CNA Exam: Everything You Need to Know [2026]

What is the CNA exam?

The Certified Nursing Assistant (CNA) exam is a standardized competency evaluation required in all 50 US states before you can work as a nursing assistant. It proves you have the knowledge and hands-on skills to provide safe, quality patient care in hospitals, nursing homes, assisted living facilities, and home health settings.

The exam is administered by third-party testing vendors designated by each state. The three main vendors are Credentia (NNAAP), which serves 15+ states including Pennsylvania, North Carolina, and Georgia; Prometric, which covers states like Texas, California, and Florida; and Pearson VUE, used in states like Virginia, Vermont, and North Carolina. Your state determines which vendor you’ll use — it’s not a choice you make.

Once you pass, your name is added to your state’s Nurse Aide Registry, and you’re legally authorized to work as a CNA. The National Nurse Aide Assessment Program (NNAAP) administers over 200,000 exams annually, making CNA one of the most popular entry-level healthcare certifications in the country.

A CNA career offers fast entry into healthcare (training takes just 4–12 weeks), solid job stability with projected growth through 2032, and a direct pathway to higher roles like LPN or RN. As of 2025, the median hourly wage for CNAs is $18.33 per hour, with experienced CNAs in high-demand areas earning $20–$24+/hour.

Eligibility & requirements

To sit for the CNA exam, you must first meet your state’s eligibility requirements. While these vary by state, most follow a similar framework.

Complete a state-approved training program. This is the most important requirement. Federal law (under OBRA) requires a minimum of 75 hours of training, but many states require significantly more. For example, Oregon requires 150 hours, Illinois requires 120 hours, and New York requires 100 hours (including 30 clinical hours). Programs typically run 4–12 weeks depending on whether you attend full-time or part-time.

Meet the minimum age requirement. Most states require candidates to be at least 16–18 years old. Some states like Florida and Texas allow 16-year-olds to train and test with parental consent.

Pass a criminal background check. This is required in virtually every state and typically includes fingerprinting. Some states also require drug screening. Certain felony convictions may disqualify you, though waiver processes exist in some states.

Provide health documentation. You’ll need a physical exam, proof of immunizations (Hepatitis B, MMR, Varicella), a negative TB test or chest X-ray, and in many states, a current CPR certification.

Education. A high school diploma or GED is preferred in most states but not universally required. States like Nevada and several others allow candidates without a diploma to sit for the exam, though having one improves your job prospects.

Special pathways. Florida offers a “challenger exam” that lets you test without completing formal training (though training is strongly recommended). Some states allow nursing students currently enrolled in an RN or LPN program to sit for the CNA exam without completing a separate CNA training program.

Exam format & structure

The CNA exam consists of two separate components that you must both pass to earn your certification. Most states schedule both parts on the same test day — plan to spend 4–6 hours total at the testing center.

Part 1: Written (Knowledge) Exam. This is a computer-based, multiple-choice test with 60–70 questions. Of those, typically 60 questions are scored and 10 are unscored “pretest” questions being evaluated for future exams (you won’t know which are which). You have 90 minutes to complete it, though some states allow 120 minutes for the oral version. An oral version (where questions are read aloud through headphones) is available for candidates who prefer it or have reading difficulties.

Part 2: Clinical Skills Evaluation. This is the hands-on portion where you demonstrate nursing skills in front of a licensed nurse evaluator. You’ll perform 5 randomly selected skills — hand hygiene is always included, plus 4 others drawn from the approved skills list. Common skills tested include measuring vital signs (blood pressure, pulse, respirations, temperature), patient transfers (bed to wheelchair), bed making (occupied and unoccupied), catheter care, perineal care, range of motion exercises, and feeding assistance. You typically have 25–35 minutes to complete all 5 skills.

Passing score. The written exam requires a score of 70–75% depending on your state and testing vendor — that means correctly answering approximately 42–53 out of 60–70 questions. The skills evaluation is pass/fail: you must correctly perform all critical steps for each skill. Missing a critical step (like forgetting hand hygiene or failing to identify the patient) results in automatic failure of that skill, even if you performed every other step perfectly.

Results. For the written exam, you’ll typically see your score immediately after finishing at the testing center. Skills results may take a few days depending on your state. If you pass both parts, your name is added to your state’s Nurse Aide Registry, usually within 1–4 weeks (California can take 60+ days).

What’s on the exam?

The CNA written exam follows the NNAAP content outline, which covers 9 major topic areas. Here’s what each domain covers and how heavily it’s weighted on the exam:

Basic Nursing Skills — ~22%. The largest section. Covers measuring and recording vital signs (blood pressure, pulse, respirations, temperature, weight), positioning patients, bed making, catheter care, specimen collection, and intake/output recording.

