Maryland - NURSE AIDE

Maryland

NURSE AIDE

Written (or Oral) Examination

& Skills Evaluation

Candidate Handbook

February 2022

verMDNA2.0

CREDENTIA REGISTRATION AND SCHEDULING

SERVICES

3 Bala Plaza West

Suite 400A

Bala Cynwyd, PA 19004

888-274-7070

Hours of Operation

Monday–Friday 8 a.m. – 11 p.m.

Saturday 8 a.m. – 5 p.m.

Sunday 8 a.m. – 4 p.m.

(Eastern Time Zone)

Call to:

• Schedule, reschedule or cancel an examination

• Request an excused absence

• Ask questions about On-Line Registration

• Obtain information regarding your Score Report

• Obtain information regarding your examination

Go to Credentia’s website at

www.credentia.com/test-takers/md to:

• Access your CNA365 Account for registering to

take exams or to complete registry functions

• To view most current exam updates

• Download a Candidate Handbook

• View the Nurse Aide Practice Written Examination

• Submit a change of name or address

• Verify your status on the Registry

QUICK REFERENCE

MARYLAND BOARD OF NURSING

Nursing Assistant Certification Program

4140 Patterson Avenue

Baltimore, MD 21215

(410) 585-1900

Hours of Operation 8:30 a.m. - 4:00 p.m.

Wednesdays 9:30 a.m. - 4:30 p.m.

(Eastern Time Zone)

Call the Maryland Board of Nursing to:

• Obtain information on official regulations and

guidelines for geriatric nursing assistants

• Change your current address or name on the

Registry

• Obtain information regarding reciprocity

• Obtain information on continued registration on

the Registry

TABLE OF CONTENTS

Quick Reference ........................... inside front cover

Introduction ........................................................ 1

National Nurse Aide Assessment Program ............... 1

Exam Overview ........................................................ 2

Eligibility .................................................................. 2

Eligibility Routes ...................................................... 2

Application and Scheduling ............................. 5

Filling Out an Application ....................................... 5

Fees ........................................................................... 5

Exam Fees ............................................................. 5

Other Fees ............................................................ 5

Exam Scheduling ...................................................... 6

Testing Locations ...................................................... 7

Accommodations ...................................................... 7

Cancellation.......................................................... 8

Refunds .................................................................... 8

Absence Policy .......................................................... 8

Weather Emergencies ................................................ 9

Ex am Day .................................................................. 9

Checking In .............................................................. 9

What to Bring .......................................................... 9

Proper Identification ................................................ 10

Security and Cheating ............................................. 10

Testing Policies ........................................................ 11

Lateness ............................................................... 11

Electronic Devices ............................................... 11

Study Aids ........................................................... 11

Eating/Drinking/Smoking ................................... 11

Misconduct .......................................................... 11

Guests/Visitors ..................................................... 11

The Written (or Oral) Exam ............................ 12

Written Exam .......................................................... 12

Oral Exam ............................................................... 12

Written (or Oral) Exam

Content Outline ............................................. 13

Sample Questions ................................................ 14

Self-assessment reading test ...................... 15 -18

The Skills Evaluation ......................................... 19

What to Expect ....................................................... 19

Setting ................................................................. 19

Who Will Act as a Client? ................................... 19

Candidate Volunteer Requirements ..................... 19

The Task s ............................................................... 20

Recording a Measurement ....................................... 21

Sample Recording Sheet for Measurement Skills .... 22

Tips for the Skills Evaluation .............................. 23

Skills Listing .................................................... 24-38

Score Reporting .................................................. 39

Exam Results ........................................................... 39

Score Reporting ................................................... 39

Duplicate Score Report ........................................ 39

Failing ...................................................................... 39

How to Read a Failing Score Report ...................... 40

Passing ..................................................................... 41

grievance process ............................................... 42

The Registry ........................................................... 42

Change of Address or Name ................................... 42

Registration Process ................................................ 42

First-time Registration ........................................ 42

Re-registration .................................................... 43

Endorsement (Reciprocity) ................................. 43

maryland nursing assistant

frequently asked questions ................. 44-47

Appendix

Appendix B: Change of Address or Name Form

Credentia does not discriminate on the basis of age, sex, race, creed,

disabling condition, religion, national origin, or any other protected characteristics.

NNAAP® Written Exam Content Outline and Practical Skills Listing

INTRODUCTION

is handbook is designed for candidates seeking

Geriatric Nursing Assistant (GNA) registration in

Maryland. It describes the process of applying for the

National Nurse Aide Assessment Program (NNAAP®)

and taking the NNAAP Examination. It should be kept

for future reference.

e Maryland Board of Nursing, Nursing Assistant

Certication Program, has contracted with Credentia, a

nationally recognized leading provider of assessment ser-

vices to regulatory agencies and national associations, to

develop, schedule, administer, score, and report the results

of the NNAAP Examination required for registration as a

GNA.

e Maryland Board of Nursing is responsible for the

Nursing Assistant Certication Program in the state of

Maryland including GNA registration and Registry services.

In order to be registered in Maryland as a GNA, you must

rst be certied as a Certied Nursing Assistant (CNA).

NATIONAL NURSE AIDE ASSESSMENT

PROGRAM (NNAAP®)

e Nursing Home Reform Act, adopted by Congress as

part of the Omnibus Budget Reconciliation Act of 1987

(OBRA ’87), was designed to improve the quality of care

in long-term health care facilities and to dene training

and evaluation standards for GNAs who work in such

facilities. Each state is responsible for following the terms

of this federal law.

e National Nurse Aide Assessment Program (NNAAP®)

is an examination program designed to determine mini-

mal competency to become a certied GNA in your state.

e NNAAP was developed by the National Council of

State Boards of Nursing, Inc., (NCSBN) to meet the nurse

aide evaluation requirement of federal and state laws and

regulations. Credentia is the authorized administrator of the

NNAAP in your state.

e NNAAP Examination is an evaluation of nurse

aide-related knowledge, skills, and abilities. e NNAAP

Examination is made up of both a Written (or Oral)

Examination and a Skills Evaluation. e purpose of the

NNAAP Examination is to test that you understand and

can safely perform the job of an entry-level GNA.

EXAM OVERVIEW

You will be allowed to choose between a Written or Oral

Examination. e two parts of the NNAAP Examination

process, the Written (or Oral) Examination and the Skills.

You must pass both parts to be certied and listed on the

Maryland Geriatric Nursing Assistant Registry.

e Written Examination consists of seventy (70) multi-

ple-choice questions written in English. Sample exami-

nation questions are provided in this handbook. An

Oral Examination may be taken in place of the Written

Examination if you have diculty reading English. e

Oral Examination consists of sixty (60) multiple-choice

questions and ten (10) reading comprehension questions. If

you want to take the Oral Examination, you must request

it when you submit your application.

At the Skills Evaluation you will be asked to perform ve

(5) randomly selected GNA skills. You will be given thirty

(30) minutes to complete the ve (5) skills. You will be

rated on these skills by a Nurse Evaluator. A complete list-

ing of the skills is shown on pages 24 to 38.

See The Written (or Oral) Exam and The Skills Evaluation

for more details about the NNAAP Examination.

ELIGIBILITY

ELIGIBILITY ROUTES

In order to become registered in Maryland as a GNA, you

must rst:

• Complete a Board of Nursing approved GNA

training program or its equivalent

• Pass both parts of the NNAAP Examination

• Be certified as a CNA in Maryland

NOTE: Every CNA working in a Maryland Licensed Nursing

Home MUST be registered as a GNA within 120 days of

being hired by the facility. You may not work as a GNA, even

while waiting to take the NNAAP Examination, unless you

are already a CNA in good standing, certified through the

Maryland Nursing Assistant Certification Program.

Choose one of the following eligibility routes to qualify for

the NNAAP Examination:

A-1 NEW GERIATRIC NURSING ASSISTANT

To qualify to take the NNAAP Examination

under Route A1, you must choose one of the following

criteria categories

• Completed Training: have successfully complet-

ed, within the last twelve (12) months, a Board

of Nursing-approved 100-hour nursing assistant

training program that includes clinical experience

in a Maryland Licensed Nursing Home. A copy of

the new training program certificate must accom-

pany your examination application.

• Student Nurse — Active: as a student nurse

currently enrolled in an nursing education pro-

gram; have successfully completed the portion

of the curriculum determined by the nursing

education program and the Board of Nursing

as having met the requirements of the (above)

100-hour Board of Nursing-approved nursing

assistant training program, including clinical

experience in a Maryland Licensed Nursing

Home. Official student transcripts must accom-

pany your examination application.

