7.5 Credentia NNAAP Skills, Part 2: Measurements, Mobility, Positioning, and Range of Motion
Key Takeaways
Every Credentia skills test includes one measurement skill: manual blood pressure (±8 mmHg), radial pulse (±4 beats), respirations (±2 breaths), urinary output (±25 mL), or weight (±2 lb).
Credentia measures urinary output from a bedpan, rounding up to the nearest 25 mL when the level falls between lines, and you must remove gloves and wash hands before recording.
For weight, put nonskid footwear on the client and set the scale to zero before the client steps on; for the knee-high stocking, the critical step is finishing with no twists or wrinkles and the heel in place.
Before standing a client for ambulation or transfer, nonskid footwear and feet flat on the floor are critical, and for the wheelchair transfer, locking the wheelchair wheels is critical.
NNAAP range of motion skills exercise one knee and ankle or one shoulder at least 3 times per motion, supporting the limb at two points and stopping if the client reports pain.
7.5 Credentia NNAAP Skills, Part 2: Measurements, Mobility, Positioning, and Range of Motion
Every Credentia skills evaluation includes one measurement skill: manual blood pressure, radial pulse, respirations, urinary output, or weight. You record the result on a digital device in a field labeled Candidate Results while you are performing the skill, and once you enter it, neither you nor the evaluator can change it. You must know how to zero both a standing scale and a non-digital bathroom scale. This section covers those measurement skills plus the stocking, ambulation, transfer, positioning, and range of motion skills on Credentia's Alabama list. Critical Element Steps are marked "(critical)."
Measurement Skills and Tolerances
| Skill | Key steps | Recorded result must be |
|---|---|---|
| Skill 6: Counts and Records Radial Pulse | Place fingertips on the thumb side of the wrist; count for one full minute; call light in reach; wash hands before recording | Within ±4 beats of the evaluator (critical) |
| Skill 7: Counts and Records Respirations | Explain the procedure (for testing purposes); count for one full minute; call light in reach; wash hands before recording | Within ±2 breaths of the evaluator (critical) |
| Skill 23: Measures and Records Manual Blood Pressure | Wipe the stethoscope with alcohol; arm palm up; cuff snug with the arrow over the brachial artery; inflate to 160–180 mmHg (reinflate no higher than 200); first sound systolic, last sound diastolic; round up to the nearest 2 mmHg; wash hands before recording | Both numbers within ±8 mmHg of the evaluator |
| Skill 13: Measures and Records Urinary Output | Gloves on before handling the bedpan; pour the urine into the measuring container without spilling; read at eye level on a flat surface; if between lines, round up to the nearest 25 mL; empty and rinse into the toilet; remove gloves and wash hands before recording | Within ±25 mL of the evaluator (critical) |
| Skill 14: Measures and Records Weight of Ambulatory Client | Nonskid footwear on before walking to the scale; set the scale to zero before the client steps on; client steps onto the center; client steps off; wash hands before recording | Within ±2 lb (or ±0.9 kg) of the evaluator (critical) |
Three differences from Prometric are easy to mix up: Credentia measures urinary output from a bedpan with a ±25 mL tolerance (Prometric empties a catheter drainage bag with ±50 mL), Credentia tests manual blood pressure and weight (Prometric's Alabama list has neither), and Credentia records results on a digital device rather than a paper form. The detailed manual blood pressure steps are in Section 5.1.
Skill 2: Applies One Knee-High Elastic Stocking
- Explain the procedure and provide privacy. The client lies supine in bed while the stocking is applied.
- Turn the stocking inside out, at least to the heel.
- Place the foot of the stocking over the toes, foot, and heel, then pull the top of the stocking over the foot, heel, and leg.
- Move the foot and leg gently and naturally, without force or overextension.
- Finish with no twists or wrinkles, the heel of the stocking over the heel, and the toe opening (if present) over or under the toes. (critical) If the client is a mannequin, you may state that the stocking must be wrinkle-free.
- Call light in reach, bed low, and wash your hands.
Elastic (anti-embolism) stockings squeeze the leg to help blood return to the heart and lower the risk of blood clots. Wrinkles or a rolled top act like a tourniquet, so smoothness is the critical point.
Skill 3: Assists to Ambulate Using Transfer Belt
- Explain and provide privacy.
