CNA

Federal law requires every nurse aide who works in a Medicare- or Medicaid-certified nursing facility to complete a state- approved training program and pass a state competency evaluation. Each state runs its own program through a contracted testing company, so the exam name and a few details vary by state, but every version has the same two parts: a written (or oral) knowledge test and a hands-on skills evaluation. You must pass both to be placed on your state's Nurse Aide Registry.

Who Gives the Exam

Your state nurse aide registry (usually part of the state health department or board of nursing) chooses the testing company. The most widely used exam is the National Nurse Aide Assessment Program (NNAAP), delivered by Credentia in many states. Other states use Prometric, Headmaster (D&S Diversified Technologies), or their own state-run exam. Check your state registry's candidate handbook for the exact format, fees, and scheduling rules before you register.

ExamPart	NNAAP(Credentia)	Prometric(examplestates)
Writtentest	70 multiple-choice questions: 60 scored and 10	60 multiple-choice questions: 50 scored and 10
	unscoredpretestquestions	unscored
Timelimit	2hours	90minutes
Oraloption	Available in English or Spanish: 60 multiple-choice	Availableinmanystatesforcandidateswith
	questions read aloud plus 10 reading-	readingdifficulty
	comprehension(wordrecognition)questions
Skillsevaluation	5randomlyselectedskillsin30minutes observed ,	Several assigned skills in about 31–40 minutes ,
	byanurseevaluator	dependingontheskills

The Written (Knowledge) Test

The written test measures your understanding of the nurse aide role. Every question is a single-best-answer multiple- choice item, and many describe a resident situation and ask what you should do first or what is best. The content falls into three areas, which are also the three sections of this guide:

The largest area: activities of daily

Emotional and mental health needs,

Communication, client rights, legal and

living, basic nursing skills (infection

and spiritual and cultural needs.

ethical behavior, and working as a

control, safety and emergencies,

member of the health care team.

therapeutic procedures, data collection and reporting), and restorative care.

The Skills Evaluation

In the skills evaluation you perform real nurse aide tasks on a volunteer "resident" or a manikin while a nurse evaluator observes. On the NNAAP, hand hygiene is always one of your five skills, and at least one skill includes a measurement you must record (for example blood pressure, radial pulse, respirations, urinary output, or weight). Each skill is scored against a checklist of steps. Some steps are critical element steps: leaving one out, or doing it incorrectly, means you fail that skill no matter how well you do the rest.

Category	Examples
Infectioncontrol	Handhygiene(handwashing);donningandremovingagownandgloves
Measurements	Manualbloodpressure radialpulse respirations urinaryoutput weightofanambulatoryresident , , , ,
Personalcare	Partialbath perinealcare mouthcare denturecare footcare dressingaresidentwithaweak , , , , ,
	arm feedingadependentresident ,
Elimination	Cathetercare assistingwithabedpan measuringandrecordingurinaryoutput , ,
Mobilityandpositioning	Transferfrombedtowheelchairwithatransferbelt ambulationwithatransferbelt positioningon , ,
	the side range-of -motion exercises; applying a knee-high elastic stocking ,

Nearly every skill opens the same way: perform hand hygiene, knock and introduce yourself, identify the resident, explain the procedure, and provide privacy. Close by leaving the bed in its lowest position with the wheels locked, place the call light within reach, perform hand hygiene, and report or record as required.

Scoring, Retakes, and Registry Rules

Topic	WhattoKnow
Passingstandard	Eachstatesetsitsownpassingstandardforthewrittentest;resultsarereportedaspassorfailrather
	thanafixednationalpercentage Fortheskillsevaluationyoumustperformeveryassignedskill .
	correctly includingallcriticalelementsteps , .
Eligibility	Completion of a state-approved nurse aide training program Federal rules require at least 75 clock .
	hours includingatleast16hoursofsupervisedpracticaltraining;manystatesrequiremore , .
Fees	Setbyeachstateandtestingcompany andchargedseparatelyforthewritten(ororal)testandthe ,
	skillsevaluation .
Retakes	Youretakeonlythepartyoufailed Eachstatelimitsthenumberofattempts(commonlythreeorfour) .
	withinasetperiodbeforeyoumustrepeatanapprovedtrainingprogram .
Registrystatus	PassingbothpartsplacesyouonthestateNurseAideRegistry Ifyougo24consecutivemonths .
	withoutworkingasanurseaideforpay youmustcompleteanewtrainingprogram anew , ,
	competencyevaluation orboth , .