Free Indiana CNA Exam Flashcards

Temperature: 97.8-99.1°F (oral). Pulse: 60-100 bpm. Respirations: 12-20 per minute. Blood pressure: 90-140 mmHg systolic over 60-90 mmHg diastolic. Any reading outside these ranges must be recorded and reported to the nurse immediately — never adjusted or ignored.

For a regular pulse, count beats for 15 seconds and multiply by 4. For an irregular pulse, count for a full 60 seconds because irregular rhythms produce inconsistent intervals. Counting an irregular pulse for only 15 seconds can produce a dangerously inaccurate rate.

Body position significantly affects blood pressure readings — standing, sitting, and lying produce different values. To compare readings meaningfully over time, the resident must be in the same position (usually seated, feet flat, arm at heart level, after 5 minutes of rest). If orthostatic BP is ordered, each position is measured and documented separately.

All beverages plus foods that are liquid at room temperature: soup, gelatin, ice cream, and pudding all count as intake. A common error is counting only drinks and overlooking liquid foods. Accurate I&O is critical for residents with cardiac, renal, or fluid-restriction orders — underreporting can mask dangerous fluid imbalances.

Normal adult urinary output is approximately 30 mL per hour or more. Output below this (e.g., 180 mL over 8 hours = ~22 mL/hr) indicates possible oliguria and must be reported to the nurse immediately. Low output can signal dehydration, kidney dysfunction, or urinary obstruction. Catheterization and diuretics are outside the CNA scope.

Stop the movement immediately, support the joint in a comfortable position, and report to the nurse. Never force ROM past resistance — doing so can cause fractures, dislocations, or tissue damage, especially in frail elderly residents. Pain during ROM can indicate injury, inflammation, or contracture requiring nurse assessment.

Grasp the center back of the gait belt with an underhand grip (palms up). This gives maximum control to guide and support the resident. Stand close with a wide stance and use leg muscles, not the back. Gripping the resident's arms, clothing, or belt loops instead of the gait belt is unsafe and can cause shoulder injury or falls.

The perineal area is always washed last because it carries the highest bacterial concentration. The correct order moves from cleanest to dirtiest: face, arms, chest, abdomen, legs, back, then perineal area. Washing the perineum earlier and then proceeding to other areas spreads bacteria and increases urinary tract infection risk.

Always dress the affected (weaker) side first and undress the stronger side first. Dressing the weak side first minimizes the range of motion required and reduces discomfort. The memory rule: 'dress the weak side first, undress the strong side first.' Forgetting this order forces the weak arm through excessive motion and causes pain.

Position supine with the head turned to the side so gravity drains any fluid out of the mouth, reducing aspiration risk. Use a small amount of fluid, swabs instead of a toothbrush, and suction if available. Never place an unconscious resident in a flat supine position with the head centered — secretions can pool in the airway and cause aspiration.

Shave in the direction of hair growth (typically downward on the face). Shaving against the grain increases the risk of skin irritation, ingrown hairs, and nicks. Hold the skin taut and rinse the razor frequently. For residents on anticoagulants, use an electric razor instead to reduce bleeding risk.

Start at the ends (tips) and work gradually upward toward the scalp. Starting at the scalp and pulling down through tangles causes pain, breaks hair, and can damage follicles. Work section by section from the ends up. Never cut a resident's hair without specific orders and permission.

Apply while the resident is lying down and before they stand up. Once upright, blood pools in the lower extremities and legs swell, making proper fit impossible and reducing effectiveness. The skin must be dry and the stockings smooth with no wrinkles — wrinkles create pressure points that can cause skin breakdown. Check circulation before and after application.

Use the clock method to describe food placement (e.g., 'meat at 6 o'clock, vegetables at 3 o'clock') and allow maximum independence. Position the resident upright (at least 45-90 degrees). Never feed a resident who can self-feed — doing so removes autonomy and dignity. Blending all foods together or feeding everything by spoon strips the resident of choice and sensory experience.

Indiana's written exam has 100 multiple-choice questions (2 hours) requiring 80 correct (80%) to pass. This is larger than most states, which use 60-75 questions. The exam is administered by Ivy Tech Community College's CNA/QMA Central Testing Office — Indiana is one of the few states that does not use Prometric or Headmaster.

Indiana requires 105 hours of ISDH-approved training: 75 clinical hours plus 30 classroom hours. This exceeds the federal OBRA minimum of 75 hours total. Candidates must complete training and pass the competency exam within 2 years; after that, the full training program must be repeated.

Indiana Nurse Aide Registry (INAR) certification must be renewed every 2 years. To maintain active status, the CNA must have performed at least 8 paid hours of nursing-related work during the 24-month period. Failing to meet the work requirement can result in loss of active registry status, requiring retaking the competency exam.

