Texas CNA Skills (Part Thirteen): Resources to Help Prepare for the CNA State Test

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The National Nurse Aide Assessment Program (NNAAP), also known as the CNA state test, must be passed by any nurse aide who wants to attain state certification as a CNA. In addition, nurse aides who plan to pass the CNA state test on the very first attempt would be wise to utilize all of the resources they can possibly get their hands on. It also helps that many of the existing resources are completely free!

Fortunately, there are numerous resources out there to help students conquer the state test successfully. Preparation is the key, so the following resources will prove useful only if the student uses them and does not wait until the last minute to cram them in and study during the final hour. In fact, studying for the CNA state test should really be an ongoing process in which small amounts of material are covered each day.

Even though a mountain of testing information exists throughout the deepest crevices of the world wide web, a few of the resources might be terribly outdated or not all that informative. Therefore, a list of more relevant resources have been compiled and listed below to help nurse aide students prepare for the CNA state test. Take a deep breath, relax, prepare, and enjoy your future nursing assistant career!

  • Other Schools’ CNA Program Websites: Many CNA programs publish their lecture notes, study guides, PowerPoint presentations, online lessons and other learning materials for free. Click here to get to a series of excellent PowerPoint presentations on CNA lessons from the Kings County Office of Education.
  • Texas Curriculum for Nurse Aides in Long Term Care Facilities: This is the official nurse aide curriculum that has been approved for use by the state of Texas. In fact, the theory and skills contained within this curricula are used to formulate the questions and skills scenarios on the Texas CNA state test. Click here to get to the Texas curriculum.
  • Illinois State Nursing Exam Practice Test: This is a sample CNA state test that is being offered completely online through the Southern Illinois University website. This exam enables the user to select the number of questions; moreover, it automatically checks the submitted answers for correctness. Unlike the real CNA state test, no time limit have been imposed on this practice test.
  • Study Guide Books: There happens to be a myriad of CNA study guides for sale on websites such as Amazon, Ebay and Barnes & Noble that are designed to help test takers prepare for the written portion of the CNA state test. Purchasing one of these study guides might be a wise investment.
  • National Nurse Aide Assessment Program (NNAAP) Practice Exam: This practice test contains a number of questions that are extremely similar to ones that will be seen on the written section of the CNA state test. Therefore, it would be a good idea to take this practice exam, review the answers, and study the rationales for all the answers. Click here to get to the NNAAP Practice Exam.
  • Bureau of Labor Statistics (BLS): The BLS website, which happens to be updated and maintained by the United States Department of Labor on a regular basis, contains the most up-to-date statistics on the nursing assistant role. The BLS site has info such as routine nurse aide duties, work environment, average pay rates, and projected job outlook. Click here to get to the BLS nursing assistant web page.
  • Your CNA School: Do not forget to utilize the CNA school that you attended because the instructors can serve as knowledgeable resources. A reputable CNA program will be staffed with instructors who want students to succeed, so it is in the best interests of the school’s staff to assist graduates in preparing for the state test.

Informative YouTube Channel

A newer YouTube channel has been created! The YouTube channel for the Legacy Healthcare Careers Nursing Assistant School can be accessed by clicking here

Legacy Healthcare Careers’ very own YouTube channel contains a host of informative videos on different topics that pertain specifically to nursing assistants and aspiring CNAs. Some of these topics include the CNA state test, hands-on skills for nurse aides, written practice questions with answers, dress codes, and additional information that nursing assistants might be able to utilize in their daily practice as healthcare clinicians.

In summary, if you are an experienced CNA, current nurse aide student, direct care worker, caregiver, or perhaps just entertaining the idea of becoming a nursing assistant one day in the distant future, you may wish to visit our channel on YouTube to see if the assorted pearls of wisdom found within the short videos may be of benefit to you.

