← CNA Exam: Patient Care Skills

CNA Certified Nursing Assistant Exam Study Guide

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

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CNA Exam: Patient Care Skills — Comprehensive Study Guide


Overview

This study guide covers the essential patient care competencies tested on the CNA (Certified Nursing Assistant) exam. Topics include personal hygiene, positioning, vital signs, nutrition, infection control, and patient rights — the core skills required for safe, effective, and compassionate patient care. Mastery of these areas is critical not only for passing the exam but for protecting patient safety in clinical practice.


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Personal Hygiene & Grooming


Summary

CNAs perform hygiene tasks daily and must follow infection control principles throughout. The guiding rule is always clean to dirty — this principle applies to bathing, perineal care, and oral care. Special populations (e.g., diabetic patients) require modified approaches to prevent injury.


Key Concepts


#### Bed Bath Procedure

  • • Wash in order: face → arms → chest → abdomen → legs → perineal area last
  • • This sequence minimizes cross-contamination from dirtier areas to cleaner ones
  • • Change bath water when it becomes cool or dirty

    • #### Water Temperature

  • • 105°F–110°F (40.5°C–43.3°C) for baths and perineal care
  • • Always test with a thermometer or inner wrist before applying to patient
  • • Patients with reduced sensation (e.g., diabetics, spinal cord injuries) cannot reliably report discomfort — temperature testing is non-negotiable

    • #### Oral Care Frequency

  • • Every 2 hours for unconscious or fully dependent patients (reduces aspiration pneumonia risk)
  • • At least twice daily for all other patients
  • • Unconscious patients: position on their side to prevent aspiration during mouth care

    • #### Perineal Care — Female Patients

  • • Always wipe front to back (urethra to rectum)
  • • Prevents transfer of fecal bacteria to the urethra
  • • Reduces risk of urinary tract infections (UTIs)

    • #### Nail Care — High-Risk Patients

  • • Refer to a nurse or podiatrist for patients with:

    • - Diabetes mellitus

    - Circulatory disorders

    - Peripheral neuropathy

  • • These patients have poor healing and reduced sensation — even small cuts can lead to serious infections or amputation

    • #### Hair Washing (Bedridden Patient)

  • • Position: supine (on back), near the top of the bed
  • • Place a shampoo trough or waterproof pad under the head to direct water away from bedding

    • Key Terms

  • • Perineal care (peri-care): Cleaning of the genitalia and surrounding area
  • • Aspiration pneumonia: Lung infection caused by inhaling food, liquid, or secretions
  • • Peripheral neuropathy: Nerve damage causing reduced sensation, especially in extremities

    • Watch Out For

    > ⚠️ Common Pitfall: Never trim nails of diabetic or circulatory-impaired patients — this is a frequently tested boundary-of-practice question. The correct answer is always to refer to a nurse or podiatrist.


    > ⚠️ Common Pitfall: Oral care every 2 hours applies specifically to unconscious or completely dependent patients — not all patients.


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    Positioning & Mobility


    Summary

    Proper positioning prevents pressure ulcers, promotes respiratory function, and ensures patient comfort. CNAs must know specific positions by name, understand which pressure points are at risk, and use correct body mechanics to protect both the patient and themselves.


    Key Concepts


    #### Common Patient Positions


    | Position | Description | Angle / Notes |

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

    | Fowler's | Semi-sitting, head elevated | 45°–60° |

    | High Fowler's | Near upright | 60°–90° |

    | Semi-Fowler's | Slight head elevation | 15°–30° |

    | Supine | Flat on back | 0° |

    | Lateral (side-lying) | On side | Requires pillows for support |

    | Prone | On stomach | Rarely used; not appropriate for all patients |


    #### Repositioning Schedule

  • • Reposition bedridden patients at least every 2 hours
  • • Prevents ischemia (blood flow cutoff) to tissues, which leads to pressure ulcers

    • #### Lateral Position — Pressure Points at Risk

    In the side-lying position, monitor these bony prominences:

  • • Ear
  • • Shoulder
  • • Hip (greater trochanter)
  • • Knee (medial and lateral)
  • • Ankle (malleolus)
  • • Use pillows between knees and ankles to reduce pressure

    • #### Draw Sheet (Lift Sheet)

  • • Purpose: Reduces friction and shear on patient's skin during repositioning
  • • Allows two caregivers to move the patient more safely
  • • Never drag a patient across sheets — this causes skin tears and pressure injury

    • #### Wheelchair Transfer — Which Side?

