10.2 High-Frequency Skills Walkthrough
Key Takeaways
- Hand washing critical steps: wet, soap, lather with friction ~20 seconds, fingertips down, rinse, dry, turn off faucet with a clean paper towel.
- Measurement tolerances: blood pressure within +/-8 mmHg, radial pulse within +/-4 beats, respirations within +/-2, weight within +/-2 lb (+/-0.9 kg) of the evaluator.
- Always lock bed and wheelchair brakes, apply a gait belt over clothing, and check non-skid footwear before any transfer or ambulation skill.
- Perineal and catheter care wash front-to-back / away from the meatus, use a clean area of the cloth each stroke, and keep the drainage bag below the bladder and off the floor.
- Feeding requires the resident upright at ~90 degrees, small bites, checking the food temperature, and verifying swallowing; ROM is slow, supported, and stops at the point of pain.
Hand Washing (always tested, not prompted)
This skill is on every Florida test and you start it yourself. Memorize the critical steps as a fixed sequence.
| # | Critical Step |
|---|---|
| 1 | Turn on water; wet hands and wrists |
| 2 | Apply soap |
| 3 | Lather with friction on all surfaces — palms, backs, between fingers, under and around nails — for about 20 seconds |
| 4 | Keep fingertips pointed down so water runs off the dirtiest area |
| 5 | Rinse thoroughly, fingertips down, from clean (wrist) to dirty (fingertips) |
| 6 | Dry hands with a clean paper towel |
| 7 | Turn off the faucet with a clean, dry paper towel, not bare hands |
| 8 | Dispose of the towel without contaminating clean hands |
Common fails: a lather shorter than 20 seconds, touching the sink or faucet with clean hands, and pointing fingertips up so dirty water runs back onto the wrists. Do not turn off the water with your bare clean hand — the handle is a contaminated surface.
Measurement Skills and Tolerances
Measurement tasks are objective: your recorded number must fall within the accepted tolerance of the evaluator's own reading, or the skill fails. These are the NNAAP-style tolerances Prometric applies.
| Skill | Critical Points | Accepted Tolerance |
|---|---|---|
| Blood pressure | Correct cuff size and placement, controlled inflation/deflation, accurate systolic/diastolic, record | Within +/-8 mmHg of the evaluator (each of systolic and diastolic) |
| Radial pulse | Count for a full 60 seconds, fingers (not thumb) on the radial artery, record | Within +/-4 beats of the evaluator |
| Respirations | Count discreetly for a full minute so the resident is unaware, record | Within +/-2 breaths of the evaluator |
| Urinary output | Pour into a graduate on a flat surface, read at eye level, record in mL/cc | Read accurately at eye level; record correct value |
| Weight (ambulatory) | Balance the scale at zero, resident steps on safely, accurate reading, record | Within +/-2 lb (or +/-0.9 kg) of the evaluator |
Record in the correct units on the device or form provided, and document before you say you are finished. For output, remove gloves before documenting, record the time and type (urine), and never include rinse water. Read every liquid at eye level on a flat surface — never estimate while holding the container in the air.
Transfer, Ambulation, Peri/Catheter Care
Transfer (bed to wheelchair, gait belt)
| Critical Step |
|---|
| Explain; provide privacy; lower the bed to a safe height |
| Lock the bed and wheelchair brakes |
| Resident wears non-skid footwear |
| Apply the gait belt snugly over clothing (two fingers fit under it) |
| Good body mechanics; block the resident's knees/feet; lift on a count |
| Pivot toward the strong side; lower in control; reposition for comfort |
| Remove gait belt; call light in reach; hand hygiene |
Ambulation (walking with a gait belt)
Lock the brakes, apply the gait belt, position non-skid footwear, help the resident stand, grasp the belt with an underhand grip, walk slightly behind and to the side, and lower the resident safely if they begin to fall (ease toward your body, protect the head) rather than catching them upright.
Perineal / Catheter Care
- Glove, provide privacy, expose only the area needed.
- Female perineal care: wash front to back, top to bottom, a clean area of the cloth for each stroke — never back to front (prevents urinary tract infection).
- Catheter care: clean away from the meatus along the catheter ~4 inches, keep the catheter secured to the leg, and keep the drainage bag below the level of the bladder and off the floor.
- Rinse, dry, reposition, remove gloves, hand hygiene.
Feeding and Range of Motion
Feeding a Resident (sitting in a chair)
| Critical Step |
|---|
| Hand hygiene; check the tray/name against the resident and any diet order |
| Position the resident upright at ~90 degrees (Fowler's), sitting safely |
| Check the food temperature (you may test against your wrist) before feeding hot items |
| Offer small bites, alternate foods and fluids, at the resident's pace |
| Verify the resident has swallowed before the next bite (aspiration safety) |
| Wipe the mouth, keep the resident upright ~30 minutes after, record intake |
Never rush feeding or feed a resident who is reclined — both are aspiration risks and exam fails.
Range of Motion (ROM)
- Support the joint above and below; move slowly and smoothly.
- Perform each motion (flexion/extension, abduction/adduction, rotation as ordered) the stated number of times, usually 3-5 repetitions.
- Stop at the point of pain or resistance — never force a joint.
- Keep the resident covered; expose only the limb being exercised; return the limb to a comfortable position when done.
Know the motion vocabulary, because the prompt names it: flexion (bend), extension (straighten), abduction (away from midline), adduction (toward midline), rotation, and for the ankle dorsiflexion/plantar flexion. ROM done passively (you move the joint) is the tested version; if the resident can move on their own, that is active ROM and you cue rather than move. Forcing past pain is both an automatic fail and a real injury risk, so the pain stop is the single most important bold step in this skill.
On the Florida CNA skills test, the evaluator reads a blood pressure of 138/86. Within what range must your recorded reading fall to pass the measurement?
While performing the hand washing skill, after rinsing the candidate turns off the faucet directly with her clean bare hand. On the Florida skills test this is:
Place these critical steps of a bed-to-wheelchair transfer in the correct order.
Arrange the items in the correct order