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CNA Skills Checklist – Free Step-by-Step Guide for the CNA Exam

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CNA Skills Checklist (Prometric / Credentia Style)

The 22 hands-on skills tested on the CNA certification exam, each broken into the key steps and the detail candidates most often miss. Indirect-care steps like handwashing, privacy, and the call light are scored on every skill – know them cold.
Handwashing
  1. Turn on water to a comfortable temperature using a paper towel if needed, wet hands, and apply soap
  2. Lather hands for at least 20 seconds, cleaning all surfaces including between fingers, backs of hands, and wrists
  3. Clean fingernails by rubbing them against the palm of the opposite hand
  4. Rinse hands thoroughly under running water with fingers pointed downward
  5. Dry hands with a clean paper towel from fingertips to wrists
  6. Use the paper towel to turn off the faucet to avoid recontamination
  7. Discard the paper towel without touching the waste container
Most-missed: Handwashing must be performed at the beginning and end of every skill; failing to wash hands before or after a skill causes point deductions on every scored task
Applying PPE and Gloves
  1. Perform hand hygiene before applying any PPE
  2. Apply gown first by slipping arms through sleeves and securing ties at neck and waist
  3. Apply surgical mask over nose and mouth and secure ties or ear loops
  4. Apply goggles or face shield if required by the scenario
  5. Don gloves last, pulling cuffs over the gown sleeves to prevent exposure
  6. Remove gloves first by pinching the outside of one glove near the wrist and peeling it off inside-out, then slide fingers under the remaining glove cuff and remove it inside-out
  7. Remove gown by untying and pulling away from the body without touching the outer surface, roll it away from the body
  8. Perform hand hygiene immediately after removing all PPE
Most-missed: Gloves are donned last and removed first; touching a contaminated outer surface during removal is a critical failure point
Measuring and Recording Blood Pressure
  1. Greet client, explain the procedure, and provide privacy
  2. Perform hand hygiene and apply gloves if indicated
  3. Position client with arm supported at heart level, palm up, and sleeve rolled up
  4. Locate the brachial artery and center the cuff bladder over it, placing the cuff edge about one inch above the antecubital space
  5. Palpate the radial pulse, inflate the cuff 30 mmHg above the point where the pulse disappears, then deflate quickly
  6. Re-inflate the cuff to 30 mmHg above the palpated estimate, place the stethoscope over the brachial artery, and deflate at 2 to 3 mmHg per second
  7. Record the first sound heard as systolic and the last sound heard as diastolic pressure
  8. Remove the cuff, report and record results, and perform hand hygiene
Most-missed: The cuff must be placed one inch above the antecubital space and centered over the brachial artery; an improperly placed cuff produces inaccurate readings and is a common test failure
Measuring Radial Pulse
  1. Greet client, explain the procedure, and perform hand hygiene
  2. Position client comfortably with arm resting at a relaxed level
  3. Place the index and middle fingers (not the thumb) on the inner wrist at the base of the thumb over the radial artery
  4. Apply light pressure until the pulse is felt clearly
  5. Count the pulse for a full 60 seconds using a watch with a second hand
  6. Note the rate, rhythm, and strength of the pulse
  7. Record results accurately and report any abnormalities
  8. Perform hand hygiene after the procedure
Most-missed: The thumb must never be used to take a radial pulse because the thumb has its own pulse, which causes an inaccurate count; timing for a full 60 seconds is required
Measuring Respirations
  1. Perform hand hygiene and greet the client
  2. Keep fingers on the radial pulse site after counting pulse so the client does not alter their breathing pattern
  3. Observe the rise and fall of the chest; one inhalation plus one exhalation equals one respiration
  4. Count respirations for a full 60 seconds
  5. Note rate, rhythm, and depth of breathing
  6. Record results accurately and report any abnormalities such as labored breathing
  7. Perform hand hygiene after completing the skill
Most-missed: Do not tell the client you are counting respirations because clients tend to alter their breathing when aware; keeping fingers on the wrist disguises the observation
Measuring and Recording Weight
  1. Greet client, explain the procedure, and perform hand hygiene
  2. Balance the scale to zero before the client steps on
  3. Have the client remove shoes and heavy clothing, and empty the bladder if possible
  4. Assist the client to stand in the center of the scale platform with feet slightly apart and without holding onto anything
  5. Adjust the scale weights until the balance beam is level and centered
  6. Read the weight and record it accurately
  7. Assist the client safely off the scale
  8. Report any significant weight changes and perform hand hygiene
Most-missed: The scale must be balanced to zero before the client steps on it; an unbalanced scale produces an inaccurate measurement, which is a critical error
Indwelling Catheter Care
