Basic Nursing Skills Study Guide for the CNA

General Information

The Basic Nursing Skills section of the CNA exam encompasses a range of essential skills needed for daily responsibilities in patient care. This section generally makes up about 30-40% of the exam, underlining its importance in practical and theoretical nursing knowledge. Skills covered here include infection control practices, vital sign monitoring, patient mobility and safety, and basic emergency procedures. Mastery of these skills is crucial not only for exam success but also for providing effective, compassionate care in real-world settings.

Patient Identification

Confirming patient identity is a vital safety step that prevents errors in care and ensures each patient receives the correct treatments, medications, and assessments. To do this, healthcare providers should ask for two identifiers, typically the patient’s full name and date of birth. This information should then be verified by checking the patient’s wristband and cross-referencing it with their chart. Repeating this process before every procedure, medication administration, or assessment is essential to maintain accuracy and safety.

Infection Control

Infection control is a foundational aspect of healthcare, vital to preventing the spread of pathogens and protecting the health of patients, CNAs, and other healthcare staff. Infection control topics on the CNA exam cover proper hand hygiene, personal protective equipment (PPE) use, and needle safety protocols.

Hand Hygiene

Hand hygiene is the most essential infection control practice. Thorough handwashing is required before and after patient contact, when handling potentially contaminated surfaces, and before any procedure involving direct contact with a patient’s skin or mucous membranes. Effective hand hygiene involves:

preparation—Wet hands with warm water.
soap application—Apply soap and lather all hand surfaces, including under the fingernails.
scrubbing—Scrub for at least 20 seconds, ensuring all areas of the hands and wrists are covered.
rinsing and drying—Rinse thoroughly and dry with a clean towel.

In situations where soap and water are unavailable, an alcohol-based hand sanitizer with at least 60% alcohol can be used as an alternative. Hand sanitizer is effective for routine decontamination, such as after touching surfaces or between patient interactions. However, handwashing with soap and water is required when hands are visibly soiled or after contact with bodily fluids.

Personal Protective Equipment (PPE)

PPE is essential in healthcare settings, as it helps create a physical barrier against pathogens and reduces the risk of exposure to infectious materials. Proper use of PPE not only protects healthcare workers but also safeguards patients by preventing the spread of infections within healthcare environments. CNAs must be proficient in the correct donning (putting on) and doffing (removing) sequence of PPE to minimize contamination risks and ensure their safety and that of their patients.

When donning PPE, it is important to begin with the gown, which covers most of the body and provides a primary layer of protection. Next, the mask is applied to prevent inhalation of airborne pathogens, followed by eye protection to shield the eyes from splashes or droplets. Gloves are donned last to keep the hands, which are frequently exposed to various surfaces and substances, as clean as possible.

The doffing process is equally critical, as improper removal can lead to cross-contamination. Gloves, often the most contaminated, are removed first. This is followed by the careful removal of eye protection, the gown, and finally, the mask. Each step in this sequence is designed to ensure that potential contaminants are removed systematically and safely, further protecting both the CNA and the patient.

Needle Safety

Although CNAs typically do not administer injections, they may encounter needles during their work and must be aware of safety protocols to prevent needlestick injuries and exposure to bloodborne pathogens. Key needle safety guidelines include:

Avoid recapping used needles.—Recapping is discouraged as it increases the risk of needlesticks. Use a one-handed “scoop” technique if absolutely necessary.
Dispose of needles properly.—Place all used needles in a designated sharps container immediately after use.
Use safety-engineered devices.—When available, choose devices with built-in safety features, such as retractable needles, to minimize exposure.

Vital Signs

Accurate measurement of vital signs—temperature, pulse, respiration, and blood pressure—is a critical CNA responsibility. This section evaluates your ability to monitor a client’s health status effectively and to identify early signs of health issues.

Blood Pressure

Blood pressure readings provide insight into a client’s cardiovascular health. CNAs may use a manual sphygmomanometer or an electronic blood pressure cuff. The steps include:

cuff placement—Wrap the cuff around the upper arm, about one inch above the elbow.
inflation—Inflate the cuff until it restricts blood flow, typically to 20-30 mmHg above the client’s usual systolic pressure.
deflation—Slowly release the pressure while listening for the first (systolic) and last (diastolic) sounds with a stethoscope.

The normal range for adult blood pressure is typically 120/80 mmHg. Recognizing values outside the normal range can help CNAs detect potential health issues and ensure prompt intervention.