• Student Nurse — Inactive: as a student nurse

no longer actively enrolled in a nursing edu-

cation program; have successfully completed,

within the last twelve (12) months, the portion

of Maryland approved education program cur-

riculum determined by the nursing education

program and the Board of Nursing as having met

the requirements of the 100-hour nursing assis-

tant training program, including clinical experi-

ence in a Maryland Licensed Nursing Home.

Official student transcripts must accompany

your examination application.

• Graduate Nurse: has graduated from an accred-

ited nursing education program in the United

States. A copy of your diploma or degree must

accompany the examination application.

• Graduate Nurse — Foreign: has graduated

from a nursing education program outside the

United States, is currently licensed in the coun-

try as a nurse (not a midwife), and have been

pre-approved by the Maryland Board of Nursing

to take the NCLEX Examination. The Board

of Nursing’s Authorization to Test (ATT) must

accompany your examination application.

A-2 EXPIRED GNA CERTIFICATE

(LESS THAN TWENTY-FOUR

(24) MONTHS)

If your GNA Certificate has been expired for less than

twenty-four (24) months, you may be eligible to become

active on the Registry by submitting to the Board of

Nursing evidence of GNA practice for a minimum of

eight (8) hours in a Maryland Licensed Nursing Home.

In the absence of working in a Maryland Licensed

Nursing Home, you must successfully re-test in order

to become active on the Maryland Geriatric Nursing

Assistant Registry. If you fail the Written (or Oral)

Examination or the Skills Evaluation on the first try,

you must complete a Board of Nursing-approved nurs-

ing assistant training program. A copy of your expired

GNA Certificate must accompany your examination

application.

A-3 EXPIRED GNA CERTIFICATE

(MORE THAN TWENTY-FOUR (24)

MONTHS)

If your GNA Certificate has been expired for more

than twenty-four (24) months, you may be eligible to

become active on the Registry by submitting evidence

to the Board of Nursing of continued GNA practice

in a Maryland Licensed Nursing Home for at least

eight (8) hours for each two (2) year period. In the

absence of continued practice, you must successfully

re-train and re-test in order to become active on the

Maryland Geriatric Nursing Assistant Registry. If you

fail the Written (or Oral) Examination or the Skills

Evaluation on the first try, you must complete a Board

of Nursing-approved nursing assistant training pro-

gram. A copy of your expired GNA Certificate must

accompany your examination application.

A-4 ENDORSEMENT/RECIPROCITY

If you are currently certied and in good standing on the

CNA registry in another state, you are NOT required to

take the NNAAP Examination. You are eligible for GNA

certication in Maryland after you have obtained certica-

tion as a Maryland CNA. You must contact the Maryland

Board of Nursing, Nursing Assistant Certication Program

for a GNA endorsement application.

REGISTRATION

AND SCHEDULING

ONLINE REGISTRATION AND

SCHEDULING

With the Credentia CNA365 system, online registration

is quick, convenient and an environmentally responsible

way to register for your examination. is process will

eliminate the transit time associated with mailing a paper

application. A detailed step-by-step reference guide on

how to create a CNA365 account and register for exams

can be found at www.credentia.com/test-takers/md.

After completing a Maryland state-approved training

course, you will create an online account with Credentia’s

CNA365 system. To create a CNA365 account, click the

“CNA365 Login” button on the top of the Maryland

nurse aide website page at www.credentia.com/test-takers/

md.

• Payment is in the form of a credit card or pre-paid

credit card (American Express, MasterCard, Visa,

or electronic voucher). Fees are non-refundable and

non-transferable once submitted.

• For exams at test center locatons, you must make

an online reservation via a PC (smart phones and

tablets are not recommended) at least ten (10) cal-

endar days prior to the test date.

• For Written (or Oral) online exams, you may sched-

ule an exam as early as the following day depending

on exam availability.

• You are responsible for completing an online appli-

cation in CNA365. You may ask someone from

your nurse aide training program or facility employ-

er for assistance in completing the application. If

you need help or have any questions about the

application process, contact a support representative

at 888-274-7070

EXAM FEES

Written Examination $35

Skills Evaluation $70

Oral Examination $35

You must pay for both the Written (or Oral) Examination

and the Skills Evaluation the first time you test.

EXAM SCHEDULING

Once your online application has been approved, you will

be able to schedule for exams in CNA365. A detailed step-

by-step reference guide on how to schedule exams can

be found at www.credentia.com/test-takers/md. When

completed, you will receive a Conrmation Notice and

Receipt of Payment via email.

ACCOMMODATIONS

Credentia complies with the provisions of the Americans

with Disabilities Act as amended. e purpose of accom-

modations is to provide candidates with full access to the

test. Accommodations are not a guarantee of improved

performance or test completion. Credentia provides rea-

sonable and appropriate accommodations to individuals

with documented disabilities who demonstrate a need for

accommodations.

Test accommodations may include things such as:

• A separate testing room

• Extra testing time for the Written/Oral exam

• A Reader or Recorder, for individuals with mobility

or vision impairments and cannot read or write on

their own

Test accommodations are individualized and considered

on a case-by-case basis. All candidates who are request-

ing accommodations because of a disability must provide

appropriate documentation of their condition and how

it is expected to aect their ability to take the test under

standard conditions. is may include:

• Supporting documentation from the professional

who diagnosed the condition, including the cre-

dentials that qualify the professional to make this

diagnosis

• A description of past accommodations the candidate

has received

Please visit www.credentia.com/accommodations full

details on the accommodations process and required sup-

porting documentation.

TESTING LOCATIONS

In-Facility Testing (INF) - In facility testing is when your

state-approved Training Program Nurse Aide instructor has

made arranagments with Credentia to test at your training

program on a specc date. Please make certain you know

your in facility (INF) Code and test date when you are

completing your registration.

CANCELLATION AND

RESCHEDULING

You may cancel or reschedule an examination online in

your CNA365 account. For details on how to cancel or

reschedule an examination, visit www.credentia.com/test-

takers/md and click on “How to Cancel or Reschedule an

Exam” in the Resources section of the webpage.

Online Written (or Oral) examinations must be can-

celed or rescheduled at least 48 hours before the scheduled

examination time.

Test center examinations must be canceled or resched-

uled at least nine (9) calender days before the scheduled

examination date

If you do not cancel or reschedule your examination with-

in the required timeframes detailed and do not show up

for your scheduled examination, you will be responsible

for the examination fee. Your fee will not be refunded and

cannot be transferred to a new examination date, and you

may not give your examination date to another person.

REFUNDS

Once payment of exam fees is received, NO REFUNDS

WILL BE ISSUED.

ABSENCE POLICY

Since unexpected situations sometimes occur, Credentia

will consider excusing an absence from a scheduled exami-

nation in certain situations. Acceptable excused absences

are as follows:

• Illness of yourself or an immediate family member

• Death in the family

• Disabling traffic accident

• Court appearance or jury duty

• Military duty

• Weather emergency

Requests for excused absences must be made in writing

and received by Credentia within ten (10) business days

following the scheduled examination date. is request

must include verication from the appropriate source of

the reason for your absence. For example, if you are absent

because of jury duty, you must supply a copy of the court

notice.

Credentia’s decisions regarding whether an absence is

excused and whether the examination fee will be forfeited

will be nal.

WEATHER EMERGENCIES

A test center examination will be delayed or cancelled

only in emergencies. If severe weather or a natural disaster

makes the test site inaccessible or unsafe, the examination

will be delayed or cancelled. In the event of an examana-

tion change due to a weather emergency, candidates will be

contacted by phone and email with change details.

EXAM DAY (ONLINE EXAM)

Take the written/oral exam conveniently from home using

the online proctor option. A live proctor will monitor you

through the webcam on your workstation to provide a secure

exam experience. Online exams also oer signicantly more

scheduling exibility than test center exams to best meet your

availability.

Please visit www.credentia.com/online-exams for information

on what to expect and how to best prepare for your online

exam. We also recommend that you click on the “Policies &

Procedures” link on this webpage to review detailed exam

rules and procedures.

WHAT YOU'LL NEED

• A properly equipped computer - a desktop, laptop, or

Chromebook with a single monitor (no smartphones or

tablets). Visit www.credentia.com/online-exams to view

or download system requirements.

• A private room - if you don't have access to a private

room, check with your training program or local library

for availability.

• A mobile device - to complete a 360 degree room scan,

you'll need a smartphone or tablet (Apple or Android)

that can download our free app.

BEFORE EXAM DAY

• Perform a system test – make sure to do the required

system test and exam simulation before exam day.

Visit www.credentia.com/online-exams and select the

“Run System Test” button.

• Find your testing space – Find a quiet, distraction-

free area in your home or oce to take your exam.

