The CNA Exam: What's on the Written Test and Skills Eval, and How to Pass Both

The CNA exam has two parts: a written/oral knowledge test and a hands-on skills evaluation. Here's exactly what each covers and how to pass on the first try.

You finished your state-approved training program, you've got the clinical hours logged, and now there's one thing standing between you and your first certified job: the CNA exam. If you've heard it described as "a test," that's the first thing to fix in your head, because it's actually two tests, and most people who fail don't fail the one they're afraid of.

Here's the short version: the CNA certification exam has two parts, a written (or oral) knowledge test of roughly 60 to 70 multiple-choice questions, and a hands-on skills evaluation where you perform a small set of randomly selected skills in front of an evaluator. The clinical content is rarely what trips people up. The procedural steps, handwashing, privacy, putting the call light back in reach, are.

Below: what each part actually covers, a topic-weighting table for the written test, exactly which "indirect care" steps get scored on every single skill, why most failures are procedural and not clinical, a prep plan, and a FAQ.

What you'll get:

• What the CNA exam is and how the two parts fit together
• What's on the written/oral knowledge test (the seven topic areas)
• A topic-weighting table so you know where to spend your time
• How the skills evaluation works and the steps scored every time
• Why most people fail the skills eval, and it's not the clinical part
• A study plan built for an entry-level timeline

What the CNA Exam Is, and Why It's Two Tests

The CNA certification exam is the gate between completing your training and getting placed on your state's nurse aide registry, which is what legally lets you work as a Certified Nursing Assistant. It is administered at the state level, and that detail matters more than almost anything else in this article. States contract with different testing vendors, Credentia, Pearson VUE, Prometric, and Headmaster/D&S are the big ones, so the exact question count, the passing score, the skill list, and even the format can vary from one state to the next.

That's why you'll see hedged numbers throughout this guide. They're accurate as general ranges, but your state registry is the source of truth. Check it before you do anything else.

Before you can sit the exam at all, almost every state requires you to complete a state-approved CNA training program; typically the federally mandated minimum of around 75 hours, though many states require more (some run to 120+ hours). That training is your eligibility ticket.

The exam itself has two components, and you generally have to pass both to be certified:

• The written (or oral) knowledge test, a multiple-choice exam, usually around 60 to 70 questions.
• The skills evaluation, a hands-on performance test where you demonstrate a handful of randomly selected nursing-assistant skills for a live evaluator.

A lot of candidates fixate on the written test because it looks like every test they've ever taken. But the skills evaluation is where the surprising failures happen, and we'll spend real time on why.

The Written (or Oral) Knowledge Test

The written test is a multiple-choice exam, commonly in the range of 60 to 70 questions, covering the core knowledge a nursing assistant needs on day one. Many states also offer an oral version, where questions are read aloud; this is designed primarily for candidates whose first language isn't English, and in some states it includes a reading-comprehension component. If English is a second language for you, find out whether your state offers the oral exam before you register.

The content breaks into a predictable set of topic areas. Across vendors and states the labels shift slightly, but you'll see some version of these seven:

• Basic nursing skills, vital signs, measuring intake and output, mobility and positioning, bedmaking, range-of-motion.
• Personal care, bathing, grooming, oral care, dressing, toileting, feeding.
• Infection control, handwashing, standard precautions, isolation, handling soiled linens, preventing the spread of pathogens.
• Safety and emergency procedures, fall prevention, transfers, body mechanics, choking, recognizing an emergency.
• Communication, interacting with residents, staff, and families; reporting and documenting observations.
• Residents' rights, privacy, dignity, independence, confidentiality, freedom from abuse and neglect.
• Role of the nurse aide, scope of practice, ethical and legal behavior, working within the care team.

The largest single chunk is almost always the physical care of residents, basic nursing skills plus personal care together make up the biggest share of the test, because that's the bulk of the actual job. But don't underweight the "soft" categories. Residents' rights and communication carry real question weight, and they're the easiest points on the test to lock in because the answers are based on principles, not memorization.

A Topic-Weighting Table

Here's roughly how the knowledge test divides its attention. These percentages are approximate and vary by vendor and state, Credentia, Prometric, Pearson VUE, and Headmaster each publish their own blueprint, so treat this as a study-priority guide, not an exact spec for your exam.

