Texas CNA Skills (Part Eighteen): Skills That Are Not Performed on Other Live People at the CNA State Test

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Candidates and test takers who have completed a nurse aide training program must attain a passing score on the National Nurse Aide Assessment Program exam, more commonly known as the CNA state test, in order to receive state certification as a certified nursing assistant (CNA) in Texas. The CNA state test consists of two parts: a written section with 70 multiple choice questions as well as a skills evaluation.

Both the written section and skills evaluation of the CNA state test must be passed in order to receive state certification. The skills evaluation requires the test taker to demonstrate five testable skills in the presence of a nurse aide evaluator (NAE) who is scoring them as he or she observes the performance of each skill. There are exactly 22 testable skills that could appear on the CNA state test in Texas, and five of them will be selected at random for the test taker to perform.

Out of the 22 testable skills, 15 of them are to be performed on a live person at the CNA state test. In other words, the vast majority of skills will be performed on a random student with whom the test taker will be partnered at the Pearson Vue testing center. This is a reciprocal process because the two partners will be performing their five skills on each other as the NAE observes the skills demonstrations for scoring purposes.

Only seven of the 22 hands-on skills are not performed on a live person at the Pearson Vue testing center during the skills evaluation portion of the CNA state test. The first skill is hand hygiene (a.k.a. hand-washing); of course, test takers will demonstrate how to wash their own hands in front of the NAE. Thus, hand hygiene is not done on another live person. Keep in mind that all test takers will be required to complete the hand hygiene skill due to the emphasis on infection prevention.

Moreover, the personal protective equipment (PPE) skill, which requires the test taker to don and doff a gown and a pair of gloves properly, is not performed on another live person. The test taker will be dressing oneself in the PPE items before demonstrating how to appropriately remove and dispose of them. Another skill that will not be performed on a live person at the CNA state test is denture care. Rather, the test taker will demonstrate how to correctly provide care for an upper or lower denture.

Measurement and recording of urinary output is yet another skill that the test taker will never perform on a live person at the testing center. The test taker will be called upon to accurately measure the amount of simulated urine in front of the NAE before recording the numeric result. Measuring and recording urinary output is considered one of the five measurement skills that requires correct documentation at the Pearson Vue testing center in order to achieve a passing score.

Due to concerns that revolve around privacy, safety and infection control, the skills of catheter care, perineal care and applying an elastic stocking to one leg will always be performed on a mannequin at the CNA state test. In essence, these three skills are not done on a live person at the Pearson Vue testing center. This bit of knowledge often relieves test takers since they would feel uncomfortable if a random student wiped their most private areas in front of a NAE during a perineal care skill demonstration.

Do you want to become a nursing assistant in two weeks in the DFW area? Call Legacy Healthcare Careers at (682)626-5266 where you will be trained to pass the Texas CNA state examination on your first attempt.

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Texas CNA Skills (Part Seventeen): Do Not Forfeit Your CNA State Examination Fees!

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Graduates of certified nursing assistant (CNA) training programs most likely put forth a whole lot of effort in a diligent manner to complete their coursework and practice their skills to perfection. The next logical step is passing the CNA state exam. Achieving a passing score on the CNA state exam is like icing on a cake because it is a rewarding culmination of the student’s perseverance and efforts throughout the previous weeks or months.

Nevertheless, there are a number of ways students can mess up on their efforts to take the CNA state test before they ever even get the opportunity to set foot in the the Pearson Vue testing center. In other words, some students make one or more silly mistakes that result in forfeiture of their testing appointments in addition to loss of the exam monies they paid.

The following is a list of actions that could potentially cause students to not be admitted into the Pearson Vue testing center and lead to forfeiture of CNA state exam fees.

  1. Test takers will need to arrive at the Pearson Vue testing center approximately 30 minutes prior to their scheduled test appointment times. A failure to arrive at the testing center on time will result in forfeiture of the CNA state exam appointment as well as any testing fees that had been previously paid.
  2. Test takers who want to change or cancel their testing appointment times will need to provide proper notice to Pearson Vue. Test takers who opt to change or cancel their state test appointment times without providing sufficient advance notice will forfeit the exam fee.
  3. Test takers will need to present two forms of unexpired identification in order to be admitted into the Pearson Vue testing center. For instance, a valid drivers license and a social security card would be acceptable forms of identification. Test takers who do not present two forms of unexpired identification will forfeit their testing appointments and lose the exam fees they previously paid.

