Free NC CNA / NNAAP Exam Flashcards

The NC NNAAP written test has 70 items: 60 scored multiple-choice questions plus 10 unscored pretest questions. You have 120 minutes and the result is Pass/Fail. You will not know which 10 items are unscored, so answer every question.

The skills evaluation tests 5 skills drawn from the 22-skill NNAAP list. Hand washing is always one of them and is failed if a single critical step is missed. Every critical step on every assigned skill must be performed correctly to pass.

North Carolina requires completion of an NCDHHS-approved Nurse Aide I program of at least 75 hours before testing. Programs combine classroom theory, skills lab, and supervised clinical practice in a licensed health care setting.

You get up to 3 attempts within 24 months of completing training. After 3 failures or once the 24-month window closes, you must complete a new NCDHHS-approved Nurse Aide I program before retesting.

NCDHHS keeps you on the active registry only if you perform at least 8 hours of paid nursing or nursing-related service for a licensed health care provider within every 24-month period. Volunteer hours and family caregiving do not count.

A substantiated finding of abuse, neglect, or misappropriation of resident property is recorded permanently on the NC Nurse Aide I Registry. NC long-term care facilities are required to check the registry before hire and cannot employ a CNA with such a finding.

On the NNAAP, hand washing requires friction with soap and water for at least 20 seconds, fingertips pointed down, with the faucet turned off using a clean paper towel. Missing the 20-second friction step or recontaminating the hands fails the entire skills test.

Use soap and water rather than alcohol-based rub when hands are visibly soiled, after caring for a resident with C. difficile or norovirus, and before eating. Alcohol does not kill C. diff spores and does not remove visible dirt or blood.

Don PPE in this order: gown, mask or respirator, goggles or face shield, gloves. Gloves go on last so the cuff covers the gown sleeve. Skipping the order on the NNAAP is a critical-step failure.

Remove PPE in this order: gloves, goggles or face shield, gown, mask or respirator. Remove the most contaminated items first, perform hand hygiene immediately after, and never touch the front of any item with bare hands.

Treat every resident's blood, body fluids (except sweat), non-intact skin, and mucous membranes as potentially infectious. Standard precautions apply to all residents at all times regardless of diagnosis and are the baseline for every NNAAP skill.

Hold soiled linens away from your uniform, never shake them, and place them directly into the labeled linen hamper in the resident's room. Carrying soiled linens against your body or into the hallway is a critical infection-control error.

Before any direct care: knock and identify yourself, identify the resident, explain the procedure, provide privacy with the door and curtain, wash your hands, and raise the bed to a safe working height. Missing any opening step lowers your skill score even if the technique is correct.

After any direct care: lower the bed to its lowest position, place the call light and personal items within reach, ask if the resident needs anything else, remove PPE, perform hand hygiene, and document or report the task. Closing steps are scored on every skill.

Place the resident's arm relaxed and supported at heart level on a firm surface, palm down. Count for a full 60 seconds using the index and middle fingers on the radial artery; never use the thumb, which has its own pulse.

Count respirations for a full 60 seconds while keeping your fingers on the resident's wrist as if still taking the pulse. Telling the resident you are counting breathing alters their rate, so observe chest rise discreetly.

Center the cuff bladder over the brachial artery 1 inch (about two finger-widths) above the antecubital space, with the arm supported at heart level. A cuff that is too small produces a falsely high reading; a cuff too large reads falsely low.

Report and recheck before charting if systolic is below 100 or above 140, diastolic is below 60 or above 90, or the reading differs sharply from baseline. On the NNAAP, recording an out-of-range BP without notifying the nurse is a reporting failure.

Normal oral temperature is about 97.6 to 99.6 degrees F (average 98.6). Wait 15 minutes if the resident just ate, drank, smoked, or chewed gum, and place the probe under the tongue in the posterior sublingual pocket.

Balance the scale at zero with the resident off, then have the resident stand still in non-skid shoes or slippers with arms at sides. Record weight to the nearest 0.1 pound and report a gain or loss of 3 or more pounds in 24 hours or 5 pounds in a week.

Wash from cleanest to dirtiest: eyes (inner to outer canthus with plain water), face, neck, arms, chest, abdomen, legs, back, then perineal area last. Change water and washcloth surfaces between regions to prevent cross-contamination.

Always wipe from front (urethra) to back (anus) using a clean area of the washcloth for each stroke. Wiping back to front pulls fecal bacteria toward the urethra and is the leading preventable cause of UTIs in long-term care.

Position the resident in a side-lying position with head turned to the side, use a padded tongue depressor (never your fingers) to keep the mouth open, and clean with small amounts of solution to prevent aspiration. Suction must be readily available.

Clean dentures over a basin lined with a washcloth or filled with water to cushion a drop. Use cool water, not hot, because hot water warps acrylic. Store dentures in a labeled, lidded container with cool water or denture solution when not in use.

Dress the weak side first and undress the weak side last. The weak limb is harder to manipulate inside the garment, so doing it first while the sleeve is empty protects the joint and shoulder from injury.

