Role of Nurse Aide
20%of exam
Promotion of Safety
22%of exam
Function and Health
20%of exam
Basic Nursing Care
24%of exam
Specialized Care
14%of exam
DementiaImpairmentsMental HealthDying CareSkills
Quick Facts
- Exam
- Texas CNA
- Vendor
- Prometric + HHSC
- Application
- TULIP portal
- Written
- 60 questions
- Time
- 90 minutes
- Skills
- 5 skills
- Attempts
- 3 each
- Window
- 24 months
- Training
- 100 hours
- Registry
- Texas NAR
Written vs Oral
Written
- Computer questions
- 60 items
- 90 minutes
Oral
- Questions read
- Reading section
- Select in application
Delivery differs
Scope Picker
- Care assigned→Follow plan
- Task unclear→Ask nurse
- Resident refuses→Respect, report
- Change observed→Report facts
- Medication requested→Get nurse
- Sterile task→Decline, report
- Abuse witnessed→Protect, report
- Charting care→Objective facts
Exam Format
- Written test
- 60 questions90 min
- Oral test
- Adds reading section
- Skills test
- 5 scored skills
- Handwashing
- Unprompted at start
- Indirect care
- Scored every skill
- Corrections
- During skill only
- Done statement
- Locks skill
- Remote option
- Knowledge only
Privacy vs Confidentiality
Privacy
- Body covered
- Curtain closed
- Knock first
Confidentiality
- Information protected
- Need-to-know
- No hallway talk
Body vs data
TULIP
- TULIP
- HHSC portal
- Application
- NA examination
- Program upload
- Training completion
- Eligibility
- Approved before scheduling
- ATT
- Admission letter
- Scheduling
- TX aide portal
- Accommodations
- Request in TULIP
- Registry
- Certificate listing
Abuse vs Neglect
Abuse
- Harmful act
- Threat or force
- Protect now
Neglect
- Care omitted
- Needs unmet
- Report promptly
Act vs omission
Texas Rules
- Training
- 100 total hours
- Classroom
- 60 hours
- Clinical
- 40 hours
- Testing window
- 24 months
- Retakes
- Two retakes each
- Three failures
- Retraining required
- Renewal
- Every 2 years
- In-service
- 24 hours
- PPE course
- Annual requirement
Scope
- CNA role
- Assigned basic care
- Care plan
- Follow exactly
- Assessment
- Nurse duty
- Diagnosis
- Never CNA duty
- Medications
- Not CNA task
- Sterile dressing
- Not CNA task
- Refusal
- Report; do not force
- Change noted
- Report promptly
Rights
- Dignity
- Respectful address
- Privacy
- Curtain and drape
- Choice
- Honor preferences
- Refusal
- Resident may decline
- Confidentiality
- Need-to-know only
- Property
- Protect possessions
- Abuse
- Act, protect, report
- Neglect
- Unmet needed care
Fire Response
RACE first; PASS only if safe
RescueAlarmContainExtinguishPullAim
Standard vs Transmission
Standard
- Every resident
- Body fluids
- Hand hygiene
Transmission
- Added PPE
- Known risk
- Isolation sign
Always vs added
Emergency Picker
- Fire seen→RACE
- Resident choking→Call help
- Short breath→Raise head
- Chest pain→Notify nurse
- Fall occurs→Stay, call nurse
- Door alarm→Make resident safe
- Seizure starts→Protect head
- Bleeding wound→Apply pressure
Infection
- Hand hygiene
- Best prevention
- Before touch
- Clean hands first
- After gloves
- Clean hands again
- Standard precautions
- Every resident
- Gloves
- Body fluids risk
- Dirty linen
- Away from uniform
- Soiled items
- Never on floor
- Sharps
- Never recap
- Water skills
- Ask temperature comfort
Safety
- Bed
- Low and locked
- Call light
- Within reach
- Falls
- Report immediately
- Gait belt
- Transfer support
- Weak side
- Guard closely
- Wheelchair
- Brakes locked
- Restraints
- Order required
- Oxygen
- No flames
- Elopement
- Door alarm risk
Weak Side Dressing
Dress weak first; undress strong first
Dress worstUndress bestPrevent strain
ADLs
- Bathing
- Clean to dirty
- Perineal
- Front to back
- Catheter care