• Get your ID ready - You are required to bring two (2)

forms of ocial, signature-bearing identication (one

of which must be a photo identication). Photocopies

of identication will NOT be accepted.

e name on your identication must be the same as

the name you used on the application to register for the

examination. If you do not bring proper identication,

you will not be allowed to test and your examination fee

will not be refunded.

ON EXAM DAY

STEP 1: Prepare your testing space

• Quiet: no background noise and inform mem

bers of your household you are taking an exam

• Well lit: proctors must be able to see you and

your testing space well.

• Privacy: no one else in the room.

• Remove prohibited items: clear workstation

area to expedite room scan

• Restroom/Beverages: use restroom and prepare

beverages before exam.

STEP 2: Have your ID ready

• Have your government issued photo ID with you

(see list or proper identication in section above).

STEP 3: Prepare your computer

• Disconnect any additional monitors and close

all other open applications.

• Have your chargers (laptop, smart phone or

tablet) plugged in or nearby

• Use a wired internet connection rather than

WiFi, if possible.

• If using WiFi, we recommend at least 3Mbps

and ask that other household members do not

use the internet during your exam.

• Disconnect any VPNs or rewalls if you have

them.

• If taking an Oral Exam you must use a wired

headset.

STEP 4: Download the ExamRoom 360 app

• Download the ExamRoom 360 app to your

smartphone or tablet and have your CNA365

password for your Credentia CNA365 account).

is app is required to complete a 360 degree

room scan.

STEP 5: Check-in for your exam

• When to check-in - you can begin the check

in process up to 30 minutes prior to your

appointment. Your onboarding agent will make

sure everything is ready for your exam

before introducing your proctor. Visit www.

credentia.com/online-exams to view or

download detailed check-in procedures.

• How to check-in - go to www.credentia.com/

test-takers/md and click the “CNA365 login”

button. Once logged in, nd your sched

uled exam and select the "Start Exam" button.

EXAM DAY (TEST CENTER EXAM)

Please visit www.credentia.com/test-center-exams for infor-

mation on what to expect and how to best prepare for your

test center exam.

WHAT TO BRING

You MUST have the following items with you when you

take the NNAAP Examination:

• Two (2) forms of ocial, signature-bearing identi-

cation, one of which must be photo identification

• Three (3) No. 2 pencils (sharpened)

• Eraser

• Your Social Security number

• Watch with a second hand

• Longman’s Dictionary of American English

(Not required, but if you choose to bring a diction-

ary with you to the test center on the day of testing,

you MUST bring a Longman’s Dictionary of American

English. All other dictionaries will not be permitted.)

No other materials will be allowed.

PROPER IDENTIFICATION

You are required to bring two (2) forms of ocial,

signature-bearing identication to the test site (one of

which must be a photo identication). Photocopies of

identication will NOT be accepted. Examples of proper

identication include:

• Driver’s license

• Signature-bearing Social Security card

• Clinic card

• Credit card

• Library card

• State-issued identification card

• Passport

• Alien registration card

e name on your identication must be the same as

the name you used on the application to register for the

examination.

If you do not bring proper identification, you will not

be allowed to test and your examination fee will not

be refunded.

SECURITY AND CHEATING

If you give help to or receive help from anyone during the

NNAAP Examination, the examination will be stopped.

e incident will be reported to the Maryland Board of

Nursing for review, and your examination will not be

scored (see Testing Policies).

Please note that all examination questions, each form of

the examination, and all other examination materials are

copyrighted by, the property of, or licensed to Credentia.

Consequently, any distribution of the examination content

or materials through any form of reproduction, or through

oral or written communication, is strictly prohibited and

punishable by law. Anyone who removes or tries to remove

examination materials or information from the test site

will be prosecuted.

TESTING POLICIES

e following policies are observed at each test site.

LATENESS

Arrive at the test center thirty (30) minutes before the

examination starts. If you are late for your scheduled

exam ination, or do not bring all of your required materi-

als, you will NOT be allowed to test and your examina-

tion fee will NOT be returned.

ELECTRONIC DEVICES

Cellular phones, beepers, or any other electronic devices

are not permitted to be used and must be turned o dur-

ing testing, and there is no place for storage of personal

belongings at the test sites.

STUDY AIDS

You are not permitted to take personal belongings such

as briefcases, large bags, study materials, extra books, or

papers into the examination room. Any such materials

brought into the examination room will be collected and

returned to you when you have completed the examina-

tion. Credentia is not responsible for lost or misplaced

items.

EATING/DRINKING/SMOKING

You are not permitted to eat, drink, or smoke during the

examination.

MISCONDUCT

If you cause a disturbance of any kind or engage in any

kind of misconduct, you will be dismissed from the

examination and reported to your state licensing agency.

Decisions regarding disciplinary measures are the respon-

sibility of this agency.

GUESTS/VISITORS

No guests, visitors, pets, or children are allowed at the

test sites.

THE WRITTEN

(OR ORAL) EXAM

WRITTEN EXAM

e Written Examination has seventy (70) multiple

choice questions. You will have two (2) hours to complete

the Written Examination. See Sample Questions for

examples of the kinds of questions found on the Written

Examination.

ORAL EXAM

An Oral Examination may be taken in place of the Written

Examination. You must request and Oral Examination

when lling out your application. e Oral Examination

consists of two (2) parts, and you must pass both parts

in order to pass the Oral Examination. If taking the

online proctored exam, not a facility test site exam, you

will need your own wired headset. e rst part of the

Oral Examination has sixty (60) multiple-choice ques-

tions. Each of the sixty (60) multiple choice questions

is read twice. As each question is read, you are asked to

choose the correct answer. e second part of the Oral

Examination has ten (10) multiple-choice questions that

test whether you know common words used in long-term

care facilities. Each word is read three (3) times. You are

asked to match the word you hear on the recording to the

written word.

2016 WRITTEN (OR ORAL)

EXAM CONTENT OUTLINE

e revised content outline is based on the ndings from

the 2014 Job Analysis and Knowledge, Skill, and Ability

Study of Nurse Aides published by the National Council of

State Boards of Nursing (NCSBN) in 2015. e examina-

tion content outline will be eective January 2016.

e NNAAP written examination is comprised of 70

multiple-choice items; 10 of these items are pretest (non-

scored) items on which statistical information will be

collected. e NNAAP oral examination is comprised of

60 multiple-choice items and 10 reading comprehension

(word recognition) items. e candidate is allowed to

choose between a written and an oral examination.

# of

% of questions

I. Physical Care Skills the exam in the exam

A. Activities of Daily Living ........ 14% ............9

1. Hygiene

2. Dressing and Grooming

3. Nutrition and Hydration

4. Elimination

5. Rest/Sleep/Comfort

B. Basic Nursing Skills .................39% ............ 23

1. Infection Control

2. Safety/Emergency

3. Therapeutic/Technical Procedures

4. Data Collection and Reporting

C. Restorative Skills ...................... 8% .............5

1. Prevention

2. Self Care/Independence

II. Psychosocial Care Skills

A. Emotional and

Mental Health Needs ..............11% .............6

B. Spiritual and Cultural Needs ....2% ..............2

III. Role of the Nurse Aide

A. Communication ....................... 8% .............4

B. Client Rights ........................... 7% .............4

C. Legal and Ethical Behavior ...... 3% .............2

D. Member of the

Health Care Team ................... 8% .............5

SAMPLE QUESTIONS

e following questions are samples of the kinds of ques-

tions that you will nd on the Written Examination.

Check your answers to these questions in the box below.

1. The client's call light should always be placed:

(A) on the bed

(B) within the client's reach

(D) over the side rail

2. Which of the following items is used in the pre-

vention and treatment of bedsores or pressure

sores?

(A) rubber sheet

(B) air mattress

(D) restraint

3. When caring for a dying client, the nurse aide

should:

(A) keep the client's room dark and quiet

(B) allow client to express his feelings

(D) contact the client's minister, priest or rabbi

4. What does the abbreviation ADL mean?

(A) Ad Lib

(B) As Doctor Likes

(D) After Daylight

5. After giving a client a back rub, the nurse aide

should always note:

(A) the last time the client had a back rub

(B) any change in the client's skin

(D) amount of lotion used

6. How should the nurse aide communicate with a

client who has a hearing loss?

(A) face the client when speaking

(B) repeat the statement

(D) use a high-pitched voice

Correct Answers

1. B 2. B 3. B 4. C 5. B 6. A

SELF-ASSESSMENT

READING TEST

PART 1: VOCABULARY

1. Circle the best answer to each question.

2. When you have finished, check your answers using

the answer key on page 18.

3. Count up the number of correct answers.

4. If your score is less than 17, you may have difficulty

reading the Written Examination and should con-

sider taking the Oral Examination.

