Basic Nursing Skills Practice Test

Answer: D — An oral temperature of 101.8 degrees F is significantly above the normal range of 97.6 to 99.6 degrees F and indicates a fever. Any temperature above 100.4 degrees F (38 degrees C) must be reported to the nurse immediately because fever can indicate infection, inflammation, or other medical conditions requiring assessment and treatment. The CNA should never delay reporting abnormal vital signs, attempt to treat the fever independently, or wait to see if it resolves on its own.

Answer: C — The first sound heard through the stethoscope (called the first Korotkoff sound) represents the systolic pressure - the force of blood against the artery walls when the heart contracts. The last sound heard represents the diastolic pressure - the force when the heart is resting between beats. The reading is recorded as systolic over diastolic: 138/88 mmHg. This reading is above the normal 120/80 and would be classified as elevated blood pressure (Stage 1 hypertension), which should be documented and reported to the nurse.

Answer: D — The apical pulse is taken by placing the stethoscope bell or diaphragm over the apex of the heart, located at the fifth intercostal space at the left midclavicular line - approximately just below the left nipple. The apical pulse is the most accurate heart rate measurement because it listens directly to the heartbeat rather than feeling a peripheral pulse wave. It is used when the radial pulse is weak, difficult to feel, or irregular, and is essential for calculating an apical-radial pulse deficit.

Answer: B — An SpO2 of 89 percent is significantly below the normal range of 95 to 100 percent and indicates hypoxemia - insufficient oxygen in the blood. This is an urgent finding that must be reported to the nurse immediately because prolonged low oxygen levels can cause confusion, organ damage, cardiac arrhythmias, and death. The CNA should NEVER adjust oxygen flow rates (this requires a physician order) and should not assume device malfunction without first checking probe placement, the resident circulation, and nail polish interference.

Answer: A — Tachypnea is an abnormally rapid respiratory rate above 20 breaths per minute in adults. A rate of 26 breaths per minute exceeds the normal range of 12 to 20 and must be reported to the nurse. Tachypnea can indicate pain, anxiety, fever, respiratory infection, heart failure, or metabolic disturbances. Bradypnea is an abnormally slow rate below 12, eupnea is normal breathing, and apnea is the complete absence of breathing. The CNA should also observe for other signs of respiratory distress such as labored breathing, nasal flaring, or use of accessory muscles.

Answer: A — Proper hand hygiene - washing with soap and water for at least 20 seconds or using alcohol-based hand sanitizer with at least 60 percent alcohol content - is consistently identified by the CDC as the single most effective measure to prevent healthcare-associated infections. Hands are the primary vehicle for transmitting pathogens between residents, contaminated surfaces, and healthcare workers. Hand hygiene must be performed before and after every resident contact, after removing gloves, and after touching contaminated surfaces.

Answer: A — The correct CDC-recommended PPE removal (doffing) sequence is: gloves FIRST (they are the most heavily contaminated item), then gown (unfasten and roll inside out), then exit the room, then mask or respirator last (removed by the straps, never touching the front). Removing gloves first prevents the heavily contaminated glove surface from touching and contaminating the gown ties, mask straps, face, or hair during removal of other PPE items. Hand hygiene must be performed after removing gloves and again after all PPE is removed.

Answer: D — Standard Precautions are the baseline infection control practices applied to the care of ALL residents in ALL healthcare settings, regardless of whether an infection has been diagnosed or suspected. This is because many infections are contagious before symptoms appear, some carriers show no symptoms at all, and blood and body fluids from any person may contain transmissible pathogens. Standard Precautions include hand hygiene, use of PPE when exposure to blood or body fluids is anticipated, respiratory hygiene, and safe handling of contaminated equipment.

