North Carolina - NURSE AIDE I

North Carolina

NURSE

AIDE I

Written (or Oral) Examination

& Skills Evaluation

Candidate Handbook

February 2022

verNCNA1.0

QUICK REFERENCE

NORTH CAROLINA DEPARTMENT OF HEALTH

AND HUMAN SERVICES

Health Care Personnel Education

and Credentialing Section

2709 Mail Service Center

Raleigh, NC 27699-2709

1-919-855-3969

Fax: 1-919-733-9764

Hours of Operation: 8:00 a.m. – 5:00 p.m.

(Eastern Time Zone, Weekdays)

The phone lines will be open between

8:00 am - 12:00 p.m. and 1:00pm - 3:00pm

Go to NC DHHS website https://ncnar.ncdhhs.gov/

for additional information

REGISTRATION AND SCHEDULING SERVICES

North Carolina NNAAP

1-888-723-6773

Hours of Operation: 8 a.m. – 11 p.m.

(Eastern Time Zone, Weekdays)

Saturday 8 a.m. – 5 p.m. & Sunday 10 a.m. – 4 p.m.

Call to:

• Schedule, reschedule or cancel an examination

• Request an excused absence

• Ask questions about On-Line Registration

• Obtain information regarding your Score Report

• Obtain information regarding your examination

Go to Credentia’s website at

www.credentia.com/test-takers/ncna to:

• Access your CNA365 account to register to take an

exam.

• To view most current exam updates

• Download a Candidate Handbook

• View the Nurse Aide Practice Written Examination

Credentia does not discriminate on the basis of age, sex, race, creed,

disabling condition, religion, national origin, or any other protected characteristics.

NNAAP® Written Exam Content Outline and Practical Skills Listing

TABLE OF CONTENTS

Quick Reference .................... inside front cover

Introduction ................................................... 1

National Nurse Aide Assessment Program . 1

Exam Overview ............................................... 2

Eligibility ....................................................... 3

North Carolina State-Approved Nurse Aide I

Trained Candidates (E1) .................................. 3

North Carolina State-Approved Refresher

Course Trained Candidates (E3) .................... 3

North Carolina State-Approved Student Nurse

Training Candidates (E5) ................................ 4

Other Trained (E8) .......................................... 4

Trained Out of State (E9) ............................... 4

NC Registry Candidates (E10) ....................... 5

Out-of-state Registry Candidates (E11) ........ 5

Regristration and Scheduling ......................... 6

Exam Fees .......................................................... 7

Exam Scheduling .............................................. 7

Accommodations .............................................. 8

Testing Locations .............................................. 8

Cancellation and Rescheduling ...................... 9

Refunds ............................................................... 9

Absence Policy ................................................... 9

Weather Emergencies ..................................... 10

Exam Day (Online Exam) ............................ 10

What You'll Need ............................................ 10

Before Exam Day ............................................ 11

On Exam Day .................................................. 11

Exam Day (Test Center Exam) ..................... 12

Proper Identification ...................................... 12

Security ............................................................ 14

Testing Policies ............................................... 14

Lateness ......................................................... 14

Electronic Devices ...................................... 15

Study Aids ..................................................... 15

Eating/Drinking/Smoking ....................... 15

Misconduct ................................................... 15

Guests/Visitors ............................................ 15

continued on next page

The Written (or Oral) Exam ......................... 16

Written Exam ................................................... 16

English or Spanish Oral Exam ..................... 16

Written (or Oral) Exam Content Outline ......... 17

Sample Questions .......................................... 18

Self-Assessment Reading Test ................... 19-22

The Skills Evaluation .....................................23

What to Expect .............................................. 23

Who Will Act As a Client? ........................... 23

Candidate Volunteer Requirements .............. 23

Candidate Dress Requirements ..................... 23

The Tasks .......................................................... 24

Recording a Measurement ............................. 25

Sample Recording Sheet for Measurement

Skills .................................................................. 26

Tips for the Skills Evaluation ........................ 27

Skills Listing .......................................... 28-43

Score Reporting ........................................... 44

Exam Results ................................................... 44

Score Reporting ............................................... 44

Failing ............................................................... 44

Reading a Failing Score Report .................... 45

Grievance Process .......................................... 45

The Registry ................................................. 45

Initial Listing ................................................... 45

Change of Address or Name ......................... 46

Online Listing Renewal ................................. 46

How to Read A Failing Score Report .......... 47

INTRODUCTION

This handbook is designed for Candidates seeking Nurse

Aide I listing on the North Carolina Nurse Aide I Registry.

It describes the process of applying for and taking the

National Nurse Aide Assessment Program (NNAAP

)

Examination.

The North Carolina Department of Health and Human

Services (DHHS) has contracted with Credentia, a nation-

ally recognized leading provider of assessment services to

regulatory agencies and national associations. Credentia

will develop, score, and report the results of the NNAAP

Examination for the North Carolina Nurse Aide I Registry.

Credentia also manages scheduling and administers the

examination to qualied individuals.

NATIONAL NURSE AIDE ASSESSMENT

PROGRAM (NNAAP

)

The Nursing Home Reform Act, adopted by Congress as

part of the Omnibus Budget Reconciliation Act of 1987

(OBRA ’87), was designed to improve the quality of care

in long-term health care facilities and to deﬁne training

and evaluation standards for nurse aides who work in such

facilities. Each state is responsible for following the terms

of this federal law.

The National Nurse Aide Assessment Program (NNAAP®)

is an examination program designed to determine minimal

competency to become listed as a nurse aide in North

Carolina on the North Carolina Nurse Aide I Registry.

The NNAAP was developed by the National Council of

State Boards of Nursing, Inc. (NCSBN), to meet the nurse

aide evaluation requirement of federal and state laws and

regulations. Credentia is the authorized administrator of

the NNAAP in your state.

The NNAAP Examination is an evaluation of nurse

aide-related knowledge, skills, and abilities. The NNAAP

Examination is made up of both a written (or oral)

examination and a Skills Evaluation. The purpose of the

NNAAP Examination is to test that you understand and

can safely perform the job of a Nurse Aide I.

EXAM OVERVIEW

The two parts of the examination process, the written

(or oral) examination and the skills evaluation, will be

administered separately. You must pass both parts in

order to become listed on the North Carolina Nurse Aide

I Registry.

The written examination consists of seventy (70) multiple-

choice questions written in English. Sample examination

questions are provided in this handbook.

An oral examination, available in English or in Spanish,

may be taken in place of the written examination may be

taken in place of the written examination. The oral exami-

nation consists of sixty (60) multiple-choice questions and

ten (10) multiple-choice reading comprehension ques-

tions. If you want to take the oral examination, you

must request it when you submit your application.

At the skills evaluation you will be asked to perform ﬁve

(5) randomly selected nurse aide skills. You will be given

thirty (30) minutes to complete the ﬁve (5) skills. You will

be rated on these skills by a Nurse Aide Evaluator. You

must successfully demonstrate all ﬁve (5) skills to pass the

skills evaluation. A complete listing of the skills is shown

on pages 28 to 42.

See The written (or oral) exam and the skills evaluation for more

details about the NNAAP Examination.

ELIGIBILITY

All Candidates applying to take the NNAAP Examination

in North Carolina MUST complete an Application

for Registration by Competency Examination on-line at

www.credentia.com/test-takers/ncna. Select your

state and go to the test taker link for additional informa-

tion. You must pass both portions of the examination

within the designated time period to be eligible for listing

on the North Carolina Nurse Aide I Registry.

LIGHT DUTY

Individuals are prohibited from taking the Skills Evaluation

if on restricted activity or light duty due to medical rea-

sons. Candidates must be able to complete all required

skills included in the Skills Evaluation. Candidates who

are on light duty are not permitted to take the Skills

Evaluation; however, they can take the written/oral exam.

Appropriate medical documentation stating return to full,

unrestricted duty is required to take the skills evaluation.

NORTH CAROLINA STATE-APPROVED

NURSE AIDE I TRAINED CANDIDATES

(E1)

All applicants who have successfully completed a North

Carolina state-approved Nurse Aide I training program.

Candidates must pass both the written examination and the

skills examination within two (2) years from the successful

completion date of a state-approved training program or

within three (3) attempts, whichever comes first, to be placed

on the North Carolina Nurse Aide I Registry. Failure to do

so will require Candidates to complete state-approved

nurse aide training and competency testing again.

In addition, a change in the eligibility route may require

Candidates to complete state-approved nurse aide training

and competency testing.

NORTH CAROLINA STATE-APPROVED

REFRESHER COURSE TRAINED CANDI-

DATES (E3)

All applicants who have successfully completed a North

Carolina state-approved Nurse Aide I refresher course at

a North Carolina state-approved Community College or

Proprietary School.

