Basic Nursing Skills & Data Collection
19.44%of exam
Task instructionsSkills timingRequired first taskGait-belt transfer
Infection Control & Safety
26.39%of exam
Bedpan and outputGown, gloves and drainage bagFemale perineal careMale perineal care and brief
Personal Care & Communication
18.06%of exam
Female perineal careUncircumcised male careCatheter hygieneWeak-limb dressing
Resident Rights, Role & Registry
13.89%of exam
Abuse concernCNA scopeKnowledge testSkill passing rule
Cognitive, Disease, Mental & Aging
22.22%of exam
Acute confusionDementia communicationLate-day distressWandering risk
Quick Facts
- Knowledge
- 72 questions; 90 minutes
- Knowledge pass
- 75% = 54/72
- Skills
- Three/four tasks; 35 minutes
- Skill pass
- All critical; 80% non-key
- Standard total
- $20 + $77 = $97
- Audio total
- $31 + $77 = $108
- Trained route
- Three attempts within six months
- Certification
- Candidate BOUNDS application after passing
Selected Measurement Tolerances
Temperature 0.1; respiration 2; pulse/BP 4; urine 10
Instrument scale for temperatureBP unit: mm HgUrine ±10mL; bedpan ±30mL
Mobility and Positioning Decisions
- Helping resident eat→Follow prescribed swallowing and positioning plan(Stop for coughing or distress)
- Applying prescribed anti-embolic stocking→Align correctly; smooth wrinkles(Report pressure, pain or color changes)
- Gait-belt transfer is assessed appropriate→Lock brakes; fit belt; use training(Mechanical-lift needs require different method)
- Resident requires assisted repositioning→Follow individualized care-plan schedule(Avoid pressure on existing injuries)
Nursing Skills and Test Performance
- Task instructions
- Follow actual checklist, not universal script
- Skills timing
- Three or four tasks; 35 minutes
- Required first task
- One of four handwashing-embedded tasks
- Gait-belt transfer
- Assess method; brakes locked; safe footwear
- Side-lying supports
- Head, upper arm, back, between knees
- ROM test
- Assigned movements at least three times
- Feeding assistance
- Correct diet; safe position; allow swallowing
Measurement Tolerances: Exam Context Only
- Manual BP
- Each value within 4 mm Hg
- Pulse / respirations
- Within 4 beats / 2 breaths
- Temperature
- Within 0.1 degree of observer
- Drainage bag / bedpan
- Within 10 mL / 30 mL
- Dependent feeding intake
- Fluid 40 mL; solids 25 percentage-points
- Ambulatory weight
- Within 1 lb of observer
Fire Response Memory Aids
Rescue, Alarm, Confine, Evacuate; Pull, Aim, Squeeze, Sweep
Facility plan governs actionsExtinguish only when trained and safeMaintain an escape route
Soap and Water or Alcohol Sanitizer
Soap and water
- Visibly soiled hands
- Mandatory first-task handwashing
- Additional indicated outbreak precautions
Alcohol sanitizer
- Usual non-soiled clinical hand hygiene
- Cover surfaces; rub until dry
- Does not kill C. difficile spores
Apply task and infection-control requirements
Infection and Emergency Responses
- Visibly soiled hands or mandatory skill-wash→Soap and water(Follow additional outbreak precautions)
- Resident starts falling→Trained assisted lowering; call for help(Do not force an upright hold)
- Choking adult coughs effectively→Encourage coughing; observe closely(Summon help if deterioration)
- Responsive adult has severe choking→Five back blows, five abdominal thrusts(Chest thrusts: late pregnancy/cannot encircle)
- Choking adult becomes unresponsive→Activate emergency response; begin CPR(Compressions first; remove only visible object)
- Resident has seizure→Protect from hazards; summon help(Nothing in mouth; no restraint)
Mandatory Tasks and Hand Hygiene
- Bedpan and output
- Measure at eye level; record amount
- Gown, gloves and drainage bag
- Avoid outlet contamination; measure output
- Female perineal care
- Clean front toward back
- Male perineal care and brief
- Replace foreskin; follow brief instructions
- Soap friction
- At least 20 seconds in task
- Faucet closure
- Clean dry paper towel; avoid recontamination
Putting On and Removing Gown/Gloves
Putting on
- Gown then gloves
- Secure gown; cover cuffs
Removing
- Avoid contaminated outer surfaces
- Glove-first or permitted combined method
- Finish required hand hygiene
Do not contaminate bare skin
Precautions and Contaminated Materials
- Standard precautions
- Apply to every resident’s care
- Droplet precautions
- Mask before room or space entry
- Airborne precautions
- Required respirator and isolation arrangements
- Soiled linen
- Contain without shaking; protect clothing
- Used sharps
- Approved container; never reach inside
- C. difficile
- Spore precautions; soap during indicated outbreaks
Safety and Urgent Changes
- Resident falling
- Trained assisted lowering; summon help
- Fire response
- Facility plan; safe rescue and alarm
- Seizure
- Protect, time, summon help; never restrain
- Severe responsive adult choking
- Five back blows, five abdominal thrusts
- Restraints
- Never convenience; individualized authorized care
- Oxygen deterioration
- Alert nurse; no independent flow change
Dressing and Undressing a Weak Limb
Dressing
- Weak side first
- Support limb; avoid painful movement
Undressing
- Strong side first
- Weak side comes out last
Use garment slack to protect limb
Personal Care Decisions
- Dressing resident with one weak arm→Dress weak side first(Undress strong side first)
- Catheter care is assigned→Avoid traction; follow care procedure(Do not disconnect closed system)
