Basic Nursing, Personal Care, Restorative
29%of exam
Infection Control + Safety
22%of exam
Resident Rights + Role
20%of exam
Mental Health, Care Impaired, Disease
15%of exam
Communication + Data Collection
14%of exam
Skill Test (3-4 Tasks)
Not publishedof exam
Quick Facts
- Exam
- MI Nurse Aide Competency
- Vendor
- D&SDT-Headmaster (TMU)
- Regulator
- LARA BCHS (MI-NATES)
- Knowledge
- 65 questions / 60 min
- Knowledge pass
- 74% (49 of 65)
- Skill test
- 3-4 tasks / 30 min
- Skill pass
- 80% + all key steps
- Training
- 75 hours, LARA-permitted
- Attempts
- 3 within 24 months
- Test fee
- $175 both parts
- Certificate
- Valid 2 years
- Pass rate
- Not published by LARA
- Weight basis
- Official subject question counts
Dressing Rule
Weak side into clothes first, out last
Dress: affected firstUndress: unaffected firstSupport the weak limb
Dressing vs Undressing
Dressing
- Affected side first
- Support the weak limb
Undressing
- Unaffected side first
- Keep resident covered
Weak side in first, out last
Move a Resident Safely
- Weak but bears weight→Gait belt transfer
- Cannot bear weight→Mechanical lift(Two staff)
- One side affected→Stand on weak side
- Bed to wheelchair→Chair touching the bed
- Turning in bed→Move toward you first
- Load is heavy→Push or slide it
Adult Vital Sign Ranges
- Oral temp
- 97.6-99.6 F
- Axillary temp
- 96.6-98.6 FLowest
- Rectal temp
- 98.6-100.6 FHighest
- Tympanic temp
- 96.6-99.7 F
- Pulse
- 60-100 beats/minute
- Respirations
- 12-20 breaths/minute
- Blood pressure
- Under 120/80 normal
- Oxygen saturation
- 95-100% typical
- Pulse quality
- Rate, rhythm, strength
Report to Nurse Now
- Any value out of range
- Report; never interpret
- Pulse under 60
- Report bradycardia
- Pulse over 100
- Report tachycardia
- Respirations under 12
- Report slow breathing
- Respirations over 20
- Report fast breathing
- Temp above 101 F
- Report possible infection
- Systolic 140 or higher
- Report to nurse
- Oxygen below 90%
- Report immediately
- Chest pain
- Report immediately; stay
- New confusion
- Report immediately
Nutrition, Fluids, I&O
- 1 ounce
- 30 mL
- 1 cup
- 240 mL
- Graduate reading
- Flat surface, eye levelKey
- Output tolerance
- Within 25 mLScored
- Fluid intake tolerance
- Within 30 mLScored
- Food intake tolerance
- Within 25 percentage points
- Solid intake recorded as
- Percent of food eaten
- Before feeding
- Upright 75-90 degrees
- After feeding
- Head raised 45 degrees
- Dysphagia
- Thickened liquids, small bites
- Dehydration signs
- Dark urine, dry mouth
Positions and Body Mechanics
- Supine
- Flat on the back
- Prone
- Lying face down
- Lateral
- Lying on the side
- Sims
- Left side, semi-prone
- Fowler's
- Head raised 45-60 degrees
- Semi-Fowler's
- Head raised 30-45 degrees
- Repositioning
- At least every 2 hours
- Base of support
- Feet shoulder width apart
- Lift with
- Legs, never the back
- Turning
- Pivot feet, never twist
- Working height
- Bed at hip level
Fire: RACE
Rescue -> Alarm -> Confine -> Extinguish
R: rescue residentsA: pull alarmC: close doorsE: extinguish or evacuate
Restraint vs Alternative
Restraint
- Physician order required
- Never for convenience
Alternative
- Always tried first
- Alarms, toileting, activity
Least restrictive always wins
Which Precautions?
