- A CNA passes a two-part NNAAP exam: a knowledge test and a hands-on Skills Evaluation.
- The written knowledge exam has 70 items (60 scored, 10 pretest) with a two-hour limit.
- Basic Nursing Skills is the largest domain, worth 35% of the knowledge exam.
- The Skills Evaluation tests five randomly selected skills in 30 minutes, and all five must be satisfactory.
What Is A CNA, Exactly?
A Certified Nursing Assistant (CNA) is a healthcare worker who has completed a state-approved training program and passed a competency exam to provide direct, hands-on care to patients under the supervision of licensed nurses. CNAs handle activities of daily living, basic nursing tasks, and communication between patients, families, and the broader care team. The title "certified" refers specifically to having passed the required knowledge and skills evaluation and being placed on a state nurse aide registry.
If you've landed here after searching What Is CNA?, CNA Meaning, or What Does CNA Stand For?, this article answers the same underlying question from a testing-and-certification angle: what does it actually take to become one, and what will the exam ask of you?
Who Manages CNA Certification
Credentia Nurse Aide LLC develops and manages the National Nurse Aide Assessment Program (NNAAP), which is used by participating state nurse aide registries as the standard competency test for certification. This is the exam most people mean when they ask what it takes to become a CNA. Because requirements and administration details flow through your state's nurse aide registry, always confirm specifics with your state agency alongside general exam preparation.
The Two-Part CNA Exam Structure
The current NNAAP has two required components, and a candidate must pass both:
- Knowledge Examination: Available as a written or oral test. The written version contains 70 multiple-choice items - 60 scored and 10 unscored pretest items - with a two-hour time allowance. The oral version substitutes 10 word-recognition items for reading-based questions but keeps 60 scored multiple-choice items and the same two-hour limit.
- Skills Evaluation: A hands-on demonstration of five randomly selected nursing skills, completed in 30 minutes before a Nurse Aide Evaluator. Hand hygiene and one measurement skill are always included among the five. Every one of the five skills must be rated satisfactory to pass this portion.
The knowledge exam may be offered through live online proctoring in some states, while the Skills Evaluation is always demonstrated live in front of an evaluator since it requires physical performance of tasks. For a deeper breakdown of exactly what score you need on each part, see CNA Passing Score 2026: Exactly What You Need to Pass.
Key Takeaway
Passing "the CNA exam" actually means passing two separate evaluations - knowledge and skills - and failing either one means you have not met certification requirements yet.
The 9 Knowledge Domains
The written or oral knowledge exam draws its 60 scored items from nine content domains defined under the national blueprint. Understanding the weight of each domain tells you where to invest your study time.
Domain 2: Basic Nursing Skills (35%)
This is by far the largest domain and covers infection control, safety, body mechanics, measuring vital signs, and other core hands-on nursing tasks. It deserves the largest share of your review time.
- Infection control and hand hygiene principles
- Vital signs and measurement procedures
- Safety and body mechanics during care
Domain 1: Activities of Daily Living (22%)
Covers assisting patients with eating, bathing, dressing, toileting, mobility, and comfort - the everyday tasks that make up much of a CNA's shift.
| Domain | Weight |
|---|---|
| Basic Nursing Skills | 35% |
| Activities of Daily Living | 22% |
| Emotional and Mental Health Needs | 8% |
| Client Rights | 8% |
| Self-Care and Independence | 7% |
| Communication | 7% |
| Member of the Health Care Team | 6% |
| Legal and Ethical Behavior | 5% |
| Spiritual and Cultural Needs | 2% |
The remaining domains - Self-Care and Independence, Emotional and Mental Health Needs, Spiritual and Cultural Needs, Communication, Client Rights, Legal and Ethical Behavior, and Member of the Health Care Team - carry smaller individual weights but together make up a substantial portion of the exam. Skipping them because they're each "small" is a common mistake. For a full walkthrough of what each domain actually tests, read CNA Exam Domains 2026: Complete Guide to All 9 Content Areas.