Answer: B — Once any part of a sterile item is touched by a non-sterile surface (bare hands, unsterile gloves, clothing, countertop), the entire item is considered contaminated and must be discarded immediately. There is no way to re-sterilize a contaminated item at the bedside. Using contaminated materials on an open wound introduces bacteria directly into the body, which can cause wound infection, delayed healing, cellulitis, or systemic sepsis. The CNA should obtain a completely new sterile dressing and use proper sterile or clean technique as directed.

Answer: B — A red, non-blanchable area over a bony prominence (meaning the redness does NOT turn white when pressed with a finger and released) is classified as a Stage 1 pressure injury - the earliest stage of pressure-related skin damage. This must be reported to the nurse immediately so interventions can begin: repositioning to relieve pressure on the area, ensuring proper nutrition and hydration, using pressure-redistribution surfaces, and monitoring for progression. Early detection and intervention at Stage 1 can prevent progression to more serious and potentially life-threatening stages.

Answer: D — Immobile residents must be repositioned at least every 2 hours, 24 hours a day (including nights and weekends), to prevent pressure injuries. When tissue is compressed between a bony prominence and a surface for more than 2 hours, the blood supply is cut off and tissue begins to die. The CNA should alternate between supine, left lateral, and right lateral positions, use pillows to float bony prominences (heels, ankles, sacrum), and document each position change with the time and position used. Some high-risk residents may require even more frequent repositioning.

Answer: C — Skin that is clean, warm, dry, and intact with normal color is a NORMAL finding that does not require urgent reporting - though it should be documented as part of routine skin assessment. All other options are abnormal findings that must be reported immediately: non-blanchable redness (Stage 1 pressure injury), open areas or skin tears (risk of infection, possible abuse), and unusual bruising in atypical locations (possible sign of abuse or bleeding disorder). The CNA performs skin assessments during every bath, repositioning, and personal care activity.

Answer: B — Catheter care requires cleaning from the urethral meatus (where the catheter enters the body) outward and downward along the catheter tubing for at least 4 inches, using a clean area of the washcloth with each stroke. This direction moves bacteria AWAY from the body, which is critical for preventing catheter-associated urinary tract infections (CAUTIs). Cleaning in the opposite direction (from the drainage bag toward the body) would push bacteria from the contaminated external tubing toward the sterile urinary tract. Catheter care should be performed at least once per shift.

Answer: C — The catheter drainage bag must always remain BELOW the level of the bladder to allow urine to flow downward by gravity. If the bag is raised above the bladder, contaminated urine can flow backward from the collection bag into the bladder, causing a urinary tract infection. However, the bag must never touch the floor because the floor is heavily contaminated with bacteria that could travel up the drainage system. The bag should hang from the bed frame or a designated hook, and the tubing should be free of kinks, loops, or obstructions.

Answer: B — Every time a catheter drainage bag is emptied, the CNA must measure the exact amount using a graduated collection container (not estimate), note the characteristics of the urine (color, clarity, odor, presence of sediment or blood), record the output on the intake and output (I and O) sheet with the time, and report any abnormal findings to the nurse. Accurate I and O monitoring is essential for assessing kidney function, hydration status, and catheter patency. Even seemingly normal output should be documented to track trends over time.

Answer: A — The safe technique for turning a resident to a side-lying position is: raise the side rail on the side the resident will face (for safety), move to the opposite side, position the resident arm and leg to facilitate the roll, then gently roll the resident toward you by pulling from the far shoulder and hip using proper body mechanics. Standing on the side the resident will face means you are pulling them toward you (using your body weight) rather than pushing away (which risks the resident rolling too far or off the bed). Support with pillows behind the back and between the knees.

Answer: A — A draw sheet (lift sheet) placed under the resident from shoulders to thighs provides a smooth, low-friction surface for repositioning. Two staff members - one on each side of the bed - grip the rolled edges of the draw sheet and shift their weight from back foot to front foot on a coordinated count to slide the resident up. This technique protects the resident skin from friction burns and tears and protects both CNAs from back injury. Pulling by armpits, gowns, or limbs causes skin tears, shoulder dislocations, pain, and is considered rough and improper handling.

