CNA Certification Test: Written Exam Blueprint & All 22 Clinical Skills
To earn placement on your state's official Nurse Aide Registry, you must pass both components of the state competency evaluation: the Written (or Oral/Audio) Knowledge Examination and the Manual Clinical Skills Demonstration.
State CNA Competency Exam Snapshot
Multiple-choice computer or scantron test (90–120 mins); minimum passing score of 70%–80% by state.
30–40 minutes to demonstrate Handwashing plus 4–5 skills drawn from the 22-skill pool.
Federal OBRA standard grants 3 attempts within 12–24 months of NATCEP graduation before retraining.
1. Part I: The Written (or Audio/Oral) Knowledge Exam Blueprint
Administered on a computer workstation or paper scantron at an approved testing site (such as Credentia/NNAAP, Headmaster D&SDT, or Prometric), the written examination consists of 60 to 75 multiple-choice questions with a 90- to 120-minute time limit. Candidates who prefer audio support or English-as-a-Second-Language (ESL) accommodations may request the Oral Examination during registration, which plays every question and answer choice through headphones and includes 10 additional reading-comprehension medical word recognition items.
- Physical Care Skills (50%–55% of Exam Questions): Covers Activities of Daily Living (personal hygiene, bathing, oral/denture care, dressing, grooming, nutrition, dysphagia feeding, hydration, urinary/bowel elimination), basic nursing skills (vital signs, standard and transmission-based infection control, skin integrity and pressure ulcer prevention, post-mortem care), and restorative mobility skills (range of motion, gait belts, mechanical lifts, prosthetic/orthotic care).
- Role of the Nurse Aide (30%–35% of Exam Questions): Covers federal OBRA resident rights, HIPAA patient confidentiality, ethical boundaries, mandatory reporting of suspected abuse, neglect, or misappropriation of property, workplace and fire safety (RACE and PASS acronyms), and clear SBAR communication with the supervising LPN or RN.
- Psychosocial Care Skills (10%–15% of Exam Questions): Covers emotional and mental health needs, supporting residents with Alzheimer's disease, dementia, delirium, or sundowning agitation, cultural and spiritual sensitivity, and grieving/end-of-life comfort support.
2. Comparing the 3 Major State CNA Testing Vendors
Each state Department of Health or Board of Nursing contracts with one primary testing vendor (or regional college consortium) to administer its competency exam. Check which vendor serves your state in our CNA Classes by State Directory:
| Testing Vendor | Written / Oral Format | Clinical Skills Format | Typical Combined Exam Fee |
|---|---|---|---|
| Credentia (NNAAP) (PA, NJ, NC, SC, GA, VA, CO, WA, CA, DC, MD, AL, AK, MS, RI, VT) |
70 multiple-choice questions (or 60 oral + 10 word-recognition questions); 2 hours allowed | 5 skills total: Mandatory Hand Hygiene + 4 randomly assigned skills (including 1 measurement skill); 30 minutes | $115 – $140 total ($40–$55 written + $75–$90 clinical) |
| Headmaster LLP (D&SDT) (AZ, AR, MI, MT, ND, NH, NV, OH, OR, SD, TN, UT, WI, WV) |
60 to 75 computer-based knowledge questions via TMU (TestMaster Universe); 90 minutes | 3 to 4 randomly selected hands-on clinical tasks (Handwashing + Indirect Care embedded); 30–35 minutes | $105 – $135 total |
| Prometric (NY, FL, TX, CT, DE, HI, ID, LA, NM, OK, WY) |
60 multiple-choice questions (90 minutes); available in English and Spanish in select states | 5 clinical skills: Handwashing + Indirect Care + 3 randomly drawn clinical skills; 31–40 minutes | $110 – $155 total |
3. Part II: Complete Table of All 22 Testable Clinical Skills
During the clinical skills exam, a Registered Nurse evaluator observes you performing 5 nursing assistant skills on a live actor/model or clinical mannequin. Hand Hygiene and Indirect Care (knocking, identifying the resident, closing the privacy curtain, locking bed wheels, placing the call light within reach) are evaluated across every single skill. Review all 22 core skills below, and study the full step-by-step sequences on our CNA Clinical Skills Checklists & Video Guide:
| Skill Category | All 22 Testable Clinical Skills | Critical Automatic-Fail Checkpoints |
|---|---|---|
| Infection Control & Clinical Measurements (Skills 1–5) |
1. Hand Hygiene (Soap & Water — Required) 2. Counts & Records Radial Pulse 3. Counts & Records Respirations 4. Measures & Records Blood Pressure 5. Measures & Records Weight of Ambulatory Resident |
Lathering hands/wrists/nails with friction for at least 20 full seconds; turning off faucet with a clean dry paper towel; recording radial pulse within ±4 bpm, respirations within ±2 breaths/min, BP within ±4–8 mmHg, and weight within ±0.5 lb; zeroing scale and putting non-skid shoes on resident before walking to scale. |
