CNA exam prep

CNA Skills List: All 23 Skills on the State Skills Test, Step by Step

Every skill the evaluator can ask for, in the order you perform it, with the steps that earn the points.

2026-10-15 · 12 min read

How the CNA skills test is scored

The CNA skills test is the hands-on half of the exam: you perform a skill on a real person or a manikin while a proctor watches and checks the steps off a sheet. The written test checks what you know; the skills test checks what you can do with your hands, out loud, in order.

The list has 23 skills and 299 steps in total. Your proctor picks a handful, usually five, and you perform each one start to finish. 27 steps across the list are critical elements: steps you must do the exact right way. Miss a critical element and that skill fails, no matter how many of the other steps you did.

  • Critical elements are the steps that keep the resident safe: locking the bed wheels, testing the water temperature, washing your hands before and after, calling for help when something is wrong.
  • Every skill is timed. Move steadily, not fast, and say what you are doing as you do it, because a proctor can only score what they see and hear.
  • If you make a mistake, say so and correct it before the end of the skill. A corrected step beats a silent one.

The CNA skills list, step by step

Below is the whole approved list, in the order most programs teach it, with every step and the critical elements marked. Open a skill to see its steps.

Work one skill at a time until it comes out without the page, then chain the skills you are most likely to draw. The skills the proctor almost always includes are hand hygiene and one transfer, so start there.

Hand hygiene (hand washing)10 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I greet the client by name and tell them my name.
  2. I turn on the water.
  3. I wet my hands and wrists all the way.
  4. I put soap on my hands.
  5. I rub soap on all parts of my wrists, hands, and fingers for at least 20 seconds. I keep my hands lower than my elbows with fingertips pointing down.
    must say
  6. I clean my fingernails by rubbing my fingertips on the palm of my other hand.
  7. I rinse all parts of my wrists, hands, and fingers, with hands lower than elbows and fingertips down.
    must say
  8. I dry my fingers, hands, and wrists with a clean paper towel, starting at the fingertips, then throw it away.
  9. I turn off the water with a clean, dry paper towel (or a knee or foot control), then throw the towel away.
  10. I never touch the inside of the sink.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Applies one knee-high elastic stocking11 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. The client is lying on their back while I put the stocking on.
  4. I turn the stocking inside out, at least down to the heel.
  5. I slide the foot of the stocking over the toes, foot, and heel.
  6. I pull the top of the stocking up over the foot, heel, and leg.
  7. I move the foot and leg gently, without forcing or overstretching the joints.
  8. When done, the stocking has no twists or wrinkles. The heel of the stocking is on the heel. The toe opening, if any, is over or under the toes. On a mannequin, I can say the stocking must have no wrinkles.
    must say
  9. I put the call light (signal device) where the client can reach it.
  10. I put the bed in its low position.
  11. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Assists to ambulate using transfer belt15 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before the client stands, they have non-skid shoes or socks on.
    must say
  4. Before the client stands, the bed is at a safe height.
  5. Before the client stands, I check or lock the bed wheels.
  6. Before the client stands, I help them sit up with feet flat on the floor.
    must say
  7. Before the client stands, I put the transfer belt snug around the waist, over clothes or gown.
  8. Before the client stands, I tell them how to help and agree on a signal to start.
  9. I stand facing the client, in a safe position, and count to three (or use our signal).
  10. On the signal, I help them stand slowly. I hold the belt on both sides with my hands facing up, and brace their legs with my knees or toes.
  11. I walk a little behind and to one side of the client for at least 10 steps, holding the belt.
  12. I help the client back to bed and take off the belt.
  13. I put the call light (signal device) where the client can reach it.
  14. I put the bed in its low position.
  15. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook; Prometric clinical skills checklist

