Your FREE NNAAP Flashcards 2026 – 200+ Cards

The National Nurse Aide Assessment Program — the exam most states use to certify CNAs.

A written (or oral) knowledge test AND a hands-on skills evaluation; you must pass both.

Credentia (it took over from Pearson VUE around 2018-2019).

70 multiple-choice (60 scored + 10 unscored pretest).

60 scored questions count; 10 pretest questions don't — answer all 70 as if they count.

2 hours (120 minutes).

5 skills, and you must pass all 5 of 5.

About 30 minutes for all five skills.

Hand hygiene (handwashing) — it's Skill 1 every time.

1 hand hygiene + 1 measurement skill + 3 randomly selected skills.

A skill that produces a recorded value: BP, pulse, respirations, weight, or output. One is always tested.

A make-or-break step on a skill checklist; missing one is an automatic fail of that whole skill.

Communication, privacy, dignity & safety steps scored INSIDE every skill, not tested separately.

Only later handwashing may be verbalized; every other step of every skill is physically performed.

Scored as a fail — pace yourself ~5-6 minutes per skill and keep moving.

60 multiple-choice read aloud + 10 reading-comprehension, for those who read English with difficulty.

A scaled cut score (not a fixed %); commonly reported around 70-80% correct.

No — each part is scored independently; you retake only the part you failed.

Complete a state-approved training program: 75+ hours including 16+ clinical (OBRA '87).

Nurse Aide Training and Competency Evaluation Program — the state-approved course you must finish to test.

Most U.S. states; a number use Prometric and some use a state-specific vendor.

Roughly $45 written + $95 skills, about $140 combined; varies by state, non-refundable.

A new fee for each part retaken; many states allow ~3 attempts before requiring retraining.

You're listed on your State Nurse Aide Registry and can work as a CNA.

No paid nursing duties for 24 straight months = you must re-test to stay on the registry.

A valid, unexpired government photo ID whose name matches your registration exactly.

A live volunteer who plays the resident while you perform the five skills.

Introduce + name client → explain → privacy → perform → call light in reach + bed low.

Usually the rules (verbalizing, time, missing indirect care), not the nursing technique.

This = how the exam works; the CNA study guide = the deep clinical content it tests.

Treat ALL blood and body fluids of EVERY resident as potentially infectious, every time.

Hand hygiene (handwashing).

At least 20 seconds with friction, fingertips down, hands below the elbows.

So dirty water runs off the fingertips, not back up the clean arms.

The inside of the sink — it's a Critical Element Step.

A clean, dry paper towel (not your bare clean hand).

Gown → mask → goggles → gloves.

Gloves → goggles → gown → mask.

They are the most contaminated item — remove them before they touch clean skin.

Wash your hands.

Gown + gloves for organisms spread by touch (MRSA, C. diff, scabies).

A surgical mask for influenza, pertussis, mumps.

An N95 respirator + negative-pressure room for TB, measles, chickenpox.

Soap and water, NOT alcohol gel — gel doesn't kill the spores.

60-100 beats per minute.

Under 60 or over 100 bpm.

10-20 breaths per minute.

Under 10 or over 20 per minute.

About 91-129 / 61-89 mmHg.

At or above 130/90 mmHg (hypertension).

About 96-99°F (35.8-37.3°C).

100.4°F (38°C).

95-100%; report under 90%.

Systolic = top number (heart contracts); diastolic = bottom (heart rests).

A full 60 seconds (apical or radial).

Without telling the resident, so they breathe naturally; one rise + fall = one breath.

Rectal reads highest; axillary (armpit) reads lowest.

Bend the knees and hips, wide base, lift with the legs, hold loads close — never twist.

Get help or use a mechanical lift; never lift alone.

Call light in reach, bed in its lowest position, wheels locked.

Rescue, Alarm, Confine, Extinguish (or Evacuate).

Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side.

The base of the flames, not the top.

A physician's order; a last resort, never for staff convenience or punishment.

At least every 2 hours to prevent pressure injuries.

Skin/tissue damage from constant pressure over a bony area.

Over bony areas: sacrum, hips, heels, elbows.

Objective = measured/observed; subjective = what the resident reports.

Chart factually, after care is given — never chart care you didn't perform.

The CNA's core duty — report any abnormal value or change to the nurse immediately.

