CNA State Exam Skills: The Complete 2026 Checklist

That knot in your stomach thinking about the clinical skills exam? You know the one—the hands-on test where everything you’ve learned comes down to performing five perfectly executed skills under pressure. You’re not alone in feeling this way. Every CNA student faces this moment, and the good news is that with the right preparation, you can walk in with confidence.

This is your definitive guide to cna state exam skills. We’ll break down exactly what evaluators look for, which skills show up most frequently, and how to avoid the critical mistakes that cause automatic failures. By the end, you’ll have a clear roadmap to mastering every skill you might face on test day.

How the CNA Clinical Skills Exam Works

First, let’s demystify the exam format itself. Understanding the structure helps eliminate surprises and lets you focus on what truly matters—demonstrating safe, effective patient care.

The clinical portion typically tests five randomly selected skills from a state-approved pool of 20-30 possibilities. You’ll have approximately 30 minutes to complete all five skills while being evaluated by a registered nurse. Each skill has specific steps, with some marked as “critical”—miss one of these, and you fail that skill regardless of how well you performed the other steps.

Clinical Pearl: Remember: the evaluator isn’t looking for perfection. They’re looking for safety, proper technique, and evidence-based practice. Show them you understand the “why” behind each action, not just the “what.”

Here’s what your exam day will look like:

Skill selection: You’ll draw five skills randomly (handwashing is usually guaranteed)
Preparation time: 2-3 minutes to gather supplies and mentally walk through each skill
Performance time: 25-30 minutes to complete all five skills
Scoring: Each skill is graded individually; you must pass all five to pass the exam

The #1 Skill You Must Perfect: Hand Hygiene

Let’s be honest—you will perform hand hygiene during your exam. In fact, you’ll do it multiple times between skills. Getting this right sets the tone for your entire evaluation and demonstrates your understanding of infection control principles from the very beginning.

Proper handwashing technique contains 10 specific steps, and evaluators watch every single one:

Adjust water to comfortable temperature
Wet hands and apply soap
Lather thoroughly, creating friction over all surfaces
Clean palms, back of hands, between fingers, back of fingers, thumbs, and fingertips
Continue for at least 20 seconds (sing “Happy Birthday” twice)
Rinse thoroughly with water flowing toward fingertips
Use clean paper towel to dry
Use same towel to turn off faucet
Discard towel properly without contaminating hands

Critical Step Failure: Never touch the sink surface with your hands or clean paper towel after washing. This automatically contaminates your hands and will result in failing the skill.

Imagine this scenario: you’ve just finished helping your patient with mouth care. You approach the sink, adjust the water, apply soap, and lather thoroughly. As you rinse, you pause—did you clean under your fingernails? Did you get the backs of your hands? These are the moments evaluators watch closely.

Pro Tip: When practicing at home, use a mirror or record yourself. You’ll be surprised how often we miss the tops of our hands or between fingers. Practice until it becomes muscle memory.

Category 1: Measurement & Vitals

Vital signs are the language of healthcare, and you’ll need to demonstrate proficiency in taking them accurately. These skills frequently appear on exams because they’re fundamental to patient assessment and monitoring.

Blood Pressure Measurement

Taking blood pressure is both science and art. The evaluator wants to see you identify the brachial artery, properly place the cuff, and document readings accurately. Most importantly, they’re watching for patient comfort and infection control.

Common pitfalls to avoid:

Taking BP on the same arm as an IV site or fistula
Talking during measurement
Incorrect cuff size (too tight or too loose)
Not waiting 2-3 minutes between readings if needed

Imagine this: Your “patient” has just finished a cup of coffee. Would you take their blood pressure immediately? No! You’d wait at least 30 minutes and ask about caffeine intake. This critical thinking shows your evaluator you understand the factors that affect vital signs.

Pulse and Respirations

Counting pulse and respirations seems simple, but details matter. Remember: never let the patient know you’re counting respirations—they’ll unconsciously alter their breathing pattern. Count respirations after taking the pulse while maintaining light finger contact.