- Away from meatus
- Dressing
- Weak side first
- Undressing
- Strong side first
- Dentures
- Cool water storage
- Foot care
- Dry between toes
- Diabetic feet
- Observe, no trim
- Grooming
- Promote independence
Mobility
- ROM
- Move joints gently
- Contracture
- Shortened muscle
- Positioning
- Protect pressure points
- Dangling
- Pause before standing
- Cane
- Strong side
- Walker
- Move walker first
- Transfer
- Pivot with belt
- Immobility
- Skin breakdown risk
Nutrition + Elimination
- Feeding
- Small bites
- Dysphagia
- Swallowing difficulty
- Coughing
- Aspiration warning
- Fluids
- Hydration support
- I&O
- Measure accurately
- Urine output
- Read at eye level
- Constipation
- Fluids and activity
- Bladder training
- Scheduled toileting
Report Fast
Sudden, severe, unsafe: tell nurse
Chest painBreathingBleedingConfusion
Acute vs Chronic
Acute
- Sudden change
- Report now
- Safety first
Chronic
- Ongoing condition
- Follow plan
- Observe trends
Sudden vs ongoing
Basic Nursing
- Observation
- See, hear, smell
- Reporting
- Tell nurse promptly
- Documentation
- Facts only
- Pulse
- Rate and rhythm
- Respirations
- Count quietly
- Blood pressure
- Systolic over diastolic
- Weight
- Fluid status clue
- Skin
- Redness report
- Pain
- Resident report
Acute Changes
- Chest pain
- Call nurse now
- Short breath
- Raise head
- Choking
- Get help fast
- Stroke signs
- Face arm speech
- Seizure
- Protect from injury
- Bleeding
- Apply pressure
- Burn
- Report immediately
- New confusion
- Urgent report
- Low sugar
- Shaky, sweaty
Skill Opening
Knock, greet, explain, privacy, wash
NameCareCurtainHands
Assigned vs Indirect
Assigned skills
- Three task cards
- Skill checklist
- Task-specific steps
Indirect care
- Every skill
- Rights, safety
- Infection control
Task vs behavior
Skills Picker
- Test begins→Wash hands
- New skill starts→Treat new resident
- Need supplies→Ask evaluator
- Need correction→Say, redo
- Measurement skill→Record before done
- Gloves removed→Avoid contamination
- Care complete→Comfort, call light
- Ready to finish→Say done
Specialized Care
- Dementia
- Validate, redirect
- Delirium
- Sudden confusion
- Depression
- Report withdrawal
- Anxiety
- Calm presence
- Combative resident
- Step back calmly
- Hearing loss
- Face resident
- Vision loss
- Identify yourself
- Dying care
- Comfort focus
- Grief
- Listen, support
Dementia vs Delirium
Dementia
- Gradual decline
- Routine helps
- Redirect calmly
Delirium
- Sudden confusion
- Medical concern
- Report fast
Gradual vs sudden
Clinical Skills
- Ambulate
- Use gait belt
- Bedpan
- Privacy, call light
- Occupied bed
- No linen shaking
- Side-lying
- Pillows support
- Feed resident
- Upright chair
- Pulse
- Record per minute
- Respirations
- Do not announce
- ROM
- Stop at pain
- Transfer
- Belt and brakes
Common Traps
Handwashing prompt
Not prompted ≠ Candidate initiates
Done means done
Correct before done ≠ No later fixes
Five skills
Three assigned tasks ≠ Handwashing plus indirect
TULIP vs Scheduling
TULIP application ≠ Portal scheduling
Oral exam
Reading section required ≠ Not reading-free
CNA scope
Reports observations ≠ Nurse assesses
Renewal education
24 hours required ≠ PPE course yearly
Clinical language
English only ≠ No translators
Last Minute
- 1.Written: 60 questions, 90 min
- 2.Domains: 20/22/20/24/14
- 3.Skills: five scored skills
- 4.Handwashing is unprompted
- 5.Indirect care every skill
- 6.Correct before saying done
- 7.TULIP application first
- 8.Pass within 24 months
- 9.Three attempts each component
- 10.CNA reports; nurse assesses
- 11.Resident refuses; CNA reports
- 12.Call light within reach
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