The CNA exam — the nurse aide competency evaluation that leads to CNA certification — has two parts: a knowledge test you may take written or oral, and a skills demonstration.
You must pass both.
Who runs the test, how many questions you answer and how scoring works depend on your state and the testing vendor, if any, that it uses.
Here is how the two parts work, who administers them and what test day looks like.
What are the two parts of the CNA exam?
Federal rules require the nurse aide competency evaluation to have two parts: a knowledge examination, which you can take as a written or an oral exam, and a skills demonstration (42 CFR 483.154).
You must pass both parts to complete the evaluation successfully, and each state sets its own standard for satisfactory completion.
The skills part is a demonstration of randomly selected items drawn from a pool of nurse aide tasks, and the pool must include all of the federal personal care skills (42 CFR 483.154).
The federal curriculum names those skills: bathing, grooming and mouth care, dressing, toileting, eating and hydration, feeding techniques, skin care, and transfers, positioning and turning (42 CFR 483.152).
Federal rules also fix the setting: the skills demonstration must be performed in a facility or laboratory comparable to the setting where the aide will work.
It must be administered and evaluated by a registered nurse with at least one year of experience caring for the elderly or chronically ill.
How many questions and skills that turns into depends on your state's testing vendor, because the formats differ.
Credentia's NNAAP handbook sets out this shape: the written exam has 70 multiple-choice questions with 2 hours allowed, and 10 of the 70 items are unscored pretest questions.
The NNAAP skills evaluation asks you to perform 5 skills in 30 minutes, and you must pass all 5 of 5.
Hand hygiene is always one of the five; the other four are randomly chosen, and one of the four is always a measurement skill — blood pressure, radial pulse, respirations, urine output or weight — that you record on a recording sheet.
In Texas, Prometric's written test has 60 multiple-choice questions with a 90-minute limit, and the clinical skills test scores five skills: three assigned skills plus handwashing and indirect care, all of which you must pass.
The oral option runs through both formats.
On the NNAAP, the oral exam has 60 multiple-choice questions plus 10 reading-comprehension questions, delivered by audio, with 2 hours to finish and both sections required to pass.
An oral exam in English or Spanish can be substituted for the written exam if you have difficulty reading English, and Credentia offers the oral portion in both languages.
In Texas the written test can also be taken orally, and oral candidates there take an additional reading comprehension section.
One caution on skill lists: they are not identical even within one exam family — the Colorado edition of Credentia's 2024 handbook lists 23 skills, including two state-specific blood pressure skills, so work from the handbook your own state's vendor publishes.
The exam is the last gate between your training and the registry listing that follows a pass, and the certified nursing assistant career guide maps the whole route, from classes to your first job.
Which company runs the exam in your state?
States do not all use the same testing company.
Federal rules set who is allowed to run the exam: the competency evaluation may be administered only by the state itself or by a state-approved entity that is not a nursing facility participating in Medicare or Medicaid (42 CFR 483.154).
National testing companies run the exam for the states that contract with them, and each company publishes its own state list.
Credentia administers the NNAAP, the National Nurse Aide Assessment Program, which the company describes as the largest nurse aide certification examination program in the United States.
It pairs a written or oral component with a skills demonstration.
Credentia's own NNAAP state list, read on October 12, 2026, names Alabama, Alaska, California, Colorado, DC, DoDEA, Georgia, Guam, Iowa, Maryland, Nevada, North Carolina, Pennsylvania, Rhode Island, Tennessee, the US Virgin Islands, Virginia and Washington.
In 2026 Credentia also announced that it had added Tennessee — full-service written and skills NNAAP exams — and Iowa to its nurse aide testing.
Prometric is another of these companies: it runs the Texas nurse aide exam, the 60-question format described above, and offers registry status checks in its states as well.
A third company is Headmaster — D&S Diversified Technologies — and its home page lists CNA testing pages for these states.
Its list covers Arizona, Arkansas, California, DC, Iowa, Kentucky (SRNA), Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, Nevada, New Jersey (skills), New Mexico, North Dakota, Ohio, Oklahoma, Oregon, South Dakota, Tennessee, Utah, Wisconsin, Wyoming and Vermont.
Read those lists with care: in our research, Alabama, Maryland, California, DC, Iowa and Tennessee each turned up on more than one vendor's materials, and a vendor's page can lag the state's current contract.
So confirm your state's current testing company with your state's nurse aide agency or registry before you register, and study from the candidate handbook the vendor publishes for your state.
One dating check matters if you buy practice material: Credentia acquired the NNAAP program from Pearson VUE in April 2021, so current NNAAP testing runs through Credentia, not Pearson VUE.
Vendors and fees change
How do you register and what does it cost?
Registration runs through your state or the testing vendor it has approved, under the state-specific process published for your state.
Headmaster, for example, takes applications and scheduling through its TestMaster Universe portal in Missouri, while Credentia candidates book online exams or test-center appointments in their account.
Who is allowed to sit for the exam is defined state by state.
Colorado's handbook, for example, lets licensed and formerly licensed LPNs, RNs and LPTs test on proof of their license or program completion, and it lets nursing students who have completed 5 semester credits of nursing fundamentals test without completing a nurse aide program.
