Utah Nursing Assistant State Certification Exam Guide, Study notes of Nursing

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Utah Nursing Assistant

State Certification

Exam Guide

Edition 2. May 2019

Once you have paid for your test, you will be able to access all the testing appointments that are available. You can also reschedule any testing appointments through your TMU personal portal. Step-by-step scheduling instructions can be found on utahcna.com.

If you schedule an appointment for your knowledge test and later decide you would like to test as a walk-in, you must first cancel your testing appointment. If you miss your scheduled appointment, you will forfeit your testing fee.

ID Requirements

A current, valid, photo ID must be presented at time of testing and must be the original ID. (Photo, fax, or digital copies will not be accepted.) First and last name on ID must match first and last name of tester in TMU. ID must have an expiration date and must be current. The following forms of ID are acceptable:

● Driver's license, learner's permit, or temporary operator card from any state ● ID issued by any branch, department, or agency of the US or State of Utah ● High school, technical school, college, or professional school within the State of Utah (may not have expiration date but must be current school year) ● A tribal ID card ● Passport from any country

What are you allowed to have with you

during testing?

Personal items are to be stored according to test site policy. No cell phones are allowed. You may use a calculator, scratch paper, and pencil/pen, all of which are provided by the testing site. A translation dictionary is allowed but must be provided to the testing center in advance for inspection and may not contain definitions or added notes.

All equipment needed for the skills test will be provided by the testing site including blood pressure cuff, stethoscope, and a watch.

Dress for Skills Exam

All examinees must wear scrubs, closed toe shoes, have their hair tied back, and no dangling jewelry.

Physical Limitations

You will not be allowed to take the skills exam if you have an injury, serious illness or are more than 6 months pregnant without providing the testing site with a health care providers release to work full duty as a CNA.

Accommodations

Accommodations for testing may be requested by

completing the ADA Accommodations Request

form available on UNAR’s website, utahcna.com. The completed form and supporting documentation should be submitted to UNAR as directed on the form.

Three Testing Attempts

Students completing a training course have up to 1 year to pass both the knowledge and skill exams and are given up to three attempts at both portions of the exam.

Any changes or cancellations to a testing appointment must be made at least 1 full business day prior to your testing appointment. If you fail to show up to your scheduled appointment, you will forfeit your testing fee.

MUST READ

The skill steps in this guide are to be used for objective testing purposes only at the state skills exam. They are not to be used to help you learn how to properly perform skills. The steps listed for each skill are not intended to be used to provide complete care that would be considered all-inclusive of best care practiced in an actual care setting. When performing actual resident care, skill steps as detailed in your nursing assistant textbook and/or taught in your nursing assistant training program are to be used as the basis for care you provide residents.

1 - Handwashing

Candidate is asked to wash hands with soap

and water.

1 Wets hands thoroughly with warm water 2 Applies soap to hands 3 Washes hands for at least 20 seconds 4 Rubs hands together lathering all surfaces of hands/fingers (^5) Lathers surfaces of wrists 6 Cleans fingernails by rubbing them in palm of other hand

7 Rinses hands/wrists with fingers pointing downward

8 Dries hands/wrists with clean paper towel (^9) Turns off faucet with paper towel(s) 10 Does not touch clean faucet^ hands to sink or

11 Immediately discards paper towel into trash can without touching other hand

2 - Vital Sign: Blood Pressure

Candidate is asked to take resident’s manual

blood pressure. Candidate may use 1 - step

method or 2-step-pulse obliteration method (as

preferred by candidate). A recording form is

provided to document blood pressure reading.

Resident is sitting at a table. A person portrays

role of resident. No more than 2 attempts per

arm is allowed (4 total).