Wash, rinse, and pat dry — especially between the toes — then apply lotion to the tops and bottoms but never between the toes. Do not cut toenails; report any cut, blister, redness, or sore to the nurse because reduced sensation hides serious wounds.

Soak the hand in a basin of warm water, clean under each nail with an orange stick, file (do not clip) nails straight across, and finish with lotion. CNAs in NC do not cut the nails of residents with diabetes or peripheral vascular disease.

Keep the drainage bag below the level of the resident's bladder at all times and never on the floor. Coil tubing on the bed so it does not loop below the bag; backflow of urine or contact with the floor can cause a catheter-associated UTI.

Clean the catheter from the meatus outward along the first 4 inches of tubing, using a fresh area of the washcloth each stroke. Never tug the catheter; secure it to the inner thigh with leg tape or strap to prevent traction injury.

Pour urine from the bedpan or graduate into a calibrated container, place it on a flat surface at eye level, and record the volume in mL. Wear gloves, rinse and dry the container, and report output under 30 mL/hour to the nurse.

Apply the belt snugly over clothing at the waist with two fingers fitting under it, lock the wheelchair at a 45-degree angle on the resident's stronger side, instruct the resident to push off the bed on the count of three, and pivot together. Never use the belt on residents with a colostomy, recent abdominal surgery, or fractured ribs.

Stand slightly behind and to the weaker side, grasp the belt underhand at the resident's back, and walk in step. If the resident starts to fall, ease them down your bent leg to the floor; never try to hold them upright, which injures both of you.

Reposition at least every 2 hours and check pressure points (sacrum, heels, elbows, ears, occiput) for redness that does not blanch. Use pillows to keep bony prominences from touching each other and the heels floating off the mattress.

Set a wide base of support with feet shoulder-width apart, bend at the hips and knees rather than the waist, hold the load close to your body, push or pull rather than lift when possible, and never twist — pivot the feet to turn.

Support the joint above and below, move each joint slowly and smoothly through its normal range 3 to 5 times, and stop immediately if the resident reports pain or you meet resistance. Begin at the head and work down, one side at a time.

Restorative care preserves the resident's ability to perform ADLs by encouraging the highest level of independent function. Doing tasks for residents that they can do themselves causes disuse atrophy, learned helplessness, and faster physical decline.

Use PROM exercises, proper positioning, hand rolls, and splints as ordered. A contracture (permanent shortening of a muscle or tendon) develops within days of immobility and is largely irreversible once formed, so prevention is the only effective intervention.

If the resident clutches the throat and cannot speak, cough, or breathe, deliver abdominal thrusts (Heimlich) just above the navel until the object is expelled or the resident becomes unresponsive. Call for help; do not leave the resident.

Seat the resident upright at 90 degrees, check that the mouth is empty before the next bite, offer small bites and sips, and keep the resident upright for 30 minutes after eating. Never feed a sleepy or supine resident.

If a resident starts to fall, ease them to the floor along your bent leg. Do not lift them — call the nurse and stay with the resident. The nurse must assess for injury before any movement, and the incident must be documented and reported.

Rescue residents in immediate danger, Activate the alarm, Contain the fire by closing doors and windows, then Extinguish or Evacuate. Rescue always comes first; never re-enter a smoke-filled room.

Report immediately, before charting: new confusion, chest pain, shortness of breath, fever, fall, bleeding, refusal to eat or drink, skin breakdown, or any sudden change from baseline. The CNA observes and reports; the nurse assesses.

Objective data is what you measure or directly observe (BP 132/78, refused breakfast, 200 mL voided). Subjective data is what the resident states, recorded in their own words and in quotation marks ("My stomach hurts"). Never chart your opinion or a diagnosis.

Sit at eye level, use open-ended questions, allow silence, and reflect feelings back to confirm understanding. Avoid "why" questions, false reassurance ("Don't worry"), giving advice, and arguing with a resident who has dementia.

Face the resident at eye level in good light, get attention before speaking, speak in a normal tone and at a normal pace, and rephrase rather than just repeat. Reduce background noise and confirm hearing aids are on and working.

Every long-term care resident has the right to be free from abuse and restraints, to privacy and dignity, to refuse treatment, to manage personal finances, to confidentiality of records (HIPAA), and to voice grievances without fear of reprisal.

Physical and chemical restraints require a current physician order, are used only after less-restrictive alternatives have failed, and must be released, repositioned, and toileted at least every 2 hours. The least restrictive device that achieves safety is required.

Approach from the front in calm light, make eye contact, use the resident's name, speak in short simple sentences, and give one direction at a time. Validate feelings rather than arguing about facts; redirect during agitation.

Sundowning is increased confusion, restlessness, or agitation in residents with dementia during late afternoon and evening. Reduce stimulation, increase daytime light exposure, keep a consistent routine, and avoid caffeine — do not restrain.

Provide frequent mouth care for dryness, reposition for comfort, keep skin clean and dry, control room temperature and lighting, and allow the resident to hear you — hearing is the last sense lost. Honor the resident's and family's spiritual and cultural wishes.