Candidates must pass both the written examination and the

skills examination within two (2) years from the successful

completion date of a state-approved training program or

within three (3) attempts, whichever comes first, to be placed

on the North Carolina Nurse Aide I Registry. Failure to do so

will require Candidates to complete state-approved nurse

aide training and competency testing again. In addition,

a change in the eligibility route may require Candidates to

complete state-approved nurse aide training and competency

testing.

NORTH CAROLINA STATE-APPROVED

STUDENT NURSE TRAINING CANDI-

DATES (E5)

All applicants who are currently enrolled in a North Carolina

state-approved nursing education program preparing for

registered nurse or practical nurse licensure.

Candidates must pass both the written examination and

the skills examination within two (2) years from successful

completion date of coursework equivalent to state-approved

nurse aide training or within three (3) attempts, whichever

comes ﬁrst, to be placed on the North Carolina Nurse Aide

I Registry. Failure to do so will require Candidates to

complete state-approved nurse aide training and com-

petency testing again. In addition, a change in the eligibil-

ity route may require Candidates to complete state-approved

nurse aide training and competency testing.

OTHER TRAINED (E8)

All applicants that are either an emergency medical

technician (EMT), an out of state licensed nurse, an unli-

censed nursing graduate, an unlicensed nursing student,

or a military veteran who received nursing/medical train-

ing credentials while in the United States Armed Forces.

Candidates must pass both the written examination

and the skills examination within two (2) years of the

application approval date or within three (3) attempts,

whichever comes ﬁrst, to be placed on the North Carolina

Nurse Aide I Registry. Failure to do so will require

Candidates to complete state-approved nurse aide

training and competency testing. In addition, a change

in the eligibility route may require Candidates to complete

state-approved nurse aide training and competency test-

ing.

OUT OF STATE TRAINED (E9)

All applicants who successfully completed a state-approved

Nurse Aide I training program in another state, excluding

North Carolina, within the previous 24 consecutive months

and are not listed on any state’s registry of nurse aides.

Candidates must pass both the written examination and

the skills examination within two (2) years from the suc-

cessful completion date of a state-approved training pro-

gram date or within three (3) attempts, whichever comes

ﬁrst, to be placed on the North Carolina Nurse Aide I

Registry. Failure to do so will require Candidates to

complete state-approved nurse aide training and

competency testing again. In addition, a change in the

eligibility route may require Candidates to complete state-

approved nurse aide training and competency testing

NC REGISTRY CANDIDATES (E10)

For all nurse aides listed as active and in good standing

status on the North Carolina Nurse Aide I Registry but

do not meet the requirements for registry listing renewal.

Candidates may apply to take the state-approved nurse

aide competency examination no more than 90 days prior

to their North Carolina Nurse Aide I Registry listing

expiration date. Candidates must successfully complete

the competency examination before their listing expira-

tion date. Candidates have three (3) attempts to pass both

the written examination and the skills examination to

be placed on the North Carolina Nurse Aide I Registry.

Failure to do so will require Candidates to complete

state-approved nurse aide training and competency

testing. In addition, a change in the eligibility route may

require Candidates to complete state-approved nurse aide

training and competency testing.

OUT-OF-STATE REGISTRY CANDIDATES

(E11)

For all out-of-state Candidates who are in active and good

standing status on another state's registry of nurse aides.

Eligible Candidates must complete and submit a

Reciprocity application (found at https://ncnar.ncdhhs.

gov/) to NC DHHS for review and approval in order

to be listed on the North Carolina Nurse Aide I Registry

without additional training or testing. In addition, a

change in the eligibility route may require Candidates to

complete state-approved nurse aide training and compe-

tency testing.

REGISTRATION

AND SCHEDULING

ONLINE REGISTRATION AND

SCHEDULING

With the Credentia CNA365 system, online registration

is quick, convenient and an environmentally responsible

way to register for your examination. A detailed step-by-

step reference guide on how to create a CNA365 account

and register for exams can be found at www.credentia.

com/test-takers/ncna.

After completing a North Carolina state-approved train-

ing course, you will create an online account with

Credentia’s CNA365 system. To create a CNA365

account, click the “CNA365 Login” button on the top

of the North Carolina nurse aide website page at www.

credentia.com/test-takers/ncna.

• Payment is in the form of a credit card or pre-paid

credit card (American Express, MasterCard, Visa,

or electronic voucher). Fees are non-refundable and

non-transferable once submitted.

• For exams at test center locations, you must make

an online reservation via a PC (smart phones and

tablets are not recommended) at least ten (10)

Calender days prior to test date

• For Written (or Oral) online exams, you may sched-

ule an exam as early as the following day depending

on exam availability.

• You are responsible for completing an online appli-

cation in CNA365. You may ask someone from your

nurse aide training program or facility employer for

assistance in completing the application.

• If you need help or have any questions about the

application process, contact a support representa-

tive at 1-888-723-6773 between 8:00 a.m. and

11:00 p.m. (Eastern Time Zone, Weekdays).

• Fees are non-refundable and non-transferable.

EXAM FEES

The fees listed below have been established for the NNAAP

Examination in North Carolina.

ex amination t ype fees

Written Examination & Skills

Evaluation

$140

Oral (English or Spanish)

Examination & Skills

Evaluation

$140

Written Examination ONLY

(re-test)

$40

Oral (English or Spanish)

Examination ONLY (re-test)

$40

Skills Evaluation ONLY (re-test) $100

Under federal and North Carolina state laws, Candidates

employed as nurse aides in nursing homes that participate

in Medicaid/Medicare programs are prohibited from

paying their examination fees. Employers must pay the

examination fee and any re-test fee for those Candidates

they employ as nurse aides or Candidates who have a writ-

ten commitment or signed acceptance of employment on

ﬁle in a Medicaid-certiﬁed nursing home. Candidates who

become employed as a nurse aide by a Medicare/Medicaid

skilled nursing facility within 12 months of successful com-

pletion of the competency evaluation may be reimbursed

by the facility for training and competency testing costs.

Therefore, Candidates should save all receipts to submit to

the skilled nursing employer.

EXAM SCHEDULING

Once your online application has been approved, you will

be able to schedule the exams in CNA365. A detailed

step-by-step reference guide on how to schedule exams can

be found at www.credentia.com/test-takers/ncna. When

completed, you will receive a Conrmation Notice and

Receipt of Payment via email.

ACCOMMODATIONS

Credentia complies with the provisions of the Americans

with Disabilities Act as amended. The purpose of accom-

modations is to provide Candidates with full access to the

test. Accommodations are not a guarantee of improved

performance or test completion. Credentia provides rea-

sonable and appropriate accommodations to individuals

with documented disabilities who demonstrate a need for

accommodations. All accommodation requests must be

approved by Credentia before reserving an examination

date.

Test accommodations may include things such as:

• A separate testing room

• Extra testing time

• A Reader or Recorder, for individuals with mobility

or vision impairments and cannot read or write on

their own

Test accommodations are individualized and considered on a

case-by-case basis. All Candidates who are requesting accom-

modations because of a disability must provide appropriate

documentation of their condition and how it is expected to

aect their ability to take the test under standard conditions.

This may include:

• Supporting documentation from the professional who

diagnosed the condition, including the credentials that

qualify the professional to make this diagnosis

• A description of past accommodations the candidate has

received

Please visit www.credentia.com/accommodations to review

the accommodation process and required supporting docu-

mentation.

TESTING LOCATIONS

In-Facility Testing (INF) is when arrangements have been

made with Credentia to test at the state-approved training

program location on a specic date. Please make certain

you know your INF code and test date when you are com-

pleting your registration.

CANCELLATION

AND RESCHEDULING

You may cancel or reschedule an examination online in

your CNA365 account. For details on how to cancel or

reschedule an examination, visit www.credentia.com/test-

takers/ncna and click on “How to Cancel or Reschedule

an Exam” in the Resources section of the webpage.

Online Written (or Oral) examinations must be canceled

or rescheduled at least 48 hours before the scheduled

examination time.

Test center examinations must be canceled or rescheduled

at least nine (9) calender days before the scheduled exami-

nation date.

If you do not cancel or reschedule your examination

within the required timeframes and do not show up for

your scheduled examination, you will be responsible for

the examination fee. Your fee will not be refunded and

cannot be transferred to a new examination date, and you

may not give your examination date to another person.

REFUNDS

Once payment of exam fees is received, NO REFUNDS

WILL BE ISSUED.

ABSENCE POLICY

Candidates who are late or absent from an exam may call

1-888-723-6773 within 14 days of the exam date to request

an excused absence for the following reasons:

• Illness of yourself or a member of your immediate

family

• Death in the family

• Disabling traffic accident

• Court appearance or jury duty

• Military duty

• Weather emergency

A case number will be assigned, and instructions provided

for emailing supporting documentation.

Your request must include documentation or veriﬁcation

for the cause of the absence. For example, if you are absent

because of jury duty, you must supply a copy of the court

notice. In the case of illness, a veriﬁcation from your med-

ical provider must be included in your request. Please note,

a request takes approximately 3-5 business days to process

and complete once documentation has been received.

