CNA Study Guide
CNA Scope of Practice: What Nurse Aides Can and Cannot Do
CNA scope of practice guide: allowed ADL and clinical support tasks, prohibited nursing duties, chain of command, documentation rules, and NNAAP exam traps.
By MedCertPrep Team · Updated August 31, 2026
Scope of practice defines which tasks a certified nurse aide (CNA) may perform under state law, facility policy, and training. On the NNAAP written exam, Role of the Nurse Aide is 16 scored items (26%), and many stems ask whether an action belongs to the aide, the nurse, or another licensed role. This guide lists high-yield can do and cannot do tasks, chain of command, documentation rules, and scenario traps. For privacy, refusal, and abuse reporting depth, see CNA resident rights. For dementia communication overlap, see CNA dementia and psychosocial care. Practice in Role of the Nurse Aide.
State rules vary. Some states allow expanded roles (for example medication aide certification). Exam items usually test the standard nurse aide boundary: assist, observe, report, and follow the care plan under nurse direction. Confirm your state handbook on Credentia (Find My State) or Prometric. Outline framing: 2024 NNAAP Content Outline.
Where does scope of practice appear on the CNA exam?
| Role of the Nurse Aide area | Scored items | Weight | Scope-related focus |
|---|---|---|---|
| Communication | 4 | 7% | Clear reporting, barriers, handoffs |
| Client Rights | 5 | 8% | See resident rights guide |
| Legal and Ethical Behavior | 3 | 5% | Scope limits, truthful documentation, professional boundaries |
| Member of the Health Care Team | 4 | 6% | Care plan follow-through, chain of command, appropriate assignments |
High-yield pattern: if an answer sounds clinically helpful but requires a nursing license or order, it is usually wrong for the CNA.
What can a CNA do within standard scope?
CNAs support daily care and safety under nurse supervision. Exam items reward assist, observe, report.
| Category | Examples within typical CNA scope |
|---|---|
| Activities of daily living (ADLs) | Bathing, dressing, grooming, feeding assistance, toileting, oral care |
| Mobility and safety | Transfers with gait belt when trained, ambulation support, positioning, ROM exercises as ordered |
| Vital signs and measurement | Temperature, pulse, respirations, blood pressure, height/weight per policy (vital signs guide) |
| Intake and output | Measure and record I&O; report significant changes |
| Specimen collection | Non-sterile specimens when trained and assigned (urine, stool) per policy |
| Catheter care support | Empty drainage bag, peri-care around existing catheter; not insertion |
| Observation and reporting | Skin changes, behavior shifts, pain cues, refusal, safety hazards to the nurse |
| Infection control | Hand hygiene, PPE, standard precautions (infection control guide) |
| Nail care | File fingernails; many exam sets teach do not cut toenails (nurse/podiatry per policy) |
| Perineal care | Front-to-back for females; clean strokes; privacy and dignity |
Pro Tip: "Assist the resident with..." is often correct. "Perform a sterile wound dressing change independently" is usually outside CNA scope.
What can a CNA not do on the exam?
These tasks typically require an RN, LPN, or provider, or explicit additional certification beyond standard CNA.
| Prohibited or out-of-scope task | Why stems use it as a trap |
|---|---|
| Administer medications (oral, topical, injection, IV) | Nursing/delegation task in standard scope teaching |
| Insert or remove urinary catheters | Sterile/advanced procedure; emptying bag is allowed |
| Sterile dressing changes on open wounds | Sterile technique and assessment beyond aide role |
| Tube feedings (gastric/jejunal) | Requires nursing assessment and protocol |
| IV insertion or IV medication administration | Licensed nursing scope |
| Nursing assessment / diagnosis | CNAs observe and report; nurses assess |
| Take physician or telephone orders | Not an aide function |
| Change the care plan independently | Follow plan; report needs to nurse |
| Apply restraints without order | Rights and safety violation |
| Cut toenails (many teaching sets) | Higher injury risk; nurse or podiatry |
| Document care you did not perform | Fraud and ethical violation |
Some states allow medication aide or expanded tech roles after separate training. Unless the stem specifies that certification, choose the standard CNA boundary.
Practice scope scenarios: medicated cream request, IV catheter insertion, and untrained sterile dressing.
What is chain of command for nurse aides?
