Certified Nursing Assistant Examination (CNA) Basic Nursing Skills and Clinical Care Syllabus

How many milliliters (mL) are in one ounce, and how do you convert ounces to mL for I&O?

1 ounce = 30 mL. Multiply the number of ounces by 30 to get mL (e.g., 8 oz cup = 240 mL).

Describe proper body alignment (posture) for a person lying or standing.

Body alignment is positioning the body so the spine is straight and body parts are in their natural position without strain, keeping the head, trunk, and limbs in line and well supported.

What is body mechanics, and name two key principles a CNA uses to prevent injury when lifting.

Body mechanics is using the body efficiently to prevent injury. Key principles: bend at the knees/hips (not the back) and use the strong leg muscles, and keep the load close to your body with a wide base of support.

Define the supine, prone, lateral, and Fowler's positions.

Supine = lying flat on the back; prone = lying on the abdomen/stomach; lateral = lying on the side; Fowler's = semi-sitting with head of bed raised 45–60 degrees.

How often should an immobile/bedbound resident be turned and repositioned, and why?

At least every 2 hours. Frequent repositioning relieves pressure on the skin, promotes circulation, and prevents pressure injuries (bedsores) and contractures.

What is a contracture, and how do repositioning and ROM exercises help prevent it?

A contracture is the permanent shortening/tightening of a muscle, tendon, or joint causing loss of motion. Regular repositioning and range-of-motion exercises keep joints mobile and prevent it.

What is the proper way to use a gait/transfer belt during a transfer?

Apply the belt snugly around the resident's waist over clothing, grasp it with an underhand (palms up) grip, and use it to support and guide the resident—never lift by the arms or under the armpits.

During a stand-and-pivot transfer from bed to wheelchair, where should the wheelchair be placed and what is done with its wheels?

Place the wheelchair on the resident's strong (stronger) side at a slight angle, and lock both wheels (brakes) before the transfer to prevent it from rolling.

When assisting a weak resident to stand or ambulate, which side does the CNA stand on?

On the resident's weak (affected) side, slightly behind, holding the gait belt, to provide support and catch them if they begin to fall.

If a resident begins to fall during ambulation, what should the CNA do?

Do not try to stop the fall. Ease/lower the resident slowly to the floor by guiding them down, protecting the head, using the gait belt and your body, then call for help and report it.

What are range-of-motion (ROM) exercises, and what is the difference between active and passive ROM?

ROM exercises move each joint through its full range to maintain mobility. Active ROM is performed by the resident alone; passive ROM (PROM) is performed by the CNA for a resident who cannot move the joint themselves.

Define the ROM joint movements: flexion, extension, abduction, and adduction.

Flexion = bending a joint; extension = straightening a joint; abduction = moving a limb away from the body's midline; adduction = moving a limb toward the midline.

List key wheelchair safety steps before transferring a resident or leaving them in the chair.

Lock both brakes, swing footrests up/out of the way during transfers, ensure feet are on footrests when moving, position correctly with hips back in the seat, and never leave the chair unlocked while occupied and stationary.

When pushing a resident in a wheelchair down a ramp or into an elevator, what is the correct technique?

Back the wheelchair down a steep ramp and back it into an elevator (so the resident faces the door), keeping control to prevent the chair from rolling too fast.

What skin changes should a CNA observe and report during care?

Redness, pallor, broken or open areas, bruises, rashes, swelling, blisters, drainage, changes in color or temperature, and any complaints of pain, tingling, or numbness.

What is a pressure injury (pressure ulcer/bedsore) and what causes it?

A localized injury to the skin and underlying tissue caused by unrelieved pressure, usually over a bony prominence, often combined with friction, shear, and moisture, which reduces blood flow and leads to tissue death.

Name the most common body sites (bony prominences) where pressure injuries develop.

Sacrum/coccyx (tailbone), hips, heels, elbows, shoulders/shoulder blades, back of the head, and ankles.

List CNA actions that help prevent pressure injuries.

Reposition at least every 2 hours, keep skin clean and dry, keep linens wrinkle-free, use pillows/cushions to relieve pressure, encourage good nutrition and fluids, inspect skin regularly, and avoid friction/shearing when moving residents.

What is the difference between friction and shearing in skin injury?

Friction is the rubbing of skin against a surface (e.g., dragging across sheets); shearing is when the skin stays in place but underlying tissue moves (e.g., sliding down in a raised bed). Both damage skin and cause pressure injuries.

What is edema, and what observations about it should a CNA report?

Edema is swelling caused by fluid buildup in body tissues, often in the feet, ankles, legs, or hands. Report its location, severity, whether it is new or worsening, and any tightness, shininess, or skin changes.

What signs of poor circulation in the extremities should a CNA observe and report?

Cold, pale, bluish (cyanotic), or mottled skin; numbness or tingling; weak or absent pedal pulses; swelling; and skin breakdown or slow-healing wounds.

What is the CNA's role regarding casts, dressings, and existing wounds?

The CNA observes and reports (drainage, odor, swelling, color, pain, loose/soiled dressings) and keeps areas clean and dry, but does NOT change sterile dressings or perform wound treatments—that is the nurse's responsibility within scope.

What observations about a cast should a CNA report immediately?

Coldness, pale or blue toes/fingers, swelling, numbness, tingling, severe pain, foul odor, drainage staining the cast, or the resident being unable to move the digits—these may signal circulation or nerve problems.

What are the key principles when assisting a resident with toileting?

Respond promptly to requests, provide privacy, encourage normal positioning, allow enough time, ensure call light and safety, perform proper perineal care (front to back), and practice good hand hygiene to prevent infection.

What is the CNA's scope in urinary catheter care, including drainage bag positioning?

CNAs provide routine catheter care (clean the area and catheter per facility policy, keep it secure), keep the drainage bag below the level of the bladder, prevent kinks, and keep the bag off the floor. They do NOT insert or remove catheters.

To prevent infection and backflow with an indwelling urinary catheter, what key positioning rule must be followed?

Always keep the drainage bag and tubing below the level of the bladder so urine drains down and does not flow back into the bladder, and never disconnect the closed system unnecessarily.

What is bladder/bowel retraining and how does the CNA support it?

It is a program to help a resident regain control of urination/defecation, often by offering toileting on a regular schedule. The CNA supports it by following the schedule, encouraging fluids/fiber, providing privacy, and giving positive encouragement.

What general rules apply to specimen collection by a CNA (labeling, timing, technique)?

Use the correct clean or sterile container, label it accurately with the resident's name and date/time, follow standard precautions (gloves), collect the right type (e.g., clean-catch midstream urine), and deliver it promptly to the lab/nurse.

What are the basics of ostomy care within the CNA role?

Provide privacy and emotional support, empty and clean the ostomy pouch, observe and report the stoma color (should be pink/red and moist) and skin condition, keep the surrounding skin clean and dry, and report any unusual color, bleeding, or skin breakdown.

List nonmedication comfort measures a CNA can use to promote comfort, rest, and sleep.

Reposition for comfort, give a back rub, ensure clean dry linens, control noise and light, maintain comfortable room temperature, offer warm drinks, provide privacy, address pain/needs promptly, and maintain a consistent bedtime routine.

What are the CNA scope and safety rules for applying heat and cold (warm/cold packs)?

Apply only with a nurse's direction, check skin frequently, never apply directly to bare skin (use a cover/cloth), follow time limits (usually no more than 15–20 minutes), and report redness, pallor, blisters, numbness, or pain—watching for burns or frostbite, especially in residents with reduced sensation.