Two honest notes on this table:

1. The categories overlap. Infection control shows up inside personal-care questions; residents' rights shows up inside communication questions. Don't study them as sealed boxes.
2. Your vendor's blueprint overrides this table. If you know which company administers your state's exam, pull their published content outline, it's free and it's the real map.

The Skills Evaluation, Where the Surprises Happen

This is the part candidates underestimate. In the skills evaluation, you perform a small set, often 3 to 5 skills, randomly selected, in front of a live evaluator, usually a nurse, often on a live person acting as your "resident." You don't know in advance which skills you'll draw, which means you have to be ready to perform any skill on your state's list cleanly.

The skills are drawn from a published list, things like measuring and recording a radial pulse, taking blood pressure, assisting with feeding, performing range-of-motion on a joint, providing perineal care, ambulating a resident with a gait belt, or making an occupied bed. The exact list is set by your state and vendor, so get your state's official skills checklist and work from that, not a generic one.

Here's the part that decides most pass-or-fail outcomes: every skill is scored on more than just the clinical maneuver. Each one is graded on a set of indirect care and safety steps that have nothing to do with the "hard" part of the skill, and these are the steps people forget under pressure.

The indirect-care and safety steps scored on essentially every skill include:

• Knocking and introducing yourself, explaining what you're going to do.
• Washing your hands at the start (more on this below, it's nearly always mandatory).
• Providing for privacy, closing the curtain or door before care.
• Maintaining the resident's safety and comfort throughout.
• Putting the call light (or signaling device) back within the resident's reach when you finish.
• Lowering the bed to its lowest safe position before you leave.
• Washing your hands again at the end.

Handwashing Is (Almost) Always Mandatory

On most state skills evaluations, handwashing is either an automatically included skill or a required step embedded in every other skill, and it's scored in detail. We're talking turning the water on, wetting your hands, lathering for a specified time (commonly around 20 seconds), scrubbing all surfaces, rinsing with fingertips pointing down, drying with a paper towel, and using the towel to turn off the faucet so you don't recontaminate your hands.

It feels almost insultingly basic. It is also one of the most common places people lose points, because they rush it or skip a sub-step when they're nervous. Treat handwashing as a graded performance, because it is one.

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"I've watched candidates nail a perfect transfer and still fail the station; they forgot the call light, or they left the bed raised. The clinical skill is almost never the problem. It's the safety steps around it. The ones who pass are the ones for whom privacy, call light, and low bed are automatic."

Why Most People Fail (It's Not the Clinical Part)

If you take one idea from this guide, take this: the most common reasons candidates fail the skills evaluation are procedural, not clinical. People rarely fail because they can't physically take a blood pressure or feed a resident. They fail because of how they execute around the skill.

The recurring failure patterns:

1. Skipping handwashing or an indirect-care step. Forgetting to wash hands, not providing privacy, leaving the call light out of reach, or leaving the bed raised. These are scored every time and they're the number-one points-leak.
2. Going out of order. Many skills have a required sequence; you provide privacy before you begin care, you wash hands before you touch the resident. Doing the right steps in the wrong order can still cost you.
3. Running out of time. Each station is timed. Candidates who fumble, second-guess, or over-explain run the clock out before they finish all the required checkpoints.
4. Failing to measure or record accurately when the skill requires it. For vital-sign skills, your recorded number usually has to fall within an accepted range of the evaluator's reading.

Notice that three of those four are about process, not knowledge. That's good news, because process is the most trainable thing there is. You can't cram a new clinical instinct in a week, but you can absolutely drill a clean, ordered, every-step-included routine until it's automatic.

Ready to lock in the knowledge half? You can drill realistic CNA practice questions free, no credit card. Start free →.

A Study and Prep Plan

This assumes you have a few weeks between finishing training and your test date. Compress or stretch it, but keep the order: knowledge first to build confidence, skills last because they need to be the freshest thing in your hands on test day.

Step 1, Pull your state's official materials

Before you study anything, find out who administers your exam (Credentia, Prometric, Pearson VUE, or Headmaster/D&S in your state) and download their candidate handbook and skills checklist. These are free and they tell you the real question count, passing score, and exact skills list. Everything else you do should be aimed at those documents.

