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CNA Skills Test: Complete Guide to the 22 NNAAP Skills

Every NNAAP clinical skill with the critical pass/fail steps. Hand washing is always tested. The other four are randomly assigned on test day.

22

NNAAP Skills

5

Tested per Candidate

30 min

Total Time

How the NNAAP Skills Test Works

The NNAAP clinical (skills) evaluation is the hands-on portion of the CNA certification exam used in most U.S. states. It is administered by Credentia, Prometric, Headmaster, or PSI, depending on your state. On test day, each candidate is randomly assigned 5 skills to perform on a live or simulated resident in approximately 30 to 35 minutes while a trained evaluator scores each step against a standardized checklist.

The 5 skills break down as follows: hand washing is always the first skill, at least one of the remaining four is a measurement skill (blood pressure, pulse, respirations, weight, or urinary output), and the remaining three are pulled at random from the rest of the NNAAP list. You will not know which skills you have been assigned until the day of the exam, so you must practice all of them.

Indirect Care Steps Are Always Scored

Across every single skill, evaluators also score indirect care behaviors: knock and identify yourself, identify the resident, explain the procedure, provide privacy, raise the bed to a safe working height (and lower it before leaving), keep the call light within reach, lock bed and chair wheels, use proper body mechanics, and preserve resident dignity throughout. Skipping or rushing these steps is the most common reason for failing the skills test.

Critical Fail Steps

Each skill has a small number of critical steps — actions so important that missing them is an automatic fail of that skill regardless of how well the rest is performed. We highlight these critical steps below for every NNAAP skill. The most common automatic fails across all skills are: touching the faucet with bare hands after washing, failing to lock wheels before a transfer, dressing the strong arm first instead of the weak side, and causing pain to the resident.

The 22 NNAAP Skills

Grouped by category. Steps marked with a red bar are critical (automatic fail) steps. Memorize those first.

Always tested (1)

Hand Hygiene (Hand Washing)

Hand washing is the only NNAAP skill tested on every single candidate. Total scrub time must be at least 20 seconds with friction over all surfaces of the hands, and the faucet must be turned off with a clean paper towel.

Key steps

  1. 1. Turn on water and adjust temperature to warm.
  2. 2. Wet hands and wrists thoroughly with fingertips pointed down.
  3. 3. Apply soap.
  4. 4. Lather all surfaces with friction for at least 20 seconds — palms, backs, between fingers, around nails. Critical
  5. 5. Rinse with fingertips pointed down so water runs from cleanest to dirtiest.
  6. 6. Dry hands with clean paper towels, then turn off the faucet with a clean dry paper towel. Critical
  7. 7. Dispose of paper towels in the trash without recontaminating the hands.

Exam tip

  • · A common automatic fail is touching the faucet or sink edge with bare hands after washing.
  • · Keep your uniform from touching the sink — the sink is considered contaminated.
  • · Do not shake water from your hands; pat dry with a paper towel.

Measurement (5)

Measures and Records Electronic Blood Pressure

Correctly applies an automated blood-pressure cuff to the brachial artery, records the reading within ± 8 mmHg of the evaluator value, and reports to the nurse.

Key steps

  1. 1. Position the resident with the arm supported at heart level.
  2. 2. Place the cuff snugly above the antecubital space with the artery marker over the brachial artery.
  3. 3. Press start and allow the machine to inflate and deflate.
  4. 4. Record the reading on the worksheet within plus or minus 8 mmHg of the evaluator value. Critical
  5. 5. Remove the cuff and ensure resident comfort.

Counts and Records Radial Pulse

Locates the radial pulse, counts for one full minute, and records the rate within ± 4 beats of the evaluator value.

Key steps

  1. 1. Place fingertips (not the thumb) on the radial artery, thumb side of the wrist. Critical
  2. 2. Count for a full 60 seconds. Critical
  3. 3. Record the rate within plus or minus 4 beats of the evaluator value. Critical

Counts and Records Respirations

Counts respirations for one full minute without telling the resident and records the rate within ± 2 breaths of the evaluator value.

Key steps

  1. 1. Without announcing what you are doing, observe the chest rising and falling.
  2. 2. Count for a full 60 seconds (one rise plus one fall equals one breath). Critical
  3. 3. Record the rate within plus or minus 2 breaths of the evaluator value.

Measures and Records Weight of Ambulatory Resident

Uses a standing scale to weigh an ambulatory resident, records the value within ± 2 lb of the evaluator value, and reports the result.