Inside the Skills Evaluation
The Skills Evaluation is where many candidates feel the most pressure, because it's performed live in front of a Nurse Aide Evaluator rather than answered on paper. Here's what to know:
- You'll be assigned five skills at random out of the full skills list, so you cannot predict in advance exactly which ones you'll perform.
- Hand hygiene is always one of the five, along with one measurement skill (such as taking a vital sign).
- You have 30 minutes total to complete all five skills.
- All five skills must be rated satisfactory - there's no partial credit for passing four out of five.
To gauge realistically how demanding this combination of knowledge and hands-on testing is compared to what you might expect, see How Hard Is the CNA Exam? Complete Difficulty Guide 2026.
Who Can Become A CNA
Eligibility to sit for the exam is set at the state level, but the most common path is completion of a state-approved nurse aide training program, or an approved alternative route recognized by the state registry. Before you register for the exam itself, you'll typically need to:
- Confirm your state's specific eligibility rules and any prerequisite training hours.
- Complete a state-approved training program or qualifying alternative route.
- Register for the knowledge exam (written or oral) and the Skills Evaluation.
- Pass both parts and be placed on your state's nurse aide registry.
For the full breakdown of prerequisites, background check requirements, and training program details by pathway, see CNA Requirements 2026: Eligibility, Prerequisites & How to Qualify. If you're still choosing a training program, CNA Training covers what to look for. And if budgeting matters to your decision, CNA Certification Cost 2026: Complete Pricing Breakdown breaks down where your money goes.
Where CNAs Work
Once certified and listed on your state registry, CNAs are hired across a wide range of care settings, including:
- Skilled nursing facilities and nursing homes
- Hospitals, particularly on medical-surgical and long-term care units
- Assisted living and memory care communities
- Home health and hospice agencies
- Rehabilitation centers
The demand for CNAs across these settings is a big part of why so many people pursue the certification as an entry point into healthcare. If you're weighing whether the time and training investment pays off, Is the CNA Certification Worth It? Complete ROI Analysis 2026 and CNA Salary Guide 2026: Complete Earnings Analysis go into more detail. You can also browse CNA Jobs to see how the role translates into real openings.
A Domain-Based Prep Approach
Rather than studying everything with equal intensity, allocate your review time according to domain weight and testing format. Since Basic Nursing Skills accounts for over a third of the knowledge exam, and the Skills Evaluation tests hands-on competence directly, these two areas should anchor your schedule.
Basic Nursing Skills & ADLs
- Drill infection control, vital signs, and safety procedures (Domain 2)
- Practice assisting with eating, bathing, dressing, and mobility (Domain 1)
Rights, Ethics & Communication
- Review Client Rights, Legal and Ethical Behavior, and Communication domains
- Practice explaining care steps clearly, as required in real interactions
Skills Evaluation & Full Review
- Rehearse the full skills list under a 30-minute time constraint
- Take timed practice questions covering all nine domains
For a structured walkthrough of this kind of study sequencing, including how to pace yourself against the two-hour knowledge exam limit, see CNA Study Guide 2026: How to Pass on Your First Attempt. You can also review CNA Cheat Sheet 2026: One-Page Review of Must-Know Facts for a condensed reference during your final review days, and check CNA Exam Dates 2026: Testing Windows, Deadlines & Scheduling before locking in your test day.
Frequently Asked Questions
A CNA is a certified healthcare worker trained to assist patients with daily care needs and basic nursing tasks under the supervision of licensed nurses, after passing a required knowledge and skills exam.
It consists of a knowledge exam (written with 70 items, 60 scored plus 10 pretest, or oral with 60 scored items plus 10 word-recognition items) and a hands-on Skills Evaluation covering five randomly selected skills in 30 minutes.
Basic Nursing Skills, which makes up 35% of the knowledge exam - the largest single domain by far - followed by Activities of Daily Living at 22%.
Yes. All five randomly selected skills, including hand hygiene and one measurement skill, must be rated satisfactory to pass that portion of the exam.
Most candidates qualify by completing a state-approved nurse aide training program or an approved alternative route, then meeting their state registry's additional eligibility requirements.