Nurse aide (CNA)
Vital signs and measurements on the CNA exam
Turn a timed pulse count into beats per minute above, and fluid amounts into milliliters just below. Then: each measurement the exam can ask for.
Radial pulse from a timed count
Beats per minute
72
- Multiplier
- × 2
- Adult resting range
- 60 to 100
MedlinePlus gives 60 to 100 beats a minute for adults at rest. On the skills test, follow the counting time your state handbook asks for.
Measurements appear in both parts of the nurse aide exam. In the NNAAP skills test, one of the 5 skills a candidate performs is always a measurement skill, drawn from the 6 skills of the listing where a value must be recorded: radial pulse, respirations, urinary output, weight of an ambulatory client, and two blood pressure skills, electronic and manual, that are state specific and tested only where the state handbook includes them. The recorded value is compared with the evaluator's, so the count must be accurate as well as the steps correct. On the written test, basic nursing skills, the heaviest area of the outline, includes measuring and recording vital signs and intake and output. The arithmetic is simple but must be exact: a count over 15 or 30 seconds is multiplied by 4 or 2 to give a rate per minute, and household fluid measures are converted with 240 mL for a cup and 30 mL for a fluid ounce, the federal labeling values. Adult resting pulse runs from 60 to 100 beats a minute according to MedlinePlus. All values here are exam content, not medical advice.
Intake in mL from household measures
Total intake
480 mL
- From cups
- 240 mL
- From fluid ounces
- 120 mL
1 cup = 240 mL and 1 fl oz = 30 mL, the federal labeling values (21 CFR 101.9). Use the conversion card your test site provides if it differs.
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The measurement skills on the listing
The NNAAP skills listing under the 2024 outline has 6 skills where you record a number:
- Counts and Records Radial Pulse
- Counts and Records Respirations
- Measures and Records Electronic Blood Pressure (state specific: only where your handbook lists it)
- Measures and Records Urinary Output
- Measures and Records Weight of Ambulatory Client
- Measures and Records Manual Blood Pressure (state specific: only where your handbook lists it)
One of them is drawn on every NNAAP skills test. Which states test blood pressure, and with which device, is decided state by state, so look at the skills list in your own handbook before you spend time on it.
Counting pulse and respirations
A rate is always reported per minute. If you count for part of a minute, multiply to reach sixty seconds. The calculator at the top does it for the pulse; here are four worked counts.
| Measure | Your count | Multiply | Record |
|---|---|---|---|
| Pulse | 19 beats in 15 seconds | × 4 | 76 per minute |
| Pulse | 41 beats in 30 seconds | × 2 | 82 per minute |
| Respirations | 9 breaths in 30 seconds | × 2 | 18 per minute |
| Respirations | 16 breaths in 60 seconds | × 1 | 16 per minute |
For the radial pulse, place two fingers, not your thumb, on the thumb side of the inner wrist, and count each beat. MedlinePlus gives 60 to 100 beats a minute as the normal range at rest for adults (MedlinePlus pulse). On the exam, any value outside the range you were taught, or any irregular rhythm, is reported to the nurse; you never interpret it to the resident.
Respirations are counted right after the pulse without telling the resident, because breathing changes when someone watches it. One breath is one rise and one fall of the chest.
Blood pressure, where it is tested
Two blood pressure skills are on the NNAAP listing, one with an electronic device and one manual with a cuff and stethoscope, and both are marked state specific. Where they are tested, the steps that matter most are the cuff size and position on the bare upper arm, the arm supported at heart level, and recording the value exactly as read, top number over bottom number. On the written test, a blood pressure question usually asks what to do with a reading, and the answer is to report an unusual value promptly rather than act on it.
Weight and urinary output
Weighing an ambulatory client starts with balancing or zeroing the scale, having the client remove shoes, and reading the value while the client stands still in the center. Record in the unit your form asks for. If a question mixes units, the factor is 0.45359237 kilograms per pound (NIST): a resident who weighs 154 pounds weighs about 69.9 kilograms, or roughly 154 divided by 2.2.
Pharmacy unit converter
154.0000 lb =
69.85 kg
- 1 tsp
- 5 mL
- 1 tbsp
- 15 mL
- 1 fl oz
- 30 mL
Household measures as federal labeling rules round them (21 CFR 101.9); 1 grain is taken as 64.79891 mg and 1 lb as 0.45359237 kg.
Urinary output is measured in a graduate, a container marked in milliliters. Put it on a flat surface, read at eye level, and record the amount in mL. Gloves go on before you touch the collection device, and come off before you write on the record.
Intake: a worked example
Intake questions give household measures and expect an answer in milliliters. Use the values of the federal labeling rules (21 CFR 101.9): one cup is 240 mL and one fluid ounce is 30 mL. Suppose a resident has a cup of coffee, a 4 ounce glass of juice and half a cup of soup at lunch:
- Coffee: 1 × 240 = 240 mL
- Juice: 4 × 30 = 120 mL
- Soup: 0.5 × 240 = 120 mL
- Total intake: 480 mL
Soup and anything that is liquid at room temperature count as fluid intake; solid food does not. If the resident leaves part of a drink, subtract what remains. The intake calculator near the top adds cups, ounces and amounts already in milliliters for you.
Practising the numbers
Take a partner's pulse and respirations together, both of you counting, and compare. Measure water in a kitchen measuring cup and pour it into a marked container to see what 240 mL looks like. Then run the measurement skills on the skills checklist and the vital signs questions in the practice test, under basic nursing skills.