Basic Nursing Skills
20%of exam
Data Collection
7%of exam
Vital SignsNormal RangesI&O TrackingSubjective vs Objective
Disease Process
9%of exam
Infection Control
7%of exam
Standard PrecautionsPPE OrderIsolation TypesHand Hygiene
Safety
7%of exam
RACE & PASSFall PreventionRestraint AlternativesFire Response
Personal Care
6%of exam
Bathing OrderPerineal CareOral HygieneWeak Side Dressing
Nutrition
6%of exam
Diet TypesThickened LiquidsDysphagiaFeeding Position
Aging Process & Restorative Care
6%of exam
Care of the Impaired Resident
6%of exam
Dementia CareSundowningSensory ImpairmentValidation Therapy
Mental Health
4%of exam
Stages of GriefMaslow's HierarchyDepression SignsHospice Care
Communication
7%of exam
Therapeutic CommunicationHIPAA & ConfidentialityIncident ReportingTelephone Etiquette
Client/Resident Rights
7%of exam
Right to RefuseOBRA RightsOmbudsmanAdvance Directives
Role & Responsibility
9%of exam
Scope of PracticeLegal TermsMandatory ReportingDCW Registry
Quick Facts
- Exam
- Iowa Nurse Aide Competency Exam
- Written Qs
- 70 questions
- Time
- 60 minutes
- Pass Score
- 70% (49/70)
- Format
- Multiple-choice, computer-based
- Skills Exam
- Separate hands-on evaluation
- Level
- Entry-level nurse aide
- Blueprint
- February 2026 (Version 2)
- Attempts
- 3 attempts allowed
- Administrator
- Headmaster / TMU Iowa
Resident Emergency Response
- Resident is choking→Perform Heimlich maneuver
- Resident having a seizure→Protect head, clear area
- Fire in the building→Follow RACE protocol
- Resident stops breathing→Start CPR, call for help
- Suspected abuse observed→Report to nurse immediately
Positioning & Transfers
- Fowler's
- Sitting upright 45-60 degrees
- Semi-Fowler's
- Reclined 30-45 degrees
- Supine
- Lying flat on back
- Prone
- Lying flat on stomach
- Lateral
- Lying on one side
- Log-rolling
- Turn resident as one unit
- Gait belt
- Support during transfers, ambulation
Emergency Response Skills
- Heimlich maneuver
- Abdominal thrusts for choking
- Universal choking sign
- Hands clutching at throat
- CPR compression rate
- 100-120 per minute
- Seizure care
- Protect head, don't restrain
- Call light
- Answer immediately, every time
- STAT
- Immediately, without any delay
Subjective vs Objective Data
Subjective
- Resident's own words
- Feelings, complaints, and pain
Objective
- What CNA observes
- Vital signs, visible signs
Reported vs observed
Vital Signs & Data Collection
- Oral temp
- 97.6-99.6°F normal range
- Pulse rate
- 60-100 beats per minute
- Respiration rate
- 12-20 breaths per minute
- Blood pressure
- 90-140 over 60-90 mmHg
- Subjective data
- What resident reports feeling
- Objective data
- What CNA observes and measures
- I&O
- Intake and output tracking
- Abnormal vitals
- Report to nurse immediately
Dementia vs Delirium
Dementia
- Gradual onset
- Progressive and irreversible
Delirium
- Sudden onset
- Often reversible, treatable cause
Slow decline vs sudden change
Common Disease Conditions
- Stroke (CVA)
- Sudden one-sided weakness, numbness
- CHF
- Fluid buildup, shortness of breath
- COPD
- Chronic breathing difficulty, limited airflow
- Diabetes
- Monitor blood sugar, diet, feet
- Parkinson's
- Tremors, rigidity, shuffling gait
- Dementia vs delirium
- Gradual vs sudden confusion onset
- Arthritis
- Joint pain, stiffness, swelling
Standard vs Transmission-Based Precautions
Standard precautions
- Used with every resident
- Basic hand hygiene, PPE
Transmission-based
- Specific to disease type
- Adds contact, droplet, airborne
Always vs disease-specific
Which Precaution Type
- Antibiotic-resistant bacteria present→Contact precautions(Gown and gloves)
- TB, measles, or chickenpox→Airborne precautions(N95 mask required)
- Flu, pertussis, or mumps→Droplet precautions(Mask within three feet)
- Caring for any resident→Standard precautions(Hand hygiene always)
- Visible blood or fluid→Wear gloves and gown
Infection Control Essentials
- Standard precautions
- Used with every single resident
- PPE donning order
- Gown, mask, goggles, then gloves
- Hand hygiene
- Before and after every contact
- Contact precautions
- Gown and gloves required always
- Droplet precautions
- Mask worn within three feet
- Airborne precautions
- N95 respirator, negative pressure room
- Medical asepsis
- Clean technique reduces germ spread
RACE for Fire
Rescue, alarm, confine, extinguish or evacuate
Rescue: move to safetyAlarm: pull the fire alarmConfine: close doors behind youExtinguish or evacuate last
Safety & Fire Response
- RACE
- Rescue, alarm, confine, extinguish
- PASS
- Pull, aim, squeeze, sweep
- Fall prevention
- Nonslip footwear, clear pathways
- Restraint alternative
- Try least restrictive option first
- MSDS
- Chemical hazard information sheet
- Bed position
- Lowest position reduces fall risk
PASS the Extinguisher
Pull, aim, squeeze, and sweep
Pull the safety pinAim at the fire's baseSqueeze the handle slowlySweep side to side
Personal Care ADLs
- Bathing order
- Clean areas, then dirty areas
- Bath water temp
- 105-115°F tested at wrist
- Dressing rule
- Weak side dressed first always
