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CNACertified Nursing AssistantSecond EditionLinda Whitenton, Marty WalkerPearson800 East 96th StreetIndianapolis, Indiana 46240 USA

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CNA Certified Nursing Assistant Exam Cram, Second EditionCopyright © 2017 by Pearson Education, Inc.All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, ortransmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, withoutwritten permission from the publisher. No patent liability is assumed with respect to the use of theinformation contained herein. Although every precaution has been taken in the preparation of thisbook, the publisher and author assume no responsibility for errors or omissions. Nor is any liabilityassumed for damages resulting from the use of the information contained herein.ISBN-13: 978-0-7897-5886-6ISBN-10: 0-7897-5886-5Library of Congress Control Number: 2017938512Printed in the United States of AmericaFirst Printing: June 2017TrademarksAll terms mentioned in this book that are known to be trademarks or service marks have beenappropriately capitalized. Pearson IT Certification cannot attest to the accuracy of this information.Use of a term in this book should not be regarded as affecting the validity of any trademark orservice mark.Warning and DisclaimerEvery effort has been made to make this book as complete and as accurate as possible, but nowarranty or fitness is implied. The information provided is on an “as is” basis. The authors and thepublisher shall have neither liability nor responsibility to any person or entity with respect to anyloss or damages arising from the information contained in this book.Special SalesFor information about buying this title in bulk quantities, or for special sales opportunities(which may include electronic versions; custom cover designs; and content particular to yourbusiness, training goals, marketing focus, or branding interests), please contact our corporatesales department at corpsales@pearsoned.com or (800) 382-3419.For government sales inquiries, please contact governmentsales@pearsoned.com.For questions about sales outside the U.S., please contact intlcs@pearson.com.Editor-in-ChiefMark TaubProduct Line ManagerBrett BartowAcquisitions EditorMichelle NewcombDevelopment EditorChristopher ClevelandManaging EditorSandra SchroederSenior Project EditorTonya SimpsonCopy EditorBarbara HachaIndexerCheryl LenserProofreaderSasirekha DurairajanTechnical EditorSteve PicrayPublishing CoordinatorVanessa EvansCover DesignerChuti PrasertsithCompositorcodeMantra

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Contents at a GlanceCHAPTER 1What You Need to Know to Prepare for the Exam1CHAPTER 2The Roles and Responsibilities of the Nursing Assistant15CHAPTER 3Promotion of Health and Safety31CHAPTER 4Promotion of Function and Health of Residents45CHAPTER 5Specialized Care71CHAPTER 6Clinical Skills Performance Checklist99Practice Exam I135Answers to Practice Exam I151Practice Exam II159Answers to Practice Exam II175Practice Exam III183Answers to Practice Exam III199APPENDIX ANursing Assistant Test Cross-Reference207Glossary209Index219

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ContentsChapter 1:What You Need to Know to Prepare for the Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Taking the Written Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Testing Readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Testing Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Answering the Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Taking the Clinical Skills Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Self-Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Exam Prep Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Answer Rationales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Chapter 2:The Roles and Responsibilities of the Nursing Assistant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Your Role and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Job Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Other Tasks and Duties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Job Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Personal Qualities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17The Nursing Assistant as a Member of the Health-Care Team. . . . . . . . . . . . . . . . . . . .19Other Team Members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Being a Team Player. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Communication and Interpersonal Skills Needed forEffective CNA Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Legal and Ethical Considerations in Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Resident Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Exam Prep Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Answer Rationales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Chapter 3:Promotion of Health and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Review of Body Systems Affected by Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Communicable Diseases and Their Effect on Health. . . . . . . . . . . . . . . . . . . . . . . . . . . .33

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ContentsvRole of the Nursing Assistant to Prevent the Spread ofCommunicable Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34Medical Asepsis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35Mask, Eye Protection, Face Shield, Gowns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Sharp Objects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37Resident Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37Environment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Linens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Surgical Asepsis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Resident Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39Reporting Accidents or Incidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Exam Prep Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Answer Rationales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Chapter 4:Promotion of Function and Health of Residents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Personal Care Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Activities of Daily Living. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Shaving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50Nail Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Restorative Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Self-Care and Independence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Mobility/Immobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57Health Maintenance and Restoration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59Psychosocial Care Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61Emotional and Mental Health Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61Cultural Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62Spiritual Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63Sexual Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64Data Collection and Reporting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Exam Prep Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67Answer Rationales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69Chapter 5:Specialized Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71Physical Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73Vision Impairment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

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viCNA Certified Nursing Assistant Exam CramHearing Impairments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74Speech Impairment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75Respiratory Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Cardiovascular Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Paralysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80Digestive and Elimination Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82HIV (Human Immunodeficiency Virus) and AIDS(Acquired Immunodeficiency Syndrome). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Psychological Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Confusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88Aggressive Residents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88Dementias. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89The Depressed Resident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90The Terminally Ill Resident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Exam Prep Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Answer Rationales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96Chapter 6:Clinical Skills Performance Checklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99Handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101Measuring Body Temperature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101Oral Temperature Measurement with Electronic Monitor. . . . . . . . . . . . . . . . . .101Rectal Temperature Measurement with Electronic Thermometer. . . . . . . . . . .102Axillary Temperature with Electronic Thermometer. . . . . . . . . . . . . . . . . . . . . . .103Tympanic Membrane Temperature with Electronic Thermometer. . . . . . . . . .103Measuring the Radial and Apical Pulse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104Radial Pulse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104Apical Pulse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Measuring the Respirations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Blood Pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106Partial Bedbath. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107Perineal Care of the Female Resident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108Nail Care (Fingers and Toes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108Mouth (Oral) Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109Mouth (Oral) Care: Care of Dentures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109Dressing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110

