9 content areas · 2024 outline · 4-week plan
CNA study guide: what the written exam covers, area by area
The written exam tests nine content areas, and two of them, Basic Nursing Skills and Activities of Daily Living, carry 57% of the scored items under the 2024 NNAAP outline. This guide shows what each area asks, how the best answer gets picked, and how to cover it all in four weeks of short sessions between shifts.
- 9content areas in the 2024 NNAAP outline
- 35%Basic Nursing Skills, the largest area (NNAAP 2024)
- ≈34 of 60NNAAP scored items from Basic Nursing Skills and ADL
The blueprint
What the written exam covers: nine areas in three groups
The written exam covers physical care, psychosocial care and the role of the nurse aide, split into nine areas. In NNAAP states the split is fixed by a published outline that took effect in April 2024. It counts only the 60 scored items; the 10 unscored pretest items on the 70-item NNAAP test are not part of it.
| Content area | Weight | ≈ Items of 60 | Share |
|---|---|---|---|
| Physical Care Skills · 64% | |||
| Activities of Daily Living | 22% | 13 | |
| Basic Nursing Skills | 35% | 21 | |
| Self Care / Independence | 7% | 4 | |
| Psychosocial Care Skills · 10% | |||
| Emotional and Mental Health Needs | 8% | 5 | |
| Spiritual and Cultural Needs | 2% | 1 | |
| Role of the Nurse Aide · 26% | |||
| Communication | 7% | 4 | |
| Client Rights | 8% | 5 | |
| Legal and Ethical Behavior | 5% | 3 | |
| Member of the Health Care Team | 6% | 4 | |
NNAAP written content outline, effective April 2024 (60 scored items). Prometric and Headmaster/D&S outlines are similar, not identical.
Read the table as a time budget. Physical Care Skills is 64% of the test, Role of the Nurse Aide 26%, Psychosocial Care 10%. Spiritual and Cultural Needs is about one scored item, so it gets an evening, not a week.
Check the date on any guide you use
The 2016 outline gave Basic Nursing Skills 39% and ADL 14%, and called Self Care/Independence Restorative Skills. A guide that still uses that name was built before the 2024 change. Prometric and Headmaster/D&S publish their own outlines, close to NNAAP but not identical, so check your vendor's candidate handbook for your version.
Area guides
Study it area by area
Start with the two biggest areas; each has a full guide with practice cards at the end. The other five areas are summed up in the table under the cards, with what each one asks and the trap that costs points, and every area has its own chip in the practice deck.
- 35% of the testBasic Nursing SkillsInfection control, falls and restraints, fire and choking, vital signs in context, and what to report versus record.
- 22% of the testActivities of Daily LivingBathing, peri-care, mouth and denture care, feeding, toileting and comfort, with dignity built into every step.
- 7% of the testSelf Care & Independence (restorative)Canes, walkers, gait belts, range of motion and letting the resident do as much as they can.Summary in the table below
- 8% + 2% of the testEmotional, Mental Health, Spiritual & Cultural NeedsDementia, depression, grief and dying, religious diets and requests for clergy.Summary in the table below
- 7% of the testCommunicationHearing and vision loss, aphasia, language barriers and open, feeling-reflecting answers.Summary in the table below
- 8% + 5% of the testClient Rights, Legal & Ethical BehaviorOBRA resident rights, abuse reporting, restraints, scope of practice, charting and tips.Summary in the table below
- 6% of the testMember of the Health Care TeamDelegation, the care plan, the chain of command and reporting changes.Summary in the table below
| Content area | What the questions ask about | The trap |
|---|---|---|
| Basic Nursing Skills | Hand hygiene and PPE, falls, restraints, fire, choking, vital signs, specimens, reporting | Reporting a normal reading when the key is to record it |
| Activities of Daily Living | Bathing, peri-care, oral and denture care, dressing, feeding, elimination, rest | Rushing the resident or skipping privacy to finish faster |
| Self Care/Independence | Ambulation aids, range of motion, bladder retraining, preventing immobility problems | Doing the task for the resident because it is quicker |
| Emotional and Mental Health | Dementia, sundowning, depression, anxiety, grief, adjusting to placement | Arguing with a confused resident or correcting them bluntly |
| Spiritual and Cultural | Religious diets and practices, clergy requests, preferences about touch and family | Calling the minister yourself instead of telling the nurse |
| Communication | Hearing loss, aphasia, language barriers, open questions, handoff | Shouting, or answering feelings with "cheer up" |
| Client Rights | Privacy, choice, refusal, mail, personal funds, abuse, restraints | Forcing care because "it is policy" |
| Legal and Ethical | Scope of practice, negligence, assault versus battery, gifts and tips, charting | Taking a tip, or asking the nurse about it, instead of refusing politely |
| Health Care Team | Delegation, the care plan, chain of command, time management | Accepting a task you were never trained to do |
Topic lists follow the 2024 NNAAP outline. Other vendors group topics a little differently.
High-yield
Side rails that stop a resident from getting out of bed count as a restraint under federal resident-rights rules (42 CFR 483.10). Items on restraints show up in Basic Nursing Skills and Client Rights, so the same fact can earn points in two areas.
The priority ladder
How the keyed answer is chosen
Every vendor writes the same kind of item: four options, one best answer, no "all of the above". Often two options look decent. The keyed one wins on a fixed order of priorities, and once you know that order you can work out items you have never seen.
Higher rung wins
1. Client safety
If someone could be hurt in the next minute, that option wins. A fire: remove the client first. A resident on the floor: stay, call for the nurse, do not lift.
2. Rights and dignity
Choice, privacy, refusal. A resident who refuses a clothing protector keeps that choice. Knock, close the curtain, hand over mail unopened.
