CNA Exam Guide: How Nurse Aide Certification Works, State by State — and the Exam Most Candidates Take

PassProfessor’s CNA program. The 2,867-question practice bank for the written exam is built and checked, and enrollment is open. Use this guide to plan your path through your own state’s certification.

The CNA exam landscape, in one paragraph

There is no single national CNA exam, because CNA certification is run by each state. Federal law — the Omnibus Budget Reconciliation Act (OBRA), implemented at 42 CFR 483.150–156 — sets the floor every state must meet: complete a state-approved training program of at least 75 hours, pass a competency evaluation with a written (or oral) knowledge exam and a hands-on skills demonstration, and be listed on your state’s nurse aide registry. Above that floor, each state chooses its own training hours, its own testing vendor, and its own fees and renewal rules. The most widely used written exam is the NNAAP (National Nurse Aide Assessment Program), developed by the National Council of State Boards of Nursing (NCSBN) and administered by Credentia in the states that contract with it: 70 multiple-choice questions in 2 hours, built on the 2024 content outline, plus the separate skills evaluation. States that test through other vendors — Prometric and Headmaster are the common alternatives — use their own item counts and skills lists. Your state’s candidate handbook is the document that governs your test; this guide explains the national picture and shows you exactly where your state fills in its own numbers.

Who can become a CNA?

The path is the same in outline everywhere, because the federal floor shapes it. The details inside each step belong to your state.

• Complete a state-approved training program. Under 42 CFR 483.152, an approved program must provide no less than 75 clock hours of training, including at least 16 hours of supervised practical training — hands-on practice in a lab or care setting, performing tasks on a person under the direct supervision of a registered nurse or licensed practical nurse. The curriculum must also include at least 16 hours of instruction in specified subjects — including communication and interpersonal skills, infection control, safety and emergency procedures, promoting residents’ independence, and respecting residents’ rights — before any direct contact with a resident. Most states require more than 75 hours, sometimes considerably more. The federal number is a floor, not a target: the requirement that applies to you is your state’s, published by your state registry and your training program.
• Pass the competency evaluation. Federal rules at 42 CFR 483.154 require the evaluation to have two parts: a written or oral examination addressing the subjects of the training curriculum, and a skills demonstration. You choose between the written and oral forms of the knowledge exam. Both parts must be passed.
• Be listed on your state’s nurse aide registry. When you pass, a record of your successful completion goes into your state’s registry (42 CFR 483.156 governs the registries). Employers check the registry; your listing is what makes you employable as a certified nurse aide in that state. A listing in one state does not automatically certify you in another — states run reciprocity processes for aides moving between registries, each with its own application.
• Meet your state’s additional rules. Age minimums, background checks, health screenings, identification requirements, and application deadlines after training are all set by the state, and they genuinely differ. Some states are specific about how long after training you must test; others are not. Do not import another state’s rules into your plan — read your own registry’s candidate information start to finish before you schedule anything.

One structural point worth understanding before you go further: the facility that employs you cannot be the body that evaluates you. Federal rules require the competency evaluation to be administered by the state or a state-approved entity independent of your training and employment, and the skills demonstration must be evaluated by a registered nurse with at least one year of experience caring for elderly or chronically ill people. That independence is why a testing vendor — Credentia, Prometric, Headmaster, or the state itself — stands between you and your registry listing.

The written exam, piece by piece

This section describes the NNAAP written exam, the one most candidates take. If your state uses a different vendor, your counts and weights will differ — the subject matter, drawn from the federal training curriculum, will be recognizably the same.

Format. Per Credentia’s NNAAP candidate materials, the written examination is comprised of 70 multiple-choice items. Ten of those items are unscored pretest questions on which statistical information is collected for future exams; 60 are scored. You cannot tell the pretest items apart, so the only workable strategy is to treat every question as scored. The time limit is 2 hours — roughly a minute and forty seconds per question, which is comfortable for candidates who have practiced at pace and tight for candidates who have not.

The oral alternative. If you have difficulty reading English, an oral examination may be taken in place of the written examination. Per Credentia’s candidate materials, the oral exam is offered in English and Spanish and must be requested when you submit your examination application — it is not something you can switch to on test day. The English oral form consists of 60 multiple-choice questions plus 10 reading-comprehension questions in which you identify job-related words; the Spanish oral form likewise pairs 60 multiple-choice questions with 10 questions you read and answer in English. Federal rules guarantee the choice of a written or oral examination in every state, whatever the vendor.

Where you take it. Per Credentia’s candidate materials, written (or oral) examinations may be taken either online, with a live proctor, or at a test center, in states that offer both routes. The skills evaluation is offered only at a test center. Your state’s handbook tells you which routes are open to you.

The content outline. The NNAAP written exam is built on the 2024 NNAAP content outline, which divides the exam into three domains. The outline below shows the domain weights and the topics inside each domain — this is the syllabus for the written exam, and it is the structure PassProfessor’s practice core is built on.

Domain (2024 NNAAP outline weight)	Topics inside the domain	What it tests, in plain terms
I. Physical Care Skills — 64%	Activities of Daily Living; Basic Nursing Skills; Restorative Skills	The hands-on knowledge of the job: hygiene, dressing and grooming, nutrition and hydration, elimination, rest and comfort; infection control, safety, vital signs, and basic clinical tasks; and restorative care that protects a resident’s independence and function
II. Psychosocial Care Skills — 10%	Emotional and Mental Health Needs; Spiritual and Cultural Needs	Responding to confusion, anxiety, grief, and changing mental health needs; respecting each resident’s spiritual practices, culture, and personal preferences
III. Role of the Nurse Aide — 26%	Communication; Client Rights; Legal and Ethical Behavior; Member of the Health Care Team	Communicating with residents, families, and the care team; the rights every resident holds and how the aide protects them; the legal and ethical boundaries of the aide’s role; and working within the chain of the health care team — what to do, what to report, and what is outside the aide’s scope

Two structural facts shape how you should prepare:

1. Physical Care Skills is nearly two-thirds of the exam. At 64%, it outweighs the other two domains combined by a wide margin, and inside it, Basic Nursing Skills is the largest single topic in PassProfessor’s practice core (697 of 1,995 questions) because it is the heaviest territory on the real exam — infection control, safety, measurements, and daily clinical tasks, usually tested as short resident scenarios rather than bare definitions.
2. Role of the Nurse Aide is the second quarter of the exam, and it is the most rule-bound. At 26%, questions about client rights, legal and ethical behavior, communication, and team membership test whether you know the boundaries of the job: what a resident may refuse, what must be reported to the nurse, what may never be shared, and what an aide must never do. Candidates who study only care tasks leave this quarter underprepared.

The skills evaluation, explained

The skills evaluation is the second half of the competency evaluation, and it is a different kind of test entirely. No questions are asked on paper. You perform care, in person, while a Nurse Aide Evaluator watches and scores each step.

How it works where the NNAAP is used. Per Credentia’s candidate handbooks, the evaluation is set up to resemble an actual caregiving situation: a skills area arranged like a work setting, with the equipment needed for the assigned skills. Before your evaluation begins, the evaluator shows you where the equipment is, answers questions about operating it, and gives you an instruction card listing the five skills selected for you. Handwashing is always one of the five. The remaining four are randomly chosen from the NNAAP Skills List published in the handbook, and one of the four will be a measurement skill — such as blood pressure, radial pulse, respirations, urinary output, or weight — whose result you must record accurately. You have 30 minutes to demonstrate all five skills; when 25 minutes have elapsed, the evaluator tells you that 5 minutes remain. The “client” for many skills is another candidate volunteering in that role, and you are expected to speak to them as you would speak to an actual resident.

How passing works. You must successfully complete five out of five skills to pass. Inside each skill, the published skills list breaks the task into steps, and certain steps are printed in bold as Critical Element Steps — steps that must be performed correctly for you to pass that skill at all. Missing a critical step fails the skill even if everything else is right; performing only the critical steps is not enough either, because you must also correctly perform enough of the remaining steps to meet the passing standard set for that skill. If you realize mid-skill that you made a mistake, Credentia’s handbooks describe a correction procedure: tell the evaluator, identify the step to be corrected, and perform the correction — before you move on to the next skill, because once a new skill begins, the previous one cannot be revisited.