Texas CNA Skills (Part Fifteen): Providing Foot Care

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The following list is a sequence of steps on the proper way to provide foot care to a client during the skills demonstration section of the CNA state examination. Keep in mind that test takers and candidates will be performing the foot care procedural skill on an actual person, not a mannequin.

  1. The candidate knocks on the door.
  2. The candidate identifies the resident.
  3. The candidate introduces himself or herself.
  4. The candidate explains that he or she is there to perform foot care.
  5. The candidate provides for privacy using a door, privacy screen or curtain.
  6. The candidate washes his or her hands.
  7. The candidate gathers the supplies needed to complete foot care.
  8. The candidate places the supplies on the over-bed table.
  9. The candidate places a barrier such as a bed protector or chuck pad on the floor.
  10. The candidate dons gloves.
  11. The candidate removes a sock from one foot and places it on the over-bed table.
  12. The candidate adds warm water to a bath basin.
  13. The candidate checks the water’s temperature with his or her wrist.
  14. The candidate directs the resident to check the water’s temperature with his/her finger or wrist before placing one entire foot in the bath basin.
  15. The candidate applies soap to one wash cloth and gets it lathered up and soapy.
  16. The candidate washes the entire foot, making sure to scrub between the toes.
  17. The candidate rinses the entire foot using another wash cloth with the rinse water from the bath basin, making sure to submerge the resident’s foot in the water.
  18. The candidate removes the resident’s foot.
  19. The candidate pats the foot dry, including the areas between the toes.
  20. The candidate applies a quarter-sized amount of lotion to his or gloved hands and warms it up by rubbing between both hands.
  21. The candidate applies lotion to the resident’s feet, making sure to avoid rubbing any lotion between the toes.
  22. The candidate must wipe away any excess lotion.
  23. The candidate cleans the resident’s area and removes the supplies.
  24. The candidate rinses the bath basin and dries it with a clean paper towel.
  25. The candidate places the bath basin and supplies in the appropriate area.
  26. The candidate places all dirty linens in the hamper and and throws away any trash that may have accumulated.
  27. The candidate removes his or her gloves and discards them.
  28. The candidate places the bed in the lowest position.
  29. The candidate places the call light or signaling device within reach.
  30. The candidate opens the door or privacy screen.
  31. The candidate asks the resident if anything else is needed before he or she leaves the room.
  32. The candidate washes his or her hands.
  33. The candidate documents the procedure and announces that the skill is complete.

Texas CNA Skills (Part Fourteen): the Five-Surface Wash Cloth Method for Perineal Care

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Perineal care, commonly referred to as peri-care, is the routine care that nurses, nursing assistants and caregivers perform on clients’ genital areas and buttocks to maintain cleanliness, eliminate unpleasant odors, and reduce the microorganism count on this part of the body. Perineal care is a state-testable skill that might randomly appear on a candidate’s CNA state exam, so knowing how to do all steps properly is important.

It is crucial that nurse aides know how to perform perineal care correctly since the client’s perineal area has the potential of becoming infected if this skill is not done the right way. Proper perineal care promotes comfort, infection control, safety and privacy. When performing this skill, always provide for the client’s privacy and wipe from front to back to avoid introducing germs from the anus and buttocks into the urinary tract.

Since the client’s comfort should be kept in mind throughout the procedure, be very gentle and careful when performing perineal care because this part of the body can be extremely sensitive to extremes in touch and temperature. The necessary supplies to perform this skill include a pair of gloves, a wash basin, lukewarm water, soap, six wash cloths, two bath towels, and two bed protectors (also known as ‘chucks’).

To maintain cleanliness and prevent infections, take the extra time to use a new part of the wash cloth with each wipe to ensure that a clean area of the cloth is always being used. Legacy Healthcare Careers recommends the five-surface method for using wash cloths while providing perineal care at the CNA state test. If executed the right way, the five-surface method enables nurse aides to use five different parts of one wash cloth.

The five-surface method has a couple of benefits. First of all, it provides a clean part of the wash cloth for each wipe, and this is important for achieving a passing score on the perineal care skill at the CNA state exam. Second of all, it keeps the nurse aide from going through too many wash cloths, and this can be immensely helpful when working at a healthcare facility that experiences ongoing shortages of clean linens.

To use the five-surface method, get a wash cloth and fold it in half, then fold it in half a second time to end up with a smaller wash cloth. Thereafter, hold the wash cloth with the four corners pointed upward. Use the first corner of the wash cloth to wipe one area. Then fold the first corner downward and wipe another area with the second corner. Continue to fold each corner until the back of the wash cloth, which will be used as the fifth wiping surface, is reached.

