CNA Certification

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Certified Nurse Assistant (CNA) is a credential which prospective employees must obtain before being allowed to work in the field of nursing assistance in the United States. Since 1992, nursing facilities which participate in Medicare or Medicaid may only employ nurse assistants (also known as "nurse aides") who have received certification.[1] Many different certification exams exist. However, the most common CNA exam, the National Nurse Aide Assessment Program (NNAAP), was introduced by the National Council of State Boards of Nursing (NCSBN) in 1999.[2]

Function and Implementation of the Credential

CNA Study Guide

A 1991 amendment to the Omnibus Budget Reconciliation Act (OBRA) of 1987 required that all nurse assistants working in Medicare or Medicaid-participating nursing facilities achieve certification by April 1992.[1] The intention of this regulation was to ensure that government-subsidized healthcare be administered only by individuals who have proven they have the proper medical education, training, and skills necessary to perform their duties.[1]

The actual implementation of the CNA credential was left up to each individual state, and requirements can vary greatly from location to location. In addition, a CNA certified to practice in one state is not automatically certified to practice in any other state, and there is no completely standardized or centralized process for transferring certification to a new state. Given the fact that there are 50 states, there are 2,450 possible ways a CNA might move across state lines (e.g., from New York to any of the other 49 states; from California to any of the other 49 states; etc.),[3] so certification transfer can be complicated. However, many CNAs may be able to successfully transfer certification from one state to another through the process of "reciprocity."[4]

According to the United Stated Bureau of Labor Statistics, there were 1,534,400 nursing assistants or orderlies in the United States in 2012, and that number was expected to rise 22% by 2022.[5]

Typical Requirements

CNA Flashcards

The national requirements for CNA certification and training programs are detailed in § 483.152 of Title 42 (Public Health) of the Code of Federal Regulations,[6] while the examination requirements are detailed in § 483.154.[7] At a minimum, prospective CNAs must receive at least 75 clock-hours of training, and the training must address at least these areas:[8]

  • Communication and interpersonal skills
  • Infection control
  • Safety/emergency procedures, including the Heimlich maneuver
  • Promoting residents' independence
  • Respecting residents' rights
  • Basic nursing skills
  • Personal care skills
  • Mental health and social service needs
  • Care of cognitively impaired residents
  • Basic restorative services
  • Residents' Rights

The training process must also include a minimum of 16 hours of "supervised practical training" in which the CNA trainee performs practical tasks outside of the classroom setting.[8] Keep in mind that these requirements are the bare minimum stipulated by the US federal government. Individual states or individual training programs may have more stringent requirements for their CNA trainees and candidates.

Test Administration

Different states implement their CNA assessment programs in different ways. Many states use their own unique examination, but 24 states (and the District of Columbia) use the National Nurse Aide Assessment Program (NNAAP) maintained by the National Council of State Boards of Nursing (NCSBN).[9]

The ten most populous states use the following examinations for CNAs:

CNA Exams in the Ten Most Populous States
State Exam
1 California NNAAP[9]
2 Texas NNAAP[9]
3 Florida Florida Nurse Aide Exam[10]
4 New York New York Nurse Aide Exam[11]
5 Illinois Illinois Nurse Aide Testing[12]
6 Pennsylvania NNAAP[9]
7 Ohio Nurse Aide Competency Exam[13]
8 Georgia NNAAP[9]
9 North Carolina NNAAP[9]
10 Michigan Michigan Nurse Aide Exam[14]

Test Format

Sections of the CNA Test
CNA Test Subject Areas Percent
Role of the Nurse Aide 18%
Promotion of Safety 18%
Promotion of Function and Health of Residents 24%
Basic Nursing Care Provided by the Nurse Aide 26%
Providing Specialized Care for Residents with Changes in Health 14%
Total 100

Test Environment

Candidates are expected to arrive at least half an hour early. The CNA exam takes place at Prometric Testing Centers. It is computer-based, and the written part consists only of multiple choice questions. During the Clinical Skills test, two nurses will score each candidate based on the five skills that are asked to be performed. Personal items such as electronics and bags are not allowed in the testing center. Restroom breaks are allowed, however time on the exam will not be paused.[15]

