Free CNA practice test

To be listed on a state nurse aide registry as a certified nurse aide (CNA), you must pass a competency evaluation with two parts: a written (or oral) knowledge test and a hands-on skills evaluation. Many states use the National Nurse Aide Assessment Program (NNAAP), whose written test has 70 multiple-choice questions in 2 hours. Some states use other test vendors and formats, so always check your own state's candidate handbook.

70 questions on the real test120 minutesFree · no sign-up

Start the free testFull-length pack · $12

Updated September 30, 2026 · official sources

Certified nursing assistant student taking a classmate's blood pressure with a stethoscope in a training lab

Free CNA Written Exam (NNAAP) practice test (20 questions)

Click an answer to see instantly if it is right, with the explanation. No sign-up, no email.

  1. Question 1During a bed bath, how should a nurse aide wash a client's eyes?

    Show the answer

    Answer: C — With a wet washcloth and no soap, wiping from the inner corner to the outer corner.

    Eyes are washed first with plain water, using a different area of the washcloth for each stroke and moving from the inner aspect to the outer aspect. Soap irritates the eyes, and reusing the same area of the cloth can carry germs from one eye to the other.

    Checked against: NNAAP skills listing, Skill 11 Gives Modified Bed Bath

  2. Question 2When giving perineal care to a female client, in which direction should the aide wash?

    Show the answer

    Answer: C — From front to back, using a clean area of the washcloth for each stroke.

    Washing from front to back with a clean area of the washcloth for each stroke keeps germs from the rectal area away from the urinary opening. The same front-to-back rule applies to rinsing and drying.

    Checked against: NNAAP skills listing, Skill 21 Provides Perineal Care for Female

  3. Question 3Before feeding a client who cannot feed himself, how should the client be positioned?

    Show the answer

    Answer: C — Sitting upright at about 75 to 90 degrees.

    An upright sitting position of 75 to 90 degrees helps food go down the esophagus rather than into the airway, which lowers the risk of choking and aspiration. The client should stay upright at the end of the meal as well.

    Checked against: NNAAP skills listing, Skill 10 Feeds Client Who Cannot Feed Self

  4. Question 4Which finding in an older resident is a sign of mild to moderate dehydration that the aide should report?

    Show the answer

    Answer: B — Dark yellow urine and a dry, sticky mouth.

    MedlinePlus lists thirst, a dry or sticky mouth, not urinating much and darker yellow urine as signs of mild to moderate dehydration. Older adults are at higher risk, so these changes should be reported to the nurse.

    Checked against: MedlinePlus, Dehydration (Symptoms)

  5. Question 5When washing hands with soap and water, how long should the aide lather all surfaces of the wrists, hands and fingers?

    Show the answer

    Answer: A — At least 20 seconds.

    The NNAAP hand hygiene skill requires lathering all surfaces of the wrists, hands and fingers with friction for at least 20 seconds, keeping the hands lower than the elbows and the fingertips down.

    Checked against: NNAAP skills listing, Skill 1 Hand Hygiene (Hand Washing)

  6. Question 6For which residents does an aide use standard precautions?

    Show the answer

    Answer: C — For all residents, whether or not they are known to have an infection.

    Standard precautions are followed with all patients, based on the type of exposure expected to blood, body fluids, mucous membranes or broken skin. Transmission-based precautions are added on top of them for certain germs.

    Checked against: MedlinePlus, Isolation precautions (Standard Precautions)

  7. Question 7Before helping a client stand to move from the bed to a wheelchair, what must the aide do with the wheelchair?

    Show the answer

    Answer: C — Lock its wheels.

    The wheelchair wheels are locked before the client stands, and the footrests are folded up or removed. An unlocked chair can roll away as the client sits, causing a fall.

    Checked against: NNAAP skills listing, Skill 22 Transfers from Bed to Wheelchair Using Transfer Belt

  8. Question 8Which resting pulse rate is within the normal range for an adult?

    Show the answer

    Answer: D — 72 beats per minute.

