How Hard Is the CNA Exam in 2026? Pass Rates, Skills Test & What to Expect

Last updated: February 2026 | Data sources: State Boards of Nursing, Prometric, D&S Diversified (Headmaster), Bureau of Labor Statistics

How Hard Is the CNA Exam? The Honest Answer

The CNA (Certified Nursing Assistant) exam is not the hardest healthcare certification you will ever take -- but it catches more people off guard than it should. With a national first-time pass rate hovering between 70% and 87% depending on the state, roughly 1 in 5 test-takers walks out without passing on their first attempt.

Why does a test that 71% of successful candidates later describe as "common sense" still trip up so many people? Three reasons:

1. Two separate exams. You must pass a written knowledge test AND a hands-on clinical skills evaluation. Failing either one means you have not passed.
2. The clinical skills portion is unforgiving. You demonstrate 3-5 randomly selected nursing skills in front of a live evaluator. Miss a single critical step -- like forgetting to check the patient's ID band -- and that entire skill is scored as a failure.
3. Underestimation. Many candidates study hard for the written test but barely practice the clinical skills. Others assume the written portion is too easy to fail, then miss the passing threshold by just 1-2 questions.

The good news is that with the right preparation, this exam is absolutely beatable on your first try. This guide gives you every data point, strategy, and insider tip you need.

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CNA Exam at a Glance

You must pass both parts to earn your CNA certification. The two sections can usually be taken on the same day or on separate dates, depending on your state and testing site availability.

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CNA Pass Rates by State

CNA pass rate data is managed at the state level, not centrally like the NCLEX. Here is what the available data shows:

What These Numbers Tell Us

• The clinical skills portion is consistently harder than the written test. Florida's data shows a 3.2 percentage-point gap, and Arizona shows a 6-point gap. This pattern holds across most states.
• State-to-state variation is significant. States with higher training hour requirements (like California at 160 hours) tend to have higher pass rates than those using the federal minimum (75 hours).
• The "overall" pass rate includes candidates who pass one section but not the other -- you need both.
• Repeat pass rates drop substantially, which is why your first attempt matters most.

Why Pass Rates Vary So Much

Several factors drive the state-by-state differences:

• Training hour requirements: States requiring 120+ hours of training generally produce better-prepared candidates
• Testing vendor: Headmaster uses 75 questions (vs. 60-70 for other vendors), which some candidates find more challenging
• Clinical hour minimums: More supervised clinical hours mean more hands-on practice before exam day
• Exam retake windows: Shorter windows create more pressure; longer windows allow more preparation time

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The Two Parts of the CNA Exam

Part 1: Written (or Oral) Knowledge Test

The written exam tests your understanding of nursing assistant concepts, patient care principles, safety procedures, and professional responsibilities. It is delivered on a computer at a testing center.

Exam structure by vendor:

Content areas tested:

Most questions follow a pattern: a short clinical scenario followed by "What should the CNA do?" or "What should the CNA do FIRST?" The exam rewards candidates who consistently choose the safest, most respectful, and most scope-appropriate answer.

Part 2: Clinical Skills Evaluation

The clinical skills test is the hands-on portion where you physically demonstrate nursing assistant procedures in front of a trained Nurse Aide Evaluator. This is the section that causes the most anxiety -- and the most failures.

How it works:

1. Random selection. You will be assigned 3-5 skills from a pool of 21-25 possible skills. You do not get to choose which skills you perform.
2. Mandatory hand hygiene. Regardless of which skills are selected, you will always be required to demonstrate proper hand washing. In most states, hand hygiene is a standalone tested skill plus a critical step within every other skill.
3. Live evaluator. A Nurse Aide Evaluator watches you perform each skill in real time, checking off each step on a detailed scoring checklist.
4. Critical steps. Each skill has designated "critical steps" that MUST be completed. Missing even one critical step results in failure of that entire skill.
5. 100% accuracy required. Unlike the written test (70% passing), you must pass each skill completely. There is no partial credit.
6. Time limit. You typically have 25-40 minutes to complete all assigned skills.

