Aging and Restorative Care
6.7%of exam
5 questionsNormal agingIndependenceADLsRange of motionAdaptive devices
Basic Nurse Skills
13.3%of exam
Care Impaired
10.7%of exam
8 questionsDementia careStroke careMobility limitsSensory lossAdaptive support
Communication
6.7%of exam
5 questionsActive listeningClear speechNonverbal cuesReportingDocumentation
Data Collection
5.3%of exam
4 questionsObservationMeasurementObjective factsChange reportingRecording
Disease Process
5.3%of exam
4 questionsAcute illnessChronic illnessWarning signsComplicationsImmediate reporting
Infection Control
9.3%of exam
7 questionsHand hygieneStandard precautionsPPEClean techniqueExposure prevention
Mental Health
5.3%of exam
4 questionsDepressionAnxietyGriefEmotional supportSafety reporting
Personal Care
10.7%of exam
8 questionsBathingOral carePerineal careNutritionSkin care
Resident Rights
9.3%of exam
7 questionsChoicePrivacyConfidentialityAbuse preventionGrievances
Role and Responsibility
6.7%of exam
5 questionsScopeDelegationCare plansSupervisionProfessional boundariesTesting and RetestingRegistry Maintenance
Safety
10.7%of exam
8 questionsFall preventionTransfersEmergenciesFire responseEquipment safety
Quick Facts
- Knowledge questions
- 75 MCQs
- Knowledge time
- 60 minutes
- Knowledge passing
- 71%
- Skills assignment
- 3 or 4 tasks
- Skills time
- 30 minutes
- Key steps
- All required
- Other steps
- 80% each task
- Knowledge fee
- $37.49
- Audio fee
- $42.94
- Skills fee
- $107.21
- Standard package
- $144.70
- Audio package
- $150.15
- Testing window
- 1 year after training
- Federal renewal
- Every 24 months
- Qualifying paid work
- 8 hours per 24 months
Aging and Independence
- Normal aging
- Varies among individuals
- Restorative care
- Maintains highest function
- Independence
- Let residents do safely
- ADLs
- Daily self-care activities
- Adaptive device
- Supports remaining ability
- Range of motion
- Maintains joint mobility
- Contracture
- Permanent joint tightening
- Affected side
- Needs added support
- Repositioning
- Relieves sustained pressure
- Encouragement
- Promotes participation
- Overhelping
- Reduces resident independence
Safe Skill Closing
Bed low | Call light | Hygiene
Comfort checkedEquipment secureRecord results
Key vs Other Steps
Key steps
- Bolded in handbook
- Every one required
- Missing one fails
Other steps
- Still must demonstrate
- 80% each task
- No combined averaging
All key plus 80% others
Perform a Skills Task
- Scenario is read→Listen for exact task
- Care begins→Explain to resident
- Body exposed→Provide curtain and drape
- Equipment can move→Lock before transfer
- Task says demonstrate→Perform every step
- Mistake recognized→Correct before finishing
- Measurement required→Record actual result
- Task is complete→Leave resident safe
Measure, Observe, and Report
- Temperature
- Measures body heat
- Radial pulse
- Count wrist beats
- Respirations
- Count unnoticed chest rises
- Blood pressure
- Report measured reading
- Pain
- Resident's reported experience
- Intake
- Fluids entering body
- Output
- Measurable fluids leaving body
- Urine measurement
- Read milliliters eye-level
- Daily weight
- Use consistent conditions
- Positioning
- Maintain alignment and comfort
- Bedmaking
- Keep linens smooth
- Change from baseline
- Report promptly
Verbalize vs Demonstrate
Verbalize
- Saying step only
- Earns no credit
- Does not replace action
Demonstrate
- Perform physical action
- Observer sees completion
- Earns eligible credit
Say it vs do it
Skills Exam Rules
- Task count
- Three or four
- Time limit
- Thirty minutes maximum
- First task
- One of four mandatory tasks
- Added tasks
- Two or three randomly selected
- Bedpan starter
- Modified bedpan plus handwashing
- Catheter starter
- Female manikin plus handwashing
- Isolation starter
- Gown, gloves, output, handwashing
- Perineal starter
- Female manikin plus handwashing
- Handwashing
- Ends each mandatory task
- Key steps
- Every bold step required
- Non-key steps
- Eighty percent per task
- Step order
- Flexible unless BEFORE or AFTER
- Verbalizing
- Earns no credit
- Correction
- Demonstrate before declaring finished
- Actors
- Live except two manikin tasks
- Skills retest
- Includes one previously failed task
Support Common Impairments
- Dementia
- Progressive cognitive impairment
- Confusion
- May have reversible cause
- Simple directions
- Give one step
- Routine
- Reduces distress
- Redirection
- Shift focus calmly
- Wandering
- Protect without punishment
- Aphasia
- Language ability impaired
- Hearing loss
- Face resident while speaking
- Vision loss
- Describe surroundings clearly
- Weak side
- Support during movement
- Assistive device
- Keep within reach
- Reality argument
- Usually increases distress
Communicate by Resident Need
- Resident cannot hear→Face and speak clearly
- Resident has aphasia→Allow response time