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Cleans earpieces of stethoscope with alcohol wipe

7 Cleans diaphragm of stethoscope with alcohol wipe

8 Positions resid position on a firm surfaceent’s arm in a resting

9 Wraps cuff bladder over artery^ around upper arm with 10 Places diaphragm over brachial artery 11 Inflates cuff to 2 - step obliteration method^160 - 180mm/Hg or uses

12 Slowly deflates cuff, watching sphygmomanometer 13 Removes cuff from arm 14 Records recording form^ blood pressure reading on

Recorded systolic blood pressure is within +/-10 mm/Hg of observer’s measurement

**16 ***

Recorded diastolic blood pressure is within +/-10 mm/Hg of observer’s measurement 17 Performs hand hygiene

*INDICATES KEY STEP

9 Stands in front and faces resident 10 Resident’s feet are flat on floor 11 Grasp of residents^ gait belt securely at both sides 12 Assists resident to stand 13 Positions self slightly behind on resident’s side

14 Ambulates resident while grasping gait belt 15 Assists resident to sit into chair 16 Positions resident in chair with hips against back of seat 17 Removes gait belt 18 Call light is left within resident’s reach 19 Water is left within resident’s reach 20 Performs hand hygiene

6 - Ambulate with Walker Using Gait Belt

Candidate is asked to assist resident to stand

and ambulate from bed to chair using a gait belt

and walker. Resident is in bed. Resident does

not have an affected side. A person portrays

role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Locks bed wheels 7 Assists resident to put on non footwear -skid

8

Places gait belt snug around resident’s waist (should be able to easily run fingers between belt and resident) 9 Stands in front and faces resident 10 Resident’s feet are flat on floor

11 Grasps gait belt securely at both sides of resident 12 Assists resident to stand 13 Positions walker in front of resident before or after resident stands

14 Positions self slightly behind on resident’s side

15 Ambulates grasping gait belt^ resident with walker while 16 Assists resident to sit into chair 17 Positions resident in chair with hips against back of seat 18 Removes gait belt 19 Call light is left within resident’s reach 20 Water is left within resident’s reach 21 Performs hand hygiene

7 - Assist with Bedpan

Candidate is asked to assist resident with a

standard bedpan. Resident is in bed on a

waterproof pad that has already been placed.

Changing waterproof pad is not tested in this

skill. Pericare is not tested in this skill. Skills

observer will indicate where the “flat, dirty

surface” is located. A mannequin portrays role

of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Lowers head of bed 8 Rolls resident away from self 9 Positions bedpan correctly 10 Rolls resident onto back/bedpan 11 Raises head of bed

12 Positions call light within reach of resident

(Resident uses bedpan and calls nursing assistant) 13 Lowers head of bed 14 Removes bedpan 15 Removes gloves

16

Performs hand hygiene immediately after removing gloves and before touching other items 17 Call light is left within resident’s reach 18 Water is left within resident’s reach

8 - Brief Change with Peri/Anal Care: Female

Candidate is asked to change soiled brief for

female resident who had a bowel movement.

Resident is confined to her bed. Resident is in

bed on a waterproof pad that has already been

placed. Changing waterproof pad is not tested

in this skill. A mannequin portrays role of

resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Lowers head of bed 8 Undoes front tabs of soiled brief 9 Rolls soiled brief down between resident’s legs 10 Separates labia majora 11 Wipes down center of labia, starting with urinary meatus

12 Wipes down both sides of labia, starting with urinary meatus 13 Wipes vaginal area/upper thighs 14 Rolls resident onto side

15 Wipes anal area 16 Removes soiled brief 17 Places soiled brief into plastic bag 18 Changes gloves 19 Tucks clean brief under resident 20 Rolls resident onto back 21 Secures clean brief in place 22 Removes gloves

23

Performs hand hygiene immediately after removing gloves and before touching other items 24 Call light is left within resident’s reach 25 Water is left within resident’s reach 26 Candidate used wipes^ disposable cleansing

27

Candidate discarded soiled wipes by tucking into soiled brief or into waste container 28 Candidate wiped clean to dirty for each stroke

29 Candidate used different part of wipe or new wipe for each stroke

9 - Brief Change with Peri/Anal Care: Male

Candidate is asked to change soiled brief for a

circumcised male resident who had a bowel

movement. Resident is confined to his bed.

