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Missouri Nurse Aide Competency Examination (CNA)
The Missouri CNA competency examination is the two-part final examination individuals must pass to be listed on the Missouri Nurse Aide Registry (MOCNAR): a 75-question multiple-choice knowledge test (60 minutes, 80% to pass, available in English or Spanish, with an audio/read-aloud version and a remotely proctored option) and a manual demonstration skill test of three or four randomly assigned tasks (30 minutes, all tasks passed with no missed key steps and 80%+ of non-key steps). The exam is administered under the Missouri Department of Health and Senior Services (DHSS) by its vendor D&S Diversified Technologies (Headmaster) through the TMU system at test sites statewide.
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QuestionsKnowledge test: 75 multiple-choice questions (subject-area counts summing to 75: Safety 9, Basic Nursing Skills 8, Infection Control 8, Personal Care 8, Communication 6, Disease Process 6, Mental Health 6, Aging Process and Restorative Care 5, Care Impaired 5, Resident Rights 5, Role and Responsibility 5, Data Collection 4). Skill test: three or four randomly assigned demonstration tasks
Testing timeKnowledge exam: 60 minutes; Skill test: 30 minutes (per part, when both taken)
ScoringKnowledge test: 80% or better to pass. Skill test: must successfully complete 100% of assigned tasks, missing no key (bolded) steps and scoring 80%+ on the non-key steps of each task
Exam feeUSD 135.00 total for the exam (USD 32.00 knowledge + USD 103.00 skills); an additional USD 10 fee for the audio (read-aloud) version of the knowledge exam; testing fees paid per portion for retakes (price increase effective January 1, 2026)
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Exam overview
What to know before choosing your prep
- Who runs it
- Missouri DHSS
- Category
- Nurse Aide & Nursing Assistant
- Current version
- Current specification; no public version label (Missouri DHSS-approved Missouri test plan; Candidate Handbook updated January 2026, mock-skills list effective for testing September 1, 2025)
- Where it applies
- US-MO, United States
- Exam languages
- English, Spanish
- Testing provider
- D&S Diversified Technologies LLP (Headmaster)
- Format
- Computer-based knowledge test delivered through the TMU system on Internet-connected computers at Missouri test sites (a remotely proctored knowledge exam from home is available); in-person manual skill demonstration observed by an RN Test Observer
- Availability
- Scheduled test events at test sites around the state ("There are testing sites all over the state"); candidates schedule or reschedule online in TMU; skills-only test sites are asked to submit a test date request form to Headmaster at least 14 days prior to the event
- Results
- Official results posted to the candidate's TMU account after 7:00 PM CT on the business day following the test event; no results released by phone or postal mail
- Credential validity
- Certification renews every two years with documented nursing-service work; inactive after a two-year break in employment (may challenge the exam to reactivate) and expired after a five-year break (course retake may be required)
- Remote testing
- Varies by jurisdiction
Exam structure
Two-part competency examination: (1) a 75-item multiple-choice knowledge test covering 12 subject areas per the Missouri test plan (Safety, Basic Nursing Skills, Infection Control, Personal Care, Communication, Disease Process, Mental Health, Aging Process and Restorative Care, Care Impaired, Resident Rights, Role and Responsibility, Data Collection), available in English or Spanish and as an audio version (only the first 67 questions read orally; the last 8 answered without audio to assess English reading comprehension); (2) a manual demonstration skill test of three or four randomly assigned DHSS-approved nurse aide tasks with scenarios read by an RN Test Observer
Where rules vary
Missouri's own state competency examination for certified nurse assistants, required for listing on the Missouri Nurse Aide Registry (MOCNAR); required by the Omnibus Nursing Home Act and Section 198.082, RSMo. Out-of-state CNAs enter via reciprocity, not this exam.
Eligibility
Standard path: completion of the state-approved 175-hour CNA course (75 hours classroom training + 100 hours on-the-job training), entered by the instructor in TMU, with testing fee paid before scheduling. Challenge path: eligibility-approved individuals (e.g., out-of-state/other qualifying training or lapsed status) may sit the same exam without the course, but are given only one attempt — failing either part requires completing the full CNA course
Retake policy
Three attempts total: a failing candidate may retake the failed portion(s) twice within 90 calendar days of the initial attempt (paying for each failed portion before rescheduling); a third failure requires retaking the entire basic course before another exam. Challenge candidates get one attempt only