Key technique tips:

Use your first two fingers (not thumb) for pulse
Count for a full 60 seconds unless specifically told otherwise
Note rhythm, volume, and any irregularities
Document immediately after counting

Temperature and Intake & Output

Whether using an oral thermometer or recording fluid intake, precision is crucial. For intake measurement, record all liquids: water, juice, soup, gelatin, and even water used for medication administration. Convert different measurements to milliliters consistently—8 ounces = 240 mL.

Measurement Type	When to Use	What to Remember
Oral thermometer	Alert patients who can hold under tongue	Wait 15 minutes after hot/cold drinks
Tympanic thermometer	Quick readings, tympanic membrane intact	Pull ear up and back for adults
Axillary thermometer	Infants, less accurate	Hold in place until timer beeps
Winner/Best For	Oral for accuracy, Tympanic for speed	Document route taken

Category 2: Patient Positioning & Mobility

Moving patients safely is at the heart of CNA work—preventing falls, skin breakdown, and caregiver injury. These skills demonstrate your understanding of body mechanics and patient positioning principles.

Moving a Patient Up in Bed

This看似 simple task trips up many students. The evaluator wants to see you assess your ability first, use proper body mechanics, and communicate throughout the procedure.

The golden rule: never pull a patient up in bed. This causes skin shear and potential injury. Instead, use a drawsheet or ask for assistance if needed.

Critical Mistake: Failing to raise the bed to working height before positioning. Always adjust the bed to your waist level to prevent back injury.

Your verbal script should include:

“I’m going to help you move up in bed now”
“Please cross your arms over your chest”
“On the count of three, bend your knees and help me push”
Count clearly: “One… two… three…”

Transferring from Bed to Chair

Bed-to-chair transfers test your ability to use transfer belts, assess patient strength, and maintain safety throughout. The evaluator watches for locked wheels, raised bed rails, and proper pivot technique.

Step-by-step success:

Position wheelchair at 45-degree angle to bed
Lock both bed and wheelchair wheels (critical step!)
Lower bed to patient’s seated height
Apply transfer belt securely
Help patient to sitting position, dangle legs
Assess for dizziness before standing
Place hands on belt, not under arms
Count together for coordinated movement

Ambulating with a Gait Belt

When walking patients, the gait belt is your safety lifeline. Position it over clothing (not bare skin) with the buckle in front. You should be able to slide two fingers comfortably between belt and patient—too loose allows hand slippage, too tight restricts breathing.

Pro Tip: Practice with different “patient” types at home: someone who moves quickly, someone who shuffles, someone who veers to one side. This prepares you for real variations you’ll encounter during your exam and career.

Category 3: Personal Care & Hygiene

Personal care skills demonstrate your ability to maintain patient dignity while providing thorough hygiene. These are frequently tested because they’re daily CNA responsibilities and essential for preventing infection and promoting comfort.

Partial Bed Bath

A partial bed bath typically includes face, hands, underarms, back, and perineal area. The key is maintaining warmth, privacy, and systematic cleaning while preventing cross-contamination.

The clean-to-dirty principle is everything:

Start with the face (cleanest area)
Progress to hands, arms, chest, abdomen
Move to back and underarms
Finish with perineal area (dirtiest)
Change water between genital and anal area

Clinical Pearl: Use separate washcloths for different body areas or fold your washcloth to use clean sections progressively. This shows infection control awareness even if your examiner doesn’t explicitly require it.

Oral Care

Whether providing routine oral care or denture care, gentleness and thoroughness are key. Remember to position patients appropriately—sitting up or side-lying to prevent aspiration.

For unconscious patients:

Position on side with head turned downward
Keep suction nearby
Use minimal liquid
Check pocketing in cheeks afterward

Denture care requires extra attention to safety. Hold dentures over a basin of water to prevent breakage if dropped. Look for cracks, loose teeth, or plaque buildup—all important patient observations to document.

Perineal Care

This skill demands a calm, professional approach that maintains patient dignity while preventing infection. The cleaning direction is gender-specific and critically important.

