22% of the 2024 NNAAP outline
Activities of daily living on the CNA exam: hygiene, feeding, elimination, comfort
Activities of daily living (ADL) is the second-largest area on the CNA written test: 22% of the 2024 NNAAP outline, about 13 of the 60 scored items. The questions cover bathing, mouth care, dressing, feeding, toileting and comfort, and many of them are decided by dignity and independence rather than technique.
What ADL covers on the written test
ADL questions test the daily hands-on care you give a resident, in five groups: hygiene, dressing and grooming, nutrition and hydration, elimination, and rest and comfort.
- 22%ADL share of scored items, 2024 NNAAP outline
- ~13of 60 scored items on an NNAAP form
Up from 14% in the 2016 outline, so older books under-weight it. Prometric and Headmaster/D&S use their own outlines, close to NNAAP but not identical.
| Subtopic | Typical question | What usually decides the key |
|---|---|---|
| Hygiene | Bath setup, peri-care, dentures, shaving, nails | Safety first, then privacy |
| Dressing and grooming | Which side first, choosing clothes | Weak side first; the resident chooses |
| Nutrition and hydration | Feeding, diets, swallowing, intake math | Upright, eye level, diet as ordered |
| Elimination | Bedpan, catheter bag, incontinence | Privacy, gloves, report what changed |
| Rest and comfort | Positioning, pain, sleep, bedmaking | Ask first, adjust, pain goes to the nurse |
Hygiene: bathing, peri-care, mouth care, shaving, nails
Hygiene questions check that the resident stays safe, covered and clean, usually in that order. A slip in the shower outranks a missed step in the wash.
Before a resident gets into the tub or shower
- Non-slip mat down and the call light within reach.
- Water checked with a bath thermometer or your inner wrist, then tested by the resident.
- Towels and clean clothes already in the room, so you never leave a resident in water.
- Door closed, curtain pulled, everything covered except the part you are washing.
No magic number for bath water
Guides quote different temperatures. The exam tests the principle: measure the water, then let the resident feel it.
Peri-care
Wash front to back, clean area to dirty, with a clean part of the washcloth for each stroke. Gloves on, a bath blanket over the rest of the body, and pat the skin dry.
Mouth care and dentures
- At least twice a day and as needed. No teeth or dentures still means cleaning gums and tongue.
- Dentures: over a towel-lined or water-filled sink, cleaned in cool water, stored in a labeled cup with water. Report a crack or chip.
- Unconscious resident: on their side, swabs with very little liquid, never your fingers in the mouth.
- Gloves for all mouth care.
Nails and razors
Do not cut the toenails of a resident with diabetes; report long or thick nails. A resident on blood thinners gets an electric razor. A small cut on either one bleeds longer or heals badly.
Dressing and grooming
Dress the weak side first and undress the strong side first; that one rule answers most dressing questions. The rest is about choice.
| Task | Start with | Why |
|---|---|---|
| Putting clothes on | The weak (affected) side | The stiff arm gets the most room to slide into the sleeve |
| Taking clothes off | The strong side | The weak arm comes out last, with the least bending |
| Picking the outfit | The resident | Clothing choice is a resident right; keep it to a small choice for a resident with dementia |
Dressing is also when you see skin nobody else checks today. Swelling, redness over a bony spot that does not fade, or an unexplained bruise goes to the nurse.
Ten minutes, one cardigan
Practice on a friend or a pillow between shifts: weak arm in, around the back, strong arm in, then reverse it. Your hands learn the order faster than your notes.
Nutrition and hydration
Feeding questions reward an upright resident, a diet that matches the order, and an aide who lets the resident run the meal.
- Check the diet card against the resident's ID before the tray goes down.
- Sit at eye level, facing the resident. Standing over someone rushes them.
- Small bites, one at a time, and let the resident say which food comes next.
- For a resident with low vision, describe the plate like a clock: meat at 6, potatoes at 9.
- Keep a resident with swallowing problems sitting up for a while after the meal.
Swallowing problems and thickened liquids
Coughing or choking while eating or drinking means food or liquid may be heading into the airway: stop the feeding and tell the nurse. Thickened liquids are served exactly as ordered, and anything that turns liquid at room temperature (ice cream, gelatin, broth) counts as fluid.
Intake and output math
Expect a little arithmetic. Memorize two conversions: 1 oz = 30 mL and 1 cup = 8 oz = 240 mL. Output is recorded in mL too.
Convert each item
6 oz of coffee = 180 mL; 4 oz of gelatin = 120 mL; 1 cup of milk = 240 mL.
Add them up
180 + 120 + 240 = 540 mL of intake for that meal.
Record it
Write the total in mL, and chart how much of the meal was eaten the way your facility's form asks (often a percentage).
Elimination: toileting, bedpans, catheters
Elimination questions test privacy, a call light within reach, and noticing what is in the bedpan or bag.
- Offer the toilet on a schedule and answer call lights quickly; a resident who waits may try to walk alone.
- Bedpan: raise the head of the bed if allowed. A resident with a hip fracture gets a fracture pan.
