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CNA Certified Nursing Assistant Exam Study Guide

Key concepts, definitions, and exam tips organized by topic.

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Basic Nursing Skills – CNA Exam Study Guide


Overview

This study guide covers the essential knowledge areas tested on the CNA (Certified Nursing Assistant) exam, including vital signs measurement, personal care and hygiene, patient positioning and mobility, infection control, and patient safety and rights. Mastering these core competencies ensures safe, competent, and compassionate patient care. Use this guide alongside your flashcards for maximum retention.


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Table of Contents

1. [Vital Signs](#vital-signs)

2. [Personal Care & Hygiene](#personal-care--hygiene)

3. [Positioning & Mobility](#positioning--mobility)

4. [Infection Control](#infection-control)

5. [Safety & Patient Rights](#safety--patient-rights)

6. [Quick Review Checklist](#quick-review-checklist)


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Vital Signs


Overview

Vital signs are the body's most basic measurable indicators of health status. CNAs are responsible for accurately measuring, recording, and reporting vital signs. Knowing normal ranges and when to escalate findings is critical.


Normal Adult Ranges at a Glance


| Vital Sign | Normal Adult Range |

|---|---|

| Heart Rate (Pulse) | 60–100 beats per minute |

| Temperature (Oral) | 97.6°F–99.6°F (36.5°C–37.5°C) |

| Respiratory Rate | 12–20 breaths per minute |

| Blood Pressure | 90/60–120/80 mmHg (typical) |


Temperature Measurement Sites

  • • Oral: Standard route for alert, cooperative adults
  • • Rectal: Most accurate core body temperature; approximately +1°F higher than oral
  • • Axillary: Least accurate; approximately -1°F lower than oral
  • • Tympanic/Temporal: Convenient but less precise than rectal

    • > Key Relationship to Remember:

    > Axillary → Oral → Rectal

    > Each step increases by ~1°F

    > Example: Axillary 98.6°F = Oral 99.6°F = Rectal 100.6°F


    Blood Pressure

  • • Systolic = pressure when the heart contracts (top number)
  • • Diastolic = pressure when the heart relaxes (bottom number)
  • • Report immediately: ≥180/110 mmHg (hypertensive crisis) or <90/60 mmHg (hypotension)

    • Respiratory Rate – Special Technique

    Count respirations without the patient's knowledge by:

  • • Keeping fingers on the wrist as if still counting the pulse
  • • Observing chest rise and fall for one full minute (or 30 seconds × 2)
  • • Patients who know they are being observed may unconsciously alter their breathing pattern

    • Key Terms

  • • Tachycardia – Heart rate >100 bpm
  • • Bradycardia – Heart rate <60 bpm
  • • Tachypnea – Respiratory rate >20 breaths/min
  • • Bradypnea – Respiratory rate <12 breaths/min
  • • Hypertension – Blood pressure consistently >130/80 mmHg
  • • Hypotension – Blood pressure <90/60 mmHg
  • • Apical pulse – Pulse measured directly over the heart with a stethoscope (used when radial pulse is irregular)

    • ⚠️ Watch Out For

  • • Axillary vs. rectal conversions are a frequent exam question — memorize the +1°F/-1°F rule
  • • Never report and wait — abnormal vital signs must be reported to the nurse immediately
  • • Counting respirations for only 15 seconds and multiplying by 4 is less accurate; prefer 30 or 60 seconds
  • • Do not take blood pressure on an arm with an IV line, dialysis access, or mastectomy side

    • ---


    Personal Care & Hygiene


    Overview

    Personal care maintains patient dignity, prevents infection, and promotes comfort. CNAs must follow proper technique and sequence to minimize the spread of microorganisms and protect vulnerable patients.


    Bed Bath Order – Clean to Dirty

    Always wash from the cleanest area to the dirtiest area:

    1. Face

    2. Arms

    3. Chest

    4. Abdomen

    5. Legs

    6. Back

    7. Perineal area last


    > This order prevents transferring microorganisms from the perineal area to cleaner body parts.


    Safe Water Temperature

  • • 105°F–115°F (40.5°C–46°C) for baths and peri-care
  • • Always test temperature with a thermometer or your wrist
  • • Always confirm comfort with the patient before proceeding
  • • Never assume water temperature is safe — patients may have reduced sensation

    • Perineal Care (Female Patients)

  • • Always wipe front to back (urethra → anus)
  • • Use a clean stroke for each wipe — never wipe back to front
  • • Purpose: Prevents fecal bacteria (e.g., E. coli) from entering the urinary tract and causing UTIs

    • Oral Care for Unconscious Patients

  • • Perform every 2 hours
  • • Prevents: drying, oral infections, and aspiration pneumonia
  • • Position patient on their side to prevent aspiration
  • • Use oral swabs rather than a toothbrush for unconscious patients
  • • Suction equipment should be readily available