1. You go to a doctor when you _____.

(A) feel sleepy

(B) need socks

(D) need money

(E) need clothes

2. A person who flies an airplane is its _____.

(A) pilot

(B) steward

(D) surgeon

(E) director

3. You use a _____ to write.

(A) bow

(B) calculator

(D) carpenter

(E) needle

4. To EXIT a room means to _____ it.

(A) enter

(B) leave

(D) read

(E) interrupt

5. A wedding is a joyous _____.

(A) focus

(B) vehicle

(D) occasion

(E) civilization

6. To REQUIRE something means to _____ it.

(A) need

(B) have

(D) understand

(E) hear go to next page

7. You _____ something to find its length.

(A) slice

(B) lock

(D) force

(E) tape

8. Soup is served in a _____.

(A) plate

(B) bowl

(D) chair

(E) closet

9. To accompany someone means to _____.

(A) disagree with him

(B) work for him

(D) speak to him

(E) choose him

10. A nursing home resident receives _____ from the

staff.

(A) quality

(B) fame

(D) care

(E) work

11. Medicine is used to _____ pain.

(A) widen

(B) conjure

(D) increase

(E) relieve

12. To DRENCH the flowers means to ____ them.

(A) steam

(B) drink

(D) soak

(E) anger

13. A bicycle is a means of _____.

(A) nourishment

(B) transportation

(D) collision

(E) walking

14. When someone speaks in a whisper,

it may be difficult to _____.

(A) deceive

(B) understand

(D) estimate

SELF-ASSESSMENT

READING TEST

PART 2: COMPREHENSION

In this part of the reading test you will be provided with a

series of brief paragraphs. You are to read each paragraph and

then answer the questions that appear after the paragraph.

There are many different kinds of fish. All fish live

in water. They use their tails and fins to swim.

15. Fish live in _____.

(A) cups

(B) houses

(D) water

(E) fountains

16. Fish use their _____ to swim.

(A) tails

(B) heads

(D) lungs

(E) floats

Maria grew up on a farm. She loved the work on

the farm. She knew when all of the crops had to

be planted. She would like a job on a farm or in a

flower garden.

17. Maria has had experience as a _____.

(A) guide

(B) farmer

(D) nurse

(E) teacher

18. She would like to work in _____.

(A) an office

(B) a library

(D) a hospital

(E) a supermarket

19. As a child Maria lived _____.

(A) in the city

(B) in an apartment

(D) in a large house

Carolyn has a good job. She is a nurse in a large hos-

pital. Every day she can help many people. She enjoys

this very much. She also makes a good salary. Each

month she can pay her bills and save some money.

20. Carolyn works in a _____.

(A) hospital

(B) doctor’s office

(D) school

(E) library

21. One of the things Carolyn enjoys is _____.

(A) working in an office

(B) helping people

(D) working late hours

(E) driving a car

22. With her salary she can pay her bills and _____.

(A) buy furniture

(B) give to charity

(D) buy new clothes

(E) pay for college

This completes the

Self-Assessment Reading Test.

Answers

1. C 7. C 13. B 19. C

2. A 8. B 14. B 20. A

3. C 9. C 15. D 21. B

4. B 10. D 16. A 22. C

5. D 11. E 17. B

6. A 12. D 18. C

If your score is less than 17, you may have difficulty

reading the Written Examination and should consider

taking the Oral Examination in place of the Written

Examination.

THE SKILLS EVALUATION

WHAT TO EXPECT

e Skills Evaluation is set up to resemble an actual care-giving

situation. e Skills Evaluation area will look similar to your work

setting. It will have all the equipment necessary to perform the

assigned skills. e Skills Evaluation will be administered by

a Nurse Aide Evaluator. Before your skills evaluation begins,

the evaluator will show you where equipment is located and

answer questions about operating the equipment. Please arrive

30 minutes early. Test times are approximate. Please plan to

spend the day. See pages 24-38 for the complete skills listing.

WHO WILL ACT AS A CLIENT?

e part of the “client” will be played by a candidate who volun-

teers to act as a weakened elderly person. While you perform

the skills, speak to the candidate volunteer as you would speak

to an actual client in a nurse aide work setting. You are encour-

aged to speak to the candidate volunteer not only because it is

part of quality care, but also because it will help you to relax as

you perform the skills. Please note, you may not receive help

from anyone during the Skills Evaluation, and the candidate

and the client must speak to one another in English so that the

evaluator can understand and correctly score the evaluation.

If either candidate gives help or receives help during the test,

or the client and candidate are communicating in a language

other than English, the test will be stopped.

CANDIDATE VOLUNTEER

REQUIREMENTS

You will need to act as a candidate volunteer for another nurse

aide’s Skills Evaluation and play the role of a nursing home patient

(client). e evaluator will give you verbal instructions that will

describe how you should act in performing the role of the client.

You must wear at, slip-on, non-skid shoes; a loose-tting

top with short sleeves that can be rolled up to the shoulder,

or tank top; and loose tting pants that can be rolled up.

You will be required to put a gown on over your clothing. In

no case may candidates remove clothing down to undergar-

ments. As a candidate volunteer, you will be asked to remove:

all body piercing, facial makeup, and jewelry.

Prior to beginning the exam, you should inform the evaluator of

any food or latex allergy or sensitivity to skin soaps or lotion. Any

limitations to range of motion must also be communicated to

the evaluator prior to the start of the skills examination.

For infection control purposes, you should have short, clean

ngernails to avoid injury to the candidate volunteer, and

you should not come to the test site with open areas/sores

on the skin. Candidates with any open areas or sores on

their skin should reschedule their skills test to a later date

after their skin fully heals.

THE TASKS

e NNAAP Skills List contains all of the skills that you

may be asked to demonstrate during the Skills Evaluation.

Each skill represents a task that you will be asked to per-

form in your job and has been broken down into a series

of steps.

A step that is highlighted in bold type is called a Critical

Element Step. Critical Element Steps are important steps

that must be performed correctly in order for you to pass

the skill. If you leave out a Critical Element Step or do

not perform a Critical Element Step properly, you will not

pass the skill. However, if you perform only the Critical

Element Step correctly in a skill, you do not automati-

cally pass that skill. You must also correctly demonstrate

enough steps to meet the passing standard (or cut score)

for each skill.

Before your Skills Evaluation begins, the Nurse Aide

Evaluator will give you an instruction card that will list the

ve (5) skills selected for you to perform. Hand-washing will

always be one of the skills to be performed. e remaining

four (4) skills are randomly chosen from the complete set of

skills listings on pages 24 to 38 of this handbook. You are

strongly encouraged to perform the skills in the order they

are listed on the instruction card.

If you make a mistake, say so, and you will be instructed

to tell the evaluator which step(s) is to be corrected and

then to perform the step(s). You will not have to redo the

entire skill, just the steps you wish to correct. ere are,

however, some exceptions to this rule. If you fail to put

on gloves or take them o when it is required to do so and

the evaluator reminds you to do so, for infection control

purposes, then you will not receive credit for attempting to

correct this step. If you wish to correct an order-dependent

step (a step stating that an action should be performed

before or after another step) and you fail to say when the

corrected step should be performed, you will not receive

credit for the correction.

Once you begin a new skill, you may not go back to cor-

rect a previous skill. e Nurse Aide Evaluator will not

answer questions during the Skills Evaluation and will not

tell you whether you performed a skill correctly. You may

not receive help from anyone during the Skills Evaluation.

If you do have any questions, please ask them before the

Skills Evaluation begins.

One (1) of the four (4) randomly-selected skills will include

a measurement skill (see the section below, Recording A

Measurement, for more information regarding measure-

ment skills).

You must successfully complete five (5) out of the five (5) skills

in the skill form to pass the Skills Evaluation. You will have

thirty (30) minutes to demonstrate all ve (5) skills.

When you have completed your skills evaluation, the

evaluator will direct you to wash your hands. Although

this will not eect your examination results, for the pur-

poses of infection control, you must wash your hands.

RECORDING A MEASUREMENT

e NNAAP Skills Evaluation requires every candidate to

perform at least one measurement skill, such as blood pres-

sure, radial pulse, respirations, urine output, or weight. You

will be given a special form, called a Recording Sheet for

Measurement Skills, to write down, or record, the measure-

ment. For example, if performing the Measures and Records

Blood Pressure skill, you will write the complete systolic and

diastolic pressures of your blood pressure reading in a box

labeled Candidate Results.

