Virginia Nurse Aide
Written (or Oral) Examination & Skills Evaluation
Candidate
Handbook
January 2024
2
It all starts here!
Reviewing this handbook is a big step toward your success.
Quick Reference . . . . . . . . . . . . . . . . . 4-5
Introduction . . . . . . . . . . . . . . . . . . . . . . . 6
National Nurse Aide Assessment
Program . . . . . . . . . . . . . . . . . . . . . . . . 6
About Credentia . . . . . . . . . . . . . . . . . . 6
Exam Overview . . . . . . . . . . . . . . . . . . 6
The Written/Online Examination . . . . . 6
Skills Evaluation . . . . . . . . . . . . . . . . . . 6
Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . 7-9
Eligibility by Examination . . . . . . .. . . 7-9
Light Duty . . . . . . . . . . . . . . . . . . . . . . 7-9
Online Registration and Scheduling . . . . 8
Here’s How it Works. . . . . . . . . . . . . . . 9
Additional Information . . . . . . . . . . . . . 9
Exam Fees . . . . . . . . . . . . . . . . . . . . . 10
Exam Scheduling . . . . . . . . . . . . . . . . 10
Accommodations . . . . . . . . . . . . . . . . 11
Testing Locations . . . . . . . . . . . . . . . . 11
Cancellation. . . . . . . . . . . . . . . . . . . . . . 12
Rescheduling . . . . . . . . . . . . . . . . . . . 12
Refunds . . . . . . . . . . . . . . . . . . . . . . . 12
Absence Policy. . . . . . . . . . . . . . . . . . 12
Weather Emergencies . . . . . . . . . . . . 12
Exam Day . . . . . . . . . . . . . . . . . . . . . . . 13
Taking your exam Online . . . . . . . 13-14
Taking your exam in Person. . . . . 15-16
The Written (or Oral) Exam . . . . . . . . . . 16
Written Exam . . . . . . . . . . . . . . . . . . . 16
Oral Exam . . . . . . . . . . . . . . . . . . . . . 16
Self-Assessment Reading Test . . . . . 16
Written (or Oral) Exam . . . . . . . . . . . . . 17
Content Outline . . . . . . . . . . . . . . . . . 17
Sample Questions . . . . . . . . . . . . . . . . . 18
Self-Assessment Reading Test . . . . . . . 19
Part 1: Vocabulary . . . . . . . . . . . . . . . 19
Part 2: Comprehension . . . . . . . . . . . 20
The Skills Evaluation . . . . . . . . . . . . . . . 21
What to Expect. . . . . . . . . . . . . . . . . . 22
Settings . . . . . . . . . . . . . . . . . . . . . . 22
Candidate Volunteer Requirements 22
The Tasks. . . . . . . . . . . . . . . . . . . . . . 22
Recording a Measurement. . . . . . . . . 23
Tips for the Skills Evaluation. . . . . . 23
Sample Recording Sheet
For Measurement Skills . . . . . . . . . . . 23
Skills Listing. . . . . . . . . . . . . . . . . . . 24-32
Exam Results . . . . . . . . . . . . . . . . . . . . 33
Score Reporting . . . . . . . . . . . . . . . . . 33
How to Read a Failing Score Report . 33
Passing. . . . . . . . . . . . . . . . . . . . . . . . 34
Grievance Process . . . . . . . . . . . . . . . . 34
The Registry . . . . . . . . . . . . . . . . . . . . . 34
Change of Address or Name . . . . . . . 34
Renewal . . . . . . . . . . . . . . . . . . . . . . . 35
Lapsed Certification . . . . . . . . . . . . . . 35
Endorsement . . . . . . . . . . . . . . . . . . . 35
FAQ . . . . . . . . . . . . . . . . . . . . . . . . . 36-38
Table of Contents
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Quick Reference
CREDENTIA REGISTRATION AND
SCHEDULING SERVICES
1025 Greenwood Blvd.
Suite 401
Lake Mary, FL 32746
Hours of Operation
Mon. – Fri. 8:00 a.m. – 11:00 p.m.
Saturday: 8:00 a.m. - 5:00 p.m.
Sunday 10:00 a.m. - 4:00 p.m.
(Eastern Time Zone)
Create or Log into your CNA365 account to:
• Change your current address and phone number.
• Submit Correction Form to update name, date of birth or social security number before your exam has been scheduled.
• Obtain and submit an Examination Testing Application.
• Check Testing Application status.
• Find test sites and availability.
• Schedule, reschedule or cancel an examination.
• View exam details such as examination type, scheduled time, date, and location.
• View Score report.
• Submit and review a Grievance application for completed examination.
• Submit an excused absence application.
Contact Customer Service to:
• Problem occurs when creating CNA365 Account.
• Did not receive activation link.
• Problem occurs when applying an assigned voucher code.
• Testing Application Issue.
• Received an error message when scheduling examination.
• Score report not viewable in CNA365 after 24 hours.
• Call 888-204-6249
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VIRGINIA BOARD OF NURSING
Perimeter Center
9960 Mayland Drive, Suite 300 Henrico, VA 23233-1463
www.dhp.virginia.gov/boards/nursing
Hours of Operation
Monday through Friday 8:15 a.m. – 5:00 p.m.
Visit the Virginia Board of Nursing at www.dhp.virginia.gov/nursing to:
• Obtain information on official laws and regulations for nurse aides.
• Find out if you are currently listed on the Registry.
• Clarify information about the Registry.
• Change your current address or name once you are on the Registry.
• Obtain information on continued certification on the Registry.
• Request an accommodation for testing under the American with Disabilities Act (ADA) guidelines.
• Find a list of approved nurse aide education programs in Virginia.
Call the Board of Nursing at (804) 367-4515 if you are unable to locate answers to your questions on the website.
DOH and Credentia do not discriminate on the basis of age, sex, race, creed, disabling condition, religion, national origin or any other protected characteristics.
Copyright © 2022 Credentia Services LLC or its affiliate(s). All Rights Reserved.
NNAAP® Written Exam Content Outline and Practical Skills Listing
Copyright © 2020 National Council of State Boards of Nursing, Inc. (NCSBN®). All rights reserved.
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Introduction
Welcome and congratulations on your decision
to take the professional Nurse Aide’s test.
This handbook is designed for candidates who
want to be listed on the Virginia Nurse Aide
Registry. It tells you how to apply for and take
the National Nurse Aide Examination.
This handbook will answer many of your
questions about the test. Please take the time
to read it and keep it so you can refer to it
whenever you have a question about the test.
THE NATIONAL NURSE AIDE ASSESSMENT
PROGRAM (NNAAP®)
The National Nurse Aide Assessment Program (NNAAP®) was developed by the
National Council of State Boards of Nursing, Inc. The NNAAP Examination is an
evaluation of nurse aide-related knowledge, skills and abilities. Its purpose is
to determine if you understand and can safely perform the job of an entry-level
nurse aide.
ABOUT CREDENTIA
This handbook was created by Credentia in partnership with the Virginia
Board of Nursing. Credentia is a nationally recognized provider of testing
services to develop, score and report the results of the Virginia Nurse Aide
Registry test. Credentia also processes applications, schedules examinations and
administers the tests.
EXAM OVERVIEW
There are two parts of the NNAAP Examination, the Written (or Oral) Examination
and the Skills Evaluation. You must pass both parts in order to be listed on the
Virginia Nurse Aide Registry.
THE WRITTEN/ONLINE EXAMINATION
The written part of your test is made of seventy (70) multiple-choice questions
written in English. Sample examination questions are provided in this handbook.
Please note: If you have difficulty reading English, you can take an Oral
Examination instead of the Written Examination.
The Oral Examination includes sixty (60) multiple-choice questions plus ten (10)
reading comprehension/word recognition questions. If you want to take the Oral
Examination, you must request it when you submit your registration form.
THE SKILLS EVALUATION
For the Skills portion of your test, you will be asked to perform five (5) randomly
selected nurse aide skills. You will be rated on these skills by a Nurse Evaluator.
Please review the complete listing of the skills shown on pages 24 to 32.
You can also review The Written (or Oral) Exam and The Skills Evaluation for more
details about the NNAAP Examination.
VISIT resource center for additional info
https://credentia.com/about-us/
nurse-aide-resource-center
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Eligibility
This section explains:
• What you need to do to become a nurse aide in Virginia
• What you need to do before you can take the NNAAP test
ELIGIBILITY FOR EMPLOYMENT AS A NURSE AIDE
In order to be a nurse aide in Virginia, you must be sixteen (16) years of age or older. You MUST also have a criminal background check and you
MUST NOT have any convictions on your record that would stop you from being a nurse aide. You cannot have any rulings against you from any other
state registry or licensing board.
ELIGIBILITY FOR NNAAP TESTING
As a test candidate, you will be put into one of several eligibility or “E” categories. Please read the categories listed at right to see which one applies to
you.
LIGHT DUTY
Federal law says that you cannot take the Skills Evaluation if you’re on restricted activity or light duty for medical reasons.
You must be able to complete all required skills included in the Skills Evaluation. THERE ARE NO EXCEPTIONS TO THIS RULE.