- Resident is confused→Use simple directions
- Resident is distressed→Listen and acknowledge feelings
- Resident refuses care→Stop and report
- Resident reports pain→Believe and report
Communicate and Document
- Introduction
- State name and role
- Identification
- Verify correct resident
- Explanation
- Describe care before starting
- Active listening
- Attend without interrupting
- Open question
- Invites fuller response
- Closed question
- Requests brief answer
- Nonverbal cue
- Behavior communicates meaning
- Hearing impairment
- Speak clearly, not shouting
- Aphasia support
- Allow extra response time
- Documentation
- Record facts promptly
- Chain of command
- Report through supervisor
- Medical jargon
- Avoid with residents
Objective vs Subjective Data
Objective
- Observed directly
- Measured result
- Factual description
Subjective
- Resident reports it
- Cannot directly measure
- Quote important wording
Measured fact vs reported experience
Collect Clinical Data
- Objective data
- Observed or measured facts
- Subjective data
- Resident-reported information
- Baseline
- Resident's usual condition
- Observation
- Use all appropriate senses
- Measurement
- Use correct units
- Recording
- Document actual result
- Late entry
- Follow facility policy
- Abnormal finding
- Report to nurse
- Sudden change
- Report immediately
- Diagnosis
- Outside aide scope
- Incident
- Report facts, not blame
Recognize Illness Changes
- Acute illness
- Sudden onset
- Chronic illness
- Long-lasting condition
- Infection signs
- Report new symptoms
- Stroke warning
- Sudden neurologic change
- Chest pain
- Report immediately
- Breathing difficulty
- Get immediate help
- Low blood sugar
- Report behavior change
- Dehydration
- Watch intake and output
- Seizure
- Protect from injury
- Edema
- Observe swelling
- New confusion
- Treat as significant change
Gown and Gloves
Gown then gloves; gloves off first
Cover gown cuffsContain contaminated surfacesClean hands afterward
Sanitizer vs Hand Washing
Sanitizer
- Routine decontamination
- Hands not visibly soiled
- Rub until dry
Soap and water
- Visible soil present
- Mechanical removal
- Dry thoroughly
Clean-looking hands vs visible soil
Choose Infection Protection
- Routine resident contact→Use standard precautions
- Body fluid contact possible→Wear gloves
- Clothing exposure possible→Add gown
- Splash exposure possible→Protect face and eyes
- Hands visibly soiled→Wash soap and water
- Isolation posted→Follow doorway signage
- Equipment reused→Clean before next resident
Break the Infection Chain
- Hand hygiene
- Before and after care
- Standard precautions
- Use for every resident
- Gloves
- Protect from body fluids
- Gown
- Protect skin and clothing
- Mask
- Protect nose and mouth
- Eye protection
- Protect from splashes
- Clean equipment
- Prevent cross-contamination
- Soiled linen
- Keep away from uniform
- Sharps
- Use puncture-resistant container
- Drainage bag
- Keep below bladder
- Cough etiquette
- Contain respiratory secretions
- Exposure
- Wash and report promptly
Support Mental Health
- Depression
- Persistent mood change
- Anxiety
- Fear or uneasiness
- Grief
- Individual response to loss
- Empathy
- Acknowledge resident feelings
- Hallucination
- Perception without stimulus
- Delusion
- Fixed false belief
- Agitation
- Reduce stimulation calmly
- Suicide statement
- Report immediately
- Therapeutic silence
- Allows resident expression
- Personal belief
- Never impose it
- Professional boundary
- Keeps relationship therapeutic
Weak-Side Clothing
Dress weak first; undress strong first
On: weak firstOff: strong first
Dressing vs Undressing Weakness
Dressing
- Weak side first
- Support affected limb
- Avoid painful pulling
Undressing
- Strong side first
- Weak side last
- Move gently
Dress weak; undress strong
Daily Personal Care
- Bathing
- Clean from least soiled
- Water temperature
- Check resident comfort
- Perineal care
- Clean front to back
- Catheter care
- Clean away from meatus
- Oral care
- Protect airway and tissues
- Denture care
- Handle over protected basin
- Feeding
- Position upright
- Aspiration sign
- Stop feeding, get help
- Weak-side dressing
- Dress weak side first
- Weak-side undressing
- Undress strong side first
- Skin care
- Observe pressure areas
- Foot care
- Inspect, clean, dry carefully
Abuse vs Neglect
Abuse
- Intentional act
- Causes harm or threat
- Report immediately
Neglect
- Care not provided
- Needs go unmet
- Report immediately
Harmful act vs omitted care
Protect Resident Rights
- Dignity
- Treat resident respectfully
- Privacy
- Curtain and proper draping
- Confidentiality
- Share only as authorized
- Choice
- Honor safe preferences
- Refusal
- Stop, ensure safety, report
- Abuse
- Intentional harm or threat
- Neglect
- Failure to provide care
- Misappropriation
- Wrongful property use
- Exploitation