Candidates absent or late to an exam who have not

changed or canceled the reservation according to

the Change/Cancel Policy will not be admitted to

the exam and will forfeit the exam fee. The decision

of Credentia to approve or deny the excused absence

will be ﬁnal.

WEATHER EMERGENCIES

A test center examination will be delayed or cancelled

only in emergencies. If severe weather or a natural disaster

makes the test site inaccessible or unsafe, the examination

will be delayed or cancelled. In the event of an examana-

tion change due to a weather emergency, candidates will be

contacted by phone and email with change details

EXAM DAY (ONLINE EXAM)

Take the written/oral exam conveniently from home using

the online proctor option. A live proctor will monitor you

through the webcam on your workstation to provide a secure

exam experience. Online proctored exams oer more sched-

uling exibility than test center exams.

Please visit www.credentia.com/online-exams for information

on what to expect and how to best prepare for the online

proctored exam. It is also recommended that you go to the

“Policies & Procedures” link to review detailed exam rules

and procedures.

WHAT YOU'LL NEED

• A properly equipped computer - a desktop, laptop, or

Chromebook with a single monitor (no smartphones or

tablets). Visit www.credentia.com/online-exams to view

or download system requirements.

• A private room - if you don't have access to a private

room, check with your training program or local library

for availability.

• A mobile device - to complete a 360 degree room scan,

you'll need a smartphone or tablet (Apple or Android)

that can download our free app.

BEFORE EXAM DAY

• Perform a system test – make sure to do the required

system test and exam simulation before exam day.

Visit www.credentia.com/online-exams and select the

“Run System Test” button.

• Find your testing space – Find a quiet, distraction-

free area in your home or oce to take the exam.

• Get your ID ready - You are required to bring two (2)

forms of ocial, signature-bearing identication (one

of which must be a photo identication). Photocopies

of identication will NOT be accepted.

e name on your identication must be the same as

the name you used on the application to register for the

examination. If you do not bring proper identication,

you will not be allowed to test and your examination fee

will not be refunded.

ON EXAM DAY

STEP 1: Prepare your testing space

• Quiet: no background noise and inform members

of your household you are taking an exam.

• Proper Lighting: Online proctors must be able to

see you and your testing space.

• Privacy: no one else in the room.

• Remove Prohibited Items: clear workstation area to

expedite room scan.

• Restroom/Beverages: use restroom and prepare

beverages before exam.

STEP 2: Have your ID ready

• Have your government issued photo ID with you

(see list or proper identication in section above).

STEP 3: Prepare your computer

• Disconnect any additional monitors and close all

other open applications.

• Have your chargers (laptop, smart phone or tablet)

plugged in or nearby.

• Use a wired internet connection rather than WiFi,

if possible.

• If using WiFi, we recommend at least 3Mbps and

ask that other household members do not use the

internet during your exam.

• Disconnect any VPNs or rewalls if you have

them.

• If taking an Oral Exam you must use a wired

headset.

STEP 4: Download the ExamRoom 360 app

• Download the ExamRoom 360 app to your

smartphone or tablet and have your CNA365

password for your Credentia CNA365 account).

is app is required to complete a 360 degree

room scan.

STEP 5: Check-in for your exam

• When To Check-In: You can begin the check in

process up to 30 minutes prior to your appoint

ment. Your onboarding agent will make sure

everything is ready for your exam before intro

ducing your proctor. Visit www.credentia.com/

online-exams to view or download detailed

check-in procedures.

• How To Check-In: Go to www.credentia.com/

test-takers/nc and click the “CNA365 login”

button. Once logged in, nd your scheduled

exam and select the "Start Exam" button.

EXAM DAY (TEST CENTER

EXAM)

Please visit www.credentia.com/test-center-exams for infor-

mation on what to expect and how to best prepare for your

test center exam.

WHAT TO BRING

You must have the following items with you when you

take the examination:

• Two (2) forms of proper identification

• Three (3) No. 2 pencils (sharpened)

• Eraser

• Watch with a second hand

No other materials will be allowed.

PROPER IDENTIFICATION

Candidates are required to to bring two (2) forms of cur-

rent, not expired ocial U.S. government-issued signature-

bearing identiﬁcation (one of which must be photo-bear-

ing) to the test site. Photocopies of identiﬁcations will not

be accepted.

• One form of identiﬁcation must be a U.S government-

issued Social Security (SS) card, signed and not lami-

nated.

• Candidates who are in the armed services may

use their current U.S. military identiﬁcation in

place of a SS card. The Candidate’s SS number

must be on the identiﬁcation, if used. Sponsor

or dependent military identiﬁcations will not be

accepted in place of a SS card.

• A second form of identiﬁcation must be any of the

items listed below and must be photo-bearing.

• Current, non-expired driver’s license

• Candidates who do not have their new license

by exam day must bring their expired driver's

license and their temporary permit.

• Current, non-expired learner's permit

• Military Identiﬁcation

• Candidate’s SS number must be on the

identiﬁcation

• Sponsor military identiﬁcation and a

dependent military identiﬁcation may be used

when presented with a valid SS card.

• State- or federal-issued identiﬁcation card

• Passport (US or foreign, current, non-expired)

• Alien registration card

• Employment authorization document (EAD)

photo identiﬁcation card (curent, non-expired,

federal-issued)

If a Candidate fails to present proper identiﬁcation, then

he or she will not be allowed to take the exam and the exam

fee will not be refunded.

The name listed on the identiﬁcations must be the same

as the name used to register for the exam, including suf-

ﬁxes and hyphens. If your name has changed, then you

must complete the steps below at least nine (9) calendar

days before your scheduled exam. Be prepared to provide

ocial government documentation of your name change.

• Contact Credentia at 1-888-723-6773 if you are not on

the North Carolina Nurse Aide I Registry.

• Contact Credentia at 1-888-723-6773 if you have

already scheduled an exam.

• Contact the North Carolina Department of Health

and Human Services at 1-919-855-3969 if you are on

the North Carolina Nurse Aide I Registry.

SECURITY AND CHEATING

If you give help to or receive help from anyone during the

examination, the examination will be stopped. The incident

will be reported to the North Carolina Department of Health

and Human Services (NC DHHS) for review, and your exami-

nation will not be scored (see Testing Policies).

Please note that all examination questions, each form of

the examination, and all other examination materials are

copyrighted by, the property of, or licensed by Credentia.

Consequently, any distribution of the examination content

or materials through any form of reproduction, or through

oral or written communication, is strictly prohibited and

punishable by law. Anyone who removes or tries to remove

examination materials or information from the test site will

be prosecuted.

TESTING POLICIES

The following policies are observed at each test center.

Lateness

You must arrive thirty (30) minutes before the examination

starts. If you are late for your scheduled examination, or

do not bring all of your required materials, you will NOT

be allowed to test, and your examination fee will NOT be

returned. If you are late for the written (or oral) examina-

tion, but arrive on time for the skills evaluation, you will be

allowed to take the skills evaluation.

If you are late for your skills evaluation or do not bring

all your required materials, you will NOT be allowed to

test and you will be required to re-apply and pay another

examination fee (Refer to page 9-10, Cancellation and

Rescheduling in this Handbook)

Electronic Devices

Cellular phone, beeper, or any other electronic device is

not permitted to be used and must be turned o during

the exam.

Study Aids

You are not permitted to take personal belongings such

as briefcases, large bags, study materials, extra books, or

papers into the examination room. Any such materials

brought into the examination room will be collected and

returned to you when you have completed the examina-

tion. Credentia is not responsible for lost or misplaced

items.

Eating/Drinking/Smoking

You are not permitted to eat, drink, or smoke during the

examination.

Misconduct

If you are discovered causing a disturbance or engaging

in any kind of misconduct, before, during or after your

examination, then you will be dismissed from the exami-

nation and the incident will be reported to the NC DHHS.

Decisions regarding disciplinary measures are the respon-

sibility of that agency.

Guests/Visitors

No guests, visitors, pets, or children are allowed at test

sites.

THE WRITTEN

(OR ORAL) EXAM

WRITTEN EXAM

The Written Examination has seventy (70) multiple-

choice questions. You will have two (2) hours to complete

the Written Examination. You will be told when ﬁfteen

(15) minutes are left to ﬁnish. Fill in only one (1) oval on

the answer sheet for each question. Markings in the test

booklet will not be accepted as answers. Your answers

must appear on the separate answer sheet. See Sample

Questions for examples of the kinds of questions found on

the Written Examination.

ORAL EXAM

An oral examination may be taken in place of the written

examination. Earphones are provided at the test center

and you will use these to hear the questions read aloud.

You must request an oral examination when ﬁlling out

your application. The oral examination consists of two (2)

parts, and you must pass both parts in order to pass the

oral examination. You have two (2) hours to complete the

entire Oral Examination.

The ﬁrst part of the oral examination has sixty (60) mul-

tiple choice questions. Each of the sixty (60) multiple-

choice questions are repeated twice. As each question is

read, you are asked to choose the correct answer and mark

it on the screen.

