So, you've made it through Nursing Assistant classes and you're now waiting to take the State exam to recieve your certification! While most students' experiences with taking the test vary slightly, the one thing everyone seems to have in common is nerves!
The test is made up of two parts, written and clinical. You will most likely be asked to bring someone with you to the test who will act as a 'model' for you to demonstrate your clinical skills on. The written portion of the test is mostly common sense. If you were given handouts or a book during your CNA classes, it would be a good idea to review. This website offers practice nursing assistant exam questions for many states.
The part of the test that most people dread is the practical part. Most people are very nervous, due to the fact that someone will be watching their every move. Keep in mind that the State examiner has done this countless times. He or she will know you are likely to be nervous and will take that into consideration, to some extent.
While taking the practical portion of the test, you will be asked to demonstrate anywhere from three to five Nursing Assistant skills. The following is a sample list of skills you may be asked to demonstrate, as well as important things to remember.
First of all, at the very beginning when you are asked to perform a skill, if you haven't already demonstrated handwashing proceed to the sink and follow the correct procedure for handwashing.
HAND WASHING: Let down some paper towel before beginning. Turn the water on and using a fair amount of soap, wash hands up to wrists and under fingernails for at least 20 seconds, which is approximately the time it takes to sing "Happy Birthday", twice. Wash thoroughly, including under the fingernails. (AVOID acrylic nails and other 'fake' nails, such as tips, which are not permitted anymore in most healthcare settings due to the fact that they harbor germs.) Tear off paper towel, dry hands and use the paper towel to turn off water. Although these steps may seem detailed and petty, the examiner will be watching for each of them, so don't cut corners! Another tip; keep fingernails trimmed. Long nails harbor germs!
PRIVACY: Before performing any skills, BE SURE TO KNOCK ON THE PATIENT'S DOOR BEFORE ENTERING THE ROOM! When I took my test, we started in the bathroom with the handwashing task, so just to be sure I covered all my bases, as we were leaving the bathroom to approach my 'patient', I knocked on the bathroom door as I came out and mentioned to the examiner that if I were entering the room from the hallway, I would knock on the door first.
Another important step they will be looking for, ALWAYS PULL THE PRIVACY CURTAIN CLOSED WHEN PERFORMING CARE! Which brings me to the issue of dignity.
DIGNITY: As mentioned above, always be sure to knock before entering, and pull the privacy curtain closed to ensure privacy. Additionally, before performing care, introduce yourself and be sure to announce each step to the 'patient' before you do it. (ex: "Now I'm going to turn you over on your side.") Speak to the patient in a dignified manner. Avoid common terms of endearment such as "HONEY", "DEAR", "SWEETY" etc. Although as CNA's we often fall into the habit of calling our patients by these names, the State examiner will consider it undignified and unprofessional.
SAFETY: In addition to privacy and dignity, safety is also a crucial element of hands on care. These three concepts will follow you throughout your Nursing Assistant career and they are reinforced every day, on the job.
The state examiner will be watching your safety awareness during your test.
ALWAYS apply a gait belt when performing a transfer, for the safety of both the patient and yourself (This applies on the job, as well...despite what many CNA's will tell you. Don't take shortcuts that could cause potential harm).
If you raise the bed up to perform care, ALWAYS be sure to put it all the way down again, when you are finished.
ALWAYS BE SURE THE CALL LIGHT IS WITHIN REACH OF THE PATIENT, paying special attention to those with a unilateral deficiency. (for example, make it a point to place the call light on a stroke patient's dominant side).
ALWAYS lock the wheels of a wheelchair before helping a patient into or out of the chair.
A few things to remember:
~Wash your hands!! Be sure to wash your hands before and after contact with your patient.
~Be sure you put gloves on before performing any kind of care that would require gloves (contact with body fluids).
~The State examiner will be very aware of your attention to the patient's dignity, privacy and safety.
~Think through what is being asked of you. If the State examiner tells you that your 'patient' is a stroke victim with left sided paralysis, then he/she tells you to get them out of bed, think, which side will they transfer to? Where will you put the wheelchair? (*Always be sure to lock the wheelchair and always use a gait belt with transfers!)
Some skills that the State examiner may ask you to demonstrate:
GIVING A BEDPAN: Be sure to put it in the right way! (Remember you will most likely be nervous!) Remember to pull the privacy curtain, roll the head of the bed up slightly (or however you learned it in CNA classes), leave the patient with a roll of toilet paper and leave the call light within reach. Ask if they are comfortable, tell the patient you will be back to check on them and tell them they can ring the call light when they are finished. Leave the privacy curtain around the patient. When you come back, knock before entering and be sure to give the patient the opportunity to wash their hands.
REPOSITIONING A PATIENT IN BED: Tell the patient you are going to roll them BEFORE you do it. Be sure the siderails are up for safety! (*if the patient doesn't have an order for siderails, be sure to put the siderails down before leaving)Try to roll gently and smoothly. Once the patient is repositioned, place a pillow or neatly folded pad or blanket between their knees for comfort. Be sure the pillow under their head looks straight and comfortable, and straighten out the covers. Place the call light within reach (the call light is VERY important--always be sure it is within reach!) Ask if the patient is comfortable before leaving.
GROOMING: You may be asked to comb your patient's hair, or clean their fingernails. If you are asked to comb their hair, I suggest that you first ask them, "How do you like your hair?" A girl in my CNA class failed the entire exam for not asking that simple question.
TAKING A TEMPERATURE: This is pretty straightforward. If you're using an oral thermometer (and be sure it IS an oral thermometer. If the end is red, it is a rectal thermometer!)
Gently shake down the mercury before beginning, to ensure an accurate reading. 98.6 is 'normal', although some people will regularly run higher or lower.
OCCUPIED BED, COMPLETE BED CHANGE: Try to keep patient covered as much as possible. DO NOT THROW DIRTY LINEN ON THE FLOOR AT ANY TIME! Be sure the siderail is up on whicever side the patient is being turned towards.
You will typically be told at the end of the exam whether or not you passed. Different states have different rules as to how many times and how often a person can re-take the test, so if you don't pass the first time, ask about taking it again.
Good luck to all who will be taking the Nursing Assistant test in the future! It's the beginning of a very rewarding and fulfilling career.