Resident is in bed on a waterproof pad that has

already been placed. Changing waterproof pad

is not tested in this skill. A mannequin portrays

role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves

4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Protects denture from damage by lining bottom of sink 8 Uses water to clean/rinse denture 9 Applies denture toothpaste to denture brush 10 Brushes all surfaces of denture 11 Rinses denture 12 Places denture in denture cup 13 Adds water to cover denture in cup 14 Removes gloves

15

Performs hand hygiene immediately after removing gloves and before touching other items 16 Call light is left within resident’s reach 17 Water is left within resident’s reach

12 - Dressing Resident: Affected Arm (Upper Body Only)

Candidate is asked to change gown/clothing

for resident who has an affected (weaker) arm.

Affected side is clearly identified by red tape.

A person or mannequin portrays role of

resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Allows resident to choose clothing 7 Undresses resident’s unaffected side first

8 Undresses resident’s affected side after undressing unaffected side 9 Places used clothing in hamper

10 Dresses resident’s affected side first 11 Dresses resident’s unaffected side after dressing affected side 12 Call light is left within resident’s reach 13 Water is left within resident’s reach 14 Performs hand hygiene

13 – Empty Down Drain Bag and Record Urine Output

Candidate is asked to empty resident’s catheter

down drain bag into graduate container and

then measure and record urine output. Output

should be recorded in ml. A recording form is

provided to document urine output

measurement. Skills observer will indicate

where the “flat, dirty surface” is located. A

mannequin portrays role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Places paper towel on floor under drainage bag 8 Places graduate on paper towel 9 Opens spout on down drain bag so urine will flow into graduate

10 Ensures drainage tube does not touch side of graduate 11 Cleans tip of spout with alcohol wipe 12 Replaces spout into holder on bag 13 Places graduate on a flat surface ,^ “dirty” 14 Reads graduate at eye level 15 Removes gloves

Performs hand hygiene immediately after removing gloves and before touching other items 17 Call light is left within resident’s reach 18 Water is left within resident’s reach 19 Records urine output measurement on recording form

20 * Recorded measurement within +/ 25mL of observer’s measurement-

14 - Feeding Resident: While in Bed

Candidate is asked to feed resident a meal.

Resident is unable to fully feed his/her self.

Resident can assist with eating by holding

small items to take bites. Resident is in bed. A

person or mannequin portrays role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Positions resident in an upright position (60-90 degree angle)

7 Assists resident to clean hands with disposable wipes

8 Asks resident if clothing protector^ they would like a 9 Places a clothing protector/towel 10 Tells resident what foods are on plate 11 Allows resident to make choices while eating 12 Offers fluid 13 Removes clothing protector from resident’s clothing 14 Call light is left within resident’s reach 15 Water is left within resident’s reach 16 Performs hand hygiene

15 - Indwelling Catheter Care: Female

Candidate is asked to provide indwelling

catheter care for female resident. Resident is in

bed on a waterproof pad that has already been

placed. Changing waterproof pad is not tested

in this skill. A mannequin portrays role of

resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Uses cleansing wipe to clean area around the resident’s urinary meatus 8 Holds catheter near meatus 9 Cleans at least 4 inches of catheter tubing beginning at the urinary meatus

10 Wipes away from urinary meatus^ catheter tubing^ in one direction 11 Secures tubing to resident’s thigh 12 Places tubing over resident’s leg 13 Attaches drainage bag to bed (non-movable part of bed)^ frame 14 Removes gloves

15

Performs hand hygiene immediately after removing gloves and before touching other items 16 Call light is left within resident’s reach 17 Water is left within resident’s reach 18 Candidate used wipes (not alcohol pad)^ disposable cleansing

19 Candidate wiped clean to dirty for each stroke

20 Candidate used different part of wipe or new wipe for each stroke

18 - Mouth Care: Conscious, Brushing Teeth

Candidate is asked to provide mouth care for a

conscious resident who is unable to brush own

teeth. Resident has his/her natural teeth.