As always, prospective students in the Dallas-Fort Worth area of Texas should contact Legacy Healthcare Careers Nursing Assistant School to obtain quality, fast-track, affordable nurse aide training in as little as 7 days. Yes, you did read that last blurb correctly: Legacy Healthcare Careers offers a unique 1-week CNA program that could help you transition into a new healthcare career as a nursing assistant in just 7 days.

In the very near future, Legacy Healthcare Careers will also offer a brand new certified medication aide training program to prospective students in the Dallas-Fort Worth metro area. The staff of Legacy Healthcare Careers is in the beginning phases of adhering to the multiple regulatory steps associated with the addition of the medication aide classes to the school’s current course offerings. More details will be added as the development of the certified medication aide training program reaches completion time.

Call (682)626-5266 to schedule an appointment time to enroll or visit the school’s website to submit an online application for enrollment at www.LegacyHealthcareCareers.com.


Top Questions You Must Ask Of Any Nursing Assistant Training Program

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To communicate this message in the most straightforward manner possible, not all certified nursing assistant (CNA) training programs are created equally. First of all, some CNA programs are offered at community colleges whereas other classes are taught at private schools or nonprofit organizations. Second of all, differing schools can charge drastically different tuition and fees for what is essentially the same CNA training.

Thirdly, some schools offer ongoing support services after students graduate from the nursing assistant training program while other schools offer absolutely nothing whatsoever. Ongoing support for nursing assistant graduates that some schools offer can be in the form of job placement assistance, CNA state test preparation courses post-graduation, provision of recommendation letters to other schools and employers, and help with writing résumés and cover letters.

Without further ado, the following is a compilation of questions that prospective students may wish to ask of any nursing assistant training programs they are considering attending.

  1. Is the CNA program approved? Nurse aide training programs must be approved to operate in the state where the school is located. If the nurse aide training program is not approved, graduates will typically not qualify to sit for the CNA state test.
  2. How long does the CNA program take to complete? Some programs take a week or two to complete, whereas other programs drag it out over the duration of an 16-week entire semester.
  3.  Does this program offer job placement assistance? Some nurse aide training programs offer job placement assistance to graduates, which is an immensely helpful service.
  4. Is the CNA program taught by nurses? Most states require nurse aide training programs to be taught by licensed nurses. Some CNA programs employ registered nurses (RNs) to teach all classes, whereas other programs utilize licensed practical/ vocational nurses (LPNs/ LVNs) to provide all the instruction. RNs tend to have more years of clinical and theoretical education than LPNs/ LVNs.
  5. Does the school offer help with passing the CNA state test? Some programs provide ongoing support to help graduates of the CNA training program pass the CNA state test. This is a fabulously helpful service that comes in handy to graduates who need extra help.
  6. What is the average class size? Some schools offer smaller class sizes of less than 10 pupils per class. Other CNA programs can have up to 20+ students attending nurse aide classes together. In general, smaller class sizes can translate into a higher level of individualized attention and more time for questions.

The nursing assistant training programs at Legacy Healthcare Careers CNA School are fully approved to operate by the Texas Workforce Commission (TWC) and the state Department of Aging and Disability (DADS). In addition, Legacy Healthcare Careers offers job placement assistance to graduates, preparation for the CNA state test, and small class sizes that promote individualized attention to all students.

Moreover, all classes offered at Legacy Healthcare Careers are taught by RNs with many years of combined clinical experience. The tuition and fees for the CNA classes are affordable; additionally, the school offers a highly innovative 7-day course of study that enables students to become nursing assistants in only one week. Call (682)626-5266 to enroll or visit the school’s website at www.LegacyHealthcareCareers.com for more information.

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Texas CNA Skills (Part Eleven): Pearls of Wisdom from Nurse Aides Who’ve Passed the CNA State Examination

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Due to legislation that had been enacted and implemented in the late 1980s, nurse aides must obtain state certification as certified nursing assistants (CNAs) if they want to secure employment in certain healthcare facilities that accept federal dollars. The Omnibus Budget Reconciliation Act of 1987, more simply known as OBRA, established the minimum acceptable standards for nurse aide training.