Assists with use of bedpan18 steps

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before placing the bedpan, I lower the head of the bed.
  4. I put on clean gloves before placing the bedpan.
  5. I place the bedpan correctly under the client's buttocks.
  6. I take off my gloves without touching the dirty side, throw them away, and wash my hands.
  7. After the client is on the bedpan, I raise the head of the bed.
  8. Toilet paper is within reach.
  9. A hand wipe is within reach, and I tell the client to clean their hands when done.
  10. The call light is in reach, and I ask the client to call me when done.
  11. I put on clean gloves before I take the bedpan out.
  12. I lower the head of the bed before I take the bedpan out.
  13. The client stays covered except when I place and remove the bedpan.
  14. I empty and rinse the bedpan and pour the rinse water into the toilet.
  15. I put the bedpan in the dirty supply area.
  16. I take off my gloves without touching the dirty side, throw them away, and wash my hands.
  17. I put the call light (signal device) where the client can reach it.
  18. I put the bed in its low position.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Cleans upper or lower denture12 steps

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I put on clean gloves before I touch the denture.
  2. Before I hold the denture over the sink, I line the bottom of the sink or fill it partly with water.
  3. I rinse the denture under cool or lukewarm (not hot) running water before brushing.
  4. I put denture toothpaste on the toothbrush.
  5. I brush every surface of the denture.
  6. I rinse every surface under cool or lukewarm (not hot) running water.
  7. I rinse the denture cup and lid.
  8. I put the denture in the cup with cool or lukewarm (not hot) water or solution and put the lid on.
  9. I rinse the toothbrush and put it in its basin or container.
  10. I keep the toothbrush and denture from touching anything dirty.
  11. I throw away the sink liner or drain the sink.
  12. I take off gloves without touching the dirty side, throw them away, and wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Counts and records radial pulse6 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I put my fingertips on the thumb side of the client's wrist to find the pulse.
  3. I count the beats for one full minute.
  4. I put the call light (signal device) where the client can reach it.
  5. I wash my hands before I write it down.
  6. I record the pulse. It must be within 4 beats of the evaluator's count.
    must say

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Counts and records respirations5 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I count breaths for one full minute.
  3. I put the call light (signal device) where the client can reach it.
  4. I wash my hands before I write it down.
  5. I record the breathing rate. It must be within 2 breaths of the evaluator's count.
    must say

