What’s on the CNA Written Exam? Full Topic Breakdown
A complete breakdown of every topic on the CNA written exam — percentage weights, how questions are actually worded, and the test-taking strategies that separate passers from failers.
The written exam at a glance
The CNA written exam is a multiple-choice, computer-based test. Of the 60–70 questions, approximately 50–60 are scored and 10 are unscored “pretest” items being evaluated for future exams. You won’t know which are which — so treat every question like it counts. An oral version (questions read aloud through headphones) is available in most states for candidates who prefer it.
The exam follows the NNAAP (National Nurse Aide Assessment Program) content outline, which organizes the material into 9 domains. Each domain has a specific weight — meaning some topics generate far more questions than others. Understanding these weights is the single most important study strategy: if you master the top 3 domains, you’ve covered 56% of the exam before touching the other 6.
All 9 exam topics, ranked by weight
Each domain below includes its approximate weight, the number of questions you’ll see, the types of questions the exam uses, and specific test-taking strategies for that domain:
The heaviest domain on the entire exam. Questions focus on vital sign measurement techniques (when to use which thermometer type, what constitutes an abnormal reading, how to position a patient for accurate BP), bed making procedures (difference between occupied and unoccupied technique), catheter care steps, specimen collection protocols, and intake/output documentation. The exam loves testing whether you know the correct sequence of steps — not just whether you know the skill exists.
“A CNA is measuring a patient’s blood pressure and gets a reading of 88/56 mmHg. What should the CNA do FIRST?” — The key word is “FIRST.” You’ll be tempted to pick “notify the nurse” but the correct answer is “retake the measurement to confirm” because you should always verify an abnormal reading before reporting.
Strategy: Memorize normal vital sign ranges cold. Know the exact steps for each procedure in order. When a question asks “what should the CNA do FIRST,” the answer is almost always verify, then report.
The second-heaviest domain. Questions hammer hand hygiene timing (before/after gloves, between patients, after touching contaminated surfaces), PPE donning and doffing order (the exam tests doffing more than donning because students mix up the removal sequence), which isolation type requires which PPE combination, and the difference between standard precautions and transmission-based precautions. Bloodborne pathogen questions focus on needlestick response steps.
“A CNA is caring for a patient on droplet precautions. Which PPE is required when entering the room?” — The trap: students who confuse droplet (surgical mask) with airborne (N95 respirator). Know the three isolation types cold: contact = gown + gloves, droplet = surgical mask, airborne = N95.
Strategy: The hand hygiene answer is almost always correct when it appears as an option. If a question involves infection risk and one answer mentions hand washing, pick it unless another answer is more immediately life-saving.
Questions center on proper bathing technique (water temperature, washing direction from cleanest to dirtiest), dressing assistance (affected side first on, unaffected first off — the exam tests this repeatedly), feeding safety (positioning at 45–60 degrees to prevent aspiration, never rushing), oral care procedures (including denture care), and the principle of promoting patient independence. The exam frequently tests whether you’d do something FOR the patient versus help them do it THEMSELVES.
“A patient with left-sided weakness needs help putting on a shirt. The CNA should put the shirt on which arm FIRST?” — Answer: the LEFT (affected/weak) arm first. When dressing: affected side first. When undressing: unaffected side first. This rule appears on nearly every CNA exam.
Strategy: When in doubt, choose the answer that promotes the patient’s independence. “Assist the patient” beats “do it for the patient” almost every time.
This domain tests your knowledge of OBRA regulations, the Patient Bill of Rights, informed consent, advance directives, privacy/confidentiality, restraint rules, and your responsibilities as a mandatory reporter for abuse and neglect. The exam loves scenario-based questions where you must identify the correct ethical response — especially situations where a patient refuses care, a family member asks for confidential information, or you witness potential abuse.
“A patient’s daughter asks the CNA about her mother’s medical condition. What should the CNA do?” — The answer is always redirect to the nurse. CNAs do not share medical information with family members, even close relatives, without the patient’s explicit consent. This is a HIPAA/confidentiality question.
