What You Need to Know to Prepare for the Certified Nursing Assistant Exam 

The Certified Nursing Assistant Examination, referred to as the exam, consists of  both a written examination (the WE) and the clinical skills test (the CST). 
The written (oral) examination content outline, effective 2016, also known as the National Nurse Aide Assessment Program (NNAAP), is published by the National Council of State Boards of Nursing (NCSBN). The examination content is based  on a national survey of the most important findings of the components of nurse  aide practice (Table 1.1). The content and its weight on the examination follows: 

The National Nurse Aide Assessment Program (NNAAP) Written  (Oral) Examination Content Outline 
Content Domain - Weighting of Content 

I. Physical Care Skills

A. Activities of Daily Living

1. Hygiene

2. Dressing and Grooming

3. Nutrition and Hydration

4. Elimination

5. Rest/Sleep/Comfort

14% of exam

Handwashing; Risk Factors
Dehydration; Dietary Restrictions; Feeding Complications
Incontinence Care
Reporting Pain

B. Basic Nursing Skills

1. Infection Control

2. Safety/Emergency

3. Therapeutic and Technical Procedures

4. Data Collection and Reporting

39% of the exam

Spread of Infection;
Airborne Precautions;
Biohazards Disposal; PPE
Call System; High Risk, Injury; Fire
Disaster Procedure

C. Restorative Skills

1. Prevention

2. Self-care/Independence

8%  of the exam

BLS; Airway Obstruction
Ambulation; Safety
Safety Alarms

II. Psychosocial Care Skills
A. Emotional and Mental Health Needs 11%  - Loneliness; Isolation
B. Spiritual and Cultural Needs 2% - Signs of Suicide Ideation

III. Role of the Nurse Aide
A. Communication 8%
B. Client Rights 7%
C. Legal and Ethical Behavior 3%
D. Member of the Health Care Team 8%

Client Plan of Care
Client Identification
HIPPA
Dignity
Privacy Confidentiality
Reporting
Workplace Activities

You must successfully pass both the WE and the CST to pass the certification examination. 
Specific details on both the WE and the CST, as well as tips on preparing for each portion,  follow. 

Taking the Written Examination 
The written examination (WE) is a computerized exam with a time limit, usually two hours. 
Test sites are regional or local, depending on the state jurisdiction. We recommend you follow  the instructions given by the testing center without exception and arrive at least 30 minutes  early or, if you’re traveling a long distance, arrive a day early to locate the testing center and  the most judicious travel route to avoid delays. Two forms of identification are required: 
- A current, unexpired driver’s license, state-issued identification card or military ID  card, one of which is a picture ID. You must also present a current photo along with  your readable signature. You should present a name that exactly matches your name as  listed on your Admission-To-Test (ATT) letter. 
- The second form of identification must also have your signature on it. Examples of  second forms of identification include credit cards and Social Security cards. The card  must also have your signature, signed prior to testing day. If any signs of alteration or  damage to the card are suspected, you may be denied admittance to test. 

Taking the Written Examination 
Dress warmly but do not bring anything to the testing area. Leave all personal items (purses,  cell phones, calculators, and so on) outside the testing areas. You will be issued testing materials  as needed. Other helpful tips for a successful testing experience are as follows: 
- Get a good night’s sleep. 
- Don’t work the night before the examination. 
- Avoid alcohol or excessive caffeine before the examination. 
- Eat a light but well-balanced meal (protein, carbohydrates, and fats plus liquids) while  studying and before the exam. You (and your brain) need energy and maximum recall  to be well prepared! Although heavy sugars give you an energy boost, avoid them  because you might experience a sudden dip in blood sugar, causing fatigue and nausea. 

You might also become hungry later when you cannot eat, for example, when taking  the exam. To avoid sudden dips in blood sugar bring protein snacks, such as dry roasted  nuts or cheese crackers. 
- Take your time with the test questions, but pace yourself to finish the examination  within the allotted time. 
- Read each question thoroughly and completely before selecting the best answer. 
- Don’t panic if you are not familiar with a question. Remember the Testing Now Tips  (TNTs) on your Cram Sheet. 
- Believe in yourself; we do! You can succeed! 

Passing scores for the WE vary from state to state. Expect to earn at least a 70% for a passing  score. You might have to wait two to three days for results. If needed, follow directions for  scheduling a repeat the examination. 
To successfully pass the Critical Skills Test (CST), you must earn a score of at least 70% while  following each critical step with 100% accuracy. You should be given the opportunity to correct  any missed checkpoints or other aspects of the skill during your performance; however,  when you have finished a particular skill and progress to the next one, you will not be able to  correct a mistake made on the previous one. If you need to repeat any portion of the CST,  you’ll receive directions from the evaluator regarding subsequent testing opportunities according  to each state’s testing guidelines. 