Abdominal thrusts (Heimlich maneuver).

Inhaling food/fluid into the lungs — prevent it with upright positioning during feeding.

Report it to the nurse — never diagnose, medicate, or wait.

There is contact with blood, body fluids, broken skin, or mucous membranes.

Activities of Daily Living: bathing, dressing, grooming, toileting, eating, mobility.

Do only what the resident cannot — encourage them to do as much as they safely can.

Weak side goes IN first; strong side comes OUT first.

Weak goes in first, strong comes out first.

About 105°F (40.5°C) — test it before bathing.

Inner corner to outer corner, clean part of the cloth for each eye.

Wash from clean to dirty.

Always wipe front to back, clean cloth area for each stroke.

To prevent spreading bacteria from the anus to the urethra (UTI prevention).

Upright at 90° (high Fowler's); stay upright 30-60 min after.

Small bites, slowly, alternate food and fluids, allow time to chew and swallow.

Difficulty swallowing; follow the care plan for thickened liquids.

Below the level of the bladder, off the floor.

Intake and Output (I&O), measured in mL/cc.

Nothing by mouth — the resident may not eat or drink.

Line/pad the sink so they don't break; use cool/tepid water, not hot.

Turn the head to the side to prevent aspiration; wear gloves.

Dry between the toes; lotion everywhere EXCEPT between the toes; don't cut nails.

Per the resident's preference; never cut hair.

Wear gloves; shave in the direction of hair growth.

Semi-sitting, head of bed raised 45-60°; used for eating and breathing.

Lying flat on the back.

Lying on the abdomen, face down.

Lying on the side; relieves pressure on the back.

Left side-lying, partly prone, upper knee flexed; for enemas.

At least twice a day and as needed; provides comfort and prevents infection.

Reddened skin, rashes, broken skin, bruises, swelling — observe and report.

Offer adaptive devices and let the resident do the task, even if slower.

Care that helps a resident regain/keep the highest possible function and prevents decline.

Moving a joint through its normal movements to keep flexibility and prevent contractures.

Active = resident moves; passive = the aide moves the joint. Active is preferred.

Support the joint above and below; move to resistance, NOT pain; never force.

Permanent tightening/shortening of a muscle or joint from disuse — prevent with ROM.

Muscle wasting from disuse.

The STRONG (unaffected) side.

Lead with the strong leg going up stairs, the weak leg going down.

Worn snug around the waist over clothing to assist transfers and walking.

Walk slightly behind and to the weaker side; use non-skid footwear.

Ease them to the floor, protect the head — don't try to hold them up.

Maximum independence and prevention of complications of immobility.

Reposition every 2 hours; keep skin clean and dry.

Scheduled toileting plus adequate fluids and fiber per the care plan.

Tools (built-up utensils, plate guards, sock aids) that help a resident self-care.

Lock the wheels and raise the footrests before transferring.

Lock the bed and wheelchair wheels every time.

Required before standing or walking a resident, to prevent falls.

The number of times in the care plan (commonly about 3-5).

Promote independence — let residents do what they can, praise the effort.

Physiological needs (food, water, oxygen) come first, then safety.

An unconscious way of coping with stress or anxiety.

Refusing to accept a painful reality.

Attributing one's own feelings to someone else.

Returning to earlier, childlike behavior.

Making excuses to justify behavior.

Redirecting emotion onto a safer target.

Progressive, irreversible loss of memory, judgment, and reasoning.

Alzheimer's disease.

Approach from the front, simple one-step instructions, calm voice, redirect & validate.

Increased confusion/agitation in the late afternoon or evening.

More evening light, less noise, a calm, consistent routine.

Don't argue with a firmly confused resident — redirect or validate instead.

Never restrain a resident just to stop wandering; make the area safe and supervise.

NOT a normal part of aging — report withdrawal, appetite/sleep changes.

Report to the nurse immediately — never keep it confidential.

Denial, anger, bargaining, depression, acceptance — no fixed order.

Listen and support; never push a resident toward acceptance.

Comfort care for someone expected to live about 6 months or less.

Comfort and symptom relief, which can be given alongside treatment at any stage.

Hearing — keep speaking gently to a dying resident.

Care of the body after death, done with dignity and per policy/family wishes.

Respect and support the resident's beliefs — never judge, change, or impose your own.

