2.1 Basic and Personal Care

Basic Nursing Care Starts with Safety

Most Virginia CNA resident-care items describe ordinary tasks: bathing, dressing, feeding, toileting, repositioning, transferring, and measuring vital signs. The correct answer is almost always the one that protects the resident from infection, injury, aspiration (food or fluid entering the airway), pressure injury, and loss of dignity while staying inside the care plan.

The Virginia knowledge exam, administered by Credentia, is 70 multiple-choice questions in the standard written form (10 of them are unscored pretest items), with a 2-hour limit. The oral version instead has 60 multiple-choice questions plus 10 reading-comprehension items. Virginia requires an 80% passing score — one of the highest CNA thresholds in the country, so you can miss only a handful of scored questions.

Care Patterns the Exam Rewards

Infection control is built into every task. Perform hand hygiene before and after resident contact, after glove removal, and whenever you move from a dirty task to a clean one. Gloves protect during contact with blood, body fluids, mucous membranes, non-intact skin, soiled linen, or contaminated equipment — but gloves never replace hand washing, and you change gloves between dirty and clean steps.

Vital Sign Ranges to Memorize

Know normal adult ranges cold, because items often hide an abnormal value:

• Temperature: about 97.0–99.0 F orally (≈ 36.1–37.2 C)
• Pulse: 60–100 beats/min; below 60 or above 100 is reportable
• Respirations: 12–20 breaths/min
• Blood pressure: below 120/80 is ideal; ≥140/90 or a sudden change is reportable

A worked example: you take a resident's pulse and it is 112 and irregular, up from a baseline of 78. You do not decide it is harmless and you do not retake it five times — you record the value and report the change to the nurse, because rate and rhythm together signal a possible cardiac problem.

ADL Technique and Common Traps

For feeding, position the resident upright at 90 degrees, verify the diet card and any thickened-liquid order, offer small bites, alternate solids and liquids, and watch for coughing or pocketing food in the cheek. Coughing on thin liquids suggests dysphagia (difficulty swallowing) — stop intake and report. For mouth care on an unconscious resident, turn the head to the side so secretions drain and the airway is protected. For diabetic residents or anyone with poor circulation, toenail trimming is outside routine CNA scope; report the need to the nurse, because a small nick can become a serious wound.

A classic distractor is the answer that prioritizes speed or task completion over safety — standing a weak resident without a gait belt, leaving a bed in the high position, or skipping the call light. On the NNAAP skills evaluation you perform five assigned skills in 30 minutes and must pass all five, and Hand Hygiene is always assigned along with four randomly selected skills. The evaluator warns you when 25 minutes have passed, so wasted setup time can cost the test.

Skin, Mobility, and Catheter Safety

Pressure-injury prevention is heavily tested because immobile residents develop skin breakdown over bony areas — the sacrum, heels, hips, elbows, and the back of the head. Reposition at least every 2 hours, keep skin clean and dry, keep linens wrinkle-free, and float heels off the mattress with a pillow. The earliest warning sign is non-blanchable redness (skin that stays red when you press it); report it before it becomes an open wound. Never massage a reddened bony prominence — that can worsen the tissue damage.

For mobility, always apply a gait belt around the waist for transfers and ambulation, lock wheelchair and bed wheels first, transfer toward the resident's strong side, and use good body mechanics: feet shoulder-width apart, bend the knees not the back, hold the load close, and pivot rather than twist. A resident who starts to fall is eased to the floor against your body — you do not try to hold them upright, which injures both of you.

Catheter and Toileting Rules

For a resident with an indwelling urinary catheter, the drainage bag is always kept below the level of the bladder to prevent backflow and catheter-associated urinary tract infection (CAUTI), the tubing is kept free of kinks, and the bag never touches the floor. Provide perineal care and meatal cleaning daily, wiping front to back in females to keep stool away from the urinary opening. Empty and measure output without letting the spout touch the graduate.

Practice the safety wrapper until it is automatic on every skill: privacy, hand hygiene, call light within reach, bed low and locked, and exact recording of every measurement before you report off.