Practice for State Exam

For those of you who haven’t taken the NAC class or are thinking of going into it. I typed up my state skills in my (practice) dialogue (by memory might I add! I’m super proud of that! Heehee. State Exams are a written exam and then a skills exam. The skills exam is when you have an evaluator who tests you on hand-washing correctly, 1 of the 4 measuring skills and three other random skills that you would use in the real world. I typed mine out in dialogue instead of just using the State Handbook because it was easier for me to remember what my brain would say versus the cold, clinical and unfeeling version of the State Handbook.

2014 Nursing Assistant State Skills: (22)

  1. Hand washing

o   Knock, Knock “Hello ______, my name is Maka and I’ll be taking care of you today. I’m going to go wash my hands but in the meantime you have your signaling device should you need me.” At sink. “I’m going to turn on the water and wet both my hands thoroughly from two inches above my wrist down to my fingertips. I’m going to grab some soap and lather all surfaces of my hands for 20 seconds, being sure to keep my hands lower than my elbows with my fingers down and creating as much friction as possible on my palms, backs of my hands, fingers, two inches above my wrists and in between my fingers. After 20 seconds is up: I’m going to clean my fingernails by rubbing them against my palms. I am making sure to wash both my thumbs. Now I’m going to rinse my hands thoroughly being sure to keep my hands lower than my elbows with my fingers down and not going above the two inch mark on my wrists. Grab some paper towels and dry from two inch mark down to my fingers, getting in between my fingers. Throw in trash, grab some more paper towels and turn off facet. My hands did not touch any surface of the sink, facet or counter. Skill Complete”

  1. Blood Pressure

o   “Alright ________, now that I have washed my hands I’m going to take your blood pressure. First I’m going to clean off all my equipment, do you have any questions? Equipment cleaned. Now if I could have you please turn your hand palm up, I’m going to expose a bit of your arm so I can find your brachial pulse and put the blood pressure cuff over it, it needs to be snug so I can get an accurate reading. Put stethoscope in ears. I’ll inflate the cuff to 160mmHG to 180mmHG, and deflate slowly. Remember systolic and diastolic numbers. Take off blood pressure cuff and put everything away. Here is your signaling device. Sanitize and then record blood pressure. Skill Complete”

  1. Pulse

o   “Now that your blood pressure is done I’m going to take your pulse. I’m going to take it at your wrist for one full minute. Starting on the…..Stop. Here is your signaling device.  Sanitize and then record pulse and Skill complete.”

  1. Respirations

o   “Okay _____, I’m going to take some vital signs real quick. (For testing purposes say respirations). I’m going to place your arm over your stomach a bit, and I’ll just be a minute. Starting on the….. Counting the rise and fall of the chest by looking at the hands make it seem like you’re taking pulse. Stop, perfect, thank you________. Here is your signaling device.  Sanitize and then record respirations and Skill Complete.”

  1. Urinary Output

o   “__________, I’m going to be in the back for a moment, you have your signaling device and your bed brakes are locked and your bed is low. Privacy is still maintained and I’ll be right back. Go to back room. I’m going to put on gloves and pour the bedpan contents into the graduate. I’m going to squat down to eye level and measure the urinary output in ccs. Now I’m going to pour the contents into the toilet, rinse the bedpan and graduate and put it in the dirty supply area. Take care of/throw away the barriers. Take off gloves, Sanitize and then record urinary output and Skill complete.”

  1. Weight of ambulatory client

o   “Alright ___________, It’s time to record your weight. We are going to go to the back room so I’m going to help you sit up, but first I’m going to make sure your bed brakes are locked and that your bed is low. Privacy is still maintained. Let me help you sit up and I need to make sure your feet are flat on the floor. May I ask you to put on your shoes? Perfect! Now let’s get up slowly, do you want assistance? Lead to back room. Now before you step on the scale I need to zero it out, here we go, let me help you on to the scale. Alright Measures. Doing good _________, let me help you off the scale and you can go back to bed. You have your signaling device, I’ll sanitize my hands. Then record weight and Skill Complete.”

  1. Bed Bath

o   “Looks like I’m giving you a bath today _____, your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go get my supplies and I’ll be right back. Supplies: Basin, Bath Towel, Hand Towel, 3 Washcloths, Soap, clean gown and gloves. Go get warm water. ________, this water is comfortable to me, is it to you? Put on Gloves. Remove gown I’m going to remove your gown but I’m going to make sure that I don’t have you overexposed. Set up Station: Bath towel under one arm, hand towel over chest, two washcloths with just water and one soapy washcloth. First I’m going to clean your face without soap. [Ask partner if wearing makeup-may not want to actually clean face, but for state exam you actually wash the face] Using one washcloth I’m going to wash from the inside of one eye outwards, switch to a clean section and do the other eye the same way, switch to a clean section and wash the rest of your face. Now I’m going to pat your face dry with this hand towel. Now I’m going to wash your hand, arm and underarm with the soapy washcloth. While I make sure to get all surfaces of the underarm, arm and hand. I’m going to do the same to rinse. And now I’m going to pat dry with this bath towel. Let’s get you into this clean gown. Feel better? You have your signaling device and I’m going to go get rid of this dirty linen and my supplies. Linen disposed first, then empty, rinse and dry basin and put in dirty supply area. Take off gloves, sanitize, and come back and put away soap and Skill complete.”