For females: Wipe from front to back (urethra to anus) For males: Clean in a circular motion from meatus outward

Common Mistake: Using the same washcloth section for multiple wipes. Fold your washcloth to expose clean surfaces with each wipe, or use multiple cloths if available. Cross-contamination here can lead to UTIs—a serious concern in healthcare settings.

Category 4: Nutrition & Elimination

These skills show your ability to assist with basic needs while assessing important patient indicators. Feeding assistance and elimination support are daily CNA tasks that require observation skills and safety awareness.

Assisting with Feeding

Helping patients eat isn’t just about physical assistance—it’s about dignity, independence, and safety. Evaluators watch for choking precautions, proper positioning, and appropriate food choices.

Essential safety measures:

Position patient upright (90 degrees if possible)
Offer liquids between solid foods
Cut food appropriately (quarter for regular, smaller if needed)
Allow time for chewing and swallowing
Observe for pocketing food in cheeks

Imagine this: Your patient has right-sided weakness. How would you approach feeding? You’d place food on the stronger (left) side of the mouth, offer smaller bites, and allow extra time. This adaptive thinking demonstrates clinical understanding beyond basic mechanics.

Bedpan and Urinal Use

Getting this skill right requires positioning, comfort, and thorough cleaning privacy. For bedpans, position the wider end toward the patient’s feet. For urinals, ensure proper placement and immediate removal after use to prevent spills.

Step-by-step success:

Lower head of bed for easier access
Warm the device with warm water if available
Assist with positioning (side-lying or Fowler’s)
Place disposable pad underneath
Provide privacy and call bell
Remove promptly when finished
Clean perineal area thoroughly
Measure output if required
Document accurately

Ostomy Care

While less common on exams, ostomy care tests your ability to handle specialized equipment and provide sensitive care. Remember to assess the stoma (color, size, condition) and skin integrity around the appliance.

Pro Tip: Always empty ostomy bags when they’re one-third to one-half full. This prevents bag detachment and leakage—important knowledge whether you’re tested on it or not.

Category 5: Post-Operative & Special Care

Post-operative skills show you can handle specialized equipment and follow specific protocols. These often appear on exams because they demonstrate your ability to work safely with different patient conditions and devices.

Applying Elastic Stockings

Compression stockings prevent blood clots but improper application can cause circulatory problems. The evaluator focuses on your technique and your assessment of the legs before and after application.

Critical application steps:

Remove for 30 minutes twice daily (unless contraindicated)
Check skin for redness, irritation, or breakdown
Turn stocking inside out to the heel
Gather and gently pull up over foot
Smooth out wrinkles (rings can cause pressure points)
Ensure toes are visible
Document circulation checks

Clinical Pearl: Measure at the widest part of the calf for thigh-high stockings. Incorrect sizing leads to poor therapeutic effect and potential harm.

Catheter and Drainage Bag Care

Catheter care requires strict infection control and understanding of equipment positioning. The drainage bag must always remain below bladder level to prevent backflow and infection.

Essential practices:

Maintain closed system whenever possible
Clean around meatus with circular motion
Secure catheter to prevent tension
Never let drainage bag touch the floor
Keep tubing free of kinks

Post-Mortem Care

While this skill appears less frequently on exams, it tests your respect for dignity and understanding of post-death procedures. Focus on providing gentle care, following facility protocols, and supporting the family.

Key considerations:

Wear appropriate PPE (post-mortem body fluids may still transmit pathogens)
Position body respectfully with slight elevation of head
Clean and dress body if requested by family
Remove all tubes and lines (unless required by coroner)
Document time of death and care provided

Critical Mistakes That Cause Automatic Failure

We’ve covered individual skills, but let’s address the universal errors that can instantly fail your entire exam regardless of how well you perform other skills. These safety violations represent serious patient harm risks in real clinical practice.

