Nursing Assistant / Nurse Aide Practical Skills Exam

For most U.S. states’ certification requirements, you will be asked to complete a performance evaluation—a hands-on test of your practical skills as well as a written or oral exam. This guide gives a sample of the variety of job tasks you will be asked to perform.

As previously noted, state requirements vary, and this guide looks at the probable scenario. In order to be certified as a nursing assistant, you will be asked to perform five job-related skills. Handwashing will most likely be one of the skills, while the other four will be randomly selected from a list of nurse aide skills. A measurement skill, such as measuring urinary output, will probably be included in these remaining four skills, and you will be required to record that measurement. You will perform these skills in a hospital/nursing home–like setting while being observed by the evaluator. A volunteer will act as the client.

Each skill is broken down into steps, and some of these are critical steps that must be completed to pass the skill. However, you must also successfully complete an adequate number of steps to pass each skill, and you must pass all five skills to pass the entire skills exam. You will be expected to know and perform these steps; directions will not be provided.

Equipment will be provided, and you may not be allowed to use your own equipment. The evaluator will not give you instructions or answer any questions during the skill performance, so ask questions before you begin. If you think you made a mistake during a skill performance, tell the evaluator at that time. You will be allowed to correct the steps that you did incorrectly—one time. There are some exceptions to this, and some corrections will not receive credit. Also, once you begin a new skill, you will not be allowed to go back and redo a previous one.

This guide provides you with several job-related skills you might be asked to perform:

handwashing; counting the radial pulse; counting respirations; measuring blood pressure; donning and removing gown and gloves, or Personal Protective Equipment (PPE); measuring urinary output; positioning on side; and transferring from bed to wheelchair.

Each skill list contains tips and evaluation criteria. Practice these skills, using a friend or family member as your client, and review the skills list after you are done to make sure you did not miss any steps. You should also contact your state’s nurse aide registry to acquire a list of testable skills and expected steps. The registry office will be able to tell you how much time is allowed for each skill performance.

Practice, practice, practice. Have a nurse or nurse aide observe you with the skill step list in hand to make sure you are performing the skills correctly, step by step. Practice first for accuracy. Once you know you can perform the steps correctly, practice to ensure that you can complete the skills in the required time frame.

Sample Skill: Handwashing
Tips:

1. Handwashing is the single most important method of preventing the spread of infection.

2. When washing your hands, make sure to clean under the fingernails and between the fingers.

3. Do not wear nail polish or artificial nails for the skills exam, and keep your nails trimmed short. Avoid wearing rings and bracelets.

4. Do not touch the inside of the sink at any time during handwashing.

Evaluation Criteria
- Introduce yourself and address the client by title and surname (for example: Mrs. Perry).
- Make sure paper towels are within reach and ready to use—you do not want to touch the “dirty” paper towel container with your freshly cleaned hands.
- Turn on the water at the sink—be careful, no splashing.
- Wet your hands and wrists thoroughly.
- Apply soap.
- Lather and rub fingers, hands, and wrists for at least 15 seconds.
- Clean your fingernails by rubbing the tips of your fingers against the palm of the opposite hand.
- Rinse fingers, hands, and wrists thoroughly; keep your hands lower than your elbows and your fingertips pointed down.
- Dry hands thoroughly with clean paper towel and dispose of paper towel. Dispose of paper towel in a waste container without contaminating yourself.
- Turn off the faucet with another clean paper towel, and dispose of that paper towel in a waste container without contaminating yourself.

Sample Skill: Radial Pulse
Tips:

1. You should count the radial pulse for one full minute. Bring a watch with a second hand.

2. Do not use your thumb to count the pulse.
 

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Wash your hands (see the Handwashing section).
- Explain the procedure to the client, speaking in a clear, slow manner. Make sure to maintain eye contact whenever possible.
- Locate the client’s radial pulse by placing two fingers over the radial artery (on the inside of the wrist).
- Count the pulse for a full minute.
- Wash your hands (see the Handwashing section).
- Record the client’s pulse rate.