  • • Place wheelchair on the patient's stronger (unaffected) side
  • • Patient uses the stronger side to bear weight and assist the transfer
  • • Lock wheelchair wheels and remove footrests before transfer

    • #### Body Mechanics for CNAs

  • • Keep back straight
  • • Bend at knees and hips, not the waist
  • • Keep load close to your body
  • • Use leg muscles (not back) to lift
  • • Avoid twisting — pivot with your feet instead

    • Key Terms

  • • Pressure ulcer (bedsore/decubitus ulcer): Skin breakdown from prolonged pressure on bony areas
  • • Shear force: Friction-like force when skin moves in opposite direction to underlying tissue
  • • Bony prominence: Area where bone is close to the skin surface (vulnerable to pressure injury)
  • • Body mechanics: The proper use of the body to prevent injury during physical tasks

    • Watch Out For

    > ⚠️ Common Pitfall: Students often confuse Fowler's (45–60°) with Semi-Fowler's (15–30°). Know the exact angles — they appear on both written and skills tests.


    > ⚠️ Common Pitfall: The wheelchair goes on the strong side, but during ambulation with a gait belt, the CNA stands on the patient's weak side (to provide support if they fall).


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    Vital Signs


    Summary

    Vital signs are objective measurements of basic body functions. CNAs must know the normal ranges for adults, understand when to report abnormal findings, and use correct technique to obtain accurate readings.


    Normal Adult Vital Sign Ranges


    | Vital Sign | Normal Range |

    |---|---|

    | Temperature (oral) | 97.6°F–99.6°F (36.5°C–37.5°C); average 98.6°F |

    | Pulse | 60–100 beats per minute (bpm) |

    | Respirations | 12–20 breaths per minute |

    | Blood Pressure | < 120/80 mmHg (normal); ≥ 130/80 mmHg = hypertension |


    Key Concepts


    #### Pulse

  • • Count for 60 seconds for accuracy (or 30 seconds × 2)
  • • Tachycardia: > 100 bpm
  • • Bradycardia: < 60 bpm
  • • Irregular pulse: Report immediately to the nurse — may indicate cardiac arrhythmia

    • #### Respirations

  • • Count without telling the patient — awareness of being observed causes people to unconsciously alter their breathing
  • • One respiration = one inhale + one exhale
  • • Tachypnea: > 20 breaths/min | Bradypnea: < 12 breaths/min

    • #### Blood Pressure

  • • Systolic (top number): Pressure when heart contracts
  • • Diastolic (bottom number): Pressure when heart rests
  • • Hypertension: ≥ 130/80 mmHg
  • • Hypotension: < 90/60 mmHg — report promptly

    • #### Oral Temperature — Patient Preparation

  • • Patient must wait 15 minutes after eating, drinking hot/cold liquids, or smoking
  • • These activities temporarily alter oral temperature readings

    • Key Terms

  • • Vital signs: Temperature, pulse, respirations, blood pressure (and pain — the "fifth vital sign")
  • • Hypertension: Elevated blood pressure ≥ 130/80 mmHg
  • • Arrhythmia: Irregular heart rhythm — requires immediate nursing notification
  • • Tachycardia / Bradycardia: Abnormally fast / slow pulse

    • Watch Out For

    > ⚠️ Common Pitfall: Never tell a patient you are counting their respirations — they will change their breathing pattern, giving you an inaccurate reading. Transition from counting the pulse directly to counting respirations without changing hand position.


    > ⚠️ Common Pitfall: Any irregular pulse, no matter the rate, must be reported immediately. This is non-negotiable and frequently tested.


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    Nutrition & Elimination


    Summary

    CNAs play a critical role in monitoring what patients eat and drink, assisting with feeding, and accurately recording intake and output. These tasks directly impact diagnosis, treatment decisions, and patient safety — especially for patients with swallowing difficulties or fluid management needs.


    Key Concepts


    #### Intake & Output (I&O)

  • • I&O = Intake and Output
  • • Monitors fluid balance, kidney function, and hydration status
  • • Detects dehydration or fluid overload (edema)
  • • All fluids consumed AND all urine, emesis, wound drainage, etc. must be recorded in milliliters (mL)

    • #### Feeding Patients with Dysphagia

  • • Dysphagia: Difficulty swallowing — high risk for aspiration
  • • Position: Upright at 90° (High Fowler's) during feeding
  • • Remain upright for at least 30 minutes after eating
  • • Offer small bites/sips, allow adequate chewing time, check for "pocketing" of food

    • #### Diet Types


    | Diet | Description |

    |---|---|

    | Regular diet | No restrictions |

    | Mechanical soft | Chopped, ground, or minced foods for chewing difficulties |

    | Pureed | Smooth, blended consistency for severe dysphagia |

    | Thickened liquids | Modified consistency to slow swallowing (nectar, honey, pudding thick) |

    | NPO | Nothing by mouth — no food or fluids |


    #### Calorie Count / Food Intake Documentation

  • • Record the percentage or amount of each food item consumed
  • • Document what was eaten AND what was left
  • • Report poor intake to the nurse

    • #### Urinary Catheter Drainage Bag Care

  • • Use a separate, labeled measuring container for each patient
  • • Do not touch the drain spigot to the container (prevents contamination)
  • • Always wear gloves and perform hand hygiene before and after
  • • Keep drainage bag below bladder level at all times to prevent backflow