The overarching goal of nurse aide training programs is to sufficiently prepare students in nursing assistant programs with the practical knowledge, clinical skills, and procedures that must be adhered to by members of staff at all skilled nursing facilities that receive federal payments. In simpler wording, OBRA is the very reason that nurse aides must attain CNA certification if they want to work at these types of workplaces.

So, this is the burning question. How in the world does a nurse aide obtain certification as a CNA? The answer to this question is the following: a nurse aide becomes certified in a particular state by passing the national CNA state exam utilized by that state. A wonderful way to become more familiar and confident with the setup of the CNA state exam is to obtain feedback from nurse aides who have taken and passed the test.

The following responses are from multiple nurse aides who possess firsthand experience in regards to taking the CNA state exam. The responses provided by these nurse aides pertain mainly to the successful completion of the skills section of the CNA state exam. Keep in mind that a written (or oral) section of the CNA state exam exists as well.

The individual and collective insights provided by these nurse aides that pertain to the CNA state test are rather enlightening. In addition, readers can learn quite a bit of new information from the varied perceptions and recollections of these nurse aides’ different experiences with the CNA state exam. Therefore, read and pay close attention to recurrent themes within the responses such as the importance of performing the procedural skills using the correct sequence of steps.

NURSE AIDE ONE: “If you mess up on a step or just forget to complete a step, you will simply lose points. If you forget to do a bold step (also known as a critical element step), or perform it wrongly, you fail the entire skill by default. You should be able to pass the CNA state test as long as you remember to perform the bold steps and always do them right.”

NURSE AIDE TWO: “You will need to do the skills in the exact order on the skills handbook or you will not pass. So, in your spare time, practice on other people or dolls until you have each step memorized. If you can memorize each and every move, you will pass your CNA state test with flying colors.”

NURSE AIDE THREE: “Where I live, the person who watches you do the skills on the CNA state test is looking for you to perform the tasks in the order listed on the handbook. If you perform the tasks out of order, but do them right, points get deducted from the total score.”

NURSE AIDE FOUR: “On the CNA state test I did the steps as I had learned them since I knew I would have forgotten to do something really important if I strayed from what I learned. All the steps are there for a reason. So I suggest you instill them into your memory bank as best as you can.”

NURSE AIDE FIVE: “Do all the steps in the exact order for the skills.”

NURSE AIDE SIX: “I took lessons for CNA and each time when I took the skills exam part of the CNA state test, we needed to complete every skill correctly step by step. It is because these steps were placed and organized the right way so as to cut down on the chances of cross contamination and to teach you the best way to do the skills for the best care of the residents.”

Texas CNA Skills (Part Five): Charting & Documentation for the CNA State Test and Beyond

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Documentation is one of multiple vital tasks that the overwhelming majority of certified nursing assistants (CNAs) are entrusted with completing. After all, many prospective nursing students and nurse aides have heard the olden adage that “if it was not documented, it was not done.” Also, any documentation completed by the nurse aide eventually ends up as a permanent part of patients’ medical records. Patients deserve accurate, complete medical records.

Since nursing assistants perform many care tasks and procedures throughout the course of a typical work shift, it would make sense that these tasks will need to be charted accurately. A correct way of documentation exists for CNAs and other healthcare workers in the medical field. On the other hand, a number of incorrect methods of documentation also exist.

Since documentation is such a vital task, it is of the utmost significance for nursing assistants to know how to complete this duty the right way and in a timely manner. In addition, nurse aide test takers who want to pass the CNA state test for certification as a certified nursing assistant will need to know how to chart their various findings and care in a proper manner in order to be successful on the skills section of the exam.

During the CNA state test, documentation is a task that the nurse aide candidate will need to complete at the testing center in front of the examiner for evaluative purposes. The skills section of the Texas CNA state test requires the nurse aide test taker to be tested on five testable skills that are selected randomly.

