Core Competencies for Certified Nursing Assistants:
A Thematic Review of the CNA Examination (Chapters 1–8, 13,
25)
Academic Review Paper
Nursing Assistant Training Programme
June 2026
, Abstract
This review examines the core competencies assessed on the Certified Nursing
Assistant (CNA) Examination covering Chapters 1–8, 13, and 25. Drawing on
50 verified examination items, the paper organises key concepts into four
thematic domains: legal and regulatory foundations; infection prevention and
safety protocols; vital signs measurement and clinical assessment; and
patient-centred care across the lifespan, including restorative, end-of-life, and
rehabilitative practices. The analysis highlights the most frequently tested
clinical distinctions—such as Standard Precautions, the RACE and PASS fire
safety acronyms, and the OBRA resident rights framework—and identifies
common points of confusion that challenge certification candidates.
Keywords: Certified Nursing Assistant, OBRA, infection prevention, vital signs,
restorative care, patient safety, CNA examination
1. Introduction
The Certified Nursing Assistant (CNA) examination serves as the primary gateway for
entry-level healthcare workers into long-term and acute care settings in the United States. The
examination assesses competency across a broad range of clinical, legal, and interpersonal skills
that form the foundation of safe and effective resident care. This review synthesises 50 verified
examination items spanning Chapters 1–8, 13, and 25 of the standard CNA curriculum into a
coherent thematic framework, providing a concise reference for candidates preparing for
certification. The four domains identified—regulatory foundations, infection control, clinical
assessment, and patient-centred care—reflect the multifaceted nature of the CNA role.
2. Legal and Regulatory Foundations
The Omnibus Budget Reconciliation Act (OBRA) of 1987 is the single most important
federal statute governing nursing assistant practice in long-term care facilities. OBRA established
mandatory resident rights, including the right to be free from abuse, the right to privacy, and the
right to refuse treatment (Centers for Medicare & Medicaid Services [CMS], 2022). The
examination frequently tests candidates' understanding of these rights, particularly the correct
response when a resident refuses care: the nursing assistant must document the refusal, report it to
the charge nurse, and attempt to offer the care again later, rather than forcing compliance or
ignoring the refusal entirely.
The chain of command is another regulatory concept heavily represented on the examination.
This formal reporting structure ensures that changes in a resident's condition, safety hazards, and
clinical concerns are communicated efficiently to the appropriate supervisory level. Additionally,
the scope-of-practice distinction is tested through items on equipment management; for example, a
nursing assistant may ensure that a CPAP mask is properly fitted and report equipment issues to the
nurse, but may not adjust pressure settings or clean internal filters.
3. Infection Prevention and Safety Protocols
3.1 Hand Hygiene and Standard Precautions
A Thematic Review of the CNA Examination (Chapters 1–8, 13,
25)
Academic Review Paper
Nursing Assistant Training Programme
June 2026
, Abstract
This review examines the core competencies assessed on the Certified Nursing
Assistant (CNA) Examination covering Chapters 1–8, 13, and 25. Drawing on
50 verified examination items, the paper organises key concepts into four
thematic domains: legal and regulatory foundations; infection prevention and
safety protocols; vital signs measurement and clinical assessment; and
patient-centred care across the lifespan, including restorative, end-of-life, and
rehabilitative practices. The analysis highlights the most frequently tested
clinical distinctions—such as Standard Precautions, the RACE and PASS fire
safety acronyms, and the OBRA resident rights framework—and identifies
common points of confusion that challenge certification candidates.
Keywords: Certified Nursing Assistant, OBRA, infection prevention, vital signs,
restorative care, patient safety, CNA examination
1. Introduction
The Certified Nursing Assistant (CNA) examination serves as the primary gateway for
entry-level healthcare workers into long-term and acute care settings in the United States. The
examination assesses competency across a broad range of clinical, legal, and interpersonal skills
that form the foundation of safe and effective resident care. This review synthesises 50 verified
examination items spanning Chapters 1–8, 13, and 25 of the standard CNA curriculum into a
coherent thematic framework, providing a concise reference for candidates preparing for
certification. The four domains identified—regulatory foundations, infection control, clinical
assessment, and patient-centred care—reflect the multifaceted nature of the CNA role.
2. Legal and Regulatory Foundations
The Omnibus Budget Reconciliation Act (OBRA) of 1987 is the single most important
federal statute governing nursing assistant practice in long-term care facilities. OBRA established
mandatory resident rights, including the right to be free from abuse, the right to privacy, and the
right to refuse treatment (Centers for Medicare & Medicaid Services [CMS], 2022). The
examination frequently tests candidates' understanding of these rights, particularly the correct
response when a resident refuses care: the nursing assistant must document the refusal, report it to
the charge nurse, and attempt to offer the care again later, rather than forcing compliance or
ignoring the refusal entirely.
The chain of command is another regulatory concept heavily represented on the examination.
This formal reporting structure ensures that changes in a resident's condition, safety hazards, and
clinical concerns are communicated efficiently to the appropriate supervisory level. Additionally,
the scope-of-practice distinction is tested through items on equipment management; for example, a
nursing assistant may ensure that a CPAP mask is properly fitted and report equipment issues to the
nurse, but may not adjust pressure settings or clean internal filters.
3. Infection Prevention and Safety Protocols
3.1 Hand Hygiene and Standard Precautions