Candidates who are on light duty are not permitted to take the Skills Evaluation, but light duty does not prevent you from taking the Written
Examination.
The Virginia Board of Nursing updated their policies and eligibility routes as of January 30, 2024.
All applications approved prior to 01/30/2024 will adhere to the prior instructions.
All applications submitted on 01/30/2024 or after must comply with the new application requirements and
instructions.
E-4
E-3
Eligibility
All applications approved prior to 01/30/2024 will adhere to these instructions.
REGISTERED NURSE OR PRACTICAL NURSE
GRADUATE:
You have completed a nursing education program
preparing for registered nurse or practical nurse
licensure. Verification of completion of a nursing
program in the form of an original or certified true copy
of a school
transcript, in English, is required to be uploaded in
Credential Management. Foreign trained RN and LPN
applicants must also provide confirmation from CGFNS that
their program meets the requirements of their home
country. The required forms must be uploaded online when
completing the application. E3 applicants have 12 months
from the time of application approval to test prior to
application expiration.
LAPSED CERTIFICATE HOLDER:
You were previously
certified in Virginia as a nurse aide, but your certification
E-4
has expired. You must also have completed a renewal or
reinstatement application with the Board of Nursing within the
past year.
E-1
E-2
NEW NURSE AIDE:
You have successfully completed a Virginia-approved nurse
aide education program within the last twenty-four months.
REGISTERED NURSE OR PRACTICAL NURSE
CURRENT ENROLLMENT:
You are currently enrolled in an approved nursing education
program preparing for registered nurse or practical nurse
licensure or enrolled in a program in the last 12 months.
When completing your online application, you must upload an
original letter on letterhead from the program director
documenting that you are currently enrolled and have
satisfactorily completed at least one (1) clinical course in the
nursing program which includes at least forty
(40) hours of clinical experience involving direct client care.
The online application and letter must be submitted within
12 months of the date on the letter. E2 applicants have 12
months from the time of application approval to test prior to
application expiration.
E-4
E-3
Eligibility
All applications submitted on 01/30/2024 or after will comply with these instructions.
E-1
E-2
NEW NURSE AIDE:
For all applicants who have successfully completed a Virginia
State-Approved Nurse Aide Education Program. A candidate
must take and pass both the board-approved skills and written
portions of the state examination within 24 months of training
program course completion date. If a candidate does not pass
the state examination within two years or has three failed
attempts within the two-year period, they must successfully
complete another approved nurse aide training program before
reapplying. Both exams must be passed under the same
application.
REGISTERED NURSE OR PRACTICAL NURSE
CURRENT ENROLLMENT:
You are currentlyenrolled in an approved nursing education
program preparingfor registered nurse orpractical nurse
licensure orenrolled in a program in the last12 months.
When completing your online application, you mustupload
anoriginal letteron letterhead from the program director
documenting thatyou are currentlyenrolled and have
satisfactorilycompleted atleast one (1)clinical course in the
nursing programwhich includes atleastforty
(40)hours of clinical experience involving directclient
care. The online applicationandlettermustbe submitted
within 12 months ofthe date onthe letter. E2 applicants
have 12 months from the time ofapplication approval to
test prior to application expiration.
REGISTERED NURSE OR PRACTICAL NURSE
GRADUATE:
For all applicants who have successfully completed a
nursing education program preparing for Registered
Nurse or Practical Nurse licensure within the past 24
months. Verification of completion of a nursing
program in the form of an original or certified true copy
of a school transcript, in English, is required to
complete this application. The date of program
completion on the transcript must match the date on
your application. Foreign trained RN and LPN
applicants must also provide confirmation from a
Board approved credential evaluation agency that their
program meets the requirements of their home
country. E3 applicants have 24 months from time of
completion of the nursing education program to test
prior to application expiration.
LAPSED CERTIFICATE HOLDER:
For all applicants who were previously certified as a Nurse Aide in
Virginia but where certification has expired. You must also have
completed a renewal or reinstatement application with the Board of
Nursing within the 12 months. E4 applicants have 24 months from time
of application approval to test prior to application expiration.
Online Registration
and Scheduling
Online registration is the best way to register for your examination.
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You must supply additional information about your criminal
convictions, other state actions, or conditions that could
interfere with safe practice.
If you have a criminal conviction, you will need to upload the
following information for review by the Board:
• A certified copy of all conviction order(s) from the court(s).
• Evidence that all court ordered requirements were met (i.e., letter
from the probation officer if on supervised probation, paid fines,
restitution, etc.) for each conviction.
• Letter from you explaining the facts and circumstances leading to
the criminal offense.
• Letters of support from your employers. (If available)
If you had previous action taken against you or been denied
a license or certification, you will need to upload the following
information for review by the Board:
• Explanation of the action that was taken (where & when it
occurred, details leading to the complaint/action taken).
• An official, certified copy from the regulatory authority of the final
Order outlining the outcome of the action taken.
If you have a mental, physical, or chemical dependency condition
that could interfere with practice, you will need to upload the
following information for review by the Board:
• Evidence of any past treatment related to the condition. (i.e.,
discharge summary from inpatient and/or outpatient treatment)
• Letter from currently treating health care providers addressing
diagnosis, treatment regimen, compliance with treatment, and
ability to practice safely.
• A letter from you explaining circumstances of your condition and
ongoing efforts to function safely.
• Letters of support from your employers. (If available)
Please note that although these circumstances may be grounds
to deny an applicant, it does not mean the Board of Nursing will
deny your application for certification. A delay in testing should be
expected and sometimes a meeting with the Board is required to
determine approval for certification by examination.
HERE’S HOW IT WORKS:
You can create an online account with Credentia’s CNA365 system. The
Credentia CNA365 system makes online registration quick and easy, and
much faster than mailing a paper application.
• To create a CNA365 account on the top of the Virginia nurse aide website
page at www.credentia.com/test-takers/va, click the “CNA365 Login”
button and select “Sign-Up.”
• You can pay by credit card or pre-paid credit card (American Express,
MasterCard, Visa, ACH/ electronic check, or electronic voucher). Fees
are non-refundable and non-transferable once you’ve paid.
• For exams at test center locations, you’ll need to make an online
reservation using a laptop. Using your phone or a tablet is not
recommended. You need to make your reservation at least ten (10)
calendar days before the test date.
• For Written or Oral online exams, you can schedule an exam as early as
one day following registration, depending on exam availability.
• You’ll need to complete your online application in CNA365. If you need
help or have any questions about the application process, contact a
support representative at 888-204-6249.
ADDITIONAL INFORMATION MAY BE NEEDED
FROM CANDIDATES
If you have ever had a criminal conviction, been denied certification/
licensure in Virginia or another state, had action taken against your
certificate/license in Virginia or another state, or have a mental, physical
or chemical dependency condition that could interfere with your ability to
practice, you must indicate such history on your online application.
Failure to reveal this information is considered falsification of an application
and grounds for denial of certification or disciplinary action by the Board of
Nursing even after successful completion of the NNAAP.
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SCHEDULING YOUR EXAM
Once you have completed your Profile (demographics) and
application, your Home Page will state: “Click here to schedule your
examinations.”
• Select PR (skills evaluation) first. Select the test site you want to
use, and a calendar will appear with available test dates
highlighted.
• Select the date you want and repeat the process for the AW
(Written) or AO (Oral English).
• Proceed to checkout and select your form of payment. When
completed, you will receive a Confirmation Notice and Receipt of
Payment via email.
• Each candidate is allowed three (3) attempts to pass each exam.
If a candidate fails either the written or the skills exam three (3)
times, or exceeds the eligibility route’s timeframe to test, the
application will expire, and the candidate must retrain.
EXAM FEES
The fees listed below have been established for the National Nurse
Aide Assessment Program in Virginia:
You must pay for both the Skills Evaluation and the Written (or Oral)
Examination the first time you test.
Under federal and Virginia laws, nursing homes are required to pay
the NNAAP fees for their nurse aide employees, including individuals
required to re-test.
Payment must be made in the form of a credit card, debit card, single-
use card or electronic voucher. Vouchers can be purchased by the
training programs.
Fees are not refundable.
Written Examination ONLY exam $45
Skills Evaluation ONLY exam $95
Oral Written Examination ONLY exam $45
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ACCOMMODATIONS
Credentia complies with the Americans with Disabilities Act and will provide reasonable
accommodations to anyone with a documented disability who might need a little help in
accessing the test.
Test accommodations may include things like:
• A separate testing room
• Extra testing time
• A Reader or Recorder, for individuals with mobility, hearing or vision difficulties who
cannot read or write on their own
Test accommodations will be considered on a case-by-case basis. If you’re requesting
accommodations because of a disability, you must provide proof of your condition.
This may include:
• Supporting documents from the professional who diagnosed the condition
• A description of past accommodations that you have received
Please visit www.credentia.com/accommodations to review the Request for
Accommodations for Nurse, Nurse Aide, and Medication Aide Testing guidance document
provided by the Virginia Board of Nursing.
