Activities of Daily Living

22% of the CNA exam · blueprint NNAAP Written (Oral) Examination Content Outline, effective April 2024

Short answer

Thirteen of the 60 scored items, and the second largest area. It covers hygiene, dressing and grooming, nutrition and hydration, elimination, and rest, sleep and comfort. These are also the personal care skills that federal rule requires the skills-evaluation pool to include, so this area is tested twice — once on paper and once in front of an evaluator.

Why it matters on this exam

Twenty-two percent of the written exam, and disproportionately more of the skills evaluation. Federal rule 483.154(b)(2) requires the skills pool to include all of the personal care skills listed in 483.152(b)(3) — bathing, grooming including mouth care, dressing, toileting, assisting with eating and hydration, proper feeding techniques, skin care, and transfers, positioning and turning.

That is why the NNAAP skills listing is dominated by ADL tasks: modified bed bath, mouth care, denture care, perineal care, foot care, dressing a client with a weak arm, feeding, bedpan use, positioning on the side, and transfers.

Key concepts

Hygiene. Bathing, mouth care and denture care. The recurring scored details are water temperature, privacy, clean gloves before contact with body fluids, and using a clean area of the washcloth for each stroke.
Dressing and grooming. The rule that the exam returns to again and again: dress the affected or weaker side first, and undress the stronger side first. The NNAAP skill is explicitly "Dresses Client with Affected (Weak) Right Arm".
Nutrition and hydration. Proper feeding technique, positioning upright, checking the tray against the diet card, offering fluids, and recording intake.
Elimination. Bedpan use, perineal care, catheter care, and measuring and recording urinary output. In perineal and catheter care the scored direction is to move away from the meatus, using a clean area of the cloth for each stroke.
Rest, sleep and comfort. Positioning, turning schedules, and pressure relief.
Independence. Federal curriculum names promoting residents' independence among the content required before any direct resident contact — do for the resident only what they cannot do for themselves.

Common mistakes

Dressing the strong arm first. It seems easier and it is the wrong answer in both the written exam and the skills evaluation: the affected limb has less range, so it goes into the sleeve while the garment is still loose.
Providing care without providing privacy. A curtain, screen or door is a scored step, and on paper it is a resident-rights answer as much as a hygiene one.

Worked example

A resident has a weak right arm and needs help dressing. The shirt goes onto the right arm first, while the sleeve is unobstructed, then over the trunk, then the left. Undressing reverses it: left arm out first, right arm last. The same logic drives the NNAAP skill and the written item, and it generalises — the affected side leads going on and follows coming off.

Original practice questions

Activities of Daily LivingDifficulty 2/5

A resident has a weak right arm and needs help putting on a shirt. Which arm goes in first?

ABoth arms together, to reduce the time the resident is uncovered
BThe right arm, because the affected side is dressed first
CThe left arm, because the stronger side is dressed first
DEither arm, provided the resident is seated upright throughout

Show answer and rationale

Correct: B. The affected limb has less range, so it goes in while the garment is still loose and unobstructed. Undressing reverses it: the stronger side comes out first. The NNAAP skill is written around exactly this.

C — Dressing the strong side first leaves the weak arm to be forced into a tightened sleeve.
D — Position matters but does not remove the rule about which side leads.
A — Dressing both arms at once is not achievable and risks injuring the affected limb.

Activities of Daily LivingDifficulty 3/5

When providing perineal care, in which direction should the aide clean?

AIn a circular motion outward, reusing the same area of the cloth
BFrom back to front, using a clean area of the cloth for each stroke
CAway from the meatus, using a clean area of the cloth for each stroke
DToward the meatus, using a clean area of the cloth for each stroke

Show answer and rationale

Correct: C. Cleaning away from the urinary meatus, with a fresh area of the cloth each time, prevents carrying organisms toward the urethra. Both halves are scored steps in the NNAAP checklist.

D — Cleaning toward the meatus carries organisms directly toward the urethra.
A — Reusing the same area of the cloth redeposits what was just removed.
B — Back to front moves organisms from the anal area toward the urethra.

Activities of Daily LivingDifficulty 2/5

Before feeding a resident who cannot feed themselves, what should the aide do first?

APosition the resident flat and check the tray against the diet card
BBegin with fluids to moisten the mouth before offering any solid food
CAsk a family member to confirm which foods the resident prefers today
DPosition the resident upright and check the tray against the diet card

Show answer and rationale

Correct: D. An upright position reduces aspiration risk, and checking the tray against the diet card catches a wrong tray before the resident eats from it. Proper feeding technique is named in the federal curriculum.

A — Feeding a resident lying flat creates a serious aspiration risk.
B — Fluids may be appropriate, but position and the correct tray come first.
C — Preference matters, but it does not replace verifying the prescribed diet.

All 4 Activities of Daily Living questions →

Tools for this topic

NNAAP skills randomiser — Draws five skills from the NNAAP listing with hand hygiene always included, exactly as the real skills evaluation does. Federal rule requires the draw to be random, so practising a favourites list is a strategy the regulation is built to defeat.

4 flashcards for Activities of Daily Living

Practice this topic

Blueprint-mapped questions with full rationales for every choice.

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Primary references

The 2024 National Nurse Aide Assessment Program (NNAAP) Written (Oral) Examination Content Outline — Credentia Nurse Aide LLC · primary · retrieved 2026-09-22, verified 2026-09-22
42 CFR Part 483 Subpart D — Requirements That Must Be Met by States and State Agencies, Nurse Aide Training and Competency Evaluation — Office of the Federal Register (eCFR) · government · retrieved 2026-09-22, verified 2026-09-22

Last reviewed: 2026-09-22Next review by: 2026-11-06Draft — pending editorial reviewHow we verify facts