Skills that may be tested include:

Critical steps that apply to EVERY skill:

• Identify the patient (check ID band or ask name and date of birth)
• Explain the procedure before starting
• Perform hand hygiene before AND after
• Provide privacy (close curtain, door, drape patient)
• Ensure safety (bed locked, side rails up when appropriate, call light within reach)
• Communicate with the patient throughout

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Hardest Clinical Skills (and Most Commonly Failed)

Testing data from state boards and testing vendors reveals clear patterns in which skills cause the most failures:

1. Blood Pressure Measurement -- The #1 Most Failed Skill

Failure rate: ~18% of candidates who are tested on this skill do not pass it. Blood pressure measurement appears on the majority of skills exams regardless of testing provider.

Why it is so hard:

• Manual technique required. You must use a stethoscope and manual sphygmomanometer (mercury or aneroid) -- no digital machines allowed on the exam.
• Cuff sizing matters. The bladder of the cuff must encircle approximately 80% of the patient's upper arm. Wrong cuff size = inaccurate reading = failure.
• Precise placement. The cuff must be positioned 1-2 inches above the antecubital space (inner elbow), with the artery marker aligned over the brachial artery.
• Sound identification. You must correctly identify the first Korotkoff sound (systolic) and the fifth sound (diastolic) -- and accurately read the gauge while listening.
• Nervousness amplifies errors. Your own hands may shake under observation, making it harder to hear the sounds and read the gauge simultaneously.

How to pass it:

• Practice on at least 5 different people (different arm sizes, different blood pressures)
• Practice until you can consistently read within 8 mmHg of the true value
• Always inflate 30 mmHg above the estimated systolic (palpate first)
• Deflate at a rate of 2-3 mmHg per second -- no faster
• Record the reading immediately; do not rely on memory

2. Perineal Care

Why candidates fail: Perineal care involves cleaning the genital area, which makes many candidates uncomfortable and prone to rushing. The skill has strict directionality requirements -- you must always wipe from front to back (clean to dirty) for female patients and use a clean area of the washcloth for each stroke. Forgetting privacy measures (pulling the curtain, keeping the patient draped) is another common failure point.

3. Catheter Care

Why candidates fail: Catheter care combines infection control, proper technique, and equipment management. You must keep the drainage bag below the level of the bladder at all times, clean the catheter tubing in the correct direction (away from the body), and never disconnect the system. Many candidates forget to check that the tubing is not kinked and that the drainage bag is not touching the floor.

4. Ambulation with Gait Belt

Why candidates fail: Candidates often forget to check the gait belt tightness (you should be able to slip a flat hand between the belt and the patient's body), position themselves on the patient's weak side, or fail to maintain a proper grip during ambulation.

5. Range of Motion Exercises

Why candidates fail: Each joint must be moved through its full range of motion smoothly and without forcing. Candidates sometimes skip joints, forget to support the extremity above and below the joint, or move too quickly. The evaluator watches for signs that you are causing pain.

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Written Test: What Makes It Tricky

While 71% of candidates who pass say the written portion felt like "common sense" in hindsight, many candidates fail by just 1-2 questions. Here is what makes the written test deceptively challenging:

1. "What Should You Do FIRST?" Questions

These questions list four actions that are ALL correct -- but only one should be done first. The priority almost always follows this hierarchy:

1. Safety first (Is the patient in immediate danger?)
2. Assessment before action (Gather information before intervening)
3. Communication (Notify the nurse of changes)
4. Documentation (Record what happened)

2. Scope of Practice Traps

The exam frequently tests whether you know what a CNA is not allowed to do. Common traps include:

• Administering medications (even over-the-counter) -- NOT in CNA scope
• Performing sterile procedures -- NOT in CNA scope
• Diagnosing conditions or giving medical advice -- NOT in CNA scope
• Adjusting oxygen flow rates -- NOT in CNA scope
• Accepting verbal orders from a physician -- NOT in CNA scope

3. Residents' Rights Questions

OBRA (Omnibus Budget Reconciliation Act) guarantees specific rights to residents in long-term care facilities. The exam tests these frequently:

• Right to privacy and dignity
• Right to refuse treatment
• Right to personal possessions
• Right to make complaints without retaliation
• Right to participate in care planning
• Right to be free from restraints (physical and chemical)

4. Infection Control Nuances

Hand hygiene questions go beyond "wash your hands." You need to know:

• When to use soap and water vs. alcohol-based hand rub (soap and water when hands are visibly soiled or after contact with C. difficile or norovirus)
• How long to scrub (at least 20 seconds with soap and water)
• Standard precautions apply to ALL patients, not just those with known infections
• Transmission-based precautions (contact, droplet, airborne) and which PPE each requires

5. "Select the BEST Answer" Format

Many questions have two or three options that seem reasonable. The "best" answer is typically the one that is:

• Most respectful of the patient's dignity and autonomy
• Safest for the patient
• Most within the CNA's scope of practice
• Most aligned with standard infection control principles

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What's New on the CNA Exam in 2026?

The 2026 CNA exam reflects updated guidelines with a renewed focus on skills critical for the modern healthcare environment:

• Enhanced infection control emphasis — Expect more questions on advanced infection prevention techniques, PPE sequencing, and pathogen-specific precautions (especially post-pandemic protocols)
• Patient mobility and fall prevention — Updated focus on safe patient handling, transfer techniques, and fall risk assessment
• Telehealth basics — New content on the CNA's role in supporting telehealth visits, including positioning patients for virtual appointments and documenting vital signs for remote providers
• Person-centered care — Increased emphasis on cultural competency, patient autonomy, and trauma-informed care approaches

These updates affect both the written and clinical skills portions. Make sure your study materials are current for 2026.

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CNA Training Requirements by State

The federal minimum for CNA training is 75 hours, but many states require significantly more. Training includes both classroom instruction and supervised clinical practice in a healthcare facility.

Key takeaways:

• Maine (180 hours), Missouri (175 hours), and California (160 hours) have the highest requirements in the nation
• States at the federal minimum of 75 hours include Colorado, Michigan, Minnesota, North Carolina, and Ohio
• Clinical hours range from 16 hours (federal minimum) to 100 hours (California, Missouri)
• More training hours generally correlate with higher first-time pass rates, though individual study habits matter just as much
• Always verify requirements with your state's Board of Nursing or Department of Health, as requirements can change

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Testing Providers: Prometric vs D&S Diversified (Headmaster)

Your state determines which testing vendor administers your CNA exam. The two largest providers are Prometric and D&S Diversified Technologies (Headmaster). A third major vendor, Credentia, administers the NNAAP exam in many states.

Prometric

D&S Diversified Technologies (Headmaster)

Key Differences

Bottom line: Neither vendor is inherently harder than the other. Prometric tests more clinical skills but asks fewer written questions. Headmaster asks more written questions but tests fewer clinical skills. The content knowledge required is the same regardless of vendor.

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What Happens If You Fail

Failing the CNA exam is not the end of the road. Here is exactly what happens and what your options are:

Retake Policy (Most States)

• You only retake the section you failed. If you passed the written test but failed the clinical skills (or vice versa), you only need to retake the failed portion.
• Most states allow 3 attempts. You typically get three chances to pass each section within a 2-year window from your first test date.
• After 3 failures, you must retrain. If you fail 3 times, most states require you to complete the entire CNA training program again before you can retest.
• Retake fees apply. Expect to pay $30-$50 for a written-only retake or $70-$125 for a skills-only retake, depending on your state and vendor.

Waiting Periods

• Most testing vendors allow you to reschedule as soon as the next available testing date
• Some states impose a minimum waiting period (often 2-4 weeks) between attempts
• Check your state's specific retake policy, as it may differ from the general guidelines

The 2-Year Window

You must pass both sections of the CNA exam within 2 years of your first test date. If you pass one section but cannot pass the other within 2 years, your passing score on the first section expires and you must retake the entire exam.

