Communication

7% of the CNA exam · blueprint NNAAP Written (Oral) Examination Content Outline, effective April 2024

Short answer

Four of the 60 scored items. Communication and interpersonal skills is one of the five areas federal rule requires to be taught before any direct resident contact. It covers communicating with residents, families and the care team, adapting to sensory and cognitive impairment, and the reporting that connects the aide to the licensed nurse.

Why it matters on this exam

Four items on paper, but communication is scored on every skill in the practical evaluation. The NNAAP skill checklists open with the same step over and over: explains procedure, speaking clearly, slowly and directly, maintaining face-to-face contact whenever possible. Miss it and you lose points on a skill you otherwise performed well.

Section 483.152(b)(1)(i) makes communication and interpersonal skills one of the five areas taught before any direct resident contact.

Key concepts

The opening step. Address the resident by name, introduce yourself by name, explain the procedure before you begin. This is scored, not courtesy.
Speaking clearly, slowly and directly, maintaining face-to-face contact whenever possible.
Sensory impairment. Face a resident with hearing loss so they can see your mouth; speak clearly rather than loudly. Shouting distorts speech and raises pitch, which makes high-frequency hearing loss worse.
Non-verbal communication — position, eye level, touch, and what your own posture conveys.
Communicating with cognitively impaired residents, named in the curriculum at 483.152(b)(5)(ii).
Reporting. The aide observes and reports; the licensed nurse assesses. Objective reporting — what was seen, heard and measured — rather than interpretation.

Common mistakes

Shouting at a resident with hearing loss. It is the classic distractor and it is wrong: face the resident and speak clearly at a normal pitch.
Talking over a resident to a colleague during care. The resident is present; the exam treats that as both a communication failure and a dignity failure.

Worked example

An aide needs to reposition a resident who has a hearing impairment. Before touching them, the aide moves into the resident's field of vision, makes face-to-face contact, addresses them by name, introduces themselves, and explains what is about to happen — speaking clearly and at normal volume rather than shouting. Every one of those is a scored step in the NNAAP checklists, and the same sequence is what a written communication item is testing.

Original practice questions

CommunicationDifficulty 2/5

How should an aide communicate with a resident who has hearing loss?

AWrite every instruction down instead of speaking at all
BFace the resident and speak clearly at a normal pitch
CShout so that the resident is certain to hear the words
DUse a high-pitched voice to carry over the hearing loss

Show answer and rationale

Correct: B. Facing the resident lets them use lip movement and expression. Shouting distorts speech and raises pitch, which makes high-frequency hearing loss worse rather than better.

C — Shouting distorts the sounds and is also undignified in front of others.
D — High-frequency hearing is usually the first lost, so raising pitch reduces clarity.
A — Writing everything removes normal interaction and is unnecessary for most residents.

CommunicationDifficulty 1/5

Which step opens nearly every skill in the NNAAP skills listing?

ARaising the bed to its highest position before beginning the procedure
BRecording the client's vital signs before any other action is taken
CExplaining the procedure, speaking clearly, slowly and directly to the client
DWashing the hands immediately before touching any part of the client

Show answer and rationale

Correct: C. The NNAAP checklists open with addressing the client by name, introducing yourself, and explaining the procedure while maintaining face-to-face contact. It is a scored step, not a courtesy.

D — Hand hygiene is essential but is its own skill and its own scored step.
A — Bed height is adjusted for specific procedures, not as a universal opening step.
B — Vital signs are taken when the task requires them, not before every skill.

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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