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ContentsviiApplying Elastic Support Hose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110Making an Occupied Bed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111Moving the Resident to the Side of the Bed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112Supine Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113Fowler’s Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113Lateral (Side-Lying) Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114Sim’s Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115Prone Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115Orthopneic Position. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116Logrolling the Resident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117Assisting the Resident to Sit on the Side of the Bed. . . . . . . . . . . . . . . . . . . . . . . . . . . .118Assisting the Resident to Transfer from the Bed to a Chair or Wheelchair. . . . . . . .119Transferring the Resident from a Bed with a Mechanical Lift. . . . . . . . . . . . . . . . . . . .120Moving the Resident from a Bed to a Stretcher (Gurney). . . . . . . . . . . . . . . . . . . . . . .121Using a Gait-Transfer Belt to Assist the Resident to Ambulate. . . . . . . . . . . . . . . . . . .122Passive Range of Motion Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123Monitoring Resident in Restraints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124Feeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124Offering the Bedpan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Performing Ostomy Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125Administering a Cleansing Enema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126Recording Intake and Output (I & O). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127Measuring and Recording Output from a Urinary Drainage Bag. . . . . . . . . . . . . . . . .127Indwelling Catheter Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128Applying a Condom Catheter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129Collecting Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129Routine Urine Specimen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130Clean Catch Urine Specimen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130Urine Specimen from an Indwelling Catheter. . . . . . . . . . . . . . . . . . . . . . . . . . . .130Stool Specimen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131Isolation Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131Choking Relief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132Putting on Disposable Gown, Gloves, Goggles, and Mask. . . . . . . . . . . . . . . . .132Removing Disposable Gown, Gloves, Goggles, and Mask. . . . . . . . . . . . . . . . . .132Assisting with Post-Mortem Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133

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viiiCNA Certified Nursing Assistant Exam CramPractice Exam I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135Exam Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136Answers to Practice Exam I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151Answers at a Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151Rationales for Answers to Practice Exam I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152Practice Exam II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159Exam Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160Answers to Practice Exam II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175Answers at a Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175Rationales for Answers to Practice Exam II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176Practice Exam III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183Exam Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184Answers to Practice Exam III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199Answers at a Glance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199Rationales for Answers to Practice Exam III. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200Appendix A:Nursing Assistant Test Cross-Reference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 1 9

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About the AuthorsMarty Walkerhas practiced nursing for the past 39 years at the vocational nursing level asa registered nurse, and at the master’s level. Marty began her nursing career as a licensedpractical nurse, receiving her vocational education certificate from Atlantic Vocational Schoolin Pompano Beach, Florida, in 1979. In 1982, she earned the associate degree in nursingfrom Broward Community College in Davie, Florida. She worked for more than 10 years as astaff nurse in telemetry, critical care, and emergency nursing before completing a bachelor ofscience degree in nursing from Florida International University in Miami, Florida. In 1995,she began teaching medical-surgical nursing at Ivy Tech State College in Sellersburg, Indiana.After relocating to Miami, Marty accepted a position as Nurse Clinical Educator for threecardiac units at Jackson Memorial Hospital. She attained a Master’s in Nursing Science inNursing Education from Barry University in Miami Shores, Florida, in 2003. Marty’s love ofteaching led her to Mercy Hospital’s School of Practical Nursing, along with adjunct teachingpositions at Florida International University and Barry University. In Miami, Marty addedpediatrics to her teaching expertise. She taught medical-surgical nursing for a short time atPensacola State College in Pensacola, Florida, before accepting a full-time associate profes-sor position at Northwest Florida State College, where she taught in the RN-BSN programas well as the associate degree nursing program. She is now the director for both programs.Marty’s expertise also includes test construction. She has led the faculty at NWF State Collegein improving the success rates of students enrolled in the program as well as their successon the NCLEX-RN. Marty’s versatility extends to her clinical practice as she completed thefamily nurse practitioner certificate program at the University of South Alabama in Mobile,Alabama, where she also completed her Doctorate in Nursing Practice in 2014. Marty hasvolunteered as the director of nursing services, as a nurse practitioner, and as board presidentfor the Crossroads Medical Center Clinic in Valparaiso, Florida, since 2007.Linda Whitentonbegan a 45-year nursing career in 1967 as a nursing assistant in Paducah,Kentucky. Following her graduation from Murray State University’s BSN program in 1970,she practiced in mental health, pediatrics, and medical-surgical nursing. Teaching nursingassistants, emergency medical technicians, and unit secretaries in a Mississippi hospitalcemented her love for teaching in her role as a hospital in-service education director in theearly 1970s. She accepted her first teaching position at Northeast Mississippi CommunityCollege in 1975. While at NEMC, she taught fundamentals, medical-surgical nursing,management, and psychiatric nursing and served as assistant director and director of theprogram for seven years. In 1977, Linda earned her master’s of science degree in nursingat the Mississippi University for Women, which also afforded her the family nurse cliniciancredential. In 1987, she relocated to Florida and accepted a position as associate director ofnursing for the associate degree nursing program at St. Petersburg College in St. Petersburg.