TESTING LOCATIONS
In-Facility Testing (INF) - In facility testing is when your state-approved Training Program
Nurse Aide instructor has made arrangements with Credentia to test at your training
program on a specific date. Please make certain you know your in facility (INF) Code
and test date when you are completing your registration. Additional information regarding
regional test sites can be found on https://credentia.com/test-takers/va
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Cancellations
You can easily cancel or reschedule an exam online using your CNA365
account. Go to www.credentia.com/test-takers/va and click on “How
to Cancel or Reschedule an Exam” in the Resources section of the
webpage.
Remember: You need to cancel or reschedule your Online Written (or
Oral) examination at least 48 hours (2 days) before your scheduled test
time.
If you are unable to attend your test, you must call Credentia Customer
Service at least ten (10) calendar days before the test date to reschedule
(Saturday and Sunday and national holidays are not considered calendar
days). If you don’t call Credentia at least ten (10) calendar days before
your test date to reschedule, and do not show up for your scheduled test,
you will be responsible for the test fee. Your fee will not be refunded and
cannot be transferred to a new test date, and you may not give your test
date to another person.
• If you do notify Credentia in time, there is no penalty, and your fee may
be transferred to your new test date. If your employer paid your test
fee, you should tell them about missing the test or rescheduling. Let
them know how you have handled rescheduling and when you plan to
take the test again.
• If you do not report to the testing location on the day of your scheduled
test, you will be considered a “no-show” and you will not get your
testing fee back.
RESCHEDULING
You can now use your CNA365 account to reschedule your exam. Go
to www.credentia.com/test-takers/va and click on “How to Cancel or
Reschedule an Exam” in the Resources section of the webpage.
If you want to reschedule by phone, call (800) 457-6752. You can
reschedule your exam one time and you must contact Credentia at
least ten (10) calendar days before your exam.
REFUNDS
Once payment of exam fees is received, NO REFUNDS WILL BE
ISSUED.
ABSENCE POLICY
Candidates who are late or absent from an exam may submit an
excused absence via CNA365 within 14 calendar days of the exam date
for the following reasons: This includes but not limited to:
• Illness of yourself or a member of your household
• Death in the family
• Traffic accident or ticket
• Court appearance or jury duty
• Military duty
• Weather emergency
• Incarceration
Your request must include documentation or verification for the cause of
the absence. For example, if you are absent because of jury duty, you
must upload a copy of the court notice. In the case of illness, verification
from a medical provider must be included in your request. Please note, a
request takes approximately 3-5 calendar days to review. The decision of
Credentia to approve or deny the excused absence will be final.
WEATHER EMERGENCIES
A test center/online examination will be delayed or canceled only in
emergencies. If severe weather or a natural disaster makes the test site
inaccessible or unsafe, the examination will be delayed or canceled.
In the event of an examination change due to a weather emergency,
candidates will be contacted with the information on file by phone and
email.
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Exam Day
TAKING YOUR WRITTEN
EXAM ONLINE
You can take your Written (or Oral) exam from home or work
through Credentia online proctoring. A live proctor (someone
who supervises the test) will securely monitor you through the
webcam on your workstation. Online exams also offer you
more scheduling flexibility than test center exams to fit with
your schedule.
Please visit www.credentia.com/online-exams for information
on what to expect and how to best prepare for your online
exam. We also recommend that you click on the “Policies &
Procedures” link on this webpage to review the exam rules and
procedures.
WHAT YOU’LL NEED
• The right computer – a desktop, laptop or Chromebook
with a single monitor (no smartphones or tablets).
Visit www.credentia.com/online-exams to view or
download system requirements.
• A private room – if you don’t have access to a private
room, check with your training program or local library for
availability.
• A mobile device – the proctor will need to see all around your
exam area with a 360-degree room scan. Please be sure you
have a smartphone or tablet (Apple or Android) that can do
this using our free app.
WHAT TO DO IN THE DAYS BEFORE YOUR ONLINE
EXAM:
• Run a system test – make sure to do the required system test and exam
simulation before exam day. Visit www.credentia.com/online-exams and select
the “Run System Test” button.
• Find your testing space – you need a quiet area in your home or office to take
your exam.
• Get your ID ready. You are required to have two (2) forms of official ID with a
signature (one must be a photo identification). Photocopies of identification
will NOT be accepted. All identification must be current (not expired), and no
birth certificates will be accepted. Examples of proper identification include:
• Driver’s license
• Social Security card
• Clinic card (example - Medicaid ID card)
• Credit card
• Library card
• State-issued identification card
• Alien registration card
• Passport
• United States Uniformed Services ID with photo
• High School ID with photo
• Signed High School ID card (must have signature line)
• University ID with photo
• Signed University ID card (must have signature line)
The name on your identification must be the same as the name you used on the
application to register for the examination.
If you do not have proper identification, you will not be allowed to take the test
and your examination fee will not be refunded.
IMPORTANT: If you can’t take the test because of this, it still counts as one of
your 3 chances to take the exam because you were not prepared — please
have the correct forms of identification!
GO ONLINE to learn more about what
to expect before your
testing day and the day of testing
credentia.com/test-center-exams
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WHAT TO DO ON YOUR ONLINE EXAM DAY
STEP 1: Prepare your testing space
• Quiet: no background noise and tell members of your
household you are taking your test.
• Well lit: proctors must be able to see you and your testing
space well.
• Privacy: no one else in the room.
• Remove prohibited items: clear workstation area to expedite
room scan.
• Restroom/Beverages: use restroom and prepare beverages
before exam.
STEP 2: Have your ID ready
Have your government-issued photo ID with you. (See list or
proper identification in section above.)
STEP 3: Prepare your computer
• Disconnect any additional monitors and close all other open
applications.
• Have your chargers (laptop, smart phone or tablet) plugged
in or nearby.
• Use a wired internet connection rather than WiFi, if possible.
• If using WiFi, we recommend at least 3Mbps and ask that
other people in your house do not use the internet during
your exam.
• Disconnect any VPNs or firewalls if you have them.
STEP 4: Download the ExamRoom 360 app
Download the ExamRoom 360 app to your smartphone or tablet and have
your CNA365 login credentials available (the user name and password for
your Credentia CNA365 account). This app is required to complete a 360
degree room scan.
STEP 5: Check in for your exam
• You can begin to check in up to 30 minutes before your appointment. Your
onboarding agent will make sure everything is ready for your exam before
introducing your proctor (the test supervisor).
• How to check in: Go to www.credentia.com/test-takers/va and click the
“CNA365 login” button. Once logged in, find your scheduled exam and
select the “Start Exam” button.
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Exam Day
TAKING YOUR EXAM IN
PERSON
CHECKING IN
• You must arrive 30 minutes before your scheduled time for BOTH
the written examination and for the skills evaluation. If you are late
for the written examination you will not be allowed to test and your
fees will not be refunded.
• If you missed your written examination and are scheduled for a
skills evaluation, please arrive 30 minutes prior to your scheduled
time. Skills Evaluation test times are approximate.
PLEASE NOTE: You will be required to check in for both the written
examination and for the skills evaluation. You will be required to
present proper identification.
WHAT TO BRING
You MUST have the following items with you when you take the
NNAAP Examination:
• Two (2) forms of official (current, not expired), legible,
signature-bearing identification, one of which must be photo
identification
• Three (3) No. 2 pencils (sharpened)
• Eraser
• Analog watch with a second sweeping seconds hand (not a
digital or Smartwatch)
No other materials will be allowed.
PROPER IDENTIFICATION
You are required to have two (2) forms of official ID with a signature
(one must be a photo identification). Photocopies of identification
will NOT be accepted. All identification must be current (not
expired), and no birth certificates will be accepted. Examples of
proper identification include:
• Driver’s license
• Social Security card
• Clinic card (example — Medicaid ID card)
• Credit card
• Library card
• State-issued identification card
• Alien registration card
• Passport
• United States Uniformed Services ID with photo
• High School ID with photo
• Signed High School ID card — (must have signature line)
• University ID with photo
• Signed University ID card — (must have signature line)
The name on your identification must be the same as the name you
used on the application to register for the examination.
If you do not bring proper identification, you will not be allowed
to test and your examination fee will not be refunded.
SECURITY AND CHEATING
If you give help to or receive help from anyone during the NNAAP
Examination, the examination will be stopped. The incident will
be reported to the Virginia Board of Nursing for review and your
examination will not be scored (see Testing Policies).
Please note that all examination questions, each form of the
examination, and all other examination materials are copyrighted
by, the property of or licensed to Credentia. Consequently, any
distribution of the examination content or materials through any form
of reproduction or through oral or written communication is strictly
prohibited and punishable by law. Anyone who removes or tries to
remove examination material or information from the test site will be
prosecuted.
GO ONLINE to learn more about
what to expect before your testing
day and the day of testing.
credentia.com/test-center-exams
15
TESTING POLICIES
The following policies are observed at each test site.
LATENESS
Plan to arrive thirty (30) minutes before the examination starts.
If you are late for your scheduled examination or do not bring
all your required materials, you will NOT be allowed to test, and
your examination fee will NOT be returned.
ELECTRONIC DEVICES
Cellular phones, beepers, or any other electronic devices are
not permitted to be used and must be turned off during testing,
and there is no place for storage of personal belongings at the
test sites.