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In essence, the five-surface method purposely involves use of five different parts of the wash cloth for wiping the client while performing perineal care:

  • the first corner
  • the second corner
  • the third corner
  • the fourth corner
  • The back of the wash cloth

REFERENCES

Tanner, D. (2019). How to Give Perineal Care. Retrieved April 28, 2019, from https://www.caregiverology.com/perineal-care.html

Texas CNA Skills (Part Twelve): Understand the Patient Care Scenario!

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The CNA state test consists of  a written section as well as a hands-on clinical skills portion. The clinical skills section of the CNA state exam test is comprised of multiple procedural skills interwoven into a simulated patient care scenario that has been formulated to resemble situations nursing assistants aides normally encounter during the course of a shift at the workplace.

The clinical skills section of the CNA state test is administered in a simulated caregiving situation that will look almost exactly like the patient care environment in which most nursing assistants are expected to function. Unless specified otherwise, all the equipment and supplies a test taker needs during the clinical skills section of the CNA state test will be supplied by the testing site.

The skills section of the CNA state test will be designed to seem as realistic as possible. Also, the test taker will perform the hand-washing skill the on first instance it is needed in the test. However, after the first hand-washing demonstration, all other moments that require hand hygiene will only need to be verbalized. For instance, after performing foot care, the test taker would verbalize, “Now I would wash my hands.”

The patient care scenario will be typed on a sheet of paper or index card and handed to the test taker by the testing site evaluator. In most cases the testing site evaluator will read the scenario instructions to the test taker before the clinical skills section of the CNA state test is slated to begin.

The ‘patient’ who participates in the simulated patient care scenario is usually another test taker who has graciously volunteered to step into that role. In other words, test takers will perform hands-on skills on each other during the CNA state test. Test takers who volunteer to pose as a patient must adhere to a predetermined dress code.

However, instances do arise where performance of a procedural skill on a mannequin would be far more appropriate. For instance, if the scenario card involves an intimate skill such as perineal care or urinary catheter care, the test taker will demonstrate it on a mannequin rather than another person.

The following is an example of a simulated patient care scenario that is similar to what one would receive during the skills section of the CNA state test.

Sample Scenario 

Ms. Hernandez: Hand-washing / Manual Blood Pressure / Give Modified Bed Bath / Mouth Care / Position on Side

Ms. Hernandez is a 65-year-old long term resident of Curry Hills Nursing & Rehab Center who has hypertension and major depressive disorder. She has refused showers for the third day in a row due to her depressed mood. When you enter Ms. Hernandez’s room, you find her laying in bed. She is wearing a hospital gown, bra and underwear.

You will wash your hands and check Ms. Hernandez’s blood pressure manually before giving her a modified bed bath. You will perform oral care prior to positioning her on her side. You will leave Ms. Hernandez in a position of safety and comfort. You will document as needed while providing the care.

 

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 Ten): General Guidelines for the CNA State Exam

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The following list is a set of general guidelines to help future nurse aide test takers know what to expect when taking the CNA state test.

  1. Always remember to speak with the patient to whom you are providing care, even if it might be a manikin. Effective communication entails introducing oneself and clearly explaining the procedural skills, which is all part of the skills section of the CNA state test.
  2. Equipment for the procedural skills will be available at the testing center. The nurse aide evaluator will give the test taker a list of all the equipment needed for the procedural skills that will need to be performed. It is the responsibility of the test taker to gather all the equipment. Thus, the test taker should gather and organize all needed equipment in a manner that is easiest for him or her.
  3. At the moment the skills competency section of the CNA state test begins, the test taker is allotted approximately 30 minutes to work through all of the assigned procedural skills.
  4. The test taker is required to wash his or her hands at the beginning of the simulated patient care scenario for the CNA state test. Hand-washing is the first procedural skill to be performed. The test taker is expected to perform hand hygiene by using hand sanitizer at other moments during the CNA state test as needed.
  5. The patient’s privacy and safety must be upheld during the entirety of the simulated patient care scenario. In addition, strict compliance with infection control techniques must be sustained during the entire scenario for the CNA state test.
  6. The test taker will need to physically work through each step associated with every procedural skill he or she has been assigned for the CNA state test. Once the skill is started, if an error is made, the test taker must say so and correct himself or herself. The test taker will be expected to complete the step that was missed.
  7. For the CNA state test, side rails are utilized only for safety with certain procedural skills performances. At other times, the side rails should be in the low position.
  8. Always keep in mind that the CNA state test should be reflective of the test taker’s provision of basic nursing care duties to a real patient and performance of direct hands-on care for that person.
  9. For the skills competency section of the CNA state test, the test taker can be safe to assume that he or she will be performing the skills on one patient and/or manikin and will not be alternating from resident to resident as a typical nursing assistant would in a nursing facility setting. The test taker must become proficient at all of the testable skills in addition to the opening procedures and closing steps for each skill.