On the following page is a copy of the recording sheet that

will be used during the skills exam. e candidate must

record his/her results in the Candidate Results box on this

sheet. is sheet will be used to record the results of the

following measurement skills:

• Measures and Records Blood Pressure

• Measures and Records Weight of

Ambulatory Client

• Measures and Records Urinary Output

• Counts and Records Radial Pulse

• Counts and Records Respirations

Tips for the Skills Evaluation

• You will be expected to perform the skills as you would

in a nursing home setting. When water is required, you

must use running water. All candidates will be required

to perform the Hand Hygiene skill. The evaluator will

inform you after you have washed your hands for the

first time that you should just tell him or her when you

would wash your hands during your performance of

the rest of the skills, rather than actually washing them

for each skill. For all steps other than hand-washing,

you must actually perform the skill in order to receive

credit. You may not simply tell the evaluator what you

would do for simulating a step. For example, you may

not simply tell the evaluator that you would wash the

client. You must actually demonstrate washing the

client. You may not simply tell the evaluator that you

would feed the client. You must actually demonstrate

feeding the client.

• After you have introduced yourself to the client for

the first time, it is not necessary for you to introduce

yourself each time you begin a new skill.

• To receive full credit for a measurement skill, you

must accurately make the required measurement and

then write that measurement on the Recording Sheet

for Measurement Skills. The evaluator will provide the

Recording Sheet to you at the test site. A sample of the

Recording Sheet is shown on page 24 of this hand-

book. You are encouraged to become familiar with the

Recording Sheet before your scheduled test date.

• You must know how to operate both a standing and

a non-digital bathroom scale and must know how to

set both types of scales to zero.

• You may not bring any of your own equipment to

the test site (i.e. transfer/gait belt).

• It is important for you to place the call signal within

the client’s reach whenever you leave the client.

• Where the word “client” appears, it refers to the person

receiving care.

2524

Date

Test Site ID

CANDIDATE NAME

CANDIDATE ID

EVALUATOR NAME

EVALUATOR ID

SKILL TESTED

Evaluator must check one box

next to the skill being tested.

■

Blood Pressure

■

Respirations

■ Oral Temperature ■ Urine Output

■ Radial Pulse ■ Weight

RECORDING SHEET FOR

MEASUREMENT SKILLS

CANDIDATE EVALUATOR

RESULTS RESULTS

SAMPLE

TIPS FOR THE SKILLS EVALUATION

• When water is required, you must use running water.

All candidates will be required to perform the Hand

Hygiene skill. The evaluator will inform you after

you have washed your hands for the first time that

you should just tell him or her when you would wash

your hands during your performance of the rest of

the skills, rather than actually washing them for each

skill. For all steps other than hand-washing, you must

actually perform the skill in order to receive credit.

You may not simply tell the evaluator what you

would do for simulating a step. For example, you

may not simply tell the evaluator that you would wash

the client. You must actually demonstrate washing the

client. You may not simply tell the evaluator that you

would feed the client. You must actually demonstrate

feeding the client.

• After you have introduced yourself to the client for

the first time, it is not necessary for you to introduce

yourself each time you begin a new skill.

• To receive full credit for a measurement skill, you

must accurately make the required measurement and

then write that measurement on the Recording Sheet

for Measurement Skills. The evaluator will provide the

Recording Sheet to you at the test site. A sample of the

Recording Sheet is shown on page 22 of this hand-

book. You are encouraged to become familiar with the

Recording Sheet before your scheduled test date.

• You must know how to operate both a standing and

a non-digital bathroom scale and must know how to

set both types of scales to zero.

• You may not bring any of your own equipment to

the test site (i.e. transfer/gait belt).

• It is important for you to place the call signal within

the client’s reach whenever you leave the client.

• Where the word “client” appears, it refers to the person

receiving care.

SKILLS LISTING

e 23 skills that follow are arranged in alphabetical

order, except for the Hand Hygiene (Hand Washing) skill.

Hand Hygiene is listed rst as a reminder of the impor-

tance of performing this skill before all other skills. e

numbered lines below each skill are the steps needed to

perform that skill. Critical Element Steps are in bold type.

SKILL 1 — HAND HYGIENE (HAND WASHING)

1 Address client by name and introduces self to client by

name

2 Turns on water at sink

3 Wets hands and wrists thoroughly

4 Applies soap to hands

5 Lathers all surfaces of wrists, hands, and ngers

producing friction, for at least 20 (twenty) seconds,

keeping hands lower than the elbows and the

ngertips down

6 Cleans ngernails by rubbing ngertips against palms

of the opposite hand

7 Rinse all surfaces of wrists, hands, and ngers,

keeping hands lower than the elbows and the

ngertips down

8 Uses clean, dry paper towel/towels to dry all surfaces

of ngers, hands, and wrists starting at ngertips then

disposes of paper towel/towels into waste container

9 Uses clean, dry paper towel/towels to turn o faucet

then disposes of paper towel/towels into waste

container or uses knee/foot control to turn o faucet

10 Does not touch inside of sink at any time

SKILL 2 — APPLIES ONE KNEE-HIGH ELASTIC

STOCKING

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Client is in supine position (lying down in bed) while

stocking is applied

4 Turns stocking inside-out, at least to the heel

5 Places foot of stocking over toes, foot, and heel

6 Pulls top of stocking over foot, heel, and leg

7 Moves foot and leg gently and naturally, avoiding force

and over-extension of limb and joints

8 Finishes procedure with no twists or wrinkles and

heel of stocking, if present, is over heel and opening

in toe area (if present) is either over or under toe

area; if using a mannequin, candidate may state

stocking needs to be wrinkle-free

9 Signaling device is within reach and bed is in low

position

10 After completing skill, wash hands

SKILL 3 — ASSISTS TO AMBULATE USING

TRANSFER BELT

1 Explains procedure, speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Before assisting to stand, client is wearing non-skid

shoes/footwear

4 Before assisting to stand, bed is at a safe level

5 Before assisting to stand, checks and/or locks bed wheels

6 Before assisting to stand, client is assisted to sitting

position with feet at on the oor

7 Before assisting to stand, applies transfer belt securely

at the waist over clothing/gown

8 Before assisting to stand, provides instructions to

enable client to assist in standing including prearranged

signal to alert client to begin standing

9 Stands facing client positioning self to ensure safety of

candidate and client during transfer. Counts to three

(or says other prearranged signal) to alert client to

begin standing

10 On signal, gradually assists client to stand by grasping

transfer belt on both sides with an upward grasp

(candidate’s hands are in upward position), and

maintaining stability of client’s legs by standing knee to

knee, or toe to toe with client

11 Walks slightly behind and to one side of client for a

distance of ten (10) feet, while holding onto the belt

12 Assists client to bed and removes transfer belt

13 Signaling device is within reach and bed is in low

position

14 After completing skill, wash hands

SKILL 4 — ASSISTS WITH USE OF BEDPAN

1 Explains procedure speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Before placing bedpan, lowers head of bed

4 Puts on clean gloves before placing bedpan under client

5 Places bedpan correctly under client’s buttocks

6 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

7 After positioning client on bedpan and removing

gloves, raises head of bed

8 Toilet tissue is within reach

9 Hand wipe is within reach and client is instructed to

clean hands with hand wipe when nished

10 Signaling device within reach and client is asked to

signal when nished

11 Puts on clean gloves before removing bedpan

12 Head of bed is lowered before bedpan is removed

13 Ensures client is covered except when placing and

removing bedpan

14 Empties and rinses bedpan and pours rinse into toilet

15 Places bedpan in designated dirty supply area

16 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

17 Signaling device is within reach and bed is in low

position

SKILL 5 — CLEANS UPPER OR LOWER

DENTURE

1 Puts on clean gloves before handling denture

2 Bottom of sink is lined and/or sink is partially lled

with water before denture is held over sink

3 Rinses denture in moderate temperature running water

before brushing them

4 Applies denture toothpaste to toothbrush

5 Brushes all surfaces of denture

6 Rinses all surfaces of denture under moderate

temperature running water

7 Rinses denture cup and lid

8 Places denture in denture cup with moderate

temperature water/solution and places lid on cup

9 Rinses toothbrush and places in designated toothbrush

basin/container

10 Maintains clean technique with placement of

toothbrush and denture

11 Sink liner is removed and disposed of appropriately

and/or sink is drained

12 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

SKILL 6 — COUNTS AND RECORDS RADIAL

PULSE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Places ngertips on thumb side of client’s wrist to

locate radial pulse

3 Count beats for one full minute

4 Signaling device is within reach

5 Before recording, washes hands

6 Records pulse rate within plus or minus 4 beats of

evaluator’s reading

SKILL 7 — COUNTS AND RECORDS

RESPIRATIONS

1 Explains procedure (for testing purposes), speaking

clearly, slowly, and directly, maintaining face-to-face

contact whenever possible

2 Counts respirations for one full minute

3 Signaling device is within reach

4 Before recording, washes hands

5 Records respiration rate within plus or minus 2

breaths of evaluator’s reading

SKILL 8 — DONNING AND REMOVING PPE

(GOWN AND GLOVES)

