NC CNA / NNAAP Exam Flashcards

Q: Who administers the North Carolina CNA exam in 2026?

Credentia administers the NNAAP written test and the 5-skill clinical evaluation for North Carolina Nurse Aide I candidates on behalf of the NC Department of Health and Human Services (NCDHHS). NCDHHS maintains the NC Nurse Aide I Registry; once you pass both portions, your name is added to the registry and you are legally cleared to work as a Nurse Aide I in North Carolina. Register at credentia.com/programs/north-carolina.

Q: How is the NC CNA exam structured?

The NC CNA exam has two parts. The NNAAP written test contains 70 multiple-choice items (60 scored + 10 unscored pretest items) with a 120-minute time limit and uses Pass/Fail scoring. The clinical skills evaluation is 5 skills randomly chosen from the 22-skill NNAAP list and runs about 25-30 minutes; hand washing is always included and every critical step of each assigned skill must be performed correctly.

Q: How does a North Carolina CNA keep their registry listing active?

To stay on the NC Nurse Aide I Registry, you must perform at least 8 hours of paid nursing or nursing-related service for a licensed health care provider within each 24-month renewal period. If you let that lapse, NCDHHS moves your listing to expired status and you must either complete competency re-testing or retake an approved training program before working again as a Nurse Aide I.

Q: How does a North Carolina CNA report suspected abuse, neglect, or exploitation?

North Carolina CNAs are mandatory reporters. Suspected abuse, neglect, exploitation, or misappropriation of a resident's property must be reported immediately to the charge nurse or supervisor and, for vulnerable adults in the community, to the county Department of Social Services under N.C. General Statute 108A-102. Substantiated findings of abuse, neglect, or misappropriation are recorded permanently on the NC Nurse Aide I Registry and prevent employment in any NC nursing facility.

Q: Can I take the NC NNAAP written test online?

Yes. Credentia offers the NC NNAAP written test through OnVUE live online proctoring as well as at in-person Credentia test centers. The 5-skill clinical evaluation must still be completed in person at a Credentia-approved Regional Testing Site because an evaluator has to observe every critical step. Schedule both portions through your Credentia candidate account.

Question 1

NNAAP written test structure

Accepted Answer

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.

Question 2

NNAAP skills evaluation structure

Accepted Answer

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.

Question 3

NC training-hour minimum

Accepted Answer

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.

Question 4

NC retake window

Accepted Answer

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.

Question 5

NC Nurse Aide I Registry renewal

Accepted Answer

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.

Question 6

Substantiated findings on the NC Registry

Accepted Answer

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.

Question 7

Hand washing — minimum lather time

Accepted Answer

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.

Question 8

When alcohol-based hand rub is not acceptable

Accepted Answer

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.

Question 9

PPE donning order

Accepted Answer

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.

Question 10

PPE doffing order

Accepted Answer

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.

Question 11

Standard precautions

Accepted Answer

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.

Question 12

Linen handling rule

Accepted Answer

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.

Question 13

Indirect care opening steps (every NNAAP skill)

Accepted Answer

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.

Question 14

Indirect care closing steps (every NNAAP skill)

Accepted Answer

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.

Question 15

Position for measuring radial pulse

Accepted Answer

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.

Question 16

Counting respirations

Accepted Answer

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.

Question 17

Manual blood pressure cuff placement

Accepted Answer

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.

Question 18

When to recheck or report a blood pressure

Accepted Answer

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.

Question 19

Electronic oral temperature normal range

Accepted Answer

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.

Question 20

Measuring weight on an upright scale

Accepted Answer

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.

Question 21

Bed bath order

Accepted Answer

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.

Question 22

Female perineal care direction

Accepted Answer

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.

Question 23

Mouth care for an unconscious resident

Accepted Answer

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.

Question 24

Denture care

Accepted Answer

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.

Question 25

Dressing a resident with one-sided weakness

Accepted Answer

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.

Question 26

Diabetic foot care

Accepted Answer

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.

Question 27

Fingernail care for a resident

Accepted Answer

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.

Question 28

Catheter bag position

Accepted Answer

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.

Question 29

Indwelling catheter perineal care

Accepted Answer

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.

Question 30

Measuring urinary output

Accepted Answer

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.

Question 31

Two-person transfer with a gait belt

Accepted Answer

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.

Question 32

Ambulating a resident with a gait belt

Accepted Answer

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.

Question 33

Repositioning interval for a bedbound resident

Accepted Answer

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.

Question 34

Body mechanics for lifting

Accepted Answer

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.

Question 35

Passive range-of-motion (PROM) rules

Accepted Answer

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.

Question 36

Why restorative care matters

Accepted Answer

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.

Question 37

Preventing contractures

Accepted Answer

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.

Question 38

Choking — conscious adult

Accepted Answer

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.

Question 39

Aspiration prevention during feeding

Accepted Answer

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.

Question 40

Witnessing a fall

Accepted Answer

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.

Question 41

RACE — fire response

Accepted Answer

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.

Question 42

Reporting a change in condition

Accepted Answer

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.

Question 43

Subjective vs. objective documentation

Accepted Answer

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.

Question 44

Therapeutic communication with a resident

Accepted Answer

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.

Question 45

Communicating with a hearing-impaired resident

Accepted Answer

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.

Question 46

Resident rights under OBRA 1987

Accepted Answer

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.

Question 47

Restraint use rules

Accepted Answer

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.

Question 48

Approaching a resident with Alzheimer's disease

Accepted Answer

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.

Question 49

Sundowning

Accepted Answer

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.

Question 50

Caring for a dying resident — comfort priorities

Accepted Answer

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.

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