1.1 About the CNA Certification Exam

What the CNA Exam Is

The CNA (Certified Nursing Assistant) exam is formally a Nurse Aide Competency Evaluation. It is required by the federal Omnibus Budget Reconciliation Act of 1987 (OBRA '87) before you can work as a nurse aide in any Medicare- or Medicaid-certified nursing facility. OBRA sets the national floor; each state board of nursing or department of health then contracts a testing vendor and adds its own rules. The most common vendor is Credentia, which administers the NNAAP (National Nurse Aide Assessment Program) and took over from Pearson VUE in 2021.

Exam At-A-Glance (NNAAP)

Why It Is Two Separate Parts

OBRA requires the evaluation to test both knowledge and hands-on competence, so the two portions are scored independently and you must pass each. A common trap on the exam and in registration paperwork: failing one portion does not void the other within the allowed retake window, but you generally must pass both within 24 months of completing training or your training certificate expires.

A second point candidates miss is the difference between certification and being on the registry. Passing the exam earns you the competency credential, but you cannot legally work as a paid nurse aide in a certified facility until the state has actually entered your name on the nurse aide registry. Processing can take days to a few weeks after results post, so do not promise an employer a start date the moment you walk out of the test center.

The Written (or Oral) Examination

The written test is multiple-choice with four options. Of the 70 NNAAP items, only 60 count toward your score; the 10 pretest items are unmarked, so you should answer every question carefully. There is no penalty for guessing — always fill in an answer. Candidates with reading difficulty or English as a second language may request the oral exam, which an examiner reads aloud and which adds a short reading-comprehension block to confirm basic literacy needed for charting.

State-Specific Variation (Know Your State)

Because certification is state-regulated, the numbers below are ranges, not fixed values. Always confirm with your state registry.

Vendors by Region

Your Path to Certification

1. Finish a state-approved program (minimum 75 hours).
2. Submit an application and pass a criminal + abuse-registry background check.
3. Pass the written/oral exam (70-75%).
4. Pass the 5-skill clinical evaluation.
5. Get placed on the state nurse aide registry — only then may you use the CNA title and work unsupervised in scope.

The 4-Month Work Rule and Registry Placement

OBRA includes a practical timing rule that confuses many new aides: a facility may put you to work before you are fully certified, but you must complete training and pass the competency evaluation within four months (120 days) of your first paid nurse-aide day. If you do not, the facility can no longer let you work as an aide. This is why programs push you to test promptly. Once you pass both portions, the vendor reports your result and the state adds you to the nurse aide registry, a public list employers check before hiring.

Being on the registry "in good standing" — with no substantiated findings of abuse, neglect, or theft — is what legally authorizes you to work.

Fees, Retakes, and Reciprocity

Exam fees are set by each state and vendor and typically fall in the $100-$150 range for the combined written-plus-skills attempt, with reduced fees to retake only the portion you failed. Most states allow three attempts within the two-year window from training completion; exhausting them usually means repeating the training course. If you move, reciprocity (endorsement) lets you transfer an active, in-good-standing certification to a new state without re-testing, provided you apply before your current certification lapses.

Always confirm the exact fee, attempt limit, and reciprocity rules on your own state registry's site, because these are the details that change most often and are the ones candidates most frequently get wrong on application paperwork.