How other vendors differ. States testing through Prometric, Headmaster, or another provider run their own skills evaluations: their own skills lists, their own number of skills drawn, and their own time limits. The federal requirement underneath is identical — a skills demonstration, performed in a setting comparable to the one you will work in, evaluated by a registered nurse with at least a year of experience caring for elderly or chronically ill people (42 CFR 483.154). Learn your own vendor’s list and steps; do not rehearse from another vendor’s.

Why our program covers the written half only. A practice-question program can teach the knowledge behind the skills — why hand hygiene comes first, what a normal reading looks like, which step protects the resident — and PassProfessor’s written questions do exactly that. What it cannot do is watch you perform. Being scored on your hands, your sequence, and your composure in front of an evaluator is a physical rehearsal, and it belongs in your training program’s skills lab, practiced against your vendor’s published step lists until the sequences are automatic. Any product that implies online questions prepare you for the skills evaluation by themselves is overstating what questions can do, and this guide will not do it.

Passing standards, explained honestly

Here is the fact most CNA pages get wrong: there is no national passing score for the CNA exam, and this guide will not invent one.

The competency evaluation is a state evaluation. Each state — working with its vendor — sets the standard its candidates must meet, for the written exam and for each skill in the skills evaluation. Secondary websites variously publish percentages for the written exam, and those figures conflict with each other because they describe different states, different vendors, or different years, stripped of the context that made them true. An NCSBN passing-standard figure from more than a decade ago also still circulates; it is not a current candidate-facing standard and is not used here.

What can be said accurately:

• Your standard is in your state’s candidate handbook. That document — from Credentia, Prometric, Headmaster, or your state agency — is where your written-exam standard and your skills-evaluation standard are authoritatively stated, in whatever form your state publishes them. Read it before you test, not after.
• For the skills evaluation, the standard is structural as well as numeric. Where the NNAAP is used, you must pass all five skills, and inside each skill you must perform every Critical Element Step correctly and enough total steps to meet that skill’s passing standard (per Credentia’s skills materials). There is no partial credit across skills: four strong skills and one failed skill is a failed evaluation, and you retake the skills part.
• Failing is diagnosable, by law. Under 42 CFR 483.154, a candidate who does not pass must be advised of the areas they did not pass. Your score report and that notification are the starting point of a retake plan — study the named areas, not the whole book again.
• Practice targets should be set in consistency, not percentages. Because no honest national percentage exists, the workable target is this: full practice exams, at the real domain weights, answered steadily across all three domains with no domain left weak. A candidate who is strong in Physical Care and guessing in Role of the Nurse Aide is not ready, whatever the average says.

Fees and registration, step by step

Fees are the second place CNA pages invent numbers, so this section names none. Every fee in CNA certification is set by your state and its vendor — training tuition, the examination fee, any retake fee, and any registry or renewal fee — and they differ enough between states that a national figure would mislead you. Your state’s candidate handbook and registry site publish the current amounts. What is national is the sequence, which runs the same way in the Credentia states and in recognizable form everywhere:

1. Complete a state-approved training program. Testing follows training. Your program confirms your completion to the state or vendor; in Credentia states, candidates who did not complete an approved program may still test under alternate eligibility routes listed in the candidate handbook (for example, certain nursing students or aides credentialed elsewhere) — the handbook’s eligibility section is the authority on whether a route applies to you.
2. Read your candidate handbook. It is specific to your state and vendor: eligibility routes, fees, scheduling windows, identification requirements, accommodation requests, and the skills list. The oral-examination request and any accommodation request happen at application time, not on test day.
3. Create your account and apply. In Credentia states, you create a Credentia Platform account, submit the examination application, and pay the examination fee through the platform — Credentia’s registration guidance specifies payment by credit or prepaid card, electronic check (ACH), or electronic voucher, and states that fees are non-refundable and non-transferable once paid. Other vendors run the same shape of process through their own portals.
4. Schedule after approval. Once your application is approved, you schedule within the same system. Credentia’s guidance requires reservations for test-center exams to be made at least two calendar days before the test date; written or oral exams taken online may be schedulable sooner, depending on availability. Written and skills appointments are scheduled as separate components — plan for both, and note that skills evaluations run only at test centers and fill on their own calendar.
5. Test, then check your result in the same account. Score reports are posted to your candidate account (per Credentia’s state handbooks). When you have passed both parts, your information goes forward for registry listing — in some states an additional application to the state board or health department completes the certification, so follow your handbook’s post-exam steps rather than assuming passing was the last step.
6. Renew on your state’s cycle. Registry listing is not permanent. States set renewal requirements and cycles — commonly tied to having worked as a nurse aide for pay within the preceding period — and a listing that lapses can require retesting or retraining to restore. Your registry’s renewal page states your rule; diarise it the day you are listed.

