Congratulations on choosing a new career in the medical field! Certified nursing assistants (CNAs) play an important role in many hospitals, assisted living homes, and other medical facilities. You are sure to make a positive difference in patients’ lives in this rewarding career. Before you find that perfect job, however, you will need to pass the certified nursing assistant test. In this CNA study guide, we summarize the information covered on the test and help you decide where to focus your studies. Included are the main topics you need to understand in order to pass with flying colors. Let’s get studying!

Acting As A Member Of A Team

As a CNA, you are a member of a team of health care professionals. Each member has his or her own responsibilities and plays an important role in providing the patients with the care they require. Everyone must work together on a comprehensive treatment plan that serves the patients’ needs.

The Team


Familiarize yourself with each member of the team. Team members may include doctors, nurses, medical aides, physical therapists, social workers, and spiritual counselors, among others. Know who is responsible for each task. Also, be sure you know whom to contact when dealing with a specific problem. If you thoroughly understand each role, you will be better equipped to offer your patients the excellent care they deserve.


The CNA is a key member of the health care team. As a CNA, you may be the team member who has the most amount of face time with a patient. This means you may be the first to notice changes to the patient’s behavior or condition, helping doctors and nurses with their assessments. CNAs are also charged with providing hands-on care, ensuring the patient’s comfort and safety, and helping the patient perform daily tasks.


sanitizing hands

Your number one priority should always be the patient’s safety. Be sure to closely follow procedure at all times. Avoid any situation that may cause harm to the patient. Wash your hands before and after handling your patients and wear gloves when appropriate. Keep the area around the patients clean, free of clutter, and hygienic. Report any problems to the appropriate staff.


holding hands

As a CNA, you will have a great deal of contact with your patients throughout the day. Immediately report any concerning changes in behavior or physical condition to the appropriate team members. Pay attention to a patient’s mood, comfort level, and appearance. Regularly record the patient’s vitals as well as eating and bathroom habits. Notice any bruising, swelling, or increases in pain. You may spot an issue that the patient does not report to other medical staff. It is important that you communicate this information to the right team member.

Activities Of Daily Living

nurse reporting sheet

Much of your day will be spent assisting patients with activities of daily living (ADLs). These include everyday tasks like dressing, eating, using the bathroom, bathing, and walking. These activities are beneficial to a patient’s physical well-being, as well as his or her emotional well-being. Completing basic self-care tasks can help a patient maintain dignity and feel more at home.

Understanding Patient Rights

Basic rights afforded to a patient include kindness, respect, cleanliness, and comfort. It is imperative that each client is treated with dignity. There are also more complex rights that a CNA should know.

Being Informed

Patients must be kept abreast of information regarding their care, their progress, and their prognosis. This information should be accurate and thorough so that they can make decisions about their health and treatment.

Protection From Abuse

Though some patients may be difficult to work with, they must always be treated with the highest standard of care. Physical, mental, and verbal abuse, as well as neglect, should never be tolerated.


You should never discuss a patient’s care outside of the work setting or share confidential information about a patient without his or her consent. Health care professionals are entrusted with sensitive information, and all patients need to feel comfortable sharing this information with those who are taking care of them. There are legal repercussions for breaking these rules that could have a negative effect on you and your facility.

Financial Control

Patients have a right to use their money however they see fit. Do not try to influence their spending habits. Your role is as a health care provider, not a financial adviser.

Freedom From Fear

Being in the care of a medical facility can make a person feel vulnerable. It is important to create an environment in which patients feel safe and secure. They should never be afraid that they will be met with punishment if they voice concerns about their treatment or any staff members. They should be allowed to express complaints freely, without fear of repercussions.

Assisting With Activities Of Daily Living

Activities of daily living are the simple activities most of us do every day without thinking about them – eating, bathing, using the restroom, etc. However, your patients may need assistance to perform these tasks. CNAs must know the proper way to assist so that the patient stays safe and comfortable.


Some patients may require the use of a bedpan or commode. It is important to respect their dignity and give them as much privacy as you can safely allow. If using a bedpan, place a pad underneath the patient to keep the bed linens clean. Ask the patient to roll onto his or her side and then place the bedpan under the buttocks. Elevate the head of the bed so that the patient is in a seated position more suitable for going to the bathroom. If using a commode, bring it close to the patient so he or she does not need to move very far. Make sure that it is in a locked position to prevent an accident. Keep any necessary items, like toilet paper, close by and then help the patient transfer to and from the commode.


Some facilities use dry shampoos and bathing wipes, while others rely on regular soap and water. When bathing a patient in bed, be sure to use warm water and keep the patient comfortable. Only expose the area you are washing. Dry each area immediately after it has been cleansed.