    • Denture Care

    | Action | Order |

    |---|---|

    | Inserting | Upper denture first, then lower |

    | Removing | Lower denture first, then upper |

  • • Handle over a basin of water or folded towel to prevent breakage if dropped
  • • Store in labeled container with cool water or denture solution (never hot water — warps dentures)

    • Special Patient Considerations

  • • Diabetes / Circulatory disorders: Require a nurse's assessment before nail care — high risk for infection and impaired wound healing
  • • Hearing aids: Remove before hair care to prevent water damage or snagging
  • • Fragile skin: Pat dry rather than rubbing; avoid friction

    • Key Terms

  • • Perineal care (peri-care) – Cleansing of the genitalia and surrounding area
  • • Oral mucosa – Moist lining of the mouth; deteriorates quickly in unconscious patients
  • • Aspiration – Inhalation of foreign material (e.g., secretions, food) into the lungs

    • ⚠️ Watch Out For

  • • The exam frequently tests perineal care direction — always front to back for females
  • • Diabetic nail care is a classic high-risk scenario — always get nurse clearance first
  • • Oral care frequency for unconscious patients (every 2 hours) is commonly tested
  • • Water temperature that is too hot can cause scalding — always verify before use

    • ---


    Positioning & Mobility


    Overview

    Proper positioning prevents pressure injuries, maintains circulation, supports respiratory function, and ensures patient comfort. CNAs must understand when to use each position and how to safely assist with patient movement.


    Common Patient Positions


    | Position | Description | Primary Use |

    |---|---|---|

    | Fowler's | HOB elevated 45°–60° | Eating, general comfort, post-procedure |

    | Semi-Fowler's | HOB elevated 15°–30° | Mild respiratory difficulty, rest |

    | High Fowler's | HOB elevated 90° | Respiratory distress — maximizes lung expansion |

    | Supine | Flat on back | Post-surgical recovery, general rest |

    | Prone | Lying face down | Back care, pressure relief on posterior |

    | Lateral (Side-lying) | On either side | Repositioning, preventing pressure ulcers |

    | Sim's (Semi-prone) | Left side, right knee bent forward | Enemas, rectal exams, peri-care |

    | Trendelenburg | Flat, feet elevated above head | Shock (less common today; requires order) |


    Repositioning Schedule

  • • Reposition immobile patients every 2 hours
  • • Purpose: Relieve prolonged pressure on bony prominences to prevent pressure injuries (bedsores/pressure ulcers)
  • • Common bony prominences at risk: heels, sacrum, coccyx, hips, elbows, shoulder blades, back of head

    • Transferring Patients – Bed to Wheelchair

  • • The stronger (unaffected) leg leads when the patient stands
  • • Position the wheelchair on the patient's stronger side
  • • Lock wheelchair wheels before transfer
  • • Use a gait belt for safety
  • • Never grab the patient by their arms or under the axilla — risk of shoulder injury

    • Logrolling

  • • Definition: Turning the patient's body as one rigid, aligned unit
  • • Purpose: Maintain spinal alignment in patients with suspected or confirmed spinal injuries
  • • Requires at least two staff members; one supports the head and directs the movement
  • • Never twist or bend the patient's spine during the turn

    • Body Mechanics for CNAs

    Follow these principles to protect yourself and the patient:

    1. Keep your back straight

    2. Bend at the knees, not the waist

    3. Keep the load close to your body

    4. Use leg muscles to do the lifting

    5. Keep feet shoulder-width apart for a stable base

    6. Avoid twisting — pivot with your feet instead

    7. Ask for help when needed — never attempt a move alone if unsafe


    Key Terms

  • • Bony prominence – Area where bone is close to the skin surface; most vulnerable to pressure injury
  • • Pressure injury/ulcer – Localized skin damage caused by prolonged pressure, friction, or shear
  • • HOB – Head of Bed (elevation described in degrees)
  • • Gait belt – Safety belt placed around the patient's waist to assist with transfers and ambulation
  • • Contracture – Permanent shortening of muscles or joints due to prolonged immobility

    • ⚠️ Watch Out For

  • • High Fowler's vs. Fowler's angles are commonly confused on exams — know the exact degree ranges
  • • For stroke patients, the affected (weaker) side receives more support but the stronger side leads during standing
  • • Logrolling is exclusively for spinal injury patients — do not use it routinely
  • • The purpose of 2-hour repositioning is specifically pressure ulcer prevention, not just comfort

    • ---


    Infection Control


    Overview

    Infection control is one of the most heavily tested areas on the CNA exam. CNAs serve as the frontline defense against healthcare-associated infections (HAIs). Proper hand hygiene, PPE use, and understanding of isolation precautions are essential.


    WHO's Five Moments for Hand Hygiene

    1. Before touching a patient

    2. Before a clean or aseptic procedure

    3. After body fluid exposure risk

    4. After touching a patient

    5. After touching patient surroundings


    > Memorize these in order — they are frequently tested exactly as listed.


