Written + skills · vendors as of Oct 2026
The CNA test explained: written (or oral) exam, skills test, and who runs it in your state
The CNA test is your state's nurse aide competency evaluation, and it has two parts: a multiple-choice written test, with an oral version in most states, and a hands-on skills test in front of an evaluator. Your state picks the company that runs it, so the format, the handbook and the registration site all depend on where you test.
- 2parts: written (or oral) test + skills test
- ~25states use the NNAAP exam (as of Oct 2026)
- 4options per written question, one best answer, every vendor
- Pass/failresult; your state sets the cut score
The two parts of the CNA state exam
Every state's nurse aide test has a knowledge part and a skills part, because federal OBRA '87 rules make both the gate to the state nurse aide registry. You need to pass both. The order, and whether they fall on the same day, depends on your state's vendor.
| Written (or oral) test | Skills test | |
|---|---|---|
| What it checks | What you know about safe, respectful entry-level care, asked through short long-term-care scenarios | Whether your hands do the care right: the steps, safety, infection control, and talking to the resident while you work |
| Format | Multiple choice, four options, one best answer. Item count and time depend on the vendor | A few skills drawn at random, performed on a mannequin or a person playing the resident while an evaluator scores a checklist |
| Oral option | Yes in most states: the items are read aloud. NNAAP's oral version adds a short word-recognition section | Not needed: the skills are performed, not answered |
| Practice here | Practice deck and timed mock | Skill families and the steps graders check |
Common trap
Passing one part does not finish the job. The registry listing comes only after both parts are passed, so book the second one as soon as your vendor allows.
Who runs the CNA test in your state (as of Oct 2026)
Your state, not a national board, chooses the test vendor, and that vendor writes the candidate handbook you will live by for the next few weeks. As of Oct 2026 the most common choice is the NNAAP exam, built by NCSBN and delivered by Credentia, used in about 25 states.
| Vendor or program | What the exam is called | Example states | |
|---|---|---|---|
| NNAAP, delivered by Credentia | National Nurse Aide Assessment Program | About 25 states | The NNAAP exam |
| Prometric | Prometric's nurse aide test | New York, Connecticut, Florida | Prometric practice test |
| Headmaster / D&S Diversified Technologies | TMU testing | California (since 2025), Ohio, Michigan, Wisconsin | Headmaster, below |
| State-specific programs | Varies; the American Red Cross runs testing in some states | Some states | Your state's nurse aide registry |
Contracts change: California moved to Headmaster in 2025, and NNAAP moved from Pearson VUE to Credentia. Confirm the current vendor on your state's nurse aide registry page before you register.
Testing in Ohio? The credential there is called STNA, and the STNA test page covers it. As of Oct 2026, Florida candidates take Prometric's version.
Tip
Old Pearson VUE pages for NNAAP still turn up in search. A handbook carrying the Pearson VUE name is out of date; get the current edition from Credentia's page for your state.
Studying on a break? The app keeps the whole deck in your pocket, with progress saved between shifts.
Get the appWritten test format by vendor
There is no single question count or time limit for the CNA written test; each vendor sets its own. This is what each one publishes as of Oct 2026:
| Vendor | Questions | Time | Oral version |
|---|---|---|---|
| NNAAP (Credentia) | 70 multiple-choice: 60 scored, 10 unscored pretest | 2 hours | 60 multiple-choice + 10 word-recognition items |
| Prometric | About 60 multiple-choice (some forms: 50 scored + 10 pretest) | 90 minutes | See your state's Prometric handbook |
| Headmaster / D&S (TMU) | Set by state, e.g. California 75, Michigan 65, Wisconsin 75 | Set by state (California: 60 minutes) | See your state's Headmaster handbook |
Figures come from each vendor's candidate materials and change with new contracts and handbook editions. Your state's current handbook is the final word.
Pacing on the clock you actually get
Do the math once, at home, for your own vendor. On Headmaster's California form, 75 items in 60 minutes is under a minute each, so one stalled question costs you real time. The NNAAP version of the math is on the NNAAP page.
Pretest items
On NNAAP, 10 of the 70 items are unscored pretest questions mixed in with the rest. You cannot tell which ones they are, so give every item the same care.
Prefer listening to reading? You normally choose the oral version when you apply, not at the test site.
What CNA test questions look like
Every vendor writes the knowledge test the same way: a short scenario, four options, one best answer. There is no select-all-that-apply, no "all of the above" and no "none of the above". The stem is one or two sentences about the nurse aide and the client or the resident, and it ends in a qualifier that tells you what kind of answer wins:
- SHOULD: the correct action for an aide working inside the job's limits.
- FIRST or NEXT: several options may be reasonable; only one comes first.
- BEST or MOST: two options look fine, and the one that better protects safety or the resident's rights is keyed.
Client rights · refusal
A resident refuses to eat her lunch. The nurse aide SHOULD FIRST:
- tell her she cannot have food again until dinner
- remove the tray and record that she refused
- feed her anyway so she does not lose weight
- ask the resident why she does not want to eat (best answer)
The resident has the right to refuse, but the aide should first find out why; she may dislike the food, feel ill, or have mouth pain, and an alternative can be offered. Threatening to withhold food or forcing her is coercion, and simply removing the tray skips the step of learning the reason and reporting it.
Why the others lose
- Threatening to hold back food until dinner is coercion. A refusal is never punished.
- Clearing the tray and charting the refusal skips the step that matters: finding out why she won't eat.
