CNA Exam 2026: Format, Content Areas and Scoring

What is the CNA exam?

It is the competency evaluation federal law requires before a nurse aide can work in a nursing home that takes Medicare or Medicaid; passing puts you on your state's nurse aide registry.

Federal rules (42 CFR 483.152) require a state-approved training program of at least 75 hours, with at least 16 hours of supervised practical training, before you sit the evaluation. The evaluation itself (42 CFR 483.154) must test both knowledge and skills, which is why every state splits it into a written part and a skills part.

Most states hand the exam to a vendor. The National Nurse Aide Assessment Program (NNAAP), written by NCSBN and delivered by Credentia, is the most widely used. Other states use Headmaster (D&S Diversified Technologies), Prometric or their own exam. The vendor runs scheduling, fees and results, so your state's candidate handbook is the document to read first.

What is on the CNA written exam?

In NNAAP states, 70 multiple-choice questions across nine content areas in three groups: physical care skills (64%), psychosocial care skills (10%) and the role of the nurse aide (26%). Basic nursing skills alone is 35% of the scored questions.

The 2024 NNAAP written exam content outline (NCSBN). Items are of the 60 scored questions.
Content area	Group	Weight	Scored items
Activities of daily living	Physical care skills	22%	13
Basic nursing skills	Physical care skills	35%	21
Self-care and independence	Physical care skills	7%	4
Emotional and mental health needs	Psychosocial care skills	8%	5
Spiritual and cultural needs	Psychosocial care skills	2%	1
Communication	Role of the nurse aide	7%	4
Client rights	Role of the nurse aide	8%	5
Legal and ethical behavior	Role of the nurse aide	5%	3
Member of the health care team	Role of the nurse aide	6%	4

Ten more unscored pretest questions are mixed in and look like the rest, so treat every question as if it counts. If reading in English is hard for you, most NNAAP states offer an oral version, read aloud, in place of the written test; you choose it when you register.

What does each part of the outline actually test?

Physical care is about doing daily care safely, psychosocial care is about the client as a person, and the role of the nurse aide is about rights, limits and reporting. Each of our four section guides covers one block with a free drill.

The three groups and their areas (NCSBN outline; scored items out of 60)
Group	Weight	Items	Areas
Physical care skills	64%	38	Activities of daily living, basic nursing skills, self-care and independence
Psychosocial care skills	10%	6	Emotional and mental health needs, spiritual and cultural needs
Role of the nurse aide	26%	16	Communication, client rights, legal and ethical behavior, member of the health care team

CNA activities of daily living practice test
Activities of daily living and self-care: bathing, toileting, nutrition, positioning, transfers, skin, sleep and comfort.
Free 12-question drill
CNA basic nursing skills practice test
The largest area: infection control, vital signs, intake and output, safety, restraints, emergencies, observation and reporting.
Free 12-question drill
CNA psychosocial care practice test
Emotional and mental health, dementia, end-of-life care, and spiritual and cultural needs.
Free 12-question drill
CNA role of the nurse aide practice test
Communication, client rights, legal and ethical behavior, and working on the care team.
Free 12-question drill

What happens in the CNA skills test?

You perform five skills on a volunteer or manikin while an evaluator scores a checklist. Hand hygiene is always one of them and one is always a measurement, such as a pulse, a blood pressure or urinary output, which you must record within the allowed range.

Skills that appear on most NNAAP lists (Credentia skills lists; your state's list is the one that counts)
Skill	How often	What evaluators watch
Hand hygiene	Every candidate, every time	Wet, soap, at least 20 seconds of friction, rinse fingertips down, dry, turn the tap off with a clean towel
Measures and records blood pressure, pulse, respirations, urinary output or weight	One measurement skill on every test	Your reading must fall within the evaluator's tolerance, so practise the arithmetic as much as the technique
Provides perineal care or catheter care	Common	Front to back, clean to dirty, a clean part of the cloth for each stroke
Transfers from bed to wheelchair with a transfer belt	Common	Brakes locked, non-skid footwear, belt snug with fingers under it, pivot toward the stronger side
Assists to ambulate with a transfer belt	Common	Stand slightly behind on the weaker side, hold the belt from underneath
Positions on side, performs range of motion	Common	Support each joint, move gently, stop at pain or resistance
Feeds a client who cannot feed self, gives mouth care, cleans dentures	Common	Sit at eye level, client upright, small bites; dentures over a lined basin
Puts on and removes a gown and gloves	Common	Gloves off first, gown rolled inside out, hand hygiene after