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xCNA Certified Nursing Assistant Exam CramWhile at SPC, she designed curriculum for more than 1,000 employees of the Pinellas CountyEMS, taught LPN transitional students at night, and practiced part time at the BayfrontMedical Center Trauma Center.During her 35 years of teaching, Linda continued to practice in emergency nursing,urological nursing, and as a nurse clinician. Linda also earned 30 hours of post-masters workin anthropology and educational psychology. In 2004, she returned to clinical practice asthe director of nursing/vice president for a Mississippi community hospital. While there,she received a national award for outstanding nursing leadership. She returned to Florida in2000 to design and direct a new AD nursing program for Northwest Florida State College,formerly Okaloosa-Walton College, the first of seven health programs now in place at thecollege. Linda served as associate dean of Health Technology for three years, adding admin-istrative oversight for the health programs she launched during her eight-year tenure atNWFSC. In 2008, she retired from the college, receiving the honor of Emeritus AssociateDean and Director of Nursing. In 2015, Linda accepted an interim position as campus deanat Pensacola State College, where she now serves as director of Nursing and EmergencyMedical Services, overseeing the nursing programs, the emergency medical service programs,the surgical technology, and the newly designed patient care technician program. Lindahas worked with Rinehart and Associates Nursing Review, a nurse-owned company thatoffers review courses for graduates preparing for their examination to become licensed RNsor LPNs. Linda is a Certified Nurse Educator, CNE, and a member of Sigma Theta TauInternational Nursing Society.

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About the Technical EditorSteven M. Picrayis a medical surgical registered nurse in a major metropolitan hospital. He hasalso been a Baptist pastor and a computer programmer. He has a bachelor’s and a master’sdegrees in theology, a B.S.N., and is currently pursuing his master’s degree in nursing tobecome a nurse practitioner.

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DedicationWe dedicate this book to the compassionate and caring nursingassistants everywhere, who dedicate their livesto caring for our precious elders.AcknowledgmentsWe wish to thank Kathy McNair for her superlative technical assistance, her encouragement,caring, and expertise in all she does for nursing education.A special thanks goes to Mrs. Jeanece C. Ridge, former instructor, Nursing Assistant Programand current instructor, Practical Nursing Program at Okaloosa Technical College in FortWalton Beach, Florida, for her thorough review of our first edition.We also thank our families for their love and patience.

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xiiiContact the Nursing Board in Your AreaBecause nursing standards sometimes vary by state due to differing legal concerns at thestate level, you should check the Nurse Aid Registries at National Council of State Boards ofNursing website for your area at https://www.ncsbn.org/725.htm.Companion WebsiteRegister this book to get access to the Pearson Test Prep practice test software and other studymaterials plus additional bonus content. Check this site regularly for new and updated post-ings written by the author that provide further insight into the more troublesome topics onthe exam. Be sure to check the box that you would like to hear from us to receive updates andexclusive discounts on future editions of this product or related products.To access this companion website, follow these steps:1.Go to www.pearsonITcertification.com/register and log in or create a new account.2.Enter the ISBN: 9780789758866.3.Answer the challenge question as proof of purchase.4.Click theAccess Bonus Contentlink in the Registered Products section of youraccount page to be taken to the page where your downloadable content is available.Please note that many of our companion content files can be very large, especially image andvideo files.If you are unable to locate the files for this title by following the preceding steps, visitwww.pearsonITcertification.com/contact and select the “Site Problems/ Comments” option.Our customer service representatives will assist you.Pearson Test Prep Practice Test SoftwareAs noted previously, this book comes complete with the Pearson Test Prep practice test soft-ware containing three full exams. These practice tests are available to you either online or asan offline Windows application. To access the practice exams that were developed with thisbook, please see the instructions in the card inserted in the sleeve in the back of the book. Thiscard includes a unique access code that enables you to activate your exams in the Pearson TestPrep software.