    MedlinePlus gives 60 to 100 beats per minute as the normal resting pulse for a healthy adult. Rates outside that range should be reported to the nurse.

    Checked against: MedlinePlus, Vital signs (normal ranges for a healthy adult at rest)

  9. Question 9A resident is coughing forcefully and can still speak after food went down the wrong way. What should the aide do?

    Show the answer

    Answer: A — Encourage her to keep coughing and stay with her.

    MedlinePlus says not to perform choking first aid if the person is coughing forcefully and able to speak, because a strong cough can dislodge the object. The aide stays with her and acts if she can no longer speak or breathe.

    Checked against: MedlinePlus, Choking - adult or child over 1 year (First Aid)

  10. Question 10While bathing a resident, the aide sees a reddened area over the tailbone that does not turn white when pressed. What should the aide do?

    Show the answer

    Answer: A — Report it to the nurse, because it may be the first stage of a pressure injury.

    A reddened area that does not blanch when pressed is a sign that a pressure ulcer may be forming (stage I). MedlinePlus warns not to massage near or on an ulcer and not to use donut-shaped cushions.

    Checked against: MedlinePlus, How to care for pressure sores (Symptoms: Stage I)

  11. Question 11At the end of care, the aide returns the bed to its low position. Why?

    Show the answer

    Answer: D — So the client's feet can touch the floor when sitting on the edge of the bed, which lowers the risk of falls.

    Almost every NNAAP client-care skill ends with the bed in low position. MedlinePlus recommends a bed low enough that the feet touch the floor when sitting on the edge, which makes getting up safer and reduces injuries from falls.

    Checked against: MedlinePlus, Preventing falls (Home Setup); NNAAP skills listing (bed in low position)

  12. Question 12A resident's left leg is weaker after surgery. In which hand should he hold his cane?

    Show the answer

    Answer: C — His right hand.

    The cane is held in the hand opposite the weaker or operated leg. It then moves forward together with the weak leg and takes some weight off it.

    Checked against: MedlinePlus, Using a cane (Cane Basics)

  13. Question 13A resident can brush her own teeth, but slowly. What should the aide do?

    Show the answer

    Answer: B — Set up the supplies and let her do it herself, helping only with what she cannot do.

    Federal rules require care that maintains or improves a resident's ability to carry out activities of daily living. Setting up supplies and helping only with what she cannot do keeps her doing as much as she can for herself.

    Checked against: 42 CFR 483.24(a)(1) Activities of daily living

  14. Question 14Which statement about depression in older adults is true?

    Show the answer

    Answer: B — It is not a normal part of aging and often goes unrecognized.

    MedlinePlus says depression in older adults is widespread, is not a normal part of aging and is often not recognized or treated. Changes in mood or behavior should be reported so the resident can be assessed.

    Checked against: MedlinePlus, Depression in older adults

  15. Question 15A resident with dementia becomes more confused and agitated every evening. What is this pattern called?

    Show the answer

    Answer: B — Sundowning.

    Sundowning describes problems such as increased confusion, anxiety, agitation and trouble sleeping that get worse when it gets dark at the end of the day and into the night.

    Checked against: MedlinePlus, Dementia - behavior and sleep problems

  16. Question 16How does the NNAAP skills listing describe the way an aide should explain a procedure to a client?

    Show the answer

    Answer: C — Speaking clearly, slowly and directly, keeping face-to-face contact whenever possible.

    Nearly every NNAAP client-care skill starts by explaining the procedure speaking clearly, slowly and directly while maintaining face-to-face contact whenever possible. The client then knows what to expect and can cooperate.

    Checked against: NNAAP skills listing, opening step of the client-care skills (e.g., Skill 2)

  17. Question 17A resident says she does not want her shower today. What should the aide do?

    Show the answer

    Answer: A — Respect her choice, ask whether another time would suit her and tell the nurse.

    Residents have the right to request, refuse or discontinue treatment. The aide respects the refusal, offers another time and reports it so the nurse can follow up; forcing care would be abuse.