The nurse aide will need to perform the five aforementioned randomly selected skills step by step in front of the examiner. The nurse aide must achieve a passing cut score on a minimum of four out of the five procedural skills in order to pass the skills evaluation section of the CNA state test.

Also, most of these procedural skills will call upon the test taker to chart or document his or her findings after completion of the procedure. For example, the procedural skill of measuring a patient’s respiration rate must be documented during the skills portion of the CNA state test. Therefore, the testing site examiner will be eyeballing the nurse aide test taker’s charting for accuracy and completeness.

If the documentation step of the procedural skill is not deemed to be accurate by the testing site examiner, the test taker will fail on this skill. For instance, the nurse aide test taker will fail the skill of measuring and recording respirations if he or she documents a respiration rate of 20 breaths per minute when the examiner records a respiratory rate of 16 breaths per minute. In the eyes of the examiner, the charting was inaccurate, so the test taking candidate fails the skill.

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Nursing assistants chart their findings based on a combination of observations as well as verbal reports from patients and families. Moreover, these findings can be either objective or subjective in nature. Objective findings are ones that the nursing assistant is able to utilize their senses to hear, see, smell and touch. Objective findings can be proven and measured or directly observed, whereas subjective findings cannot be proven or observed because they are merely what the patient or family member has reported to the nursing assistant.

Objective findings are measurable and/or based in provable fact, such as a blood pressure reading of 118/62 mmHg or urine that is clear and light yellow in coloration. Subjective findings cannot be proven or directly observed by the nurse aide, such as a patient reporting that he has a toothache or a family member reporting that her elderly mother passed out near the bed prior to lunchtime.

To recap, objective findings are clearly based on numerical metrics that can be measured. A heart rate of 72 beats per minute is an objective finding because it is obviously measurable. Objective findings are also based on observable data utilizing the nurse aide’s sense of smell, touch, sight and sound. Therefore, a finding of a patient’s skin that is warm and dry to touch also would be objective data since the nurse aide used his or her sense of touch to come up with that finding.

On the other hand, subjective findings include all data that cannot be measured or verified by the nurse aide’s various senses. If a patient tells nursing members of staff that he slipped and fell in a puddle of orange juice near the dining area after breakfast, this is subjective data because the nurse aide did not see the fall and cannot prove it even took place through his or her sense of sight. If a patient says, “My tummy hurts,” this is a subjective finding because the patient is telling the nurse aide what his pain is.

Pain is subjective because it is a feeling that cannot be measured or observed, and even though a facial grimace can be observable, keep in mind that many patients grimace for reasons other than the unpleasant sensations associated with being in pain. So, anything the patient or her family tells the nurse aide is subjective if he or she did not observe it as it supposedly happened or cannot possibly measure it in any meaningful way.

The following list contains a handful of general guidelines for charting and documenting related to the nurse aide role during the CNA state test, as well as beyond (read: the workplace).

  1. The nursing assistant should utilize the correct chart, paperwork, or ADL form.
  2. The nursing assistant should always avoid the use of felt tipped markers when recording findings in the medical record.
  3. The nursing assistant must bring three sharpened no. 2 pencils to the testing center to take the CNA state test.
  4. The nursing assistant must record all vital signs in the appropriate sections on the paperwork provided.
  5. The nursing assistant should correct mistakes by crossing them out with one line. The nursing assistant should proceed to write his or her initials next to the error.
  6. The nursing assistant must write his or her initials next to all skills that he or she has performed.
  7. The nursing assistant must record all intake and output findings in cc or mL increments and percentages (e.g., 50% of meal was consumed; 750mL of urine output obtained, etc.).
  8. The nursing assistant should document that he or she notified the nurse of any abnormal patient findings or observations.
  9. The nursing assistant should utilize only approved abbreviations and terms when charting.
  10. The nursing assistant should chart subjective findings utilizing quotation marks as stated by the patient (e.g., patient states, “I have a really throbbing headache.”).
  11. The nursing assistant should avoid charting procedures and care that has not yet been provided. The nursing assistant should not record any care before it has actually been delivered.
  12. The nursing assistant should initial the bottom of the paperwork. The nursing assistant must sign the bottom of the document with his or her first name, last name, and title (N.A.). The nursing assistant must date the document.


Brit2829537. (n.d.). I went into nursing for the charting (image). Retrieved from https://www.someecards.com/usercards/viewcard/i-went-into-nursing-for-the-charting-said-no-nurse-ever–9f173/?tagSlug=workplace


Texas CNA Skills (Part Three): Measuring and Recording Respirations

Screenshot 2018-12-01 at 12.22.36 PMRespiration, also known as breathing, is one of the four main vital signs that nursing assistants, nurses, respiratory therapists, paramedics, emergency medical technicians and other healthcare workers must know how to accurately obtain and record. Of course, the other three vital signs include temperature, pulse and blood pressure.

Alternately worded, a patient’s respiratory rate is his or her breathing rate. It is the number of breaths that he or she takes over the course of one full minute (60 seconds). Generally, a respiration rate that falls between 12 and 20 breaths over the course of one whole minute is considered a normal and expected finding in an adult who is resting.

Remember the concept in this manner for enhanced ease of recollection and lack of confusion: the process of respiration is more commonly known as the process of breathing. Respiration is a very high-priority basic need because a patient who stops breathing will be dead in a matter of minutes without timely outside intervention. Fortunately, taking and recording a patient’s respiratory rate is one of the technically easier procedural skills for a healthcare worker to carry out.

Respiration is an enormously complex activity that is comprised of two differing processes called inspiration and expiration. Through inspiration and expiration, the cells of the body continually exchange two gases called oxygen and carbon dioxide. The body simultaneously breathes in oxygen and expels carbon dioxide. Inspiration is the process of inhaling air into the lungs; likewise, it occurs when a patient breathes in. Expiration is the process of exhaling; therefore, it takes place when a patient breathes out.

Inspiration and expiration are massively important processes to the continual functioning of all human bodies since they are responsible for keeping the blood, organs and tissues rich with oxygen (read: inspiration) while ensuring that excess carbon dioxide leaves the body (read: expiration).

Furthermore, the procedure of measuring and recording a patient’s respiration rate is a testable skill on the Texas CNA state test. It is also a testable procedural skill in most other states. Therefore, a nurses aide who wants to pass the CNA state test to obtain certification as a certified nursing assistant will need to know how to accurately take and record a patient’s respiratory rate in the presence of an examiner at the testing site.

According to Pearson Vue (2018), a patient’s respirations should be counted and recorded using the following listed sequence of steps during the skills portion of the state CNA examination:

  1. The nursing assistant should explain the procedure to the patient in a slow and clearly understandable manner while maintaining regular face to face contact as needed.
  2. The nursing assistant must measure the patient’s respiratory rate for one entire minute (60 seconds).
  3. The nursing assistant should ensure that the patient’s call light or signaling device is within easy reach prior to ending the skill.
  4. The nursing assistant must wash his or her hands prior to recording the patient’s one-minute respiratory rate.
  5. The nursing assistant must document a respiratory rate number that is within two breaths of the examiner’s recorded reading. For instance, the nursing assistant will pass this skill if he or she records a respiratory rate of 16, even if the examiner had  documented a respiration rate of 14.

To pass the procedural skill of measuring and recording respirations on the CNA state exam, the test taker’s documented one-minute respiration rate must fall within a predetermined range of plus or minus two breaths of the test site examiner’s recorded reading. Here are a handful of additional tips that can potentially help with obtaining a respiration rate from patients in clinical settings:

  1. Perform the opening procedures before starting the skill.
  2. Count it as one respiration each time the patient’s chest rises.
  3. Count the respirations for one entire minute (60 seconds) to obtain the one-minute respiratory rate.
  4. Record the respiratory rate as indicated.
  5. Perform the closing procedures after ending the skill.


