How the Written Exam Is Built
The written half of nurse-aide certification under the National Nurse Aide Assessment Program (NNAAP) is a 70-question multiple-choice test with a two-hour limit. Sixty questions are scored; ten are unscored pretest items you cannot tell apart from the rest. The questions are drawn from a published content outline — nine categories with fixed percentages — so you know before you sit down that roughly a third of the scored questions are Basic Nursing Skills and about a fifth are Activities of Daily Living. Candidates who struggle with reading can take the same content as an oral exam: 60 questions read aloud through headphones plus 10 word-recognition items.
This guide walks the outline category by category, then collects the numbers and rules the questions are written around. The practical half of the exam is covered in our skills-test guide; the free set of our CNA practice questions is weighted to the same nine categories.
The Numbers
| Item | NNAAP written (or oral) examination — 2024 outline |
|---|---|
| Questions | 70 multiple choice: 60 scored + 10 unscored pretest |
| Time | 2 hours |
| Oral version | 60 multiple-choice items read aloud + 10 reading-comprehension (word-recognition) items; 2 hours |
| Passing standard | Pass/fail per part; no raw cut score is published — the score report shows your standing by category |
| Both parts required | Written (or oral) and the five-skill evaluation; each can be retaken separately |
| Attempts | Three attempts at each part; failing three times means repeating a state-approved training program (California rule; most states match) |
| Window | Both parts passed within 24 months of completing training (California) |
| Outline effective | April 2024, from a 2023 practice analysis |
The Nine Categories and Their Weights
| Group | Category | Share of scored questions | Questions of 60 |
|---|---|---|---|
| Physical Care Skills | Basic Nursing Skills | 35% | 21 |
| Activities of Daily Living | 22% | 13 | |
| Self Care / Independence | 7% | 4 | |
| Psychosocial Care Skills | Emotional and Mental Health Needs | 8% | 5 |
| Spiritual and Cultural Needs | 2% | 1 | |
| Role of the Nurse Aide | Client Rights | 8% | 5 |
| Communication | 7% | 4 | |
| Member of the Health Care Team | 6% | 4 | |
| Legal and Ethical Behavior | 5% | 3 |
Physical Care Skills is 64% of the exam on its own. If your study time is limited, Basic Nursing Skills and ADLs together — 34 of the 60 scored questions — are where it should go.
Basic Nursing Skills (35%)
The biggest category covers infection control, safety and emergencies, data collection and reporting, and the basic technical care an aide gives. The questions are practical: which action prevents the spread of infection, what you do first when a resident falls, which observation you must report at once.
- Infection control — hand hygiene for at least 20 seconds with soap and water (always after using the toilet, before eating, and when hands are visibly soiled — alcohol rub otherwise); standard precautions for every resident; gloves for any contact with blood, body fluids, mucous membranes or broken skin; gown, then mask, then eye protection, then gloves going on; gloves off first coming off. Linen held away from the uniform, never shaken. Sharps into the sharps container only.
- Safety — call light within reach and bed in the low position every time you leave; wheels locked before any transfer; non-skid footwear; wipe spills at once; the resident is never left alone on a bedpan, in a tub or on a scale. Fire: RACE (rescue, alarm, contain, extinguish) and PASS for the extinguisher.
- Restraints — used only with a physician's order for the resident's safety, never for staff convenience; checked at least every 15 minutes and released for repositioning, toileting and exercise at least every two hours; two fingers should fit under the strap; tied to the bed frame with a quick-release knot, never to a rail.
- Data collection and reporting — measure and record vital signs, weight, intake and output; report any change from the resident's usual condition to the nurse immediately, in objective terms (what you saw, heard, measured), not conclusions.
- Technical care — positioning and turning at least every two hours, range of motion, applying elastic stockings, catheter care, collecting specimens, measuring output, warm and cold applications as directed.
Activities of Daily Living (22%) and Self Care / Independence (7%)
Hygiene, dressing, grooming, nutrition and hydration, elimination, rest and sleep, comfort — and, in the smaller category, everything about letting the resident do as much as possible for themselves.
- Bathing and skin — water at a comfortable temperature checked before use; wash from cleanest to dirtiest, eyes from the inner corner outward with a fresh part of the cloth; pat dry, especially skin folds and between toes; inspect skin for redness that does not fade, the first sign of a pressure injury.
- Dressing — weak or affected side dressed first and undressed last; encourage the resident to choose clothing.
- Nutrition — resident upright (Fowler's or in a chair) for meals; identify each food for a resident with a visual impairment using the clock method; small bites, alternate solids and liquids, check for pocketing; thickened liquids exactly as ordered; stay upright for at least 30 minutes after eating to lower aspiration risk.
- Hydration and I&O — 1 ounce is 30 mL; a cup is 240 mL; record everything liquid at room temperature, including ice cream and gelatin; report intake far below what is expected and any output under about 30 mL an hour if you are asked to monitor it.
- Elimination — privacy, prompt answers to the call light, perineal care front to back, catheter bag below bladder level and off the floor, never disconnect the tubing.
- Independence — set up and encourage rather than do; use assistive devices (built-up utensils, reachers, grab bars); allow extra time; praise effort. Restorative care is about ability, not speed.