Infection Control — ~18%. The second-largest section, and growing in importance since COVID-19. Hand hygiene, PPE donning and doffing order, standard precautions vs. transmission-based precautions (contact, droplet, airborne), bloodborne pathogen safety, isolation procedures, and proper waste disposal.

Activities of Daily Living (ADL) — ~16%. Assisting patients with bathing, dressing, grooming, feeding, toileting, and mobility. Know how to promote patient independence while ensuring safety.

Patient Rights & Legal/Ethical Behavior — ~14%. OBRA regulations, the Patient’s Bill of Rights, informed consent, advance directives, privacy and confidentiality, abuse and neglect recognition and mandatory reporting requirements.

Safety & Emergency Procedures — ~12%. Fall prevention, fire safety (RACE and PASS acronyms), choking response (Heimlich maneuver), seizure management, body mechanics for safe patient transfers, restraints, and disaster procedures.

Communication — ~10%. Verbal and nonverbal communication, active listening, communicating with patients who have hearing or vision impairments, proper documentation and reporting to nurses, medical terminology, and cultural sensitivity.

Mental Health & Social Needs — ~8%. Maslow’s Hierarchy of Needs, caring for patients with dementia and Alzheimer’s, depression awareness, emotional support techniques, end-of-life care, and grief and loss.

Restorative Skills — ~6%. Range of motion exercises, mobility assistance, preventing complications of immobility like pressure ulcers and contractures, and promoting rehabilitation.

Member of the Health Care Team — ~4%. Understanding the CNA’s role and scope of practice, working with the interdisciplinary team, and knowing when and how to delegate and report.

On the clinical skills exam, you’ll demonstrate 5 hands-on skills: hand hygiene (always included) plus 4 randomly selected from the approved list. The most commonly tested skills include measuring vital signs, patient transfers (bed to wheelchair using a gait belt), bed making, catheter care, perineal care, range of motion exercises, and feeding assistance.

How much does it cost?

The total cost to become a CNA in 2026 typically ranges from $1,300 to $3,100, depending on your state and training program. Here’s how the costs break down:

CNA exam fee: $90–$200. This is paid directly to your state’s testing vendor (Credentia, Prometric, or Pearson VUE). Most states charge $100–$150 for both the written and clinical skills portions combined. If you fail one section, retake fees are typically $30–$50 for the written exam only and $70–$100 for the skills exam only.

Training program: $500–$2,500. Community college programs run $500–$1,500, while private schools and accelerated programs can cost $2,500+. This is the biggest expense — but it’s also the most avoidable cost (see the tip below).

Additional costs: $200–$500. Budget for background check and fingerprinting ($50–$100), physical exam and immunizations ($100–$300), CPR certification ($30–$60), scrubs ($30–$50), textbooks ($20–$50), and state registry application ($20–$50).

For a detailed breakdown of exam fees in every state, see our CNA Exam Cost by State [2026] guide.

How to register

Registering for the CNA exam is straightforward, but the process varies slightly depending on your state’s testing vendor. Here’s the general process:

Step 1: Complete your training program. Your school or training program will typically notify the testing vendor that you’re eligible to test. In states using Credentia, this is done through the TULIP system. In Prometric states, your program submits eligibility documentation directly.

Step 2: Create an account with your testing vendor. For Credentia states, create a CNA365 account at credentia.com. For Prometric states, visit prometric.com. For Pearson VUE states, go to pearsonvue.com. Your school should tell you which vendor your state uses.

Step 3: Submit your application. Select your eligibility route, enter your personal information, and upload any required documents (training completion certificate, background check clearance, etc.).

Step 4: Pay the exam fee and schedule your test. Once your application is approved (usually within a few days), you can select your preferred date, time, and testing location. Schedule as early as possible — popular test dates fill up quickly, especially at the beginning and end of each month.

What to bring on test day: Two forms of valid identification (at least one must be a government-issued photo ID), your confirmation email or scheduling letter, and clean scrubs for the clinical skills portion. Leave cell phones, calculators, smart watches, and personal items outside the testing area. All testing materials are provided.

Pro tip: Schedule your exam within 2–3 weeks of completing your training program. Studies consistently show that candidates who test soon after training have significantly higher pass rates than those who wait months. The material is freshest in your mind right after training — don’t let that advantage fade.

Pass rates & scoring

Here’s the encouraging news: most well-prepared candidates pass the CNA exam on their first try.

National first-time pass rates typically fall between 70–80% for all test-takers. However, candidates from accredited training programs with strong clinical components consistently perform better — Florida Board of Nursing data showed an 87.14% first-time pass rate in Q1 2024, with 84.7% passing the written and 81.5% passing clinical skills.

If you don’t pass: Don’t panic. You only need to retake the section you failed. Your passing score on the other section remains valid (usually for 12–24 months, depending on your state). Most states allow 2–3 retake attempts. After exhausting your retakes, most states require you to repeat a training program before testing again.

