200+ Free Iowa CNA Practice Questions

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When performing a complete bed bath on a resident in an Iowa long-term care facility, in which order should the CNA wash the body?

Perineal area, legs, abdomen, chest, arms, face

Face, neck, arms, chest, abdomen, legs, back, perineal area

Back, buttocks, legs, abdomen, chest, arms, face

Arms, legs, face, chest, abdomen, back, perineal area

to track

2026 Statistics

Key Facts: Iowa CNA Exam

Written Questions

Headmaster/TMU Iowa

70%

Passing Score Required

Iowa DIAL (49/70 correct)

75 hrs

Training (Optional Pre-Test)

45 didactic + 30 clinical

$50

Written Exam Fee

Community college proctor

24 mo

DCW Registry Work Cycle

Iowa Admin. Code 441 Ch. 81

12 hrs

Annual In-Service Required

Iowa Code Ch. 135C

Iowa's standout difference: you can sit for the CNA exam WITHOUT completing the 75-hour training first — Iowa is the only state with no training prerequisite. The exam is administered by Headmaster/TMU Iowa using 70 questions with a 70% passing bar. Passing gets you listed on the Iowa Direct Care Worker (DCW) Registry maintained by DIAL, not a traditional 'CNA registry.' CNAs must complete 8 hours of qualifying work per 24-month cycle and 12 hours of annual in-service training to stay active. Iowa Code Ch. 135C governs long-term care facilities; Iowa Code Ch. 235B governs mandatory abuse reporting.

Sample Iowa CNA Practice Questions

Try these sample questions to test your Iowa CNA exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1When performing a complete bed bath on a resident in an Iowa long-term care facility, in which order should the CNA wash the body?

A.Perineal area, legs, abdomen, chest, arms, face

B.Face, neck, arms, chest, abdomen, legs, back, perineal area

C.Back, buttocks, legs, abdomen, chest, arms, face

D.Arms, legs, face, chest, abdomen, back, perineal area

Explanation: The correct bed bath sequence moves from cleanest to dirtiest: face and neck first, then arms, chest, abdomen, legs, back, and perineal area last. This clean-to-dirty sequence prevents cross-contamination and reduces the risk of spreading bacteria from soiled to clean areas. Iowa DIAL and federal OBRA standards require maintaining dignity and infection control during all personal care procedures.

2An Iowa CNA is preparing to bathe a resident. Before placing the resident in the tub, the CNA should check the water temperature by:

A.Dipping a finger briefly and estimating

B.Testing the inside of the wrist first, then confirming with a thermometer if available — water should be 105–115°F (40–46°C)

C.Asking the resident to test the water with their foot

D.Checking that steam is visible above the surface

Explanation: The inside of the wrist is sensitive and provides a reliable temperature estimate. A thermometer confirms the safe range of 105–115°F (40–46°C). Elderly residents often have reduced temperature sensation and are at high risk for scalding. Iowa Administrative Code 441 Ch. 81 regulations require CNAs to maintain resident safety, which includes preventing burns during bathing.

3During a bed bath, the Iowa CNA uses a separate washcloth for the perineal area. What is the PRIMARY reason for this practice?

A.To conserve laundry supplies in the facility

B.To prevent the transfer of microorganisms from the perineal area to other body areas

C.Because Iowa DIAL regulations require a minimum of two washcloths per bath

D.To comply with the resident's personal preference for cleanliness

Explanation: Using a separate washcloth for the perineal area prevents cross-contamination — fecal bacteria (e.g., E. coli) from the anal region can cause urinary tract infections if transferred to the urethral area. This is a standard infection-control practice required under OBRA 1987 and enforced by Iowa DIAL in all certified nursing facilities.

4A female resident in an Iowa nursing home asks the CNA to skip her bath today because she feels tired. What is the BEST response?

A.Insist on the bath because it is on the care plan schedule

B.Respect her right to refuse, offer a sponge bath as an alternative, document the refusal, and report to the nurse

C.Call the family to convince her to bathe

D.Report her as non-compliant to the charge nurse immediately

Explanation: Residents have the federally guaranteed right to refuse care under OBRA 1987, which Iowa enforces through Iowa Code Chapter 135C. The CNA must respect this right, offer alternatives (such as a partial or sponge bath), document the refusal accurately in the care notes, and notify the nurse so the refusal is communicated to the care team. Forcing care violates resident rights and can constitute abuse.

5During perineal care for a female resident, the Iowa CNA should cleanse in which direction?

A.Back to front (anus toward urethra) using firm circular strokes

B.Front to back (urethra toward anus), using one downward stroke per wipe

C.Side to side across the perineal area using gentle back-and-forth motions

D.In an outward circular motion starting from the urethral opening

Explanation: Always wipe from front to back (urethra toward anus) with a clean area of the cloth for each stroke. This prevents intestinal bacteria from contaminating the urethra, reducing the risk of urinary tract infections (UTIs). UTIs are among the most common infections in long-term care facilities, and proper perineal care is a primary prevention strategy required by Iowa DIAL regulations.

6An Iowa CNA observes a red, open area on a resident's buttock during the bed bath. What should the CNA do FIRST?

A.Apply a bandage and continue the bath

B.Cover it with a towel and note it in the shift log at the end of the day

C.Complete the bath while protecting the area from moisture, then immediately report the finding to the nurse

D.Ask the resident if they have been sitting too long and adjust their schedule

Explanation: A red, open area on a bony prominence (like the coccyx or sacrum) is a potential pressure injury or skin breakdown requiring prompt nursing assessment. The CNA should complete the bath while keeping the area dry, then report to the nurse immediately. Under Iowa Administrative Code 441 Ch. 81 and federal requirements, CNAs must report observed changes in resident condition without delay — never at end of shift.

7Which of the following best describes a "partial bath" in an Iowa long-term care facility?

A.A full bath that the resident partially performs themselves

B.Washing the face, hands, axillae (underarms), perineal area, and any other areas causing discomfort or odor

C.A bath performed only on alternate days to conserve water

D.A bath that skips the lower extremities due to resident mobility issues

Explanation: A partial bath focuses on the areas most critical for hygiene and comfort: face, hands, underarms, and perineal area — plus any other areas causing odor or skin irritation. It is appropriate when a resident is fatigued, acutely ill, or declines a full bath. Iowa facilities must document all care delivered and any care refusals per Iowa Code Chapter 135C nursing facility standards.

8An Iowa CNA is giving a shower to a resident who uses a shower chair. During the shower, the resident begins coughing and says she feels dizzy. The CNA should:

A.Finish the shower quickly to minimize resident exposure to water

B.Leave the resident alone to get the nurse immediately

C.Stop the shower, wrap the resident in a towel, stay with her, call for help using the call light or bell, and monitor her condition

D.Recline the shower chair and elevate her legs while continuing the shower

Explanation: Dizziness during a shower may indicate orthostatic hypotension, overheating, or a cardiac event. The CNA must stop the shower, secure the resident's safety and warmth, and use the call light or call for help WITHOUT leaving the resident alone. Leaving a dizzy resident unattended in a shower increases fall risk significantly. Iowa DIAL requires CNAs to prioritize resident safety and call for nursing help promptly.

9To protect the privacy and dignity of a resident during bathing in an Iowa nursing facility, the CNA should:

A.Keep the door open so help is quickly accessible in case of emergency

B.Expose only the body part being washed at any time and keep curtains or doors closed throughout

C.Explain all steps of bathing to other staff outside the door so they can assist if needed

D.Ask the resident's roommate to wait outside the room during the bath

Explanation: Maintaining privacy and dignity during bathing is a core resident right under OBRA 1987 and Iowa Code Chapter 135C. The CNA should close doors and curtains and use bath blankets to drape the resident, exposing only the area being cleaned. This protects modesty, maintains warmth, and shows respect — any violation of this requirement can be cited as a deficiency by Iowa DIAL inspectors.

10An Iowa CNA is bathing a resident with a recent left hip replacement. When assisting the resident to the tub chair, the CNA notes the resident's affected leg is swollen and warm compared to the right. What should the CNA do?

A.Proceed with the tub bath, using extra caution with the left leg

B.Postpone the bath, assist the resident back to bed, and immediately report the swelling and warmth to the nurse

C.Elevate the left leg on a bath towel and complete the bath normally

D.Apply a warm compress to the swollen leg before bathing to reduce discomfort

Explanation: Unilateral swelling and warmth after hip replacement are classic signs of deep vein thrombosis (DVT), a life-threatening complication. A DVT can lead to pulmonary embolism if dislodged. The CNA must stop the planned activity, ensure resident safety, and notify the nurse immediately. CNAs must recognize and report changes in condition without delay — this is required by Iowa DIAL regulations and federal OBRA standards.

About the Iowa CNA Exam

The Iowa CNA (Direct Care Worker) competency exam is a two-part test administered by Headmaster/TMU Iowa under oversight of Iowa DIAL (Department of Inspections, Appeals & Licensing). The written portion is 70 multiple-choice questions (60 minutes) requiring 70% to pass (49 correct), plus a clinical skills demonstration. Iowa is unique: it is the only state that does NOT require completion of the 75-hour CNA training before taking the exam — candidates may test first and train later. The Iowa DCW Registry is maintained by DIAL under Iowa Admin. Code 441 Ch. 81.

