Common Mistakes on CNA Infection Control Skills
Skipping or Improper Hand Hygiene
Hand hygiene is the single most important skill in the clinical portion of the exam and is often a Bold Step that must be performed correctly to pass. A frequent error is failing to wash hands at the appropriate transition points, such as before touching a patient or immediately after removing gloves. Evaluators look for specific technical markers: you must use warm water, apply soap, and create friction for at least 20 seconds. A common technical failure occurs when a candidate touches the inside of the sink or allows their uniform to contact the basin, which constitutes a break in aseptic technique. Furthermore, forgetting to use a clean, dry paper towel to turn off the faucet after drying your hands is a critical oversight that results in immediate point deductions. To avoid this, narrate your actions out loud, stating "I am now washing my hands for 20 seconds," to ensure both you and the evaluator remain focused on the timing.
Contaminating Sterile Fields and Clean Supplies
In the context of CNA clinical skills errors, contamination of clean supplies often happens when candidates fail to recognize the boundary between "clean" and "dirty" zones. For example, when performing catheter care or perineal care, placing a used washcloth on the bedside table without a protective barrier is a significant mistake. Candidates often inadvertently reach over a designated clean field, which is a violation of infection control protocols. Another frequent error is allowing linens to touch the floor or holding dirty laundry against the uniform. In the eyes of the evaluator, the uniform is considered contaminated once the skill begins; therefore, any clean linen that touches the scrubs must be discarded. Precision in movement is required to maintain the integrity of the environment, ensuring that clean supplies only touch other clean surfaces or the patient’s intact skin.
Incorrect Use or Order of Personal Protective Equipment (PPE)
Donning and doffing PPE is a high-stakes skill where the sequence is as important as the equipment itself. Many candidates fail by removing their mask before their gloves or by failing to secure the ties of the gown properly at the neck and waist. The standard sequence for doffing—gloves, goggles, gown, then mask—is designed to prevent the transfer of pathogens to the candidate's face and mucous membranes. A common mistake is "snapping" the gloves off, which can create micro-aerosols, or failing to roll the gown away from the body from the inside out. In a testing environment, you must demonstrate that you understand the Standard Precautions protocol. If you realize you have touched the outside of a contaminated gown with your bare hands, you must immediately verbalize the error and perform hand hygiene to potentially save your score.
Critical Safety Oversights That Lead to Failure
Neglecting Patient Identification Checks
Every clinical skill must begin with the fundamental step of patient identification, often referred to as the "Introduction and ID" phase. A major CNA test pitfalls is entering the room and beginning a procedure without verifying the patient's identity via their wristband or asking them to state their name. This is a safety violation because performing a procedure on the wrong resident can have catastrophic medical consequences. Evaluators look for a formal introduction: "Hello, Mr. Jones, my name is [Name], and I am your CNA today." Following this, you must physically check the ID band. Simply looking at the bed tag is insufficient; the state-mandated protocol requires active verification. Failing this step indicates a lack of foundational safety awareness, which is a primary reason for failing the clinical portion of the exam.
Forgetting to Lower the Bed and Engage Brakes
Mechanical safety is a non-negotiable component of the CNA skills test. Candidates frequently lose points or fail entirely because they forget to engage the bed brakes before performing a transfer or leaving the bedside. An unbraked bed can move during a pivot transfer, leading to a patient fall. Similarly, the Bed Height Rule is a critical safety standard. While you should raise the bed to a comfortable working height to protect your back, you must return the bed to its lowest position before leaving the room. This ensures that if a resident attempts to get out of bed, the distance to the floor is minimized, reducing injury risk. Evaluators often wait until the very end of the skill to see if you remember to lower the bed and place the call light within reach; forgetting these final safety checks is a common reason for an otherwise proficient candidate to fail.
Incorrect Body Mechanics Leading to Self-Injury Risk
Body mechanics are assessed to ensure the longevity of the nursing assistant's career and the safety of the patient. A common error is lifting with the back rather than the legs, or failing to maintain a wide base of support during a transfer. When using a Gait Belt, candidates often fail to apply it snugly enough or grasp it with an underhand grip, which is the required standard for maximum control. If you attempt to lift a patient while your feet are close together, you lack the stability needed to prevent a fall if the patient stumbles. Evaluators look for the "pivot" rather than the "twist"; twisting the torso while load-bearing is a significant technical error. Demonstrating proper alignment and using your center of gravity effectively proves that you can provide care without endangering yourself or the resident.