Strategy: When a question involves a patient’s rights, the correct answer always protects the patient’s autonomy, dignity, and privacy — even when the patient’s choice seems unwise.
Questions cover fall prevention protocols, fire safety acronyms (RACE and PASS), choking response for conscious vs. unconscious adults, seizure management (what to do AND what NOT to do), safe body mechanics for lifting and transfers, gait belt usage, and restraint regulations. The exam particularly tests what you should NOT do during emergencies — restraining a seizing patient, putting objects in their mouth, or moving a fall victim before assessment.
“A patient is having a seizure. What should the CNA do?” — Wrong answers always include restraining the patient or placing something in their mouth. Correct answer: protect from injury, turn on side if possible, time the seizure, call for help. Never restrain.
Strategy: Safety questions often test what NOT to do. Read all options carefully — the wrong answers usually contain one dangerous action disguised as helpful.
Questions test active listening, how to communicate with patients who have sensory impairments (hearing: face them, reduce noise, speak clearly; vision: identify yourself, describe what you’re doing), objective vs. subjective reporting to nurses, documentation accuracy, and cultural sensitivity. The exam also tests common medical abbreviations — NPO, BID, PRN, ADL, I&O, and VS are the most frequently tested.
“A CNA notices a patient seems sad and withdrawn today. What should the CNA document?” — The answer uses objective language: “Patient refused breakfast, remained in bed, did not participate in activities” NOT “Patient is depressed.” CNAs document observations, not diagnoses.
Strategy: If an answer choice uses diagnostic language (“the patient is depressed/anxious/confused”), it’s almost always wrong. The correct answer describes observable behavior.
The two smallest domains combined account for about 10% of the exam. Restorative skills questions cover range of motion exercises, preventing immobility complications (pressure ulcers, contractures, blood clots), and rehabilitation principles. Health care team questions test your understanding of the CNA scope of practice — specifically what you CAN and CANNOT do, who you report to, and when to delegate vs. when to act independently. The exam frequently presents scenarios where a patient or family member asks you to do something outside your scope.
“A patient asks the CNA to adjust their oxygen flow rate. The CNA should…” — Wrong: adjust the oxygen. Right: explain that adjusting oxygen is outside the CNA scope and notify the nurse. CNAs never adjust medical equipment settings.
Strategy: If a question asks whether you should perform a clinical task (medications, oxygen, wound care, IV adjustments), the answer is almost always “notify the nurse.” CNAs observe and report — they don’t treat.
Maslow’s Hierarchy of Needs appears on virtually every CNA exam — know the five levels and that physiological needs (food, water, oxygen) always come first. Questions also cover dementia care approaches (don’t argue, redirect, maintain routines), recognizing signs of depression, end-of-life care principles (comfort over cure), and grief stages (Kübler-Ross model). The exam tests whether you understand that emotional care is part of your job, not just physical care.
“A confused dementia patient insists her deceased husband is coming to visit. The CNA should…” — Wrong: correct the patient or explain her husband is dead. Right: redirect the conversation gently or ask the patient to tell you about her husband. Never argue with a confused patient.
Strategy: For Maslow questions, always address the lowest unmet need first. A hungry, anxious patient needs food before a counseling conversation.
6 wrong-answer traps the exam uses
CNA exam questions are designed to have multiple plausible-sounding answers. Here are the patterns test writers use to trick you — once you recognize them, your score jumps immediately:
The “right but not first” trap
Questions asking what to do “FIRST” will include actions that are correct but not the immediate priority. Notifying the nurse is important — but confirming an abnormal vital sign comes first. Read for priority keywords.
The “sounds caring but is wrong” trap
“Comfort the patient by explaining…” sounds compassionate, but if the correct action is to report to the nurse immediately, compassion isn’t the right answer. Caring doesn’t override protocol.
The “scope creep” trap
Answers that have you performing tasks outside CNA scope (adjusting meds, interpreting results, giving medical advice) sound proactive but are always wrong. When in doubt, “notify the nurse” is correct.
The “absolute word” trap
Answers containing “always,” “never,” “all,” or “none” are usually wrong in healthcare. Clinical care has exceptions. Answers with “usually,” “most,” or “generally” are more likely correct.