Test Structure

The Certified Nursing Assistant test deals with six major topics: Role of the Nurse Aide; Promotion of Safety; Promotion of Function and Health of Residents; Basic Nursing Care Provided by the Nurse Aide; and Providing Specialized Care for Residents with Changes in Health. There will also be a practical Clinical Skills test. The written exam willl consist of 60 multiple choice questions to be answered within an hour and a half. The clinical skills test will score each candidate on five skills, and will generally last around 30 to 40 minutes.[16]

Test Content

  • Sample CNA Practice Questions
  1. Which of the following is NOT considered personal protective equipment?
    A. Gloves
    B. Gowns or other outer clothing
    C. Hand washing equipment
    D. Masks, face shields, goggles, and glasses
  2. For what type of patients is the use of the logrolling technique appropriate?
    A. Patients from whom you need to obtain a urine specimen
    B. Patients capable of helping you to move them
    C. Patients in respiratory distress
    D. Patients who have sustained a neck or spinal cord injury
  3. When might an NPO diet be ordered for a patient?
    A. If the patient is a diabetic
    B. When the patient is about to undergo some type of testing or surgical procedure, or if the patient is in a situation where he/she cannot swallow
    C. If the patient has hypertension
    D. If the patient has difficulty chewing
  4. Your patient has poor lower body strength and fairly weak upper body strength as well. What is the best technique to use the ambulation on crutches?
    A. The three-point technique
    B. The four-point technique
    C. The swing-to method
    D. The swing-through method
  5. The team member responsible for the policies, procedures, and actions of other team members while caring for a resident is the:
    A. Registered nurse (RN)
    B. Physical therapist
    C. Director of Nursing
    D. Licensed practical nurse (LPN)
  6. Which selection would not be considered a comfort measure for an elderly dying resident?
    A. Offering a back rub without turning the resident
    B. Repositioning the resident once a shift
    C. Turning and repositioning every two hours
    D. Allowing family members to leave the room when care is taking place
  7. What is the most appropriate attire for a new admission to the nursing facility to wear during an assessment?
    A. A jogging suit
    B. Silk pajamas
    C. A hospital gown
    D. Street clothes of any kind
  8. The appropriate order of putting on isolations protection should be:
    A. Gown, mask, gloves
    B. Mask, gloves, gown
    C. Gown, gloves, mask
    D. Mask, gown, gloves
  9. Which is the most appropriate way to give oral hygiene to an unconscious resident?
    A. A toothbrush and water
    B. With oral glycerin swabs
    C. With a syringe and mouthwash
    D. It is not necessary to do oral care for an unconscious client

More free CNA practice test questions.

Answers to Sample Questions

1;C 2;D 3;B 4;B 5;C 6;C 7;C 8;A 9;B


  1. ^ a b c New Jersey Department of Health - Navigating the NATCEP December 30 2014
  2. ^ NCSBN - NCSBN Historical Timeline, 1995-2002, Milestones, 1999; December 30 2014
  3. ^ Combinations and Permutations Calculator, n = 50, r = 2, order important, repetition disallowed; December 30 2014
  4. ^ CNA Tips - CNA Certification Transfer December 30 2014
  5. ^ BLS - Occupational Outlook Handbook - Nursing Assistants and Orderlies December 30 2014
  6. ^ NCSBN - NNAAP FAQs December 30 2014
  7. ^ § 483.154 Nurse aide competency evaluation December 30 2014
  8. ^ a b § 483.152 Requirements for approval of a nurse aide training and competency evaluation program December 30 2014
  9. ^ a b c d e f NCSBN - NNAAP Clients December 30 2014
  10. ^ Prometric - Florida Certified Nursing Assistant December 30 2014
  11. ^ Prometric - New York Certified Nursing Assistant December 30 2014
  12. ^ Southern Illinois University - Postmark and Exam Dates 2014 & 2015 December 30 2014
  13. ^ D&S Diversified Technologies LLP - STNA Candidate Handbook December 30 2014
  14. ^ Prometric - Michigan Certified Nursing Assistant December 30 2014
  15. ^ Nurse Assistant Training 30 December 2014
  16. ^ CNA Exam 30 December 2014

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