Two money notes that hold nationally. First, federal rules prohibit charging a nurse aide who is employed by — or has an offer of employment from — a nursing facility when they begin training for any portion of that training program (42 CFR 483.152); if that describes you, ask your employer and your program about it before you pay tuition. Second, treat any website publishing a single “CNA exam cost” for the whole country as unreliable: the honest figure lives in exactly one place, your state’s handbook.

Retakes and registry listing

• The federal guarantee: at least three opportunities. Under 42 CFR 483.154, every candidate must be given at least three opportunities to pass the competency evaluation before being required to retake training. States may allow more than three. Credentia’s own state handbooks show the variation plainly: Colorado’s handbook allows three attempts to pass both portions, while Washington’s allows four — after which the candidate must successfully complete a state-approved training program again and retake both parts. Your state’s handbook states your number; it is one of the first things to check in it.
• You retake the part you failed. The written (or oral) exam and the skills evaluation are scored separately. A candidate who passes one part and fails the other retakes the failed part, subject to their state’s rules and any deadline by which both parts must be passed — some states set an overall window (for example, a period running from application or from training completion), and windows differ by state.
• Each attempt is a new fee and a new appointment. Retake fees are state- and vendor-set (see the fees section). Schedule the retake after studying the areas your score report named — a second attempt on identical preparation usually produces an identical result.
• Registry listing follows passing both parts. A record of your successful completion of the evaluation is included in your state’s nurse aide registry (42 CFR 483.154, 483.156). The registry also records findings of abuse, neglect, or misappropriation of resident property where a state has made them — which is why the registry, not a certificate on a wall, is the record employers verify.
• Moving states means a new state’s process. Because registries are state-run, an aide listed in one state who moves applies through the new state’s reciprocity or endorsement process. Being listed and in good standing in your current state is the usual foundation; the new state’s registry publishes its exact requirements.

Test day

• Arrive 30 minutes early for the skills evaluation. Credentia’s handbooks are explicit: arrive 30 minutes early, plan to spend the day, and know that missing the check-in cutoff or arriving without required materials can mean you are not allowed to test and your fees are not refunded. Test times are approximate; skills evaluations run in groups, not on a personal timetable.
• Expect to be both candidate and client. For the skills evaluation, you will also act as the volunteer “client” for another candidate’s evaluation, following the evaluator’s instructions on how to play the role, in the clothing the handbook specifies (flat, non-skid shoes and loose clothing that can be rolled up are typical requirements). Tell the evaluator beforehand about any latex or soap sensitivity, food allergy, or range-of-motion limitation, and do not test with open sores on your skin — reschedule instead, per Credentia’s guidance.
• Bring identification that matches your application. Your name in the testing system must match your government identification. A mismatch is the most preventable way to lose a test day, and it is checked before either part begins.
• During the skills evaluation, work like it is a real shift. Use running water where water is required, perform each step rather than describing it (hand hygiene timing is the stated exception — you will tell the evaluator when you would wash your hands between skills, rather than washing repeatedly), keep the signaling device within the client’s reach whenever you leave them, and ask every question you have before the evaluation starts, because the evaluator will not answer questions or tell you how you are doing during it.
• For the written exam, pace for 70. Two hours for 70 questions is about a minute and forty seconds each. Answer in order, flag what stalls you, and return with the time remaining — 10 of the questions are unscored pretest items you cannot identify, so no single question is worth a stall.
• Results come through your candidate account. Check the account your vendor issued rather than waiting for mail, and if you did not pass, save the score report: the areas it names are your retake syllabus.