Pulse and Respirations

To take a radial pulse, locate the artery on the thumb side of the wrist and use your index and middle fingers to apply gentle pressure until you feel the heartbeat. Count the beats for 30 seconds and multiply by two to get the beats per minute (bpm). The normal adult range is 60-100 bpm, with any significant deviation potentially indicating an underlying condition. Immediately after, observe the patient’s respirations, noting rhythm and depth.

The normal respiratory rate for adults is 12-20 breaths per minute. Irregularities in breathing patterns, such as rapid or shallow breathing, may signal cardiovascular or respiratory concerns and should be reported immediately.

Temperature

Temperature measurement methods include oral, tympanic (ear), axillary (underarm), and rectal. Each method has specific protocols:

oral—Place the thermometer under the tongue.
tympanic—Insert the probe into the ear canal.
rectal— Insert the thermometer gently into the rectum. (most accurate method)
axillary—Insert the thermometer under the armpit. (less accurate method)

Understanding these methods and normal temperature ranges (around 98.6°F or 37°C) is critical, as fever or hypothermia can indicate infection or other health problems.

Client Safety and Mobility

Ensuring client safety through proper body mechanics, mobility assistance, and fall prevention is a primary CNA duty. This section evaluates your ability to assist clients in maintaining mobility and minimizing injury risk.

Body Mechanics

Using proper body mechanics protects both the CNA and the client from injury. The following principles are essential for safe lifting and transferring:

Lift with your legs.—Always bend at the knees, keeping your back straight to avoid strain.
Keep the load close to your body.—This reduces strain on the back, particularly when lifting clients or equipment.
Avoid twisting.—To prevent injury, move your entire body instead of twisting your spine.

Assisting Clients with Mobility

CNAs frequently assist clients with transfers and ambulation. Using a transfer belt can enhance stability and safety for both the client and the CNA.

Safe Transfer Techniques

Prepare the area.—Ensure the client is wearing non-slip footwear and the surrounding area is clear of obstacles.
Apply the transfer belt.—Secure the belt snugly around the client’s waist, over their clothing.
Position yourself for stability.—Stand with your feet shoulder-width apart to create a stable base.
Assist with standing.—Use your legs to help the client rise, keeping a firm hold on the belt for support.

Assisting with Ambulation Using a Transfer Belt

When helping a client walk:

Secure the belt.—Place it around the client’s waist securely.
Stand slightly behind and to the side.—This position allows you to guide and support the client while maintaining balance.
Encourage a steady pace.—Walk at a comfortable speed, ensuring the client feels secure.

Transferring from Bed to Wheelchair

To transfer a client safely from bed to wheelchair:

Position the wheelchair.—Place it close to the bed, lock the wheels, and ensure footrests are out of the way.
Assist client to stand using the transfer belt.—Help the client rise, keeping a secure grip on the belt.
Guide into the wheelchair.—Pivot the client toward the wheelchair, positioning their legs against the seat before gently lowering them.

Preventing Falls

Falls are a leading cause of injury among clients, particularly those with limited mobility, so proactive measures are crucial for prevention. Ensuring a clear pathway by removing clutter and keeping floors free from obstacles can significantly reduce the risk of tripping. Providing adequate lighting, especially at night, helps clients see where they are going, minimizing the chances of a fall. Additionally, placing call buttons within easy reach allows clients to request assistance when needed, offering them greater safety and reassurance.

Range of Motion (ROM) Exercises

ROM exercises are essential for clients with limited mobility, as they help maintain joint flexibility and circulation, preventing stiffness and contractures.

shoulder exercise—Support the arm at the elbow and wrist, lifting and lowering gently.
knee exercise—Support the ankle, bending and straightening the knee.
ankle exercise—Gently move the foot up and down, supporting the ankle.

Perform each exercise at least three times, ensuring client comfort and stopping if there’s any discomfort. ROM exercises maintain joint health and enhance circulation.

Preventing Pressure Ulcers

Pressure ulcers, also known as bedsores, occur when prolonged pressure impedes blood flow to the skin. CNAs play a crucial role in prevention, particularly for bedridden clients.

Reposition clients every two hours.—Regular repositioning minimizes pressure on sensitive areas.
Use supportive devices.—Cushions or specialized mattresses distribute weight more evenly.
Perform routine skin checks.—Monitor for early signs of skin breakdown, such as redness or warmth, and report to nursing staff immediately.