All About Medical Training. (2015). Count and Record Respirations – CNA Skill Video AAMT. Retrieved from https://www.youtube.com/watch?v=VS0adbHFneA

BioSpine Institute. (2018). Breathing (picture). Retrieved from https://biospine.com/diaphragm-back-pain/

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas

Nursing Career Ladder in the United States (Part Three): the Registered Nurse (RN)

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This post is intended to be the third in a four-part installment series that aims to illuminate the dynamic, ever-evolving nursing career ladder in the United States.

The first post in this particular series discussed certified nursing assistants, known as CNAs for short. The second post in this series elaborated on the unique importance of licensed practical nurses (LPNs), also known as licensed vocational nurses (LVNs) in the states of California and Texas. This post will shed some light on registered nurses.

A professional registered nurse, known as an RN for short, is a multi-faceted healthcare professional who is entrusted with the delivery of both direct and indirect nursing care duties and responsibilities. During the course of providing nursing care, the RN observes, assesses and records objective signs and subjective symptoms that patients experience.

RNs document additional findings such as reactions to treatments, progress and patient outcomes. The RN’s keen observations and clear documentation serve as the the hardcore foundation for the planning of patient care, initiation of interventions, and overall evaluation of the patient care that is being provided.

RNs routinely report changes in patients’ conditions to the physician and carry out physicians’ orders as indicated. Moreover, RNs promptly respond to subtle and overt changes in condition to prevent further deterioration of patients’ health statuses. RNs work work in bedside or clinical settings may perform a wide repertoire of procedural skills such as medication administration, complex wound care, respiratory ventilator management, and so forth.

RNs plan all aspects of the care of their patients. In fact, RNs continually formulate and revise nursing plans of care. RNs also teach and educate patients and families on the provision of appropriate care techniques. They also help different individuals, groups and populations to sustain and/or improve their various health statuses.

Professional registered nursing practice regularly draws upon an amazingly large fund of knowledge in order for the nurse to deliver appropriate assessment, planning, nursing diagnoses, intervention and evaluation. These actions, collectively referred to as the nursing process, are executed in a timely fashion to promote patients’ health statuses, prevent devastating illnesses and help clients manage their varied disease processes.

RNs can be found working in varied healthcare settings such as hospitals, extended care facilities, hospices, clinics, doctors offices, home health companies, colleges, universities, occupational health centers, private duty cases, and psychiatric facilities. RNs also work for insurance companies, research firms, governmental agencies, jails, prisons, public health centers, parishes, pharmaceutical corporations, and an array of other workplace settings.

While state laws tend to dictate nursing’s breadth and scope of practice, it is often the specific needs of the patient load on a particular day that determine the RN’s duties for that day. To become an RN, a prospective candidate must graduate from a state-approved nursing program at a community college, diploma school of nursing, trade school, technical college, or university. The graduate must also pass a national exam to secure state licensure as a registered nurse.

Many certified nursing assistants (CNAs) continue their education to become LPNs and/or RNs, thereby ascending the nursing career ladder. Legacy Healthcare Careers offers four-week CNA classes in the Dallas/Fort Worth area that are affordable and will fit in with prospective pupils’ budgets and lifestyles. Call (682)626-5266 or the 24-hour hotline at (682)313-6404 to enroll at our Mid-Cities / HEB area location.

Be sure to look for the fourth and final post in this information-packed four-part series on the dynamic nursing career ladder in the United States. Also, do not forget to place a quick telephone call to Legacy Healthcare Careers at (682)626-5266 or the 24-hour hotline at (682)313-6404 to enroll in fast-track certified nursing assistant (CNA) training coursework.