  1. Mouth Care

o   “Now that I’ve given you a bed bath I’m going to brush your teeth. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go get my supplies and I’ll be right back.Supplies: Emesis Basin, Hand Towel, toothbrush, toothpaste, paper towel barriers, gloves and a cup filled with water. Go get water. Alright ______, I’m going to raise your head of bed to about 75-90 degrees to prevent aspiration. Now I’m going to put on my gloves, and set up everything. Put down paper towel barriers, set up emesis basin, place hand towel on chest, cup of water and MOISTEN THE TOOTHBRUSH before applying toothpaste.Please open your mouth and I’ll brush all surfaces of your teeth including the sides, top and the insides. Would you like to rinse before I continue? Rinse into emesis basin, wiping lips with hand towel. Now I need to get your tongue, let’s rinse again. Rinse into emesis basin, wiping lips with hand towel. All done! You have your signaling device and I’m going to go get rid of this dirty linen and my supplies. Linen disposed first, then empty, rinse and dry basin and put in dirty supply area. Take off gloves, sanitize and Skill Complete.

  1. Bed Pan

o   “Alright ______, I’m going to help you use the bedpan today. Your bed brakes are locked and your bed is low. Privacy is still maintained. And your head of bed is completely lowered. You have your signaling device I’m going to go grab some supplies and I’ll be right back. Supplies: bedpan, paper towel barriers, 2 pairs of gloves, hand wipes, toilet paper. Remember a designated clean hand and designated dirty hand! Set up station by placing the barriers down first, then putting on gloves, then putting the toilet paper and hand wipe on the tray. Only grab the bedpan with one hand, the other hand will lift up the sheets. May I ask you to lift your hips please? Now with the bedpan in correct position I’m going to raise your head of bed. Are you comfortable? Check the bed pan and adjust if necessary.  Take off gloves Sanitize. Here is toilet paper and a hand wipe for you when you are finished. You have your signaling device call me when you’re done. Leave room and wait for call. Put on clean gloves and use one hand for the linen and the other for the dirty garbage/barriers and then the bedpan. Dispose of the barriers and put the toilet paper and hand wipes away then grab the bedpan (May I ask you to lift your hips again please?) You have your signaling device still I’m going to go dispose of this. Dispose bedpan contents in the toilet then rinse (DO NOT DRY!) and place in dirty supply area. Dispose gloves and sanitize and Skill Complete.”

  1. Foot Care

o   “Now that you’ve used the bedpan, I’m going to wash your feet. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go grab some supplies. Supplies: basin, soap, lotion, bath towel, hand towel, 1 washcloth, incontinent pad and gloves. Go get warm water. This water is comfortably warm to me, is it to you? Set up station: Bath towel next to bed with incontinent pad in front of it. Basin on towel where foot will be I’m going to help you to sit on the side of the bed and we’ll soak your foot for a few while I get ready and linen on incontinent pad with soap and lotion (EVERYTHING GETS A BARRIER). Now I’m going to put on my gloves and make sure that your whole foot and ankle is wet. I’m going to get my washcloth soapy and wash all surfaces of your foot from your ankle to between your toes and everything in between while supporting your foot and ankle. Now I’m going to lower your foot into the basin and rinse all surfaces of your foot and ankle making sure to get in between your toes. Then I will lift your foot, being sure to have it supported as I dry your foot thoroughly, making sure to get in between your toes. Setting your foot down for the moment I’m going to get some lotion and apply the lotion to your ankle and foot but making sure to not get any lotion in between your toes. I’ll use the hand towel to get the excess lotion off. I’m going to dispose of my linens and you have your signaling device so I’ll go put my supplies away. Dispose linens. Empty, rinse and dry basin and place in dirty supply area. Dispose of gloves and Sanitize. Put away soap and lotion. Skill complete”

  1. Ambulate

o   “Looks like we’re going for a little walk today _______. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to help assist you to sit on the side of your bed. Make sure your feet are flat on the floor. May I ask you to please put on your shoes? Now I’m going to put this gait belt snuggly on your waist, I know it is squeeze-y but it’s so you don’t fall. Now I’m going to stand with my feet and my knees in front of yours so that I can stabilize your legs as you stand. Please put your hands on my upper arms and on the count of three we’ll stand up. 1. 2. 3. Perfect, are you steady? Let’s walk ten paces. Now we’re going to turn a bit and head back to bed. You did a great job ________. Now don’t sit down until you feel the bed at the back of your legs. Feel it? Perfect let’s sit. Remove gait belt. Here’s your signaling device again. Sanitize and Skill Complete.”