The second part of the oral examination has ten (10) mul-

tiple-choice questions that test whether you know com-

mon words used in long-term care facilities. Each word is

repeated three (3) times. You are asked to match the word

you hear on the recording to the written word. As you ﬁnd

the match, you mark your answer on the screen.

In the Spanish oral examination, the 10 multiple-choice

questions are read in Spanish and you are asked to match

the word you hear on the recording to the English written

word on the screen.

WRITTEN (OR ORAL) EXAM

CONTENT OUTLINE

The revised content outline is based on the ﬁndings from

the 2014 Job Analysis and Knowledge, Skill, and Ability Study

of Nurse Aides published by the National Council of State

Boards of Nursing (NCSBN) in 2015. The examination

content outline became eective in January 2016.

The NNAAP written examination is comprised of 70

multiple-choice items; 10 of these items are pretest (non-

scored) items on which statistical information will be

collected. The NNAAP oral examination is comprised

of 60 multiple-choice items and 10 reading comprehen-

sion (word recognition) items. The candidate is allowed to

choose between a written and an oral examination.

# of

% of questions

I. Physical Care Skills the exam in the exam

A. Activities of Daily Living ......... 14% ............. 9

1. Hygiene

2. Dressing and Grooming

3. Nutrition and Hydration

4. Elimination

5. Rest/Sleep/Comfort

B. Basic Nursing Skills ...................39% ............... 23

1. Infection Control

2. Safety/Emergency

3. Therapeutic/Technical Procedures

4. Data Collection and Reporting

C. Restorative Skills ......................... 8% ............... 5

1. Prevention

2. Self-Care/Independence

II. Psychosocial Care Skills

A. Emotional and

Mental Health Needs ................ 11% .............. 6

B. Spiritual and Cultural Needs .......2% ................2

III. Role of the Nurse Aide

A. Communication ........................... 8% ............... 4

B. Client Rights ................................ 7% ............... 4

C. Legal and Ethical Behavior ....... 3% ............... 2

D. Member of the

Health Care Team ....................... 8% ............... 5

SAMPLE QUESTIONS

The following questions are samples of the kinds of

questions that you will ﬁnd on the Written Examination.

Check your answers to these questions in the box below.

1. The client's call light should always be placed:

(A) on the bed

(B) within the client's reach

(D) over the side rail

2. Which of the following items is used in the pre-

vention and treatment of bedsores or pressure

sores?

(A) rubber sheet

(B) air mattress

(D) restraint

3. When caring for a dying client, the nurse aide

should:

(A) keep the client's room dark and quiet

(B) allow client to express his feelings

(D) contact the client's minister, priest, or rabbi

4. What does the abbreviation ADL mean?

(A) Ad Lib

(B) As Doctor Likes

(D) After Daylight

5. After giving a client a back rub, the nurse aide

should always note:

(A) the last time the client had a back rub

(B) any change in the client's skin

(D) amount of lotion used

6. How should the nurse aide communicate with

a client who has a hearing loss?

(A) face the client when speaking

(B) repeat the statement

(D) use a high-pitched voice

Correct Answers

1. B 2. B 3. B 4. C 5. B 6. A

SELF-ASSESSMENT

READING TEST

The two-part self-assessment reading test that appears

below will help you decide if you should consider taking

the oral examination instead of the written examination.

To complete the reading test, follow the instructions pro-

vided below and select the answer to each question. When

you have completed the reading test, you will be able to

determine the number of questions you answered correctly.

PART 1: VOCABULARY

1. Circle the best answer to each question.

2. When you have finished, check your answers using

the answer key on page 18.

3. Count up the number of correct answers.

4. If your score is less than 17, you may have difficulty

reading the written examination and should consider

taking the oral examination.

1. You go to a doctor when you _____.

(A) feel sleepy (D) need money

(B) need socks (E) need clothes

2. A person who flies an airplane is its _____.

(A) pilot (D) surgeon

(B) steward (E) director

3. You use a _____ to write.

(A) bow (D) carpenter

(B) calculator (E) needle

4. To EXIT a room means to _____ it.

(A) enter (D) read

(B) leave (E) interrupt

5. A wedding is a joyous _____.

(A) focus (D) occasion

(B) vehicle (E) civilization

6. To REQUIRE something means to _____ it.

(A) need (D) understand

(B) have (E) hear

go to next page

7. You _____ something to find its length.

(A) slice

(B) lock

(D) force

(E) tape

8. Soup is served in a _____.

(A) plate

(B) bowl

(D) chair

(E) closet

9. To accompany someone means to _____.

(A) disagree with him

(B) work for him

(D) speak to him

(E) choose him

10. A nursing home resident receives _____ from

the staff.

(A) quality

(B) fame

(D) care

(E) work

11. Medicine is used to _____ pain.

(A) widen

(B) conjure

(D) increase

(E) relieve

12. To DRENCH the flowers means to ____ them.

(A) steam

(B) drink

(D) soak

(E) anger

13. A bicycle is a means of _____.

(A) nourishment

(B) transportation

(D) collision

(E) walking

14. When someone speaks in a whisper,

it may be difficult to _____.

(A) deceive

(B) understand

(D) estimate

(E) regulate go to next page

SELF-ASSESSMENT

READING TEST

PART 2: COMPREHENSION

In this part of the reading test, you will be provided with a

series of brief paragraphs. You are to read each paragraph and

then answer the questions that appear after the paragraph.

There are many different kinds of fish. All fish live

in water. They use their tails and fins to swim.

15. Fish live in _____.

(A) cups

(B) houses

(D) water

(E) fountains

16. Fish use their _____ to swim.

(A) tails

(B) heads

(D) lungs

(E) floats

Maria grew up on a farm. She loved the work on

the farm. She knew when all of the crops had to

be planted. She would like a job on a farm or in a

flower garden.

17. Maria has had experience as a _____.

(A) guide

(B) farmer

(D) nurse

(E) teacher

18. She would like to work in _____.

(A) an office

(B) a library

(D) a hospital

(E) a supermarket

19. As a child Maria lived _____.

(A) in the city

(B) in an apartment

(D) in a large house

(E) on the beach go to next page

Carolyn has a good job. She is a nurse in a large hos-

pital. Every day she can help many people. She enjoys

this very much. She also makes a good salary. Each

month she can pay her bills and save some money.

20. Carolyn works in a _____.

(A) hospital

(B) doctor’s office

(D) school

(E) library

21. One of the things Carolyn enjoys is _____.

(A) working in an office

(B) helping people

(D) working late hours

(E) driving a car

22. With her salary she can pay her bills and _____.

(A) buy furniture

(B) give to charity

(D) buy new clothes

(E) pay for college

This completes the

Self-Assessment Reading Test.

Answers

1. C 7. C 13. B 19. C

2. A 8. B 14. B 20. A

3. C 9. C 15. D 21. B

4. B 10. D 16. A 22. C

5. D 11. E 17. B

6. A 12. D 18. C

If your score is less than 17, you may have difficulty

reading the Written Examination and should consider

taking the Oral Examination in place of the Written

Examination.

THE SKILLS EVALUATION

WHAT TO EXPECT

The skills evaluation is set up to resemble an actual care-

giving situation. The skills evaluation area will look similar

to your work setting. It will have all the equipment necessary

to perform the assigned skills. The skills evaluation will be

administered by a Nurse Aide Evaluator. Before your skills

evaluation begins, the evaluator will show you where equip-

ment is located and answer questions about operating the

equipment. Please arrive 30 minutes early. Test times are

approximate. Please plan to spend the day.

Who Will Act as a Client?

The part of the “client” will be played by a candidate who

volunteers to act as a weakened elderly person. While you

perform the skills, speak to the candidate volunteer as you

would speak to an actual client in a nurse aide work setting.

You are encouraged to speak to the candidate volunteer not

only because it is part of quality care, but also because it will

help you to relax as you perform the skills. Please note, you

may not receive help from anyone during the skills evaluation,

and the candidate and the client must speak to one another

in English so that the evaluator can understand and correctly

score the evaluation. If either candidate gives help or receives

help during the test, or the client and candidate are communicat-

ing in a language other than English, the test will be stopped.

Candidate Volunteer

Requirements

You will need to act as a candidate volunteer for another

candidate’s skills evaluation and play the role of a nursing

home patient (client). The evaluator will give you verbal

instructions that will describe how you should act in per-

forming the role of the client.

Candidate Dress Requirements

You must wear ﬂat, slip-on, non-skid shoes, a loose-ﬁtting

top with short sleeves that can be rolled up to the shoulder or

tank top, and loose-ﬁtting pants that can be rolled up. You will be

required to put a gown on over your clothing. In no case may

Candidates remove clothing down to undergarments.

Prior to beginning the exam, you should inform the evalu-

ator of any food or latex allergy or sensitivity to skin soaps

or lotion. Any limitations to range of motion must also be

communicated to the evaluator prior to the start of the

skills examination.