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xivCNA Certified Nursing Assistant Exam CramAccessing the Pearson Test Prep Software OnlineThe online version of this software can be used on any device with a browser and connectiv-ity to the Internet, including desktop machines, tablets, and smartphones. To start using yourpractice exams online, follow these steps:1.Go to http://www.PearsonTestPrep.com.2.SelectPearson IT Certificationas your product group.3.Enter your email/password for your account. If you don’t have an account onPearsonITCertification.com or CiscoPress.com, you will need to establish one bygoing to PearsonITCertification.com/join.4.In the My Products tab, click theActivate New Productbutton.5.Enter the access code printed on the insert card in the back of your book to activateyour product.6.The product will now be listed in your My Products page. Click theExamsbutton tolaunch the exam settings screen and start your exam.Accessing the Pearson Test Prep Software OfflineIf you want to study offline, you can download and install the Windows version of the PearsonTest Prep software. There is a download link for this software on the book’s companion web-site, or you can enter this link in your browser:http://www.pearsonitcertification.com/content/downloads/pcpt/engine.zipTo access the book’s companion website and the software, follow these steps:1.Register your book by going to: PearsonITCertification.com/register and entering theISBN: 9780789758866.2.Respond to the challenge questions.3.Go to your account page and select theRegistered Productstab.4.Click theAccess Bonus Contentlink under the product listing.5.Click theInstall Pearson Test Prep Desktop Versionlink under the Practice Examssection of the page to download the software.6.After the software finishes downloading, unzip all the files on your computer.7.Double-click the application file to start the installation, and follow the onscreeninstructions to complete the registration.

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xv8.After the installation is complete, launch the application and selectActivate Exambutton on the My Products tab.9.Click theActivate a Productbutton in the Activate Product Wizard.10.Enter the unique access code found on the card in the sleeve in the back of your book,and click theActivatebutton.11.ClickNextand then theFinishbutton to download the exam data to your application.12.You can now start using the practice exams by selecting the product and clicking theOpen Exambutton to open the exam settings screen.Note that the offline and online versions will synch together, so saved exams and grade resultsrecorded on one version will be available to you on the other as well.Customizing Your ExamsWhen you are in the exam settings screen, you can choose to take exams in one of three modes:▶Study Mode▶Practice Exam Mode▶Flash Card ModeStudy Mode enables you to fully customize your exams and review answers as you are takingthe exam. This is typically the mode you would use first to assess your knowledge and identifyinformation gaps. Practice Exam Mode locks certain customization options because it is pre-senting a realistic exam experience. Use this mode when you are preparing to test your examreadiness. Flash Card Mode strips out the answers and presents you with only the questionstem. This mode is great for late stage preparation when you want to challenge yourself toprovide answers without the benefit of seeing multiple choice options. This mode will notprovide the detailed score reports that the other two modes will, so it should not be used ifyou are trying to identify knowledge gaps.In addition to these three modes, you will be able to select the source of your questions. Youcan choose to take exams that cover all the chapters, or you can narrow your selection to asingle chapter or the chapters that make up specific parts in the book. All chapters are selectedby default. If you want to narrow your focus to individual chapters, deselect all the chapters,and then select only those on which you wish to focus in the Objectives area.You can also select the exam banks on which to focus. Each exam bank comes complete with afull exam of questions that cover topics in every chapter. The three exams printed in the bookare also available online. You can have the test engine serve up exams from all three banks orjust from one individual bank by selecting the desired banks in the exam bank area.

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xviCNA Certified Nursing Assistant Exam CramYou can make several other customizations to your exam from the exam settings screen, suchas the time of the exam, the number of questions served up, whether to randomize questionsand answers, whether to show the number of correct answers for multiple answer questions,or whether to serve up only specific types of questions. You can also create custom test banksby selecting only questions that you have marked or questions on which you have added notes.Updating Your ExamsIf you are using the online version of the Pearson Test Prep software, you should always haveaccess to the latest version of the software as well as the exam data. If you are using the Windowsdesktop version, every time you launch the software, it will check to see if there are any updatesto your exam data and automatically download any changes that were made since the last timeyou used the software. This requires that you are connected to the Internet at the time youlaunch the software.Sometimes, due to many factors, the exam data may not fully download when you activateyour exam. If you find that figures or exhibits are missing, you may need to manually updateyour exams.To update a particular exam you have already activated and downloaded, select theToolstaband select theUpdate Productsbutton. Again, this is an issue only with the desktop Windowsapplication.If you want to check for updates to the Pearson Test Prep exam engine software, Windowsdesktop version, simply select theToolstab and select theUpdate Applicationbutton. Thiswill ensure you are running the latest version of the software engine.

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xviiWe Want to Hear from You!As the reader of this book,youare our most important critic and commentator. We value youropinion and want to know what we’re doing right, what we could do better, what areas you’dlike to see us publish in, and any other words of wisdom you’re willing to pass our way.We welcome your comments. You can email or write to let us know what you did or didn’t likeabout this book—as well as what we can do to make our books better.Please note that we cannot help you with technical problems related to the topic of this book.When you write, please be sure to include this book’s title and author as well as your name andemail address. We will carefully review your comments and share them with the author andeditors who worked on the book.Email:feedback@pearsonitcertification.comMail:Pearson IT CertificationATTN: Reader Feedback800 East 96th StreetIndianapolis, IN 46240 USAReader ServicesRegister your copy ofCNA Certified Nursing Assistant Exam Cramatwww.pearsonitcertification.com for convenient access to downloads, updates, and correctionsas they become available. To start the registration process, go to www.pearsonitcertification.com/register and log in or create an account*. Enter the product ISBN 9780789758866and click Submit. When the process is complete, you will find any available bonus contentunder Registered Products.*Be sure to check the box that you would like to hear from us to receive exclusive discounts onfuture editions of this product.

