CNA Exam Topics: Complete NNAAP Category Breakdown

The NNAAP written exam is divided into six content categories. Each category has a defined percentage of the total exam, which determines how many of the 70 questions come from that topic. Knowing the weight of each category helps you allocate study time effectively. Here is the complete breakdown: • Physical Care Skills: 45% • Safety & Emergency Procedures: 14% • Infection Control: 14% • Resident Rights: 11% • Psychosocial Care Skills: 8% • Role of the Nurse Aide: 8% The two largest categories — Physical Care Skills and the combination of Safety and Infection Control — make up nearly three-quarters of the entire exam. Note: These categories and percentages 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 dominant category on the NNAAP exam. Approximately 31 of the 70 questions come from this section. Subtopics covered: • Personal hygiene: bathing, oral care, hair care, shaving, nail care, perineal care • Dressing and grooming assistance • Feeding: positioning for meals, feeding techniques, aspiration prevention • Fluid and nutritional intake monitoring • Elimination care: bedpan and commode use, catheter care, ostomy care • Positioning: Fowler's, semi-Fowler's, lateral, Sims', prone • Transfers: bed to wheelchair, wheelchair to chair, gait belt use • Ambulation and mobility assistance • Range of motion exercises • Skin care and pressure injury prevention The most frequently tested physical care concepts are the correct steps for bathing, the proper technique for transfers (gait belt, positioning toward the stronger side), and catheter care direction (front to back for female residents).

Safety questions test your knowledge of how to prevent accidents and respond to emergencies. Approximately 10 questions come from this category. Subtopics covered: • Fall prevention: identifying fall risk factors, bed position, call light placement, non-slip footwear • Side rail use and restraint policy • Restraint alternatives: toileting schedules, bed alarms, diversional activities • Fire safety: RACE protocol (Rescue, Alarm, Confine, Extinguish/Evacuate), PASS for fire extinguishers • Choking and the Heimlich maneuver • Seizure response: protect from injury, do not restrain, do not put anything in the mouth, time the seizure • Disaster preparedness • Safe use of equipment: wheelchairs, walkers, mechanical lifts The RACE protocol and fall prevention are the most heavily tested areas in this category.

Infection control questions focus on preventing the spread of disease. Approximately 10 questions come from this category. Subtopics covered: • Hand hygiene: technique, timing, soap and water vs. alcohol-based hand rub • Standard precautions: applies to all residents, all body fluids • PPE: types, when to use, correct donning order (gown, mask, eye protection, gloves) and doffing order (gloves, eye protection, gown, mask) • Transmission-based precautions: - Airborne precautions: TB, varicella, measles — N95 respirator, negative pressure room - Droplet precautions: influenza, pertussis — surgical mask - Contact precautions: MRSA, C. diff, scabies — gloves and gown • Chain of infection: pathogen, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host • Sterile technique basics • Disposal of contaminated materials PPE order and isolation precaution types are the most tested concepts in this category.

Resident rights are legally protected under OBRA 1987. Approximately 8 questions test your knowledge of these rights. Subtopics covered: • The right to privacy and dignity • The right to refuse care or treatment • Informed consent • Confidentiality and HIPAA basics • Grievance procedures • Freedom from abuse, neglect, and exploitation • Recognizing and reporting abuse (physical, emotional, financial, sexual) • The right to personal property • The right to visitors and communication • Advance directives (DNR orders, living wills) The most tested concept is the right to refuse care — a resident who refuses a bath or treatment must have that refusal respected and reported to the charge nurse. Never force care on a resident.

Psychosocial care questions test communication and emotional support skills. Approximately 6 questions come from this category. Subtopics covered: • Therapeutic communication: active listening, open-ended questions, silence, reflection • Barriers to communication: cultural differences, language, hearing impairment, dementia • Mental health conditions: depression, anxiety, dementia, delirium • Dementia care techniques: redirection, reminiscence, validation therapy • Cultural and spiritual sensitivity • Grief and loss: stages of grief (denial, anger, bargaining, depression, acceptance) • End-of-life care: comfort measures, supporting families, signs of approaching death • Social needs: meaningful activity, family involvement, community connection The most tested psychosocial concepts are therapeutic communication (what to say and what NOT to say) and dementia care approach.

Role of the Nurse Aide questions test professional, legal, and ethical responsibilities. Approximately 5–6 questions come from this category. Subtopics covered: • Scope of practice: what CNAs can and cannot do • Chain of command: reporting structure, when to escalate • Observation and reporting: what to report, to whom, how quickly • Documentation: objectivity, accuracy, timeliness, confidentiality • Legal responsibilities: mandated reporting, patient rights, advance directives • Ethical principles: autonomy, beneficence, non-maleficence, justice • Professional behavior: punctuality, appearance, attitude, teamwork • Continuing education and maintaining certification The most commonly tested concept is scope of practice. If an answer choice involves performing a task that requires a nursing license — such as administering medications, performing wound care, or taking physician orders — that answer is wrong for the CNA exam.

Physical Care Skills accounts for approximately 45% of the NNAAP written exam — about 31 of the 70 questions. It is the largest topic by far, covering bathing, oral care, nail care, transfers, positioning, feeding, elimination care, catheter care, range of motion, and skin care. Because it makes up nearly half the exam, most study plans recommend spending the first full week of preparation exclusively on Physical Care Skills before moving to other topics.

Airborne precautions are used for diseases that spread through tiny particles suspended in the air over long distances — tuberculosis (TB), chickenpox (varicella), and measles. They require an N95 respirator (not a surgical mask) and a negative pressure room. Droplet precautions are for diseases spread through larger respiratory droplets that fall quickly — influenza, pertussis, and COVID-19. A surgical mask and a standard private room are sufficient. The CNA exam frequently tests whether you know the correct PPE for each precaution type, so memorize which diseases go with which category.

Scope of practice defines the tasks a CNA is legally authorized to perform. CNAs assist with activities of daily living (ADLs): bathing, dressing, grooming, feeding, and mobility assistance. CNAs are NOT permitted to administer medications, perform wound care, insert or remove catheters, take physician orders, or make medical decisions — those tasks require a nursing license. When an answer choice on the CNA exam describes something a nurse or doctor would do, eliminate it — the correct answer will always describe an action within the nurse aide's scope.