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Donning and removing PPE (gown and gloves)14 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I pick up the gown and unfold it.
  2. With the opening at my back, I put my arms through the sleeves.
  3. I fasten the gown at the neck.
  4. I fasten the gown at the waist, covering the back of my clothes as much as I can.
  5. I put on gloves.
  6. The glove cuffs go over the gown cuffs.
  7. Before I take off the gown, I use one gloved hand to grab the other glove at the palm and pull it off.
    must say
  8. I slip my bare fingers under the cuff of the other glove at the wrist and pull it off, turning it inside out.
    must say
  9. I throw the gloves in the right trash without touching myself with them.
  10. After the gloves are off, I untie the gown at the waist and neck.
  11. After the gloves are off, I take off the gown without touching the outside of it.
  12. I hold the gown away from my body, keep it off the floor, and roll it inward so it stays inside out.
  13. I put the gown in the right container without touching myself with it.
  14. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Dresses client with affected (weak) right arm12 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. I ask which shirt the client wants and dress them in that shirt.
  4. I keep the client's chest covered so they are not exposed.
  5. I take the gown off the strong (left) side first, then the weak (right) side.
  6. Before dressing, I put the gown in the dirty linen container.
  7. I put the weak (right) arm into the right sleeve first, before the strong (left) arm.
    must say
  8. I move the client's body gently, without forcing or overstretching.
  9. The clothes are on and in place.
  10. I put the call light (signal device) where the client can reach it.
  11. I put the bed in its low position.
  12. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Feeds client who cannot feed self16 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I make sure I have the right person, for example by asking their name or checking the name card.
  2. I tell the client what I am going to do. I speak clearly and slowly and face them.
  3. Before feeding, I check the name card on the tray and ask the client to say their name.
  4. Before feeding, the client is sitting straight up at 90 degrees.
    must say
  5. I put the tray where the client can see the food.
  6. I clean the client's hands before the meal.
  7. I sit in a chair facing the client while I feed them.
  8. I tell the client what food and drink are on the tray.
  9. I ask what they want to eat first.
  10. With a spoon, I offer one bite of each food and say what is in each spoonful.
  11. I offer a drink at least once during the meal.
  12. I ask if they are ready before each bite or sip.
  13. At the end, I clean the client's mouth and hands.
  14. I take the tray away.
  15. I leave the client sitting up at 90 degrees with the call light in reach.
  16. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Gives modified bed bath (face and one arm, hand, and underarm)20 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. I take off the gown and put it right into the dirty linen container, keeping the chest and lower body covered.
  4. Before washing, I check the water temperature and ask the client if it feels okay.
  5. I put on clean gloves before washing.
  6. I start with the eyes, using a wet washcloth with no soap. I wipe from the inner corner to the outer corner and use a different part of the cloth for each wipe. Then I wash the face.
    must say
  7. I dry the face with a towel.
  8. I uncover one arm and put a towel under it.
  9. I put soap on the wet washcloth.
  10. I wash the fingers (and nails), hand, arm, and underarm, keeping the rest of the body covered.
  11. I rinse and dry the fingers, hand, arm, and underarm.
  12. I move the body gently, without forcing or overstretching.
  13. I put a clean gown on the client.
  14. I empty, rinse, and dry the basin and put it in the dirty supply area.
  15. I put used linen in the dirty linen container.
  16. I keep my clothes from touching the used linen.
  17. I take off my gloves without touching my skin with the dirty side and throw them away.
  18. I wash my hands.
  19. I put the call light (signal device) where the client can reach it.
  20. I put the bed in its low position.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Measures and records electronic blood pressure13 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. I help the client lie or sit comfortably.
  4. The client's arm is at heart level, palm up, upper arm bare.
  5. I pick the right cuff size.
  6. I feel for the brachial artery on the inside of the elbow bend.
  7. I put the cuff snug on the upper arm with the arrow over the artery.
  8. I turn on the machine and make sure it works. If it has infant, child, and adult settings, I pick the right one.
  9. I press start. If the cuff goes above 200 mm Hg, I stop the machine and use the other arm.
  10. I wait for the reading and for the cuff to let out its air, then take the cuff off.
  11. I put the call light (signal device) where the client can reach it.
  12. I wash my hands before I write it down.
  13. I record both the top (systolic) and bottom (diastolic) numbers exactly as the screen shows them.
    must say

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Measures and records urinary output8 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I put on clean gloves before I handle the bedpan.
  2. I pour the bedpan into the measuring container without spilling or splashing.
  3. I rinse the bedpan and pour the rinse water into the toilet.
  4. With the container on a flat surface, I read it at eye level. If it is between lines, I round up to the nearest 25 mL.
  5. After measuring, I empty the container into the toilet.
  6. I rinse the measuring container and pour the rinse water into the toilet.
  7. Before I write it down, I take off my gloves, throw them away, and wash my hands.
  8. I record the amount. It must be within 25 mL of the evaluator's reading.
    must say

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Measures and records weight of ambulatory client7 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. The client has non-skid shoes on before walking to the scale.
  3. Before the client steps on, I set the scale to zero.
  4. I ask the client to step onto the middle of the scale, and I read the weight.
  5. I ask the client to step off the scale.
  6. I wash my hands before I write it down.
  7. I record the weight. It must be within 2 pounds (or 0.9 kg) of the evaluator's reading.
    must say

