CNA Exam Study Guide: All 6 NNAAP Topics Explained

Note: The six topic categories and exam weights in this guide reflect the practical grouping used in most CNA preparation programs. The official NNAAP content outline organizes exam content into three main domains — Physical Care Skills, Psychosocial Care Skills, and Role of the Nurse Aide — with multiple subcategories each. Physical Care Skills is the most heavily tested section on the NNAAP written exam. Nearly half of all questions come from this topic. Key areas to know: • Bathing: The correct water temperature for a bed bath is 105–115°F (warm, not hot). Always test the water before applying it to a resident. Wash from cleanest to dirtiest areas. • Oral Care: For unconscious residents, position them on their side to prevent aspiration. Use a toothbrush with toothpaste and rinse with a small amount of water. • Nail Care: CNAs may file fingernails but should NOT cut toenails — that is outside the CNA scope of practice (a nurse or podiatrist must do this). • Perineal Care: Always wipe front to back for female residents to prevent infection. Use clean strokes each time. • Positioning: Common positions on the exam include Fowler's (sitting up 45–60 degrees), semi-Fowler's (30–45 degrees), lateral (side-lying), and Sims' (left lateral with knee bent). • Transfers: Always use a gait belt for transfers. Stand the resident on their stronger side. Lock wheelchair wheels before transferring. • Range of Motion: Support the joint above and below during range of motion exercises. Stop if the resident reports pain. Move to the point of resistance, not beyond.

Safety questions test your knowledge of fall prevention, fire response, and emergency procedures. • RACE Protocol for fires: Rescue (move residents away from fire), Alarm (pull the fire alarm), Confine (close doors and windows), Extinguish or Evacuate. The first step is always Rescue. • Fire extinguisher use follows the PASS acronym: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side. • Fall prevention: Keep call lights within reach. Keep the bed in the lowest position when not providing care. Keep pathways clear. Side rails are a restraint — follow facility policy. • Restraint alternatives: Offer toileting every 2 hours, use bed alarms, provide activities, or reposition the resident. Restraints should be a last resort. • Choking — Heimlich Maneuver: Give 5 back blows then 5 abdominal thrusts for a conscious adult who cannot speak, cough, or breathe. Call for help immediately.

Infection control questions focus heavily on handwashing and PPE. • Hand hygiene: Wash hands for at least 20 seconds with soap and water. Use the full technique — palm to palm, between fingers, back of hands, thumbs, and fingernails. Use alcohol-based hand rub when hands are not visibly soiled. • When to wash hands: Before and after patient contact, before putting on gloves, after removing gloves, before and after eating, after using the restroom. • PPE donning order (putting on): Gown first, then mask, then eye protection, then gloves. • PPE doffing order (taking off): Gloves first, then eye protection, then gown, then mask. This order prevents contamination of clean surfaces. • Isolation precautions: - Airborne: Tuberculosis, chickenpox, measles. Requires N95 respirator and negative pressure room. - Droplet: Influenza, COVID-19, pertussis. Requires surgical mask. - Contact: MRSA, C. diff, scabies. Requires gloves and gown. • Standard precautions apply to ALL residents regardless of known infection status.

Resident rights are protected under the Omnibus Budget Reconciliation Act (OBRA) of 1987. The NNAAP exam tests whether you know how to uphold these rights. • Right to refuse care: If a resident refuses a bath, treatment, or procedure, the CNA must respect that refusal and report it to the charge nurse. You cannot force care. • Privacy and dignity: Knock before entering a resident's room. Provide privacy during care. Use the resident's preferred name. • Confidentiality: Do not discuss resident information in hallways or with people who do not need to know. HIPAA protects all patient health information. • Abuse and neglect: CNAs are mandated reporters. Any suspected abuse — physical, emotional, financial, or sexual — must be reported to the charge nurse and the appropriate authorities immediately. • Informed consent: Residents have the right to be told about their care and treatment and to make decisions about it. • Grievances: Residents have the right to file complaints without fear of retaliation.

Psychosocial care questions test communication skills and emotional support. • Therapeutic communication: Use open-ended questions, active listening, and empathy. Avoid giving advice, arguing, or using medical jargon. • What NOT to say: Never say "I know how you feel" or "Everything will be okay." These dismiss the resident's emotions. • Dementia care: Use a calm, reassuring tone. Redirect rather than correct. Do not argue with a confused resident about what is real. • Stages of grief (Kübler-Ross): Denial, Anger, Bargaining, Depression, Acceptance. Residents and families may move through these stages in any order. • End-of-life care: Allow residents to express their feelings. Provide comfort, not just medical care. Support family members as well as the resident.

These questions test your understanding of your legal scope of practice and your responsibilities on the healthcare team. • Scope of practice: CNAs assist with activities of daily living (ADLs) — bathing, dressing, grooming, feeding, and mobility. CNAs do NOT administer medications, insert catheters, perform wound care, or take physician orders. • Chain of command: CNAs report to licensed nurses (LPN or RN). If you are asked to do something outside your scope, politely decline and report it to your supervisor. • Documentation: Record only what you observed, not what you think. Use objective language. Document care after it is given, not before. Never document for someone else. • Observation and reporting: CNAs are the eyes and ears of the nursing team. Report any change in a resident's condition — skin breakdown, change in appetite, unusual behavior — to the charge nurse promptly.

Physical Care Skills is widely considered the most challenging section because it is also the largest — accounting for approximately 45% of the exam, or about 31 of the 70 questions. It covers a wide range of hands-on tasks, each with specific procedural steps: bathing (water temperature, clean-to-dirty order), transfers (gait belt placement, stronger-side pivoting), positioning (Fowler's, Sims', lateral), catheter care, and perineal care. The difficulty is not just the volume of content but the level of procedural detail the exam expects. Mastering Physical Care Skills first is the single most high-leverage use of your study time.

The NNAAP written exam has 70 questions distributed across six topics: • Physical Care Skills: ~31 questions (45%) • Safety & Emergency Procedures: ~10 questions (14%) • Infection Control: ~10 questions (14%) • Resident Rights: ~8 questions (11%) • Psychosocial Care Skills: ~6 questions (8%) • Role of the Nurse Aide: ~5 questions (8%) Note that 10 of the 70 questions are unscored pilot questions used for future exam development — you will not know which ones, so answer every question as if it counts.

The passing score for the NNAAP written exam is 70%. Of the 70 questions on the exam, 10 are unscored pilot questions, so the 70% threshold applies to the 60 scored questions. Aim for at least 80% on practice tests before your exam date — the extra buffer protects you against questions that might trip you up on test day.