- Before helping the client stand, make sure the client is wearing nonskid shoes or footwear. (critical)
- Put the bed at a safe level and check or lock the bed wheels.
- Help the client to a sitting position with feet flat on the floor. (critical)
- Apply the transfer belt securely at the waist over clothing, and give instructions, including a prearranged signal for standing.
- Stand facing the client, count to three (or give the signal), and help the client stand by grasping the belt on both sides with an upward grasp, stabilizing the client's legs knee to knee or toe to toe.
- Walk slightly behind and to one side of the client for 10 feet, holding the belt.
- Help the client back to the bed, remove the belt, leave the call light in reach and the bed low, and wash your hands.
Skill 22: Transfers from Bed to Wheelchair Using Transfer Belt
- Position the wheelchair alongside the bed, at the head of the bed facing the foot or at the foot of the bed facing the head, with the footrests folded up or removed.
- Lock the wheelchair wheels before helping the client stand. (critical) Put the bed at a safe level and lock the bed wheels.
- Help the client sit with feet flat on the floor. (critical) Make sure the client is wearing shoes, then apply the belt over clothing and explain the signal.
- Stand facing the client and assist to standing with an upward grasp on both sides of the belt, stabilizing the legs knee to knee or toe to toe.
- Help the client turn to stand in front of the wheelchair with the backs of the legs against it, then lower the client into the chair.
- Position the hips against the back of the wheelchair, remove the belt, place the feet on the footrests, put the call light within reach, and wash your hands.
Skill 17: Positions On Side
- Explain and provide privacy, then lower the head of the bed before turning.
- Raise the side rail on the side the client will be turned toward, and help the client roll slowly toward it.
- Place or adjust a pillow under the head for support, and reposition the arm and shoulder so the client is not lying on the arm.
- Support the top arm with a supportive device, and place a supportive device behind the back.
- Place a supportive device between the legs with the top knee flexed, supporting the knee and ankle.
- Call light in reach, bed low, and wash your hands.
Range of Motion Skills
Both NNAAP range of motion skills are "modified passive" skills done at least 3 times each, gently, slowly, and smoothly, and you must stop the exercise if the client says it hurts. Instruct the client to tell you about any pain before you begin.
| Skill | Motions (each at least 3 times) |
|---|---|
| Skill 15: One knee and one ankle (client supine) | Supporting the leg at the knee and ankle, bend the knee and return it to its normal position (flexion/extension) (critical). Supporting the foot and ankle close to the bed, push the foot toward the head (dorsiflexion) and then point the toes down (plantar flexion) (critical). |
| Skill 16: One shoulder | Supporting the arm at the elbow and wrist, raise the straightened arm from the side up toward the head to ear level and back down (flexion/extension) (critical). Supporting the arm at the elbow and wrist, move the straightened arm away from the side to shoulder level and back (abduction/adduction) (critical). |
Prometric's shoulder skill uses the same two motions, but Prometric also has an elbow-and-wrist skill and a hip-knee-ankle skill that include the hip; Credentia's leg skill exercises only the knee and ankle.
Practice Strategy
- Practice each measurement until your counts land inside the tolerance every time; count a full minute, never 30 seconds times two.
- Say the prearranged signal out loud during transfers and ambulation, because "provides instructions, including a prearranged signal" is a listed step.
- After the first skill, tell the evaluator when you would wash your hands, and still finish every skill with the call light in reach.
On Credentia's Measures and Records Urinary Output skill, the urine level in the measuring container falls between the 200 mL and 225 mL lines. What should the candidate record?
200 mL, rounding down to the lower line
212 mL, estimating the midpoint between the lines
250 mL, rounding up to the next 50 mL
225 mL, rounding up to the nearest 25 mL
Which action is a Critical Element Step in Credentia's Transfers from Bed to Wheelchair Using Transfer Belt skill?
Placing the wheelchair at a 90-degree angle to the foot of the bed
Raising the bed to its highest position before standing
Locking the wheelchair wheels before helping the client stand
Asking the client to hold the candidate around the neck
On Credentia's Measures and Records Weight of Ambulatory Client skill, when must the candidate set the scale to zero?
Only if the evaluator asks for it
After recording the weight on the device
Before the client steps onto the scale
After the client steps off the scale
Sections you finish are checked off in the contents.
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