REFERENCES

Lewis-Clark State College. (2013). Student Skills Packet. Retrieved from http://www.lcsc.edu/media/117278/2013-Student-Skills-Packet.pdf

CNA State Examination Practice Questions (Part One)

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As nursing assistant students enrolled in a nurse aide training program, a number of steps exist that can be taken to promote mastery of the knowledge and skills needed to pass the CNA state test. A few of these steps include cultivating top-notch study habits that are conducive to one’s personal learning style, reviewing some material on a daily basis, and staying abreast of various tips and tricks to help answer the trickiest of practice test questions.

A diligent student engages in self-discovery to pinpoint the manner in which he or she learns most optimally. Even though a wide array of different theories exist regarding adult learning styles, it is best to simplify things by asserting that a pupil can be a visual learner, auditory learner, tactile learner, kinesthetic learner, or perhaps a combination of two or more learning styles.

It has also been said that repetition is the mother of all learning. Learning by repetition is a valid way of becoming proficient at answering knowledge-based questions. Simply put, the more a nurse aide student answers practice questions, the more prepared he or she will be at the testing center when answering the real exam questions on the knowledge (or oral) section of the CNA state test.

One proven way of boosting a skill proficiency or becoming competent at a task is to ensure that it is a stored routine in the consciousness of the learner. To make sure this process takes place, the most imperative first step is to elevate the skill to a conscious level whereby the nurse aide student deliberately ruminates over the activity, but not necessarily the desired skill itself.

In other words, the nurse aide student has full knowledge about the particular skill that he or she lacks (read: answering knowledge-based test questions) and, therefore, focuses on accomplishing the types of activities that will help him or her build the skill (e.g., reading, creating flashcards, repeatedly answering practice questions). This type of learning is what educators commonly refer to as learning by repetition.

To prepare adequately for the written knowledge section of the CNA state test, a nurse aide student should answer multiple practice questions each and every day. Click on the video below to see a handful of examples of the types of questions that will appear on the written portion of the CNA state test.

Texas CNA Skills (Part Nine): Skills on the CNA State Test that Require Measurements

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The National Nurse Aide Assessment Program, or NNAAP for short, is a nationwide credentialing program for nurse aides who want to pursue certification as a certified nursing assistant (CNA). In other words, the NNAAP exam is better known as the CNA state test. Additionally, the National Council of State Boards of Nursing (NCSBN) is the entity that has been entrusted with the formulation, revision and administration of the CNA state test.

In most states in the US, the CNA state test is comprised of two distinct sections: a written (or oral) knowledge test made up of 70 multiple choice questions, and a procedural skills competency evaluation consisting of five different hands-on skills that must be demonstrated in front of a nurse aide evaluator.

The procedural hands-on skills evaluation section of the CNA state test takes place in a setting that has been arranged to simulate a patient care environment such as a room inside a long term care facility. Each test taker will have exactly 30 minutes to demonstrate competency in the five skills. The nurse aide candidate must attain a passing cut score on four out of the five procedural skills in order to pass the skills evaluation section of the CNA state test.

The first procedural skill that all test takers in Texas complete is hand-washing, and the remaining four skills will be selected totally at random. Moreover, the NNAAP skills evaluation mandates that all test takers complete at least one numerical measurement skill as part of the CNA state test (Pearson Vue, 2018). All of the hands-on procedural skills that require documentation of a numeric measurement have been listed below.

  1. Measurement and documentation of blood pressure
  2. Measurement and documentation of respiration rate
  3. Measurement and documentation of radial pulse
  4. Measurement and documentation of urinary output
  5. Measurement and documentation of an ambulatory patient’s body weight

On the scheduled day of the CNA state test, the test taker will need to bring three sharpened number two pencils with erasers to the testing center site to record the numerical measurements. The test taker will also need to bring a wristwatch with a second hand to the testing center to perform certain skills.

During the CNA state test, nurse aide test takers in Texas will be using the following standardized, approved form to document the numerical measurement(s) of the random procedural skill(s) they have been assigned.