For infection control purposes, you should not come to the

test site with open areas/sores on the skin. Candidates with

any open areas or sores on their skin should reschedule

their skills test to a later date after their skin fully heals.

THE TASKS

The NNAAP Skills List contains all of the skills that you

may be asked to demonstrate during the skills evaluation.

Each skill represents a task that you will be asked to per-

form in your job and has been broken down into a series

of steps.

See pages 28-43 for the complete skills listing.

A step that is highlighted in bold type is called a Critical

Element Step. Critical Element Steps are important steps

that must be performed correctly in order for you to pass

the skill. If you leave out a Critical Element Step or do

not perform a Critical Element Step properly, you will not

pass the skill. However, if you perform only the Critical

Element Step correctly in a skill, you do not automati-

cally pass that skill. You must also correctly demonstrate

enough steps to meet the passing standard (or cut score) for

each skill.

Before your skills evaluation begins, the Nurse Aide

Evaluator will give you an instruction card that will list the

ﬁve (5) skills selected for you to perform. Hand-washing will

always be one of the skills to be performed. The remaining

four (4) skills are randomly chosen from the complete set of

skills listings on pages 28 to 43 of this handbook. You are

strongly encouraged to perform the skills in the order they

are listed on the instruction card.

If you make a mistake, say so, and you will be instructed

to tell the evaluator which step(s) is to be corrected and

then to perform the step(s). You will not have to redo the

entire skill, just the steps you wish to correct. There are,

however, some exceptions to this rule. If you fail to put

on gloves or take them o when it is required to do so and

the evaluator reminds you to do so, for infection control

purposes, then you will not receive credit for attempting to

correct this step. If you wish to correct an order-dependent

step (a step stating that an action should be performed

before or after another step) and you fail to say when the

corrected step should be performed, you will not receive

credit for the correction.

Once you begin a new skill, you may not go back to cor-

rect a previous skill. The Nurse Aide Evaluator will not

answer questions during the skills evaluation and will not

tell you whether you performed a skill correctly. You may

not receive help from anyone during the skills evaluation.

If you do have any questions, please ask them before the

skills evaluation begins.

One (1) of the four (4) randomly selected skills will include

a measurement skill (see the section below, Recording A

Measurement, for more information regarding measure-

ment skills).

You will be asked to decontaminate your hands (with hand

sanitizer) before proceeding from skills performed on a

live client to skills that are not. This is for infection control

purposes and will not aect the result of your evaluation.

When you have completed your skills evaluation, the

evaluator will direct you to wash your hands. Although

this will not aect your examination results, for the pur-

poses of infection control, you must wash your hands.

You must successfully complete all five (5) skills to pass the skills

evaluation. You will have thirty (30) minutes to demon-

strate all ﬁve (5) skills.

RECORDING A MEASUREMENT

The NNAAP skills evaluation requires every candidate to

perform one measurement skill, such as blood pressure,

radial pulse, respirations, urine output, or weight. You

will be given a special form, called a Recording Sheet for

Measurement Skills, to write down, or record, the measure-

ment. For example, if performing the Measures and Records

Blood Pressure skill, you will write the complete systolic and

diastolic pressures of your blood pressure reading in a box

labeled Candidate Results.

On the following page is a copy of the recording sheet that

will be used during the skills exam. The candidate must

record his/her results in the Candidate Results box on this

sheet. This sheet will be used to record the results of the

following measurement skills:

• Measures and Records Blood Pressure

• Measures and Records Weight of

Ambulatory Client

• Measures and Records Urinary Output

• Counts and Records Radial Pulse

• Counts and Records Respirations

Tips for the Skills Evaluation

• You will be expected to perform the skills as you

would in a nursing home setting. When water is

required, you must use running water. All Candidates

will be required to perform the Hand Hygiene skill. The

evaluator will inform you after you have washed your

hands for the first time that you should just tell him

or her when you would wash your hands during your

performance of the rest of the skills, rather than actu-

ally washing them for each skill. For all steps other

than handwashing, you must actually perform the skill

in order to receive credit. You may not simply tell the

evaluator what you would do for simulating a step. For

example, you may not simply tell the evaluator that you

would wash the client. You must actually demonstrate

washing the client. You may not simply tell the evalu-

ator that you would feed the client. You must actually

demonstrate feeding the client.

• After you have introduced yourself to the client for

the first time, it is not necessary for you to introduce

yourself each time you begin a new skill.

• To receive full credit for a measurement skill, you

must accurately make the required measurement and

then write that measurement on the Recording Sheet

for Measurement Skills. The evaluator will provide the

Recording Sheet to you at the test site. A sample of

the Recording Sheet is shown on page 27 of this hand-

book. You are encouraged to become familiar with

the Recording Sheet before your scheduled test date.

• You must know how to operate both a standing and

a non-digital bathroom scale and must know how to

set both types of scales to zero.

• You may not bring any of your own equipment to

the test site (e.g., transfer/gait belt).

• It is important for you to place the call signal within

the client’s reach whenever you leave the client.

• Where the word “client” appears, it refers to the person

receiving care.

Tips for the Skills Evaluation

• You will be expected to perform the skills as you would

in a nursing home setting. When water is required, you

must use running water. All candidates will be required

to perform the Hand Hygiene skill. The evaluator will

inform you after you have washed your hands for the

first time that you should just tell him or her when you

would wash your hands during your performance of

the rest of the skills, rather than actually washing them

for each skill. For all steps other than hand-washing,

you must actually perform the skill in order to receive

credit. You may not simply tell the evaluator what you

would do for simulating a step. For example, you may

not simply tell the evaluator that you would wash the

client. You must actually demonstrate washing the

client. You may not simply tell the evaluator that you

would feed the client. You must actually demonstrate

feeding the client.

• After you have introduced yourself to the client for

the first time, it is not necessary for you to introduce

yourself each time you begin a new skill.

• To receive full credit for a measurement skill, you

must accurately make the required measurement and

then write that measurement on the Recording Sheet

for Measurement Skills. The evaluator will provide the

Recording Sheet to you at the test site. A sample of the

Recording Sheet is shown on page 24 of this hand-

book. You are encouraged to become familiar with the

Recording Sheet before your scheduled test date.

• You must know how to operate both a standing and

a non-digital bathroom scale and must know how to

set both types of scales to zero.

• You may not bring any of your own equipment to

the test site (i.e. transfer/gait belt).

• It is important for you to place the call signal within

the client’s reach whenever you leave the client.

• Where the word “client” appears, it refers to the person

receiving care.

2524

Date

Test Site ID

CANDIDATE NAME

CANDIDATE ID

EVALUATOR NAME

EVALUATOR ID

SKILL TESTED

Evaluator must check one box

next to the skill being tested.

■

Blood Pressure

■

Respirations

■

Oral Temperature

■

Urine Output

■

Radial Pulse

■

Weight

RECORDING SHEET FOR

MEASUREMENT SKILLS

CANDIDATE EVALUATOR

RESULTS RESULTS

SAMPLE

CCrreeddeennttiiaa

SKILLS LISTING

The 23 skills that follow are arranged in alphabetical

order, except for the Hand Hygiene (Hand Washing) skill.

Hand Hygiene is listed ﬁrst as a reminder of the impor-

tance of performing this skill before all other skills. The

numbered lines below each skill are the steps needed to

perform that skill. Critical Element Steps are in bold type.

SKILL 1 — HAND HYGIENE (HAND WASHING)

1 Address client by name and introduces self to client by

name

2 Turns on water at sink

3 Wets hands and wrists thoroughly

4 Applies soap to hands

5 Lathers all surfaces of wrists, hands, and ﬁngers

producing friction, for at least 20 (twenty) seconds,

keeping hands lower than the elbows and the

ﬁngertips down

6 Cleans ﬁngernails by rubbing ﬁngertips against palms

of the opposite hand

7 Rinse all surfaces of wrists, hands, and ﬁngers,

keeping hands lower than the elbows and the

ﬁngertips down

8 Uses clean, dry paper towel/towels to dry all surfaces

of ﬁngers, hands, and wrists starting at ﬁngertips then

disposes of paper towel/towels into waste container

9 Uses clean, dry paper towel/towels to turn o faucet

then disposes of paper towel/towels into waste

container or uses knee/foot control to turn o faucet

10 Does not touch inside of sink at any time

SKILL 2 — APPLIES ONE KNEE-HIGH ELASTIC

STOCKING

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Client is in supine position (lying down in bed) while

stocking is applied

4 Turns stocking inside-out, at least to the heel

5 Place's foot of stocking over toes, foot, and heel

Skill continues

6 Pulls top of stocking over foot, heel, and leg

7 Moves foot and leg gently and naturally, avoiding force

and over-extension of limb and joints

8 Finishes procedure with no twists or wrinkles

and heel of stocking, if present, is over heel and

opening in the toe area (if present) is either over

or under toe area; if using a mannequin, candidate

may state stocking needs to be wrinkle-free

9 Signaling device is within reach and bed is in low

position

10 After completing skill, wash hands

SKILL 3 — ASSISTS TO AMBULATE USING

TRANSFER BELT

1 Explains procedure, speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Before assisting to stand, client is wearing non-