Answer: C — The wheelchair must be positioned on the resident STRONG (right) side, with brakes firmly locked and footrests swung out of the way. This allows the resident to lead the transfer with their stronger leg (bearing weight on the right leg during the pivot), use their stronger arm to grip the wheelchair armrest for support, and actively participate in the transfer. Placing the chair on the weak side forces the resident to pivot on their impaired leg, which cannot safely support their weight and greatly increases fall and injury risk.

Answer: D — Dangling - having the resident sit on the edge of the bed with feet flat on the floor for 1 to 2 minutes - is an essential safety step before standing. This allows the cardiovascular system to adjust to the position change and prevents orthostatic hypotension (a sudden drop in blood pressure when moving from lying to standing). During dangling, the CNA should ask the resident if they feel dizzy, lightheaded, or nauseous, and check for visible signs of distress. If the resident reports dizziness, do not proceed to standing - lower them back to bed and report to the nurse.

Answer: B — Residents with dysphagia must be positioned as upright as possible (60 to 90 degrees in high Fowler position) during all meals and for at least 30 minutes after eating. This upright positioning uses gravity to direct food and liquids safely down the esophagus into the stomach. A reclined position or lying flat allows food and liquids to pool in the throat and enter the airway (aspiration), which can cause aspiration pneumonia - a serious and potentially fatal lung infection. The CNA should also offer small bites, allow adequate swallowing time, and monitor for coughing or wet voice quality.

Answer: D — For intake and output monitoring, the CNA must count ALL fluids consumed plus any food item that becomes liquid at room temperature. Gelatin (Jell-O) melts to liquid at body temperature and room temperature, so it counts as fluid intake. Coffee is obviously a fluid. Both must be measured and recorded: the gelatin (typically served in a 4- to 6-ounce portion) plus the 6-ounce coffee (approximately 180 mL). Other foods that count as fluid intake include ice cream, sherbet, popsicles, and soup broth.

Answer: C — The CNA should provide a simple, honest, and compassionate answer - acknowledging that the physician ordered the tube feeding for safety reasons (often due to severe dysphagia, unconsciousness, or inability to take adequate nutrition by mouth) - while directing the resident to the nurse or physician for detailed medical explanations and questions about their treatment plan. The CNA should never remove medical devices, make promises about future treatment changes, or dismiss the resident questions. Emotional support and honest communication are important parts of the CNA role.

Answer: D — A midstream clean-catch specimen requires: first cleaning the perineal area with antiseptic wipes, then beginning to urinate into the toilet for several seconds to flush bacteria from the urethra, then catching the MIDDLE portion of the stream in the sterile specimen container without touching the inside of the container, and finishing urination into the toilet. This technique minimizes contamination from skin bacteria and provides the most accurate specimen for laboratory analysis. The specimen must be labeled immediately with the resident name, date, time, and type of specimen.

Answer: A — Stool specimens must be collected from a clean, dry receptacle (such as a specimen collection hat placed in the toilet or a clean bedpan) - never from toilet bowl water, which dilutes and contaminates the sample. The CNA uses a clean tongue depressor or the specimen collection spoon attached to the container lid to transfer a small amount of stool into the specimen cup. Gloves must be worn throughout the collection. The specimen must not be contaminated with urine or water, as this invalidates laboratory results. Label the specimen immediately at the bedside and transport it to the lab promptly per facility policy.

Answer: C — Every specimen must be labeled IMMEDIATELY at the bedside - before the CNA leaves the resident room - with: the resident full name, date of birth or identification number, the date and exact time of collection, the type of specimen (urine, stool, sputum), and the CNA initials. Labeling at the bedside prevents specimen mix-ups which can lead to incorrect diagnoses and wrong treatments for residents. Taking an unlabeled specimen to the nurse station or lab creates the risk of mislabeling or confusion with other specimens. An unlabeled specimen must be discarded and recollected.