Resident is in bed. A mannequin portrays role

of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Positions resident in an upright position (60-90 degree angle)

8 Offers resident clothing protector or towel 9 Applies toothpaste to toothbrush 10 Inserts toothbrush into resident’s mouth 11 Brushes all surfaces of upper teeth 12 Brushes all surfaces of lower teeth 13 Brushes tongue 14 Provides resident water to rinse mouth 15 Provides resident a basin for spitting 16 Cleans/dries around resident’s mouth 17 Offers resident lip moisturizer 18 Removes gloves

19

Performs hand hygiene immediately after removing gloves and before touching other items 20 Call light is left within resident’s reach 21 Water is left within resident’s reach

19 - Mouth Care: Unconscious

Candidate is asked to provide mouth care for

unconscious resident. Resident has his/her

natural teeth. Resident is in bed. A mannequin

portrays role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Turns resident’s head to side 8 Places a towel under resident’s head cheek/chin^ or 9 Wets sponge in cup of water 10 Removes excess water from sponge by rolling along cup

11 Inserts sponge into resident’s (does not use toothbrush or toothpaste)^ mouth

12 Rotates sponge against all surfaces of mouth 13 Cleans/dries around resident’s mouth 14 Applies lip moisturizer 15 Removes gloves

16

Performs hand hygiene immediately after removing gloves and before touching other items 17 Call light is left within resident’s reach 18 Water is left within resident’s reach

20 - Occupied Draw Sheet Change

Candidate is asked to change resident’s draw

sheet, turning no more than once to each side.

Resident is able to roll on either side without

difficulty. Resident is confined to bed. A

mannequin portrays role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Dons gloves 7 Places clean draw sheet on a clean surface within reach 8 Positions bed flat 9 Rolls resident onto side 10 Rolls resident^ used^ draw sheet inward toward 11 Places clean draw sheet on bed 12 Rolls one half of towards resident’^ clean draw sheets back

13 Smooths out other side of clean draw sheet 14 Rolls resident onto back 15 Rolls resident onto resident’s other side 16 Removes used draw sheet 17 Unrolls clean draw sheet 18 Rolls resident onto back onto clean draw sheet

19 Ensures draw sheet is free from wrinkles 20 Removes gloves

21

Performs hand hygiene immediately after removing gloves and before touching other items 22 Call light is left within resident’s reach 23 Water is left within resident’s reach

21 - Position: Lateral

Candidate is asked to reposition resident to a

lateral position. Candidate can choose to place

resident in either a left lateral or a right lateral

position. Resident is in bed. A mannequin

portrays role of resident.

1 Greets resident by name 2 Introduces self by name 3 Identifies self as a CNA 4 Performs hand hygiene 5 Explains procedure to resident 6 Positions bed flat

7

Slides hands/arms under resident’s head/shoulders, moves resident toward self 8 Slides hands/arms under resident midsection, moves resident toward self’s

9 Slides hands/arms under resident hips/legs, moves resident toward self’s 10 Turns resident onto a lateral position 11 Flexes resident’s knee on resident’s body^ upper side of

12 Places pillow(s) leg/knee^ underneath^ resident’s

13 Places arm for support^ pillow(s)^ under resident’s upper

14 Places pillow(s) against resident torso for support ’s back/ 15 Call light is left within resident’s reach 16 Water is left within resident’s reach 17 Performs hand hygiene

Practice Knowledge Test

1. If a nursing assistant finds medications left over on the bedside table, what should happen? a. Ignore it b. Report it to the charge nurse c. Encourage the resident to take it d. Throw them away
2. HS means:

a. Hour of sleep b. Hour for supper c. Hours for sitting d. Hours resident slept

3. The person’s written statement about the use of life sustaining measures is called: a. Durable Power of Attorney b. DNA Order c. Living Will d. Hospice Care
4. Mrs. Shumway has an order for I&O. You have picked up her breakfast and note she drank a 6 oz. glass of juice, 4 oz. of milk and 8 oz. of coffee. You document: a. 920ml b. 240ml c. 540ml d. 685ml
5. Your elderly patient speaks a different language than you do. It would help you to: a. Use very simple words and directions b. Talk louder c. Avoid any conversation d. Make the patient speak their language 6. If a resident is retaining fluid in the tissue, he is said to have: a. Hypertension b. Distension c. Hypothermia d. Edema 7. Which response violates patient confidentiality? a. Telling funny stories about your patients to your family and friends b. Telling the nurse that your patient is taking extra medication c. Talking about your patient’s care to your relief on the next shift d. Exchanging information about Mrs. Green with her physician 8. A microbe that is harmful and causes infection is a: a. Reservoir b. Pathogen c. Microorganism d. Flora 9. While dressing a post CVA resident with one-sided weakness, which arm should be put through the sleeve first? a. Weak arm b. Strong arm c. It doesn’t matter d. Both arms at the same time 10. If a resident refuses to eat a certain food because of a religious preference, the CNA should: a. Allow the resident to go hungry b. Ask the family to bring in special foods

c. Respect the resident’s religion and notify the dietician d. Tell the resident to eat the food, no preference is given

11. Identify the one factor that is common to all communication: a. Words are being used b. There is a transfer of a message c. It occurs in one direction d. The people feel comfortable
12. When nursing assistants find equipment in need of repair, they should: a. Throw it away b. Fix it themselves c. Continue to use the item d. Report it to the appropriate personnel
13. Residents who lie in bed all day are at risk for: a. Pneumonia b. Sensory stimulation c. Myocardial infarction d. Developmental disability
14. Aphasia is the loss of:

a. Memory b. Appetite c. Ability to swallow d. Ability to speak

15. You are giving mouth care to an unconscious resident. You must be especially careful to prevent the resident from: a. Eating the toothpaste b. Aspirating any fluid c. Talking during the procedure d. Biting down on the toothbrush
16. An elderly Native American has been diagnosed as dying. Her family wishes to perform a ceremony with candles and incense. The facility should: a. Allow the ceremony with proper safety measures b. Not allow the ceremony because of the fire code

c. Transfer her to a private facility for Native Americans d. Teach the family that the ceremony will not help her condition

17. Misuse of Resident’s money or property by family, friends or staff is known as: a. Malpractice b. Chemical restraint c. Misappropriation of property d. Abetting & aiding
18. You observe two adult residents sharing the same bed after lunch. You know these residents are capable of exercising their own rights. This means that they: a. Can perform ROM for each other b. Have the right to share the same bed c. Have the right to privacy d. Should be discharged for lewd conduct
19. Mrs. Sparks is an 83-year-old female patient with left sided hemiplegia. This is: a. Paralysis on the left side of the body b. A rash on the left arm c. A left arm contracture d. Left arm and leg itching
20. When caring for a resident with an indwelling Foley catheter it is important to: a. Withhold fluids if the bag is too full b. Tuck the tubing under the patient’s leg to keep it off the floor c. Pin the tubing to the resident gown d. Check the bag and tubing for adequate urinary flow
21. The basic foundation of medical asepsis is: a. Hand washing b. Wearing goggles c. Wearing a mask d. Sterile technique

Practice Knowledge Test - Answers

1. B – Report it to the charge nurse
2. A – Hour of sleep
3. C – Living Will
4. C – 540ml
5. A – Use very simple words and directions
6. D – Edema
7. A – Telling funny stories about your patients to your family and friends
8. B – Pathogen
9. A – Weak arm
10. C – Respect the resident’s religion and notify the dietician
11. B – There is a transfer of a message
12. D – Report it to the appropriate personnel
13. A – Pneumonia
14. D – Ability to speak
15. B – Aspirating any fluid
16. A – Allow the ceremony with proper safety measures
17. C – Misappropriation of property
18. C – Have the right to privacy
19. A – Paralysis on the left side of the body
20. D – Check the bag and tubing frequently for adequate urinary flow
21. A – Hand washing
22. A – B/P 190/
23. D – Apply direct pressure
24. B – Move objects away which may cause injury
25. C – A structured, safe environment
26. A – Putting yourself in their place
27. D – Talk with your supervisor
28. B – Sit beside the resident
29. B – Front to back
30. C – Stoma