Communication and Care Errors Evaluators Watch For
Failing to Explain Procedures to the 'Patient'
In the clinical exam, the "patient" is often a manikin or a fellow student acting as a volunteer. A frequent mistake is treating the patient as an object rather than a human being. Candidates often start a procedure—such as range of motion exercises or a bed bath—without explaining what they are doing. This violates the Resident’s Rights mandate, specifically the right to be informed about care. You must explain the procedure before you start and continue to provide updates throughout the process. For example, saying, "I am going to move your arm now; let me know if you feel any discomfort," shows the evaluator that you prioritize the patient's psychological well-being and consent. Silence during a skill is often interpreted as a lack of communication competence.
Not Asking Permission or Respecting Privacy
Privacy is a legal requirement under HIPAA and state long-term care regulations. A common error is failing to pull the privacy curtain or close the door before exposing a patient's body. Even if the "patient" is a manikin, the evaluator expects you to treat the scenario with the same dignity as a real-life encounter. Furthermore, many candidates fail to ask permission before beginning a task. Simply stating what you are going to do is not the same as asking, "Is it okay if I change your gown now?" Additionally, failing to properly drape the patient during perineal care or a bed bath—leaving more of the body exposed than necessary—is a significant breach of professional standards. You must ensure that only the area being cleaned is visible, maintaining the resident's modesty at all times.
Using Poor Therapeutic Communication Techniques
Therapeutic communication involves more than just being polite; it requires active listening and appropriate responses to patient cues. A common mistake is using "elderspeak" (e.g., calling a patient "sweetie" or "honey") or using medical jargon that a resident might not understand. Evaluators look for clear, respectful, and age-appropriate language. Another error is ignoring the patient’s verbal or non-verbal signals of pain or distress. If the volunteer patient winces during a range of motion skill and you continue without acknowledging it, you have failed the communication and safety assessment. You must stop, ask about the pain, and report it. Effective communication is a scored component of every skill, and failing to demonstrate empathy and clarity can lead to failing the CNA exam even if your technical movements are perfect.
Written Test Pitfalls: Misreading and Misunderstanding
Misinterpreting What the Question is Asking
Many CNA written exam mistakes occur because candidates rush through the text and miss the core intent of the question. The exam often presents scenarios where multiple answers seem plausible in a real-world setting, but only one is legally or clinically correct according to the scope of practice. For example, a question might ask what a CNA should do if a patient complains of chest pain. While "giving the patient an aspirin" might be a common medical response, it is outside the CNA's Scope of Practice. The correct answer will always involve immediate safety and reporting to the licensed nurse. Candidates often choose the "medical" answer rather than the "nursing assistant" answer because they misunderstand their specific role in the hierarchy of the healthcare team.
Overlooking Key Words Like 'BEST', 'FIRST', or 'SAFEST'
CNA exam questions are frequently structured using qualifiers that change the required logic. Words like "FIRST," "MOST," "BEST," or "EXCEPT" are pivotal. A common mistake is identifying a correct action but failing to realize it is not the first action. For instance, if a fire breaks out, the options might include "Extinguish the fire," "Activate the alarm," and "Remove the residents." While all are part of the RACE Protocol (Rescue, Alarm, Confine, Extinguish), the "FIRST" action is always to rescue/remove the residents. Candidates who do not read carefully often pick the first "good" action they see rather than the one the question specifically demands. Training yourself to circle or mentally highlight these qualifiers is a vital strategy for navigating the multiple-choice section successfully.
Letting Anxiety Cloud Your Reading Comprehension
Test anxiety can lead to a phenomenon known as "tunnel vision," where a candidate focuses on a single word and ignores the rest of the sentence. This often results in misreading a negative as a positive (e.g., missing the word "not"). In the written exam, you are often faced with 60 to 70 questions within a set timeframe, usually 90 to 120 minutes. Anxiety causes candidates to second-guess their initial, often correct, instincts. Statistically, most students who change their answers during a test move from a correct answer to an incorrect one. To combat this, utilize the Flagging Technique: if a question causes immediate stress, flag it and move on. Return to it only after you have built confidence by answering the questions you find easier, ensuring that anxiety does not sabotage your reading comprehension.