skid shoes/footwear

4 Before assisting to stand, bed is at a safe level

5 Before assisting to stand, checks and/or locks bed wheels

6 Before assisting to stand, client is assisted to

sitting position with feet ﬂat on the ﬂoor

7 Before assisting to stand, applies transfer belt securely

at the waist over clothing/gown

8 Before assisting to stand, provides instructions to

enable client to assist in standing including prearranged

signal to alert client to begin standing

9 Stands facing client positioning self to ensure safety of

candidate and client during transfer. Counts to three

(or says other prearranged signal) to alert client to

begin standing

10 On signal, gradually assists client to stand by grasping

transfer belt on both sides with an upward grasp

(candidate’s hands are in upward position), and

maintaining stability of client’s legs by standing knee to

knee, or toe to toe with client

11 Walks slightly behind and to one side of client for a

distance of ten (10) feet, while holding onto the belt

12 Assists client to bed and removes transfer belt

13 Signaling device is within reach and bed is in low

position

14 After completing skill, wash hands Skill continues

SKILL 4 — ASSISTS WITH USE OF BEDPAN

1 Explains procedure speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Before placing bedpan, lowers head of bed

4 Puts on clean gloves before placing bedpan under client

5 Place's bedpan correctly under client’s buttocks

6 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

7 After positioning client on bedpan and removing

gloves, raises head of bed

8 Toilet tissue is within reach

9 Hand wipe is within reach and client is instructed to

clean hands with hand wipe when ﬁnished

10 Signaling device within reach and client is asked to

signal when ﬁnished

11 Puts on clean gloves before removing bedpan

12 Head of bed is lowered before bedpan is removed

13 Ensures client is covered except when placing and

removing bedpan

14 Empties and rinses bedpan and pours rinse into toilet

15 Places bedpan in designated dirty supply area

16 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

17 Signaling device is within reach and bed is in low

position

SKILL 5 — CLEANS UPPER OR LOWER DENTURE

1 Puts on clean gloves before handling denture

2 Bottom of sink is lined and/or sink is partially ﬁlled

with water before denture is held over sink

3 Rinse's denture in moderate temperature running water

before brushing them

4 Applies denture toothpaste to toothbrush

5 Brushes all surfaces of denture

6 Rinse's all surfaces of denture under moderate

temperature running water

7 Rinse's denture cup and lid

8 Place's denture in denture cup with moderate

temperature water/solution and places lid on cup

Skill continues

9 Rinse's toothbrush and places in designated toothbrush

basin/container

10 Maintains clean technique with placement of

toothbrush and denture

11 Sink liner is removed and disposed of appropriately

and/or sink is drained

12 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

SKILL 6 — COUNTS AND RECORDS RADIAL

PULSE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Places ﬁngertips on thumb side of client’s wrist to

locate radial pulse

3 Count beats for one full minute

4 Signaling device is within reach

5 Before recording, washes hands

6 Records pulse rate within plus or minus 4 beats of

evaluator’s reading

SKILL 7 — COUNTS AND RECORDS

RESPIR ATIONS

1 Explains procedure (for testing purposes), speaking

clearly, slowly, and directly, maintaining face-to-face

contact whenever possible

2 Counts respirations for one full minute

3 Signaling device is within reach

4 Before recording, washes hands

5 Records respiration rate within plus or minus 2

breaths of evaluator’s reading

SKILL 8 — DONNING AND REMOVING PPE

(GOWN AND GLOVES)

1 Picks up gown and unfolds

2 Facing the back opening of the gown places arms

through each sleeve

3 Fastens the neck opening

4 Secures gown at waist making sure that back of

clothing is covered by gown (as much as possible)

5 Puts on gloves

Skill continues

6 Cus of gloves overlap cus of gown

7 Before removing gown, with one gloved hand,

grasps the other glove at the palm, remove glove

8 Slips ﬁngers from ungloved hand underneath cu

of remaining glove at wrist, and removes glove

turning it inside out as it is removed

9 Disposes of gloves into designated waste container

without contaminating self

10 After removing gloves, unfastens gown at waist and

neck

11 After removing gloves, removes gown without

touching outside of gown

12 While removing gown, holds gown away from body

without touching the ﬂoor, turns gown inward and

keeps it inside out

13 Disposes of gown in designated container without

contaminating self

14 After completing skill, washes hands

SKILL 9 — DRESSES CLIENT WITH AFFECTED

(WEAK) RIGHT ARM

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Asks which shirt he/she would like to wear and dresses

him/her in shirt of choice

4 Avoids overexposure of client by ensuring client’s chest

is covered

5 Removes gown from the left (unaected) side ﬁrst,

then removes gown from the right (aected/weak) side

6 Before dressing client, disposes of gown into soiled

linen container

7 Assists to put the right (aected/weak) arm

through the right sleeve of the shirt before placing

garment on left (unaected) arm

8 While putting on shirt, moves body gently and

naturally, avoiding force and over-extension of limbs

and joints

9 Finishes with clothing in place

10 Signaling device is within reach and bed is in low

position

Skill continues

11 After completing skill, washes hands

SKILL 10 — FEEDS CLIENT WHO CANNOT FEED

SELF

1 Explains procedure to client, speaking clearly, slowly,

and directly, maintaining face-to-face contact whenever

possible

2 Before feeding, looks at name card on tray and asks

client to state name

3 Before feeding client, client is in an upright sitting

position (75-90 degrees)

4 Places tray where the food can be easily seen by client

5 Candidate cleans client’s hands before beginning

feeding

6 Candidate sits in a chair facing client during feeding

7 Tells client what foods and beverage are on tray

8 Asks client what he/she would like to eat ﬁrst

9 Using spoon, oers client one bite of each type of

food on tray, telling client the content of each spoonful

10 Oers beverage at least once during meal

11 Candidate asks client if they are ready for next bite of

food or sip of beverage

12 At end of meal, candidate cleans client’s mouth and

hands

13 Removes food tray

14 Leaves client in upright sitting position (75-90 degrees)

with signaling device within client’s reach

15 After completing skill, washes hands

SKILL 11 — GIVES MODIFIED BED BATH (FACE

AND ONE ARM, HAND, AND UNDERARM)

1 Explains procedure, speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

3 Removes gown and places directly in soiled linen

container while ensuring client’s chest and lower body

is covered

4 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

5 Puts on clean gloves before washing client.

Skill continues

6 Beginning with eyes, washes eyes with wet

washcloth (no soap), using a dierent area of the

washcloth for each stroke, washing inner aspect to

outer aspect then proceeds to wash face

7 Dries face with dry cloth towel/washcloth

8 Exposes one arm and places cloth towel underneath arm

9 Applies soap to wet washcloth

10 Washes ﬁngers (including ﬁngernails), hand, arm, and

underarm keeping rest of body covered

11 Rinses and dries ﬁngers, hand, arm, and underarm

12 Moves body gently and naturally, avoiding force and

over-extension of limbs and joints

13 Puts clean gown on client

14 Empties, rinses, and dries basin

15 Place's basin in designated dirty supply area

16 Disposes of linen into soiled linen container

17 Avoids contact between candidate clothing and used

linens

18 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

19 Signaling device is within reach and bed is in low

position

SKILL 12* — MEASURES AND RECORDS

ELECTRONIC BLOOD PRESSURE

*STATE SPECIFIC (EVALUATOR: DO NOT

SUBSTITUTE THIS SKILL FOR SKILL 23 ‘MANUAL

BLOOD PRESSURE’)

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Has client assume a comfortable lying or sitting position

4 Client’s arm is positioned at level of heart with palm up

and upper arm is exposed

5 Selects appropriate cu size

6 Feels for brachial artery on inner aspect of arm, at bend

of elbow

7 Places blood pressure cu snugly on client’s upper arm

and sensor/arrow is over the brachial artery site

Skill continues

SKILL

NOT

TESTED

8 Turns on the machine and ensures device is functioning.

If the machine has dierent settings for infants, children,

and adults, selects the appropriate setting

9 Pushes start button. If cu inﬂates to more than 200

mm Hg, then stops machine and uses cu on client’s

other arm

10 Waits until the blood pressure reading appears on the

screen and for the cu to deﬂate, then removes the cu

11 Signaling device is within reach

12 Before recording, washes hands

13 After obtaining reading using BP cu, records

both systolic and diastolic pressures exactly as

displayed on the digital screen

SKILL 13 — MEASURES AND RECORDS URINARY

OUTPUT

1 Puts on clean gloves before handling bedpan

2 Pours the contents of the bedpan into measuring

container without spilling or splashing urine outside of

container

3 Rinse.s bedpan and pours rinse into toilet

4 Measures the amount of urine at eye level with

container on ﬂat surface (if between measurement

lines, round up to nearest 25 ml/cc)

