California CNA Exam Guide: What's on the State Test and How to Pass It

The California Certified Nurse Assistant (CNA) state competency exam is a two-part test that every CNA training program graduate must pass before working as a paid nursing assistant in California. Many candidates pass one part but struggle with the other — this guide explains both parts and how to approach them strategically.

Who Administers the California CNA Exam

California's CNA competency exam is administered by Prometric under contract with the California Department of Public Health (CDPH). It is separate from the federal CNA competency evaluation, though it meets the same federal requirements under OBRA '87 (Omnibus Budget Reconciliation Act of 1987).

The Two-Part Structure

The California CNA exam has two distinct components, both of which must be passed:

Part 1: Written (or Oral) Knowledge Test

• 60 multiple-choice questions, 90-minute time limit
• Available as a written test or an oral test (the oral version is read aloud by headphones for candidates who need accommodations or prefer it)
• 70% passing score — 42 of 60 questions correct
• Computer-based at Prometric testing centers throughout California

Part 2: Clinical Skills Test

• Candidate performs 5 randomly selected clinical skills in front of a trained evaluator
• Hand washing is always one of the 5 skills — it is tested every time
• The other 4 skills are drawn randomly from a pool of approximately 25 testable skills
• Each skill is scored on a checklist — certain steps are mandatory and failing them results in automatic failure of that skill
• You must pass all 5 skills to pass the clinical portion

Both parts can be taken on the same day or on separate days. Most candidates take the written test first, then the clinical test.

Written Test Content Areas

The California CNA written exam draws from eight content areas, weighted approximately as follows:

1. Physical Care Skills (largest category)

Activities of daily living, personal hygiene, bathing, oral care, dressing, grooming, toileting, positioning and transferring residents, range-of-motion exercises, feeding assistance, and vital signs measurement. This is the largest section and the most practice-dependent — the questions test procedural knowledge that comes directly from clinical training.

2. Psychosocial Care Skills

Communication with residents, supporting residents' dignity and independence, handling residents with dementia (validation techniques, redirection), end-of-life care concepts, and supporting residents' rights.

3. Restorative Services

Assisting residents to maintain or regain functional independence, use of assistive devices, restorative nursing program principles, and preventing complications of immobility (pressure injuries, contractures, pneumonia).

4. Member/Resident Rights

This is a heavily tested area. California CNAs are required to know and uphold residents' rights under both federal OBRA regulations and California Health and Safety Code. Key rights include privacy, dignity, the right to refuse treatment, the right to information about their condition, freedom from restraints, and the right to file a grievance without retaliation.

5. Infection Control

Standard precautions, transmission-based precautions (contact, droplet, airborne), proper hand washing technique, PPE usage and donning/doffing sequence, isolation procedures, and the chain of infection. Hand washing is both a clinical skills test component and a written test topic — most candidates should know the CDC-recommended 20-second minimum duration.

6. Safety/Emergency Procedures

Fall prevention, fire safety (RACE and PASS), emergency response procedures, proper use of call lights, recognizing signs of abuse and neglect (and mandatory reporting obligations), and safe use of bed rails and positioning devices.

7. Basic Nursing Skills

Measuring and recording intake and output, applying elastic stockings, catheter care, oxygen safety, basic wound care observation, and specimen collection procedures.

8. Mental Health and Social Service Needs

Recognizing depression, anxiety, and behavioral changes in residents; supporting residents with cognitive impairment; understanding the social model vs medical model of care; and end-of-life/hospice concepts.

The Clinical Skills Test: What Gets People

The clinical skills test has a higher failure rate than the written test for one primary reason: automatic failure steps. Each skill has a few critical steps that, if missed, result in automatic failure of that entire skill — regardless of how well you performed the rest of the procedure.

The most commonly failed automatic-failure steps:

• Forgetting to wash hands at the beginning of the session, before a skill, or after a skill
• Failing to identify the resident (checking the wristband or asking for name and date of birth) before performing any care
• Failing to explain the procedure to the resident before beginning
• Leaving the resident in an unsafe position at the end of a skill (side rail down, bed too high, call light out of reach)
• Breaking sterile technique during skills that require it

These steps are the same regardless of which skills are drawn. If you build the habit of doing them automatically for every skill during your training, they become muscle memory and are unlikely to be forgotten under exam pressure.

The Skills Pool: What You Might Be Tested On

California's Prometric CNA clinical skills pool includes approximately 25 skills. The most commonly tested (and therefore most important to master) include:

• Hand washing (always tested)
• Vital signs: blood pressure, pulse, respirations, temperature
• Catheter care (perineal care with indwelling catheter)
• Positioning a resident: supine, lateral (side-lying), semi-Fowler's
• Range of motion: shoulder, elbow, wrist, hip, knee, ankle
• Transferring a resident: bed to wheelchair, wheelchair to bed
• Mouth care (including denture care)
• Bathing: partial bath, peri care
• Feeding a resident
• Ambulation with a gait belt
• Applying elastic stockings
• Making an occupied bed

How Many Attempts Do You Get?

California follows the OBRA '87 federal requirement: candidates have 3 attempts to pass each portion of the exam within 24 months of completing their CNA training program. If a candidate does not pass within 3 attempts or within 24 months (whichever comes first), they must repeat the full CNA training program before attempting the exam again.

Each attempt requires scheduling through Prometric and paying the exam fee. CDPH maintains the California Nurse Aide Registry — passing the exam and completing the application process results in your name being added to the registry, which employers verify before hiring.

Study Strategy

For the written test: Focus on residents' rights (the most consistently tested topic) and infection control. Residents' rights questions appear in larger numbers than their topical weight suggests because they can be embedded in any care scenario. For infection control, know the difference between standard precautions and transmission-based precautions, and know which type of isolation (contact, droplet, airborne) each common infection requires.

For the clinical test: Practice every skill until the universal steps (identify resident, explain procedure, wash hands, ensure safety at end) are automatic — not something you think about, but something you do reflexively. Then practice the specific skill steps for the most common testable skills. Have a partner watch you and check against the official skill checklists, available from Prometric.

The candidates who fail the clinical test almost universally report the same thing afterward: they knew how to do the skill, but they forgot a step because they were nervous. The remedy is deliberate repetition in practice until the complete sequence — including every automatic-failure step — is truly automatic.