  1. Greet client, explain the procedure, provide privacy, and perform hand hygiene
  2. Lower the side rail on the working side and position the client in a dorsal recumbent or Sims position
  3. Apply gloves and expose the perineal area with minimal exposure
  4. Assess the catheter insertion site and tubing for signs of irritation, discharge, or leakage
  5. Using a clean washcloth with soap and water, clean around the catheter at the urinary meatus using a front-to-back motion, one stroke per area
  6. Clean at least four inches of the catheter tubing from the meatus outward using a circular motion
  7. Ensure the drainage tubing is secured to the leg without tension and the drainage bag is below bladder level at all times
  8. Remove gloves, raise the side rail, ensure call light is in reach, and perform hand hygiene
Most-missed: The drainage bag must always remain below the level of the bladder to prevent backflow of urine; placing the bag on the bed or above the bladder is a critical safety error
Perineal Care for a Female Client
  1. Greet client, explain the procedure, and provide privacy; perform hand hygiene and apply gloves
  2. Position client on her back with knees bent and feet flat; drape to minimize exposure
  3. Fill a basin with warm water and test temperature on inner wrist
  4. Clean the labia majora using front-to-back strokes, one stroke per area, using a clean portion of the washcloth for each stroke
  5. Separate the labia minora and clean from the urethral meatus toward the anus using front-to-back strokes
  6. Rinse the area thoroughly from front to back
  7. Pat dry thoroughly from front to back
  8. Remove gloves, reposition client comfortably, raise side rail, place call light in reach, and perform hand hygiene
Most-missed: All cleaning strokes must go front to back to prevent transferring rectal organisms to the urethral or vaginal area; reusing the same surface of the washcloth is a critical infection-control failure
Foot Care
  1. Greet client, explain the procedure, and perform hand hygiene; apply gloves
  2. Assist client to a seated position and place a basin of warm water on a protective barrier on the floor
  3. Test water temperature on the inner wrist before soaking
  4. Soak one foot for 5 to 10 minutes, then the other if appropriate
  5. Wash each foot with a soapy washcloth, cleaning between all toes
  6. Rinse each foot thoroughly and pat dry completely, including between the toes
  7. Apply lotion to the tops and bottoms of the feet but not between the toes
  8. Assist client with footwear, ensure safety, raise side rail, place call light in reach, and perform hand hygiene
Most-missed: Lotion must never be applied between the toes because moisture trapped there promotes fungal infection and skin breakdown; this is a frequently missed step
Mouth Care for a Conscious Client
  1. Greet client, explain the procedure, and perform hand hygiene; apply gloves
  2. Raise the head of the bed to a comfortable position and place a towel over the client's chest
  3. Wet the toothbrush, apply a small amount of toothpaste, and offer the client a rinse of water
  4. Brush all tooth surfaces (outer, inner, and chewing surfaces) using gentle circular motions
  5. Brush the tongue gently to remove bacteria
  6. Have the client rinse and spit into an emesis basin
  7. Offer mouth rinse if appropriate; pat lips dry and apply lip moisturizer if needed
  8. Remove gloves, reposition client comfortably, place call light in reach, and perform hand hygiene
Most-missed: Privacy and call light placement are scored independently of the oral care technique; forgetting these indirect-care steps costs points even when the physical technique is correct
Denture Care
  1. Greet client, explain the procedure, and perform hand hygiene; apply gloves
  2. Line the sink or basin with a paper towel or fill with water to protect dentures from breakage if dropped
  3. Have the client remove dentures or gently assist by loosening the upper denture with a slight rocking motion, then remove the lower
  4. Carry dentures to the sink in an emesis basin; never wrap in a tissue
  5. Brush all surfaces of the dentures with a denture brush and denture cleaner or toothpaste
  6. Rinse thoroughly under running water
  7. Return dentures to the client or store in a labeled denture cup with water or denture solution
  8. Provide oral care to the gums and tongue with a moist swab, remove gloves, and perform hand hygiene
Most-missed: Lining the sink with a paper towel or filling it with water before handling dentures prevents breakage; dropping and breaking dentures is a preventable error commonly missed under test pressure
Dressing a Client with an Affected (Weak) Arm
  1. Greet client, explain the procedure, and provide privacy; perform hand hygiene
  2. Gather clothing and assess which arm is weak or affected
  3. For undressing, remove the garment from the strong (unaffected) arm first
  4. For dressing, place the garment on the weak (affected) arm first
  5. Gently support the weak arm throughout all movements to prevent injury
  6. Pull the garment over the head or across the back as needed, then thread the strong arm through
  7. Adjust the garment for comfort and ensure no wrinkles are under the client
  8. Ensure call light is in reach and perform hand hygiene