Retake fees are typically lower than the initial exam — around $30–$50 for the written portion and $70–$100 for the skills portion.

Common reasons for failure: On the written exam, candidates typically fail by just 1–2 questions, often due to overconfidence leading to under-preparation. On the clinical skills exam, the most common failures are forgetting hand hygiene between skills, not identifying the patient before starting a procedure, failing to explain what you’re doing to the patient, and not providing for patient privacy (closing the curtain or door).

Checking your results: Written exam scores are usually displayed immediately on screen after you finish. Clinical skills results may take a few business days and are typically posted to your testing vendor’s online portal. Once you pass both parts, your state registry listing can take anywhere from 1–4 weeks (and up to 60+ days in California).

Tips to pass on your first try

Based on data from successful CNA candidates and nursing educators, here are the most effective strategies to pass on your first attempt:

1. Take a practice test first. Before you start studying, take a full-length practice test to identify your weak areas. This gives you a baseline score and shows you exactly which topics need the most work. Don’t waste time studying topics you already know well.

2. Follow a structured study schedule. A 4-week study plan prevents cramming and ensures you cover every topic. Dedicate 1–2 hours per day and space your studying over several weeks rather than trying to memorize everything the night before.

3. Don’t neglect the clinical skills portion. This is where most failures happen. Practice each skill until you can perform it perfectly without thinking. Pay special attention to hand hygiene (required before and after EVERY skill), patient identification, explaining procedures to the patient, providing privacy, and raising the bed rails when you leave.

4. Focus on the high-weight topics. Basic Nursing Skills (22%) and Infection Control (18%) make up 40% of your written exam. Master these two topics and you’re nearly halfway to passing before you even touch the other domains.

5. Learn to read questions carefully. CNA exam questions often include words like “first,” “best,” “most important,” or “priority.” These signal that multiple answers may seem correct, but only one is the BEST answer. When in doubt, choose the answer that prioritizes patient safety.

6. Prepare for test day logistics. Eat a good breakfast, arrive 30 minutes early, bring both forms of ID, and wear clean scrubs for the clinical portion. Being rushed or flustered before the exam can hurt your performance.

7. Score 80%+ on practice tests before testing. Don’t schedule your exam until you consistently score 80% or higher on practice tests. The real exam will feel slightly harder due to test-day nerves, so give yourself a buffer above the minimum passing score of 70–75%.

Frequently asked questions

How long does it take to become a CNA?
From start to finish, most people become certified in 6–16 weeks. Training programs run 4–12 weeks (depending on full-time or part-time), plus 1–3 weeks for exam scheduling and testing. Once you pass, registry enrollment takes 1–4 weeks in most states.

Can I take the CNA exam without completing a training program?
In most states, no — a state-approved training program is required. However, Florida offers a “challenger exam” pathway, and some states allow current nursing students (enrolled in RN or LPN programs) to test without separate CNA training. Check your state’s Board of Nursing for specific exemptions.

How many times can I retake the CNA exam?
Most states allow 2–3 retake attempts within 12–24 months. You only retake the section you failed (written or clinical skills). After exhausting your attempts, you’ll typically need to re-enroll in a training program. Retake fees range from $30–$100 depending on the section.

Is the CNA exam hard?
The CNA exam is considered moderate in difficulty. National first-time pass rates are 70–80%, meaning most prepared candidates pass. The written portion is often described as “common sense” by those who pass, but underestimating it is a common mistake. The clinical skills portion is generally considered harder because missing a single critical step means automatic failure.

How long is CNA certification valid?
CNA certification must be renewed every 2 years in most states. Renewal typically requires proof of active employment as a CNA (usually at least 8 hours of paid nursing-related work) and completion of continuing education hours (varies by state, typically 12–48 hours per renewal cycle).

Can I transfer my CNA certification to another state?
Yes, most states allow reciprocity — meaning you can transfer your certification without retesting. You’ll need to apply to the new state’s registry, verify your certification is in good standing, and may need to meet any additional state-specific requirements (like extra training hours). Some states require a background check in the new state.

What’s the difference between a CNA and a CMA?
A CNA (Certified Nursing Assistant) provides basic patient care like vital signs, bathing, and feeding. A CMA (Certified Medical Assistant) works in outpatient settings (doctor’s offices, clinics) performing both clinical tasks (blood draws, injections, EKGs) and administrative duties (scheduling, billing). CMA training is typically longer (9–12 months) and covers a broader scope.

How much do CNAs make per hour?
As of 2025, the national median wage for CNAs is $18.33/hour (approximately $38,000/year). Pay varies significantly by location and setting — CNAs in metropolitan areas and hospital settings earn more ($20–$24/hour), while those in rural nursing homes may earn closer to $14–$16/hour. Travel CNA positions can pay $25–$35+/hour.