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REFERENCES

National Council of State Boards of Nursing. (2018). NNAAP & MACE. Retrieved from https://www.ncsbn.org/nnaap-and-mace.htm

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

Texas CNA Skills (Part Eight): What to Wear and How to Dress for the CNA State Test

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The broad majority of states in the U.S. have enacted laws that require graduates of nurse aide training programs to pass the respective state-approved examination in order to secure occupational certification as a certified nursing assistant (CNA). Therefore, the CNA state test is extremely important to the future career prospects of countless nursing assistants.

Nonetheless, many nurse aide students remain blissfully unaware that a testing center dress code exists. Well, a dress code certainly does exist for the CNA state test, and more than one rationale for being dressed in a specific way at the testing center site has been presented. The rationales for the dress code have been listed below.

  1. Nurse aide test takers should anticipate the remote possibility of spending all day at the testing center. Therefore, all-day comfort is of the utmost importance.
  2. A nurse aide test taker might be asked to participate in a simulated patient care environment where he or she plays the role of a debilitated elderly patient for one or more other test takers who need to perform hands-on skills. Thus, nurse aide candidates will actually be performing their skills on each other during the skills evaluation section of the CNA state test.
  3. Nurse aide test takers should wear shoes with non-skid soles (bottoms) for safety reasons. The safety of all test-taking candidates needs to be upheld at the testing center.
  4. Any candidate who volunteers to play the role of the patient must wear flat slip-on non-skid closed toe shoes, loose pants or bottoms that are capable of being rolled up, and a loose tank top or loose-fitting shirt with sleeves that can be rolled up to the shoulders (Pearson Vue, 2018).

In general, test takers will never go wrong by dressing the part of an employed nursing assistant regardless of whether or not they opt to volunteer to pose as a patient. The following dress code is more of a basic set of guidelines for appropriate testing center clothing for the CNA state test. Keep in mind that Pearson Vue testing centers are the testing sites where all CNA state tests are conducted in the state of Texas. The following list contains generalities surrounding proper attire in regards to the Texas CNA state test, as well as testing sites in the majority of other states in the US.

  1. Wear closed-toe shoes with flat non-skid soles.
  2. Nurse aide test takers who do not volunteer to play the role of a patient should wear a medical uniform, scrub set, or casual attire. Clothing should be clean.
  3. Nurse aide test takers who choose to wear casual attire should wear jeans, pants, khakis or slacks to comply with the potential need for hands-on skills practice. Dresses and skirts are discouraged with the exception of religious reasons.
  4. Midriffs and abdominal areas should be covered.
  5. Nurse aide test takers should appear clean, groomed, and be free from strong body odor. Perfumes, body sprays and colognes are discouraged.
  6. Nurse aide test takers who wear white bottoms should wear proper underwear since patterned panties, briefs or boxer shorts might be seen through white material.
  7. Long hair should be worn back into a ponytail, bun, contained by a headband, or pinned.
  8. Fingernails should be kept short and trimmed.
  9. Nurse aide test takers must wear a wristwatch with a second hand.
  10. Limit / curtail the amount of jewelry worn to the testing center. The amount of jewelry the nurse aide test taker wears to the testing center site should be minimal.

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Be completely mindful that the CNA state test dress code is different in a handful of states in the US. For example, CNA state test sites in Arizona require all test-taking candidates to adhere to a very specific dress code, and those who do not comply will not be permitted to take the exam.

With regards to the CNA state test in Arizona, Headmaster LLP (2018) asserts that “SCRUBS (which consists of a scrubs top and scrub pants, scrub skirt (long, loose-fitting) or scrub dress (long, loose-fitting) and closed-toed, soft-soled shoes are the required dress code for testing. You will not be admitted for testing if you are not wearing scrub attire and the appropriate shoes. You will be considered a NO SHOW. You will have to pay for another exam date.”

Be sure to dress for success on the day of the CNA state test and beyond. The nurse aide testing site evaluator is the individual who will be observing for competency as the test taker performs the skills evaluation section of the state test. Dressing the part for the CNA state test can go a long way in presenting the image of a candidate who is fully competent, prepared, professional, and serious about his or her future career as a nursing assistant.

Readers have probably heard the olden adage that one never gets a second chance to make a first impression. The point is to present oneself to the testing site evaluator as a nurse aide who deserves to pass the CNA state test. A cleanly nurse aide candidate looks the part, whereas a test taker with 10 gold chains, a tight-fitting cropped top that exposes the torso and dirty blue jeans does not look professional.

REFERENCES

Headmaster, LLP. (2018). Arizona Nursing Assistant Candidate Handbook. Retrieved from http://hdmaster.com/testing/cnatesting/arizona/azformpages/azforms/AZCandidateHandbook%202.1.18.pdf

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