    • #### Signs of Dehydration to Report

  • • Dry mouth and skin
  • • Decreased and dark urine output (concentrated)
  • • Sunken eyes
  • • Confusion or dizziness
  • • Rapid, weak pulse
  • • Poor skin turgor

    • Key Terms

  • • Dysphagia: Difficulty swallowing
  • • Aspiration: Inhaling food, liquid, or secretions into the lungs
  • • I&O (Intake & Output): Documentation of all fluids taken in and expelled
  • • NPO: Nothing by mouth (Latin: nil per os)
  • • Catheter: Tube inserted into the bladder to drain urine

    • Watch Out For

    > ⚠️ Common Pitfall: Patients with dysphagia must be at 90 degrees — not just any elevated position. Semi-Fowler's is NOT sufficient for safe feeding of a dysphagic patient.


    > ⚠️ Common Pitfall: When emptying a catheter bag, the spigot must never touch the measuring container — contact causes contamination of the closed drainage system and increases UTI risk.


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    Safety & Infection Control


    Summary

    Infection control is the most consistently tested domain on the CNA exam. CNAs are the frontline defense against healthcare-associated infections (HAIs). Understanding hand hygiene, PPE, precaution types, and sharps safety is essential for patient and caregiver protection.


    Key Concepts


    #### The WHO 5 Moments of Hand Hygiene

    1. Before patient contact

    2. Before an aseptic (sterile/clean) task

    3. After body fluid exposure risk

    4. After patient contact

    5. After contact with patient surroundings


    #### Hand Washing Technique

  • • Use soap and water for at least 20 seconds
  • • Cover all surfaces: palms, backs of hands, between fingers, thumbs, under nails
  • • Use soap and water (not hand sanitizer) when hands are visibly soiled or when dealing with C. difficile

    • #### Standard vs. Transmission-Based Precautions


    | Precaution Type | Who It Applies To | Key Actions |

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

    | Standard Precautions | ALL patients, every time | Gloves, hand hygiene, PPE as needed |

    | Contact Precautions | Direct/indirect contact spread (MRSA, C. diff) | Gloves + gown upon room entry |

    | Droplet Precautions | Large droplet spread (flu, COVID) | Surgical mask within 3–6 feet |

    | Airborne Precautions | Airborne spread (TB, measles, chickenpox) | N95 respirator, negative pressure room |


    #### PPE Donning and Doffing Order


    Donning (Putting On):

    1. Gown

    2. Mask/respirator

    3. Eye protection (goggles/face shield)

    4. Gloves


    Doffing (Removing) — Most to Least Contaminated:

    1. Gloves (most contaminated)

    2. Eye protection / face shield

    3. Gown

    4. Mask/respirator (last — protects airway)

    5. Perform hand hygiene after each removal


    #### Needlestick Injury Protocol

    1. Immediately wash the area with soap and water

    2. Report to supervisor immediately

    3. Follow facility's exposure control protocol

    4. Seek medical evaluation — may require post-exposure prophylaxis (PEP)

    5. Complete an incident report


    #### Sharps Disposal

  • • Dispose immediately in a puncture-resistant, leak-proof sharps container
  • • Never recap a needle by hand (two-handed recapping is prohibited)
  • • Never place in regular trash or leave uncapped

    • Key Terms

  • • Standard Precautions: Infection control practices applied to ALL patients regardless of diagnosis
  • • Transmission-Based Precautions: Additional measures for known/suspected infectious patients
  • • PPE (Personal Protective Equipment): Gloves, gown, mask, eye protection
  • • MRSA: Methicillin-resistant Staphylococcus aureus — requires Contact Precautions
  • • HAI (Healthcare-Associated Infection): Infection acquired in a healthcare setting

    • Watch Out For

    > ⚠️ Common Pitfall: Gloves come OFF first when removing PPE — they are the most contaminated item. The mask is removed last to protect your airway as long as possible.


    > ⚠️ Common Pitfall: C. difficile (C. diff) spores are NOT killed by alcohol-based hand sanitizer — you must use soap and water with these patients.


    > ⚠️ Common Pitfall: Standard Precautions apply to all patients, not just those who appear sick or have a known diagnosis.


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    Patient Rights & Communication


    Summary

    Patient rights are legally and ethically protected. CNAs must maintain confidentiality, use proper identification, respond appropriately to refusals of care, and know emergency response protocols. These are not optional courtesies — they are legal and professional obligations.


    Key Concepts


    #### Responding to Patient Refusal

    1. Respect the refusal — patients have the right to refuse any care

    2. Explain consequences calmly (do not threaten or coerce)

    3. Report immediately to the supervising nurse

    4. Document the refusal per facility policy

  • • Never force care on a patient who refuses — this constitutes assault and battery

    • #### HIPAA Confidentiality Requirements

  • • All patient health information (PHI) is confidential
  • • Share information only with authorized care team members
  • • Never discuss patient information in hallways, elevators, or public areas
  • • No social media posts about patients or patient care
  • • Violations can
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