1.2 Credentia NNAAP Format

The Two-Part NNAAP Exam

Maryland delivers the National Nurse Aide Assessment Program (NNAAP) through Credentia (via its CNA365 platform); since October 2024 MBON has also approved Headmaster / D&S Diversified Technologies as a second testing vendor to add capacity during the 2026 redesignation, so confirm which vendor your training program uses before you register. Either way the exam checks whether a candidate has the knowledge, skills, and judgment for safe entry-level nursing-home (CNA-I / GNA) work. The structure is fixed: one knowledge exam plus one skills evaluation, and you must pass both to be listed on the registry.

Passing only one part does nothing for employment.

The knowledge exam is taken as a written test, or as an oral test if you request that option on your application. The skills evaluation is separate and is performed in front of a trained Nurse Evaluator. Split your study time accordingly: concepts you answer on screen, and procedures you can perform out loud, in correct order, with resident safety built into every step.

Maryland NNAAP Format (verified against the 2024 Credentia handbook)

What the Knowledge Exam Tests

The NNAAP content outline groups items around four domains: physical care skills, psychosocial care skills, the role of the nurse aide, and basic restorative services. The largest weight sits in physical care and the nurse-aide role. Maryland practice materials emphasize the same pattern — basic nursing skills, personal care (bathing, grooming, toileting), resident rights, documentation, infection control, body mechanics, communication, restorative care, and Maryland-specific scope rules. Treat this credential chapter as scope knowledge, not just paperwork: the exam still tests whether you can recognize safe care.

A reliable answering habit: ask who owns the decision. A CNA/GNA observes, reports, documents facts, and performs delegated basic care. The nurse assesses, changes the care plan, and responds to abnormal findings. That boundary drives the right answer in scenarios about resident refusal, falls, abnormal vital signs, skin changes, intake and output, and ethics. If an option has the aide diagnosing, medicating (outside the CMA path), or altering the plan of care, it is almost always wrong.

What the Skills Evaluation Rewards

The skills test is a performance exam, not a recitation. You are proving you can do the procedure in a resident-safe sequence. The same anchors appear in nearly every skill:

• Hand hygiene at the start and after glove removal — the most commonly tested critical element.
• Explain the procedure and identify the resident.
• Provide privacy (close the door/curtain).
• Protect against falls and contamination throughout.
• Keep the call signal within reach and leave the bed in a low, safe position at the end.

Indirect-care steps (the wash-hands / privacy / call-signal cluster) are scored on every skill, so practicing them as automatic habits protects your score across all five randomly drawn skills. Hand washing itself is a frequently selected stand-alone skill and has strict timed-friction and paper-towel-to-faucet steps that candidates lose points on.

For a failed skills evaluation, the CNA365 score report identifies the five performed skills and marks each satisfactory or unsatisfactory. Any unsatisfactory skill fails that skill, and all five must be satisfactory to pass. Missed critical elements count heavily because they map to real resident harm — for example, omitting hand hygiene or failing to lock a wheelchair before a transfer.

Avoid the Pass-Percentage Trap

Some unofficial prep sites quote a raw written percentage cut score. The official Maryland framing is simpler and safer: pass the Written (or Oral) Examination and pass the Skills Evaluation. Build your plan around the verified facts — 70 written items, 2 hours, 5 skills, 30 minutes, score reports in CNA365, and the retraining rules after repeated failures — not a shortcut percentage.

Practical Prep Sequence

Use this order: (1) learn Maryland credential rules so eligibility and deadlines are clear; (2) drill knowledge domains with practice questions; (3) rehearse the skills list until you can verbalize every safety step while performing it; (4) treat each failed practice run as a score-report rehearsal — identify the missed critical step, redo the entire skill in sequence, and never memorize only the isolated error.

High-Yield Knowledge Topics and the Numbers To Memorize

The written exam rewards a small set of recurring facts. Memorize the normal adult vital-sign ranges, because vitals questions appear in every Maryland sitting:

Other high-yield anchors: the PPE removal order (gloves, goggles/face shield, gown, mask — "dirtiest first," mask last); positioning a resident in Fowler's position (head of bed 45–60°) for breathing or eating; allowing at least 1 inch of urinary-drainage tubing slack and keeping the bag below bladder level; and measuring apical pulse for a full 60 seconds. Resident-rights items center on the Omnibus Budget Reconciliation Act (OBRA) of 1987, which guarantees dignity, privacy, freedom from abuse and unnecessary restraints, and the right to refuse care.

If a question pits efficiency against a resident's right to refuse, the right to refuse wins — document and report it.

Worked Skills Example: Handwashing

Because handwashing is both a critical element and a frequently selected stand-alone skill, rehearse it as a scored sequence: turn on water and wet hands, apply soap, lather with friction for at least 20 seconds keeping fingertips pointed down, rinse from clean (wrist) to dirty (fingertips), dry with a paper towel, and use a dry paper towel to turn off the faucet so you never recontaminate clean hands. Candidates most often lose this skill by touching the faucet bare-handed or by holding hands upward, which lets dirty water run back over clean skin.