4.3 Basic Nursing Skills and Vital Signs

The Heaviest-Weighted Domain

Basic Nursing Skills is the largest content area on the Virginia NNAAP written exam, roughly 35% of scored items, and it supplies four of the five possible measurement skills on the skills evaluation (blood pressure, radial pulse, respirations, urine output, weight). Vital signs are where careless candidates lose the most points, so accuracy and the recording rule must be automatic.

Normal Adult Vital-Sign Ranges

Memorize these cold; written items often bury an abnormal value inside a calm-sounding scenario so you must recognize what is reportable.

Temperature varies by site: a rectal reading runs about 1 degree higher than oral, an axillary (armpit) reading about 1 degree lower. The CNA uses the site ordered and never takes an oral temperature on a confused resident who may bite the probe.

Measurement Technique and the Recording Rule

The most-missed point across all measurement skills is writing the result on the Recording Sheet for Measurement Skills. You earn credit only when you both measure accurately and document the value digitally in the Candidate Results box. Drill the write-down as a built-in step, and read it back to catch transposition (recording 67 when you measured 76).

• Radial pulse: locate the thumb-side wrist artery, count for a full 60 seconds, note rate and rhythm (regular or irregular). Halving a 30-second count is wrong on the NNAAP.
• Respirations: count for a full 60 seconds while keeping your fingers on the wrist so the resident thinks you are still taking the pulse. Do not tell the resident you are counting breaths, because awareness changes the rate. Count one full inhale-plus-exhale as one respiration.
• Blood pressure (electronic or manual): use the correct cuff size, position the arm at heart level, and for manual technique deflate slowly; the first sound is systolic, the last is diastolic. Wait a full minute before re-inflating.
• Weight: balance or zero the scale first, weigh in light clothing without shoes, and record promptly; rising weight can signal fluid retention.

Fluid Intake, Output, and Hydration

A CNA records intake and output (I&O) in milliliters. Measure urine output at eye level on a flat surface, not while holding the graduate in the air, which distorts the reading. Watch for dehydration (dry mouth, dark concentrated urine, confusion) and fluid overload (swelling, sudden weight gain). The CNA encourages fluids per the care plan and reports decreased output, but never restricts or pushes fluids beyond orders.

Common Conversions and Numerics

• 1 ounce = 30 mL, so an 8-ounce cup of juice fully consumed is recorded as 240 mL; if the resident drinks half, record 120 mL.
• 1 kilogram = 2.2 pounds, useful when a chart lists weight in kg.
• A pound of body weight gained per day in a day or two is reported as possible fluid retention.

Observing and Reporting Versus Interpreting

The bright line on every Basic Nursing Skills item: the CNA measures, records, and reports; the licensed nurse interprets, diagnoses, and treats. A worked example: you measure a blood pressure of 168/96, far above this resident's baseline of 122/78. You do not call it hypertension, you do not withhold a meal, and you do not re-take it ten times. You record the value and report it promptly to the nurse, who assesses and decides. Any answer where the aide interprets, treats, or independently changes the plan is the distractor.

Objective reporting also matters: report what you measured and observed, not your guess. "BP 168/96, resident reports headache, nurse notified at 0900" is correct; "resident has high blood pressure and is probably stressed" is not, because it diagnoses and editorializes.

Pain, Edema, and Other Reportable Observations

Basic Nursing Skills items also test recognizing common findings the CNA must observe and report without interpreting. Pain is whatever the resident says it is; report the location, the resident's description, and any 0-10 rating, plus nonverbal cues (grimacing, guarding, restlessness) in residents who cannot speak. Edema (swelling, often in the ankles and feet) is reported because it can signal fluid overload or circulatory problems. Report also skin changes, unusual drainage, changes in appetite or behavior, and any complaint of dizziness or shortness of breath.

The CNA's job is to be the eyes and ears of the nurse: notice, record objectively, and report promptly.

Bedmaking, Comfort, and the Environment

A safe, clean environment is part of basic nursing care. Keep the bed wrinkle-free to prevent skin breakdown, make an occupied bed by turning the resident and working one side at a time, and keep the bed in the lowest locked position with the call light reachable when you leave. Maintain a comfortable temperature, reduce noise, and keep the floor dry and clear to prevent falls. Promptly answer call lights and address comfort needs, because unmet basic needs drive both safety incidents and behavior problems. These environmental steps are the same indirect-care checkpoints scored on nearly every NNAAP skill.