STUDY AIDS
You are not permitted to take personal belongings such as
briefcases, large bags, study materials, extra books or papers
into the examination room. Any such materials brought into
the examination room will be collected and returned to you
when you have completed the examination. Credentia is not
responsible for lost or misplaced items.
EATING/DRINKING/SMOKING
You are not permitted to eat, drink or smoke during the
examination.
MISCONDUCT
If you are discovered causing a disturbance of any kind or
engaging in any kind of misconduct, you will be dismissed
from the examination and reported to the Board of
Nursing. Decisions regarding disciplinary measures are the
responsibility of that agency.
GUESTS/VISITORS
No guests, visitors, pets or children are allowed at the test
sites.
The Written (or Oral) Exam
WRITTEN/ONLINE EXAM
The Written Examination has seventy (70) multiple choice questions. You
will have two (2) hours to complete the Written Examination. See Sample
Questions for examples of the kinds of questions found on the Written
Examination.
ORAL EXAM
An Oral Examination may be taken in place of the Written Examination. You
must request an Oral Examination when filling out your application. The Oral
Examination consists of two (2) parts, and you must pass both parts in order
to pass the Oral Examination. When taking the online proctored exam, you will
need your own wired headset. The first part of the Oral Examination has sixty
(60) multiple-choice questions. Each of the sixty (60) multiple choice questions
is read twice. As each question is read, you are asked to choose the correct
answer. The second part of the Oral Examination has ten (10) multiple-choice
questions that test whether you know common words used in long-term care
facilities. Each word is read three (3) times. You are asked to match the word
you hear on the recording to the written word on the computer screen.
SELF-ASSESSMENT READING TEST
A self-assessment reading test, found on page 19 of this handbook, will help
you decide if you should take the Oral Examination.
16
The 2024 National Nurse Aide
Assessment Program (NNAAP®)
Written (Oral) Examination
Content Outline
The revised content outline is based on the findings
from the 2019–2020 Job Analysis and Knowledge,
Skill, and
Ability Study of Nurse Aides published by the National
Council of State Boards of Nursing (NCSBN) in 2023.
The
examination content outline will be effective April
2024.
The NNAAP written examination is comprised of 70
multiple-choice items; 10 of these items are pretest
(non-scored) items on which statistical information will
be collected. The NNAAP oral examination is
comprised of 60
multiple-choice items and 10 reading comprehension
(word recognition) items.
17
4. What does the abbreviation ADL mean?
(A) Ad Lib
(B) As Doctor Likes
(C)Activities of Daily Living
(D)After Daylight
5. After giving a client a back rub, the nurse aide should always note:
(A) the last time the client had a back rub
(B) any change in the client’s skin
(C)client’s weight
(D)amount of lotion used
6. How should the nurse aide communicate with a client who has a
hearing loss?
(A) face the client when speaking
(B) repeat the statement
(C)shout so that the client can hear
(D)use a high-pitched voice
Sample Questions
The following questions are samples of the kinds of questions that
you will find on the Written Examination. Check your answers to
these questions in the box below.
1. The client’s call light should always be placed:
(A) on the bed
(B) within the client’s reach
(C)on the client’s right side
(D)over the side rail
2. Which of the following items is used in the prevention and
treatment of bedsores or pressure sores?
(A) rubber sheet
(B) air mattress
(C)emesis basin
(D) restraint
3. When caring for a dying client, the nurse aide should:
(A) keep the client’s room dark and quiet
(B) allow client to express his feelings
(C)change the subject if client talks about death
(D)contact the client’s minister, priest or rabbi
18
1. B 2. B
Correct Answers
3. B 4. C
5. B 6. A
Self-Assessment
Reading Test
The two (2)-part Self-Assessment Reading Test
that appears below will help you decide if you
should consider taking the Oral Examination
instead of the Written Examination. To complete
the reading test, follow the instructions provided
below and select the answer to each question.
When you have completed the reading test, you
will be able to determine the number of questions
you answered correctly.
PART 1: VOCABULARY
1. Circle the best answer to each question.
2. When you have finished, check your answers
using the answer key on page 17.
3. Count up the number of correct answers.
4. If your score is less than 17, you may have
difficulty reading the Written Examination and
should consider taking the Oral Examination.
1. You go to a doctor when you .
(A) feel sleepy
(B) need socks
(C) feel sick
(D) need money
(E) need clothes
2. A person who flies an airplane is its .
(A) pilot
(B) steward
(C) mother
(D) surgeon
(E) director
3. You use a to write.
(A) bow
(B) calculator
(C) pencil
(D) carpenter
(E) needle
4. To exit a room means to it.
(A) enter
(B) leave
(C) forget
(D) read
(E) interrupt
5. A wedding is a joyous .
(A) focus
(B) vehicle
(C) balloon
(D) occasion
(E) civilization
6. To require something means to it.
(A) need
(B) have
(C) forget
(D) understand
(E) hear
7. You something to find its length.
(A) slice
(B) lock
(C) measure
(D) force
(E) tape
8. Soup is served in a .
(A) plate
(B) bowl
(C) fork
(D) chair
(E) closet
9. To accompany someone means to .
(A) disagree with him
(B) work for him
(C)go with him
(D)speak to him
(E) choose him
10. A nursing home resident receives
from the staff.
(A) quality
(B) fame
(C) interruption
(D) care
(E) work
11. Medicine is used to pain.
(A) widen
(B) conjure
(C) enliven
(D) increase
(E) relieve
12. To drench the flowers means to
them.
(A) steam
(B) drink
(C) touch
(D) soak
(E) anger
13. A bicycle is a means of .
(A) nourishment
(B) transportation
(C) prediction
(D) collision
(E) walking
14. When someone speaks in a whisper, it
may be difficult to .
(A) deceive
(B) understand
(C) frighten
(D) estimate
(E) regulate
19
Answers
19. C
20. A
21. B
22. C
1. C 7. C
2. A 8. B
3. C 9. C
4. B 10. D
5. D 11. E
6. A 12. D
13. B
14. B
15. D
16. A
17. B
18. C
If your score is less than 17, you may
have difficulty reading the Written
Examination and should consider taking
the Oral Examination in place of the Written
Examination.
(E) a supermarket
19. As a child Maria lived .
(A) in the city
(B) in an apartment
(C)on a farm
(D)in a large house
(E) on the beach
Carolyn has a good job. She is a nurse in a
large hospital. Every day she can help many
people. She enjoys this very much. She also
makes a good salary. Each month she can
pay her bills and save some money.
20. Carolyn works in a .
(A) hospital
(B) doctor’s office
(C) garage
(D) school
(E) library
21. One of the things Carolyn enjoys is
.
(A) working in an office
(B) helping people
(C)reading books
(D)working late hours
(E) driving a car
22. With her salary she can pay her bills and
.
(A) buy furniture
(B) give to charity
(C)save money
(D)buy new clothes
(E) pay for college
This completes the Self-Assessment
Reading Test.
PART 2: COMPREHENSION
In this part of the reading test, you will be
provided with a series of brief paragraphs. You
are to read each paragraph and then answer
the questions that appear after the paragraph.
There are many different kinds of fish. All fish
live in water. They use their tails and fins to
swim.
15. Fish live in .
(A) cups
(B) houses
(C) air
(D) water
(E) fountains
16. Fish use their to swim.
(A) tails
(B) heads
(C) gills
(D) lungs
(E) floats
Maria grew up on a farm. She loved the work on
the farm. She knew when all of the crops had to
be planted. She would like a job on a farm or in
a flower garden.
17. Maria has had experience as a .
(A) guide
(B) farmer
(C) driver
(D) nurse
(E) teacher
18. She would like to work in .
(A) an office
(B) a library
(C)a garden
(D)a hospital
GO ONLINE for a Quick Guide on
how to get your exam score results in
CNA365
credentia.com/test-takers/va
20
The Skills Evaluation
21
WHAT TO EXPECT
SETTINGS
The Skills Evaluation is set up to look like an actual care-giving situation.
The Skills Evaluation area will look like your work setting. It will have
all the equipment needed to perform the assigned skills. The Skills
Evaluation will be given by a Nurse Aide Evaluator. Before your Skills
Evaluation begins, the evaluator will show you where the equipment is
and answer questions about using the equipment. Please arrive 30
minutes early. Please plan to spend the day as you will also play the part
of the “client” for another candidate. See pages 24-32 for the complete
skills listing.
While you perform the skills, speak to the client as you would speak to an
actual client in a nurse aide work setting. It’s good to speak to the client
not only because it is part of quality care, but also because it will help you
to relax as you perform the skills.
Please note, you cannot get help from anyone during the Skills
Evaluation, and you must speak to the client in English so that the
evaluator can understand and correctly score the evaluation. If either one
of you gives help or receives help during the test or you and the client are
talking in a language other than English, the test will be stopped.
CANDIDATE VOLUNTEER REQUIREMENTS
You will need to act as a candidate volunteer for another candidates’
Skills Evaluation and play the role of a client. You will get instructions on
how you should act in your role as the client. You must wear flat, slip-on,
non-skid shoes; a loose-fitting top with short sleeves that can be rolled
up to the shoulder or tank top; and loose-fitting pants that can be rolled
up. You will have to put a gown on over your clothing. In no case should
anyone remove clothing down to undergarments.
