Learn Nursing assistant (CNA) knowledge from scratch
1The nursing assistant’s role and the residents’ rights
A nursing assistant (often called a CNA or nurse aide) gives hands-on daily care: bathing, dressing, toileting, feeding, moving residents and measuring vital signs. The work is assigned and supervised by a licensed nurse.
The written knowledge exam checks that you know where your role ends. As a rule, nursing assistants do not:
- give medicines, or change oxygen flow rates or IV settings;
- insert or remove tubes, or do sterile procedures;
- take orders from a doctor directly, or explain diagnoses and test results;
- do a task they have not been trained for. Say so, and ask the nurse for training or help.
When you are unsure, ask the nurse. When a task is outside your scope, decline politely and explain why.
Residents keep their rights in a care facility: privacy and confidentiality, making their own choices (clothes, routines, food), refusing care, keeping personal belongings, voicing complaints without fear, and being free from abuse and from restraints that are not needed.
Abuse can be physical, verbal, psychological, sexual or financial, and includes involuntary seclusion and neglect. You must report suspected abuse or neglect immediately to the nurse or supervisor. You do not need proof, and you do not investigate yourself.
Self-check A resident refuses a bed bath. What should the nursing assistant do?
- Ask the roommate to persuade the resident
- Give the bath anyway, because it is on the care plan
- Respect the refusal, ask why, offer another time or option and tell the nurse
- Skip the bath and leave it out of the report
Answer: Respect the refusal, ask why, offer another time or option and tell the nurse. Residents have the right to refuse care. Asking why often solves the problem (the room is cold, the resident is in pain), and the nurse must know about the refusal. Forcing care can be abuse.
2Infection control and safety
Hand hygiene is the most important way to stop infections. With soap and water, rub for at least 20 seconds with the fingertips pointing down, and turn off the faucet with a clean paper towel. Use soap and water when hands are visibly dirty and for C. difficile; otherwise alcohol hand rub works well.
Standard precautions apply to every resident: gloves for contact with body fluids, a gown or eye protection if splashes are likely, and safe disposal of razors and other sharps. Gloves never replace hand hygiene.
Carry used linen away from your uniform, never shake it and never put it on the floor.
Body mechanics protect your back: feet about shoulder-width apart, bend the knees and hips, keep the load close and do not twist. Ask for help, or use the lift the care plan names.
Safety habits after every care task: bed in the lowest position with the wheels locked, call light within reach, non-slip footwear, a clear path.
Restraints need a doctor’s order and are a last resort. Try alternatives first, such as toileting schedules, frequent checks and activities. A restraint in use is checked often and released at least every 2 hours to reposition the resident, offer the toilet and fluids and check the skin.
Emergencies: a choking adult who cannot speak or cough needs abdominal thrusts; if they become unresponsive, lower them to the floor, call for help and start CPR. For fire, remember RACE (Rescue, Alarm, Contain, Extinguish or Evacuate) and PASS (Pull, Aim at the base, Squeeze, Sweep).
Self-check Where is the call light left when the nursing assistant leaves the room?
- At the nurses’ station
- Clipped to the wall near the door
- In the bedside drawer
- Within the resident’s easy reach
Answer: Within the resident’s easy reach. A resident who cannot reach the call light may try to get up alone and fall. Leaving it within reach is part of every safety check at the end of care.
3Vital signs, intake and output
Learn these usual ranges for a resting adult (textbooks differ slightly; the care plan may give a resident’s own normal values):
- Temperature (oral) about 97.6–99.6 °F (36.5–37.5 °C). Rectal readings are about 1 °F higher and axillary readings about 1 °F lower.
- Pulse 60–100 beats per minute. Count an irregular pulse for a full minute.
- Respirations 12–20 per minute. Count them without telling the resident, for example while still holding the wrist.
- Blood pressure below about 120/80 mmHg. Support the arm at heart level, and do not use an arm with an IV line, a dialysis access or a cast.
- Pain: ask the resident; their own report is the best measure.
Intake is everything the resident drinks, plus foods that are liquid at room temperature (soup, ice cream, gelatin). Output is urine, vomit, liquid stool and drainage. Use 1 fl oz = 30 mL, and read a measuring container on a flat surface at eye level.
Weigh at the same time of day, on the same scale, in similar clothing, after the resident has urinated.
Always report a value that is clearly outside the normal range or far from the resident’s usual value.
Self-check A resident drinks an 8 oz cup of coffee. How many milliliters are recorded as intake?
- 120 mL
- 240 mL
- 300 mL
- 80 mL
Answer: 240 mL. One fluid ounce is 30 mL, so 8 × 30 = 240 mL. Recording 80 mL treats one ounce as 10 mL; 120 mL is the rule for ice chips, not for a drink.
