipment: Standing Scale Weight: (standing scale only) 1. Move weight to zero before assisting resident on to scale 2. Assist resident to stand on scale 3. Ensure resident is balanced and centered on the scale with arms at side 4.*Accurately record weight within +/-0.25 lbs. of nurse's measurement Height: (standing) 1. Assist resident to stand on scales 2. Resident is balanced and centered on the scale with arms at side 3. Raise folded measuring bar above resident's head, open and lower gently until bar rests on top of the head (not hair) 4.*Accurately record height within +/-0.5 inch of nurse's measurement Skill 11: Application of Anti-Embolism Stockings (TED Hose) *Equipment: TED Hose 1. Explain what position resident should be in when applying stockings-*apply while resident is in bed or with feet elevated 2. Hold foot and heel of stocking and gather up stocking-turning the stocking inside out down to the heel, aids in application 3.*Smooth up and over leg so hose is even, snug and not twisted or wrinkled 4.*Heel and toe in proper location 5. The toe hole may be on the top or bottom of the toes, depending on the manufactures design (usually hole on bottom, or may have heel patch) Skill 12: Passive Range of Motion 2 Joints-Examiner's Choice 1. Exercise passively 2 joints 2.When asked by examiner, explain or demonstrate that you understand to never exercise past the point of pain or resistance 3.*Provide support for joint 4. Avoid fast jerky movements; *demonstrate flexion, extension, adduction, abduction and rotation if applicable 5. Repeat exercise at least 3 times or as ordered Skill 13: Moving and Positioning Residents-Examiner's Choice *Equipment: Draw Sheet (only for draw sheet option), Pillows (used on Lateral and Sim's) -*Raise side rail while turning patient except on side you are working on -Demonstrate proper body mechanics -*Maintain residents proper alignment at all time, for all positions 1. Draw sheet: -Move using a draw sheet (2 persons): Provide support for resident's head. Grasp rolled draw sheet near resident's shoulder and hips 2. Fowlers: -Position in *Fowler's (high Fowler's is 60-90 degrees; semi-Fowler's is 30-45 degrees; knees may be elevated approximately 15 degrees) 3. Supine: - Position in *supine, in proper anatomical alignment 4. Chair/Wheelchair: -Position in chair of W/C: *Provide good alignment-upper body and head erect, back and buttocks against back of chair, feet flat on floor or on W/C footrests 5. Sims (Semi Prone): -Position in *Sims/Semi prone on the correct side as directed by examiner, *Left: Resident left side lying, right leg flexed, lower arm behind resident. *Right: Resident right side lying, left leg flexed, lower arm behind resident. -*Provide good alignment. Place a pillow under the head, upper arm and flexed leg 6. Lateral: (right or left) - Position *lateral/side-lying on the correct side as directed by examiner. Provide good alignment. Place a pillow between legs, behind back and under arm -Note: *For enema position place resident in left Sims or left lateral position.