  1. Range of Motion Shoulder

o   “Alright _____, we’re going to do a bit of exercise on your shoulder. If you feel any pain during the exercise at any time, please let me know and we will stop immediately. Your bed brakes are locked and your bed is low. Privacy is still maintained. First I’m going to take your arm and support the upper and lower parts of your arm. I’m going to bring your arm up to the level of your ear and then come back down. I’m going to do this three times unless you have pain in which case we will stop immediately. Ready? 1. 2. 3. Good job! Next I’m going to bring your arm out from your body and then back in. Again, I’m going to do this three times unless you have pain in which case we will stop immediately. Ready? 1. 2. 3. Good job! You’re all done! You have your signaling device Sanitize and Skill Complete.”

  1. Transfer to Wheelchair

o   “Looks like we’re going to put you in your wheelchair today so you can go to bingo, _______. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device, I’m going to go get your wheelchair and I’ll be right back. Place wheelchair at head of bed (straight) lock the wheel chair brakes well and make sure the foot rests are out of the way. I’m going to help assist you to sit on the side of your bed. Make sure your feet are flat on the floor. May I ask you to please put on your shoes? Now I’m going to put this gait belt snuggly on your waist, I know it is squeeze-y but it’s so you don’t fall. Now I’m going to stand with my feet and my knees in front of yours so that I can stabilize your legs as you stand. Please put your hands on my upper arms and on the count of three we’ll stand up. 1. 2. 3. Perfect, are you steady? We are going to pivot ever so slightly Great job ________. Now don’t sit down until you feel the bed at the back of your legs. Feel it? Perfect let’s sit and try to sit as far back as possible so that your hips are touching the back. Good? Remove gait belt, unlocks wheelchair brakes.I’m going to assist you in putting your feet on the foot rests. There you go. Here’s your signaling device again.Sanitize and Skill Complete.”

  1. Range of Motion Knee and Ankle

o   “Alright _____, we’re going to do a bit of exercise on your knee and foot. If you feel any pain during the exercise at any time, please let me know and we will stop immediately. Your bed brakes are locked and your bed is low. Privacy is still maintained. First I’m going to take your leg and support the upper and lower parts of your leg. I’m going to bend your knee up and then back down.  I’m going to do this three times unless you have pain in which case we will stop immediately. Ready? 1. 2. 3. Good job! Next I’m going to bend your foot forwards and backwards. Again, I’m going to do this three times unless you have pain in which case we will stop immediately. Ready? 1. 2. 3. Good job! You’re all done! You have your signaling device Sanitize and Skill Complete.”

  1. Feeding

o   “Looks like its dinner time ______! Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go grab your food tray and I’ll be right back. Alright, first I’m going to raise your bed 75-90 degrees to prevent choking and aspiration. Also, can I have you verify your name for me? Thank you. I’m going to set your food tray in front of you and sit so we can have eye contact. Let me wipe your hands real quick and then we can eat! I have on the tray a [peach, cherry and pear] which would you like to eat first? Here is the peach. Did you swallow? Would you like a drink of water or another bite of food? Here is your drink of water. What would you like to eat next? Here is the cherry. Did you swallow? Would you like a drink of water or another bite of food? What would you like to eat next? Here is the pear. Did you swallow? Would you like another drink of water?  Here is your drink of water. Let me wipe your mouth. Let’s clean your hands again. You still have your signaling device; I’m going to go put this tray away. Place food tray in designated dirty supply area. Sanitize and Skill Complete.”

  1. Personal Care (Aka Peri-Care)

o   “Alright _____, I’m going to do some personal care today. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go grab some supplies. Supplies: Basin, soap, incontinent pad, bath towel, 4 washcloths, 2 pairs of gloves. Go get warm water. This water is comfortably warm to me, is it to you? Set up station: put on gloves, put incontinent pad under client, get 2 soapy washcloths and 2 rinse washcloths. Pull linen barrel closer and pull table closer. _____, I’m going to expose but not over expose you so you can be more comfortable. First, I am going to spread the labia and using a soapy washcloth wipe in the middle from front to back. Then I will wipe down each side from front to back using a clean section of the wash cloth each time. I’m going to do the same for rinsing. And again for drying, making sure to only wipe in one direction. Now, my partner is going to help me roll you onto your side and I’m going to use the other soapy washcloth to wash from anus to tailbone, and each buttock using a clean section of the wash cloth each time. I’m going to do the same for rinsing. And again for drying, making sure to only wipe in one direction. Now I’m going to roll you back on your back again. I’m going to take care of my linen, then take off my gloves, sanitize, cover you up and here is your signaling device. Now I’m going to put on new gloves and take care of my supplies and empty, rinse and dry the basin putting it in the dirty supply area. Dispose gloves. Sanitize and Skill Complete.”