Before starting the test, you should tell the evaluator about any food or
latex allergy or sensitivity to skin soaps or lotion. If you have trouble with
any range of motion, you should tell the evaluator before you start.
You should not come to the test site with open sores on the skin.
Candidates with any open sores on their skin should reschedule their
skills test to a later date.
THE TASKS
The NNAAP Skills List shows all of the skills that you may be asked to
perform during the Skills Evaluation. The skills have been broken down
into steps.
A step that is highlighted in bold type is called a Critical Element Step.
Critical Element Steps are important steps that must be performed
correctly in order for you to pass the skill. If you leave out a Critical
Element Step or do not perform a Critical Element Step correctly, you
will not pass the skill. However, if you perform only the Critical Element
Step correctly, you do not automatically pass that skill. You must also
correctly perform enough steps to meet the passing standard (or cut
score) for each skill.
Before your Skills Evaluation begins, the Nurse Aide Evaluator will give
you an instruction card that will list the five (5) skills selected for you to
perform. Hand-washing will always be one of the skills to be performed.
The remaining four (4) skills are randomly chosen from the skills listings
on pages 24 to 32 of this handbook. You should perform the skills in the
order they are listed on the instruction card.
• If you make a mistake, say so, and you will be instructed to tell the
evaluator which step(s) is to be corrected and then to perform the
step(s). You will not have to redo the entire skill, just the steps you
want to correct. There are some exceptions to this rule. If you don’t
put on gloves or take them off when required, and the evaluator
reminds you to do that, then you will not get credit for trying to
correct this step.
• If you want to correct a step that must be done in order — a step
that has to be performed before or after another step — and you
forget to say when the corrected step should be performed, you will
not get credit for the correction.
• Once you begin a new skill, you can’t go back to correct the skill
that came before it.
22
• The Nurse Aide Evaluator will not answer questions during the
Skills Evaluation and will not tell you whether you performed a skill
correctly. You may not receive help from anyone during the Skills
Evaluation. If you do have any questions, please ask them before
the Skills Evaluation begins.
• One (1) of the four (4) randomly selected skills will include
a measurement skill (see the section below, Recording A
Measurement, for more information on measurement skills).
• You must successfully complete five (5) out of the five (5) skills
in the skill form to pass the Skills Evaluation. You will have 30
minutes to demonstrate all 5 skills. When 25 minutes have
elapsed the Nurse Aide Evaluator will tell you that you have 5
minutes left.
• When you have finished your Skills Evaluation, the evaluator will
tell you to wash your hands. This will not affect your score, but you
must wash your hands as a hygiene measure.
RECORDING A MEASUREMENT
For your Skills Evaluation, you must perform one measurement skill,
such as blood pressure, radial pulse, respirations, urine output or
weight. You will be given a special form, called a Recording Sheet for
Measurement Skills, to write down the measurement. For example,
if performing the Measures and Records Blood Pressure skill, you
will write the complete systolic and diastolic pressures of your blood
pressure reading in a box labeled Candidate Results.
On the following page is a copy of the recording sheet that will be used
during the skills exam. You must record your results in the Candidate
Results box on this sheet. This sheet will be used to record the results
of the following measurement skills:
• Measures and Records Blood Pressure
• Measures and Records Weight of Ambulatory Client
• Measures and Records Urinary Output
• Counts and Records Radial Pulse
• Counts and Records Respirations
TIPS FOR THE SKILLS EVALUATION
• You will be expected to perform the skills just like you would in
a nursing hom e setting. When water is required, you m ust use
running water. You will be required to perform the Hand Hygiene
skill.
• For your skills evaluation, you don’t have to was h your hands for
each skill. You can just tell the evaluator “Now I would was h my
hands.” You don’t have to was h them each time, as long as you
tell the evaluator when you would was h them if this were a real
situation.
• For all steps other than hand-washing, you m ust actually perform
the skill in order to get credit. You can’t tell the evaluator what you
would do for simulating a step. You have to actually do the step.
• After you have introduced yourself to the client for the first time, it
is not necessary for you to introduce yourself each time you begin
a new skill.
• To receive full credit for a m easurement skill, you m ust accurately
make the required measurement and then write that m easurement
on the Recording Sheet for Measurement Skills. The evaluator
will provide the Recording Sheet to you at the test site. A sample
of the Recording Sheet is shown on page 23 of this handbook. It’s
best for you to becom e familiar with the Recording Sheet before
your scheduled test date.
• You mus t know how to use both a standing and a non-digital
bathroom scale and must know how to set both types of scales to
zero.
• You may not bring any of your own equipment to the test site (like
a transfer/gait belt).
• It is important for you to place the call signal within the client’s
reach whenever you leave the client.
• Where the word “client” appears, it refers to the person receiving
care.
23
Skills Listing
The 23 skills that follow are arranged in alphabetical order, except for the Hand
Hygiene (Hand Washing) skill. Hand Hygiene is listed first as a reminder of the
importance of performing this skill before all other skills. The numbered lines below
each skill are the steps needed to perform that skill. Critical Element Steps are in bold
type.
SKILL 1 — HAND HYGIENE (HAND WASHING)
1 Address client by name and introduces self to client by name
2 Turns on water at sink
3 Wets hands and wrists thoroughly
4 Applies soap to hands
5 Lathers all surfaces of wrists, hands and fingers producing friction, for at
least 20 (twenty) seconds, keeping hands lower than the elbows and the
fingertips down
6 Cleans fingernails by rubbing fingertips against palms of the opposite hand
7 Rinse all surfaces of wrists, hands and fingers, keeping hands lower than the
elbows and the fingertips down
8 Uses clean, dry paper towel/towels to dry all surfaces of fingers, hands and wrists
starting at fingertips then disposes of paper towel/towels into waste container
9 Uses clean, dry paper towel/towels to turn off faucet then disposes of paper towel/
towels into waste container or uses knee/foot control to turn off faucet
10 Does not touch inside of sink at any time
SKILL 2 — APPLIES ONE KNEE-HIGH ELASTIC STOCKING
1 Explains procedure, speaking clearly, slowly and directly, maintaining face-to-face
contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Client is in supine position (lying down in bed) while stocking is applied
4 Turns stocking inside-out, at least to the heel
5 Places foot of stocking over toes, foot and heel
6 Pulls top of stocking over foot, heel and leg
24
7 Moves foot and leg gently and naturally, avoiding force and over-
extension of limb
and joints
8 Finishes procedure with no twists or wrinkles and heel of stocking,
if present, is over heel and opening in toe area (if present) is either
over or under toe area; if using a mannequin, candidate may state
stocking needs to be wrinkle-free
9 Signaling device is within reach and bed is in low position
10 After completing skill, wash hands
SKILL 3 — ASSISTS TO AMBULATE USING
TRANSFER BELT
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before assisting to stand, client is wearing non-skid shoes/
footwear
4 Before assisting to stand, bed is at a safe level
5 Before assisting to stand, checks and/or locks bed wheels
6 Before assisting to stand, client is assisted to sitting position with
feet flat on the floor
7 Before assisting to stand, applies transfer belt securely at the waist over
clothing/gown
8 Before assisting to stand, provides instructions to enable client to assist
in standing including prearranged signal to alert client to begin standing
9 Stands facing client positioning self to ensure safety of candidate and
client during transfer. Counts to three (or says other prearranged signal)
to alert client to begin standing
10 On signal, gradually assists client to stand by grasping transfer belt
on both sides with an upward grasp (candidate’s hands are in upward
position), and maintaining stability of client’s legs by standing knee to
knee or toe to toe with client
11 Walks slightly behind and to one side of client for a distance of ten (10)
feet, while holding onto the belt
12 Assists client to bed and removes transfer belt
13 Signaling device is within reach and bed is in low position
14 After completing skill, wash hands
SKILL 4 — ASSISTS WITH USE OF BEDPAN
1 Explains procedure speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before placing bedpan, lowers head of bed
4 Puts on clean gloves before placing bedpan under client
5 Places bedpan correctly under client’s buttocks
6 Removes and disposes of gloves (without contaminating self) into waste
container and washes hands
7 After positioning client on bedpan and removing gloves, raises head of
bed
8 Toilet tissue is within reach
9 Hand wipe is within reach and client is instructed to clean hands with
hand wipe when finished
10 Signaling device within reach and client is asked to signal when finished
11 Puts on clean gloves before removing bedpan
12 Head of bed is lowered before bedpan is removed
13 Ensures client is covered except when placing and removing bedpan
14 Empties and rinses bedpan and pours rinse into toilet
15 Places bedpan in designated dirty supply area
16 Removes and disposes of gloves (without contaminating self) into waste
container and washes hands