Key steps

  1. 1. Balance the scale to zero before the resident steps on.
  2. 2. Help the resident remove shoes and step onto the scale.
  3. 3. Record the weight within plus or minus 2 lb of the evaluator value. Critical
  4. 4. Assist the resident off the scale safely.

Measures and Records Urinary Output

Pours urine into a graduate, measures at eye level on a flat surface, and records the volume in mL within ± 25 mL of the evaluator value.

Key steps

  1. 1. Don gloves before handling the urinal or bedpan. Critical
  2. 2. Pour the urine into a clean graduate.
  3. 3. Place the graduate on a flat surface and read at eye level. Critical
  4. 4. Record the volume in mL within plus or minus 25 mL of the evaluator value.
  5. 5. Empty, rinse, and store the graduate per facility policy.
  6. 6. Remove gloves and perform hand hygiene.

Personal care (6)

Provides Mouth Care

Brushes the resident teeth, gums, and tongue using a toothbrush; rinses; and dries the face afterward.

Key steps

  1. 1. Position the resident with the head of the bed elevated.
  2. 2. Wet the toothbrush, apply toothpaste, and brush all surfaces of the teeth, tongue, and gums.
  3. 3. Allow the resident to rinse and spit into the basin.
  4. 4. Wipe the mouth and chin, and remove the towel.
  5. 5. Dispose of soiled supplies and perform hand hygiene.

Cleans Upper or Lower Denture

Cleans a denture over a cushioned surface, rinses with cool water, and returns it to a labeled storage container.

Key steps

  1. 1. Line the sink with a soft cloth or fill the basin with water to cushion the denture if dropped. Critical
  2. 2. Brush all surfaces of the denture with denture cleaner under cool running water (never hot). Critical
  3. 3. Rinse the denture thoroughly.
  4. 4. Place the denture in a labeled, water-filled storage cup.
  5. 5. Remove gloves and perform hand hygiene.

Gives Modified Bed Bath (Face and One Arm, Hand, and Underarm)

Washes face, one arm, the hand, and the underarm using the correct cleanest-to-dirtiest sequence with privacy and dignity.

Key steps

  1. 1. Provide privacy by closing the door and curtain and draping the resident. Critical
  2. 2. Check water temperature with the inner wrist or a thermometer (around 105 F).
  3. 3. Wash eyes from inner to outer canthus, using a clean section of the cloth for each eye. Critical
  4. 4. Wash face, then arm using long strokes from wrist toward shoulder.
  5. 5. Soak the hand briefly, then wash and dry.
  6. 6. Wash the underarm thoroughly and dry completely.
  7. 7. Empty water, dispose of linens, and perform hand hygiene.

Dresses Resident with Affected (Weak) Right Arm

Dresses a resident by putting the garment on the weak side first and removing it from the strong side first.

Key steps

  1. 1. Provide privacy and drape the resident.
  2. 2. Place the garment on the weak (right) arm first. Critical
  3. 3. Bring the garment over the strong (left) arm.
  4. 4. Smooth and fasten the garment for comfort.
  5. 5. Dispose of soiled clothing and perform hand hygiene.

Exam tip

  • · Memorize the rule: sick (weak) goes in first; well (strong) comes out first.

Provides Perineal Care for an Incontinent Female

Cleanses the perineum from front to back with a clean section of the cloth for each stroke, maintaining privacy and skin integrity.

Key steps

  1. 1. Don gloves and provide privacy. Critical
  2. 2. Wash perineum from front to back, using a clean section of cloth for each stroke. Critical
  3. 3. Rinse and dry the area thoroughly.
  4. 4. Reposition the resident comfortably and remove the bath blanket.
  5. 5. Dispose of soiled linens, remove gloves, and perform hand hygiene.

Provides Foot Care for One Foot

Washes, rinses, and dries the foot, then applies lotion (avoiding between the toes) and inspects skin and nails.

Key steps

  1. 1. Don gloves and provide privacy.
  2. 2. Check water temperature with the inner wrist (warm, never hot). Critical
  3. 3. Soak the foot briefly in the basin, then wash with soap.
  4. 4. Rinse, lift the foot from the basin, and dry thoroughly, especially between the toes. Critical
  5. 5. Apply lotion to the foot, avoiding the area between the toes.
  6. 6. Inspect skin and nails; report redness, sores, or thickened nails to the nurse.
  7. 7. Remove gloves and perform hand hygiene.

Mobility (3)

Positions Resident on Side

Turns the resident onto the side and supports the position with pillows for comfort and pressure relief.