- Feeding a resident who has refused is care without consent, however good the reason.
Common trap
Reflex answers lose points. "Report to the nurse" is right for changes, pain and anything outside your scope, and wrong for a normal reading; the record-or-report table sorts the common cases in one screen.
What the questions cover
In NNAAP states the 60 scored items follow the 2024 content outline below. Prometric and Headmaster outlines cover the same care with slightly different weights. To find your weak group, sit the timed mock and read the per-area score.
- Physical Care Skills64%
- Psychosocial Care Skills10%
- Role of the Nurse Aide26%
NNAAP written content outline, effective April 2024 (60 scored items). Prometric and Headmaster/D&S outlines are similar, not identical.
How to register for the CNA exam
You register for the CNA state exam through your state's test vendor, not through a national office. In many states your training program confirms that you finished first, and then you complete the application on the vendor's site.
Find your vendor
Your state's nurse aide registry or health department page names the current vendor. Check the date on that page; contracts change.
Download the candidate handbook
The current edition lists the fee, ID rules, what to wear, retake rules and how results arrive. Keep it on your phone.
Apply and pick a version
Choose written or oral when you apply. Type your name exactly as it appears on the ID you will bring: same spelling, same order, same hyphen.
Book a date and a site
Pick from the dates and sites the vendor offers near you. If you work nights, don't book the morning after a shift; a tired brain misreads FIRST and NEXT.
Save the confirmation
Screenshot and print it, with the arrival time and the exact address.
What it costs
Exam fees, and retake fees, vary by state and vendor. The current amount is in your vendor's candidate handbook. Ask your training program or employer whether they cover it before you pay.
Test day: what to bring and how it runs
Plan to sit the CNA test in person, at the site on your confirmation. The skills part needs a lab, equipment and an evaluator; assume the written part is in person too unless your handbook offers otherwise.
Before you leave home
- ID that matches your registration letter for letter, and is not expired
- Your confirmation, on paper and as a screenshot
- For the skills part: the clothing your handbook names, plus closed-toe shoes with grip
- A plain watch with a second hand, only if your handbook allows one
- Hair tied back, nails short, rings off so gloves go on cleanly
- Water and a quiet snack for the wait between parts
Your phone goes in a locker or the car, switched off. Drink enough to stay sharp but not so much that you need the restroom halfway through a 2-hour NNAAP sitting, and plan as if the clock keeps running while you are out.
How the CNA test is scored
The CNA test is scored pass or fail, and each state sets its own cut score. That is why there is no honest single answer to "how many can I miss": the cut differs by state and vendor, and on NNAAP 10 of your 70 items are unscored pretest items you cannot spot.
The skills test is scored against a checklist of steps for each skill. Vendors' checklists mark some steps as critical, typically safety and infection-control steps, and missing one of those can fail the skill even if the rest was smooth. The skills test page covers the steps graders check in every skill.
Tip
Chase an even score, not just a high one. On the timed mock, look at all nine bars: a cut score you can't see bites hardest in the area you skipped.
How results reach you (at the site, online or by mail) is in the handbook, next to the retake rules.
Retaking the CNA test
If you fail a part, your state's rules decide what happens next: how many attempts you get, how long you have, and whether you repeat only the part you failed. Many states let you retake just the failed part, but confirm that in the handbook before you re-register.
- Read the result letter: which part, and, if the report shows it, which areas or skills fell short.
- Re-register with the same vendor and pay the retake fee the handbook lists.
- Rebuild the weak spot: drill that area's chip on the practice deck, or say the failed skill's steps out loud, start to finish, until they come without thinking.
- Book the retake inside your state's window, with a rested day in front of it.
Headmaster (D&S) CNA testing
Headmaster, also known as D&S Diversified Technologies, runs nurse aide testing for a group of states through its TMU system. As of Oct 2026 that group includes California (since 2025), Ohio, Michigan and Wisconsin.
The knowledge test is the same kind of exam as everywhere else: four options, one best answer, entry-level long-term care. Its length is set state by state, for example 75 items in California, 65 in Michigan and 75 in Wisconsin, so read your own state's Headmaster handbook rather than a neighbor's. Registration, scheduling and results go through the Headmaster site for your state.
Our practice questions are original and none are Headmaster items. What carries over is the content: the practice deck covers the same nine areas of care in the same four-option format. In Ohio, read the STNA test page as well.
Common trap
California candidates: guides written before 2025 describe the old testing setup. If a page about the California exam never mentions Headmaster, it predates the switch.
CNA test questions people ask
Can I take my CNA test at home or online?
Plan on in person. The skills test needs equipment and an evaluator in the room, and the written part is normally taken at a test site too. If your state's vendor offers anything remote, its candidate handbook says so.
What is the hardest part of a CNA test?
For many candidates it is the skills test, because a missed critical step, such as hand hygiene or leaving the call light in reach, can fail a skill on its own. See how the skills test works.
What to expect on the CNA state board exam?
A written (or oral) multiple-choice test and a hands-on skills test, run by the vendor your state contracts with, such as Credentia for NNAAP, Prometric or Headmaster/D&S. Item counts and time limits depend on that vendor.
Which states let you challenge the CNA state exam?
It is a state-by-state rule that changes, so ask your state's nurse aide registry. Challenging the exam explains who usually asks and what to check.
How many questions can you miss on a CNA state exam?
There is no single number. Each state sets its own pass/fail cut, and on NNAAP 10 of the 70 items are unscored pretest items you can't identify. Aim to be solid in every content area.