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Modified passive range of motion: one knee and one ankle8 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. The client is lying on their back. I ask them to tell me if anything hurts during the exercise.
  4. Holding the leg under the knee and ankle, I bend the knee and then straighten it back, at least 3 times. I move slowly and gently, and I stop if the client says it hurts.
    must say
  5. Holding the foot and ankle close to the bed, I push the foot up toward the head, then point the toes down, at least 3 times. I move slowly and gently, and I stop if the client says it hurts.
    must say
  6. I put the call light (signal device) where the client can reach it.
  7. I put the bed in its low position.
  8. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Modified passive range of motion: one shoulder8 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. I ask the client to tell me if anything hurts during the exercise.
  4. Holding the arm at the elbow and wrist, I raise the straight arm up toward the head to ear level, then bring it back down to the side, at least 3 times. I move slowly and gently, and stop if it hurts.
    must say
  5. Holding the arm at the elbow and wrist, I move the straight arm out from the side to shoulder level and back, at least 3 times. I move slowly and gently, and stop if it hurts.
    must say
  6. I put the call light (signal device) where the client can reach it.
  7. I put the bed in its low position.
  8. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Positions on side13 steps

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before turning, I lower the head of the bed.
  4. I raise the side rail on the side the client will turn toward.
  5. I help the client roll slowly onto their side, toward the raised rail.
  6. I put or fix a pillow under the head.
  7. I move the lower arm and shoulder so the client is not lying on their arm.
  8. I support the top arm with a pillow or other support.
  9. I put a support behind the client's back.
  10. I put a support between the legs, with the top knee bent and the knee and ankle supported.
  11. I put the call light (signal device) where the client can reach it.
  12. I put the bed in its low position.
  13. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Provides catheter care for female17 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before washing, I check the water temperature and ask the client if it feels okay.
  4. I put on clean gloves before washing.
  5. I put a pad (linen protector) under the private area and buttocks before washing.
  6. I uncover only the area around the catheter, between the hips and knees.
  7. I put soap on a wet washcloth.
  8. Holding the catheter where it enters the body, without pulling it, I clean at least 4 inches of the tube. I wipe only away from the body and use a clean part of the cloth for each wipe.
    must say
  9. Still holding it without pulling, I use a clean washcloth to rinse at least 4 inches of the tube, wiping only away from the body, with a clean part of the cloth for each wipe.
    must say
  10. Still holding it without pulling, I dry at least 4 inches of the tube, moving away from the body.
  11. I empty, rinse, and dry the basin and put it in the dirty supply area.
  12. I put used linen in the dirty linen container and throw away the pad the right way.
  13. I keep my clothes from touching the used linen.
  14. I take off my gloves without touching my skin with the dirty side and throw them away.
  15. I wash my hands.
  16. I put the call light (signal device) where the client can reach it.
  17. I put the bed in its low position.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Provides foot care on one foot17 steps