    Handwashing Technique

  • • Scrub with soap and water for at least 20 seconds
  • • Cover all surfaces: palms, backs of hands, between fingers, thumbs, and under nails
  • • Rinse with water flowing away from clean hands (fingertips down)

    • Hand Hygiene Decision Guide


    | Situation | Use |

    |---|---|

    | Hands not visibly soiled | Alcohol-based hand rub (ABHR) |

    | Hands visibly dirty or soiled | Soap and water |

    | After caring for C. difficile patient | Soap and water only (ABHR is ineffective against C. diff spores) |

    | Before eating | Soap and water |


    Medical vs. Surgical Asepsis


    | Type | Also Called | Goal |

    |---|---|---|

    | Medical asepsis | Clean technique | Reduce and prevent spread of microorganisms |

    | Surgical asepsis | Sterile technique | Eliminate ALL microorganisms and their spores |


  • • CNAs most commonly use medical asepsis
  • • Surgical asepsis is used for invasive procedures (wound care with sterile dressing, catheter insertion)

    • Isolation Precautions & Required PPE


    | Precaution Type | Diseases/Conditions | Required PPE |

    |---|---|---|

    | Standard | All patients, always | Gloves; add gown/mask as needed |

    | Contact | MRSA, VRE, C. diff | Gloves + Gown before entering room |

    | Droplet | Influenza, COVID-19, meningitis | Surgical mask within 3 feet |

    | Airborne | TB, measles, chickenpox | N95 respirator + negative pressure room |


    Donning (Putting On) PPE Order

    1. Gown

    2. Mask or respirator

    3. Eye protection/face shield

    4. Gloves


    Doffing (Removing) PPE Order – Most Contaminated to Least

    1. Gloves (most contaminated)

    2. Gown

    3. Mask/respirator

    4. Eye protection

  • • Perform hand hygiene after each step

    • > Think: "GORE" for donning (Gown, goggles/eye protection, Respirator/mask, gloves) and reverse for doffing, removing gloves first.


    Key Terms

  • • HAI (Healthcare-Associated Infection) – Infection acquired in a healthcare setting
  • • PPE (Personal Protective Equipment) – Protective gear worn to prevent exposure to infectious agents
  • • Asepsis – Absence of disease-causing microorganisms
  • • Pathogen – Disease-causing microorganism
  • • C. difficile (C. diff) – Spore-forming bacterium requiring soap-and-water handwashing; causes severe diarrhea
  • • MRSA – Methicillin-resistant Staphylococcus aureus; requires contact precautions

    • ⚠️ Watch Out For

  • • C. difficile is the classic exception — alcohol-based rubs do NOT kill its spores; only soap and water works
  • • PPE doffing order is critical — removing gloves first prevents transferring contaminants during removal of other PPE
  • • Contact precautions require both gloves AND gown — gloves alone are not sufficient
  • • The five moments for hand hygiene are tested in exact order — memorize all five

    • ---


    Safety & Patient Rights


    Overview

    Patient safety and legal/ethical rights form the foundation of CNA practice. CNAs must know how to respond to emergencies, respect patient autonomy, and follow legal obligations including HIPAA.


    Fall Response – Priority Actions

    When a patient is found on the floor:

    1. Do NOT move the patient (risk of worsening an injury)

    2. Call for the nurse immediately

    3. Stay with the patient — provide reassurance and monitor for injury

    4. Complete an incident report as directed by the nurse


    Fire Safety – RACE

    | Letter | Action |

    |---|---|

    | R | Rescue – Remove patients in immediate danger |

    | A | Alarm – Activate the fire alarm |

    | C | Contain – Close doors and windows to contain the fire |

    | E | Extinguish/Evacuate – Use extinguisher if safe; otherwise evacuate |


    Fire Extinguisher – PASS

    | Letter | Action |

    |---|---|

    | P | Pull the pin |

    | A | Aim at the base of the fire |

    | S | Squeeze the handle |

    | S | Sweep side to side |


    > Always aim at the base of the fire, not the flames — extinguishing the fuel source stops the fire.


    Patient Identifiers

  • • Use two identifiers before any care procedure
  • • Examples: full name + date of birth, or name + ID bracelet number
  • • Purpose: Prevents medical errors — ensuring the right patient receives the right care

    • Restraints

  • • Physical restraints require a physician's order and informed consent
  • • CNAs must never apply restraints without an order
  • • When restraints are in use, check the patient every 2 hours (or per facility policy) for:

    • - Circulation

    - Skin integrity

    - Repositioning needs

    - Toileting needs

  • • Restraints should be the last resort after all alternatives are exhausted

    • HIPAA & Patient Confidentiality

  • • HIPAA (Health Insurance Portability and Accountability Act) protects patient health information
  • • Do NOT share patient information with:

    • - Family members (

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