- Gloves for bedpans, urinals and emptying a drainage bag.
- Incontinence care: clean and dry the skin promptly and never shame the resident.
| Check | Correct | Why |
|---|---|---|
| Bag | Below the bladder, off the floor | Urine drains down; the floor is dirty |
| Tubing | No kinks, secured to the upper thigh | Kinks stop drainage; securing stops pulling |
| Connection | Never opened | An open system lets germs in |
| Catheter care | Clean from the opening outward, about 4 inches | Clean to dirty, away from the body |
Check the tubing before you call the nurse
An empty or nearly empty bag has a simple first suspect: a kink, or a resident lying on the tubing. Fix the mechanical cause first, then report if urine still is not draining.
Report what you can see changing: blood, very dark or cloudy urine, a foul smell, red streaks in stool. Do not flush; the nurse may want to look. Normal output is recorded, not reported.
Rest, sleep and comfort
Comfort questions are about asking what is wrong, adjusting position, and passing pain to the nurse instead of treating it yourself.
- Reposition a resident who cannot move on their own at least every 2 hours. Lift, do not drag: dragging shears the skin.
- Pain: ask where it hurts, help with position or a back rub, and tell the nurse. The aide never gives or offers medication.
- Bedmaking: hold linen away from your uniform, never shake it, never put it on the floor. Clean linen you carried into a room is treated as used.
- Sleep: if a resident cannot sleep, find out why first (toilet, pain, noise, cold) before you try anything else.
The dignity and independence traps
Most wrong ADL answers are faster for the aide and worse for the resident. Spot that pattern and you can often rule out an option or two before you know the procedure.
| Tempting answer | Why it loses | What usually gets the key |
|---|---|---|
| Do it for them, it is quicker | Takes away independence the resident still has | Let them do as much as they can; help with the rest |
| Hurry them so the food stays warm | Speed serves the aide, not the resident | Warm the food again and let them set the pace |
| Insist on the clothing protector | Refusing it is the resident's choice | Respect the wish |
| Report it to the nurse, by reflex | A normal finding or a preference is not a problem | Record normal findings; report changes |
When a resident refuses care
Do not argue, bribe or quote policy. Ask why, offer another time, come back later, and let the nurse know if the refusal continues.
Activities of daily living · dignity at bath time
A resident who was abused in the past becomes fearful when undressed for a bath. The nurse aide SHOULD:
- ask two coworkers to hold her so the bath is done
- tell her there is nothing to be afraid of
- keep her covered and let her set the pace (best answer)
- remove all her clothes quickly to finish
Keeping the resident covered and letting her control the pace gives her a sense of safety and control, which reduces fear. Undressing her quickly, dismissing her fear, or having staff hold her can feel like the past abuse and may be abuse itself.
Why the others lose
- Holding her still is a restraint, and for a resident who was abused it repeats the worst part of the past; fear is never solved with force.
- Telling her there is nothing to fear brushes the feeling aside and changes nothing about the bath.
- Undressing her quickly takes away the privacy and control that make the bath bearable for her.
ADL on the skills test
ADL tasks also appear on the hands-on half: hygiene, feeding, dressing and toileting are common skill families, though which skills are drawn, and how many, differ by vendor and state. The skills test guide covers how the evaluation runs and what graders check in every skill.
It is physical work: you bend over a bed for the whole evaluation. Wear the closed-toe shoes and clothing your vendor's candidate handbook asks for, and rehearse feeding at your kitchen table with a real spoon, sitting at eye level, so the posture is automatic on the day.
Practice: 12 ADL questions
These 12 cards are original practice questions written in the style of the NNAAP and Prometric written tests, all from this content area. Each rationale opens the moment you answer, so the set fits into one 20-minute break.
Card 1 of 12
Activities of Daily Living
60:00
Before a resident with poor balance gets into the shower, the nurse aide SHOULD:
Pick an answer. The rationale flips up right here, on the back of the card.
0 right · 0 missed · 12 to go
When these feel easy, mix ADL with everything else in the full practice deck, or sit the timed mock at a quiet table, phone in another room. Basic nursing skills and the rest of the outline are in the study guide.
Questions people ask
How many ADL questions are on the CNA exam?
On the NNAAP written test, ADL is 22% of the 60 scored items, about 13 questions (2024 outline). Prometric and Headmaster/D&S tests follow their own outlines, so the share depends on your state's vendor.
What are the activities of daily living for a nurse aide?
Bathing and hygiene, mouth care, dressing and grooming, eating and drinking, toileting, and rest and comfort. On the exam they sit under Physical Care Skills.
Do you wear gloves for every ADL task?
No. Gloves go on when you may touch body fluids, mucous membranes or broken skin: peri-care, mouth care, bedpans, emptying a drainage bag. Feeding, a back rub on intact skin and a transfer do not need them. Hand hygiene comes before and after either way.
Is ADL part of the skills test too?
Yes. Hygiene, feeding, dressing and toileting are common skill families on the hands-on test, but the skills drawn and their number vary by vendor and state. See the skills test guide.