Texas CNA Practice Test — Free NNAAP Prep

Texas employs roughly 95,000 certified nursing assistants — the largest CNA workforce of any state in the country. The state's 30+ million residents are spread across four major metros (Houston, Dallas–Fort Worth, San Antonio, Austin) plus hundreds of mid-sized and rural communities, and every one of those markets is short on direct-care staff. Texas also has more than 1,200 licensed nursing facilities and one of the fastest-growing assisted living sectors in the US, which means new CNA roles open daily across the state.

Demand here is driven by two trends that aren't slowing down: population growth and aging. Texas adds roughly 470,000 new residents per year through births and net migration, and the 65+ population is projected to roughly double by 2040. The Rio Grande Valley, East Texas, and the Panhandle face the tightest staffing shortages — facilities in those regions often hire CNAs within days of certification and frequently offer sign-on bonuses that urban hospitals don't match.

The average CNA wage in Texas is approximately $16.10/hour, and Texas has no state income tax. The practical take-home is meaningfully higher than the same nominal wage in California, New York, or Illinois. Cost of living varies sharply by metro — Austin and Dallas now exceed national averages, while San Antonio, Houston suburbs, and most rural markets remain well below — so where you work determines how far your paycheck stretches.

Texas requires 100 hours of state-approved training before you can sit for the certification exam — 25 hours above the federal minimum and one of the higher requirements in the South. The extra hours typically split into roughly 60 hours of classroom instruction and 40 hours of supervised clinical practice in a long-term care facility. Programs are offered through community colleges, vocational schools, the Texas Workforce Commission, and many nursing homes that train candidates in exchange for an employment commitment.

The exam is administered by Prometric and consists of a written (or oral) knowledge test plus a clinical skills evaluation. The written portion covers the six NNAAP content domains — Physical Care Skills, Safety and Emergency Procedures, Infection Control, Resident Rights, Psychosocial Care Skills, and Role of the Nurse Aide. The clinical portion requires demonstrating five randomly assigned hands-on skills (always including handwashing) in front of a Prometric evaluator. You must pass both portions to be added to the Texas Nurse Aide Registry maintained by HHSC.

You have up to 3 attempts within 24 months of completing your training program. If you fail all three or let the 24-month window expire, Texas requires you to complete a new approved program before retesting. Schedule through prometricncs.com once your training program has uploaded your eligibility — Texas usually processes that submission within a few business days.

The largest CNA employers in Texas include HCA Houston Healthcare, Methodist Health System, Baylor Scott & White Health, Memorial Hermann, Texas Health Resources, CHRISTUS Health, and UT Health systems in Houston, San Antonio, and Tyler. These hospital systems generally pay above the state average and offer tuition assistance toward LPN and RN pathways, but most prefer 6–12 months of facility experience before hiring new CNAs into acute care. New graduates typically start at a skilled nursing facility, long-term acute care hospital, or assisted living community to build clinical hours.

Home health is enormous in Texas because of the state's geography — rural counties simply don't have enough facility beds, and most aging Texans prefer to remain at home. Encompass Health, Amedisys, LHC Group, Addus HomeCare, and dozens of regional agencies actively recruit new CNAs across every metro and rural region. Home health roles in Texas usually require a personal vehicle and willingness to drive between client homes, but offer scheduling flexibility and often higher per-visit pay than facility-based work.

Per-diem and staffing platforms like ShiftKey, NurseDash, CareRev, and Clipboard Health are especially active in Houston, Dallas–Fort Worth, San Antonio, and Austin. New CNAs frequently use these apps to sample different facility types — SNF, memory care, rehab, hospital sitter shifts — before committing to a permanent role. Per-diem rates in Texas metros commonly run $2–5/hour above base facility wages.