Most-missed: The memory phrase is 'weak in first, strong out first' (dress the affected side first, undress it last); reversing this order stresses the weak shoulder joint and is a common critical error
Feeding a Client
  1. Greet client, explain the procedure, and perform hand hygiene; offer a hand-washing opportunity to the client
  2. Provide privacy and elevate the head of the bed to at least 45 degrees or assist client to sit upright
  3. Check the meal tray for accuracy (correct diet, client name) and check food temperature
  4. Place a protective covering over the client and position the tray within reach
  5. Offer small bites, alternating food and fluids, and allow adequate time between each bite for chewing and swallowing
  6. Observe for and report any coughing, choking, or difficulty swallowing immediately
  7. Record intake accurately on the I and O sheet
  8. Perform oral care after the meal, remove tray, reposition client comfortably, place call light in reach, and perform hand hygiene
Most-missed: The client must be positioned upright at a minimum of 45 degrees before and during feeding to reduce aspiration risk; placing a client flat while feeding is a critical safety error
Providing Fluids and Recording Intake
  1. Greet client, explain the procedure, and perform hand hygiene
  2. Verify the client is on an intake and output (I and O) order and check for any fluid restrictions
  3. Pour the desired fluid into a cup, noting the starting amount in mL or identifying the container volume
  4. Offer the fluid to the client at a comfortable temperature; use adaptive equipment if needed
  5. Encourage fluid intake at the client's pace and record how much the client actually drank
  6. Convert fluid amounts to mL if recorded in another unit (8 oz equals 240 mL)
  7. Record the intake amount accurately on the I and O flow sheet
  8. Place call light in reach, ensure comfort, and perform hand hygiene
Most-missed: Record only what the client actually drank, not what was poured; documentation must be in mL and must reflect actual consumption to ensure accurate clinical monitoring
Positioning a Client on Their Side (Lateral Position)
  1. Greet client, explain the procedure, and provide privacy; perform hand hygiene
  2. Raise the bed to working height and lower the side rail on the working side
  3. Position the client on their back, move them toward the side opposite to which they will be turned
  4. Cross the client's near arm over the chest and cross the near ankle over the far ankle
  5. Stand on the side toward which the client will face; place one hand on the shoulder and one on the hip
  6. Roll the client toward you in a smooth motion
  7. Place a pillow behind the back for support and a pillow between the knees to maintain alignment
  8. Ensure the client is in good alignment, raise side rail, place call light in reach, and perform hand hygiene
Most-missed: A pillow between the knees is required to maintain spinal alignment and prevent pressure on bony prominences; omitting the pillow is a common missed step on the skills exam
Transferring a Client to a Wheelchair Using a Gait Belt
  1. Greet client, explain the procedure, and perform hand hygiene; apply gait belt snugly around the client's waist over clothing
  2. Lock the wheels of the wheelchair and position it at a 45-degree angle to the bed on the client's stronger side
  3. Raise the footrests and remove or swing away the armrest closest to the bed
  4. Assist the client to a sitting position with feet flat on the floor; allow a moment to prevent dizziness
  5. Stand close to the client, hold the gait belt with an underhand grip on both sides, and instruct the client to push up on the count of three
  6. Pivot the client toward the wheelchair and position them in front of the seat
  7. Lower the client slowly by bending at knees and hips, not the back, until seated securely
  8. Position feet on footrests, ensure safety, remove gait belt if indicated, place call light in reach, and perform hand hygiene
Most-missed: The wheelchair wheels must be locked and footrests raised before the transfer begins; an unlocked wheelchair can roll away and cause a fall, which is a critical safety failure
Ambulating a Client with a Gait Belt
  1. Greet client, explain the procedure, and perform hand hygiene; ensure client has proper footwear
  2. Apply gait belt snugly over clothing; check that two fingers fit under the belt to confirm fit
  3. Assist client to a sitting position and allow time to adjust before standing
  4. Stand on the client's weaker side and hold the gait belt from behind with an underhand grip
  5. Assist client to standing and ensure balance is stable before beginning ambulation
  6. Walk slightly behind and to the side of the client, maintaining the gait belt hold throughout
  7. Observe for dizziness, weakness, or unsafe gait; if client begins to fall, lower them safely to the floor using the gait belt
  8. Assist client back to a seated position safely, remove gait belt, ensure comfort and call light placement, and perform hand hygiene
Most-missed: If the client begins to fall, the CNA must lower them to the floor in a controlled manner using the gait belt rather than trying to hold them up; attempting to prevent a fall by pulling upward can injure both client and CNA
Range of Motion for One Knee and Ankle