Sample Skill: Respirations
Tips:

1. The respiratory rate may be affected by fever, pain, fear, disease, and other factors.

2. People can control their respirations to some extent (e.g., holding one’s breath).

3. Do not tell the client that you are measuring her respiratory rate, because that will affect the reading. Instead, take it immediately after you measure her radial pulse. This is one time it is acceptable to perform a task without telling the client what you are going to do.

4. Count respirations by watching the rise and fall of the chest, and/or by placing your hand against the person’s chest and feeling for the rise and fall.

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Wash your hands (see the Handwashing section).
- Measure the client’s radial pulse (see the Radial Pulse section).
- Count respirations for a full minute.
- Wash your hands (see the Handwashing section).
- Record the client’s respiratory rate.

Sample Skill: Blood Pressure
Tips:

1. The systolic pressure is the top number and is pressure caused when the heart muscle contracts.

2. The diastolic pressure is the lower number and is created when the heart muscle relaxes.

3. If you cannot find the brachial artery, have the client hyperextend his arm and try again.

4. Use the correct size cuff, or the blood pressure measurement will not be accurate.

5. Clean the diaphragm of the stethoscope with the alcohol-based sanitizer before going to the next patient.

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Wash your hands (see the Handwashing section).
- Explain the procedure to the client, speaking in a clear, slow manner. Make sure to maintain eye contact whenever possible.
- Clean ear pieces and diaphragm/bell of stethoscope with an alcohol wipe.
- Position client’s arm with the palm up and upper arm exposed.
- Find the brachial artery at the bend of the elbow, on the inner aspect of the arm.
- Place the correct size blood pressure cuff snugly on the client’s upper arm with the arrow over the brachial artery.
- Locate the radial pulse (see the Radial Pulse section).
- Inflate the cuff to no more than 30 mm Hg more than where the pulse is felt.
- Deflate the cuff.
- Locate the brachial artery again, using your fingertips.
- Put the stethoscope in your ears and place the diaphragm/bell over the brachial artery.
- Inflate the cuff to no more than 30 mm Hg more than where the pulse is felt.
- Deflate cuff slowly and note the first sound that you hear (systolic).
- Note the last sound you hear (diastolic).
- Remove the cuff.
- Wash hands (see the Handwashing section).
- Record blood pressure reading, both systolic and diastolic.
- Clean the diaphragm of the stethoscope using an alcohol-based sanitizer before taking the blood pressure of another patient

Sample Skill: Measuring Urinary Output
Tips:

1. Some people who are critically ill need to have their urinary output measured hourly.

2. If a client uses the regular toilet, the client can use a “commode hat” to collect the urine for measuring.

3. Make sure to hold the measuring container at eye level to determine the amount.

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Wash your hands (see the Handwashing section).
- Explain the procedure to the client, speaking in a clear, slow manner. Make sure to maintain eye contact whenever possible.
- Put on clean gloves before touching the bedpan.
- Pour the contents of the bedpan into a measuring container. Do not spill or splash urine.
- Measure urine at eye level with the container securely placed on a flat surface.
- After measuring urine, empty the measuring container.
- Rinse the measuring container and pour rinse contents into the toilet.
- Rinse the bedpan and pour rinse contents into the toilet.
- Remove gloves. Dispose of gloves in a waste container without contaminating yourself.
- Wash hands (see the Handwashing section).
- Record urine output.

Sample Skill: Positioning on Side (Lateral Position)
Tips:

1. Make sure you have supportive devices ready before positioning client.

2. The lateral position is used for people with back pain, those in casts, and those who cannot reposition themselves.

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Wash your hands (see the Handwashing section).
- Explain the procedure to the client, speaking in a clear, slow manner. Make sure to maintain eye contact whenever possible.
- Provide privacy by closing the curtain or door.
- Lower the head of the bed.
- Raise side rail on the side toward which the client will be turned.
- Slowly roll client as one unit onto his side, toward the raised side rail.
- Place a pillow under his head for support.
- Make sure client is not lying on the arm that is on the bed, and support the top arm with a supportive device.
- Place supportive device behind the client’s back.
- Flex the client’s top knee and place supportive device between the client’s legs; make sure the knee and ankle are supported.
- Lower the bed.
- Make sure the call bell is within reach.
- Wash hands (see the Handwashing section).

