CNAMB cheat sheet

Normal adult vital signs: oral temperature 97.0–99.5 °F (36.1–37.5 °C), pulse 60–100 beats/min, respirations 12–20 breaths/min, blood pressure below 120/80 mmHg.

Hand hygiene is performed before and after every resident contact and after glove removal; gloves supplement but never replace handwashing.

Bath water is approximately 105 °F (40.5 °C); test with a thermometer or the inner wrist before the resident bathes.

Oral temperatures require a 15-minute wait after smoking or hot/cold fluids; rectal temperatures are avoided with diarrhea, rectal surgery, or a low platelet count.

Pulse is counted for 30 seconds and multiplied by 2; an irregular pulse is counted for a full minute.

Respirations are counted for 30 seconds and multiplied by 2 immediately after the pulse, without announcing the count, because awareness alters the rate.

Blood pressure cuff placement: 1 inch above the antecubital space, arm supported at heart level, bladder centered over the brachial artery.

Range of motion stops at the point of resistance or pain; joints are never forced and new pain, swelling, or redness is reported.

Lifting rule: feet shoulder-width apart, knees bent, back straight, load close to the body, lift with the legs, pivot with the feet instead of twisting the trunk.

Standard precautions apply to every resident regardless of diagnosis; transmission-based precautions (contact, droplet, airborne) are added for known or suspected infection.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host - breaking any one link stops transmission.

Fire response is RACE: Rescue anyone in danger, Activate the alarm, Contain the fire by closing doors, Extinguish or Evacuate per policy.

Fire extinguisher use is PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Adult one-rescuer CPR: 30 compressions to 2 breaths, rate 100–120 compressions/min, depth at least 2 inches with full chest recoil.

Adult with an ineffective cough (silent, cannot breathe or speak): activate the emergency response and begin abdominal thrusts; if the person becomes unresponsive, start CPR.

During a seizure: protect the head, loosen tight clothing, move hazards away, place nothing in the mouth, do not restrain, time the event, and turn the resident to the side afterward.

PPE removal order: gloves, then goggles or face shield, then gown, then mask; hand hygiene follows immediately after leaving the room.

Soiled linen is held away from the uniform, never placed on the floor, and bagged at the point of use in the designated laundry bag.

OBRA resident rights include dignity, privacy, self-determination, freedom from abuse and restraints, choice of physician, visitors, retention of personal possessions, and grievance without retaliation.

A resident may refuse any care or medication; the aide documents the refusal, informs the nurse, and does not coerce, threaten, or bargain.

HIPAA limits discussion of resident information to those needing it for care; hallway, elevator, and social media discussion of residents is prohibited.

Suspected abuse, neglect, or misappropriation of property must be reported immediately to the nurse and administrator; the aide does not investigate or confront the accused.

Knock and identify yourself before entering; close the door or pull the curtain during personal care.

Aphasia: use short sentences, one question at a time, allow response time, offer yes/no or picture choices, and never finish the resident's sentences.

Hearing loss: face the person, lower the pitch rather than shouting, reduce background noise, and verify the hearing aid is on with a working battery.

Vision loss: identify yourself and announce when leaving, describe the environment, offer your arm and let the resident hold it rather than pulling them.

Ethical boundaries: accept no gifts, money, or loans from residents, and never witness a resident's will or handle resident finances.

Six rights: right resident, right drug, right dose, right route, right time, right documentation - verified before every dose.

Three checks: comparing the medication with the MAR when removing it from storage, before preparing it, and again before administering it.

Never administer a medication prepared by another person, never leave a dose at the bedside, and never chart a dose before it is actually given.

Enteric-coated, sustained-release, and capsule forms are not crushed or opened without a prescriber's order because altering the form changes absorption.

Sublingual medications are placed under the tongue and not swallowed; nitroglycerin is the classic example.

Eye drops: one drop at a time into the lower conjunctival sac, dropper never touches the eye, and pressure on the inner canthus reduces systemic absorption.

Ear drops: for adults pull the pinna up and back; for children under 3 pull the pinna down and back.

PRN documentation includes time, dose, route, the reason given, and the resident's response to the medication.

Hold parameters: report and withhold before giving digoxin when the apical pulse is below 60 or above 100 beats/min unless ordered otherwise; errors are reported to the nurse immediately and documented per policy, never in the progress notes as an incident report.

Prefixes: hyper- high, hypo- low, tachy- fast, brady- slow, a-/an- without, dys- difficult or painful, pre- before, post- after.

Suffixes: -itis inflammation, -ectomy surgical removal, -ostomy creation of an opening, -emia blood condition, -uria urine condition, -pnea breathing, -algia pain.

Anatomical position: standing upright, facing forward, arms at the sides with palms forward.

Directional terms: proximal nearer the trunk, distal farther away; medial toward the midline, lateral away; superior above, inferior below; anterior front, posterior back.

Body planes: sagittal divides left and right, frontal (coronal) divides front and back, transverse divides upper and lower.

The adult skeleton has 206 bones; the vertebral column has 33 vertebrae in five regions (cervical, thoracic, lumbar, sacral, coccygeal).

Gas exchange occurs in the alveoli of the lungs, where oxygen enters the blood and carbon dioxide is released.

Blood pressure categories: normal under 120/80, elevated 120–129 over under 80, stage 1 hypertension 130–139 or 80–89, stage 2 hypertension 140 or higher over 90 or higher.

Common terms: dysphagia (difficulty swallowing), dyspnea (difficulty breathing), edema (swelling), cyanosis (bluish skin), hemiplegia (paralysis of one side).

Objective data are observed or measured (pulse 88, reddened sacrum); subjective data are what the resident reports (pain, nausea, dizziness).

Charting is completed immediately after care, in black ink, factual and concise, with no opinions and no vague wording such as 'seems' or 'appears' without description.

Error correction: single line through the entry, write 'error', then initials and date; no white-out, erasing, or overwriting.

Chart only care you personally performed; never chart in advance or document care given by another caregiver.

Report immediately: chest pain, difficulty breathing, sudden confusion, bleeding, a fall, temperature at or above 100.4 °F (38 °C), pulse outside 60–100, or systolic pressure below 90 or above 160.

Intake and output are recorded in milliliters: 1 ounce equals 30 mL and 1 cup equals 240 mL.

Skin observation includes color, temperature, moisture, turgor, and integrity; redness that does not blanch is reported as a pressure injury risk.

Shift report is structured with SBAR: Situation, Background, Assessment, Recommendation.

Flow sheets and checklists supplement but do not replace the narrative notes required by facility policy.

The nursing assistant practices under the supervision of a licensed nurse and performs only tasks covered by state-approved training and lawful delegation.

Outside the aide's scope: IV medications, sterile procedures, catheter insertion, tracheostomy care changes, interpreting orders, diagnosing, or altering the care plan independently.

Federal OBRA minimum for nurse aides: 75 hours of training, including 16 hours of supervised clinical experience, with competency evaluation within 4 months of hire.

Substantiated findings of abuse, neglect, or misappropriation are entered in the state nurse aide registry and may bar employment in nursing facilities.

Advance directives - living will and durable power of attorney for health care - record the resident's own wishes; the aide honors them and does not make the decision.

Abuse categories include physical, sexual, verbal or emotional, financial, neglect, involuntary seclusion, and misappropriation of property.

False imprisonment is unlawfully restricting a resident's movement; battery is unauthorized touching; assault is a threat that creates reasonable fear.

Incident reports go to risk management and are not part of the medical record; the record contains only facts about the resident's condition and the care given.

Confidentiality of resident information continues after the resident's death.