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1C H A P T E RO N EWhat You Need to Knowto Prepare for the ExamThe Certified Nursing Assistant Examination, referred to as theexam, consists ofboth a written examination (the WE) and the clinical skills test (the CST).The written (oral) examination content outline, effective 2016, also known as theNational Nurse Aide Assessment Program (NNAAP), is published by the NationalCouncil of State Boards of Nursing (NCSBN). The examination content is basedon a national survey of the most important findings of the components of nurseaide practice (Table 1.1). The content and its weight on the examination follows:TABLE 1.1The 2016 National Nurse Aide Assessment Program (NNAAP) Written(Oral) Examination Content OutlineContent DomainWeighting of ContentDomainKey Knowledge FocusI. Physical Care SkillsA. Activities of Daily Living1. Hygiene2. Dressing and Grooming3. Nutrition and Hydration4. Elimination5. Rest/Sleep/Comfort14%Handwashing; Risk FactorsDehydration; DietaryRestrictions; FeedingComplicationsIncontinence CareReporting PainB. Basic Nursing Skills1. Infection Control2. Safety/Emergency3. Therapeutic and TechnicalProcedures4. Data Collection and Reporting39%Spread of Infection;Airborne Precautions;Biohazards Disposal; PPECall System; High Risk,Injury; FireDisaster ProcedureC. Restorative Skills1. Prevention2. Self-care/Independence8%BLS; Airway ObstructionAmbulation; SafetySafety Alarms

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2Chapter 1: What You Need to Know to Prepare for the ExamYou must successfully pass both the WE and the CST to pass the certification examination.Specific details on both the WE and the CST, as well as tips on preparing for each portion,follow.Taking the Written ExaminationThe written examination (WE) is a computerized exam with a time limit, usually two hours.Test sites are regional or local, depending on the state jurisdiction. We recommend you followthe instructions given by the testing center without exception and arrive at least 30 minutesearly or, if you’re traveling a long distance, arrive a day early to locate the testing center andthe most judicious travel route to avoid delays. Two forms of identification are required:▶A current, unexpired driver’s license, state-issued identification card or military IDcard, one of which is a picture ID. You must also present a current photo along withyour readable signature. You should present a name that exactly matches your name aslisted on your Admission-To-Test (ATT) letter.▶The second form of identification must also have your signature on it. Examples ofsecond forms of identification include credit cards and Social Security cards. The cardmust also have your signature, signed prior to testing day. If any signs of alteration ordamage to the card are suspected, you may be denied admittance to test.Content DomainWeighting of ContentDomainKey Knowledge FocusII. Psychosocial Care SkillsA. Emotional and Mental Health NeedsB. Spiritual and Cultural Needs11%2%Loneliness; IsolationSigns of Suicide IdeationIII. Role of the Nurse AideA. CommunicationB. Client RightsC. Legal and Ethical BehaviorD. Member of the Health Care Team8%7%3%8%Client Plan of CareClient IdentificationHIPPADignityPrivacy ConfidentialityReportingWorkplace ActivitiesTotal100%Note: A cross-reference table in Appendix A will further assist you in concentrating on content and key knowledge review.Source: National Council of State Boards of Nursing. (2016). www.ncsbn.org

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Taking the Written Examination3Dress warmly but do not bring anything to the testing area. Leave all personal items (purses,cell phones, calculators, and so on) outside the testing areas. You will be issued testing materialsas needed. Other helpful tips for a successful testing experience are as follows:▶Get a good night’s sleep.▶Don’t work the night before the examination.▶Avoid alcohol or excessive caffeine before the examination.▶Eat a light but well-balanced meal (protein, carbohydrates, and fats plus liquids) whilestudying and before the exam. You (and your brain) need energy and maximum recallto be well prepared! Although heavy sugars give you an energy boost, avoid thembecause you might experience a sudden dip in blood sugar, causing fatigue and nausea.You might also become hungry later when you cannot eat, for example, when takingthe exam. To avoid sudden dips in blood sugar bring protein snacks, such as dry roastednuts or cheese crackers.▶Take your time with the test questions, but pace yourself to finish the examinationwithin the allotted time.▶Read each question thoroughly and completely before selecting the best answer.▶Don’t panic if you are not familiar with a question. Remember the Testing Now Tips(TNTs) on your Cram Sheet.▶Believe in yourself; we do! You can succeed!Passing scores for the WE vary from state to state. Expect to earn at least a 70% for a passingscore. You might have to wait two to three days for results. If needed, follow directions forscheduling a repeat the examination.To successfully pass the Critical Skills Test (CST), you must earn a score of at least 70% whilefollowing each critical step with 100% accuracy. You should be given the opportunity to cor-rect any missed checkpoints or other aspects of the skill during your performance; however,when you have finished a particular skill and progress to the next one, you will not be able tocorrect a mistake made on the previous one. If you need to repeat any portion of the CST,you’ll receive directions from the evaluator regarding subsequent testing opportunities accord-ing to each state’s testing guidelines.Some helpful tips for success on the CST are as follows:▶Practice, practice, practice!▶Follow each skill/procedure exactly as you learned them in your nurse aide program;this isnotthe time to improvise or take shortcuts!