Key steps

  1. 1. Raise the bed to a safe working height and lower the side rail on the working side.
  2. 2. Cross the resident arms over the chest and the leg over the other leg.
  3. 3. Turn the resident onto the side using proper body mechanics. Critical
  4. 4. Place a pillow behind the back for support.
  5. 5. Place a pillow between the knees.
  6. 6. Place a pillow under the upper arm.
  7. 7. Return the bed to its lowest position with the call light in reach. Critical

Transfers Resident from Bed to Chair Using a Transfer (Gait) Belt

Performs a safe stand-pivot transfer from bed to chair using a transfer belt and locked wheels.

Key steps

  1. 1. Position the chair on the resident strong side at a slight angle.
  2. 2. Lock the bed wheels and chair wheels. Critical
  3. 3. Raise the head of the bed and dangle the resident legs at the bedside.
  4. 4. Place non-skid footwear on the resident.
  5. 5. Apply the gait belt snugly over clothing (fingers fit underneath but not the whole hand). Critical
  6. 6. Stand in front of the resident, block their knees with yours, and grasp the belt underhand.
  7. 7. On a count of three, assist the resident to stand, pivot, and lower into the chair.
  8. 8. Remove the gait belt and position comfortably with the call light in reach.

Assists to Ambulate Using Transfer Belt

Helps the resident ambulate a measured distance with a transfer belt, walking slightly behind and to the weak side.

Key steps

  1. 1. Apply non-skid footwear to the resident.
  2. 2. Apply the gait belt snugly over clothing. Critical
  3. 3. Assist the resident to a standing position and check for dizziness before walking.
  4. 4. Walk slightly behind and to the resident weaker side, grasping the belt underhand.
  5. 5. Walk the measured distance (typically 10 feet) and safely return the resident to a seated position.

Restorative (4)

Feeds a Resident Who Cannot Feed Self

Identifies the meal, positions the resident upright, feeds at the resident pace, and offers fluids between bites.

Key steps

  1. 1. Verify the meal matches the resident dietary order and identify the food to the resident.
  2. 2. Position the resident upright (90 degrees) for safe swallowing. Critical
  3. 3. Place a clothing protector if desired, and explain each food before offering it.
  4. 4. Offer small bites at the resident pace, alternating with sips of fluid.
  5. 5. Wipe the mouth as needed and converse with the resident.
  6. 6. Keep the resident upright for at least 30 minutes after the meal to reduce aspiration risk.

Applies One Knee-High Elastic Stocking

Smoothly applies a TED hose or elastic stocking to one leg with no twists or wrinkles.

Key steps

  1. 1. Provide privacy and expose only the leg being treated.
  2. 2. Turn the stocking inside out to the heel.
  3. 3. Slip the foot of the stocking onto the resident foot, aligning the heel. Critical
  4. 4. Roll the stocking smoothly up the calf without bunching or twisting. Critical
  5. 5. Ensure no wrinkles remain — they can cause skin breakdown or impair circulation.

Performs Passive ROM on One Shoulder

Moves the resident shoulder through flexion, extension, abduction, and adduction with the joint supported above and below.

Key steps

  1. 1. Support the elbow and wrist throughout the exercise. Critical
  2. 2. Move the shoulder through flexion and extension 3 to 5 times.
  3. 3. Move the shoulder through abduction and adduction 3 to 5 times.
  4. 4. Move slowly and stop if the resident reports pain. Critical
  5. 5. Return the arm to a comfortable position when finished.

Performs Passive ROM on One Knee and One Ankle

Moves the resident knee and ankle through their normal range, supporting the joint above and below.

Key steps

  1. 1. Support the knee and ankle throughout the exercise. Critical
  2. 2. Flex and extend the knee 3 to 5 times.
  3. 3. Dorsiflex and plantar flex the ankle 3 to 5 times.
  4. 4. Move slowly and stop if pain is reported. Critical
  5. 5. Return the leg to a comfortable position.

Elimination (2)

Provides Catheter Care for a Female Resident

Cleans the catheter starting at the meatus and moving outward for approximately 4 inches, using a clean section of cloth for each stroke.

Key steps

  1. 1. Don gloves and provide privacy. Critical
  2. 2. Position the resident supine with knees bent and apart, draping for privacy.
  3. 3. Clean the perineum from front to back first.
  4. 4. Clean the catheter starting at the meatus and moving outward 4 inches along the catheter, with a clean section of cloth for each stroke. Critical
  5. 5. Avoid pulling or tugging on the catheter.
  6. 6. Secure the catheter and ensure the drainage bag is below the bladder.
  7. 7. Remove gloves and perform hand hygiene.