Some helpful tips for success on the CST are as follows: 
- Practice, practice, practice! 
- Follow each skill/procedure exactly as you learned them in your nurse aide program;  this is not the time to improvise or take shortcuts! 
- Follow safety standards and include them in your skill performance. This includes, but  is not limited to, handwashing, handling of soiled items, and other safety precautions. 

These are examples of indirect care standards that will be evaluated with each skill. For  example, prior to performing a skill, you must actually use water and wash your hands;  the evaluator will tell you after you’ve washed your hands correctly for the first time  that you can tell him or her when you would wash your hands rather than actually  washing them for each subsequent skill. 
- Work confidently and efficiently; you must complete each procedure in a timely  manner. 
- Remember, the skills test is designed to measure your competency; you will not be  given assistance by the evaluator except to remind you of time limitations related to the  skill performance. 
- Imagine getting the good news: You passed! Imagery is a powerful tool to encourage  success. 

Taking the Written Examination 
- Multiple-choice test item: A question offering four options. Test items are designed  to measure your knowledge, attitude, or ability, not to trick you. With the multiple- choice test item, it is possible that you might not like the question or any options in the  item. However, you must choose the best option available and answer the question in  the best way you can. 

Follow these strategies for success in answering test questions. 
- Take your time: A common problem observed in test-takers is failing to read each  question carefully. You might already be thinking of the right answer (option) before  you finish reading the question in its entirety. Slow down and force yourself to finish  reading the question before you select the option; you might be surprised that the  end of the stem contains the most important information needed to select the correct  option you would have otherwise missed by hurrying to record your answer. In other  words, take your time! 
- In your own words: Rethinking the question and answers in your own mind helps you  translate the intent of the question, or what the question is asking and how you would  answer it in words that mean the most to you. After you’ve done so, look for the option  that is closest to the one you thought about; ask yourself whether that option is the  best one available of the four provided. If so, go for it! 
- Stay under the umbrella: Two or more options might be similar and, in your opinion,  part of the answer; however, you can choose only one option. If this occurs, look for  an option that contains a broader choice, an umbrella term, which includes those similar  options and best answers to the question. For example, if the question asks you to  measure the resident’s physical status, you would not select option A (temperature) nor  option B (pulse), nor option C (blood pressure), but option D (vital signs) that includes  the other options. 
- Key into key terms: Very few absolutes occur in patient care, especially when selecting  the best test option. These answers are seldom, if ever correct. For that reason,  look for key words in the options such as always, never, all, only, most, none, every, and  except. If part of the option, choose another one! 
- Opposites attract: Look for opposite options; usually, one of them is correct. 

Example: 
Question: When washing the perineum of the female resident, in which direction  should the washcloth be applied? 
A. From the front to the back of the perineum 
B. From the middle of the perineum to the top of the perineum 
C. From any direction as long as the washcloth is wet and warm 
D. From the back of the perineum to the front 

Option A is the correct answer. Option D is opposite from option A; thus, one of the two  options is most likely the intended correct answer. 
- Feelings, feelings, feelings: When answering a communication-type question or one  requiring a response, choose the option that acknowledges or deals with the resident’s  feelings. 

Example: 
Question: A resident is upset and crying over being admitted to the nursing home. How  should the nurse aide respond? 
A. Tell the resident that this is normal and not to be upset. 
B. Leave the resident alone to cry in private. 
C. Change the subject to help the resident forget her current situation. 
D. Sit with the resident and allow her to talk about her feelings. 
Option D is the correct option because it acknowledges and focuses on the resident’s  feelings. 

- Safety first: If a test item asks you for an immediate response or for deciding what to  do first, choose the option that protects the resident’s safety or well-being. Look for  cues in the question that describe priority actions you would take; for example, 'The  first thing the nurse aide would do is'; 'the most important step the nurse aide would  take is to…'; 'the best action the nurse aide should take is to…', 'which of the following  is the nurse aide’s best response?', and so on. 
- Remember the face value: Avoid reading too much into the test item. You might be  tempted to remember a particular work-related or resident experience or situation  that was very different from the test option you encounter. Read the item at face value,  selecting the best option from the information presented. 
- When all else fails, choose option C: You will encounter questions for which you have  no idea of the answer. If so, and all of the preceding listed strategies fail, give it your  most educated guess. No evidence exists that choosing option C is the best strategy. The  point is, you will not be penalized for guessing, only for not selecting any answer at all. 
With a multiple-choice question, you have four chances to answer it correctly. 

Taking the Clinical Skills Test 
The Clinical Skills Test (CST) is the competency validation portion that most certified nurse- aide candidates dread; it is nerve racking to perform skills in front of a strange skills evaluator. 
A key to success on this test is, once again, to practice at least two hours each day. Review  each skill you’ve learned so that when the performance test day arrives, you can consider it  just another practice day…only for real. Practice helps build confidence; confidence decreases  test anxiety.