1 Picks up gown and unfolds

2 Facing the back opening of the gown places arms

through each sleeve

3 Fastens the neck opening

4 Secures gown at waist making sure that back of

clothing is covered by gown (as much as possible)

5 Puts on gloves

6 Cus of gloves overlap cus of gown

7 Before removing gown, with one gloved hand, grasps

the other glove at the palm, remove glove

8 Slips ngers from ungloved hand underneath cu of

remaining glove at wrist, and removes glove turning

it inside out as it is removed

9 Disposes of gloves into designated waste container

without contaminating self

10 After removing gloves, unfastens gown at waist and

neck

11 After removing gloves, removes gown without touching

outside of gown

12 While removing gown, holds gown away from body

without touching the oor, turns gown inward and

keeps it inside out

13 Disposes of gown in designated container without

contaminating self

14 After completing skill, washes hands

SKILL 9 — DRESSES CLIENT WITH AFFECTED

(WEAK) RIGHT ARM

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Asks which shirt he/she would like to wear and dresses

him/her in shirt of choice

4 Avoids overexposure of client by ensuring client’s chest

is covered

5 Removes gown from the left (unaected) side rst, then

removes gown from the right (aected/weak) side

6 Before dressing client, disposes of gown into soiled

linen container

7 Assists to put the right (aected/weak) arm through

the right sleeve of the shirt before placing garment

on left (unaected) arm

8 While putting on shirt, moves body gently and

naturally, avoiding force and over-extension of limbs

and joints

9 Finishes with clothing in place

10 Signaling device is within reach and bed is in low

position

11 After completing skill, washes hands

SKILL 10 — FEEDS CLIENT WHO CANNOT

FEED SELF

1 Explains procedure to client, speaking clearly, slowly,

and directly, maintaining face-to-face contact whenever

possible

2 Before feeding, looks at name card on tray and asks

client to state name

3 Before feeding client, client is in an upright sitting

position (75-90 degrees)

4 Places tray where the food can be easily seen by client

5 Candidate cleans client’s hands before beginning

feeding

6 Candidate sits in a chair facing client during feeding

7 Tells client what foods and beverage are on tray

8 Asks client what he/she would like to eat rst

9 Using spoon, oers client one bite of each type of food

on tray, telling client the content of each spoonful

10 Oers beverage at least once during meal

11 Candidate asks client if they are ready for next bite of

food or sip of beverage

12 At end of meal, candidate cleans client’s mouth and

hands

13 Removes food tray

14 Leaves client in upright sitting position (75-90 degrees)

with signaling device within client’s reach

15 After completing skill, washes hands

SKILL 11 — GIVES MODIFIED BED BATH (FACE

AND ONE ARM, HAND AND UNDERARM)

1 Explains procedure, speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Removes gown and places directly in soiled linen

container while ensuring client’s chest and lower body

is covered

4 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

5 Puts on clean gloves before washing client.

6 Beginning with eyes, washes eyes with wet washcloth

(no soap), using a dierent area of the washcloth for

each stroke, washing inner aspect to outer aspect

then proceeds to wash face

7 Dries face with dry cloth towel/washcloth

8 Exposes one arm and places cloth towel underneath arm

9 Applies soap to wet washcloth

10 Washes ngers (including ngernails), hand, arm, and

underarm keeping rest of body covered

11 Rinses and dries ngers, hand, arm, and underarm

12 Moves body gently and naturally, avoiding force and

over-extension of limbs and joints

13 Puts clean gown on client

14 Empties, rinses, and dries basin

15 Places basin in designated dirty supply area

16 Disposes of linen into soiled linen container

17 Avoids contact between candidate clothing and used

linens

18 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

19 Signaling device is within reach and bed is in low

position

SKILL 12* — MEASURES AND RECORDS

ELECTRONIC BLOOD PRESSURE

*STATE SPECIFIC (EVALUATOR: DO NOT

SUBSTITUTE THIS SKILL FOR SKILL 23 ‘MANUAL

BLOOD PRESSURE’)

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Has client assume a comfortable lying or sitting position

4 Client’s arm is positioned at level of heart with palm up

and upper arm is exposed

5 Selects appropriate cu size

6 Feels for brachial artery on inner aspect of arm, at bend

of elbow

7 Places blood pressure cu snugly on client’s upper arm

and sensor/arrow is over the brachial artery site

8 Turns on the machine and ensures device is functioning.

If the machine has dierent settings for infants, children,

and adults, selects the appropriate setting

9 Pushes start button. If cu inates to more than 200

mm Hg then stops machine and uses cu on client’s

other arm

SKILL

NOT

TESTED

10 Waits until the blood pressure reading appears on the

screen and for the cu to deate, then removes the cu

11 Signaling device is within reach

12 Before recording, washes hands

13 After obtaining reading using BP cu, records both

systolic and diastolic pressures exactly as displayed

on the digital screen

SKILL 13 — MEASURES AND RECORDS

URINARY OUTPUT

1 Puts on clean gloves before handling bedpan

2 Pours the contents of the bedpan into measuring

container without spilling or splashing urine outside of

container

3 Rinses bedpan and pours rinse into toilet

4 Measures the amount of urine at eye level with

container on at surface (if between measurement

lines, round up to nearest 25 ml/cc)

5 After measuring urine, empties contents of measuring

container into toilet

6 Rinses measuring container and pours rinse into toilet

7 Before recording output, removes and disposes

of gloves (without contaminating self) into waste

container and washes hands

8 Records contents of container within plus or minus

25 ml/cc of evaluator’s reading

SKILL 14 — MEASURES AND RECORDS

WEIGHT OF AMBULATORY CLIENT

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Client has non-skid shoes/footwear on before walking

to scale

3 Before client steps on scale, candidate sets scale to zero

4 Asks client to step on center of scale and obtains

client’s weight

5 Asks client to step o scale

6 Before recording, washes hands

7 Records weight based on indicator on scale. Weight

is within plus or minus 2 lbs of evaluator’s reading

(If weight recorded in kg weight is within plus or

SKILL NOT

TESTED

SKILL 15 — PERFORMS MODIFIED PASSIVE

RANGE OF MOTION (PROM) FOR ONE KNEE

AND ONE ANKLE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Ensures that client is supine in bed and instructs client

to inform candidate if pain is experienced during

exercise

4 While supporting the leg at knee and ankle, bends

the knee and then returns leg to client’s normal

position (exion/extension) (AT LEAST 3 TIMES

unless pain is verbalized). Moves joints gently,

slowly and smoothly through the range of motion,

discontinuing exercise if client verbalizes pain.

5 While supporting the foot and ankle close to the

bed, pushes/pulls foot toward head (dorsiexion),

and pushes/pulls foot down, toes point down

(plantar exion) (AT LEAST 3 TIMES unless

pain is verbalized). Moves joints gently, slowly

and smoothly through the range of motion,

discontinuing exercise if client verbalizes pain.

6 Signaling device is within reach and bed is in low

position

7 After completing skill, washes hands

SKILL 16 — PERFORMS MODIFIED PASSIVE

RANGE OF MOTION (PROM) FOR ONE

SHOULDER

1 Explains procedure, speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Instructs client to inform candidate if pain experienced

during exercise

4 While supporting arm at the elbow and at the wrist,

raises client’s straightened arm from side position

upward toward head to ear level and returns arm

down to side of body (exion/extension) (AT

LEAST 3 TIMES unless pain is verbalized). Moves

joint gently, slowly and smoothly through the range

of motion, discontinuing exercise if client verbalizes

5 While supporting arm at the elbow and at the wrist,

moves client’s straightened arm away from the side

of body to shoulder level and returns to side of

body (abduction/adduction) (AT LEAST 3 TIMES

unless pain is verbalized). Moves joint gently,

slowly and smoothly through the range of motion,

discontinuing exercise if client verbalizes pain.