17 Signaling device is within reach and bed is in low position
25
SKILL 5 — CLEANS UPPER OR LOWER DENTURE
1 Puts on clean gloves before handling denture
2 Bottom of sink is lined and/or sink is partially filled with water before
denture is held over sink
3 Rinses denture in moderate temperature running water before brushing
them
4 Applies denture toothpaste to toothbrush
5 Brushes all surfaces of denture
6 Rinses all surfaces of denture under moderate temperature running
water
7 Rinses denture cup and lid
8 Places denture in denture cup with moderate temperature water/solution
and places lid on cup
9 Rinses toothbrush and places in designated toothbrush basin/container
10 Maintains clean technique with placement of toothbrush and denture
11 Sink liner is removed and disposed of appropriately and/or sink is
drained
12 Removes and disposes of gloves (without contaminating self) into waste
container and washes hands
SKILL 6 — COUNTS AND RECORDS RADIAL
PULSE
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Places fingertips on thumb side of client’s wrist to locate radial pulse
3 Count beats for one full minute
4 Signaling device is within reach
5 Before recording, washes hands
6 Records pulse rate within plus or minus 4 beats of evaluator’s
reading
SKILL 7 — COUNTS AND RECORDS RESPIRATIONS
1 Explains procedure (for testing purposes), speaking clearly, slowly and
directly, maintaining face-to-face contact whenever possible
2 Counts respirations for one full minute
3 Signaling device is within reach
4 Before recording, washes hands
5 Records respiration rate within plus or minus 2 breaths of
evaluator’s reading
SKILL 8 — DONNING AND REMOVING PPE (GOWN
AND GLOVES)
1 Picks up gown and unfolds
2 Facing the back opening of the gown places arms through each sleeve
3 Fastens the neck opening
4 Secures gown at waist making sure that back of clothing is covered by
gown (as much as possible)
5 Puts on gloves
6 Cuffs of gloves overlap cuffs of gown
7 Before removing gown, with one gloved hand, grasps the other
glove at the palm, remove glove
8 Slips fingers from ungloved hand underneath cuff of remaining
glove at wrist, and removes glove turning it inside out as it is
removed
9 Disposes of gloves into designated waste container without
contaminating self
10 After removing gloves, unfastens gown at waist and neck
11 After removing gloves, removes gown without touching outside of gown
12 While removing gown, holds gown away from body without touching the
floor, turns gown inward and keeps it inside out
13 Disposes of gown in designated container without contaminating self
14 After completing skill, washes hands
26
SKILL 9 — DRESSES CLIENT WITH AFFECTED
(WEAK) RIGHT ARM
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Asks which shirt he/she would like to wear and dresses him/her in shirt of
choice
4 Avoids overexposure of client by ensuring client’s chest is covered
5 Removes gown from the left (unaffected) side first, then removes gown
from the right (affected/weak) side
6 Before dressing client, disposes of gown into soiled linen container
7 Assists to put the right (affected/weak) arm through the right sleeve
of the shirt before placing garment on left (unaffected) arm
8 While putting on shirt, moves body gently and naturally, avoiding force
and over-extension of limbs and joints
9 Finishes with clothing in place
10 Signaling device is within reach and bed is in low position
11 After completing skill, washes hands
SKILL 10 — FEEDS CLIENT WHO CANNOT FEED
SELF
1 Explains procedure to client, speaking clearly, slowly and directly,
maintaining face-to-face contact whenever possible
2 Before feeding, looks at name card on tray and asks client to state name
3 Before feeding client, client is in an upright sitting position (75-90
degrees)
4 Places tray where the food can be easily seen by client
5 Candidate cleans client’s hands before beginning feeding
6 Candidate sits in a chair facing client during feeding
7 Tells client what foods and beverage are on tray
8 Asks client what he/she would like to eat first
9 Using spoon, offers client one bite of each type of food on tray, telling
client the content of each spoonful
10 Offers beverage at least once during meal
11 Candidate asks client if they are ready for next bite of food or sip of
beverage
12 At end of meal, candidate cleans client’s mouth and hands
13 Removes food tray
14 Leaves client in upright sitting position (75-90 degrees) with signaling
device within client’s reach
15 After completing skill, washes hands
SKILL 11 — GIVES MODIFIED BED BATH (FACE
AND ONE ARM, HAND AND UNDERARM)
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Removes gown and places directly in soiled linen container while
ensuring client’s chest and lower body is covered
4 Before washing, checks water temperature for safety and comfort and
asks client to verify comfort of water
5 Puts on clean gloves before washing client.
6 Beginning with eyes, washes eyes with wet washcloth (no soap),
using a different area of the washcloth for each stroke, washing
inner aspect to outer aspect then proceeds to wash face
7 Dries face with dry cloth towel/washcloth
8 Exposes one arm and places cloth towel underneath arm
9 Applies soap to wet washcloth
10 Washes fingers (including fingernails), hand, arm and underarm keeping
rest of body covered
11 Rinses and dries fingers, hand, arm and underarm
12 Moves body gently and naturally, avoiding force and over-extension of
limbs and joints
13 Puts clean gown on client
14 Empties, rinses, and dries basin
15 Places basin in designated dirty supply area
16 Disposes of linen into soiled linen container
17 Avoids contact between candidate clothing and used linens
18 Removes and disposes of gloves (without contaminating self) into waste
27
container and washes hands
19 Signaling device is within reach and bed is in low position
SKILL 12* — MEASURES AND RECORDS
ELECTRONIC BLOOD PRESSURE
*STATE SPECIFIC (EVALUATOR: DO NOT SUBSTITUTE THIS SKILL
FOR SKILL 23 ‘MANUAL BLOOD PRESSURE’)
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Has client assume a comfortable lying or sitting position
4 Client’s arm is positioned at level of heart with palm up and upper arm
is exposed
5 Selects appropriate cuff size
6 Feels for brachial artery on inner aspect of arm, at bend of elbow
7 Places blood pressure cuff snugly on client’s upper arm and sensor/
arrow is over the brachial artery site
8 Turns on the machine and ensures device is functioning. If the machine
has different settings for infants, children and adults, selects the
appropriate setting.
9 Pushes start button. If cuff inflates to more than 200 mm Hg then stops
machine and uses cuff on client’s other arm.
10 Waits until the blood pressure reading appears on the screen and for
the cuff to deflate, then removes the cuff
11 Signaling device is within reach
12 Before recording, washes hands
13 After obtaining reading using BP cuff, records both systolic and
diastolic pressures exactly as displayed on the digital screen
SKILL 13 — MEASURES AND RECORDS URINARY
OUTPUT
1 Puts on clean gloves before handling bedpan
2 Pours the contents of the bedpan into measuring container without
spilling or splashing urine outside of container
3 Rinses bedpan and pours rinse into toilet
4 Measures the amount of urine at eye level with container on flat surface
(if between measurement lines, round up to nearest 25 ml/cc)
5 After measuring urine, empties contents of measuring container into
toilet
6 Rinses measuring container and pours rinse into toilet
7 Before recording output, removes and disposes of gloves (without
contaminating self) into waste container and washes hands
8 Records contents of container within plus or minus 25 ml/cc of
evaluator’s reading
SKILL 14 — MEASURES AND RECORDS WEIGHT
OF AMBULATORY CLIENT
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Client has non-skid shoes/footwear on before walking to scale
3 Before client steps on scale, candidate sets scale to zero
4 Asks client to step on center of scale and obtains client’s weight
5 Asks client to step off scale
6 Before recording, washes hands
7 Records weight based on indicator on scale. Weight is within plus
or minus 2 lbs. of evaluator’s reading (If weight recorded in kg
weight is within plus or minus 0.9 kg of evaluator’s reading).
28
SKILL
NOT
TESTED
SKILL 15 — PERFORMS MODIFIED PASSIVE
RANGE OF MOTION (PROM) FOR ONE KNEE AND
ONE ANKLE
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Ensures that client is supine in bed and instructs client to inform
candidate if pain is experienced during exercise
4 While supporting the leg at knee and ankle, bends the knee and
then returns leg to client’s normal position (flexion/extension) (AT
LEAST 3 TIMES unless pain is verbalized). Moves joints gently,
slowly and smoothly through the range of motion, discontinuing
exercise if client verbalizes pain.
5 While supporting the foot and ankle close to the bed, pushes/pulls
foot toward head (dorsiflexion), and pushes/pulls foot down, toes
point down (plantar flexion) (AT LEAST 3 TIMES unless pain is
verbalized). Moves joints gently, slowly and smoothly through the
range of motion, discontinuing exercise if client verbalizes pain.
6 Signaling device is within reach and bed is in low position
7 After completing skill, washes hands
SKILL 16 — PERFORMS MODIFIED PASSIVE
RANGE OF MOTION (PROM) FOR ONE
SHOULDER
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Instructs client to inform candidate if pain experienced during exercise
4 While supporting arm at the elbow and at the wrist, raises client’s
straightened arm from side position upward toward head to ear
level and returns arm down to side of body (flexion/extension)
(AT LEAST 3 TIMES unless pain is verbalized). Moves joint gently,
slowly and smoothly through the range of motion, discontinuing
exercise if client verbalizes pain.
5 While supporting arm at the elbow and at the wrist, moves client’s
straightened arm away from the side of body to shoulder level and
returns to side of body (abduction/adduction) (AT LEAST 3 TIMES
unless pain is verbalized). Moves joint gently, slowly and smoothly
through the range of motion, discontinuing exercise if client
verbalizes pain.
