1.4 Exam Format, Fees, Scheduling, and Remote Options

Know exactly which exam you are scheduling

The Texas CNA competency evaluation has two required sides: knowledge and hands-on performance. The knowledge side is either the Written test or the Oral test. The performance side is the Clinical Skills test. Both must be passed before Registry placement.

The Written test is 60 multiple-choice questions with a 90-minute limit. That pace allows careful reading - about 90 seconds per item - but not endless second-guessing. The Oral test may be chosen instead: it has 60 multiple-choice questions plus an English reading-comprehension section, and the candidate must pass the reading-comprehension section on the same day to pass the Oral test. The Oral option is not a shortcut around understanding care; it changes the delivery format (items are read to the candidate) and adds the reading requirement.

Candidates with reading or language concerns should review the bulletin and any accommodation process early rather than days before testing.

The Clinical Skills test: five assigned skills

The Clinical Skills test is performance-based. An evaluator assigns five skills drawn from the official Prometric skills list - the candidate does not pick them, so preparation must cover the entire list. Hand hygiene (handwashing) is itself a graded skill and is also expected as an indirect behavior across the others. Representative skills include:

• Ambulation with a gait belt; bed-to-wheelchair transfer
• Bedpan assistance; perineal care; catheter care; urinary drainage-bag output measurement
• Occupied bed change; side-lying positioning; passive range of motion
• Dressing a resident with a weak (affected) arm; partial bed bath
• Feeding a resident; measuring pulse and counting respirations
• Mouth care; foot care; hand and nail care

Current exam and fee snapshot

Scheduling is part of exam preparation

Choose the Written or Oral route deliberately, not by default. A candidate taking the Oral test must still clear English reading comprehension the same day. A candidate taking a remote Written or Oral test must still satisfy Prometric rules for identity verification, a clean private environment, working technology, and live proctoring - and must still appear at a site for Clinical Skills. A remote knowledge test never converts the skills test to remote.

Fees should be checked against current Prometric materials before payment. Verified figures: $125 first-time Written + Skills and $135 first-time Oral + Skills; single/retake fees $35 Written, $45 Oral, $90 Skills. Budget for the route you are actually taking. A common mistake is assuming the cheap single-test number ($35) is the whole cost - it is only the Written component, not the required Skills test.

Let format drive the study plan

For the knowledge test, practice with a timer so 60 questions in 90 minutes feels routine; build the habit of rereading items that hinge on words such as first, best, most important, report, immediately, refuse, change, or unsafe. For the skills test, rehearse physically and out loud because you perform while observed. Many failures occur in the wraparound steps, not the central task: forgetting hand hygiene, skipping privacy, mismeasuring output, leaving the bed in a high position, or not placing the call light.

Finally, do not study around myths. There is no confirmable single Texas written passing-score percentage for this guide to teach, and the skills test is reliably described as five assigned skills - not a fixed total-checklist count to memorize. Worked example: a candidate budgets only "$35 for the test" and arrives unable to pay for Skills. The correct expectation for a first-time Written candidate is the $125 combined fee, because both components are required to reach the Registry.

What test day actually looks like, and how skills are scored

Knowing the flow of test day calms nerves and prevents avoidable failures. Arrive early with the required government-issued photo identification whose name matches your application exactly; a name mismatch can turn you away at the door. For the knowledge test, you answer 60 multiple-choice items - on screen for the Written route, read aloud for the Oral route - and the Oral route adds the same-day English reading-comprehension section you must also pass. For the Clinical Skills test, an evaluator observes you perform five assigned skills on a person acting as the resident, often in a lab-style setting.

You will not know in advance which five you draw, so every official skill must be practiced.

Clinical Skills scoring rewards completeness, not speed. Each skill has critical-element steps, and missing certain ones - notably hand hygiene, infection control, safety, and resident privacy - can fail the whole skill even if the central task looked smooth. The graded behaviors include knocking and identifying the resident, explaining care, washing hands at the right moments, protecting privacy, using safe body mechanics, measuring accurately when required, and leaving the resident safe with the call light in reach.

Because these wraparound behaviors decide pass/fail as much as the core task, the smartest preparation rehearses the entire scene end to end rather than only the central movement of each skill.