- Cleaning beneath retractable foreskin→Gently clean; replace normal position(Never force retraction)
- Cleaning removable dentures→Protect sink; use cool water(Handle carefully; prevent damage)
Personal Care and Comfort
- Female perineal care
- Fresh cleaning surface for each stroke
- Uncircumcised male care
- Gently replace foreskin after cleaning
- Catheter hygiene
- Avoid traction; maintain closed system
- Weak-limb dressing
- Weak side first; strong side out-first
- Diabetic foot care
- Assigned plan; report injury and changes
- Denture care
- Protect sink; use cool water
Communication and Records
- Hearing impairment
- Face resident; reduce background noise
- Visual impairment
- Identify yourself; explain surroundings and care
- Aphasia
- Allow time; confirm intended meaning
- Charting
- Objective, timely, accurate; never pre-chart
- Refusal
- Respect; clarify; report to nurse
- Confidentiality
- Authorized purpose, appropriate access and disclosure
Knowledge and Manual Skill Tests
Knowledge
- 72 questions in 90 minutes
- 75% threshold: 54 correct
- English written or audio format
Skills
- Three or four tasks; 35 minutes
- All critical steps required
- 80% non-key steps per task
Pass both; then apply through BOUNDS
Rights and Certification Decisions
- Resident refuses routine care→Pause, clarify and notify nurse(No coercion)
- Abuse or neglect suspected→Protect; use required reporting channels(Do not wait for proof)
- Both Montana exam components passed→Submit BOUNDS certification application(Verify actual registry listing)
- Challenge fails or trained eligibility exhausted→Complete approved training before retesting(Different route-specific attempt limits)
Rights, Role and Montana Certification
- Abuse concern
- Protect and report promptly
- CNA scope
- Assigned care; no independent diagnosis
- Knowledge test
- 72 questions; 90 minutes; 75%
- Skill passing rule
- All critical; 80% non-key per task
- Trained-candidate attempts
- Three within six months after training
- Challenge failure
- Approved training required before retesting
- After passing both tests
- Submit BOUNDS CNA by Exam Application
FAST: Possible Stroke
Face, Arm, Speech, Time; activate emergency response
Note onset or last known wellDo not delay for routine roundsAvoid oral intake pending swallowing assessment
Low and High Blood Glucose
Low glucose
- Below 70 mg/dL
- May cause sweating, shakiness, confusion
- Prompt treatment protocol if swallow safe
High glucose
- May cause thirst and frequent urination
- Symptoms vary; measurement matters
- Vomiting or altered alertness needs escalation
Symptoms alone do not diagnose either
Cognition, Mental Health and Aging
- Acute confusion
- Prompt nurse assessment; not normal aging
- Dementia communication
- Calm approach; acknowledge feelings
- Late-day distress
- Check unmet needs and new changes
- Wandering risk
- Individual safety plan; no punishment
- Self-harm statement
- Stay safe; summon immediate clinical help
- Grief
- Individual reactions; no required stage order
- Restorative care
- Encourage safe participation and independence
Grief Reactions, Not Required Stages
Denial, anger, bargaining, depression, acceptance; no fixed order
Listen without forcing progressRespect personal and cultural needsEscalate severe distress or safety concerns
Dementia Support and Acute Confusion
Established dementia
- Calm familiar approach
- Acknowledge feelings; check unmet needs
New acute confusion
- Report promptly for clinical assessment
- Check safety while help arrives
A new change is not normal-aging
Disease Changes and Calculations
- Possible stroke
- FAST; note onset; activate emergency response
- Glucose below 70 mg/dL
- Low glucose; immediate protocol and reporting
- Unsafe swallow or unresponsive
- No oral carbohydrate; summon emergency help
- Worsening breathing or swelling
- Report changes; follow prescribed care plan
- Practice fluid conversion
- 10oz×30mL/oz = 300mL
- Pressure injury prevention
- Individual repositioning plan; report skin changes
Common Traps
Critical Steps Cannot Be Averaged Away
All critical steps required per task ≠ Non-key steps need 80%
Individual Repositioning versus Universal Pressure-Injury Routine
Individual assessment/plan; report skin changes ≠ Universal turning intervals or reddened-area massage
Restraints: Authorized Care versus Staffing Convenience
Individualized authorization, device and monitoring plan ≠ Restraint for staffing convenience
Diabetic Foot Care: Plan versus Improvisation
Individual care plan defines permitted care ≠ Unassigned soaking or nail-cutting
Passing Is Not Registry Listing
Headmaster reports results ≠ Candidate submits BOUNDS certification application
New Confusion versus Routine Reassurance
New changes: prompt reporting for assessment ≠ Reassurance alone or normal-aging assumption
Last Minute
- 1.Knowledge: 72 questions, 90 minutes, 75%
- 2.Skills: three/four tasks, 35 minutes
- 3.All critical plus 80% non-key steps
- 4.Trained route: three attempts, six months
- 5.Challenge failure requires approved training
- 6.Required IDs must match TMU record
- 7.Mandatory first task includes actual handwashing
- 8.Test tolerances are not clinical thresholds
- 9.Care plan determines safe repositioning schedule
- 10.Dress weak side first; undress strong-first
- 11.Pass both; apply through BOUNDS
- 12.Renew through portal before certification expiry
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