    Checked against: 42 CFR 483.10(c)(6)

  18. Question 18When may a physical restraint be used on a resident?

    Show the answer

    Answer: B — Only when required to treat the resident's medical symptoms, not for discipline or staff convenience.

    Residents have the right to be free from physical or chemical restraints imposed for discipline or convenience and not required to treat medical symptoms. When restraints are indicated, the least restrictive alternative is used for the least amount of time.

    Checked against: 42 CFR 483.12 Freedom from abuse, neglect, and exploitation

  19. Question 19An aide does not answer a resident's call light for an hour because she is on her phone, and the resident is left wet and uncomfortable. This is an example of:

    Show the answer

    Answer: C — Neglect.

    Federal rules define neglect as the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress.

    Checked against: 42 CFR 483.5 Definitions (Neglect)

  20. Question 20Under federal rules, what is the minimum length of a state-approved nurse aide training program?

    Show the answer

    Answer: A — 75 clock hours, including at least 16 hours of supervised practical training.

    Federal rules require at least 75 clock hours of training, including at least 16 hours of supervised practical training. States may require more hours than this federal minimum.

    Checked against: 42 CFR 483.152(a)

0 / 20 answered

CNA Written Exam (NNAAP) format

CNA Written Exam (NNAAP)Official rule
Number of questions70 multiple-choice questions: 60 scored and 10 unscored pretest questions that you cannot tell apart source
Time limit2 hours for the written examination; you are told when 15 minutes remain source
Physical Care Skills64% of scored items (38): activities of daily living 22% (13), basic nursing skills 35% (21), self care/independence 7% (4) source
Psychosocial Care Skills10% of scored items (6): emotional and mental health needs 8% (5), spiritual and cultural needs 2% (1) source
Role of the Nurse Aide26% of scored items (16): communication 7% (4), client rights 8% (5), legal and ethical behavior 5% (3), member of the health care team 6% (4) source
Oral optionAn oral examination may replace the written one: 60 multiple-choice questions read aloud plus 10 word-recognition (reading comprehension) questions; you must pass both parts. Federal rules require states to let aides choose between a written and an oral examination. source
Skills evaluation (separate part)5 randomly selected nurse aide skills performed in front of an evaluator in 30 minutes; you must pass both the written (or oral) test and the skills evaluation to be placed on the registry source
Passing standardSet by each state (42 CFR 483.154(e)); for example, Tennessee requires 75% or better on its knowledge test source
AttemptsFederal rules give at least three opportunities to pass; states may not set a maximum below three. Some allow more (Washington's handbook allows four attempts at the written or oral test). source
Fees (examples)Set by each state. Pennsylvania: $135 for written and skills, $50 to retake the written test. Virginia: $45 written only. Alabama: $55 written. source
Who paysAn aide employed by, or with a job offer from, a Medicare or Medicaid nursing facility when starting the competency evaluation may not be charged for it source
Where you testIn Credentia states such as Pennsylvania and South Carolina, the written (or oral) test can be taken online with a live remote proctor or at a test center; the skills evaluation is in person source
IdentificationCredentia handbooks such as South Carolina's require two forms of current, signature-bearing ID, one with a photo; the name must match your application source
Other formatsNot every state uses the NNAAP. Florida's test administrator is Prometric (written test: 60 multiple-choice questions in 90 minutes); Ohio's CNA testing is run by D&S Diversified Technologies. Tennessee's Credentia knowledge exam has 75 questions (10 experimental). source
Content outline2024 NNAAP written (oral) content outline, based on NCSBN's 2019-2020 job analysis of nurse aides published in 2023 source

Checked on the official sources on September 30, 2026. Rules change: always confirm on the official site before test day.

Practice by section

What the CNA written exam is

To work as a certified nurse aide (CNA) in a nursing facility, you must pass a state competency evaluation and be placed on your state's nurse aide registry. Federal rules (42 CFR 483.154) require that evaluation to have two parts: a written or oral knowledge test, and a skills demonstration in front of an evaluator. You must pass both.