- Perineal care
- Wipe front to back always
- Oral hygiene
- At least twice daily care
- Diabetic foot care
- Never trim a resident's toenails
Which Diet Consistency
- No swallowing difficulty→Regular diet
- Mild chewing difficulty→Mechanical soft diet
- Severe chew or swallow issue→Pureed diet
- Pre or post surgery→Clear liquid diet
- Thin liquids cause choking→Add thickened liquids
Nutrition & Special Diets
- Regular diet
- No food restrictions needed
- Mechanical soft diet
- Chopped, ground, easy to chew
- Pureed diet
- Smooth, blended food consistency
- Clear liquid diet
- See-through liquids only allowed
- Thickened liquids
- Nectar, honey, or pudding thick
- Dysphagia
- Swallowing difficulty, aspiration risk high
- Feeding position
- Upright at ninety degrees
Active vs Passive ROM
Active ROM
- Resident moves independently
- Maintains muscle strength
Passive ROM
- CNA moves the resident
- Prevents contractures only
Self-move vs assisted-move
Restorative Care & ROM
- Active ROM
- Resident moves the joint alone
- Passive ROM
- CNA moves the resident's joint
- Contracture
- Permanent muscle or joint shortening
- Ambulation device
- Cane, walker, or gait belt
- Restorative dining
- Maximizes resident's own self-feeding
- Aging changes
- Slower reflexes, thinner, fragile skin
Cognitive & Sensory Impairment Care
- Sundowning
- Confusion worsens in late evening
- Validation therapy
- Don't argue, redirect gently instead
- Hearing impaired
- Face resident, speak clearly, slowly
- Vision impaired
- Use clock method for food
- Wandering
- Redirect calmly, ensure resident safety
- Reality orientation
- Cues for time, place, person
5 Stages of Grief
Denial, anger, bargaining, depression, acceptance
Denial: refuses to believe itAnger: frustration and blameBargaining: seeking alternative optionsDepression: withdrawal, sadnessAcceptance: comes to terms
Maslow's Hierarchy Order
Physical, safety, love, esteem, self-actualization
Physical needs come firstSafety and security nextLove and belonging thirdEsteem then self-actualization last
Communication & Documentation
- Therapeutic communication
- Active listening, open-ended questions
- Non-verbal communication
- Body language and facial expression
- HIPAA
- Protects resident's private health information
- Confidentiality
- Share only on need-to-know basis
- Incident report
- Document objectively, factually, and promptly
- Telephone etiquette
- Professional, clear, and confidential always
Restraint vs Restraint Alternative
Restraint
- Restricts resident's movement
- Used as last resort
Alternative
- Alarms, low bed, supervision
- Tried first, less restrictive
Last resort vs first try
Resident Rights (OBRA)
- Right to refuse
- Resident can decline any care
- Right to privacy
- Knock, close door, and drape
- Right to grievance
- Voice complaints without any reprisal
- Freedom from restraint
- Try least restrictive method first
- Ombudsman
- Advocates for resident's concerns, rights
- Advance directive
- Documents resident's future care wishes
Abandonment vs Neglect
Abandonment
- Leaving without arranging care
- A one-time act
Neglect
- Failing to provide needed care
- An ongoing pattern
Leaving vs failing to care
Reporting Priority
- Change in condition→Report to nurse immediately
- Resident refuses care→Document and notify nurse
- Suspected abuse or neglect→Mandatory report, don't delay
- Unsure if in scope→Ask nurse before acting
Scope of Practice & Legal Terms
- CNA scope limits
- No medications, no diagnosis given
- Abandonment
- Leaving resident without arranging care
- False imprisonment
- Unjustified restraint of a resident
- Negligence
- Careless act that causes harm
- Defamation
- Spoken slander or written libel
- Mandatory reporting
- Must report any suspected abuse
- Chain of command
- Report through your immediate supervisor
- DCW Registry
- Iowa's official direct care registry
Common Traps
Training Required ≠ Iowa's Exam Rule
Other states train candidates first ≠ Iowa allows testing before training
DCW Registry ≠ Standard CNA Registry
Iowa's official term is DCW ≠ Most states just say CNA
Reporting Abuse ≠ Optional Action
CNAs are mandatory reporters always ≠ Report to supervisor and DHHS
Passive ROM ≠ Active ROM
CNA moves the resident's joint ≠ Resident does not move alone
Restraint ≠ First-Line Response
Try alternatives before any restraint ≠ Restraint needs a physician order
Subjective Data ≠ Objective Data
Subjective is the resident's words ≠ Objective is what CNA measures
Last Minute
- 1.70 questions, 60 minutes, 70% passing
- 2.Iowa needs no training before testing
- 3.Bathe clean areas, then dirty areas
- 4.Wipe perineal area front to back
- 5.Report changes to nurse immediately
- 6.PPE order: gown, mask, goggles, gloves
- 7.RACE for fire, PASS for extinguisher
- 8.Residents can refuse any care
- 9.Normal pulse: 60-100 beats per minute
- 10.Mandatory reporter: supervisor and Iowa DHHS
- 11.DCW renewal needs 8 hrs biennially
- 12.Bring a valid, non-expired photo ID
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