6 Signaling device is within reach and bed is in low

position

7 After completing skill, washes hands

SKILL 17 — POSITIONS ON SIDE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before turning, lowers head of bed

4 Raises side rail on side to which body will be turned

5 Candidate assists client to slowly roll onto side toward

raised side rail

6 Places or adjusts pillow under head for support

7 Candidate repositions arm and shoulder so that client

is not lying on arm

8 Supports top arm with supportive device

9 Places supportive device behind client’s back

10 Places supportive device between legs with top knee

exed; knee and ankle supported

11 Signaling device is within reach and bed is in low

position

12 After completing skill, washes hands

SKILL 18 — PROVIDES CATHETER CARE FOR

FEMALE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

4 Puts on clean gloves before washing

5 Places linen protector under perineal area including b

6 Exposes area surrounding catheter (only exposing client

between hip and knee)

7 Applies soap to wet washcloth

SKILL

NOT

TESTED

8 While holding catheter at meatus without tugging,

cleans at least four inches of catheter from meatus,

moving in only one direction, away from meatus,

using a clean area of the washcloth for each stroke

9 While holding catheter at meatus without tugging,

using a clean washcloth, rinses at least four inches

of catheter from meatus, moving only in one

direction, away from meatus, using a clean area of

the washcloth for each stroke

10 While holding catheter at meatus without tugging,

dries at least four inches of catheter moving away from

meatus using a dry cloth towel/washcloth

11 Empties, rinses, and dries basin

12 Places basin in designated dirty supply area

13 Disposes of used linen into soiled linen container and

disposes of linen protector appropriately

14 Avoids contact between candidate clothing and used

linen

15 Removes and disposes of gloves (without

contaminating self) into waste container and washes

hands

16 Signaling device is within reach and bed is in low

position

SKILL 19 — PROVIDES FOOT CARE ON ONE

FOOT

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

4 Basin is in a comfortable position for client and on

protective barrier

5 Puts on clean gloves before washing foot

6 Client’s bare foot is placed into the water

7 Applies soap to wet washcloth

8 Lifts foot from water and washes foot (including

between the toes)

9 Foot is rinsed (including between the toes)

10 Dries foot (including between the toes) with dry cloth

towel/washcloth

11 Applies lotion to top and bottom of foot (excluding

SKILL

NOT

TESTED

between the toes) removing excess with a towel/

washcloth

12 Supports foot and ankle during procedure

13 Empties, rinses, and dries basin

14 Places basin in designated dirty supply area

15 Disposes of used linen into soiled linen container

16 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

17 Signaling device is within reach

SKILL 20 — PROVIDES MOUTH CARE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before providing mouth care, client is in upright sitting

position (75-90 degrees)

4 Puts on clean gloves before cleaning mouth

5 Places cloth towel across chest before providing mouth

care

6 Secures cup of water and moistens toothbrush

7 Before cleaning mouth, applies toothpaste to

moistened toothbrush

8 Cleans mouth (including tongue and all surfaces of

teeth), using gentle motions

9 Maintains clean technique with placement of

toothbrush

10 Candidate holds emesis basin to chin while client

rinses mouth

11 Candidate wipes mouth and removes clothing

protector

12 Disposes of used linen into soiled linen container

13 Rinses toothbrush and empties, rinses, and dries basin

14 Removes and disposes of gloves (without

contaminating self) into waste container and washes

hands

SKILL 21 — PROVIDES PERINEAL CARE

(PERI-CARE) FOR FEMALE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

4 Puts on clean gloves before washing perineal area

5 Places pad/ linen protector under perineal area

including buttocks before washing

6 Exposes perineal area (only exposing between hips and

knees)

7 Applies soap to wet washcloth

8 Washes genital area, moving from front to back,

while using a clean area of the washcloth for each

stroke

9 Using clean washcloth, rinses soap from genital

area, moving from front to back, while using a clean

area of the washcloth for each stroke

10 Dries genital area moving from front to back with dry

cloth towel/washcloth

11 After washing genital area, turns to side, then washes

rectal area moving from front to back using a clean area

of washcloth for each stroke.

12 Using clean washcloth, rinses soap from rectal area,

moving from front to back, while using a clean area of

the washcloth for each stroke

13 Dries rectal area moving from front to back with dry

cloth towel/washcloth

14 Repositions client

15 Empties, rinses, and dries basin

16 Places basin in designated dirty supply area

17 Disposes of used linen into soiled linen container and

disposes of linen protector appropriately

18 Avoids contact between candidate clothing and used

linen

19 Removes and disposes of gloves (without

contaminating self) into waste container and washes

hands

20 Signaling device is within reach and bed is in low

SKILL 22 — TRANSFERS FROM BED TO

WHEELCHAIR USING TRANSFER BELT

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before assisting to stand, wheelchair is positioned

alongside of bed, at head of bed facing foot or foot of

bed facing head

4 Before assisting to stand, footrests are folded up or

removed

5 Before assisting to stand, locks wheels on wheelchair

6 Before assisting to stand, bed is at a safe level

7 Before assisting to stand, checks and/or locks bed

wheels

8 Before assisting to stand, client is assisted to a sitting

position with feet at on the oor

9 Before assisting to stand, client is wearing shoes

10 Before assisting to stand, applies transfer belt securely at

the waist over clothing/gown

11 Before assisting to stand, provides instructions to enable

client to assist in transfer including prearranged signal

to alert when to begin standing

12 Stands facing client positioning self to ensure safety of

candidate and client during transfer. Counts to three

(or says other prearranged signal) to alert client to begin

standing

13 On signal, gradually assists client to stand by grasping

transfer belt on both sides with an upward grasp

(candidates hands are in upward position) and

maintaining stability of client’s legs by standing knee to

knee, or toe to toe with the client

14 Assists client to turn to stand in front of wheelchair

with back of client’s legs against wheelchair

15 Lowers client into wheelchair

16 Positions client with hips touching back of wheelchair

and transfer belt is removed

17 Positions feet on footrests

18 Signaling device is within reach

SKILL 23* — MEASURES AND RECORDS

MANUAL BLOOD PRESSURE

*STATE SPECIFIC (EVALUATOR: DO NOT

SUBSTITUTE THIS SKILL FOR SKILL 12

‘ELECTRONIC BLOOD PRESSURE’)

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Before using stethoscope, wipes bell/diaphragm and

earpieces of stethoscope with alcohol

3 Client’s arm is positioned with palm up and upper arm

is exposed

4 Feels for brachial artery on inner aspect of arm, at bend

of elbow

5 Places blood pressure cu snugly on client’s upper arm,

with sensor/arrow over brachial artery site

6 Earpieces of stethoscope are in ears and bell/diaphragm

is over brachial artery site

7 Candidate inates cu between 160mm Hg to 180

mm Hg. If beat heard immediately upon cu deation,

completely deate cu. Re-inate cu to no more than

200 mm Hg

8 Deates cu slowly and notes the rst sound (systolic

reading), and last sound (diastolic reading) (If rounding

needed, measurements are rounded UP to the nearest 2

mm of mercury)

9 Removes cu

10 Signaling device is within reach

11 Before recording, washes hands

12 After obtaining reading using BP cu and

stethoscope, records both systolic and diastolic

pressures each within plus or minus 8 mm of

evaluator’s reading

SCORE REPORTING

EX AM RESULTS

You will receive a notication email from CNA365 when

a new exam score has been posted to your online account.

To access your score report, please login to your CNA365

account by clicking the “CNA365 Login” button on the top

of the Maryland nurse aide website page at www.credentia.

com/test-takers/md Score reports are generally available

within a few hours after a testing event is completed for the

day. If it has been more than 24 hours and you are unable to

view your score report in CNA365, please contact customer

service at (888)-240-0448

SCORE REPORTING

Credentia will provide you with your ocial examination

results within a few hours after a testing event is completed

for the day. Score reports are provided online and are avail-

able for you to print or download. Examinations results

will not be given over the telephone nor can they be sent by

Credentia to your employer.

FAILING

If you fail all or part of the NNAAP Examination, your Score

Report will tell you how to apply for re-testing. By state and

federal regulations, you are permitted to take the NNAAP

Examination up to four (4) times within twenty-four (24)

months immediately after your nursing assistant training com-

pletion date. If you do not pass both portions of the NNAAP

Examination within twenty-four months or after four (4) test

attempts, you will be required to successfully complete a one-

hundred (100) hour nursing assistant training program that is

approved by the Maryland Board of Nursing and to take both

parts of the NNAAP Examination.

HOW TO READ A FAILING

SCORE REPORT

If you do not pass the Skills Evaluation, you will receive

a Failing Score Report. e score report will list the ve

(5) skills that you performed and a score of Satisfactory

or Unsatisfactory for each skill. Any skill with an

Unsatisfactory result is considered a failed skill. You must

receive a Satisfactory result on all ve (5) skills in order to

pass the Skills Evaluation.

Use your failing Score Report as an aid in studying to

re-take the Skills Evaluation. A failed skill will show the

reason for the failure. You may not have performed the

steps of a skill correctly, or you may have forgotten a step,

especially a Critical Element Step.

e failing Score Report will list steps that were missed or

incorrect—look for numbers printed directly under a skill

marked Unsatisfactory. A list of all the skills and the steps

needed for each skill can be found in this handbook. Find

the skill you failed, and study the steps, especially steps

listed as Unsatisfactory on the score report.