Time Management and Procedural Flow Mistakes
Rushing Through Skills and Missing Steps
During the clinical skills evaluation, there is a natural tendency to move quickly to ensure all five skills are completed within the allotted 30 to 40 minutes. However, rushing is a leading cause of CNA clinical skills errors. When you move too fast, you are more likely to forget the "small" but essential steps, such as checking the water temperature or offering the patient a choice of clothing. Rushing also leads to poor verbalization; if the evaluator does not see you do something and you do not say you are doing it, they cannot give you credit. It is better to move with deliberate, steady purpose. If you find yourself ahead of time, use the extra minutes to mentally review the Skill Checklist for the task you just completed. Most testing centers allow you to correct a mistake if the skill has not yet ended.
Poor Pacing on the Written Exam Section
While the written exam is generally not as time-pressured as the skills test, poor pacing can still lead to errors toward the end of the booklet. Some candidates spend five minutes agonizing over a single difficult question, which reduces the time available for the final ten questions. This often leads to rushing through the end of the test, where simple errors in logic occur. A professional strategy is to allocate approximately one minute per question. This pace leaves ample time at the end for a Final Review. If you encounter a complex scenario regarding legal issues or ethical dilemmas, do not let it stall your progress. Consistent pacing ensures that your mental energy is distributed evenly across all content domains, from basic nursing skills to restorative care.
Not Knowing How to Recover From a Minor Error
One of the most significant mistakes candidates make is giving up mentally after realizing they missed a step. In many testing jurisdictions, you are allowed to correct an error as long as you have not signaled that you are finished with that specific skill. For example, if you realize you forgot to lock the wheelchair brakes after you have already started the transfer, you should stop, verbalize "I am going to correct a step; I am locking the brakes now," and then proceed. Many students assume that one mistake means they have already failed, which leads to a cascade of further errors due to loss of focus. Understanding the Correction Protocol of your specific testing provider is essential. You are being evaluated on your ability to provide safe care, and recognizing and fixing a mistake is a sign of a competent, safe practitioner.
How to Practice to Eliminate These Common Errors
Incorporating 'Error Spotting' in Study Sessions
Traditional studying often focuses on the "right" way to do things, but high-level preparation involves identifying the "wrong" way. Practice with a partner and intentionally perform a skill with three deliberate errors. Have your partner identify them using the official State Skills Checklist. This exercise, known as "negative practice," sharpens your ability to recognize deviations from the standard. For the written exam, look at practice questions and explain why the three incorrect distractors are wrong. Understanding the rationale behind why an answer is incorrect—perhaps it’s outside the scope of practice or it’s not the highest priority—builds a deeper level of critical thinking than simply memorizing the correct answer. This method ensures that on exam day, you are hyper-aware of the traps set in the questions.
Recording and Reviewing Your Skills Practice
Because we are often unaware of our own physical habits, recording your practice sessions is an invaluable tool. You might not realize that you are touching your face during a skill or that you are failing to maintain a straight back during a lift. When you review the footage against the Candidate Handbook criteria, these habits become obvious. Pay close attention to your "indirect care" skills—things like dignity, rights, and safety. Are you knocking before entering? Are you closing the curtain? These are the areas where candidates frequently lose points. By watching yourself, you can refine your procedural flow and ensure that your physical movements are efficient and meet the evaluator’s expectations for professional conduct.
Taking Full-Length, Timed Practice Exams
To overcome the pressure of the testing environment, you must simulate it as closely as possible. Taking a full-length, 60-question practice test in one sitting helps build the mental endurance required for the actual exam. Use a timer to track your progress and identify which sections take the longest. If you consistently struggle with the Safety and Emergency Procedures section, you can redirect your study efforts there. For the skills portion, set a timer for 30 minutes and attempt to perform three random skills in a row without stopping. This builds the "procedural memory" necessary to transition smoothly between tasks. The more familiar you are with the sensation of being timed, the less likely you are to experience the paralyzing effects of test anxiety, allowing your true expertise to show through.