#1: Breaking the Chain of Infection

Any action that could spread infection between patients or from environment to patient results in immediate failure. This includes:

Not washing hands at appropriate times
Contaminating clean supplies
Reusing dirty linens/supplies
Using the same gloves for multiple procedures

#2: Compromising Patient Safety

Safety never takes a backseat. These mistakes cost you points instantly:

Forgetting to lock bed or wheelchair wheels before transfers
Leaving side rails down when bed unattended
Not raising bed to working height (prevents provider injury)
Failing to call for help when appropriate

#3: Violating Patient Rights

Patients have rights, and you must demonstrate respect for them:

Not explaining procedures before starting
Failing to maintain privacy (closing door/curtain)
Not obtaining consent for care
Disregarding patient comfort or dignity

Common Mistake: Rushing through communication steps. Take a deep breath and remember: explaining what you’re doing isn’t just a skill requirement—it’s your ethical duty as a healthcare provider.

#4: Equipment Misuse

Improper use of medical equipment demonstrates dangerous practice:

Using blood pressure cuff incorrectly positioned
Improper thermometer technique
Misusing transfer equipment
Incorrect oxygen equipment handling

Pro Tips for Exam Day Success

You’ve practiced your skills, you understand the critical steps, and you’re ready for test day. These strategies from experienced CNAs will help you perform at your best when it counts.

Master Your Mental Game

Test anxiety is real, but manageable. Arrive early, take deep breaths, and remember: you’ve prepared for this. Many experienced CNAs still get nervous—they’ve just learned to channel that energy into focus rather than fear.

Pro Tip: Create a mental script for each skill. When anxious, your brain defaults to what you’ve rehearsed. Verbalizing your steps aloud during practice creates this default pathway.

Pace Yourself Effectively

With roughly six minutes per skill, proper time management is crucial. More complex skills like transfers may take longer, while handwashing should be automatic. During practice, time yourself with realistic distractions.

Time allocation strategy:

Gather supplies: 1-2 minutes
Explain procedure: 30 seconds
Perform skill: 3-4 minutes
Clean up and documentation: 1 minute

Communicate Like a Pro

Your evaluator is both scorer and “pretend patient.” They want to hear you:

Identify yourself by name and title
Explain each step before doing it
Ask for consent (“Is it okay if I…”)
Check comfort and safety (“Are you comfortable?”)
Alert to your actions (“I’m lowering the bed now”)

Perfect Your “Critical Step” Checklist

Before testing, make your own critical steps checklist for the 10 most likely exam skills. On test day, mentally review these when drawing your skills. This targeted preparation prevents last-minute panic.

Sample critical steps for transfers:

✅ Lock wheels
✅ Raise bed to waist height
✅ Apply transfer belt
✅ Position for 45-degree angle
✅ Use proper body mechanics
✅ Communicate throughout

Conclusion

Mastering cna state exam skills comes down to three things: practice preparation, safety awareness, and professional communication. Focus on understanding the “why” behind each step, not just memorizing procedures. The most successful CNAs aren’t perfect—they’re thoughtful, safety-conscious, and genuinely care about their patients’ well-being.

You’ve got this. Every practice session, every skill mastered, brings you closer to joining the ranks of competent, compassionate CNAs who make a real difference every day.

Frequently Asked Questions

Q: How many skills are typically on the CNA exam? A: Most states test 5 randomly selected skills from an approved list of 20-30 possibilities. Handwashing is almost always included as one of the five.

Q: What’s the most common reason for failing the CNA skills test? A: Safety violations, particularly forgetting to lock wheels or raise bed rails, and infection control breaches like improper handwashing technique.

Q: Can I ask the evaluator to repeat instructions? A: Absolutely! It shows you want to provide accurate care. Just ask politely: “Could you please repeat that?” It’s better to clarify than to perform a skill incorrectly.

Q: How much time will I have for each skill? A: Approximately 30 minutes total for all five skills, averaging about 6 minutes per skill including setup and cleanup.

Q: What if I make a mistake during the exam? A: It depends on whether it’s a “critical step” error. Non-critical mistakes might lose points but won’t cause automatic failure. If you recognize a mistake, correct it immediately and verbally acknowledge what you’re doing to fix it.

What skill are you most nervous about for your exam? Share in the comments below—talking it through with fellow students who understand exactly how you’re feeling!

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