HHA and CNA Competency Domain Review
Objective. Students will correctly answer practice items across all major HHA and CNA competency domains—including infection control, personal care, safety, emergency procedures, nutrition, residents' rights, mental health, and role and responsibilities—at or above the credential passing benchmark.
This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.
VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.
Why Domain Review Matters
The Home Health Aide (HHA) and Certified Nursing Assistant (CNA) credentials are government licenses. Without them, providing paid personal care or nursing-assistant services is illegal regardless of your skill level. Both credentials are awarded only after you pass a competency evaluation that typically includes a written (or oral) knowledge test and a hands-on skills demonstration. Your state candidate handbook lists the exact domains and the minimum passing score required in your jurisdiction. Use that handbook as your primary reference throughout this review—it is the official source.
This lesson walks through every major competency domain so you can identify strengths, locate gaps, and practice answering the kinds of questions that appear on the real exams.
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Competency Domain 1: Infection Control
Infection control protects both residents and caregivers. Core concepts include the chain of infection (pathogen, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host) and how breaking any link stops the spread of disease. Standard Precautions apply to every client, every time. Proper handwashing—at least 20 seconds with soap and running water—is the single most effective infection-control action an aide can take. Gloves are changed between tasks and between clients; hands are washed after glove removal. Transmission-based precautions (contact, droplet, airborne) add extra layers when a specific pathogen is present. Proper disposal of soiled materials in designated containers and correct donning and doffing of personal protective equipment (PPE) are tested skills.
Safety point: Never recap used needles. Report any needlestick injury to your supervisor immediately and follow your facility's exposure-control plan.
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Competency Domain 2: Personal Care Skills
Personal care includes bathing, oral hygiene, hair care, nail care, dressing, toileting, and perineal care. Always explain each procedure to the client before starting, provide privacy, and maintain dignity throughout. For bed baths, the water temperature must be tested (ideally with a thermometer or the inner wrist) to prevent scalding—older adults often have reduced sensation and thinner skin. Perineal care is performed front to back to prevent urinary tract infections.
Safety point: Never leave a confused or fall-risk client unattended during bathing or toileting.
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Competency Domain 3: Safety and Emergency Procedures
Environmental safety includes removing fall hazards, keeping call lights within reach, using proper body mechanics, and locking wheelchair brakes before transfers. The RACE acronym (Rescue, Alarm, Confine, Extinguish/Evacuate) guides fire response. Know your facility's evacuation routes. For choking in a conscious adult, deliver abdominal thrusts (Heimlich maneuver). If a client is unresponsive and not breathing normally, activate emergency medical services and begin CPR according to your current AHA training.
Safety point: Always follow your scope of practice. Aides do not diagnose conditions or administer prescription medications unless specifically trained and permitted by state law.
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Competency Domain 4: Nutrition and Hydration
Aides assist with meal preparation, feeding, and monitoring intake and output when directed. Recognize the signs of dysphagia (difficulty swallowing): coughing during meals, wet or gurgling voice, pocketing food. Report these signs immediately—aspiration pneumonia is a serious risk. Clients on thickened liquids or special diets must receive the correct consistency every time. Adequate hydration is especially important for older adults, who have a diminished thirst response. Record fluid intake accurately on the care plan form.
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Competency Domain 5: Residents' Rights
Residents' rights are protected by federal and state law for clients in Medicare- and Medicaid-certified facilities, and by broader ethical standards everywhere. Key rights include the right to privacy, confidentiality of medical information (HIPAA), freedom from abuse and neglect, the right to participate in care planning, and the right to refuse treatment. Aides are mandated reporters: if you observe or suspect abuse, neglect, or exploitation, you are legally required to report it to your supervisor and, in many states, directly to Adult Protective Services. Failure to report is itself a legal violation.
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Competency Domain 6: Mental Health and Social Needs
Many clients experience depression, anxiety, grief, or cognitive changes. Therapeutic communication techniques—active listening, open-ended questions, validating feelings—are foundational skills. For clients with dementia, use simple sentences, maintain eye contact, approach from the front, and use redirection rather than confrontation. The CDP credential (reviewed in a later lesson) deepens this knowledge; for the HHA/CNA exam, focus on recognizing behavioral changes and reporting them accurately.
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Competency Domain 7: Role and Responsibilities
Aides work under the supervision of a licensed nurse or therapist. The care plan is the legally binding document that directs your work; never perform tasks not on the care plan without approval. Documentation must be accurate, timely, and objective—record what you observe, not what you interpret. Scope of practice varies by state; when in doubt, ask your supervising nurse before acting.
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How to Use This Review Effectively
1. Read your state candidate handbook for the exact domain list and item distribution.
2. Use the self-assessment checklist to rate your confidence in each domain (1–3).
3. Work through domain-specific practice questions in small groups, explaining your rationale aloud.
4. Track every question you miss on your gap-tracking sheet.
5. Take the timed 60-question practice exam under test-like conditions—no notes, time yourself.
6. Any score below 80% triggers a targeted remediation worksheet before you advance.
Consistency in daily review, honest self-assessment, and deliberate practice on weak areas are the proven strategies for reaching and exceeding the passing benchmark.
Key terms10
Materials: Current state HHA and CNA candidate handbooks; state-approved curriculum content outline; domain-mapped practice question bank (minimum 300 questions); whiteboard for concept mapping; student gap-tracking worksheets; highlight markers
Check: Students score 80% or higher on the end-of-lesson 60-question mixed-domain practice exam; any student below 80% completes a targeted remediation worksheet for missed domains before Lesson 2.
Practice check8
Answer each question, then check it. Nothing is recorded; this is your own practice.