Each skill has critical element steps. Miss a critical step, such as locking the wheelchair brakes or washing your hands, and you fail that skill however well you did the rest. Your state's skills list sets out every step, so practise from it word for word.

Know the written exam before you sit it

8 full 70-question mocks on the 2-hour clock, 16 section drills and every answer explained.

The CNA Pass Pack gives you 8 full mocks on the real clock, 16 drills of 12 questions for the sections that cost you points, and a predictor that turns your mocks into the odds of reaching your target. One payment, no subscription, and your free score stays free.

Prep courses for these tests usually cost $19 to $129. The CNA Pass Pack is US$39 (£29), once.

See what is inside the CNA Pass Pack How our questions are built and checked

8
timed mocks: 16
topic drills: 1
score predictor

How is the CNA exam scored?

Each part is pass or fail. The written test is scored on the scored questions only, against a cut-off your state sets; reported cut-offs are mostly 70% to 80%. The skills test is passed skill by skill, and you must pass all five.

On a 60-question scored section, 70% is 42 correct and 80% is 48. The full table, and why we tell you to aim higher, is on the CNA passing score page.

Results usually go to you through the vendor's portal and to the state registry. If you pass both parts you are placed on the registry; if you fail one part, you retake only that part.

How many times can you take the CNA exam?

Federal rules give at least three chances to pass the competency evaluation, and your state sets the details: how many attempts, how long you have after training, and whether you must retrain after repeated failures.

In practice most states let you retake only the part you failed, and many require you to pass both parts within a set window after finishing training. Check your state's handbook for the exact rule before you book, because the window is the one that catches people out.

Once you are on the registry, the listing lapses if you go 24 consecutive months without doing nursing-related work for pay, and you would need to retrain or retest. While you work in a nursing home, federal rules also require at least 12 hours of in-service training a year.

How should I prepare for the CNA exam?

Take a full timed practice test to find your weak area, drill that area, learn the handful of rules that decide most questions, and practise the skills from your state's list until every critical step is automatic.

The free CNA practice test has the real length and clock and shows your score by section. The full plan, with a two-week schedule for both parts, is in how to pass the CNA exam, and worked examples of every question type are in the CNA test questions.

Many CNAs go on to nursing school, where the next exam is an entrance test such as the ATI TEAS or the HESI A2. If you are heading into emergency care instead, the NREMT exam guide covers the EMT certification exam.

Frequently asked questions

How many questions are on the CNA exam?

In NNAAP states the written test has 70 multiple-choice questions, 60 scored, in 2 hours. The skills test has five skills in about 30 minutes. Other states' exams differ, so check your handbook.

What is the CNA exam called in my state?

It is the state nurse aide competency evaluation, often called the state board or the NNAAP. The name of the vendor (Credentia, Headmaster, Prometric) is on your state's nurse aide registry website.

Which part of the CNA exam is harder?

More candidates struggle with the skills test, because one missed critical step fails a skill. The written test is more forgiving if you know the core rules.

Can I take the CNA exam without going to school?

Usually not. Federal rules require a state-approved training program of at least 75 hours. Some states let nursing students or people trained elsewhere challenge the exam, so ask your state registry.

How long is a CNA certification good for?

A registry listing stays active while you keep doing paid nursing-related work; it lapses after 24 consecutive months without it. States add their own renewal rules.

Is the CNA exam the same in every state?

The content is the same federal curriculum, but the vendor, length, fees and passing score differ. NNAAP states share the same 70-question format.

Walk in having already sat the written exam eight times

8 full mocks, 16 section drills and a practice predictor, in one payment with no subscription.