The Certified Nursing Assistant exam is a two-part competency evaluation required by all 50 states. While each state regulates its own CNA certification, nearly every state uses either the NNAAP® (National Nurse Aide Assessment Program) blueprint or an equivalent standardized format. Understanding the exam inside-out removes anxiety and lets you focus on what matters: mastering the content and skills.
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Exam Structure at a Glance
| Format | 60–70 multiple-choice questions | 3–5 skills demonstrated |
| Time Limit | 90 minutes (most states) / 2 hours (CA, TX) | 25–40 minutes |
| Passing Score | 70% (varies by state) | 100% accuracy per skill |
| Testing Vendors | Prometric, NNAAP/Credentia, D&S, Headmaster | Same as written exam |
| Fee Range | $35–$45 | $45–$100 |
| Retake Policy | 3 attempts (then retraining required) | Same as written |
Key Fact: You must pass BOTH parts — passing one and failing the other means you retake only the failed portion (in most states).
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Written Exam Format
Question Count and Timing
| Standard NNAAP | 70 total | 60 scored | 10 pretest | 2 hours |
| Prometric (most states) | 60 total | 60 scored | 0 | 90 minutes |
| California (D&S) | 70 questions | 70 scored | 0 | 2 hours |
| New York (Prometric) | 60 questions | 60 scored | 0 | 90 minutes |
| Texas (Prometric) | 70 questions | 70 scored | 0 | 2 hours |
| Florida (Prometric) | 60 questions | 60 scored | 0 | 90 minutes |
Question Types
- Multiple Choice — Select the best answer from 4 options
- True/False — Occasionally used (more common on oral exam)
- Fill-in-the-blank — Rare, but appears on some state exams
- "EXCEPT" questions — "All of the following are true EXCEPT..."
- "FIRST" questions — "What should you do FIRST?"
Oral Exam Option
Candidates who struggle with reading can request the oral exam:
- Audio version: Headphones + audio playback of each question
- Translator-assisted: A state-approved translator reads questions (rare, specific states only)
- Spanish language: Available in TX, CA, FL, and several other states through Prometric
Fee: Usually $5–$10 extra for audio version (e.g., California charges $45 vs. $40 for standard).
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Complete Syllabus: Written Exam Content Outline
NNAAP® 3-Domain Model (Most States)
Domain I: Physical Care Skills (40 questions / ~60% of exam)
A. Activities of Daily Living (ADLs) — 13 questions
- Bed making (occupied and unoccupied)
- Bathing (partial, full, bed bath)
- Dressing and grooming
- Feeding and hydration
- Toileting and perineal care
- Mobility assistance and positioning
- Skin care and pressure injury prevention
B. Basic Nursing Skills — 11 questions
- Vital signs (temperature, pulse, respiration, blood pressure, pulse oximetry)
- Measuring and recording intake and output (I&O)
- Specimen collection (urine, stool, sputum)
- Hand hygiene and infection control
- Body mechanics and safe patient handling
- Nutrition and hydration monitoring
- Enema administration (some states)
C. Restorative Skills — 8 questions
- Range of motion (ROM) exercises — active, passive, active-assisted
- Transfer techniques (bed to chair, chair to bed, using transfer belt)
- Using assistive devices (walkers, canes, transfer belts)
- Promoting independence and self-care
- Positioning to prevent contractures
Domain II: Psychosocial Care Skills (7 questions / ~12% of exam)
- Emotional and mental health needs
- Therapeutic communication techniques
- Responding to confusion, agitation, or depression
- Privacy, dignity, and respect in care delivery
- Cultural and spiritual sensitivity
- Death and dying (end-of-life care)
Domain III: Role of the Nurse Aide (10 questions / ~15% of exam)
- Chain of command and scope of practice
- Documentation and reporting (what to report, what not to)
- Legal and ethical responsibilities (resident rights, abuse reporting)
- HIPAA and confidentiality
- Member of the health care team
- Professional behavior and appearance
- Workplace safety (OSHA, hazardous materials)
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Prometric 5-Domain Model (Alternative Format)
Some states using Prometric use a 5-domain breakdown instead:
| 1. Activities of Daily Living | Bathing, dressing, feeding, toileting, mobility | 13 |
| 2. Basic Nursing Skills | Vital signs, I&O, infection control, body mechanics | 11 |
| 3. Restorative Skills | ROM, transfers, assistive devices | 8 |
| 4. Emotional and Mental Health Needs | Communication, emotional support, cultural care | 7 |
| 5. Legal and Ethical Responsibilities | Resident rights, abuse reporting, HIPAA, documentation | 6–8 |
Note: The content is identical — only the grouping differs.