Handle with care; provide privacy for prayer or clergy visits.

Honor kosher, halal, vegetarian per the care plan; never serve a forbidden food.

Respect them equally — never preach or push beliefs.

Communication, personal space, eye contact, modesty, family roles, and diet.

Respect and accommodate it; tell the nurse if you can't.

Provide draping and honor requests for same-gender care.

Follow the resident's and family's wishes for the body; report to the nurse.

Verbal = spoken/written words; nonverbal = body language, tone, eye contact, touch.

Face the resident, sit at eye level, allow silence, use open-ended questions.

Don't say 'you'll be fine' — it shuts down real concerns.

Talking down/baby-talk to an older adult — avoid it; it's disrespectful.

Face them, LOWER your pitch (don't shout), reduce background noise, check hearing aids.

Shouting raises pitch and distorts sound — lower your pitch instead.

Announce yourself before touching; describe the surroundings; use the clock method for food.

Allow time, don't finish sentences, ask yes/no questions, use communication boards.

Reporting = telling the nurse verbally; recording = writing it in the chart.

A question that encourages the resident to talk, not just say yes or no.

Give full attention, make eye contact, and show you understand.

Describing food location on a plate by clock position for a vision-impaired resident.

Never discuss a resident in public areas or on social media (HIPAA).

The Federal Nursing Home Reform Act (OBRA '87), 42 CFR 483.10.

Privacy, choice, dignity, voice grievances, refuse care, freedom from abuse/restraints.

A competent resident may refuse any care or treatment — honor it and report it.

A CNA must report suspected abuse or neglect immediately — to the nurse.

Report a suspicion; you don't need proof and don't confront the abuser yourself.

Intentional harm: physical, verbal/psychological, sexual, or financial.

Failure to provide the goods or services a resident needs to avoid harm.

Confining a resident against their will — a form of abuse.

Protects Protected Health Information (PHI) — share only on a need-to-know basis.

Close the door/curtain, drape the resident, knock before entering.

By their preferred name — never 'honey,' 'sweetie,' or a room number.

An advocate who investigates and resolves residents' complaints.

Residents may keep and use personal belongings.

Residents may voice complaints without fear of retaliation.

Misusing a resident's money or property — a form of abuse, report it.

Residents have the right to dignity, respect, and to make their own choices.

Improper restraint can be abuse and false imprisonment.

Failing to give the care a reasonable aide would, resulting in harm.

A threat that makes someone fear harm — no contact needed.

Touching a person without consent (e.g., forcing care on someone who refused).

Assault is the threat; battery is the unwanted touch.

Unlawfully restricting freedom of movement (e.g., restraining without an order).

Harming reputation with false statements — libel (written) or slander (spoken).

Agreement to care after understanding it; a competent resident may refuse.

A legal document stating care wishes if the resident can't speak (living will, DNR).

Do Not Resuscitate — do NOT perform CPR if the heart or breathing stops.

Check the resident often (every 15-30 min); release/reposition about every 2 hours.

Last resort, physician's order only, never for discipline or convenience.

Diagnose, assess, give medications, or perform sterile/invasive procedures.

Refer it to the nurse — the CNA never gives a diagnosis or prognosis.

Taking a resident's property is illegal and reportable.

Never chart care that wasn't done — it's illegal and dangerous.

CNA → LPN/LVN → RN → Director of Nursing → physician.

The nurse — report observations and concerns to the nurse first.

Tasks a CNA is trained and legally allowed to do; observe, record, report.

When a nurse assigns a task; the aide accepts only what's within scope and training.

A CNA may refuse an unsafe or out-of-scope task — and tell the nurse why.

Assessment, Diagnosis, Planning, Implementation, Evaluation.

Carry out delegated implementation and report data — the nurse assesses.

The team's written, individualized plan; the CNA must read and follow it.

Helps residents with swallowing (dysphagia) and speech.

Helps with walking, transferring, and balance.

Helps with dressing, eating, and daily tasks (ADLs).

Plans special or therapeutic diets.

Helps with emotional, financial, and discharge needs.

A factual written record of an accident or unusual event.

Report any change in a resident's condition to the nurse right away.

Prioritize by urgency and the care plan; ask the nurse if unsure.

Discuss residents only with the team, only on a need-to-know basis.

Be punctual, dependable, respectful, and follow facility policy.