The INAR also records substantiated findings of resident abuse, neglect, or misappropriation of property. These findings are permanently noted and can bar a CNA from working in Medicare/Medicaid-certified facilities nationwide. Employers are required to check the INAR before hiring. This dual function (certification + misconduct tracking) is governed by 410 IAC 16.2.

Indiana CNAs are mandated reporters. Suspected abuse, neglect, or exploitation must be reported immediately to the supervisor AND to Adult Protective Services (APS) and/or ISDH. Delaying or failing to report is a violation of law and can result in removal from the INAR. The Indiana Long-Term Care Ombudsman (under FSSA) can also be contacted for resident rights advocacy.

Within scope: measuring and recording vital signs, assisting with ADLs, I&O measurement, ROM, reporting changes. Outside scope: inserting urinary catheters, sterile dressing changes, adjusting IV flow rates, administering medications (requires QMA certification), and performing nursing assessments. Performing out-of-scope tasks can result in INAR removal and legal liability.

The Indiana Long-Term Care Ombudsman Program (LTCO), operating under the Indiana Family and Social Services Administration (FSSA), advocates for residents' rights and quality of life in nursing homes and assisted living. The LTCO investigates complaints about care quality, rights violations, and facility conditions. CNAs should refer residents and families to the ombudsman when facility-level complaints cannot be resolved.

R — Rescue residents in immediate danger. A — Activate the fire alarm. C — Contain the fire by closing doors and windows. E — Extinguish if trained and safe, or Evacuate. Rescue always comes first. This is the facility-wide response protocol; CNAs must know it along with PASS for extinguisher operation.

P — Pull the pin. A — Aim at the base of the fire. S — Squeeze the handle. S — Sweep from side to side. RACE is the overall fire response protocol; PASS is specifically for using the extinguisher. Both acronyms are tested on the Indiana CNA exam.

Check the resident for injury and call for the nurse immediately. Do NOT move the resident until the nurse assesses for fractures or head injury — moving an injured resident can cause further harm. Stay with the resident and provide reassurance. Falls must be documented per facility policy and may require ISDH notification depending on severity.

Perform abdominal thrusts (Heimlich maneuver) immediately — position yourself behind the resident, make a fist above the navel and below the xiphoid process, and give firm upward thrusts. Call for help simultaneously. Never give water to a resident with a complete airway obstruction — it can worsen the blockage. Laying the resident flat is not appropriate.

Restrained residents must be released, repositioned, and offered toileting, exercise, and hydration at least every 2 hours. Circulation must be checked with each monitoring visit. Restraints require a physician's order and must be the least restrictive alternative after non-restraint approaches fail. Tight restraints can cause strangulation, pressure injuries, and death — four raised side rails also count as a restraint.

Bend at the knees (not the waist), keep the back straight, and hold the object close to the body. Use leg muscles to lift, never twist the torso while lifting — twisting is a leading cause of back injury. The common error is bending at the waist with the object held far from the body, which multiplies the force on the spine.

Scrub for at least 20 seconds — roughly the time to sing 'Happy Birthday' twice. Hand hygiene is the single most important infection prevention measure. Alcohol-based hand rub is acceptable when hands are not visibly soiled, but soap and water is required when hands are visibly dirty, after restroom use, before eating, and after C. diff or norovirus contact.

1) Gown, 2) Mask or respirator, 3) Goggles or face shield, 4) Gloves. The gown goes first to cover clothing, and gloves go last to cover the gown cuffs and provide a clean exterior layer. Reversing this order leaves cuffs exposed or contaminates the mask during gowning.

1) Gloves, 2) Goggles or face shield, 3) Gown, 4) Mask or respirator. Perform hand hygiene after each step and immediately after all PPE is removed. Gloves come off first because they are the most contaminated. The mask is removed last to avoid touching the face with contaminated hands.

C. difficile produces spores that alcohol cannot kill. During a C. diff outbreak, soap-and-water handwashing for at least 20 seconds is required because mechanical friction and rinsing physically remove spores from the hands. This is the key exception: alcohol rub is acceptable for most pathogens but NOT for C. diff or norovirus.

Gloves and a gown are required when entering the room or having direct contact. An N95 respirator or surgical mask is NOT routinely required for contact precautions alone — those are for airborne or droplet precautions. Gowns and gloves must be removed before exiting the room, followed immediately by hand hygiene.

Used for tuberculosis, measles, and varicella (chickenpox) — pathogens suspended in air that travel long distances. Requires a negative-pressure room and an N95 respirator (not a surgical mask). Keep the door closed. Droplet precautions (influenza, meningitis, pertussis) use a surgical mask and do not require negative pressure.

Draw a single line through the error so it remains legible, write 'error' beside it, initial and date the correction, then write the correct information. Never use correction fluid, erase, or destroy pages — these constitute falsification of a medical record, which is illegal and can result in INAR removal and criminal charges.

PHI may be shared for treatment purposes among the care team (e.g., reporting a condition change to the nurse during a care conference). Sharing with family without the resident's authorization, discussing residents in hallways where others can overhear, or posting photos on social media — even in 'private' groups — all violate HIPAA and Indiana privacy law.

Acknowledge the feeling without judgment and invite expression: 'I understand you're upset. Can you tell me what's bothering you?' This validates emotion and opens communication. Threatening to leave, ordering the resident to calm down, or dismissing behavior as attention-seeking are non-therapeutic and can escalate the situation. Remain calm, use a soft tone.

Face the resident directly so they can see lip movement and facial expressions, speak at a normal volume with clear enunciation, and ensure adequate lighting. Shouting distorts the voice and is demeaning; lower-pitched voices are easier to hear than high-pitched. Check that hearing aids are working and inserted. Never shout from behind or across the room.

Report all changes in resident condition, vital sign abnormalities, intake and output totals, new skin issues, refusals of care or meals, pain reports, behavioral changes, and any incidents. The outgoing CNA must ensure the incoming CNA knows the status of every assigned resident. Incomplete handoff reporting can delay critical interventions and compromise resident safety.

Residents have the right to refuse any care, including bathing. The CNA must respect the refusal, offer an alternative (partial bath, sponge bath), document the refusal, and report it to the nurse so the care plan can be adjusted. Never force care or attempt the bath anyway with 'gentle reassurance' — forced care is a violation of resident rights and can constitute abuse.

Acknowledge the emotion and redirect to a comforting activity rather than repeatedly correcting with facts ('Your spouse passed away'). Repeatedly informing a dementia resident of a death causes fresh grief each time without improving orientation. Validation therapy reduces distress and preserves dignity. Example: 'You miss your husband; he sounds very special to you.'

Persistent sadness, withdrawal from social interaction, loss of interest in previously enjoyed activities (anhedonia), and changes in sleep and appetite. Confusion about time and place is more characteristic of dementia; agitation and wandering are more typical of dementia. Depression is common in nursing home residents and must be reported for medical evaluation.

Denial is a normal, healthy coping mechanism. The CNA should listen with empathy, be present, and avoid forcing the resident to face reality or pushing them through grief stages. The role is to provide compassionate presence and validate feelings, not to confront or correct. Report significant distress to the nurse.

Approach calmly using the resident's name, use gentle redirection toward a safe activity, avoid confrontation, and notify the nurse. Physically blocking, locking the resident in their room, or applying restraints without orders are violations of resident rights and federal regulations. Facilities should use environmental measures (door alarms, secured exits) per the care plan.

Report to the nurse immediately and do not leave the resident alone. Statements like 'I don't see the point of going on' are potential indicators of suicidal ideation. The CNA's role is not to conduct a risk assessment or ask about a plan — that is the nurse's or social worker's job. Getting the nurse involved immediately is always the correct first action.

Sundowning is increased confusion, agitation, or restlessness in the late afternoon or evening, common in dementia. Reduce triggers by maintaining a calm environment, ensuring adequate lighting, minimizing noise, and following a consistent routine. Report patterns to the nurse so the care plan can address triggers. Never respond with confrontation or restraints.

Decreased cardiac reserve (heart less able to rapidly increase output), thinner and drier skin (not increased elasticity), reduced pain sensitivity (increasing injury risk), decreased bone density (osteoporosis), and muscle mass loss (sarcopenia). Recognizing these as normal aging — not disease — helps the CNA anticipate care needs and prevent injuries like falls and pressure ulcers.

Maintain the resident's current functional abilities and prevent further decline — not to restore pre-illness function (that is rehabilitation's goal). Indiana facilities are required under CMS guidelines to implement restorative programs for eligible residents, and CNAs play a central role by performing ROM, ambulation assistance, and ADL support during daily care.

Perform regular passive and active range-of-motion exercises, position residents with proper alignment and support pillows, use splints or orthotics as ordered, and reposition at least every 2 hours. Contractures develop when joints remain immobile for prolonged periods — muscles shorten and freeze the joint in a fixed position. Once established, contractures are difficult to reverse.

A 30-degree tilt distributes weight across a larger surface area rather than concentrating pressure directly on the greater trochanter (hip bone), a high-risk area for pressure injuries. Full 90-degree side-lying puts all pressure on the trochanter. Use pillows to support the back, between the knees, and under the top leg (positioned slightly forward).

After immobility, the cardiovascular system loses its ability to compensate for position changes — standing causes blood to pool in the legs, dropping blood pressure and causing dizziness or falls. Prevent by raising the head of the bed slowly, sitting the resident at the edge of the bed, pausing for circulation to adjust, then assisting to standing. Check BP before and after position changes.