6 Signaling device is within reach and bed is in low position
7 After completing skill, washes hands
SKILL 17 — POSITIONS ON SIDE
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before turning, lowers head of bed
4 Raises side rail on side to which body will be turned
5 Candidate assists client to slowly roll onto side toward raised side rail
6 Places or adjusts pillow under head for support
7 Candidate repositions arm and shoulder so that client is not lying on arm
8 Supports top arm with supportive device
9 Places supportive device behind client’s back
10 Places supportive device between legs with top knee flexed, knee and
ankle supported
11 Signaling device is within reach and bed is in low position
12 After completing skill, washes hands
SKILL 18 — PROVIDES CATHETER CARE FOR
FEMALE
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before washing, checks water temperature for safety and comfort and
asks client to verify comfort of water
4 Puts on clean gloves before washing
29
5 Places linen protector under perineal area including buttocks before
washing
6 Exposes area surrounding catheter (only exposing client between hip
and knee)
7 Applies soap to wet washcloth
8 While holding catheter at meatus without tugging, cleans at least
four inches of catheter from meatus, moving in only one direction,
away from meatus, using a clean area of the washcloth for each
stroke
9 While holding catheter at meatus without tugging, using a clean
washcloth, rinses at least four inches of catheter from meatus,
moving only in one direction, away from meatus, using a clean
area of the washcloth for each stroke
10 While holding catheter at meatus without tugging, dries at least four
inches of catheter moving away from meatus using a dry cloth towel/
washcloth
11 Empties, rinses and dries basin
12 Places basin in designated dirty supply area
13 Disposes of used linen into soiled linen container and disposes of linen
protector appropriately
14 Avoids contact between candidate clothing and used linen
15 Removes and disposes of gloves (without contaminating self) into
waste container and washes hands
16 Signaling device is within reach and bed is in low position
SKILL 19 — PROVIDES FOOT CARE ON ONE
FOOT
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before washing, checks water temperature for safety and comfort and
asks client to verify comfort of water
4 Basin is in a comfortable position for client and on protective barrier
5 Puts on clean gloves before washing foot
6 Client’s bare foot is placed into the water
7 Applies soap to wet washcloth
8 Lifts foot from water and washes foot (including between the toes)
9 Foot is rinsed (including between the toes)
10 Dries foot (including between the toes) with dry cloth towel/washcloth
11 Applies lotion to top and bottom of foot (excluding between the toes)
removing excess with a towel/washcloth
12 Supports foot and ankle during procedure
13 Empties, rinses and dries basin
14 Places basin in designated dirty supply area
15 Disposes of used linen into soiled linen container
16 Removes and disposes of gloves (without contaminating self) into waste
container and washes hands
17 Signaling device is within reach
SKILL 20 — PROVIDES MOUTH CARE
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before providing mouth care, client is in upright sitting position (75-90
degrees)
4 Puts on clean gloves before cleaning mouth
5 Places cloth towel across chest before providing mouth care
6 Secures cup of water and moistens toothbrush
7 Before cleaning mouth, applies toothpaste to moistened toothbrush
8 Cleans mouth (including tongue and all surfaces of teeth), using
gentle motions
9 Maintains clean technique with placement of toothbrush
10 Candidate holds emesis basin to chin while client rinses mouth
11 Candidate wipes mouth and removes clothing protector
12 Disposes of used linen into soiled linen container
13 Rinses toothbrush and empties, rinses and dries basin
14 Removes and disposes of gloves (without contaminating self) into waste
container and washes hands
15 Signaling device is within reach and bed is in low position
30
SKILL 21 — PROVIDES PERINEAL CARE
(Peri-Care) for Female
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before washing, checks water temperature for safety and comfort and
asks client to verify comfort of water
4 Puts on clean gloves before washing perineal area
5 Places pad/ linen protector under perineal area including buttocks before
washing
6 Exposes perineal area (only exposing between hips and knees)
7 Applies soap to wet washcloth
8 Washes genital area, moving from front to back, while using a clean
area of the washcloth for each stroke
9 Using clean washcloth, rinses soap from genital area, moving from
front to back, while using a clean area of the washcloth for each
stroke
10 Dries genital area moving from front to back with dry cloth towel/
washcloth
11 After washing genital area, turns to side, then washes rectal area moving
from front to back using a clean area of washcloth for each stroke.
12 Using clean washcloth, rinses soap from rectal area, moving from front to
back, while using a clean area of the washcloth for each stroke
13 Dries rectal area moving from front to back with dry cloth towel/washcloth
14 Repositions client
15 Empties, rinses and dries basin
16 Places basin in designated dirty supply area
17 Disposes of used linen into soiled linen container and disposes of linen
protector appropriately
18 Avoids contact between candidate clothing and used linen
19 Removes and disposes of gloves (without contaminating self) into waste
container and washes hands
20 Signaling device is within reach and bed is in low position
SKILL 22 — TRANSFERS FROM BED TO
WHEELCHAIR USING TRANSFER BELT
1 Explains procedure, speaking clearly, slowly and directly,
maintaining face-to-face contact whenever possible
2 Privacy is provided with a curtain, screen or door
3 Before assisting to stand, wheelchair is positioned alongside of bed,
at head of bed facing foot or foot of bed facing head
4 Before assisting to stand, footrests are folded up or removed
5 Before assisting to stand, locks wheels on wheelchair
6 Before assisting to stand, bed is at a safe level
7 Before assisting to stand, checks and/or locks bed wheels
8 Before assisting to stand, client is assisted to a sitting position
with feet flat on the floor
9 Before assisting to stand, client is wearing shoes
10 Before assisting to stand, applies transfer belt securely at the waist
over clothing/gown
11 Before assisting to stand, provides instructions to enable client to
assist in transfer including prearranged signal to alert when to begin
standing
12 Stands facing client positioning self to ensure safety of candidate
and client during transfer. Counts to three (or says other
prearranged signal) to alert client to begin standing.
13 On signal, gradually assists client to stand by grasping transfer
belt on both sides with an upward grasp (candidates’ hands are
in upward position) and maintaining stability of client’s legs by
standing knee to knee or toe to toe with the client
14 Assists client to turn to stand in front of wheelchair with back of
client’s legs against wheelchair
15 Lowers client into wheelchair
16 Positions client with hips touching back of wheelchair and transfer
belt is removed
17 Positions feet on footrests
18 Signaling device is within reach
31
SKILL 23* — MEASURES AND RECORDS MANUAL
BLOOD PRESSURE
*STATE SPECIFIC (EVALUATOR: DO NOT SUBSTITUTE THIS SKILL
FOR SKILL 12 ‘ELECTRONIC BLOOD PRESSURE’)
1 Explains procedure, speaking clearly, slowly and directly, maintaining
face-to-face contact whenever possible
2 Before using stethoscope, wipes bell/diaphragm and earpieces of
stethoscope with alcohol
3 Client’s arm is positioned with palm up and upper arm is exposed
4 Feels for brachial artery on inner aspect of arm, at bend of elbow
5 Places blood pressure cuff snugly on client’s upper arm, with sensor/
arrow over brachial artery site
6 Earpieces of stethoscope are in ears and bell/diaphragm is over
brachial artery site
7 Candidate inflates cuff between 160mm Hg to 180 mm Hg. If beat
heard immediately upon cuff deflation, completely deflate cuff.
Reinflate cuff to no more than 200 mm Hg.
8 Deflates cuff slowly and notes the first sound (systolic reading), and
last sound (diastolic reading) (If rounding needed, measurements are
rounded UP to the nearest 2 mm of mercury)
9 Removes cuff
10 Signaling device is within reach
11 Before recording, washes hands
12 After obtaining reading using BP cuff and stethoscope, records
both systolic and diastolic pressures each within plus or minus
8 mm of evaluator’s readings
While a formal nurse aide “scope of practice”
does not exist, these skills addressed as part
of the NATCEP program constitute the range
of acceptable duties that may be assigned to a
nurse aide and that a nurse aide will be deemed
competent to perform. Duties inherent to another
professional scope of practice, such as those
associated with a Licensed Practical Nurse or
Registered Nurse, are deemed inappropriate for
a nurse aide to perform.
32
Exam Results
You will get a notification email from CNA365 when a new exam score has
been posted to your online account. To see your score report, please login
to your CNA365 account by clicking the “CNA365 Login” button on the top
of the Virginia nurse aide website page at www.credentia.com/test-takers/
va.
Score reports are generally available within a few hours after the day’s
testing event is completed. If it has been more than 24 hours and you’re not
able to see your score report in CNA365, please contact customer service
at 800-457-6752.
SCORE REPORTING
Credentia will provide you with your official examination results for your
skills examination within a few hours after a testing event is completed for
the day. You will receive your online proctored exam score immediately
upon completion of the exam. Score reports are provided online and
are available for you to print or download. Examinations results will not
be given over the telephone, nor can they be sent by Credentia to your
employer.
