Texas CNA Skills (Part Sixteen): Facts About the CNA State Examination

black and white blood pressure kit
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The National Nurse Aide Assessment Program, or NNAAP for short, is also known as the CNA state examination. In essence, this is the two-part exam that nurse aide candidates must pass in order to obtain state certification as a certified nursing assistant (CNA) in the state of Texas. In addition, Pearson Vue is the corporation entrusted with administering the CNA state examination in Texas, as well as many other states.

The CNA state examination consists of two sections. The first section is the written examination, which consists of 70 multiple choice questions. Of these 70 questions, only 60 will be graded. However, the test taker is not made aware regarding which questions will be graded, so it is important to answer all questions correctly and to the best of one’s ability. Test takers have approximately two hours to take the written examination.

Test takers who either cannot read well or simply feel uncomfortable with a written test can choose to have the written examination administered orally in their choice of either English or Spanish. When the written examination is administered orally, the test taker receives earphones in order to listen in as the exam questions are transmitted by way of an mp3 player. Each test question can be repeated via mp3 player up to two times.

The second section of the CNA state examination consists of a comprehensive hands-on skills evaluation. During the skills evaluation, the test taker is given 30 minutes to demonstrate five random procedural skills in the presence of a nurse aide evaluator (NAE) who observes and grades them as they are performed. The test taker will receive a laminated card with a listing of the five skills that he or she must perform.

All test takers will be called upon to perform the hand-washing skill in Texas as part of the skills evaluation section of the CNA state examination. This is because hand hygiene is the single most effective action nurse aides can take to prevent the spread of infections. Moreover, all test takers can expect to receive a minimum of one random measurement skill to perform in front of the nurse aide evaluator.

The five testable measurement skills include the following: weighing an ambulatory resident, measuring and recording blood pressure, measuring and recording respiration rate, measuring and recording urinary output, and measuring and recording pulse. The results of measurement skills must be properly documented on a sheet of paper provided by the Pearson Vue testing center. When recording a weight, the test taker must indicate whether the result is in pounds (lbs) or kilograms (kgs).

The other skills are selected completely at random based on the laminated card that the test taker is given. Most skills will be demonstrated on another test taker. At the Pearson Vue testing center, each test taker is paired with another test taker. The pair must perform skills on each other. For instance, a test taker who is asked to perform foot care and a partial bed bath will be performing these skills on their partner.

The only hands-on skills that are not performed on another live person include hand-washing, perineal care, urinary catheter care, and applying a stocking to one leg. The test taker will wash his or her own hands, of course. On the other hand, perineal care and urinary catheter care will be performed on a female mannequin. The stocking skill will also be performed on a mannequin.

Test takers should arrive at the Pearson Vue testing center approximately 30 minutes prior to the scheduled testing time. This is crucial because people who arrive late are sent home, automatically forfeit their testing fees and must reschedule. Also, they should plan to remain at the Pearson Vue testing center all day. Test takers are made aware of their passing or failing result prior to leaving the testing center that same day.


Pearson Education. (2018). Texas Nurse Aide Candidate Handbook. Retrieved May 21, 2019, from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas%20Nurse%20Aide%20Candidate%20Handbook-064400.aspx



Texas CNA Skills (Part Three): Measuring and Recording Respirations

Screenshot 2018-12-01 at 12.22.36 PMRespiration, also known as breathing, is one of the four main vital signs that nursing assistants, nurses, respiratory therapists, paramedics, emergency medical technicians and other healthcare workers must know how to accurately obtain and record. Of course, the other three vital signs include temperature, pulse and blood pressure.

Alternately worded, a patient’s respiratory rate is his or her breathing rate. It is the number of breaths that he or she takes over the course of one full minute (60 seconds). Generally, a respiration rate that falls between 12 and 20 breaths over the course of one whole minute is considered a normal and expected finding in an adult who is resting.

Remember the concept in this manner for enhanced ease of recollection and lack of confusion: the process of respiration is more commonly known as the process of breathing. Respiration is a very high-priority basic need because a patient who stops breathing will be dead in a matter of minutes without timely outside intervention. Fortunately, taking and recording a patient’s respiratory rate is one of the technically easier procedural skills for a healthcare worker to carry out.

Respiration is an enormously complex activity that is comprised of two differing processes called inspiration and expiration. Through inspiration and expiration, the cells of the body continually exchange two gases called oxygen and carbon dioxide. The body simultaneously breathes in oxygen and expels carbon dioxide. Inspiration is the process of inhaling air into the lungs; likewise, it occurs when a patient breathes in. Expiration is the process of exhaling; therefore, it takes place when a patient breathes out.

Inspiration and expiration are massively important processes to the continual functioning of all human bodies since they are responsible for keeping the blood, organs and tissues rich with oxygen (read: inspiration) while ensuring that excess carbon dioxide leaves the body (read: expiration).

Furthermore, the procedure of measuring and recording a patient’s respiration rate is a testable skill on the Texas CNA state test. It is also a testable procedural skill in most other states. Therefore, a nurses aide who wants to pass the CNA state test to obtain certification as a certified nursing assistant will need to know how to accurately take and record a patient’s respiratory rate in the presence of an examiner at the testing site.

According to Pearson Vue (2018), a patient’s respirations should be counted and recorded using the following listed sequence of steps during the skills portion of the state CNA examination:

  1. The nursing assistant should explain the procedure to the patient in a slow and clearly understandable manner while maintaining regular face to face contact as needed.
  2. The nursing assistant must measure the patient’s respiratory rate for one entire minute (60 seconds).
  3. The nursing assistant should ensure that the patient’s call light or signaling device is within easy reach prior to ending the skill.
  4. The nursing assistant must wash his or her hands prior to recording the patient’s one-minute respiratory rate.
  5. The nursing assistant must document a respiratory rate number that is within two breaths of the examiner’s recorded reading. For instance, the nursing assistant will pass this skill if he or she records a respiratory rate of 16, even if the examiner had  documented a respiration rate of 14.

To pass the procedural skill of measuring and recording respirations on the CNA state exam, the test taker’s documented one-minute respiration rate must fall within a predetermined range of plus or minus two breaths of the test site examiner’s recorded reading. Here are a handful of additional tips that can potentially help with obtaining a respiration rate from patients in clinical settings:

  1. Perform the opening procedures before starting the skill.
  2. Count it as one respiration each time the patient’s chest rises.
  3. Count the respirations for one entire minute (60 seconds) to obtain the one-minute respiratory rate.
  4. Record the respiratory rate as indicated.
  5. Perform the closing procedures after ending the skill.


All About Medical Training. (2015). Count and Record Respirations – CNA Skill Video AAMT. Retrieved from https://www.youtube.com/watch?v=VS0adbHFneA

BioSpine Institute. (2018). Breathing (picture). Retrieved from https://biospine.com/diaphragm-back-pain/

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas