Michigan CNA Exam Flashcards

Q: How many questions are on the Michigan CNA knowledge exam and what score do I need?

The Michigan knowledge exam is 65 multiple-choice questions with a maximum of 60 minutes, and you must score 74% or better to pass. Questions are drawn from 12 LARA-approved subject areas, and an audio (oral) version is available if you request it in advance.

Q: How does the Michigan skill test work?

You get 3 or 4 randomly assigned tasks and 30 minutes total. Your first task is always one of four mandatory tasks that end with hand washing using soap and water: bedpan with urine output, catheter care for a female resident, donning and doffing PPE while emptying a urinary drainage bag, or perineal care for a female resident. You must score 80% or better on each task with no missed key steps.

Q: How many times can I retake the Michigan nurse aide exam?

You have three attempts to pass the knowledge and skill portions within 24 months of completing your training program. There is no mandatory waiting period between attempts; you pay for the failed component in your TMU account and schedule a new date. If you use all three attempts or run past 24 months, you must complete a new LARA-approved training program before testing again.

Q: How many training hours does Michigan require before I can test?

Michigan requires a LARA-permitted nurse aide training program of at least 75 total hours, structured as 16 classroom hours, 16 clinical hours, and 43 additional classroom, laboratory, or clinical hours. The first 16 hours of instruction must be completed before a student has direct contact with residents.

Q: Who runs the Michigan test and who maintains the registry?

LARA contracts with D&S Diversified Technologies (D&SDT-Headmaster) to deliver and score the competency exam through the TestMaster Universe (TMU) system. Since July 26, 2023, LARA's Bureau of Community and Health Systems maintains the registry itself in MI-NATES, so passing the exam is only part of the process; you must also apply and pay the application fee in MI-NATES to be certified.

Q: How do I renew a Michigan CNA certificate?

Certificates are valid for two years and are renewed in MI-NATES as early as 45 days before expiration. You attest that you worked at least 40 hours as a nurse aide for pay during the 24-month cycle and, for certificates expiring on or after March 23, 2026, that you completed 12 hours of continuing education each year (24 hours per cycle) including abuse, neglect, and care plan training.

Q: What happens if my Michigan CNA certificate lapses?

If it has been lapsed less than two years, you can renew through MI-NATES using the same work and continuing-education attestations. If it has been lapsed more than two years, or you cannot show paid nurse aide work in the last 24 consecutive months, you must retake a state-approved training program and pass the competency exam again.

Q: Can I work before I pass the Michigan competency exam?

Yes, for a limited time. Under 42 CFR 483.35(d), a graduate of a Michigan-permitted training program who is not yet on the registry may work in a skilled nursing facility as a temporary nurse aide for up to four months. If you have not passed testing within four months of starting that employment, you may not continue working as a nurse aide until you are listed on the registry.

Question 1

On the Michigan skill test, how do you count and record a radial pulse and respirations, and how close must your numbers be?

Accepted Answer

Count each for one full minute, telling the RN Test Observer when you start and stop. Your recorded pulse must be within 4 beats of the observer's count and your recorded respirations within 2 breaths. Counting for 30 seconds and doubling is not accepted on this task.

Question 2

What order of steps makes a bed-to-wheelchair transfer with a gait belt safe?

Accepted Answer

Lock the bed brakes and the wheelchair brakes, sit the resident up, put on non-skid footwear, lower the bed until the feet are flat on the floor, apply and tighten the gait belt, check tightness by slipping your fingers under it, place the wheelchair touching the side of the bed, then stand the resident using an upward grasp on both sides of the belt and pivot in a controlled way.

Question 3

When ambulating a resident with a gait belt on the Michigan skill test, how far must you walk them?

Accepted Answer

At least ten steps to the wheelchair before assisting them to pivot and sit. You face the resident, grasp the belt on both sides with an upward grasp, stabilize before moving, and use proper body mechanics the entire time.

Question 4

How is a knee-high anti-embolic (elastic) stocking applied correctly?

Accepted Answer

Roll or turn the stocking inside out down to at least the heel, place it over the toes, foot, and heel, then pull it up the leg. Check the toes for pressure, adjust as needed, and leave the stocking smooth and wrinkle-free. Wrinkles concentrate pressure and can restrict circulation instead of supporting it.

Question 5

Which support devices are required when positioning a dependent resident on their side?

Accepted Answer

A pillow under the head, a support device under the upside arm, a support device behind the back, and a support device between the knees. Move the upper body, then the hips, then the legs toward yourself before turning, and reposition the arm and shoulder so the resident is not lying on their own arm.

Question 6

How should a dependent resident be positioned before, during, and after you assist them with a meal in bed?

Accepted Answer

Sit them upright at least 75 to 90 degrees before the meal, provide hand hygiene and dry their hands first, sit in a chair facing them, describe the food, offer small amounts at a reasonable rate with fluids offered frequently, and leave the head of the bed at 45 degrees or higher afterward to reduce aspiration risk.

Question 7

Which adult vital sign readings should a nurse aide report to the nurse right away?

Accepted Answer

Report a pulse outside roughly 60 to 100 beats per minute, respirations outside roughly 12 to 20 per minute, a temperature above the resident's baseline range, or a blood pressure that has changed sharply from the resident's usual reading. The aide measures and reports; the nurse interprets and decides on treatment.

Question 8

What body mechanics protect a nurse aide during lifting and moving?

Accepted Answer

Keep your feet shoulder width apart, bend at the hips and knees rather than the waist, hold the load close to your body, push or slide rather than lift when possible, pivot with your feet instead of twisting your spine, and raise the bed to hip height before working. Ask for help or a mechanical lift rather than lifting alone.

Question 9

What is the difference between objective and subjective observations, and which one gets reported immediately?

Accepted Answer

Objective data is what you can see, hear, feel, or measure, such as a reddened heel or a pulse of 108. Subjective data is what the resident tells you, such as "my chest hurts." Both are recorded, but anything new, sudden, or abnormal, including resident complaints of pain or shortness of breath, is reported to the nurse immediately rather than saved for the end of shift.

Question 10

How is urine output measured and recorded on the Michigan skill test?

Accepted Answer

Pour the contents into a graduate, set the graduate on a level, flat surface, and read it with the graduate at eye level. Record the amount in milliliters on the previously signed recording form; your figure must be within 25 mL of the RN Test Observer's reading. Reading a graduate held in the air or at an angle produces a false measurement.

Question 11

What are the required elements of hand washing with soap and water on the Michigan skill test?

Accepted Answer

Wet hands and wrists, apply soap, scrub with friction for at least 20 seconds with fingers interlaced and pointing downward, wash all hand surfaces and the wrists, clean fingernails against the opposite palm, rinse with fingers pointing down, dry from fingertips toward wrists with clean paper towels, and turn off the faucet with a clean dry paper towel.

Question 12

When does the Michigan skill test require hand sanitizer versus soap and water?

Accepted Answer

Most tasks begin and end with hand sanitizer, covering all surfaces of the hands and rubbing until completely dry. The mandatory first task of every skill test ends with full soap-and-water hand washing at the sink, which is why candidates should practice the 20-second washing sequence until it is automatic.

Question 13

What is the correct order for putting on and taking off a gown and gloves?

Accepted Answer

Put the gown on first, tie it at the neck and waist so the back flaps cover your clothing, then put on gloves so the glove cuffs overlap the gown cuffs. Reverse the contamination risk when removing: gloves come off before the gown, then the gown is unfastened and pulled off inside out without touching its outer surface.

Question 14

Describe the correct technique for removing contaminated gloves.

Accepted Answer

With one gloved hand, grasp the other glove at the palm and pull it off. Slip the fingers of your bare hand under the cuff of the remaining glove at the wrist and pull it off, turning it inside out over the first glove. Discard both in a trash container without touching your skin, then perform hand hygiene.

Question 15

What do standard precautions require of a nurse aide?

Accepted Answer

Treat every resident's blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes as potentially infectious, no matter what diagnosis the chart shows. Standard precautions apply to all residents at all times, which is why hand hygiene and gloves are used for perineal care, catheter care, and emptying drainage bags.

Question 16

How do contact, droplet, and airborne precautions differ?

Accepted Answer

Contact precautions add gown and gloves for organisms spread by touch, such as C. difficile or MRSA. Droplet precautions add a surgical mask for organisms spread by coughing or sneezing at close range, such as influenza. Airborne precautions require a negative-pressure room and a fitted respirator for organisms that stay suspended in air, such as tuberculosis. All are used in addition to standard precautions, never instead of them.

Question 17

How is perineal care for a female resident performed on the Michigan skill test?

Accepted Answer

Separate the labia and clean each side and then the vaginal area from front to back, using a clean portion of the washcloth for every stroke, then rinse the same way and pat dry. Turn the resident and wash from the vagina toward the rectal area. The task is demonstrated on a manikin, and peri-wash or no-rinse products are not allowed; you must use water and a soapy washcloth.

Question 18

What is the correct order and technique when washing a resident's face during a bed bath?

Accepted Answer

Wash the eyes first without soap, moving from the inner corner outward, using a clean portion of the washcloth for each stroke and each eye. Then wash the whole face, including the mouth and nose, without soap, and pat it dry. Soap dries and irritates facial skin and can burn the eyes.

Question 19

What protects a denture from damage during cleaning and storage?

Accepted Answer

Line the sink with a towel, washcloth, or paper towels before you start, handle the denture carefully, and rinse and brush all inner, outer, and chewing surfaces under cool running water. Store it in a rinsed, labeled denture cup filled with cool clean water and put the lid on. Hot water can warp a denture, and an unlined sink turns a dropped denture into a broken one.

Question 20

Where does lotion go, and not go, when giving foot care?

Accepted Answer

Apply lotion to the top and bottom of the foot and wipe away any excess, but never apply lotion between the toes. Trapped moisture between the toes softens the skin and encourages fungal growth and skin breakdown, so that area is washed, rinsed, and dried thoroughly instead. Nurse aides do not cut or trim a resident's toenails.

Question 21

Why does an open-ended question get better information from a resident than a closed one?

Accepted Answer

A closed question such as "Are you in pain?" invites a yes or no answer that can be shaped by what the resident thinks you want to hear. An open-ended question such as "Tell me how your hip feels this morning" invites description, gives you observations to report, and shows the resident you are listening rather than checking a box.

Question 22

How should you communicate with a resident who has expressive aphasia after a stroke?

Accepted Answer

Face the resident at eye level, speak normally and unhurriedly, ask one question at a time, and allow generous silence for them to find words. Do not finish their sentences or pretend to understand. Offer a communication board, picture cards, or yes and no questions, and report any change in their ability to communicate to the nurse.

Question 23

What is the difference between reporting and recording, and who does a Michigan nurse aide report to first?

Accepted Answer

Reporting is telling information verbally; recording is writing it in the resident's record. Nurse aides report to the charge nurse or supervising licensed nurse first, following the facility chain of command. Record only care you actually gave and observations you actually made, and never chart care in advance.

Question 24

Which courtesy steps are scored on essentially every Michigan skill task?

Accepted Answer

Knock before entering, explain the procedure to the resident, provide privacy by pulling the privacy curtain, place the call light or signaling device within easy reach before you leave, and maintain respectful, courteous interpersonal interactions at all times. These are scored steps, not optional politeness, and candidates lose points by working in silence.

Question 25

A resident's family asks you in the hallway how her mother's wound is healing. What do you do?

Accepted Answer

Do not discuss the resident's condition. Politely explain that you cannot share clinical information and refer the family to the nurse. Resident information is confidential under HIPAA and under resident rights rules, and casual hallway conversations are one of the most common privacy violations in long-term care.

Question 26

Which federal law created nurse aide training, testing, and registry requirements?

Accepted Answer

The Nursing Home Reform Act, passed by Congress in 1987 as part of the Omnibus Budget Reconciliation Act (OBRA 1987). It set the national standards for nurse aide competency evaluation and resident rights that Michigan's training, testing, and registry rules are built on.

Question 27

A resident refuses her bath. What is the correct response?

Accepted Answer

Stop, do not argue or force care, and try to learn why she is refusing, such as pain, cold, fatigue, or modesty. Offer an alternative time or a modified bath, then report the refusal to the nurse and document it. The right to refuse treatment is a protected resident right, and forcing care can be treated as abuse.

Question 28

What does protecting a resident's privacy and dignity look like during hands-on care?

Accepted Answer

Knock and wait, pull the privacy curtain and close the door, expose only the body part you are working on, keep the resident covered with a bath blanket, use their preferred name, and avoid discussing them in front of others. On the Michigan skill test, exposing only one leg or only the perineal area is a scored step.

Question 29

How are findings of abuse, neglect, or misappropriation handled on the Michigan Nurse Aide Registry?

Accepted Answer

A substantiated finding is displayed on the registry. Abuse and misappropriation of resident property carry permanent revocation and the finding stays on the registry permanently. Neglect carries a revocation of at least one year, after which the aide may petition LARA's Bureau of Community and Health Systems through MI-NATES to have the finding removed.

Question 30

You see bruising in the shape of fingerprints on a resident's upper arm. What must you do in Michigan?

Accepted Answer

Report it to your charge nurse immediately and document exactly what you observed without interpreting it. Suspected abuse, neglect, or exploitation of a vulnerable adult is also reported to MDHHS Adult Protective Services through the statewide centralized intake line at 855-444-3911, and residents and families can contact the Michigan Long Term Care Ombudsman for advocacy. Failing to report is itself a violation.

Question 31

How are Michigan's 75 required nurse aide training hours structured?

Accepted Answer

A LARA-permitted program must provide at least 75 total hours: 16 hours of classroom time, 16 hours of clinical time, and 43 additional hours mixed among classroom, laboratory, and clinical instruction. Students must complete 16 hours of instruction before any direct contact with residents, and programs follow the Michigan Competency-Driven Core Curriculum for Nurse Aides.

Question 32

You passed both parts of the Headmaster exam. Are you now a certified nurse aide in Michigan?

Accepted Answer

Not yet. Passing is only one part. You must create a MILogin account, build a profile in MI-NATES (the Michigan Nurse Aide, Training, and Enforcement System), submit the application, and pay the application fee before a certificate is issued and your name appears on the registry. LARA's Bureau of Community and Health Systems has maintained the registry itself since July 26, 2023.

Question 33

What must a Michigan CNA attest to in order to renew, and what happens after a long lapse?

Accepted Answer

Renewal is every two years through MI-NATES, available as early as 45 days before expiration. You attest to at least 40 hours of paid nurse aide work during the 24-month cycle and, for certificates expiring on or after March 23, 2026, to 12 hours of continuing education per year including abuse, neglect, and care plan training. Lapsed under two years can be renewed; lapsed over two years requires retraining and retesting.

Question 34

Which tasks fall outside a Michigan nurse aide's scope of practice?

Accepted Answer

Nurse aides do not administer medications, perform sterile procedures, insert or remove tubes, cut nails on residents with diabetes or circulatory disease, give tube feedings, or interpret assessments and give medical advice. Medication administration in Michigan requires a separate medication aide certificate. If a task is outside your training or scope, decline it and tell the nurse why.

Question 35

Summarize the structure and attempt limits of the Michigan nurse aide competency evaluation.

Accepted Answer

A 65-question knowledge exam in up to 60 minutes requiring 74%, plus a skill test of 3 or 4 randomly assigned tasks in 30 minutes requiring 80% on each task with no missed key steps. You get three attempts at each portion within 24 months of finishing training; after that you must complete a new LARA-approved program to test again.

Question 36

A resident begins to fall while you are walking with them. What do you do?

Accepted Answer

Do not try to hold them upright. Widen your stance, pull them close to your body using the gait belt, and ease them slowly to the floor while protecting the head. Stay with the resident, call for help, and do not move them or get them up until the nurse has assessed them. Then report and complete an incident report.

Question 37

What do RACE and PASS stand for in fire safety?

Accepted Answer

RACE is the response order: Rescue anyone in immediate danger, Alarm by pulling the alarm and calling out, Confine the fire by closing doors and windows, Extinguish or Evacuate as directed. PASS is how the extinguisher is used: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Question 38

What are the rules around physical restraints in long-term care?

Accepted Answer

Restraints require a physician's order for a specific medical reason and may never be used for staff convenience or discipline. The least restrictive alternative must be tried first, such as repositioning, activity, toileting schedules, bed or chair alarms, and lowering the bed. Facility policy typically requires visual checks at least every 30 minutes and release at least every 2 hours for repositioning, toileting, and range of motion.

Question 39

A resident is coughing forcefully while eating. Should you perform abdominal thrusts?

Accepted Answer

No. A forceful cough means the airway is only partly blocked and the resident is moving air; encourage them to keep coughing and stay with them. Abdominal thrusts are used when the obstruction is complete, shown by a silent cough, inability to speak or breathe, clutching the throat, or blue lips. Call for the nurse and for help either way.

Question 40

What should the resident's environment look like before you leave the room?

Accepted Answer

Bed lowered to its lowest safe position, brakes locked, call light or signaling device within easy reach, needed personal items within reach, floor dry and free of clutter, and soiled linen placed in the designated hamper. Leaving the call light out of reach is one of the fastest ways to fail a Michigan skill task and one of the most common causes of real falls.

Question 41

Which signs suggest depression rather than normal adjustment in an older resident?

Accepted Answer

Persistent sadness, loss of interest in activities the resident used to enjoy, appetite or weight change, sleeping too much or too little, fatigue, withdrawal from other residents, expressions of worthlessness, and any statement about wanting to die or not wanting to go on. Report all of these to the nurse; statements about self-harm are reported immediately.

Question 42

How should a nurse aide approach a resident who has become agitated and combative?

Accepted Answer

Stay calm, keep your voice low and unhurried, approach from the front where the resident can see you, allow personal space, and do not argue or restrain. Remove the trigger if you can identify one, such as noise, pain, a full bladder, or a crowded room, then redirect to a calming activity. Protect yourself and others, call for help, and report the episode.

Question 43

What is sundowning, and how do you manage it?

Accepted Answer

Sundowning is increased confusion, restlessness, and agitation in the late afternoon and evening in residents with dementia. Manage it by increasing light before dusk, keeping a consistent routine, reducing noise and stimulation, avoiding caffeine late in the day, offering a familiar activity, and scheduling demanding care earlier in the day.

Question 44

A resident with Alzheimer's disease insists she must leave to pick up her children from school. How do you respond?

Accepted Answer

Do not argue, correct her, or explain that her children are grown, which usually causes distress. Acknowledge the feeling behind the statement, reassure her, and redirect to a comforting activity or a walk. Validating the emotion rather than the fact keeps trust intact and prevents a catastrophic reaction.

Question 45

What is the safest response when a cognitively impaired resident is wandering toward an exit?

Accepted Answer

Approach calmly from the front, walk alongside rather than blocking or grabbing, use the resident's name, and redirect toward a safe activity or a supervised walking route. Report the incident so the care plan can be updated, and check that any wander alarm or door monitoring device is in place and functioning. Never restrain a resident to stop wandering.

Question 46

Which changes are normal in aging, and which are not?

Accepted Answer

Normal aging brings thinner and less elastic skin, decreased bone density, reduced muscle mass, slower reflexes, diminished hearing of high-pitched sound, decreased thirst sensation, and slower digestion. Confusion, incontinence, depression, and severe memory loss are not normal aging; they signal a problem to report to the nurse.

Question 47

What is the core principle of restorative care?

Accepted Answer

Do things with the resident, not for the resident. Restorative care preserves the abilities the resident still has by allowing extra time, using assistive devices such as built-up handles, plate guards, and grab bars, and encouraging self-care even when it is slower. Doing everything for a resident causes avoidable loss of function.

Question 48

How is passive range of motion performed on the Michigan skill test?

Accepted Answer

Support the joint above and below, for example one hand under the knee and one under the ankle for hip and knee exercises. Move slowly through each motion at least three times, never force a joint past the point of free movement, stop and report any resistance or pain, and ask the resident at least once during the exercise whether they have any pain or discomfort.

Question 49

A resident with diabetes becomes shaky, sweaty, pale, and confused before lunch. What is happening and what do you do?

Accepted Answer

These are signs of hypoglycemia, or low blood sugar. Stay with the resident and call the nurse immediately. A nurse aide does not administer insulin or make treatment decisions, but delay is dangerous, so report the change at once rather than waiting to see if it passes.

Question 50

How do you dress and undress a resident who has a weak (affected) side after a stroke?

Accepted Answer

Dress the affected side first and undress the unaffected side first, so the weaker limb moves through the smallest range while clothing is loose. Support the affected arm or leg through the sleeve or pant leg instead of pulling on it, place the call light and personal items on the unaffected side, and watch for swallowing difficulty and drooping on the affected side.

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