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The Certified Nurse Assistant (CNA) examination is the last test a nurse aide student must pass in order to become eligible for employment and to be listed on a U.S. State Nurse Aide Registry. The test consists of two parts: a written or oral exam, and a hands-on skills exam. A prospective nurse aide must obtain passing scores on both portions of the test in order to earn certification. Minimum passing scores vary by state, as do the number of written questions a candidate must answer; however, the average is approximately 70 questions. Written questions are all in a multiple-choice format.
The hands-on portion of the test takes place in an area that resembles a nurse aide’s actual working environment. A trained evaluator assesses this portion of the test. Five skills will be chosen for the candidate to complete within a set time frame, usually between 20 and 30 minutes. Candidates must complete all skills correctly in order to pass this portion of the examination. All candidates will be tested on their skill in correctly measuring and recording the blood pressure, weight, urinary output, radial pulse, and respiration of a patient in their care. The other skills tested will be chosen randomly from the following list. All skills will have been thoroughly covered in the nurse aide’s training program in preparation for the job:
If a candidate fails only one portion (written or hands-on) of the test, it is allowable to retake only that portion of the test. If a candidate fails the entire test or fails a portion of it three times, retraining will be required.
1. How would you classify a pressure sore that has a pink wound bed, but does not extend through the full thickness of the skin?
2. A patient is scheduled for surgery later in the day. What type of food would you expect on his breakfast tray?
3. What is the proper term for an infection that is transmitted during a medical procedure?
4. A CNA encounters a small fire in a patient's room. The room is empty. What is her first priority?
5. Which of the following is a measurement of the pressure in a patient's heart during contraction?
1. B: A stage I pressure sore would appear as a reddened area that does not blanch (turn white) when pressed. A stage II pressure sore involves a partial breakdown of the upper layer of skin, but does not extend all the way through the skin. A stage II pressure ulcer may look like a blister. Stage III and stage IV ulcers extend all the way through the skin. You may see the underlying subcutaneous fat in a stage III ulcer, whereas a stage IV may proceed all the way down to the muscles, tendons, or bones. Make sure to report any skin redness to the nurse so that the skin can be thoroughly assessed.
2. A: A patient who is about to undergo surgery or another procedure requiring an anesthetic should be NPO for a minimum of eight hours before the procedure. If the patient receives a tray, you should double check with the nurse before serving the patient his breakfast. If a procedure is scheduled for later in the day, the anesthesiologist may be okay with the patient eating breakfast.
3. B: An infection that is transmitted during a medical procedure is called iatrogenic. Droplet transmission is when bacteria or viruses are released in droplets when a person sneezes or coughs. Direct oral contact is transmission between people when there is direct oral contact, such as kissing or sharing a drinking cup. Fecal-oral contamination is exactly what it sounds like: fecal material contaminates food, usually through poor hand washing or poor food preparation techniques.
4. B: This question can be answered using the acronym R.A.C.E. (rescue, activate alarm, confine the fire, evacuate/extinguish). The CNA should first rescue patients in imminent danger. Because the room is empty, her first priority should be to pull the fire alarm. If the fire is small and contained, she could try to extinguish the fire herself with a fire extinguisher using the P.A.S.S. method (pull the pin, aim at the base of the fire, and sweep side to side). If not, she should start closing fire doors and rescuing patients in neighboring rooms if necessary.
5. A: Systolic blood pressure, or the top number of the patient's blood pressure, looks at the pressure in the patient's heart during contraction. Diastolic blood pressure, or the lower number, looks at the pressure in the heart during rest. The pulse measures the number of cardiac contractions per minute. Pulse oximetry measures the amount of oxygen in the blood.