The “similar options” trap
When two answer choices sound almost identical, one of them is usually correct. The test writers included both to see if you know the specific difference. Focus on the exact wording distinction.
The “diagnosis” trap
Any answer that uses diagnostic language (“the patient has pneumonia,” “the patient is dehydrated”) is wrong for CNAs. You describe symptoms and observations — you never diagnose. Correct answers use objective language.
Time management on test day
You have 90 minutes for 60–70 questions. That’s roughly 1 minute and 20 seconds per question. Here’s how to pace yourself:
Approximately 10 of your questions are unscored “pretest” items being evaluated for future exams. You won’t know which ones they are. Some may feel unusually hard or cover obscure topics — that’s often a sign they’re pretest questions. Don’t panic if you encounter a question on something you’ve never heard of. Answer it as best you can and move on. It probably doesn’t count anyway.
5 golden rules for CNA exam questions
1. Patient safety is always the top priority. When stuck between two plausible answers, choose the one that protects the patient from immediate harm. Safety trumps comfort, education, and efficiency every time.
2. “Notify the nurse” is correct more often than you think. Whenever a question involves clinical judgment, medication, abnormal findings, or anything outside basic care — the answer is report to the nurse. CNAs observe and report. Period.
3. Read the question stem twice. The difference between “what should the CNA do FIRST” and “what should the CNA do” is enormous. “First” means the immediate action. Without “first,” it means the best overall action. One word changes the correct answer.
4. Eliminate two wrong answers immediately. On most CNA questions, two of the four options are clearly wrong if you read carefully. Once you eliminate those, you’re choosing between two — a 50/50 chance even if you’re unsure.
5. When two answers seem equally correct, choose the one that’s more specific. “Check the patient’s ID band” is more specific (and more correct) than “identify the patient.” Specific, actionable answers beat vague, general ones.
Frequently asked questions
What topics are on the CNA written exam?
The CNA written exam covers 9 domains: Basic Nursing Skills (22%), Infection Control (18%), Activities of Daily Living (16%), Patient Rights and Ethics (14%), Safety and Emergencies (12%), Communication (10%), Mental Health and Social Needs (8%), Restorative Skills (6%), and Health Care Team (4%). The top three domains alone account for 56% of the exam.
What is the hardest topic on the CNA exam?
Most students report that Infection Control and Patient Rights are the trickiest domains — not because the content is difficult, but because the questions use subtle wording differences to test precise knowledge. For example, knowing the difference between droplet and airborne precautions, or understanding exactly when a patient can refuse care. Basic Nursing Skills has the most questions but students who practiced clinicals usually find those questions straightforward.
Are there trick questions on the CNA exam?
Not intentionally, but the exam uses carefully worded questions where multiple answers seem correct. The “trick” is usually in one keyword: “FIRST,” “BEST,” “MOST important,” or “PRIORITY.” These signal that more than one answer is partially correct but only one is the highest priority action. Reading the question stem carefully — especially the last sentence — prevents most mistakes.
What are pretest questions on the CNA exam?
Approximately 10 of the 60 to 70 questions on the CNA exam are unscored pretest items. These are new questions being evaluated for use on future exams. They do not count toward your score. You cannot tell which questions are pretest items so you should answer every question to the best of your ability. If you encounter a question on an obscure topic you never studied, it may be a pretest item.
What score do I need to pass the CNA written exam?
Most states require a passing score of 70 to 75% on the written exam. This means correctly answering approximately 42 to 53 out of 60 to 70 scored questions depending on your state and testing vendor. Some states use a scaled scoring system where the passing threshold adjusts based on question difficulty. Your testing vendor will tell you the exact passing standard for your state.
How should I study for the CNA written exam?
Focus on the three highest-weighted domains first: Basic Nursing Skills, Infection Control, and ADLs — these make up 56% of the exam. Use our CNA study guide for topic-by-topic content review and our free practice test to identify weak areas. Follow a structured 4-week study schedule and aim to score 80% or higher on practice tests before scheduling your real exam.
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