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Clinical Skills Exam Format
How It Works
- Check-in: Present ID, confirmation, wear non-skid closed-toe shoes
- Preparation: Wash hands, don PPE if required
- Skill Selection: Evaluator randomly selects 3–5 skills from the 22–23 testable skills
- Performance: You have 25–40 minutes to complete all assigned skills
- Critical Elements: Certain steps are "critical" — miss one = fail that skill
- Scoring: You need 100% accuracy on critical elements for EACH skill
The 22–23 Testable Skills
| 1 | Hand Hygiene (Hand Washing) | 20 sec lather, fingertips down, no sink contact |
| 2 | Applies One Knee-High Elastic Stocking | Inside-out to heel, no wrinkles |
| 3 | Assists to Ambulate Using Transfer Belt | Non-skid shoes, lock wheels, belt secure |
| 4 | Measures and Records Blood Pressure | Cuff positioning, deflate 2–3 mmHg/sec |
| 5 | Measures Radial Pulse | Fingertips not thumb, full 60 seconds |
| 6 | Measures Respiration | Don't announce, full 60 seconds |
| 7 | Measures Body Temperature (Oral) | Wait 15 min after food, under tongue |
| 8 | Feeds Dependent Client | Upright position, small bites, check pocketing |
| 9 | PROM — Arm | Support joints, gentle, no force |
| 10 | PROM — Leg | Support joints, gentle, no force |
| 11 | Assists with Bedpan | Privacy, front-to-back (females) |
| 12 | Changes Occupied Bed | Raise opposite rail, no wrinkles |
| 13 | Gives Modified Bed Bath | Test water temp, clean to dirty |
| 14 | Mouth Care (Natural Teeth) | All surfaces, upright position |
| 15 | Mouth Care (Dentures) | Lined basin, denture cleaner not toothpaste |
| 16 | Dresses Client with Affected Side | Undress strong first, dress affected first |
| 17 | Assists with Use of Commode | Privacy, clothing at ankles not feet |
| 18 | Measures Urine Output | Eye-level measurement, document color/clarity |
| 19 | Catheter Care | Front-to-back, meatus outward, bag below bladder |
| 20 | Applies Anti-Embolism Stockings (TED) | Inside-out, circulation check |
| 21 | Donning and Removing PPE | Correct order: gown→mask→gloves (don); gloves→gown→mask (remove) |
| 22 | Measures Weight (Standing Scale) | Zero scale, nearest 0.5 lb |
| 23* | Additional state-specific skill | Varies by state |
*Skill 23 is included in some state handbooks (e.g., California's Credentia handbook lists 23 skills).
Skills Scoring Rubric
| Pass | All critical elements completed correctly, no safety violations |
| Fail | Any critical element missed OR safety violation (e.g., leaving bed wheels unlocked) |
| Automatic Fail | Forgetting hand hygiene before/after skill, violating privacy, unsafe patient handling |
Key Rule: Hand hygiene is required before and after EVERY skill. Missing it = automatic fail for that skill.
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Testing Vendors by State
| Prometric | NY, TX, FL, IL, OH, PA, GA, NC, MI, and 30+ others | prometric.com |
| Credentia (NNAAP) | CA, WA, OR, NV, AZ, and 15+ others | credentia.com |
| D&S/Headmaster | CA (alternate), ND, SD, NE, KS, IA, MN | hdmaster.com |
| Pearson VUE | Select states for specific nursing exams | pearsonvue.com |
How to find your vendor: Check your state's Board of Nursing or Department of Health website. Look for "Nurse Aide Registry" or "CNA Certification."