  1. Greet client, explain the procedure, and provide privacy; perform hand hygiene
  2. Position client in supine position with the bed flat; expose only the leg being exercised
  3. Support the leg at the knee and ankle throughout each movement
  4. Perform knee flexion by bending the knee toward the chest, then extension by straightening the leg
  5. Perform ankle dorsiflexion by gently pushing the foot upward toward the shin
  6. Perform plantar flexion by gently pushing the foot downward away from the shin
  7. Perform ankle rotation by supporting the heel and rotating the foot in a complete circle in each direction
  8. Repeat each movement 3 to 5 times as instructed; observe for pain, resistance, or discomfort; reposition client, raise side rail, place call light in reach, and perform hand hygiene
Most-missed: All movements must be performed slowly, gently, and within the client's pain-free range of motion; forcing a joint past resistance can cause injury and is a critical error
Range of Motion for One Shoulder
  1. Greet client, explain the procedure, and perform hand hygiene
  2. Position client in supine position with bed flat; expose only the shoulder being exercised
  3. Support the arm at the elbow and wrist throughout all movements
  4. Perform shoulder flexion by raising the arm forward and upward above the head, then return to the starting position
  5. Perform shoulder extension by gently moving the arm downward and slightly behind the body
  6. Perform shoulder abduction by moving the arm out to the side away from the body
  7. Perform adduction by returning the arm back toward the midline of the body
  8. Perform internal and external rotation if indicated; repeat each movement 3 to 5 times; reposition client, raise side rail, place call light in reach, and perform hand hygiene
Most-missed: The arm must be supported at both the elbow and wrist, not just the hand, to protect the shoulder joint from strain during passive range of motion exercises
Applying Anti-Embolic Stockings (TED Hose)
  1. Greet client, explain the procedure, and perform hand hygiene; apply gloves if skin integrity is a concern
  2. Assess the legs and feet for redness, swelling, skin breakdown, or pain before applying
  3. Have the client lie supine with legs elevated or apply before the client gets out of bed in the morning
  4. Turn the stocking inside out to the heel, then place the foot section over the toes and foot
  5. Position the heel pocket correctly over the client's heel
  6. Grasp the stocking at the turned-down edge and pull it up the leg in a smooth, even motion without creases or wrinkles
  7. Ensure the top of the stocking is below the knee or at the thigh as indicated; smooth out any wrinkles
  8. Perform hand hygiene; document application and any skin findings; assess every 8 hours
Most-missed: Wrinkles or folds in the stocking create pressure points that can cause skin breakdown and reduce effectiveness; the stocking must be applied smoothly and reassessed regularly
Assisting with a Bedpan
  1. Greet client, explain the procedure, and provide privacy; perform hand hygiene and apply gloves
  2. Raise the bed to working height and lower the side rail on the working side
  3. Place a protective pad under the client's buttocks area
  4. Assist the client to lift hips by bending the knees and pushing up; slide the bedpan under the buttocks with the wider end toward the back of the client
  5. Raise the head of the bed to a comfortable sitting angle (30 to 45 degrees) to facilitate elimination
  6. Place toilet tissue and call light within reach and allow the client privacy
  7. After use, lower head of bed, instruct client to lift hips and remove the bedpan; clean the perineal area from front to back and pat dry
  8. Cover the bedpan, take it to the bathroom, observe and record output, dispose of contents, rinse the bedpan, remove gloves, and perform hand hygiene
Most-missed: Providing privacy during elimination is both a dignity right and a scored indirect-care point; the call light must always be left within reach while the client is left alone on the bedpan
Making an Occupied Bed
  1. Greet client, explain the procedure, and provide privacy; perform hand hygiene and apply gloves if needed
  2. Lower the head of the bed to a flat position (if tolerated) and raise the bed to working height
  3. Lower the side rail on the working side and loosen all bedding from under the mattress
  4. Roll the soiled linen toward the client's back, tucking it close against the client; never shake or fan linen
  5. Place clean bottom sheet on the exposed mattress, miter the corner at the top, and tuck the side; roll the remaining sheet against the soiled linen
  6. Raise the side rail, move to the opposite side, lower that side rail, and assist client to roll toward you over the linen
  7. Remove soiled linen and place in a linen bag (do not place on floor); pull clean linen through and tuck in
  8. Apply clean top sheet and blanket, make a toe pleat, raise both side rails, lower the bed, place call light in reach, and perform hand hygiene
Most-missed: Soiled linen must never be placed on the floor, shaken, or held against the CNA's uniform because this spreads pathogens; all soiled linen goes directly into the linen bag

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