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4Chapter 1: What You Need to Know to Prepare for the Exam▶Follow safety standards and include them in your skill performance. This includes, butis not limited to, handwashing, handling of soiled items, and other safety precautions.These are examples of indirect care standards that will be evaluated with each skill. Forexample,priorto performing a skill, you must actually use water and wash your hands;the evaluator will tell you after you’ve washed your hands correctly for the first timethat you can tell him or her when you would wash your hands rather than actuallywashing them for each subsequent skill.▶Work confidently and efficiently; you must complete each procedure in a timelymanner.▶Remember, the skills test is designed to measureyourcompetency; you will not begiven assistance by the evaluator except to remind you of time limitations related to theskill performance.▶Imagine getting the good news: You passed! Imagery is a powerful tool to encouragesuccess.Find a quiet location each day where you can concentrate and review your notes, textbooks,CDs/DVDs, this review book, and any other helpful materials. A good plan is to review for aminimum of two hours each day. Studying in a group is helpful.Testing ReadinessAnswering practice questions at the end of each chapter in this text is one of the best strategiesyou can use to prepare for success on the WE. For the difficult questions, refer to the textbookand study that content. Pay particular attention to the Exam Alerts as well. Through review ofmissed practice test items, you might see a pattern of difficulty; for example, medical asepsis.If so, study that chapter in your textbook or other resource. Repeat those questions afterfurther study to see how you progress. Keep repeating the process until you become moreconfident in your knowledge. Remember, answeringeveryquestion correctly is not a realisticexpectation. To successfully pass the WE, however, you must have sufficient knowledge abouta variety of subjects. Use the test outline in the Introduction to help you prioritize the timeyou spend in reviewing the content. For example, if 35% of the examination covers nursingskills, spend more time reviewing that category than, say, legal/ethical aspects of care, whichcover only 3% of the exam.Another activity to help measure your testing readiness is to use Appendix A, “NursingAssistant Test Cross-Reference.” The appendix refers you to the questions in PracticeExaminations I, II, and III that match the exam category. Review your score on the questionsasked in each category to see which category requires the most study. Using the same exampleof medical asepsis, review your responses to questions in the Practice Examinations deal-ing with basic nursing skills. Pay particular attention to those questions that measure yourknowledge of medical asepsis and the rationales for the correct response. Next, thoroughly

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Taking the Written Examination5review Chapter 4, “Promotion of Function and Health of Residents,” and Chapter5,“Specialized Care.” Make flash cards of all terms in the chapters and use them to test yourrecall of the correct definitions (write the key term on one side of a note card and place thedefinition of the term on the back of the card). Repeat the drill until you can easily recallthe terms. Continue to use Appendix A as a reference for further review of each category inthe practice examinations to ensure that you do not omit any area in preparing for the exam.Finally, repeat all practice examinations (total of 225 questions) until you score at least 80% ofthe questions correctly. Earning a score less than 80% means you need further study.Use the sample 30-day review plan that follows to help organize your study time and increaseyour knowledge and confidence in being ready for the exam.Four Weeks Before the ExamReview your score on Practice Exam I. Mark those questions you missed according to thecategories listed in Appendix A. Read and make notes on the chapters that help answer thosemissed questions. Make flash cards of all terms in those chapters, paying particular attention tothe terms included in the questions you missed and those for which you have more difficultyremembering. After you read, study, and drill the flash cards, repeat the self-assessment prepquestions at the end of the chapters; repeat Practice Exam I.Three Weeks Before the ExamReview your score on Practice Exams II and III. Mark those questions you missed accordingto the categories listed in Appendix A. Read and make notes on the chapters that help answerthose missed questions. Make flash cards of all terms in those chapters, paying particular atten-tion to the terms included in the questions you missed and those that you have more difficultyremembering. After you read, study, and drill the flash cards, repeat the self-assessment prepquestions at the end of the chapters. Repeat Practice Exams II and III.Two Weeks Before the ExamReview all basic nursing skills included in Chapters 2–5, paying particular attention to directand indirect care activities and their rationales. Review Chapter 6, “Clinical Skills PerformanceChecklist.” Study the checkpoints for each skill until you are comfortable with them. Practiceeach skill with a partner, including each checkpoint and critical step, until you feel comfortable.One Week Before the ExamReview your notes on each chapter, all self-assessment prep questions, and both practiceexaminations again. Reduce your flash cards to those terms included in the missed questions,and complete another drill on those terms.Review all instructions given to you by the testing center to ensure your understanding ofwhere to report for the exam, what to bring (especially personal identification), and otherdirections.

