1.5 Formats, Fees, Language Options, and Results Basics

Knowledge-Test Format: Items, Pretest, and Timing

The online knowledge exam follows the national NNAAP structure:

The pretest detail matters psychologically: 10 of the 70 questions do not count toward your score, and you cannot tell which ones they are. Do not waste energy hunting for "throwaway" questions — answer all 70 as if they count. The two-hour window is generous for 70 items, so the time pressure is mild; accuracy, not speed, is the constraint.

The oral alternative restructures this slightly: the oral exam consists of 60 multiple-choice questions plus 10 reading-comprehension questions, and a candidate must pass both the multiple-choice and reading-comprehension sections. The oral forms exist for candidates who read English with difficulty, and they are available in English and Spanish audio.

Fees: Three Separate Charges

Candidates routinely underestimate cost because the NAC process has three distinct fees owned by different parties:

Two nuances are worth memorizing. First, the skills-test fee is not a flat statewide number — it is determined by the training program, so two candidates can pay different amounts. Second, special situations carry different application fees: for example, if a NAC credential has been expired for more than a year, the reactivation application fee is $197 rather than $85. Always read the credentialing fee page for your specific situation rather than assuming the first-time $85 figure applies. Budget for all applicable charges up front so a missing payment never blocks scheduling — payments are due at the time of scheduling.

Results and Who Finalizes Certification

Result flow follows the agency map from earlier in the chapter. The skills test is scored on the day you take it by the RN evaluator, and you typically learn the outcome quickly — passing skills is what unlocks knowledge-test registration. The knowledge test is scored and reported by Credentia, the exam vendor.

But passing the test is not the same as being certified. Credentia reports your results; the credentialing agency (DOH today, WABON after July 1, 2026) is what actually issues the NAC credential and records it. The certificate is then reflected in the DSHS OBRA registry, the official record employers verify against. So the practical results checklist is:

1. Pass skills → unlocks knowledge registration.
2. Pass knowledge → Credentia reports the result.
3. Credentialing agency issues the NAC credential.
4. Certification appears in the OBRA registry for employer verification.

This guide deliberately avoids quoting an unofficial "pass percentage" or passing score, because the passing standard is set by the program owner and is reported as pass/fail to the candidate. Focus on demonstrating competence on every scored item and skill rather than chasing a rumored cutoff number.

Language Accommodations and Why the Oral Option Exists

The oral exam is not a shortcut or an "easier" test — it exists specifically to remove a reading barrier so that a candidate's clinical knowledge, not their English reading speed, determines the result. Understanding the three delivery modes helps you choose correctly:

• Online Knowledge (written): You read each English question yourself and select an answer. Best for candidates comfortable reading English.
• Online Oral (English): The computer reads each question and all answer choices aloud in English while you read along, and you select the answer. Best for candidates who understand spoken English well but read it slowly.
• Online Oral (Spanish): Questions and answers are read aloud in Spanish. Built for Spanish-dominant candidates who read English with difficulty.

The oral forms replace ten of the standard items with a reading-comprehension component in which you identify job-related words, and you must pass that section in addition to the multiple-choice section. The practical advice: choose the mode that lets your real knowledge show. A candidate who knows the material cold but reads English slowly often scores higher on the oral form, because they are not racing the clock to decode sentences. Decide your mode before scheduling — switching later can complicate registration.

Whichever mode you pick, the underlying clinical content and the standard you must meet are identical; only the delivery changes.

A closing reminder on logistics: because the knowledge test is webcam-proctored, plan for the environment it requires — a working camera, a quiet private space, and acceptable identification. Payment is due at the time of scheduling, so have your method ready and confirm the current fee for your situation (the routine $55 test fee, plus any separate application fees) before you sit down to book. Sorting out the format, the language mode, the proctoring setup, and the payment in advance turns test day into a formality rather than a scramble.