Step 2, Drill the written test by topic

• Take a broad practice test untimed to find your weak areas.
• Score it by topic area, not just the total; the composite tells you where you stand, the breakdown tells you what to fix.
• Put the bulk of your time into your two weakest areas. For a lot of candidates that's safety/emergency procedures and the finer points of residents' rights.
• Then take timed practice tests to build pacing, because the real exam is timed.

Step 3, Memorize the indirect-care routine

This is the single highest-leverage thing you can do for the skills eval. Write out the universal open-and-close sequence, knock, introduce, wash hands, provide privacy, do the skill safely, call light in reach, bed low, wash hands, and rehearse it until you can run it half-asleep. It applies to nearly every skill on the list, so mastering it once protects you on every station.

Step 4, Practice each skill out loud, in order, against a timer

• Work from your state's actual skills checklist, not a generic one.
• Perform each skill on a friend or family member acting as the resident.
• Say the steps out loud as you do them; it slows you down just enough to catch a missed checkpoint.
• Time yourself, because the real stations are timed and fumbling is a top failure cause.

Step 5, The 48 hours before

• Stop learning new content. Do a light review of high-yield facts, normal vital-sign ranges, the handwashing sequence, residents' rights.
• Run your indirect-care routine a few more times until it's automatic.
• Sleep. A rested brain doesn't skip steps; a tired one does.

After You Pass: Getting on the Registry

Passing both parts gets you placed on your state's nurse aide registry, which is what employers verify before hiring you. Certification is time-limited, most states require renewal, often tied to working a minimum number of paid hours within a set period and completing continuing education. The specifics, again, are state-dependent, so check your registry for renewal rules once you're certified.

And if you don't pass one part on the first try, you generally retake only the part you failed; pass the written but miss skills, and you re-sit skills, not the whole exam. States cap the number of attempts and may require a waiting period or additional training between tries, so confirm your state's retake policy rather than assuming.

Practice the Knowledge Half for Free

The written test rewards exactly the kind of focused, topic-by-topic practice that's easy to put off. Precision Nursing's free tier lets you drill realistic CNA practice questions across all the core topic areas, basic care, infection control, safety, communication, and residents' rights, with rationales that explain why an answer is right, not just which letter it is. Start free →. No credit card.

FAQ

How many questions is the CNA exam?

The written (or oral) knowledge portion is typically around 60 to 70 multiple-choice questions, but the exact count is set by your state and its testing vendor. The skills evaluation is separate and isn't measured in questions; you perform a small set of skills, often 3 to 5, selected at random. Always confirm the numbers on your state registry or vendor handbook.

What skills are tested on the CNA skills evaluation?

You'll perform a handful of randomly selected skills from your state's published list, things like measuring vital signs, perineal care, feeding, range-of-motion, ambulating with a gait belt, or making an occupied bed. Handwashing is nearly always mandatory, and every skill is also scored on indirect-care steps like privacy, putting the call light in reach, and lowering the bed. Get your state's official checklist and practice from that.

What's the passing score on the CNA exam?

It varies by state and vendor, and the written test and skills evaluation are scored separately; you generally have to pass both. Many states set the written passing mark somewhere in the 70 to 80 percent range, while the skills eval is often scored as a percentage of required checkpoints performed correctly. Your candidate handbook lists the exact thresholds for your state.

Can I take the CNA exam in another language or orally?

Many states offer an oral version of the knowledge test, primarily for candidates whose first language isn't English, and some offer the written exam in additional languages. The oral version tests the same content; it just removes reading as a barrier. Check whether your state and vendor offer it before you register.

What happens if I fail one part?

In most states you retake only the part you failed, if you pass the written test but miss the skills eval, you re-sit just the skills. States limit the number of attempts and may require a waiting period or extra training between tries. Confirm your state's specific retake rules so you're not surprised.

Pass Both Parts on the First Try

The skills eval is about clean, automatic routine; the knowledge test is about focused practice across the core topics. Precision Nursing covers the written half with realistic questions and rationales that build the reasoning the exam rewards, and a free tier that lets you start today. Start practicing free →. Free forever. No credit card.