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before washing, I check the water temperature and ask the client if it feels okay.
  4. The basin is in a comfortable spot for the client, on a protective barrier.
  5. I put on clean gloves before washing the foot.
  6. I place the client's bare foot in the water.
  7. I put soap on a wet washcloth.
  8. I lift the foot out of the water and wash it, including between the toes.
  9. I rinse the foot, including between the toes.
  10. I dry the foot with a towel, including between the toes.
  11. I put lotion on the top and bottom of the foot, not between the toes, and wipe off any extra.
  12. I support the foot and ankle the whole time.
  13. I empty, rinse, and dry the basin and put it in the dirty supply area.
  14. I put used linen in the dirty linen container.
  15. I take off my gloves without touching my skin with the dirty side and throw them away.
  16. I wash my hands.
  17. I put the call light (signal device) where the client can reach it.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Provides mouth care17 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before mouth care, the client is sitting straight up at 90 degrees.
  4. I put on clean gloves before cleaning the mouth.
  5. I put a towel across the chest first.
  6. I get a cup of water and wet the toothbrush.
  7. I put toothpaste on the wet toothbrush.
  8. I gently clean the whole mouth, including the tongue and every surface of the teeth.
    must say
  9. I keep the toothbrush from touching anything dirty.
  10. I hold the small basin (emesis basin) at the chin while the client rinses.
  11. I wipe the client's mouth and take off the towel.
  12. I put used linen in the dirty linen container.
  13. I rinse the toothbrush and empty, rinse, and dry the basin.
  14. I take off my gloves without touching my skin with the dirty side and throw them away.
  15. I wash my hands.
  16. I put the call light (signal device) where the client can reach it.
  17. I put the bed in its low position.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Provides perineal care (peri-care) for female21 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before washing, I check the water temperature and ask the client if it feels okay.
  4. I put on clean gloves before washing.
  5. I put a pad under the private area and buttocks before washing.
  6. I uncover only the private area, between the hips and knees.
  7. I put soap on a wet washcloth.
  8. I wash the genital area from front to back, using a clean part of the cloth for each wipe.
    must say
  9. With a clean washcloth, I rinse the genital area from front to back, using a clean part of the cloth for each wipe.
    must say
  10. I dry the genital area from front to back with a towel.
  11. I turn the client on their side and wash the rectal area from front to back, using a clean part of the cloth for each wipe.
  12. With a clean washcloth, I rinse the rectal area from front to back, using a clean part of the cloth for each wipe.
  13. I dry the rectal area from front to back.
  14. I move the client back to a comfortable position.
  15. I empty, rinse, and dry the basin and put it in the dirty supply area.
  16. I put used linen in the dirty linen container and throw away the pad the right way.
  17. I keep my clothes from touching the used linen.
  18. I take off my gloves without touching my skin with the dirty side and throw them away.
  19. I wash my hands.
  20. I put the call light (signal device) where the client can reach it.
  21. I put the bed in its low position.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Transfers from bed to wheelchair using transfer belt19 steps - 2 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. I give privacy: I pull the curtain, use a screen, or close the door.
  3. Before the client stands, I put the wheelchair beside the bed (at the head of the bed facing the foot, or at the foot facing the head).
  4. Before the client stands, I fold up or remove the footrests.
  5. Before the client stands, I lock the wheelchair wheels.
    must say
  6. Before the client stands, the bed is at a safe height.
  7. Before the client stands, I check or lock the bed wheels.
  8. Before the client stands, I help them sit up with feet flat on the floor.
    must say
  9. Before the client stands, they have shoes on.
  10. Before the client stands, I put the transfer belt snug around the waist, over clothes or gown.
  11. Before the client stands, I tell them how to help and agree on a signal to start.
  12. I stand facing the client in a safe position and count to three (or use our signal).
  13. On the signal, I help them stand slowly. I hold the belt on both sides with my hands facing up, and brace their legs with my knees or toes.
  14. I help the client turn so the backs of their legs touch the wheelchair.
  15. I lower the client into the wheelchair.
  16. I position the client with hips against the back of the chair, then take off the belt.
  17. I put the client's feet on the footrests.
  18. I put the call light (signal device) where the client can reach it.
  19. I wash my hands.

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

Measures and records manual blood pressure12 steps - 1 must-say

Say each step as you do it, the way you would for the evaluator. Steps marked "Must say" fail the skill if you miss them.

  1. I tell the client what I am going to do. I speak clearly and slowly and face them.
  2. Before using the stethoscope, I wipe the bell or diaphragm and the earpieces with alcohol.
  3. The client's arm is palm up and the upper arm is bare.
  4. I feel for the brachial artery on the inside of the elbow bend.
  5. I put the cuff snug on the upper arm with the arrow over the artery.
  6. The earpieces are in my ears and the bell or diaphragm is over the artery.
  7. I pump the cuff to 160 to 180 mm Hg. If I hear a beat right away as it lets out air, I let all the air out, then pump again, but not above 200.
  8. I let the air out slowly. The first sound I hear is the top number (systolic). The last sound is the bottom number (diastolic). If needed, I round up to the nearest 2.
  9. I take off the cuff.
  10. I put the call light (signal device) where the client can reach it.
  11. I wash my hands before I write it down.
  12. I record both numbers. Each should be within 4 mm Hg of the evaluator's reading.
    must say

Source: NNAAP skills list (2018); Headmaster (D&S) North Dakota candidate handbook

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CNA skills check: test yourself

CNA skills check

Question 1 of 10 · Hand hygiene

Hand hygiene: you just said "I rinse all parts of my wrists, hands, and fingers, with hands lower than elbows and fingertips down." What comes next?