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Registration Process
Step-by-Step
- Complete state-approved training (75–160 hours depending on state)
- Locate your testing vendor (see table above)
- Create an account on the vendor's website
- Submit application with:
- Proof of training completion (certificate)
- Government-issued photo ID
- Social Security card (some states)
- Fingerprint/background check clearance (some states)
- Pay exam fees ($80–$140 total for both portions)
- Schedule exam (choose date, time, location)
- Receive confirmation via email
What to Bring on Exam Day
Required:
- Government-issued photo ID (driver's license, passport)
- Exam confirmation (printed or on phone)
- Social Security card (some states require original)
- Non-skid closed-toe shoes (for skills exam)
- Comfortable clothes that allow bending/kneeling
Do NOT Bring:
- Study materials (phones must be stored)
- Bags/purses (lockers usually provided)
- Food/drinks (not allowed in testing room)
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Passing Scores and Scoring
Written Exam
| Most states | 70% (42/60 or 49/70) | Standard NNAAP/Prometric |
| California | 70% (49/70) | D&S Headmaster |
| New York | 70% (42/60) | Prometric |
| Texas | 70% (49/70) | Prometric |
| Florida | 70% (42/60) | Prometric |
Skills Exam
- Each skill: 100% accuracy on critical elements required
- Overall: Pass all 3–5 skills = pass the skills portion
- Partial pass: If you pass written but fail skills (or vice versa), you only retake the failed portion (most states)
Score Reporting
- Written exam: Results available immediately (computer-based) or within 24–48 hours (paper-based)
- Skills exam: Results announced immediately after evaluation
- Full results: Mailed to you within 7–10 business days
- CNA Registry: Your name is added to the state registry within 2–4 weeks after passing
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Retake Policy by State
| California | 3 | No time limit specified | Retrain (160 hours) | 7 days |
| New York | 3 | Within 24 months of training | Retrain (100 hours) | 7–14 days |
| Texas | 3 | Within 24 months of training | Retrain (100 hours) | 7 days |
| Florida | 3 | Within 24 months of training | Retrain or challenge again* | 7–14 days |
*Florida allows "challenge the test" without training — if you fail 3 times, you must complete a 120-hour approved program before retesting.
Partial Retake: If you pass written but fail skills (or vice versa), you retake ONLY the failed portion. Your passed portion remains valid for 12–24 months (varies by state).
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Exam Day Timeline
Morning Written Exam
| 7:30 AM | Arrive at testing center (30 min early) |
| 7:45 AM | Check-in: ID verification, locker assignment |
| 8:00 AM | Enter testing room, computer assigned |
| 8:10 AM | Written exam begins (90 min or 2 hrs) |
| 9:30 AM | Written exam ends, results displayed (if computer-based) |
| 9:40 AM | Break (10–15 minutes) |
Clinical Skills Exam
| 9:55 AM | Report to skills testing room |
| 10:00 AM | Skills exam begins (25–40 min for 3–5 skills) |
| 10:35 AM | Skills exam ends, evaluator provides result |
| 10:40 AM | Exit and receive full results (if both passed) |
*Timeline varies by location. Some centers run skills first, then written. Some split into two separate days.*
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Fees at a Glance
| Written Exam | $40 | $40 | $35 | $35 |
| Oral Exam (Audio) | $45 | $45 | $40 | $40 |
| Skills Test | $100 | $68 | $45 | $45 |
| Total (Standard) | $140 | $108 | $80 | $80 |
| Retake (Written only) | $40 | $40 | $35 | $35 |
| Retake (Skills only) | $100 | $68 | $45 | $45 |
*Fees effective 2026. Check your vendor's website for latest pricing.*
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Common Exam Day Mistakes (Avoid These)
| Forgetting hand hygiene | Automatic fail for that skill | Make it a habit — practice with every skill |
| Not wearing non-skid shoes | Turned away from skills exam | Check requirement list the night before |
| Arriving late | Not allowed to test, forfeit fee | Arrive 30 minutes early |
| Using phone during exam | Immediate disqualification | Store in locker before entering |
| Forgetting privacy curtain | Critical element fail | Practice: curtain first, then skill |
| Not locking bed wheels | Safety violation = fail | Check wheels before every transfer skill |
| Leaving bed in high position | Safety violation = fail | Always return bed to low position |
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Key Takeaways
- Written exam: 60–70 questions, 70% passing, 90 min–2 hrs depending on state
- Skills exam: 3–5 skills, 100% accuracy on critical elements, 25–40 min
- Syllabus: 3 domains (Physical Care, Psychosocial Care, Role of Nurse Aide) OR 5 domains (same content, different grouping)
- Hand hygiene before/after every skill — missing it = automatic fail
- Retake policy: 3 attempts in most states, then mandatory retraining
- Testing vendors: Prometric (30+ states), Credentia/NNAAP (15+ states), D&S/Headmaster (select states)
- Exam day: Arrive 30 min early, non-skid closed-toe shoes, bring government ID + confirmation
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Conclusion
The CNA exam isn't a mystery once you know the format. Sixty to seventy questions across three content domains, plus 3–5 hands-on skills with 100% accuracy required — that's the entire test. Register with the right vendor for your state, memorize the critical elements for all 22 skills, and arrive on exam day knowing exactly what to expect. You've got this.