Many states run this evaluation with the National Nurse Aide Assessment Program (NNAAP), now developed and managed by Credentia. NCSBN states that it no longer develops or owns the NNAAP content and sends candidates to Credentia. This page and our practice questions follow the NNAAP written examination.

Check your own state first. Not every state uses the NNAAP, and even NNAAP states set their own fees, attempt limits and passing standard. For example, Florida's written test is run by Prometric, with 60 questions in 90 minutes, Ohio's testing is run by D&S Diversified Technologies, and Tennessee's Credentia knowledge exam has 75 questions, 10 of them experimental. Your state's candidate handbook is the only document that counts.

Format at a glance (NNAAP written exam)

The 2024 NNAAP content outline says the written examination has 70 multiple-choice questions: 60 scored and 10 unscored pretest questions. You cannot tell which ones are pretest items, so answer every question carefully. Credentia handbooks, such as Pennsylvania's, give 2 hours for the written test, and you are told when 15 minutes remain.

The 60 scored questions follow these weights (content outline):

Content areaWeightScored questions
Physical Care Skills64%38
Activities of daily living (hygiene, dressing and grooming; nutrition and hydration; elimination; rest, sleep and comfort)22%13
Basic nursing skills (infection control; safety and emergencies; technical procedures; data collection and reporting)35%21
Self care and independence7%4
Psychosocial Care Skills10%6
Emotional and mental health needs8%5
Spiritual and cultural needs2%1
Role of the Nurse Aide26%16
Communication7%4
Client rights8%5
Legal and ethical behavior5%3
Member of the health care team6%4

Basic nursing skills alone make up more than a third of the test, so infection control, safety, vital signs and reporting deserve the most study time.

The oral option

If reading English is hard for you, you can ask for the oral exam instead. Federal rules require states to let aides choose between a written and an oral examination. The NNAAP oral version has 60 multiple-choice questions read aloud plus 10 word-recognition questions, and you must pass both parts. Some states offer Spanish: Pennsylvania lets you take the written or oral test in English or Spanish, and Alabama lists a Spanish oral exam. You usually request the oral exam when you apply, and handbooks include a short self-assessment reading test to help you decide.

The skills evaluation

The second part of the NNAAP is hands-on. In South Carolina's handbook you perform 5 randomly selected skills in 30 minutes in front of a nurse aide evaluator. The handbook lists every skill step by step, with "critical element" steps in bold. Studying that list also helps with the written test, because many written questions ask about the same safety and infection-control steps.

Passing score

There is no national passing score. Federal rules say each state must set its own standard for passing the competency evaluation. As one example, Tennessee's handbook requires 75% or better on its knowledge test. Look up the rule in your own state's handbook rather than relying on a number you saw online.

Booking, fees and ID

You usually register after finishing a state-approved training program. Federal rules require that program to last at least 75 clock hours, including 16 hours of supervised practical training, and many states require more. In Credentia states you create an account on the Credentia platform, apply and then schedule. In states such as Pennsylvania and South Carolina, the written or oral test can be taken online with a live remote proctor or at a test center, while the skills evaluation is in person.

Fees are set by each state. Some examples from current Credentia handbooks:

  • Pennsylvania: $135 for the written (or oral) and skills tests together, $50 to retake the written test.
  • Virginia: $45 for the written exam only.
  • Alabama: $55 for the written exam.

If you work for a Medicare or Medicaid nursing facility, or have a job offer from one, when you start the evaluation, federal rules say you cannot be charged for it.

On test day, bring the ID your handbook asks for. South Carolina's handbook, for example, requires two forms of current, signature-bearing ID, one with a photo, and the name must match your application. In South Carolina, if you arrive late for the written exam or without proper ID, you will not be allowed to test and the fee is not refunded.