The steps that fail a skill

Across the 23 skills, 27 steps are critical elements. They cluster in the same places: infection control, safety, and the resident's rights.

  • Hand hygiene: wetting, lathering for at least 20 seconds, and rinsing, before and after contact.
  • Safety: locking the bed or wheelchair wheels before and after a transfer, keeping the call light within reach, and never leaving a resident in an unsafe position.
  • Privacy and dignity: closing the curtain, covering the resident, and knocking before entering.

The full list marks each critical element so you can drill exactly the steps that decide pass or fail.

Practice saying each skill out loud

Reading the list is the easy half. The test is performing the skill while you talk through it, in order, without the page.

The exam prep practice tool does exactly that. You speak the skill, it marks the steps you said against this same list, and it shows the step you missed. Two scored runs on the CNA skills test are free, and hand hygiene and the transfers are what most aides end up re-running.

CNA test day: what to expect

You take the written test and the skills test in one sitting, usually the same day. The skills test comes with a proctor, a resident or manikin, and a set of supplies laid out at the station.

  • Bring your photo ID and your admission ticket. Ask your school what else your state requires.
  • Wash your hands the moment you walk in, and say it out loud: it is the one critical element on nearly every skill.
  • Read the skill card twice before you start, and gather every supply you will need first.
  • If you forget a step, name it as soon as you remember instead of skipping ahead. A recalled step beats a silent gap.

How CNA training gets paid for

CNA training is short and cheap compared to most healthcare programs, and much of it is free: many nursing homes pay for the class in exchange for a work commitment, and WIOA training grants cover tuition and the exam fee for people who qualify.

Find out what your state will pay for before you enroll. The step-by-step version is in the CNA training guide linked below.

Next step

Practice the steps out loud

Part of the guide: AI interview practice app: what it scores, plans and free guides

Frequently asked questions

How many skills are on the CNA skills test?

The approved list has 23 skills. Your proctor does not test you on all of them: most states pick around five, and at least one is usually hand hygiene and one a transfer. Practise the full list, but drill those two first.

What is a critical element on the CNA test?

A critical element is a step you must do the exact right way or the whole skill fails. There are 27 of them across the 23 skills, and they cluster around hand hygiene, safety, and the resident's rights. This page marks every one.

Do I have to talk while I perform the skill?

Yes. The proctor scores what they can see and hear, so say what you are doing as you do it. A silent step can be scored as not done even when you did it correctly.

Is the CNA skills test the same in every state?

Most states use the same NNAAP-style list. Texas, Florida and New York use the Prometric skills test, which is why both lists are on this page: the skills overlap, but the steps and the scoring differ.

Can I retake the CNA skills test?

Yes, and retest rules and fees are set by your state. Most people who fail the skills test fail one critical element, and pass the retest after one session that scores what they said out loud.

Can I practice the CNA skills without a partner?

Yes. The part being tested is remembering the steps in order and saying them, and you can practise that alone. The exam prep tool listens to your run, marks the steps you said against this list, and shows the skill you missed.

For individuals

Practice it out loud until it's automatic

The exam prep tool listens while you speak the steps, scores what you named against this list, and shows the part you missed. Two scored runs on the CNA skills test are free, then Exam Prep Practice unlocks unlimited runs: $4.99 for 7 days, $9.99 for 30 days, or $14.99 until you pass.

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Last updated: 2026-10-15