If a patient needs assistance eating, be sure to wash your hands thoroughly. Use a spoon to feed the patient, allowing proper time for chewing and swallowing between bites. Regularly offer sips of fluid. Have a conversation with the patient to make it a more pleasurable experience.

Moving Around

CNAs are often entrusted with helping the patient with ambulation. Each patient will have different needs in this regard:

  • Range of Motion Exercises: When assisting a patient with range of motion exercises, have him or her lie flat on the back. Rotate the joints, starting at the shoulders. Flex the lower arms, making sure to support the elbows and wrists. Rotate the wrists, extending each finger. Bend the knees while supporting the feet and ankles. Rotate the legs from the hip joint, then move them toward and away from the body. Flex and extend the feet and toes. If a body part is stiff and inflexible, do not force it to move.
  • Ambulation: You may need to help your patients move from place to place. Some patients may need little support, while others may need greater assistance. For those who need more support, a gait-transfer belt is often used. To help a patient stand, fasten the belt around his or her waist. While standing in front of the patient with your legs apart, hold the belt with both hands and pull the patient up to a standing position. Grab the belt at the side with one hand and the back with your other hand. Stand to the patient’s side, or just slightly behind, and guide along as he or she walks. If the patient starts to stumble, bend your knees and gently lower him or her to the floor to prevent injury. Then call for help. If you try to move the patient by yourself, you may cause further injury.

Promoting Emotional And Mental Health

Some patients may have specific emotional and mental health needs in addition to their physical needs. It is important to have a basic understanding of the mental health field to deliver the care your patients require.

Emotional Health

A hospital stay can be a stressful and frightening experience. Though you are not expected to take on the role of doctor or family member as a CNA, maintaining a good bedside manner with your patients can support their emotional health. Offer comfort when your patients receive bad news and encouragement when they receive good news. Acting with compassion is a key part of being a CNA.

Mental Health

Be observant of any changes to a patient’s mental state. Identify triggers that are causing increased mental anguish and report them to appropriate staff. Have a basic knowledge of common mental health disorders so that you can be valuable to doctors making diagnoses and treatment plans.


Clear communication is imperative when working in the health care field. You must be attuned to a patient’s verbal and nonverbal cues. You must also be able to reliably communicate to other medical professionals.

Patient Communication

nurse reading to an elderly patient

Be sure to listen closely when interacting with a patient. When sensitive information is being addressed, patients may sometimes be vague or incomplete with their stories. Make sure you ask follow-up questions and look for subtext. Also, be sure to clearly communicate any information you need to relay to your patients and ask them if they have questions. Pay attention to your own body language and tone. A patient may be more receptive to your requests if you are open and kind.

Medical Staff Communication

When taking direction from medical staff, listen attentively, repeat any instructions back to the speaker, and write down all pertinent information. Always report any concerning information about a patient. As patients can be in danger if information is misunderstood, it is imperative that you and the other staff member walk away from a conversation with clarity and confidence. Do not be afraid to ask questions if you are unsure about any details.

Learning Nursing Skills

As part of the clinical skills section of the CNA exam, you need to demonstrate a working knowledge of basic nursing skills. Some of those skills include taking vitals, CPR, changing bandages, cleaning wounds, and bathing patients.

General Safety

Familiarize yourself with protective equipment used to keep you and your patients safe. Understand when it is necessary to use gloves, masks, gowns, and eye shields. Use caution when changing sheets as they can often hide discarded needles or other dangerous objects. Know how to properly dispose of medical waste. Keep patients’ rooms clean and uncluttered to reduce the chance of a fall.

Technical Procedures

CNAs are often tasked with performing simple yet crucial technical procedures. These include taking a patient’s temperature and blood type, trimming nails, and assisting with toothbrushing. Understand the differences between tympanic, axillary, oral, and rectal temperature readings and techniques. Be familiar with manual and machine-assisted blood pressure techniques. A normal blood pressure reading is typically around 120/80. The normal range for a pulse is 60-100 beats per minute. Before trimming nails, soak them in warm water for up to 20 minutes. Allow patients to brush their own teeth if they can do so safely. Soak dentures in water and take care to prevent any breakage.

Preventing Spread of Disease

holding hands

It is important to take steps to prevent the spread of infection and to keep yourself healthy as well. Handwashing is a simple yet effective technique that must be performed before and after handling each patient. Scrub hands, wrists, and nails with soap and water for at least 15 seconds. If your hands are not visibly dirty, you may use a waterless antiseptic. When an activity requires gloves, remove and safely dispose of them immediately after you are finished.

Learning Rehabilitative Skills

elderly under rehabilitation therapy

Rehabilitative skills are key to helping patients restore certain abilities, prevent reinjury, and resume self-care. As a CNA, you may be responsible for applying direct restorative care or offering encouragement and emotional support while the patient goes through therapy. While a doctor, physical therapist, or other medical professional will likely develop a patient’s treatment plan, you may assist him or her in reaching outlined goals. It is important to be fully observant while fulfilling these duties, noticing any problems that may require the attention of additional medical staff.

