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Texas Nurse Aide Competency Evaluation Program (CNA)
The Texas CNA competency evaluation is the two-test examination individuals must pass to be placed on the Texas Nurse Aide Registry: a 60-question multiple-choice Written Test (90 minutes, also offered as an Oral test with an additional ~15-question Reading Comprehension section, in English or Spanish) and a Clinical Skills Test in which the candidate performs three assigned skills plus Handwashing and Indirect Care (five skills scored, all must be passed). The Texas Health and Human Services Commission (HHSC) contracts Prometric to develop, score, and report the examination; applications go through the TULIP portal, and the Written/Oral test can be taken via live remote proctoring.
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QuestionsWritten Test: 60 multiple-choice questions. Oral test: the same multiple-choice knowledge questions plus a Reading Comprehension section of approximately 15 questions. Clinical Skills Test: three assigned skills, scored together with Handwashing and Indirect Care (five skills scored)
Testing timeWritten Test: 90 minutes. Clinical Skills Test: timed per test form; time limit given on the candidate's instruction card (varies by skill combination)
ScoringPass/fail per test; candidates must pass both tests. Clinical Skills: must pass all five skills. Oral candidates: must pass both the Reading Comprehension section and the Oral test section on the same day (Reading Comprehension must be retaken on every Oral attempt). No numerical cut score is published
Exam feeUSD 31 Written Test / USD 41 Oral Test (Oral includes the Reading Comprehension Exam) / USD 89 Clinical Skills Test, per the CIB fee table for "Newly Trained, Lapsed, or Re-tester"; paid to Prometric at scheduling by credit card or voucher; nonrefundable and nontransferable. NOTE: the Prometric Texas Nurse Aide page posts a notice "Effective September 1, 2026, the following exam pricing will be implemented" — re-verify fees at import (the new prices are posted as a graphic and were not text-extractable)
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Exam overview
What to know before choosing your prep
- Who runs it
- Texas HHSC
- Category
- Nurse Aide & Nursing Assistant
- Current version
- Current specification; no public version label (Prometric Texas Nurse Aide Candidate Information Bulletin; Written Test content outline with five domains; Clinical Skills list of 20 skills)
- Where it applies
- US-TX, United States
- Exam languages
- English, Spanish
- Testing provider
- Prometric
- Format
- Written/Oral Test: computer-based at CBT locations, Regional Testing Sites, or In-Facility Testing sites, or via Live Remote Proctoring from home/school. Clinical Skills Test: in-person performance in a clinical laboratory with a resident actor or mannequin, observed by a Nurse Aide Evaluator (NAE)
- Availability
- Year-round by appointment: Written/Oral exams at computer-based testing locations, regional testing sites, in-facility testing sites (with pre-approval), or via live remote proctoring, on dates and times of the candidate's choosing after application approval
- Results
- Pass/fail score report emailed the next day for both the Written/Oral test and the Clinical Skills Test; oral candidates receive a separate reading comprehension score; results are confidential and not given by phone
- Credential validity
- Registry certificate valid for two years from issue; renewal requires verification of qualifying employment (nursing-related duties plus 24 hours of in-service education every 24 months), otherwise registration expires and retesting is required to renew
- Remote testing
- Varies by jurisdiction
Exam structure
Two-test competency evaluation: (1) Written (Knowledge) Test — 60 multiple-choice questions on computer, covering five content domains: Role of the Nurse Aide (20%), Promotion of Safety (22%), Promotion of Function and Health of Residents (20%), Basic Nursing Care Provided by the Nurse Aide (24%), Providing Specialized Care for Residents with Changes in Health (14%); available as an Oral test (questions read aloud, replayable) with an additional ~15-question Reading Comprehension section; (2) Clinical Skills Test — performance of three skills randomly assigned from a published list of 20 possible skills, with Handwashing (unprompted, evaluated at test start) and Indirect Care scored in addition
Where rules vary
Texas's own nurse aide competency examination, required for certification and placement on the Texas Nurse Aide Registry maintained by HHSC. Out-of-state aides transfer via the reciprocity process of the destination state, not this exam.
Eligibility
Eligibility established via HHSC routes (new nurse aide with Texas-approved training in the last 24 months; expired-status aide; equivalent military training of 100+ hours; RN/LVN graduate or student; out-of-state training) — application submitted in TULIP, training uploaded/approved by the NATCEP Program Director, Social Security number or ITIN required, and both tests must be passed within 24 months of training completion
Retake policy
Three attempts to pass the Clinical Skills exam and three attempts to pass the Written or Oral exam; a candidate unable to pass both tests within the allotted attempts (in 24 months) must retrain before retesting. Unsuccessful candidates receive an email the following day with payment and retest-scheduling instructions