Questions

70 scored questions

Time Limit

60 minutes written + skills evaluation

Passing Score

70% written (49/70) + skills competency

Exam Fee

$50 written (community college proctor) + $115–$135 skills (Headmaster / D&S Diversified Technologies (TMU Iowa) / Iowa DIAL)

Iowa CNA Exam Content Outline

39%

Basic Nursing Skills

Vital signs, infection control, safety, fall prevention, wound observation, oxygen use, emergency procedures, body mechanics, transfers

14%

Activities of Daily Living (ADL)

Bathing, dressing, grooming, oral hygiene, nutrition/feeding, elimination/toileting, rest and sleep support

26%

Role of the Nurse Aide

Iowa DIAL/DCW Registry, Iowa Admin. Code 441 Ch. 81, communication, documentation, client rights, OBRA, mandatory reporting, Iowa Code Ch. 235B, healthcare team, scope of practice

10%

Psychosocial Care Skills

Mental/emotional health, spiritual/cultural needs, resident dignity, cognitive impairment, end-of-life care

Restorative Skills

ROM exercises, ambulation assist, assistive devices, restorative dining, rehabilitation goals

Spiritual/Cultural Care

Respecting religious and cultural practices, chaplain referrals, culturally competent care

How to Pass the Iowa CNA Exam

What You Need to Know

Passing score: 70% written (49/70) + skills competency
Exam length: 70 questions
Time limit: 60 minutes written + skills evaluation
Exam fee: $50 written (community college proctor) + $115–$135 skills

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

Iowa CNA Study Tips from Top Performers

1Know Iowa's unique rule: NO training required before testing — only state with this policy

2Study Iowa Admin. Code 441 Ch. 81 — governs training, certification, and DCW Registry requirements

3Understand the DCW Registry (not 'CNA Registry') maintained by Iowa DIAL

4Memorize DCW renewal: 8 hours qualifying work per 24 months + 12 hours annual in-service

5Know Iowa Code Ch. 235B for mandatory abuse reporting — report to supervisor AND Iowa DHHS APS

6Know Iowa Code Ch. 135C — governs long-term care facilities and employer in-service requirements

7Know Iowa Code Ch. 144A — Iowa's advance directives/living wills law

8The exam is 70 questions, 60 minutes, 70% passing (49/70) — administered by Headmaster/TMU Iowa

9Practice vital signs: normal temp 97.6-99.6°F, pulse 60-100, resp 12-20, BP 90-140/60-90

10Review infection control: standard precautions, PPE sequences, hand hygiene steps

Frequently Asked Questions

Do I need to complete CNA training before taking the Iowa exam?

No — Iowa is the ONLY state that does NOT require completion of CNA training before testing. You may take the Iowa CNA competency exam first, then complete the required 75-hour training (45 didactic + 30 clinical) afterward. However, most employers and community colleges strongly recommend completing training before testing. Iowa Admin. Code 441 Ch. 81 governs training requirements.

Who administers the Iowa CNA exam?

The Iowa CNA written exam is administered by Headmaster / D&S Diversified Technologies through their TMU Iowa platform. Community colleges serve as proctor sites, and remote online proctoring is available through Credentia ($70 fee). The clinical skills evaluation is administered at community colleges or through Health Tech Associates. Iowa DIAL (Department of Inspections, Appeals & Licensing) oversees all certification.

What is the Iowa DCW Registry?

Iowa uses the Direct Care Worker (DCW) Registry, not a traditional 'CNA Registry.' It is maintained by Iowa DIAL under Iowa Admin. Code 441 Ch. 81. All CNAs working in Iowa long-term care facilities must be listed on the DCW Registry. The registry also records substantiated findings of abuse, neglect, or misappropriation of property.

How do I maintain my Iowa CNA certification?

To stay active on the Iowa DCW Registry, you must: (1) complete at least 8 hours of qualifying work as a CNA every 24 months, and (2) complete 12 hours of in-service training each calendar year. In-service training must be paid by the employer if you work in a state-licensed LTC facility under Iowa Code Ch. 135C.

How do I report abuse as an Iowa CNA?

Iowa CNAs are mandatory reporters under Iowa Code Ch. 235B. Suspected abuse, neglect, or exploitation must be reported immediately to: (1) your supervisor, and (2) the Iowa Department of Health and Human Services (DHHS) Adult Protective Services. For residents in long-term care facilities, you may also contact the Iowa Long-Term Care Ombudsman (LTCOP), which operates under Iowa DHHS.

What are the fees for the Iowa CNA exam?

Written exam: $50 if testing at a community college proctor site (Headmaster/TMU Iowa); online remote proctoring through Credentia costs $70. Clinical skills evaluation: $115 at a community college site or $135 through Health Tech Associates. Fees are subject to change — verify at the TMU Iowa website before scheduling.