3. Scope: get the nurse
Anything that needs a nurse's judgment: new pain, red streaks in stool, a skin change, a request for clergy. You observe and report. You do not diagnose, give medications or adjust oxygen.
4. Infection control
Hand hygiene, gloves for the right reasons, linen that touched the floor goes to the soiled hamper.
5. Comfort and independence
Let the resident do as much as they can. Doing everything for them is the classic wrong answer.
"Report to the nurse" is not a free point
Cheap prep keys it by reflex; the real test does not. A normal finding such as an SpO2 of 95% gets recorded. A refusal gets respected and re-offered later. A tip gets politely refused. A catheter bag with little urine gets a check for kinked tubing first.
The ladder also tells you when reporting does win. In the example below, respecting the refusal sits on rung 2, but a week-long change in behavior is a change in condition, and that is the nurse's call.
Client rights · refusal or change?
A resident who always enjoyed bingo has refused all activities for a week and stays in her room. The nurse aide SHOULD:
- respect her choice and say nothing more
- insist she go to bingo to cheer her up
- ask her roommate to talk her into going
- tell the nurse about this change (best answer)
A single refusal is her choice, but a sudden withdrawal from things she enjoyed is a change in behavior that can signal depression or illness, so the nurse must know. Saying nothing respects the choice but misses the change. Pushing her or using a roommate to persuade her ignores her right to refuse.
Why the others lose
- One skipped game is her choice. A week of withdrawal from something she loved can signal illness or depression, so saying nothing misses it.
- Insisting overrides her right to refuse, and cheering her up does not find out why she stopped.
- Sending the roommate to persuade her pressures her choice and pulls someone outside the care team into it.
The plan
A 4-week study plan that fits around shifts
Four weeks of 20-minute sessions, five days a week, covers the outline in weight order. Do the hard area before a shift, when you are fresh, and keep the after-shift session for review cards, because nobody learns restraint rules well at 7:30 a.m. after a night on the floor.
Week 1: Basic Nursing Skills
21 of the 60 scored NNAAP items. Read the Basic Nursing Skills guide, infection control and safety first, then vital signs and reporting. Drill that chip in the deck every day.
Week 2: Daily care and independence
ADL and Self Care/Independence, 17 scored items together. Work through the activities of daily living guide. Practise saying each step out loud as if a resident were listening: knock, explain, privacy, let them help.
Week 3: Psychosocial and the aide's role
The remaining 22 items: mental health, spiritual and cultural needs, communication, rights, legal and ethical, the team. These are ladder questions, so name the rung that decides each one before you check the back of the card.
Week 4: Timed mocks and the skills half
Sit one timed mock early in the week, re-deal what you missed, then sit a second. Spend the other evenings on the skills test steps and on your vendor's handbook: what to bring and what name your ID must match.
One 20-minute session
- Pick one content-area chip, not "All"
- Answer about ten cards and read every rationale, the right ones too
- Send any card you guessed on to the back of the deck
- Write the rule behind each miss on one line of a pocket notebook
- Stop when the timer goes off, even mid-streak
Sit the mock like the real room
A quiet table, phone in another room, water within reach but not a full bottle, restroom first. Try to sit it at the same time of day as your appointment, so your brain is used to working then.
Free practice
Use the practice deck as flashcards
The free practice deck already works like flashcards: answer a card and the rationale appears on the back. Filter by content area, push a card you guessed to the back of the deck, and restart when the pile is clean. It holds 60 practice questions written in the style of the NNAAP and Prometric written tests. They are original, not questions from any real exam.
Do you need a study book?
No. A book helps if you study best on paper or lose signal on the bus, but your training-program textbook plus practice questions covers the same outline. If you buy or borrow one, check it before you read it.
Before you trust a study book
- It follows the 2024 outline: Self Care/Independence, not Restorative Skills
- Practice items have four options and one best answer, with no "all of the above"
- Every answer comes with a written explanation of why it wins
- Fees, dates and pass scores, if printed, are marked as varying by state
- The skills section says your vendor's list is the one that counts
Note
The one document every candidate should read is the candidate handbook from the vendor that runs your state's test. It lists the format, the skills you may be asked to perform, what to bring and the ID rules. Vendors change contracts (California moved to Headmaster in 2025), so get the current edition from your state's vendor.
Study guide questions people ask
What is the best CNA study guide?
One built on the current outline for your test (the 2024 version in NNAAP states), with an explanation for every practice answer, used alongside your vendor's candidate handbook. A free guide that meets those points does the job; price does not make a guide more accurate.
What are the new CNA 2026 exam questions?
Vendors release sample items in their handbooks but keep live exam questions private, so anything sold as "real 2026 questions" is practice material. The most recent change in NNAAP states is the outline that took effect in April 2024: ADL went up, Basic Nursing Skills went down, and Restorative Skills became Self Care/Independence. As of Oct 2026, that outline is still the one to study from.
What is the NNAAP examination?
The National Nurse Aide Assessment Program is NCSBN's nurse aide test, delivered by Credentia (it took over from Pearson VUE) in about 25 states as of Oct 2026. The written version has 70 multiple-choice items, 60 scored, in 2 hours; the oral version has 60 multiple-choice plus 10 word-recognition items. A skills test is the second part. More on the NNAAP exam page.
How long should I study for the written exam?
Four weeks of 20-minute sessions, five days a week, is enough to work through the outline once and review your misses. Take longer if your timed mocks still show a weak area at the end of week 4.
Does this guide cover the skills test?
This page covers the written half. The skills test page explains how the hands-on part runs and the steps graders look for, but your vendor's handbook has the skill list for your state.