What to Do Differently

If you failed the written test:

• Focus on the content areas where you lost the most points (your score report usually indicates this)
• Practice with timed practice exams to improve your pacing
• Pay special attention to "priority" questions and scope-of-practice boundaries

If you failed the clinical skills test:

• Identify which specific skill(s) you failed and which critical steps you missed
• Practice each skill with a partner who can observe and give feedback
• Narrate each step out loud as you perform it -- this helps you remember steps and shows the evaluator your thought process
• Practice under time pressure to simulate exam conditions

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How to Pass the CNA Exam on Your First Attempt

Written Exam Strategies

1. Master the priority framework. Safety > Assessment > Communication > Documentation. When in doubt, choose the safest option.

2. Know your scope. If an answer involves administering medication, performing a sterile procedure, or making a diagnosis, eliminate it immediately. CNAs do not do these things.

3. Respect the patient. When two answers seem equally correct, choose the one that better protects the patient's dignity, privacy, and autonomy.

4. Read every word. Questions often include key qualifiers like "FIRST," "BEST," "MOST important," or "EXCEPT." Missing these words leads to wrong answers.

5. Do not change answers. Research consistently shows that your first instinct is more likely to be correct unless you find a specific reason to change it.

6. Manage your time. With 60-75 questions in 90 minutes, you have approximately 1-1.5 minutes per question. Flag difficult questions and come back to them.

Clinical Skills Strategies

1. Practice until it is automatic. You should be able to perform each skill without thinking about what comes next. Hesitation during the exam leads to forgotten steps.

2. Talk through every step. Narrate what you are doing as you do it: "I am now checking the patient's identification band." This demonstrates your knowledge to the evaluator and helps prevent you from skipping steps.

3. NEVER skip hand hygiene. Wash your hands before AND after every single skill. This is the most commonly tested procedural element and the easiest points to lose.

4. Always identify the patient. Every skill begins with patient identification. Check the ID band, state the patient's name, and confirm their identity.

5. Always explain the procedure. Before touching the patient or any equipment, explain what you are about to do and why. "Mrs. Smith, I am going to take your blood pressure now to check how your heart is doing."

6. Prioritize privacy. Close the curtain. Close the door. Drape the patient. These steps are critical elements in almost every skill.

7. Practice blood pressure obsessively. Since it has the highest failure rate of any skill (18%), practice it more than any other. Use a manual cuff on as many different people as possible.

8. End every skill properly. Place the call light within reach, lower the bed to its lowest position, make sure side rails are up (if applicable), and ask if the patient needs anything.

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CNA Career Outlook & Salary

Salary Data (Bureau of Labor Statistics, May 2024)

Top-Paying Industries for CNAs

Job Growth Projections (2024-2034)

• Projected growth rate: 2% (slower than the 3% average for all occupations)
• Annual openings projected: ~211,800 per year
• Primary driver: Replacement of workers who leave the occupation or retire
• Demand factor: Aging population increasing need for long-term care
• Growth areas: Home health and community-based care settings are expanding fastest

Why Openings Remain High Despite Slow Growth

Even though the growth rate is modest at 2%, the sheer number of CNAs in the workforce (~1.4 million) means that 211,800 positions open up every year due to turnover and retirements. This makes CNA one of the easiest healthcare certifications to convert into immediate employment.

CNA as a Stepping Stone

Many CNAs work while attending nursing school, gaining valuable bedside experience that makes them stronger nursing students and more competitive job candidates after graduation.

Certification Renewal

CNA certification is valid for 2 years in most states. To renew, you must:

• Have worked at least 8 paid hours performing nursing assistant duties during the renewal period
• Complete any state-required continuing education
• Submit a renewal application to your state's nurse aide registry
• Pass a background check (if required by your state)

If your certification lapses and you did not work the required hours, most states require you to retake the competency exam (and sometimes complete additional training) before reinstatement.

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Official Resources

• Prometric CNA Testing -- Registration and scheduling for Prometric states
• D&S Diversified (Headmaster) Testing -- Registration and scheduling for Headmaster states
• Credentia CNA Testing -- NNAAP testing provider
• NCSBN NNAAP Information -- National Council of State Boards of Nursing
• BLS Nursing Assistants Outlook -- Salary and job growth data
• CMS Nurse Aide Registry -- Federal registry information
• Your state's Board of Nursing website -- For state-specific requirements