Emotional, Mental, Spiritual and Cultural Needs (10%)
Confusion, dementia, depression, grief, anger and the resident's beliefs. The exam favours the response that validates feelings, keeps the resident safe and does not argue. With a resident who has dementia: approach from the front, one short instruction at a time, do not correct their reality, redirect rather than restrain, and keep routines. A resident who talks about dying or wanting to die is reported to the nurse at once. Spiritual and cultural needs are met by asking, not assuming — and by never imposing your own beliefs.
Role of the Nurse Aide (26%)
- Client rights (8%) — privacy and confidentiality, informed choice, freedom from abuse, neglect and restraint, the right to refuse care, to see their own records, to voice grievances, to keep personal possessions. Knock before entering. A resident who refuses a bath is not forced — you explain, offer again later and tell the nurse.
- Communication (7%) — face the resident, speak clearly at eye level, use open-ended questions, listen; for hearing impairment lower your pitch rather than shouting; for a resident with aphasia allow time and use yes/no questions; document objectively and report changes verbally to the nurse.
- Member of the health care team (6%) — the aide works under the supervision of the nurse, follows the care plan, reports rather than diagnoses, and never performs a task outside the aide's scope: no medications, no injections, no changing sterile dressings, no taking verbal orders from a physician, no telling the family a diagnosis.
- Legal and ethical behaviour (5%) — abuse (physical, verbal, sexual, financial), neglect and involuntary seclusion; the aide is a mandated reporter and reports suspected abuse to the nurse or supervisor at once. HIPAA: no resident information shared with anyone not involved in care, including on social media. Never accept gifts or money from residents.
The Numbers the Questions Turn On
| Fact | Value the exam expects |
|---|---|
| Hand washing | At least 20 seconds of friction; fingertips down; paper towel to turn off the tap |
| Adult pulse | 60–100 beats per minute; count a full minute if irregular |
| Adult respirations | 12–20 per minute; count without telling the resident |
| Blood pressure | Below 120/80 is normal; report readings the nurse defines as out of range for that resident (often above 140/90 or a large change) |
| Oral temperature | About 97.6–99.6 °F (36.5–37.5 °C); rectal about 1 °F higher, axillary about 1 °F lower |
| Repositioning | At least every 2 hours in bed; every hour or less in a chair |
| Head of bed for meals and tube feeding | Upright for meals (Fowler's, 45–90°); at least 30° during and after tube feeding |
| After a meal | Upright for at least 30 minutes |
| Restraint checks | Every 15 minutes; release and reposition at least every 2 hours |
| Fluids | 1 oz = 30 mL; 1 cup = 240 mL; 1 L = 1,000 mL |
| Catheter bag | Below the bladder, off the floor; emptied at the end of every shift and when two-thirds full |
| Elastic stockings | Applied before the resident gets up in the morning, smooth with no wrinkles |
| Skin check | Every time you bathe or reposition; redness that does not fade after pressure is relieved is reported |
| Written exam | 70 questions, 60 scored, 2 hours; oral version 60 + 10 |
How to Read the Questions
- Find the category. Most stems belong to one outline category, and that tells you the rule being tested — a question with gloves in it is infection control; one with a resident who says "no" is client rights.
- Look for the safest action within your scope. If two answers both seem kind, choose the one that keeps the resident safe and stays inside what an aide may do.
- Prefer the resident's dignity and choice over efficiency: "ask which shirt she prefers" beats "choose a shirt quickly so she is not late".
- Distrust absolutes. "Always", "never" and "all residents" are usually wrong unless the rule really is absolute (hand hygiene, standard precautions, reporting abuse).
- Answer every question. There is no penalty for guessing, and two hours is generous — use the time to reread the stems you flagged.
Frequently Asked Questions
How many questions are on the CNA written exam?
Seventy multiple-choice questions, of which 60 are scored and 10 are unscored pretest items, with a two-hour limit. The oral version has 60 questions read aloud plus 10 word-recognition items.
What score do I need to pass?
NNAAP does not publish a raw cut score. Each part is reported as pass or fail, and the written score report shows how you did in each content category so you know what to study for a retake.
What is the biggest topic on the CNA written test?
Basic Nursing Skills at 35% — infection control, safety, data collection and reporting, and basic technical care. Activities of Daily Living is next at 22%. Together they are 34 of the 60 scored questions.
Can I take the CNA exam orally?
Yes. The oral examination presents the same content through headphones, 60 questions plus 10 reading-comprehension items, in two hours. The candidate handbook includes a self-assessment reading test to help you decide; you choose the format when you register.
How many times can I retake the CNA exam?
Three attempts at each part. In California both parts must be passed within 24 months of finishing training; after three failures of either part you must complete a state-approved training program again before retesting. Other states' limits are similar but not identical — check your state's handbook.
Sources
- 2024 NNAAP Written (Oral) Examination Content Outline, effective April 2024 — the nine categories, their percentages and item counts, and the exam composition (70 items, 10 pretest; oral 60 + 10).
- California Nurse Assistant Candidate Handbook (Credentia; online edition, Northern California) — time limits, the oral-examination format, attempt limits and the 24-month window, score reporting.
- The care rules and reference values are the standard content of state-approved nurse-aide training programs and the federal nursing-home regulations (42 CFR 483) they are built on; they paraphrase, and do not reproduce, any outline or handbook text or sample question.
