The Montana CNA Knowledge Exam: Format, Fees, and Content Outline

What the Montana CNA Exam Is

To work as a Certified Nursing Assistant (CNA) in Montana, you must pass the state competency evaluation and be placed on the Montana Nurse Aide Registry. The evaluation has two separate components: a knowledge exam (written or oral) and a clinical skill test. You must pass both — passing one does not compensate for failing the other, and each is scheduled, scored, and paid for separately.

The exam is administered by Headmaster LLP, also known as D&S Diversified Technologies, a testing company based in Helena, Montana, working under contract with the Montana Department of Public Health and Human Services (DPHHS). The legal foundation for the whole system is the federal Omnibus Budget Reconciliation Act of 1987 (OBRA '87), which requires every state to train and test nurse aides before they work in nursing facilities that accept Medicare or Medicaid. Montana's test blueprint, training minimums, and registry rules all trace back to OBRA '87.

Knowledge Exam Format

The knowledge exam is a multiple-choice test with a precise, published structure:

• 72 questions, all multiple choice with four answer options
• 90 minutes of testing time — about 75 seconds per question, which is generous if you have studied
• Passing score: 75%, which works out to exactly 54 correct answers out of 72

The exam is normally taken on a computer at an approved test site. Questions are scenario-based as often as they are factual: instead of simply asking what a normal pulse range is, the exam typically describes a resident situation and asks what the nurse aide should do first, do next, or report. That style rewards understanding scope of practice, safety priorities, and resident rights — not just memorized lists.

The Audio (Oral) Option

Candidates who have difficulty reading English may request the audio (oral) knowledge exam, in which each question and its answer options are read aloud through wired headphones while also appearing on screen. On-screen audio controls let you play, rewind, and pause each question as often as you need. Three rules matter here. First, the audio version replaces the standard written fee rather than adding to it: it costs $31 instead of $20. Second, the audio exam is offered in English only and only electronically — Bluetooth headphones are not allowed, so you use the wired headphones or earbuds plugged into the testing computer. Third, you must request it before paying your testing fees by checking 'Enable Audio Testing' in your TMU account — it cannot be added afterward, and you cannot decide on test day. Candidates who simply want to re-read questions at their own pace do not need the audio version; it is intended for documented reading or language needs.

Fees at a Glance

The published Montana fee schedule lists only three prices, and the knowledge fee is either the standard $20 or the audio $31 — never both:

Combining them gives the two totals candidates actually pay:

Most first-time candidates take the standard knowledge exam and the skill test together for $97. Fees are paid when you schedule, and a no-show forfeits them — the scheduling section of this chapter covers those policies.

The Twelve Official Subject Areas

The Montana Candidate Handbook publishes the exact content outline, including how many of the 72 questions come from each subject area. Learn this table — it tells you where your study time earns the most points.

Reading the Blueprint Strategically

Three observations should shape your preparation:

• Basic Nursing Skills and Infection Control dominate. At 11 questions each, these two areas supply 22 of the 72 questions — nearly a third of the exam. Together with Safety (8) and Personal Care (7), the top four areas account for 37 questions, more than half the test.
• Small areas still matter. Older Adult Growth & Development contributes only 2 questions and Data Collection only 3, but at a 75% passing bar you can miss at most 18 questions, so giving away easy points in low-weight areas is a real risk.
• Everything maps to daily CNA work. The outline is not academic. Infection Control questions test hand hygiene, glove and gown use, and transmission-based precautions in realistic scenarios; Safety questions test falls, fires, and body mechanics. Study each area as "what would I do on the floor," and the scenarios become predictable.

The clinical skill test has its own format — one mandatory first task drawn from four hand-washing-embedded tasks, plus two or three randomly selected tasks, for three or four tasks total in 35 minutes — and is covered in the final chapter of this guide. For now, keep the knowledge exam's core numbers fixed in memory: 72 questions, 90 minutes, 54 correct to pass.