The CNA written exam has 70 multiple-choice questions, and you get two hours to complete it. Of those 70 questions, only 60 are scored. The other 10 are pre-test questions being evaluated for future exams, but you won’t know which ones they are. The key to passing is understanding what the exam actually tests, then studying with methods that force your brain to retrieve information rather than just re-read it.
What the Exam Covers
The written exam, formally called the NNAAP (National Nurse Aide Assessment Program), is divided into three broad categories. Knowing how heavily each one is weighted helps you prioritize your study time.
Physical Care Skills make up roughly half the exam. Within this category, Basic Nursing Skills alone account for 37% of all questions. That includes infection control, vital signs, body mechanics, nutrition, fluid intake, and elimination. Activities of Daily Living (bathing, dressing, grooming, feeding) add another 7%, and Restorative Skills like range-of-motion exercises and mobility assistance contribute 5%.
The Role of the Nurse Aide is the second-largest category at 38%. Client Rights is the biggest piece here at 15%, covering privacy, dignity, autonomy, and the right to refuse care. Communication accounts for 10%, Legal and Ethical Behavior for 5%, and your role as a Member of the Health Care Team for 8%. These questions test whether you understand your scope of practice, when to report observations, and how to interact with residents and other staff.
Psychosocial Care Skills round out the remaining 13%. Emotional and Mental Health Needs make up 10%, and Spiritual and Cultural Needs account for 3%. These questions focus on recognizing anxiety, depression, grief, and how to provide culturally sensitive care.
How Scoring Works
The CNA exam does not use a simple percentage cutoff the way your training program did. There’s no universal “you need 70% correct” rule. Each state sets its own passing standard based on a national difficulty study, and different versions of the test may require a slightly different number of correct answers to pass. Prometric, the major testing vendor, adjusts for difficulty across exam forms so that every candidate faces an equivalent challenge regardless of which version they receive.
What this means practically: you can’t calculate your score during the test. Focus on answering every question as well as you can rather than counting how many you think you got right.
How to Study Effectively
Passive studying, like re-reading your textbook or highlighting notes, feels productive but doesn’t build the kind of memory you need for a timed multiple-choice test. Active recall, where you force your brain to pull up information from scratch, strengthens the neural pathways to those memories and makes retrieval faster and more reliable. Here’s how to apply that to CNA prep.
Flashcards
Write a question or key term on one side and the answer on the other. Cover topics proportional to the exam: make roughly a third of your cards about basic nursing skills, since that’s 37% of the test. Include cards on normal vital sign ranges, positioning techniques, infection control steps like proper handwashing sequence, and intake/output measurement. Test yourself daily, and separate the cards you get wrong into a pile you review more frequently.
Practice Questions
The single most effective thing you can do is practice with questions formatted like the real exam. Your state’s candidate handbook often includes a practice test. The NNAAP practice exam packet, available through your state health department’s website, contains sample questions with answer explanations that mirror the actual test structure. Work through these under timed conditions. When you get a question wrong, don’t just read the correct answer. Go back to your notes and understand why that answer is right and why the others are wrong.
Teach It Back
Pick a topic you’re shaky on, like chain of infection or residents’ rights, and explain it out loud to someone else as if they’ve never heard of it. If you stumble or get vague, that’s exactly where you need more review. This technique, sometimes called the Feynman method, exposes gaps in your understanding that re-reading would miss entirely.
Summarize in Your Own Words
After studying a section, close your book and write down the key points from memory in your own language. Compare what you wrote to the source material. The gaps between what you remembered and what was actually there tell you precisely what to study next.
High-Yield Topics to Prioritize
Given the exam’s weighting, certain topics deliver the most points per hour of study time:
- Infection control: Handwashing, standard precautions, isolation procedures, and when to use gloves versus gowns. This falls within the 37% basic nursing skills block and comes up repeatedly.
- Client rights: At 15% of the exam, this is the single largest non-clinical topic. Know that residents can refuse treatment, have the right to privacy during care, can access their own medical records, and must be free from restraints except under specific circumstances.
- Communication and reporting: Understand the difference between objective observations (what you can see and measure) and subjective information (what the resident tells you). Know what gets reported immediately versus what goes in routine documentation.
- Vital signs: Normal ranges for blood pressure, pulse, respiration, and temperature. Know what positions residents should be in for each measurement and common errors that produce inaccurate readings.
- Safety and body mechanics: Proper lifting technique, fall prevention, use of side rails, and how to transfer a resident from bed to wheelchair. These overlap with both basic nursing skills and restorative skills.
- Scope of practice: The exam tests whether you know what a CNA can and cannot do. You don’t diagnose, you don’t give medications (in most states), and you always report changes in a resident’s condition to the nurse.
Test Day Logistics
Bring a valid government-issued photo ID to the testing center. A driver’s license, state ID, or passport all work. If your state recently issued you a temporary paper ID (like a DMV certificate valid for 60 days), that’s typically accepted on its own without needing the expired version alongside it. Check your state’s candidate handbook for specific requirements, since some states are stricter than others.
Arrive early. Most testing centers close their doors at the scheduled start time with no exceptions. You won’t be allowed to bring phones, notes, or study materials into the testing room. Some centers provide scratch paper or a small whiteboard for working through questions.
If You Don’t Pass
Policies vary by state, but the general framework allows multiple attempts within a set window. In North Carolina, for example, candidates get three attempts to pass within two years of completing their training program. If you exhaust your attempts or run out of time, most states require you to retake a training program before testing again.
Testing fees are relatively modest. In California, the written knowledge exam currently costs $40, with a small surcharge for the audio version. Fees differ by state and testing vendor, so check with your state’s approved testing organization (Prometric, Credentia, or Headmaster depending on where you live).
If you fail on your first attempt, request a score report if one is available. Some states break down your performance by content area, which tells you exactly where to focus before retaking. Resist the urge to reschedule immediately. Give yourself at least one to two weeks of targeted study on your weak areas before sitting for the exam again.