Nebraska Exam + Registry
Not publishedof exam
Physical Care Skills
Not publishedof exam
Psychosocial + Dementia Care
Not publishedof exam
Rights, Role, Reporting
Not publishedof exam
Infection Control + Safety
Not publishedof exam
Quick Facts
- Exam
- Nebraska nurse aide evaluation
- Written/oral
- 50 multiple-choice questions
- Skills
- Six demonstrated skills
- Pass mark
- 70% on each part
- Skill scoring
- 70% on every skill
- Attempts
- Three per exam
- Training
- 75 approved hours
- Extra hour
- Nebraska abuse training
- State fee
- None for nurse aides
- Oversight
- Nebraska DHHS registry
Written vs Skills
Written/oral
- 50 questions
- 70 percent overall
- Oral option available
Skills
- Six skills demonstrated
- 70 percent each skill
- One failure fails all
Three attempts on each
Nebraska Exam Rules
- Written/oral
- 50 multiple-choice questionsDHHS
- Written pass
- 70 percent or greater
- Skills exam
- Demonstrate six skills
- Skills pass
- 70 percent each skill
- One skill failed
- Whole skills exam fails
- Attempts
- Three chances per exam
- After three fails
- Retake 75-hour course
- Time limit
- Not published by DHHS
- Oral option
- Reader instead of written
Registry + Renewal
- Training
- 75 state-approved hours
- Abuse training
- One Nebraska hour
- ICF/DD route
- 21-hour resident care
- State fee
- None for nurse aides
- Listing delay
- About three weeks
- Stay active
- Paid work within 24 months
- Lapsed status
- Retest both exams
- Moving states
- Interstate endorsement form
Dressing Rule
Weak arm in first, out last
Dress: weak firstUndress: strong firstProtects the affected limb
Weak vs Strong Side
Weak side
- Dressed first
- Undressed last
- You stand here
Strong side
- Cane goes here
- Chair placed here
- Leads the step
Weak dresses, strong leads
Every Skill Setup
- Entering the room→Knock, greet by name(Identify yourself)
- Before touching resident→Wash hands(Graded step)
- Before each action→Explain what happens
- During any care→Curtain plus door(Privacy)
- Exposing the body→Uncover working area only
- Working at bedside→Raise to working height(Your back)
- Care finished→Bed low, wheels locked
- Before leaving→Call light within reach
- After leaving→Wash hands, report
Vital Sign Ranges
- Oral temp
- 97.7-99.1 F normal
- Rectal temp
- About 1 F higher
- Axillary temp
- About 1 F lower
- Pulse
- 60-100 beats/minute
- Respirations
- 12-20 breaths/minute
- Blood pressure
- 90/60 to 120/80 mmHg
- Pulse oximetry
- 95-100 percent
- Apical site
- Left fifth intercostal space
- Irregular pulse
- Count full minute
- Counting respirations
- Do not announce it
Walking Order
Cane, weak leg, strong leg
Cane on strong sideStand on weak sideHold the gait belt
Active vs Passive ROM
Active
- Resident moves alone
- You supervise
- Encourage independence
Passive
- You move joint
- Resident cannot
- Support above and below
Who moves the joint
What Do I Report?
- Blood pressure 150/95→Report the number(Outside range)
- Resident refuses bath→Report and document(Right to refuse)
- New red heel→Report immediately(Stage 1 risk)
- Resident reports chest pain→Call nurse, stay
- Ate 25 percent lunch→Chart and report
- Suspected abuse→Nurse plus authorities(28-372 duty)
- Broken bed crank→Tag, tell nurse
Report Immediately
- Chest pain
- Tell nurse now
- Trouble breathing
- Report immediately
- New confusion
- Sudden mental change
- Any fall
- Report before moving resident
- Bleeding
- Report and apply pressure
- Reddened skin
- Possible stage 1
- Vitals outside range
- Report the number
- Refused care
- Report and document
- Poor intake
- Report meal percentage
Bed Angles
Semi 30-45, Fowler's 45-60, High 60-90
Semi-Fowler's: restFowler's: breathingHigh Fowler's: eating
Which Transfer?