How to study for the written exam

The outline is the syllabus — the 2024 NNAAP content outline publishes exactly what the written exam covers and how heavily, and a plan built on that structure beats a plan built on rereading a textbook cover to cover.

1. Give Physical Care Skills its two-thirds. Sixty-four percent of the exam is physical care. Inside it, spend the most time on Basic Nursing Skills — infection control, safety and emergency procedures, vital signs and measurements, and basic clinical tasks — and on Activities of Daily Living: hygiene, grooming, nutrition and hydration, elimination, and comfort. These are scenario topics: the exam describes a resident and asks what the aide should do, so study them as decisions, not definitions.
2. Treat Role of the Nurse Aide as a rules exam inside the exam. Client rights, legal and ethical behavior, communication, and team membership (26% combined) reward precise knowledge: what a resident may refuse, what must be reported immediately and to whom, what an aide may never accept, share, or attempt. These questions have a correct answer because a rule says so — learn the rules cold.
3. Do not skip the smallest domain. Psychosocial Care Skills is 10% of the exam — emotional and mental health needs, spiritual and cultural needs. It is also where candidates who studied only physical tasks donate questions. A focused pass over how to respond to confusion, grief, anxiety, and individual spiritual and cultural practices is short study with a reliable return.
4. Practice at full length, against the clock. Seventy questions in 2 hours is a pacing skill separate from knowledge. Full generated practice exams at the real domain weights build both; short quizzes build only one.
5. Read every explanation, especially for questions you got right. A right answer from a wrong reason is a wrong answer waiting for a differently worded question. Explanations are where scenario judgment actually forms — why this action comes first, why that tempting action endangers the resident or exceeds the aide’s scope.
6. Rehearse the skills half in person, on its own track. Parallel to written study, practice the published skills steps in your training lab until the sequences — hand hygiene, the measurement skills, transfers, personal care — run without prompts. Written study and skills rehearsal prepare different halves of the same certification, and neither substitutes for the other.
7. Schedule the exam when your simulations say so — consistently steady full-exam practice results across all three domains, with no domain left to chance.

PassProfessor’s CNA practice bank (2,867 questions — a 1,995-question national core built on the 2024 NNAAP outline, plus 872 state-variant questions for CA, TX, FL, NY, OH, KY, and NC) covers the written exam described in this guide, with an explanation on every question. The CNA Exam Prep program page shows the full topic-by-topic coverage and enrollment.

Verified questions

Every question in this program is original — written for PassProfessor from the official exam blueprint, never copied from a test bank or another provider’s materials. Before enrollment opened, each answer key was independently verified: reviewers re-answered sampled questions blind, disagreements were settled against the primary sources, and every numeric answer was recomputed from first principles. Questions whose facts could not be confirmed were removed, and the bank passed a text-overlap screen. Practice exams draw a fresh, blueprint-weighted set from the full bank on every attempt, so no two practice exams are the same.

Frequently asked questions

Is there a national CNA exam? No. Certification is run by each state under the federal floor at 42 CFR 483.150–156: states approve training, contract with testing vendors, set fees and passing standards, and keep the nurse aide registries. The NNAAP is the most widely used exam program, but it is a program states adopt — not a national license, and not the exam in every state.

How many questions are on the CNA written exam? Where the NNAAP is used, 70 multiple-choice questions in 2 hours, per Credentia’s NNAAP candidate materials — 60 scored and 10 unscored pretest questions mixed in so candidates cannot identify them. States using Prometric, Headmaster, or another vendor set their own counts; your state’s candidate handbook states the number for the exam you will take.

How long must CNA training be? At least 75 hours under federal law (42 CFR 483.152), including at least 16 hours of supervised practical training and 16 hours in specified subjects before any direct resident contact. That is a floor: most states require more, and your state’s requirement is the one that applies to you. Check your state registry’s published figure rather than planning around 75.