In the following example (see top of next page), a candi-

date received a result of Unsatisfactory on the skill Hand

Hygiene. e numbers 1, 5, and 10 printed below the skill

refer to steps that were missed or performed incorrectly.

To study for re-taking the Skills Evaluation, this candidate

should turn to the Skills Listing in this handbook, look for

the Hand Hygiene skill, and review all the steps, especially

steps 1, 5, and 10.

Maryland NNAAP

Examination Results

Exam: Skills Result: Fail

Skills Performance:

Hand Hygiene Unsatisfactory

1, 5, 10

Provides Mouth Care Satisfactory

Measures and Records Satisfactory

Blood Pressure

Puts One Knee-High Satisfactory

Elastic Stocking on Client

Assists with Use of Bedpan Satisfactory

A sample of a Failing Score Report

PASSING

You must successfully pass both the Written (or Oral)

Examination and the Skills Evaluation within twenty-four

(24) months of completion of your approved nursing assis-

tant training program in order to be eligible to be placed

on the Maryland Geriatric Nursing Assistant Registry.

GRIEVANCE PROCESS

All grievances must be in writing and submitted through

the online system. e candidate must provide as much

detail as possible in the grievance form. e grievance

must be submitted within 30 days of the candidate’s exam

date. After receipt of the grievance form, the complaint

will be investigated. Once the investigation is complete,

Credentia will send email correspondence back to the

candidate informing him/her of the outcome of the inves-

tigation. If the grievance is substantiated, the candidate

will be allowed to retest at no additional cost. For details

on how to submit a grievance, visit www.credentia.com/

test-takers/md and click on “Grievances” in the Resources

section of the webpage. You will receive a response within

30 days of receipt.

THE REGISTRY

CHANGE OF ADDRESS OR NAME

e Maryland Geriatric Nursing Assistant Registry must

be kept informed of your correct address in writing. In

order to receive your notication of continued enrollment

on the Registry, you MUST inform the Registry about

any changes in your name or address. To change your

name or address, use the Change of Address or Name

Form in the back of this handbook, or send a letter to the

Maryland Board of Nursing, Nursing Assistant Program

informing them of the change. Failure to inform the

Registry of an address change may jeopardize your reg-

istration status. Be sure to list both the old information

and the updated information, including your name,

address, Social Security number, and telephone number.

If you change your name, you must provide notarized

documentation of that change. A notarized copy of a

marriage certicate or divorce decree or other ocial

document is required.

REGISTRATION PROCESS

If you successfully complete both the Written (or Oral)

Examination and the Skills Evaluation, you will receive

a notice of passing from Credentia. Credentia will for-

ward your name to the Maryland Board of Nursing for

placement on the Maryland Geriatric Nursing Assistant

Registry. If you have already been certied as a nurs-

ing assistant (CNA) in Maryland, your geriatric nurs-

ing assistant (GNA) registration will be entered on the

Registry. e Board of Nursing will not send a new

Certicate. e registration may be veried on-line at

www.mbon.org. If you are not certied by the Maryland

Board of Nursing as a nursing assistant, you may not

work and you must contact the Board of Nursing imme-

diately at (410) 585-2044.

NOTE: There is no charge for the additional registration

of GNA.

RE-REGISTRATION

GNA registration expires at the same time as your

Maryland CNA certication. ere is one fee for CNA

renewal. is fee includes the GNA re-registration fee.

ENDORSEMENT (RECIPROCITY)

If you wish to transfer your GNA registration, please con-

tact the Maryland Board of Nursing, Nursing Assistant

Program at (410) 585-2044.

MD NURSE AIDE CERTIFICATION —

FREQUENTLY ASKED QUESTIONS

TESTING

QUESTION ANSWER

1. How do

I become a

GNA?

You must successfully complete a

state-approved nurse aide training

program and pass both the written

and skills portions of the NNAAP

examination. The time frame for

successfully completing both exams

varies, by state. Please check with

your training program or the Exam

Overview section of this handbook.

2. May I

perform the

duties of a

Nurse Aide

before I am

certified?

If you are currently attending an

approved training program in a

nursing home, you have 120 days

in which to complete the training

and become certified. During that

period, a student may not perform

any duty for which they have not

been trained and checked by the

instructor.

If you are not enrolled in an

approved facility training course,

you may not perform any nurse aide

duties until you become certified.

3. How do

I arrange

for special

accommoda-

tions?

Special requests must be submit-

ted and approved prior to testing.

Documentation from your physician

or other qualifying professional must

be included with the request. Please

refer to the Special Exam Requests

and Services section of the candidate

handbook for details.

4. How do I

decide which

exam to take?

An Oral Examination in English

may be substituted for the Written

examination if you have difficulty

reading English. It contains 10

reading comprehension questions in

which you must identify job-related

words.

MD NURSE AIDE CERTIFICATION —

FREQUENTLY ASKED QUESTIONS

TESTING

QUESTION ANSWER

5. Is there a

time limit in

which I must

pass both

exams?

You have up to 12 months following

completion of a Maryland Board of

Nursing approved CNA program to

take the NNAAP examination.

If you fail any portion of the

NNAAP exam with your first

attempt, you have a total of 4

attempts within 24 months to retake

and pass both parts of the exam,

immediately after your nursing assis-

tant completion date.

6. Can I

an exam or

check my

scores online?

Registration must be done through

CNA 365.

• Results may be viewed atwww.cre-

dentia.com/test-takers/md.

• If you passed both parts of the

examination, your name will be

forwarded to the Maryland Board

of Nursing for placement on

the Maryland Geriatric Nursing

Assistant Registry. Registration

may be verified online at

www.mbon.org.

7. What form

of payment

do you accept

and may I

take it to the

test site?

All payments (money order, com-

pany check, or certified check, made

payable to "Credentia") must be sent

with the application to Credentia

prior to scheduling an exam. NO

form of payment will be accepted at

the test site.

8. What is

the next test

date?

Test dates at Regional Test Sites are

listed on the Credentia website at

www.credentia.com/test-takers/

md.

MD NURSE AIDE CERTIFICATION —

FREQUENTLY ASKED QUESTIONS

TESTING

QUESTION ANSWER

9. How long

will it take

me to find

out if I passed

or failed?

Score Reports are provided the day

of the examination. If the site experi-

ences technical difficulties with fax-

ing answer sheets, they will be sent to

Credentia for hand scoring and results

will be posted within 5-7 business

days after testing.

MD NURSE AIDE CERTIFICATION —

FREQUENTLY ASKED QUESTIONS

REGISTRY

QUESTION ANSWER

1. How do

I verify if

I’m on the

Nurse Aide

Registry?

1. You can verify your status on the

Geriatric Nurse Aide Registry online

at www.mbon.org.

2. How do

I change my

name and/or

address?

2. Complete the form in the back

of the handbook and mail it with

appropriate documentation to

the Maryland Board of Nursing,

Nursing Assistant program.

3. How long

will my name

remain on the

registry?

3. GNA registration expires at the

same time as your Maryland CNA

certification. There is one fee for the

CNA renewal and that includes the

GNA-re-registration fee.

4. My

certification

expired. How

do I renew

it or become

certified

again?

4. You must contact the

Maryland Board of Nursing,

Nursing Assistant Certification

Program, at 410-585-2041.

5. I am

moving to or

from another

state. May I

perform nurse

aide duties in

that state?

5. If you wish to transfer your GNA

registration, contact the Maryland

Board of Nursing, Nursing Assistant

program at 410-585-2044.

Maryland

Geriatric Nursing Assistant

DIRECTIONS: Use this form to inform the Registry of your change of address or name. Please print or type all information

on the reverse side of this form. Be sure to provide all information, or your request cannot be filled.

For name changes you must also provide notarized written documentation of your name change.

SEND TO: Maryland Nursing Assistant Registry

4140 Patterson Avenue

Baltimore, MD 21215

PLEASE COMPLETE OTHER SIDE OF THIS FORM

Change of Address or Name

APPENDIX

Print your new name and address below.

Name ____________________________________________________________________________________________________________

Street ____________________________________________________________________________________________________________

City _______________________________________________________________State ______________ Zip _______________________

Tel. (__________) ___________________________________

Please print your old name and address below.

Name ____________________________________________________________________________________________________________

Street ____________________________________________________________________________________________________________

City _______________________________________________________________State ______________ Zip _______________________

Social Security Number ____________________________ GNA Registration Number _____________________________________

Your Signature _________________________________________________________________ Date __________________________

NOTE: A copy of an official document (marriage certificate or other court order) verifying your name change must accompany this request if you are notifying the

Registry of a change in name.