Direct answer: CNAs work under licensed nurse supervision and report through the facility chain.
| Situation | Correct CNA action |
|---|---|
| Resident condition change (pain, fever, confusion, fall) | Report to the nurse immediately per urgency |
| Request to perform unfamiliar task | Decline until clarified; ask the nurse |
| Nurse asks task outside your training | Politely refuse; notify supervisor per policy |
| Family demands clinical information | Do not invent answers; redirect to nurse |
| Unsafe coworker practice | Report through policy (chain of command, not public confrontation alone) |
| Conflict between aide and nurse instruction | Follow facility hierarchy; clarify with charge nurse |
Silence when a resident is in distress, or hiding a near-miss to avoid bothering the nurse, is a common wrong answer pattern.
What documentation rules apply to CNAs?
Legal and ethical stems often test accuracy, timing, and objectivity.
| Rule | Exam direction |
|---|---|
| Document what you observed, not assumptions | "Resident ate 50%" not "resident was lazy" |
| Document after care when describing care given | Pre-charting is wrong |
| Record times, measurements, and refusals accurately | Falsification is never acceptable |
| Never document for another caregiver | Each worker charts own actions |
| Report errors according to policy | Covering up documentation mistakes is unethical |
| Protect confidentiality | Tied to resident rights |
Objective language example: "Resident stated sharp pain in left knee, rated 7/10" beats "resident faking pain."
How do scope questions overlap with other Role topics?
| Overlap | Where to study |
|---|---|
| Refusal of care | CNA resident rights |
| Abuse/neglect mandatory reporting | CNA resident rights |
| Communication with barriers | Role of the Nurse Aide practice |
| Physical tasks (transfers, ADLs) | CNA ADLs, transfers and gait belt |
| Infection control during care | CNA infection control |
Scope is the boundary line. Rights are the ethical floor. Both appear in Role stems.
What mistakes cost the most scope points?
| Mistake | Why it fails |
|---|---|
| Accepting medication administration to "help the nurse" | Outside standard CNA scope |
| Performing sterile wound care alone | Nursing/sterile task |
| Taking a physician phone order | Not aide role |
| Ignoring a resident fall to finish linen cart | Failure to report |
| Cutting toenails when stem expects nurse referral | Common grooming boundary |
| Charting care before it happens | Documentation violation |
| Diagnosing why a resident is confused | Assessment beyond aide scope |
Rewrite misses as: "That action requires the nurse/license; aide should observe and report."
Frequently Asked Questions
What is CNA scope of practice?
The legally and policy-defined set of tasks a certified nurse aide may perform after completing an approved program and passing the competency exam. It emphasizes ADL support, observation, and reporting under nurse supervision.
Can a CNA give medications?
On most NNAAP-style exams, no for standard CNA scope. Some states offer separate medication aide certification. Unless the stem names that role, do not select administer medication answers.
Can a CNA insert a urinary catheter?
Usually no. CNAs may empty a catheter bag and provide peri-care around an existing catheter per policy. Insertion and removal are nursing procedures in standard teaching.
Can a CNA change a sterile wound dressing?
Usually no independently. CNAs may assist (positioning, supplies) while a nurse performs sterile dressing changes. Performing the sterile change alone is a common trap.
Who should a CNA report to when a resident's condition changes?
The licensed nurse (charge nurse or assigned nurse) promptly. Urgent changes (chest pain, breathing distress, fall with injury) require immediate escalation.
What should a CNA do if asked to perform a task outside scope?
Politely refuse, explain it is outside aide training/scope, and notify the nurse or supervisor per policy. Do not perform the task to be helpful.
Where should I practice scope of practice questions?
Role of the Nurse Aide. Cross-train rights in CNA resident rights. Free mixed sets: Try CNA.
Next steps for CNA scope prep
- Memorize the cannot do list until medication and sterile procedure traps feel automatic.
- Try scenario items: task outside nurse aide scope and new wound without sterile training.
- Complete one Role set focused on scope and chain of command.
- Review Week 3 Role days in the CNA study plan.
- Pair with CNA resident rights for Legal/Ethics overlap.
- For pass method, see How to pass the CNA.
For unlimited domain drills, see CNA pricing and the CNA landing page.
Practice what you just read
Use blueprint-aligned questions and timed mocks for CNA to turn this guide into exam-day readiness.