Sample Skill: Personal Protective Equipment (PPE)—Donning and Removing Gown and Gloves
Tips:

1. PPE includes gowns, gloves, masks, and protective eyewear.

2. Gloves must be intact and fit properly.

3. If you are allergic to latex, use gloves made from another synthetic material.

4. If you touch a contaminated surface with your gloves, your gloves become contaminated.

5. Gowns are used when you are likely to soil your uniform with bodily fluids and for certain types of isolation.

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Wash your hands (see the Handwashing section).

Donning the gown and gloves
- Unfold gown.
- With back opening of gown facing you, place arms through each of the sleeves.
- Fasten the neck ties.
- Secure the gown at your waist, and make sure your clothing is covered as much as possible.
- Put on gloves, making sure the cuffs of the gloves overlap the cuffs of the gown.

Removing the gown and gloves.
- Use one gloved hand to remove the opposite glove at the palm.
- Slip the fingers from your ungloved hand under the cuff of the remaining glove and remove the glove, turning it inside out as you proceed.
- Dispose of gloves in a waste container without contaminating yourself.
- Untie the gown at the neck and waist.
- Remove the gown without touching the outside of the gown.
- Hold the gown away from your body and turn it inward to keep it inside out.
- Dispose of gown in a waste container without contaminating yourself.
- Wash hands (see the Handwashing section).

Sample Skill: Transferring Client from Bed to Wheelchair
Tips:

1. A transfer belt is used to assist weak or unsteady persons with transferring, walking, and standing. Many facilities require nurse aides to use these when transferring clients.

2. Always plan in advance when transferring clients. Know your client’s specific limitations.

3. Wheelchairs should be checked to make sure they have no broken or missing parts.

4. Make sure to lock the brakes before transferring clients into and out of wheelchairs.

Evaluation Criteria
- Introduce yourself and address the client by title and surname.
- Depending on a client’s weight or ability to assist, you may need more than a one-person assist.
- Helping a client to a wheelchair may require assistive devices such as lifts.
- Wash your hands (see the Handwashing section).
- Explain the procedure to the client, speaking in a clear, slow manner. Make sure to maintain eye contact whenever possible.
- Provide privacy by pulling the curtain or shutting the door.
- Position the wheelchair at the side of the bed, facing the foot of the bed.
- Make sure footrests are removed or folded up.
- Make sure to lock the wheelchair brakes.
- Assist the client into a sitting position with her feet flat on the floor. Make sure the client is wearing shoes before the client attempts to stand.
- Securely apply the transfer belt over the client’s clothing before assisting her to stand.
- Instruct the client on the transfer process and provide her with a signal for when to begin standing (e.g., “Stand on three.”).
- Stand facing the client during transfer.
- Count to three to alert the client to begin standing.
- On “three,” slowly help the client to stand by grasping the transfer belt on both sides with an upward grasp. Maintain the stability of the client’s legs. Use body mechanics when transferring a patient. Bend your knees and keep your back straight while assisting a client to a standing position. You may need a lifting assistive device, depending on the client’s weight and ability to assist the nursing assistant.
- Assist the client to turn to stand in front of the wheelchair, making sure her legs are against the wheelchair.
- Lower the client into the wheelchair. Use proper body mechanics by bending your knees as you lower the client to the wheelchair. You may need a lifting assistive device depending on the client’s weight and ability to assist the nursing assistant.
- Position the client so that her hips touch the back of the chair, assuring that she is not sitting on any objects that may cause pressure to her skin.
- Remove the transfer belt.
- Position footrests in the down position and assist the client in placing her feet on them.
- Make sure the client’s call bell is within reach.
- Wash hands (see the Handwashing section).
- The use of proper body mechanics and assistive devices will help in decreasing the chance of back injury for the nursing assistant.