2.2 Core Workflows and Decision Points

2.2 Core Workflows and Decision Points

Every Basic Nursing Skills question hides a workflow. If you know the correct order of steps and the technique detail, you can usually eliminate three options instantly. Below are the workflows the Ohio STNA exam tests most often.

Vital-sign technique

• Pulse: Use the radial artery at the wrist. Count for a full 60 seconds if irregular; a 30-second count times 2 is acceptable only if regular. Report below 60 or above 100.
• Respirations: Count immediately after the pulse without telling the resident, keeping your fingers on the wrist so they do not consciously change their breathing. One rise and fall equals one respiration.
• Blood pressure: Position the arm at heart level and supported, cuff snug, bladder centered over the brachial artery. An arm below heart level reads falsely high; above heart level reads falsely low.
• Temperature: Choose the correct site and probe cover, and wait 15-20 minutes after eating, drinking, or smoking for an oral reading.

Measuring intake and output (I&O)

I&O is charted in milliliters (mL). The exam routinely gives ounces and expects you to convert.

Worked example: a resident drinks one 8 oz cup of coffee, a 4 oz juice, and 6 oz of water. Intake is (8 + 4 + 6) oz = 18 oz x 30 = 540 mL. Output includes urine, emesis, and liquid stool, also measured in mL. Always empty the graduate at eye level on a flat surface to read accurately.

Elimination and catheter workflow

For catheter care, clean from the urethral meatus outward, using a fresh area of the cloth for each stroke, so bacteria are not dragged toward the bladder. Never use alcohol on mucous membranes. Keep the drainage bag below bladder level at all times and never let the drain spout touch the collection container, which would break the closed sterile system and risk a catheter-associated urinary tract infection (CAUTI).

Weighing and measuring residents

Weight changes are an early warning of fluid problems, so accurate measurement matters. Weigh the resident at the same time of day, on the same scale, in similar clothing, with the bladder emptied first. A standing scale requires the resident to stand still without holding on; a chair or lift scale is used when standing is unsafe. Convert pounds to kilograms by dividing by 2.2 when the chart uses metric. A sudden gain of two or more pounds in a day can signal fluid retention and is reported to the nurse rather than simply charted.

Positioning and transfer workflow

Safe transfers protect both resident and aide. Lock the bed and wheelchair wheels, lower the bed to the resident's seated height, apply a gait or transfer belt around the waist over clothing, and have the resident push up rather than be pulled by the arms. Use a wide base of support, bend at the knees and hips, keep the back straight, and lift with the legs. Never twist while lifting; pivot your feet instead. These body-mechanics rules show up both as written questions and as graded steps in the skills test.

Decision points the exam rewards

At each step, ask two questions: is the finding normal or abnormal, and is this action inside my scope? Aides measure and report; they do not interpret or treat. A falsely positioned cuff, an alcohol wipe on a catheter, a drainage bag lifted above the bladder, or pulling a resident up by the arms are classic wrong answers because each violates a known technique or safety rule. The safest, infection-controlled, in-scope action that produces an accurate, reported measurement is almost always the correct choice.

Putting a workflow question together

Consider a worked example that blends several of these workflows. A resident is due for a blood pressure check and an I&O entry, and the aide notices the urinary drainage bag is hanging on the upper bed rail above the resident's hip. The correct sequence is: wash hands and greet the resident, lower the drainage bag below bladder level immediately because it has been allowing backflow, then position the arm at heart level and take the blood pressure, reading a value such as 150/92. That reading is above the 140/90 threshold, so the aide records it and reports it to the nurse rather than acting on it.

The aide then measures and records the urine in milliliters at eye level, never letting the spout touch the container. Each step respects a known technique rule, stays inside the aide's scope, and ends with accurate documentation and a report of the abnormal finding. Practicing questions this way, by narrating the full ordered workflow instead of jumping straight to an answer letter, trains you to spot the step a distractor skips or performs out of order, which is exactly how the close calls on this domain are decided.