HOW TO READ A FAILING SCORE REPORT
If you do not pass the Skills Evaluation, you will receive a Failing Score
Report. The score report will list the five (5) skills that you performed
and a score of Satisfactory or Unsatisfactory for each skill. Any skill with
an Unsatisfactory result is considered a failed skill. You must receive
a Satisfactory result on all five (5) skills to pass the Skills Evaluation.
Use your failing Score Report as an aid in studying to re-take the Skills
Evaluation.
A failed skill will show the reason for the failure. You may not have
performed the steps of a skill correctly, or you may have forgotten a step,
especially a Critical Element Step.
The failing Score Report will list steps that were missed or incorrect—look
for numbers printed directly under a skill marked Unsatisfactory. A list
of all the skills and the steps needed for each skill can be found in this
handbook. Find the skill you failed, and study the steps, especially steps
listed as Unsatisfactory on the score report.
In the example on the following page, a candidate received a result of
Unsatisfactory on the skill Hand Hygiene. The numbers 1, 5, and 10
printed below the skill refer to steps that were missed or performed
incorrectly. To study for re-taking the Skills Evaluation, this candidate
should turn to the Skills Listing in this handbook, look for the Hand
Hygiene skill, and review all the steps, especially steps 1, 5, and 10.
VIRGINIA NNAAP® EXAMINATION RESULTS
Exam:
Skills Result: Fail
Skills
Performance:
Hand
Hygiene
1, 5,
10
Unsatisfactory
Provides
Mouth Care Satisfactory
Written
Examination only Satisfactory
Measures
and Records Blood Pressure Satisfactory
Puts
One Knee-High
Elastic
Stocking on Client
Satisfactory
Assists
Client to Ambulate using transfer
belt
Satisfactory
A sample of a Failing Score Report
33
The Registry
CHANGE OF ADDRESS OR NAME
The Virginia Board of Nursing requires that you inform them in writing
of your correct address. In most cases it is permissible for an individual
to provide an address of record other than a resident address, such
as a post office box or a practice location address. In order to receive
renewal notification and other correspondence from the Virginia Board of
Nursing, you MUST inform the Registry about any changes to your name
or address within thirty (30) days after any change is made.
A change of address may be made online at the time of renewal or at
any time by written notification to the Board of Nursing. To change your
address, you may:
• Send a separate letter to the Virginia Board of Nursing/Nurse Aide
Registry informing them of the change. (If you are writing a separate
letter, please be sure to list both the old information and the updated
information, including your name, address, Social Security or
certificate number, and telephone number.)
• Email the Board at: nursebd@dhp.virginia.gov or do so online at:
www.license.dhp.virginia.gov.
Please be advised that all notices and correspondence from the Board,
including renewal notices, licenses, and other legal documents, will be
mailed to the address of record that you provide. Failure to inform the
Registry of an address change may jeopardize your timely receipt of
these important documents.
If you change your name, you must provide appropriate documentation
of that change when you notify the Board of Nursing. A copy of a marriage
certificate, divorce decree granting you the right to resume your former
name, or other court order is required.
PASSING
Once you have passed both the Written (or Oral) Examination and the
Skills Evaluation, your name will be submitted to the Virginia Board
of Nursing for placement on the Virginia Nurse Aide Registry. You must
successfully pass both the Written (or Oral) Examination and the Skills
Evaluation in order to be placed on the Registry. Although you have
received a passing score report, you are not permitted to call yourself
a “Certified Nurse Aide (CNA)” until your name appears on the
Registry.
Grievance Process
If you disagree with your score, you can file what’s called a “grievance,”
an explanation or reason for why you think your score was not correct
or fair.
• All grievances must be in writing and submitted through the
online system. You must provide as much detail as possible. The
grievance must be submitted within 30 days of your exam date.
• After we receive your grievance form, your complaint will be
investigated. Once the investigation is complete, Credentia will
contact you to tell you whether or not your grievance was accepted.
If the grievance is accepted, you’ll be allowed to retest at no
additional cost.
• For details on how to submit a grievance, visit www.credentia.com/
test-takers/va and click on “Grievances” in the Resources section
of the webpage. You will receive a response within 30 days of
Credentia receiving your form.
34
RENEWAL
Your initial nurse aide certification is valid for two (2) years. At least sixty
(60) days prior to the expiration date of your certificate, a renewal notice
will be mailed to your last address on record with the Board of Nursing/
Nurse Aide Registry requesting you to renew online at www.license.dhp.
virginia.gov. You are required to personally attest that you have been
employed for pay performing nursing-related activities within the previous
two (2) years. In order to be renewed and maintained on the Registry, you
must meet the work requirement mentioned above or you will be required
to re-take the NNAAP Examination to demonstrate continued
competency.
Your nurse aide certification will expire if you do not renew it. It is your
responsibility to renew your certification, regardless of whether or not you
receive the renewal notice mailed from the Board office. If you do not
receive your renewal notice by the middle of the month in which your
certificate is due to expire, please contact the Board of Nursing at (804)
367-4515.
LAPSED CERTIFICATION
If you were previously listed on the Virginia Board of Nursing Registry
and have been lapsed for more than 90 days, you MUST submit a
reinstatement application and fees to the Board of Nursing. The Board
will then determine if you also need to take the NNAAP examination to
demonstrate competency for reinstatement.
Reinstatement applications with instructions may be obtained from the
Board of Nursing website at www.dhp.virginia.gov/boards/nursing or by
calling the Board office at (804) 367-4515.
ENDORSEMENT
If you are a nurse aide currently listed on another state’s nurse aide
registry, and you are seeking certification on the Virginia Nurse Aide
Registry, you MAY NOT need to test. Endorsement applications are
available for on-line submission through the Virginia Board of Nursing’s
web site at www.dhp.virginia.gov/boards/nursing.
The length of the endorsement process depends on the time it takes your
state to provide verification that you are a certified nurse aide and meet
requirements similar to those for initial certification in Virginia.
35
Frequently asked Questions
VA Nurse Aide Registry
36
QUESTION ANSWER AND REFERENCE (WHERE APPLICABLE)
1. How do I become a CNA? You must meet the eligibility requirements for one of the applications. Once your application is approved you
must pass both the written and skills portions of the NNAAP examination. The time frame for successfully
completing both exams varies, by state. Please check with your training program or the Exam Overview
section of this handbook.
2. May I perform the duties of a
nurse aide before I am certified?
If you are currently attending an approved training program in a nursing home, you have 120 days in which to
complete the training and become certified. During that period, a student may not perform any duty for which
they have not been trained and checked by the instructor.
3. How do I arrange for special
accommodations?
Special requests must be submitted and approved prior to testing. Documentation from your physician or
other qualifying professional must be included with the request. Please refer to the Accommodations section
of the candidate handbook for details.
4. How do I decide which exam to
take?
An Oral Examination in English may be substituted for the Written examination if you have difficulty reading
English. It contains 10 reading comprehension questions in which you must identify job-related words.
5. Is there a time limit in which I must
pass both exams?
Within two years per federal regulation of training program completion.
6. Can I register for an exam or check
my scores online?
Registration must be done online.
Score Reports are provided online (see page 43).
If you passed both parts of the examination, your name will be forwarded to the Virginia Board of Nursing for
determination of placement on the Nurse Aide Registry. You can also verify your status by checking online. A
link for the Virginia Registry: www.credentia.com/testtakers/va.
7. What form of payment do you
accept, and may I take it to the test
site?
You will not be scheduled unless payment is made using a credit card, debit card, single use card or
electronic voucher. No form of payment will be accepted, at a test site.
8. What is the next test date? Examination dates will appear on your screen when logged in CNA365 when selecting your scheduled exam.
9. How do I verify if I’m on the Nurse
Aide Registry?
You can verify your status on the Virginia Nurse Aide Registry online at www.credentia.com/test-takers/va.
10. How long will my name remain
on the registry?
Your initial certification is for two (2) years from when your name is provided to the Board as passing
both parts of the competency test within a 24-month period. Once your certificate is up for renewal, it is
renewed annually. A renewal notice will be sent to the address of record 60 days before your certificate’s
expiration date.
37
QUESTION ANSWER AND REFERENCE (WHERE APPLICABLE)
11. My certification expired. How do I
renew it or become certified again?
• If your certificate has been expired for less than 90 days, contact the Board office at (804) 367-4515 for
information on renewing it. If it has been expired for more than 90 days, a reinstatement application must
be completed and mailed to the Board of Nursing. You can access and download that application from the
Board’s website at www.dhp.virginia.gov/ boards/nursing or by calling the Board office at the same phone
number listed above. Once renewal/ reinstatement information has been received, the Board will determine
if you have to retest to complete the renewal/reinstatement process due to a lack of nursing-related
employment within the required time frame.
12. I’m moving to or from another
state. May I perform nurse aide
duties in that state?
If you are moving TO Virginia, you will need to complete an Endorsement Application. This is now an on-line
application which you can access and complete from the Board of Nursing’s website at www.dhp.virginia.
gov/ boards/nursing. If you do not have access to a computer, you can get an application mailed to you by
contacting the Board office at (804) 367-4515.
If you are moving FROM Virginia, you should contact the Board of Nursing or Board of Nursing for that state,
to obtain state requirements.
38
Notes:
39
Notes:
40
41
10185(04/23)HB-VA