| Personal Hygiene, Grooming & Nutrition (Skills 6–12) |
6. Performs Mouth Care (Conscious Resident) 7. Cleans Upper or Lower Denture 8. Gives Modified Bed Bath (Face, Arm, Hand & Underarm) 9. Provides Foot Care on One Foot 10. Provides Fingernail Care on One Hand 11. Dresses Client with Affected (Weak) Right Arm 12. Feeds a Dependent Resident Who Cannot Feed Self |
Testing water temperature before bathing or soaking; lining sink basin with a towel/washcloth during denture care; drying carefully between toes (and never applying lotion between toes); placing shirt sleeve onto the weak/affected arm first (and removing from strong arm first); positioning dependent diner upright at 45 to 90 degrees before feeding. |
| Perineal Care, Elimination & Output (Skills 13–16) |
13. Provides Female Perineal Care 14. Provides Indwelling Urinary Catheter Care 15. Assists with Use of Bedpan 16. Measures & Records Urinary Output |
Always wiping front to back (urethra toward rectum) using a clean section of washcloth for each stroke; holding catheter securely at the meatus to prevent pulling and cleaning 4 inches down the tubing away from the meatus; reading urinary graduate at eye level on a flat surface within ±25 mL. |
| Positioning, Transfers, ROM & Environment (Skills 17–22) |
17. Transfers from Bed to Wheelchair Using Gait Belt 18. Assists Resident to Ambulate Using Gait Belt 19. Positions on Side (Lateral Position) 20. Performs Passive Range of Motion (PROM) — Knee & Ankle 21. Performs Passive Range of Motion (PROM) — One Shoulder 22. Makes an Occupied Bed (or Dons/Doffs PPE Gown & Gloves) |
Locking both wheelchair brakes and bed wheels before standing resident; ensuring non-skid footwear is worn before standing; fastening gait belt snugly with an upward underhand grip; supporting joints above and below during PROM and asking about pain; keeping side rails up or protecting resident from rolling while making an occupied bed. |
4. The "Correction Rule" & What Happens If You Fail the CNA Exam
What happens if you pass one part of the exam (such as the written knowledge test) but fail the other part (the clinical skills evaluation)?
- You Only Retake the Component You Failed: In all 50 states and D.C., your passing score on Part I (Written) or Part II (Clinical Skills) is banked. If you pass the written exam but miss a critical step on one clinical skill, you only register and pay to re-take the clinical skills portion—where you will be assigned a new random set of 5 skills.
- Federal 3-Attempt & 24-Month Eligibility Window: Under federal OBRA-87 rules (42 CFR § 483.154), candidates are permitted 3 attempts to pass both components within 12 to 24 months of graduating from their NATCEP course. If a candidate fails either component three times (or lets their 24-month training certificate expire before testing), federal law requires completing a new state-approved CNA training program before testing again.
5. Exam Day Checklist & Frequently Asked Questions
- Bring Two Matching Government IDs: One unexpired, government-issued photo ID with signature (driver's license, state ID, passport, or military ID) plus a secondary ID (Social Security card or signed credit/debit card) with the exact same legal first and last name as your exam registration.
- Wear Clinical Scrubs & Bring an Analog Watch: Wear clean clinical scrubs, non-skid closed-toe shoes, and a watch with a sweeping second hand (smartwatches and Apple Watches are strictly banned in the testing room) to count radial pulse and respirations for a full 60 seconds.
- Complete Practice Tests Ahead of Time: Drill all 25 high-yield written questions on our Interactive CNA Practice Exam and rehearse the 22 skill steps on our Clinical Skills Training Guide.
How soon after passing the CNA test will my name appear on the Nurse Aide Registry?
Computer-based written and clinical results from Credentia (CNA365) and Headmaster (TMU) are typically posted online within 24 to 48 business hours, and your official certification number is searchable on your state's Nurse Aide Registry within 3 to 10 business days.
Can I challenge the CNA exam without taking a CNA class?
Florida is the primary state that allows any adult candidate to "challenge" the Prometric CNA written and clinical exam without first completing a 120-hour NATCEP class. Additionally, most states grant an Exam Challenge / Equivalency Waiver to nursing students who have completed their first semester of Fundamentals of Nursing clinicals, foreign-trained nurses/physicians, and military hospital corpsmen/medics.