  1. Catheter care

o    “Alright _____, I’m going to do some catheter care today. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go grab some supplies. Supplies: Basin, soap, incontinent pad, hand towel, 2 washcloths, 2 pairs of gloves. Go get warm water. This water is comfortably warm to me, is it to you? Set up station: put on gloves, put incontinent pad under client at a diagonal, get 1 soapy washcloth and 1 rinse washcloth. Pull linen barrel closer and pull table closer. _____, I’m going to expose but not over expose you so you can be more comfortable. First, I am going to stabilize your catheter at the meatus and using my soapy washcloth clean four inches of your catheter in one direction. I’m going to do the same with the rinse and with the dry, making sure to only wipe in one direction. I’m going to take care of my linen, then take off my gloves, sanitize, cover you up and here is your signaling device. Now I’m going to put on new gloves and take care of my supplies and empty, rinse and dry the basin putting it in the dirty supply area. Dispose gloves, Sanitize and Skill Complete.”

  1. Position on Side

o   “___________, it’s been two hours so I’m going to position you on your side to make you more comfortable. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go get some supplies and I’ll be right back. Supplies: 2 pillows and a bath blanket. I’m going to lower your head of bed flat and put up this rail just so that you don’t roll off. Now I’m going to roll you towards that rail as one unit. Let me adjust your head and this bottom arm for you. Now I’m going to put this pillow behind your back to stabilize you and this pillow in between your legs so that your knee and ankle aren’t lying directly on top of each other. This is blanket is going to go under your arm here. Here is your signaling device and I’m going to lower this rail. Are you comfortable? Sanitize.  Skill Complete”

  1. TED hose (elastic stocking)

o   “Next I’m going to put your elastic stocking on you. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go grab your stockings and I’ll be right back. Now ‘m going to make sure your head of bed is completely flat so I can put your stocking on. I’m going to expose your bare foot and calf without over exposure. Turning your stocking inside out to the heel I’m going to place this over your toes, top of foot and heel making sure I get your heel in the correct spot and there are no wrinkles or twists. Now I’m going to bring the rest of this stocking up your leg still making sure there are no twists or wrinkles. Are you comfortable? Let me check your toes to be sure that you’re still getting blood circulation. Let’s put your sheet back over you, you still have your signaling device. Sanitize.  Skill Complete”

  1. Clean Dentures

o   “I’m going to go to the back room to clean your dentures real quick, you have your signaling device and I’ll be right back. At the sink with the denture kit start by placing the denture kit on the counter I’m going to put on gloves and put down barriers on the counter and inside the sink. Next I’m going to use lukewarm running water to rinse the lid place on barrier, rinse the cup and fill with water place on barrier, and rinse the denture place on barrier. Next I’m going to get the brush ready and put paste on it, and then I’m going to brush all surfaces of the dentures. When I’m done I’ll rinse the dentures and the brush putting the dentures in the cup and putting the lid on it, then the brush and the cup go back in the denture kit. I’m going to turn off the water and then take care of all my barriers in the sink and on the counter. Take the denture kit to the dirty supple area. Dispose of my gloves, sanitize and skill complete.”

  1. Dressing Client with Weak Right arm

o   “Hello ____, I’m going to help you get dressed for bingo today. Your bed brakes are locked and your bed is low. Privacy is still maintained. You have your signaling device I’m going to go grab a couple shirts for you. Which would you like to wear today? Good choice! I know your right side is a bit sore so I’m going to take off your gown on your strong side and then gently help you take the rest of your gown on your weaker side okay? Now to put on your new pretty shirt I’m going to do the opposite and help you put your weaker arm through first, that way you don’t have to bend it. I’m going to make sure we have this on correctly and that all your buttons line up nicely. You’re already, you can wait here until they’re ready for you and you have your signaling device just in case. Sanitize. Skill Complete”

  1. Personal Protective Equipment (donning and removing)

o   “I’m going to grab a gown and gloves. Unfolding the gown I’m going to put it on without touching the floor. I’m going to fasten at the neck first and then roll and fasten at the waist. Next I’m going to put on my gloves making sure that they go over at least two inches of my gown. To remove my personal protective equipment I’m going to first take of my gloves correctly without touching the outside of the gloves or my gown. Dispose gloves. Then I’m going to unfasten my neck tie and waist ties. Then taking the cuffs of my gown which were covered by my gloves I’m going to roll my gown inwards and inside out and dispose. Sanitize my hands and Skill Complete.”

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