- Every resident, every shift→Standard precautions
- Spread by touch→Contact(Gown, gloves)
- C. difficile suspected→Soap and water(Not sanitizer)
- Spread by coughing→Droplet(Surgical mask)
- Stays airborne→Airborne(Negative pressure)
- Hands visibly soiled→Wash, do not sanitize
- Before helping eat→Hand hygiene first
PPE Donning and Doffing
- Don gown
- Face back opening first
- Tie gown
- Neck, then waist
- Back flaps
- Cover clothing completely
- Don gloves
- Cuffs overlap gown cuffs
- Doff order
- Gloves before gownKey
- First glove
- Grasp palm, pull off
- Second glove
- Bare fingers under cuff
- Remove gown
- Turn inward, inside out
- Discard
- Designated container, no self-contact
Extinguisher: PASS
Pull -> Aim -> Squeeze -> Sweep
P: pull the pinA: aim at baseS: squeeze handleS: sweep side to side
Emergency Response
- Forceful cough while eating→Encourage coughing(Partial block)
- Silent, cannot speak→Abdominal thrusts(Complete block)
- Resident starts falling→Ease to floor
- Fire in the room→Follow RACE
- Using an extinguisher→Follow PASS
- Shaky, sweaty, confused→Call nurse now(Low sugar)
- Seizure begins→Protect head, time it
Precaution Types
- Standard precautions
- All residents, all times
- Treat as infectious
- All fluids except sweat
- Contact
- Gown and gloves
- Droplet
- Add surgical mask
- Airborne
- Respirator, negative-pressure room
- MRSA
- Contact precautions
- Influenza
- Droplet precautions
- Tuberculosis
- Airborne precautions
- C. difficile
- Soap and water only
- Clean to dirty
- Direction of every stroke
Fire and Emergency Codes
- RACE: R
- Rescue anyone in danger
- RACE: A
- Alarm; pull and call
- RACE: C
- Confine; close doors
- RACE: E
- Extinguish or evacuate
- PASS: P
- Pull the pin
- PASS: A
- Aim at fire base
- PASS: S
- Squeeze the handle
- PASS: final S
- Sweep side to side
- Oxygen in use
- No smoking, no sparks
Falls and Restraints
- Resident starts falling
- Ease to floor; protect head
- After a fall
- Do not move; call nurse
- Bed left
- Lowest safe position
- Wheels
- Locked before every transfer
- Footwear
- Non-skid shoes on
- Restraint order
- Physician order required
- Least restrictive
- Alternatives tried first
- Never restrain for
- Convenience or discipline
- Restraint checks
- Often every 30 minutes
- Restraint release
- Usually every 2 hours
Michigan Numbers
75 train, 65 ask, 74 pass, 3 tries
75: training hours65: knowledge questions74%: pass mark3: attempts in 24 months
Abuse vs Neglect
Abuse
- Willful harmful act
- Permanent registry revocation
Neglect
- Failure to provide care
- Petition after one year
Doing harm versus omitting care
OBRA Resident Rights
- OBRA 1987
- Nursing Home Reform Act
- Refuse care
- Protected; report the refusal
- Privacy
- Care, mail, calls, visits
- Dignity
- Preferred name, stay covered
- Information
- See own medical record
- Grievance
- Complain without retaliation
- Choice
- Doctor, roommate, daily schedule
- Advance directive
- Living will, DPOA
- Ombudsman
- Free long-term care advocate
- Freedom from restraint
- Unless medically ordered
Headmaster vs LARA
Headmaster
- Runs both test parts
- Schedules through TMU
LARA BCHS
- Issues the certificate
- Runs MI-NATES registry
Tested by one, certified by other
Abuse Types and Reporting
- Physical abuse
- Hitting, rough handling
- Verbal abuse
- Demeaning words, threats
- Neglect
- Failing to provide care
- Misappropriation
- Taking resident property
- Involuntary seclusion
- Separating without consent
- First report
- Charge nurse, immediately
- Michigan APS
- 855-444-3911, 24/7MI
- Nursing home hotline
- 800-242-2873 (Attorney General)MI
- Document
- What you saw, unfiltered
- Complaint window
- Within 12 months
Nurse Aide Scope
- Aide does
- Measure, observe, report
- Aide never
- Diagnose or interpret
- Medications
- Needs separate MA-C certificateMI
- Sterile procedures
- Outside aide scope
- Tube feedings
- Outside aide scope
- Nail trimming
- Never diabetic or circulatory
- Chain of command
- Charge nurse first
- Delegation
- Nurse assigns, aide performs
- Untrained task
- Decline; tell the nurse
Michigan Registry Rules
- Training
- 16 classroom, 16 clinical, 43 mixed
- Before resident contact
- 16 classroom hours first
- Registry system
- MI-NATES via MILogin
- Passing is not certification