- Improper personal gain
- Restraint
- Follow care plan and law
- Grievance
- Resident may complain safely
- Abuse suspicion
- Protect and report immediately
Choice vs Immediate Safety
Resident choice
- Honor preferences
- Accept informed refusal
- Report care refusal
Immediate safety
- Prevent imminent harm
- Use least restriction
- Get nurse help
Honor choice while preventing harm
Federal vs State Eligibility
Federal eligibility
- Renews every 24 months
- 8 paid hours per 24 months
- Covers federally certified settings
State-only status
- May remain on registry
- Facility eligibility differs
- Verify before employment
Check registry eligibility type
Practice Within Role
- Scope of practice
- Defines permitted aide tasks
- Delegation
- Accept only trained tasks
- RN/LPN supervision
- Required for aide work
- Care plan
- Follow assigned directions
- Condition change
- Report to nurse
- Medication administration
- Outside standard CNA role
- Sterile procedure
- Outside standard CNA role
- Charting
- Accurate, timely, factual
- Error
- Report honestly and promptly
- Assignment concern
- Clarify before proceeding
- Resident gift
- Follow facility policy
- Caregiver misconduct
- Can affect work eligibility
Testing and Retesting
- Completion deadline
- Within one year after training
- Attempts in window
- As many as needed
- Failed component
- Retake only failed component
- After one year
- Complete DHS-approved training again
- Scheduling
- Book and pay through TMU
Registry Maintenance
- Federal cycle
- Twenty-four months
- Qualifying minimum
- Eight paid hours
- Work duties
- Nursing or nursing-related services
- Supervision
- RN or LPN required
- Self-employment
- Does not qualify
- Private duty
- Does not qualify
- Verification
- Employer confirms through TMU
- Federal lapse
- Retake both exam components
- Retraining after lapse
- Not required in Wisconsin
- State-only work
- May continue where eligible
RACE Fire Response
Rescue | Alarm | Contain | Extinguish/Evacuate
R: rescueA: alarmC: containE: extinguish/evacuate
Respond to Urgent Changes
- Resident unresponsive→Call immediate help(Follow facility policy)
- Breathing suddenly difficult→Get immediate help
- Resident is choking→Use trained response
- Resident begins falling→Guide down safely
- Resident found fallen→Stay and call nurse
- Seizure begins→Protect from injury
- New condition change→Observe and report promptly
- Abuse suspected→Protect and report immediately
Prevent and Respond to Hazards
- Call light
- Leave within reach
- Bed position
- Low and locked
- Wheelchair brakes
- Lock before transfer
- Footrests
- Move before standing
- Non-skid footwear
- Reduce slipping
- Gait belt
- Secure over clothing
- Body mechanics
- Wide base, avoid twisting
- Fall
- Stay and call nurse
- Choking
- Use trained emergency response
- Fire
- Follow facility emergency plan
- Spill
- Guard and clean promptly
- Restraint alternative
- Use least restrictive measure
PASS Extinguisher
Pull | Aim | Squeeze | Sweep
Pull pinAim baseSqueeze handleSweep side-to-side
Common Traps
Treating 71% as 53
53 of 75 is 70.7% ≠ Need at least 54 correct
Expecting full audio coverage
Only first 67 read ≠ Final 8 test reading
Bringing scratch paper
Scratch paper is prohibited ≠ Calculators also prohibited
Averaging skills together
Each task needs 80% ≠ Every key step required
Only saying skill steps
Verbalizing earns no credit ≠ Actually demonstrate every step
Assuming strict universal order
Most steps allow reordering ≠ Before/after wording controls sequence
Hiding a skills mistake
State the correction ≠ Demonstrate it before finishing
Expecting every task on manikin
Most use live actors ≠ Two care tasks use manikin
Forcing refused care
Residents may refuse ≠ Stop safely and report
Diagnosing a resident
Observe measurable changes ≠ Report; nurse evaluates
Failed component vs lapse
Exam failure: retake failed component ≠ Federal lapse: retake both components
Two different deadlines
Initial window expiry requires retraining ≠ Registry lapse does not
Last Minute
- 1.Memorize all 12 subject counts
- 2.Target at least 54 correct
- 3.Budget 48 seconds each
- 4.Review every possible skill
- 5.Know four mandatory starters
- 6.Demonstrate every listed step
- 7.Never miss a key step
- 8.Earn 80% on each task
- 9.Correct mistakes before finishing
- 10.Retake only the failed component
- 11.Finish all testing within one year
- 12.Use privacy curtain
- 13.Lock movable equipment
- 14.Keep call light reachable
- 15.Leave bed low and locked
- 16.Record actual measured values
- 17.Use hand hygiene correctly
- 18.Report urgent changes immediately
- 19.Renew with eight paid supervised hours
- 20.Federal lapse requires both exam components
- 21.Bring matching signed unexpired photo ID
- 22.Confirm current TMU appointment
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