Those Colorado candidates get only one attempt — a reminder that special routes carry special conditions.
Texas runs a different route: nurse aides trained in another state within the past 24 months can test there through an out-of-state training eligibility route.
Federal law sets the price for one group of candidates at zero (42 CFR 483.154).
A nurse aide who is employed by a nursing facility, or who has received an offer of employment from one, on the date the competency evaluation program begins cannot be charged for any portion of it.
The same section pairs that no-charge rule with a 12-month pro-rata reimbursement rule, and both apply to the competency evaluation itself (42 CFR 483.154).
For everyone else, the state and its vendor set the fees.
Credentia's handbook notes that NNAAP fees cover both the skills and the written-or-oral parts when you first test, are not refundable, and can be paid through vouchers that training programs buy.
The published amounts we found are state-specific.
Prometric's Texas price list, effective September 1, 2026, charges $125 for the written test plus clinical skills, $125 for oral plus clinical skills, $92 for clinical skills only and $33 for the written test only.
One fee never applies: federal rules bar states from charging nurse aides any registration fee for being listed on the nurse aide registry (42 CFR 483.156).
Booking rules have teeth: under Credentia's handbook, an online written-or-oral exam must be cancelled or rescheduled at least 48 hours ahead, and a test-center appointment at least 9 business days ahead, or the fee is forfeited.
A no-show on an NNAAP test forfeits the fee but does not count as one of the three attempts.
What happens on test day?
The two parts can happen in different places.
The skills demonstration must be performed in a facility or laboratory setting comparable to where you will work as an aide, in front of the registered nurse who evaluates it.
The knowledge exam is more flexible: under Credentia's NNAAP handbook you can take the written or oral portion from home or work with a live remote proctor watching by webcam, or at a scheduled test center.
Bring the identification your vendor's handbook lists for your state, and leave your own equipment at home: NNAAP candidates may not bring supplies of their own, including a transfer or gait belt.
On the NNAAP skills evaluation you have 30 minutes for all five skills, with a warning at the 25-minute mark.
The rules about fixing mistakes are specific.
You may correct a step by telling the evaluator, but once a new skill has started you cannot go back to a previous one.
And if the evaluator has to remind you about gloves, that voids credit for the correction.
Texas adds a detail that catches people out: on the Prometric clinical skills test there, handwashing is evaluated at the start and is not prompted, so candidates are not told to wash their hands.
How is the exam scored?
The federal frame is simple: to complete the competency evaluation successfully, you must pass both the written-or-oral exam and the skills demonstration, and each state sets its own standard for satisfactory completion (42 CFR 483.154).
On the NNAAP, the skills standard is all-or-nothing: five skills out of five, with each skill's Critical Element Steps — printed in bold in the handbook — performed correctly.
Critical steps alone are not enough: the handbook states that candidates must also meet the skill's passing standard, its cut score.
Other vendors score differently.
Headmaster's Missouri knowledge test has 75 multiple-choice questions with 60 minutes allowed, and a score of 80% or better is needed to pass.
The Missouri skill test gives you three or four randomly selected tasks in 30 minutes, and you must pass 100% of the tasks, miss no key (bolded) steps and score 80% or higher on the non-key steps.
Results come back quickly, with the timing set by the vendor.
Credentia says NNAAP score reports are generally available in your account within a few hours after the day's testing event.
A failing skills report tells you where you stood: it lists the five skills performed and the reason any skill was failed.
Prometric emails Texas clinical skills score reports the next day.
Passing triggers the registry step: federal rules require a record of the pass to be added to the state nurse aide registry within 30 days of the date the person is found competent (42 CFR 483.154).
In Texas, that handoff goes to HHSC — the state's health and human services agency, which keeps the Texas Nurse Aide Registry — after a candidate passes both tests.
What if you fail a part?
Federal rules set the floor.
A candidate who fails must be told which areas were failed and that they have at least three opportunities to take the evaluation, and a state may cap attempts but not below three (42 CFR 483.154).
States and vendors build their own rules on top of that floor.
Texas counts attempts for the knowledge test and the clinical skills test separately: candidates there may take each three times within 24 months before having to retrain.
Retaking a single part is priced accordingly — $92 for clinical skills only or $33 for the written test only on the September 2026 Texas price list.
Under Credentia's handbook, NNAAP candidates get three attempts to pass both parts; after failing either part three times, you must complete another state-approved training program and retake both parts.
Colorado candidates have 24 months from the date of application to pass both exams — a Colorado-specific window, so other states differ.
Headmaster's Missouri candidates also have three attempts to pass the knowledge and skill portions.
The pattern worth planning around: attempts are limited, windows run on the calendar, and the quoted rules say where running out leads — Texas candidates who exhaust their attempts must retrain, and Credentia's three-fails rule requires another training program plus a retake of both parts.
This page is career information, not licensing, legal, medical, benefits or tax advice. Exam formats, fees and retake rules are set by your state's nurse aide agency and its testing vendor, so confirm the current requirements with them before you register.
Retake rules are state rules