4Daily care, positioning and skin
Bathing goes from clean to dirty: eyes first with plain water, from the inner to the outer corner. Female perineal care goes from front to back. Catheter tubing is cleaned from the urinary opening outward.
Dressing a resident with one-sided weakness: weak arm first when dressing, strong arm first when undressing. A cane is held on the strong side. Walk slightly behind the resident on the weak side, with a gait belt that is snug but has room for two fingers.
Transfers: place the wheelchair on the resident’s stronger side and lock the brakes. If a resident starts to fall, do not try to hold them up: widen your stance, pull them close with the gait belt and ease them to the floor.
Eating: sit the resident upright at about 90°, follow the ordered diet and liquid thickness exactly, and keep a resident with a swallowing problem upright for at least 30 minutes after the meal. Coughing or a wet voice while eating means stop and report.
Skin: reposition residents who cannot move themselves at least every 2 hours. Check the bony areas (tailbone, heels, hips, elbows). Report redness that does not fade, blisters or open skin; do not massage red areas.
A urinary drainage bag stays below the level of the bladder, attached to the bed frame and off the floor.
Self-check Which arm goes into the sleeve first when dressing a resident with right-sided weakness?
- Both arms together
- The arm closer to the nursing assistant
- The left arm
- The right arm
Answer: The right arm. Dress the weak side first and undress the strong side first. The right side is the weak side here, so the right arm goes in first.
5Dementia care, end of life and reporting changes
Dementia: approach from the front, speak calmly in short sentences, give one instruction at a time and keep a routine. Do not argue with the resident’s reality: respond to the feeling and redirect.
Wandering, rummaging and sundowning (more confusion late in the day) are common; respond with supervision and activity, never with seclusion or restraints that have not been ordered.
End of life: comfort care continues to the end, including mouth care, repositioning and clean, dry skin. Hearing is thought to be one of the last senses lost, so keep talking to the resident. Respect the family’s cultural and religious wishes, and know each resident’s code status, such as a DNR order.
Observe and report. Objective observations are what you see or measure; subjective ones are what the resident tells you, recorded in their own words. Report at once:
- chest pain, trouble breathing, or new confusion or drowsiness;
- signs of stroke (face drooping, arm weakness, speech problems) or low blood sugar (shaky, sweaty, pale, confused);
- falls, bleeding, vital signs far from normal, very low urine output;
- a sudden change from the resident’s usual eating, drinking, weight or behavior;
- any sign of abuse, neglect or injury.
Document only care you have actually given, after you give it. Correct a paper error with one line, your initials and the date.
6A worked example
Hard questions describe a situation and ask what the nursing assistant should do first. Try to choose the action before you open each step.
Worked exampleYou find Mrs Ortiz, who has diabetes, sitting on the floor of her bathroom. She is awake but pale and sweaty, and she says, “I’m fine, just help me up before the nurse sees.” What do you do?
1She is awake and breathing, so this is not a CPR situation. She may still be injured, and pale, sweaty skin in a resident with diabetes may mean low blood sugar.
2A hidden fracture or head injury is possible. Keep her still and comfortable, and do not lift her, even though she asks you to.
3Use the call light or call out for help. Stay with her; leaving her alone could lead to another fall or a missed emergency.
4Tell the nurse how you found her, that she is pale and sweaty, and her exact words. After the nurse has assessed her, help move her as directed and document the fall.
Answer Stay with the resident, keep her still, call the nurse at once and report your observations. The resident’s request does not change your duty to report a fall.
7How exam questions look
- Easy (key facts): normal vital signs, positions such as Fowler’s and Sims’, hand hygiene steps, types of abuse, measuring intake and output.
- Medium (doing the task right): how to count respirations, place a wheelchair, give mouth care to an unconscious resident or collect a urine specimen, and how to respond to a resident with dementia.
- Hard (scenarios): what to do first or what to report: a fall, choking, signs of a stroke, a possible abuse case, a request that is outside your scope.
For scenario questions, choose the answer that keeps the resident safe, respects their rights and gets the nurse involved. Beware of answers where the nursing assistant acts alone outside their role, keeps a secret or waits.
This practice covers the written (knowledge) part of nurse aide exams only. The skills test, where you perform care in front of an evaluator, has to be practised hands-on in your training program.
Self-check A resident tells you she has chest pressure but asks you not to bother the nurse. What do you do?
- Help her walk to see whether it eases
- Respect her wish and check again in an hour
- Stay with her and get the nurse immediately
- Write it down and report it at the end of the shift
Answer: Stay with her and get the nurse immediately. Chest pain may be a heart attack and must be reported at once, whatever the resident asks. Waiting or walking could make it worse.
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