What is the skills evaluation? The hands-on half of the competency evaluation. Where the NNAAP is used, per Credentia’s candidate materials, you perform five skills in 30 minutes in front of a Nurse Aide Evaluator: handwashing, which is always included, plus four randomly drawn skills, one of which is a measurement skill. You must pass all five skills, including every Critical Element Step in each. Other vendors run their own skills lists and formats.

What score do I need to pass the CNA exam? Your state sets the passing standard, and there is no national passing score — which is why this guide publishes none. Credentia’s and other vendors’ state handbooks state the standard for their state’s evaluation. Any single percentage presented as “the CNA passing score” for the whole country is describing one state at most, and possibly none.

Can I take the exam orally instead of in writing? Yes. Federal rules at 42 CFR 483.154 give every candidate the choice of a written or oral examination. In NNAAP states, per Credentia’s candidate materials, the oral exam in English or Spanish is for candidates who have difficulty reading English, consists of 60 multiple-choice questions plus 10 reading-comprehension questions, and must be requested when you submit your application.

How much does the CNA exam cost? Whatever your state and its vendor charge — there is no national fee, and fees differ by state and by component (written versus skills, first attempt versus retake). Your state’s candidate handbook publishes the current fee schedule. Be skeptical of any site quoting one national price; and note that federal rules bar charging aides employed by, or holding an offer from, a nursing facility for their training program.

How do I register for the CNA exam? First complete a state-approved training program. Then apply through your state’s testing vendor — in Credentia states, by creating a Credentia Platform account, submitting the examination application and fee, and scheduling once the application is approved (test-center reservations at least two calendar days ahead, per Credentia’s guidance). Other vendors follow the same application-then-scheduling shape through their own portals.

How many times can I retake the CNA exam? Federal rules guarantee at least three opportunities to pass the competency evaluation before retraining is required (42 CFR 483.154), and states may allow more. Credentia handbooks illustrate the spread: three attempts in Colorado, four in Washington. You generally retake only the part you failed, and you must be told the areas you did not pass. Your state’s handbook gives your exact limit and any deadline.

Do I have to pass both parts to be certified? Yes. The written (or oral) exam and the skills evaluation are both required parts of the competency evaluation under 42 CFR 483.154. Passing one part does not certify you; when both are passed and your state’s remaining steps are complete, your name is entered on the state nurse aide registry, which is the record employers verify.

Does the PassProfessor CNA program prepare me for the skills evaluation? No. The program prepares you for the written (knowledge) exam only — its questions do teach the knowledge behind the skills, but the evaluation itself is a watched, in-person performance that can only be rehearsed in a skills lab against your vendor’s published step lists. Our program page and this guide say so plainly because your certification depends on both halves.

If I move to another state, does my CNA certification move with me? Not automatically. Registries are state-run, so you apply through the new state’s reciprocity or endorsement process, which typically starts from your active, good-standing listing in your current state. The new state’s registry publishes its requirements and application route. Until that process completes, your original state’s listing is the credential you hold.

How do I stay on the nurse aide registry? By meeting your state’s renewal requirements on its cycle. States commonly tie renewal to having worked as a nurse aide for pay during the preceding period and set their own documentation rules; a listing allowed to lapse can require retesting or retraining to restore. Your registry’s renewal instructions state the rule that applies to you — read them when you are first listed, not when renewal is due.

Free study sheet (PDF): Download the Certified Nursing Assistant study sheet — vital-sign values, measurement rules, infection control, positioning, and resident rights on two printable pages

Disclaimer

PassProfessor is an independent exam-preparation provider and is not affiliated with Credentia, the National Council of State Boards of Nursing (NCSBN), the Centers for Medicare & Medicaid Services, Prometric, Headmaster, or any state nurse aide registry or state agency. This guide is general information about nurse aide certification, current as of October 2026; your state’s registry publications and candidate handbook govern if anything here differs from them. PassProfessor’s CNA program is exam preparation for the written (knowledge) exam only — it is not a training program, provides no training hours, and does not prepare candidates for the hands-on skills evaluation beyond the knowledge behind it.