What's on the CNA Written Exam? The 2024 NNAAP Content Outline and Its Weights

The 2024 NNAAP outline: three groups, nine content areas

The NNAAP written exam is built on the 2024 NNAAP Written (Oral) Examination Content Outline. Credentia publishes it in each state's handbook. The figures below come from the Pennsylvania page as checked on October 18, 2026. The percentages add up to 100 and the item counts to 60, the number of scored questions. The 10 unscored pretest questions on the 70-question written exam are not part of these counts.

Two things stand out. Basic Nursing Skills and Activities of Daily Living together carry 34 of the 60 scored items, more than half. And the outline does not split the 21 Basic Nursing Skills items among its four topics, so infection control, safety, procedures and reporting all need real attention.

The outline says "Client Rights" because NNAAP handbooks call the person receiving care the client. Federal nursing home rules say "resident," and this guide does too. They mean the same person.

Because the weights are this uneven, practice CNA knowledge-exam questions with explanations and keep a tally of which rows of this table your wrong answers come from.

What each CNA content area asks you to decide

The outline names areas, not question types. Below is Passy's reading of the decision each area usually asks you to make, with one short example for each. The people in the examples are fictional, and the areas overlap: a privacy question during a bath could sit under Activities of Daily Living or Client Rights.

Physical Care Skills: Activities of Daily Living, Basic Nursing Skills, Self-Care

• Activities of Daily Living (22%, 13 items). How to give personal care safely, comfortably and the resident's way, and what to notice while you do it. Example: at the end of your shift, Mr. Ruiz's water pitcher is still full from the morning. Record his intake the way your facility requires and tell the nurse. Federal training rules list "recognizing abnormal changes in body functioning and the importance of reporting such changes to a supervisor" as a basic nursing skill (42 CFR 483.152(b)(2)(iv)). Connect these topics with the personal-care skill groups and practice from your state’s checklist.
• Basic Nursing Skills (35%, 21 items). Which action prevents harm first, and whether a finding goes in the record or needs a report to the nurse now. Example: you count a resident's pulse, and his roommate makes a nonurgent request before you write the number down. Record the pulse promptly, then respond to the request. An emergency takes priority over documentation. A number recorded later from memory is a number the nurse cannot fully trust. Start with CDC’s clinical hand-hygiene guidance, fall prevention and measurements and reporting.
• Self-Care and Independence (7%, 4 items). Whether to do a task for the resident or help the resident do it. Example: Mrs. Patel can brush her own teeth, slowly. Set out her supplies and let her do it. "Promoting residents' independence" is one of the five topics every nurse aide must be trained in before any direct contact with a resident (483.152(b)(1)(iv)). Study it in range of motion and restorative care.

Psychosocial Care Skills: emotional, mental health, spiritual and cultural needs

• Emotional and Mental Health Needs (8%, 5 items). How to respond to feelings and behavior without dismissing, arguing or isolating. Example: Mr. Okafor snaps at you when you come to help him dress, then says he hates needing help. Acknowledge the feeling and give him every choice you can, such as which shirt and in what order. The federal curriculum includes changing your own approach in response to a resident's behavior and supporting choices consistent with dignity (483.152(b)(4)). Practice responding to feelings and preferences in the communication guide.
• Spiritual and Cultural Needs (2%, 1 item). Whether a stated preference should shape the care you give. Example: a resident tells you he does not eat until sundown on certain days and asks that his lunch tray be held. Treat it as care information and tell the nurse, so the plan of care can reflect it. Residents' care plans must incorporate their "personal and cultural preferences" (42 CFR 483.10(c)(3)(iii)). Study it in communication and care near the end of life.

Role of the Nurse Aide: communication, rights, legal and ethical duties, the team

• Communication (7%, 4 items). How to make sure you and the resident understand each other, and what to pass on to the nurse. Example: before you start care, you explain what you are about to do, even though Mrs. Chen rarely answers. Residents have the right to be told in advance about the care they will receive (483.10(c)(4)). Study it in communication with residents, families and the team.
• Client Rights (8%, 5 items). Whether you will protect a resident's choice or privacy when it is inconvenient. Example: a coworker offers to open a resident's mail and read it to her "to save time." The resident decides. She has the right to receive her mail unopened (483.10(h)(2)). Study it in federal resident-rights rule.
• Legal and Ethical Behavior (5%, 3 items). What you must report, how fast, and what you must never do. Example: during morning care you find a bruise on a resident's forearm that nobody can explain. Protect the resident and report it promptly through the facility procedure and any required external reporting route. Do not wait for proof or a supervisor's permission to fulfill a reporting duty. Federal rules list "injuries of unknown source" among the alleged violations a facility must report (42 CFR 483.12(c)(1)). Study it in federal abuse-reporting rule.
• Member of the Health Care Team (6%, 4 items). Working within your training and your assignment, and getting information to the right person. Example: a visitor asks you whether her father's new medicine is working. Tell her the nurse can answer that, and let the nurse know she asked. Study it in the nurse aide's role and delegation.

Two effective dates for the 2024 NNAAP outline

Credentia's own pages disagree on when this outline took effect. As checked on October 18, 2026:

All of these pages describe the same outline, based on the 2019–2020 job analysis of nurse aides, and the Pennsylvania and Tennessee pages print the same percentages. Passy does not pick one date. If the month matters to you, for example because your study materials predate 2024, check the outline page in your own state's handbook and ask Credentia.

Tennessee's knowledge exam uses the same weights

Tennessee calls its written part the "Knowledge" exam. Its outline page uses the same nine percentages as Pennsylvania's, without item counts, but its question count differs from the standard 70, and Credentia's Tennessee pages do not state that count consistently. The written exam format guide lays out both versions and what they mean for pacing.

Why older CNA study guides cite an NCSBN outline

The NNAAP was originally developed by the National Council of State Boards of Nursing (NCSBN), as Credentia's Pennsylvania introduction says. NCSBN's NNAAP page now says it "no longer develops and owns the content for the NNAAP" and refers questions to Credentia, and Credentia's outline pages say the exam "is now developed and managed by Credentia Nurse Aide LLC." The Virgin Islands page adds that the job analysis behind the 2024 outline was published by NCSBN in 2023.

So an older guide that links to an NCSBN outline document is pointing at the exam's previous owner. Use the outline in your state's Credentia handbook instead, and check that your study material is built on the 2024 version.

How the federal training curriculum maps to the nine areas

Federal rules require the written or oral exam to "address each course requirement" in the nurse aide training curriculum (42 CFR 483.154(b)(1)(ii)). The outline does not print a crosswalk, so the right-hand column is Passy's mapping:

Member of the Health Care Team has no single federal heading. It draws on reporting changes to a supervisor and on a rule from the training requirements: students may not perform services they have not been trained for and found proficient in by the instructor (483.152(a)(4)(i)). For how to spread your study time across these areas, see the CNA exam study guide.