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6Chapter 1: What You Need to Know to Prepare for the ExamTwo Days Before the ExamContact the testing center if you have any questions concerning directions or other concerns.Make secure travel arrangements. If long-distance travel is necessary, plan to arrive a day earlyor, if not possible, at least two hours earlier than the scheduled testing time to be sure you findthe testing center location without delay.One Day Before the ExamStudy the Exam Cram page in this book, and take the page with you to the testing center site.Review the test tips and other preparation discussion in this chapter. Eat a light dinner andavoid alcohol, sleeping pills, or other drugs that might cause drowsiness or affect your think-ing. Get at least eight hours of sleep. Follow the testing center’s directions regarding dressor, if none available, dress comfortably in clean, tidy scrubs. Record the telephone number ofthe testing center in a safe, readily accessible place in the event you might need to contact thecenter on testing day. Prepare a snack to have on hand during testing. Make sure your personalID and other required materials are ready. Set your clock to arrive early for the examination.Day of the ExaminationEat a hearty but well-balanced breakfast. Drive safely to the testing center and arrive early soyou can become familiar and more comfortable with the environment. Try to relax! You’reprepared to pass!Pay particular attention to Exam Alerts and the Cram Sheet in this book for last-minute,just-in-timepreparation. Thebetterpreparedyouare, thelessstressfulyouwillfeel.Overpreparation is a good thing!Testing StrategiesTest-taking is a skill you can learn. Based on teaching experience, those students who use test-taking techniques are more likely to succeed on their examinations. The strategies suggestedhere are in no way a substitute for thorough knowledge of the subject matter. If you study thereview materials thoroughly and practice using the suggested strategies wisely while applyingyour knowledge, you can successfully pass the exam. Remember the mantra: Practice, Practice,and Practice!Answering the QuestionsThe following terms help describe the key parts of a test question, commonly calledtest items:▶Test item:The question and the answer options (all possible answer choices).▶Options:All possible answers to a particular question.▶Stem:The part of the test item that asks a question or states a problem.

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Taking the Written Examination7▶Multiple-choice test item:A question offering four options. Test items are designedto measure your knowledge, attitude, or ability, not to trick you. With the multiple-choice test item, it is possible that you might not like the question or any options in theitem. However, you must choose the best option available and answer the question inthe best way you can.Follow these strategies (Testing Now Tips [TNTs]) for success in answering test questions.▶Take your time:A common problem observed in test-takers is failing to read eachquestion carefully. You might already be thinking of the right answer (option) beforeyou finish reading the question in its entirety. Slow down and force yourself to fin-ish reading the question before you select the option; you might be surprised that theend of the stem contains the most important information needed to select the correctoption you would have otherwise missed by hurrying to record your answer. In otherwords, take your time!▶In your own words:Rethinking the question and answers in your own mind helps youtranslate the intent of the question, or what the question is asking and how you wouldanswer it in words that mean the most to you. After you’ve done so, look for the optionthat is closest to the one you thought about; ask yourself whether that option is thebest one available of the four provided. If so, go for it!▶Stay under the umbrella:Two or more options might be similar and, in your opinion,part of the answer; however, you can choose only one option. If this occurs, look foran option that contains a broader choice, anumbrella term, which includes those simi-lar options and best answers to the question. For example, if the question asks you tomeasure the resident’s physical status, you would not select option A (temperature) noroption B (pulse), nor option C (blood pressure), but option D (vital signs) that includesthe other options.▶Key into key terms:Very few absolutes occur in patient care, especially when select-ing the best test option. These answers are seldom, if ever correct. For that reason,look for key words in the options such asalways, never, all, only, most, none, every, andexcept. If part of the option, choose another one!▶Opposites attract:Look for opposite options; usually, one of them is correct.Example:Question:When washing the perineum of the female resident, in which directionshould the washcloth be applied?A.From the front to the back of the perineumB.From the middle of the perineum to the top of the perineumC.From any direction as long as the washcloth is wet and warmD.From the back of the perineum to the front

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8Chapter 1: What You Need to Know to Prepare for the ExamOption A is the correct answer. Option D is opposite from option A; thus, one of the twooptions is most likely the intended correct answer.▶Feelings, feelings, feelings:When answering a communication-type question or onerequiring a response, choose the option that acknowledges or deals with the resident’sfeelings.Example:Question:A resident is upset and crying over being admitted to the nursing home. Howshould the nurse aide respond?A.Tell the resident that this is normal and not to be upset.B.Leave the resident alone to cry in private.C.Change the subject to help the resident forget her current situation.D.Sit with the resident and allow her to talk about her feelings.Option D is the correct option because it acknowledges and focuses on the resident’sfeelings.▶Safety first:If a test item asks you for an immediate response or for deciding what todo first, choose the option that protects the resident’s safety or well-being. Look forcues in the question that describe priority actions you would take; for example, “Thefirstthing the nurse aide would do is”; “themost importantstep the nurse aide wouldtake is to…”; “thebestaction the nurse aide should take is to…”, “which of the follow-ing is the nurse aide’sbestresponse?”, and so on.▶Remember the face value:Avoid reading too much into the test item. You might betempted to remember a particular work-related or resident experience or situationthat was very different from the test option you encounter. Read the item at face value,selecting the best option from the information presented.▶When all else fails, choose option C:You will encounter questions for which you haveno idea of the answer. If so, and all of the preceding listed strategies fail, give it yourmost educated guess. No evidence exists that choosing option C is the best strategy. Thepoint is, you will not be penalized for guessing, only for not selecting any answer at all.With a multiple-choice question, you have four chances to answer it correctly.Taking the Clinical Skills TestThe Clinical Skills Test (CST) is the competency validation portion that most certified nurse-aide candidates dread; it is nerve racking to perform skills in front of a strange skills evaluator.A key to success on this test is, once again, to practice at least two hours each day. Revieweach skill you’ve learned so that when the performance test day arrives, you can consider itjust another practice day…only for real. Practice helps build confidence; confidence decreasestest anxiety.