Assists with Use of Bedpan

Positions the bedpan correctly, allows for privacy and elimination, and provides clean-up afterward.

Key steps

  1. 1. Don gloves and provide privacy.
  2. 2. Raise the head of the bed slightly.
  3. 3. Ask the resident to lift the hips or assist by rolling, then place the bedpan with the rounded edge toward the back. Critical
  4. 4. Place the call light within reach and leave for privacy when safe.
  5. 5. On return, lower the head of the bed, remove the bedpan, and clean the perineum.
  6. 6. Empty, rinse, and disinfect the bedpan.
  7. 7. Remove gloves and perform hand hygiene.

Infection control (1)

Donning and Removing PPE (Gown and Gloves)

Demonstrates the correct order for putting on and removing a gown and gloves without self-contamination.

Key steps

  1. 1. Don gown: opening in back, tie at neck and waist.
  2. 2. Don gloves over the cuffs of the gown.
  3. 3. When finished, remove gloves first (peel off, glove inside glove). Critical
  4. 4. Untie the gown waist tie, then neck tie.
  5. 5. Remove gown by pulling away from neck and shoulders, turning it inside out as it comes off.
  6. 6. Roll the gown and dispose of it.
  7. 7. Perform hand hygiene immediately after PPE removal. Critical

Indirect Care Steps — Scored on Every Skill

  • · Knock, identify yourself, and identify the resident before beginning.
  • · Explain the procedure in simple terms.
  • · Provide privacy (close door, pull curtain, drape the resident).
  • · Wash hands at the start and after the skill.
  • · Raise the bed to a safe working height; lower it before leaving.
  • · Lock the bed wheels (and chair wheels for transfers).
  • · Place the call light within reach when finished.
  • · Use proper body mechanics (feet apart, bend knees, hold load close).
  • · Maintain resident dignity and respect at all times.

Frequently Asked Questions

How many skills are on the CNA skills test?

The current NNAAP skills list maintained by Credentia contains 22 skills (some state versions list 23, with the additional skill being foot care or modified bed bath variants). On test day, each candidate is randomly assigned 5 skills to perform. Hand washing is always the first skill assigned, and at least one of the remaining four is a measurement skill (blood pressure, pulse, respirations, weight, or urinary output). The remaining skills are drawn from the personal care, mobility, restorative, and elimination categories.

Which CNA skill is on every exam?

Hand washing is the only NNAAP skill that is tested on every candidate, every time. It must be at least 20 seconds of friction with soap and water across all hand surfaces, with the faucet turned off using a clean paper towel. Touching the faucet or sink with bare hands after washing is the most common automatic-fail step on the entire skills exam.

What are 'indirect care' steps on the CNA skills exam?

Indirect care steps are the behaviors scored on every single skill, regardless of the procedure being performed: knock and identify yourself, identify the resident, explain the procedure, provide privacy, raise the bed to a safe working height (and lower it when finished), keep the call light within reach, lock bed wheels, use proper body mechanics, and maintain dignity. Skipping any of these can cost points or trigger an automatic fail, even if the rest of the skill is perfect.

How long is the CNA skills test?

Candidates are typically given 30 to 35 minutes to perform their 5 randomly assigned skills. The evaluator times the test and observes each step against a standardized checklist. The skills test is taken on the same day as the written exam in most states, either before or after the knowledge portion.

What causes an automatic fail on the CNA skills exam?

Common automatic-fail steps include: touching the faucet with bare hands after washing, failing to lock bed or chair wheels before a transfer, putting the wrong arm into clothing first when dressing an affected resident, contaminating sterile or clean items, leaving the bed in the highest position, leaving the call light out of reach, or causing pain. The exact 'critical fail' steps are marked on the evaluator's checklist for each skill — focus on those during practice.

Can I retake the skills test if I fail?

Yes. Most states allow up to 3 attempts within a 24-month window of completing your training program. Some states allow you to retake only the portion you failed (written or skills) and keep your passing score on the other section. After the third failure, candidates typically must retake the full state-approved nurse aide training program before testing again.

Don't Forget the Written Exam

You also have to pass a 60-question written exam. Drill these free NNAAP-style practice tests until you score above 80%.

Full exam

60-Question CNA Practice Test

25 questions

Infection Control

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Patient Rights

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Basic Nursing Skills

22 questions

Safety and Emergency Procedures

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