5 After measuring urine, empties contents of measuring

container into toilet

6 Rinses measuring container and pours rinse into toilet

7 Before recording output, removes and disposes

of gloves (without contaminating self) into waste

container and washes hands

8 Records contents of container within plus or

minus 25 ml/cc of evaluator’s reading

SKILL 14 — MEASURES AND RECORDS WEIGHT

OF AMBULATORY CLIENT

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Client has non-skid shoes/footwear on before walking

to scale

3 Before client steps on scale, candidate sets scale to zero

Skill continues

SKILL NOT

TESTED

4 Asks client to step on center of scale and obtains

client’s weight

5 Asks client to step o scale

6 Before recording, washes hands

7 Records weight based on indicator on scale.

Weight is within plus or minus 2 lbs. of evaluator’s

reading (If weight recorded in kg weight is within

plus or minus 0.9 kg of evaluator’s reading)

SKILL 15 — PERFORMS MODIFIED PASSIVE

RANGE OF MOTION (PROM) FOR ONE KNEE

AND ONE ANKLE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Ensures that client is supine in bed and instructs client

to inform candidate if pain is experienced during

exercise

4 While supporting the leg at knee and ankle,

bends the knee and then returns leg to client’s

normal position (ﬂexion/extension) (AT LEAST

3 TIMES unless pain is verbalized). Moves joints

gently, slowly, and smoothly through the range of

motion, discontinuing exercise if client verbalizes

pain.

5 While supporting the foot and ankle close to the

bed, pushes/pulls foot toward head (dorsiﬂexion),

and pushes/pulls foot down, toes point down

(plantar ﬂexion) (AT LEAST 3 TIMES unless

pain is verbalized). Moves joints gently, slowly,

and smoothly through the range of motion,

discontinuing exercise if client verbalizes pain.

6 Signaling device is within reach and bed is in low

position

7 After completing skill, washes hands

SKILL 16 — PERFORMS MODIFIED PASSIVE

RANGE OF MOTION (PROM) FOR ONE

SHOULDER

1 Explains procedure, speaking clearly, slowly, and directly,

maintaining face-to-face contact whenever possible

2 Privacy is provided with a curtain, screen, or door

Skill continues

3 Instructs client to inform candidate if pain experienced

during exercise

4 While supporting arm at the elbow and at the

wrist, raises client’s straightened arm from side

position upward toward head to ear level and

returns arm down to side of body (ﬂexion/

extension) (AT LEAST 3 TIMES unless pain

is verbalized). Moves joint gently, slowly,

and smoothly through the range of motion,

discontinuing exercise if client verbalizes pain.

5 While supporting arm at the elbow and at the wrist,

moves client’s straightened arm away from the side

of body to shoulder level and returns to side of

body (abduction/adduction) (AT LEAST 3 TIMES

unless pain is verbalized). Moves joint gently,

slowly, and smoothly through the range of motion,

discontinuing exercise if client verbalizes pain.

6 Signaling device is within reach and bed is in low

position

7 After completing skill, washes hands

SKILL 17 — POSITIONS ON SIDE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before turning, lowers head of bed

4 Raises side rail on side to which body will be turned

5 Candidate assists client to slowly roll onto side toward

raised side rail

6 Places or adjusts pillow under head for support

7 Candidate repositions arm and shoulder so that client

is not lying on arm

8 Supports top arm with supportive device

9 Places supportive device behind client’s back

10 Places supportive device between legs with top knee

ﬂexed; knee and ankle supported

11 Signaling device is within reach and bed is in low

position

12 After completing skill, washes hands

Skill continues

SKILL 18 — PROVIDES CATHETER CARE FOR

FEMALE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

4 Puts on clean gloves before washing

5 Places linen protector under perineal area including

buttocks before washing

6 Exposes area surrounding catheter (only exposing

client between hip and knee)

7 Applies soap to wet washcloth

8 While holding catheter at meatus without tugging,

cleans at least four inches of catheter from

meatus, moving in only one direction, away from

meatus, using a clean area of the washcloth for

each stroke

9 While holding catheter at meatus without tugging,

using a clean washcloth, rinses at least four inches

of catheter from meatus, moving only in one

direction, away from meatus, using a clean area of

the washcloth for each stroke

10 While holding catheter at meatus without tugging,

dries at least four inches of catheter moving away from

meatus using a dry cloth towel/washcloth

11 Empties, rinses, and dries basin

12 Place's basin in designated dirty supply area

13 Disposes of used linen into soiled linen container and

disposes of linen protector appropriately

14 Avoids contact between candidate clothing and used

linen

15 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

16 Signaling device is within reach and bed is in low

position

Skill continues

SKILL 19 — PROVIDES FOOT CARE ON ONE

FOOT

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

4 Basin is in a comfortable position for client and on

protective barrier

5 Puts on clean gloves before washing foot

6 Client’s bare foot is placed into the water

7 Applies soap to wet washcloth

8 Lifts foot from water and washes foot (including

between the toes)

9 Foot is rinsed (including between the toes)

10 Dries foot (including between the toes) with dry cloth

towel/washcloth

11 Applies lotion to top and bottom of foot (excluding

between the toes) removing excess with a towel/

washcloth

12 Supports foot and ankle during procedure

13 Empties, rinses, and dries basin

14 Place's basin in designated dirty supply area

15 Disposes of used linen into soiled linen container

16 Removes and disposes of gloves (without contaminating

self) into waste container and washes hands

17 Signaling device is within reach

SKILL 20 — PROVIDES MOUTH CARE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before providing mouth care, client is in upright sitting

position (75-90 degrees)

4 Puts on clean gloves before cleaning mouth

5 Place's cloth towel across chest before providing

mouth care

6 Secures cup of water and moistens toothbrush

Skill continues

7 Before cleaning mouth, applies toothpaste to

moistened toothbrush

8 Cleans mouth (including tongue and all surfaces

of teeth), using gentle motions

9 Maintains clean technique with placement of

toothbrush

10 Candidate holds emesis basin to chin while client rinses

mouth

11 Candidate wipes mouth and removes clothing

protector

12 Disposes of used linen into soiled linen container

13 Rinse's toothbrush and empties, rinses, and dries basin

14 Removes and disposes of gloves (without

contaminating self) into waste container and washes

hands

15 Signaling device is within reach and bed is in low

position

SKILL 21 — PROVIDES PERINEAL CARE

(PERI-CARE) FOR FEMALE

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before washing, checks water temperature for safety

and comfort and asks client to verify comfort of water

4 Puts on clean gloves before washing perineal area

5 Place's pad/ linen protector under perineal area

including buttocks before washing

6 Exposes perineal area (only exposing between hips and

knees)

7 Applies soap to wet washcloth

8 Washes genital area, moving from front to back,

while using a clean area of the washcloth for each

stroke

9 Using clean washcloth, rinses soap from genital

area, moving from front to back, while using a

clean area of the washcloth for each stroke

10 Dries genital area moving from front to back with dry

cloth towel/washcloth.

Skill continues

11 After washing genital area, turns to side, then washes

rectal area moving from front to back using a clean area

of washcloth for each stroke.

12 Using clean washcloth, rinses soap from rectal area,

moving from front to back, while using a clean area of

the washcloth for each stroke

13 Dries rectal area moving from front to back with dry

cloth towel/washcloth

14 Repositions client

15 Empties, rinses, and dries basin

16 Place's basin in designated dirty supply area

17 Disposes of used linen into soiled linen container and

disposes of linen protector appropriately

18 Avoids contact between candidate clothing and used

linen

19 Removes and disposes of gloves (without

contaminating self) into waste container and washes

hands

20 Signaling device is within reach and bed is in low

position

SKILL 22 — TRANSFERS FROM BED TO

WHEELCHAIR USING TRANSFER BELT

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Privacy is provided with a curtain, screen, or door

3 Before assisting to stand, wheelchair is positioned

alongside of bed, at head of bed facing foot or foot of

bed facing head

4 Before assisting to stand, footrests are folded up or

removed

5 Before assisting to stand, locks wheels on

wheelchair

6 Before assisting to stand, bed is at a safe level

7 Before assisting to stand, checks and/or locks bed

wheels

8 Before assisting to stand, client is assisted to a

sitting position with feet ﬂat on the ﬂoor

9 Before assisting to stand, client is wearing shoes

10 Before assisting to stand, applies transfer belt securely

at the waist over clothing/gown

Skill continues

11 Before assisting to stand, provides instructions to

enable client to assist in transfer including prearranged

signal to alert when to begin standing

12 Stands facing client positioning self to ensure safety of

candidate and client during transfer. Counts to three

(or says another prearranged signal) to alert client to

begin standing

13 On signal, gradually assists client to stand by grasping

transfer belt on both sides with an upward grasp

(Candidates' hands are in upward position) and

maintaining stability of client’s legs by standing knee to

knee, or toe to toe with the client

14 Assists client to turn to stand in front of wheelchair

with back of client’s legs against wheelchair

15 Lowers client into wheelchair

16 Positions client with hips touching back of wheelchair

and transfer belt is removed

17 Positions feet on footrests

18 Signaling device is within reach

19 After completing skill, washes hands

SKILL 23* — MEASURES AND RECORDS

MANUAL BLOOD PRESSURE

*STATE SPECIFIC (EVALUATOR: DO NOT

SUBSTITUTE THIS SKILL FOR SKILL 12

‘ELECTRONIC BLOOD PRESSURE’)