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Exam Prep Questions9Speaking of real, you might be required to bring along someone who can serve as the clinicalactor/resident on whom you will perform selected nursing skills. Your testing actor/residentwill be briefed prior to the skills examination. Each procedure will be selected by the skillsevaluator. Within a specified time limit, around 30–45 minutes, you will perform at least threeprocedures selected from a pool of 25–30 skills. Each selected procedure will be evaluatedand scored according to a skills performance checklist. Although you are not expected toperform each skill perfectly, you mustnotomit a critical step or key checkpoint of the skill,often noted with an asterisk. A critical step is defined as a step within a procedure that ensuressafety of the resident (or yourself), which includes infection control. You can perform steps ina procedure out of sequence as long as infection control or another physical safety principle isnot compromised. In most cases, the evaluator will not talk to you during the procedure. He/she may show you where supplies are kept and assign the skill to be performed, but, after thetesting begins, the evaluator will not talk to you. The silence may be unnerving and increaseyour anxiety. Consider the silence “golden,” in that it allows you to concentrate and performwithout interruption. If you need to adjust to the silence, practice with a friend who acts as theevaluator and stress that you must have complete silence during your practice.Another important tip regarding anxiety: BREATHE…deeply and slowly. Deep breathing willhelp calm your nerves and allow you to concentrate.Self-AssessmentBefore moving on to the remaining chapters of the book, complete the self-assessment ExamPrep Questions that follow to give you a baseline for focus in the upcoming chapters. Seehow well you recall information as you answer each question. The answer key and rationalesare provided for immediate feedback. If you score 75% or better, congratulate yourself andbegin reading the chapters with a smile. If you score less than 75%, congratulate yourself forcompleting the first step in your review journey with an honest appraisal of your knowledge,the “before” in your test readiness. Now, you can use the Exam Prep Questions as a beginning;subsequent questions at the end of each chapter and a mock written examination serve as the“after” story of your progress in preparing for the real exam. Good luck! Let’s get started!Exam Prep Questions1.The nursing assistant can help prevent tooth decay by assisting residents to brush their teeth howoften?❍A.At least once a day❍B.Once in the morning and once in the evening❍C.In the morning and then after each meal❍D.Three times at least three hours apart

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10Chapter 1: What You Need to Know to Prepare for the Exam2.The first step in preventing the spread of germs is which of the following?❍A.Covering of the resident’s mouth when sneezing❍B.Handwashing❍C.Keeping the living area clean❍D.Emptying the trash every dayNotice the priority given in this question, that is, thefirststep. First steps often mean what you do to keepthe patient safe.TIP3.All of the following are examples of the Patients’ Bill of Rights except the right to which of thefollowing?❍A.Privacy and dignity❍B.Confidentiality❍C.Accept or refuse treatment❍D.Low-cost care4.Which of the following members of the health-care team is responsible for prescribing medical care?❍A.Nurse❍B.Physician or nurse practitioner❍C.Social worker❍D.Nurse assistant5.When the resident requests pain medication, but the nurse appears busy, what is the appropriateaction of the nursing assistant?❍A.Report the request for pain medication to the nurse immediately.❍B.Report the request for pain medication to the nurse when he or she appears less busy.❍C.Tell the resident to wait for the pain medication until the pain is worse.❍D.Tell the resident to call the nurse herself and request the pain medication.6.The steps used to rescue a conscious choking victim that cannot cough, speak or breathe beginswith❍A.back blows❍B.CPR❍C.Arm elevation❍D.Abdominal thrust

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Exam Prep Questions117.An observation of warmth and redness to the resident’s elbow is reported as which of the following?❍A.Jaundice❍B.Edema❍C.Inflammation❍D.Cyanosis8.The correct statement regarding religious beliefs of residents is which of the following?❍A.Residents should not be concerned about religious beliefs.❍B.Each resident has a right to his or her own religious beliefs.❍C.The staff may force residents to believe as they do.❍D.Staff or residents are not to discuss religious beliefs.Resident rights always take priority in the nursing home setting.EXAM ALERT9.Which of the following residents has the greatest risk for falling?❍A.The resident who has difficulty with balance❍B.The hearing-impaired resident❍C.The resident who uses a cane to ambulate❍D.The resident who often has visitorsThe previous question lists four residents at risk for falling; you must select the best choice.TIP10.Which of the following is appropriate for a nursing assistant working in a long-term care facility?❍A.Preparing and administering tube feedings for a resident who is on aspirationprecautions❍B.Changing linens of an incontinent resident❍C.Applying splints of a resident who has had a stroke❍D.Changing the intravenous tubings of a resident receiving medicationRemember your job duties and limitations in order to practice safely and legally according to thestate’s practice rules for nursing assistants.EXAM ALERT

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