- Apply and pay separately
- Renewal
- Every 2 years
- Work attestation
- 40 paid hours per cycle
- Continuing education
- 12 hours annually2026
- Required CE topics
- Abuse, neglect, care plans
- Lapsed over 2 years
- Retrain and retest
- Temporary nurse aide
- Up to 4 months
- Abuse finding
- Permanent revocation
- Neglect finding
- Petition after 1 year
Validation vs Reality Orientation
Validation
- Advanced dementia
- Honor the feeling
Reality orientation
- Mild confusion only
- State day and place
Dementia validate, confusion orient
Behavior Response Picker
- Wandering toward exit→Walk alongside, redirect(Never grab)
- Agitated and combative→Calm voice, give space
- Confusion rises at dusk→More light, familiar routine(Sundowning)
- Insists on false belief→Validate the feeling
- Mild, recent confusion→Reality orientation
- Repeats same question→Answer calmly, redirect
- Refuses all care→Stop; report and document
Dementia and Behavior
- Sundowning
- Late-day confusion and agitation
- Sundowning fix
- More light, calm routine
- Validation
- Honor feeling, not fact
- Reality orientation
- Mild confusion only
- Catastrophic reaction
- Overreaction to small trigger
- Wandering
- Walk alongside, then redirect
- Combative resident
- Stay calm, allow space
- Common triggers
- Pain, noise, full bladder
- Task approach
- One short step at a time
- Never
- Argue or correct them
Aging Changes and Conditions
- Normal aging
- Thinner skin, slower reflexes
- Not normal aging
- Confusion, incontinence, depression
- Restorative care
- Do with, not for
- Hypoglycemia
- Shaky, sweaty, confused
- Stroke signs
- Facial droop, slurred speech
- Angina
- Chest pain; call nurse
- Partial airway block
- Forceful cough; encourage it
- Complete airway block
- Silent; abdominal thrusts
- Pressure injury sites
- Sacrum, heels, hips, elbows
- Depression signs
- Withdrawal, appetite change, sadness
Report vs Record
Report
- Spoken to the nurse
- Anything new or sudden
Record
- Written in the chart
- Only care actually given
Say it, then write it
Report or Record?
- Resident reports chest pain→Tell nurse now(Emergency)
- New bruising seen→Report immediately(Possible abuse)
- Talk of self-harm→Report immediately
- Pulse measured at 108→Record, then report
- Resident refuses bath→Report and document
- Fall happened→Report; incident report
- Routine bath completed→Record only
- Ate half the meal→Record 50 percent
Communication Rules
- Open-ended question
- Invites description, not yes
- Closed question
- Gets yes or no
- Hearing loss
- Face resident, lower pitch
- Aphasia
- Wait; never finish sentences
- Vision loss
- Announce yourself, describe surroundings
- Nonverbal
- Tone, touch, eye contact
- Empathy
- Acknowledge the feeling first
- Family questions
- Refer them to nurse
- HIPAA
- No hallway or elevator talk
Objective vs Subjective
Objective
- You measured it
- Reddened heel, pulse 108
Subjective
- Resident stated it
- My chest hurts
Seen versus stated
Reporting and Recording
- Objective
- Seen, heard, measured
- Subjective
- What the resident says
- Report
- Spoken to the nurse
- Record
- Written in the chart
- Timing
- Chart after care, never before
- Error fix
- Single line, initial, date
- Resident words
- Chart as direct quote
- Change of condition
- Report before shift ends
Four Mandatory First Tasks
Bedpan, Catheter, PPE bag, Perineal
Bedpan: measure outputCatheter: manikinPPE: gloves before gownPerineal: manikin
Knowledge Exam vs Skill Test
Knowledge exam
- 65 questions, 60 minutes
- 74% to pass
- Written or audio
Skill test
- 3-4 tasks, 30 minutes
- 80% plus key steps
- RN Test Observer scores
Both pass separately, three attempts
First Task Prediction
- Skill test begins→One mandatory task(Always first)
- Bedpan drawn→Measure output, wash hands
- Catheter care drawn→Manikin, then wash hands
- PPE task drawn→Gloves off before gown
- Perineal care drawn→Manikin, then wash hands
- You failed skills→Retest repeats failed task
Vitals Technique Rules
- Radial pulse site
- Thumb side of wrist
- Pulse count
- One full minute
- Respiration count
- One full minute
- Tell observer
- When starting, when stopping
- Pulse tolerance
- Within 4 beatsScored
- Respiration tolerance
- Within 2 breathsScored
- Count 30, double it
- Not accepted here
- Recording form