1 Explains procedure, speaking clearly, slowly, and

directly, maintaining face-to-face contact whenever

possible

2 Before using stethoscope, wipes bell/diaphragm and

earpieces of stethoscope with alcohol

3 Client’s arm is positioned with palm up and upper arm

is exposed

4 Feels for brachial artery on inner aspect of arm, at

bend of elbow

5 Places blood pressure cu snugly on client’s upper arm,

with sensor/arrow over brachial artery site

6 Earpieces of stethoscope are in ears and bell/

diaphragm is over brachial artery site

7 Candidate inﬂates cu between 160mm Hg to 180 mm

Hg. If beat heard immediately upon cu deﬂation,

completely deﬂate cu. Re-inﬂate cu to no more than

200 mm Hg

Skill continues

8 Deﬂates cu slowly and notes the ﬁrst sound (systolic

reading), and last sound (diastolic reading) (If rounding

needed, measurements are rounded UP to the nearest 2

mm of mercury)

9 Removes cu

10 Signaling device is within reach

11 Before recording, washes hands

12 After obtaining reading using BP cu and

stethoscope, records both systolic and diastolic

pressures each within plus or minus 8 mm of

evaluator’s reading

SCORE REPORTING

EX AM RESULTS

You will receive a notication email from CNA365 when

a new exam score has been posted to your online account.

To access your score report, please login to your CNA365

account by clicking the “CNA365 Login” button on the

top of the North Carolina nurse aide website page at www.

credentia.com/test-takers/ncna. Score reports are generally

available within a few hours after a testing event is com-

pleted for the day. If it has been more than 24 hours and

you are unable to view your score report in CNA365, please

contact customer service at 1-888-723-6773.

SCORE REPORTING

Credentia will provide you with your ocial examination

results within a few hours after a testing event is completed

for the day. Score reports are provided online and are avail-

able for you to print or download. Examinations results

will not be given over the telephone nor can they be sent by

Credentia to your employer.

FAILING

If you fail the written (or English or Spanish oral) exami-

nation or the skills evaluation, your score report will pro-

vide you with information on how to re-take either or

both parts of the evaluation. A new examination fee is

required each time you re-take any part of the NNAAP

Examination. To re-take either or both parts, you must

re-register online.

Candidates must pass both the written examination and the

skills examination within two (2) years from the successful

completion date of a state-approved training program or

within three (3) attempts, whichever comes ﬁrst, to be placed

on the North Carolina Nurse Aide I Registry. Failure to do

so will require Candidates to complete state-approved nurse

aide training and competency testing again. In addition, a

change in the eligibility route may require Candidates to

complete state-approved nurse aide training and competency

testing.

GRIEVANCE PROCESS

All grievances must be in writing and submitted through

the online system. e candidate must provide as much

detail as possible in the grievance form. e grievance

must be submitted within 30 days of the candidate’s exam

date. After receipt of the grievance form, the complaint

will be investigated.

Once the investigation is complete, Credentia will send

email correspondence back to the candidate informing

him/her of the outcome of the investigation. If the griev-

ance is substantiated, the candidate will be allowed to

retest at no additional cost.

For details on how to submit a grievance, visit www.

credentia.com/test-takers/nc and click on “Grievances” in

the Resources section of the webpage. You will receive a

response within 30 days of receipt.

THE REGISTRY

INITIAL LISTING

You must pass both the written and skills portions of the

NNAAP competency evaluation to be listed on the North

Carolina Nurse Aide I Registry After successfully complet-

ing both portions of the exam, your name will be submit-

ted to the North Carolina Nurse Aide I Registry for listing.

It generally takes two (2) to five (5) days for your name

to be listed on the registry. Exams requiring hand-scoring

will take longer.

Your listing can be verified immediately upon entry by

contacting registry staff at 1-919-855-3969 (8:00 a.m. to

12:00 p.m. and 1:00 p.m. to 3:00 p.m. weekdays) and will

be available for verification via the registry’s website on the

following day. Verifications are available online at:

https://ncnar.ncdhhs.gov/

You are encouraged to confirm yournew listing entry and

the accuracy of the information listed on the registry via

the online verification system at https://ncnar.ncdhhs.gov/.

CHANGE OF ADDRESS OR NAME

The North Carolina Nurse Aide I Registry must be

kept informed of your current address and name.

There is no charge for changing your name or address on

the registry. You may notify the registry of a name or address

change by using the Name and Address Change Form on

the North Carolina Nurse Aide I Registry website (https://

ncnar.ncdhhs.gov). Alternately, you may call the Nurse

Aide I Registry at 1-919-855-3969 to change your mailing

address on the registry.

If your name changes at any time after you are placed

on the registry, you must send written notiﬁcation of

this change to the registry. Please remember, however,

that if you changed your name, you MUST provide ocial

documentation along with your notiﬁcation. Written docu-

mentation must include 1) a COPY of your signed social

security card with the new name on it, AND 2) a COPY

of a court-issued marriage certificate, divorce decree, or

other legal document that demonstrates the name change.

Your notiﬁcation must include your previous name, current

name, mailing address, phone number, and the last four

(4) digits of your Social Security number. All documents

provided to the registry in support of your name change

MUST be ocial and legal documents. Any documents

provided may be subject to veriﬁcation with the issuing

source.

Failure to inform the registry of an address or name

change may jeopardize your listing status.

ONLINE LISTING RENEWAL

*North Carolina Nurse Aide I Registry no longer

mails renewal forms.

*It is a Nurse Aide’s responsibility to renew their

North Carolina Nurse Aide I Registry. In order to

verify when your listing will expire visit: https://

ncnar.ncdhhs.gov/

Nurse aides on the North Carolina Nurse Aide I Registry

must renew their registry listing online to remain eligible

for employment as a nurse aide. Renew online by going

to https://ncnar.ncdhhs.gov/ and completing the Online

Registry Renewal up to 3 months before your listing

expires.

HOW TO READ A FAILING

SCORE REPORT

If you do not pass the skills evaluation, you will receive

a failing score report. The score report will list the ﬁve

(5) skills that you performed and a score of Satisfactory or

Unsatisfactory for each skill. Any skill with an Unsatisfactory

result is considered a failed skill. You must receive a

Satisfactory result on all ﬁve (5) skills to pass the skills

evaluation.

Use your failing score report as an aid in studying to

re-take the skills evaluation. A failed skill will show the

reason for the failure. You may not have performed the

steps of a skill correctly, or you may have forgotten a step,

especially a Critical Element Step.

The failing score report will list steps that were missed or

incorrect—look for numbers printed directly under a skill

marked Unsatisfactory. A list of all the skills and the steps

needed for each skill can be found in this handbook. Find

the skill you failed, and study the steps, especially steps

listed as Unsatisfactory on the score report.

In the example on the next page, a candidate received a result

of Unsatisfactory on the skill Hand Hygiene. The numbers 1, 5,

and 10 printed below the skill refer to steps that were missed

or performed incorrectly. To study for re-taking the skills

evaluation, this candidate should turn to the Skills Listing in

this handbook, look for the Hand Hygiene skill, and review

all the steps, especially steps 1, 5, and 10.

North Carolina NNAAP

Examination Results

Exam: Skills Result: Fail

Skills Performance:

Hand Hygiene

1, 5, 10

Unsatisfactory

Provides Mouth Care Satisfactory

Measures and Records

Blood Pressure

Satisfactory

Puts One Knee-High

Elastic Stocking on Client

Satisfactory

Measures and Records

Weight of Ambulatory Client

Satisfactory

A sample of a Failing Score Report

There are two parts to be completed: The Nurse Aide I

Online Renewal Form (to be completed by the nurse aide)

and The Nurse Aide I Employment Veriﬁcation Form

(to be completed by a Registered Nurse).

To be eligible for renewal, you must work for pay, per-

forming nursing-related services, under Registered Nurse

supervision, for at least eight (8) hours during your current

24-month listing period. This employment must be docu-

mented and reported to the North Carolina Nurse Aide I

Registry prior to the listing expiration date. Re-training

and testing is required if you do not meet the renewal

criteria.

• Failure to inform the registry of an address or name

change may jeopardize your listing status.

• Current renewal procedures can be found at https://

ncnar.ncdhhs.gov/