TL;DR
The NNAAP (National Nurse Aide Assessment Program) is the most widely used CNA certification exam, consisting of a written (or oral) knowledge test and a clinical skills evaluation. The written portion has 60–70 multiple-choice questions covering patient care, safety, infection control, communication, legal rights, and psychosocial care. Most states require a score of 70–80% to pass. The exam is not especially difficult if you completed your training program attentively, but many candidates fail because they rush through questions, misread scenarios, or neglect the legal/rights and communication domains. With 2–4 weeks of focused preparation using practice tests, you can pass confidently on your first attempt.
How to Pass the CNA Written Examination (NNAAP) in 2026
| Questions on written exam | 60–70 |
| Time allowed | 90 minutes |
| Typical passing score | 70–80% |
| First-time pass rate | ~85% |
| Number of skills tested | 3–5 (randomly selected) |
| Certification renewal | Every 2 years (with work requirement) |
The CNA certification exam is the final step between completing your Certified Nursing Assistant training program and beginning your career in healthcare. The NNAAP written exam tests whether you understand the knowledge required to safely care for patients in long-term care and hospital settings.
The exam covers five major domains: Physical Care Skills (the largest portion, covering vitals, hygiene, nutrition, positioning, and skin care), Safety (falls prevention, fire safety, infection control, body mechanics), Communication (therapeutic communication, reporting and documentation), Legal and Ethical Issues (patient rights, advance directives, abuse reporting, scope of practice), and Psychosocial Care (mental health, cultural sensitivity, restorative care).
The key to passing is understanding that this is not a memorization test — it's a judgment test. Questions present scenarios and ask you to choose the best course of action. The correct answer is almost always the one that prioritizes patient safety, dignity, and communication. If you approach each question by asking "What would keep the patient safe and respected?", you'll find the right answer more often than not.
Study Schedule
Week 1: Foundation: Physical Care Skills
- -Review all vital signs procedures — normal ranges, when to report
- -Practice hygiene and grooming care concepts — patient dignity is key
- -Study nutrition and feeding assistance — aspiration precautions, special diets
- -Complete 2 adaptive practice sessions focusing on nursing skills modules
Week 2: Physical Care + Safety
- -Study positioning, transfers, and range of motion — body mechanics for you AND the patient
- -Review skin care and pressure injury prevention — staging, turning schedules
- -Master infection control — standard precautions, hand hygiene, PPE, isolation types
- -Study fall prevention and fire safety (RACE and PASS)
- -Complete 2 adaptive sessions and 1 topic drill on safety
Week 3: Communication, Legal, and Psychosocial
- -Study therapeutic communication techniques — open-ended questions, active listening, empathy
- -Review reporting and documentation — what to report, chain of command, objective vs subjective
- -Master patient rights — privacy, refusal of treatment, informed consent
- -Study advance directives, abuse recognition and reporting obligations
- -Review scope of practice — what CNAs can and cannot do
- -Complete 2 adaptive sessions covering communication and legal modules
Week 4: Review and Exam Simulation
- -Review psychosocial care — mental health observations, cultural competence, restorative care
- -Take 2 full timed mock exams — simulate real test conditions
- -Review all incorrect answers and identify remaining weak areas
- -Do targeted topic drills on your weakest 2–3 modules
- -Review exam-day procedures and logistics
Want more practice like this?
Start practicing free →Common Mistakes to Avoid
Choosing the "nurse" answer instead of the CNA answer
Always stay within CNA scope of practice. If a question asks what YOU should do, the answer is never to administer medication, change a care plan, or perform assessments. Report to the nurse and document.
Ignoring patient dignity and autonomy
The correct answer almost always respects patient preferences, provides privacy, and promotes independence. If an answer involves doing something TO a patient without their input, it's probably wrong.
Rushing through scenario questions
Read the entire scenario carefully. Many wrong answers are technically correct actions but not the BEST or FIRST action. Look for keywords like "first," "best," "most important," and "priority."
Neglecting the legal/rights domain
Many candidates focus all their study on clinical skills and are surprised by questions about advance directives, HIPAA, abuse reporting, and patient bill of rights. These questions are straightforward if you've studied them, but impossible to guess.
Confusing infection control precautions
Know the difference between standard precautions (used for ALL patients) and transmission-based precautions (contact, droplet, airborne). Know which PPE goes with which type. This is heavily tested.
Not practicing with timed conditions
The written exam is timed, and anxiety causes mistakes. Take at least 2 full practice exams under timed conditions before exam day so you're comfortable with the pace.
Score Targets
The NNAAP passing score varies by state but typically requires 70–80% correct on the written portion. Most states set the bar at 70% (approximately 42–49 correct out of 60–70 questions).
Aim for 80% or higher on practice tests to give yourself a comfortable margin. If you're consistently scoring 85%+ on Valenke's adaptive sessions, you're well-prepared. If you're scoring below 75%, focus on your weakest domains — check your readiness report for specific module scores.
The clinical skills evaluation is scored separately as pass/fail. You must pass both the written and skills portions to earn certification. Practice your skills at home or with a study partner — the skills test evaluates specific steps that must be performed in order.
Exam Day Checklist
- Arrive 30 minutes early with two forms of ID — check your state's specific requirements
- Read every question completely before looking at the answer choices — many errors come from misreading the scenario
- When stuck between two answers, choose the one that prioritizes patient safety and dignity
- Don't change answers unless you're certain your first choice was wrong — your first instinct is usually correct
- Mark difficult questions and return to them after completing easier ones
- For the skills evaluation, narrate what you're doing as you perform each step — evaluators can't give credit for steps they don't observe
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