The CNA clinical skills exam tests you on a specific set of hands-on competencies that cover infection control, personal care, mobility assistance, and vital sign measurement. While the exact number and naming can vary slightly by state, most state exams draw from a standard list of roughly 22 to 25 skills. During your test, you’ll be asked to perform a handful of these skills (typically five) on a mannequin or actor while an evaluator watches and scores each step.
The Full CNA Skills List
Here are the clinical skills that appear on CNA competency checklists, based on state nursing assistant evaluation standards:
- Hand hygiene (handwashing)
- Donning and removing PPE (gown and gloves)
- Applying one knee-high elastic stocking
- Assisting with ambulation using a transfer belt
- Assisting with use of a bedpan
- Cleaning upper or lower dentures
- Counting and recording radial pulse
- Counting and recording respirations
- Dressing a client with a weak arm
- Feeding a client who cannot feed themselves
- Giving a modified bed bath (face, one arm, hand, and underarm)
- Measuring and recording blood pressure manually
- Measuring and recording urinary output
- Measuring and recording weight of an ambulatory client
- Passive range of motion for one knee and one ankle
- Passive range of motion for one shoulder
- Positioning a resident on their side
- Providing catheter care (female)
- Providing foot care on one foot
- Providing mouth care
- Providing perineal care (female)
- Transferring from bed to wheelchair using a transfer belt
Some states add additional skills like making an occupied bed, measuring oral temperature, or performing indirect care tasks such as communication and documentation. Check your state’s nursing board website for the exact list used in your exam, since the count may land anywhere from 22 to 25 depending on how your state groups or splits certain competencies.
Hand Hygiene: The Skill You’ll Always Perform
Handwashing is the foundation skill, and you’ll perform it before and after every other skill on test day. The exam requires a minimum of 20 seconds of scrubbing with soap and warm water. Your hands and forearms must stay lower than your elbows the entire time so water flows away from clean areas toward your fingertips.
The specific friction sequence matters: rub palms together, interlace fingers to clean the backs of both hands, rotate around each thumb, rub fingertips against the opposite palm, and scrub both wrists. Repeat that full sequence at least twice. When you’re done, dry from fingers to wrists with a paper towel, then use a fresh paper towel to turn off the faucet. Never touch the inside of the sink or shake water from your hands.
Transfers and Mobility Skills
The bed-to-wheelchair transfer is one of the most commonly tested skills, and it has a lot of moving parts. You start by locking the bed brakes, helping the resident sit on the edge of the bed with their feet flat on the floor, and letting them dangle for a moment to check for dizziness. Nonskid footwear goes on before anyone stands up.
The gait belt (also called a transfer belt) wraps around the resident’s waist. You position the wheelchair so the resident pivots toward their stronger side, lock the wheelchair brakes, then grasp the belt with both hands, palms and fingertips pointing upward. On a count of three, you assist them to standing while placing your feet in front of theirs to prevent slipping. The resident pivots, feels the wheelchair seat against the backs of their knees, reaches for the armrests, and sits. You remove the belt gently to avoid skin friction, release the brakes, and make sure the call light is within reach.
Ambulation with a transfer belt follows a similar setup but involves walking alongside the resident rather than pivoting to a chair. In both skills, body mechanics are critical: keep your back straight, bend at the knees, and stay close to the resident’s center of gravity.
Vital Signs: Pulse, Respirations, Blood Pressure
Three separate skills cover vital sign measurement. For radial pulse, you locate the pulse on the thumb side of the resident’s wrist using two or three fingertips (never your thumb, which has its own pulse). Count the beats for a full 60 seconds and record the number.
Respirations are counted immediately after the pulse, ideally while still appearing to hold the resident’s wrist. This prevents the resident from consciously changing their breathing pattern. One rise and fall of the chest equals one breath. Again, count for a full 60 seconds.
Manual blood pressure requires placing the cuff on a bare upper arm, positioning the stethoscope over the inner elbow, inflating the cuff, and slowly releasing it while listening for the first and last audible beats. The first sound is the systolic number (top), and the point where sound disappears is the diastolic number (bottom). Record both.
Personal Care and Hygiene Skills
A large chunk of the skills list involves helping residents with daily hygiene tasks. These share a common thread: you always explain what you’re doing before you start, provide privacy, check water temperature by letting the resident feel it first, and wear gloves when contact with body fluids is possible.
Perineal care for a female resident has one of the most precise sequences on the exam. Every wiping stroke moves from front to back (top to bottom) to prevent bacteria from the rectal area reaching the urethra. You use a clean portion of the washcloth for each stroke, washing one side of the labia, then the other, then the vaginal area. After rinsing the same way, you turn the resident onto their side and clean the buttocks and rectal area, again wiping away from the vagina with each stroke. The skill uses four separate washcloths total.
Catheter care follows a similar infection-control logic. You clean around the catheter where it exits the body, then wipe 3 to 4 inches down the tubing using strokes that move away from the urethra. Before you begin, you check that the drainage tubing runs downhill from the resident to the bag with no kinks, which prevents urine from flowing backward into the bladder.
Mouth care, denture cleaning, and foot care are simpler but still scored on specific steps. Dentures, for instance, are cleaned over a basin lined with a towel or water to cushion them if dropped.
Range of Motion Exercises
Two skills cover passive range of motion, where you move a resident’s joints through their full motion while they relax. One skill targets the shoulder (raising the arm forward and overhead for flexion, returning it for extension, then moving it out to the side for abduction and back for adduction). The other targets the knee and ankle.
The key rules: support the limb above and below the joint, move slowly and gently, never force a joint past the point of resistance, and watch the resident’s face for signs of pain. These exercises help prevent stiffness and contractures in residents who can’t move on their own.
Feeding a Resident Safely
Before offering a single bite, you verify that the meal matches the resident’s prescribed diet, texture, and liquid consistency on the diet card. The resident must be positioned upright, at least 45 degrees. Offer small amounts of food at a pace that gives the resident time to chew and swallow between bites, and offer fluids frequently throughout the meal. When the meal is over, keep their head elevated at least 30 degrees to reduce the risk of choking or aspiration.
Infection Control With PPE
Donning and removing a gown and gloves is its own scored skill. The sequence matters because removing PPE in the wrong order can contaminate your skin or clothing. Gloves come off first (by peeling from the wrist and turning inside out), followed by the gown (untying and rolling it away from your body so the contaminated outside folds inward). Hand hygiene immediately follows.
What the Exam Day Looks Like
You won’t perform all 22 to 25 skills on test day. Most states randomly assign five skills, and hand hygiene is almost always one of them. An evaluator watches you in real time, checking off each step on a detailed scoring sheet. Every skill also has built-in requirements that apply across the board: identifying the resident, explaining the procedure, providing privacy, and ensuring the call light is within reach when you leave.
Missing certain steps can result in an automatic failure of that individual skill. Forgetting to lock the wheelchair brakes during a transfer, skipping hand hygiene entirely, or moving a joint forcefully past a resident’s pain point are the kinds of errors that carry the most weight. You typically need to pass all assigned skills to pass the clinical portion of the exam, though retesting policies vary by state.
The best preparation strategy is repetitive hands-on practice, not just reading. Set up the supplies, talk through each step out loud as if narrating to the evaluator, and have a classmate or instructor score you against the checklist. The skills themselves aren’t complicated, but performing them in the correct order under pressure is where most candidates trip up.