When assisting a patient with rehabilitation, it is also important to exercise patience and a positive disposition. Encourage your patients to perform all assigned exercises and put forth their best effort. Be respectful and be sure to treat your patients as adults, not children, no matter how difficult they may be. Using condescension will likely cause patients to further resist actively participating in their treatment or follow-up care. While it is your responsibility to provide motivation, do not force patients to partake in any exercises they refuse to perform.

Managing Legal and Ethical Matters

Each job within the medical field is subject to both legal and ethical standards. As a CNA, you must be familiar with government-mandated standards of care, as well as those implemented by your specific facility. If you do not meet these standards, you may face serious consequences through the legal system.

The Patient’s Bill of Rights

The Patient’s Bill of Rights, created by the American Hospital Association, outlines several rights that each patient has while in the care of a medical facility. All patients have certain rights:

  • Be free of abuse
  • Be informed of their medical condition
  • Participate in their own treatment plan
  • Enjoy respect and privacy
  • Control their own finances

It is important to adhere to the rights listed in the bill without stepping outside the scope of your responsibilities. If a patient has a question about his or her care that you are not trained to answer, seek the right team member to provide patient assistance. If you see another team member violating this bill, immediately report the activity to the appropriate person.

Legal Liabilities

As the health care industry is government-regulated, staff members who harm a patient through behaviors considered to be abusive or neglectful may be prosecuted for a crime. Following are activities that should be avoided and immediately reported if witnessed:

  • Abuse: Purposefully harming a patient mentally or physically
  • False imprisonment: Keeping a patient from moving freely, including using unwarranted restraints
  • Assault and battery: Threatening and/or using unwelcome touch or force on a patient
  • Aiding and abetting: Participating in or having knowledge of abuse by another staff member and not reporting the incident to the proper authorities
  • Neglect: Failing to perform adequate care or omitting care entirely
  • Theft: Stealing patient property

Another legally actionable behavior is violating a patient’s privacy. The Health Insurance Portability and Accountability Act (HIPAA) deals with issues of patient confidentiality. Disclosing private information about a patient’s medical record to an unauthorized person can lead to job loss and legal action. Unlike abuse, a HIPAA violation can occur even when you have the best intentions in mind. It is therefore imperative that you understand the rules and abide by them at all times.

Ethical Behavior

Generally speaking, ethics are a matter of what is right and wrong. While each person may have his or her own set of ethics, a medical facility will typically have a written code that each staff member must adhere to. If you are not sure what action to take in a given situation, consult with other team members or trusted medical professionals to come up with a satisfactory solution. Remember that it is always best to act with beneficence (being good toward others) and nonmaleficence (doing no harm against others).

Understanding Religious and Cultural Issues

Issues related to culture and spirituality may arise when working with a patient. They may present certain challenges to a proposed treatment plan but must always be handled with respect and understanding.

Religious Issues

religious issues

Some religious issues may be small and relatively manageable, like dietary restrictions or regular visits to a chapel. Others may pose a more serious challenge, like the refusal of a blood transfusion or organ transplant. It is important to try to work with a patient’s beliefs rather than brushing them off or attempting to change someone’s views. Listen carefully to the patient’s concerns to fully understand his or her viewpoint. Clear up any misconceptions the patient may have about the treatment that is being proposed. Do not proceed with any procedures the patient has expressly refused.

Cultural Issues

Cultural attitudes can at times be just as powerful as religious beliefs. Culture encompasses the characteristics and customs of a particular group of people. These can include ideas, rituals, and shared behaviors. As a CNA, you may care for patients who have competing ideas about lifestyle choices, parenting techniques, gender roles, and other cultural norms. You may even come across a general distrust of medicine and medical professionals. Cultural beliefs are often passed down over several generations and can be quite ingrained. Keep an open mind while treating patients with differing ideas and respect their opinions. Be sure to take any concerns seriously when providing care and advice.

Final Test Tips

If you familiarize yourself with each of the topics in this study guide, you should be well-prepared on exam day. The test is administered in two parts: a written exam and a clinical skills test. In most cases, you will need a score of 70 or above on each part to pass. The written exam is taken on a computer and features multiple-choice questions. It typically takes about two hours to complete. The clinical skills test is performed in person under the direction of an evaluator. You will be asked to demonstrate your knowledge of important procedures. This will take between 30 and 45 minutes.

Passing the CNA test demonstrates to potential employers that you have the knowledge necessary to competently perform the duties of a CNA. It is sure to be the first step in a satisfying career in the medical field.