Retakes and the registry

Federal rules give you at least three chances to pass, and a state cannot set a limit below three. Some NNAAP states add a time limit: Alabama allows three attempts in the two years after training, and South Carolina requires you to pass within two years of training or three attempts, whichever comes first. Washington allows four attempts at the written or oral test. After the last failed attempt, you usually have to retrain. Once you pass both parts, your record must be added to the registry within 30 days.

How to prepare

  • Start with your state handbook. Read the skills listing and the sample questions in your state's Credentia handbook (or your vendor's handbook if your state does not use the NNAAP). Credentia also lists practice exams.
  • Study by weight. Physical care skills are 64% of the test. Know hand hygiene, PPE, isolation precautions, transfers, fall and choking responses, positioning, and normal vital sign ranges.
  • Learn residents' rights from the source. Questions on rights, abuse and neglect follow federal rules such as 42 CFR 483.10 and 483.12. Privacy, the right to refuse care, freedom from restraints and reporting abuse come up often.
  • Think like a safe beginner. The test checks whether you can do the job of an entry-level aide safely. The best answer usually protects the resident's safety and dignity, stays within your role and involves reporting to the nurse.
  • Practise under time. Answering 70 questions in 2 hours gives you well over a minute each, so time is rarely the problem. Careful reading is. Use our free questions below, then a full-length timed practice test, and review every explanation you got wrong.

Our questions are original practice questions written from the official NNAAP content outline, the NNAAP skills listing and the federal and health sources cited with each answer. They are not taken from the real exam.

Frequently asked questions

How many questions are on the CNA written test?

On the NNAAP written examination there are 70 multiple-choice questions, of which 60 are scored and 10 are unscored pretest items mixed in with the others. You have 2 hours. States that do not use the NNAAP can differ: Florida's written test, for example, has 60 questions in 90 minutes, and Tennessee's knowledge exam has 75 questions. Source

What score do I need to pass?

There is no single national passing score. Federal rules require each state to set its own standard for passing the competency evaluation, and you must pass both the written (or oral) test and the skills evaluation. Tennessee's handbook, for example, requires 75% or better on the knowledge test. Your state's candidate handbook gives the rule that applies to you. Source

Can I take the test orally or in Spanish?

Yes, an oral version is always available: federal rules require states to let you choose between a written and an oral examination. On the NNAAP the oral version has 60 multiple-choice questions read aloud plus 10 word-recognition questions, and you must pass both parts. Some states also offer Spanish: Pennsylvania offers the written or oral test in English or Spanish, and Alabama lists a Spanish oral exam. You usually have to ask for the oral exam when you apply. Source

How many times can I retake the CNA exam?

Federal rules say you must have at least three opportunities to pass, and a state cannot set a limit below three. Some NNAAP states add a time limit: Alabama allows three attempts within two years of finishing training, and South Carolina requires you to pass within two years of training or three attempts, whichever comes first. Washington allows four attempts at the written or oral test. After the last failed attempt you usually have to retrain. Source

Do I have to pay for the exam myself?

Not always. If you are employed by, or have a job offer from, a nursing facility that takes Medicare or Medicaid when you start the competency evaluation, you may not be charged for it. Otherwise you pay the fee set by your state, for example $135 for the written and skills tests together in Pennsylvania. Source

Does every state use the NNAAP?

No. Credentia's test-takers page lists the states and territories it serves, and even among them formats differ (Tennessee's Credentia knowledge exam has 75 questions instead of 70). Other states use other vendors: Florida uses Prometric, and Ohio uses D&S Diversified Technologies. Always follow the candidate handbook of the state where you want to be certified. Source

What happens after I pass?

Once you pass both the written (or oral) test and the skills evaluation, your name is added to the state nurse aide registry. Federal rules require the record to be entered within 30 days. In South Carolina, for example, this takes about ten business days. Source

More free practice tests

Sources

NNAAP is a registered trademark of its owner. passmock is not affiliated with or endorsed by Credentia, the National Council of State Boards of Nursing (NCSBN), Prometric, D&S Diversified Technologies (Headmaster) or any state nurse aide registry. Our questions are original practice questions written from the official test description and study materials; they are not questions from the real test.