- Previously signed sheet
Task Bookends
Sanitize, explain, privacy, call light, sanitize
Open: hand hygieneExplain: every taskCurtain: most tasksClose: call light reachable
Sanitizer vs Soap Washing
Hand sanitizer
- Opens and closes tasks
- Rub until fully dry
- Cover all hand surfaces
Soap and water
- Ends the mandatory task
- 20 seconds minimum
- Paper towel turns faucet
Sanitizer routine, soap mandatory task
Hand Washing Key Steps
- Start
- Water on, wet wrists
- Scrub time
- At least 20 secondsKey
- Finger position
- Interlaced, pointing downward
- Coverage
- All surfaces plus wrists
- Fingernails
- Rub against opposite palm
- Rinse
- Fingers pointed downward
- Dry
- Fingertips toward wrists
- Faucet off
- Clean dry paper towel
- Sink edges
- Never touch; recontamination fails
Measurement Tolerances
Pulse 4, breaths 2, urine 25
Pulse: within 4 beatsBreaths: within 2Urine: within 25 mLFluids: within 30 mL
Key vs Non-Key Steps
Key steps
- Bolded in the handbook
- Miss one and fail
Non-key steps
- Need 80% of them
- A few misses survive
Key absolute, non-key 80%
Scored Courtesy Steps
- Hand hygiene
- Opens and closes every task
- Explain procedure
- Scored on every task
- Call light
- In reach before leaving
- Courtesy
- Respectful throughout, scored
- Privacy curtain
- Most tasks, not all
- Knock first
- Four mandatory first tasks
- Raise bed
- Then lower before leaving
- Verbalized steps
- Score zero; demonstrate them
- Made a mistake
- Ask to redo step
The 17 Skill Tasks
- Bedpan and urine output
- Mandatory first; soap washingFirst
- Catheter care, female
- Mandatory first; manikinFirst
- PPE and drainage bag
- Mandatory first; soap washingFirst
- Perineal care, female
- Mandatory first; manikinFirst
- Anti-embolic stocking
- Inside out to heel
- Ambulate with gait belt
- At least ten steps
- Bed to wheelchair transfer
- Gait belt, controlled pivot
- Denture care
- Line sink; cool water
- Dress affected side
- Weak arm and leg first
- Assist with meal
- Upright 75-90 degrees
- Foot care
- No lotion between toes
- Modified bed bath
- Face, one arm, armpit
- Mouth care
- Teeth and tongue brushed
- PROM hip and knee
- Each motion three times
- PROM shoulder
- Each motion three times
- Position on side
- Three support devices
- Pulse and respirations
- One full minute each
Task Details Candidates Miss
- Perineal care
- Front to back, clean cloth
- Peri-wash products
- Not allowed; soapy washcloth
- Catheter cleaning
- Away from urethra, 3-4 inches
- Never tug
- The catheter drainage tube
- Eyes in bed bath
- No soap, inner to outer
- Face in bed bath
- Washed without soap
- Gait belt check
- Slip fingers underneath
- Wheelchair placement
- Touching the bed side
- Side-lying supports
- Arm, back, between knees
- PROM support
- Hold above and below joint
- PROM question
- Ask about pain once
- Drainage bag drain
- Wipe with alcohol after
Common Traps
Wrong vendor
Michigan uses Headmaster ≠ Not Prometric or Credentia
Wrong question count
Michigan asks 65 questions ≠ Not the 75 elsewhere
Two different pass marks
Knowledge needs 74% ≠ Skills need 80% plus
Wrong skill count
Michigan assigns 3-4 tasks ≠ Not the usual five
Wrong hand hygiene
Sanitizer opens most tasks ≠ Soap ends mandatory task
Talking is not doing
Verbalized steps score zero ≠ Steps must be demonstrated
Passing is not certification
Headmaster reports the score ≠ MI-NATES issues the certificate
Renewal work rule
Michigan wants 40 hours ≠ Not one paid hour
Lotion placement
Lotion on foot surfaces ≠ Never between the toes
Bath water and soap
Face washed without soap ≠ Eyes inner to outer
Last Minute
- 1.65 questions; 60 minutes; 74%
- 2.Skills: 3-4 tasks; 30 minutes
- 3.Skills: 80% plus every key step
- 4.First task is always mandatory
- 5.Mandatory task ends with soap washing
- 6.Wash 20 seconds; fingers down
- 7.Sanitizer opens and closes tasks
- 8.Gloves off before the gown
- 9.Call light in reach; bed low
- 10.Pulse within 4; breaths within 2
- 11.Urine within 25 mL
- 12.Ambulate ten steps; PROM three times
- 13.Dress affected side first
- 14.Report to nurse; never diagnose
- 15.Michigan APS: 855-444-3911
- 16.75 training hours; 3 attempts
- 17.Renew: 40 paid hours; 12 CE
- 18.MI-NATES issues the certificate
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