- Bears weight, follows directions→Gait belt stand
- One-sided weakness→Move toward strong side
- Cannot bear weight→Mechanical lift(Two staff)
- Sling looks frayed→Stop, get replacement
- Bed to wheelchair→Lock wheels first
- Resident starts falling→Ease to floor(Protect head)
Personal Care Rules
- Bath water
- About 105 F
- Wash order
- Cleanest to dirtiest
- Eye washing
- Inner to outer corner
- Dressing
- Weak arm goes first
- Undressing
- Strong arm comes first
- Dentures
- Line sink with water
- Shaving
- Skin taut, downward strokes
- Nail care
- Never cut diabetic nails
- Reddened bony area
- Never massage it
- Repositioning
- At least every two hours
Fluid Math
1 oz = 30 mL, cup = 240
Half cup: 120 mLRead at eye levelRecord every shift
Perineal Care Steps
- Setup
- Gloves, privacy, warm water
- Drape
- Cover, expose only perineum
- Direction
- Front to back always
- Each stroke
- Use clean cloth area
- Female care
- Separate labia, clean middle
- Male care
- Retract foreskin, circular strokes
- After male care
- Return foreskin forward
- Rectal area
- Turn resident, clean last
- Soiled gloves
- Change before clean tasks
Catheter Care Steps
- Bag height
- Always below bladder
- Bag placement
- Never on the floor
- Tubing
- Free of kinks
- Securement
- Strap to thigh
- Cleaning length
- About four inches
- Cleaning direction
- Away from meatus
- Never
- Disconnect the drainage tubing
- Emptying
- Measure and record output
- Report
- Cloudy, bloody, foul urine
Nutrition + I&O
- 1 ounce
- 30 mL
- 8-ounce cup
- 240 mL
- Half a cup
- 120 mL
- Feeding position
- Upright about 90 degrees
- Chin
- Tucked slightly downward
- Bites
- Small, alternate with liquids
- Dysphagia
- Thickened liquids as ordered
- After meals
- Upright 30 minutes
- Output
- Urine, emesis, drainage
- Graduate reading
- Flat surface, eye level
- Weighing
- Same scale, same time
Transfer + Ambulation
- Gait belt
- Over clothing, never skin
- Belt fit
- Flat hand fits under
- Belt grip
- Underhand grasp, buckle offset
- Chair placement
- Strong side, slight angle
- Wheels
- Locked before moving
- Bed height
- Low, feet flat
- Footwear
- Non-skid shoes on
- Stand cue
- Count of three
- Walking position
- Behind, on weak side
- Cane hand
- Strong unaffected side
- Step order
- Device, weak, strong
- Falling resident
- Ease down your leg
Positioning + ROM
- Supine
- Flat on back
- Prone
- On abdomen
- Lateral
- Side-lying
- Sims
- Left side, semi-prone
- Semi-Fowler's
- Head 30-45 degrees
- Fowler's
- Head 45-60 degrees
- High Fowler's
- Head 60-90 degrees
- Passive ROM
- You move the joint
- Active ROM
- Resident moves independently
- Active-assistive ROM
- Resident starts, you help
- ROM support
- Above and below joint
- ROM limit
- Stop at pain
Dementia vs Delirium
Dementia
- Gradual onset
- Progressive, not reversible
- Months to years
Delirium
- Sudden onset
- Often reversible
- Report immediately
Slow decline versus sudden change
Communication + Documentation
- Open-ended question
- Invites a full answer
- Objective data
- Seen, heard, measured
- Subjective data
- Resident's own words
- Nonverbal
- Eye level, face resident
- Silence
- Let resident finish thinking
- Hearing loss
- Face them, lower pitch
- Vision loss
- Announce entry, describe surroundings
- Aphasia
- Yes/no questions, picture boards
- Charting time
- After care, never before
- Chart error
- One line, initial it
Objective vs Subjective
Objective
- Seen or measured
- BP 148/92
- Ate 50 percent
Subjective
- Resident tells you
- Quote their words
- Reports of pain
Observed versus reported
Dementia Care Approaches
- Approach
- From front, identify yourself
- Instructions
- One short step
- Never
- Argue or quiz them
- Sundowning
- Late-day confusion, agitation
- Sundowning help
- More light, steady routine
- Wandering
- Safe path, supervised exit
- Catastrophic reaction
- Stop, reduce stimulation
- Validation
- Acknowledge the feeling
- Reminiscing
- Long-term memory lasts longer
- Agitation
- Remove trigger, stay calm
- Repeated questions
- Answer calmly, then redirect
Abuse vs Neglect
Abuse
- Intentional act
- Hitting or threatening
- Includes verbal harm
Neglect
- Failure to act
- Missed repositioning
- Ignored call light
Doing versus not doing
OBRA Resident Rights
- Dignity
- Respectful treatment always
- Privacy
- Body, mail, visits, calls
- Confidentiality
- Share only with team
- Refuse care
- Resident may say no
- Free from restraint
- Unless medically ordered
- Free from abuse
- All forms, all staff
- Personal choice
- Routine, clothing, food
- Grievances
- Complain without retaliation
- Possessions
- Keep and secure belongings
- Care planning
- Resident participates
- Advance notice
- Before transfer or discharge
Restraint vs Alternative
Restraint
- Provider order needed
- Never for convenience
- Release every two hours
Alternative
- Try these first
- Bed alarm, low bed
- Activity and toileting
Least restrictive first
Abuse + Reporting
- Nebraska statute
- Neb. Rev. Stat. 28-372
- Nurse aide status
- Named mandatory reporter
- Trigger
- Reasonable cause to believe
- Report to
- Law enforcement or DHHS
- Nebraska APS
- 800-652-1999
- Written follow-up
- 48 hours if requested
- Physical abuse
- Hitting, rough handling
- Verbal abuse
- Threats, yelling, name-calling
- Neglect
- Failing to provide care
- Exploitation
- Misusing resident money
- Misappropriation
- Taking resident property
- Involuntary seclusion
- Separating without consent
Fire Response
RACE: Rescue, Alarm, Confine, Extinguish
Rescue people firstPull the alarmClose doorsExtinguish or evacuate
Standard vs Transmission-Based
Standard
- Every resident
- No diagnosis needed
- Hand hygiene, gloves
Transmission-based
- Added for organism
- Contact, droplet, airborne
- Sign on door
Baseline versus added layer
Soap or Sanitizer?
- Hands look soiled→Soap and water
- After C. diff care→Soap and water(Spores survive alcohol)
- After using restroom→Soap and water
- Before handling food→Soap and water
- Hands look clean→Alcohol hand rub
- Between clean tasks→Alcohol hand rub
Handwashing Checkpoints
- Before starting
- Push sleeves up
- Wet hands
- Fingertips pointing down
- Friction time
- At least 20 seconds
- Cover
- Nails, webs, wrists
- Rinse
- Fingertips down, water runs off
- Dry
- Clean paper towel
- Faucet
- Turn off using towel
- Discard
- Towel into waste container
- Do not
- Touch sink with hands
Extinguisher Use
PASS: Pull, Aim, Squeeze, Sweep
Aim at baseSweep side to sideSmall fires only
Which Precautions?
- Any resident, any task→Standard precautions
- MRSA wound→Contact precautions
- Influenza→Droplet, surgical mask
- Tuberculosis→Airborne, fitted N95
- C. diff diarrhea→Contact, wash with soap
PPE Order
- Put on first
- Gown
- Put on second
- Mask or respirator
- Put on third
- Goggles or face shield
- Put on last
- Gloves over gown cuffs
- Take off first
- Gloves
- Take off second
- Goggles or face shield
- Take off third
- Gown
- Take off last
- Mask, outside the room
- Torn glove
- Stop, remove, rewash
- Hand hygiene
- Before and after PPE
Chain of Infection
Agent, reservoir, exit, transmission, entry, host
Break transmission linkHand hygiene works bestSusceptible host: elderly
Precaution Types
- Standard precautions
- Every resident, every time
- Body fluid rule
- All fluids except sweat
- Contact
- Gown and gloves
- Droplet
- Mask within 3-6 feet
- Airborne
- N95, door closed
- MRSA
- Contact precautions
- C. diff
- Contact plus soap washing
- Influenza
- Droplet precautions
- Tuberculosis
- Airborne precautions
Safety + Emergencies
- RACE
- Rescue, Alarm, Confine, Extinguish
- PASS
- Pull, Aim, Squeeze, Sweep
- Oxygen room
- No flames or aerosols
- Partial choking
- Encourage forceful coughing
- Complete choking
- Abdominal thrusts, call help
- Seizure
- Protect head, never restrain
- Found on floor
- Do not move, call
- Restraint release
- Every two hours
- Side rails
- Can count as restraints
- Leaving room
- Bed low, wheels locked
Common Traps
Refusal is a right
Resident may refuse ≠ Never force or bribe
Massage myth
Never rub reddened skin ≠ Reposition and offload instead
Sanitizer and C. diff
Alcohol misses spores ≠ Soap and water required
Report, do not diagnose
Aides report observations ≠ Nurses assess and diagnose
Side rails count
Rails can restrain ≠ Order and alternatives first
Weak side confusion
Dress weak side first ≠ Cane on strong side
Drainage bag height
Bag below bladder ≠ Never on the floor
Charting ahead
Chart after care ≠ Never chart in advance
Six skills, not five
Nebraska demonstrates six ≠ One failure fails all
Last Minute
- 1.Nebraska: 50 questions, six skills
- 2.70% written; 70% each skill
- 3.Three attempts, then retake course
- 4.75 training hours plus abuse hour
- 5.Registry active: paid work/24 months
- 6.Wash 20 seconds, fingertips down
- 7.Gloves on last, off first
- 8.Pulse 60-100; respirations 12-20
- 9.Oral temp 97.7-99.1 F
- 10.BP normal 90/60-120/80 mmHg
- 11.Weak arm dressed first
- 12.Cane on strong side
- 13.Reposition at least every 2h
- 14.Call light in reach, bed low
- 15.Peri care: front to back
- 16.Catheter bag below bladder
- 17.Report abuse: 800-652-1999
- 18.1 oz = 30 mL
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